Description of the COVID-19 epidemiology in Malaysia

Introduction

Since the COVID-19 pandemic began, it has spread rapidly across the world and has resulted in recurrent outbreaks. This study aims to describe the COVID-19 epidemiology in terms of COVID-19 cases, deaths, ICU admissions, ventilator requirements, testing, incidence rate, death rate, case fatality rate (CFR) and test positivity rate for each outbreak from the beginning of the pandemic in 2020 till endemicity of COVID-19 in 2022 in Malaysia.

Methods

Data was sourced from the GitHub repository and the Ministry of Health's official COVID-19 website. The study period was from the beginning of the outbreak in Malaysia, which began during Epidemiological Week (Ep Wk) 4 in 2020, to the last Ep Wk 18 in 2022. Data were aggregated by Ep Wk and analyzed in terms of COVID-19 cases, deaths, ICU admissions, ventilator requirements, testing, incidence rate, death rate, case fatality rate (CFR) and test positivity rate by years (2020 and 2022) and for each outbreak of COVID-19.

Results

A total of 4,456,736 cases, 35,579 deaths and 58,906,954 COVID-19 tests were reported for the period from 2020 to 2022. The COVID-19 incidence rate, death rate, CFR and test positivity rate were reported at 1.085 and 0.009 per 1,000 populations, 0.80 and 7.57%, respectively, for the period from 2020 to 2022. Higher cases, deaths, testing, incidence/death rate, CFR and test positivity rates were reported in 2021 and during the Delta outbreak. This is evident by the highest number of COVID-19 cases, ICU admissions, ventilatory requirements and deaths observed during the Delta outbreak.

Conclusion

The Delta outbreak was the most severe compared to other outbreaks in Malaysia's study period. In addition, this study provides evidence that outbreaks of COVID-19, which are caused by highly virulent and transmissible variants, tend to be more severe and devastating if these outbreaks are not controlled early on. Therefore, close monitoring of key epidemiological indicators, as reported in this study, is essential in the control and management of future COVID-19 outbreaks in Malaysia.

A novel CNN architecture for accurate early detection and classification of Alzheimer's disease using MRI data

Alzheimer's disease (AD) is a debilitating neurodegenerative disorder that requires accurate diagnosis for effective management and treatment. In this article, we propose an architecture for a convolutional neural network (CNN) that utilizes magnetic resonance imaging (MRI) data from the Alzheimer's disease Neuroimaging Initiative (ADNI) dataset to categorize AD. The network employs two separate CNN models, each with distinct filter sizes and pooling layers, which are concatenated in a classification layer. The multi-class problem is addressed across three, four, and five categories. The proposed CNN architecture achieves exceptional accuracies of 99.43%, 99.57%, and 99.13%, respectively. These high accuracies demonstrate the efficacy of the network in capturing and discerning relevant features from MRI images, enabling precise classification of AD subtypes and stages. The network architecture leverages the hierarchical nature of convolutional layers, pooling layers, and fully connected layers to extract both local and global patterns from the data, facilitating accurate discrimination between different AD categories. Accurate classification of AD carries significant clinical implications, including early detection, personalized treatment planning, disease monitoring, and prognostic assessment. The reported accuracy underscores the potential of the proposed CNN architecture to assist medical professionals and researchers in making precise and informed judgments regarding AD patients.

Supply Chain of Iron Chelators for Thalassaemia in Malaysia: An Overview for Process Optimisation

Iron chelating therapy (ICT) drugs are prescribed to transfusion dependent thalassaemia (TDT) patients to prevent iron overload complications. The high number of TDT patients in Malaysia strained the public healthcare resources. This paper aims to provide an insight on existing supply chain management of ICT medicines in Malaysia and to explore ways for a more efficient system. A rapid review of literatures was conducted in electronic databases (PubMed, Emerald, Scopus and ScienceDirect) and other relevant Malaysian government documents. Supply of ICT to thalassaemia patients is publicly funded but much availability of oral ICT is restricted due to financial consideration. ICT in Malaysia is supplied through central procurement but purchasing and inventory management are decentralised to each hospital. Vendor-managed inventory system is an ideal option to the inventory management practice in Malaysian public healthcare facilities as it could provide better efficiency and reduces inventory management costs.

Efficiency and management factors: finding the balance in Thalassaemia care centres

BACKGROUND

Optimizing efficiency has become increasingly critical with the growing demand for finite healthcare resources driven by population growth and an ageing society. Hence, policymakers are urgently finding more efficient ways to deliver health services. Thalassemia is a complex inherited blood disorder with significant prevalence in Malaysia. The high number of patients put substantial strain on the healthcare system. This study aims to evaluate the technical efficiency of thalassaemia care centres throughout Malaysia and the determinants that affect the efficiency.

METHOD

Data from 30 public hospitals with thalassaemia care centres were collected. A double bootstrap data envelopment analysis (DEA) approach is used with the assumption of input-oriented and variable-to-scale DEA models to generate technical efficiency scores. Bootstrap truncated regression was later conducted to identify the factors affecting the efficiency scores.

RESULTS

The mean bias-corrected technical efficiency score has improved to 0.75 in 2017 from 0.71 in 2016. In both years, more than 50% of thalassaemia care centres showed good efficiency scores (0.8-1.0). Management factors that affect the efficiency scores include separation of patient management (β = 0.0653) and budget (β = 0.0843), where they are found to positively affect the efficiency scores. In contrast, having longer operating hours is found to inversely influence the performance levels (β = - 0.4023).

CONCLUSIONS

The study provides a pioneering framework to evaluate the technical efficiency of thalassaemia treatment centres in public healthcare settings and could provide a useful guide for policymaker and thalassaemia care centre managers to improve efficiency in service delivery to thalassaemia patients and their caregivers without compromising quality of care.

PICK-ing Malaysia's Epidemic Apart: Effectiveness of a Diverse COVID-19 Vaccine Portfolio

Malaysia rolled out a diverse portfolio of predominantly three COVID-19 vaccines (AZD1222, BNT162b2, and CoronaVac) beginning 24 February 2021. We evaluated vaccine effectiveness with two methods, covering 1 April to 15 September 2021: (1) the screening method for COVID-19 (SARS-CoV-2) infection and symptomatic COVID-19; and (2) a retrospective cohort of confirmed COVID-19 cases for COVID-19 related ICU admission and death using logistic regression. The screening method estimated partial vaccination to be 48.8% effective (95% CI: 46.8, 50.7) against COVID-19 infection and 33.5% effective (95% CI: 31.6, 35.5) against symptomatic COVID-19. Full vaccination is estimated at 87.8% effective (95% CI: 85.8, 89.7) against COVID-19 infection and 85.4% effective (95% CI: 83.4, 87.3) against symptomatic COVID-19. Among the cohort of confirmed COVID-19 cases, partial vaccination with any of the three vaccines is estimated at 31.3% effective (95% CI: 28.5, 34.1) in preventing ICU admission, and 45.1% effective (95% CI: 42.6, 47.5) in preventing death. Full vaccination with any of the three vaccines is estimated at 79.1% effective (95% CI: 77.7, 80.4) in preventing ICU admission and 86.7% effective (95% CI: 85.7, 87.6) in preventing deaths. Our findings suggest that full vaccination with any of the three predominant vaccines (AZD1222, BNT162b2, and CoronaVac) in Malaysia has been highly effective in preventing COVID-19 infection, symptomatic COVID-19, COVID-19-related ICU admission, and death.

Effectiveness of the movement control measures during the third wave of COVID-19 in Malaysia

OBJECTIVES

Starting in March 2020, movement control measures were instituted across several phases in Malaysia to break the chain of transmission of coronavirus disease 2019 (COVID-19). In this study, we developed a susceptible-exposed-infected-recovered (SEIR) model to examine the effects of the various phases of movement control measures on disease transmissibility and the trend of cases during the third wave of the COVID-19 pandemic in Malaysia.

METHODS

Three SEIR models were developed using the R programming software ODIN interface based on COVID-19 case data from September 1, 2020, to March 29, 2021. The models were validated and subsequently used to provide forecasts of daily cases from October 14, 2020, to March 29, 2021, based on 3 phases of movement control measures.

RESULTS

We found that the reproduction rate (R-value) of COVID-19 decreased by 59.1% from an initial high of 2.2 during the nationwide Recovery Movement Control Order (RMCO) to 0.9 during the Movement Control Order (MCO) and Conditional MCO (CMCO) phases. In addition, the observed cumulative and daily highest numbers of cases were much lower than the forecasted cumulative and daily highest numbers of cases (by 64.4-98.9% and 68.8-99.8%, respectively).

CONCLUSIONS

The movement control measures progressively reduced the R-value during the COVID-19 pandemic. In addition, more stringent movement control measures such as the MCO and CMCO were effective for further lowering the R-value and case numbers during the third wave of the COVID-19 pandemic in Malaysia due to their higher stringency than the nationwide RMCO.

Economic burden in the management of transfusion-dependent thalassaemia patients in Malaysia from a societal perspective

BACKGROUND

Transfusion-dependent thalassaemia (TDT) is a hereditary blood disorder in which blood transfusion is the mainstay treatment to prolong survival and improve quality of life. Patients with this disease require blood transfusion at more than 100 ml/kg annually and iron-chelating therapy (ICT) to prevent iron overload (IOL) complications. There are substantial numbers of TDT patients in Malaysia, but limited data are available regarding the economic burden associated with this disease. The purpose of this study was to determine the lifetime cost of TDT from a societal perspective and identify potential factors increasing patient and family expenditures among thalassaemia populations.

METHODS

The total lifetime cost per TDT patient (TC1) is the sum of lifetime healthcare cost (TC2) and lifetime patient and family healthcare expenditure (TC3). TC2 was simulated using the Markov model, taking into account all costs subsidized by the government, and TC3 was estimated through a cross-sectional health survey approach. A survey was performed using a two-stage sampling method in 13 thalassaemia centres covering all regions in Malaysia.

RESULTS

A TDT patient is expected to incur TC2 of USD 561,208. ICT was the main driver of cost and accounted for 56.9% of the total cost followed by blood transfusion cost at 13.1%. TC3 was estimated to be USD 45,458. Therefore, the estimated TC1 of a TDT patient was USD 606,665. Sensitivity analyses showed that if all patients were prescribed oral ICT deferasirox for their lifetime, the total healthcare cost would increase by approximately 65%. Frequency of visits to health facilities for blood transfusion/routine monitoring and patients who were prescribed desferrioxamine were observed to be factors affecting patient and family monthly expenses.

CONCLUSION

The lifetime cost per TDT patient was USD 606,665, and this result may be useful for national health allocation planning. An estimation of the economic burden will provide additional information to decision makers on implementing prevention interventions to reduce the number of new births and medical service reimbursement.

Validity of the Malay EQ-5D-3L in the Malaysian Transfusion-Dependent Thalassemia Population

OBJECTIVE

The objective of this study was to examine the cross-sectional convergent and known-group validity of the Malay-language EQ-5D-3L instrument in children and adults with transfusion-dependent thalassemia (TDT).

METHODS

A cross-sectional health-related quality of life survey involving TDT patients from 12 different treatment centers across Malaysia was conducted using the Malay PedsQL 4.0 Generic Core Scales and the Malay EQ-5D-3L questionnaire. Patients with non-TDT and other hemoglobinopathies were excluded. Convergent, discriminant, and known-group validity of the EQ-5D-3L was assessed against the PedsQL 4.0 Generic Core Scales in children. In the adult population, known-group validity of the EQ-5D-3L was assessed using an a priori hypothesis between patients' demographic characteristics and health outcomes obtained from literature.

RESULTS

A total of 370 children and 225 adults were sampled. The mean (standard deviation) EQ-5D-3L scores of the children were 0.892 (0.082) and the adults were 0.887 (0.085). Convergent and discriminant validity was identified when correlated with the PedsQL domain in children. In both groups, known-group validity was evident when comparing groups of patients with reported problems to the group of patients with no reported problems on the EQ-5D-3L domains based on the a priori hypothesis derived from literature.

CONCLUSION

This study found convergent, discriminant, and known-group validity of the Malay EQ-5D-3L in a population-based sample of patients with TDT. Hence, the instrument is valid for the assessment of health-related quality of life in children and adults with TDT in Malaysia.

Ameliorating effect of selenium nanoparticles on cyclophosphamide induced hippocampal neurotoxicity in male rats: light, electron microscopic and immunohistochemical study

BACKGROUND

Cyclophosphamide (CPH) is a widely used chemotherapeutic drug that can affect the hippocampal neurocytes with a subsequent effect on memory and cognitive functions. Nanomedicine has the potential to overcome the current chemotherapeutic side effects, because of the unique nanoscale size and distinctive bioeffects of nanomaterials. So, the present study aims to investigate the potential ameliorative effect of the biologically synthesized nano-selenium (nano Se) on CPH induced hippocampal neurotoxicity.

MATERIALS AND METHODS

Twenty four rats were randomly classified into four groups of 6 rats each: control group, nano Se group (dose of 0.5 mg biological nano Se /kg daily via oral gavage), CPH group (dose of 20 mg CPH/kg daily intraperitoneally), and CPH plus Nano Se group. After 4 weeks, the rats were sacrificed and the hippocampus was excised and processed. Sections were stained with H&E stain and immunohistochemically stained for caspase 3 (apoptosis marker) and GFAB (astrocytic activity marker). Morphometric analysis and transmission electron microscopic (TEM) examination were also done.

RESULTS

Control and nano Se groups revealed no structural changes. By light microscopy, CPH group showed degeneration and necrosis of hippocampal neurocytes, significantly reduced thickness of the neurocyte cell layers, increased expression of GFAB and caspase 3 immunostains and significantly elevated apoptotic index. Moreover, neurocytes damage, mitochondrial cristeolysis, mild dilation of rough endoplasmic reticulum (Er), and disrupted neurolemmal sheaths of nerve fibers were also demonstrated by TEM. Nano Se cotreatment in the fourth group reversed all the aforementioned deleterious changes that induced by CPH in the hippocampal neurocytes.

CONCLUSIONS

Treatment with CPH caused damage to hippocampal neurocytes that can be reversed by biological nano Se co-treatment.

Modelling the Effectiveness of Epidemic Control Measures in Preventing the Transmission of COVID-19 in Malaysia

Malaysia is currently facing an outbreak of COVID-19. We aim to present the first study in Malaysia to report the reproduction numbers and develop a mathematical model forecasting COVID-19 transmission by including isolation, quarantine, and movement control measures. We utilized a susceptible, exposed, infectious, and recovered (SEIR) model by incorporating isolation, quarantine, and movement control order (MCO) taken in Malaysia. The simulations were fitted into the Malaysian COVID-19 active case numbers, allowing approximation of parameters consisting of probability of transmission per contact (β), average number of contacts per day per case (ζ), and proportion of close-contact traced per day (q). The effective reproduction number (Rt) was also determined through this model. Our model calibration estimated that (β), (ζ), and (q) were 0.052, 25 persons, and 0.23, respectively. The (Rt) was estimated to be 1.68. MCO measures reduce the peak number of active COVID-19 cases by 99.1% and reduce (ζ) from 25 (pre-MCO) to 7 (during MCO). The flattening of the epidemic curve was also observed with the implementation of these control measures. We conclude that isolation, quarantine, and MCO measures are essential to break the transmission of COVID-19 in Malaysia.

Observational study on the current status of thalassaemia in Malaysia: a report from the Malaysian Thalassaemia Registry

OBJECTIVE

Thalassaemia is the most common inherited blood disorder in Malaysia. This study aims to report the current status of thalassaemia in Malaysia and provide a comprehensive understanding of the disease through data obtained from the Malaysian Thalassaemia Registry.

DESIGN

Data were extracted from the Malaysian Thalassaemia Registry, a web-based system accessible to enrolled users through www.mytalasemia.net.my.

SETTING

The Malaysian Thalassaemia Registry data was recorded from reports obtained from 110 participating government and university hospitals in Malaysia.

PARTICIPANTS

The patients were those attending the 110 participating hospitals for thalassaemia treatment.

INTERVENTION

Data were collected from the Malaysian Thalassaemia Registry from 2007 until the fourth quarter of 2018.

PRIMARY OUTCOME MEASURE

7984 out of 8681 patients with thalassaemia registered in the Malaysian Thalassaemia Registry were reported alive.

RESULTS

Majority of the patients were reported in the state of Sabah (22.72%); the largest age group affected was 5.0-24.9 years old (64.45%); the largest ethnic group involved was Malay (63.95%); and the major diagnosis was haemoglobin E/β-thalassaemia (34.37%). From the 7984 patients, 56.73% were on regular blood transfusions and 61.72% were on chelation therapy. A small fraction (14.23%) has undergone splenectomy, while the percentage of patients with severe iron overload (serum ferritin ≥5000 µg/L) reduced over time. However, cardiac complications are still the main cause of death in patients with thalassaemia.

CONCLUSION

Data gathered into the registry can be used to understand the progression of the disorder, to monitor iron overload management and to improve the outcomes of treatment, to enhance preventive strategies, reduce healthcare burden and improve the quality of life. Sustainability of the Malaysian Thalassaemia Registry is important for surveillance of thalassaemia management in the country and help the national health authorities to develop more effective policies.

Health-related quality of life among children with transfusion-dependent thalassemia: A cross-sectional study in Malaysia

Background

The treatment of children with transfusion-dependent thalassemia (TDT) in Malaysia has progressed since 2005. This study provides an updated health-related quality of life (HRQoL) assessment for children with the disorder and the factors affecting the HRQoL.

Methods

A cross-sectional HRQoL survey of Malaysian children with TDT was conducted using the PedsQL™ 4.0 Generic Core Scales. Patients with non-transfusion dependent thalassemia and other haemoglobinopathies were excluded. Parent-proxy and self-reported HRQoL scores were obtained using a multi-stage convenient sampling. The relationship between HRQoL scores and demographic factors were tested using association, correlation and regression analysis.

Results

A total of 368 patients were recruited. The mean (SD) Total Summary Score (TSS) was 80.12(13.87). Predictors for a lower TSS was an increasing age group and the use of dual chelating agents (R² = 0.057, F (4, 359) = 5.40, p = < 0.001). The mean (SD) Physical Health Summary Score (PHSS) was 82.21 (16.82). Predictors of a higher PHSS score was being male, while predictors of a lower score was an increasing age group and parent-proxy reports(R² = 0.075, F (5,358) = 5.80, p = < 0.001). The mean (SD) Psychosocial Health Summary Score (PCHS) was 79.39 (14.81). Predictors for a lower PCHS was the use of dual chelating agents(R² = 0.041, F (1, 362) = 15.60, p = < 0.001). The school functioning score had the lowest mean (SD) score of 69.52(20.92) in the psychosocial dimension.

Conclusion

The HRQoL of TDT children in Malaysia has improved over the last decade owing to the better access in treatment. However, further effort is needed to improve the school functioning dimension.

Association of ABCC2 with levels and toxicity of methotrexate in Malaysian Childhood Acute Lymphoblastic Leukemia (ALL)

Studies had shown that genetic polymorphism plays a significant role in the pharmacokinetics and pharmacodynamics variation of high dose methotrexate (MTX), 5000 mg/m² regimen. The objective of this study was to investigate the genetic variations associated with the serum level and toxicity of MTX in Malaysian children with acute lymphoblastic leukemia (ALL). Thirty-eight patients were genotyped for rs717620 (ABCC2), rs4948496 (ARID5B), rs1801133 (MTHFR) and rs4149056 (SLCO1B1). Serum levels of MTX at 48 h post 24 h of intravenous infusion were analyzed by high-performance liquid chromatography-mass spectrometry. The ABCC2 genotype was significantly associated with the serum levels of MTX at 48 h after treatment (p = 0.017). Patients with CT and TT of rs717620 (ABCC2) and TC and CC of rs4948496 (ARID5B) were significantly associated with leukopenia grade I-IV (Fisher Exact Test; p = 0.03 and 0.02, respectively). The three most common MTX related toxicities were leukopenia (60.5%), increased alanine aminotransferase enzyme (47.4%), and thrombocytopenia (47.4%). Our results demonstrate that by prescreening of patients for ABCC2 and ARID5B associated with the serum levels and adverse effects of MTX would identify patients at risk and therefore help a pediatric oncologist to personalize chemotherapy drugs for precision health.

Potential use of N-carboxyethylchitosan in biomedical applications: Preparation, characterization, biological properties

N-carboxyethylchitosan (CECS) was successfully prepared via Michael addition reaction of chitosan (CS) with acrylic acid in water. The structure of CECS was characterized by Fourier transform Infra-Red spectrometry (FT-IR), ¹HNMR, elemental analysis, X-ray diffraction (XRD), thermogravimetric analysis (TGA) and Differential scanning calorimetry (DSC). Antibacterial activity of CECS was evaluated against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) by using minimum inhibition concentration (MIC). The results showed that the prepared CECS soluble in water at wide range of pH values. In addition, it has amorphous character improve its chemical reactivity than CS itself, in addition it has been showed stronger antibacterial activity than chitosan itself due to the presence of both -COOH and -NH₂ groups and the CECS shows higher antibacterial activity towards S. aureus than E. coli. Finally, the cytotoxicity of CECS has been evaluated through Cell viability assay, which confirm that CECS is non-toxic and tissue compatible like CS.

Effect of high-fat diet-induced obesity on thyroid gland structure in female rats and the possible ameliorating effect of metformin therapy

BACKGROUND

Obesity is known to induce a state of lipotoxicity that affects the different organs of the body. Metformin is an antidiabetic drug commonly used in obesity treatment. It was known to improve thyroid function and its regulating hormones. Structural changes in the thyroid gland associated with obesity have not been well investigated. So, the aim of the present study is to detect structural changes in thyroid gland induced by obesity and to investigate the possible protective role of metformin therapy.

MATERIALS AND METHODS

Thirty adult female albino rats were divided into three groups (10 rats each). Group I (control group), group II (rats fed with a high-fat diet), and group III (rats fed with a high-fat diet and treated with metformin therapy). After 12 weeks, rats from all groups were sacrificed. Blood samples were taken for measurement of lipid profile, thyroid stimulating hormone (TSH), free T3 and free T4. Thyroid glands were extracted and processed for histological and ultrastructural study. Morphometric measurements for the colloid area of thyroid follicles and height of the follicular cells were done.

RESULTS

Group I displayed normal biochemical parameters and architecture of the thyroid gland. Group II revealed disordered lipid profile, high TSH, free T3 and T4. Microscopically, large thyroid follicles with excessive colloid accumulation and decreased follicular cells height were seen. Some follicular cells showed pyknotic nuclei, vacuolated cytoplasm and disrupted basement membrane with mast cell infiltration of the thyroid tissue. Ultrastructurally, group II follicular cells showed loss of apical microvilli, dense shrunken nuclei, dilated endoplasmic reticulum, swollen damaged mitochondria with large intracellular vacuoles and colloid droplets. In group III, the biochemical parameters and structure of thyroid follicles were improved, and they had a near-normal appearance.

CONCLUSIONS

Obesity induced by high-fat diet in female rats structurally and functionally changed the thyroid gland in a way that may explain hypothyroidism associated with obesity. These changes were improved by metformin therapy.

Demographic, clinical and laboratory features of leptospirosis and dengue co-infection in Malaysia

Purpose. In this study, we aim to describe and compare the demographical, clinical and laboratory features of leptospirosis and dengue co-infections (LDCI) against single leptospirosis infections in Malaysia.Methodology. Data of patients admitted to various hospitals in Malaysia from 2011 to 2015 diagnosed with leptospirosis in our laboratory were obtained from their admission records. Co-infection with dengue was determined by collecting dengue serology results. Multivariate analysis and multiple logistic regression were used to differentiate features between single leptospirosis infection and confirmed LDCI.Results/Key findings. Only 602 (29.11 %) out of 2068 leptospira-positive patients were concurrently tested for dengue during their admission in which 44 (7.31 %) patients had positive non-structural protein 1 (confirmed LDCI) while 140 (23.26 %) were positive for dengue IgM (probable LDCI) with the highest number of cases recorded in high-density suburban districts. Myalgia and arthralgia were the only significant distinguishing clinical feature of LDCI while significant laboratory features were thrombocytopenia and high levels of alanine and aspartate transaminases. Only thrombocytopenia displayed a predictive value for LDCI from analysis of multiple logistic regression. Death occurred in 19 (3.16 %) patients in this dataset studied but only three (0.50 %) were attributed to LDCI.Conclusion. There is a considerable prevalence of LDCI in this country of which overlapping demographic, clinical and laboratory presentations pose diagnostic and therapeutic challenges. Efforts to raise awareness regarding LDCI, better access to diagnostic services and further prospective studies are warranted.

ADAMTSL5 and CDH11: putative epigenetic markers for therapeutic resistance in acute lymphoblastic leukemia

BACKGROUND AND OBJECTIVES

DNA hypermethylation has been linked to poor treatment outcome in childhood acute lymphoblastic leukemia (ALL). Genes differentially methylated in the chemoresponsive pre-B-ALL compared to chemoresistant pre-B-ALL cases provide potential prognostic markers.

METHODS

DNA methylation profiles of five B-ALL childhood patients who achieved morphological complete remission (chemoresponsive) and five B-ALL patients who did not (chemoresistant) after induction treatments as well as four normal controls were compared on 27 000 CpG sites microarray chips. Subsequently, methylation-specific polymerase chain reaction (MSP) on selected hypermethylated genes was conducted on an additional 37 chemoresponsive and 9 chemoresistant B-ALL samples and 2 normal controls.

RESULTS

Both methods were found to be highly correlated. Unsupervised principal component analysis showed that the chemotherapy-responsive and -resistant B-ALL patients could be segregated from one another. Selection of segregated genes at high stringency identified two potential genes (CDH11 and ADAMTSL5). MSP analysis on the larger cohort of samples (42 chemoresponsive, 14 chemoresistant B-ALL samples and 6 normal controls) revealed significantly higher rates of hypermethylation in chemoresistant samples for ADAMTSL5 (93 vs. 38%; p = 0.0001) and CDH11 (79% vs. 40%, p < 0.01). All control cases remained unmethylated.

CONCLUSION

Chemoresistant B-ALL patients are associated with increased methylation in ADAMTSL5 and CDH11. These findings need to be validated in a larger group of patients, and the functional biological and prognostic significance of differential methylation needs to be studied further.

The protective role of the opioid antagonist LY255582 in the management of high fat diet-induced obesity in adult male albino rats

OBJECTIVES

The involvement of the opioid system in energy balance has been known for several decades but many questions remain unanswered. Therefore, this study was designed to investigate the effect of the non-selective opioid receptor antagonist (LY255582) on high fat diet (HFD)-induced obesity.

METHODS

Twenty-four adult male albino rats were divided into 4 groups: Control, HFD non-treated, HFD+LY255582 treated during the first 4 weeks and Obese-LY255582- treated groups during the following 4 weeks after the induction of obesity. LY255582 (0.31 mg/kg, s.c.) was administrated daily with HFD feeding. Blood samples were collected for measurement of lipid profile, glucose, insulin, and leptin. Body weight, body mass index (BMI), and food intake were also measured.

RESULTS

Consumption of HFD resulted in a significant increase in body weight, body mass index (BMI), glucose, insulin, leptin levels, and induced a state of dyslipideamia. Opioid antagonist LY255582 administration with HFD decreased food intake, body weight and BMI, in addition to the improvement of HFD related metabolic abnormalities (dyslipidemia and insulin resistance) during the dynamic phase of obesity development than in animals with already developed dietary obesity.

CONCLUSION

The use of opioid antagonist may be a promising approach in treatment of HFD-induced obesity.

Increased soluble HLA-DRB1in B-cell acute lymphoblastic leukaemia

Soluble HLA (sHLA) are potential tumour markers released in order to counter immune surveillance. sHLA-class II is less known especially in acute lymphoblastic leukaemia (ALL). This study aimed to investigate soluble, surface and allelic expression of HLA Class II (sHLA-DR) in B-cell ALL patients and compare with soluble expression in normal individuals. A sandwich enzyme-linked immunosorbent assay (ELISA) was developed to measure soluble HLA-DRB1 in plasma. Flow cytometric analysis was performed to determine median fluorescence intensity in HLA-DR surface expression. HLA-DNA typing by polymerase chain reaction, sequence specific oligonucleotides, PCRSSO was performed to determine HLA-DRB1 type in ALL samples. Results showed sHLA-DRB1 (mean±SEM) was significantly increased (p=0.001) in plasma of ALL patients (0.260 ±0.057 μg/mL; n=30) compared to healthy controls (0.051 ± 0.007µg/mL; n=31) of Malay ethnicity. However, these levels did not correlate with percentage or median fluorescence intensity of HLA-DR expressed on leukemia blasts (CD19+CD34 ± CD45(lo)HLA-DR+) or in the normal B cell population (CD19+CD34- CD45(hi)HLA-DR+) of patients. No significant difference was observed in gender (male/female) or age (paediatric/adult). Only a trend in reduced sHLA was observed in patients carrying HLA-DR04. These results have to be validated with a larger number of samples.

Determinants of stillbirths in katsina, Nigeria: a hospital-based study

Every year, about 3 million stillbirths occur globally, almost a third occurring during the intra-partum period. Almost all stillbirths (98%) occur in low and middle income countries, with Nigeria having the third largest burden. The aim of this study was to determine the stillbirth rate and its determinants in the Federal Medical Centre Katsina, located in north western Nigeria. This study was a retrospective review of all deliveries conducted between 1(st) March 2010 and 31(st) December 2012 in Federal Medical Centre Katsina. Data were extracted from labor room and theatre records, and patient folders. Cases were matched with controls by booking status. The privacy and confidentiality of information retrieved from cases and controls was also ensured by anonymizing the data retrieved. No conflict of interest was identified. The data was analyzed with SPSS 20. During the period under review, there were 6628 deliveries, out of which 331 of the products were stillborn. The stillbirth rate was 46.9±3.6 per 1000 deliveries. Determinants of stillbirths were antepartum hemorrhage, hypertensive disorders of pregnancy, uterine rupture, low birth weight and congenital fetal malformations. The study highlighted the poor perinatal health in the study population.

Roles of cancer registries in enhancing oncology drug access in the Asia-Pacific region

Cancer registries help to establish and maintain cancer incidence reporting systems, serve as a resource for investigation of cancer and its causes, and provide information for planning and evaluation of preventive and control programs. However, their wider role in directly enhancing oncology drug access has not been fully explored. We examined the value of cancer registries in oncology drug access in the Asia-Pacific region on three levels: (1) specific registry variable types; (2) macroscopic strategies on the national level; and (3) a regional cancer registry network. Using literature search and proceedings from an expert forum, this paper covers recent cancer registry developments in eight economies in the Asia-Pacific region - Australia, China, Hong Kong, Malaysia, Singapore, South Korea, Taiwan, and Thailand - and the ways they can contribute to oncology drug access. Specific registry variables relating to demographics, tumor characteristics, initial treatment plans, prognostic markers, risk factors, and mortality help to anticipate drug needs, identify high-priority research area and design access programs. On a national level, linking registry data with clinical, drug safety, financial, or drug utilization databases allows analyses of associations between utilization and outcomes. Concurrent efforts should also be channeled into developing and implementing data integrity and stewardship policies, and providing clear avenues to make data available. Less mature registry systems can employ modeling techniques and ad-hoc surveys while increasing coverage. Beyond local settings, a cancer registry network for the Asia-Pacific region would offer cross-learning and research opportunities that can exert leverage through the experiences and capabilities of a highly diverse region.

Prevalence of vaginal candidiasis among pregnant women with abnormal vaginal discharge in Maiduguri

BACKGROUND

Pregnancy represents a risk factor in the occurrence of vaginal candidiasis.

OBJECTIVES

To determine the prevalence and clinical features associated with abnormal vaginal discharge and C. albicans infection in pregnant women.

METHODS

High vaginal swab samples and data on epidemiological characteristics were collected from 400 pregnant women with complaints of abnormal vaginal discharge at booking clinic of University of Maiduguri Teaching Hospital. The data was analysed using SPSS 16.0 statistical software.

RESULTS

The prevalence of abnormal vaginal discharge in pregnancy was 31.5%. The frequency of abnormal vaginal discharge was 183 (45.8%) among those aged 20-24 years, 291 (72.8%) in multipara, 223 (55.8%) in those with Primary education and 293 (73.2%) in unemployed. Vulval pruritus 300 (75.0%) was significantly related to abnormal vaginal discharge (P < 0.001). The prevalence of C. albicans was 41%. The frequencies of Vulval itching, Dyspareunia and vulval excoriation among those with candidiasis were 151 (50.3%), 14 (56.0%) and 75 (75.0%) respectively (P < 0.001).

CONCLUSION

The prevalence of abnormal vaginal discharge in pregnancy was high in this study and C. albicans was the commonest cause. It is recommended that a pregnant woman complaining of abnormal vaginal discharge be assessed and Laboratory diagnosis done in order to give appropriate treatment.

Pattern of gynaecological malignancies at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

Gynaecological malignancies contribute to the global burden of diseases and are of public health interest. The objective of this study was to determine the pattern of distribution of gynaecological malignancies seen between 1 January 2002 and 31 December 2006, at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. It was a retrospective descriptive study. A total of 166 cases of gynaecological malignancies were encountered, cervical cancer was the most common (59.6%). This was followed by ovarian cancer (21.1%), trophoblastic tumour (7.8%) and corpus uteri cancer (6.0%). Others included cancer of the vulva (3.6%) and cancer of the vagina (1.8%). Squamous cell carcinoma accounted for 96.0% of cervical cancers. Epithelial tumours represented 60.0% of ovarian cancers, and serous cyst adenocarcinoma was the most common histological variety. All the vulval and vaginal cancers were of squamous cell type. In conclusion, genital malignancies are common and cervical cancer remains the leading gynaecological malignancy in this centre.

Maternal deaths: initial report of an on-going monitoring of maternal deaths at the Federal Medical Centre Katsina, Northwest Nigeria

OBJECTIVES

To assess the maternal mortality ratio (MMR) from data collected as maternal deaths occurred over a 4-year period.

METHODS

A Departmental database established in 2008 was used to keep data on deliveries and maternal deaths as they occurred. The causes of death were decided after a meeting reviewed the case. Analysis was done using Microsoft Excel software and results presented in means and frequencies.

RESULTS

Eight thousand two hundred and twenty live deliveries that occurred were complicated by 68 maternal deaths. The MMR was 827/100 000 live births. The MMR for unbooked women was four times higher than for booked women. Obstetric haemorrhage was the main (21.6%) direct cause of death followed by preeclampsia/eclampsia (18.9%). While anaemia was the leading (8.1%) indirect cause of death, tetanus in the puerperium reared its head as an emerging (5.4%) indirect cause of maternal death. None of the women ever used contraceptives. Most deaths occurred in teenage mothers (23.5%), unbooked women (86%) and in the postpartum period (69%).

CONCLUSION

The MMR was high and tetanus in puerperium emerged as an indirect cause of maternal deaths. There is a need to curb the emergence of tetanus in the puerperium as a cause of maternal death.

Treating impaired cognition in schizophrenia

Cognitive impairment is a core feature of schizophrenia that substantially accounts for poor functional outcomes associated with this disease in areas such as work, independent living and social relationships. Until recently, drug development in schizophrenia has focused on developing compounds that mainly target the positive psychotic symptoms of the illness. Although current antipsychotic drugs treat psychosis in schizophrenia rather well, their impact on cognitive dysfunction is minimal. In recent years there has been growing interest in developing novel treatments for cognitive deficits in schizophrenia. In this review we discuss pharmacologic strategies considered most likely to improve cognition. These putative molecular targets include receptors for acetylcholine, dopamine, glutamate, g-aminobutyric acid (GABA), serotonin and histamine. In addition, we propose that not only pharmacological, but also psychological treatments should be considered to enhance cognition in schizophrenia.

The efficacy of 10gram intramuscular loading dose of MgSO(4) in severe preeclampsia/ eclampsia at a tertiary referral centre in Northwest Nigeria

AIMS AND OBJECTIVES

The efficacy of 10g intramuscular loading dose of magnesium sulphate in women with severe preeclampsia/eclampsia was assessed at a tertiary health centre for potential use at primary health level.

SUBJECTS AND METHODS

Intramuscular 10g loading dose and 14g loading dose of Pritchard were compared in women with severe preeclampsia/eclampsia. Primary outcome measures were the occurrence of fits in women with severe preeclampsia, further fits in those with eclampsia and maternal death. Other outcome measures were mode of delivery and severe birth asphyxia at 5 minutes of life.

RESULTS

One hundred and three women were enrolled; 54 and 49 women had 10g and 14g loading dose respectively. No significant convulsions (p= 0.1424) occurred in women with severe preeclampsia who had 10g intramuscular loading dose and repeat convulsion was averted in 93% of women with eclampsia. 10g loading dose did not increase the likelihood of caesarean section in women with preeclampsia (p=0.2832) or eclampsia (p=0.9112). The mean Apgar score at 5 minutes of life of neonates whose mothers had 10g and 14g loading dose for preeclampsia was 8 and 8.46 respectively, and 8.9 and 8.8 respectively for eclampsia. There was no statistically significant difference in maternal death between the two groups for severe preeclampsia (p= 0.2020) and eclampsia (p=0.3496).

CONCLUSION

This study suggests a potential use of intramuscular 10 gram loading dose of MgSO at the primary health care level in Nigeria.

The efficacy of intramuscular loading dose of MgSO4 in severe pre-eclampsia/ eclampsia at a tertiary referral centre in Northwest Nigeria

AIMS AND OBJECTIVES

The efficacy of 10g intramuscular loading dose of magnesium sulphate in women with severe preeclampsia/eclampsia was assessed at a tertiary health centre for potential use at primary health level.

SUBJECTS AND METHODS

Intramuscular 10g loading dose and 14g loading dose of Pritchard were compared in women with severe preeclampsia/eclampsia. Primary outcome measures were the occurrence of fits in women with severe preeclampsia, further fits in those with eclampsia and maternal death. Other outcome measures were mode of delivery and severe birth asphyxia at 5 minutes of life.

RESULTS

One hundred and three women were enrolled; 54 and 49 women had 10g and 14g loading dose respectively. No significant convulsions (p= 0.1424) occurred in women with severe preeclampsia who had 10g intramuscular loading dose and repeat convulsion was averted in 93% of women with eclampsia. 10g loading dose did not increase the likelihood of caesarean section in women with preeclampsia (p=0.2832) or eclampsia (p=0.9112). The mean Apgar score at 5 minutes of life of neonates whose mothers had 10g and 14g loading dose for preeclampsia was 8 and 8.46 respectively, and 8.9 and 8.8 respectively for eclampsia. There was no statistically significant difference in maternal death between the two groups for severe preeclampsia (p= 0.2020) and eclampsia (p=0.3496).

CONCLUSION

This study suggests a potential use of intramuscular 10 gram loading dose of MgSO4 at the primary health care level in Nigeria.

A case-control study on the association between environmental factors and the occurrence of acute leukemia among children in Klang Valley, Malaysia

BACKGROUND

In Malaysia, acute leukemia is the most common cancer among children below the age of 15. A case-control study was here conducted for cases from the Klang Valley, Malaysia, who received treatment at the National University of Malaysia Hospital (HUKM) and Kuala Lumpur General Hospital (GHKL). The main objective was to determine any association with environmental factors.

METHODS

Case subjects were children aged below 15 years and diagnosed with acute leukemia in HUKM and GHKL between January 1, 2001 and May 30, 2007. Control subjects were children aged below 15 years who were diagnosed with any non-cancerous acute illnesses in these hospitals. A total of 128 case subjects and 128 control subjects were enrolled in this study. The information was collected using a structured questionnaire and a global positioning system (GPS) device. All factors were analyzed using unmatched logistic regression.

RESULTS

The analysis showed that the occurrence of acute leukemia among children was strongly determined by the following factors: family income (odds ratio (OR) 0.19, 95% confidence interval (CI): 0.09-0.42), father with higher social contact (OR 7.61, 95% CI: 3.78-15.4), number of elder siblings (OR 0.36, 95% CI: 0.18-0.77), father who smokes (OR 2.78, 95% CI: 1.49-5.16), and the distance of the house from a power line (OR 2.30, 95% CI: 1.18-4.49).

CONCLUSIONS

Some socioeconomic, demographic, and environmental factors are strong predictors of the occurrence of acute leukemia among children in Klang Valley, Malaysia. In terms of environmental factors, it is recommended that future housing areas should be developed at least 200 m away from power lines.

Health Related Quality of Life in Malaysian children with thalassaemia

Background

Health Related Quality of Life (HRQoL) studies on children with chronic illness such as thalassaemia are limited. We conducted the first study to investigate if children with thalassaemia have a lower quality of life in the four dimensions as measured using the PedsQL 4.0 generic Scale Score: physical, emotional, social and role (school) functioning compared to the healthy controls allowing for age, gender, ethnicity and household income.

Methods

The PedsQL 4.0 was administered to children receiving blood transfusions and treatments at Hospital Kuala Lumpur, Malaysia using PedsQL 4.0 generic Scale Score. Accordingly, the questionnaire was also administered to a control group of healthy school children. Socio-demographic data were also collected from patients and controls using an interview schedule designed for the study.

Results

Of the 96 thalassaemia patients approached, 78 gave consent to be interviewed giving a response rate of 81.3%. Out of 235 healthy controls approached, all agreed to participate giving a response rate of 100%. The mean age for the patients and schoolchildren is 11.9 and 13.2 years respectively. The age range for the patients and the schoolchildren is between 5 to 18 years and 7 to 18 years respectively. After controlling for age and demographic background, the thalassaemia patients reported having significantly lower quality of life than the healthy controls.

Conclusion

Thalassaemia has a negative impact on perceived physical, emotional, social and school functioning in thalassaemia patients which was also found to be worse than the children's healthy counterparts. Continuing support of free desferal from the Ministry of Health should be given to these patients. More understanding and support especially from health authorities, school authorities and the society is essential to enhance their quality of life.

The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation

BACKGROUND

The present study provides additional data on the psychometric properties of the 30-item Inventory of Depressive Symptomatology (IDS) and of the recently developed Quick Inventory of Depressive Symptomatology (QIDS), a brief 16-item symptom severity rating scale that was derived from the longer form. Both the IDS and QIDS are available in matched clinician-rated (IDS-C30; QIDS-C16) and self-report (IDS-SR30; QIDS-SR16) formats.

METHOD

The patient samples included 544 out-patients with major depressive disorder (MDD) and 402 out-patients with bipolar disorder (BD) drawn from 19 regionally and ethnicically diverse clinics as part of the Texas Medication Algorithm Project (TMAP). Psychometric analyses including sensitivity to change with treatment were conducted.

RESULTS

Internal consistencies (Cronbach's alpha) ranged from 0.81 to 0.94 for all four scales (QIDS-C16, QIDS-SR16, IDS-C30 and IDS-SR30) in both MDD and BD patients. Sad mood, involvement, energy, concentration and self-outlook had the highest item-total correlations among patients with MDD and BD across all four scales. QIDS-SR16 and IDS-SR30 total scores were highly correlated among patients with MDD at exit (c = 0.83). QIDS-C16 and IDS-C30 total scores were also highly correlated among patients with MDD (c = 0.82) and patients with BD (c = 0.81). The IDS-SR30, IDS-C30, QIDS-SR16, and QIDS-C16 were equivalently sensitive to symptom change, indicating high concurrent validity for all four scales. High concurrent validity was also documented based on the SF-12 Mental Health Summary score for the population divided in quintiles based on their IDS or QIDS score.

CONCLUSION

The QIDS-SR16 and QIDS-C16, as well as the longer 30-item versions, have highly acceptable psychometric properties and are treatment sensitive measures of symptom severity in depression.

Acceleration of curing period of pastrami manufactured from buffalo meat: Chemical and microbiological properties

Usually the curing period of meat used for pastrami manufacture is three weeks at room temperature. In the present work a trial aimed to accelerate the curing period of pastrami (dry cured meat) prepared from buffalo lean round muscles by heat treatment (approximately 71 degrees C--internal; for partial drying) was carried out to investigate the probable changes during processing and in quality parameters of the end product. Results showed that pH value and the residual NaNO2 content decreased, while lactic acid and conversion in meat pigment percentages were increased. The determined data indicated remarkable decrease of moisture content during aging and curing periods, while the NaCl content in the investigated product was noticeably increased. During pastrami processing soluble proteins were decreased; the sarcoplasmic protein fraction denatured more rapidly than myofibrillar protein. On the other hand, the non-protein nitrogen and the insoluble protein nitrogen were increased gradually during ageing and after the heat treatment step. Slight variations in their values were observed during ripening of pastrami (complete curing and drying in air at room temperature up to 6 days). Heat treatment caused apparent decrease in Aerobic Plate Count (APC). Salmonella and Coliform bacteria were not detected through meat curing and in the end product. The suggested heat-treated pastrami was of good quality and nearly similar to the traditional sample.

Ionotropic glutamate receptor binding and subunit mRNA expression in thalamic nuclei in schizophrenia

OBJECTIVE

Both thalamic and glutamatergic dysfunction have been implicated in the pathophysiology of schizophrenia. The authors examined ionotropic glutamate receptor expression in postmortem samples from patients with schizophrenia and comparison subjects, using the hypothesis that glutamate receptor expression differs in limbic nuclei of the thalamus in schizophrenia.

METHOD

N-Methyl-D-aspartate (NMDA), AMPA, and kainate receptor expression was determined in six thalamic nuclei from 12 subjects with DSM-III-R diagnoses of schizophrenia and eight psychiatrically normal individuals. The authors used in situ hybridization to determine NMDAR1, NMDAR2A-NMDAR2D, gluR1-gluR7, KA1, and KA2 subunit mRNA levels and receptor autoradiography to determine binding to glutamate binding sites of the three receptor subtypes and to the glycine, polyamine, and ion channel binding sites of the NMDA receptor.

RESULTS

Glutamate receptor expression was lower at both transcriptional (NMDAR1, NMDAR2B, NMDAR2C, gluR1, gluR3, and KA2 subunit mRNAs) and posttranscriptional ([(3)H]ifenprodil and [(3)H]MDL105,519 binding to polyamine and glycine sites of the NMDA receptor) levels in the thalamus in patients with schizophrenia than in comparison subjects, but differences were most prominent in nuclei with reciprocal projections to limbic regions.

CONCLUSIONS

Abnormalities in NMDA, AMPA, and kainate receptor expression in limbic thalamus are suggestive of the NMDA receptor hypoactivity hypothesis of schizophrenia and are consistent with diminished glutamatergic activity in the thalamus in schizophrenia. Alternatively, these results could suggest abnormal glutamatergic innervation in afferent and/or efferent regions, which are limbic structures that have been implicated in this illness. These results may provide a neurochemical anatomical substrate for antipsychotic therapies targeting ionotropic glutamate receptors.

Placental transfusion: umbilical cord clamping and preterm infants

OBJECTIVE

To investigate the clinical effects of early versus late cord clamping in preterm infants.

STUDY DESIGN

A total of 32 premature infants were prospectively randomized. The following parameters were measured: Initial spun hematocrit (Hct), hemoglobin (Hgb), red blood cell (RBC) counts, frequency of blood transfusions, peak serum bilirubin, mean blood pressure (MBP), oxygen index, intraventricular hemorrhage, and significant patent ductus arteriosus (PDA).

RESULTS

Over the 4-week study period, the delayed cord clamping (DCC) group exhibited a decrease in the frequency of blood transfusion (p < 0.001) and also a decrease in albumin transfusions over the first 24 hours (p < 0.03). MBP in the first 4 hours was higher in the DCC group (p < 0.01), and there were statistically significant increases in Hct (21%), Hgb (23%), and RBC count (21%) compared with the early cord clamping group. The risks of patent ductus arteriosus, hyperbilirubinemia, or intraventricular hemorrhage were similar in both groups. Late clamping of the umbilical cord had little or no effect on the oxygen index.

CONCLUSION

DCC significantly reduced the requirement for blood and albumin transfusion. It also increased the initial Hct, RBC count, Hgb levels, and MBP.

Nucleus-specific expression of ionotropic glutamate receptor subunit mRNAs and binding sites in primate thalamus

Thalamic afferents and efferents utilize glutamate as their primary neurotransmitter. There are four families of glutamate receptors that can transduce this activity, as well as regulate glutamate release from thalamic relay neurons. The three ionotropic subtypes are of particular importance, because subunit composition confers variability in functional properties of each subtype. We have quantified the expression of NMDA, AMPA and kainate receptors in the thalamus of the macaque using receptor autoradiography and in situ hybridization. NMDA receptors are multimeric associations of NR1 and NR2A-NR2D subunits that form ligand-gated ion channels. Particular subunits are associated with modulatory binding sites that affect receptor activity. NR1 was the most abundant subunit mRNA; NR2A, NR2B, and NR2D subunit mRNAs were also present, but were expressed in nucleus-specific patterns. Very high levels of [3H]ifenprodil binding to the polyamine site of the NMDA complex were detected in a fairly homogeneous distribution. Binding of the ion channel ligand [3H]MK-801 was also abundant, and limbic nuclei expressed higher levels than motor nuclei or the reticular nucleus. [3H]CGP39653 binding to the glutamate site of the NMDA receptor was the least abundant of the NMDA receptor binding sites. There was variability in the stoichiometric relationships of binding sites across nuclei, suggesting that there is heterogeneity in the pharmacological properties of NMDA receptors expressed in the thalamus. AMPA and kainate are also multimeric associations of specific subunits that form ligand-gated ion channels. These subunits are encoded by specific genes: gluR1-gluR4 for AMPA receptors, and gluR5-gluR7 and KA1-KA2 for kainate receptors. GluR4 and gluR6 mRNAs were, respectively the most abundant of the AMPA and kainate receptor subunit transcripts. Both AMPA and kainate receptor subunit transcripts were expressed in a nucleus-specific pattern. The binding of [3H]kainate was higher than that of [3H]AMPA throughout the thalamus, but AMPA subunit mRNA levels were three to five orders of magnitude higher than those encoding the kainate receptor subunits. The mismatch between the levels of expression of kainate receptor subunit transcripts and binding sites is suggestive of a presynaptic localization of kainate receptors on thalamic afferents. These results suggest that ionotropic glutamate receptors are heterogeneously expressed in the thalamus of the primate, and that their differential expression is both subunit- and nucleus-specific.

Microbial hazard of salted OM El-Kholoul (wedge shell Donax trunculus)

Sixty samples of salted OM El-Kholoul were collected from different localities in Giza, Alexandria and Ismailia. The samples were examined organoleptically and bacteriological examination of samples were performed for enumeration of aerobic, Enterobacteriaceae, Staph. aureus, Enterococci counts as well as isolation and identification of Vibrio parahaemolyticus. The mean counts/gm of aerobes, Enterobacteriaceae, Staph. aureus, Strept. faecalis and Strept. faecum were 4.9 x 10(5), 4.8 x 10(4), 1.9 x 10(5), 1.5 x 10(5) and 8 x 10(2), respectively. V. parahaemolyticus was isolated from all examined samples. Moreover, the weight, pH and sodium chloride percentage of ten samples were estimated. Trial was done to investigate the inhibitory effect of lemon juice (Citrus aurantifolia) on the microbial load of Om El-Kholoul, where the inhibitory effect of this juice was noticed. The public health significance of isolated microorganisms was discussed, moreover the suggestive measures for improvement of the microbial quality of the product were mentioned.

Head growth in cocaine-exposed infants: relationship to neonate hair level

Intrauterine brain growth retardation is the most common brain abnormality in infants of cocaine-abusing mothers. We report a cross-sectional study of "at-risk" pregnancies with 34 infants born to mothers urine positive for cocaine at delivery compared to 33 infants born to urine-negative mothers from the same clinic. Degree of cocaine exposure was assessed by radioimmunoassay of combined cocaine and benzoylecgonine (BE) levels in neonatal hair samples. Twenty-eight neonates were hair-positive for BE (mean 2507.40 +/- 1248.88 ng/g hair; range 716 to 5440 ng/g) and differed significantly from the control infants (n = 33) in head circumference and head growth percentiles. A negative correlation approaching significance was found between mean BE and head circumference (r = -.36; p < .06) in the group of newborns with hair positive for BE (n = 28). The study demonstrates for the first time head growth abnormalities in association with levels of cocaine exposure.