Supplementation of Selenium Nanoparticles-Loaded Chitosan Improves Production Performance, Intestinal Morphology, and Gut Microflora in Broiler Chickens.

The current study aimed to evaluate the efficacy of selenium nanoparticles (SeNPs), combined or loaded with chitosan (COS), in broiler chickens reared under standard management protocols. The parameters under investigation were production performance, organ development, components of the intestinal barrier, and ileal microbial count. Two hundred and forty day-old chicks were raised in five groups, with each group containing eight replicates (n=6/replicate). The control group received a basal diet whereas the other four groups received basal diets supplemented with SeNPs (0.5 mg/kg), COS (200 mg/kg), SeNPs+COS (0.5 mg/kg SeNPs + 200 mg/kg COS), and SeNPs-loaded COS (SeNPs-L-COS) (200 mg/kg) respectively. On day 35, two birds/replicate were sampled to collect the viscera under investigation. The results revealed that dietary inclusion of SeNPs-L-COS increased (p<0.05) the body weight gain and improved (p<0.05) feed conversion ratio. Similarly, SeNPs-L-COS supplementation increased (p<0.05) the small intestinal villus surface area as well as the count of acidic goblet cells and intraepithelial lymphocytes when compared with the control group. Whereas the total goblet cell count was higher (p<0.05) in the small intestines of both the SeNPs+COS and SeNPs-L-COS groups. Microbial analysis of ileal contents also revealed an increase (p<0.05) in Lactobacilli species count with a concurrent decrease (p<0.05) in Escherichia coli count in the SeNPs-L-COS group when compared with the COS and control groups. Based on the results of the current trial, we can conclude that supplementation with SeNPs-L-COS is a superior combination for promoting the gut health and performance of broilers.

Primary Hyperparathyroidism: To Evaluate Benefit of Ultrasound and Tc99m-SESTAMIBI Scan in Localizing Abnormal Parathyroid Gland Before Surgery, in a Secondary Care Hospital.

Introduction Primary hyperparathyroidism is a common endocrine condition requiring parathyroidectomy for curative management. Localization of parathyroid gland by ultrasound and Tc99m-SESTAMIBI is important to opt for less invasive and comparatively lower complication risk surgery minimal invasive parathyroidectomy (MIP) instead of four-gland exploration surgery. Aim To evaluate ultrasound and Tc99m-SESTAMIBI in localization of abnormal parathyroid gland before surgery. Method and materials All patients of primary hyperparathyroidism (PHPT) that presented to a secondary care hospital (endocrinology department) from 2015-2019 were recruited retrospectively from electronic fusion system of hospital. Results of ultrasound parathyroid and Tc99m-SESTAMIBI done for localization of abnormal parathyroid gland were analyzed. Results Total PHPT patients recruited were 59, mean age 64.2 years, male 11 (18.64%) and female 48 (81.3%). Ultrasound parathyroid was done in 44 patients, Tc 99m-SESTAMIBI was done in 31, both tests were done in 31 patients. Combined concordant adenoma in both tests was seen in 11 (35%) cases which can opt for minimal invasive parathyroidectomy (MIP) with confidence whereas 65% of cases would require either four-gland exploration or further testing like single-photon emission computed tomography-computed tomography (SPECT-CT) or intraoperative parathyroid hormone measurement to opt for MIP. Conclusion Combined ultrasound parathyroid and Tc 99m-SESTAMIBI scan was useful in localization of parathyroid adenoma in 11 (35%) patients that can opt for MIP which is a lower complication risk surgery whereas 20 (65%) patients would need further investigation with SPECT-CT or intraoperative parathyroid hormone measurement or four-gland exploration surgery. Recommendation Third modality of investigation such as SPECT-CT or intraoperative parathyroid hormone measurement needs evaluation so that more patients can benefit from MIP instead of four-gland exploration surgery.

Effects of dietary chromium supplementation on muscle and bone mineral interaction in broiler chicken.

The study was conducted to ascertain the effects of dietary chromium chloride (CrCl3·6H2O) supplementation on mineral interaction in blood serum, leg muscles and bones of broilers at 35th day of age. For this purpose, ninety male broiler chicks were divided into three groups. One served as control (group I) while, the other two groups were supplemented with CrCl3 (group II-12.5mg/Kg feed; group III-25mg/Kg feed) from 12 to 28days of age. In serum, Cr concentration remained non-significant however, Zn, and K concentrations decreased (P<0.05) with both levels of Cr-supplementation. Furthermore, in muscles Cr, Cu, Ca and Na levels remained non-significant but concentrations of Zn and K decreased (P<0.05) with feed Cr enrichment. Chromium had a substantial effect on femur and fibula Zn retention with 25mg/Kg feed supplementation while, Cr deposition decreased (P<0.05) in fibula. Femur Ca (P<0.002), Na (P<0.001) and K (P<0.05) retention was inversely proportional to both Cr concentrations in feed. In tibia, Cu and Na concentration decreased (P<0.002) with high dietary Cr supplementation. Fibular Ca and Na concentrations remained significantly (P<0.001) lower in Cr supplemented groups. Bone robusticity index was non-significant but ash to weight ratio of femur, tibia and fibula decreased (P<0.05) in group III. Chromium supplementation has a major effect on serum or muscle Zn and K deposition while bone mineral interaction shows a major thrust on Zn, Ca and Na levels.

Antinuclear antibodies: when to test and how to interpret findings.

Order ANA assays only when clinical features suggest a connective tissue disorder. Let ANA immunofluorescent patterns direct additional testing decisions.

Determination of hepatitis C virus genotypes circulating in different districts of Punjab (Pakistan).

INTRODUCTION: Hepatitis C virus (HCV) is a principal cause of severe liver diseases worldwide and a possible source of significant morbidity and fatality in the long term. Information on the genotype is more significant because it has prognostic value in the response to antiviral therapy. OBJECTIVES: This study aimed to determine the frequency of various HCV genotypes circulating in the different districts of Punjab and to show the pattern distribution of HCV genotypes in different age groups and sexes. MATERIALS AND METHODS: A total of 542 HCV-positive patients were selected from various districts of the province and were subjected to an HCV genotype-specific assay. Among 542 positive patients, 300 (55.35%) were men and 242 (44.65%) were women. There were 245 (45.20%), 61 (11.25%), 56 (10.33%), 56 (10.33%), 53 (9.77%), 27 (5%), 20 (3.69%), 16 (3%), and eight (1.47%) HCV-positive patients from Lahore, Sargodha, Multan, Toba Tek Singh, Faisalabad, Rawalpindi, Mandi Bahauddin Gujranwala, and Sahiwal districts, respectively. RESULTS: Of a total of 542 serum samples analyzed, 476 (88%) were successfully genotyped whereas 66 (12%) samples were undetermined genotypes. Among the typable genotypes, 1a was found in 37 (7%), 1b in 18 (3%), 3a in 386 (71%), and genotype 3b in five (1%) patients. Thirty patients (6%) were identified to be infected with mixed HCV genotypes. Genotypes 3a (P=0.0001), 1a (P=0.001), and untypable genotypes (P=0.03) were circulating significantly in all the studied districts. All the genotypes were distributed evenly in male and female patients. The most affected age range of patients was 21-40 years as compared with teenage and older age groups. CONCLUSION: The study found a significantly high prevalence of HCV among the patients of Punjab. In addition, genotype 1a was found to be a significantly and rapidly increasing genotype in the study area. It appears that HCV-3a (the most prevalent genotype) may be replaced by genotype 1a. If this occurs, it will make the present scenario more complex in terms of response to therapy and economic burden on the health sector of Pakistan. HCV infection is more common in the age group of 21-40 years. All the genotypes were distributed at the same frequency in men and women.

Mutations in the NS5A gene are associated with response to interferon+ribavirin combination therapy in patients with chronic hepatitis C virus 3a infection.

INTRODUCTION: The clinical correlation between hepatitis C virus (HCV) NS5A gene mutations and response to antiviral treatment in HCV-3a-infected patients is not as well known as that in HCV-1a-infected and HCV-1b-infected patients. OBJECTIVES: This study attempted to determine mutations in the NS5A gene in isolates of HCV-3a obtained from infected Pakistani patients treated with interferon-α standard therapy and to determine its association with several host factors. METHODS: A total of 71 consecutive chronically infected HCV patients [43 men and 28 women, mean age 38 years (range, 16-70 years)] without previous antiviral therapy, who fulfilled other criteria of the current study were enrolled for antiviral therapy. RESULTS: Of the 71 patients enrolled, 53 completed the course of antiviral therapy. Among them, 23 (43.3%) patients showed an end-of-treatment response, 20 (41.4%) showed a sustained virological response, and three (5.6%) patients were HCV-RNA negative at the end of treatment but developed a relapse thereafter. Only seven (13.2%) patients were virologic nonresponders (NR). Probable transmission risk factors were previous major/minor surgery (20%), transfusion of blood or blood products (2%), dental surgery (10%), or sporadic (unknown; 60%). The estimated duration of infection varied from 6 months to 20 years. The correlation between the number of mutations and several factors was also studied. The first factor that was associated with the number of mutations in the NS5A gene was age older than 40 years, where the difference was statistically significant between viral sequences of patients showing an end-of-treatment response and NR (P<0.001). Further, the difference in the average number of mutations was statistically significant between patients showing sustained virological response and NR (P<0.005). The second and third factors that were found to be associated with number of mutations in the NS5A gene were sex and viral load, respectively. CONCLUSION: Along with host factors such as age older than 40 years, female sex, and low baseline viral load, the less number of mutations in the NS5A gene of HCV-3a is associated with a positive outcome of treatment response in HCV patients receiving interferon plus ribavirin therapy.

Update on guidelines for management of hypercholesterolemia.

Coronary heart disease (CHD) is a leading cause of morbidity and mortality globally. Hypercholesterolemia is one of the major risk factors for CHD. With the increase in aging populations and progressively sedentary lifestyles, the global burden of CHD is likely to increase in the future despite better preventive strategies. It is vitally important to manage hypercholesterolemia effectively because it is a modifiable risk factor. At present, there are several guidelines with differences in recommendations. In this paper the authors present an update on the guidelines on hypercholesterolemia management. The authors have systematically reviewed guidelines in hypercholesterolemia management and discussed a pragmatic approach to follow the most recent guidelines including guidance from NICE in the primary care setting.

Birt-Hogg-Dubé syndrome: report of a new mutation.

Birt-Hogg-Dubé syndrome is an autosomal dominant genodermatosis caused by germline mutations in the folliculin gene and characterized by facial papules, pulmonary cysts, kidney tumours and recurrent pneumothoraces. Several distinct mutations in the folliculin gene resulting in a truncated protein have been described. The present report describes a new mutation, which has not been reported in individuals with Birt-Hogg-Dubé syndrome but is of a type predicted to cause disease.

Systematic review on evidence of the effectiveness of cholesterol-lowering drugs.

INTRODUCTION: Coronary heart disease (CHD) is the leading cause of mortality worldwide. With increasingly urbanized lifestyles in developing countries and the aging populations, the major risk factors for CHD such as obesity, diabetes mellitus, and hypercholesterolemia are likely to increase in the future. In the current report, we reviewed the evidence on the effect of cholesterol lowering using pharmacological agents. METHODS: A PubMed/Medline systematic search was performed over the past 12 years (1998-2009 inclusive) and relevant papers written in the English language were selected. We used key phrases including, "risk factors for hypercholesterolemia," "management of hypercholesterolemia," "guidelines for management of hypercholesterolemia," and "pharmacological management of hypercholesterolemia." RESULTS: There were a total of over 3500 reports. We selected key publications on the effect of cholesterol lowering using different pharmacological agents. CONCLUSION: Several options exist with regards to pharmacological management of hypercholesterolemia. There is a substantial body of evidence to support the effect of a population shift towards a favorable risk profile, which has huge potential in reducing the burden of CHD globally.