Brolucizumab after failure of aflibercept with photodynamic therapy in polypoidal choroidal vasculopathy: A case report

We describe one case of polypoidal choroidal vasculopathy with persistent subretinal fluid despite multiple treatment with intravitreal Bevacizumab, Ranibizumab and Aflibercept, as well as Aflibercept associated with photodynamic therapy. The patient reached complete resolution after intravitreal Brolucizumab injection, but experienced recurrence of subretinal fluid 12 weeks after discontinuation. Brolucizumab might be an option in treating subretinal fluid after failure of other anti-VEGF agents associated with photodynamic therapy.

Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients With Liver Cirrhosis: Analysis of Trends and Outcomes From the National Inpatient Sample Database

GOALS

We aimed to assess outcomes of patients with liver cirrhosis who underwent therapeutic or diagnostic endoscopic retrograde cholangiopancreatography (ERCP) to determine whether these patients had different outcomes relative to patients without cirrhosis.

BACKGROUND

ERCP is an important procedure for treatment of biliary and pancreatic disease. However, ERCP is relatively technically difficult to perform when compared with procedures such as esophagogastroduodenoscopy or colonoscopy. Little is known about how ERCP use affects patients with liver cirrhosis.

STUDY

Using patient records from the National Inpatient Sample (NIS) database, we identified adult patients who underwent ERCP between 2009 and 2014 using International Classification of Disease, Ninth Revision coding and stratified data into 2 groups: patients with liver cirrhosis and those without liver cirrhosis. We compared baseline characteristics and multiple outcomes between groups and compared outcomes of diagnostic versus therapeutic ERCP in patients with cirrhosis. A multivariate regression model was used to estimate the association of cirrhosis with ERCP outcomes.

RESULTS

A total of 1,038,258 hospitalizations of patients who underwent ERCP between 2009 and 2014 were identified, of which 31,294 had cirrhosis and 994,681 did not have cirrhosis. Of the patients with cirrhosis, 21,835 (69.8%) received therapeutic ERCP and 9459 (30.2%) received diagnostic ERCP. Patients with cirrhosis had more ERCP-associated hemorrhages (2.5% vs. 1.2%; P <0.0001) compared with noncirrhosis patients but had lower incidence of perforations (0.1% vs. 0.2%; P <0.0001) and post-ERCP pancreatitis (8.6% vs. 7%; P <0.0001). Cholecystitis was the same between groups (2.3% vs. 2.3%; P <0.0001). In patients with cirrhosis, those who received therapeutic ERCP had higher post-ERCP pancreatitis (7.9% vs. 5.1%; P <0.0001) and ERCP-associated hemorrhage (2.7% vs. 2.1%; P <0.0001) but lower incidences of perforation and cholecystitis (0.1% vs. 0.3%; P <0.0001) and cholecystitis (1.9 vs. 3.1%; P <0.0001) compared with those who received diagnostic ERCP.

CONCLUSIONS

Use of therapeutic ERCP in patients with liver cirrhosis may lead to higher risk of complications such as pancreatitis and postprocedure hemorrhage, whereas diagnostic ERCP may increase the risk of pancreatitis and cholecystitis in patients with cirrhosis. Comorbidities in cirrhosis patients may increase the risk of post-ERCP complications and mortality; therefore, use of ERCP in cirrhosis patients should be carefully considered, and further studies on this patient population are needed.

209 Breast Lymphoma Treatment Outcomes in a Pakistani Population: 20 Years of Experience at a Single Centre

Background

Breast lymphomas constitute a rare disease entity. To date, limited relevant data have been reported. We therefore here present a review of breast lymphoma patients treated at a single centre over 20-year period, focusing on histological types, treatment modalities and outcomes.

Method

We identified patients who were diagnosed and treated for breast lymphoma at a single centre from January 1995 to January 2014 and extracted data regarding patient demographics and clinical data.

Results

Twenty-seven patients with breast lymphoma were identified, of which 3 were males. Median age at diagnosis was 37 years (range:22-76 years). Chemotherapy was main stay of treatment and 55.6% patients also received radiation to affected breast. At our institute, only 3 patients, all with progressive disease, had surgery performed to achieve local palliation. Complete response after chemotherapy was seen in 63% patients and partial response in 7.4%, while 26% patients demonstrated disease progression. The mean follow up was 46.8 months. Seven patients (33.3%) who were alive at last follow up, as well as 1 patient who died, survived more than 5 years after diagnosis.

Conclusions

Patients with breast lymphoma should receive aggressive treatment, with combination of chemotherapy and radiation therapy. Surgery should be limited for diagnosis and palliation of local symptoms in cases of progressive disease.

210 Prognosis of Breast Cancer in Very Young Age (Less Than 30 Years)

Background

Breast cancer diagnosed at younger age has aggressive biology being triple negative and high grade and associated with poor prognosis.

Method

Retrospectively data of 121 patients age 30 years or younger registered during the year 2008 was reviewed. Demographics studied were age at diagnosis, gender, pregnancy, or lactation associated, family history, histopathological diagnosis, stage of the disease, receptors, type of treatment, response, local recurrence, distant relapse, survival.

Results

One patient was male. Age range 20 -30 years, single patient had bilateral involvement. half 50.4%(n = 61) patients had locally advanced disease at presentation. Pregnancy/ lactation associated breast cancer was seen in 29.8%(n = 36). Most common stage was stage III (52.1%) & stage II (33.9%). IDC was the most common histology 94.2% (n = 114) Triple negative was most common molecular subtype present in 46.3%(56). After 5 years follow up, local recurrence was observed in 12.4%(n = 15), cancer related deaths were 42.1%(n = 51).

Conclusions

Breast cancer in very young has very aggressive tumor biology, needs aggressive treatment with surgery, chemotherapy, radiation therapy and hormonal therapy, furthermore there is need to identify possible environmental factors which may contribute in the rising incidence in this age group.

In vitro Assessment of Tris Egg Yolk and Soybean Lecithin Based Extenders for Cryopreservation of Crossbred Ram Semen

BACKGROUND

The replacement of egg yolk with alternative plant-derived soybean lecithin is gaining interest in both animal and human sperm cryopreservation owing to biosecurity issues with egg yolk based extenders.

OBJECTIVE

To evaluate the comparative effect of egg yolk and soyabean lecithin based extenders on the quality of cryopreserved crossbred ram semen.

METHODS

Pooled ejaculates (total ejaculates = 36) were divided into two aliquots and extended with Tris egg yolk extender (Tris extender) and soybean lecithin based commercial extender (Ovixcell) RESULTS: Among the two extenders, Ovixcell showed better sperm quality both at the pre-freeze (Sperm motility) and post-thaw stages. Lower malondialdehyde (MDA) level (nmol/mL) was observed in Ovixcell as compared to Tris extender. Both sperm quality and MDA level decreased significantly (P < 0.05) from pre-freeze to post-thaw in both the extenders.

CONCLUSION

The findings of the present study indicate that Ovixcell is a comparable alternative to Tris extender for the cryopreservation of crossbred ram semen.

Workload pressure of nurses at an emergency satellite hospital in Peshawar Pakistan

Introduction

Health managers face challenges to respond to the demands of the population with limited resources. Balancing the health workforce is of high concern as the health workers are indispensable resource in a health system. The objective of this study was to determine the workload pressure of nurses working at an Emergency Satellite Hospital for efficient planning and management.

Methods

The Workload Indicators of Staffing Need (WISN) method was used for this study which is a human resource management tool which determines the number of health workers required to cope with the workload and asses the workload pressure by using the available service statistics. It calculates the level of staff shortage or surplus in a facility and the ratio of actual to the required number of staff determines the workload pressure with which the staff is coping.

Results

According to the findings of the study there were 1966 available working hours for the nurses in a year. Out of this time 33.33% was taken by support activities of all nurses, 18.75% by additional activities of some of the nurses and 47.92% by health services activities of all the nurses. At the time of the study there were 4 nurses working in the in the hospital but according to the calculations based on WISN 3 nurses were required to carry out the activities identified by the experts working group. The study shows that there was no workload pressure on the nursing staff as the WISN ratio was 1.33 and one nurse was surplus.

Conclusions

The study found that there was no workload pressure on the nursing staff and one nurse was surplus who can be adjusted in any other unit where there is more need of nursing staff. This can increase the overall productivity and the demands of the population for health services can be responded to in an efficient way.

Key messages

Balancing the health workforce in any institution is of high concern as the health workers are the most costly, least readily available and indispensable resource in a health system. Efficient planning and management of health workforce is essential for better productivity.

Interaction of Al(2)O(3) nanoparticles with Escherichia coli and their cell envelope biomolecules

AIMS

The aim of this study is to investigate the antibacterial activity of aluminium oxide nanoparticles (Al2 O3 NPs) against multidrug-resistant clinical isolates of Escherichia coli and their interaction with cell envelope biomolecules.

METHODS AND RESULTS

Al2 O3 NPs were characterized by scanning electron microscope (SEM), high-resolution transmission electron microscope (HR-TEM) and X-ray diffraction (XRD) analyses. Antibacterial activity and interaction of Al2 O3 NPs with E. coli and its surface biomolecules were assessed by spectrophotometry, SEM, HR-TEM and attenuated total reflectance/Fourier transform infrared (ATR-FTIR). Of the 80 isolates tested, about 64 (80%) were found to be extended spectrum β-lactamase (ESBL) positive and 16 (20%) were non-ESBL producers. Al2 O3 NPs at 1000 μg ml(-1) significantly inhibited the bacterial growth. SEM and HR-TEM analyses revealed the attachment of NPs to the surface of cell membrane and also their presence inside the cells due to formation of irregular-shaped pits and perforation on the surfaces of bacterial cells. The intracellular Al2 O3 NPs might have interacted with cellular biomolecules and caused adverse effects eventually triggering the cell death. ATR-FTIR studies suggested the interaction of lipopolysaccharide (LPS) and L-α-Phosphatidyl-ethanolamine (PE) with Al2 O3 NPs. Infrared (IR) spectral changes revealed that the LPS could bind to Al2 O3 NPs through hydrogen binding and ligand exchange. The Al2 O3 NPs-induced structural changes in phospholipids may lead to the loss of amphiphilic properties, destruction of the membrane and cell leaking.

CONCLUSIONS

The penetration and accumulation of NPs inside the bacterial cell cause pit formation, perforation and disorganization and thus drastically disturb its proper function. The cell surface biomolecular changes revealed by ATR-FTIR spectra provide a better understanding of the cytotoxicity of Al2 O3 NPs.

SIGNIFICANCE AND IMPACT OF THE STUDY

Al2 O3 NPs may serve as broad-spectrum bactericidal agents to control the emergent pathogens regardless of their drug-resistance mechanisms.

Comparison of slow freezing and vitrification on ovine immature oocytes

BACKGROUND

Immature oocytes are more sensitive to cold injury than mature oocytes.

OBJECTIVE

The study was to evaluate the post thaw normal oocytes, cleavage and blastocyst rates of ovine cumulus oocyte complexes (COC's) using different cryoprotectants by slow freezing and Open pulled straw (OPS) vitrification.

METHODS

In five replicates, abattoir derived COC's were collected and distributed into three groups. In Experiment 1, COC's were cryopreserved by a slow freezing protocol using 10% concentration of ethylene glycol (EG), 10% dimethyl sulphoxide (DMSO) or 5% EG and 5% DMSO mixture. In Experiment 2 and 3 embryos were cryopreserved by OPS vitrification using either 33% or 40% (EG, DMSO or an equal mixture of EG and DMSO mixture. Normal oocytes post thaw were in vitro matured and parthenogenetically activated.

RESULTS

Although, there was no difference in the number of post thaw normal oocytes between the groups, cleavage and blastocyst rates were higher in 10% slow freezing group than any of the vitrified groups.

CONCLUSION

The study demonstrates better cryopreservation of ovine COC's by controlled slow freezing than OPS vitrification.

Biochemical alteration of hepatic functions by histamine H3-receptor agonist and antagonist in immunized rabbits

AIM

The aim of our study was to investigate the functional roles of H3R agonist and antagonist in the development of hepatic functions impairment in immunized rabbits.

METHODS

The study comprised of six groups containing 18 rabbits in each. Group-I (negative control) and group-II (positive control) received sterile distilled water intramuscularly while Group III-VI received histamine (100 µgkg-1, s.c.), R-[-]-α-methylhistamine (H3R-agonist, 10 µgkg-1, s.c.), iodophenpropit (H3R-antagonist, 1 µgkg-1, i.m.), and the combination of iodophenpropit (1 µgkg-1, i.m.) plus histamine (100 µgkg-1, s.c.), respectively, b.i.d. (12 hours [8 am and 8 pm]) for 10 days. Groups II-VI were immunized on day 3 with intravenous injection of sheep red blood cells (1×109 cells/ml).

RESULTS

On each experimental day, the mean values of serum enzymes and bilirubin in group-I and group-II showed no changes while in groups III, IV, V, and VI, these enzymes and bilirubin levels showed significant changes (p<0.05), when compared with their values within the group. Profile of ALT and AST production revealed that ALT and AST levels moderately were changed due to degeneration of the liver.

CONCLUSION

Our results suggest that R-[-]-α-methylhistamine showed moderate, and histamine and iodophenpropit showed mild degeneration of liver functions; while iodophenpropit plus histamine showed hepatic functions similar to control group. This study suggests that H3R antagonist in combination with histamine may be a non-toxic therapeutic target for histamine research (Fig. 7, Ref. 28). Text in PDF www.elis.sk.

In vitro development of goat-sheep and goat-goat zona-free cloned embryos in different culture media

The gradual decline in the genetic diversity of farm animals has threatened their survival and risk of their extinction has increased many fold in the recent past. Endangered species could be rescued using interspecies embryo production. The objective of this study was to investigate the effect of three different culture media on the development of Handmade cloned intraspecies (goat-goat) and interspecies (goat-sheep) embryo reconstructs. Research vitro cleave media (RVCL) yielded higher cleavage and morula-blastocyst development in intraspecies and interspecies nuclear transfer groups compared with G1.G2 and modified synthetic oviductal fluid (mSOFaaci). Cleavage frequency of intraspecies cloned embryos in RVCL, mSOFaaci, and G1.G2 did not differ significantly (87.12%, 82.45%, and 92.52%, respectively). However, the morula/blastocyst frequency in RVCL was greater in mSOFaaci and G1.G2 (51.18% vs. 38.28% vs. 36.50%, respectively). Cleavage and morula/blastocyst frequency in interspecies cloned embryos was greater in RVCL than in mSOFaaci and G1.G2 (76.14% and 42.3% vs. 65.9% and 38.3% vs. 58.56% and 33.1%, respectively). Goat oocytes were parthenogenetically activated and cultured in RVCL, mSOFaaci, and G1.G2 and kept as control. Cleavage and morula/blastocyst frequency in this group was greater in RVCL than in mSOFaaci and G1.G2 (89.66% and 65.26% vs. 85.44% and 48.05% vs. 86.58% and 42.06%, respectively). Conclusively, the results suggest that not only can the interspecies embryos of goat be produced using sheep oocytes as donor cytoplast but also the percentages can be improved by using RVCL media for culturing of the embryos.

Characterization and polymorphism of keratin associated protein 1.4 gene in goats

Keratin-associated proteins (KAPs) are among the main structural components of the animal fibers and form semi-rigid matrix wherein the keratin intermediate filaments (KIFs) are embedded. Variation in the KAP genes has been reported to affect the structure of KAPs and hence fiber characteristics. As no information is available on this gene in Capra hircus therefore, present work was undertaken to characterize and explore the different polymorphic variants of KAP1.4 gene at DNA level in different breeds/genetic groups of goats of Kashmir. Cashmere (Changthangi, 30 animals) and non-Cashmere (Bakerwal and Kargil goats, 20 animals each) goats formed the experimental animals for the study. Single strand conformation polymorphism technique was employed for exploring variability at gene level. On exploring the size variability in KAP1.4 gene between Ovine and Caprine, it was concluded that sheep KAP1.4 gene has a deletion of 30 nucleotides. In comparison to published nucleotide sequences of sheep, goat sequences explored are differing at positions 174, 462 and 568 and at these positions "G", "T" and "T" nucleotides are present in sheep, but are replaced by "A", "C" and "C" respectively, in goats. By SSC studies, two genotypes were observed in each genetic group and in Bakerwal goats the genotypes were designated as A1A1 (0.40) and A1A2 (0.60) and were formed by two alleles A1 (0.70) andA2 (0.30). The different SSC patterns observed in Kargil goats were designated as B1B1 (0.35) and B1B2 (0.65) genotypes with frequencies of B1 and B2 alleles as 0.675 and 0.325, respectively. Similarly, two genotypes C1C1 (0.60) and C1C2 (0.40) were observed in Changthangi goats and the frequencies of C1 and C2 alleles were 0.80 and 0.20, respectively. These alleles were later confirmed by sequencing. The sequences of these alleles are available in NCBI under Acc. No's. JN012101.1, JN012102.1, JN000317.1, JN000318.1, JQ436929 and JQ627657. It was concluded that all the alleles observed in a breed were unique to the breed. The designated A1 and A2 alleles of Bakerwal goats differ from each other at positions 245 and the nucleotides observed were "C" or "A" and at position 605 of the nucleotide sequence "T" or "C", were observed. The designated B1 and B2 alleles of Kargil goats differed from each other at positions 224, 374, 375 and 521. The nucleotides observed in two SSC pattern were C→G, A→G, G→A and T→C, respectively. The designated C1 and C2 alleles of Changthangi goats differed from each other at one position 440 with the change of "A"→"C". Only two mutations C224G and G375A in Kargil goats resulted in change of the Cysteine (C)→Serine (S) and Alanine (A)→Threonine (T), respectively. The nucleotide sequences of KAP 1.4 gene in Bakerwal, Kargil and Changthangi goats showed 99.7% similarity with each other and 96.7% with sheep and 74.4% with mice. Average guard fiber length and diameter were 81.02±0.16 mm and 67.53±0.97 μm, respectively, and average down fiber length and diameter was 48.38±0.70 mm and 13.32±0.29 μm, respectively for Changthangi goats. Average guard fiber length and diameter were 63.51±4.52 mm and 105.31±4.48 μm, respectively for Bakerwal goats and 62.60±5.03 mm and 107.18±2.30 μm, respectively for Kargil goats. The effects of the observed genotypes on Cashmere fiber diameter, Cashmere fiber length in Changthangi goats and guard fiber length and guard fiber diameters in Changthangi, Kargil and Bakerwal goats were found to be non-significant (P>0.05).The nonsignificant association between the polymorphism and fiber attributes reported herein may be due to small sample size.

Beta-lactams and beta-lactamase-inhibitors in current- or potential-clinical practice: a comprehensive update

The use of successive generations of beta-lactams has selected successive generations of beta-lactamases including CTX-M ESBLs, AmpC beta-lactamases, and KPC carbapenamases in Enterobacteriaceae. Moreover, this cephalosporin resistance, along with rising resistance to fluoroquinolones, is now driving the use of carbapenems and unfortunately the carbapenem resistance has emerged markedly, especially in Acinetobacter spp. due to OXA- and metallo-carbapenemases. The industry responded to the challenge of rising resistance and recently developed some novel beta-lactams such as ceftobiprole, ceftaroline etc. and many beta-lactam compounds, including beta-lactamase-inhibitors, such as BMS-247243, S-3578, RWJ-54428, CS-023, SMP-601, NXL 104, BAL 30376, LK 157, and so on are under trials. This review provides the comprehensive accounts of the developments in penicillins, cephalosporins, carbapenems, and beta-lactamase-inhibitors, and the insight about medicinal chemistry, mechanism(s) of action and resistance, potential strategies to overcome resistance due to beta-lactamases, and also the recent advancements in the development of newer beta-lactam compounds; some of which are still under trials and yet to be classified. This review will fill the gap since previously published reviews and will serve as a comprehensive update on the current topic.

Femoral pseudoaneurysm in drug addicts--excision without revascularization is a viable option

PURPOSE

To present a series of patients presenting with femoral pseudoaneurysm.

RESULTS

Seventeen patients who presented with a femoral pseudoaneurysm during a 1 year period were included in this study. Parenteral drug abuse was the most common aetiological factor. The femoral artery was most commonly involved at its bifurcation. Sixteen patients (94%) had excision of the pseudoaneurysm with ligation of vessel and debridement without any revascularization and one patient (6%) had reverse saphenous grafting after excision and ligation of vessels. Four amputations (23%) were performed. Three (17%) were major limb amputations, which included one above knee and two below knee amputations. Four patients (23%) developed intermittent claudication.

CONCLUSION

Excision of the pseudoaneurysm with ligation of vessels and wide debridement without immediate revascularization in infected pseudoaneurysms is a safe and effective treatment.

A comparative clinical trial of artemether and quinine in children with severe malaria

OBJECTIVE

To compare the efficacy of artemether and quinine in the treatment of severe malaria in hospitalized children.

STUDY DESIGN

Open randomized trial.

SETTING

Pediatric ward of a tertiary care center.

METHODS

All children admitted with clinical manifestations of severe malaria (as per WHO criteria) and asexual forms of Plasmodium falciparum demonstrated on peripheral smear were randomized to receive either artemether or quinine. Their clinical status and smears for parasite count were assessed every 12 hours until two successive blood films were negative. The primary end point of the study was death in the hospital and residual damage to the organ involved. The secondary end points were clearance of parasites and fever, length of time of recovery from coma and normal functions of the involved system.

RESULTS

Forty-six cases completed the study protocol, 23 assigned to each drug group. Cerebral malaria was the commonest manifestation (76.1%). Mean age in artemether versus quinine group (6.6 +/- 3.5 and 5.8 +/- 2.4 years) as well as degree of parasitemia at admission (55,800 and 60,300 per microlitre) were comparable. The overall mortality rate was 23.9% with no significant difference between the two groups. Twenty six cases (56.5%) presented with more than one manifestations of severe malaria. The mortality rate was 100% with four coexisting manifestations of severe malaria. Fever clearance time in artemether and quinine group was 44.5 and 45.9 hours respectively (P >0.05). Parasite clearance time was significantly shorter in artemether group (40.9 vs. 51.9 hours; P<0.001). Recovery from coma was shorter in artemether group (34.8 vs. 38.1 hours; P<0.05).

CONCLUSION

Cerebral malaria is the most common manifestation of severe malaria in children. Artemether is a good alternative drug to quinine for P. falciparum malaria. Mortality rate is directly proportional to the number of coexisting manifestations of severe malaria.

Nosocomial Klebsiella infection in neonates in a tertiary care hospital: protein profile by SDS-page and klebocin typing as epidemiological markers

PURPOSE

To find out the prevalence of Klebsiella in hospital acquired neonatal infections in a tertiary care set up and to evaluate the role of klebocin typing and protein profile by SDS-PAGE in epidemiological typing of the isolates.

METHODS

Hospital born neonates transferred to the neonatal unit after birth and available in the unit 48 hours later comprised the study group. Two hundred and three neonates were found eligible for inclusion in the study. Repeated blood cultures, other relevant clinical specimens and environmental samples were collected and identified according to the standard techniques. Isolated clinical and environmental Klebsiella pneumoniae strains were subjected to klebocin typing and protein profiling by SDS-PAGE at regular intervals.

RESULTS

Multi drug resistant K. pneumoniae were the commonest organism isolated in 30 neonates leading to the incidence of Klebsiella nosocomial infection to be 14.7%. Klebocin typing of the K. pneumoniae isolates showed four patterns with type 312 being the commonest (43.4%). Whole cell protein analysis by SDS-PAGE of K. pneumoniae isolates revealed four types of banding pattern. Analysis of the typing method showed that the typeability and reproducibility of klebocin was 83.3% and 73.3% respectively whereas typeability and reproducibility of SDS-PAGE was 100%.

CONCLUSIONS

Based on the present study it is concluded that SDS-PAGE typing method is better than klebocin typing in neonatal nosocomial infection. It is also suggested that protein profile by SDS-PAGE may be used as a tool for epidemiological typing of Klebsiella pneumoniae isolates in laboratories where genomic based molecular typing technique is not available.

Prevalence of malaria in Aligarh

In Aligarh Plasmodium vivax and Plasmodium falciparum infections during 1998 and 1999 were 69.6% and 62.2%, and 30.4% and 37.8%, respectively. Peak transmission of malaria with highest slide positivity rates (38-44.6%) and slide P. falciparum rates (13 to 16%) were recorded during the months of September and October. About 7.5 to 10% cases showed resistance to chloroquine in P. falciparum infections while 11.3 to 16% P. vivax cases relapsed after getting required doses of chloroquine. About 75% of relapsing cases were of short-term type. Patients who were given both chloroquine and primaquine also relapsed but frequency was less (3.17%). A few chloroquine resistant cases were recorded in patients suffering from vivax malaria.

Norm and associated radiation hazards in bricks fabricated in various localities of the North-West Frontier Province (Pakistan)

The activity concentrations of natural gamma-emitting radionuclides and associated radiation hazards due to 40K, 226Ra and 232Th have been measured in baked brick samples, collected from six highly populated areas of the North-West Frontier Province (NWFP) of Pakistan. For the detection, analysis and data acquisition, a high purity germanium (HPGe) detector coupled with a high resolution multichannel analyser (MCA) was used. The range of the average values of the activity concentrations due to 40K, 226Ra and 232Th were found to be 680.3 +/- 22.2-784.4 +/- 30.7 Bq kg(-1), 36.9 +/- 3.5-51.9 +/- 3.3 Bq kg(-1) and 52.5 +/- 3.6-67.6 +/- 3.1 Bq kg(-1), respectively. Radium equivalent (Ra(eq)) activities and various hazard indices were also calculated to assess the radiation hazards. All the brick samples showed Ra, activities within the limit (370 Bq kg(-1)) set by the Organization for Economic Cooperation and Development (OECD) countries. The results of different criterion formulae also complemented each other in this study. The derived data have been compared with the reported values for other countries of the world.

Natural gamma-emiting radionuclides in Pakistani Portland cement

Studies of the natural gamma-emitting radionuclides in Portland cement manufactured in the North West Frontier Province (NWFP) of Pakistan and the various raw materials which compose the product have been carried out using gamma-spectrometric techniques. For data acquisition a high-purity germanium detector (HPGe) was used. The range of the total specific activity (minimum and maximum values) due to all the three radionuclides (40K, 226Ra and 232Th) were found to be 187.8+/-63.5-573.2+/-73.1 Bq kg(-1) (Portland cement); 54.5+/-16.1-183.9+/-31.4 Bq kg(-1) (limestone); 87.1+/-30.7-297.1+/-64.4 Bq kg(-1) (gypsum); 696.4+/-79.1-1043.9+/-85.0 Bq kg(-1) (slate); and 490.9+/-54.5-570.2+/-59.8 Bq kg(-1) (latrite). The average specific activities due to 40K in Portland cement and all the raw materials were found to be higher when compared with 226Ra and 232Th. Such materials do not pose any excess radiological health problem.

Radiological significance of building bricks in Pakistan

Baked clay bricks samples were collected from both urban and rural areas of the North West Frontier Province of Pakistan and natural radioactivity due to 40K, 226Ra and 232Th has been measured in these samples. The specific absorbed dose rates due to natural radioactivity emanating from the walls, floors and ceilings of the typical model rooms made of these building bricks have been calculated applying the mesh size adaptive volume integral methodology. The occupancy factor, representing the weighted average of all the population in the country, was taken to be 0.3 in this study. The values of estimated annual effective dose rates for whole body were found to be 0.38 and 0.35 mSv.y(-1) for the two types of model rooms. These values are smaller than those predicted by UNSCEAR for normal background areas. Thus the building bricks analysed in this study do not pose any significant health problem to the population.

Rapid diagnosis of typhoid fever by co-agglutination in an Indian hospital

Detection of Salmonella typhi infection by a co-agglutination assay for specific O, H and Vi antigens and by blood culture were compared for 110 patients with suspected typhoid fever. Blood cultures were positive for S. typhi in 25.5% of patients. Co-agglutination tests with patients' serum and with blood culture supernates gave positive results in 70.9% and 67.3% of cases respectively. S. typhi antigens Hd and O9 were detected in patients' serum by co-agglutination in 96.4% of blood culture-positive, and 62.2% of blood culture-negative patients. Co-agglutination results were uniformly negative with serum samples from a control group of 50 healthy individuals, 20 patients with febrile non-typhoid infectious disease and 20 patients with non-infectious febrile disease. Of the 25 patients with suspected typhoid fever who had not received prior antibiotic treatment, 88% yielded positive blood cultures and 96% gave positive results in serum co-agglutination tests. By contrast, of the 85 patients who had received prior antibiotics, only 7% yielded positive blood cultures, but 63.5% gave positive results in serum co-agglutination tests. Co-agglutination tests with serum offer a simple, rapid, sensitive, specific and economical method for the early diagnosis of typhoid fever.

Factors affecting fertility in a rural area of Bangladesh

"The purpose of this paper is to examine the effects of selected socioeconomic and demographic factors on fertility in a rural area of Bangladesh. It has been revealed that age at first marriage and coital frequency have direct significant effects while ever use of contraception and duration of breast-feeding have direct positive significant effects on total parity. Total effects of wife's education and age at first marriage on fertility are found to be negative while those of religion and household income on fertility are found to be positive."

Fertility differentials in rural Bangladesh

"Data from two sources in rural Bangladesh have been used in this study to examine the differentials in fertility by selected socio-economic and demographic factors. Results [indicate] that age at first marriage, education of spouses and availability of electricity in the household...have [an] inverse relationship with fertility. Higher fertility is observed for Muslim women than for non-Muslims. It has been found that fertility is the lowest to those women whose husbands are service holders and the highest for agriculture."

A study on socio-economic and intermediate variables on fertility

"In this paper an attempt has been made to examine fertility differentials of currently married rural women [in Bangladesh] by their socioeconomic (viz, education of women, land ownership and family type) and demographic (viz, age at the first marriage, duration of breast feeding and duration of post partum amenorrhoea for the child) characterisation. This study is based on data collected from 995 currently married women of childbearing age. It has been found that women's (i) level of education (ii) age at first marriage (iii) duration of breastfeeding and (iv) duration of post-partum amenorrhoea, are inversely related with fertility. Joint family shows higher fertility than that of nuclear family and land ownership reveals [a] U-shaped relationship with fertility."

Biochemical studies on mouse liver following Plasmodium berghei infection

The lipid composition of mouse liver following infection with P. berghei was investigated. The liver lipid contents of infected animals were greatly increased mainly due to the accumulation of triacylglycerides. There was enhanced lipid concentration (85.29%). Significantly (23.7%) depleted liver cholesterol was also found in the mice. Similarly, phospholipid contents of liver were also decreased by 19.90 per cent. The liver from P. berghei infected mouse produced more lipid peroxide, as compared to control animals (314%). Significant depletion was also observed in carbohydrate, glycogen and glucose (79.1, 86.26 and 78.6% respectively) contents of liver at high parasitaemia. The lower contents of nucleic acid in the infected hosts observed in the study may be partly due to the absorption of nucleic acids by the parasites from the host cells.

Vaccination of rhesus monkeys against Plasmodium knowlesi with aqueous suspension of MDP as an adjuvant

In these investigations two types of antigen preparations were used: (i) Whole Antigen (WAg), and (ii) Soluble Antigen (SAg). For immunization, Muramyl Dipeptide (MDP) was employed as an adjuvant. Highest reciprocal antibody titre values were recorded in ELISA and IHA tests from animals immunized by WAg-MDP. Skin reactions in animals sensitized with WAg-MDP combination showed a well developed zone of erythema with induration after 24 hours of intradermal injection. Animals immunized with WAg-MDP showed a maximum leukocyte migration inhibition. All the animals in experimental and control groups showed patent infection following challenge with live parasites. Animals belonging to the control groups showed 100% mortality. On the basis of these experiments it could be concluded that MDP preparation afforded some protection to the test animals.

Protective effect of L. donovani antigens using glucan as an adjuvant

Golden hamsters were immunized with various antigen fractions of Leishmania donovani promastigotes. Beta 1,3-glucan was used as an adjuvant in these vaccination experiments. The results indicate that immunization of animals with the microsomal fraction (subcellular fraction III) in combination with glucan confers considerable immune protection against L. donovani infection. The immune protection was confirmed by correspondingly lower parasite burden in the livers and spleens of test animals compared to controls. Additionally, the vaccinated animals showed positive skin test responsiveness after challenge, along with increased antibody titres. Immunization of animals with whole and particulate antigen fractions was also found to afford a high degree of resistance. The other subcellular and soluble antigen fractions conferred very little protection. In these experiments, glucan was found to be a potent adjuvant when injected, intraperitoneally, with Leishmania antigens. Similar doses of parasite extracts given without an adjuvant were able to confer only very little or no protection.

Entamoeba histolytica antigens as possible vaccinogens? A short review

A few key papers which have recently been published on the characterization of amoeba antigens are reviewed. Immunofluorescence tests and immunoelectron microscopy have demonstrated the localization of certain surface antigens on axenically cultured trophozoites. Most of the surface antigens have largely been shown to elicit a humoral response. The elicitation of cellular response has not been well illustrated. The localization of a large number of antigens in cytoplasmic vacuoles and plasma membrane indicates that a greater stimulus to the host would be provided by intracellular antigens than by those located on the surface of amoeba trophozoites. In a few inoculation studies, amoeba antigens, in combination with several adjuvants, have been successfully employed for inducing protective immunity in various animal model systems. These and other results clearly demonstrate that amoeba antigens are fully capable of generating humoral and as well as CMI responses. A combination of these two effector limbs of immunity can be fully exploited through effective use of future vaccines.

Experimental infection of rhesus monkeys with Entamoeba histolytica mimics human infection

Experimental infection of Entamoeba histolytica was successfully established in rhesus monkeys (Macaca mulatta). Parasites of proven pathogenicity maintained through liver passage in hamsters were used in this study. Laparotomized monkeys were inoculated intracecally/intrahepatically with trophozoites, or by oral administration of cysts (2000 cysts/ml). The cysts were isolated from an infected human stool sample. Formation of typical amebic lesions in the inoculated tissues along with alterations in hematologic indices were studied in the infected monkeys. All the experimentally inoculated monkeys showed leukocytosis and mild neutrophilia, while the hemoglobin content and levels of blood sugar and blood urea remained unaltered during the post-infection period. Specific antiamebic antibodies were readily detectable in post-infected sera.

Clinical therapeutic analysis of vitiligo phase--II

The incidence of vitiligo varies from country to country. In the present study, seventy cases of vitiligo have been studied from skin out patient department of the Institute of Post-graduate Medicine & Research over a period of 2 years. The prevalence rate of vitiligo among the total out patient attendent was 0.4 per cent. 85 per cent of the cases belonged to the age group to 11-40 years. Male and female ratio was 2:1. Precipitating factors like physical injury, mental stress and strain had close link with development of skin lesion. In 11.4 per cent cases near relations were involved. Skin lesions according to the site showed lower extremity to be the maximally involved area and the genital areas were least involved.

Incidence of cutaneous diphtheria in Bangladesh

Corynebacterium diphtheriae (C. diphtheriae) was isolated from 23 (7%) skin ulcers out of 327 cases studied. Eight (33%) of the 23 positive cases belonged to the age group of 6 to 10 years. Of the 19 strains of C. diphtheriae typed, 18 (95%) were gravis and of which 14 (77%) were toxigenic. More than 90% of the C. diphtheriae positive ulcer cases had serum anti-toxin level at or above the protective level as against 49% of control. No diphtheria bacilli were isolated from throat of any of the skin positive cases. All the ulcers from which C. diphtheriae were isolated also harboured other definite wound pathogens. It is believed that the presence of toxigenic C. diphtheriae in skin wound might play an important role in the spread of faucial diphtheriae. It is evident from serum anti-toxin level that infected persons develop natural immunity.

Incidence of urethritis in Bangladesh

Urethritis is either gonococcal or non-gonococcal. This paper describes the investigation of 286 cases of urethral or vaginal discharges, dysuria or urethral irritation. Non-gonococcal urethritis (NGU) was found to be the commonest form of urethritis accounting for 65.05 per cent of cases. Gonococcal urethritis (GU) and abacterial urethritis were accounted for 24.47 per cent and 10.48 per cent of cases respectively. No history of sexual exposure was found in 21.27 per cent of cases with NGU, whereas this was invariably present in cases of GU. This may indicate that in at least some of the patients with NGU, the disease may not be sexually transmitted. This point needs further study.

Post-Kala-azar dermal leishmaniasis ( a review of 10 cases)

Ten cases of Post-Kala-azar Dermal Leishmaniasis (PKDL) have been studied. The sites of involvement and morphological character have been noted. Skin scraping, biopsy, serological and biochemical changes have been looked for. Presence of visceral leishmaniasis along with PKDL had been searched. Response to therapy with antimony compounds have been observed and found satisfactory. Visceral leishmaniasis although not frequent now a days, the incidence of PKDL is still prevalent to some extent in this country.