Safflower polysaccharide ameliorates acute ulcerative colitis by regulating STAT3/NF-κB signaling pathways and repairing intestinal barrier function

This study is to investigate the effect of SPS on the UC model. An animal model of UC induced by DSS was developed using C57BL/6 mice. The body weight was recorded every day, and the symptoms related to UC were detected. H&E staining, AB-PAS staining and PSR staining were used to evaluate the histopathological changes of the colon. Inflammation and mucosal barrier indicators were detected by qRT-PCR, and the 16 S rRNA sequence was used to detect the intestinal flora. SPS can significantly prevent and treat DSS-induced ulcerative colitis in animals. SPS significantly improved clinical symptoms, alleviated pathological damage, inhibited the infiltration of intestinal inflammatory cells. SPS treatment can protect goblet cells, enhance the expression of tight junction proteins and mucins, inhibit the expression of antimicrobial peptides, thereby improving intestinal barrier integrity. The prevention and treatment mechanism of SPS may be related to the inhibition of STAT3/NF-κB signaling pathway to regulate intestinal barrier function. In particular, SPS also significantly adjusted the structure of intestinal flora, significantly increasing the abundance of Akkermansia and Limosilactobacillus and inhibiting the abundance of Bacteroides. Overall, SPS has a significant therapeutic effect on ulcerative colitis mice, and is expected to play its value effectively in clinical treatment.

Alocasia macrorrhiza rhizome lectin inhibits growth of pathogenic bacteria and human lung cancer cell in vitro and Ehrlich ascites carcinoma cell in vivo in mice

Cancer and antibiotic resistance represent significant global challenges, affecting public health and healthcare systems worldwide. Lectin, a carbohydrate-binding protein, displays various biological properties, including antimicrobial and anticancer activities. This study focused on anticancer and antibacterial properties of Alocasia macrorrhiza lectin (AML). AML, with a molecular weight of 11.0 ± 1.0 kDa was purified using Ion-exchange chromatography, and the homotetrameric form was detected by gel-filtration chromatography. It agglutinates mouse erythrocytes, that was inhibited by 4-Nitrophenyl-α-d-mannopyranoside. Maximum hemagglutination activity was observed below 60 °C and within a pH range from 8 to 11. Additionally, it exhibited moderate toxicity against brine shrimp nauplii with LD50 values of 321 μg/ml and showed antibacterial activity against Escherichia coli and Shigella dysenteriae. In vitro experiments demonstrated that AML suppressed the proliferation of mice Ehrlich ascites carcinoma (EAC) cells by 35 % and human lung cancer (A549) cells by 40 % at 512 μg/ml concentration. In vivo experiments involved intraperitoneal injection of AML in EAC-bearing mice for five consecutive days at doses of 2.5 and 5.0 mg/kg/day, and the results indicated that AML inhibited EAC cell growth by 37 % and 54 %, respectively. Finally, it can be concluded that AML can be used for further anticancer and antibacterial studies.

Zebrafish prss59.1 is involved in chorion development

The prss59.1 gene was identified as one of 11 genes that were highly upregulated during the induction of ovulation in zebrafish by using an in vivo ovulation assay. Previously, we conducted biochemical characterization of Prss59.1 and revealed it to be a trypsin-like proteolytic enzyme. In this study, we established a prss59.1 gene knockout strain using the CRISPR/Cas9 system. Phenotypic analysis of prss59.1 knockout fish showed that prss59.1 is associated with chorion elevation, a prominent event in egg activation during fertilization. The chorions of heterozygous and homozygous prss59.1 mutant zebrafish were smaller than those of the wild type. The results suggested that Prss59.1 is necessary for chorion expansion. The homozygous prss59.1 mutant strain, with a small chorion, showed an extremely low survival rate. Fiber-supported knob-like structures (KS) on the chorion showed an abnormal structure in prss59.1 mutants. Prss59.1 was detected in the KS on the chorion. The pores on the chorion were smaller in the prss59.1 mutants than in the wild type. Transmission electron microscopy (TEM) observations of the cross sections of the chorions showed abnormalities in the chorion structure in prss59.1 mutants. These results demonstrated that Prss59.1 is involved in chorion elevation and in proper formation of the chorion, which is necessary for embryo development.

Hydrothermal Synthesis, Phase Analysis, and Magneto-Electronic Characterizations of Lead-Free Ferroelectric BM2+(Zn, Ca, Mg)T-BFO System

In this study, lead-free BiM2+(Zn, Ca, Mg)Ti-BiFeO3 ceramics are fabricated under eco-friendly hydrothermal reaction conditions at 250 °C. XRD patterns show that all the synthesized compounds exhibit a phase coexistence of monoclinic and tetragonal perovskite-type structures with a morphotropic phase boundary at x = 0.4, with minimum impurity. The calculated average crystallite/grain size of the samples was close to 50 nm at full width at half-maximum of the main peak. The corresponding bonds of the constituent elements were observed by FTIR analysis, which further supports the formation of the local structure. EDS analyses detect all of the elements, their quantities, and compositional homogeneity. SEM data show agglomerated and nearly spherical morphology with an average particle size of about 128 nm. All synthesized ceramic powders revealed thermal stability with trivial mass loss up to investigated high temperatures (1000 οC). The dielectric constant reached its maximum at 38.7 MHz and finally remained constant after 80 MHz for all nanoceramics. Because of the complementary impact of different compositions, the most effective piezoelectric characteristics of d33 = 136 pCN-1, Pr = 8.6 pCN-1 cm-2, and kp = 11% at 30 °C were attained at x = 0.4 content for 0.4BiCaTi-0.6BiFeO3 ceramic. The measured magnetic hysteresis data (M-H curve) showed a weak ferromagnetic nature with the highest moment of ∼0.23 emu/g for 0.4BiCaTi-0.6BiFeO3, and other samples exhibited negligible ferromagnetic to diamagnetic transition. The optical response study shows that the 0.4BiMgTi-0.6BiFeO3 sample yielded the maximal transmittance (50%), whereas the 0.4BiCaTi-0.6BiFeO3 compound exhibited the highest refractive index. The calculated large band gap shows a high insulating or dielectric nature. Our findings demonstrate that the BiM2+Ti-BiFeO3 system, which was fabricated using a low-temperature hydrothermal technique, is an excellent lead-free piezoelectric and multiferroic nanoceramic.

Harnessing the potential of CsPbBr3-based perovskite solar cells using efficient charge transport materials and global optimization

Perovskite solar cells (PSCs) have become a possible alternative to traditional photovoltaic devices for their high performance, low cost, and ease of fabrication. Here in this study, the SCAPS-1D simulator numerically simulates and optimizes CsPbBr₃-based PSCs under the optimum illumination situation. We explore the impact of different back metal contacts (BMCs), including Cu, Ag, Fe, C, Au, W, Pt, Se, Ni, and Pd combined with the TiO₂ electron transport layer (ETL) and CFTS hole transport layer (HTL), on the performance of the devices. After optimization, the ITO/TiO₂/CsPbBr₃/CFTS/Ni structure showed a maximum power conversion efficiency (PCE or η) of 13.86%, with Ni as a more cost-effective alternative to Au. After the optimization of the BMC the rest of the investigation is conducted both with and without HTL mode. We investigate the impact of changing the thickness and the comparison with acceptor and defect densities (with and without HTL) of the CsPbBr₃ perovskite absorber layer on the PSC performance. Finally, we optimized the thickness, charge carrier densities, and defect densities of the absorber, ETL, and HTL, along with the interfacial defect densities at HTL/absorber and absorber/ETL interfaces to improve the PCE of the device; and the effect of variation of these parameters is also investigated both with and without HTL connected. The final optimized configuration achieved a V_OC of 0.87 V, J_SC of 27.57 mA cm^-2, FF of 85.93%, and PCE of 20.73%. To further investigate the performance of the optimized device, we explore the impact of the temperature, shunt resistance, series resistance, capacitance, generation rate, recombination rate, Mott-Schottky, JV, and QE features of both with and without HTL connected. The optimized device offers the best thermal stability at a temperature of 300 K. Our study highlights the potential of CsPbBr₃-based PSCs and provides valuable insights for their optimization and future development.

High efficiency Cu2MnSnS4 thin film solar cells with SnS BSF and CdS ETL layers: A numerical simulation

The quaternary compound copper manganese tin sulfide Cu₂MnSnS₄ is a potential absorber semiconductor material for fabricating thin film solar cells (TFSC) thanks to their promising optoelectronic parameters. This article numerically investigated the performance of Cu₂MnSnS₄ (CMTS)-based TFSC without and with tin sulphide (SnS) back surface field (BSF) thin-film layer. First, the impact of several major influential parameters such as the active material's thickness, doping concentration of photoactive materials, density of bulk and interface defect, working temperature, and metal contact, were studied systematically without a BSF layer. Thereafter, the photovoltaic performance of the optimized pristine cell was further investigated with an SnS as BSF inserted between the absorber (CMTS) with a Platinum back metal of an optimized heterostructure of Cu/ZnO:Al/i-ZnO/n-CdS/p-Cu₂MnSnS₄/Pt. Thus, the photoconversion efficiency (PCE) of 25.43% with a J _SC of 34.41nullmA/cm² and V _OC of 0.883 V was achieved under AM1.5G solar spectrum without SnS BSF layer. Furthermore, an improved PCE of 31.4% with a J _SC of 36.21nullmA/cm² and V _OC of 1.07 V was achieved with a quantum efficiency of over 85% in the wavelengths of 450-1000 nm by the addition of SnS BSF layer. Thus, this obtained systematic and consistent outcomes reveal immense potential of CMTS with SnS as absorber and BSF, respectively and provide imperious guidance for fabricating highly a massive potential efficient solar cell.

Isoliquiritigenin alleviates the development of alcoholic liver fibrosis by inhibiting ANXA2

The study aimed to investigate the effect of isoliquiritigenin (ISL) on model of alcoholic liver fibrosis (ALF). C57BL/6 mice were used to establish animal model of ALF, HSC-T6 cells were used to establish alcohol-activated cell model, and tandem mass tag (TMT) assays were used to analyze the proteome. The results showed that ISL obviously alleviated hepatic fibrosis in model mice. ISL visually improved the area of liver pathological stasis and deposition of fibrillar collagen (Sirius Red staining, Masson staining), inhibited the mRNA expression levels of interleukin 6 (IL-6), tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β) in liver tissues. ISL down-regulated the mRNA expression levels of IL-6 and transforming growth factor-β1(TGF-β1) in activated hepatic stellate cells (HSCs). And ISL significantly reduced annexin A2 (ANXA2) in vitro detected by TMT proteomics technology. Interestingly, it was found for the first time that ISL could inhibit ANXA2 expression both in vivo and in vitro, block the sphingosine kinases (SPHKs)/sphingosine-1-phosphate (S1P)/interleukin 17 (IL-17) signaling pathway and regulate the expression of α-smooth muscle actin (α-SMA) by inhibiting the phosphorylation of signal transducer and activator of transcription 3 (STAT3) at the downstream signal to finally reverse HSCs activation and hepatic fibrosis. Thus, we demonstrated that ISL is a drug monomer with notable anti-hepatic fibrosis activity.

The antagonistic activity of Padina arborescens extracts on mPRα

The current study attempted to evaluate the antagonistic activity of compounds isolated and purified from the marine algae Padina arborescens during cultivation. The compounds were collected on a filter, concentrated on ODS columns and separated by HPLC. Two peaks that showed competitive progesterone binding activity with membrane progesterone receptor α (mPRα) were purified. Their physiological activity was further uncovered by in vitro and in vivo oocyte maturation and ovulation-inducing assays using zebrafish. The compounds inhibited the induction of oocyte maturation and ovulation. Moreover, the results showed that the compounds have antagonistic activity against mPRα. The purified compounds with antagonistic activity against mPRα would be considered as new pharmaceutical candidate.

Transgenerational effects of bisphenol A on zebrafish reproductive tissues and sperm motility

In a previous study, we demonstrated the next-generation effects and further transgenerational adverse effects of bisphenol A (BPA) in zebrafish. The adverse effects on reproductive factors, such as gonadal activity, fertility, hatching rate and malformation of embryo caused by the dietary administration on initial generation (F0) male and female zebrafish were continued until third filial (F3) generation. In this study, we examined how much amount of BPA contained in the diet was taken up by the zebrafish. We showed that only about 3.5-6.8% of BPA in the diet was taken into fish body. Also, we confirmed the transgenerational effects caused by 100 times lower amount of BPA than previous study. Even a low amount of BPA (1 μg/g diet) administered to F0 not only caused retraction of the ovaries and testes but also lowered the survival rate and increased the rate of malformation in the offspring. The effects were continued to F3 generation as previously described. Moreover, the sperm motility of the offspring of the BPA-treated ancestral animals was significantly lower, and this adverse effect was continued to F2 generations. These findings demonstrated that BPA at levels comparable to those ingested by humans can cause transgenerational adverse effects on fish reproduction.

Zebrafish stm is involved in the development of otoliths and of the fertilization envelope

Using an in vivo assay, we selected 11 genes that were highly upregulated during the induction of ovulation in zebrafish using microarray analysis and RNA sequencing. The starmaker gene (stm) was one of these genes. Although stm has been previously reported to be involved in otolith formation during the early development of zebrafish, we detected its expression in eggs and showed that stm was related to fertilization by establishing an stm gene knockout strain using the CRISPR/Cas9 system. Further phenotypic analysis of stm knockout fish was conducted in this study. With a higher nonfertilization rate, the stm mutant strain showed an extremely low survival rate. Otoliths of stm homozygous mutant zebrafish showed abnormal morphology in embryos and adult fish. However, fish did not show any abnormalities in swimming behaviour in either embryos or adults. Stm proteins were detected on the chorion of ovulated eggs before spawning. Fibre-supported knob-like structures on the fertilization envelope (FE) also showed abnormal structures in stm mutants. The Stm protein is necessary for otolith formation, and a lack of Stm causes abnormal otolith formation. The partial defect of otolith formation does not cause defects in swimming behaviour. The Stm protein is expressed in the chorion and is responsible for the formation of fibre-supported knob-like structures on the FE. It was suggested that a lack of Stm caused a lower fertilization rate due to inadequate formation of the FE.

Lay summary

In zebrafish, the protein Starmaker (Stm) was identified as having a role in ovulation. Stm is also known to be required for the formation of ear stones (otoliths) which are needed to keep the body in balance. Zebrafish lacking Stm were produced by genome editing. As expected, Stm-deficient fish formed abnormal otoliths. To investigate the role of Stm in ovulation, fertilization and early development, we tried mating of Stm mutants and observed their juveniles. Although no problem found in ovulation, we found low fertilization rate and abnormal structure of knob-like structure (small pit) on the egg membrane. Survival rate of embryos with abnormal egg membrane was extremely low. It was demonstrated that Stm protein is necessary to form the functional egg membrane to protect embryos from the outside environment.

Establishment of a steroid binding assay for membrane progesterone receptor alpha (PAQR7) by using graphene quantum dots (GQDs)

Currently, semiconductor nanoparticles known as quantum dots (QDs) have attracted interest in various application fields such as those requiring sensing properties, binding assays, and cellular imaging and are the very important in the acceleration of drug discovery due to their unique photophysical properties. Here, we applied graphene quantum dots (GQDs) for the binding assay of membrane progesterone receptor alpha (mPRα), one of the probable membrane receptors that have potential in drug discovery applications. By coupling the amino groups of mPRα with GQDs, we prepared fluorogenic GQD-conjugated mPRα (GQD-mPRα). When mixed with a progesterone-BSA-fluorescein isothiocyanate conjugate (P4-BSA-FITC) to check the ligand receptor binding activity of GQD-mPRα, fluorescence at 520 nm appeared. The fluorescence at 520 nm was reduced by the addition of free progesterone into the reaction mixture. GQD-coupled BSA (GQD-BSA) did not show a reduction in fluorescence at 520 nm. The results demonstrated the formation of a complex of GQD-mPRα and P4-BSA-FITC with ligand receptor binding. We established a ligand binding assay for membrane steroid receptors that is applicable for high-throughput assays.

Wideband full double-pass serial hybrid fiber amplifier utilizing L-shape configuration

In this work, a new, to the best of our knowledge, full double-pass serial hybrid fiber amplifier is simulated on OptiSystem 7.0 software. A wideband flat gain spectrum covered both conventional and long communication bandwidth (C+L) from 1530 to 1590 nm, which is approximately 60 nm with high average gain of 23.6 dB; acceptable noise figure of 7 dB is achieved via the L-shape configuration. The main innovative step in the proposed design is decreasing the cascading amplification effect between the combined amplifiers, by making the individual full double-pass for the input signal in each amplifier stage.

Study on Precipitating Factor of Chronic Hepatic Encephalopathy

Hepatic encephalopathy (HE) is a neuro-psychiatric manifestation of chronic liver disease causing significant morbidity and mortality worldwide. Though the exact mechanism is unknown but it is well accepted that various precipitating factors are involved in hepatic encephalopathy. Aim of the study was explore the precipitating factors of chronic hepatic encephalopathy. This cross sectional descriptive study was conducted in the Department of Medicine and Department of Hepatology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh during the period from April 2016 to October 2016. One hundred patients with hepatic encephalopathy fulfilling the inclusion and exclusion criteria were enrolled. Inclusion criteria were designed for all diagnosed cases of hepatic encephalopathy associated with cirrhosis of liver aged 18 years or above irrespective of sex. Patients with acute fulminant hepatitis and non-cirrhotic hepatic encephalopathy were excluded. The result of the study was mean age of hepatic encephalopathy was 52.81±8.15 years and 94.0% patients were above 40 years. Male (66.0%) were predominant over female (34.0%). HBsAg and Anti HCV were positive in 49.0% and 11.0% patients respectively. Stage of hepatic encephalopathy was stage-I in 8.0%, stage-II in 37.0%, stage-III in 39.0% and stage-IV in 16.0% patients. Changes of biochemical parameters were low haemoglobin level (70.0%), raised total count of leukocyte (25.0%), low platelet count (68.0%), low serum albumin (98.0%) raised prothrombin time (60.0%), low serum sodium (34.0%) and low serum potassium (63.0%). The recoded precipitating factors were gastrointestinal bleeding (14.0%), constipation (37.0%), hyponatremia (34.0%), hypokalemia (28.0%) infections (20.0%), use of diruretics (8.0%), use of sedatives (4.0%) and excess intake of protein (6.0%). While precipitating factor was absent in 11.0% of cases. In conclusion there are different factors which play a key role in precipitating hepatic encephalopathy but electrolytes imbalance, constipation, infections, Upper GI bleed, diuretics are the most common precipitating factors.

Two-Step Mechanism of Cyclin B Degradation Initiated by Proteolytic Cleavage with the 26 S Proteasome in Fish

To complete meiosis II, cyclin B is degraded in a short period by the inactivation of M-phase promoting factor (MPF). Previously, we showed that the destruction of cyclin B was initiated by the ubiquitin-independent proteolytic activity of the 26 S proteasome through an initial cut in the N-terminus of cyclin (at K57 in the case of goldfish cyclin B). We hypothesized that this cut allows cyclin to be ubiquitinated for further destruction by the ubiquitin-dependent proteolytic pathway, which leads to MPF inactivation. In this study, we aimed to identify the ubiquitination site for further degradation. The destruction of cyclin B point mutants in which lysine residues in a lysine-rich stretch following the cut site of cyclin B had been mutated was analyzed. All the lysine point mutants except K57R (a point mutant in which K57 was substituted with arginine) were susceptible to proteolytic cleavage by the 26 S proteasome. However, the degradation of the K77R and K7677R mutants in Xenopus egg extracts was significantly slower than the degradation of other mutants, and a 42 kDa truncated form of cyclin B was detected during the onset of the degradation of these mutants. The truncated form of recombinant cyclin B, an N-terminal truncated cyclin BΔ57 produced as cut by the 26 S proteasome, was not further cleaved by the 26 S proteasome but rather degraded in Xenopus egg extracts. The injection of the K57R, K77R and K7677R cyclin B proteins stopped cleavage in Xenopus embryos. From the results of a series of experiments, we concluded that cyclin B degradation involves a two-step mechanism initiated by initial ubiquitin-independent cleavage by the 26 S proteasome at lysine 57 followed by its ubiquitin-dependent destruction by the 26 S proteasome following ubiquitination at lysine 77.

Hearing gain after myringoplasty in relation to the size of tympanic membrane perforation

Objectives: To assess hearing gain after successful myringoplasty in relation to the size of tympanic membrane perforation. Methods: This cross-sectional study was done in the department of otolaryngology and head neck surgery, BSMMU, Sahbag, Dhaka during the period of January 2009 to December 2010.A total of 60 patients were under went myringoplasty operation after taking detailed history, clinical examination and investigation. Preoperative and postoperative hearing assessment was done. Analysed data presented by various tables, graphics and figures. Results: In case of small size perforation preoperative mean bone conduction threshold was 7.66 dB, mean air conduction threshold was 34.14 dB and mean air bone gap was 26.48 dB. In case of medium size perforation preoperative mean bone conduction threshold was 9.61 dB, mean air conduction threshold was 44.48 dB. Mean air bone gap was 34.87 dB. In case of large size perforation preoperative mean bone conduction threshold was 13.12 dB, mean air conduction threshold was 59 dB, and mean air bone gap was 45.88 dB. Hearing loss increases with increasing size of perforation. Ahmed and Rahim (1979) showed in the study that hearing loss increases with increasing the size of the perforation which was relevant in the study. After myringoplasty post-operative mean air bone gap was 21.24 dB in small size, 21.74 dB in medium sized and 24 dB in large size. From the record improvement of mean air bone gap or hearing gain was 5.24 dB in small size perforation respectively. The different of air bone gap closure between small and medium size perforation was statistically significant by unpaired’ test. Conclusion: Hearing gain after myringoplasty is better in large size perforation. Bangladesh J Otorhinolaryngol; April 2019; 25(1): 54-59

Early Functional Outcome of Wide Resection and Endoprosthesis Replacement for Recurrent Giant Cell Tumour of the Distal Femur

Giant cell tumors (GCT) are usually benign bone tumors with aggressive characteristics. Giant cell tumors have a benign indolent course in most patients, but tumors may recur locally in as many as 50% of cases depending on the type of treatment and initial presentation of the tumor. The aim in the management of long bone GCT is to eradicate the tumor and prevent local recurrences. In this study, we retrospectively assessed the functional outcomes in 5 patients having recurrent GCTs of the distal femur treated with custom made modular endoprosthesis following wide resection of the tumor from January 2017 to December 2018 in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Tumor Society functional score (MSTS) was used to assess the results of our patients. The mean follow-up period was 13.2 months. We achieved good to excellent results with our mean functional score of 80.66%. To the best of our knowledge, probably first started by us using customized modularendoprosthetic massive replacements for recurrent GCTs in our country. The use of custom made modular mega prosthesis is a simple and technically superior method of feeling the bone defects after wide resection in aggressive recurrent GCTs. In our opinion endoprosthesis replacement for recurrent GCTs had early good to excellent functional results 5.

Anterior Cruciate Ligament Reconstruction Using Autologous Hamstring Double Bundle Graft Compared With Single Bundle Graft Procedures

Anterior cruciate ligament injury is one of the commonest sports injuries, which often markedly reduces activity and the quality of life. The autologous hamstring double bundle graft and single bundle graft are commonly used for anterior cruciate ligament reconstruction. The choice of graft material for ACL reconstruction is believed to play a major role in the outcome but still there are controversies about the graft selection for primary ACL reconstruction. The aim of this study was to compare the clinical and functional outcome of autologous double bundle (DB) hamstring graft and single bundle (SB) hamstring graft reconstruction for the ACL injury. This prospective observational study was conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2015 to September 2017. Total 42 cases of ACL injury that required reconstruction surgery was selected as per inclusion criteria. Total patients were allocated into two groups. One group was treated by single bundle graft and other group was treated by double bundle graft for the ACL reconstruction. In this study, the mean age of double bundle and single bundle groups were 28±6.63 and 30.14±7.55 years respectively and majority of the subjects were male. The post-operative symptoms and signs were more improved in double bundle group than single bundle group during last follow-up period of 6th months. The Lachman test, Anterior drawer test and pivot sift test were more negative in double bundle group than that of single bundle groups. The Lysholm and Tegner activity were better in double bundle group than single bundle group. Again rotational and anterior stability of the knee was better in the double bundle group. However, the differences were not statistically significant and all patients in our study were able to return their activity. Double bundle group showed better rotational stability than the single bundle groups and all knees were improved by anterior cruciate ligament reconstruction compared with their pre-operative status.

Review of General Dental Council and General Medical Council "fitness to practise" hearings related to maxillofacial surgery

Dually-registered specialists in oral and maxillofacial surgery (OMFS) may be subject to disciplinary hearings by the General Medical Council (GMC) and the General Dental Council (GDC) for the same allegations, a phenomenon referred to as "double jeopardy" within the specialty. Previous efforts by both councils to simplify regulatory arrangements have made little progress. We have therefore reviewed the range and scope of fitness to practise (FTP) proceedings relevant to OMFS. We searched the online GMC register to find registered OMFS specialists and obtained FTP proceedings from 2004-2016 through a Freedom of Information request from the GDC. We then searched for cases relevant to OMFS, and cross-checked GMC and GDC registers for dual registration before reviewing relevant cases and identifying and discussing themes. Seven OMFS specialists are currently subject to GMC sanctions. A total of 22 GDC hearings related to OMFS, all of which began after 2011. Six involved the practice of OMFS, work within an OMFS department, or work by a dually-registered doctor. While "double jeopardy" is uncommon, it does happen. The cases reviewed raise issues about the remit of the GDC and their understanding of clinical practice in OMFS. We found no evidence of progress in attempts to simplify FTP proceedings. The number of GDC hearings relevant to OMFS is increasing.

Correlation between Troponin-I and B-Type Natriuretic Peptide Level in Acute Myocardial Infarction Patients with Heart Failure

Troponins are regarded as markers of choice for the diagnosis of acute myocardial infarction (AMI). But B-type natriuretic peptide (BNP) level is also elevated in AMI and is a quantitative biochemical marker related to the extent of infarction and the left ventricle systolic dysfunction. Thus, BNP has prognostic value. In this study, we investigate the correlation of Troponin-I with BNP levels in patients presenting with AMI with or without Acute Heart Failure. Rationale of this study is to see, whether quantitative Troponin alone can serve for both diagnosis and prognosis of AMI Patients with heart failure or not. This cross-sectional analytical study was conducted in the Department of Cardiology in Mymensingh Medical College Hospital from January 2014 to December 2014. Total 100 patients were studied and divided into two groups - 50 patients in each group. Group I: Patients with first attack of acute myocardial infarction (without heart failure) & Group II: Patients with first attack of acute myocardial infarction with acute heart failure. Mean Troponin-I of Group I and Group II were 3.10±2.68 and 62.93±32.75ng/ml respectively & mean BNP value of Group I and Group II were 20.96±14.18 and 615.65±249.27pg/ml respectively. In this study, it was shown that the levels of BNP had positive correlation with Troponin-I levels, with medium strength of association (r=0.734, p<0.05). Echocardiography shows that patients with high BNP level has low ejection fraction (LVEF) and patients with low BNP level has preserved ejection fraction (LVEF). Thus, the present study shows that the higher the Troponin-I levels, the higher the BNP levels in first attack of AMI patients and the more severe the heart failure (more severe left ventricle dysfunction). There is positive correlation between Troponin-I and BNP levels in first attack of AMI patients with acute heart failure.

Study of the risk factors and complications of diabetes mellitus after live kidney donation

OBJECTIVES

Kidney donors, similar to the general population, are at risk for developing type 2 diabetes mellitus (T2DM). The course of donors who develop T2DM has not been well studied. This work estimates the incidence of diabetes after kidney donation, and some risk factors and complications of diabetes mellitus postdonation.

MATERIALS AND METHODS

This study examined the records of 2267 donors who donated one of their kidneys between 1976 and 2014 at the Urology and Nephrology Center, Mansoura University, Egypt, and who were regularly followed up at its outpatient clinic. A total of 388 donors were included in the study, and their medical records were revised.

RESULTS

Postdonation weight gain and family history of diabetes mellitus were statistically significant for the development of diabetes mellitus, high or very high albuminuria, and/or decreased creatinine clearance. Metformin and insulin use seemed to significantly reduce the protein excretion and creatinine clearance decline in the studied group.

CONCLUSIONS

There is a significant impact of a family history of diabetes mellitus on the development of high or very high albuminuria and/or decreased creatinine clearance.

Enhancing performance of multiwavelength Brillouin-Raman fiber laser by capturing residual pump power

We demonstrate a simple design to enhance the performance of a multiwavelength Brillouin-Raman fiber laser by capturing the residual Raman pump power (RPP) from the laser cavity using a wavelength-selective coupler. The performance parameters of the laser system are investigated and compared with the conventional design under the same input design parameters. Both laser systems at a RPP of 375 mW can generate up to 33 Stokes lines with an equal channel spacing of 0.08 nm; however, the tunability of the laser without injection of residual RPP is 25% higher than the conventional laser structure. In addition, for a laser system without residual RPP injection, increasing the RPP improves the laser performance and generates up to 42 Stokes lines with a tunability of 24.5 nm, from 1570 to 1594.5 nm, at 475 mW. In contrast, the laser system with a residual RPP has the worst performance as the pump power is increased, and generates only nine Stokes lines with a tuning range of 5 nm at the same RPP of 475 mW.

Gender Differentials In Nutritional Status of Elderly People In Selected Rural Areas of Bangladesh

Background: The present cross sectional study was undertaken to assess the food habits and nutritional status among elderly people in rural Bangladesh and to compare the same between male and female. A simple random sampling and geographical re-conciliation method was used to select the study population. All the patients in a pre-publicized medical camp were approached and a total of 186 male and 237 female participated in the study. Data were collected through face to face interview with a semi-structured questionnaire and anthropometric measures were collected using instruments. Associations between dietary intake and World Health Organization (WHO) referred Body Mass Index (BMI) range was done using cross tabulation. Results: The mean age of male was 67.69 years and that of female was 65.46 years. The female subjects were higher than males in number in this study. The rate of male literacy was found to be 39.8% where literacy among the female was 13.9%. Among all, 79.6% males were found to be living with their spouse where the rate of living with spouse among the female amounted 53.2%. About half of elderly people were found to be living under poor and 32% in low middle class socio-economic condition. Study revealed that 80.6% male and 78.9% female got no opportunity to take protein-rich food more than three days per week. Again 95.7% male and 97.5% female had no opportunity take more than two servings of protein rich food per week. The similar case occurred in case of taking fatty food, vegetable and fruits per week. Similarly 100 % male and 99.6% female reported that they were taking more than two servings of fatty food per week. No significant association was found between BMI and food intake. The significance was tested by Pearson chi-square. In this test the p –value for protein rich food was 0.234 (p?0.05), while fatty food (0.712), vegetable (0.502) and fruits (0.274) which was more than referred significance p-value ?0.05. Hence, the study confirmed that malnutrition remains a common problem among older people living in rural Bangladesh though there is no significant association was found between food intake and nutrition. Conclusion: Management of malnutrition in case of elderly population requires a multidisciplinary approach that treats pathology and uses both social and dietary forms of intervention. Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13 Page 150-157 DOI: http://dx.doi.org/10.3329/bjms.v12i2.14943

CLINICAL AND LABORATORY DIAGNOSES OF NEWCASTLE AND INFECTIOUS BURSAL DISEASES OF CHICKENS

A comparative study was conducted to compare the disease diagnostic parameters (clinical signs & postmortem findings, organism isolation, serological test and molecular method) used to diagnose the Newcastle disease (ND) and infectious bursal disease (IBD) during the period from March 2009 to February 2010 in the laboratory of the Department of Microbiology and Hygiene, Bangladesh Agricultural University (BAU), Mymensingh. A total of 187 sick and dead chickens (63 broilers and 124 layers) of different ages (1 week to >15 weeks) were collected from 12 selective poultry farms (4 broilers and 8 layers) of Mymensingh and Gazipur districts. Clinically, 7 (14.89%) of 63 affected broiler and 27 (30.68%) of 124 affected layer chickens were diagnosed as Newcastle disease (ND) whereas, 11 (23.4%) of 63 affected broiler and 6 (4.82%) of the 124 affected layer birds were diagnosed as IBD on the basis of clinical history, clinical signs and postmortem findings. Virus isolation from field samples was performed by inoculating each suspected sample into 10-day-old chicken embryos. Out of 34 ND suspected field samples, 26 (5 broilers and 21 layers) were positive for NDV isolation and 11 (8 broilers and 3 layers) of 17 IBD suspected field samples, were positive for IBDV isolation. For confirmatory diagnosis, virus detection was confirmed by serological tests (HI and AGID) and RT-PCR assay. Out of 34 clinically diagnosed ND field samples, 20 (5 broiler & 15 layer) were positive by RT-PCR assay and 15 (10 broiler & 5 layer) of 17 IBD suspected field samples, were positive by both AGIDT and RT-PCR assay. Of the 26 HA positive NDV suspected AF, 19 (4 broilers and 15 layers) were positive by both HI & RT-PCR assay whereas, 10 (7 broilers and 3 layers) of 11 IBDV isolation positive tissue suspension were positive by both AGIDT & RT-PCR assay in the laboratory. Therefore, it may be concluded that serological (HI & AGIDT) and molecular (RT-PCR) techniques which allow rapid identification of most of samples are the reliable, sensitive, specific and more accurate methods to detect the viruses for the confirmatory diagnosis of diseases.DOI = http://dx.doi.org/10.3329/bjvm.v8i2.11196 Bangl. J. Vet. Med. (2010). 8 (2) : 131-140 

CLINICAL AND LABORATORY DIAGNOSES OF COMMON BACTERIAL DISEASES OF BROILER AND LAYER CHICKENS

The study was undertaken with a view to compare clinical and laboratory diagnoses of various bacterial diseases of poultry during the period from March 2009 to February 2010 in the laboratory of the Dept. of Microbiology and Hygiene, Bangladesh Agricultural University (BAU), Mymensingh. A total of 135 sick and dead chickens (47 broilers and 88 layers) were collected from 12 different poultry farms (4 broilers and 8 layers) of Mymensingh and Gazipur districts which were subjected for clinical followed by laboratory diagnosis. Clinical diagnosis was made on the basis of clinical history, clinical signs and postmortem findings of the affected birds whereas; confirmatory diagnosis was made by using cultural examination, Gram’s staining and different biochemical tests. In this study, out of 47 broilers, 16 (34%) chickens were clinically diagnosed as colibacillosis, 11 (23.40%) as salmonellosis and 2 (4.25%) as fowl cholera. In the same way, out of 88 layer chickens, 28 (31.82%) were diagnosed as colibacillosis, 16 (18.18%) as salmonellosis and 11 (12.50%) as fowl cholera. In laboratory, out of 47 suspected broiler chickens, 12 (25.53%) chickens were diagnosed as colibacillosis, 7 (14.89%) as salmonellosis and 0 (0%) as fowl cholera. Correspondingly of the 88 layer chickens 22 (25%) were diagnosed as colibacillosis, 11 (13.64%) as salmonellosis and 8 (9.09%) as fowl cholera. So the findings concluded that clinical diagnosis is not always accurate like laboratory diagnosis because in most cases clinical history, clinical signs and post-mortem lesions of different bacterial diseases including mixed infections are almost similar to other related diseases and it is recommended to confirm laboratory diagnosis before treatment of the diseases.DOI = http://dx.doi.org/10.3329/bjvm.v8i2.11188 Bangl. J. Vet. Med. (2010). 8 (2) : 107-115 

Epidemiological study of gastro-esophageal reflux disease in rural population

The present survey was conducted to find out the prevalence of Gastro-Esophageal Reflux Disease (GERD) among rural population in Bangladesh. The survey was carried out between the periods of June and October 2005 in a defined population at Jangalia village of Gazipur district. All respondents were interviewed face-to-face at their home by using a structured questionnaire. Total 3948 respondents were interviewed and 3924 were included in the final analysis. Response rate was 87.73%. Among the respondents male and female were 2089(53.2%) and 1835(46.8%) respectively. Male: female ratio was 1:0.87. The mean±SD age was 33.74±15.52 years. The prevalence of heartburn for at least monthly, weekly and daily episodes was 17.8%, 12.1% and 2.7% respectively. The corresponding figures for acid regurgitation were 19.2%, 10.9% and 1.6% respectively. The prevalence of GERD, as defined by the presence of heartburn and/or acid regurgitation at least once weekly was 19.4%. Prevalence of GERD by scoring system using the questionnaire was 22.1%. The multivariate analysis revealed that the increasing prevalence of GERD in older age group (p>0.05; OR, 1.04; 95% CI 0.31-3.67), men (p>0.05; OR, 1.44; 95% CI, 0.89-2.36), with smoking habit (p<0.001; OR, 2.49; 95% CI, 1.94-3.20). Prevalence of GERD was significantly more in housewives (p<0.05; OR, 2.56; 95% CI, 1.80-3.63). This can be concluded from the present study that GERD is highly prevalent in the community.

Effectiveness of levofloxacin in enteric fever

This intervention study was conducted to determine the efficacy of Levofloxacin in the treatment of uncomplicated enteric fever. Among 100 patients, who were purposively selected for the study had presented sign and symptoms of enteric fever with blood culture positive salmonella in laboratory findings during the admission in the department of Medicine, Uttara Adhunik Medical College & Hospital, Dhaka. Patients who fulfilled the diagnostic criteria were enrolled in the study and divided into two groups. One group was treated with oral levofloxacin 750mg once daily (OD) and another was injected with Levofloxacin 500mg once daily for 7 days. All the patients were examined twice daily to observe the clinical cure or failure of levofloxacin. Study was conducted from January 2008 to December 2008. Statistical analysis was performed by using statistical software SPSS version 12. Among the 100 patients in the study, majority of them 46(92%) were aged between 15 to 25 years, the next group was between 25 to 35 years 26(52%) and only three patients were aged above 65 years. Significant number of the patients were male (67), and the rest of them were female. The patients were clinically examined specially for anaemia, jaundice, caecal gurgling, hepatosplenomegaly in both the groups and the relevant investigations were performed. It was found that 46 patients in group A, who took oral levofloxacin, were cured after seven days, whereas 48 patients in group B were fully cured by taking injectable levofloxacin by seven days. In this study, levofloxacin was found to be the most effective drug in both oral and injectable form in one-week treatment of uncomplicated typhoid.

Failure to implement hospital antimicrobial prescribing guidelines: a comparison of two UK academic centres

BACKGROUND

Rational antimicrobial therapy should provide maximum benefit to patients while minimizing the development of resistant microorganisms.

OBJECTIVES

The aim of this study was to investigate (i) which antimicrobial drugs were chosen by hospital doctors faced with two common infections [community-acquired pneumonia (CAP) and urinary tract infection (UTI)], (ii) whether these choices were compliant with local guidance and (iii) the factors that influenced antimicrobial choice.

METHODS

A questionnaire based on two hypothetical clinical scenarios was distributed to 316 hospital doctors across four UK NHS hospitals in two cities (Newcastle and Edinburgh).

RESULTS

Doctors in Newcastle were significantly more aggressive in their management: more patients were admitted (CAP: 78.9% versus 48.4%, P < 0.05) and given antimicrobials intravenously (CAP: 53.4% versus 21.2%, P < 0.05). Adherence to the local hospital guideline for CAP was significantly higher in Newcastle (83.3% versus 38.0%; P < 0.05). Fewer than half of the doctors surveyed used the local hospital guideline when choosing an antimicrobial, and the British National Formulary was the most frequently used resource (>90%). Junior doctors also identified medical school teaching and opinions of senior doctors as important influences.

CONCLUSIONS

This study highlights inadequacies in the implementation and promotion of local guidelines, and demonstrates the potential for widely varying antimicrobial practices in two comparable UK cities.

An improved method for the palladium-catalyzed amination of aryl iodides

Aryl iodides are coupled with amines to give the corresponding arylamines in high yield in the presence of palladium, a suitable ligand, and NaOt-Bu. Functionalized aryl iodides give good yields of the corresponding arylamines when Cs(2)CO(3) is substituted as the base.

Evidence that the lizard helospectin peptides are O-glycosylated

Six forms of helospectin (a vasoactive intestinal peptide analogue) were purified from the venom of the Heloderma horridum lizard. Their identification was performed by combining sequencing by automated Edman degradation and electrospray mass spectrometry analysis on the complete peptides and their tryptic fragments. The products resulting from the action of an O-glycosidase were also analysed. Two forms were identified as the previously named Hs1 and Hs2 of 38 and 37 amino-acid residues, respectively. Two forms corresponded to Hs1 and Hs2 O-glycosylated by a N-acetylhexosamine-hexose motif attached to the Ser32 residue. Two other forms were not completely characterized but might correspond to the O-glycosylated forms bearing a phosphate or a sulfate group. The glycosylation did not affect the capacity of the helospectins to recognize and to activate the human and the rat VPAC1 and VPAC2 receptors.

A single centre's 20 years' experience of columnar-lined (Barrett's) oesophagus diagnosis

BACKGROUND

The pattern of oesophageal carcinoma type has been changing for some time in a number of countries, with adenocarcinoma becoming more frequent

OBJECTIVE

To investigate the prevalence of columnar-lined (Barrett's) oesophagus and oesophageal adenocarcinoma in Barrett's oesophagus during a 20-year period in a single centre.

METHODS

All upper gastrointestinal endoscopy and histology reports for the period January 1977 to December 1996 inclusive were reviewed. Data were analysed from patients who had histologically proven Barrett's oesophagus. The data were analysed as a single cohort and in five-year bands according to the date of diagnosis.

RESULTS

Of 44,721 endoscopies, 636 Barrett's oesophagus cases were diagnosed; 508 (323 males 185 females; M:F ratio 1.7) were histologically proven. The frequency of Barrett's oesophagus detection increased steadily from 0.2% to 1.6% of all endoscopies per five-year band. The M:F ratio and the mean ages at diagnosis (61 years, range 60-63 for males and 69 years, range 68-79 for females) remained constant throughout. Barrett's oesophagus was diagnosed at a younger age in males (peak 60-69 years) compared to females (peak 70-79 years). The male oesophageal adenocarcinoma incidence (11.1%) was almost twice that in females (6.5%). In the majority (81%), the initial diagnosis of oesophageal adenocarcinoma and Barrett's oesophagus was made concurrently.

CONCLUSIONS

The increasing Barrett's oesophagus frequency may reflect an increasing incidence or recognition of this condition or both. Barrett's oesophagus males are more likely to develop oesophageal adenocarcinoma than females.

Endothelial permeability and IL-6 production during hypoxia: role of ROS in signal transduction

Prolonged hypoxia produces reversible changes in endothelial permeability, but the mechanisms involved are not fully known. Previous studies have implicated reactive oxygen species (ROS) and cytokines in the regulation of permeability. We tested whether prolonged hypoxia alters permeability to increasing ROS generation, which amplifies cytokine production. Human umbilical vein endothelial cell (HUVEC) monolayers were exposed to hypoxia while secretion of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1alpha, IL-6, and IL-8 was measured. IL-6 and IL-8 secretion increased fourfold over 24 h in a pattern corresponding to changes in HUVEC permeability measured by transendothelial electrical resistance (TEER). Addition of exogenous IL-6 to normoxic HUVEC monolayers caused time-dependent changes in TEER that mimicked the hypoxic response. An antibody to IL-6 significantly attenuated the hypoxia-induced changes in TEER (86 +/- 4 vs. 63 +/- 3% with hypoxia alone at 18 h), whereas treatment with anti-IL-8 had no effect. To determine the role of hypoxia-induced ROS on this response, HUVEC monolayers were incubated with the antioxidants ebselen (50 microM) and N-acetyl-L-cysteine (NAC, 1 mM) before hypoxia. Antioxidants attenuated hypoxia-induced IL-6 secretion (13 +/- 2 pg/ml with ebselen and 19 +/- 3 pg/ml with NAC vs. 140 +/- 15 pg/ml with hypoxia). Ebselen and NAC prevented changes in TEER during hypoxia (94 +/- 2% with ebselen and 90 +/- 6% with NAC vs. 63 +/- 3% with hypoxia at 18 h). N-nitro-L-arginine (500 microM) did not decrease hypoxia-induced changes in dichlorofluorescin fluorescence, IL-6 secretion, or TEER. Thus ROS generated during hypoxia act as signaling elements, regulating secretion of the proinflammatory cytokines that lead to alterations of endothelial permeability.

Prolonged hypoxia alters endothelial barrier function

BACKGROUND

It is well recognized that hypoxia/reoxygenation and exposure to inflammatory mediators such as cytokines and neutrophils alter the barrier function of the vascular endothelium. The experiments we conducted tested whether hypoxia alone could produce changes in permeability and whether a prolonged period of hypoxia alters the surface expression of cell adhesion molecules.

METHODS

Endothelial cells were cultured from human umbilical vein endothelial cells (HUVECs). Hypoxia was created by isolating the cells in a chamber through which 1% 02, 5% CO2, and 94% N2 were insufflated (30 min at 1/min). Oxygen tension was measured through oxygen-quenching phosphorescence. Hypoxia was maintained for 24 hours. Changes in endothelial permeability were measured by transendothelial electrical resistance (TEER). Endothelial leukocyte adhesion molecule 1 (ELAM-1) and intercellular adhesion molecule 1 (ICAM-1) expression were assessed by flow cytometry (mean +/ standard error of the mean [SEM].

RESULTS

Exposure of endothelial cells to hypoxia resulted in increased permeability between 6 and 24 hours, with the greatest decrease in TEER at 18 hours (63% +/ 3%; P < .05). Prolonged hypoxia produced no change in the surface expression of ELAM-1 or ICAM-1.

CONCLUSIONS

Hypoxia alone produced a significant reversible alteration in endothelial permeability. However, this change was observed only under severe hypoxic conditions (eg, below 20 mm Hg); higher oxygen tensions (25 and 35 mm Hg) had no significant effect. Unlike observations made after cytokine exposure, hypoxic breakdown of endothelial barrier function was unassociated with up-regulation of either ELAM-1 or ICAM-1.

Cytokines and the malnutrition of chronic renal failure

Malnutrition in uremic patients remains one of the major causes of morbidity and mortality. Its mediators remain largely unknown. Uremia is characterized by changes in circulating levels of catabolic cytokines and anabolic growth factors. The aim of this study was to investigate whether these changes are associated with the malnutrition of patients with chronic renal failure (CRF). We have studied the prevalence of malnutrition in a small group of patients (n = 20) with CRF (serum creatinine = 551 +/- 105 mumol/l, mean +/- SD) and 25 age-matched controls. Nutritional status was assessed by dietary diaries, subjective global assessment (SGA), and by measurement of anthropometric parameters. Regression analysis was applied to examine the relationship between biochemical and anthropometric parameters. Simultaneously, we have investigated changes in the circulating levels of catabolic cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1 beta and IL-6] and an anabolic growth factor [insulin-like growth factor-I (IGF-I)]. We observed a high prevalence of malnutrition as judged initially by SGA: 50% moderately malnourished and 15% severely malnourished. This was confirmed by anthropometric measurements. We noted a significant reduction in both triceps skinfold thickness (TST; 35% of patients < 25th centile) and midarm muscle circumference (MAMC, 65% of patients < 25th centile). We also noted a reduction in serum IGF-I in malnourished patients (IGF-I in well-nourished patients = 207 +/- 48 micrograms/l, in malnourished patients = 133 +/- 33 micrograms/l, p < 0.01). IGF-I correlated with TST (r = 0.71, p < 0.001) and MAMC (r = 0.47, p < 0.05). IGF-I had a high predictive value for TST (R2 = 51%, p < 0.001). In contrast, TNF-alpha levels were higher in malnourished patients: 19.5 +/- 30 pg/ml compared to 3.9 +/- 8 pg/ml in healthy patients (p < 0.001) and TNF-alpha showed a negative correlation with MAMC (r = -0.69, p < 0.01; R2 = 47%, p < 0.01). IL-1 beta levels were higher in CRF than in controls but did not correlate with nutritional parameters. No significant changes could be detected in serum IL-6. A significant percentage of predialysis patients with CRF suffer from some degree of malnutrition. This may be attributed in part to a fall in circulating anabolic growth factors and an increase in catabolic cytokines.

Invasive carcinoma in juvenile polyposis--report of a case in an African patient

Since the 1980s it has been recognized that the polyps of juvenile polyposis have malignant potential. Since the introduction of colonoscopy this syndrome has been redefined and the hamartoma-adenoma-carcinoma sequence recognized. We believe this case is the first report of an invasive carcinoma associated with juvenile polyposis to be described in an African patient.

Community-acquired bacteremia in human immunodeficiency virus-infected children in Harare, Zimbabwe

BACKGROUND

HIV infection is common in mothers and their children in Zimbabwe, and HIV-infected children are particularly susceptible to bacterial infections. There is little information on the etiology and outcome of HIV-related bacteremia in African children.

METHODS

Blood cultures from 309 hospitalized children in Zimbabwe, of whom 168 were diagnosed as having HIV, were examined for pathogens. The association among significant bacteremia, HIV infection and mortality was assessed in these children.

RESULTS

The most common isolates were coagulase-negative staphylococci (31 children, 25 clinically significant), Staphylococcus aureus (22 children) and Streptococcus pneumoniae (20 children). Nontyphoidal Salmonella (10 children), Escherichia coli (4 children) and Klebsiella sp. (4 children) were the most frequent Gram-negative bacteria. Two children had Rhodococcus equi pneumonia. HIV-infected children showed increased risk of bacteremia (odds ratio (OR) = 2.68), especially if younger than 18 months of age (OR = 2.94), and high risk of enterobacteremia (OR = 15.76). There was no significant association of bacteremia with nutritional status. Mortality was 17% overall but was higher in HIV-infected children up to 6 months of age (OR = 2.81) and in bacteremic children of any age (OR = 2.03).

CONCLUSIONS

Prompt recognition of pathogens and early administration of appropriate antimicrobials is important in reducing the morbidity and mortality associated with bacteremia in HIV-infected children in Africa.

Are junior doctors taught to use problem lists?

One hundred junior doctors were asked to complete a questionnaire about the training they had received in the use of problem lists. A questionnaire was sent about the training in the use of problems lists at their medical school to the Deans in all 27 British medical schools. Of the 100 junior doctors, 57 reported that problem lists 'had hardly been mentioned' at their medical school. In contrast only one of the 24 Deans who responded thought that problems lists were 'likely to be hardly mentioned' at his medical school. After graduation only 35 junior doctors had worked for a consultant who had demanded the use of problem lists and only 17 of these had worked for more than one such consultant. Most junior doctors have received little training in the use of problem lists as undergraduates and even fewer as postgraduates. Few consultants demand the use of problem lists.

Community based distribution of ivermectin in eastern Sudan: acceptability and early post-treatment reactions

A study to monitor ivermectin acceptability and post-treatment reactions during mass community distribution was carried out in eastern Sudan, where severe reactive onchodermatitis is prevalent. Of 1081 individuals eligible for treatment, 1076 (99.5%) accepted the ivermectin. Post-treatment reactions were monitored by self reporting, 5 d after a single dose of about 150 micrograms/kg (range 103-200 micrograms/kg); 230 persons reported adverse events (21.4%). No reaction was rated as severe. The most common problem was itching with cutaneous papular eruptions (16.2%). Local oedematous swelling was the second most common and the most slowly resolving complaint (5.4%), followed by musculoskeletal pain. There was a high acceptance rate of the treatment and remarkable tolerance of the post-treatment effects, probably due to efforts made to prepare the community to expect reactions to ivermectin, widespread awareness of the beneficial effects of treatment by villagers who had participated in clinical trials previously, and the encouragement we gave to the population to become involved in improvement of their health care services. Single doses of ivermectin resulted in good clinical responses and created much goodwill among villagers. Improvements in physical fitness, ability to work, and freedom from musculoskeletal pain were reported at the 3 months' follow-up. We recommend that, during mass distribution of ivermectin, community involvement in planning overall health improvement should be included, since the treatment initiates the process well. In areas where sowda syndrome is prevalent, medical surveillance for 3 d or more should be considered.

Ivermectin treatment in severe asymmetric reactive onchodermatitis (sowda) in Sudan

Ivermectin efficacy and post-treatment reactions in asymmetric severe reactive ochodermatitis (sowda) were studied in 8 patients with sowda syndrome and 6 with mild generalized onchodermatitis in Sudan. Initial skin snips from 12 patients contained microfilariae (1-9 per mg skin). Patients were treated in hospital with a single oral dose of c. 150 micrograms/kg ivermectin (103-200 micrograms/kg) and monitored for frequency and severity of post-treatment reactions for 4 weeks. Serial samples of heparinized blood were collected over the first 24 h after treatment for determination of ivermectin pharmacokinetics. Skin snips from all patients on days 3 and 28 revealed no microfilariae. Post-treatment reactions were more common and severe in individuals with sowda; they consisted mainly of musculoskeletal pain, local swellings with pitting oedema, and lymph gland tenderness and enlargement. No relation was established between these reactions, the microfilarial infection intensity, or the plasma pharmacokinetic profiles. A single oral dose of ivermectin cleared the skin of microfilariae and led to improvement of symptoms and dermatological signs of sowda, but resulted in more marked reactions than in cases of generalized onchodermatitis.

The polymerase chain reaction can reveal the occurrence of naturally mixed infections with Leishmania parasites

On isolation and characterization of Leishmania parasites from Sudanese patients with visceral leishmaniasis (VL), four cases of mixed infections were found. Three of those cases were from the Eastern Sudan focus of VL. In one case the patient was found to be concomitantly infected with Leishmania donovani and Leishmania aethiopica, while the remaining three patients possessed mixed infections of Leishmania donovani and Leishmania major. Mixed infections were identified by PCR amplification of Leishmania kinetoplast DNA (kDNA) from parasites in culture or in original patient aspirate material and, additionally in the former cases by isoenzyme electrophoresis. In those cases where parasite culture was successful, PCR also demonstrated the rapidity with which one Leishmania species was eliminated from culture during continuous passage.

Characterization of a variant tandem repeat from Sudanese Onchocerca volvulus

Strategies for detection and control of onchocerciasis in Africa have included identification of DNA probes and PCR target sequences for sensitive and specific detection of parasites. To evaluate the applicability of published PCR and DNA probe based methods for the study of onchocerciasis in Sudan, we collected adult O. volvulus from geographically distinct regions of Sudan (700 miles apart), Abu Hamed (northern desert) and Raja (southwestern savannah), and we examined the similarities between Sudanese O. volvulus repeats and published versions of the repeat from West African O. volvulus. Amplification of DNA extracted from the Raja O. volvulus strain predictably generated a ladder of products, multiples of the base 150 bp repeat, as has been reported from West Africa. However, amplification of DNA from the Abu Hamed O. volvulus isolate resulted in a series of doublets. The unexpected DNA fragments thus amplified differed in size from the base 150 bp unit by approximately 50 base pairs and was most clearly visualized at 150-200 base pairs. DNA sequence analysis of the amplified repeats in the isolate of O. volvulus from Abu Hamed revealed a variant of the 150 bp tandem repeat which contained an extra 49 bp. The additional 49 bp contained two short repeats of 21 bp and 10 bp, corresponding to bases 99-119 and 128-137 respectively, of the known 150 bp O. volvulus repeat. This work demonstrates a variant of the O. volvulus 150 bp tandem repeat, which easily distinguishes Raja and Abu Hamed isolates of O. volvulus, and which has potential value for differentiating Abu Hamed strains of O. volvulus from other strains in East Africa.