Significant Psychosocial Influence in Frail People Living with HIV Independent of Frailty Instrument Used.

BACKGROUND: Antiretroviral therapy (ART) usage among people living with HIV (PLWH) has led to significant mortality declines and increasing lifespan. However, high incidence and early onset of aging-related conditions such as frailty, pose as a new threat to this population. OBJECTIVES: We aimed to characterize frailty by comparing health domains consisting of psychosocial, functional and physical deficits between frail PLWH and matched uninfected controls; identify associated risk factors and the impact on negative health outcomes including mortality risk score, quality of life, healthcare utilization, functional disability and history of falls among virally suppressed PLWH. DESIGN: Cross-sectional study. SETTING: Infectious disease clinic in a tertiary institution. PARTICIPANTS: Individuals aged >25 years, on ART >12 months, not pregnant and without acute illness; multi-ethnic, Asian. MEASUREMENTS: Frailty instruments included Frailty phenotype (FP), FRAIL scale (FS) and Frailty index (FI). FI health deficits were categorized into health domains (psychosocial, functional and physical) and used as standard comparator to characterize frailty. Health domains of frail PLWH were compared with frail matched, uninfected controls. Regression analyses were applied to explore associated risk factors and health-related frailty outcomes. RESULTS: We recruited 336 PLWH. Majority were male (83%), Chinese (71%) with CD4+ count 561 (397-738) cells/µl. Frailty prevalence among PLWH were 7% (FP); 16% (FS) and 22% (FI). Proportions of psychosocial, functional, and physical domains were similarly distributed among frail PLWH measured by different frailty instruments. When compared with matched controls, psychosocial dominance was significant among the PLWH, but not in functional and physical domains. Identified frailty risk factors included poor nutritional status, higher CD4+ count nadir, depression, metabolic syndrome, higher highly sensitive C-reactive protein (hsCRP) and history of AIDS-defining illness (ADI). Frailty influenced the risk for negative health outcomes including increased mortality risk scores, poor quality of life (QOL), frequent healthcare utilization and increased functional disability (p<0.05). CONCLUSIONS: This study highlighted the importance of psychosocial influence in the development of frailty among treated PLWH in a multi-ethnic, Asian setting.

Spontaneous pneumomediastinum and pneumothorax in COVID-19 patients: A tertiary care experience.

INTRODUCTION: COVID-19 can occasionally complicate into spontaneous pneumothorax (SP) and/or spontaneous pneumomediastinum (SM). This study aims at exploring the occurrence of SP and or SM, risk factors, and outcomes in COVID-19 patients. MATERIALS AND METHODS: All patients with COVID-19, which complicated into SP and/or SM at Hamad Medical Corporation (the principal public healthcare provider in Qatar) from March to September 2020, were retrospectively enrolled. The clinical diagnosis was confirmed by CXR and CT. Between-group comparisons were performed by using Chi-square and t-test. Differences were considered statistically significant at P ≤ .05. RESULTS: A total of 1100 patients were admitted, and 43 patients developed SP, SP + SM, or SM. Most patients were males (42/97.9%), and the most common comorbidity was diabetes mellitus (13/30.2%). All patients had acute respiratory distress syndrome (ARDS), and most patients had low lung compliance at the time of developing SP or SM. Twenty-two of the patients developed SP (51.2%), 11 patients had both SP and SM (25.6%), and 10 patients had SM only (23.3%). There was no significant difference in the development of SP or SM and patients' gender or blood group or whether patients were on invasive or noninvasive ventilation or even the mortality (P > .05). Lung compliance was significantly (P < .05) lower in patients complicated with SP and or SM. Patients with SP required significantly higher (P < .001) chest drain insertion. CONCLUSION: Patients with severe COVID-19 pneumonia can complicate into SP and SM. These complications are more common in male diabetic patients. Patients with ARDS and having low lung compliance are at a higher risk of developing SP, SP + SM, or SM.

Gamma / neutron radiation shielding, structural and physical characteristics of iron slag nanopowder.

The current study explores the effectiveness of an iron slag nanopowder (ISNP), which prepared from local iron steel industry, against gamma/neutron shielding. The structural and physical characteristics were experimentally determined. The crystal structure, morphology and elemental composition of the ISNP were studied using X-ray diffraction, scanning electron microscopy (SEM), energy dispersive X-ray analysis (EDX). On the other hand, a comprehensive experimental and theoretical study on the γ-ray shielding effectiveness of the ISNP was performed. In which, the experimental results have been validated by comparison with theoretical data which obtained by using the WinXcom program. This paper uses the well-known mathematical relationships to derive many shielding and dosimetry parameters such as effective atomic number and, effective electron density, for photon interaction and photon energy absorption as well as the γ-ray kerma coefficient from the mass attenuation coefficient. The exposure and energy absorption buildup factors have been also calculated. Furthermore, the shielding effectiveness against thermal and fast neutrons has been tested in terms of total macroscopic cross-sections. The results have revealed that the produced ISNP, with crystallite size of 24.5 nm, exhibits good shielding characteristics. Finally, based on this preliminary study, we can have concluded that the iron slag nanoparticles can be suitably used as an effective and safe (lead - free) component for radiation shielding.

Mixed phenotype acute leukaemia with t(9,22), BCR-ABL1: A case report.

INTRODUCTION: Mixed phenotype acute leukaemia (MPAL) is a rare entity of acute leukaemia. CASE REPORT: Here we report a case of a 39-year-old lady, with an incidental finding of hyperleukocytosis (white blood cells count: 139.2 x 109/L). Her peripheral blood film revealed 36% of blasts and a bone marrow aspiration showed 53% of blasts. Immunophenotyping showed a population of blasts exhibiting positivity of two lineages, myeloid lineage and B-lymphoid lineage with strong positivity of CD34 and terminal deoxynucleotidyl transferase (Tdt). A conventional karyotyping revealed the presence of Philadelphia chromosome. She was diagnosed with MPAL with t(9,22), BCR ABL1, which carried a poor prognosis. She was treated with acute lymphoblastic leukaemia (ALL) chemotherapy protocol coupled with a tyrosine kinase inhibitor and was planned for an allogeneic stem cells transplant. CONCLUSION: This MPAL case was diagnosed incidentally in an asymptomatic patient during medical check-up. We highlight this rare case report to raise the awareness about this rare disease. Understanding the pathogenesis of the disease with the underlying genes responsible for triggering the disease, uniform protocols for diagnosis and targeted treatment will help for proper management of these patients.

Plasma-derived microparticles in polycythaemia vera.

INTRODUCTION: Microparticles are membrane bound vesicles, measuring less than 1.0 um, which are released during cellular activation or during apoptosis. Studies have shown that these circulating microparticles play a role in coagulation, cell signaling and cellular interactions. Increased levels of circulating microparticles have been observed in a number of conditions where there is vascular dysfunction, thrombosis and inflammation. The objective of this study was to determine the various plasma-derived microparticles in patients with polycythaemia vera (PV) in Universiti Kebangsaan Malaysia Medical Centre and to compare them with normal control. METHODS: A total of 15 patients with PV and 15 healthy volunteers were included in this cross-sectional descriptive study. Plasma samples from both patients and healthy volunteers were prepared and further processed for isolation of microparticles. Flow cytometry analyses were then carried out in all samples to determine the cellular origin of the microparticles. Full blood count parameters for both groups were also collected. Data collected were analyzed using SPSS version 12.0. RESULTS: Patients with PV had a significantly higher percentage of platelet derived microparticles compared to healthy controls (P <0.05). The control group had a higher level of endothelial derived microparticles but the differences were not statistically significant (P > 0.05). CONCLUSION: The median percentage of positive events for platelet derived microparticles was higher in patients with PV compared to normal healthy controls.

Case-control investigation on the risk factors of melioidosis in small ruminant farms in Peninsular Malaysia.

AIMS: Epidemiology of melioidosis is poorly understood because its occurrence is influenced by complex interaction of environmental, climatic, physicochemical and host factors. We investigated the potential risk factors for the exposure to Burkholderia pseudomallei in small ruminants' farms in Peninsular Malaysia. METHODS AND RESULTS: Melioidosis-positive (n = 33) and negative (n = 27) farms were selected and visited for interviews and environmental samples collection. The characteristics and putative disease risk factors were compared between the case and the control farms using Chi-square test and logistic regression analysis. The multivariable logistic regression analysis showed that the odds of melioidosis were significantly higher in farms that had bush clearing around farms (odds ratio (OR) = 6.61, 95% confidence interval (CI) = 1.12-38.84, P = 0.037), in farms with B. pseudomallei present in the soil (OR = 6.23, 95% CI = 1.03-37.68, P = 0.046), in farms that have other animal species present (OR = 7.96, 95% CI = 1.14-55.99, P = 0.037) and in farms that had flooding or waterlogging conditions (OR = 11.95, 95% CI = 1.39-102.6, P = 0.024) when compared to the odds of the disease in farms that did not have the above conditions. The odds of the disease in farms that treated their soils with lime were significantly lower (OR = 0.028, 95% CI = 0.003-0.29, P = 0.003) compared to the odds in those that did not. CONCLUSIONS: The risk factors for the exposure to B. pseudomallei highlighted above may have contributed to the occurrence of melioidosis in animals in the study farms. SIGNIFICANCE AND IMPACT OF THE STUDY: Information from the study may be helpful in planning control measures against melioidosis and have improved understanding of the epidemiology of the disease in livestock farms.

Mycobiota and mycotoxins (aflatoxins and ochratoxin) associated with some Saudi date palm fruits.

This study aimed to determine the mycological profile of the retail date fruits distributed in different markets at Taif, Saudi Arabia. The presence of aflatoxins and ochratoxin A was also measured. Twenty-two fungal species belonging to 12 genera were isolated from 50 different date samples. Aspergillus flavus, A. niger, Penicillium chrysogenum, and Rhizopus stolonifer were the most prevalent species among isolated fungi. Eighty isolates of A. flavus and 36 of A. niger were detected for their aflatoxins and ochratoxin production potentials using thin layer chromatography. Toxicity test using Artimia larvae indicated that seven out of 18 A. flavus isolates had aflatoxins potentials, while nine out of 36 isolates of A. niger were ochratoxigenic. The quadruplex polymerase chain reaction using specific primers demonstrated the presence of four genes: nor A, ver 1, omt A, and avf A in seven A. flavus toxigenic isolates. Nine A. niger toxigenic isolates showed positive results for the presence of the PKS gene. In conclusion, the present study highlighted the potential hazards of mycotoxins on human health from consuming raw dates. Rapid molecular detection methods described here might help the food authorities to assure the safety of raw dates distributed in local markets.

Quantitative DNA analysis of very low-level hepatitis B viremic patients reporting to the gastroenterology clinic.

OBJECTIVE: To examine data on very low-level viremic hepatitis B virus (HBV) infections in patients reporting to a gastroenterology clinic, and to investigate methods to improve analysis to avoid missing follow-up data and improve the management of HBV infection, and minimize morbidity and mortality outcomes. METHODS: A total of 104 patients with very low-level viremic HBV whom reported to the gastroenterology clinic at Al-Hada Armed Forces Hospital, Taif, Saudi Arabia and had a reading of <12 IU/mL on the real time (RT) polymerase chain reaction (PCR) detection system were enrolled in this study. For serological testing (for example, hepatitis B surface antigen [HBsAg]), we examined patients' results recorded in the laboratory information system since early 2007. Liver enzymes, alanine aminotransferase, and aspartate aminotransferase were assessed in some cases. RESULTS: After analyzing the data collected from 1,178 patients, we found 104 (8.83%) cases that fit the criteria for our study, including a reading of <12 IU/mL. We formed 6 groups of participants based on HBsAg reactivity and very low, elevated, or no viremia, and found 4 cases of continuous occult hepatitis B infection. CONCLUSION: The very low levels of DNA found had a diagnostic impact on the management of HBI and yielded several suggestions for clinicians regarding follow-up with patients. It is important to use a sensitive RT PCR to monitor the course of HBV infection.

Prevalence and risk indicators of myopia among schoolchildren in Amman, Jordan.

We aimed to identify the prevalence and risk factors of myopia among secondary-school students in Amman. Thus 1777 (1081 males and 696 females) students aged 12-17 years old were recruited from 8 schools randomly selected from 8 different geographic locations in Amman. Data were collected by questionnaire, and self-reported myopia was checked against school medical records. The prevalence of myopia was 17.6%, with no significant difference between males and females after adjusting for other possible variables. Myopia was significantly associated with age, family history of myopia, computer use, and reading and writing outside school. Playing sports was inversely associated with myopia but there was no association with watching television.

Prevalence and risk indicators of myopia among schoolchildren in Amman, Jordan

We aimed to identify the prevalence and risk factors of myopia among secondary-school students in Amman. Thus 1777 [1081 males and 696 females] students aged 12-17 years old were recruited from 8 schools randomly selected from 8 different geographic locations in Amman. Data were collected by questionnaire, and self-reported myopia was checked against school medical records. The prevalence of myopia was 17.6%, with no significant difference between males and females after adjusting for other possible variables. Myopia was significantly associated with age, family history of myopia, computer use, and reading and writing outside school. Playing sports was inversely associated with myopia but there was no association with watching television

Prevalence of H.influenzae biotypes and their clinical significance in a University Hospital.

OBJECTIVE: Hemophilus influenzae is an important pathogen that is responsible for invasive and non-invasive infections in both children and adults. This study aims to assess the relationship of biotypes to the sites of infection, serotypes, antimicrobial susceptibility, beta-lactamase production and age. METHODS: A total of 200 isolates of H.influenzae were obtained from clinical specimens over a period of 12 months from January 2001 through to January 2002 from King Abdul-Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia. RESULTS: Most of the strains were non-typable and were isolated from patients with non-invasive infections. The typable isolates from invasive infections mostly serotype b were isolated from blood, cerebrospinal fluid and hip joint aspirate. Biotype II accounted for 37% of the isolates followed by biotypes III and I (29.5% and 23%). The remaining 10.5% were made up of biotypes IV, V, VI and VII. A significantly high resistance to cotrimoxazole (33.5%) and ampicillin (19%) was observed. Two point five percent of the isolates were resistant to chloramphenicol. All the isolates resistant to ampicillin were beta-lactamase producers and susceptible to cefuroxime, ceftriaxone, ciprofloxacin and rifampicin. CONCLUSION: This study revealed that biotypes II and III are the predominant biotypes of H.influenzae found in non-invasive infections. There is an apparent relationship between biotype and site of infection which could be useful as an epidemiological marker.

The Ross procedure for endocarditis in a 4-month-old infant.

Streptococcal endocarditis in an infant is rare. We report a case of acute aortic valve endocarditis with abscess and aorta-to-right atrial fistula formation. This 4-month-old infant with a structurally normal heart had been previously well. The child was successfully treated with the Ross procedure and remains well 13 months postoperatively.

Subtentorial diverticulum of the third ventricle associated with a mural cavernous angioma in a child.

The authors describe a case of a large subtentorial supracollicular diverticulum of the third ventricle associated with a cavernous angioma in its wall in a 6-year-old girl who presented with developmental delay and obstructive hydrocephalus. This is the first case in which such association has been diagnosed and successfully treated. The literature is reviewed, and the possible relationship between these two rare lesions is discussed.