Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India

PURPOSE

To ascertain the prevalence and pattern of epilepsy and to characterize and quantify knowledge, attitude, and practice (KAP) toward epilepsy among the people of the state of Kerala, which is distinguished from the rest of India by a high level of literacy and health awareness of its population.

METHODS

We conducted a door-to-door survey covering the entire population of 238,102 people residing in 43,681 households in a semiurban area of central Kerala. The screening questionnaire administered by medical social workers had a sensitivity of 100% for identifying persons with epilepsy. Neurologists examined all the individuals suspected of having epilepsy. We evaluated KAP toward epilepsy among 1,118 subjects (439 males and 679 females; mean age, 33.3 years; age range, 15-85 years) from households without epilepsy in the study area.

RESULTS

Through a three-phased survey, we ascertained 1,175 cases (616 males and 559 females) with active epilepsy, providing a crude point prevalence ratio of 4.9 cases per 1,000 people and an age-adjusted prevalence ratio of 4.7 cases per 1,000 population. The highest age-specific prevalence rate of 6.5 per 1,000 occurred in the 10- to 19-year-old age group. Sex-specific prevalence rates did not significantly differ. The proportion of generalized and localization-related epilepsies was 58.8% and 30.6%, respectively. Ninety-nine percent of the KAP respondents had read or heard about epilepsy. Thirty-one percent and 27% thought epilepsy was a hereditary disorder and a form of insanity, respectively. About 40% of the respondents felt that individuals with epilepsy could not be properly educated or employed. Eleven percent would object to their children having contact with epileptic children.

CONCLUSIONS

The prevalence and pattern of epilepsy in central Kerala, South India, do not differ from that of developed countries. Although the awareness of epilepsy among the people of Kerala was comparable to that of developed countries, the attitudes were much more negative. The need for educating the people of Kerala on epilepsy and for incorporating an adequate knowledge of epilepsy in the school curricula cannot be overemphasized.

Efficacy, Tolerability, and Safety of Lanthanum Carbonate in Hyperphosphatemia: A 6-Month, Randomized, Comparative Trial versus Calcium Carbonate

BACKGROUND/AIMS

Hyperphosphatemia is an important clinical consequence of renal failure, and its multiple adverse systemic effects are associated with significantly increased risks of morbidity and mortality in dialysis patients. Existing oral phosphate binders have not permitted control of serum phosphate within currently accepted guidelines. This study compares lanthanum carbonate with calcium carbonate for control of serum phosphate in hemodialysis patients.

METHODS

In this European multicentre study, 800 patients were randomised to receive either lanthanum or calcium carbonate and the dose titrated over 5 weeks to achieve control of serum phosphate. Serum levels of phosphate, calcium and parathryoid hormone were followed over the following 20 weeks.

RESULTS

Around 65% of patients in each group achieved phosphate control, but in the calcium carbonate group this was at the expense of significant hypercalcemia (20.2% of patients vs. 0.4%). Consequently, calcium x phosphate product tended to be better controlled in the lanthanum group.

CONCLUSION

This 6-month study demonstrates that serum phosphate control with lanthanum carbonate (750-3,000 mg/day) is similar to that seen with calcium carbonate (1,500-9,000 mg/day), but with a significantly reduced incidence of hypercalcemia. Lanthanum carbonate is well tolerated and may be more effective in reducing calcium x phosphate product than calcium carbonate.

Metabolomic profiling and antioxidant activity of some Acacia species

Metabolomic profiling of different parts (leaves, flowers and pods) of Acacia species (Acacia nilotica, Acacia seyal and Acacia laeta) was evaluated. The multivariate data analyses such as principal component analysis (PCA) and partial least square-discriminant analysis (PLS-DA) were used to differentiate the distribution of plant metabolites among different species or different organs of the same species. A. nilotica was characterized with a high content of saponins and A. seyal was characterized with high contents of proteins, phenolics, flavonoids and anthocyanins. A. laeta had a higher content of carbohydrates than A. nilotica and A. seyal. On the basis of these results, total antioxidant capacity, DPPH free radical scavenging activity and reducing power of the methanolic extracts of studied parts were evaluated. A. nilotica and A. seyal extracts showed less inhibitory concentration 50 (IC50) compared to A. laeta extracts which means that these two species have the strongest radical scavenging activity whereas A. laeta extracts have the lowest radical scavenging activity. A positive correlation between saponins and flavonoids with total antioxidant capacity and DPPH radical scavenging activity was observed. Based on these results, the potentiality of these plants as antioxidants was discussed.

Capacitation status of stored boar spermatozoa is related to litter size of sows

Semen parameters can be considered useful predictors of sperm fertility. The objective of this study was to address the question of whether differences in in vivo fertility after the use of different ejaculates could be predicted using sperm kinematics, capacitation status, and sperm penetration ability under commercial pig production conditions. The percentage of capacitated sperm, as assessed by chlortetracycline (CTC) staining, was positively correlated with litter size (p<0.01). Our data suggest that litter size increases in proportion to the number of capacitated spermatozoa. When all semen parameters (kinematics, sperm capacitation status, and sperm penetration ability) and litter size were included in a multiple linear regression analysis, significant associations were found between the percentage of capacitated sperm (B-type), the sperm fertility index as assessed by a sperm penetration assay (SPA), and litter size. This relationship between capacitated sperm and litter size, however, was more predictive for smaller litter groups than larger ones. We found that the percentage of B-type sperm was significantly correlated with historic average litter size. However, there was no significant correlation between the percentage of B-type sperm and historic farrowing rates. To determine the normal range for B-type sperm, the lower limits were established as 30% for small litters (<8 piglets) and 35% for large litters. The overall accuracy of the assay was 92% and 83% for small and large litters, respectively. These results indicate that capacitation status as measured by CTC staining is a useful predictor of sperm fertility, equivalent to SPA. Moreover, original capacitation status exhibited better predictive ability for small litters than for large ones. Therefore, subfertile boars can be identified primarily by capacitation status.

Acute tubular necrosis associated with non-hemorrhagic Dengue fever: a case report

Dengue fever (DF) is an arthropod-born viral infection affecting humans. Dengue viruses are transmitted through the bites of the mosquito Aedes aegypti. Acute renal failure (ARF) is reported in patients who are affected mainly with Dengue hemorrhagic fever (DHF), which is a severe presentation of the disease. We report the case of a 24-year-old Omani female with no past history of particular medical problems. She was referred to our hospital for the further management of acute renal failure. She had clinical features of DF without DHF. The kidney biopsy showed features of acute tubular necrosis (ATN). She had a complete recovery after 25 days and required three sessions of hemodialysis. We conclude that DF even without DHF may lead to ATN and ARF. Clinicians should be aware of this etiology. Treatment is supportive and may require dialysis. The prognosis could be favorable.

Solar drying of whole mint plant under natural and forced convection

Two identical prototype solar dryers (direct and indirect) having the same dimensions were used to dry whole mint. Both prototypes were operated under natural and forced convection modes. In the case of the later one the ambient air was entered the dryer with the velocity of 4.2 m s⁻¹. The effect of flow mode and the type of solar dryers on the drying kinetics of whole mint were investigated. Ten empirical models were used to fit the drying curves; nine of them represented well the solar drying behavior of mint. The results indicated that drying of mint under different operating conditions occurred in the falling rate period, where no constant rate period of drying was observed. Also, the obtained data revealed that the drying rate of mint under forced convection was higher than that of mint under natural convection, especially during first hours of drying (first day). The values of the effective diffusivity coefficient for the mint drying ranged between 1.2 × 10⁻¹¹ and 1.33 × 10⁻¹¹ m² s⁻¹.

Experimental and Theoretical Studies of Methyl Orange Uptake by Mn-Rich Synthetic Mica: Insights into Manganese Role in Adsorption and Selectivity

Manganese–containing mica (Mn–mica) was synthesized at 200 °C/96 h using Mn–carbonate, Al–nitrate, silicic acid, and high KOH concentration under hydrothermal conditions. Mn–mica was characterized and tested as a new adsorbent for the removal of methyl orange (MO) dye from aqueous solutions. Compared to naturally occurring mica, the Mn–mica with manganese in the octahedral sheet resulted in enhanced MO uptake by four times at pH 3.0 and 25 °C. The pseudo–second order equation for kinetics and Freundlich equation for adsorption isotherm fitted well to the experimental data at all adsorption temperatures (i.e., 25, 40 and 55 °C). The decrease of Langmuir uptake capacity from 107.3 to 92.76 mg·g⁻¹ within the temperature range of 25–55 °C suggested that MO adsorption is an exothermic process. The role of manganese in MO selectivity and the adsorption mechanism was analyzed via the physicochemical parameters of a multilayer adsorption model. The aggregated number of MO ions per Mn–mica active site (n) was superior to unity at all temperatures signifying a vertical geometry and a mechanism of multi–interactions. The active sites number (D_M) of Mn–mica and the total removed MO layers (N_t) slightly changed with temperature. The decrease in the MO adsorption capacities (Q_sat = n·D_M·N_t) from 190.44 to 140.33 mg·g⁻¹ in the temperature range of 25–55 °C was mainly controlled by the n parameter. The results of adsorption energies revealed that MO uptake was an exothermic (i.e., negative ΔE values) and a physisorption process (ΔE < 40 kJ mol ⁻¹). Accordingly, the adsorption of MO onto Mn–mica was governed by the number of active sites and the adsorption energy. This study offers insights into the manganese control of the interactions between MO ions and Mn–mica active sites.

N-acetylcysteine versus progesterone on the cisplatin-induced peripheral neurotoxicity

BACKGROUND

Cisplatin-induced peripheral nerve neurotoxicity (CIPN) is the main obstacle in cisplatin treatment. The aim of this study was to compare the modulatory effects of N-acetylcysteine (NAC) and progesterone on CIPN, because there are scarce literature data on the protective effect of the proge-sterone on the CIPN.

MATERIALS AND METHODS

Twenty-four rats were divided into four groups: control, cisplatin-treated, concomitant cisplatin-treated and NAC-treated, and concomitant cisplatin-treated and progesterone-treated. Electron microscopic, immunohistochemical, real time polymerase chain reaction and histomorphome-tric analysis; oxidative/antioxidative markers (MDA/GSH and SOD), neurotoxic/ neuroprotective markers (iNOS/nNOS), inflammatory mediators (TNF-a and NF-kB) and BAX were done.

RESULTS

The myelin sheath in the cisplatin-treated group elucidated infolding. The myelin was disfigured, degenerated, and extensively split with areas of focal loss. The axoplasm was atrophic. Ballooning and vacuolations of the mitochon-dria with alterations of Remak bundles structures were observed. Fewer of these changes were noted in the NAC and progesterone-treated groups. Decrease of the antioxidant SOD and GSH (81% and 64%) and increase of the oxidant MDA (9 folds), increment of the neurotoxic iNOS (1.9 folds) and decrement of the neuroprotective nNOS (64%) and elevation of the inflammatory mediators' TNF-a and NF-kB (8.3 and 11 folds) in the cisplatin-treated group. Increase of the antioxidant SOD (1.3 and 2.5 folds) and GSH (120% and 79%) and decrease of the oxidant MDA (69% and 88%), decrement of the neurotoxic iNOS (56% and 68%) and increment of the neuroprotective nNOS (1.6 and one folds) and elevation of the inflammatory mediators' TNF-a and NF-kB were observed in the NAC and progesterone-treated groups, respectively.

CONCLUSIONS

The toxic effect of CIPN might be attributed to either oxidative or severe inflammatory stress. Progesterone is efficient in ameliorating these effects; however, NAC is better. (Folia Morphol 2018; 77, 2: 234-245).

The front-line general surgery consultant as a new model of emergency care

Introduction Emergency general surgery services in England are undergoing rapid structural change with the aim of improving care. In our centre, the key issues identified were high numbers of admissions, inappropriate referrals, prolonged waiting times, delayed senior input and poor patient satisfaction. A new model was launched in January 2015 to address these issues: the surgical triage unit (STU). This study assesses the success of the new service. Methods All emergency general surgical admissions during a five-month period before introduction of the STU were compared with those of a comparable five-month period after its introduction. Process, clinical and patient experience outcomes were assessed to identify improvement. Results Attendance fell from 3,304 patients in the 2014 cohort to 2,830 in the 2015 cohort. During the 2015 study period, 279 more patients were discharged on the same day. Resource requirement fell by 2,635 bed days (23%). The number of true surgical emergencies remained consistent. Rates for reattendance (7.8% for 2014 vs 8.1% for 2015) and readmission (5.7% for 2014 vs 5.7% for 2015) showed no significant difference. Patient experience data demonstrated a significant improvement in both net promoter score (64.1 vs 82.2) and number of complaints (34 vs 5). Clinical outcomes for low risk procedures remained similar. Emergency laparotomy in-hospital mortality fell (11.4% vs 10.3%) despite preoperative risk stratification suggesting a risk burden that was significantly higher than the national average. Conclusions This novel model of emergency general surgery provision has improved clinical efficiency, patient satisfaction and outcomes. We encourage other units to consider similar programmes of service improvement.

Impact of an educational programme on knowledge, beliefs, practices and expectations about care among adolescent glaucoma patients in Cairo

Glaucoma is a leading cause of blindness worldwide. The aim of the current study was to evaluate the impact of an educational programme on knowledge, beliefs, practices and expectations towards glaucoma and eye care among adolescent patients with glaucoma. A purposive sample of 50 patients with glaucoma aged 12-18 years, attending ophthalmology outpatient clinics in Cairo, Egypt, were given an educational programme focusing on information about glaucoma, correcting patients' incorrect beliefs and expectations, and demonstrations and retraining about eye care. A range of tools was used to assess patients before and after the programme: questionnaire, observation checklist, physical assessment sheet, childrens' depression scale, children manifest anxiety scale, self-esteem inventory and patients' expectations scale. The programme significantly improved patients' knowledge and beliefs about glaucoma and their practices and expectations concerning eye care. Innovative educational programmes about eye diseases are needed to improve patients' knowledge and practices.

Spectral, thermal studies and biological activity of pyrazinamide complexes

Synthesis and spectrothermal characterization of new fabricated pyrazinamide complexes with metal [Cr(III), Mn(II), Fe(III), Co(II), Ni(II), Cu(II), Zn(II), Cd(II) and Hg(II)] salts are reported. The structural chemistry of these complexes is achieved via elemental analysis, spectral (UV, visible, and IR), thermal (DTA and TGA) as well as magnetic susceptibility. In these new octahedral complexes (Zn complex is tetrahedral), pyrazinamide acts as a bidentate ligand. Pyrazinamide complexes show higher activity than pyrazinamide for some strains. The geometry of the complexes is converted from Oh to Td during their thermal decomposition. The decomposition mechanisms are suggested and the thermodynamic parameters for the thermal decomposition steps are evaluated.

Hydrogeochemical evolution of inland lakes' water: A study of major element geochemistry in the Wadi El Raiyan depression, Egypt

Wadi El Raiyan is a great depression located southwest of Cairo in the Western Desert of Egypt. Lake Qarun, located north of the study area, is a closed basin with a high evaporation rate. The source of water in the lake is agricultural and municipal drainage from the El Faiyum province. In 1973, Wadi El Raiyan was connected with the agricultural wastewater drainage system of the Faiyum province and received water that exceeded the capacity of Lake Qarun. Two hydrogeological regimes have been established in the area: (i) higher cultivated land and (ii) lower Wadi El Raiyan depression lakes. The agricultural drainage water of the cultivated land has been collected in one main drain (El Wadi Drain) and directed toward the Wadi El Raiyan depression, forming two lakes at different elevations (upper and lower). In the summer of 2012, the major chemical components were studied using data from 36 stations distributed over both hydrogeological regimes in addition to one water sample collected from Bahr Youssef, the main source of freshwater for the Faiyum province. Chemical analyses were made collaboratively. The major ion geochemical evolution of the drainage water recharging the El Raiyan depression was examined. Geochemically, the Bahr Youssef sample is considered the starting point in the geochemical evolution of the studied surface water. In the cultivated area, major-ion chemistry is generally influenced by chemical weathering of rocks and minerals that are associated with anthropogenic inputs, as well as diffuse urban and/or agricultural drainage. In the depression lakes, the water chemistry generally exhibits an evaporation-dependent evolutionary trend that is further modified by cation exchange and precipitation of carbonate minerals.

Outcome of indeterminate liver lesions on computed tomography in patients with colorectal cancer

Introduction The aim of this study was to determinate the outcome of indeterminate liver lesions on computed tomography (CT) in patients with a background history of colorectal cancer (CRC) and to identify clinicopathological variables associated with malignancy in these lesions. A secondary aim was to devise a management algorithm for such patients. Methods Patients referred to our institution with indeterminate liver lesions on CT with a background history of CRC between January 2012 and December 2014 were included in the study. Clinicopathological factors, surveillance period and histological findings were analysed. Results Fifty-six patients with indeterminate liver lesions were identified. Fifty-three (94.6%) of these required further imaging (magnetic resonance imaging [MRI; n=50] and positron emission tomography combined with CT [n=3]). For the patients who had MRI, the underlying diagnosis was benign in 19 and colorectal liver metastasis (CRLM) in 8 while 23 patients and an indeterminate lesion. In cases that remained indeterminate following MRI, liver resection was performed in 2 patients for a high suspicion of CRLM while the 21 remaining patients underwent interval surveillance (median: 9 months, range: 3-52 months). Of these 21 patients, 14 had benign lesions while CRLM was noted in 6 patients and an incidental hepatocellular carcinoma in a single patient. Age ≥65 years was the only statistically significant clinicopathological factor in predicting an underlying malignancy in patients with indeterminate liver lesions on CT. Conclusions Over a third of the patients diagnosed with indeterminate liver lesions on CT subsequently showed evidence of CRLM. These indeterminate lesions are more likely to be malignant in patients aged ≥65 years.

Alkaline phosphatase and phosphoamino acid phosphatases in normal and cancerous tissues of the human larynx

The activities of alkaline phosphatase and phosphoamino acid phosphatases were measured in normal and cancerous regions of the human larynx. For each larynx, alkaline phosphatase and phosphotyrosine phosphatase activities were higher in the tumor than in the corresponding normal tissue. Phosphothreonine and phosphoserine phosphatase activities were relatively low and there were no consistent trends. The increased alkaline phosphatase activity in the tumors supports histological observations that ossification of cartilage seems to occur at the site of invasion; the phosphatase acting on phosphotyrosine could serve as a regulator of cell differentiation during tumorigenesis.

Vascular endothelial growth factor A polymorphism and risk of Kaposi's sarcoma herpesvirus viremia in kidney allograft recipients

BACKGROUND

Kaposi's sarcoma herpesvirus (KSHV) causes Kaposi's sarcoma (KS), primary effusion lymphoma, and multicentric Castleman's disease in immunocompromised patients including allograft recipients. Detection of KSHV DNA in blood, as well as host genetic polymorphisms has been found to be associated with an increased risk for KS. We investigated an association between single nucleotide polymorphisms (SNPs) in vascular endothelial growth factor A (VEGFA) gene region and KSHV viremia in kidney transplant recipients (KTR) in Saudi Arabia.

METHODS

In total, 152 KTR who have survived kidney transplantation for at least 6 months were included in the study. KSHV viremia was determined by real-time polymerase chain reaction (PCR). Genotyping of SNPs in the VEGFA region was performed by PCR and direct sequencing, as well as by restriction fragment length polymorphism.

RESULTS

KSHV DNA was detected in 28.9% (n = 44) of the study population. The A-allele at position C172A VEGFA gene promoter region was found to be associated with KSHV viremia (odd ratio [OR] = 4.8, P = 0.005). In addition, the G-allele at position C+405G in the 5'-untranslated region was associated with KSHV viremia in women, but not in men (OR = 3.98, P = 0.004).

CONCLUSIONS

Our results suggest an association of VEGFA polymorphisms with KSHV viremia among KTR in this study population. A limitation of our study is that the results can only be predicated for patients 6 months after kidney transplantation and should be validated in another cohort with larger sample size.

Study of the relationship between electrical and magnetic properties and Jahn-Teller distortion in R(0.7)Ca(0.3)Mn(0.95)Fe(0.05)O(3) perovskites

In this work structural, magnetic and electrical properties of R(0.7)Ca(0.3)Mn(0.95)Fe(0.05)O(3) (R = Pr and Nd) perovskite manganites are presented. Structural characterization of these compounds shows that both have orthorhombic (Pbnm) phase. The Mössbauer spectra show clear evidence of the local structural distortion of the Mn(Fe)O(6) octahedron on the basis of non-zero nuclear quadrupole interactions for high-spin Fe(3+) ions. It was found that the local structural distortion decreases significantly on replacing Pr(3+) by Nd(3+). This replacement dependence of the Jahn-Teller coupling strength estimated from the Mössbauer results was found to be consistent with the electrical and magnetic properties.

Response surface modeling and optimization of lead uptake from aqueous solution by porous graphitic carbon synthesized from Egyptian bituminous coal

El Maghara bituminous coal, collected from northern Sinai, Egypt, was used as a precursor material in the synthesis of porous graphitic carbon by chemical and thermal treatment. The activation process was carried out using phosphoric acid followed by thermal treatment at 800ºC in an electric muffle furnace for 1h. The raw coal and the synthetic porous carbon were characterized by polarized light microscope (PLM), XRD, SEM and FTIR. Experiments were conducted based on a central composite rotatable statistical design (CCRD) and analyzed using response surface methodology (RSM). The sorption process was investigated as a function of four independent parameters, initial solution pH (2–7), initial lead concentration (50–150 mg/l), contact time (30-240 min) and porous carbon dose (0.1–0.5 g). According to the F-values, the second order polynomial model was found to be highly significant for lead uptake with only a 0.01% noise. Also, the matching between the actual and the predicted results (R2 > 0.98) reflects the suitability of the design to represent the sorption process. The experimental optimum conditions for the uptake of lead by the porous carbon at pH 4 were found to be120 min, 50 mg/L, 0.3 g for contact time, initial concentration and adsorbent mass, respectively. By studying the effect of the selected parameters and the interaction between them, the applied model can enhance the adsorbed amount of lead (qe) and the removal efficiency (%) through a series of suggested solutions.

Adverse effects of energy drink on rat pancreas and the therapeutic role of each of bone marrow mesenchymal stem cells and Nigella Sativa oil

BACKGROUND

Energy drinks have been observed to threaten public health leading to many medical problems. Bone marrow-derived mesenchymal stem cells (BMSCs) have broad prospects in tissue regeneration. Nigella Sativa (NS) possess great therapeutic properties for the treatment of a wide range of diseases.

MATERIALS AND METHODS

Forty adult male albino rats were divided into: control group and treated group. The treated group was further subdivided into: energy drink subgroup 2a, BMSCs-injected subgroup 2b, NS-injected subgroup 2c. Histological, immunohistochemical and biochemical assessment was performed.

RESULTS

Administration of energy drink revealed that it adversely affected the pancreatic cytoarchitecture. BMSCs and NS have been similarly observed to significantly ameliorate the histological, biochemical and immunohistochemical changes induced by energy drink.

CONCLUSIONS

The extent of pancreatic regeneration, exerted by each of BMSCs and NS oil, is nearly similar but the effect of BMSCs is more superior; however, NS could be privileged to BMSCs as a line of treatment being easily accessible and of lower cost.