Short-course radiotherapy with consolidation chemotherapy versus conventionally fractionated long-course chemoradiotherapy for locally advanced rectal cancer: randomized clinical trial.

BACKGROUND: The trial hypothesis was that, in a resource-constrained situation, short-course radiotherapy would improve treatment compliance compared with conventional chemoradiotherapy for locally advanced rectal cancer, without compromising oncological outcomes. METHODS: In this open-label RCT, patients with cT3, cT4 or node-positive non-metastatic rectal cancer were allocated randomly to 5 × 5 Gy radiotherapy and two cycles of XELOX (arm A) or chemoradiotherapy with concurrent capecitabine (arm B), followed by total mesorectal excision in both arms. All patients received a further six cycles of adjuvant chemotherapy with the XELOX regimen. The primary endpoint was treatment compliance, defined as the ability to complete planned treatment, including neoadjuvant radiochemotherapy, surgery, and adjuvant chemotherapy to a dose of six cycles. RESULTS: Of 162 allocated patients, 140 were eligible for analysis: 69 in arm A and 71 in arm B. Compliance with planned treatment (primary endpoint) was greater in arm A (63 versus 41 per cent; P = 0.005). The incidence of acute toxicities of neoadjuvant therapy was similar (haematological: 28 versus 32 per cent, P = 0.533; gastrointestinal: 14 versus 21 per cent, P = 0.305; grade III-IV: 2 versus 4 per cent, P = 1.000). Delays in radiotherapy were less common in arm A (9 versus 45 per cent; P < 0.001), and overall times for completion of neoadjuvant treatment were shorter (P < 0.001). The rates of R0 resection (87 versus 90 per cent; P = 0.554), sphincter preservation (32 versus 35 per cent; P = 0.708), pathological complete response (12 versus 10 per cent; P = 0.740), and overall tumour downstaging (75 versus 75 per cent; P = 0.920) were similar. Downstaging of the primary tumour (ypT) was more common in arm A (P = 0.044). There was no difference in postoperative complications between trial arms (P = 0.838). CONCLUSION: Reduced treatment delays and a higher rate of compliance were observed with treatment for short-course radiotherapy with consolidation chemotherapy, with no difference in early oncological surgical outcomes. In time- and resource-constrained rectal cancer units in developing countries, short-course radiotherapy should be the standard of care.

Temporomandibular joint dysfunction following the use of a supraglottic airway device during general anaesthesia: a prospective observational study.

Supraglottic airway devices are commonly used to manage the airway during general anaesthesia. There are sporadic case reports of temporomandibular joint dysfunction and dislocation following supraglottic airway device use. We conducted a prospective observational study of adult patients undergoing elective surgery where a supraglottic airway device was used as the primary airway device. Pre-operatively, all participants were asked to complete a questionnaire involving 12 points adapted from the Temporomandibular Joint Scale and the Liverpool Oral Rehabilitation Questionnaire. Objective measurements included inter-incisor distance as well as forward and lateral jaw movements. The primary outcome was the inter-incisor distance, an accepted measure of temporomandibular joint mobility. Both the questionnaire and measurements were repeated in the postoperative period and we analysed data from 130 participants. Mean (SD) inter-incisor distance in the pre- and postoperative period was 46.5 (7.2) mm and 46.3 (7.5) mm, respectively (p = 0.521) with a difference (95%CI) of 0.2 (-0.5 to 0.9) mm. Mean (SD) forward jaw movement in the pre- and postoperative period was 3.6 (2.4) mm and 3.9 (2.4) mm, respectively (p = 0.018). Mean (SD) lateral jaw movement to the right in the pre- and postoperative period was 8.9 (4.1) mm and 9.1 (4.0) mm, respectively (p = 0.314). Mean (SD) lateral jaw movement to the left in the pre- and postoperative period was 8.8 (4.0) mm and 9.3 (3.6) mm, respectively (p = 0.008). The number of patients who reported jaw clicks or pops before opening their mouth as wide as possible was 28 (21.5%) vs. 12 (9.2%) in the pre- and postoperative period, respectively (p < 0.001) with a difference (95%CI) of 12.3% (6.7-17.9%). There was no significant difference in the responses to the other 11 questions or in the number of patients who reported pain in the temporomandibular joint area postoperatively. No clinically significant dysfunction of the temporomandibular joint following the use of supraglottic airway devices in the postoperative period was identified by either patient questionnaires or objective measurements.

Immunogenetics of cytokine genes in parthenium dermatitis: a review.

Summary: Parthenium dermatitis is a chronic immuno-inflammatory, distressing skin disease and is mediated by activated T-lymphocyte which is primarily manifested on the exposed sites of the face, neck, hand and flexures. Parthenium hysterophorus is ubiquitous, hence it is diffi-cult to avoid the aero-allergenic antigen parthenin, responsible for the contact dermatitis. The pathogenesis of parthenium dermatitis is characterized by infiltration of T-lymphocytes into challenged skin sites and the development of a cutaneous inflammation due to altered regulatory network of pro and anti-inflammatory cytokines. Regulation of inflammatory events perpetuated by cytokines continues to complicate efforts to analyze both the function of individual cytokine and the influence of candidate gene polymorphism on expression and disease severity. The genetic polymorphisms in these cytokines are significantly affecting immunological parameters and, subsequently, modulation and polarization of immune responses. This review has focused mainly on understanding of the mechanisms of genetic susceptibility of cytokine genes in this disease and, further, this process is likely to achieve significant advances in the diagnosis and management of parthenium dermatitis.

Role of endoscopic ultrasound-guided-fine needle aspiration biopsy in the diagnosis of lymphoma of the pancreas: A clinicopathological study of nine cases.

OBJECTIVE: Endoscopic ultrasound-guided-fine needle aspiration (EUS-FNA) is an established first-line procedure in the management of solid and cystic pancreatic masses. Lymphoma is an uncommon diagnosis in EUS-FNA of the pancreas, and it is more common for such a diagnosis to be because of secondary involvement of the pancreas by a lymphoproliferative disorder than for this to represent isolated primary pancreatic lymphoma (PPL). We present the clinical, EUS and cytological features of these lesions. MATERIAL AND METHODS: After obtaining approval from our Institutional Review Board (IRB), nine cases of lymphoma diagnosed on EUS-FNA at a tertiary care cancer centre over a period of 8 years from 2008 to 2016 were retrieved from our endoscopy and pathology archives. Rapid onsite evaluation (ROSE) was carried out by a trained cytopathologist in all these cases. Cell blocks were available in seven cases, and immunophenotyping was performed on cell blocks using the immunoperoxidase method. Flow cytometry was performed in two cases. RESULTS: The most frequent site of involvement was the head of the pancreas (n=5, 55.6%). Four out of nine cases were diagnosed as PPL (44.4%). Five cases were diagnosed as lymphoma secondarily involving the pancreas (55.6%). The most frequent diagnosis was diffuse large B-cell lymphoma (n=6, 66.7%), followed by Hodgkin's lymphoma (n=2, 22.2%) and peripheral T-cell lymphoma (n=1, 11.1%). CONCLUSION: EUS-FNA in experienced hands is a valuable diagnostic modality, in conjunction with ROSE, immunohistochemistry and flow cytometry, in the diagnosis and sub-typing of both primary and secondary pancreatic lymphoma.

Microbiology of Chronic Suppurative Otitis Media in a Tertiary Care Hospital in Bangladesh.

This cross sectional prospective study was carried out in the Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Microbiology, University of Dhaka from July 2012 to June 2013. The objectives of this study were to identify the common microorganisms involved and the antibiograms of chronic suppurative otitis media (CSOM) patients in this tertiary care hospital in Bangladesh. A total of 117 patients clinically diagnosed of CSOM were enrolled in the study. They had chronic ear discharge & had not received any topical or systemic antibiotics for the previous five days. Swabs was taken and cultured for bacteria. The standard of isolation and identification was followed. Antimicrobial susceptibility of all aerobic bacterial isolates was performed by using modified Kirby Bauer Disk diffusion method. There were 186 positive cultures for organism from 117 patients. The most common causal organisms isolated were S. aureus (47.30%) and Pseudomonas spp. (27.40%) followed by S. epidermidis (16.10%), Klebsiella spp. (8.10%) and Escherichia coli. (1.10%). Gentamicin showed the highest sensitivity (89.8%) to S. aureus whereas erythromycin showed the lowest sensitivity (14.8%) with highest resistance (67%) to S. aureus. Pseudomonas spp. showed highest sensitivity against ciprofloxacin (78.4%) and highest resistance against cloxacillin (96.1%). Novobiocin showed the highest sensitivity (100%) followed by chloram phenicol (94.1%) to S. epidermidis. Klebsiella spp. and E. coli showed highest sensitivity against chloram phenicol. This study suggests that Staphylococcus aureus and Pseudomonas are the commonest bacteria involved in CSOM in Bangladesh and Ciprofloxacin is an important tool in the management of active CSOM.

Preliminary 1 month stability screening of cosmetic multiple emulsions (W/O/W) prepared using cetyl dimethicone copolyol and Polysorbate 80.

OBJECTIVES: The objective of this work was to develop W/O/W emulsions with different concentration of paraffin oil, lipophilic (cetyl dimethicone copolyol) and hydrophilic emulsifiers (polysorbate 80) and to check their stability at different storage conditions. METHODS: Approximately, 20 formulations (W/O/W) multiple emulsions were prepared, and their stability was checked at different storage conditions for the period of 30 days. Stability of some multiple emulsions ME12, ME13, ME14, ME19 and ME20 was also checked with carbomer as viscosity-enhancing agent. Microscopic analysis for droplet size determination and rheological characterization of most stable multiple emulsions, that is, ME20 were also performed. RESULTS: It was observed that stability of multiple emulsion increases with the addition of gelling agent. Formulation (ME20) with 13.6% paraffin oil, 2.4% cetyl dimethicone copolyol and 0.8% polysorbate 80 was found more stable at 25°C and 40°C for the period of 30 days. Rheological analysis indicated a decrease in viscosity with the passage of time, while droplet size analysis indicated an increase in droplet size with the passage of time. CONCLUSION: As a conclusion of this work, a stable multiple emulsion with 13.6% paraffin oil, 2.4% cetyl dimethicone copolyol and 0.8% polysorbate 80 can be formulated and can be further studied for any active ingredient for cosmetic purposes.

Formulation and evaluation on human skin of a water-in-oil emulsion containing Muscat hamburg black grape seed extract.

BACKGROUND: Vitis vinifera 'muscat hamburg' (Vitaceae) is a blue-black grape variety commonly found in Pakistan. It has been consumed and used in traditional medicine for centuries. Compared to other grapes, M. hamburg records one of the greatest amount of polyphenols and displays potent antioxidant activities, which make it a great candidate for its exploitation in the development of stable cream emulsions destined to improve the skin appearance. OBJECTIVE: Evaluate the effects of stable water-in-oil (W/O) emulsion containing 2% M. hamburg grape seed extract ('formulation') on human cheek skin in comparison with the placebo ('base'). METHODS: An occlusive patch test, containing either the formulation or the base, was topically tested for 8 weeks during a winter period in young adult and healthy Pakistani male volunteers. The subjects were instructed to use twice a day the base and the formulation on their right and left cheek skin, respectively. Non-invasive measurements on these skin areas were carried out every week to assess any effects produced on melanin, elasticity and sebum. Skin compatibility assay (Burchard test) was used to report any potential skin reactivity. ANOVA, paired sample t-test and LSD test were applied to determine the statistical data significance. RESULTS: Significant differences (P ≤ 0.05) were found between the placebo and the formulation in terms of their respective skin effects elicited on melanin, elasticity and sebum content. Nevertheless, placebo and formulation exerted similar effects on skin erythema and moisture contents. Importantly, no skin hypersensitivity cases were reported during the whole course of the study. CONCLUSION: The developed grape-based cream could be efficiently and safely applied to improve a number of skin conditions (e.g. hyper-pigmentation, premature ageing, acne).

First Report of Leaf Spot of Rice Caused by Alternaria arborescens in Pakistan.

Rice (Oryza sativa) is one of the most profitable and popular cereal crops in Pakistan. In July 2012, symptoms consisting of circular, black, necrotic spots, 2 to 4 mm in diameter, were observed on leaves of a commonly grown rice cultivar, Basmati-198, in private rice fields at Lahore (Punjab). This disease was observed later on rice cultivar KSK-133 grown at Faisalabad (Punjab) during the same cropping season. Disease incidence was ~35% and 25% for Basmati-198 and KSK-133, respectively. To our knowledge, the pathogen was confined only in these areas and cultivars and was not present on other rice varieties or crops. Ten infected plants were selected randomly from each field of two rice cultivars and one infected leaf for each of the 10 infected plants was selected for the isolation of fungal pathogen. Necrotic lesions were cut into pieces of ~2 mm2, surface-disinfected with 0.5% sodium hypochlorite, placed on 2% malt extract agar (MEA) (Sigma, Dorset, UK), and incubated at 25 ± 2°C for 4 to 5 days. Emerging fungal colonies were transferred aseptically to fresh MEA petri plates for purification. Alternaria spp. were consistently recovered from infected leaves. Three isolates per variety were selected for detailed morphological studies. Each isolate was grown at 25°C on MEA and potato carrot agar (PCA) for 7 days. All isolates displayed similar morphological features including black radiate, floccose colonies with irregular margins, 6 to 7 cm in diameter on MEA and 2 to 3 cm with 1 to 2 pairs of concentric growth rings on PCA. Conidial chains were not crowded with 1 to 10 conidia per branch and bearing several lateral branches. Conidiophores were tapering and narrow, 40 to 200 × 2 µm. Conidia were ovoid within a size range of 10 to 30 × 5 to 14 µm, with 1 to 5 transverse and 1 longitudinal septum. Conidial color darkens from a dull tan to a medium brown as the culture matures. Based on morphology, the pathogen was identified as Alternaria arborescens (1). A pure culture of the pathogen was deposited in First Fungal Culture Bank of Pakistan (FCBP) with accession FCBP1351. Identification based on morphology was verified by sequencing the internal transcribed spacer (ITS) region. For this, a DNA fragment of ~650 bp was amplified using total genomic DNA as template and ITS1 and ITS4 primers (2). The nucleotide sequence of the ITS region was submitted to GenBank under accession KF679683. Comparison of the sequence with those in GenBank revealed that the sequence was 99% identical with A. arborescens, isolate ALT-242 (KC415808), causing Eucalyptus leaf spot in India and strain STE-U4345 (AF404667), a causal pathogen of apple core rot in South Africa. Pathogenicity testing was performed on both cultivars. One-month-old plants grown in greenhouse were sprayed with 10 ml of spore suspension (2 × 105 spores/ml) as well as 10 ml of this spore suspension in soil at the time of sowing. Control plants were sprayed with sterilized water. The plants were covered with plastic bags for 48 h and kept under observation for 2 weeks in a glasshouse at 30 ± 2°C. Lesions appeared on leaves after 10 days of inoculation whereas control plants remained healthy. Pathogenicity tests were repeated in triplicate. Similar disease symptoms and re-isolation of A. arborescens fulfilled Koch's postulates. To our knowledge, this is the first report of A. arborescens leaf spot of rice in Pakistan. At present, the distribution of this disease is limited to the fields where it was observed. References: (1) E. G. Simmons. Alternaria: An Identification Manual. CBS, Fungal Biodiversity Center Utrecht, The Netherlands, 2007. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

First Report of Alternaria longipes Causing Leaf Spot of Potato Cultivar Sante in Pakistan.

Potato (Solanum tuberosum) is one of the most important vegetable crops worldwide, including Pakistan. During surveys from November to February of 2011 to 2013 in Sahiwal (Punjab), a severe leaf spot disease, new to farmers, was recorded. Symptoms consisted of 1- to 3-mm diameter black circular necrotic spots and appeared on the leaves of 2- to 3-week-old plants. Disease incidence was ~70 to 80%. This disease was localized to few fields in Sahiwal on potato variety Sante and to our knowledge, this has not been found on other areas or potato varieties in Pakistan. Fungi were isolated from randomly selected diseased plants. Ten infected plants were brought to the laboratory in sterilized polyethylene bags. One infected leaf per plant was selected for pathogen isolation. Infected parts of leaves were cut into ~2 mm2 pieces. Leaf pieces were surface sterilized for 1 min with 0.5% sodium hypochlorite and then inoculated aseptically onto 2% malt extract agar (MEA) (Sigma, Dorset, UK) and incubated at 25 ± 2°C for 3 to 4 days in the dark. Hyphal tip transfer from emerging colonies was performed to obtain pure cultures. Initial microscopic examination of pure fungal colonies revealed Alternaria as the likely causal organism. For morphology-based identification, five isolates from separate infected leaves were grown on MEA as well as potato carrot agar (PCA) for 7 days. All isolates showed similar morphological characters including dusty greenish black, floccose colonies with regular and smooth margins reaching 3 to 4.5 cm in diameter on MEA and sporulation with well-defined zones of growth. Aerial hyphae produced long branches that bore lateral chains of 1 to 7 conidia. Conidia were pointed at the tip, ovoid or ellipsoid, ranged from 18 to 40 × 5 to 12 µm with 4 to 8 transverse and 0 to 1 longitudinal septa. No conidial beak was present. Conidial color darkened from dull olive to brown as the culture matured. Based on morphology, the pathogen was identified as Alternaria longipes (1). A pure culture of a fungal pathogen was submitted to First Fungal Culture Bank of Pakistan (FCBP1355) for future reference. To confirm the morphology-based identification, the rDNA internal transcribed spacer (ITS) nucleotide sequence was amplified using ITS1 forward and ITS4 reverse primers (2). The amplicon of 537 bp was sequenced and submitted to GenBank under accession KJ806191. A BLASTn search using the KJ806191 sequence revealed it to be 99% identical to around 20 different strains of A. longipes deposited in GenBank including leaf spot pathogens of another Solanaceaeous member, Nicotiana tabacum (AY154684) and Asteraceous plant, Atractylodes macrocepha (JQ004404). Pathogenicity testing was performed in the greenhouse at 30 ± 2°C. Pots (16 × 9 cm) were filled with sterilized soil. Since spores of Alternaria sp. are known to survive in soil or plant debris, soil was sterilized and inoculated with 106 spore suspension of the isolated pathogen before sowing the potato seeds. Control pots were not inoculated. Approximately 10 days after plant germination, the previously observed disease symptoms appeared on leaves and A. longipes was re-isolated from the necrotic areas of leaves, thus fulfilling Koch's postulates. Plants in control treatments were asymptomatic. Pathogenicity tests were repeated three times. To our knowledge, this is the first report of A. longipes leaf spot of potato cultivar Sante from Pakistan. However, the distribution of this disease is confined to the area where it was observed, but it could be a threat for potato crop if not managed timely. References: (1) E. G. Simmons. Alternaria: An identification manual. CBS, Fungal Biodiversity Center Utrecht, The Netherlands, 2007. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

First Report of Rice Leaf Spot by Alternaria gaisen from Pakistan.

A rice field owned by an individual grower in Lahore, Pakistan, was surveyed in July 2013. Plants with symptoms of black, circular, necrotic spots 3 to 4 mm in diameter and an average of 8 to 10 spots per leaf were observed. Diseased plants were present in the field either singly or in groups of three to five. Ten symptomatic plants were selected randomly, and one infected leaf per plant and one necrotic spot per leaf was selected for the isolation of the pathogen. Necrotic areas were cut into small pieces, surface sterilized with 1% sodium hypochlorite solution, and plated on 2% malt extract agar (MEA) (Sigma, Dorset, UK). After incubation at 25 ± 2°C for 4 to 5 days, fungal mycelium was transferred aseptically to fresh MEA for pure culture. Three different isolates grown for 7 days on MEA were selected for detailed morphological studies. The fungal colony was dark greenish-black, reaching 7 to 8 cm in diameter, with 2 to 3 poorly defined growth rings. Conidiophores were geniculate and 50 to 140 × 3 to 4.5 µm in size. Conidia were in chains of 4 to 10, ovoid, ranging in size from 35 to 50 × 8 to 10 µm, with 12 to 15 transversal and 0 to 2 longitudinal septa. Conidia darkened from dull tan yellow to brown as the culture aged. Based on morphological characteristics, the pathogen was identified as Alternaria gaisen (2). A pure culture of the pathogen was deposited in First Fungal Culture Bank of Pakistan (FCBP1354). Due to the complexity of morphology-based identification of the genus Alternaria, sequencing of the internal transcribed spacer (ITS) region was carried out using the ITS1/ITS4 primer pair (1,3). The nucleotide sequence (KJ806190) of an amplified DNA fragment was compared with those already submitted to GenBank. The BLAST results revealed 99% identity of our A. gaisen isolate to strains NW680 (EU520123.1), FC3s (JX391937.1), and CBS 632.93 (KC584197.1), as well as some other A. gaisen strains. Pathogenicity testing of the fungus was performed on Basmati-198, a common cultivar of rice in Pakistan, by either spraying leaves of 1-month-old plants with 10 ml of spore suspension (2 × 105 spores/ml) or mixing this spore suspension in soil at the time of sowing. Control plants were sprayed with sterilized water. Plants were kept in a glasshouse at 30 ± 2°C and monitored for disease development. After 15 days of incubation, similar leaf necrotic spots to those observed in the field, developed on all inoculated plants, whereas all control plants remained healthy and asympomatic. The experiment was repeated three times and similar results were obtained. Re-isolation of A. gaisen from the symptomatic leaves fulfilled Koch's pathogenicity postulate. Although limited to the field where it was observed, to our best of knowledge, this is the first report of rice leaf spot by A. gaisen from Pakistan. Also, rice has not been reported as the host of A. gaisen from any part of the world. This study indicates that A. gaisen is potentially an important pathogen of rice plants. Further investigations into epidemiology and disease management strategies for this new disease are warranted especially where rice crop is grown extensively. References: (1) G. S. de Hoog and R. Horre. Mycoses 45:259, 2002. (2) E. G. Simmons. Alternaria: An identification manual. CBS, Fungal Biodiversity Center Utrecht, The Netherlands, 2007. (3) T. J. White et al. Page 315 in: PCR Protocols, A Guide to Methods and Applications, Academic Press, San Diego, 1990.

First Report of New Postharvest Rot in Ginger Rhizome by Aspergillus parvisclerotigenus in Pakistan.

Ginger (Zingiber officinale) rhizome is widely used in Pakistan as a spice. During the summer of 2013, several ginger sellers in a local vegetable market of Lahore, Pakistan, reported a green powdery mass of an unidentified pathogen that rotted a considerable quantity of ginger in its packaging. As far as we know, this disease was limited to stored rhizomes and not reported in fields. A survey was conducted in August to September of 2013 in three different vegetable markets in Lahore to collect infected samples. From each of three survey points from individual markets, 20 bags (10 kg each) were selected randomly. Average incidence of decay (by weight) was found to be 45%. Initial symptoms appeared as discoloration, soft and slippery skin with abundant green sporulation. Ten samples (rhizomes) from each market were brought to the laboratory for further studies. Isolation of the causal agent was carried out on two growth media: malt extract agar (MEA) and Czapek Dox agar (CZA). Inoculation was carried out by direct transfer of visible green spores as well as transferring a small fragment of surface sterilized infected rhizome to the media. Inoculated media plates were incubated at 25°C for 3 to 4 days. Emerging fungal colonies were sub-cultured to get pure cultures. The fungal colony was powdery, green, 3.5 to 4 cm in diameter, and without zonation after 7 days of incubation. Sclerotia were brown to black and globose. Conidial heads were columnar and biseriate, occasionally unseriate. Conidiophores were 1 to 2.5 mm long. Vesicles were sub-globose to globose and 25 to 30 µm wide. Metulae were 12 to 18 µm high and phialides were 6 to 12 µm. Conidia were globose to sub-globose, green, and 4 to 5 µm in diameter. Based on morphology, the fungus was identified as Aspergillus parvisclerotigenus (1). The identity of the pathogen was confirmed by ITS sequence analysis of two different isolates. For this, ITS1-5.8S-ITS2 nucleotide sequence of ~560 bp was amplified using total fungal genomic DNA as a template and ITS1 forward (5'-TCCGTAGGTGAACCTGCGG-3') and ITS4 reverse primer (5'-TCCTCCGCTTATTGATATGC-3') (2). Sequences from both isolates were 100% similar with each other. A BLAST search showed that this sequence had 99% homology with that A. parvisclerotigenus CBS 121.62 (EF409240.1). A culture of the fungus was deposited in First Fungal Culture Bank of Pakistan (FCBP1352) and the nucleotide sequence of ITS region to GenBank (KJ445022). For completion of Koch's postulates, a spore suspension (105 spores/ml) from a 1-week-old culture was prepared. Ten surface-disinfested, air-dried ginger rhizomes were placed on sterilized wet blotting papers in a glass beaker and inoculated by spore suspension using a hand sprayer. Similarly, 10 control rhizomes were sprayed with sterile distilled water. Rhizomes were incubated at 25°C for 7 days. The experiment was replicated three times. The same symptoms noticed in the vegetable markets were observed in 80% of the inoculated rhizomes while control rhizomes remained healthy. Re-isolation of the pathogen from symptomatic rhizomes fulfilled Koch's postulates. Poor hygiene is thought to be the main cause of rotting; therefore, this disease is not a threat to ginger if stored properly. To our knowledge, this is the first report of postharvest ginger rhizome rot from Pakistan caused by A. parvisclerotigenus. References: (1) J. Varga et al. Stud. Mycol. 69:57, 2011. (2) T. J. White et al. In: PCR Protocols: A Guide to Methods and Applications, page 315. Academic Press, San Diego, CA, 1990.

Chlamydia trachomatis IgM seropositivity during pregnancy and assessment of its risk factors.

The study was undertaken to determine socio-demographic and reproductive risk factors associated with Chlamydia trachomaties IgM seropositivity during pregnancy. This cross sectional comparative study was carried out in the obstetrics outdoor of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh in collaboration with the department of Virology between the periods from July 2007 to December 2008. Pregnant women at their first visit to the hospital were approached consecutively and asked to complete a questionnaire and 2cc blood was collected from each subject for Chlamydia trachomatis IgM antibody testing using ELISA method. The study population was divided into two groups according to the presence and absence of serum Chlamydia trachomatis IgM antibody. Finally socio-demographic and reproductive risk factors were compared between the groups. Among 172 women the sero-prevalence of Chlamydia IgM was 41%. The multiple logistic regression model (step wise) finally extracted for characteristics correlated with seropositivity. Ten years or less (≤SSC) education (OR 2.6 95% CI 1.1to 5.9), history of adverse pregnancy outcome (OR 2.8 95% CI 1.2 to 6.5) and multiple sex partner of husband (OR 4.1 95% CI 1.2 to 14.8) were associated with chlamydia infection. The use of condom (OR 0.28 95% CI 0.12 to 0.63) was associated with decreased risk of infection. Chlamydia trachomatis infection during pregnancy is associated with risk factors on the basis of which selective screening can be done.

Augmented telomerase activity and reduced telomere length in parthenium-induced contact dermatitis.

BACKGROUND: Parthenium dermatitis is a common chronic inflammatory disease with activated T lymphocytes that recognize the antigens, which leads to proliferation and differentiation. Telomeres and telomerase play an important role in the regulation of life span of the cell. Telomere length maintained by telomerase, are specialized repeats present at the end of chromosomes which protect it from degradation, end-to-end fusion and are important for integrity of chromosomes. OBJECTIVES: The aim of this study was to measure telomerase activity and telomere length in Peripheral blood mononuclear cell (PBMC), CD4(+) and CD8(+) T lymphocytes from parthenium dermatitis patients. METHODS: The study includes 50 patients of parthenium dermatitis confirmed by patch testing and 50 healthy controls. Telomerase activity was measured using the telomere repeat amplification protocol using PCR-ELISA kit. Telomere length was measured by using Telo TAGGG Telomere Length Assay Kit. RESULTS: Significantly elevated levels of telomerase activity was observed in PBMC, CD4(+) and CD8(+) T cells of parthenium dermatitis patients as compared with healthy controls. However, significantly reduced telomere length in PBMC, CD4(+) and CD8(+) T cells have been found in patients than healthy subjects, but there was no difference between CD4(+) and CD8(+) T cells in patients. CONCLUSION: This study might have provided insight into the role of telomerase in parthenium dermatitis that is characterized by the recruitment of T lymphocytes, which play an important role in this inflammatory disease. The augmented telomerase activity and reduced terminal restriction fragment length might be explored as a potential diagnostic/prognostic marker for parthenium dermatitis in future.

Quantitative ethnomedicinal study and conservation status of medicinal flora used by the indigenous peoples of Sultan Khail valley, Dir Upper, Pakistan.

The present study was conducted to explore the ethnomedicinal uses, quantitative analysis and conservation status of medicinal flora of Sultan Khail valley, Dir Upper, Pakistan. The data was collected during 2017-2019 using a semi-structured questionnaire. Ethnomedicinal uses of plant species were determined and the plant species were classified based on habits, parts used, and method of preparation of remedies. Frequency of citation (FC), relative frequency of citation (RFC) and family importance values (FIV) were calculated. The plant species were assessed for their conservation status as per IUCN standard criteria. The inhabitants of the Sultan Khail valley use 88 plant species belonging to 57 families for the treatment of different human diseases. Lamiaceae was the dominant family represented with 8 medicinal species (9%) followed by Rosaceae (5 species, 6%). The most commonly used plant parts were leaves (33.1%) followed by fruits (16.1%), while the main method of remedy preparation was decoctions (33.3%). The highest RFC value was recorded for Geranium wallichianum (0.47), followed by Berberis lycium (0.44). Lamiaceae was the most cited family (FIV, 231), followed by Polygonaceae (73). Five plant species were found to be endangered, 39 species were vulnerable, 32 species were rare, and 12 species were found to be infrequent. The medicinal flora of the area is under severe biotic pressure and needs proper conservation; otherwise, they will be lost in the near future.

Successful Pregnancy with SLE-associated Antiphospholipid Syndrome: A Case Report.

Pregnancy in women with systemic lupus erythematosus (SLE) is associated with an increased risk of adverse maternal and fetal outcomes. Risk is significantly increased when SLE pregnancy is complicated by anti-phospholipid syndrome (APS). Here, we present a case of a 21 year-old multi-gravid lady with SLE- associated APS who was diagnosed as such when she presented with multisystem flare at her 16 weeks of gestation. At presentation she had fever, multiple joint pain in both upper and lower limbs, loss of hair, history of recurrent oral ulcer, skin rash over hand and feet. Physical examination and laboratory evaluation were consistent with an active SLE flare. A diagnosis of antiphospholipid syndrome (APS) was made based on her clinical presentation and laboratory findings. The reported patient had APS secondary to SLE. She had all the risk factors that would confer a remarkably high risk of pregnancy morbidity: positive anti-SSA(RO) antibody and lupus anticoagulant, history of one neonatal death due to congenital heart block and two consecutive first trimester pregnancy loss. Multidisciplinary management approach with appropriate intervention and close monitoring can bring a successful outcome.

A survey in the West Midlands of the United Kingdom of current practice in managing hypotension in lower segment caesarean section under spinal anaesthesia.

BACKGROUND: Spinal anaesthesia, the most common form of anaesthesia for caesarean section, leads to sympathetic blockade and profound maternal hypotension resulting in adverse maternal and neonatal outcomes. Hypotension, nausea and vomiting remain common but until the publication of the National Institute of Health and Care Excellence (NICE) 2021 guidance, no national guideline existed on how best to manage maternal hypotension following spinal anaesthesia for caesarean section. A 2017 international consensus statement recommended prophylactic vasopressor administration to maintain a systolic blood pressure of >90% of an accurate pre-spinal value, and to avoid a drop to <80% of this value. This survey aimed to assess regional adherence to these recommendations, the presence of local guidelines for management of hypotension during caesarean section under spinal anaesthesia, and the individual clinician's treatment thresholds for maternal hypotension and tachycardia. METHODS: The West Midlands Trainee-led Research in Anaesthesia and Intensive Care Network co-ordinated surveys of obstetric anaesthetic departments and consultant obstetric anaesthetists across 11 National Health Service Trusts in the Midlands, England. RESULTS: One-hundred-and-two consultant obstetric anaesthetists returned the survey and 73% of sites had a policy for vasopressor use; 91% used phenylephrine as the first-line drug but a wide range of recommended delivery methods was noted and target blood pressure was only listed in 50% of policies. Significant variation existed in both vasopressor delivery methods and target blood pressures. CONCLUSIONS: Although NICE has since recommended prophylactic phenylephrine infusion and a target blood pressure, the previous international consensus statement was not adhered to routinely.

Formulation development of a cream containing fennel extract: in vivo evaluation for anti-aging effects.

This study was aimed to formulate and evaluate anti-aging effects of a topical cream (w/o emulsion) containig extract of Fennel (Foeniculum vulgare) versus its base. Formulation containing 4% concentrated extract of Foeniculum vulgare was developed by entrapping in the inner aqueous phase of w/o emulsion and base contained no extract. Both the base and formulation were stored under different storage conditions to predict their stability. The formulation and base were evaluated for effect on skin moisture and transepidermal water loss (TEWL). The base showed insignificant while the formulation showed significant effects on skin moisture and TEWL. The parameter volume and surface evaluation of living skin (SELS) parameters SEr, SEsc, SEsm, SEw were also evaluated and showed a significant (p < or = 0.05) decline. The texture parameter energy showed a significant increase proving that the formulation possesses potential anti-aging effects.

Varieties of foetal congenital abnormality.

The purpose of the study is to determine the type of fetal congenital abnormalities found among high risk pregnancies admitted in Fetomaternal Unit of Obs & Gynae Department in BSMMU. This is a cross sectional study done during the period July 2007 to June 2010. All the patients admitted with congenital abnormality in fetomaternal unit during this study period were included in this study. One hundred five cases had congenital abnormality of fetus among 1134 deliveries. Out of which 46.66% had CNS abnormalities and 19.04% had renal abnormalities. Out of CNS abnormalities Hydrocephalous (40.81%) was the most common, 31.42% patients were of age between 20-24 years, 69.52% patients had parity between 1-3, 35.37% had deliveries ≥ 37 weeks, 69.52% patients had vaginal deliveries, 82.89% patients were terminated by prostaglandins, 96.19% patients had no drug history other than intake of iron and calcium, 26.67% babies had birth weight between 1.1-1.5 kg and 70.4% were of male babies. Advances in ultrasound technology have made possible the prenatal identification of an increasingly large number of fetal congenital malformations. Now fetal anatomical survey is performed routinely between 18 to 22 weeks.

Brassica oleracea L. (Acephala Group) based zinc oxide nanoparticles and their efficacy as antibacterial agent.

Zinc oxide nanoparticles were synthesized from the leaf extract of Brassica oleracea L. Acephala group (collard green) followed by their characterization using Scanning Electron Microscope (SEM), and Energy Dispersive X-ray (EDX). The antibacterial properties of zinc nanoparticles were tested against Gram-negative bacteria, Pseudomonas aeruginosa (ATCC ® 9027™), Escherichia coli (ATCC ® 8739™), Klebsiella pneumoniae (ATCC® BAA-1705™) and Gram-positive bacteria, Staphylococcus aureus (ATCC ® 6538™) and Listeria monocytogenes (ATCC ® 13932™), at four different concentrations (50.00 µg/ml, 100.00 µg/ml, 500.00 µg/ml and 1 mg/ml) of zinc oxide nanoparticles suspension. Results revealed that the synthesized nanoparticles exhibit strong antibacterial effects against Pseudomonas aeruginosa, Listeria monocytogenes, Klebsiella pneumonia, Staphylococcus aureus and Escherichia coli at 500.00 µg/ml-1 mg/ml concentrations. An increase in efficacy of nanoparticles with the decrease of their size was also evident. This is a first ever report on Brassica oleracea, L. based nanoparticles which demonstrates that 500.00 µg-1 mg/ml conc. of zinc oxide nanoparticles have antibacterial activity against both Gram -ve and Gram +ve bacteria and have the potential to be considered as an antibacterial agent in future.