Challenges in HbA1c Analysis and Reporting in Patients with Variant Hemoglobins.

Hemoglobin A1c (HbA(1)c) is a well-established indicator of mean glycemia. The presence of genetic variants of hemoglobin can profoundly affect the accuracy of HbA(1)c measurements. Variants of hemoglobin especially Hemoglobin E (HbE) is prevalent in South East Asia including Bangladesh. The objective of our study is to compare the HbA(1)c values measured on high performance liquid chromatography (HPLC) and Turbidimetric Inhibition Immunoassay (TINIA) in diabetic patients with variant hemoglobins including HbE. A total of 7595 diabetic patients receiving treatment at BIRDEM General Hospital were analyzed for HbA(1)c results within a period of two months from December 2013 to January 2014. Seventy two cases out of 7595 (0.95%) had either undetectable or below normal HbA(1)c levels (males-33 and females-39; ratio = 0.82:1) by HPLC method. In 34(0.45%) cases, HbA(1)c value was undetectable by HPLC method but was in the reportable range by TINIA method. In the other 38 (0.55%) cases, HbA(1)c levels were below the reportable range (<4%) by HPLC method but were in the normal or higher range by TINIA method. TINIA method did not agree with HPLC method on Bland Altman plot in the 38 cases with below normal HbA(1)c levels, [Mean bias -5.2(-9.3 to 1.0), 95% CI] but agreed very well [mean bias -0.21 (-0.84 to 0.42), y=1.1037+0.776X; r(2)=0.30, p<0.01] in controls. In control group mean MCV was 83.80±7.48 and in study group was 73.65±10.44. Alkaline electrophoresis confirmed the variant hemoglobin to be HbE. The fasting blood sugar levels of all the 72 cases correlated strongly with TINIA method (r(2) =0.75, p<0.0001) but not with HPLC (r = 0.24, p=0.13). In our regions where populations have a high prevalence of Hb variant, proper knowledge of hemoglobin variants which affect the measurements HbA(1)c level is essential. MCV of 80fl or below may serve as a rough guide to select samples that require analysis by TINIA method. Moreover, HPLC may be a convenient and inexpensive tool for screening of hemoglobinopathies especially among diabetic population in Bangladesh. It may therefore be helpful in improving management of complications related to both anaemia and iron overload.

A case of acute intermittent porphyria.

Acute intermittent porphyria (AIP) is a rare autosomal dominant hereditary metabolic disorder having protean manifestations. The clinical presentations of abdominal pain, peripheral neuropathy and changes in mental status are the classic triad of an acute attack. A 15-year old girl was admitted in the medicine department of Sylhet MAG Osmani Medical College with the complaints of recurrent abdominal pain, convulsions and weakness of lower limbs. She presented with a combination of medical and neuropsychiatric symptoms suggestive of a case of AIP. The clinical presentation and the presence of porphyrins in urine confirmed the diagnosis of AIP. AIP can be life-threatening, so an accurate diagnosis and proper management are highly important.

Aflatoxin biosynthesis control produced by Aspergillus flavus in layer hens feed during storage period of six months.

Aflatoxins (AFTs) are a group of closely related toxins that are produced by different fungus species. Food and feed contamination with AFT is a worldwide health-related problem. As a result of fungal attack, the food and feed resulted in a principal socioeconomic loss and toxins produced in feed and food items harm the humans and animals in different ways. The anti-aflatoxigenic effect Psidium guajava, Ficus benghalensis, Gardenia radicans, Punica granatum and Ziziphus jujuba leaves were evaluated against aflatoxins (AFTs), produced by Aspergillus flavus in layer feed during storage. Among the investigated medicinal plant leaves, P. granatum showed highly promising anti-aflatoxigenic activity and completely inhibited the AFTs (B1 and B2) production over storage period without compromising the nutritive quality of feed (ash, protein, fat, fiber, Fe, Ca, P and K contents). Leaves of F. benghalensis and Z. jujuba were also effective however, higher concentration (15%) inhibited the AFTs production up to 99% and also maintained nutritive quality of feed. G. radicans was found least effective in controlling the AFTs production. Results revealed that all plant leaves were effective in controlling AFTs production in layer feed over the storage period of six months and these plants are potential candidate to replace the fungicides used to protect feed and other agricultural commodities from AFTs production during storage.

Aflatoxin, proximate composition and mineral profile of stored broiler feed treated with medicinal plant leaves.

OBJECTIVES: In the present investigation, the Morus alba (M. alba), Vitis vinifera (V. vinifera), Ficus religiosa (F. religiosa) and Citrus paradisi (C. paradisi) leaves anti-aflatoxigenic activities were evaluated in Aspergillus flavus (A. flavus) inoculated feed. METHODS: The broiler feed inoculated with A. flavus was treated with selected medicinal plant leaf powder (5%, 10% and 15% w/w) and stored for the period of six months at 28°C and 16% moisture. The aflatoxins (AFTs) were estimated at the end of each month by Reversed Phase High Performance Liquid Chromatography (RP-HPLC) method along with proximate composition and mineral contents. RESULTS: Plant leaves controlled AFTs efficiently without affecting the feed proximate composition and mineral contents. The M. alba leaves completely inhibition (100%) the AFTs (B1 and B2) in feed at very low concentration (5%). Other plants also showed significant (P<0.05) inhibition of AFTs production without affecting the feed quality over the storage period of six months. CONCLUSION: Based on promising efficiency of selected medicinal plant leaves, A. flavus produced AFTs could possibly be controlled in stored poultry feed.

Utilization of agro-wastes to inhibit aflatoxins synthesis by Aspergillus parasiticus: A biotreatment of three cereals for safe long-term storage.

The growth of Aspergillus parasiticus and aflatoxins production were inhibited during storage of three important cereals (wheat, maize and rice) using leaves of neem (Azadirachta indica) and kikar (Acacia nilotica). Cereals were inoculated with mould spores and stabilized by neem and kikar leaves-powder. Test samples with moisture levels of 21% were stored at 30°C for a period of 9months. Aflatoxins were quantified at different time intervals in stored cereals. Neem leaves fully inhibited all types of aflatoxins synthesis for 4months in wheat and for 2months in maize while in rice inhibited synthesis of only B2, G1 and G2 aflatoxin for 3months. Kikar leaves fully inhibited aflatoxin B2, G1 and G2 for 3months in wheat, and for 2months in maize. Among two investigated plants, neem leaves were found more effective for preventing the production of all types of aflatoxins in cereals' long-term storage.

Survival of a patient with intestinal anthrax.

A patient with intestinal anthrax, the first documented surviving patient to be described in detail, presented with an acute condition within the abdomen. Intestinal anthrax should be considered in the differential diagnosis of abdominal conditions in areas in which anthrax is prevalent, especially when a history is available of ingesting putrid or improperly cooked meat. Clinical and therapeutic details are given as a guide in future cases.

Chemical composition and antioxidant activity of seeds of different cultivars of mungbean.

Seeds of 4 cultivars (M-1, M-6, NM-92, and NM-98) of mungbean [Vigna radiata (L.) Wilczek] were investigated for proximate composition, antioxidant potential, fatty acids, tocopherols, and minerals profiles. Hexane-extracted seed oil content of the investigated cultivars of mungbeans ranged from 1.20% to 1.56%. Mungbean seeds were found to be a rich source of protein (20.97% to 31.32%). The contents of Fe, Cu, Mg, Na, K, Ca, and Zn were found to be 105.8 to 190.9, 4.8 to 6.3, 48.6 to 51.7, 382.6 to 562.7, 11.6 to 18.8, 359.2 to 482.9, and 24.9 to 47.2 mg/kg, respectively. The mungbean seeds contained linoleic acid in the highest amount, 340.5 to 465.7 mg/100 g of dry seed, followed by palmitic, oleic, linolenic, stearic, and arachidic acids: 278.1 to 401.2, 212.6 to 293.5, 188.7 to 236.8, 135.5 to 168.4, and 22.8 to 24.5 mg/100 g of dry seed, respectively. The seeds were found to be a rich source of tocopherols (alpha, gamma, delta) ranged from 1.1 to 10.1, 60.7 to 80.9, and 4.6 to 11.2 mg/kg, respectively. Methanolic extracts of the seeds of the mungbean cultivars exhibited a good antioxidant activity as determined in terms of measurement of total phenolic contents (TPC) (0.62 to 1.08 g/100 g of dry matter), percent inhibition of peroxidation (49.8% to 89.2%), reducing power (1.19% to 1.45%), and bleaching beta-carotene. The results of the present analytical study revealed these 4 mungbean cultivars to be a potential source of essential fatty acids, antioxidants, minerals and protein, all of which are linked with positive health benefits.