Accuracy of the DIAGNOcam and bitewing radiographs in the diagnosis of cavitated proximal carious lesions in primary molars.

AIMS: To evaluate the diagnostic abilities of near-infrared light transillumination (using the DIAGNOcam) and bitewing radiographs in detecting cavitated proximal carious lesions in primary molars. SUBJECTS AND METHODS: The study was a cross-sectional analytical, clinical study. The proximal surfaces of primary molars of healthy 5- to 8-year-old children were radiographically screened for the presence of carious lesions in the enamel or outer third of dentin (D1). Two trained and calibrated examiners evaluated the depth of caries in bitewing radiographs and DIAGNOcam images and then verified the presence of cavitation by direct visual examination using the "International Caries Detection and Assessment System" after temporary tooth separation. RESULTS: A total of 236 proximal lesions were included in the study. Most of the clinically cavitated lesions (51.9%) were D1 radiographically and in outer dentin lesions (scores 3 and 4) by the DIAGNOcam (37% and 48.1%, respectively). Although DIAGNOcam showed higher sensitivity (0.852) compared to the radiographs (0.519), it showed slightly less specificity (0.569) compared to the radiographs (0.579). However, DIAGNOcam showed higher value of the area under the curve (AUC = 0.722; P < 0.001) compared to the radiographic method (AUC = 0.561; P = 0.308). CONCLUSIONS: The DIAGNOcam showed higher sensitivity and better accuracy than bitewing radiographs in diagnosing cavitated proximal lesions in primary molars and can be generally considered as an alternative to radiographs to detect cavitation without the hazards of ionizing radiation in children.

Long-term outcomes of a randomized clinical trial of supervised exercise, percutaneous transluminal angioplasty or combined treatment for patients with intermittent claudication due to femoropopliteal disease.

BACKGROUND: The aim was to compare the long-term outcomes of percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined treatment (PTA + SEP) in patients with intermittent claudication owing to femoropopliteal disease. METHODS: Patients recruited to an RCT comparing these treatments were invited for long-term follow-up from 2010 to 2011. Indicators of limb ischaemia were recorded (ankle : brachial pressure index (ABPI) and treadmill walking distances). Duplex ultrasound imaging was also done. Patients completed Short Form 36 and VascuQol quality-of-life (QoL) questionnaires. RESULTS: Of 178 patients initially recruited to the trial, 139 were alive at the time of follow-up (PTA 46, SEP 47, PTA + SEP 46). Assessments were completed for 111 patients. Median time to follow-up was 5·2 (i.q.r. 3·8-7·4) years. Sixty-nine patients (62·2 per cent) were symptomatic; 18 (16·2 per cent) had experienced a major cardiovascular event since their last follow-up visit. Improvement was observed in ABPI in all groups. QoL outcomes were inconsistent across individual groups. PTA and PTA + SEP groups had a significantly higher ABPI than the SEP group. No significant difference was observed in treadmill walking distances, QoL outcomes, restenosis rates, and new ipsilateral and contralateral lesions on duplex imaging. Patients in all groups required reinterventions (PTA 14, SEP 10, PTA + SEP 6). The total number of reinterventions was higher after PTA (29) compared with SEP (17) and PTA + SEP (9), but failed to reach statistical significance. CONCLUSION: PTA, SEP and combined treatment were equally effective long-term treatment options for patients with claudication owing to femoropopliteal disease. The addition of a SEP to PTA can reduce the rate of symptomatic restenosis and reintervention. Registration number: NCT00798850 (http://www.clinicaltrials.gov).

Antioxidant potential analysis of P. ostreatus, P. sajor-caju, P. sapidus and P. columbinus.

The present study was conducted to evaluate the antioxidant activity of ethanol, n-hexane, dichloromethane, ethyl acetate and water extracts of four different Pleurotus spps. P. ostreatus, P. sajor-caju, P. sapidus and P. columbinus. The extraction was performed by classical organic solvent extraction (COSE). The extracts of Pleurotus spps. contained appreciable levels of total phenolic contents (TPC) (0.95-19.49 GAE, mg/g) and total flavonoid contents (0.85-3.73 CE, mg/g). All Pleurotus spps. also contained considerable DPPH radical scavenging activity, showing IC50 (19.15-54.50%) and reducing power (0.50-2.94 nm), respectively. The ascorbic acid content was in the range of (2.90-5.97 mg/g) for all Pleurotus spps. All studied Pleurotus spps. showed potential antioxidant activity. The results of four different Pleurotus spps. extracts showed that they can be used as a good food ingredient, and as a medicinal mushroom for digestive ailments, as well as in the pharmaceutical industry and in cosmetics.

Assessing Attitudes and Perceptions of Obstructive Pulmonary Disease Patients towards Inhaler Therapy in a Low Income Country: A Cross Sectional Study.

Chronic respiratory diseases (CRD) like asthma and chronic obstructive pulmonary disease (COPD) are one of the leading causes of morbidity and mortality worldwide. A patient's perception, about his or her medicine, may have an impact on adherence to medications. The purpose was to assess the attitudes and perceptions, regarding inhaler therapy use, among patients with obstructive pulmonary disease in Pakistan, a developing country. With a questionnaire developing this cross-sectional study was conducted at the Department of Medicine's outpatient clinic at Civil Hospital, Karachi from October 2013 to January 2014. We used SPSS version 19 for data entry. The number of patients included in the study was 202. Fifty eight percent (58%) of the patients concurred that they were not compliant with the usage of inhalers and frequently missed their doses. Thirty three percent (33%) patients had the misconception that inhalers are prescribed for severe diseases only. Almost forty percent (40%) patients said that they would prefer oral medicines over inhalers for the management of their lung diseases. Sixteen percent (16%) of the patients had problems using their inhalers. Twenty six percent (26%) of the patients believed that inhalers have side effects. Thirty eight percent (38%) of the patients believed inhalers are addictive. Misconceptions regarding inhalers and its usage in asthma and COPD patients are common in Pakistan. These misconceptions not only lead to poor compliance with medications prescribed but also to frequent visits to hospitals. There is a need to educate patients in the country regarding inhalers in order to improve not only their symptoms, but also to improve their quality of life.

Comparative Efficacy of Silymarin and Choline Chloride (Liver Tonics) in Preventing the Effects of Aflatoxin B1 in Bovine Calves.

Aflatoxins are secondary metabolites produced by Aspergillus spp. which are injurious to animals and humans The aim of this study was to determine the effects of aflatoxin B1 (AFB1) on Average Daily Feed Intake (ADFI), Average Daily Weight Gain (ADWG), haematological and serum biochemical responses of Bovine Calves and to determine the comparative efficacy of two different liver tonics against AFB1. Twenty seven calves were selected from herd and divided into 3 groups. All calves were fed with 1.0 mg/kg AFB1 for a period of 10 days. After that they were fed with liver tonics: Silymarin fed at a rate of 600 mg/kg and Choline chloride 500 mg/kg for 7 days. The results indicate that the ADFI and ADWG of AFB1 treated calves decreased significantly. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN) and creatinine significantly increased due to AFB1. In haematology the total erythrocyte count (TEC), total leukocyte count (TLC), haemoglobin concentration (HGB), haematocrit levels (HCT), mean corpuscular haemoglobin (MCH), mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC), lymphocyte %, neutrophil % and monocyte % significantly decreased in AFB1 treated calves after 10 days of feeding. Both liver tonics significantly (p<0.05) improved all the parameters, including ADFI, ADWG, hematologial and serum biochemical test. However, Silymarin comparatively more efficiently ameliorate the effects induced by AFB1 than choline chloride.

Recurrent Laryngeal Nerve Injury in Thyroid Surgery: One Year Prospective Study in a Tertiary Care Hospital.

This prospective, cross sectional study was carried out in the Department of Otolaryngology & Head-Neck Surgery, Mymensingh Medical College Hospital, Bangladesh from August 2010 to July 2011. One hundred & twenty eight (128) patients with thyroid swelling who underwent surgery were purposely included. The study was designed to determine the incidence of recurrent laryngeal nerve injury during thyroid surgery. Among the 128 patients, female were predominant 78.90%, majority of the patient were in third decade, 96.87% patients were biochemically euthyroid. Total 5.46% patient had recurrent laryngeal nerve injury. Among them 14.28% had transient and 85.72% had permanent injury. Injury was more in total thyroidectomy done for extensive malignancy.

Etiology of Laryngeal Squamous Cell Carcinoma: Study of 50 Cases in Mymensingh Medical College Hospital.

This cross sectional observational study was done in the Department of ENT & Head-Neck Surgery, Mymensingh Medical College, Bangladesh from January 2013 to July 2014. Fifty (50) cases of carcinoma larynx were purposively selected. Clinically diagnosed cases of carcinoma larynx and histologically proven squamous cell carcinoma were included. Among 50 cases age ranged from 35-75 years with an average age of 58.1 years. Maximum patients were in 5th and 6th decades with male-female ratio 16:1. Most of the patient (78%) came from rural areas and came from low socio-economic condition (58%); maximum patients were cultivator (42%) & illiterate (50%). Smoking was the commonest (64%) personal habit. The other common personal habits were chewing of Betel nut & leaf (44%) and chewing of Tobacco (36%). Most of them have more than one habit.

Study of Commonest Variety of Sinonasal Malignancy and Its Sex Wise Distribution.

This study was done to find the commonest variety of sinonasal malignancy and its association with sex.This cross-sectional study was conducted in the Department of Otolaryngology - Head & Neck Surgery Department, Dhaka Medical College & Hospital and in the Department of Otolaryngology - Head & Neck Surgery Department, Bangabandhu Sheikh Mujib Medical University between January 2009 and December 2009. A total of 146 cases of sinonasal malignancy were consecutively included in the study. The diagnosis was confirmed by histopathology. The mean age was 47.8 years (range: 22-75 years). Over three-quarters (77%) of the patients were male with male to female ratio being 3:1. Nearly one-third (30.8%) of the patients was farmer and over one-third (36.3%) was illiterate. The right sinonasal region was involved in 48.6% cases, left sinonasal region in 39% and both sinonasal region in 12.4% cases. Histopathological diagnosis of sinonasal malignancy revealed that squamous cell carcinoma accounted for 82.9% of sinonasal malignancies, 9.6% adenocarcinoma and the rest were olfactory neuroblastoma, adenoid cystic carcinoma and mucoepidermoid carcinoma. About 96.6% of the tumours involved nasal cavity, 97.9% maxillary sinuses, 17.8% frontal sinuses, 48.6% ethmoidal sinuses and 13% sphenoid sinuses. Over 80% of patients were smoker. Exposure to wood dust was found in 26% of cases. Lather tanning in 4.8% of cases and welding in 4.1% of cases. T staging shows that nearly half (48.6%) of the patients lesion was T2, 29.5% T3, 19.9% T4 and 2.1% T1. None of the patients exhibited lymph node involvement or distant metastasis. Males tend to develop squamous cell carcinoma significantly more than the females with risk of acquiring squamous cell carcinoma being nearly 3(1.1-7.1) times higher in male than that in female (p=0.022). The study concludes that the most common histopathological variety of sinonasal malignancy is squamous cell carcinoma and males are prone to develop this malignancy more frequently than the females.

Left Ventricular Diastolic Dysfunction is More Common in Patients of Uncontrolled Diabetes Mellitus.

There is a relationship between the left ventricular diastolic dysfunction with uncontrolled diabetes mellitus. A cross sectional study was designed to see the association of uncontrolled diabetes mellitus with diastolic dysfunction of the heart. The study was conducted from April 2012 to March 2013 in the department of cardiology, Mymensingh Medical College Hospital, Mymensingh. Sixty cases were selected as study population; twenty one patients were in Group I with good glycaemic controlled of HbA1C <7% and 39 patients were in Group II with poorly controlled diabetes mellitus having HbA1C ≥ 7%. In the study population male were 43(71.70%) and female were 17(28.30%). Mean age in the two groups were 49.05 ± 6.34 years vs. 53.64 ± 5.38 years, which was not significant difference. Duration of diabetes was <10 years and ≥ 10 years in two groups. Glycaemic status (percentage of HbA1C) was 6.55 ± 0.29% vs. 8.72 ± 1.01% in controlled and uncontrolled diabetic patient groups respectively which was significant difference. Diastolic dysfunction was found more in uncontrolled diabetic patient (patients having HbA1C% ≥ 7%) than controlled diabetic patients (HbA1C <7%). Grade I diastolic dysfunction was in uncontrolled and controlled glycaemic status were 33(84.60%) and 04(19.00%). The difference was statistically significant. Diastolic dysfunction in type 2 diabetic subjects was significantly higher as compared to the well control group (p<0.001). And this study concluded as - Diastolic dysfunction is more common in patient with poorly controlled diabetes mellitus.

Outcome of Titanium Elastic Intramedullary Nail in the Treatment of Shaft of Femur Fracture in Children.

Background Femoral-shaft fractures are among the most common fractures of the lower extremity in children. There are several different options for treating femoral-shaft fractures in children. Elastic stable intramedullary nailing (ESIN) has become the standard treatment for fractures of shaft of femur in children for reasons including mini-invasive surgery, no need for casting, early mobilization and discharge as well as growing concerns toward cost-effectiveness. Objective To demonstrate the effectiveness of intramedullary fixation of fracture shaft of femur in skeletally immature children using the titanium elastic intramedullary nails. Method Forty children who underwent fixation with titanium intramedullary nails because of fracture of shaft of femur (Winquist and Hansen type 1 and 2) were reviewed. There were 60% male and 40% female patients and mean follow-up was six months. Time of union, deformity at fracture site, limb length discrepancy, knee range of motion and complications were assessed. Result Average age of the patients was 5.17 years (range 3 to 10). All patients achieved complete healing at a mean 12.8 weeks (range 10 to 20 weeks). Average limb length discrepancy was -0.16 cm (range -1.0 to 1.1 cm) average knee range of motion was 137.55 degrees (range 118 to 152 degrees). Complications were recorded in 13 (31.7%) patients and included: Five malunion which did not show any deformity or functional impairment and eight superficial wound infections which were healed after removal of nail. All patients were active as their pre injury levels at six months follow up. Conclusion Elastic stable intramedullary nailing is the method of choice for the simple pediatrics fracture shaft of femur, as it is minimally invasive and shows good functional and cosmetic results. It allows short hospital stay and quick recovery from pain and is cast-free.

Effect of supervised exercise on physical function and balance in patients with intermittent claudication.

BACKGROUND: The aim of the study was to identify whether a standard supervised exercise programme (SEP) for patients with intermittent claudication improved specific measures of functional performance including balance. METHODS: A prospective observational study was performed at a single tertiary vascular centre. Patients with symptomatic intermittent claudication (Rutherford grades 1-3) were recruited to the study. Participants were assessed at baseline (before SEP) and 3, 6 and 12 months afterwards for markers of lower-limb ischaemia (treadmill walking distance and ankle : brachial pressure index), physical function (6-min walk, Timed Up and Go test, and Short Physical Performance Battery (SPPB) score), balance impairment using computerized dynamic posturography with the Sensory Organization Test (SOT), and quality of life (VascuQoL and Short Form 36). RESULTS: Fifty-one participants underwent SEP, which significantly improved initial treadmill walking distance (P = 0·001). Enrolment in a SEP also resulted in improvements in physical function as determined by 6-min maximum walking distance (P = 0·006), SPPB score (P < 0·001), and some domains of both generic (bodily pain, P = 0·025) and disease-specific (social domain, P = 0·039) quality of life. Significant improvements were also noted in balance, as determined by the SOT (P < 0·001). CONCLUSION: Supervised exercise improves both physical function and balance impairment.

Economic analysis of a randomized trial of percutaneous angioplasty, supervised exercise or combined treatment for intermittent claudication due to femoropopliteal arterial disease.

BACKGROUND: The aim was to compare costs and utilities of percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined treatment (PTA + SEP) in patients with intermittent claudication (IC) to establish the most cost-effective treatment. METHODS: Patients with IC due to femoropopliteal disease were randomized to receive PTA, SEP or PTA + SEP. Assessments were performed before, and at 1, 3, 6 and 12 months postintervention. Clinical and quality-of-life indicators were recorded. The SF-6D Health Utilities index was calculated from the Short Form 36, plotted, and quality-adjusted life-years (QALYs) were generated by calculating the area under the curve. Costs were calculated using National Health Service 2009-2010 payment-by-results tariffs and the National Institute for Health Research Clinical Research Network Investigation pricing index, and adjusted for reinterventions. Cost per QALY and incremental costs were calculated, and sensitivity analyses performed. RESULTS: A total of 178 patients (PTA, 60; SEP, 60; PTA + SEP, 58) were randomized. All treatments resulted in significant improvement in the SF-6D index (P < 0.001). There was no significant difference between treatments in mean QALYs gained (PTA: 0.620, 95 per cent confidence interval 0.588 to 0.652; SEP: 0.629, 0.597 to 0.660; PTA + SEP: 0.649, 0.622 to 0.675). The adjusted mean cost per procedure was significantly higher for PTA (€7301.74) compared with SEP (€3866.49) and PTA + SEP (€6911.68) (P < 0.001). The cost per QALY was significantly higher for PTA (€11,777.00) compared with SEP (€6147.04) and PTA + SEP (€10,649.74). QALYs were lost when PTA alone was used as first-line treatment in comparison with SEP or PTA + SEP. These results were robust and valid in sensitivity analyses. CONCLUSION: Supervised exercise is the most cost-effective first-line treatment for IC, and when combined with PTA is more cost-effective than PTA alone.

Biofilm forming multidrug resistant Staphylococcus aureus of dairy origin: molecular and evolutionary perspectives.

Background: Biofilm production by Staphylococcus aureus is a prevailing cause of multidrug resistance. The evolutionary mechanisms of adaption with host and pathogenicity are poorly understood. Aims: The present study aimed to investigate the biofilm-forming potential, associated multidrug resistance, and the evolutionary analysis of S. aureus isolated from bovine subclinical mastitis. Methods: 122 S. aureus isolates were subjected to Congo red agar method (CRA), microtitre plate method (MTP), and PCR to check the biofilm-forming potential. The Kirby-Bauer disk diffusion method was used to evaluate the antibiotic resistance pattern. The icaA gene of isolates was subjected to molecular and evolutionary analysis using different bioinformatics tools. Results: The results showed that 63.93% of S. aureus isolates carried the icaA gene and the detection rate of CRA was higher (36.07%) compared to the MTP test (24.59%). A total of 78.21% and 56.41% of biofilm-positive isolates were methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA), respectively. All S. aureus isolates (100%) showed multidrug resistance. The molecular analysis showed an evolutionary link between isolates and revealed a strong codon bias, three different recombination events, and positive selection in some residues of the semi-conserved segments of the icaA gene. Conclusion: The study concluded that biofilm-positive isolates have a high tendency to exhibit methicillin, vancomycin, and multidrug resistance. The findings suggest that mutation and selection are the most likely causes of codon bias in the icaA gene sequences. The variations led by recombination events and positive selection are suggestive of bacterial strategy to combat antimicrobial effects and to escape the host's immune surveillance.

Molecular prevalence of Anaplasma marginale in ruminants and Rhipicephalus ticks in northern Pakistan.

Anaplasma marginale is the most prevalent tick-borne haemoparasite of cattle and causes huge economic losses to the dairy industry worldwide. This study aimed to determine the occurrence of A. marginale infection in blood and tick samples collected from livestock animals in the districts located in Khyber Pakhtunkhwa (KPK), Pakistan. A total of 184 blood and 370 tick samples were included in this study. It has never been reported that sheep, goats, and cattle in Tank, Ghulam Khan, Birmil and Miran Shah areas were infected with A. marginale. All samples of blood and ticks were collected through random sampling from March 2021 to January 2022 from cattle, sheep and goats and screened through PCR for anaplasmosis by using primer pairs of Anaplasma spp. Three hundred and seventy ticks were collected from infested hosts (120/184, 64.21%). Among the four morphologically identified tick species, the highest occurrence was recorded for Rhipicephalus sanguineus (n=138, 37.29%), followed by Rhipicephalus microplus (n=131, 35.4%), Rhipicephalus annulatus (n=40, 10.81%), Hyalomma anatolicum (n=31, 8.37%), and Hyalomma marginatum (n=30, 8.1%). The occurrence of female tick was highest (n=160, 43.24%), followed by nymphs (n=140, 37.38%) and males ticks (n=70, 18.9%). Among these ticks, A. marginale was detected in female ticks of R. microplus, and R. sanguineus. Molecular identification of A. marginale was confirmed in 120 out of 184 blood samples and 6 out of 74 tick samples. Overall, occurrence of A. marginale in blood and tick samples was found to be 65.21% and 8.1% respectively. Species-wise occurrence in blood samples of goats were 71.11% followed by sheep 68.31% and cattle 50%. Specie-wise occurrence of A. marginale in tick samples of cattle were 12.5% followed by goats 6.89%. The obtained sequence showed similarity with A. marginale reported from Kenya and USA. We report the first PCR based detection of A. marginale infection in blood samples and in R. sanguineus ticks of goats simultaneously.

Differential expression of inflammatory cytokines, prostaglandin synthases and secretory leukocyte protease inhibitor in the endometrium and circulation in different graded CEH-pyometra in bitch.

Cystic endometrial hyperplasia (CEH)-pyometra (CEH-P) is one of the most common reproductive disorders in bitches, posing a risk to both future fertility and life. The aims of the current study were to elucidate the differential expression patterns of inflammatory mediators at transcript and protein levels in the endometrium and to assess the concentrations of key inflammatory mediators in the peripheral circulation of bitches with different graded CEH-P. A total of 25 client-owned intact mixed breed bitches of 3-10 years presented to the outpatient department of RVP-TVCC of the institute were considered for the study. Of which, 22 cases suggestive of pyometra and 3 cases of CEH obtained during routine elective ovariohysterectomy were subjected to histopathological examination. Uteri were categorized into CEH (n = 3), moderate CEH-P (mCEH-P, n = 9), severe CEH-P (sCEH-P, n = 6) and atrophic pyometra (AT-P, n = 7). A group of age matched (n = 12) bitches without pyometra served as control. Endometrial transcripts such as IL6, IL8, PTGS2, PGFS, and SLPI were expressed differentially in the CEH and CEH-P bitch. In addition, a strong immunoreactivity (IR) of IL6, IL8, PTGS2, and mPGES1 was recorded in the sCEH-P uterus, while expression of IL10 was noticed in AT-P. In circulation, serum IL6 was the most relevant marker with high sensitivity of 96.2% and specificity of 84.6% at a cut off concentration 8.5 pg/mL followed by SLPI with 95.2% sensitivity, and 84.6% specificity at cut off concentration of 1.3 ng/mL. Serum IL10, PGFM and SLPI concentration in the peripheral circulation were 1.5-2.23 fold higher in mCEH-P, 0.87-2.5 fold higher in sCEH-P and 2.9-3.5 fold higher in AT-P than that of control. It is concluded that monitoring the serum concentration of IL6, IL10 and SLPI would be useful adjunct to the established hematobiochemical parameters in the management of pyometra in the bitch with critical illness.

Randomized clinical trial of percutaneous transluminal angioplasty, supervised exercise and combined treatment for intermittent claudication due to femoropopliteal arterial disease.

BACKGROUND: The aim was to compare percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined treatment (PTA plus SEP) for intermittent claudication due to femoropopliteal arterial disease. METHODS: Consenting patients with femoropopliteal arterial lesions were randomized to one of three treatment arms: PTA, SEP, or PTA plus SEP. All patients received optimal medical treatment. Patients were assessed at baseline and 1, 3, 6 and 12 months after intervention. Clinical (ankle pressures, walking distances, symptoms) and quality-of-life (QoL) outcomes (Short Form 36, VascuQol) were analysed. RESULTS: A total of 178 patients (108 men, median age 70 years) were included. All three treatment groups demonstrated significant clinical and QoL improvements. One year after PTA (60 patients, 8 withdrew), 37 patients (71 per cent) had improved (16 mild, 16 moderate, 5 marked), nine (17 per cent) showed no improvement and six (12 per cent) had deteriorated. After SEP (60 patients, 14 withdrew), 32 patients (70 per cent) had improved (19 mild, 10 moderate, 3 marked), six (13 per cent) showed no improvement and eight (17 per cent) had deteriorated. After PTA plus SEP (58 patients, 11 withdrew), 40 patients (85 per cent) had improved (18 mild, 20 moderate, 2 marked), seven (15 per cent) showed no improvement and none had deteriorated. On intergroup analysis, PTA and SEP alone were equally effective in improving clinical outcomes, although the effect was short-lived. PTA plus SEP produced a more sustained clinical improvement, but there was no significant QoL advantage. CONCLUSION: For patients with intermittent claudication due to femoropopliteal disease, PTA, SEP, and PTA plus SEP were all equally effective in improving walking distance and QoL after 12 months. REGISTRATION NUMBER: NCT00798850 (http://www.clinicaltrials.gov).

An analysis of the performance of UK medical graduates in the MRCOG Part 1 and Part 2 written examinations.

BACKGROUND: There is a lack of evidence on whether graduates from different medical schools perform differently in postgraduate examinations. OBJECTIVE: To evaluate the variations in performance of UK medical graduates in Member of the Royal College of Obstetricians and Gynaecologists (MRCOG) examination. METHODS: A retrospective analysis of performance of 1335 doctors graduating in UK medical schools who entered the Part 1 MRCOG and 822 doctors taking the Part 2 MRCOG written examination for the first time between 1998 and 2008. The main outcome measures were to evaluate medical school effects, gender effects and academic performance effect. RESULTS: Graduates of UK medical schools performed differently in the Part 1 and Part 2 written MRCOG examination. The graduates of Oxford (pass rate 82.6%), Cambridge (75%), Bristol (59.3%) and Edinburgh (57.5%) performed significantly better and the graduates of Liverpool (26.8%), Southampton (21.8%) and Wales (18.2%) performed significantly worse than the remaining cohort in the Part 1 examination. The candidates of Newcastle (88.9%), Oxford (82.4%), Cambridge (81%) and Edinburgh (78.2%) performed significantly better and the graduates of Glasgow (49.2%) and Leicester (36.2%) have significantly underperformed compared with the remaining cohort in Part 2 written examination. There was no difference in the success rates of male (47.5%) and female (42.0%) candidates in the Part 1; however, female candidates had a significantly better success rate in the Part 2 written examination than male candidates (65.6% vs 52.9%). CONCLUSION: These results show that there is variation in performance among the graduates from different medical schools in the Part 1 and Part 2 MRCOG written examination.

Difficulty in diagnosis of nasopharyngeal carcinoma.

Due to difficult anatomical position nasopharyngeal carcinoma (NPC) is always challenging problems both from the diagnostic and therapeutic corner. A 24 years old lady came to our Department of Otolaryngology and Head-Neck Surgery with the complaints of epistaxis, right sided neck swelling, nasal obstruction and headache. On digital palpation Nasopharyngeal mass was found. We took biopsy from nasopharynx under indirect vision but report was not conclusive. Then we did CT scan, nasendoscopy. Nasendoscopy showed bilateral ethmoidal polyp with nasopharyngeal mass. We took biopsy from the nasopharyngeal mass and confirmed the diagnosis.

First substantiation of clinico-molecular investigation of pathogenic Listeria monocytogenes in Nili-Ravi buffaloes.

Background: Listeriosis is a zoonotic disease of humans, animals, birds, fish, and crustaceans worldwide. Domestic animals, especially ruminants, are more susceptible to listeriosis. This infectious disease is caused by Listeria monocytogenes, an intracellular bacterium that can cross blood-brain, placental and intestinal barriers. In Pakistan, the incidence and reliable diagnostic tools for the L. monocytogenes are unidentified in Nili-Ravi buffaloes. Aims: This study was designed to inspect listeriosis in buffaloes through molecular techniques and haemato-biochemical analyses. Methods: A total of 230 samples (115 milk and 115 faecal samples) were collected from symptomatic listeriosis cases in Nili-Ravi buffaloes of 3 geographical districts (Rawalpindi, Faisalabad, and Muzaffargarh) Punjab, Pakistan. These samples were processed for DNA extraction using commercialized kits, and L. monocytogenes was confirmed by conventional PCR. Results: The results revealed that 6.08% and 4.34% of the isolates from milk and faecal samples were found positive for L. monocytogenes, respectively. The phylogenetic analysis of these isolates showed 97-100% similarity to isolates from the USA, Switzerland, Japan, and India. The accession numbers on NCBI GenBank appeared as HF558398 (Switzerland), KP965732 (India), EU372032 (USA), and LC259850 (Japan). Haemato-biochemical examinations showed that the values of WBCs, plasma fibrinogen, ALT, and AST significantly increased (P<0.05) in diseased buffaloes compared to healthy ones. Conclusion: The occurrence of listeriosis in buffaloes urges continuous monitoring and surveillance to prevent this emerging disease in Pakistan.

Systemic human Netrin-1 gene delivery by adeno-associated virus type 8 alters leukocyte accumulation and atherogenesis in vivo.

Atherosclerosis is an inflammatory disorder of arteries. Atherosclerotic plaque, in its early to intermediate stages, is composed largely of lipid-engorged foam cells. These foam cells are derived from the trafficking of monocytes (Mo) into the arterial intima, attracted to the site by chemoattractants. Given that foam cells are derived from the trafficking of Mo, the use of Netrin-1, an Mo chemorepellent, may be useful in limiting Mo accumulation and subsequent plaque formation. To investigate the potential of Netrin-1 for limiting atherosclerosis, we systemically delivered its human (h) cDNA by adeno-associated virus type 8 (AAV8, single-stranded structure) delivery into low-density lipoprotein receptor knockout (LDLR-/-) mice and placed the animals on a high cholesterol diet (HCD). Compared with control neomycin resistance (Neo) gene delivery/HCD, hNetrin-1 delivery resulted in a significant reduction in plaque formation, as determined by larger aortic lumen size, thinner intima-media thickness and lower blood velocity than the Neo/HCD control (all statistically significant). Indices of monocyte/macrophage (Mo/MΦ) accumulation, CD68, integrin, alpha M (ITGAM) and egf-like module containing, mucin-like, hormone receptor-like 1 (EMR-1), were reduced in hNetrin-1/HCD-treated animal's aortas and spleens compared with Neo/HCD-treated animals. Unexpectedly, CD25 and foxp3 (regulatory T cells (Tregs)) in the aorta were strongly upregulated. This is the first time the Mo/MΦ chemorepellent approach, and specific Netrin-1 gene delivery, has been performed for the reduction of Mo/MΦ burden and atherosclerosis. In addition, Netrin-1 has never before been linked to altered Treg levels. These data strongly suggest that hNetrin-1 gene delivery can reduce Mo/MΦ accumulation, inflammation and subsequent plaque formation.