Mass online training of health care workers during COVID-19: approach, impact, and outcomes for over 10,000 health care providers.

OBJECTIVES: COVID-19 revealed major shortfalls in healthcare workers (HCWs) trained in acute and critical care worldwide, especially in low-resource settings. We aimed to assess mass online courses' efficacy in preparing HCWs to manage COVID-19 patients and to determine whether rapidly deployed e-learning can enhance their knowledge and confidence during a pandemic. STUDY DESIGN: Retrospective cohort study. METHODS: This international retrospective cohort study, led by a large Academic Medical Centre (AMC), was conducted via YouTube and the AMC's online learning platform. From 2020 to 2021, multidisciplinary experts developed and deployed six online training courses based on the latest evidence-based management guidelines. Participants were selected through a voluntary sample following an electronic campaign. Training outcomes were assessed using pre-and post-test questionnaires, evaluation forms, and post-training assessment surveys. Kirkpatrick's Model guided training evaluation to measure self-reported knowledge, clinical skills, and confidence improvement. We also captured the number and type of COVID-19 patients managed by HCWs after the trainings. RESULTS: Every 22.8 reach/impression and every 1.2 engagements led to a course registration. The 10,425 registrants (56.8% female, 43.1% male) represented 584 medical facilities across 154 cities. The largest segments of participants were students/interns (20.6%) and medical officers (13.4%). Of the 2169 registered participants in courses with tests, 66.9% completed post-tests. Test scores from all courses increased from the initial baseline to subsequent improvement post-course. Participants completing post-training assessment surveys reported that the online courses improved their knowledge and clinical skills (83.5%) and confidence (89.4%). Respondents managed over 19,720 COVID-19 patients after attending the courses, with 47.7% patients being moderately/severely ill. CONCLUSIONS: Participants' confidence in handling COVID-19 patients is increased by rapidly deploying mass training to a substantial target population through digital tools. The findings present a virtual education and assessment model that can be leveraged for future global public health issues, and estimates for future electronic campaigns to target.

Outcome and feasibility of radiotherapy bridging in large B-cell lymphoma patients receiving CD19 CAR T in the UK.

Radiotherapy (RT) has potential synergistic effects with chimeric antigen receptor (CAR) T but is not widely used as bridging therapy due to logistical challenges and lack of standardised protocols. We analysed RT bridging in a multicentre national cohort of large B-cell lymphoma patients approved for 3L axicabtagene ciloleucel or tisagenlecleucel across 12 UK centres. Of 763 approved patients, 722 were leukapheresed, 717 had data available on bridging therapy. 169/717 (24%) received RT bridging, 129 as single modality and 40 as combined modality treatment (CMT). Of 169 patients, 65.7% had advanced stage, 36.9% bulky disease, 86.5% elevated LDH, 41.7% international prognostic index (IPI) ≥3 and 15.2% double/triple hit at the time of approval. Use of RT bridging varied from 11% to 32% between centres and increased over time. Vein-to-vein time and infusion rate did not differ between bridging modalities. RT-bridged patients had favourable outcomes with 1-year progression-free survival (PFS) of 56% for single modality and 47% for CMT (1-year PFS 43% for systemic bridging). This is the largest cohort of LBCL patients receiving RT bridging prior to CAR T reported to date. Our results show that RT bridging can be safely and effectively used even in advanced stage and high-risk disease, with low dropout rates and excellent outcomes.

A comparative study of earthquake disaster management laws between USA and Indonesia.

The frequent occurrence of disasters because of Indonesia's geographical location within the Ring of Fire calls for effective disaster-management efforts. With the issuance of Law No. 24 of 2007 on Disaster Management, the Indonesian National Disaster Management Agency (Badan Nasional Penanggulangan Bencana or BNPB) was subsequently established. Keeping in mind previous disasters in Indonesia which occur in different regions, that is, Palu and Aceh Tsunami, Cianjur earthquake, and Mount Merapi, Indonesia's disaster-management law is general and lacks technical guidelines in addressing the needs of the various regions and the different contours of geography. This article aims to analyse existing Indonesian regulatory and agency problems in disaster management by conducting a normative and comparative approach between the disaster management policy in the United States of America (USA) and Indonesia. The authors chose the USA's disaster-management policy in particular as most comparative studies on disaster management law do not involve the USA despite the State's ability to provide a comprehensive and consistent policy in the midst of the decentralisation of responsibilities with the numerous states. The authors conclude that according to existing disaster-management laws in USA and Indonesia, the government is obligated to fulfil its citizens' rights in the event of natural disasters. Furthermore, noting the issues that exist within the Indonesian disaster-management system, Indonesia can adopt the best practices of the USA to improve its disaster-management system. Among others, Indonesia can learn from the USA in the fields of accountability and transparency amongst agencies, the development of Early Warning Systems, an improved system of interagency cooperation, as well as the provision of specific disaster-management assistance. Contribution: The findings of this study are expected to serve as evaluation material and to improve government effectiveness in dealing with natural disasters.

A nucleic acid-based surface-enhanced Raman scattering of gold nanorods in N-gene integrated principal component analysis for COVID-19 detection.

A rapid, simple, sensitive, and selective point-of-care diagnosis tool kit is vital for detecting the coronavirus disease (COVID-19) based on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain. Currently, the reverse transcriptase-polymerase chain reaction (RT-PCR) is the best technique to detect the disease. Although a good sensitivity has been observed in RT-PCR, the isolation and screening process for high sample volume is limited due to the time-consuming and laborious work. This study introduced a nucleic acid-based surface-enhanced Raman scattering (SERS) sensor to detect the nucleocapsid gene (N-gene) of SARS-CoV-2. The Raman scattering signal was amplified using gold nanoparticles (AuNPs) possessing a rod-like morphology to improve the SERS effect, which was approximately 12-15 nm in diameter and 40-50 nm in length. These nanoparticles were functionalised with the single-stranded deoxyribonucleic acid (ssDNA) complemented with the N-gene. Furthermore, the study demonstrates method selectivity by strategically testing the same virus genome at different locations. This focused approach showcases the method's capability to discern specific genetic variations, ensuring accuracy in viral detection. A multivariate statistical analysis technique was then applied to analyse the raw SERS spectra data using the principal component analysis (PCA). An acceptable variance amount was demonstrated by the overall variance (82.4 %) for PC1 and PC2, which exceeded the desired value of 80 %. These results successfully revealed the hidden information in the raw SERS spectra data. The outcome suggested a more significant thymine base detection than other nitrogenous bases at wavenumbers 613, 779, 1219, 1345, and 1382 cm-1. Adenine was also less observed at 734 cm-1, and ssDNA-RNA hybridisations were presented in the ketone with amino base SERS bands in 1746, 1815, 1871, and 1971 cm-1 of the fingerprint. Overall, the N-gene could be detected as low as 0.1 nM within 10 mins of incubation time. This approach could be developed as an alternative point-of-care diagnosis tool kit to detect and monitor the COVID-19 disease.

Improved outcomes of large B-cell lymphoma patients treated with CD19 CAR T in the UK over time.

The success of CD19 Chimeric antigen receptor (CAR) T-cell therapy in large B-cell lymphoma (LBCL) has been partially offset by toxicity and logistical challenges, which off-the-shelf agents like CD20xCD3 bispecific antibodies might potentially overcome. However, when using CAR T outcomes as the 'standard-of-care comparator̕ for relapsed/refractory (r/r) LBCL, a potential learning curve with implementing a novel, complex therapy like CAR T needs to be considered. To address this, we analysed 726 UK patients intended to be treated with CD19 CAR T for r/r LBCL and compared outcomes between the first year of the national CAR T programme (Era 1; 2019) and the more recent treatment era (Era 2; 2020-2022). We identified significant improvements for Era 2 versus Era 1 in dropout rate (17% vs. 27%, p = 0.001), progression-free survival (1-year PFS 50% vs. 32%, p < 0.001) and overall survival (1-year OS 60% vs. 40%, p < 0.001). We also observed increased use of bridging therapy, improvement in bridging outcomes, more tocilizumab/corticosteroid use, reduced high-grade cytokine release syndrome (4% vs. 9%, p = 0.01) and intensive care unit admissions (20% vs. 32%, p = 0.001). Our results demonstrate significant improvement in CAR T outcomes over time, highlighting the importance of using up-to-date clinical data when comparing CAR T against new treatment options for r/r LBCL.

Probiotic yeast Saccharomyces cerevisiae Az-12 isolated from pomegranate juice presented inhibitory effects against pathogenic bacteria.

The potential probiotic yeast was isolated from the Kyzyl Anor pomegranate variety growing in the Turkestan region (Kazakhstan). The yeast strain was identified as Saccharomyces cerevisiae Az-12. Molecular genetic identification was carried out using the Sanger sequencing method. The degree of homology of the S. cerevisiae Az-12 strain with the strain MH608341.1 Saccharomyces cerevisiae isolate extr03 was 99.65%. Antagonistic effect of the yeast against pathogenic bacteria was confirmed according inhibition zones for Staphylococcus aureus 13.5 ± 0.05 mm; the inhibition zones for Escherichia coli 12.8 ± 0.05 mm; and 10.7 ± 0.05 mm for Pseudomonas aeruginosa. Scanning microscopy of S. cerevisiae Az-12 and S. aureus confirmed the adhesive ability of the yeast cell surface to S. aureus. S. cerevisiae Az-12 were chosen as the most promising, as they are able to quickly ferment juices. Functional drinks containing pomegranate juice and yeast with a probiotic effect can be considered as a useful synbiotic product formulation.

CAR T in patients with large B-cell lymphoma not fit for autologous transplant.

Large B-cell lymphoma (LBCL) patients with comorbidities and/or advanced age are increasingly considered for treatment with CD19 CAR T, but data on the clinical benefit of CAR T in the less fit patient population are still limited. We analysed outcomes of consecutive patients approved for treatment with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) by the UK National CAR T Clinical Panel, according to fitness for autologous stem cell transplant (ASCT). 81/404 (20%) of approved patients were deemed unfit for ASCT. Unfit patients were more likely to receive tisa-cel versus axi-cel (52% vs. 48%) compared to 20% versus 80% in ASCT-fit patients; p < 0.0001. The drop-out rate from approval to infusion was significantly higher in the ASCT-unfit group (34.6% vs. 23.5%; p = 0.042). Among infused patients, response rate, progression-free and overall survival were similar in both cohorts. CAR T was well-tolerated in ASCT-unfit patients with an incidence of grade ≥3 cytokine release syndrome and neurotoxicity of 2% and 11%, respectively. Results from this multicentre real-world cohort demonstrate that CD19 CAR T can be safely delivered in carefully selected older patients and patients with comorbidities who are not deemed suitable for transplant.

Potential of phenolic compounds from pomegranate (Punica granatum L.) by-product with significant antioxidant and therapeutic effects: A narrative review.

The wealth of epidemiological evidence in the scientific world underscores the possibility that a plant-based diet can reduce the prevalence of common diseases such as diabetes, cardiovascular disease, cancer, and stroke. The therapeutic effects of plant sources are partly explained by phenolic secondary metabolites or polyphenolic compounds. Therefore, polyphenolic compounds, which are widely distributed in plants, are of great interest for the development of effective specific drugs with antioxidant and anti-inflammatory effects. Moreover, polyphenol compounds have no harmful effects due to their natural biocompatibility and safety. Numerous studies have highlighted the potential of some industrial food wastes from plant material processing, including apple peels and mashed potatoes, grape skins, tomato and carrot peels, pomegranate peels and seeds, and many others. These byproducts are considered low-cost sources of natural biological compounds, including antioxidants, which have beneficial effects on human health. The polyphenol complex of pomegranate peel (Punica granatum L.), which makes up half of the pomegranate fruit, has more pronounced antioxidant and anti-inflammatory properties than other parts. And the most important active components of pomegranate peel, which are found only in this plant, are punicalagin, followed by ellagic acid and gallic acid. It is known that these polyphenolic compounds of pomegranate peel have the most pronounced therapeutic effect. Several studies have shown the protective effect of ellagic acid, punicalagin, against oxidative stress damage caused by free radicals. The potential of pomegranate peel as an antioxidant and therapeutic component in various biological systems is high, according to scientific sources. However, despite extensive research in recent years, a review of sources has shown that there is insufficient evidence to support the therapeutic effects of polyphenolic compounds from pomegranate peels. The role of pomegranate peel polyphenolic compounds, including flavonoids, as antioxidants in various biological systems also requires further research. Of particular importance are the mechanisms by which antioxidants influence the cellular response against oxidative stress. The purpose of this review was to report our current knowledge of plant polyphenolic compounds and their classification, and to evaluate the potential of phenolic compounds from pomegranate peels with significant antioxidant and therapeutic effects.

Relationship between Renal Function and Bone Mineral Density in Postmenopausal Women.

Renal insufficiency is a risk factor for osteoporosis and can increase risk of fracture. It may be a result of an age-related decline in renal function or chronic kidney disease. In patients with CKD, accurate diagnosis of osteoporosis or CKD-MBD is important for determining the most appropriate treatment. This was a cross sectional study was done at Institute of nuclear medicine and Allied Sciences, BSMMU, Dhaka from 1st January 2014 to 31st December 2014. Study population was total 69 postmenopausal women age over 50 years. Women with Bilateral hip replacement or bilateral hip pins or screws, metallic rods in spine, Carrying out BMD scan within the week after other radiological investigation using contrast media e.g. Barium meals or enema, IVPs were excluded from study. Clinical variables were- age (years), height (cm), weight (kg), BMI. Laboratory variables were- serum creatinine and BMD (Dexa). Estimated GFR was determined by using the serum Creatinine by MDRD formula. Renal function test and Bone mineral density (BMD) were done in all of these patients. Majority (43.4%) of the patients were in 6th decade. The mean weight was found 57.4±11.2kg. Majority 41(59.4%) patients belonged to T score at hip (-1 to -2.5) and their mean T score at hip was found (-1.1±1.1). Osteopenia and osteoporosis were found in 59.4% and 4.3% respectively according to BMD. High serum creatinine level was found in 10.1% cases. Renal function impairment was found in 79.6% of patient. Majority (50.7%) patients had mild decrease of eGFR (60-89 ml/min/1.73m²), There was Pearson's correlation (r=0.156; p=0.200) but not significant was found between age with T score at hip of the patients. Positive Pearson's correlation (r=0.112; p=0.361) was found but not significant between age and serum creatinine level. A significant negative Pearson's correlation (r= -0.274; p=0.023) was found between T score at hip and serum creatinine level of the patients. A significant negative Spearman correlation (r=-0.278; p=0.021) was found between BMD and serum creatinine of the patients. A significant positive Spearman correlation (r=0.580; p=0.001) was found between BMD and estimated GFR of the patients. This study was undertaken to evaluate the relationship between renal function and bone mineral density in postmenopausal women. Majority of the postmenopausal women were in 6th decade and most of them were overweight and obese. Renal function impairment was found in 79.6% of patient. Osteoporosis was found in 04.3% and 20.3% cases according to T score at hip and T score at lumber spine respectively. Significant negative Pearson's correlation was found between T score at hip and serum creatinine level of the patients. Significant negative Spearman correlation was found between BMD and serum creatinine of the patients. Significant positive Spearman correlation was found between BMD and estimated GFR of the patients.

Effect of magnetized water on blood indices and histomorphometric parameters of intestinal sections of Japanese quail.

A two-way experimental design was used to demonstrate the physiological effects of magnetized water and sex on blood indices and histomorphometric parameters of Japanese quail intestine sections. Red blood cell count (RBCs), packed cell volume (PCV), hemoglobin concentration (Hb), thrombocytes, white blood cell count (WBCs), and WBC differentiation were investigated. A total of 450 unsexed Japanese quail were randomized into three groups (45/replicate; 3 replicates; 135/group). As a monitoring group, the first group was given untreated tap water to drink. The two others were consumed magnetized water that were subjected to an electrical magnetic field with a power of 1 Tesla (10,000 Gauss) and 2 Tesla (20,000 Gauss), respectively. The treatments had a significant (p ≤ 0.05) effect on thrombocytes and Hb. Sex showed significant (p ≤ 0.05) differences for RBCs and PCV at 42 days of age. At different ages, significant effects were observed on histomorphometric parameters of the Japanese quail intestinal tract. It may be inferred that the influence of magnetized water, up to 1 Tesla, was positive on the haematological and histomorphometric parameters of the Japanese quail intestinal tract by augmenting the haematological measurements, which were within a normal range and increasing the surface area of the villus.

Clinical outcomes following surgical management of insertional Achilles tendinopathy using a double-row suture bridge technique with mean two-year follow-up.

BACKGROUND: The clinical outcomes following surgical management of insertional Achilles tendinopathy (IAT) vary depending on the surgical technique used to reattach the Achilles tendon following debridement. The aim of this study was to investigate the clinical outcomes of patients with IAT who underwent surgical management with a double-row suture bridge technique used to reattach the Achilles tendon. METHODS: A retrospective review of consecutive patients diagnosed with IAT, who underwent surgical management utilising a double-row suture bridge technique (Arthex Speedbridge), and a minimum of 3-month follow-up were included. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOXFQ) Index score which is a patient reported outcome measure (PROM). Secondary outcomes included EuroQol EQ-5D-5L health-related quality of life PROM and complication rates. RESULTS: Between July 2013 and June 2020, 50 consecutive patients (23 male; 27 female) were included. The mean age (± standard deviation) was 52.3 ± 11.3 (range 29.0-84.3). Pre- and post-operative PROM data were available for all cases. The mean follow-up was 2.4 ± 1.9 years. The MOXFQ Index score improved from 48.5 to 12.4 (p < 0.01), EQ-5D-5L improved from 2.7 ± 0.46 to 1.2 ± 0.37 (p < 0.01), and EQ-VAS improved from 48.0 ± 18.4 to 84.1 ± 12.6 (p < 0.01). Four patients had complications which were of minimal clinical relevance and caused no deviation from routine recovery. There were no cases of tendon rupture. CONCLUSION: This study has demonstrated that surgical management of IAT is safe and effective with clinical improvement in both clinical and general health-related quality of life outcome PROMs. LEVEL OF EVIDENCE: IV.

Prevalence and correlates of knowledge and practices regarding infection prevention and control, and triage in primary healthcare settings: A cross-sectional study in Bangladesh.

Background: Despite the high prevalence of healthcare-acquired infection in resource-limited settings, healthcare workers' (HCWs') knowledge and practices of infection prevention and control (IPC) and triage are not well-researched. We examined thisin Bangladesh's primary healthcare facilities (HCFs) during the COVID-19 pandemic. Methods: We surveyed 312 HCWs in 94 community clinics (CCs) and 90 family welfare centres (FWCs) in six districts from February to April 2021. We assessed HCWs' self-reported knowledge and observed practices in four domains: personal hygiene, medical instrument processing, waste management, and triage. We constructed a weighted composite knowledge score and estimated the association between knowledge and background characteristics using a generalised linear mixed effects model. Practices were described through univariate analysis. Findings: On a scale of 100, the mean composite knowledge score was 38.3 (SD: 13.3) overall and 44.0 (SD: 13.1) and 33.8 (SD: 11.6) for FWCs and CCs, respectively. The HCWs of FWCs were more aged, experienced, and educated than those of CCs. Knowledge score was the highest in personal hygiene and the lowest in medical waste segregation. Knowledge was significantly associated with HCWs' designation and education. Concerning practices, not more than one-third of the HCWs or HCFs, on average, followed the recommended protocols, except for wearing face masks while on duty (87.1%) and referring potential COVID-19 patients to higher-level facilities (68.3%). Conclusions: HCWs' capacity in instrument processing, waste management, and triage needs to be improved through formal education and training initiatives. Our study can contribute to the under-researched IPC and triage domains in resource-limited settings.

Health-related quality of life in patients with Achilles tendinopathy: Comparison to the general population of the United Kingdom.

BACKGROUND: There is little evidence available regarding the impact of Achilles Tendinopathy (AT) on health-related quality of life (HRQOL). The primary aim of this study was to quantify the clinical and health-related quality-of-life patient-reported outcome measures for a population presenting with either mid-substance or insertional Achilles tendinopathy. METHODS: A prospective comparative observational study of consecutive patients with AT presenting for extracorporeal shockwave therapy (ESWT) at a large teaching hospital. The primary outcome was assessment of a validated health-related quality of life PROMs (Euroqol EQ-5D-5L) and comparison to 2 general UK population datasets. The secondary outcomes were Visual Analogue Pain Scale (VAS-Pain) and two validated foot-specific patient reported outcome measures (Foot Function Index (FFI) and Victorian Institute of Sports Assessment-Achilles (VISA-A)). RESULTS: Between March 2014 and June 2021, 320 consecutive patients (125 male; 195 female) were diagnosed with AT and referred for a first course of ESWT. EQ-5D-5L PROMs were prospectively collected for 303 of these patients (94.7%). The mean age (± standard deviation(SD)) was 52.1 ± 11.4 years. The mean EQ-5D-5L Index score (mean±SD) for the AT cohort was 0.783 ± 0.131. Patients less than 55 years with AT had a statistically significantly worse quality of life compared with members of the same age group in the general population. The mean VAS-Pain, FFI, VISA-A clinical outcome scores were 6.0 ± 2.3, 49.5 ± 21.2 and 34.1 ± 14.4 respectively. There was a statistically significant moderate correlation between HRQOL and clinical PROMs (VAS-Pain and FFI vs EQ-5D) however there was no correlation with age. CONCLUSION: This study demonstrates that patients under the age of 55 with AT have a significantly reduced quality of life compared with the general population. LEVEL OF EVIDENCE: III.

Development of inactivated heartwater (Ehrlichia ruminantium) vaccine in South Africa.

Heartwater, Ehrlichia ruminantium infection in cattle, sheep, goats, and some wild ruminants, is an economically important disease in Africa characterized by high mortality rates in susceptible populations. In South Africa, the current commercial heartwater vaccine is an infection and treatment type of immunization using virulent live E. ruminantium organisms generated from blood of infected sheep with subsequent treatment of the animals with antibiotics at specific times during the course of infection. This vaccine has several inherent problems preventing its wide use as the vaccine must be administered intravenously and it does not protect against all the South African field isolates. A vaccine based on inactivation of Zimbabwean E. ruminantium Mbizi strain organisms produced in endothelial cell cultures can be a sustainable option because it will not require antibiotic treatment and will be safe as there is no potential for reversion to virulence. Previous data generated in laboratory trials and under natural field setting provides support for this vaccine approach. Four inactivated vaccine formulations using the E. ruminantium Mbizi strain were tested for their efficacy in Merino sheep compared to an unvaccinated control group (11 sheep per group). Two vaccines were prepared by beta-propiolactone (BPL) inactivation, and two were inactivated with binary ethylenimine (BEI) while purification was done with both percoll and polyethylene glycol (PEG). The four vaccine preparations were formulated with Montanide ISA 50V2 adjuvant and administered twice subcutaneously (2 ml per dose) at an interval of 4 weeks. All groups were challenged with a virulent homologous cell-cultured E. ruminantium inoculated via the intra-venous route on day 56. The primary variable of efficacy was measured by the percentage survival rate or mortality between the Controls and Vaccine Groups. Three vaccine formulations (BEI/Percoll (Group 3), BEI/PEG (Group 4), BPL/Percoll, (Group 1) had a significantly higher percent of animal surviving challenge compared to the unvaccinated control (p-values 0.001, 0.035, 0.030, respectively). The highest number of survivors was obtained in Group 3 BEI/Percoll; 10/11 (91%). Groups 4 (BEI/PEG) and Group 1 (BPL/Percoll) produced similar percentage of survivals of 64%. In contrast, the lowest survival rate of 50% was observed in Group 2 (BPL/PEG) which was numerically different but not significantly different from the unvaccinated control which had an 18% survival rate (2/11). The inactivated vaccine using BEI or BPL as inactivating agents blended with ISA 50 adjuvant induced protective immunity against challenge. The BEI/Percoll (Group 3) vaccination regimen was most efficacious against a lethal heartwater challenge as it significantly protected sheep against mortality which is the most important aspect of heartwater infections. Future work should be directed towards improvement of this vaccine formulation especially from the down-stream processing point of view as the percoll method is not scalable for commercialization purposes.

Terapia láser transescleral de micropulsos en el manejo de los pacientes de glaucoma / MicroPulse® transscleral laser therapy in the management of glaucoma patients

Objetivo Evaluar la eficacia y seguridad de la terapia láser transescleral MicroPulse® (TLT) en el tratamiento de pacientes con glaucoma. Métodos Se llevó a cabo una serie de casos prospectiva, intervencionista y no comparativa en el Servicio de Oftalmología del Hospital Universitario Ain Shams en 61 ojos de 46 pacientes con diversos tipos de glaucoma y de gravedad, de leves a graves. Además de la agudeza visual mejor corregida, se registraron la presión intraocular (PIO) y el número de medicamentos para el glaucoma antes y después del tratamiento, junto con la necesidad postoperatoria de inhibidores sistémicos de la anhidrasa carbónica, las tasas de éxito, el número de sesiones de tratamiento y las complicaciones postoperatorias. El éxito se definió como una PIO de 6-18mmHg o una disminución de al menos el 30% de la PIO preoperatoria en ausencia de complicaciones que amenazaran la visión durante el periodo de seguimiento de 6 meses. Resultados Se realizó la TLT MicroPulse® en 61 ojos glaucomatosos. Se repitió la sesión de TLT MicroPulse® en 11 de los 61 ojos (18%) que no alcanzaron una PIO entre 6 y 18mmHg, o una disminución de al menos el 30% con respecto al valor inicial a los 6 meses. A los 6 meses de seguimiento tras una única sesión de TLT MicroPulse® la reducción media de la PIO fue del 35,9%±14,2%, y 6 meses después de la segunda sesión fue del 36,2%±17,5% (p<0,001). La tasa de éxito tras la primera sesión fue del 73,8%, que aumentó al 78,7% tras la segunda sesión. La reacción celular media de la cámara anterior fue de+1,9±0,8 al primer día,+1,0±0,7 a la primera semana y+0,2±0,4 al primer mes del postoperatorio. No se detectaron células en ninguno de los casos a los 3 y 6 meses de seguimiento (p<0,001). El número medio de colirios antiglaucomatosos antes del TLT MicroPulse® fue de 2,6±1,0 (AU)

Objective To evaluate the efficacy and safety of MicroPulse® transscleral laser therapy (TLT) in the management of glaucoma patients. Methods A prospective, interventional, non-comparative case series was conducted in the department of ophthalmology, Ain Shams University Hospital on 61 eyes of 46 patients with various glaucoma types and of severity, ranging from mild to severe. In addition to best-corrected visual acuity (BCVA), intraocular pressure (IOP) and the number of glaucoma medications were recorded before and after treatment, along with the postoperative need for systemic carbonic anhydrase inhibitors (CAI), success rates, number of treatment sessions and postoperative complications. Success was defined as an IOP of 6-18mmHg or at least a 30% decrease from preoperative IOP in the absence of any vision-threatening complications during the 6-month follow-up period. Results MicroPulse TLT was performed on 61 glaucomatous eyes. Eleven of the 61 eyes (18%) that did not achieve IOP between 6-18mmHg, or at least a 30% decrease from baseline at 6 months, had a repeat MicroPulse TLT session. At 6 months follow-up post a single MicroPulse TLT session, the mean IOP reduction was 35.9±14.2%; and 6 months after the second session, it was 36.2±17.5% (P<.001). The success rate after the first session was 73.8% which increased to 78.7% after the second session. The mean anterior chamber (AC) cell reaction was+1.9±.8 at 1 day,+1.0±.7 at 1 week, and+.2±.4 at 1 month postoperatively. No cells were detected in any of the cases at 3 and 6 months follow-up (P<.001). The average number of anti-glaucoma eye drops before MicroPulse TLT was 2.6±1.0. Postintervention, the average number of anti-glaucoma eye drops was 1.7±1.2, and sustained at 6 months follow-up after the last treatment session (P<.001). There were no significant complications were noted. One eye developed transient hypotony for 3 months after MicroPulse TLT (AU)

MicroPulse® transscleral laser therapy in the management of glaucoma patients.

PURPOSE: To evaluate the efficacy and safety of MicroPulse® transscleral laser therapy (TLT) in the management of glaucoma patients. METHODS: A prospective, interventional, non-comparative case series was conducted in the department of ophthalmology, Ain Shams University Hospital on 61 eyes of 46 patients with various glaucoma types and of severity, ranging from mild to severe. In addition to best-corrected visual acuity (BCVA), intraocular pressure (IOP) and the number of glaucoma medications were recorded before and after treatment, along with the postoperative need for systemic carbonic anhydrase inhibitors (CAI), success rates, number of treatment sessions and postoperative complications. Success was defined as an IOP of 6-18 mmHg or at least a 30% decrease from preoperative IOP in the absence of any vision-threatening complications during the 6-month follow-up period. RESULTS: MicroPulse TLT was performed on 61 glaucomatous eyes. Eleven of the 61 eyes (18%) that did not achieve IOP between 6-18 mmHg, or at least a 30% decrease from baseline at 6 months, had a repeat MicroPulse TLT session. At 6 months follow-up post a single MicroPulse TLT session, the mean IOP reduction was 35.9 ± 14.2%; and 6 months after the second session, it was 36.2 ± 17.5% (p < 0.001). The success rate after the first session was 73.8% which increased to 78.7% after the second session. The mean anterior chamber (AC) cell reaction was +1.9 ± 0.8 at 1 day, +1.0 ± 0.7 at 1 week, and +0.2 ± 0.4 at 1 month postoperatively. No cells were detected in any of the cases at 3 and 6 months follow-up (p < 0.001). The average number of anti-glaucoma eye drops before MicroPulse TLT was 2.6 ± 1.0. Postintervention, the average number of anti-glaucoma eye drops was 1.7 ± 1.2, and sustained at 6 months follow-up after the last treatment session (p < 0.001). There were no significant complications were noted. One eye developed transient hypotony for 3 months after MicroPulse TLT. CONCLUSIONS: MicroPulse TLT is safe and effective in lowering IOP in a variety of glaucoma types and severity.

Status of Serum Calcium, Phosphate and Intact Parathyroid Hormone in Predialysis Chronic Kidney Disease Patients of Stage-3 to Stage-5 Compared To KDOQI Guideline.

The chronic kidney disease (CKD) is associated with a variety of bone disorders and disorders of calcium and phosphorus metabolism. Bone disease associated with chronic kidney disease having higher rate of CKD progression and increased risk of death. To see the status of serum calcium, phosphate and intact parathyroid hormone in pre-dialysis CKD (stage- 3 to 5) patients. This was a across sectional study done in outpatient department of Nephrology of National Institute of Kidney Diseases and Urology, Dhaka, between 1st June 2012 to 31st May 2013. The patients of CKD stage 3, 4 and 5 yet not on dialysis attending out patients department of Nephrology, NIKDU by using MDRD-4 equation according to K/DOQI guidelines and reviewing previous medical records and investigation reports were enrolled in this study. There after serum calcium (corrected for serum albumin), phosphate and iPTH levels were measured and compared with the recommended target ranges in K/DOQI guideline. The number of patients with serum levels according to K/DOQI guidelines for different stages CKD(3,4,5) were as follows: serum calcium: 56.6, 58.5 and 76.7; serum phosphate: 55.2, 58.5 and 56.7; iPTH 37.9, 12.2 and 36.7 and Ca x P product 100.0, 97.6 and 86.7, respectively. The percentages of patients (who received drug) with serum calcium levels within according to K/DOQI guidelines for stages 3, 4 and 5 were as follows: serum calcium: 63.2%, 64.7% and 83.3%; respectively, serum phosphate: 63.2%, 61.8% and 66.7%; respectively, iPTH 42.1%, 14.7% and 4.7% and Ca x P product 100.0%, 100.0% and 87.5%, respectively. On the other hand patients who didn't receive drug the percentages of patients with serum calcium levels according to K/DOQI guidelines for CKD stages 3, 4 and 5 were as follows: serum calcium: 50.0%, 28.6% and 50.0%; respectively, serum phosphate: 40.0%, 42.9% and 16.7%; respectively, iPTH 30.0%, 14.7% and 16.7% and Ca x P product 100.0%, 85.7% and 83.3%, respectively. The patients achieving the four recommendations of K/DOQI guidelines was 4(13.8%) in stage-3, 3(7.3%) in stage-4 and 5(16.7%) in stage-5. More than half of the pre-dialysis patients of CKD were within target range of serum calcium and phosphate recommended in K/DOQI guideline and this proportion was more in those who were taking both phosphate binder and Vit-D. Ca x P was within target range in almost all patients so it may not be an important parameter for therapeutic decision making. However majority of the patients were out of target range of iPTH even though having normal serum calcium and phosphate level. So emphasis should be given in monitoring of iPTH level in early stages of CKD.

Increased Expression of Cardiotrophin-1 in Cardiomyopathy Patients.

Cardiomyopathy (CM) is a condition of cardiac dysfunction. It is one of the leading causes of mortality in which both genetic and environmental factors are involved. Cardiotrophin-1 (CT-1) level in plasma is associated with CM. It affects the cardiomyocyte differentiation. To evaluate the expression of CT-1 in cardiomyopathy, this study was done on CM subjects attending the Fatima Memorial Hospital, Lahore, Pakistan, between January and June, 2016. A total of 40 subjects were enrolled who were divided into two groups; CM group (n = 20) and a control group (n = 20). A self-designed questionnaire was filled in by each subject to collect data regarding age, body mass index (BMI) and CM history. RNA was isolated from blood after its quantification, cDNA was prepared and reverse-transcriptase-polymerase chain reaction (RT-PCR) was performed for expression of CT-1. The mean age in CM subjects was 40.1±6.03 years, while it was 35.0±3.7 years in the control group. The mean expression of CT-1 in the CM subjects was 5.2±0.66, while it was 1.00±0.001 in the control group. A highly significant difference was observed in CT-1 expression in the CM group, and expression was significantly correlated with age and BMI in CM subjects.

Effective connectivity between precuneus and supramarginal gyrus in healthy subjects and temporal lobe epileptic patients.

INTRODUCTION: The effective connectivity (EC) when the brain is resting and how a neuronal system exerts influence over other regions of the brain, in different groups of subjects are still being investigated. Limited information was seen about the relationship between precuneus (PRE) which is a wellknown resting state hub with supramarginal gyrus (SMG) in healthy subjects (HS) and temporal lobe epilepsy (TLE) participants. MATERIALS AND METHODS: Fourteen HS and 14 TLE patients with age and gender matched underwent resting state functional magnetic resonance imaging (rsfMRI) scanning using a 3-Tesla MRI machine to investigate the EC and percentage of amplitude fluctuation (PerAF) involving SMG and PRE. The rsfMRI data were analysed using Statistical Parametric Mapping (SPM12) and Spectral Dynamic Causal Modelling (spDCM) from which causal models were specified, estimated and inferred. RESULTS: Model with bidirectional connections between PRE and SMG was chosen as the winning model. The EC from PRE to SMG is positive but the EC from SMG to PRE is negative in both hemispheres and in HS and TLE. Based on the findings from the EC analysis, there is an excitatory effect shown by PRE to SMG connection indicating a dominant role of PRE over SMG in both groups. CONCLUSION: There is important evidence showing that PRE might also have influence on areas outside resting state network and the influence changes in the presence of brain abnormality.

E. coli expression and immunological assessment of expressed recombinant Newcastle disease virus hemagglutinin-neuraminidase protein in chickens.

Every year, the poultry industry experiences significant economic losses due to epidemics of Newcastle disease virus (NDV). Developing new vaccines by identifying and using the immunogenic hemagglutinin-neuraminidase (HN) protein can protect the poultry industry. In the present study, the full-length HN protein was expressed in Escherichia coli (E. coli) BL21 (DE3) cells, purified via affinity chromatography and detected via western blot analysis using His-specific antibodies. The purified HN protein was further evaluated in chickens to study the immune response against NDV. The successful production of HN-specific IgY proved the activity of the purified HN protein. IgY was present in the serum of immunized chickens. However, the immune response was higher in chickens immunized with purified HN protein along with complete and incomplete adjuvants than in chickens immunized with only the HN protein. Keywords: protein; Newcastle disease virus; poultry; infectious diseases; vaccines.