Nickel tolerance and phytoremediation potential of quinoa are modulated under salinity: multivariate comparison of physiological and biochemical attributes.

Soils salinization along with heavy metals contamination is among the serious environmental menaces. The present experiment was conducted to study the combined influence of salinity and nickel (Ni) on growth and physiological attributes of quinoa (Chenopodium quinoa Willd.). Thirty-day-old healthy and uniform seedlings of quinoa genotype A7 were exposed to different concentrations of Ni (0, 100, 200, 400 µM), NaCl (0, 150, 300 mM) and their combinations for three weeks. Results indicated that plant growth, pigments and stomatal conductance decreased with increasing Ni concentrations in nutrient solution. Combining lower level of salt (150 mM NaCl) with Ni resulted in improvement in growth and physiological attributes of quinoa. However, the combined application of higher level of salt (300 mM NaCl) with Ni was more detrimental for plant growth and caused more oxidative stress (H2O2 and TBARS) than the alone treatments. The oxidative stress was mitigated by 5.5-fold, 5-fold and 15-fold increase in the activities of SOD, CAT and APX, respectively. The concentration of Na was increased, while K and Ni decreased under the combined treatment of Ni and salinity. Multivariate analysis revealed that a moderate level of salinity had positive effects on growth and Ni phytoremediation potential of quinoa. The higher tolerance index, bioconcentration factor and lower translocation factor depicted that quinoa genotype A7 can be cultivated for phytostabilization of Ni under salinity stress. It was concluded that NaCl salinity level of 150 mM is promising for increasing growth of quinoa on Ni contaminated soils.

Effect of salinity on physiological, biochemical and photostabilizing attributes of two genotypes of quinoa (Chenopodium quinoa Willd.) exposed to arsenic stress.

Soil salinity and arsenic (As) contamination are serious environmental problems. To investigate the effects of salinity on As uptake and physiological and biochemical attributes of quinoa (Chenopodiumquinoa Willd.), a hydroponic experiment was performed. One-month old healthy plants of two quinoa genotypes; Vikinga and A7 were transplanted in plastic tubs containing half strength Hoagland's nutrient solution. Plants were exposed to different levels of As (0, 150 and 300 µM), salinity (0, 150 and 300 mM) and their combinations (150 µM As + 300 mM NaCl; 300 µM As + 300 mM NaCl) for five weeks. Results revealed that combined application of salinity and As caused more pronounced reduction in growth, chlorophyll contents and caused more oxidative damage in both quinoa genotypes. Under combined application of salinity and As, Na+ concentration was increased whereas As content was decreased in plant tissues. Quinoa genotype A7 was more tolerant than Vikinga against salinity, As and their combination perhaps because of less uptake of toxic ions and higher activities of antioxidant enzymes (SOD, CAT, POD). Bioconcentration factor (BCF), translocation factor (TF) and tolerance index (TI) indicated that genotype A7 can be successfully employed for phytostabilization of As contaminated saline soils.

A new biochar from cotton stalks for As (V) removal from aqueous solutions: its improvement with H3PO4 and KOH.

The present study is the first attempt to evaluate the potential of acid and base activated biochar derived from cotton stalks (CSB) for the removal of As from contaminated water. The CSB was treated with 0.5 M KOH (BCSB) and H3PO4 (ACSB) separately to change its surface properties. The CSB, ACSB and BSCB were characterized using BET, FTIR, and SEM analysis to check the effectiveness and insight of the main mechanisms involved in the removal of As. A series of batch experiments was performed using As-contaminated synthetic water and groundwater samples. The effects of initial concentration of As, contact time, dose of the biochars, solution pH, type of the biochar and coexisting ions on the removal of As were investigated. Results revealed that BCSB efficiently removed As (90-99.5%) from contaminated water as compared with ACSB (84-98%) and CSB (81-98%) due to improved surface properties when As concentration was varied from 0.1 to 4.0 mg/L. The experimental data were best fitted with Freundlich adsorption isotherm as compared with Langmuir, Temkin and Dubinin-Radushkevich models. However, kinetic data were well explained with pseudo-second-order kinetic model rather than pseudo-first-order, intra-particle diffusion and Elovich models. The sorption energy indicated that physical adsorption was involved in the removal of As. The comparison of adsorption results with other biochars and their modified forms suggests that activation of CSB with base can be used effectively (4.48 mg/g) as a low-cost adsorbent for maximum removal of As from contaminated aqueous systems.

Effect of salinity on cadmium tolerance, ionic homeostasis and oxidative stress responses in conocarpus exposed to cadmium stress: Implications for phytoremediation.

Contamination of soil with salinity and Cd negatively affects growth and productivity of plants. The proposed study has been planned to explore the effects of salinity on Cd uptake, tolerance and phytoremediation potential of conocarpus (Conocarpus erectus L.). One-month-old uniform plants of conocarpus were exposed to 0, 8.9, 44.5, 89 and 178 µM Cd alone or in combination with 0, 100 and 200 mM NaCl in Hoagland's nutrient solution. Results revealed that shoot and root biomasses, leaf water content and pigment content decreased more in response to combination of Cd and salinity compared to Cd alone. The Na+ and Cl- concentrations in shoot and root were not affected by Cd alone, but increased in Cd + salinity treatments. The K+ concentration decreased by Cd alone as well as Cd combination with salinity. Plant Cd uptake increased in the presence of salinity but its translocation from root to shoot remained unaffected. Exposure of plants to Cd alone and Cd + salinity caused oxidative stress via overproduction of H2O2 and inducing lipid peroxidation. The activities of antioxidant enzymes such as SOD, CAT, POD and APX increased to mitigate this oxidative stress. It is concluded that the tolerance of conocarpus against Cd stress is decreased in the presence of salinity due to increased uptake of toxic ions and intensification of oxidative stress. Moreover, the Cd uptake behavior of this tree indicates its suitability for phytostabilization of Cd contaminated saline and non-saline soils.

Cadmium tolerance and phytoremediation potential of acacia (Acacia nilotica L.) under salinity stress.

In this study, we explored the effect of salinity on cadmium (Cd) tolerance and phytoremediation potential of Acacia nilotica. Two-month-old uniform plants of A. nilotica were grown in pots contaminated with various levels of Cd (0, 5, 10, and 15 mg kg-1), NaCl (0%, 0.5%, 1.0% (hereafter referred as salinity), and all possible combinations of Cd + salinity for a period of six months. Results showed that shoot and root growth, biomass, tissue water content and chlorophyll (chl a, chl b, and total chl a+b) contents decreased more in response to salinity and combination of Cd + salinity compared to Cd alone. Shoot and root K concentrations significantly decreased with increasing soil Cd levels, whereas Na and Cl concentrations were not affected significantly. Shoot and root Cd concentrations, bioconcentration factor (BCF) and translocation factor (TF) increased with increasing soil Cd and Cd + salinity levels. At low level of salinity (0.5%), shoot and root Cd uptake enhanced, while it decreased at high level of salinity (1.0%). Due to Cd tolerance, high shoot biomass and shoot Cd uptake, this tree species has some potential for phytoremediation of Cd from the metal contaminated saline and nonsaline soils.

Outcomes of cataract surgery in Microophthalmia.

OBJECTIVE: To find out outcomes of cataract surgery with Microophthalmia in children less than two years. METHODS: This cross-sectional study was conducted at Al-Ibrahim Eye Hospital, Karachi from January 2016 to August 2017. It included thirty micro ophthalmic eyes of infants with visually significant cataract of age less than two years who had cataract surgery without intraocular lens implantation. Axial length of globe was 19 mm or less in all thirty eyes of seventeen infants. in which thirteen infants had bilateral cataract and four had unilateral cataract. RESULT: Thirty Simple Micro ophthalmic eyes from seventeen patients having visually significant congenital cataract were studied. Thirteen had bilateral cataract and four had unilateral cataract. Mean preoperative IOP was 9.0±1.2 mmHg and postoperative IOP after three months was 10.9±3.2 mmHg. Three patients had secondary capsular opacification 17.6%. Two patients had posterior synachae 11.8% after three months. CONCLUSION: The results suggest that cataract surgery in simple microophthalmia is safe procedure. Postoperative complications in this study were within acceptable limits. Long term study with intraocular lens is required to confirm our observation.

Anatomical Variants Of Celiac Trunk, Hepatic And Renal Arteries In A Population Of Developing Country Using Multidetector Computed Tomography Angiography.

BACKGROUND: Multidetector Computed Tomography (MDCT)s has become a major part in evaluation of hepatic and renal tumours. With improvements in MDCT, CT angiography has also improved and normal anatomy and its variants in patients undergoing operative or interventional procedures can be effectively studied. The purpose of this study was to evaluate the frequency of anatomical variation of celiac trunk, hepatic and renal arterial systems in patients undergoing multidetector CT (MDCT) angiography of the abdominal aorta. METHODS: A descriptive, retrospective cross-sectional study was carried out on CT angiographies performed during the months of October till December 2015. Hepatic and renal arteries and celiac trunk were studied and normal and anatomical variations were noted. All patients with abnormalities affecting the vessels or a history of any vascular abnormality were excluded from the study. RESULTS: Out of total 110 patients, 69.1% had normal and 30.9% had variant hepatic artery with Michel Type IV being the most common variant whereas 88.2% had normal celiac trunk and 8.2% had gastrosplenic trunk variant. Variation in renal arterial system was observed in 15.5% of the patients with two renal arteries on right and two on left being the most common type. Multiple variants were identified in 11.8% of the patients.. CONCLUSIONS: The type and knowledge of anatomy is of prime importance for an optimum preoperative planning in surgical or radiological procedure. MDCT allows minimally invasive assessment of arterial anatomy with high quality 3D reconstruction images.

Relationship of Oral Tumor Thickness with the rate of lymph node metastasis in Neck based on CT Scan.

OBJECTIVE: To determine the relationship of tumor thickness of oral lesions with metastasis in neck based on CT scan. METHODS: A total of 58 oral squamous cell carcinoma patients having the median age of 46 (39-55) years. with either gender presented with malignant tumor of buccal mucosa and tongue were prospectively enrolled. A CT Scan with contrast was performed on all patients. Correlation of tumor thickness level with metastasis in neck was calculated using spearman's rank correlation coefficient test. RESULTS: Median age of the patients was 46 (39-55) years with preponderance of male gender, i.e. 48 (82.8%). Strong positive significant correlation was observed in between transverse dimension (TS) tumor size and stages of tumor (rho 0.673, p-value <0.001), Anterioposterior (AP) tumor size and stages of tumor (rho 0.675, p-value <0.001), and Craniocaudal (CC) tumor size and stages of tumor (rho 0.771, p-value <0.001). CONCLUSION: CT scan of neck with contrast can be used for predicting the positive presence of lymph node in neck with primary tumors having a size of more than 4 mm.

Successful Pregnancy and Live Birth from Oocytes Retrieved After 50 Hours of Human Chorionic Gonadotropin Injection: A Case Report.

BACKGROUND: The timing of human chorionic goadotropin (hCG) injection and oocyte retrieval in women undergoing in vitro fertilization and intracytoplasmic sperm injection is crucial. If not properly timed, premature spontaneous luteinizing hormone surge or even premature ovulation may lead to cancellation of the treatment cycle. Commonly, oocyte retrieval is planned 32-36 hours after hCG injection. This time interval is of relevance because a number of essential processes, including the start of luteinization and resumption of the reduction division of the oocytes, should be well established before oocyte retrieval. CASE: We present a rare case in which, due to patient misunderstanding of timing of hCG injection, oocytes were retrieved 50 hours after hCG injection. On the morning of the oocyte retrieval at 08.00 hours it became apparent that, by mistake, the patient had taken the hCG injection at 09.15 hours rather than at 21.15 hours, 12 hours earlier than advised. It was therefore already 48 hours post-hCG injection. Nineteen good- quality, mature oocytes were retrieved, resulting in 11 good-quality embryos. A single expanded blastocyst was transferred, resulting in pregnancy and delivery of a healthy female infant. CONCLUSION: This is the first reported case of successful pregnancy after oocyte retrieval 5o hours after hCG injection. This case could be a stimulus for others to conduct further studies of prolonged exposure of hCG to oocyte retrieval to show the improved outcome of assisted reproduction treatment.

Molecularly Imprinted Polymer Nanoparticles for Formaldehyde Sensing with QCM.

Herein, we report on molecularly imprinted polymers (MIPs) for detecting formaldehyde vapors in air streams. A copolymer thin film consisting of styrene, methacrylic acid, and ethylene glycol dimethacrylate on quartz crystal microbalance (QCM) yielded a detection limit of 500 ppb formaldehyde in dry air. Surprisingly, these MIPs showed specific behavior when tested against a range of volatile organic compounds (VOCs), such as acetaldehyde, methanol, formic acid, and dichloromethane. Despite thus being a suitable receptor in principle, the MIPs were not useful for measurements at 50% humidity due to surface saturation by water. This was overcome by introducing primary amino groups into the polymer via allyl amine and by changing the coating morphology from thin film to nanoparticles. This led to the same limit of detection (500 ppb) and selectivity as before, but at the real-life conditions of 50% relative humidity.

Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding.

BACKGROUND: Heavy menstrual bleeding (HMB) is an important cause of ill health in women and it accounts for 12% of all gynaecology referrals in the UK. Heavy menstrual bleeding is clinically defined as greater than or equal to 80 mL of blood loss per menstrual cycle. However, women may complain of excessive bleeding when their blood loss is less than 80 mL. Hysterectomy is often used to treat women with this complaint but medical therapy may be a successful alternative.The intrauterine device was originally developed as a contraceptive but the addition of progestogens to these devices resulted in a large reduction in menstrual blood loss. Case studies of two types of progesterone or progestogen-releasing systems, Progestasert and Mirena, reported reductions of up to 90% and improvements in dysmenorrhoea (pain or cramps during menstruation). Insertion, however, may be regarded as invasive by some women, which affects its acceptability as a treatment. Frequent intermenstrual bleeding and spotting is also likely during the first few months after commencing treatment. OBJECTIVES: To determine the effectiveness, acceptability and safety of progesterone or progestogen-releasing intrauterine devices in achieving a reduction in heavy menstrual bleeding. SEARCH METHODS: All randomised controlled trials of progesterone or progestogen-releasing intrauterine devices for the treatment of heavy menstrual bleeding were obtained by electronic searches of The Cochrane Library, the specialised register of MDSG, MEDLINE (1966 to January 2015), EMBASE (1980 to January 2015), CINAHL (inception to December 2014) and PsycINFO (inception to January 2015). Additional searches were undertaken for grey literature and for unpublished trials in trial registers. Companies producing progestogen-releasing intrauterine devices and experts in the field were contacted for information on published and unpublished trials. SELECTION CRITERIA: Randomised controlled trials in women of reproductive age treated with progesterone or progestogen-releasing intrauterine devices versus no treatment, placebo, or other medical or surgical therapy for heavy menstrual bleeding within primary care, family planning or specialist clinic settings were eligible for inclusion. Women with postmenopausal bleeding, intermenstrual or irregular bleeding, or pathological causes of heavy menstrual bleeding were excluded. DATA COLLECTION AND ANALYSIS: Potential trials were independently assessed by at least two review authors. The review authors extracted the data independently and data were pooled where appropriate. Risk ratios (RRs) were estimated from the data for dichotomous outcomes and mean differences (MD) for continuous outcomes. The primary outcomes were reduction in menstrual blood loss and satisfaction; in addition, rate of adverse effects, changes in quality of life, failure of treatment and withdrawal from treatment were also assessed. MAIN RESULTS: We included 21 RCTs (2082 women). The included trials mostly assessed the levonorgestrel-releasing intrauterine device (LNG IUS) (no conclusions could be reached from one small study assessing Progestasert which was discontinued in 2001) and so conclusions are based only on LNG IUS. Comparisons were made with placebo, oral medical treatment, endometrial destruction techniques and hysterectomy. Ratings for the overall quality of the evidence for each comparison ranged from very low to high. Limitations in the evidence included inadequate reporting of study methods and inconsistency.Seven studies compared the LNG IUS with oral medical therapy: either norethisterone acetate (NET) administered over most of the menstrual cycle, medroxyprogesterone acetate (MPA) (administered for 10 days), the oral contraceptive pill, mefenamic acid or usual medical treatment where participants could choose the oral treatment that was most suitable. The LNG IUS was more effective at reducing HMB as measured by the alkaline haematin method (MD 66.91 mL, 95% CI 42.61 to 91.20; two studies, 170 women; I(2) = 81%, low quality evidence) or by Pictorial Bleeding Assessment Chart (PBAC) scores (MD 55.05, 95% CI 27.83 to 82.28; three studies, 335 women; I(2) = 79%, low quality evidence), improving quality of life and a greater number of women continued with their treatment at two years when compared with oral treatment. Although substantial heterogeneity was identified for the bleeding outcomes, the direction of effect consistently favoured the LNG IUS. There was insufficient evidence to reach conclusions on satisfaction. Minor adverse effects (such as pelvic pain, breast tenderness and ovarian cysts) were more common with the LNG IUS.Ten studies compared the LNG IUS with endometrial destruction techniques: three with transcervical resection, one with rollerball ablation and six with thermal balloon ablation. Evidence was inconsistent and very low quality with respect to reduction in bleeding outcomes and satisfaction was comparable between treatments (low and moderate quality evidence). Improvements in quality of life were experienced with both types of treatment. Minor adverse events were more common with the LNG IUS overall, but it appeared more cost effective compared to thermal ablation within a two-year time frame in one study.Three studies compared the LNG IUS with hysterectomy. The LNG IUS was not as successful at reducing HMB as hysterectomy (high quality evidence). The women in these studies reported improved quality of life, regardless of treatment. In spite of the high rate of surgical treatment in those having LNG IUS within 10 years, the LNG IUS was more cost effective than hysterectomy. AUTHORS' CONCLUSIONS: The levonorgestrel-releasing intrauterine device (LNG IUS) is more effective than oral medication as a treatment for heavy menstrual bleeding (HMB). It is associated with a greater reduction in HMB, improved quality of life and appears to be more acceptable long term but is associated with more minor adverse effects than oral therapy.When compared to endometrial ablation, it is not clear whether the LNG IUS offers any benefits with regard to reduced HMB and satisfaction rates and quality of life measures were similar. Some minor adverse effects were more common with the LNG IUS but it appeared to be more cost effective than endometrial ablation techniques.The LNG IUS was less effective than hysterectomy in reducing HMB. Both treatments improved quality of life but the LNG IUS appeared more cost effective than hysterectomy for up to 10 years after treatment.

Clinical, lifestyle, socioeconomic determinants and rate of asymptomatic intracranial atherosclerosis in stroke free Pakistanis.

BACKGROUND: Intracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region. METHODS: The study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used in the Warfarin-Aspirin Symptomatic Intracranial Disease study. The risk factors associated with asymptomatic ICAD are reported along with prevalence ratios. RESULTS: Of the 200 participants, ICAD was found in 34.5% (n = 69) of the participants. Mean age was 37.1 (S.D 15.1) years with 62% younger than 45 years. Self-reported hypertension was found in 26.5% subjects, diabetes in 9%, dyslipidemia in 5% and depression in 60%. Smokeless tobacco (Adjusted PR 3.27 (1.07-6.05)), Western diet, high socioeconomic status (Adjusted PR 2.26 (1.99-5.62)) and dyslipidemia (Adjusted PR 1.88 (1.25-2.21)) had significant associations with ICAD after multivariable analysis. Age, gender, diabetes, hypertension, depression and physical activity did not have a significant association. CONCLUSION: ICAD was found on MRI in one in three asymptomatic Pakistanis and was associated with modifiable risks. Initiatives targeting primary prevention may be able to decrease the burden of disease caused by stroke due to ICAD. STUDY REGISTRATION NUMBER: NCT02072876 2/25/2014.

Microbial-catalyzed biotransformation of multifunctional triterpenoids derived from phytonutrients.

Microbial-catalyzed biotransformations have considerable potential for the generation of an enormous variety of structurally diversified organic compounds, especially natural products with complex structures like triterpenoids. They offer efficient and economical ways to produce semi-synthetic analogues and novel lead molecules. Microorganisms such as bacteria and fungi could catalyze chemo-, regio- and stereospecific hydroxylations of diverse triterpenoid substrates that are extremely difficult to produce by chemical routes. During recent years, considerable research has been performed on the microbial transformation of bioactive triterpenoids, in order to obtain biologically active molecules with diverse structures features. This article reviews the microbial modifications of tetranortriterpenoids, tetracyclic triterpenoids and pentacyclic triterpenoids.

Efficacy of sub-conjunctival and topical bevacizumab in high-risk corneal transplant survival.

OBJECTIVE: To evaluate the effectiveness of subconjunctival bevacizumab and topical bevacizumab in preventing neovascularisation on high-risk corneal grafts. METHODS: The randomised, controlled, parallel group study was carried out from February 2008 to April 2012 at Isra Postgraduate Institute of Ophthalmology and Yasin Eye Hospital, Karachi. Eyes with high-risk corneal transplantation with corneal neovascularisation were included in the trial. Patients were randomly allocated to 3 groups: A, B and C. After penetrating keratoplasty, Group A patients received subconjunctival bevacizumab (2.5 mg/ 0.1 ml), Group B, patients received sham injection, while Group C patients received topical bevacizumab (2.5%, 25 mg/ml). lt was self-administered 4 times a day for 24 weeks. Group B was the control group. Corneal neovascular invasion area was measured using mathematical software programme Mat Lab. Data analyses were done using SPSS version 19. RESULTS: Of the total 122 patients, there were 41 (33.88%) each in Group A and B, while Group C had 40 (32.78%) patients. Among the 3 groups, mean corneal neovascular invasion area was minimum in Group A (n = 3; 6.23%), while in Group B it was 12.3% (n = 5). Group C had the maximum corneal neovascular invasion area after 24 weks (n = 11; 26.7%). Maximum number of patients (n = 36; 87.80%) attained visual acuity of 6/36 or better in Group Afollowed by Group C (n = 26; 65%) and Group B (n = 17; 41.46%). CONCLUSION: Subconjunctival bevacizumab reduces the recurrence of neovascularisation and, thus, helps increasing the frequency of graft survival in cases of high-risk corneal transplants. When used topically, it is less effective.

Efficacy of topical bevacizumab in high-risk corneal transplant survival.

OBJECTIVE: To evaluate the effectiveness of topical Bevacizumab in preventing neovascularisation on high risk corneal grafts. METHODOLOGY: This study was a randomized, controlled, parallel group study, carried out from February 2008 to April 2012 (51 months) at Isra Postgraduate Institute of Ophthalmology and Yasin eye hospital, Karachi. Eyes with high risk corneal transplantation with corneal neovascularization were included in this interventional study/randomized clinical trial. Patients were randomly allocated to 2 groups. Group A and Group B. After penetrating keratoplasty, group A patients received topical bevacizumab (2.5%, 25 mg/ml) which was self-administered 4 times a day for 24 week while group B patients received only sham eye drops. Group B was the control group. Corneal neovascular invasion area i.e. the fraction of area on transplanted cornea in which vessels were present was measured using mathematical software program MatLab. Data analyses was done using SPSS version 19. Frequencies of age gender and groups were measured. Neovascular invasion area and change in visual acuity was compared between the 2 groups using paired t test . P value of less than 0.05 was considered significant. RESULTS: Among the 2 groups mean Corneal neo vascular invasion area was minimum in group A (6.23%) while in group B it was (26.7%). Maximum number of patients (26) attained visual acuity of 6/36 or better in the topical bevacizumab group compared to 17 sham group. CONCLUSION: When topical Bevacizumab is used, it reduces the recurrence of neovascularisation and thus helps increasing the frequency of graft survival in cases of high risk corneal transplants.

Synchronous bilateral ovarian torsion followed by recurrent unilateral torsion in a patient undergoing fertility treatment: A case report and literature review.

BACKGROUND: Ovarian torsion (OT) is a gynaecological emergency and requires prompt recognition and treatment in order to prevent the loss of ovarian function. Patients who are undergoing fertility treatment are at an increased risk of developing OT. OBJECTIVE: The diagnosis of OT in patients undergoing fertility treatment can be challenging as they often present with abdominal pain and other non-specific symptoms. We highlight the importance of early diagnosis of suspected torsion and performed a literature review on cases of bilateral OT to review its presentation, investigation, and subsequent management. CASE REPORT: A 32-year-old nulliparous woman who was undergoing controlled ovarian stimulation presented with lower abdominal pain and was initially managed as ovarian hyperstimulation syndrome (OHSS). Her pain did not subside following conservative management and she proceeded to have a laparoscopy which demonstrated synchronous bilateral ovarian torsion (SBOT), both ovaries were detorted. Eight months later, she was preparing for her frozen embryo transfer (FET) cycle, patient again presented with significant right sided abdominal pain and was found to have a recurrent torsion of the right ovary which was again detorted successfully. CONCLUSIONS: Clinicians should have a low-threshold to investigate and rule out OT in patients who present with lower abdominal pain, especially in those with additional risk factors for torsion. Patients with confirmed torsion can be successfully managed with detorsion of the ovaries. Further research is needed to determine the best management option for patients with recurrent torsion episodes.

Impact of Exogenous Xylanase and Phytase, Individually or in Combination, on Performance, Digesta Viscosity and Carcass Characteristics in Broiler Birds Fed Wheat-Based Diets.

The current study was conducted to evaluate the effects of stored wheat-based diet (1.5 and 2.5 years stored wheat) with and without the supplementation of xylanase and phytase enzymes in combination or individually on performance parameters, digestibility, digesta viscosity and carcass characteristics of broilers. For this purpose, a total of 640-day-old male broilers were randomly distributed to the 64 pens, and each pen had 10 birds. Two basal isocaloric and isonitrogenous diets contained 1.5 and 2.5 years stored wheat were formulated in this experiment. In the current study, experimental feeds were prepared by supplementing exogenous enzymes in both basal diets with xylanase (500 XU), phytase (500 FTU) alone or in a combination of phytase and xylanase. Performance parameters data represents that both in starter phase and finisher phase, inclusion of exogenous enzymes xylanase and phytase in both basal diets alone or in combination enhance the feed intake, and body weight gain (p < 0.05) and improve the feed conversion ratio in overall phase (p < 0.05). Similarly, supplementation of exogenous xylanase and phytase alone or in combination enhance the nutrient digestibility and reduce the digesta viscosity (p < 0.05). Based on the results of this experiment, it is concluded that supplementation of exogenous xylanase and phytase enzymes alone or in combination in wheat-based diets (stored wheat 1.5 and 2.5 years) enhance and improves the performance of birds.

A rare case of postmenopausal hyperandrogenism due to ovarian hyperthecosis and hilus cell hyperplasia.

Postmenopausal hyperandrogenism is rare, and without consensus on specific investigative indices, diagnosis is challenging. A 77-year-old woman had a three-year history of hirsutism, male-pattern baldness and increased libido alongside elevated androstenedione, total testosterone and free androgen index levels. A magnetic resonance imaging (MRI) scan showed bilateral ovarian lesions, suggesting ovarian hyperthecosis. Histopathology obtained after a laparoscopic bilateral salpingo-oophorectomy confirmed ovarian hyperthecosis and hilus cell hyperplasia. We believe it's the first time they have been reported to occur in combination. The symptoms resolved within a month of surgery. This case highlights the difficulties of diagnosis alongside demonstrating the importance of management by a multidisciplinary team.

Sugar Reduction Initiatives in the Eastern Mediterranean Region: A Systematic Review.

This systematic review aims to identify and characterize existing national sugar reduction initiatives and strategies in the Eastern Mediterranean Region. For this purpose, a systematic review of published and grey literature was performed. A comprehensive list of search terms in the title/abstract/keyword fields was used to cover the four following concepts (1) sugar, (2) reduction OR intake, (3) policy and (4) EMR countries. A total of 162 peer-reviewed documents were identified, until the 2nd of August 2022. The key characteristics of the identified national strategies/initiatives included the average sugar intake of each country's population; sugar levels in food products/beverages; implementation strategies (taxation; elimination of subsidies; marketing regulation; reformulation; consumer education; labeling; interventions in public institution settings), as well as monitoring and evaluation of program impact. Twenty-one countries (95%) implemented at least one type of sugar reduction initiatives, the most common of which was consumer education (71%). The implemented fiscal policies included sugar subsidies' elimination (fourteen countries; 67%) and taxation (thirteen countries 62%). Thirteen countries (62%) have implemented interventions in public institution settings, compared to twelve and ten countries that implemented food product reformulation and marketing regulation initiatives, respectively. Food labeling was the least implemented sugar reduction initiative (nine countries). Monitoring activities were conducted by four countries only and impact evaluations were identified in only Iran and Kingdom of Saudi Arabia (KSA). Further action is needed to ensure that countries of the region strengthen their regulatory capacities and compliance monitoring of sugar reduction policy actions.

Site-selective Suzuki-Miyaura cross-coupling reactions of 2,3,4,5-tetrabromofuran.

Suzuki-Miyaura reactions of 2,3,4,5-tetrabromofuran allow a convenient and site-selective synthesis of mono-, di- and tetraarylfurans which are not readily available by other methods.