A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus

BACKGROUND

Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes.

METHODS

Multidisciplinary professionals from The Association of Children's Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology.

RESULTS AND DISCUSSION

Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events.

CONCLUSIONS

This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.

Usefulness of Diagnostic Ultrasound for Detection of Common Shoulder Abnormalities Prior to MRI

Shoulder pain is a common musculoskeletal pain in the general population and results in significant disability, quality of life impairment and financial burden to the health care system. This cross-sectional study was carried out among purposively selected 61 adult patients with shoulder pain and or limited range of motion in the Department of Radiology and Imaging, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from September 2018 to August 2020 to determine the usefulness of USG in detection of common shoulder abnormalities, as an initial imaging modality using MRI as reference standard. The majority of the patients 25(40.98%) were in age group of 51-60 years with mean age of 52.98±10.85 years. In the dectection of rotator cuff pathology, the overall sensitivity, specificity and accuracy of USG for any complete tear were 100.0% each, for any partial tear were 79.71%, 96.57% and 91.80%, for any rotator cuff tear were 83.33%, 96.25% and 91.80%, and for any tendinosis were 90.48%, 99.37% and 96.31% respectively. The sensitivity, specificity and accuracy of USG were 88.23%, 92.59% & 90.16% for long head of biceps tendon sheath effusion, 100.0% each for long head of biceps tendon dislocation, 71.11%, 87.50% and 75.41% for glenohumeral joint effusion, and 58.06%, 96.67% and 77.05% for bursal effusion respectively. From this study, it is concluded that high resolution USG showed high sensitivity, specificity and accuracy compared to MRI in detecting common shoulder abnormalities, and could be considered as the first line imaging modality in the evaluation of shoulder pain.

Clinical and Haematological Findings in Dengue Fever

From 2000 onwards dengue fever has been occurring at regular intervals in Bangladesh. Ultrasonography is a useful diagnostic procedure. This study was done, keeping this background in mind. Objective of this study was to identify the role of ultrasonography as a useful tool in early diagnosis of dengue haemorrhagic fever. This was a cross-sectional descriptive type of observational study. Results of ultrasonography, haematogy an immunology were observed in 2004 and 2019 in 32 patients on each occasion. In 2004 out of 32 patients 29 had positive ultrsonographic findings supported by corresponding haematological and immunological findings. In 2019 ultrsonography was done in three out of thirty two patients, all three had had positive ultra sonographic findings which were supported by haematological and immunological findings. Dengue fever has serious complications like plasma leakage which manifest in the form of ascites, pleural effusion, thick gallbladder wall etc. If such complications can be detected at an early stage many lives can be saved.

Prevalence of disorders in preweaned dairy calves from 731 dairies in Germany: A cross-sectional study

The objective of this cross-sectional study was to determine the prevalence of disorders in preweaned calves in 3 regions in Germany, exemplary for structural diversity in dairy farming. A farm visit was performed on a single occasion on 731 dairy farms in the northern, eastern, and southern regions of Germany between December 2016 and July 2019. Farms differed in herd size, geographical location, and management. In the northern region, the farms had a median of 90 milking cows and were often run as full-time family businesses, partly with external workers. The eastern region tended to have larger farms (a median of 251 milking cows), which were often large-scale agricultural enterprises with employees. In the southern region, the farms had a median of 39 milking cows and were often traditional family businesses, some of these being part-time businesses. Clinical examinations were performed on 14,164 preweaned dairy calves (median 12 calves per farm) by trained veterinarians. A complete data set was available for 13,656 calves. Almost half (42.0%) of the evaluated calves were classified as being affected by at least 1 of the common calf disorders. Omphalitis (O, 20.9%; n = 2,876) and diarrhea (D, 18.5%; n = 2,670) were the most frequently recorded diagnoses, whereas respiratory diseases (RD) were observed to a lesser extent (8.7%; n = 1,100). A striking feature was the fact that 7.1% (n = 987) of the calves were affected by more than 1 disorder at the same time (multimorbidity, M). The following combinations of disorders were frequently observed: O and D (n = 596), O and RD (n = 164), and D and RD (n = 140). Disorders such as O and D, as well as M, were predominantly observed in calves aged 2 wk. A gradual increase in the frequency of RD was observed with age. For all disorders except RD, male calves were more often affected than females. Omphalitis was predominantly diagnosed in the summer months, whereas RD, D, and M were more common in the fall. We detected several statistically significant differences in the prevalence of clinical signs and disorders in preweaned dairy calves between the 3 exemplary regions. The prevalence of RD was higher in the south (10.8%) than in the north (8.2%) and east (7.4%). In the north (33.2%), O was observed more frequently than in the other regions (east: 18.9%; south: 10.5%), whereas D was found less frequently in the north (13.8%) than in the east (21.6%) and south (20.0%).

Synthesis and Evaluation of Anisomelic acid-like Compounds for the Treatment of HPV-Mediated Carcinomas

The vast majority of cervical and 75% of oropharyngeal carcinomas are triggered by infection with a type of high-risk oncogenic human papillomavirus (HPV). It is well-known that E6 and E7 oncoproteins are critical for viral-induced cancer, and hence, they represent valuable targets for therapeutic intervention in HPV-mediated cancers. Our earlier research on the cembranoid, anisomelic acid (AA) showed that, AA has the potential to induce apoptosis in HPV cells by the depletion of E6 and E7 oncoproteins. The present study describes the structure-activity relationship and the evaluation of synthetic AA like compounds, i.e simplified cembranoid-like structures, as HPV inhibitors against some papilloma cell lines. Both from experimental and computational results, we observed that these compounds induced apoptosis by the same E6/E7-based mechanism as AA, but at earlier time points, thus being far more effective than AA. Further, the data indicated that only part of the structure of AA is required for the molecular action. Based on these results, we identified some novel and potential compounds for specific treatment of HPV-associated carcinomas.

Relation of Hepatic Venous Doppler Sonography and Portal Flowmetry in Determination of Severity of Esophageal Varices in Liver Cirrhosis

Cirrhotic patients have hepatic vein waveform abnormalities (HVWA). Both Doppler ultrasonography of hepatic venous wave form (HVWF) and portal Doppler flowmetry (PDF) can non invasively recognize hepatic vein wave form abnormalities and determine severity of esophageal varices. Here we applied cross sectional study and found out the relation between HVWF and PDF and duration of the study from July 2016 to June 2017 in a tertiary Medical College Hospital, Bangladesh. 49 purposively taken diagnosed, hospital admitted, cirrhotic patients were included. Face to face interview and reviewing of records were the source of data and it was analyzed by SPSS windows version-12 software programs. At first, local ethical committee approved the study protocol, p<0.05 was statistically significant and 95% was confidence interval. Esophagogastroduodenoscopy is the gold standard for the diagnosis of esophageal varices. Alternative diagnostic investigations would be either HVWF or PDF. HVWF were normal triphasic. Abnormal biphasic and monophasic PDF consisted of the maximum values of portal flow velocity, portal vein flow volume, diameter of the portal vein, and congestion index. Small and large varices were the easiest form of endoscopic grading of esophageal varices. No clinical or echocardiographic feature of right sided heart failure had found in any patient. Both HVWF and PDF can certainly demonstrate the presence of varices but only HVWF detected severity of esophageal varices - monophasic wave (60.47%) in Doppler USG which signified (<0.05) large varices (67.44%) in endoscopy and in biphasic wave (31.53%) in Doppler USG which signified small varices (32.66%) in endoscopy. Patients who developed varices had portal vein diameter (PVD) and congestion index (CI) were higher (p<0.02) and portal vein velocity (PVV) was lower (p<0.05) than whom did not develop varices, but severity of varices could not be detected. Portal vein flow volume (PVFV) did not signify the presence or severity of varices. Moderately positive correlation (correlation co-efficient was 0.0064) was found between Doppler USG of HVWF and esophagogastroduodenoscopic in severity detection varices. In determination of severity of esophageal varices in patients with liver cirrhosis Hepatic venous Doppler sonography plays more vital role than PDF.

Transmigrated and Impacted Upper 2nd Premolar Associated with Dentigerous Cyst

A male patient about 45 years old came to my private clinic "The Dental Aid", Dhanmondi, Dhaka, Bangladesh last year (February 2016) with the complaint of pain at right palatal premolar region. On clinical examination we found the absence of upper left 2nd premolar from the series of dentition but on the right side premolars are present. The oral mucosa was intact and normal in color. There was no caries, dental pocket or any other pathology in the teeth of both jaws. On palpation we found soft area on the right palatal side at the premolar area. We took intraoral peri-apical radiograph and found impacted left 2nd premolar whose crown was encircled by radiolucent area at the palatal side. Here, we present a rare case of transmigrated and impacted left 2nd maxillary premolar associated with dentigerous cyst. The cyst was successfully treated under general anaesthesia by enucleation along with extraction of the involved maxillary transposed and impacted left second premolar.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Magnetic Resonance Imaging in Evaluation of Sinonasal Masses with Histopathological Correlation

Sinonasal mass is the abnormal growth of tissue from nasal cavity and mucosa of the paranasal sinuses. The growth may be benign or malignant. The benign lesion grows slowly and does not metastasize. The malignant lesion grows rapidly and metastasizes early. The aim of this study is to evaluate and diagnose the various types of sinonasal masses with MRI and its correlation with histopathological findings. This cross sectional descriptive study was carried out for a period of 02 years, from July 2015 to June 2017. The patients were selected from the ENT outpatient department and from the department Radiology & Imaging of Mymensingh Medical College Hospital, Mymensingh, Bangladesh who were reported as case of sinonasal masses. Thirty three (33) patients (17 males and 16 females) with sinonasal masses were included after fulfilling exclusion & inclusion criteria which was confirmed by proper clinical examination & were subjected to MRI and histopathological examination. The age range was 11 to 85 years. The nasal cavity was the most commonly involved site with sinonasal malignancies (were 4 cases, 12.12%) followed by the maxillary sinuses (were 2 cases, 6.06%). The least commonly affected site was the frontal sinuses (was 1 case, 3.03%). Histopathological findings shows benign sinonasal tumors were present in 25 cases. The most common benign lesion was sinonasal polyposis 10 cases (30.30%), followed by inverted papilloma 6 cases (18.18%) & juvenile nasopharyngeal angiofibroma 6 cases (18.18%), adenoma 02 cases (6.06%), and one case was rhinosporidiosis (3.03%). Malignant sinonasal tumors were present in 8 cases. Most common malignant tumors were nasopharyngeal carcinoma in 4 cases (12.12%), adenoid cystic carcinoma in 3 cases (9.09%) and non-Hodgkin lymphoma was present in 01 case (3.03%). MRI report shows benign masses in 23 cases of which nasopharyngeal polyposis was 10(30.30%), inverted papilloma 6(18.18%), juvenile angiofibroma 4(12.12%), adenoma 02(6.06%) & rhinosporidiosis 1(3.03%). Among 10 malignant tumors nasopharyngeal carcinoma were 6(18.18%), adenoid cystic carcinoma 3(9.09%) & non-Hodgkin lymphoma 1(3.03%). MRI findings of malignant sinonasal masses revealed that sensitivity 87.5%, specificity 40.0%, positive predictive value (PPV) 70% & negative predictive value 66%. Statistically significant association was observed between histopathology & MRI findings, p value was 0.305. Statistically significant association was found between histopathology & MRI findings.

Detection of Ovarian Tumor by Color Doppler Ultrasonography and CA-125

Ovarian cancer is the most frequent cause of death from all gynaecological malignancies because of its insidious onset, vague symptoms and late presentation. This cross-sectional study was carried out on purposively selected 43 patients with suspected ovarian tumor in the Department of Radiology and Imaging in collaboration with the Department of Gynaecology and Obstetrics and Department of Pathology, Mymensingh Medical College Hospital, Bangladesh from January 2015 to December 2016 to assess the diagnostic performance of color Doppler ultrasonography and CA-125 in a combination described as Novel Index in detection of ovarian tumor. Highest number of patients of ovarian tumor 10(23.26%) were in age group 35 to 44 years and 45 to 54 years with a mean of 37.72±15.65 years with a range of 8-70 years. Histopathology findings revealed 19(44.18%) benign tumors and 24(55.82%) malignant tumors. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Resistance Index (RI) in diagnosis of ovarian tumor were 91.67%, 89.47%, 91.67%, 89.47% and 90.69% respectively. Sensitivity, specificity, PPV, NPV and accuracy of serum CA-125 were 83.33%, 89.47%, 90.90%, 80.95% and 86.04% respectively. Sensitivity, specificity, PPV, NPV and accuracy of Novel index were 95.83%, 89.47%, 92.00%, 94.44% and 93.02% respectively. Novel index showed better diagnostic performance. Based on the current study it is concluded that the combination of color Doppler ultrasonography and serum CA-125 can be useful for diagnosis of ovarian tumor.

Baseline study and risk analysis of landfill leachate - Current state-of-the-science of computer aided approaches

For the successful completion of a risk analysis process, its foundation (i.e. a baseline study) has to be well established. For this purpose, a baseline study needs to be more integrated than ever, particularly when environmental legislation is increasingly becoming stringent and integrated. This research investigates and concludes that no clear evidence of computer models for baseline study has been found in a whole-system and integrated format, which risk assessors could readily and effectively use to underpin risk analyses holistically and yet specifically for landfill leachate. This is established on the basis of investigation of software packages that are particularly closely related to landfills. Holistic baseline study is also defined along with its implications and in the context of risk assessment of landfill leachate. The study also indicates a number of factors and features that need to be added to baseline study in order to render it more integrated thereby enhancing risk analyses for landfill leachate.

Plasma Protein Binding of Anisomelic Acid: Spectroscopy and Molecular Dynamic Simulations

Anisomelic acid (AA) is a macrocyclic cembranolide compound extracted from Anisomeles herbal species. Recently, we have shown that AA possesses both anticancer and antiviral activity. However, to date, the plasma protein binding properties of AA are unknown. Here, we describe the molecular interactions of AA with two serum proteins, human serum albumin (HSA) and bovine serum albumin (BSA), adopting multiple physicochemical methods. Besides, molecular docking and dynamics simulations were performed to predict the interaction mode and the dynamic behavior of AA with HSA and BSA. The experimental results revealed that hydrophobic forces play a significant part in the interaction of AA to HSA and BSA. The outcomes of the principal components analysis (PCA) of the poses based on root-mean-squared distances showed less variation in AA-HSA, opposed to what is seen for BSA-AA. Furthermore, binding free energies estimated for AA-HSA and AA-BSA complexes at different temperatures (298, 303, 308, and 313 K) based on molecular mechanics-generalized Born surface area (MMGBSA) approaches were well correlated with our experimental results.

Prevalence and Visual Outcomes of Cataract Surgery in Rural South India: A Cross-Sectional Study

PURPOSE

To determine the prevalence of cataract surgery and postoperative vision-related outcomes, especially with respect to sex, socioeconomic status (SES) and site of first contact with eye care, in a rural area of South India.

METHODS

In a population-based cross-sectional survey of 5530 individuals aged 50 years or older from 10 villages selected by cluster sampling, individuals who had undergone cataract surgery in one or both eyes were identified. Consenting participants were administered a questionnaire, underwent vision assessment and ophthalmic examination. Outcomes were classified as good if visual acuity of the operated eye was 6/18 or better, fair if worse than 6/18 but better than or equal to 6/60, and poor if worse than 6/60.

RESULTS

Prevalence of cataract surgery in this age group (771 persons) was 13.9% (95% confidence interval, CI, 13.0-14.9%). In the 1112 eyes of 749 persons studied, at presentation, 53.1% (95% CI 50.1-56.1%) of operated eyes had good, 38.1% (95% CI 35.2-41.0%) had fair, and 8.8% (95% CI 7.1-10.5%) had poor outcomes. With pinhole, 75.2% (95% CI 72.6-77.8%) had good, 17.2% (95% CI 14.9-19.5%) had fair, and 7.4% (95% CI 5.8-9.0%) had poor outcomes. In 76.3% of eyes with fair and poor presenting outcomes we detected an avoidable cause for the suboptimal visual acuity. Place of surgery and duration since surgery of 3 years or more were risk factors for blindness, while SES, sex and site of first eye care contact were not.

CONCLUSION

The high prevalence of avoidable causes of visual impairment in this rural setting indicates the scope for preventive strategies.

Autophagy and Mammalian Viruses: Roles in Immune Response, Viral Replication, and Beyond

Autophagy is an important cellular catabolic process conserved from yeast to man. Double-membrane vesicles deliver their cargo to the lysosome for degradation. Hence, autophagy is one of the key mechanisms mammalian cells deploy to rid themselves of intracellular pathogens including viruses. However, autophagy serves many more functions during viral infection. First, it regulates the immune response through selective degradation of immune components, thus preventing possibly harmful overactivation and inflammation. Additionally, it delivers virus-derived antigens to antigen-loading compartments for presentation to T lymphocytes. Second, it might take an active part in the viral life cycle by, eg, facilitating its release from cells. Lastly, in the constant arms race between host and virus, autophagy is often hijacked by viruses and manipulated to their own advantage. In this review, we will highlight key steps during viral infection in which autophagy plays a role. We have selected some exemplary viruses and will describe the molecular mechanisms behind their intricate relationship with the autophagic machinery, a result of host-pathogen coevolution.

UK service level audit of insulin pump therapy in paediatrics

AIM

To conduct an audit of insulin pump therapy in the UK after the issue of guidelines for the use of continuous subcutaneous insulin infusion by NICE in 2008 (Technology Appraisal 151).

METHODS

All centres in the UK, providing pump services to children and young people were invited to participate in an online audit. Audit metrics were aligned to NICE Technology Appraisal 151 and an electronic data collection tool was used.

RESULTS

Of the 176 UK centres identified as providing pump services, 166 (94.3%) participated in the study. A total of 5094 children and young people were identified as using continuous subcutaneous insulin infusion (19% of all paediatric patients with Type 1 diabetes), with a median (range) of 16.9 (0.67-69.4)% per centre. Units had a median of 0.58 consultant sessions, 0.43 full-time equivalent diabetic specialist nurses, and 0.1 full-time equivalent dieticians delivering the pump service. The majority of this time was not formally funded. Families could access 24-h clinical and technical support (83% units), although the delivery varied between consultant, diabetic specialist nurse and company representatives. Only 53% of units ran, or accessed, structured education programmes for continuous subcutaneous insulin infusion use. Most units (86%) allowed continuous subcutaneous insulin infusion use for paediatric inpatients, but only 56% had written guidelines for this scenario. Nine percent of units had encountered funding refusal for a patient fulfilling NICE (Technology Appraisal 151) criteria.

CONCLUSION

The number of children and young people on continuous subcutaneous insulin infusion therapy is consistent with numbers estimated by NICE. There is a worrying lack of funded healthcare professional time. The audit also identified gaps in the provision of structured education and absence of written inpatient guidelines.

Targeted delivery of a novel anticancer compound anisomelic acid using chitosan-coated porous silica nanorods for enhancing the apoptotic effect

Chitosan-coated and FA-conjugated mesoporous silica nanorods were developed for cancer-cell targeted delivery of a novel naturally derived anticancer compound.

The U.K. service level audit of insulin pump therapy in adults

AIMS

The National Institute for Health and Clinical Excellence (NICE) published guidelines for the use of continuous subcutaneous insulin infusion in 2008 (technology appraisal 151). The first U.K.-wide insulin pump audit took place in 2012 with the aim of determining adherence to the guidance issued in NICE technology appraisal 151. The results of the adult service level audit are reported here.

METHODS

All centres providing continuous subcutaneous insulin infusion services to adults with diabetes in the U.K. were invited to participate. Audit metrics were aligned to technology appraisal 151. Data entry took place online using a DiabetesE formatted data collection tool.

RESULTS

One hundred and eighty-three centres were identified as delivering adult continuous subcutaneous insulin infusion services in the U.K., of which 178 (97.3%) participated in the audit. At the time of the audit, 13 428 adults were using insulin pump therapy, giving an estimated prevalence of use of 6%. Ninety-three per cent of centres did not report any barriers in obtaining funding for patients who fulfilled NICE criteria. The mean number of consultant programmed activities dedicated to continuous subcutaneous insulin infusion services was 0.96 (range 0-8), mean whole-time equivalent diabetes specialist nurses was 0.62 (range 0-3) and mean whole-time equivalent dietitian services was 0.3 (range 0-2), of which 39, 61 and 60%, respectively, were not formally funded.

CONCLUSIONS

The prevalence of continuous subcutaneous insulin infusion use in the U.K. falls well below the expectation of NICE (15-20%) and that of other European countries (> 15%) and the U.S.A. (40%). This may be attributable, in part, to lack of healthcare professional time needed for identification and training of new pump therapy users.

Novel action modality of the diterpenoid anisomelic acid causes depletion of E6 and E7 viral oncoproteins in HPV-transformed cervical carcinoma cells

Cervical cancer, the second most common malignancy among women, is mainly caused by human papilloma virus (HPV) infection. In HPV-positive cervical cancer cells, the activity of p53 and the induction of p21 are inhibited by the HPV oncoproteins E6 and E7. Therefore, blocking the activity of E6 and E7 would serve as an important therapeutic target in these cancer cells. In this study, anisomelic acid (AA), a natural compound belonging to the same diterpenoid family of bioactive compounds as taxol, was found to deplete the E6 and E7 proteins in HPV-positive cervical cancer cells. Consequently, p53 and the p53-responsive gene, p21, were dramatically induced, leading to G2/M-phase cell cycle arrest. AA-mediated cell cycle arrest and p21 expression were canceled when p53 was down-regulated by p53-shRNA. AA also induced p53-independent intrinsic apoptosis by depletion of the cellular inhibitor of apoptosis protein 2 (cIAP2) whose proteosomal degradation is inhibited by E6. The in ovo chick embryo chorioallantoic membrane (CAM) assay showed that anisomelic acid inhibited the tumor growth of the cervical cancer SiHa cells. AA is revealed to hold a novel action modality based on specific targeting of the HPV oncoproteins, which restores p53-mediated growth arrest and induces apoptosis by terminating E6-mediated cIAP2 stabilization.

General practitioners' knowledge of whiplash guidelines improved with online education

OBJECTIVE

The primary objective of this study was to evaluate the effect of an online education program used to implement the Australian (New South Wales) whiplash guidelines with general practitioners (GP). The secondary aim was to identify factors associated with learning.

METHODS

An online educational and evaluation activity was developed to reflect the key messages for GP from the Australian whiplash guidelines. The educational activity was hosted on the Royal Australian College of General Practitioners' website (www.gplearning.com.au) for a period of 3 years. Participants were recruited through advertisement and media releases. Participants completed a baseline evaluation of their knowledge, participated in the interactive educational activity and completed a post-knowledge questionnaire. The primary outcome was change in professional knowledge, predictors of learning were computed using linear regression.

RESULTS

Two hundred and fifteen GP participated. Knowledge significantly improved between baseline and post-knowledge questionnaire scores (P < 0.00001). A total of 57.2% of participants improved their knowledge by more than 20%, indicating a large effect. Low baseline knowledge predicted learning, accounting for 71% of the variance.

CONCLUSIONS

Online education of GP significantly improved their knowledge in relation to guidelines for whiplash. Those with low baseline knowledge improved their knowledge the most, suggesting that implementation strategies should be targeted at this group.

Literature review of baseline study for risk analysis - the landfill leachate case

There is growing awareness and public concern about environmental impacts of waste management and disposal. Environmental policy instruments have been strengthened and associated governmental programmes have increased in recent years, resulting in high level strategies for waste management. Risk assessment is now an essential tool in the prioritisation of environmental and human health protection. However, regulators need to compare the full range of risks on a sound and consistent basis. Comparing risks from such diverse sources poses a significant challenge, and traditional hazard and risk assessments are no longer sufficient. Consideration now needs to be given to a much wider range of factors if risk assessment is to be used as an aid to more integrated decision-making process. For this purpose, baseline study - the foundation of risk assessment - can play a crucial role. To date limited research has been conducted on the need, parameters, requirements, and constituents of baseline study particularly in the context of how, why, and what information is to be collated in order to render risk assessments more appropriately integrated and complete. To establish the 'state-of-the-art' of baseline study, this paper comprehensively reviews the literature regarding environmental risk assessment in general terms, and then proceeds to review work that is specifically related to landfills and landfill leachate, thereby identifying knowledge gaps and shortfall areas. This review concludes that a holistic baseline study procedure for waste disposal sites, which risk assessors could use for carrying out risk analyses specifically for landfill leachate, does not as yet exist.

Nurse-led epilepsy follow-up clinic in India: is it feasible and acceptable to patients? A pilot study

PURPOSE

India has an epilepsy treatment gap of up to 90%. Shortage of doctors, especially in rural communities makes getting epilepsy treatment almost impossible for the vast majority. Nurses are relatively more in number and available even in smaller cities and villages. This pilot study investigated if a nurse-led epilepsy follow-up clinic is feasible in India and is acceptable to patients.

METHOD

A II year Nursing postgraduate student was given 8h of didactic teaching tailored for epilepsy patient follow-up, followed by supervised observation time in the epilepsy clinic with a neurologist before conducting epilepsy follow-up clinics independently. Epilepsy patients ≥ 10 years of age and in follow-up for ≥ 6 months were included. They were independently followed-up both in the nurse-led clinic and in the neurologist's clinic. Outcome was measured in terms of interrater agreement (kappa) between the recommendations of the neurologist and the nurse in five domains. Patient satisfaction for nurse-led clinic was also evaluated.

RESULTS

The interrater agreement between the trained nurse and neurologist in following-up 175 enrolled patients was 76-94%; most unanimity (κ=94%) seen in identifying AED adverse effects while least agreement (κ=76%) was present regarding decisions to modify AED. The mean patient satisfaction score was 37.63 ± 3.26 (maximum possible score 40).

CONCLUSION

It is feasible for trained nurses to run epilepsy follow-up clinics in India and patients are likely to be satisfied with this approach.

HYPOLIPIDEMIC EFFECT OF GINGER EXTRACT IN VANASPATI FED RATS

The aim of the present study was to evaluate the hypolipidemic effect of ginger in vanaspati fed rats. A total of 18 rats of Long Evans strain weighing 200-250 g were randomly assigned to three groups: Group I, normal control; Group II, 5% vanaspati supplement and Group III, 5% vanaspati + ginger extract (300 mg/ 100ml/ kg b. wt./ day) orally. Serum lipid profile was measured at day 1st and day 49th. The administration of vanaspati augmented the total cholesterol, LDL-C, triglycerides levels and decreased the HDL-C level significantly (p <0.05). Simultaneous administration of ginger extract significantly (p <0.05) prevented the rise in total cholesterol, LDL-C(bad cholesterol), triglycerides levels and rise HDL(good cholesterol). In histopathological study, no significant changes were found in the liver and aorta of all treated groups as compared with control group. It is concluded that ginger extract showed hypolipidemic effect in vanaspati supplemented rats.DOI: http://dx.doi.org/10.3329/bjvm.v10i1-2.15652

The antitumor lignan Nortrachelogenin sensitizes prostate cancer cells to TRAIL-induced cell death by inhibition of the Akt pathway and growth factor signaling

Prostate cancer cells frequently develop resistance toward androgen-deprivation and chemotherapy. To identify new approaches to treat androgen-dependent prostate cancer, we have performed a structure-activity analysis of lignan polyphenols for cancer cell specific sensitization to tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), a death ligand that has ability to induce tumor-specific cell death. In this study, we report that the lignan nortrachelogenin (NTG) is the most efficient of the 27 tested lignan compounds in sensitizing prostate cancer cells to TRAIL-induced apoptosis. Importantly, pretreatment with NTG does not sensitize a non-malignant prostate cell line to TRAIL-induced cell death. The structural comparison of lignans reveals that the dibenzylbutyrolactone skeleton is required for the apoptosis-sensitizing activity, while substitutions at the aromatic rings do not seem to play a critical role in this lignan function. Our study also characterizes the cellular effects and molecular mechanisms involved in NTG anticancer activity. We previously reported that specific lignans inhibit the Akt survival-signaling pathway in concert with TRAIL sensitization. While NTG is also shown to be a effective inhibitor of Akt signaling, in this study we further demonstrate that NTG potently inhibits tyrosine kinase (RTK) activation in response to growth factors, such as insulin and insulin-like growth factor I (IGF-I). Our results identify NTG as a novel agent for prostate cancer therapy with ability to inhibit Akt membrane localization and activity as well as the activation of growth factor receptors (GFRs), thereby efficiently synergizing with TRAIL exposure.

Thyroid function at diagnosis of type I diabetes

BACKGROUND

National guidelines recommend that thyroid function is assessed at diagnosis of type I diabetes (TIDM) and annually thereafter. This paper reports an audit of thyroid surveillance in accordance with this guideline.

PATIENTS

110 patients (66 males), median age 11.3 (1.2-15.7) years at diagnosis of TIDM, were monitored for 2.3 (0.7-4.2) years.

RESULTS

21/110 (19.0%) patients had abnormal thyroid function at diagnosis of TIDM. Of these, 16 had normal thyroid function on reassessment after 45 (3-540) days. Abnormalities of thyroid function occurred more commonly in children with diabetic ketoacidosis (DKA) than those who did not have DKA (9/29, 31.0% vs 12/81, 14.8%, p<0.025). At the end of the observation period, five (4.5%) patients had minor abnormalities of thyroid function not requiring treatment and three (2.7%) were treated.

CONCLUSIONS

Transient abnormalities of thyroid function are common at diagnosis of TIDM, and therefore, thyroid hormones should not be measured at this time.

Indication of electron neutrino appearance from an accelerator-produced off-axis muon neutrino beam

The T2K experiment observes indications of ν(μ) → ν(e) appearance in data accumulated with 1.43×10(20) protons on target. Six events pass all selection criteria at the far detector. In a three-flavor neutrino oscillation scenario with |Δm(23)(2)| = 2.4×10(-3)  eV(2), sin(2)2θ(23) = 1 and sin(2)2θ(13) = 0, the expected number of such events is 1.5±0.3(syst). Under this hypothesis, the probability to observe six or more candidate events is 7×10(-3), equivalent to 2.5σ significance. At 90% C.L., the data are consistent with 0.03(0.04) < sin(2)2θ(13) < 0.28(0.34) for δ(CP) = 0 and a normal (inverted) hierarchy.

Climate change impacts on mycotoxin risks in US maize

To ensure future food security, it is crucial to understand how potential climate change scenarios will affect agriculture. One key area of interest is how climatic factors, both in the near- and the long-term future, could affect fungal infection of crops and mycotoxin production by these fungi. The objective of this paper is to review the potential impact of climate change on three important mycotoxins that contaminate maize in the United States, and to highlight key research questions and approaches for understanding this impact. Recent climate change analyses that pertain to agriculture and in particular to mycotoxigenic fungi are discussed, with respect to the climatic factors – temperature and relative humidity – at which they thrive and cause severe damage. Additionally, we discuss how climate change will likely alter the life cycles and geographic distribution of insects that are known to facilitate fungal infection of crops.

Electronic and vibrational spectra of some rare earth trifluoromethanesulfonates crystals

The Raman and infrared spectra of some rare earth (dysprosium and terbium) trifluoromethanesulfonates crystals have been analyzed. Different vibrational frequencies of trifluoromethanesulfonate ions (CF3SO3-) are identified and assigned to different vibrations of the SO3 and CF3 groups. Electronic transitions of R3+ ions (R=Dy, Tb) in these salts have been assigned to transitions from the ground to different energy levels of the ground multiplet. The electronic energy levels of the rare earth ions are also determined theoretically with the help of single electron crystal field theory. They are found to yield results not only in good agreement with the observed spectral data but also in good conformity with those obtained previously from magnetic measurements.