Antibiotic resistance modulation of Clostridium perfringens type D using indigenous plants extracts

Aims@#The study was aimed to explore the antimicrobial potential of ethanolic leaf extracts of Eucalyptus globulus, Moringa oliefera, Syzygium cumini and Citrus limon against antibiotic-resistant Clostridium perfringens type D (n=5).@*Methodology and results@#Antibiotic resistance pattern of C. perfringens type D isolates against tetracycline, gentamicin, ceftriaxone, amoxicillin and streptomycin was evaluated by disc diffusion method. Well diffusion and micro broth dilution methods were used to determine the anti-bacterial activity, sub-inhibitory concentrations and antibiotic resistance modulating effects of the plant extracts. Ethanolic extract of E. globules was selected to evaluate its modulatory impact and subjected to GC-MS analysis to separate and identify the phytochemicals. The results showed that the isolates were resistant to gentamicin (0 ± 0.00 mm), streptomycin (0 ± 0.00 mm), tetracycline (13.2 ± 2.28 mm) and ceftriaxone (0 ± 0.00 mm) while sensitive to amoxicillin (23.8 ± 1.30 mm) and tetracycline (13.2 ± 2.28 mm). Eucalyptus globulus exhibited the maximum anti-bacterial activity with a zone of inhibition (ZOI) of 14.6 ± 0.54 mm and minimum inhibitory concentration (MIC) (1500 ± 947.85 µg/mL). Other plant extracts (M. oliefera, S. cumini and C. limon) also showed anti-bacterial activity but couldn’t modulate the resistance. The activity of ceftriaxone associated with E. globulus extract was improved with 20.2 ± 0.20 mm ZOI at 78.125 µg/mL sub-inhibitory concentration.@*Conclusion, significance and impact of study: @#The study results indicate the possible use of the ethanolic extract of E. globulus alone or in combination with common antibiotics for the treatment of C. perfringens infections in small ruminants.

Analysis of Germin-like protein genes family in Vitis vinifera (VvGLPs) using various in silico approaches

Abstract Germin-like proteins (GLPs) play an important role against various stresses. Vitis vinifera L. genome contains 7 GLPs; many of them are functionally unexplored. However, the computational analysis may provide important new insight into their function. Currently, physicochemical properties, subcellular localization, domain architectures, 3D structures, N-glycosylation & phosphorylation sites, and phylogeney of the VvGLPs were investigated using the latest computational tools. Their functions were predicted using the Search tool for the retrieval of interacting genes/proteins (STRING) and Blast2Go servers. Most of the VvGLPs were extracellular (43%) in nature but also showed periplasmic (29%), plasma membrane (14%), and mitochondrial- or chloroplast-specific (14%) expression. The functional analysis predicted unique enzymatic activities for these proteins including terpene synthase, isoprenoid synthase, lipoxygenase, phosphate permease, receptor kinase, and hydrolases generally mediated by Mn+ cation. VvGLPs showed similarity in the overall structure, shape, and position of the cupin domain. Functionally, VvGLPs control and regulate the production of secondary metabolites to cope with various stresses. Phylogenetically VvGLP1, -3, -4, -5, and VvGLP7 showed greater similarity due to duplication while VvGLP2 and VvGLP6 revealed a distant relationship. Promoter analysis revealed the presence of diverse cis-regulatory elements among which CAAT box, MYB, MYC, unnamed-4 were common to all of them. The analysis will help to utilize VvGLPs and their promoters in future food programs by developing resistant cultivars against various biotic (Erysiphe necator and in Powdery Mildew etc.) and abiotic (Salt, drought, heat, dehydration, etc.) stresses.

Resumo As proteínas do tipo germin (GLPs) desempenham um papel importante contra vários estresses. O genoma de Vitis vinifera L. contém 7 GLPs; muitos deles são funcionalmente inexplorados. No entanto, a análise computacional pode fornecer informações importantes sobre sua função. Atualmente, as propriedades físico-químicas, localização subcelular, arquitetura de domínio, estruturas 3D, sítios de N-glicosilação e fosforilação e estudos filogenéticos dos VvGLPs foram conduzidos usando as ferramentas computacionais mais recentes. Suas funções foram previstas usando a ferramenta Search para recuperação de genes/proteínas em interação (STRING) e servidores Blast2Go. A maioria dos VvGLPs são extracelulares (43%) na natureza, mas também mostraram expressão periplasmática (29%), na membrana plasmática (14%) e específica para mitocôndrias ou cloroplastos (14%). A análise funcional previu atividades enzimáticas únicas para essas proteínas, incluindo terpeno sintase, isoprenoide sintase, lipoxigenase, fosfato permease, receptor quinase e hidrolases geralmente mediadas por cátion Mn +. VvGLPs mostraram similaridade na estrutura geral, forma e posição do domínio cupin. Funcionalmente, os VvGLPs controlam e regulam a produção de metabólitos secundários para lidar com vários estresses. Filogeneticamente, VvGLP1, -3, -4, -5 e VvGLP7 mostraram maior similaridade devido à duplicação, enquanto VvGLP2 e VvGLP6 revelaram uma relação distante. A análise do promotor revelou a presença de diversos elementos cis-reguladores, entre os quais CAAT box, MYB, MYC, sem nome-4, sendo comum a todos eles. A análise ajudará a utilizar VvGLPs e seus promotores em programas alimentares futuros, desenvolvendo cultivares resistentes contra vários estresses bióticos (Erysiphe necator e no oídio, etc.) e abióticos (sal, seca, calor, estresse hídrico, etc.).

Analysis of Germin-like protein genes family in Vitis vinifera (VvGLPs) using various in silico approaches / Análise da família de genes de proteínas semelhantes a germin em Vitis vinifera (VvGLPs) usando várias abordagens in silico

Germin-like proteins (GLPs) play an important role against various stresses. Vitis vinifera L. genome contains 7 GLPs; many of them are functionally unexplored. However, the computational analysis may provide important new insight into their function. Currently, physicochemical properties, subcellular localization, domain architectures, 3D structures, N-glycosylation & phosphorylation sites, and phylogeney of the VvGLPs were investigated using the latest computational tools. Their functions were predicted using the Search tool for the retrieval of interacting genes/proteins (STRING) and Blast2Go servers. Most of the VvGLPs were extracellular (43%) in nature but also showed periplasmic (29%), plasma membrane (14%), and mitochondrial- or chloroplast-specific (14%) expression. The functional analysis predicted unique enzymatic activities for these proteins including terpene synthase, isoprenoid synthase, lipoxygenase, phosphate permease, receptor kinase, and hydrolases generally mediated by Mn+ cation. VvGLPs showed similarity in the overall structure, shape, and position of the cupin domain. Functionally, VvGLPs control and regulate the production of secondary metabolites to cope with various stresses. Phylogenetically VvGLP1, -3, -4, -5, and VvGLP7 showed greater similarity due to duplication while VvGLP2 and VvGLP6 revealed a distant relationship. Promoter analysis revealed the presence of diverse cis-regulatory elements among which CAAT box, MYB, MYC, unnamed-4 were common to all of them. The analysis will help to utilize VvGLPs and their promoters in future food programs by developing resistant cultivars against various biotic (Erysiphe necator and in Powdery Mildew etc.) and abiotic (Salt, drought, heat, dehydration, etc.) stresses.

As proteínas do tipo germin (GLPs) desempenham um papel importante contra vários estresses. O genoma de Vitis vinifera L. contém 7 GLPs; muitos deles são funcionalmente inexplorados. No entanto, a análise computacional pode fornecer informações importantes sobre sua função. Atualmente, as propriedades físico-químicas, localização subcelular, arquitetura de domínio, estruturas 3D, sítios de N-glicosilação e fosforilação e estudos filogenéticos dos VvGLPs foram conduzidos usando as ferramentas computacionais mais recentes. Suas funções foram previstas usando a ferramenta Search para recuperação de genes/proteínas em interação (STRING) e servidores Blast2Go. A maioria dos VvGLPs são extracelulares (43%) na natureza, mas também mostraram expressão periplasmática (29%), na membrana plasmática (14%) e específica para mitocôndrias ou cloroplastos (14%). A análise funcional previu atividades enzimáticas únicas para essas proteínas, incluindo terpeno sintase, isoprenoide sintase, lipoxigenase, fosfato permease, receptor quinase e hidrolases geralmente mediadas por cátion Mn +. VvGLPs mostraram similaridade na estrutura geral, forma e posição do domínio cupin. Funcionalmente, os VvGLPs controlam e regulam a produção de metabólitos secundários para lidar com vários estresses. Filogeneticamente, VvGLP1, -3, -4, -5 e VvGLP7 mostraram maior similaridade devido à duplicação, enquanto VvGLP2 e VvGLP6 revelaram uma relação distante. A análise do promotor revelou a presença de diversos elementos cis-reguladores, entre os quais CAAT box, MYB, MYC, sem nome-4, sendo comum a todos eles. A análise ajudará a utilizar VvGLPs e seus promotores em programas alimentares futuros, desenvolvendo cultivares resistentes contra vários estresses bióticos (Erysiphe necator e no oídio, etc.) e abióticos (sal, seca, calor, estresse hídrico, etc.).

Unmasking the elusive: an early gestational age placenta accreta case series to illuminate the path towards avoiding missed diagnosis

Placenta accreta is a condition characterized by the abnormal invasion of the placenta into the uterine wall, leading to torrential hemorrhage. This case series, highlights the importance of accurate diagnosis and early detection of this life-threatening complication. The incidence of this iatrogenic complication is rising due to increased caesarean deliveries. While in advance stages of pregnancy the chances of missing accreta are less but in early pregnancy the diagnosis may be elusive. Timely detection by using imaging modalities like ultrasound both 2D and colour Doppler, provide valuable clues. Misdiagnosis may be fatal, especially in the first trimester. The present case series presents 3 cases where initial diagnosis of missed abortion followed by repeated curettage and gestational trophoblastic disease (GTD) was made respectively. The agony of suffering leads the patient to our tertiary care center where the diagnosis of accreta was made. Accurate diagnosis and early detection of placenta accreta are vital to optimize patient outcome. Detecting the nicheand an anteriorly situated low lying placenta with history of previous birth by caesarian section should raise suspicion, and vigilance on the part of treating obstetrician is must.

Unmasking the elusive: an early gestational age placenta accreta case series to illuminate the path towards avoiding missed diagnosis

Placenta accreta is a condition characterized by the abnormal invasion of the placenta into the uterine wall, leading to torrential hemorrhage. This case series, highlights the importance of accurate diagnosis and early detection of this life-threatening complication. The incidence of this iatrogenic complication is rising due to increased caesarean deliveries. While in advance stages of pregnancy the chances of missing accreta are less but in early pregnancy the diagnosis may be elusive. Timely detection by using imaging modalities like ultrasound both 2D and colour Doppler, provide valuable clues. Misdiagnosis may be fatal, especially in the first trimester. The present case series presents 3 cases where initial diagnosis of missed abortion followed by repeated curettage and gestational trophoblastic disease (GTD) was made respectively. The agony of suffering leads the patient to our tertiary care center where the diagnosis of accreta was made. Accurate diagnosis and early detection of placenta accreta are vital to optimize patient outcome. Detecting the nicheand an anteriorly situated low lying placenta with history of previous birth by caesarian section should raise suspicion, and vigilance on the part of treating obstetrician is must.

Risk of malignancy in thyroid nodules classified as Bethesda categories III, III - subcategories and IV: 2.5 years study

Introduction: Thyroid fine-needle aspiration cytology (FNAC) has gained significance as a quick, safe, and relatively simple method to differentiate malignant from benign thyroid nodules and is regarded as the gold-standard first-line diagnostic test in the evaluation of thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a standardized, category-based reporting system for thyroid FNAC with each category having an implied cancer risk. However, the optimal management of thyroid nodules in the Bethesda III and IV categories is controversial, given the variable malignancy rates. Aims/Objectives: (1) Analysis of the cytomorphological characteristics of patients with categories III and IV of “TBSRTC.” (2) Assessment of risk of malignancy of TBSRTC category III, IV, and substratification of TBSRTC category III. Materials and Methods: A retrospective and prospective study of cases categorized under TBSRTC as category III and IV at a tertiary-care center. Cytological along with their histological results were compared. Results: We identified an overall malignancy rate of 33% for nodules belonging to Bethesda category III and a malignancy rate between 19% and 33% for Bethesda category IV. Also, a significantly higher risk of malignancy in subcategories with nuclear and architectural atypia (66.6%) than only architectural atypia (28.7%). Conclusion: Although surgery is recommended in most of these cases, cytomorphology helps to predict the final histopathological findings with greater accuracy. Substratification of category III into subgroups may help reduce the heterogeneity of the atypia of undetermined significance/follicular lesion of undetermined significance category and more.

ROLE OF INFORMED CONSENT IN CLINICAL DECISION MAKING

In recent decades, the clinical procedures surrounding informed consent in healthcare settings have experienced a revolution for the better. However, the method by which doctors get informed consent is still challenging. The causes of this ambiguity are numerous. Part of the doubt stems from the intellectual dullness of key foundational notions. The complexities of therapeutic communication, the importance of autonomy, and the changing nature of the doctor-patient relationship have all contributed to the ongoing uncertainty in many clinical settings. Many patients who face medical dilemmas are unsure of which therapy options to take. The informed consent helps in minimizing uncertainty and empowering patients’ in choosing clinical decisions.

The effect of COVID-19 pandemic on anxiety disorders among workers in a hospital in Balikpapan, East Kalimantan

INTRODUCTION@#During the global COVID-19 pandemic, health workers were found to have a higher prevalence of anxiety disorder compared to non-health workers. Anxiety disorder that occurs chronically have a 25% chance to become a major depression disorder.@*OBJECTIVE@#The aim of this study is to understand the anxiety condition and related risk factors among workers in a Balikpapan hospital during the COVID-19 pandemic.@*METHOD@#The design of this research used a cross sectional method that involved 279 respondents who are workers in a Balikpapan hospital. The study used SPSS version 20.0, using the chi square and Fisher’s Exact test for the bivariate analysis, and the logistic regression with enter method for the multivariate analysis.@*RESULTS@#The study shows that using the General Anxiety Disorder 7 (GAD-7) questionnaire from 279 hospital workers, there were 10.8% with mild-, 1.45% with moderate-, and 0.4% with severe anxiety disorder. A significant relation was found between anxiety disorder and risk factors such as being a health worker with p=0.001 and a 4.8 OR adj (95% CI: 1.9-12.3), working in areas with high risk of transmitting COVID-19 with p=0.04 and a 5.1 OR adj (95% CI: 1.0-24.2), and workers who are being quarantined with p=0.001 a 10.5 OR adj (2.6-42.3) after being adjusted by age and gender variables.@*CONCLUSION@#Significant relations were found between anxiety disorder among hospital workers with risk factors such as being health workers, working in areas with high risk of transmitting COVID-19, and workers who are being quarantined. Researchers strongly advise health providers to do regular monitoring and seek moral support especially for workers who have higher risk of anxiety disorder.

Renal function analysis of crane operators in a container terminal and its related factors

Objective@#The objective of this study was to assess factors related to renal function in crane operators at a port container terminal in Indonesia. @*Methods@#A cross-sectional study on crane operators in Medan Container Terminal, Indonesia, was conducted. Renal function was measured through Glomerular Filtration Rate (GFR). Individual characteristics such as age, nutritional status, fluid consumption, hydration status, and physical activity level were collected. Fluid consumption was obtained from a 24-h food recall questionnaire. Physical activity was measured based on the Bouchard questionnaire. Association was determined by calculating the odds ratio (OR) and its 95% confidence interval (CI). @*Results@#A total of 87 subjects were involved. All were male with the median age of 30.1 ± 2.4 years old. The prevalence of decreased renal function was 49.4%. Inadequate fluid consumption (OR = 6.1, 95% CI 2.1 -17.7; p<0.001) significantly increase the risk of renal function decreased, while being overweight/obese (OR 3.3, 95% CI 0.7 -11.7;p<0.125) and dehydration (OR 2.3, 95% CI 0.8-26.9; p=0.111) also increase the risk although not significantly. @*Conclusion@#Inadequate fluid consumption increases the risk of decline in the renal function of crane operators in the container terminal. A company should regularly monitor and evaluate the kidney function of this group of workers through annual medical checkups and provide easier access to drinking water and convenient toilets to improve fluid consumption of the workers.

Vertebral Endplate Changes Correlate with Presence of Cartilaginous Endplate in the Herniated Disc Tissue: Factor Predicting Failure of Conservative Treatment

Methods@#Fifty-one discs were obtained from patients undergoing surgery for herniated disc. Their ages ranged from 19-65 years, and 31/51 were male. Pre-surgical T1 and T2 weighted lumbar-spine MRIs were analyzed to observe Pfirrmann grade, VEP defects, herniation type, Modic changes, and high-intensity zones (HIZ) at the affected level. Five-micron thick sections were stained with hematoxylin and eosin, Alcian blue periodic acid–Schiff stain; examined for histological degeneration scores (HDS; 0–15), inflammation (0 [absence]–3 [severe]), and presence of cartilaginous endplate (CEP). Three-micron thick sections were stained with protein-gene-product 9.5 and expression was counted/mm2. Data was analyzed, and p<0.05 was considered to indicate statistical significance. @*Results@#VEP defects, Modic changes, and HIZ were respectively observed in 30/51, 16/51, and 6/51 of the samples. CEP was observed in 26/51 samples and in 23/51 with endplate defects. Discs with adjacent VEP defects showed increased HDS (p<0.001) and inflammation (p<0.001). Discs with adjacent Modic changes also revealed increased HDS (p=0.01). Histological sections with CEP showed increased HDS (p<0.001) and inflammation (p<0.001), and nerve density was significantly positively correlated with HDS (r=0.27, p=0.02). @*Conclusions@#VEP changes can modulate degeneration and inflammation of herniated discs. Presence of these changes is highly predictive of the occurrence of CEP in herniated discs, which leads to slow resorption and persistent clinical symptoms.

Relation of urinary mercury level to chronic fatigue syndrome among workers of artisanal and small-scale gold mining: A study of 3 districts in West Nusa Tenggara Province and Lebak District of Banten Province, Indonesia

INTRODUCTION@#Chronic Fatigue Syndrome (CFS) is a collection of symptoms from a substantial reduction in the ability to engage in preillness levels of occupational, educational, social, or personal activities that persists for more than six months and is accompanied by fatigue, post-exertional malaise, and unrefreshing sleep. One of the effects of heavy metal exposure is the occurrence of CFS among workers. Artisanal and Small-scale Gold Mining (ASGM) workers used mercury in their work, and this leads to a higher risk of chronic mercury poisoning. One of the health problems dueto mercury exposure is the occurrence of CFS and this has not been studied among ASGM workers.@*OBJECTIVE@#This study intended to discover the prevalence of CFS among ASGM workers and the factors associated with it.@*METHOD@#This study used a cross-sectional design to find the relationship between independent variables such as age, sex, working period as a miner, type of work activities in ASGM, and cumulative urinary mercury levels with CFS in ASGM workers in West Nusa Tenggara and Banten province. CFS was measured using standardized questionnaire on effect on mercury released by WHO-UNEP, and creatinine-corrected urinary mercury levels.@*RESULTS@#The prevalence of CFS in ASGM workers in West Nusa Tenggara and Banten provinces was 17.9%. Based on the results, the factors of age, sex, work period, type of work, province of origin and cumulative urinary mercury levels did not have a statistically significant relationship with CFS (p> 0.05).@*CONCLUSION@#There was no significant relationship between age, sex, work period, type of work, urinary mercury level and cumulative urinary mercury levels with CFS in ASGM workers.

Effect of Different Preparations of Fluoride Gel on Salivary pH of Albino Rats

Abstract Objective: To evaluate the effect of different preparations of fluoride gels on the salivary pH of albino rats. Material and Methods: This experimental study consisted of 40 Albino rats randomly divided into four equal groups. Group A was the control group and received no intervention. Experimental group B received a topical application of 0.2% sodium fluoride gel. Experimental group C received topical application of stannous fluoride gel 0.4%. Experimental group D received topical application of APF gel (1.23% acidulated phosphate fluoride gel). The different preparations of the gels were applied once daily for 4 minutes on the occlusal surface of the right maxillary molars for 14 days. Salivary pH values were recorded immediately after the application of gels with the help of pH paper on day 1 and day 14. Results: There was a significant difference in the pH level of groups B, C and D after 14 days of fluoride application (p < 0.05). The non-parametric Kruskal Wallis test was applied for the comparison between the groups. Conclusion: This study concluded that all the fluoride gels after administration caused the acidic pH of saliva with the most acidic effect produced by APF gel (AU).

Food handlers: an important reservoir of protozoans and helminth parasites of public health importance / Manipuladores de alimentos: um importante reservatório de protozoários e helmintos parasitas de importância para a saúde pública

Food handlers plays a primary role in the transmission of pathogenically important protozoans and helminth parasites. This study was aimed to evaluate the prevalence of intestinal pathogenic protozoans and helminth parasites among food handlers in and around University of Malakand, Lower Dir, Pakistan. Stool samples were collected from 642 food handlers (all of male) in a cross-sectional study from January to November, 2017. Wet Mount Techniques and concentration methods by using salt and formol–ether solutions. Three hundred and eighty four cases (59.8%) were found infected with one more parasites. Most of the individuals were found infected with helminth (47.6%) as compared to intestinal protozoans (0.93%). Seventy two cases (11.2%) of the cases presented mixed infection with both intestinal protozoan and helminth parasites. The order of prevalence for intestinal helminth was Ancylostoma duodenale (n = 258, 40.1%), followed by Taeniasa ginata (n=96, 14.9%) Ascaris lumbricoides (n = 54, 8.40%) and Trichuris trichura (n=30, 4.60%). For intestinal protozoa, Entamoeba histolytica/dispar (n = 36, 5.64%) was the only protozoan detected. Mono-parasitism was higher than poly-parasitism. Family size income and education level were the factors significantly (P<0.05) associated in the parasites prevalence. Current research showed that IPIs are primarily the foodborne pathogens still an important public health problem in Pakistan. Effective control programs on parasitic diseases transfer and their associated factors are recommended.

Os manipuladores de alimentos desempenham um papel fundamental na transmissão de protozoários e helmintos parasitas patogenicamente importantes. Este estudo teve como objetivo avaliar a prevalência de protozoários patogênicos intestinais e helmintos parasitas entre manipuladores de alimentos na Universidade de Malakand, Lower Dir, Paquistão. Amostras de fezes foram coletadas de 642 manipuladores de alimentos (todos do sexo masculino) em um estudo transversal de janeiro a novembro de 2017. Técnicas de montagem úmida e métodos de concentração usando soluções de sal e formol-éter. Trezentos e oitenta e quatro casos (59,8%) foram encontrados infectados com mais um parasita. A maioria dos indivíduos foi encontrada infectada por helmintos (47,6%) em comparação com protozoários intestinais (0,93%). Setenta e dois casos (11,2%) dos casos apresentavam infecção mista com protozoários intestinais e helmintos parasitas. A ordem de prevalência de helmintos intestinais foi Ancylostoma duodenale (n = 258, 40,1%), seguido por Taeniasa ginata (n = 96, 14,9%) Ascaris lumbricoides (n = 54, 8,40%) e Trichuris trichura (n = 30, 4,60 %). Para protozoários intestinais, Entamoeba histolytica / dispar (n = 36, 5,64%) foi o único protozoário detectado. Monoparasitismo foi maior do que poliparasitismo. A renda familiar e o nível de escolaridade foram os fatores significativamente (P <0,05) associados na prevalência de parasitos. A pesquisa atual mostrou que os IPIs são principalmente os patógenos de origem alimentar, ainda um importante problema de saúde pública no Paquistão. Programas eficazes de controle da transferência de doenças parasitárias e seus fatores associados são recomendados.

Food handlers: an important reservoir of protozoans and helminth parasites of public health importance

Abstract Food handlers plays a primary role in the transmission of pathogenically important protozoans and helminth parasites. This study was aimed to evaluate the prevalence of intestinal pathogenic protozoans and helminth parasites among food handlers in and around University of Malakand, Lower Dir, Pakistan. Stool samples were collected from 642 food handlers (all of male) in a cross-sectional study from January to November, 2017. Wet Mount Techniques and concentration methods by using salt and formolether solutions. Three hundred and eighty four cases (59.8%) were found infected with one more parasites. Most of the individuals were found infected with helminth (47.6%) as compared to intestinal protozoans (0.93%). Seventy two cases (11.2%) of the cases presented mixed infection with both intestinal protozoan and helminth parasites. The order of prevalence for intestinal helminth was Ancylostoma duodenale (n = 258, 40.1%), followed by Taeniasa ginata (n=96, 14.9%) Ascaris lumbricoides (n = 54, 8.40%) and Trichuris trichura (n=30, 4.60%). For intestinal protozoa, Entamoeba histolytica/dispar (n = 36, 5.64%) was the only protozoan detected. Mono-parasitism was higher than poly-parasitism. Family size income and education level were the factors significantly (P 0.05) associated in the parasites prevalence. Current research showed that IPIs are primarily the foodborne pathogens still an important public health problem in Pakistan. Effective control programs on parasitic diseases transfer and their associated factors are recommended.

Resumo Os manipuladores de alimentos desempenham um papel fundamental na transmissão de protozoários e helmintos parasitas patogenicamente importantes. Este estudo teve como objetivo avaliar a prevalência de protozoários patogênicos intestinais e helmintos parasitas entre manipuladores de alimentos na Universidade de Malakand, Lower Dir, Paquistão. Amostras de fezes foram coletadas de 642 manipuladores de alimentos (todos do sexo masculino) em um estudo transversal de janeiro a novembro de 2017. Técnicas de montagem úmida e métodos de concentração usando soluções de sal e formol-éter. Trezentos e oitenta e quatro casos (59,8%) foram encontrados infectados com mais um parasita. A maioria dos indivíduos foi encontrada infectada por helmintos (47,6%) em comparação com protozoários intestinais (0,93%). Setenta e dois casos (11,2%) dos casos apresentavam infecção mista com protozoários intestinais e helmintos parasitas. A ordem de prevalência de helmintos intestinais foi Ancylostoma duodenale (n = 258, 40,1%), seguido por Taeniasa ginata (n = 96, 14,9%) Ascaris lumbricoides (n = 54, 8,40%) e Trichuris trichura (n = 30, 4,60 %). Para protozoários intestinais, Entamoeba histolytica / dispar (n = 36, 5,64%) foi o único protozoário detectado. Monoparasitismo foi maior do que poliparasitismo. A renda familiar e o nível de escolaridade foram os fatores significativamente (P 0,05) associados na prevalência de parasitos. A pesquisa atual mostrou que os IPIs são principalmente os patógenos de origem alimentar, ainda um importante problema de saúde pública no Paquistão. Programas eficazes de controle da transferência de doenças parasitárias e seus fatores associados são recomendados.

Food handlers: an important reservoir of protozoans and helminth parasites of public health importance / Manipuladores de alimentos: um importante reservatório de protozoários e helmintos parasitas de importância para a saúde pública

Food handlers plays a primary role in the transmission of pathogenically important protozoans and helminth parasites. This study was aimed to evaluate the prevalence of intestinal pathogenic protozoans and helminth parasites among food handlers in and around University of Malakand, Lower Dir, Pakistan. Stool samples were collected from 642 food handlers (all of male) in a cross-sectional study from January to November, 2017. Wet Mount Techniques and concentration methods by using salt and formol­ether solutions. Three hundred and eighty four cases (59.8%) were found infected with one more parasites. Most of the individuals were found infected with helminth (47.6%) as compared to intestinal protozoans (0.93%). Seventy two cases (11.2%) of the cases presented mixed infection with both intestinal protozoan and helminth parasites. The order of prevalence for intestinal helminth was Ancylostoma duodenale (n = 258, 40.1%), followed by Taeniasa ginata (n=96, 14.9%) Ascaris lumbricoides (n = 54, 8.40%) and Trichuris trichura (n=30, 4.60%). For intestinal protozoa, Entamoeba histolytica/díspar (n = 36, 5.64%) was the only protozoan detected. Mono-parasitism was higher than poly-parasitism. Family size income and education level were the factors significantly (P<0.05) associated in the parasites prevalence. Current research showed that IPIs are primarily the foodborne pathogens still an important public health problem in Pakistan. Effective control programs on parasitic diseases transfer and their associated factors are recommended.

Os manipuladores de alimentos desempenham um papel fundamental na transmissão de protozoários e helmintos parasitas patogenicamente importantes. Este estudo teve como objetivo avaliar a prevalência de protozoários patogênicos intestinais e helmintos parasitas entre manipuladores de alimentos na Universidade de Malakand, Lower Dir, Paquistão. Amostras de fezes foram coletadas de 642 manipuladores de alimentos (todos do sexo masculino) em um estudo transversal de janeiro a novembro de 2017. Técnicas de montagem úmida e métodos de concentração usando soluções de sal e formol-éter. Trezentos e oitenta e quatro casos (59,8%) foram encontrados infectados com mais um parasita. A maioria dos indivíduos foi encontrada infectada por helmintos (47,6%) em comparação com protozoários intestinais (0,93%). Setenta e dois casos (11,2%) dos casos apresentavam infecção mista com protozoários intestinais e helmintos parasitas. A ordem de prevalência de helmintos intestinais foi Ancylostoma duodenale (n = 258, 40,1%), seguido por Taeniasa ginata (n = 96, 14,9%) Ascaris lumbricoides (n = 54, 8,40%) e Trichuris trichura (n = 30, 4,60 %). Para protozoários intestinais, Entamoeba histolytica / dispar (n = 36, 5,64%) foi o único protozoário detectado. Monoparasitismo foi maior do que poliparasitismo. A renda familiar e o nível de escolaridade foram os fatores significativamente (P <0,05) associados na prevalência de parasitos. A pesquisa atual mostrou que os IPIs são principalmente os patógenos de origem alimentar, ainda um importante problema de saúde pública no Paquistão. Programas eficazes de controle da transferência de doenças parasitárias e seus fatores associados são recomendados.

Safety of Transrectal or Transvaginal Drainage of Pelvic Abscesses / Segurança da drenagem transretal ou transvaginal de abscessos pélvicos

Abstract Objective The literature on the safety and long-term sequelae of transrectal and transvaginal drainage of pelvic abscesses is limited. We evaluated the outcomes and safety of pelvic abscess drainage by interventional radiology at our institution. Methods After obtaining institutional review board approval, we retrospectively evaluated the outcomes of transrectal and transvaginal pelvic abscesses drainage using computed tomography, endorectal ultrasound, and or fluoroscopy. Results The study included 26 patients, with an age range of 24 to 88 years old, out of whom 53.8% were men. A total of 46.1% of the participants were African Americans and 26.9% were Caucasians. The average body mass index was 28.4 (range: 15.6 to 41.9). The most common etiology was penetrating abdominal injury (27%), followed by appendectomy (23%), diverticular disease (11.5%), anastomotic leak (11.5%), and disorders of gynecological causes (11.5%). The mean abscess diameter was 6.3 cm (range: 3.3 to 10.0 cm). Transrectal drainage was performed in all except one patient who had a transvaginal drainage. Transrectal ultrasound was used for drainage in 92.3% cases, and fluoroscopy was used as an additional imaging modality in 75% of the cases. An 8- or 10-Fr pigtail catheter was used in>80% of the patients. Drains were removed between 2 and 7 days in 92.3% of the cases. The average follow-up was 30.4 months (range: 1 to 107 months), and no long-term complications were reported. Only one patient required subsequent operative intervention for an anastomotic leak. Conclusions Pelvic abscess drainage by transrectal route using radiological guidance is a safe and effective procedure.

Resumo Objetivo A literatura sobre a segurança e as sequelas no longo prazo da drenagem transretal e transvaginal do abscesso pélvico é limitada. Avaliamos os resultados e a segurança da drenagem do abscesso pélvico por radiologia intervencionista em nossa instituição. Métodos Após obter a aprovação do conselho de revisão institucional, avaliamos retrospectivamente os resultados da drenagem de abscessos pélvicos transretais e transvaginais por meio de tomografia computadorizada, ultrassom endorretal, e/ou fluoroscopia. Resultados Participaram do estudo 26 pacientes, com faixa etária de 24 a 88 anos, dos quais 53,8% eram homens. Um total de 46,1% eram afro-descendentes, e 26,9% eram brancos. O índice de massa corporal médio foi de 28,4 (gama: 15,6 a 41,9). A etiologia mais comum foi lesão abdominal penetrante (27%), seguida de apendicectomia (23%), doença diverticular (11,5%), fístula anastomótica (11,5%) e distúrbios de causas ginecológicas (11,5%). O diâmetro médio do abscesso foi de 6,3 cm(gama: 3,3 a 10,0 cm). A drenagem transretal foi realizada em todos os pacientes, com exceção de uma, que foi submetida a uma drenagem transvaginal. A ultrassonografia transretal foi utilizada para drenagem em 92,3% dos casos, e a fluoroscopia como modalidade adicional de imagem, em 75% dos casos. Um catéter duplo J de 8 ou 10 Fr foi usado em>80% dos pacientes. Os drenos foram retirados entre 2 e 7 dias em 92,3% dos casos. O acompanhamentomédio foi de 30,4meses (gama: 1 a 107 meses), e nenhuma complicação de longo prazo foi relatada. Apenas um paciente necessitou de intervenção cirúrgica subsequente para um vazamento anastomótico. Conclusão A drenagem do abscesso pélvico por via transretal com orientação radiológica é um procedimento seguro e eficaz.

Orthopaedic Practices and Surgeries during COVID-19 in Pakistan - A Survey Based Study

@#Introduction: The study aimed to target the current practices of the orthopaedic community in outpatient (OPD), emergency (ER) and surgical services (OT) during COVID19. Material and method: This study surveyed 303 orthopaedic surgeons from all over Pakistan. The survey had 30 questions targeting the setup of outpatient, emergency and operation services in orthopaedic departments of different hospitals in Pakistan. Result: A total of 302 surgeons were included from 53 cities all over Pakistan. Between 35-48% of the respondents reported lack of availability of standard operating procedures in OPD, ER and in OT. Majority of the respondents noted that their OPD and surgical practice had been affected to some degree and 69% of the surgeons were only doing trauma surgery. This trend was higher in younger consultants of less than 45 years of age (p<0.001). Almost two-third of the surgeons, mostly senior (p=0.03) were using surgical masks as the only protective measure during various practices of OPD, ER and OT, while most of the setups were not assessing patients even for signs and symptoms of COVID. Almost 89% of the orthopaedic community is facing definite to mild stress during this pandemic and this has significantly affected the senior surgeons (p=0.01). Conclusion: Our study highlighted that COVID-19 has resulted in marked changes to the practices of the majority of Pakistani orthopaedic surgeons. Despite a sharp upsurge in the number of cases and mortality due to COVID-19, guidelines were still lacking at most of the settings and a substantial percentage of the orthopaedic community were not following adequate safety measures while attending to patients.

Rapidly Progressive Pansclerotic Morphea Associated With Raynaud Phenomenon

No abstract available.

Ameliorating Effect of Melatonin on L- Arginine Induced Acute Pancreatitis in Rats

The present study was aimed to evaluate the ameliorative potential of melatonin against L-arginine induced acute pancreatitis in rats. Male Sprague Dawley rats (150–240 g) were divided into 3 groups, viz. group I (control group), group II (acute pancreatitis control group) and group III (treatment control) which were further subdivided into 3 subgroups according to time points of 24 hours, 3 days and 7 days. Rats from groups II and III received two injections of L-arginine (2 g/kg i.p.) at 1 h intervals for induction of acute pancreatitis. Melatonin was administered to group III daily at a single dose of 10 mg/kg i.p. On 6 hours, 24 hours, 3 days and 7 days, blood samples were obtained from each group and subjected for the assays of oxidative stress and serum biochemical parameters. Erythrocytic lipid peroxides contents in acute pancreatitis group were significantly higher, while reduced glutathione contents were significantly lower in comparison with the normal controls. The activities of other antioxidant enzymes were also significantly low in these rats. Moreover, significantly increased activities of serum amylase and serum lipase were found in these rats. Administration of melatonin significantly reduced the over production of malonaldialdehyde levels. Other antioxidant enzymes viz. reduced glutathione, superoxide dismutase and catalase activities were improved significantly in melatonin treated rats. Melatonin had also considerably ameliorated the altered serum amylase and serum lipase levels towards normalcy. Thus, it can be concluded that melatonin may possess therapeutic efficacy against L-arginine induced acute pancreatitis in rats

Effects of Indonesian marine sponges ethanol extracts on the lipid profile of hyperlipidemic rats

This study was aimed to investigate the effects of ethanol extracts of Indonesian marine sponges (Callyspongia sp.,Melophlus sarasinorum, and Xestospongia sp.) on the lipid profile of hyperlipidemic rats. The antihyperlipidemicstudy of these sponges is firstly reported in this study. Experimental hyperlipidemic rats were induced by daily intakeof propylthiouracil (1.8 mg/200 g b.wt and quail yolk (10 ml/kg) for the duration of 3 weeks. Hyperlipidemic ratgroups were administered orally with three doses (30, 60, and 120 mg/kg) of the ethanol extracts for 1-week onward.Blood sample was then collected via intracardiac puncture and serum was biochemically analyzed. Ethanol extractsof Callyspongia sp., M. sarasinorum, and Xestospongia sp. at doses of 60 and 120 mg/kg exhibited a significantreduction of cholesterols, triglycerides, and low-density lipoprotein. These doses also significantly increased the highdensity lipoprotein level. Levels of atherogenic indices (Atherogenic Index, Atherogenic Index Plasma, Castelli’s RiskIndex-I, and Castelli’s Risk Index-II) were also decreased by both doses with percentages protection ranging from70.6% to 81.6%. These results showed that ethanol extracts of Callyspongia sp., M. sarasinorum, and Xestospongiasp. exhibited a lipid-lowering activity in hyperlipidemic rats. Hence, these extracts could be used as sources of leadmolecules in the development of natural lipid-lowering agents from marine species