Bioaccumulation of lead in different organs of Ctenopharyngodon Idella (grass fish) and Tor putitora (Mahseer) fish

Abstract Bioaccumulation of toxic heavy metals in the human body can give rise to adverse health effects, the severity of which depends upon their dosage and duration of exposure. In this study, yearlings of two different species of edible fish, i.e., Tor putitora (Mahseer) and Ctenopharyngodon Idella (grass carp), were exposed to different concentrations of lead nitrate in a controlled environment of aquarium for three different lengths of duration (14, 28, and 60 days). The bioaccumulation of lead in different organs, including gills, skin, muscles, liver, intestine, and swim bladder of the fish, was assessed using atomic absorption spectrometry. Generally, the highest lead concentration was observed in the gills and lowest in the muscles for both species at each experimental dosage and duration. In 14-days exposure, the relative pattern of bioaccumulation in different organs was observed as gill > liver > skin > intestine > swim bladder > muscle for both fish species. Similarly, the pattern of bioaccumulation observed in 28-days exposure was as: gill > liver > intestine > skin > swim bladder > muscle in both species. Whereas, pattern in 60-days exposure was observed as gill > liver > intestine > swim bladder > muscle > skin. The data shows that grass carp had stored higher concentrations of lead than Mahseer, which may be attributed to the fact that they are omnivorous. Furthermore, the lowest bioaccumulation was recorded in the muscles until the 56th day of the exposure, after which the concentration steadily increased in the muscles. The observed pattern highlights the importance of exposure’s duration to lead; chronic exposure could result in its bioaccumulation at toxic concentrations in the muscles, which is particularly of concern because the fish muscles are heavily consumed as food worldwide.

Impact of short-duration voltage variations on VSC-HVDC performance

The growing load demand globally necessitates increasing the penetration of renewable energy sources into electrical grids as well as interconnecting grids from different countries and even continents through HVDC transmission systems. Since these applications rely on power electronics devices, several power quality issues arise, namely voltage sags and swells. This paper analyzes the response of a VSC-HVDC transmission system that interconnects two asynchronous AC grids to short-duration voltage variations like sag and swell by adjusting the voltage of the controllable AC source. The system is simulated with the help of MATLAB/Simulink. The study records the effect of the manipulated AC voltage on the active/reactive powers and AC/DC voltages at both converter stations to evaluate the system stability due to these prevalent power quality challenges. The obtained results reveal that the system hardly withstands voltage variation for a short period.

Impact of unemployment on cardiovascular mortality in united states: a nationwide county-level analysis 2010–2019

Background

Unemployment has been linked with a myriad of adverse health outcomes; however, its population-level impact on cardiovascular mortality (CVM), particularly amongst various demographic subgroups, remains understudied.

Purpose

To determine the impact of county unemployment levels on CVM rates, in overall and between different demographic subgroups.

Methods

We utilized the CDC WONDER database tool to retrieve county-level CVM rates for U.S. counties between 2010 and 2019. The County Health Rankings project was used to retrieve data on unemployment levels in each county as well as other characteristics used in an adjusted multivariate model. Generalized linear mixed models using Poisson regression were used to estimate the impact of unemployment on county-level CVM using relative (incidence rate ratios; IRR) and absolute (additional yearly deaths; AYD) measures.

Results

From 2010 to 2019, a total of 2904 U.S. counties (64.2% white; 50.81% female) with data available on CVM and unemployment levels were analyzed. In a multivariate model adjusted for demographic composition, CV risk, socioeconomic, environmental, and healthcare-access factors, unemployment was significantly associated with higher levels of CVM (IRR: 1.026; 95% CI: 1.018 to 1.033; 6.00 AYD). The relative impact of unemployment was strongest in elderly Blacks (IRR: 1.051; 95% CI: 1.029 to 1.074), middle-aged whites (IRR: 1.050; 95% CI: 1.032 to 1.067), and middle-aged females (IRR: 1.046; 95% CI: 1.018 to 1.075). The absolute impact of unemployment was highest in elderly Blacks (AYD: 94.70), elderly Whites (AYD: 35.30), and elderly females (AYD: 32.70). On a relative basis, the impact was more pronounced in the middle-aged (IRR: 1.030; 95% CI: 1.015 to 1.044) compared to the elderly (IRR: 1.022; 95% CI: 1.014 to 1.030), females (IRR: 1.026; 95% CI: 1.017 to 1.036) compared to males (IRR: 1.022; 95% CI: 1.014 to 1.031), and Blacks (IRR: 1.036; 95% CI: 1.016 to 1.057) compared to Whites (IRR: 1.030; 95% CI: 1.022 to 1.038).

Conclusion(s)

Unemployment is significantly associated with county-level CVM, and this impact is most pronounced in vulnerable demographic subgroups, namely females and Blacks. Efforts to reduce unemployment levels may significantly lower the burden of cardiovascular disease, particularly in groups most strongly affected by health disparities.

Funding Acknowledgement

Type of funding sources: None.

Impact of sexually transmitted infections on cardiovascular mortality in united states: a nationwide county-level analysis 2011–2019

Background

Sexually Transmitted Infections (STIs) are associated with a significantly increased risk of morbidity and mortality; however, its population-level effect on cardiovascular mortality (CVM), particularly amongst various demographic subgroups, remains unknown.

Purpose

To assess the impact of county STIs levels on CVM rates, in overall and between different patient groups stratified by age, sex and race.

Methods

The CDC WONDER database tool was utilized to retrieve age adjusted county-level CVM rates (ACVM) for U.S. counties between 2011 and 2019. Data on STIs were provided by the County Health Rankings project database. STIs is the number of newly diagnosed chlamydia (the most common STI in north America) cases per 100,000 population in a county. Rates measure the number of events in a given time period (generally one year) divided by the average number of people at risk during that period. The Behavioral risk Factors Surveillance System and County Health Rankings project were used to retrieve county data on demographics, CV risk, socioeconomic, environmental, and health care access factors. Generalized linear mixed models using Poisson regression were used to estimate the impact of unemployment on county-level CVM using relative (incidence rate ratios; IRR) and absolute (additional yearly deaths; AYD) measures.

Results

Of 3143 U.S. counties, a total of 2890 counties (62.09% white; 50.76% female; 14.12% aged ≥65) with data available on ACVM and STIs levels were analyzed. In a multivariate model adjusted for demographic composition, CV risk, socioeconomic, environmental, and healthcare-access factors, STIs were significantly associated with higher levels of ACVM (IRR: 1.015; 95% CI: 1.007 to 1.022; 3.40 AYD). Additionally, this association was relatively higher in the middle-aged [45–64] (IRR: 1.016; 95% CI: 1.002 to 1.030) compared to the elderly [≥65] (IRR: 1.010; 95% CI: 1.002 to 1.018), males (IRR: 1.013; 95% CI: 1.004 to 1.021) compared to females (IRR: 1.011; 95% CI: 1.002 to 1.020), and non-Hispanic Blacks (IRR: 1.026; 95% CI: 1.011 to 1.040) compared to non-Hispanic Whites (IRR: 1.010; 95% CI: 1.002 to 1.018). Notably, the relative impact of STIs was highest in middle-aged non-Hispanic Blacks (IRR: 1.038; 95% CI: 1.013 to 1.063; AYD: 10.50), and middle-aged males (IRR: 1.021; 95% CI: 1.006 to 1.037; AYD: 4.30), (Figure).

Conclusions

STIs is robustly associated with county-level ACVM, independent from several important confounders. This impact is most prominent in vulnerable demographic subgroups, namely middle-aged, males, and Blacks. Efforts to reduce STIs levels may significantly lower the burden of cardiovascular mortality attributable to STIs, particularly in groups most frequently affected by health disparities.

Funding Acknowledgement

Type of funding sources: None.

Impact of sleep insufficiency on cardiovascular mortality in United States: a nationwide county-level analysis 2016–2019

Background

Sleep plays an integrated role in health maintenance including cardiovascular (CV) health. Sleep Insufficiency (SI) is a common modifiable risk condition that is strongly linked to major adverse CV events and mortality. However, data on the overall impact and related disparities of SI on CV mortality (CVM), at nationwide level and within different patient groups, are scarce and uncertain.

Purpose

Herein, we aim to study the independent relationship between county level SI and CVM in overall population and within various age, sex, and race/ethnic subgroups.

Methods

Using the Behavioral risk Factors Surveillance System (BRFSS), SI county levels were assessed as the percentage of adults who report fewer than the recommended level of optimal sleep duration (<7 hours). Age-adjusted CVM rates (ACVM) between 2016 to 2019, were obtained using wide-ranging online data for epidemiologic research tool of Centers for Disease and Prevention (CDC). BRFSS, CDC diabetes interactive atlas, census population estimates, environmental public network, and county health rankings databases, were utilized to acquire county data of demographics, CV risk, socio-environmental, and health care access factors. Poisson multivariate generalized linear mixed models were employed to assess incidence rate ratios (IRR). To evaluate the absolute impact of SI on ACVM, additional yearly deaths per 100,000 individuals (AYD) were calculated.

Results

Among 3143 US counties, 2853 counties who had data on SI and ACVM, were analyzed. Of 321,625,744 residents (50.8% women, 12.4% non-Hispanic blacks, 15% aged ≥65) lived at 2853 US counties in 2016, total 3,408,047 (1.1%) CV deaths occurred between 2016–2019. In fully adjusted analysis*, SI significantly associated with overall ACVM (IRR: 1.021; 95% CI: 1.013 to 1.029), that translated to 4.6 AYD. In additional subgroup analysis, SI significantly associated with higher ACVM among middle aged adults [45 to 64] (IRR: 1.024; 95% CI: 1.010 to 1.038), elderly [≥65] (IRR: 1.022; 95% CI: 1.014 to 1.030), males (IRR: 1.019; 95% CI: 1.010 to 1.028), females (IRR: 1.023; 95% CI: 1.013 to 1.033), and in non-Hispanic whites (IRR: 1.024; 95% CI: 1.016 to 1.033). Notably, this association remained significant in the (≥65) aged subgroup of males, and females, as well as in both age subgroups of the non-Hispanic whites, (Figure).

Conclusion

County level SI is robustly related to high ACVM, and that relationship is most apparent amongst both age and sex subgroups as well as non-Hispanic whites. Moreover, this association is significantly independent of potential confounders that have a plausible association with CVM, such as demographics, socioeconomic, environmental, health care access, and cardiovascular risk factors. Therefore, tailored population-level strategies to promote healthy sleep pattern and reduce the prevalence of SI, are imperative for preventing CVM, especially in the most impacted communities and patient subgroups.

Funding Acknowledgement

Type of funding sources: None.

Burden and disparities in cardiovascular mortality rates associated with obesity prevalence in United States: county-level analysis from 2010 to 2019

Background

Obesity is a grave public health threat linked to high morbidity and mortality rates. A significant rise in obesity rates amongst U.S. adults and worldwide has been observed in recent decades. Although associations between obesity and cardiovascular mortality (CVM) are well-known, impact and disparities in CVM attributable to obesity at a nationwide community level, aren't well defined.

Purpose

At county level, we sought to evaluate the independent impact of adult obesity on CVM in overall population and within different age, sex, and race/ethnic subgroups.

Methods

Age-adjusted CVM rates (ACVM) between 2010 to 2019, were obtained using Wide-ranging Online Data for Epidemiologic Research tool of Center for Disease Control (CDC). Using the Behavioral risk Factors Surveillance System (BRFSS), obesity rates per county was assessed as the percentage of adult population (age ≥20) that reports a body mass index ≥30 kg/m2. BRFSS, CDC Diabetes Interactive Atlas, census population estimates, environmental public health network and health county ranking project databases, were utilized to acquire county data of demographics, CV risk, socio-environmental, and health care access factors. Poisson multivariate generalized linear mixed models were employed to assess incidence rate ratios (IRR) of ACVM associated with obesity rates. To evaluate the absolute impact of obesity on ACVM, additional yearly deaths (AYD) per 100,000 individuals were calculated. All study analysis were weighted for the relevant county baseline population.

Results

Among 307,045,647 residents (50% women, 12% non-Hispanic blacks, 24% aged 45–64) lived at 2904 US counties in 2010, total 8,157,571 (2.7%) CV deaths occurred between 2010–2019. In fully adjusted model*, high obesity rates significantly associated with high ACVM (IRR: 1.015; 95% CI: 1.008 to 1.022), that translated to 3.5 AYD per 100,000 individuals. In a subgroup analysis, obesity rates associated with a relatively higher ACVM among overall middle aged adults [45 to 64] (IRR: 1.028; 95% CI: 1.018 to 1.037) versus elderly [≥65] (IRR: 1.013; 95% CI: 1.006 to 1.020), and in males (IRR: 1.018; 95% CI: 1.010 to 1.026) versus females (IRR: 1.014; 95% CI: 1.006 to 1.022), and in Hispanics (IRR: 1.035; 95% CI: 1.005 to 1.065) versus non-Hispanic Whites (IRR: 1.020; 95% CI: 1.012 to 1.027). Interestingly, middle aged adults had higher ACVM IRRs as compared to elderly, among males (IRR: 1.022), females (IRR: 1.039), and non-Hispanic Whites (IRR: 1.044) (Figure).

Conclusions

Obesity prevalence is independently associated with high ACVM among different age, sex, and race/ethnic groups, and this impact is most pronounced in Hispanics and the middle-aged group of females and non-Hispanic Whites. More research is needed to further uncover the mechanisms leading to these observations a long with community-level interventions to reduce the burden of this ongoing epidemic, in overall and most impacted population groups.

Funding Acknowledgement

Type of funding sources: None.

Omecamtiv mecarbil in heart failure with reduced ejection fraction: systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Background

Heart failure (HF) is a growing public health challenge worldwide, with high rates of mortality and morbidity. Omecamtiv Mecarbil (OM) is a cardiac myosin activator and the first of a novel class of myotropes, agents that directly improve myocardial function by selectively improving cardiac sarcomere function. Data on its effect on cardiovascular outcomes remains scarce.

Objectives

To evaluate the safety and efficacy of Omecamtiv Mecarbil in Heart Failure with Reduced Ejection Fraction (HFrEF) and its effect on mid-term clinical outcomes.

Methods

We systematically searched MEDLINE/Pubmed, CENTRAL, clinicaltrials.gov, and the International Clinical Trials Registry Platform for randomized clinical trials (RCTs) evaluating OM safety and efficacy in HFrEF. Outcomes of interest included all-cause mortality, cerebrovascular events, hospitalization, myocardial infarction (MI), anginal events, atrial fibrillation (AF) or flutter, and hypotension. Data screening and extraction was performed by two independent reviewers. We used a random-effects model using the Dersimonian-Laird and Mantel-Haenszel methods to calculate the risk ratio (RR) with 95% confidence intervals.

Results

A total of 232 records were identified, of which six RCTs (N = 9,547; Omecamtiv: 4,889; Placebo: 4,658) met inclusion criteria. The average age was 64.4 years (standard deviation (SD): 0.82), and 79.0% (N = 7,538) were males. The weighted follow-up duration was 19.4 months. OM was associated with a significant reduction in the incidence of cerebrovascular events (RR: 0.68; 95% CI: 0.51 to 0.91). Moreover, OM was associated with a significant increase in the risk of hypotension (RR: 1.45; 95% CI: 1.03 to 2.02), compared to placebo when utilized as an adjuvant therapy to HF guideline-directed medical therapy (GDMT). No statistically significant difference was noted with all-cause mortality (RR: 1.00; 95% CI: 0.93 to 1.07), hospitalization (RR: 0.96; 95% CI: 0.90 to 1.03), incidence of atrial fibrillation or flutter (RR: 0.79; 95% CI: 0.61 to 1.02), anginal events (RR: 1.32; 95% CI: 0.92 to 1.88) or myocardial infarction (RR: 1.07; 95% CI: 0.84 to 1.36). Heterogeneity was low (I2 = 0%) in all analyses.

Asymptomatic severe aortic stenosis, conservative treatment or early valve replacement? a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Background

Asymptomatic aortic stenosis’ management is not only a daily practice challenge but also an area of clinical research controversy. As evidence on conservative versus early aortic valve replacement (AVR) is debatable, we conducted a systematic review and meta-analysis to compare the efficacy of conservative management versus AVR in asymptomatic aortic stenosis (AS).

Methods

Electronic databases were systematically searched to identify any observational or interventional studies that compared the effects of conservative management versus AVR on all causes, cardiovascular, non-cardiovascular mortality. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated using random-effects models.

Results

A total of 6216 patients were included from 12 studies (observational=9, and randomized clinical trial=3) with a mean follow-up duration of 50 months. When compared to early AVR, conservative management has statistically significant higher risk of all causes mortality (RR: 0.36, 95%CI [0.31 to 0.42], p<0.00001, figure 1), cardiovascular mortality (RR: 0.32, 95%CI [0.24 to 0.41], p<0.00001, figure 2), and non-cardiovascular mortality (RR: 0.42, 95%CI [0.24 to 0.56], p=0.0005). Regarding other complications, conservative treatment showed significant higher risk of sudden cardiac death (RR: 0.46, 95%CI [0.15 to 0.90], p=0.005), yet with no difference over AVR in stroke and myocardial infarction (RR: 0.79, 95% CI [0.17 to 3.64], p=0.61) and (RR: 0.67, 95% CI [0.39 to 1.16], p=0.15), respectively. A subgroup sensitivity analysis based on surgical AVR vs. transcatheter AVR and severe vs. very severe AS reflected the findings of the overall results.

Conclusions

Patients with asymptomatic aortic valve stenosis, managed with early AVR, have a lower risk of all-cause, cardiovascular, and non-cardiovascular mortality when compared to conservative management.

Impact of physical inactivity on cardiovascular mortality in united states: county-level analysis from 2011 to 2019

Funding Acknowledgements

Type of funding sources: None.

Background

Physical inactivity and sedentary behavior are among the leading modifiable risk factors worldwide for cardiovascular (CV) disease and mortality. However, data about disparities of CV mortality related to physical inactivity, has been limited and/or inconsistent.

Purpose

We sought to evaluate county-level associations between physical inactivity and cardiovascular mortality (CVM) in overall population and among different age, gender, and racial/ethnic subgroups.

Methods

Age-adjusted CV mortality rates (ACVM) between 2011 to 2019, were obtained using Wide-ranging Online Data for Epidemiologic Research tool of Center for Disease Control (CDC). Behavioral Risk Factors Surveillance System, CDC Diabetes Interactive Atlas, Census population estimates, environmental public health network and drinking water information system, were utilized to acquire county physical inactivity levels (percentage of adults reporting no physical activity in past month), demographics, rates of obesity, diabetes, smoking and environmental factors. Poisson generalized linear mixed models were employed to assess incidence rate ratios (IRR) of ACVM associated with physical inactivity while adjusting for other potential confounders. The burden of additional yearly deaths (AYD) per 100,000 individuals was calculated by multiplying the baseline CV death rates by the percentage increase attributable to physical inactivity in each subgroup.

Results

Among 303,857,140 residents (49.5% men, 11.9% non-Hispanic blacks, 23.8% [45-64 age group]) lived at 2900 US counties in 2011, total 7,226,447 (2.4%) CV deaths occurred between 2011-2019. In fully adjusted model*, physical inactivity significantly associated with high ACVM (IRR: 1.02; 95% CI: 1.01 to 1.02), that translated to 4.4 AYD per 100,000 individuals. Notably, physical inactivity associated with a relatively higher ACVM among middle aged adults [45 to 64] (IRR: 1.04; 95% CI: 1.03 to 1.04) versus elderly [≥65] (IRR: 1.02; 95% CI: 1.01 to 1.02), and in males (IRR: 1.03; 95% CI: 1.02 to 1.03) versus females (IRR: 1.01; 95% CI: 1.01 to 1.02). Interestingly, middle aged adults were relatively most impacted by physical inactivity as compared to elderly, among each of gender and racial/ethnic subgroups, (Figure). Additionally, physical inactivity seemed to have similar impact on both non-Hispanic whites (IRR: 1.02), and non-Hispanic blacks (IRR: 1.02), with a slightly larger impact among Hispanics (IRR: 1.03), (Figure).

Conclusion

Physical inactivity is robustly associated with age-adjusted CVM independent of other well-established determinants of CV death, including CV risk factors, socioeconomic, environmental and health care access factors. Physical inactivity appears to confer greater negative impact among middle-aged adults, males, and Hispanic individuals. Therefore, public health policies directed towards greater efforts at preventing sedentary behavior and promoting adequate physical activity, are desperately needed.

Impact of food insecurity on cardiovascular mortality in united states: county-level analysis from 2014 to 2019

Funding Acknowledgements

Type of funding sources: None.

Background

Food insecurity is a global public health challenge, that is defined as a social condition of limited or uncertain access to adequate food. Food insecurity is significantly linked to a myriad of negative health outcomes including high risk of cardiovascular (CV) morbidities and mortality. However, data on disparities of CV mortality attributable to food insecurity, is limited.

Purpose

We sought to investigate the independent association between food insecurity and cardiovascular mortality among age, gender, and race/ethnicity subgroups.

Methods

Age-adjusted CV mortality rates (ACVM) between 2014 to 2019, were obtained using Wide-ranging Online Data for Epidemiologic Research tool of Center for Disease Control (CDC). Food insecurity levels were obtained using the Core Food Insecurity Model. Census population estimates, CDC Diabetes Interactive Atlas, and the Behavioral Risk Factors Surveillance System, were utilized to acquire county-level demographics, rates of obesity, diabetes, and smoking data. Poisson generalized linear mixed models were employed to assess incidence rate ratios (IRR) of CV mortality associated with food insecurity while adjusting for other potential confounders. The burden of additional yearly deaths (AYD) per 100,000 individuals was calculated by multiplying the baseline CV death rates by the percentage increase attributable to food insecurity in each subgroup.

Results

Of 317,203,618 residents (49.6% men, 12.1% black) lived at 2878 US counties in 2014, total 4,933,002 (1.6%) CV deaths occurred between 2014-2019. In fully adjusted model*, food insecurity significantly associated with high levels of ACVM (IRR: 1.03; 95% CI: 1.02 to 1.04), that translated to 6.9 AYD per 100,000 individuals. Notably, food insecurity associated with a relatively higher ACVM among middle aged adults [45 to 64] (IRR: 1.04) as compared to elderly [≥65] (IRR: 1.02), and in non-Hispanic blacks (IRR: 1.05) versus non-Hispanic whites (IRR: 1.03). Interestingly, food insecurity had a relatively larger impact on middle aged adults among non-Hispanic whites (IRR: 1.07; 10.6 AYD), while among non-Hispanic blacks, elderly group were most impacted (IRR: 1.05; 76.5 AYD). Additionally, ACVM associated with food insecurity, was significantly similar among males (IRR: 1.03), and females (IRR: 1.03), with a greater impact among middle aged subgroup of each gender (IRR: 1.06; IRR: 1,04, respectively), (Figure).

Conclusion

Food insecurity is strongly associated with county-level age-adjusted CV mortality, independent of other well-established determinants of CV death, including CV risk factors, socioeconomic, environmental and health care access factors. Food insecurity has the greatest impact among those most vulnerable and disadvantaged, namely middle-aged adults and non-Hispanic black individuals. Accordingly, reducing levels of food insecurity, and addressing disparities in associated CV mortality rates, are an emergent public health priority.

Risk Factors for Coronavirus Disease 2019 (COVID-19) Death in a Population Cohort Study from the Western Cape Province, South Africa

BACKGROUND

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown.

METHODS

We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector "active patients" (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.

RESULTS

Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID-19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70-2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81-4.04] and 1.51 [95% CI, 1.18-1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96-2.86); population attributable fraction 8.5% (95% CI, 6.1-11.1).

CONCLUSIONS

While our findings may overestimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both living with HIV and having current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex, and other comorbidities and COVID-19 mortality were similar to those in other settings.

Hand dominance in early and established rheumatoid arthritis: evaluation by dynamometer, Ritchie index and musculoskeletal ultrasound: a cross sectional study

Rheumatoid arthritis (RA) usually occurs as a symmetrical disease, which mainly affects the small joints of the hands and feet. The correlation of handedness with radiological changes shows significantly greater radiological changes in the dominant hand than in the non-dominant one. Additionally, the dominant hand is more severely affected in terms of strength, function and deformity. Our objective is to evaluate the influence of handedness on musculoskeletal ultrasound (US), Ritchie articular index (RAI) and digital dynamometer findings in patients with active RA (early, group B, vs. established, group A). A total number of 113 patients with established RA and 44 patients with early RA with active disease (DAS28-ESR >3.2) were included in the study. US assessments of both hands were performed to assess synovitis, tenosynovitis, and erosions. RAI was used to evaluate three joint groups in each hand. Handgrip strength was measured with a digital dynamometer. The US5 score showed that the dominant hand was more affected than the non-dominant one. This was significant in group A for the synovitis Power Doppler (PD) mode (p=0.032) and tenosynovitis PD (p=0.005) scores, and in group B for synovitis Grey Scale (GS) mode (p<0.001), synovitis PD (p=0.037) and erosions (p=0.027) scores. RAI was significantly higher in the dominant hand (p=0.013) in group A and even greater in group B (p=0.011). The dominant hand was stronger than the non-dominant hand in both groups. The dominant hand is generally affected in early RA. Subsequently, the disease tends to become more symmetrical with disease progression.

Influence of perfusable microvasculature on excitation-contraction coupling in IPSC-derived myocardium

 

The myocardium is one of the most densely vascularised tissues in the body, with dynamic metabolic demand from beating cardiomyocytes (CM) necessitating an intimate relationship with microvasculature. Endothelial cells (EC) produce a diverse array of cardio-active factors which acutely and chronically modulate myocardial phenotype. Disruption of CM-EC signalling results in pathological remodelling, and ultimately organ failure. However, as physiologically relevant recapitulation of CM-EC interaction has been difficult to achieve in vitro, many molecular mechanisms governing their interaction remain poorly understood.

To induce cardiac vasculogenesis in vitro, we have developed microfluidic chips which subject 3D hydrogel cultures to precisely controlled flow. We then co-cultured human cardiac microvascular ECs, human left ventricular fibroblasts (FB), and human induced pluripotent stem cell-derived cardiomyocytes for 5 days under a pro-vasculogenic protocol (0.5 ul/min flow rate, 50ng/ml VEGF, 100ng/ml Ang-1). Via live and fixed immunofluorescence microscopy, we observed spontaneous formation of a microvasculature network with a continuously open lumen embedded within beating myocardium. Simultaneous quantification of iPSC-CM contractility and perfused red blood cell velocity reveals biomimetic pulsatile flow profile within the microvasculature. To evaluate the influence of microvasculature on CM function, we incorporated CMs differentiated from stem cells with the genetically encoded calcium biosensor GCaMP6F. Compared to CM only control, vascularised preparations demonstrate significantly faster calcium transient time to peak (−11.5%, p=0.007) and time to 50% relaxation (−15%, p=0.01). Under static conditions and 1Hz electrical stimulation, presence of EC was associated with reduced iPSC-CM arrhythmia at baseline (p&lt;0.0001) and during 1uM isoprenaline treatment (p=0.0003), while maintaining isoprenaline induced Ca2+ handling quickening.

To the best of our knowledge, this work represents the first fully perfusable model of the myocardial microvasculature, and highlights the importance of EC regulatory influence on CM function. Further work aims to investigate underlying molecular mechanisms to provide therapeutically relevant insight into cardiac biology.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): British Heart Foundation

Outcome of Closed Reduction and Internal Fixation by Titanium Elastic Nailing for Fracture Shaft of Femur in Children

Femoral fractures are frequent in the pediatric population. Treatment options are based on the patient's age, fracture pattern, type of trauma and associated soft tissue injury. The traditional treatment method for pediatric femoral shaft fracture has been traction and spica casting. The immediate spica cast is safe and effective for children up to 6 years of age with isolated femoral fracture and acceptable reduction. Patients between 6 and 10 years of age can also be treated with spica casting with or without traction. This prospective study was done in the department of Orthopaedics, Mymensingh Medical College Hospital, Mymensingh, Bangladesh form from July 2015 to June 2019 to evaluate the outcome of closed reduction and internal fixation by titanium elastic nailing for fracture shaft of femur. Twenty patients, all presenting with fresh diaphyseal fractures of femur, treated with closed reduction and internal fixation by titanium elastic nailing. These patients were prospectively evaluated over a period of at least 18 months. Fractures were classified according to Association of Orthopaedics (AO) classification of shaft of femur fractures. According to AO classification, all were A1, A2, A3 fractures. Average age of the patients was 11±2.7 years; range was 6 to 16 years. There were 15 males and 5 females. Out of 20 cases treated with this method, stable fixation and union was achieved in all of them. Radiological union was achieved at an average of 10±2.3 weeks (8-15 weeks). The results were excellent in twelve patients (60%), successful in five (25%) and poor in three patients (15%) as per the scoring criteria for TEN. The effective treatment of diaphyseal fractures of the femur is intramedullary fixation by titanium elastic nailing in patients of the 6-16 years age group.

Anterior Cruciate Ligament Reconstruction using Bone Patellar Tendon Bone Autograft in ACL Deficient Knee

More than 120,000 anterior cruciate ligament (ACL) injuries occur every year in the United States, mostly during the high school and college years. The incidence of these injuries is slowly increasing, especially in females. This is likely caused by their increasing participation in high school and other organized sports. In addition, several studies have shown that female athletes are at an increased risk of ACL injury in sex comparable sports. The goal of this study was to evaluate the functional outcome of Arthroscopic anterior cruciate ligament reconstruction using Bone-Patellar tendon- Bone autograft. 25 patients with chronic ACL deficient knee presenting to Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2018 to December 2019 were included in the study. The patients with severe osteoarthritis (OA) knee, local active infection and systemic disease, intraarticular fracture of knee that might influence the study results were excluded from the study. Bone patellar tendon bone graft was harvested from ipsilateral knee. The patient was followed till 6 months with specified program of rehabilitation. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using Lysholm's score was 50 (42-63) preoperatively and 90.8 (63-97) at the latest follow up (p<0.005). No patient complained of instability at latest follow up. The quadriceps muscle showed atrophy at final follow-up. Five Patients complained of anterior knee pain. We found no graft displacement on follow up radiographs. Osteo-integration occurred in all cases. ACLR with a BPTB graft can stabilize the knee without loss of motion by closely mimicking the native ACL without any hazards and additional complications. It is useful in high demand patients and cost effective option with high patient satisfaction rate for reconstruction of ACL.

Complete Right Ovarian Vein Thrombosis Extending to the Inferior Vena Cava during Early Postpartum Period in a Low Risk Patient

Postpartum ovarian vein thrombosis is rare but life-threatening complication of puerperium. It predominantly occurs in the right side of the abdomen, mimicking various other conditions like acute appendicitis, ureteral stones or tubo-ovarian abscess. It is imperative to envisage the possibility of this rare disease even in an uncomplicated pregnancy. Here, we reported a 28-year-old female with no significant underlying risk factors who presented with high-grade fever and right lower abdominal pain after four days of an uncomplicated cesarean delivery. A right-sided complete ovarian vein thrombosis extending to the inferior vena cava was diagnosed and subsequently managed with long-term anticoagulant therapy. She had an uneventful recovery, with repeat imaging after three months showing complete resolution of thrombus.

Nipah virus: a narrative review of viral characteristics and epidemiological determinants

OBJECTIVES

The objectives of this article are to highlight the properties of the Nipah virus (NiV) and discuss its epidemiological determinants.

STUDY DESIGN

A review of conjectures, epidemiological and clinically related studies, and identification and discussion of preventive approaches is conducted.

METHODS

A review of the current literature is performed going through online search engines: PubMed and Google Scholar. The search strategy was focused on two main components, first on the NiV ('Nipah' OR 'Nipah Virus') and subsequently on its epidemiology, including determinants and preventive measures ('Epidemiology/determinants' OR 'Epidemiology/prevention').

RESULTS

NiV infection is an emerging zoonotic infectious disease causing sporadic outbursts in many developing countries within Asia, Africa, and South America. Pteroid bats are the natural reservoirs, but human-to-human transmission is possible. Clinical course ranges from non-specific influenza-like symptoms to rapidly progressive respiratory and neurologic complications. Vector control has been challenging because of its widely distributed ecological niche. Currently, no definitive treatment protocols are available in humans, but profound breakthrough in vaccine technology and successful equine vaccines has shown the way for the development of NiV vaccine and immunization in the near future.

CONCLUSIONS

The NiV poses a significant public health risk because of its intricate transmission cycle, unpredictable viral course, murky management protocol, and unavailability of vaccine. Complicated by emergence and subsequent reemergence, prevention and containment are the two most important public health promotion strategies. Early anticipation, intergovernmental preparedness and cooperation, and surveillance of zoonotic infections still remain the key to mitigate the risk.

An improved, rapid competitive ELISA using a novel conserved 3B epitope for the detection of serum antibodies to foot-and-mouth disease virus

The highly contagious foot-and-mouth disease virus (FMDV) afflicts cloven-hoofed animals, resulting in significant costs because of loss of trade and recovery from disease. We developed a sensitive, specific, and rapid competitive ELISA (cELISA) to detect serum antibodies to FMDV. The cELISA utilized a monoclonal blocking antibody specific for a highly conserved FMDV nonstructural 3B epitope, a recombinant mutant FMDV 3ABC coating protein, and optimized format variables including serum incubation for 90 min at 20-25°C. Samples from 16 animals experimentally infected with one FMDV serotype (A, O, Asia, or SAT-1) demonstrated early detection capacity beginning 7 d post-inoculation. All samples from 55 vesicular stomatitis virus antibody-positive cattle and 44 samples from cloven-hoofed animals affected by non-FMD vesicular diseases were negative in the cELISA, demonstrating 100% analytical specificity. The diagnostic sensitivity was 100% against sera from 128 cattle infected with isolates of all FMDV serotypes, emphasizing serotype-agnostic results. Diagnostic specificities of U.S. cattle ( n = 1135) and swine ( n = 207) sera were 99.4% and 100%, respectively. High repeatability and reproducibility were demonstrated with 3.1% coefficient of variation in percent inhibition data and 100% agreement using 2 kit lots and 400 negative control serum samples, with no difference between bench and biosafety cabinet operation. Negative results from vaccinated, uninfected cattle, pig, and sheep sera confirmed the DIVA (differentiate infected from vaccinated animals) capability. This rapid (<3 h), select agent-free assay with high sensitivity and specificity, DIVA capability, and room temperature processing capability will serve as a useful tool in FMDV surveillance, emergency preparedness, response, and outbreak recovery programs.

A Case Report: Symptomatic Sacral Tarlov Cyst in a Male of 24 Years

Perineural (Tarlov) cyst, a rare but benign condition, is meningeal dilatations of the posterior spinal nerve root sheath that most often affects sacral roots and can cause a progressive painful radiculopathy. Tarlov cysts are most commonly diagnosed by lumbosacral magnetic resonance imaging (MRI) and can often be demonstrated by computerized tomography (CT) to communicate with the spinal subarachnoid space. The cyst can enlarge via a net inflow of cerebrospinal fluid, eventually causing symptoms by distorting, compressing, or stretching adjacent nerve roots. It is generally agreed that asymptomatic Tarlov cysts do not require treatment. When symptomatic, the potential surgery-related benefit and the specific surgical intervention remain controversial. A 24 years old male presented with a history of trauma and pain in his low back with dull headache for six months. Physical and radiographic examination was consistent with tarlov cyst. Microsurgical excision with plication of the cyst wall was performed. Histo-pathological examination confirmed the diagnosis of Tarlov cyst. Excellent clinical and functional results were obtained with no recurrence after 6 months of follow-up. Tarlov cyst in a male of age 24 is a rare entity and decision making for management poses difficulties. Our experience with microsurgical excision with plication of the cyst wall was quite satisfactory with excellent clinical result, and we recommend this as one of the satisfactory modalities of treatment of Tarlov cyst in adult.Delta Med Col J. Jul 2017 5(2): 99-103

Aortic bypass surgery using synthetic conduits in a child with mycotic aneurysmal disease

A six-year-old child developed multiple aortic aneurysms as a consequence of fungal infection following thoracic aortic surgery for coarctation. Several repairs of both the thoracic and abdominal aorta were carried out using synthetic material combined with long-term postoperative antifungal treatment. We describe the surgical interventions performed and follow-up. The choice of conduit continues to be the main concern; however, when other alternatives are not available, synthetic material combined with indefinite antifungal treatment can produce satisfactory medium-term results.

Postoperative Spontaneous Gastric Perforation in a Ruptured Exomphalos: A Case Report

Spontaneous gastric perforation is a rare entity in neonates. We report a case of spontaneous gastric perforation in a neonate operated for in-utero rupture of omphalocele.

Real-Time Reverse Transcription PCR Assay for Detection of Senecavirus A in Swine Vesicular Diagnostic Specimens

Senecavirus A (SV-A), formerly, Seneca Valley virus (SVV), has been detected in swine with vesicular lesions and is thought to be associated with swine idiopathic vesicular disease (SIVD), a vesicular disease syndrome that lacks a defined causative agent. The clinical presentation of SIVD resembles that of other more contagious and economically devastating vesicular diseases, such as foot-and-mouth disease (FMD), swine vesicular disease (SVD), and vesicular stomatitis (VS), that typically require immediate rule out diagnostics to lift restrictions on animal quarantine, movement, and trade. This study presents the development of a sensitive, SYBR Green RT-qPCR assay suitable for detection of SV-A in diagnostic swine specimens. After testing 50 pigs with clinical signs consistent with vesicular disease, 44 (88%) were found to be positive for SV-A by RT-qPCR as compared to none from a negative cohort of 35 animals without vesicular disease, indicating that the assay is able to successfully detect the virus in an endemic population. SV-A RNA was also detectable at a low level in sera from a subset of pigs that presented with (18%) or without (6%) vesicular signs. In 2015, there has been an increase in the occurrence of SV-A in the US, and over 200 specimens submitted to our laboratory for vesicular investigation have tested positive for the virus using this method. SV-A RNA was detectable in all common types of vesicular specimens including swabs and tissue from hoof lesions, oral and snout epithelium, oral swabs, scabs, and internal organ tissues such as liver and lymph node. Genome sequencing analysis from recent virus isolates was performed to confirm target amplicon specificity and was aligned to previous isolates.

Impact of the mode of delivery on female sexual function after childbirth

This cohort study aimed to assess the effect of the mode of delivery on female sexual function (FSF) after childbirth. Out of 256 primiparous women, 200 subjects that completed the study were divided into two groups; women that delivered vaginally and women that had elective cesarean section (CS). They were subjected to a translated version of female sexual function index (FSFI) questionnaire evaluating desire, lubrication, orgasm, satisfaction, pain both antenatally and 12 weeks postpartum. The mean FSFI total score of the two investigated groups demonstrated nonsignificant difference 12 weeks after delivery compared with these scores antenatally. Women that delivered vaginally demonstrated significant decreases in the scores of desire, arousal and lubrication domains 12 weeks after delivery compared with these scores antenatally where other scores demonstrated nonsignificant differences. Women that delivered by CS demonstrated a significant difference in desire domain 12 weeks after delivery compared with these scores antenatally where other scores demonstrated nonsignificant differences. It is concluded that the mode of delivery has nonsignificant effect on the FSF 12 weeks after childbirth. Specifically, vaginal delivery is associated with significant decrease in the desire, arousal and lubrication domains where elective CS is associated with significant decrease in the desire domain.

CD36 AA genotype is associated with decreased lipid taste perception in young obese, but not lean, children

BACKGROUND/OBJECTIVE

Obesity is an alarming threat for all age groups, including children. Fat overconsumption is one of the factors that directly influences this pathology. Recent studies have suggested that a common variant in the CD36 gene, that is, single-nucleotide polymorphism (SNP) rs1761667-A allele, that reduces CD36 expression, associates with high oral fat detection thresholds in some obese subjects. The objective was to assess fatty acid sensitivity in relation to CD36 SNP in young lean and obese children.

SUBJECTS/METHODS

We studied lingual detection thresholds for emulsions, containing oleic acid, in Algerian children (n=116, age=8±0.5 years) who were divided into two groups: obese (n=57; body mass index (BMI) z-score=2.513±0.490) and lean children (n=59; BMI z-score=-0.138±0.601) by alternative-forced choice method. To correlate the lipid taste perception thresholds with CD36 SNP, the children were genotyped for A/G SNP rs1761667 in 5'UTR region of CD36 by using PCR and restriction fragment length polymorphism.

RESULTS

We noticed significantly higher CD36 A-allele frequency (P=0.036) in young obese children compared with leans. CD36 A-allele was associated with higher lipid taste perception thresholds than G-allele in obese children, but not in lean controls. Moreover, waist circumference was positively correlated with reduced fat taste sensitivity in these children.

CONCLUSIONS

CD36 SNP A-allele, being present both in young lean and in obese children, is associated with high threshold for fatty acid taste sensitivity only in obese children.

Outcome of oral sildenafil in neonatal persistent pulmonary hypertension of non-cardiac causes

BACKGROUND

Despite recent treatment modalities, mortality from persistent pulmonary hypertension (PPHN) remains significant. In instances where infants do not respond to inhaled nitric oxide (iNO), oral sildenafil could hold promise as a selective pulmonary vasodilator. Further studies are still needed to explore its efficacy and safety in newborns with PPHN.

OBJECTIVES

To validate the efficacy of oral sildenafil on oxygenation and its short-term safety in newborns with persistent pulmonary hypertension.

METHODS

A total of 27 newborns ≥36 weeks gestational age were admitted to NICU with oxygenation index (OI) ≥15 and confirmed diagnosis of PPHN with echocardiography. Oral sildenafil given at a dose of 1-2 mg/kg every 6 hours. We monitored improvement in oxygenation, safety and short-term outcomes.

RESULTS

Among 27 newborns, oral sildenafil was efficacious in 21 patients (78%) with reduction of OI from 34.9 ± 9.6 to 13 ± 3.2 (p <  0.001), increase of PaO2 from 42.4 ± 13.5 to 78 ± 11.5 mmHg (<0.001), and reduction of FiO2 from 1.0 ± 0 to 0.3 ± 0.06 (<0.001). OI decreased by 6.3 % from baseline after the first dose of sildenafil and continued to decrease with subsequent doses. In 6 patients (22%) sildenafil did not work; 5/6 patients (18%) transferred to another tertiary NICU and one patient (4%) died of sepsis. None of the patients had significant systemic hypotension.

CONCLUSION

Oral sildenafil is a promising pulmonary vasodilator in patients with PPHN, particularly in medical facilities with no available iNO and ECMO. It is well tolerated with no significant short term complications.

The Applicability of TaqMan-Based Quantitative Real-Time PCR Assays for Detecting and Enumerating Cryptosporidium spp. Oocysts in the Environment

Quantitative real-time polymerase chain reaction (qPCR) assays to detect Cryptosporidium oocysts in clinical samples are increasingly being used to diagnose human cryptosporidiosis, but a parallel approach for detecting and identifying Cryptosporidium oocyst contamination in surface water sources has yet to be established for current drinking water quality monitoring practices. It has been proposed that Cryptosporidium qPCR-based assays could be used as viable alternatives to current microscopic-based detection methods to quantify levels of oocysts in drinking water sources; however, data on specificity, analytical sensitivity, and the ability to accurately quantify low levels of oocysts are limited. The purpose of this study was to provide a comprehensive evaluation of TaqMan-based qPCR assays, which were developed for either clinical or environmental investigations, for detecting Cryptosporidium oocyst contamination in water. Ten different qPCR assays, six previously published and four developed in this study were analyzed for specificity and analytical sensitivity. Specificity varied between all ten assays, and in one particular assay, which targeted the Cryptosporidium 18S rRNA gene, successfully detected all Cryptosporidium spp. tested, but also cross-amplified T. gondii, fungi, algae, and dinoflagellates. When evaluating the analytical sensitivity of these qPCR assays, results showed that eight of the assays could reliably detect ten flow-sorted oocysts in reagent water or environmental matrix. This study revealed that while a qPCR-based detection assay can be useful for detecting and differentiating different Cryptosporidium species in environmental samples, it cannot accurately measure low levels of oocysts that are typically found in drinking water sources.

Transplant of kidneys with small renal cell carcinoma in incompatible, heavily immunosuppressed recipients

Renal cell carcinoma (RCC) is considered a contraindication for transplant. However, an increasing number of cases of transplant kidneys with RCC have been reported with encouraging results. We present our experience of two cases of transplanting kidneys with small RCCs. Donors and recipients were aware of the presence and possible consequences of RCC in the transplanted kidney before transplantation. Cases were discussed in the multidisciplinary team meetings. Regular, 6-12 monthly follow-up of donors and recipients was carried out with ultrasonography and/or computed tomography to detect recurrence of RCC or new tumours in the recipients' transplant kidneys or the donors' native kidneys. The outcome was recorded. There were no suspicious masses in the any of the kidneys during the follow-up period. The transplant kidneys are functioning.

Tibial angioplasty in diabetic patients: should all vessels be treated?

AIM

Patients with severe critical limb ischemia (CLI) due to tibial disease are commonly treated nowadays with tibial angioplasty. However, the benefits and complications of treating "more than one tibial vessel" have not yet been determined. This study compares the outcome of angioplasty of one vessel versus that of more than one vessel in patients with CLI due to tibial disease.

METHODS

We retrospectively reviewed all consecutive diabetic patients with tibial disease with no concomitant proximal lesions who were treated by angioplasty. Among 82 patients with isolated tibial disease 48 patients were selected. All patients had to have more than one diseased tibial vessel that can be treated by angioplasty. Group A patients (N.=25) had only one tibial vessel treated while group B patients (N.=23) had more than one tibial vessel treated. We compared both groups with respect to patients' characteristics, lesion morphology, and limb salvage rate.

RESULTS

Lesion morphology was worse in group A than B: anterior tibial artery showed more long lesions (17 vs. 8), more multiple lesions (22 vs. 11), and peroneal artery showed more long lesions (23 vs. 10), more multiple lesions (24 vs. 12), and more occlusions (18 vs. 10). Limb salvage rate at 12 months was similar (91%) in both groups. There were 5 complications in each group.

CONCLUSION

The lesion morphology was worse in group A. Simpler lesions in group B motivated performing more than one vessel angioplasty. There was no difference in the limb salvage rate in the medium term among both groups. Additional vessels angioplasty in less diseased arteries was not associated with substantial additional morbidity.

Isolation of transcripts from Diabrotica virgifera virgifera LeConte responsive to the Bacillus thuringiensis toxin Cry3Bb1

Crystal (Cry) proteins derived from Bacillus thuringiensis (Bt) have been widely used as a method of insect pest management for several decades. In recent years, a transgenic corn expressing the Cry3Bb1 toxin has been successfully used for protection against corn rootworm larvae (genus Diabrotica). The biological action of the Bt toxin in corn rootworms has not yet been clearly defined. Because development of resistance to Bt by corn rootworms will have huge economic and ecological costs, insight into larval response to Bt toxin is highly desirable. We identified 19 unique transcripts that are differentially expressed in D. virgifera virgifera larvae reared on corn transgenic for Cry3Bb1. Putative identities of these genes were consistent with impacts on metabolism and development. Analysis of highly modulated transcripts resulted in the characterization of genes coding for a member of a cysteine-rich secretory protein family and a glutamine-rich membrane protein. A third gene that was isolated encodes a nondescript 132 amino acid protein while a fourth highly modulated transcript could not be further characterized. Expression patterns of these four genes were strikingly different between susceptible and resistant western corn rootworm populations. These genes may provide useful targets for monitoring of Bt exposure patterns and resistance development in pest and non-target insect populations.

The use of Dispholidus typus venom in elucidating the cause of a low prothrombin index

A simple and rapid in vitro test was devised to detect the presence of the prothrombin precursor molecule circulating in the plasma of 55 out of 56 patients receiving oral vitamin K antagonists and in 4 out of 5 patients with obstructive jaundice, using either Dispholidus typus or Echis carinatus venoms. The absence of the molecule from the plasma of jaundiced patients was suggestive of hepatocellular rather than obstructive jaundice. The test is based on the clotting of aluminium hydroxide gel adsorbed plasma by the venoms. It is more sensitive and easier to perform than measuring antigenic prothrombin levels.

A novel cadherin-like gene from western corn rootworm, Diabrotica virgifera virgifera (Coleoptera: Chrysomelidae), larval midgut tissue

A cadherin-like gene associated with larval midgut tissues was cloned from western corn rootworm (Diabrotica virgifera virgifera: Coleoptera), an economically important agricultural pest in North America and Europe and the primary target pest species for corn hybrids expressing Cry3 toxins from Bacillus thuringiensis (Bt). The full-length cDNA (5371 bp in length) encodes an open reading frame for a 1688 amino acid polypeptide. The putative protein has similar architecture to cadherin-like proteins isolated from lepidopteran midguts that have been shown to bind to Cry1 Bt toxins and have been implicated in Bt resistance. The D. v. virgifera cadherin-like gene is expressed primarily in the larval midgut and regulated during development, with high levels of expression observed in all instars and adults but not pupae. The corresponding genomic sequence spans more than 90 kb and is interspersed with 30 large introns. The genomic organization of the cadherin-like gene for this coleopteran species bears strong resemblance to lepidopteran cadherins suggesting a common molecular basis for susceptibility to Cry3 toxins in Coleoptera.

Introduction of an early pregnancy assessment unit: audit on the first 6 months of service

BACKGROUND

Women experiencing bleeding in early pregnancy suffer considerable anxiety. Waiting for a considerable time for a diagnosis adds to their grievance. Early Pregnancy Assessment Unit (EPAU) is a dedicated service that provides quick and easy accessibility to diagnosis, treatment and support service.

AIM

To monitor the first 6 months of the EPAU service in the Rotunda Hospital, to identify its shortcomings, so that we can ensure effective EPAU care in future.

METHODS

A retrospective audit between July and December 2002 was performed.

RESULTS

A majority of patients (83.4%) were self-referrals. All patients were seen between 1 and 3 h. In the miscarriage group, 218/278 (78.4%) was managed surgically by evacuation and a further 60/278 (21.6%) received conservative or medical treatment. Among 13 ectopic pregnancies, 5/13 (39%) had laparoscopic management.

CONCLUSION

This clinic has enabled us to manage early pregnancy bleeding in an effective manner within a satisfactory time period. The high surgical intervention rate for miscarriages is highlighted to support the need for greater emphasis on medical and expectant management.

Utility of misoprostol for labor induction in severe pre-eclampsia and eclampsia

OBJECTIVES

To determine the effectiveness and safety of misoprostol in severe pre-eclampsia and eclampsia patients with unripe cervix.

METHODS

A prospective observational study was carried out in 135 severe pre-eclampsia and eclampsia patients who required termination of pregnancy at the Department of Obstetrics and Gynecology, Khulna Medical College Hospital, Khulna, Bangladesh during January 2002 to October 2003. Fifty micrograms of misoprostol was used every 4 h in cases of unripe cervix (Bishop score < or = 6) in severe pre-eclampsia and eclampsia patients. Maternal and perinatal outcome as well as any complications were recorded.

RESULTS

In severe pre-eclampsia and eclampsia patients vaginal delivery occurred in 79.3 and 80.5% of cases, and cesarean section was performed in 20.6 and 19.4% of cases, respectively. The maximum required responsive dose was 50-150 microg. Oxytocin augmentation was required in 29.3 and 35% of cases, respectively. Induction to delivery time was median 8 h, interquartile ranges 4.2-8.2 h in the severe pre-eclampsia group, and median 9 h, interquartile ranges 6.8-12.5 h in the eclampsia group, and average hospital stay was 3.4 +/- 1.8 and 3.7 +/- 1.7 days, respectively. The only maternal complications were hyperstimulation which occurred in 6.8 and 5.1% of cases, respectively. Neonatal death occurred in five (11.3%) and eight cases (12.1%), respectively.

CONCLUSION

Intravaginal misoprostol is well tolerated and very effective for the induction of labor in severe pre-eclampsia and eclampsia patients with unripe cervix.