Clinical Profile and Outcome of Organophosphorus Poisoning in a Tertiary Hospital

Organophosphorus compound (OPC) poisoning is common in Bangladesh. The toxicity of the agent and paucity of appropriate medical services has resulted in high mortality rates. To find out the clinical profile and outcome of OPC poisoning patients is the main aim of my study. This descriptive cross-sectional study was conducted in the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from September 2016 to November 2018. In this study, mean age of the study subjects was 25.90±11.24 years. Males (70.8%) were predominant than female (29.2%). In this study, most of the poisoning was done by ingestion (98.3%) and only two (1.7%) by inhalation. Regarding features, most muscarinic effect was constricted pupil and bronchospasm (65.0%). Common nicotinic effect was fasciculation (25.0%) and central effect was headache (61.67%). Mean amount of OPC ingestion was 26.30±17.24 ml in this study. Regarding circumstances of poisoning, familial disharmony (38.3%) and quarrel with other family members (37.5%) were the major reason followed by failure of personal affairs (15.0%) and other reasons (9.2%). Regarding complications, aspiration pneumonia was found in 6.7% cases, cardiac arrhythmia was in 6.7% cases and intermediate syndrome was in 1.7% cases. Most of the study subjects (95.0%) recovered fully. Most of the patients were from rural area. Suicidal was the common motive and familial disharmony and quarrel with other family members are the common circumstances of poisoning. Mortality rate was 5.0%.

Dynamic interplay of metal and metal oxide nanoparticles with plants: Influencing factors, action mechanisms, and assessment of stimulatory and inhibitory effects

Nanoparticles (NPs) of metals and metal oxides have received increasing attention regarding their characteristic behavior in plant systems. The fate and transport of metal NPs and metal oxide NPs in plants is of emerging concern for researchers because they ultimately become part of the food chain. The widespread use of metal-based NPs (MBNPs) in plants has revealed their beneficial and harmful effects. This review addresses the main factors affecting the uptake, translocation, absorption, bioavailability, toxicity, and accumulation of MBNPs in different plant species. It appraises the mechanism of nanoparticle-plant interaction in detail and provides understanding of the estimation strategies for the associated pros and cons with this interplay. Critical parameters of NPs include, but are not limited to, particle size and shape, surface chemistry, surface charge, concentration, solubility, and exposure route. On exposure to MBNPs, the molecular, physiological, and biochemical reactions of plants have been assessed. We have filled knowledge gaps and answered research questions regarding the positive and negative effects of metal and metal oxide NPs on seed germination, callus induction, growth and yield of plant, nutritional content, antioxidants, and enzymes. Besides, the phytotoxicity, cytotoxicity, genotoxicity, and detoxification studies of MBNPs in plants have been outlined. Furthermore, the recent developments and future perspectives of the two-way traffic of interplay of MBNPs and plants have been provided in this comprehensive review.

Proteomic-miRNA Biomics Profile Reveals 2D Cultures of Human iPSC-Derived Neural Progenitor Cells More Sensitive than 3D Spheroid System Against the Experimental Exposure to Arsenic

The iPSC-derived 3D models are considered to be a connective link between 2D culture and in vivo studies. However, the sensitivity of such 3D models is yet to be established. We assessed the sensitivity of the hiPSC-derived 3D spheroids against 2D cultures of neural progenitor cells. The sub-toxic dose of Sodium Arsenite (SA) was used to investigate the alterations in miRNA-proteins in both systems. Though SA exposure induced significant alterations in the proteins in both 2D and 3D systems, these proteins were uncommon except for 20 proteins. The number and magnitude of altered proteins were higher in the 2D system compared to 3D. The association of dysregulated miRNAs with the target proteins showed their involvement primarily in mitochondrial bioenergetics, oxidative and ER stress, transcription and translation mechanism, cytostructure, etc., in both culture systems. Further, the impact of dysregulated miRNAs and associated proteins on these functions and ultrastructural changes was compared in both culture systems. The ultrastructural studies revealed a similar pattern of mitochondrial damage, while the cellular bioenergetics studies confirm a significantly higher energy failure in the 2D system than to 3D. Such a higher magnitude of changes could be correlated with a higher amount of internalization of SA in 2D cultures than in 3D spheroids. Our findings demonstrate that a 2D culture system seems better responsive than a 3D spheroid system against SA exposure.

Antibiotic Resistance Profiling and Phylogenicity of Uropathogenic Bacteria Isolated from Patients with Urinary Tract Infections

Urinary tract infections (UTIs) are healthcare problems that commonly involve bacterial and, in some rare instances, fungal or viral infections. The irrational prescription and use of antibiotics in UTI treatment have led to an increase in antibiotic resistance. Urine samples (145) were collected from male and female patients from Lower Dir, Khyber Pakhtunkhwa (KP), Pakistan. Biochemical analyses were carried out to identify uropathogens. Molecular analysis for the identification of 16S ribosomal RNA in samples was performed via Sanger sequencing. Evolutionary linkage was determined using Molecular Evolutionary Genetics Analysis-7 (MEGA-7). The study observed significant growth in 52% of the samples (83/145). Gram-negative bacteria were identified in 85.5% of samples, while Gram-positive bacteria were reported in 14.5%. The UTI prevalence was 67.5% in females and 32.5% in males. The most prevalent uropathogenic bacteria were Klebsiella pneumoniae (39.7%, 33/83), followed by Escherichia coli (27.7%, 23/83), Pseudomonas aeruginosa (10.8%, 9/83), Staphylococcus aureus (9.6%, 8/83), Proteus mirabilis (7.2%, 6/83) and Staphylococcus saprophyticus (4.8%, 4/83). Phylogenetic analysis was performed using the neighbor-joining method, further confirming the relation of the isolates in our study with previously reported uropathogenic isolates. Antibiotic susceptibility tests identified K. pneumonia as being sensitive to imipenem (100%) and fosfomycin (78.7%) and resistant to cefuroxime (100%) and ciprofloxacin (94%). Similarly, E. coli showed high susceptibility to imipenem (100%), fosfomycin (78.2%) and nitrofurantoin (78.2%), and resistance to ciprofloxacin (100%) and cefuroxime (100%). Imipenem was identified as the most effective antibiotic, while cefuroxime and ciprofloxacin were the least. The phylogenetic tree analysis indicated that K. pneumoniae, E. coli, P. aeruginosa, S. aureus and P. mirabilis clustered with each other and the reference sequences, indicating high similarity (based on 16S rRNA sequencing). It can be concluded that genetically varied uropathogenic organisms are commonly present within the KP population. Our findings demonstrate the need to optimize antibiotic use in treating UTIs and the prevention of antibiotic resistance in the KP population.

Serum Electrolyte Status of Patients with Acute Stroke Admitted in a Tertiary Care Hospital

Stroke, usually a focal rather than global neurological deficit resulting from vascular origin with sudden onset, may be with cerebral infarction or intracerebral haemorrhage. It results in brain oedema following vascular injury and electrolyte imbalance. A descriptive cross sectional study was carried out in the Department of Medicine, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during March 2016 to May 2018 to assess the electrolyte levels among 220 purposively selected patients with stroke confirmed by CT scan. Data were collected by the principal investigator himself by using interview schedule and case record form after attaining consent. Blood samples were collected from the patients to carry out biochemical and haematological tests and to assess serum electrolyte levels. Data were cross-checked for completeness, consistency and relevancy, and were analyzed by computer software SPSS 20.0. Age was significantly higher in haemorrhagic stroke (64.88±13.00 years) than ischaemic stroke (60.92±13.96 years). Male (55.91%) were predominant than female (44.09%). One hundred nineteen (54.09%) patients had ischaemic stroke and 101(45.91%) patients had haemorrhagic stroke. The serum concentration of Na+, K+, Cl- and HCO₃- were measured during acute period of stroke. Imbalance in serum Sodium, Chloride, Potassium and Bicarbonate level were observed in 37.27%, 29.55%, 23.18% and 6.36% patients respectively. Hyponatremia, hypokalemia, hypochloremia and acidosis were most common electrolyte imbalance in both ischaemic and haemorrhagic strokes. In ischaemic stroke hyponatremia was 35.29%, hypernatremia was 3.36%, hypokalemia 19.33%, hyperkalemia 0.84%, hypochloraemia 30.25%, hyperchloraemia 3.36%, acidosis was in 6.72% and alkalosdis in 1.68% patients while in haemorrhagic stroke hyponatremia 33.66%, hypernatremia 1.98%, hypokalaemia 22.77% hyperkalemia 3.96%, hypochloremia 19.80%, hyperchloraemia 4.95%, acidosis 2.97% and alkalosis was in 0.99% of patients. Mortality was more in hyponatremic, hypokalemic and in hypochloremic patients.

Measuring the Intention in Favour and Against Getting Vaccinated from COVID-19 Using the Health Belief Model: Cross-Sectional Study of Pakistan

Vaccination is without a doubt one of the most efficient ways to stop the COVID-19 pandemic from spreading. The goal of this study was to look into the acceptance and resistance to COVID-19 vaccination and its associated components using the Health Belief Model, which is a framework for changing health behaviours (HBM). The current study is quantitative; hence data was collected from attendants of patients admitted to hospitals in Pakistan's top-tier cities using a survey-based self-administered questionnaire. Nonprobability convenient sampling was utilised to approach the respondents. The model was tested in two stages using partial least squares (variance-based structural equation modelling). The measurement model's reliability and validity imply that the data is reliable and valid. Except for the impact of benefits on accepting behaviour, all of the study postulated relationships are supported by the results. The study agenda adds to our understanding of health care, immunisation, consumer behaviour, and behavioural research. It adds to the body of knowledge in the fields of immunisation and behavioural research by examining people's behaviours and changes during the worldwide mass vaccination period.

Therapeutic potential of stem cell and melatonin on the reduction of CCl4-induced liver fibrosis in experimental mice model

Liver fibrosis is initial stage of any chronic liver disease and its end stage is develops into cirrhosis. Chronic liver diseases are a crucial global health issue and the cause of approximately 2 million deaths per year worldwide. Cirrhosis is currently the 11th most common cause of death globally. Mesenchymal stem cell (MSCs) treatment is the best way to treat acute and chronic liver disease. The aim of this study is to improve the therapeutic potential of MSCs combined with melatonin (MLT) to overcome CCl4-induced liver fibrosis and also investigate the individual impact of melatonin and MSCs against CCl4-induced liver impairment in animal model. Female BALB/c mice were used as CCL4-induced liver fibrotic animal model. Five groups of animal model were made; negative control, Positive control, CCl4+MSCs treated group, CCl4+MLT treated group and CCl4+MSCs+MLT treated group. Cultured MSCs from mice bone marrow were transplanted to CCl4-induced liver injured mice model, individually as well as together with melatonin. Two weeks after MSCs and MLT administration, all groups of mice were sacrificed for examination. Morphological and Histopathological results showed that combined therapy of MSCs+MLT showed substantial beneficial impact on CCl4-induced liver injured model, compared with MSCs and MLT individually. Biochemically, considerable reduction was observed in serum bilirubin and ALT levels of MLT+MSC treated mice, compared to other groups. PCR results shown down-regulation of Bax and up-regulation of Bcl-xl and Albumin, confirm a significant therapeutic effect of MSCs+MLT on CCI4-induced liver fibrosis. From the results, it is concluded that combined therapy of MSCs and MLT show strong therapeutic effect on CCL4-induced liver fibrosis, compared with MSCs and MLT individually.

Anti-hyperglycemic and anti-hyperlipidemic effects of a methanolic extract of Debregeasia salicifolia in Alloxan-induced diabetic albino mice

Diabetes mellitus (DM), an endocrine syndrome characterized by high blood glucose levels due to abrogated insulin activity. The existing treatments for DM have side effects and varying degrees of efficacy. Therefore, it is paramount that novel approaches be developed to enhance the management of DM. Therapeutic plants have been accredited as having comparatively high efficacy with fewer adverse effects. The current study aims to elucidate the phytochemical profile, anti-hyperlipidemic, and anti-diabetic effects of methanolic extract D. salicifolia (leaves) in Alloxan-induced diabetic mice. Alloxan was injected intraperitoneally (150 mg kg-1, b.w), to induced diabetes in mice. The mice were divided into three groups (n=10). Group 1 (normal control) received normal food and purified water, Group II (diabetic control) received regular feed and clean water and group III (diabetic treated) received a methanolic extract of the plant (300 mg kg-1) for 28 days with a typical diet and clean water throughout the experiment. Blood samples were collected to checked serum glucose and concentration of LDL, TC, TG. The extract demonstrated significant antihyperglycemic activity (P<0.05), whereas improvements in mice's body weight and lipid profiles were observed after treatment with the extract. This study establishes that the extract has high efficacy with comparatively less toxicity that can be used for DM management.

Diagnostic approaches and potential therapeutic options for coronavirus disease 2019

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan city of China in late December 2019 and identified as a novel coronavirus. Due to its contagious nature, the virus spreads rapidly and causes coronavirus disease 2019 (COVID-19). The global tally of COVID-19 was 28 million in early September 2020. The fears and stress associated with SARS-CoV-2 has demolished the socio-economic status worldwide. Researchers are trying to identify treatments, especially antiviral drugs and/or vaccines, that could potentially control the viral spread and manage the ongoing unprecedented global crisis. To date, more than 300 clinical trials have been conducted on various antiviral drugs, and immunomodulators are being evaluated at various stages of COVID-19. This review aims to collect and summarize a list of drugs used to treat COVID-19, including dexamethasone, chloroquine, hydroxychloroquine, lopinavir/ritonavir, favipiravir, remdesivir, tociluzimab, nitazoxanide and ivermectin. However, some of these drugs are not effective and their use has been suspended by WHO.

Quantification of regional murine ozone-induced lung inflammation using [18F]F-FDG microPET/CT imaging

Ozone (O₃) is a highly potent and reactive air pollutant. It has been linked to acute and chronic respiratory diseases in humans by inducing inflammation. Our studies have found evidence that 0.05 ppm of O₃, within the threshold of air quality standards, is capable of inducing acute lung injury. This study was undertaken to examine O₃-induced lung damage using [¹⁸F]F-FDG (2-deoxy-2-[¹⁸F]fluoro-D-glucose) microPET/CT in wild-type mice. [¹⁸F]F-FDG is a known PET tracer for inflammation. Sequential [¹⁸F]F-FDG microPET/CT was performed at baseline (i.e. before O₃ exposure), immediately (0 h), at 24 h and at 28 h following 2 h of 0.05 ppm O₃ exposure. The images were quantified to determine O₃ induced spatial standard uptake ratio of [¹⁸F]F-FDG in relation to lung tissue density and compared with baseline values. Immediately after O₃ exposure, we detected a 72.21 ± 0.79% increase in lung [¹⁸F]F-FDG uptake ratio when compared to baseline measures. At 24 h post-O₃ exposure, the [¹⁸F]F-FDG uptake becomes highly variable (S.D. in [¹⁸F]F-FDG = 5.174 × 10^–4 units) with a 42.54 ± 0.33% increase in lung [¹⁸F]F-FDG compared to baseline. At 28 h time-point, [¹⁸F]F-FDG uptake ratio was similar to baseline values. However, the pattern of [¹⁸F]F-FDG distribution varied and was interspersed with zones of minimal uptake. Our microPET/CT imaging protocol can quantify and identify atypical regional lung uptake of [¹⁸F]F-FDG to understand the lung response to O₃ exposure.

Postponement growth and antioxidative response of Brassica nigra on CuO and ZnO nanoparticles exposure under soil conditions

Due to unique physiochemical properties, nanoparticles (NPs) have acquired substantial attention in the field of research. However, threats of ecotoxicity and phytotoxicity have limited their biological applications. In this study in vivo experiments were performed to determine the effect of CuO (12.5, 25 and 50 mg/kg) and ZnO (200, 400 and 600 mg/kg) NPs on growth, and antioxidant activities of Brassica nigra. The results showed that CuO NPs did not affect the seed germination while presence of ZnO NPs in the soil generated an inhibitory effect. Both CuO and ZnO NPs positively influenced the growth of stem and other physiological parameters i.e. stem height increased (23%) at 50 mg/kg CuO while root length decreased (up to 44%) with an increase in the concentration of NPs. Phytochemical screening of apical, middle and basal leaves showed elevated phenolic and flavonoid contents in the range of 15.3-59 μg Gallic Acid Equivalent (GAE)/mg Dry Weight (DW) and 10-35 μg Querceitin Equivalent (QE)/mg DW, respectively, in NPs-treated plants. Antioxidant activity was higher in CuO NPs-treated plants as compared to ZnO and control plants. Results conclude that CuO and ZnO NPs at low concentrations can be exploited as nanofertilisers in agriculture fields.

TRIM32 Deficiency Impairs Synaptic Plasticity by Excitatory-Inhibitory Imbalance via Notch Pathway

Synaptic plasticity is the neural basis of physiological processes involved in learning and memory. Tripartite motif-containing 32 (TRIM32) has been found to play many important roles in the brain such as neural stem cell proliferation, neurogenesis, inhibition of nerve proliferation, and apoptosis. TRIM32 has been linked to several nervous system diseases including autism spectrum disorder, depression, anxiety, and Alzheimer's disease. However, the role of TRIM32 in regulating the mechanism of synaptic plasticity is still unknown. Our electrophysiological studies using hippocampal slices revealed that long-term potentiation of CA1 synapses was impaired in TRIM32 deficient (KO) mice. Further research found that dendritic spines density, AMPA receptors, and synaptic plasticity-related proteins were also reduced. NMDA receptors were upregulated whereas GABA receptors were downregulated in TRIM32 deficient mice, explaining the imbalance in excitatory and inhibitory neurotransmission. This caused overexcitation leading to decreased neuronal numbers in the hippocampus and cortex. In summary, this study provides this maiden evidence on the synaptic plasticity changes of TRIM32 deficiency in the brain and proposes that TRIM32 relates the notch signaling pathway and its related mechanisms contribute to this deficit.

CuO and ZnO Nanoparticle Application in Synthetic Soil Modulates Morphology, Nutritional Contents, and Metal Analysis of Brassica nigra

Black mustard (Brassica nigra) was grown in pots amended with 41 nm ZnO (200-600 mg/kg soil) and 47 nm CuO (12.5-50 mg/kg soil) nanoparticles (NPs) to analyze growth response and yield characteristics. B. nigra seed germination was not affected by CuO NPs, but significant toxicity was observed by ZnO NP treatment. Both NPs significantly increased the growth profile of B. nigra, i.e., the stem height, number of leaves, average leaf area, number of branches, and number of nodes per plant. Application of ZnO and CuO NPs brought a significant dose-dependent decrease in primary root length; however, the number of secondary roots increased in the presence of CuO NPs. The average number of flowers and pods per plant significantly increased in the presence of CuO NPs. The seed yield, average seed weight per plant, and seed diameter parameters were observed to be better in the presence of CuO NPs as compared with ZnO NPs. Total protein contents and glucosinolates increased in the seeds grown in the NP-amended soil, while total oil contents decreased. Oil analysis depicted that oleic acid and linolenic acid percentage decreased while erucic acid percentage increased in seeds in the presence of both NPs in the soil. An atomic absorption spectrophotometer showed accumulation of Cu and Zn in B. nigra in the following order: root > stem > leaves > seeds. The study concludes that CuO and ZnO NPs have detrimental effect on the B. nigra plant and yield. The release of NPs and type of metal in NPs might also have a positive effect on the plant; however, their concentration in the soil also matters.

FRI0649-HPR HYDROXYCHLOROQUINE PRESCRIBING AND OPHTHALMOLOGY SCREENING WITHIN RHEUMATOLOGY DEPARTMENTS IN THE NORTH-WEST OF THE UNITED KINGDOM: A PROSPECTIVE REGIONAL AUDIT

Background:

Hydroxychloroquine (HCQ) is widely used in the management of rheumatoid arthritis and connective tissue disease. The prevalence of retinopathy in patients taking long-term HCQ is approximately 7.5%, increasing to 20-50% after 20 years of therapy. Hydroxychloroquine prescribed at ≤5 mg/kg poses a toxicity risk of <1% up to five years and <2% up to ten years, but increases sharply to almost 20% after 20 years. Risk factors for retinopathy include doses >5mg/kg/day, concomitant tamoxifen or chloroquine use and renal impairment. The UK Royal College of Ophthalmologists (RCOphth) 2018 guidelines for HCQ screening recommend optimal treatment dosage and timing for both baseline and follow-up ophthalmology review for patients on HCQ, with the aim of preventing iatrogenic visual loss. This is similar to recommendations made by the American Academy of Ophthalmology (2016).

Objectives:

To determine adherence to the RCOphth guidelines for HCQ screening within the Rheumatology departments in the North-West of the UK.

Methods:

Data for patients established on HCQ and those initiated on HCQ therapy were collected over a 7 week period from 9 Rheumatology departments.

Results:

473 patients were included of which 56 (12%) were new starters and 417 (88%) were already established on HCQ. 79% of the patients were female, with median ages of 60.5 and 57 years for new and established patients respectively. The median (IQR) weight for new starters was 71 (27.9) kg and for established patients, 74 (24.7) kg.

20% of new starters exceeded 5mg/kg daily HCQ dose. 16% were identified as high risk (9% had previously taken chloroquine, 5% had an eGFR <60ml/min/m2and 2% had retinal co-pathology). Of the high-risk group, 44% were taking <5mg/kg. In total, 36% of new starters were referred for a formal baseline Ophthalmology review.

In the established patients, 74% were taking ≤5mg/kg/day HCQ dose and 16% were categorized as high risk (10% had an eGFR less than 60ml/min/m2, 3% had previous chloroquine or tamoxifen use and 2% had retinal co-pathology). In the high-risk group, 75% were not referred for spectral domain optical coherence tomography (SD-OCT). 41% of patients established on HCQ for <5 years, and 33% of patients on HCQ for >5 years were not referred for SD-OCT. Reasons for not referring included; awaiting 5 year review, previous screening already performed and optician review advised.

Since the introduction of the RCOphth guidelines, 29% patients already established on HCQ had an alteration in the dosage of HCQ in accordance with the guidelines. In the high-risk group, 16% were not on the recommended HCQ dose.

Conclusion:

This audit demonstrates inconsistencies in adherence to the RCOphth guidelines for HCQ prescribing and ophthalmology screening within Rheumatology departments in the North-West of the UK for both new starters and established patients. Plans to improve this include wider dissemination of the guidelines to Rheumatology departments and strict service level agreements with ophthalmology teams to help optimize HCQ prescribing and screening for retinopathy.

Acknowledgments:

Drs. S Jones, E MacPhie, A Madan, L Coates & Prof L Teh. Co-1st author, T David.

Disclosure of Interests:

None declared

Successful Lung Transplantation From Hepatitis C Positive Donor to Seronegative Recipient

Lung transplantation using RNA+ hepatitis C (HCV+) donors to seronegative recipients is not currently performed due to the very high risk of transmission. Previous reports have shown poor survival when this practice was applied. The emergence of new direct-acting antiviral drugs (DAA) suggests a high chance of sustained virologic response in immunocompetent patients. We report here successful transplantation of lungs from HCV+ donor to HCV- recipient. The recipient was an HCV- patient with chronic lung allograft dysfunction. Viral transmission occurred early posttransplant but excellent clinical outcomes were observed including elimination of HCV after 12 weeks of treatment using DAAs.

Dietary Quality Is Associated with Abdominal Aortic Calcification: A Mean of 18-Year Longitudinal Study in Community-Dwelling Older Adults

OBJECTIVE

This study aimed to examine the association between baseline and changes in dietary quality assessed by the Alternative Healthy Eating Index-2010 (AHEI-2010) and abdominal aortic calcification (AAC) among community-dwelling older adults.

DESIGN

Population-based longitudinal study.

SETTING

A subset of the Melbourne Collaborative Cohort Study (MCCS).

PARTICIPANTS

262 community-dwelling adults (60% female) aged 53 ± 5 years at baseline.

MEASUREMENTS

Dietary intake was assessed using validated Food Frequency Questionnaires at baseline (1990-1994) and follow-up (2010-2011). AAC was evaluated by radiography and dual-energy x-ray absorptiometry (DXA) at follow-up.

RESULTS

Higher baseline AHEI-2010 score was associated with lower AAC severity by radiography [OR (95% CI) for Tertile 3 VS Tertile 1: 0.53 (0.29-0.99)] after adjustment for gender, age, physical activity, smoking, BMI, systolic blood pressure, plasma total cholesterol, calcium and energy intake. The association between AHEI-2010 and AAC severity by DXA was also significant in the multivariate-adjusted model [OR (95% CI) for Tertile 3 VS Tertile 1: 0.38 (0.20-0.70)]. Changes in AHEI-2010 over 18 years were not associated with AAC severity.

CONCLUSION

Baseline but not the changes in AHEI-2010 was inversely associated with the risk of AAC severity suggesting that a high quality diet might help prevent or delay the progression of AAC in community-dwelling older adults and the benefits might be manifested over the long-term.

Stochastic and Statistical Analysis of Utility Revenues and Weather Data Analysis for Consumer Demand Estimation in Smart Grids

In smart grid paradigm, the consumer demands are random and time-dependent, owning towards stochastic probabilities. The stochastically varying consumer demands have put the policy makers and supplying agencies in a demanding position for optimal generation management. The utility revenue functions are highly dependent on the consumer deterministic stochastic demand models. The sudden drifts in weather parameters effects the living standards of the consumers that in turn influence the power demands. Considering above, we analyzed stochastically and statistically the effect of random consumer demands on the fixed and variable revenues of the electrical utilities. Our work presented the Multi-Variate Gaussian Distribution Function (MVGDF) probabilistic model of the utility revenues with time-dependent consumer random demands. Moreover, the Gaussian probabilities outcome of the utility revenues is based on the varying consumer n demands data-pattern. Furthermore, Standard Monte Carlo (SMC) simulations are performed that validated the factor of accuracy in the aforesaid probabilistic demand-revenue model. We critically analyzed the effect of weather data parameters on consumer demands using correlation and multi-linear regression schemes. The statistical analysis of consumer demands provided a relationship between dependent (demand) and independent variables (weather data) for utility load management, generation control, and network expansion.

Qualitative adaptation of child behaviour problem instruments in a developing-country setting

A key barrier to epidemiological research on child behaviour problems in developing countries is the lack of culturally relevant, internationally recognized psychometric instruments. This paper proposes a model for the qualitative adaptation of psychometric instruments in developing-country settings and presents a case study of the adaptation of 3 internationally recognized instruments in Pakistan: the Child Behavior Checklist, the Youth Self-Report and the Teacher's Report Form. This model encompassed a systematic procedure with 6 distinct phases to minimize bias and ensure equivalence with the original instruments: selection, deliberation, alteration, feasibility, testing and formal approval. The process was conducted in collaboration with the instruments' developer. A multidisciplinary working group of experts identified equivalence issues and suggested modifications. Focus group discussions with informants highlighted comprehension issues. Subsequently modified instruments were thoroughly tested. Finally, the instruments' developer approval further validated the qualitative adaptation. The study proposes a rigorous and systematic model to effectively achieve cultural adaptation of psychometric instruments.

Evaluation of Pakgen 99mTc generators loaded with indigenous fission 99Mo

Fission produced 99Mo/99mTc generators, called Pakgen, have been manufactured at the PINSTECH generator production facility since 2000 for nuclear medicine applications in Pakistan. These generators were loaded with fission 99Mo imported from NTP South Africa. Recently production of fission 99Mo has begun in the Molybdenum-99 Production Facility at PINSTECH. Prior to use in the clinic, eight sets of generators were produced, 23 GBq and 74 GBq at time of calibration, and they were subjected to various quality control procedures recommended in the pharmacopoeia to assess their performance. The elution profile, volume, activity, pH, radionuclidic, chemical, radiochemical and biological purity, and expiry time of the eluates were examined. Labeling efficiency tests were also carried out with a number of the more widely used in vivo radiopharmaceutical kits like DTPA, MDP and MIBI. Performance of 99mTc generators loaded with locally produced and imported fission 99Mo was comparable, and the users of Pakgen generators were fully satisfied. The effect of a wet vs. a dry column on 99mTc yields of generators loaded with low and high activity was also studied for the first time.

Non-conventional hemostatic risk factors for coronary heart disease in individuals with spinal cord injury

STUDY DESIGN

Review.

OBJECTIVES

In subjects with spinal cord injury (SCI), there is strong evidence for platelet hyperactivity, which may stimulate atherosclerosis and coronary heart disease (CHD). The literature was reviewed.

BACKGROUND

Individuals with SCI develop premature CHD. In addition to the conventional risk factors associated with CHD, there are pathologic hematological factors involved in atherogenesis that are similar to those that have been demonstrated in individuals with diabetes, and these hematological factors might affect individuals with SCI. One such hematological factor, platelet aggregation, is essential for the development of CHD, which results from thrombus formation in the coronary vasculature. Prostacyclin (PGI(2)) is a potent inhibitor of platelet aggregation and is thought to have a beneficial role in inhibiting atherogenesis; therefore, it is possible that individuals with SCI have impaired PGI(2) receptor function.

METHODS

We reviewed the literature by conducting a search using PubMed (1970-2007).

RESULTS

Acute thrombosis is emerging as an important factor in the etiology of CHD and therefore could mediate the risk of CHD in persons with SCI, in addition to previously known risk factors such as hyperlipidemia, hypertension, hyperlipidemia, diabetes mellitus and hyperinsulinemia. Because PGI(2) may retard atherogenesis through its inhibitory effects on platelet function, we discuss the effects of PGI(2) on platelets in persons with SCI in this review.

CONCLUSIONS

Subjects with chronic SCI develop abnormal platelet function, resulting in the production of atherogenic and thrombogenic factors for the following reasons: (1) the PGI(2) and insulin receptors on their platelets are impaired; (2) thrombin generation and platelet-derived growth factor release are elevated; (3) insulin-induced nitric oxide production by platelets is markedly impaired; and (4) a circulating antibody (immunoglobulin G (IgG)) blocks the antithrombotic effect of both insulin and PGI(2) receptors. Thus, this IgG molecule is thought to be one of the pathological mediators of the increased incidence of CHD in individuals with SCI.