Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study

OBJECTIVE

This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital.

PATIENTS AND METHODS

Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence.

RESULTS

778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications.

CONCLUSIONS

In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

Numerical exploration of slip effects on second-grade fluid motion over a porous revolving disk with heat and mass transfer

Revolving-disk systems are employed in various industrial settings including turbine engineering, chemical and food processing industries and others. The current article scrutinizes a second-grade fluid motion generated by an infinite porous disk having partial slip character. Heat transfer induced by heating of the disk surface and by viscous and ohmic heating effects is modeled and analyzed under thermal slip condition. Accompanying mass transfer process with thermophoretic diffusion is also formulated. A self-similar system is obtained akin to the case of no-slip case discussed in a previously published study. The adoption of velocity slip assumption induces non-linearity in the boundary conditions in velocity components. Computational procedure embedded in MATLAB bvp4c platform is opted to simulate the system for full range of slip parameters. In contrast to a previously published work pertaining to the no-slip case, present numerical methodology gives accurate results for wide ranges of Prandtl number and elasticity parameter. Boundary layer formations above the disk are examined under various controlling parameters. A comparative assessment of slip and no-slip cases is presented through both graphical illustrations and tabulated results for the resisting torque, the Nusselt number and the Sherwood number. Current numerical findings match very well with the existing homotopy solutions for the no-slip case. The presence of a wall slip mechanism leads to a clear suppression of all the velocity components. Furthermore, an augmentation in the thermal/concentration slip coefficient significantly reduces the thermal/solutal penetration depth. Additionally, we observe a noticeable increase in the driving torque as the elasticity parameter enhances. The slip action of the surface is also predicted to raise the torque required by the disk.

Central serous chorioretinopathy secondary to intramuscular testosterone therapy

Summary

A patient treated with intramuscular testosterone replacement therapy for primary hypogonadism developed blurred vision shortly after receiving his testosterone injection. The symptom resolved over subsequent weeks and recurred after his next injection. A diagnosis of central serous chorioretinopathy (CSR) was confirmed following ophthalmology review. A decision was made to change the patient's testosterone regime from this 12-weekly intramuscular injection to a daily topical testosterone gel, given the possibility that peak blood levels of testosterone following intramuscular injection were causing his ocular complaint. His CSR did not recur after this change in treatment. CSR secondary to testosterone therapy is a rare finding but has been reported previously in the literature.

Learning Points

Blurred vision in patients treated with testosterone replacement therapy (TRT) should prompt an ophthalmology review. The potential for reduced risk of central serous chorioretinopathy (CSR) with daily transdermal testosterone remains a matter of conjecture. CSR is a rare potential side effect of TRT.

LDL goal as a risk factor target in the post-intervention outpatient cardiology population

Funding Acknowledgements

Type of funding sources: None.

Background

The relationship between an acute coronary event and cholesterol levels has been immensely researched, specifically the low-density lipoprotein (LDL) component of cholesterol. According to the Canadian guidelines, LDL cholesterol should be below 1.8 mmol/L if the patient has suffered an acute cardiac event. The European guidelines suggests that LDL target concentration should be below 1.4 mmol/L if the patient has had a previous cardiac event. European guidelines also lowered the LDL recommendations to less than 1 mmol/L if the patient has had 2 previous cardiac event in the previous 2 years.

Purpose

Assess the concordance of one Canadian cardiology clinic to the European LDL guidelines in patients with coronary artery disease.

Methods

Patients were randomly selected from a single centre outpatient Cardiology practice between January and June 2021. All patients were selected by 1 researcher. The patients selected must have been diagnosed with coronary artery disease by Angiography and undergone intervention in the form of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The blood cholesterol levels were evaluated before and after intervention.

Results

101 patients were randomly selected for this study. Data encompassed 83 males and 18 females ages 43 to 88. Before the intervention, 15 patients had an LDL level below 1.4 mmol/L, 29 patients had an LDL level below 1.8 mmol/L. After the intervention, the number of patients with LDL <1.4 mmol/L was 50 and LDL<1.8 was 85. This population was divided by risk factors and the LDL levels were compared before and after intervention. 9 patients were known to be smokers, their LDL levels were on average 2.73 mmol/L before intervention and 1.3 mmol/L after intervention. 31 patients were known diabetic, their LDL levels were on average 2.15 mmol/L before intervention and 1.43 mmol/L after intervention. 69 patients had hypertension, their LDL levels were 2.36 mmol/L before intervention and 1.46 mmol/L after intervention. Of the 30 patient who had a positive family history, the LDL on average was 2.39 mmol/L before intervention and 1.84 mmol/L after intervention. Positive family history was contingent on having an immediate female relative with age <65 or immediate male relative with age <55 having had a cardiac event or coronary intervention.

Conclusions

The number of individuals on appropriate cholesterol medications after intervention increased thereby reducing the LDL concentration. The data shows that in a sample of the typical Canadian population, 84% of patients were adequately managed after a coronary artery intervention according to the Canadian guidelines. According to the UK guidelines, only 29.5% are being adequately managed. The North American guidelines will likely incorporate the new LDL targets into upcoming revisions and therefore more aggressive risk factor management will be required to meet the new target goals.

Anticoagulation use in the setting of atrial fibrillation in a typical outpatient cardiology population

Funding Acknowledgements

Type of funding sources: None.

Background

The risk of cerebrovascular events has been greatly reduced with the guideline recommendation of anticoagulation in the presence of atrial fibrillation (AF). Based on current epidemiological evidence, over ⅓ of patients with known AF who are eligible for anticoagulation, do not receive them. The elderly population are especially susceptible to this disparity. The CHA2DS2-VASC score is currently being used to assess for need for anticoagulation in patients with AF. More recently, the HAS-BLED score has been developed to assess for bleeding risk. Weighing the bleeding risk using HAS-BLED score with stroke risk using CHA2DS2-VASC score, we assessed if a segment of the Canadian population with AF were appropriately anti-coagulated.

Purpose

Assess the concordance of one outpatient cardiology practice with anticoagulation guidelines for atrial fibrillation.

Materials & Methods

Patients were randomly selected from a single centre outpatient Cardiology practice between January and May 2021. The patients were selected by 1 researcher. The patients selected must have been diagnosed with atrial fibrillation by ECG and Holter analysis. The HAS-BLED and CHA2DS2-VASC scores were calculated for each individual.

Results

101 patients were selected for this study. 66 were male and 35 were female with ages ranging from 33 to 91 years old. Patients with a CHA2DS2-VASC score greater than 1, were anti-coagulated with direct oral anticoagulation (DOAC) unless they were in severe renal failure (creatinine clearance <30ml/min) in which case Warfarin was used. In the age group of 65 and under, 12 patients had a CHA2DS2-VASC score greater than 1 and were anti-coagulated. In the age group 65 and over, 72 had a CHA2DS2-VASC score greater than 1. Of the 72 individuals, 71 were appropriately anti-coagulated. In the age group 80 and over, 29 individuals had a CHA2DS2-VASC score greater than 1 and were anti-coagulated. For the individuals on anticoagulants, the HAS-BLED score was less than or equal to the CHA2DS2-VASC score. Only one of the patients in the study with a CHA2DS2-VASC score greater than 1, was not anti-coagulated. There were no reported major bleeding risks in the patients reviewed.

Conclusion

In a sample of the typical Canadian population, based on risk factor assessments using both the CHA2DS2-VASC and HAS-BLED scores, 99% of patients were appropriately anti-coagulated in the presence of AF. This shows a significant increase in appropriate management of AF patients compared to the current national and global averages. There were no major bleeding events reported in any of the patients receiving full anticoagulation. This supports the recommendation that the benefit of anticoagulation in stroke reduction from thromboembolism outweighs the risk of major bleeding events.

Antibacterial activity of Ricinus communis plant extract against antibiotic resistant Helicobacter pylori and Gluconobacter oxydans isolated from fresh apple juices samples

Bacteria were isolated from samples of Fresh Apple juices from shops of three different localities of Lahore. Analysis of samples from Liberty, Anarkali and Yateem khana Markets show different levels of contamination. There were pathogenic and non-pathogenic bacteria in all samples and were identified by the morphological and biochemical tests. Most of the plasmids of pathogenic bacteria were 4kb in their molecular size. Ribotyping of 16S ribosomal RNA gene sequencing was done to confirm Helicobacter pylori strain and Gluconobacter oxydans. The highest sensitivity of 210mm was shown by Enterobacter sp. against Aztheromysine disk (15µg) while Micrococcus sp. was highly resistant against all of the Antibiotics applied. The antibiotic resistance of pathogenic bacteria was also checked against Ricinus communis plant's extracts, all isolated bacterial pathogens were resistant but only, E.coli was inhibited at 300µl of the extracts. Presence of pathogenic bacteria in Apple juice samples was due to contamination of sewage water in drinking water while some of these pathogenic bacteria came from Apple's tree and other from store houses of fruits.

Immunohistochemical expression of PCNA, STRO-1 and CD 44 in the healing of experimentally induced periapical lesions in rats

OBJECTIVE

The aim of the study was to determine the expression of cell proliferating marker, anti-proliferating cell nuclear antigen (anti-PCNA) and mesenchymal stem cell (MSC) markers (anti-STRO-1 and anti-CD44) in periapical periodontitis and their role in the healing of periapical lesion in periapical periodontitis.

MATERIALS AND METHODS

Ninety Sprague-Dawley male rats (100 g) were divided into 3 groups: Experimental group I (EG I: n = 30), experimental group II (EG II: n=30) and control group (CG: n = 30). Periapical lesions were experimentally developed by leaving the dental pulp of maxillary first molars mesial root open to oral environment for 4 weeks. Conventional root canal treatment was performed in EG II. Maxillary first molars along with alveolar bone were resected and fixed. The processed samples were stained with routine hematoxylin and eosin (H&E), and evaluated immunohistochemically using antibodies against anti-PCNA, anti-STRO-1, and anti-CD44 polyclonal antibodies. Data were analyzed using Chi-square test and a p-value of <0.05 was considered significant.

RESULTS

Immunostaining of anti-PCNA showed 30%, 70% and 53.3% positive staining in CG, EG I, and EG II, respectively (p<0.001). Moreover, the CD44 staining was 20% in CG in contrast to 63.6% in EG I and 43.3 in EG II. STRO-1 staining in CG was 10%, 50% in the EG I and 36.6% in the EG II (p<0.001).

CONCLUSIONS

Periapical inflammatory tissues expressed significant proliferative cell marker PCNA and mesenchymal stem cell markers STRO-1, and CD44. These findings further reaffirm the promising role of mesenchymal stem cells in the healing of periapical periodontitis.

Comparison of Airway Measurements in Rheumatoid Arthritis and Non-rheumatoid Patients using Lateral Cephalometric Radiographs

Objective

The aim of this study was to investigate the potential relationship between the volumetric area of the upper airway and rheumatoid arthritis (RA) by comparing upper airway measurements between patients with and without RA.

Methods

This case-control study compared upper airway measurements between patients with and without RA using lateral cephalometric radiographs. Two distinct measurements were made: the area of the upper airway, which is defined as "the area extending from the point of the retro-palatal region to the base of the epiglottis," and the distance of the upper airway, which is defined as "the distance between the anterior border of the third cervical vertebra (C3) and the anterior border of the soft tissue of the neck". A single examiner performed all measurements, and the intra-examiner reliability was assessed.

Results

Sixty-one RA patients and 95 non-RA patients were included in the case and control groups, respectively. RA patients were significantly older in age and with higher BMI values. Patients with or without RA had Angle Class II as the most prevalent orthodontic classification. The upper airway was slightly narrower in RA patients, resulting in a smaller area, and the length of the upper airway was significantly longer in RA patients.

Conclusion

Patients with RA have narrower upper airways as measured on lateral cephalometric radiographs. This may partially explain the high prevalence of obstructive sleep apnea among patients with RA. Focusing on airways measurements when cephalometric radiographs are taken for patients with RA could give some idea about which patient is likely to have OSA.

Algorithms For Management Of Post-Burn Contracture In Upper Extremity In Children

The aim of this study is to describe the management and outcome of surgical treatment for post burn contractures in different parts of the upper extremities in children, and provide a final decision algorithm that can be a useful guide for the Resident regarding surgical approach to contracture management. This was a retrospective study conducted in the Clinic of Plastic and Reconstructive Surgery, Pristina-Kosovo, between 2014-2016. All cases continued check ups in the Gentiana-Grelor private clinic in Pristina until 2019. Followups were conducted for no less than 6 months with respect to the viability and healing of the repaired area. Patients of both genders, aged from 0 months to 18 years with post-burn contracture in upper extremity, were included in the study. For the sake of presentation, we divided them anatomically into four main areas: axilla, elbow, wrist and hand. We start with a reconstructive ladder using skin grafts (STSG, FTSG), and local flaps such as advancement flaps, Z-plasties, V-Y or Y-V advancement flap, abdonimal/groin pedicled flap, cross finger flap, radial forearm flap were used. Patients were called for follow-up lasting a minimum of one to up to three years. The study included 144 patients. Their age ranged from 9 months to 18 years, the mean age being 12 years. Ordering them by location, post-burn contracture percentage in upper extremity in children was 68% on the hands, 18% on the elbows, 8% on the axilla and 6% on the wrist. A classification and treatment algorithm aids in achieving significant improvements in both joint motions and aesthetic deformities.

Evaluation of the causes of failure of root canal treatment among patients in the City of Al-Kharj, Saudi Arabia

Background

Endodontic treatment failure is one of the most common problems encountered in dentistry.

Aims

This study aimed to evaluate the causes of failure of endodontic treatment among patients in the Saudi Arabian city of Al-Kharj.

Subjects and Methods

A total of 250 patients of both genders were involved in the study. Criteria confirming the failure of the endodontic treatment were pain, tenderness on pressure, periapical radiolucency, and sinus tract. Patients were selected by convenience sampling methods. A diagnostic chart was prepared to complete the investigation in three different hospitals, during a six-month period (October 2018 - March 2019). The results were analyzed statistically using Chi-square test and use of simple arithmetical methods to determine percentage and frequencies.

Results

The main cause for endodontic failure was poor quality adjunctive treatment. 147 out of 179 male patients and 53 out of 71 female patients received poor quality treatment. There was a statistically significant difference between gender versus adjunctive treatment (P = 0.009) and between hospital versus adjunctive treatment (P = 0.005), and quality of adjunctive treatment between private hospital as compared to government hospital which was also statistically significant (P = 0.008). In quadrant wise distribution, first molars were the most commonly involved teeth. Inadequate filling of the root canal was (36.8%), missed canals (14.4), over-extension root canal fillings (12.8%), perforations (9.6%), instrumentation related (8.8%), and endodontic access preparation related (2.4%) in the decreasing order of frequency were seen as the most common causes of failure of endodontic treatment.

Conclusion

First molars were the most commonly affected tooth in the failure of endodontic treatment. Poor adjunctive treatment and inadequate filling of the root canals were the most common causes of endodontic failure, more commonly seen in male than female patients and in private clinics/hospitals than government hospitals.

Physics-informed machine learning: case studies for weather and climate modelling

Machine learning (ML) provides novel and powerful ways of accurately and efficiently recognizing complex patterns, emulating nonlinear dynamics, and predicting the spatio-temporal evolution of weather and climate processes. Off-the-shelf ML models, however, do not necessarily obey the fundamental governing laws of physical systems, nor do they generalize well to scenarios on which they have not been trained. We survey systematic approaches to incorporating physics and domain knowledge into ML models and distill these approaches into broad categories. Through 10 case studies, we show how these approaches have been used successfully for emulating, downscaling, and forecasting weather and climate processes. The accomplishments of these studies include greater physical consistency, reduced training time, improved data efficiency, and better generalization. Finally, we synthesize the lessons learned and identify scientific, diagnostic, computational, and resource challenges for developing truly robust and reliable physics-informed ML models for weather and climate processes. This article is part of the theme issue 'Machine learning for weather and climate modelling'.

A study of elastico-viscous fluid flow by a revolving disk with heat dissipation effects using HAM based package BVPh 2.0

Von Kármán problem of infinite disk is re-examined when fluid under consideration is elastico-viscous, satisfying the constitutive relations of Walters-B model. Main target here is to demonstrate how the presence of elasticity alters heat transfer phenomenon for the said problem especially when heat dissipation term is included in the analysis. We assume a self-similarity solution that results in a system of coupled non-linear equations. An easy to use package BVPh 2.0 based on the homotopy analysis method is used to present series solutions for values of elastico-viscous fluid parameter (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$K$$\end{document}K) in the range \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$0 \le K \le 1$$\end{document}0≤K≤1. Residuals are evaluated numerically at various order of approximations which depict that obtained solutions converge to the exact solutions. Boundary layer is substantially suppressed due to the consideration of elastico-viscous fluid assumption. Furthermore, velocity of the entrained fluid is inversely proportional to the parameter \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$K$$\end{document}K. The results predict a substantial drop in heat transfer rate whenever elasticity effects are present. A considerable role of heat dissipation towards thickening of thermal boundary layer is apparent from the findings.

Early gestational diabetes mellitus (GDM) is associated with worse pregnancy outcomes compared with GDM diagnosed at 24-28 weeks gestation despite early treatment

BACKGROUND

Gestational diabetes mellitus (GDM) is associated+ with adverse pregnancy outcomes compared with women with normal glucose tolerance in pregnancy. The WHO recommends screening at 24-28 weeks gestation for GDM. Women who are diagnosed before 24-28 weeks gestation have a longer intervention period which may impact positively on pregnancy outcomes.

AIM

This study aimed to examine pregnancy outcomes of women with GDM diagnosed <24 weeks gestation compared with those diagnosed at 24-28 weeks in a large Irish cohort.

METHODS

A retrospective cohort study of 1471 pregnancies in women with GDM diagnosed using IADPSG criteria between September 2012 and April 2016 was conducted. At GDM diagnosis, women were classified as early GDM <24 weeks or standard GDM 24-28 weeks gestation.

RESULTS

Women with early GDM had a significantly greater risk of pregnancy-induced hypertension (12.4% vs. 5.3%; P < 0.05), post-partum haemorrhage (8.7% vs. 2.4%; P < 0.05) and post-partum glucose abnormalities (32% vs. 15.6%; P < 0.05). Their offspring had a greater risk of pre-maturity (10.9% vs. 6.6%; P < 0.05), stillbirth (1.4% vs. 0.5%; P < 0.05), large for gestational age (19.1% vs. 13.4% P < 0.05) and need neonatal intensive care (30.7% vs. 22.1%; P < 0.05) compared with offspring of women with standard GDM. Rates of C-section and pre-maturity were still higher in the early GDM group when the two groups where compared based on their post-natal OGTT.

CONCLUSION

Early GDM women and their offspring are at greater risk of an adverse pregnancy outcome compared with those diagnosed at 24-28 weeks. In view of the abnormal post-natal glucose findings, early GDM may reflect a more advanced state in diabetes pathogenesis.

Estimation of height and width of bone in anterior hard palate as a donor site for autogenous bone graft using IOPA by long cone paralleling technique

Objective

The purpose of this study was to determine the amount of bone available for harvesting from the anterior palate region using IOPA (Intra Oral Peri Apical) radiographs.

Materials and Methods

A total of 80 patients visiting the outpatient Department of Periodontics were selected. Two groups of male and female consisting 40 patients each were made. They were further subdivided into two groups based on age, 18-30 and 31-60 years of age, each with twenty patients. The patients were subjected to radiographic examination consisting of IOPA radiographs. All IOPA radiographs were taken using long cone paralleling technique. Availability of bone for harvesting, above the apices of teeth was calculated.

Results

The bone available in the incisor region was approximately 6.5 to 6.9 mm in height and 7.4 to 8 mm in width, in canine region 6.35 to 6.65 mm in height and 7.6 to 8.1 mm width, and in the premolar region 3.65 to 3.75 mm in height and width. When the bone height and width were compared gender and age wise for CI (central incisors), LI (lateral incisors), canine and premolars, using Student's t- test the results were not statistically significant.

Conclusion

For the purpose of harvesting autogenous bone, from the region of incisor and canine approximately 6.35 to 6.9 mm height and 7.4 to 8.1 mm width of bone may be harvested maintaining a safe distance from the apices of the teeth and the nasal floor. The premolar region does appear to yield sufficient bone at safe distances from the maxillary sinus and the apices of the premolars.

Evaluation of a voluntary augmented reality nutrition menu labelling application (Nutrilabelapps©) usage in a university café: a cross-sectional study in Terengganu, Malaysia

Nutrilabelapps© is an interactive augmented reality mobile application (app) providing nutrition menu labelling specifically built for Mutiara Café, a café in Universiti Malaysia Terengganu. However, no evaluation of the usage of Nutrilabelapps© has been carried out. Therefore, this cross-sectional study was aimed to determine the knowledge and attitude of nutrition menu labelling among Mutiara Café customers; the feasibility and acceptability of the app among customers; and also, the relationships between knowledge, attitude, feasibility and acceptability of this augmented reality nutrition menu labelling app. This study was conducted among 108 Mutiara Café customers who owned a smartphone and were able to download the Nutrilabelapps©. The data were analyzed using SPSS version 25. Findings showed that only 4.6% of Mutiara Café customers had good knowledge of nutrition menu labelling, while 71.3% of them had a positive attitude towards nutrition menu labelling. Nutrilabelapps© was accepted by users based on the feasibility (67.6%) and acceptability (75.9%) of the app. Remarkably, there was a significant association between knowledge, attitude, feasibility, and acceptability of the app at p < 0.05. As a conclusion, Nutrilabelapps© is highly recommended among the café customer despite their low knowledge of the nutrition menu labelling. Therefore, more education of the public about nutrition menu labelling is highly recommended

Molecular Mechanism and Role of Translational Values of Heat Shock Protein (HSP27) in Various Disease

HSP27, also known as HSPB1, was first discovered with a molecular weight 27kDa belonging to the four member gene family. Elevated levels of HSP27 are seen when different unfavorable conditions prevail such as increase in temperature and oxidative stress or exposure to heavy metals or organic solvents. They possess ATP-independent chaperone like activity which helps in maintaining protein homeostasis. It can also form large oligomers (300-600 kDa) containing different numbers of subunits. It is composed of total 205 amino acids. HSP27 undergoes post-translational modifications i.e. phosphorylation thereby converting large oligomers into dimers. It can act as an anti-apoptotic and antioxidant molecule during oxidative stress.  The elevated form of HSP27 is also seen in some cancer belongs to breast, ovary, prostate, brain, colorectal, hepatocellular carcinoma, lung, liver, and cervical regions. Keeping in view of molecular roles of HSP27 signaling in various pathways, we have proposed their translational values in different diseases. In addition, we have also reported the existing scientific data on the HSP27 as the potential cancer biomarker and their therapeutic targets for improved prognosis and treatment in different diseases.

Building Strong Health Supply Chain Systems: The Visibility and Analytics Network approach to improving the Nigeria Immunization Supply Chain

BACKGROUND

 Health supply chain managers are unable to effectively monitor the performance of the Immunization supply chain in Nigeria. As a result, they are unable to make effective, data-driven decisions. This results in poor vaccine availability at some service delivery points. A lack of reliable data for evidence-based decision making is a significant contributor to this challenge.

METHOD

The Visibility and Analytics Network ("VAN") principles were introduced to enable end-to-end visibility in the immunization supply chain and logistics (ISCL) system and make more accurate data available to health supply chain managers.

RESULTS

 The application of the VAN principles has led to improved data collection, real-time stock visibility, enhanced data analytics framework. This enhanced visibility has promoted a culture of accountability and data-driven decision-making previously unattainable. Health supply chain managers are now equipped with better skills and tools to promote effective operation of the immunization supply chain.

CONCLUSION

 The introduction of VAN principles has been an effective approach to improving data visibility and creating incremental improvements in the ISCL in Nigeria.

Detection of blaoxa genes and identification of biofilm-producing capacity of Acinetobacter baumannii in a tertiary teaching hospital, Klaten, Indonesia

INTRODUCTION

Acinetobacter baumannii (A. baumannii) is commonly found as an agent of nosocomial infections and demonstrates a high antibiotic resistance due to its carbapenemase production. The objectives of this study were to explore the antibiotic resistance pattern, the presence of OXAs genes and the biofilm-producing capacity of A. baumannii isolated from clinical specimens.

METHODS

Antibiotics susceptibility testing, detection of OXAs genes and the biofilm-producing capacity were performed using the Kirby Bauer method, polymerase chain reaction (PCR) and adherence quantitative assays, respectively.

RESULTS

A total of 80 A. baumannii isolates were mainly obtained from sputum and most of them were resistant to antibiotics. All A. baumannii carried bla_OXA-51 gene, yet no bla_OXA-24 and bla_OXA-58 genes were detected. Fourteen (82.4%) of the 17 meropenem resistant isolates carried bla_OXA-23 gene, but it was not found in meropenem sensitive isolates. In addition, sixty (75.0%) of 80 isolates were biofilm producers with 2 (2.5%), 16 (20.0%), and 42 (52.5%) isolates were identified as strong, moderate and weak biofilm producers, respectively.

CONCLUSION

Most of A. baumannii isolates had a high level of antibiotic resistance and had a capacity to produce biofilm.

The effect of smoking on inflammatory and bone remodeling markers in gingival crevicular fluid and subgingival microbiota following periodontal therapy

BACKGROUND AND OBJECTIVE

Periodontal health is mediated by suppressing microorganisms inducing a local inflammatory host response. Smoking may impair this process. This study compares gingival crevicular fluid levels of inflammatory and bone remodeling markers in heavy smokers and non-smokers following active and supportive periodontal therapy in patients with chronic periodontitis.

MATERIAL AND METHODS

Gingival crevicular fluid and subgingival plaque were collected from the deepest periodontal pocket in 50 patients, 25 smokers and 25 non-smokers, at baseline (T0), following active (T1) and 12 mo of supportive periodontal therapy (T2). Smoking status was validated measuring serum cotinine levels. Gingival crevicular fluid levels of 27 inflammatory and two bone remodeling markers were analyzed using multiplex and singleplex micro-bed immunoassays, and subgingival plaque samples using checkerboard DNA-DNA hybridization. Amounts of markers in smokers and non-smokers were compared calculating the effect size.

RESULTS

Expression of inflammatory and bone-remodeling markers in smokers demonstrated an overall reduced effect size at T0 and T2 (p < 0.001). In particular, proinflammatory markers (p < 0.001), chemokines (p = 0.007) and growth factors (p = 0.003) at T0, osteoprotegerin (p = 0.003) at T1, proinflammatory markers (p = 0.019) and chemokines (p = 0.005) at T2. At T2, interleukin-8 was detected in significantly higher levels in smokers. Ten different markers in non-smokers and none in smokers responded to periodontal therapy (p < 0.05). An overall negative association was revealed between smoking and subgroups of markers at sites presenting ≥ 10⁵ red complex periodontal microbial species.

CONCLUSION

Except for an upregulation of interleukin-8, smokers exhibited reduced gingival crevicular fluid levels of several inflammatory markers at baseline and following active and supportive periodontal therapy. Only inflammatory responses in non-smokers adapted to periodontal therapy. Apparently, there seems to be an immunosuppressant effect of smoking regulating the local inflammatory response and bone remodeling markers captured in gingival crevicular fluid following periodontal therapy.

Numerical Study of MHD Viscoelastic Fluid Flow with Binary Chemical Reaction and Arrhenius Activation Energy

Here we address the influence of heat/mass transfer on MHD axisymmetric viscoelastic fluid flow developed by an elastic sheet stretching linearly in the radial direction. Constitutive relations of Maxwell fluid model are utilized in mathematical formulation of the problem. Non-linear radiation heat flux is factored in the model which accounts for both small and large temperature differences. Chemical reaction effects with modified Arrhenius energy function are analyzed which are not yet explored for viscoelastic fluid flows. Highly accurate numerical computations are performed. Our computations show S-shaped profiles of temperature function in case of sufficiently large temperature differences. Species concentration increases when activation energy for chemical reaction is increased. However, both chemical reaction rate and temperature gradient tend to reduce the solute concentration.

Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015

Background

Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria.

Methods

Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014–2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12–23 months was documented based on vaccination card or caretaker’s recall. District-level coverage estimates were calculated using survey methods.

Results

Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1–63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%–139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%).

Conclusions

Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues contributing to poor vaccination coverage could serve as an example in countries with sub-optimal vaccination coverage, similar to Nigeria.

Peristaltic flow of Powell-Eyring fluid in curved channel with heat transfer: A useful application in biomedicine

BACKGROUND AND OBJECTIVE

In this work, we explore the heat transfer characteristics in the peristaltic transport of Powell-Eyring fluid inside a curved channel with complaint walls. The study has motivation toward the understanding of blood flow in microcirculatory system.

METHOD

Formulation is developed in the existence of velocity slip and temperature jump conditions. Perturbation approach has been utilized to present series expressions of axial velocity and temperature distributions. Streamlines are prepared to analyze the interesting phenomenon of trapping. Moreover, the plots of heat transfer coefficient for a broad range of embedded parameters are presented and discussed.

RESULTS

The results indicate that slip effects substantially influence the velocity and temperature distributions. Axial flow accelerates when slip parameter is incremented. Temperature rises and wall heat flux grows when viscous dissipation effect is strengthened. In contrast to the planar channels, here velocity and temperature functions do not exhibit symmetry with respect to the central line. In addition, bolus size and its shape are different in upper and lower portions of the channel.

CONCLUSIONS

Heat transfer coefficient enlarges when the curvature effects are reduced. The behaviors of wall tension and wall mass parameters on the profiles are qualitatively similar.

Successful orthotopic heart transplantation using a donor heart with ALCAPA

With the imbalance between donation rates and potential recipients growing, transplant programs are increasingly using non-ideal organs from so-called marginal donors. This is the first reported case of the intentional use of a donor heart with ALCAPA. The recipient was aged one yr with restrictive cardiomyopathy who had been supported with BiVAD for over six months. Function of the donor left ventricle was shown to be well preserved, with no obvious signs of ischemia, except for a fibrotic layer on the anterolateral papillary muscle of the mitral valve. To prevent coronary steal, the anomalous left coronary artery ostium from the MPA was oversewn prior to implantation. The transplanted heart spontaneously regained sinus rhythm immediately following cross-clamp release and showed good contractility from the first postoperative echocardiogram. The patient continues to do well 18 months post-transplant, with excellent function on echocardiography, and good flow on coronary angiography.

Cattaneo-Christov Heat Flux Model for MHD Three-Dimensional Flow of Maxwell Fluid over a Stretching Sheet

This letter investigates the MHD three-dimensional flow of upper-convected Maxwell (UCM) fluid over a bi-directional stretching surface by considering the Cattaneo-Christov heat flux model. This model has tendency to capture the characteristics of thermal relaxation time. The governing partial differential equations even after employing the boundary layer approximations are non linear. Accurate analytic solutions for velocity and temperature distributions are computed through well-known homotopy analysis method (HAM). It is noticed that velocity decreases and temperature rises when stronger magnetic field strength is accounted. Penetration depth of temperature is a decreasing function of thermal relaxation time. The analysis for classical Fourier heat conduction law can be obtained as a special case of the present work. To our knowledge, the Cattaneo-Christov heat flux model law for three-dimensional viscoelastic flow problem is just introduced here.

Rotating Flow of Magnetite-Water Nanofluid over a Stretching Surface Inspired by Non-Linear Thermal Radiation

Present study explores the MHD three-dimensional rotating flow and heat transfer of ferrofluid induced by a radiative surface. The base fluid is considered as water with magnetite-Fe₃O₄ nanoparticles. Novel concept of non-linear radiative heat flux is considered which produces a non-linear energy equation in temperature field. Conventional transformations are employed to obtain the self-similar form of the governing differential system. The arising system involves an interesting temperature ratio parameter which is an indicator of small/large temperature differences in the flow. Numerical simulations with high precision are determined by well-known shooting approach. Both uniform stretching and rotation have significant impact on the solutions. The variation in velocity components with the nanoparticle volume fraction is non-monotonic. Local Nusselt number in Fe₃O₄–water ferrofluid is larger in comparison to the pure fluid even at low particle concentration.

Laparoendoscopic Transgastric Enucleation of an awkwardly sited Peri-Cardial Gastrointestinal Stromal Tumour (GIST): A Multi- Modal Approach

In the modern era of surgery, minimally invasive surgery is increasingly applied for excision of gastrointestinal stromal tumors. Site, size and tumor location are important factors that affect the surgical approach and excision. We performed a laparoendoscopic transgastric enucleation of a 4-cm pericardial endophytic gastrointestinal stromal tumor (GIST) using an energy device. The surgery was successful and post-operative recovery uneventful. No tumor recurrence was detected on surveillance gastroscopy. In the safe hands of a well-trained laparoscopic upper gastrointestinal surgeon, pericardial GIST can be enucleated safely by this method. The avoidance of surgical staplers is not only cost-effective, but also reduces the risk of associated complications.

Near-infrared dispersion and spin-orbit interaction of Co doped (80-x)Sb2O3-20Na2O-xWO3 glasses

The present paper discusses the fact that the absorption spectra of doped with 0.1% Co3O4 glasses with the composition (80-x)Sb2O3-20Na2O-xWO3 are measured in the spectral region 1200-1400nm. The optical structure of Co(2+) is analyzed and the energies of the electron transitions in the metal ion are determined. The spin-orbit interaction is thoroughly analyzed. The refractive index n is calculated for the examined sample with x=20mol% WO3.