Stunting and food insecurity among children from low socioeconomic family during COVID-19 pandemic in urban area in Selangor

INTRODUCTION

Food insecurity is often link with nutritional status. An increased rate of food insecurity can have a severe impact on children's growth. During the COVID-19 outbreak, little is known regarding its effect on food security and nutritional status, especially concerning vulnerable groups such as children. The purpose of this study was to assess household food security status, children's nutritional status along with their association, and the determinants of food insecurity during the COVID-19 pandemic.

MATERIALS AND METHODS

This cross-sectional study was conducted from May to July 2022 in urban areas in Selangor among children aged less than two years old from B40 households using purposive sampling through both online surveys and face-to-face interviews. There were 112 children aged < 2 years old from B40 households participating in this study. The data obtained on maternal sociodemographic, Household Food Insecurity Scale (HFIAS), and children's anthropometric measurements were analysed by using the WHO Anthro Survey, descriptive analysis, Person's Chisquare test and Fischer's exact test.

RESULTS

The prevalence of food insecurity was more significant than the prevalence of food secured, at 55.4% and 44.6% respectively. The stunting among the children rated at 34.8%, followed by 7.2% of the sample found underweight, 7.8% (BAZ) and 16.1% (BAZ) of them were wasted, and overweight & obese, proportionately. This study discovered that household size was the sole determinant of household food security status. This finding suggested that size of a household influenced the odds of a household being food insecure.

CONCLUSION

The findings of this study provide insights into how the COVID-19 pandemic have an impact on children's nutritional status especially those from low-income and bigger size households. Therefore, more thorough and effective interventions should be designed particularly targeting this urban poor community to enhance their nutritional status and health.

Post-cardiac surgery outcomes following COVID-19 infection in unvaccinated patients

The provision of cardiac surgery services nationwide has been affected by the COVID-19 pandemic. We noticed a high COVID-19 mortality rate in unvaccinated patients who were diagnosed with COVID-19 after recent cardiac surgery. All the patients were tested negative for COVID-19 before surgery. We conducted a review of our hospital data and reported our findings. We identified 15 patients and reported 7 deaths (46.7%). All the patients died from COVID-19 or its complications. We recommend that cardiac centres actively promote vaccination before cardiac surgery and also enhance infection control measures to prevent nosocomial infections.

Epidemiology and clinical profiles of cutaneous graft versus host disease in allogeneic peripheral blood stem cell transplantation

INTRODUCTION

The epidemiology of cutaneous graft versus host disease (GVHD) in allogeneic peripheral blood stem cell transplantation (PBSCT) in Malaysia has not been described.

MATERIALS AND METHODS

We retrospectively analysed 691 allogeneic PBSCT patients between 2010-2017 in two centers.

RESULTS

The prevalence of cutaneous GVHD was 31.4% (217/691). No associations were detected with race, age or gender of donor and recipients. Cutaneous GVHD was associated with host cytomegalovirus (CMV) seropositivity (p<0.01), conditioning (p<0.01), GVHD prophylaxis (p=0.046) and survival (p<0.01). Majority developed the acute form (58.1%;126/217). Biopsies in 20.7% (45/217) showed 55.6% positivity for GVHD. Overall, involvement was non-severe. A majority demonstrated complete response (CR) to first-line corticosteroids (70.0%;152/217). Secondline therapies (extracorporeal phototherapy (ECP), psolaren ultraviolet A (PUVA), mycophenolate, tumour necrosis factor (TNF) inhibitors, interleukins inhibitors, or CD20 monoclonal antibodies) were required in 65/217, with 38.5% CR. Second-line therapy was associated with gender (p=0.042), extra-cutaneous GVHD (p=0.021), treatment outcomes (p=0.026) and survival (p=0.048). Mortality in cutaneous GVHD was 24.0% with severe sepsis being the leading cause at Day 100 (7.8%) and 5-years (7.8%), and relapsed disease at 2-years (32.7%). In steroid refractoriness, severe GVHD caused 30.8% mortality. In cutaneous GVHD, survival at Day 100 was 95.4%; 80.2% at 2-years and 73.1% at 5-years. The median survival in cutaneous GVHD was significantly shorter at 55 months, compared to those without GVHD at 69 months (p=0.001).

CONCLUSION

Cutaneous involvement is the commonest clinical manifestation of GVHD. A larger national study is warranted to further analyse severity and outcome of multiorgan GVHD, and factors associated with steroid refractoriness.

Multicentre study to establish interpretive criteria for clofazimine drug susceptibility testing

<sec id="st1"> <title>OBJECTIVE</title> To conduct a multicentre study to establish the critical concentration (CC) for clofazimine (CFZ) for drug susceptibility testing (DST) of Mycobacterium tuberculosis on the MGIT™960™ system using the distribution of minimum inhibitory concentrations (MIC) and genotypic analyses of Rv0678 mutations. </sec> <sec id="st2"> <title>DESIGN</title> In phase I of the study, the MIC distribution of laboratory strains (H37Rv and in vitro-selected Rv0678 mutants) and clinical pan-susceptible isolates were determined (n = 70). In phase II, a tentative CC for CFZ (n = 55) was proposed. In phase III, the proposed CC was validated using clinical drug-resistant tuberculosis (DR-TB) isolates stratified by Rv0678 mutation (n = 85). </sec> <sec id="st3"> <title>RESULTS AND CONCLUSION</title> The MIC distribution of CFZ for laboratory and clinical pan-susceptible strains ranged between 0.125 μg/ml and 0.5 μg/ml. As the MIC values of DR-TB isolates used for phase II ranged between 0.25 μg/ml and 1 μg/ml, a CC of 1 μg/ml was proposed. Validation of the CC in phase III showed that probably susceptible and probably resistant Rv0678 mutants overlapped at 1 μg/ml. We therefore recommend a CC of 1 μg/ml, with additional testing at 0.5 μg/ml to define an intermediate category. This was the first comprehensive study to establish a CC for routine phenotypic DST of CFZ using the MGIT960 system to guide therapeutic decisions. </sec>.

Microvascular Dysfunction in Dilated Cardiomyopathy: A Quantitative Stress Perfusion Cardiovascular Magnetic Resonance Study

OBJECTIVES

This study sought to quantify myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) in dilated cardiomyopathy (DCM) and examine the relationship between myocardial perfusion and adverse left ventricular (LV) remodeling.

BACKGROUND

Although regarded as a nonischemic condition, DCM has been associated with microvascular dysfunction, which is postulated to play a role in its pathogenesis. However, the relationship of the resulting perfusion abnormalities to myocardial fibrosis and the degree of LV remodeling is unclear.

METHODS

A total of 65 patients and 35 healthy control subjects underwent adenosine (140 μg/kg/min) stress perfusion cardiovascular magnetic resonance with late gadolinium enhancement imaging. Stress and rest MBF and MPR were derived using a modified Fermi-constrained deconvolution algorithm.

RESULTS

Patients had significantly higher global rest MBF compared with control subjects (1.73 ± 0.42 ml/g/min vs. 1.14 ± 0.42 ml/g/min; p < 0.001). In contrast, global stress MBF was significantly lower versus control subjects (3.07 ± 1.02 ml/g/min vs. 3.53 ± 0.79 ml/g/min; p = 0.02), resulting in impaired MPR in the DCM group (1.83 ± 0.58 vs. 3.50 ± 1.45; p < 0.001). Global stress MBF (2.70 ± 0.89 ml/g/min vs. 3.44 ± 1.03 ml/g/min; p = 0.017) and global MPR (1.67 ± 0.61 vs. 1.99 ± 0.50; p = 0.047) were significantly reduced in patients with DCM with LV ejection fraction ≤35% compared with those with LV ejection fraction >35%. Segments with fibrosis had lower rest MBF (mean difference: -0.12 ml/g/min; 95% confidence interval: -0.23 to -0.01 ml/g/min; p = 0.035) and lower stress MBF (mean difference: -0.15 ml/g/min; 95% confidence interval: -0.28 to -0.03 ml/g/min; p = 0.013).

CONCLUSIONS

Patients with DCM exhibit microvascular dysfunction, the severity of which is associated with the degree of LV impairment. However, rest MBF is elevated rather than reduced in DCM. If microvascular dysfunction contributes to the pathogenesis of DCM, then the underlying mechanism is more likely to involve stress-induced repetitive stunning rather than chronic myocardial hypoperfusion.

Stature estimation in the South-East Asian population: A systematic review

INTRODUCTION

Stature estimation is population dependent, and population-specific regression equations should be generated for accurate anthropological assessments. Nevertheless, stature estimation data was inaccessible and limited in some of the South-East Asian countries. The systematic review was conducted to analyse the regression equations of stature estimations developed in South-East Asian region.

MATERIALS AND METHODS

A systematic literature search was performed through SCOPUS database and Google Scholar from January till March 2018. All published articles which developed stature estimation from different types of bone, methods and type of statures (i.e. living stature, forensic stature and cadaveric stature) were included in this study. Risks of biases were also assessed. Population studies with no regression equations were excluded from the study.

RESULTS

Seven studies that met the inclusion criteria were identified. In the South-East Asia region, regression equations for stature estimation were developed in Thailand and Malaysia. In these studies, bone measurements were done either by radiography, direct bone measurement, or palpation on body surface for anatomical bony prominence. All of these studies used various parts of bones for stature estimation.

CONCLUSION

The most widely used regression equations for stature estimation in South-East Asian population were from the Thailand population. Further research is recommended to develop regression equations for other South-East Asian countries.

Implication of CDKAL1 single-nucleotide polymorphism rs 9465871 in obese and non-obese Egyptian children

INTRODUCTION

CDKAL1 single-nucleotide polymorphism rs 9465871variant is a risk locus for Type 2 Diabetes (T2DM).The study evaluated the associations of CDKAL1- rs9465871 with glycosylated hemoglobin A1C Level (HbA1c), fasting insulin level, insulin resistance and metabolic syndrome among obese and non- obese Egyptian children.

MATERIALS AND METHODS

The study included 43 obese children and 40 normal weight children. Anthropometric body measurements, bio-specimen and biochemistry assays were done. Genotyping of rs9465871 (CDKAL1) was conducted.

RESULTS

The percentages of the CC, CT, and TT genotypes of rs9465871in the lean children were 15%, 42.5%, and 42.5%, respectively. Regarding obese children, the frequencies were 18.6%, 58.1% and 23.3% respectively with no significant statistical difference. Comparison between the CDKAL1 rs 9465871 polymorphism showed that the highest value of fasting insulin was recorded in CC genotype (22.80± 15.18 [uIU/mL] P<.014). Levels of HOMA-IR, FBS and HBA1C were highest in CC group with no statistical significant differences. However, fasting insulin level was higher in the CC group than in the TT+ CT group (P<.01). A higher level of HbA1c was found among CC group at CDKAL1-rs9465871 (5.9%) than TT+CT genotype group (5.6%), with no statistical significant difference. There was increase in the risk of type 2 diabetes the percentages were 78.6% and 46.4% respectively when comparing CC with TT+CT genotype groups ( P<.039). CC group was not associated with significant increase in metabolic syndrome.

CONCLUSION

There is a significant risk association between CDKAL1-rs9465871polymorphism and development of T2DM in a subset of the Egyptian children.

In vitro approaches for generation of Mycobacterium tuberculosis mutants resistant to bedaquiline, clofazimine or linezolid and identification of associated genetic variants

Bedaquiline, clofazimine and linezolid are pertinent drugs for drug-resistant tuberculosis. Drug-resistant mutants provide insight into important resistance acquisition mechanisms. Methods for in vitro Mycobacterium tuberculosis mutant generation are poorly described. Induction (serial passaging) and spontaneous (adapted Luria-Delbrück assay) approaches using M. tuberculosis ATCC reference strains (one fully-susceptible, four unique mono-resistant) were performed. Mutant MIC values were confirmed (MGIT960) and resultant RAVs compared between approaches and to a catalog of previously published RAVs. Mutant MIC values showed a 3-4-fold (induced) and a 1-4-fold (spontaneous) increase compared to baseline. The pyrazinamide-resistant strain had higher baseline MIC values and acquired resistance (≥4-fold) in fewer passages than other strains (induction approach) for bedaquiline. Previously described and novel RAVs in atpE (8 vs. 1) and rv0678 (4 vs. 12) genes were identified in bedaquiline- and clofazimine-resistant mutants. No rv1979c and rv2535c RAVs were identified. Previously described RAVs were identified in rplC and rrl genes for linezolid-resistant mutants. Both approaches successfully led to in vitro mutants with novel RAVs being described in atpE and rv0678 genes. It was observed that pre-existing resistance may influence mutant phenotypic and genotypic characteristics and warrants further attention.

Autologous mononuclear cells from different sources are seen to improve wound healing in patients with haematological malignancies

INTRODUCTION

Immunosuppressive state due to haematological malignancies and chemotherapy may cause disruption to wound healing despite optimum conventional treatment and standard wound dressing. Non-healing wounds are predisposed to infection whereas chemotherapy dose reductions or interruptions are associated with poor survival.

BACKGROUND

Mononuclear cells contain progenitor cells including haematopoietic and mesenchymal stem cells, endothelial progenitor cells and fibroblasts which facilitate wound healing through cytokines, growth factor secretions, cell-cell interactions and provision of extracellular matrix scaffolding. Clinical applications of autologous mononuclear cells therapy in wound healing in non-malignant patients with critical limb ischaemia have been reported with remarkable outcome.

METHODS

We report three patients with haematological malignancies undergoing chemotherapy, who received autologous mononuclear cells implantation to treat non-healing wound after optimum conventional wound care. The sources of mononuclear cells (MNC) were from bone marrow (BM), peripheral blood (PB) and mobilised PB cells (mPB-MNC) using granulocyte colony stimulating factor (G-CSF). The cells were directly implanted into wound and below epidermis. Wound sizes and adverse effects from implantation were assessed at regular intervals.

RESULTS

All patients achieved wound healing within three months following autologous mononuclear cells implantation. No implantation adverse effects were observed.

CONCLUSIONS

Autologous mononuclear cells therapy is a feasible alternative to conventional wound care to promote complete healing in non-healing wounds compounded by morbid factors such as haematological malignancies, chemotherapy, diabetes mellitus (DM), infections and prolonged immobility.

Molecular detection of Mycobacterium tuberculosis from sputum transported in PrimeStore(®) from rural settings

SETTING

Mopani District, South Africa.

OBJECTIVE

To explore remote, molecular detection of Mycobacterium tuberculosis from sputum transported using PrimeStore(®) Molecular Transport Medium (PS-MTM) compared to settings where microscopy or Xpert(®) MTB/RIF is used as the baseline test.

DESIGN

Two sputum specimens were collected from patients with cough of ⩾ 2 weeks at clinics in rural South Africa. Shortly after expectoration and before processing using Xpert, microscopy and liquid culture, a flocked swab was swirled in each of these specimens and placed in PS-MTM. Swabs were stored and transported to the United States at ambient temperature for real-time PrimeMix(®) polymerase chain reaction (PM-PCR).

RESULTS

Of 132 patients, 23 (17%) were positive on microscopy, 39 (30%) on Xpert and 44 (33%) by PS-MTM/PM-PCR. Concordance of PS-MTM/PM-PCR with positive microscopy and Xpert was respectively 96% and 85%. Of 107 microscopy-negative samples, 22 (21%) were positive using PS-MTM/PM-PCR, while 11/91 (12%) Xpert-negative samples were PS-MTM/PM-PCR-positive. PS-MTM/PM-PCR positivity was significantly higher than smear microscopy positivity (P < 0.001), but similar to Xpert (P = 0.33).

CONCLUSION

PCR testing of specimens transported in PS-MTM would enhance TB diagnosis in settings where smear microscopy is the baseline diagnostic test, and could provide an alternative in settings where Xpert testing is not available.

Surgical ventricular reconstruction and subendocardial resection for the treatment of refractory ventricular tachycardia

We describe a case of 64-year-old female patient with ventricular tachycardia intractable to medical treatment and acute heart failure following myocardial infarction. Emergency surgical ventricular reconstruction and subendocardial resection was undertaken. We discuss the option of surgical intervention in this difficult and unusual clinical scenario.

Hepcidin levels in diabetes mellitus and polycystic ovary syndrome

AIM

Increased body iron is associated with insulin resistance. Hepcidin is the key hormone that negatively regulates iron homeostasis. We hypothesized that individuals with insulin resistance have inadequate hepcidin levels for their iron load.

METHODS

Serum concentrations of the active form of hepcidin (hepcidin-25) and hepcidin:ferritin ratio were evaluated in participants with Type 2 diabetes (n = 33, control subjects matched for age, gender and BMI, n = 33) and participants with polycystic ovary syndrome (n = 27, control subjects matched for age and BMI, n = 16). To investigate whether any changes observed were associated with insulin resistance rather than insulin deficiency or hyperglycaemia per se, the same measurements were made in participants with Type 1 diabetes (n = 28, control subjects matched for age, gender and BMI, n = 30). Finally, the relationship between homeostasis model assessment of insulin resistance and serum hepcidin:ferritin ratio was explored in overweight or obese participants without diabetes (n = 16).

RESULTS

Participants with Type 2 diabetes had significantly lower hepcidin and hepcidin:ferritin ratio than control subjects (P < 0.05 and P < 0.01, respectively). Participants with polycystic ovary syndrome had a significantly lower hepcidin:ferritin ratio than control subjects (P < 0.05). There was no significant difference in hepcidin or hepcidin:ferritin ratio between participants with Type 1 diabetes and control subjects (P = 0.88 and P = 0.94). Serum hepcidin:ferritin ratio inversely correlated with homeostasis model assessment of insulin resistance (r = -0.59, P < 0.05).

CONCLUSION

Insulin resistance, but not insulin deficiency or hyperglycaemia per se, is associated with inadequate hepcidin levels. Reduced hepcidin concentrations may cause increased body iron stores in insulin-resistant states.

The prevalence and prognostic significance of right ventricular systolic dysfunction in nonischemic dilated cardiomyopathy

BACKGROUND

Cardiovascular magnetic resonance is the gold-standard technique for the assessment of ventricular function. Although left ventricular volumes and ejection fraction are strong predictors of outcome in dilated cardiomyopathy (DCM), there are limited data regarding the prognostic significance of right ventricular (RV) systolic dysfunction (RVSD). We investigated whether cardiovascular magnetic resonance assessment of RV function has prognostic value in DCM.

METHODS AND RESULTS

We prospectively studied 250 consecutive DCM patients with the use of cardiovascular magnetic resonance. RVSD, defined by RV ejection fraction≤45%, was present in 86 (34%) patients. During a median follow-up period of 6.8 years, there were 52 deaths, and 7 patients underwent cardiac transplantation. The primary end point of all-cause mortality or cardiac transplantation was reached by 42 of 86 patients with RVSD and 17 of 164 patients without RVSD (49% versus 10%; hazard ratio, 5.90; 95% confidence interval [CI], 3.35-10.37; P<0.001). On multivariable analysis, RVSD remained a significant independent predictor of the primary end point (hazard ratio, 3.90; 95% CI, 2.16-7.04; P<0.001), as well as secondary outcomes of cardiovascular mortality or cardiac transplantation (hazard ratio, 3.35; 95% CI, 1.76-6.39; P<0.001), and heart failure death, heart failure hospitalization, or cardiac transplantation (hazard ratio, 2.70; 95% CI, 1.32-5.51; P=0.006). Assessment of RVSD improved risk stratification for all-cause mortality or cardiac transplantation (net reclassification improvement, 0.31; 95% CI 0.10-0.53; P=0.001).

CONCLUSIONS

RVSD is a powerful, independent predictor of transplant-free survival and adverse heart failure outcomes in DCM. Cardiovascular magnetic resonance assessment of RV function is important in the evaluation and risk stratification of DCM patients.

Clinical utility and prognostic value of left atrial volume assessment by cardiovascular magnetic resonance in non-ischaemic dilated cardiomyopathy

AIMS

Echocardiographic studies have shown that left atrial volume (LAV) predicts adverse outcome in small heart failure (HF) cohorts of mixed aetiology. However, the prognostic value of LAV in non-ischaemic dilated cardiomyopathy (DCM) is unknown. Cardiovascular magnetic resonance (CMR) allows accurate and reproducible measurement of LAV. We sought to determine the long-term prognostic significance of LAV assessed by CMR in DCM.

METHODS AND RESULTS

We measured LAV indexed to body surface area (LAVi) in 483 consecutive DCM patients referred for CMR. Patients were prospectively followed up for a primary endpoint of all-cause mortality or cardiac transplantation. During a median follow-up of 5.3 years, 75 patients died and 9 underwent cardiac transplantation. After adjustment for established risk factors, LAVi was an independent predictor of the primary endpoint [hazard ratio (HR) per 10 mL/m(2) 1.08; 95% confidence interval (CI) 1.01-1.15; P = 0.022]. LAVi was also independently associated with the secondary composite endpoints of cardiovascular mortality or cardiac transplantation (HR per 10 mL/m(2) 1.11; 95% CI 1.04-1.19; P = 0.003), and HF death, HF hospitalization, or cardiac transplantation (HR per 10 mL/m(2) 1.11; 95% CI 1.04-1.18; P = 0.001). The optimal LAVi cut-off value for predicting the primary endpoint was 72 mL/m(2). Patients with LAVi >72 mL/m(2) had a three-fold elevated risk of death or transplantation (HR 3.00; 95% CI 1.92-4.70; P < 0.001). LAVi provided incremental prognostic value for the prediction of transplant-free survival (net reclassification improvement 0.17; 95% CI 0.05-0.29; P = 0.002).

CONCLUSIONS

LAVi is a powerful independent predictor of transplant-free survival and HF outcomes in DCM. Assessment of LAV improves risk stratification in DCM and should be incorporated into routine CMR examination.

Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy

IMPORTANCE

Risk stratification of patients with nonischemic dilated cardiomyopathy is primarily based on left ventricular ejection fraction (LVEF). Superior prognostic factors may improve patient selection for implantable cardioverter-defibrillators (ICDs) and other management decisions.

OBJECTIVE

To determine whether myocardial fibrosis (detected by late gadolinium enhancement cardiovascular magnetic resonance [LGE-CMR] imaging) is an independent and incremental predictor of mortality and sudden cardiac death (SCD) in dilated cardiomyopathy.

DESIGN, SETTING, AND PATIENTS

Prospective, longitudinal study of 472 patients with dilated cardiomyopathy referred to a UK center for CMR imaging between November 2000 and December 2008 after presence and extent of midwall replacement fibrosis were determined. Patients were followed up through December 2011.

MAIN OUTCOME MEASURES

Primary end point was all-cause mortality. Secondary end points included cardiovascular mortality or cardiac transplantation; an arrhythmic composite of SCD or aborted SCD (appropriate ICD shock, nonfatal ventricular fibrillation, or sustained ventricular tachycardia); and a composite of HF death, HF hospitalization, or cardiac transplantation.

RESULTS

Among the 142 patients with midwall fibrosis, there were 38 deaths (26.8%) vs 35 deaths (10.6%) among the 330 patients without fibrosis (hazard ratio [HR], 2.96 [95% CI, 1.87-4.69]; absolute risk difference, 16.2% [95% CI, 8.2%-24.2%]; P < .001) during a median follow-up of 5.3 years (2557 patient-years of follow-up). The arrhythmic composite was reached by 42 patients with fibrosis (29.6%) and 23 patients without fibrosis (7.0%) (HR, 5.24 [95% CI, 3.15-8.72]; absolute risk difference, 22.6% [95% CI, 14.6%-30.6%]; P < .001). After adjustment for LVEF and other conventional prognostic factors, both the presence of fibrosis (HR, 2.43 [95% CI, 1.50-3.92]; P < .001) and the extent (HR, 1.11 [95% CI, 1.06-1.16]; P < .001) were independently and incrementally associated with all-cause mortality. Fibrosis was also independently associated with cardiovascular mortality or cardiac transplantation (by fibrosis presence: HR, 3.22 [95% CI, 1.95-5.31], P < .001; and by fibrosis extent: HR, 1.15 [95% CI, 1.10-1.20], P < .001), SCD or aborted SCD (by fibrosis presence: HR, 4.61 [95% CI, 2.75-7.74], P < .001; and by fibrosis extent: HR, 1.10 [95% CI, 1.05-1.16], P < .001), and the HF composite (by fibrosis presence: HR, 1.62 [95% CI, 1.00-2.61], P = .049; and by fibrosis extent: HR, 1.08 [95% CI, 1.04-1.13], P < .001). Addition of fibrosis to LVEF significantly improved risk reclassification for all-cause mortality and the SCD composite (net reclassification improvement: 0.26 [95% CI, 0.11-0.41]; P = .001 and 0.29 [95% CI, 0.11-0.48]; P = .002, respectively).

CONCLUSIONS AND RELEVANCE

Assessment of midwall fibrosis with LGE-CMR imaging provided independent prognostic information beyond LVEF in patients with nonischemic dilated cardiomyopathy. The role of LGE-CMR in the risk stratification of dilated cardiomyopathy requires further investigation.

Assessment of patient safety culture among healthcare providers at a teaching hospital in Cairo, Egypt

A previous study in Cairo, Egypt highlighted the need to improve the patient safety culture among health-care providers at Ain Shams University hospitals. This descriptive cross-sectional study assessed healthcare providers' perceptions of patient safety culture within the organization and determined factors that played a role in patient safety culture. A representative sample of 510 physicians, nurses, pharmacists, technicians and labourers in different departments answered an Arabic version of the Agency of Healthcare Research and Quality hospital survey for patient safety culture. The highest mean composite positive score among the 12 dimensions was for the organizational learning for continuous improvement (78.2%), followed by teamwork (58.1%). The lowest mean score was for the dimension of non-punitive response to error (19.5%). Patient safety culture still has many areas for improvement that need continuous evaluation and monitoring to attain a safe environment both for patients and health-care providers.

Evaluation of the GenoType® MTBDRsl assay for susceptibility testing of second-line anti-tuberculosis drugs

BACKGROUND

The GenoType® MTBDRsl assay is a new rapid assay for the detection of resistance to second-line anti-tuberculosis drugs.

OBJECTIVE

To evaluate the MTBDRsl assay on 342 multidrug-resistant tuberculosis isolates for resistance to ofloxacin (OFX), kanamycin (KM), capreomycin (CPM) and ethambutol (EMB), to compare the results to the agar proportion method, and to test discrepant results using DNA sequencing.

RESULT

The sensitivity and specificity of the MTBDRsl assay were respectively 70.3% and 97.7% for OFX, 25.0% and 98.7% for KM, 21.2% and 98.7% for CPM and 56.3% and 56.0% for EMB. DNA sequencing identified mutations that were not detected by the MTBDRsl assay. The 8/11 phenotypically OFX-resistant isolates had mutations in gyrA (2/8 had an additional mutation in the gyrB gene), 1/11 had mutations only in the gyrB gene, 6/21 phenotypically KM-resistant isolates had mutations in the rrs gene, and 7/26 and 20/26 phenotypically CPM-resistant isolates had mutations in the rrs and tlyA genes.

CONCLUSION

The MTBDRsl assay showed lower sensitivity than previous studies. The assay performed favourably for OFX; however, it was less sensitive in the detection of KM/CPM resistance and demonstrated low sensitivity and specificity for EMB resistance. It is recommended that the MTBDRsl assay include additional genes to achieve better sensitivity for all the drugs tested.

Antiulcer activity of methanol extract of Melastoma malabathricum leaves in rats

OBJECTIVE

To determine the potential antiulcer activity of methanol extract of Melastoma malabathricum leaves (MEMM) using various established rat models.

MATERIALS AND METHODS

Ten groups of rats were used and orally administered 10% DMSO (negative control), 100 mg/kg ranitidine (positive control) or MEMM (50, 250 and 500 mg/kg) followed by gastric ulcer induction either using ethanol or indomethacin. The stomachs were collected and subjected to macroscopic and microscopic analyses.

RESULTS

MEMM exhibited significant (p < 0.05) antiulcer activity in the ethanol, but not in the indomethacin-induced gastric ulcer model. The percentage of antiulcer activity for 50-500 mg/kg MEMM ranged between 3 and 75%, respectively. The gross observations were supported by histological findings. MEMM also aggravated the indomethacin-induced gastric ulcer, leading to an increase in ulcer area formation and ulcer score.

CONCLUSION

The M. malabathricum leaves showed antiulcer activity, which could be attributed to their antioxidant and anti-inflammatory activities. This requires further in-depth studies.

Use of an immunochromatographic kit for the rapid detection of Mycobacterium tuberculosis from broth cultures

In settings of high human immunodeficiency virus (HIV) prevalence, culture confirmation, preferably by liquid culture, is required for the diagnosis of tuberculosis (TB). However, long delays with phenotypic identification offsets the short turnaround time of liquid cultures. We report here the advantages of using a commercial immunochromatographic (ICT) assay targeting the Mycobacterium tuberculosis protein 64 (MPT-64) Ag and compare it with the Accuprobe MTB complex molecular probe assay. The performance of the ICT kit was excellent, with sensitivity, specificity, positive and negative predictive values of respectively 97%, 100%, 100%, and 92%. The kit requires a 15-min assay time, is easy to perform and is a good method for simplifying the diagnosis of TB.

Safe injection practice among health-care workers in Gharbiya Governorate, Egypt

We assessed safe injection practices among 1100 health-care workers in 25 health-care facilities in Gharbiya Governorate. Questionnaires were used to collect information and 278 injections were observed using a standardized checklist. There was a lack of infection control policies in all the facilities and a lack of many supplies needed for safe injection. Proper needle manipulation before disposal was observed in only 41% of injections, safe needle disposal in 47.5% and safe syringe disposal in 0%. Reuse of used syringes and needles was reported by 13.2% of the health-care workers and 66.2% had experienced a needle-stick injury. Only 11.3% had received a full course of hepatitis B vaccination.

Analysis of water compartment in dengue patients

This paper describes the water compartments in healthy subjects and dengue patients on the day of defervescence of fever using bioelectrical impedance analysis. A total of 223 healthy subjects (65 males and 158 females) and 210 dengue patients (119 males and 91 females) in Hospital Universiti Kebangsaan Malaysia (HUKM), were studied. The ages for healthy subjects vary between 14 and 60 years old with mean age of 26.05 years while the ages for the dengue patients vary between 12 and 83 years old with mean age of 30.14 years. The parameters of water compartments investigated were total body water (TBW), extracellular water (ECW) and intracellular water (ICW). There were significant difference between healthy subjects and dengue patients for both male (p<0.05) and female (p<0.001) beginning on fever day 0 till fever day 4. The mean TBW and ECW values of dengue patients obtained were found to be higher than the normal healthy subjects while the mean ICW was lower. The mean TBW and ICW for male were higher than female while the mean ECW for male was lower than female for healthy subjects and dengue patients.

Peritoneal Dialysis: A Clinical Update Congestive Heart Failure and PD

BACKGROUND

There is a belief that peritoneal dialysis may be an important treatment modality for refractory heart failure, allowing at least an improvement in quality if not quantity of life during the last stage of this debilitating chronic disease. This paper examines the rationale behind this modality, critically appraises the available literature, calls for more research in the area and puts forward a framework for considering peritoneal dialysis in refractory heart failure.

CONCLUSION

When faced with a patient with refractory heart failure admitted to hospital on multiple occasions because of complications of volume overload, the following approach to initiating peritoneal dialysis should be considered: subjects for dialysis must have a minimal blood pressure, and those whose hemodynamic status improves with diuresis, even though they develop a pre-renal picture, may be the best candidates.

Modeling of hemoglobin in dengue fever and dengue hemorrhagic fever using bioelectrical impedance

This paper describes a model for predicting hemoglobin (Hb) by using bioelectrical impedance analysis (BIA) in dengue patients in the Hospital Universiti Kebangsaan Malaysia (HUKM). Bioelectrical impedance measurements were conducted on 83 (47 males and 36 females) serologically confirmed dengue fever (DF) and dengue hemorrhagic fever (DHF) patients during their hospitalization. The predictive equation for Hb was derived using multivariate analysis. We investigated all the parameters in BIA, patients' symptom and demographic data. In this developed model, four predictors (reactance (XC), sex, weight and vomiting) were found to be the best predictive factors for modeling Hb in dengue patients. However, the model can only explain approximately 42% of the variation in Hb status, thus single frequency bio-impedance stand-alone technique is insufficient to monitor Hb for the DF and DHF patients. Further investigation using multi-frequency BIA is recommended in modeling Hb to achieve the most parsimonious model.

Impact of life style on the nutritional status of medical students at Ain Shams University

This cross sectional study was carried out to assess the nutritional status of medical students and to determine its relation to their life style. The study involved 317 students at, Am Shams University. Anthropometric measurements such as weight, height, mid-arm circumference, triceps skin fold thickness and body mass index were measured. The students completed a self-administered questionnaire including data about some life style factors and food-frequency consumption. The study revealed that 41.3% of the students were of normal weight while 9.5% of the sample were underweight, 36.9% were overweight and 12.5% were obese. The mean mid upper arm circumference (MUAC) and mid arm muscle circumference (MAMC) of males was significant higher than that of females, while the mean triceps skin fold (TSF) of females was significant higher than that of males. The food frequency questionnaire analysis showed that most of students consume all food groups items faire. There was no statistical significant difference between the body mass index (BMI) of students and different types of food consumption. About two thirds of the students used to practice exercise, 26.9% of the students practiced exercise for less than 2 hours per week, while 33.9% of them for more than 2 hours. There was no statistical significant difference between the BMI of students and different types of exercise. However, there was significant higher percentage of males play sports and practice running (44.7% and 19.4% respectively) compared to (11.7% and 8.1%) of females. Sixty four percent of the students usually have regular meals. About 87.2% of obese compared to 64.9% of normal weight students eat snacks between meals, the difference was statistically significant. Obese individuals eat more during watching television and during feeling of stress compared to non-obese and the difference was statistically significant. The duration of practicing exercise, sports and playing computer was significantly higher in males than females. However, the duration of watching television was significantly higher in females than males. Logistic regression analysis results showed that family history of obesity and some life style factors as duration of computer use, eating more during stress time and snacking between meals were important risk factors for obesity. We concluded that about half of medical students were overweight and obese. The most important life style factors responsible for obesity were longer time spent using computer, eating more during time of stress and snacking between meals. Also, genetic factors played an important role in development of obesity. It is recommended to develop nutritional education and physical activities programs to face the problem of increasing the rate of overweight and obesity among university students.

Pre-eclampsia: epidemiology and outcome of 995 cases

OBJECTIVE

To study the epidemiology and pregnancy outcome of pre-eclampsia at Ain Shams University Hospital for Obstetrics and Gynecology.

STUDY DESIGN

A case control study involved 995 cases of pre-eclampsia, 227 cases with chronic hypertension and 1375 cases with normal pregnancy delivered during the year 2000 at Ain Shams University Maternity Hospital. All these cases were critically analyzed regarding to some risk factors as age, parity, blood group, diabetes mellitus, Rhesus factor and multiple pregnancy. The outcomes of all these 3 groups were compared regarding to maternal and fetal morbidity and mortality.

RESULTS

Pre-eclampsia was more common in elder age, blood group B, in Rhesus negative, during summer, multiple pregnancy and in patients with diabetes mellitus. The difference was statistically significant regarding all these risk factors (p < 0.01) when compared with cases of chronic hypertension and patients with normal pregnancies.

CONCLUSIONS

In this work pre-eclampsia was found to be an important cause for maternal and fetal mortality. Also it was found to be an important cause for premature deliveries.

Development of weight gain charts for healthy Egyptian pregnant women

A prospective study was conducted to develop weight gain charts for healthy Egyptian pregnant women and to determine the relationship between different anthropometric indicators and favorable birth weight. A total of 830 pregnant women were enrolled in the study. The mean total weight gain was 9.3 kg. The velocity growth chart that were developed for weight gain showed that the increment of weight was about one kg up to the 4th gestational month, then, a steady increase of 0.37 kg per week till the end of pregnancy. The mean total gain in mid upper arm circumference (MUAC) was 0.8 cm and in triceps skin fold was 1.9 mm. There was a highly positive correlation between all anthropometric indicators studied and the birth weight. However only total weight gain and weight of the mother at first trimester showed significant relation with birth weight after using multi regression analysis. It is recommended to use the developed weight gain charts for monitoring the nutritional status of pregnant women and the MUAC and triceps skin folds are to be used for screening women at risk for malnutrition.

Injury-induced alterations in newly synthesized sulphated proteoglycans from rabbit arterial neointima covered by regenerated endothelium

Proteoglycan (PG) synthesis is a highly regulated, dynamic process that is known to be altered during atherogenesis. Endothelial injury, which may be the primary event in atherosclerosis, has been reported to stimulate PG synthesis and accumulation in the arterial extracellular matrix. The objective of this investigation was to study injury-induced alterations in PG synthesis and accumulation in the neointima, developed in response to a selective balloon catheter de-endothelialization of aortas of normocholesterolaemic rabbits. One group of rabbit aortas was incubated with 35S-Na2SO4 for 8 h, to study in vitro the de novo synthesis of sulphated PG. Another group of rabbit aortas was used to study PG accumulated in aortic neointima vs. PG present in intima-media of normal aortas. Newly synthesized sulphated PG was characterized by light microscopic radioautography and size exclusion chromatography. Purified intimal-medial PG extracts from unlabelled aortas were analysed for protein and glycosaminoglycan (GAG) content and GAG distribution pattern. Results from this study revealed that the neointima of injured aortas synthesized sulphated PG at a significantly higher concentration than the intima of normal aortas. Size exclusion chromatography revealed that neointima synthesized higher molecular weight PG, and in a higher proportion, than its counterpart PG from normal aortas. PG accumulated in neointima of injured aortas showed a significantly altered GAG distribution pattern. These data confirm that neointima developed in response to injury synthesizes and accumulates PG which is altered compared to PG present in the intima-media of normal aorta.

Nicotine and stress: effect on sex hormones and lipid profile in female rats

This work aimed to study the changes in sex hormones and lipid profile in adult female albino rats subjected to treatment with nicotine (N), immobilization stress (S), or their combinations (N+S). These treatments were applied either for one day (T1) or daily for 10 days (T10), after which rats in the estrus stage were used for the determination of plasma corticosterone (CS), serum sex hormones as progesterone (P), estrogen (E), FSH, LH and serum lipid profile including total cholesterol (TC), HDL-C, LDL-C, triacylglycerol (TG) and non esterified fatty acids (NEFA). It was clear that either N or S raised plasma CS and serum P levels in both the treatment regimens and that N+S induced a higher level of these hormones compared to each treatment alone. Serum E level was only elevated during T10 regimen only. An increase in serum LH level was only observed after a single exposure to either N or S, however their combination abolished the stimulatory effect induced by each treatment alone. Serum FSH was not altered by exposure to either N or S alone in both regimens, but in the T10 regimen their combination significantly lowered FSH level. Regarding the effect on serum lipid profile, serum TC was increased in all T10 regimen groups. LDL-C was increased by N+S treatment in both regimens, however no change in HDL-C level was observed in all groups. Serum NEFA was increased in all the treated groups during T10 regimen, while in the T1 regimen NEFA level was only elevated by the combination N+S. Serum TG was insignificantly altered in all the treated groups. The observed changes in the lipid pattern were attributed to the alterations occurred in CS and female sex hormones that caused by N, S or their combinations.

Effect of calcium channel antagonists in modifying the inhibitory influence of adenosine on insulin secretion

The present work was performed to study the effect of two calcium channel antagonists, namely verapamil (CAS 52-53-9) and nifedipine (CAS 21829-25-4) in modifying the inhibitory influence of adenosine on insulin secretion from isolated rat pancreatic islets. The combined effect of adenosine and these agents on serum insulin and glucose levels in vivo was also investigated. Both verapamil and nifedipine at 100 mumol/l and 1 mumol/l, respectively, produced a significant inhibition of glucose-stimulated insulin secretion from pancreatic islets. Combination of these agents with adenosine 10 mumol/l did not modify the inhibitory effect of adenosine on insulin secretion. Verapamil (21.6 mg/kg b.wt.) and nifedipine (5.4 mg/kg b.wt.) intraperitoneally injected prior to glucose loading produced a significant increase in serum glucose with an accompanied decrease in serum insulin levels. Concurrent administration of verapamil with adenosine neither affected the hyperglycaemic nor the hypoinsulinaemic effects of adenosine, whereas combined administration of nifedipine and adenosine decreased the hyperglycaemic effect of adenosine but not its hypoinsulinaemic effect. These results may indicate that these calcium channel antagonists do not interact with adenosine receptors which mediate its inhibitory effect on insulin secretion.

Isolation of lipoprotein-proteoglycan complexes from balloon catheter deendothelialized aortas and the uptake of these complexes by blood monocyte-derived macrophages

Lipoprotein-Proteoglycan (LP-PG) complexes from the neointima, developed in response to injury, were studied to examine their ability to stimulate lipid accumulation in blood monocyte-derived macrophages (BMDM). LP-PG complexes were extracted from intimal-medial tissues from normal and balloon catheter deendothelialized aortas of normocholesterolemic rabbits, in 0.16 M NaCl for 24 h at 4 degrees C. The extract was purified through an anti-apo-B affinity column. Adsorbed material dissociated with 4 M Gu-HCI buffer was analyzed for lipoproteins (LP) and glycosaminoglycans (GAG). Results demonstrated that LP-PG complexes consisted of apo-B associated with chondroitin sulfate and hyaluronic acid. BMDM were incubated with 125I-LP, 125I-LP-NPG (from normal aortas) or 125I-LP-IPG (from injured aortas) for 20 h at 37 degrees C. LP binding, internalization and degradation was markedly increased for LP-NPG and LP-IPG over native LP. Phagocytosis appeared to be the primary route of uptake of LP-PG complexes. Competition experiments indicated that about 40% of the uptake of LP-PG complexes is mediated by the apo-B/E receptor pathway. The scavenger receptor played a minor part in the uptake of LP-PG complexes. Data from this study indicate that LP-PG complexes are present in normal and injured aortas of normocholesterolemic rabbits and these complexes accelerate LP uptake by BMDM more than native LP. Therefore, LP-PG complexes may contribute to lipid accumulation by BMDM, thus generating foam cells. Furthermore, LP-PG complexes prepared from PG of injured aortas are more effective in lipid accumulation than LP-PG complexes from PG of normal aortas.

Combined effect of adenosine, alpha adrenergic and adenosine antagonists on serum insulin and insulin secretion from rat pancreatic islets

1. The effect of adenosine separately or in combination with alpha-1 adrenergic antagonist prazosin and alpha-2 adrenergic antagonist yohimbine as well as adenosine antagonists 8-phenyltheophylline and xanthine amine conjugate on glucose-induced insulin secretion from isolated rat pancreatic islets was studied. 2. Their in vivo effects on serum glucose and insulin levels were also investigated. Adenosine at 10 and 100 microM inhibited significantly, insulin secretion from the isolated islets whereas at 10 mM slightly increased the secretion of insulin. 3. Prazosin used at 100 microM inhibited insulin secretion. When it combined with adenosine (10 microM) it augmented the inhibitory effect of adenosine. 4. In vivo prazosin (21 mg/kg body wt) caused a hyperglycaemia which was accompanied by hypoinsulinaemia. 5. Concurrent administration of this drug with adenosine neither affect the hyperglycaemic nor the hypoinsulinaemic effects of adenosine. 6. On the other hand, yohimbine (100 microM) has no effect neither separately nor in combination with adenosine (10 microM) in modulating the inhibitory effect of adenosine on insulin secretion. 7. When Yohimbine administered at 19.5 mg/kg body wt it did not alter serum glucose but it markedly increased the serum insulin level. Its combined administration with adenosine reduced the hyperglycaemic effect of adenosine with a remarkable increase in serum insulin. 8. Both adenosine-antagonists were ineffective in alteration of insulin secretion. 9. However, combination of 8-phenyltheophylline with adenosine (10 microM) totally blocked the inhibitory effect of adenosine on insulin secretion while xanthine amine conjugate failed to prevent this effect of adenosine.(ABSTRACT TRUNCATED AT 250 WORDS)

Lipoprotein-proteoglycan complexes from injured rabbit aortas accelerate lipoprotein uptake by arterial smooth muscle cells

Lipoprotein-proteoglycan (LP-PG) complexes are taken up more avidly by macrophages and smooth muscle cells (SMCs) than native lipoproteins (LPs). The enhanced uptake may contribute to lipid accumulation and foam cell formation during atherogenesis. Endothelial injury is known to alter proteoglycan (PG) synthesis and distribution in the neointima developed in response to injury. The present study examines the uptake and degradation of LP-PG complexes, derived from PG of injured aortas by arterial SMCs. Rabbit apo-B lipoprotein (LP), including VLDL, IDL and LDL was isolated by ultracentrifugation and coupled with PG extracted from normal aortas (NPG) or with PG from injured aortas (IPG). Rabbit aortic SMCs were cultured from intima-media explants, incubated with 125I-LP, 125I-LP-NPG or 125I-LP-IPG for 20 h at 37 degrees C. LP binding, internalization and degradation were markedly increased (P < 0.001) for LP-NPG and LP-IPG over native LP. Competition experiments indicated that more than 50% of the LP-PG complexes were taken up by the apo-B/E receptor pathway. Phagocytosis was the second important route of uptake of these complexes, whereas the scavenger receptor played a minor part in the uptake and degradation of LP-PG complexes. Data from this study indicate that LP-PG complexes accelerate LP uptake and degradation by SMC more than native LP. Therefore, these complexes may contribute to lipid accumulation by SMC, thus generating foam cells. Furthermore, LP-PG complexes prepared from PG of injured aortas are more effective in lipid accumulation than LP-PG complexes from PG of normal aortas.

Effects of alpha-adrenoceptor agonists and antagonists on insulin secretion, calcium uptake, and rubidium efflux in mouse pancreatic islets

Epinephrine, norepinephrine or the more selective alpha-2 adrenoceptor agonist, clonidine, inhibited insulin release from isolated pancreatic islets of lean mice or obese mice homozygous for the gene ob. Clonidine was highly effective at 0.1 mumol/l. In contrast, the preferential alpha-1 adrenoceptor agonist, phenylephrine, had no or only a modest effect at 10 mumol/l. The effects of norepinephrine or clonidine were counteracted by yohimbine, a preferential blocker of alpha-2 receptors, but not by prazosine, an alpha-1 receptor blocker. The glucose-stimulated uptake of 45Ca2+ in the islets was only consistently inhibited by epinephrine. This effect was counteracted by yohimbine. Clonidine had no effect on the release of 86Rb+ from preloaded islets. It is concluded that insulin secretion is suppressed by alpha-2 receptor agonism in the pancreatic beta-cells and that this effect is mediated by mechanisms other than the transmembrane fluxes of calcium or potassium ions.

Bromocriptine and insulin secretion

The dopaminergic drug bromocriptine inhibited the release of insulin from isolated mouse pancreatic islets. The effect was counteracted by haloperidol or pimozide. It is suggested that insulin release may be inhibited through activation of D-2 dopaminergic receptors in the pancreatic beta-cells.

Effects of guanosine on insulin secretion and adenylyl and guanylyl cyclase activities of isolated rat islets of Langerhans

The effect of guanosine on insulin secretion, adenylyl and guanylyl cyclase activities of isolated rat islets of Langerhans was investigated. Guanosine (1-100 micron) inhibited glucose, tolbutamide, theophylline and prostaglandin E2-stimulated insulin secretion although it failed to affect glucagon stimulated secretion. Prostaglandin E2-stimulated adenylyl cyclase activity of islets was inhibited by guanosine although guanosine had no effect on basal, fluoride, glucagon or GTP-stimulated activity. Guanosine markedly decreased basal guanylyl cyclase activity of islets. These results suggest that guanosine may affect insulin release by inhibiting adenylyl and guanylyl cyclase activities in the beta-cell thereby decreasing the intracellular concentrations of cyclic nucleotides. This effect may be important in modulating the secretory response of the islets to a variety of hormonal agents.

Adenosine and the regulation of insulin secretion by isolated rat islets of Langerhans

The effect of adenosine in insulin secretion and adenylate cyclase activity of rat islets of Langerhans was investigated. Adenosine inhibited insulin secretion stimulated by glucose, glucagon, prostaglandin E2, tolbutamine and theophylline. Adenosine decreased basal adenylate cyclase activity of the islets as well as that stimulated by glucagon prostaglandin E2 and GTP, although fluoride-stimulated activity was not affected. Neither insulin secretion nor adenylate cyclase activity of the islets was affected by adenine, AMP or ADP. The inhibitory effect of adenosine on adenylate cyclase activity was not altered by either phenoxybenzamine (alpha-adrenergic blocker) or propranolol (beta-adrenergic blocker), suggesting that the effect is not mediated through the adrenergic receptors of the islet cells. These results suggest that the intracellular concentration of adenosine in the beta-cell may play a role in regulating insulin secretion and that this effect may be mediated via alterations in the activity of adenylate cyclase in the beta-cell.