Unveiling the Anthelminthic Potential of Merremia vitifolia Stem through in Vitro and in Silico Approach.

This study aimed to assess the anthelmintic activity of methanol extracts from Merremia vitifolia stems using a combination approach encompassing experimental, in vitro, and in silico evaluations. Despite the well-recognized pharmacological properties of M. vitifolia, its potential as an anthelmintic agent remained unexplored. This plant's anthelmintic potential was assessed on adult earthworms (Pheretima posthuma), revealing a dose-dependent reduction in spontaneous motility leading to paralysis and eventual mortality. The most effective dose of M. vitifolia (200 mg/ml) for anthelmintic effects on Pheretima posthuma was identified. Complementary in silico investigations were also conducted, employing Autodock PyRx 0.8 for docking studies of reported M. vitifolia compounds. Notably, quercetin emerged as a promising candidate with superior binding energies against ß-tubulin (-8.3 Kcal/mol). Moreover, this comprehensive research underlines the anthelmintic potential of Merremia vitifolia stem extract and highlights quercetin as a noteworthy compound for further investigation in the quest for novel anthelmintic agents.

Silent Bowels From a Silent Bite: A Rare Case of Paralytic Ileus Complicating Plasmodium falciparum Infection.

Malaria is a life-threatening, parasitic disease that continues to infect millions of people, especially in endemic regions. Despite advancements in malaria treatment, treating the disease remains challenging. One major challenge is identifying the disease from its unconventional manifestations. Therefore, recognizing its unusual clinical presentations is imperative in early detection and management with a better prognosis. This case report highlights the unique finding of paralytic ileus from a patient with confirmed malaria. Further investigation on the concurrence between paralytic ileus and malaria may aid in identifying the disease and subsequent improvement in treatment.

Risk of adverse pregnancy outcomes prior to the onset of an autoimmune rheumatic disease: a systematic review.

OBJECTIVES: An increased risk of adverse maternal and foetal pregnancy complications (including pre-eclampsia, intrauterine growth restriction, and small for gestational age) is well described in women with autoimmune rheumatic disease (ARD) compared with the general population (GenPop). It is less clear, however, whether this risk of adverse pregnancy outcome (APO) also exists in women with 'preclinical ARD' (pre-ARD) before they are diagnosed with an ARD many years post-partum. Therefore, we have undertaken a systematic review of the available evidence on APO in patients who subsequently were diagnosed with a rheumatic disease to identify whether there is an increased risk in pre-ARD. METHODS: The present study was reported in accordance with the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. A systematic literature review was performed using the online PubMed database. Pre-SLE and pre-RA patients were defined as those who, over the subsequent years, developed SLE or RA according to international classification criteria. RESULTS: A total of 176 articles were screened, and 27 original articles were selected for final analysis. Pre-RA was the most studied group, with 15 studies and a total of >1600 pregnancies, and pre-SLE was the second-most studied pre-ARD in pregnancy, with 14 studies and a total of >1000 pregnancies. We found that patients who subsequently developed SLE had an increased burden of poor pregnancy outcomes compared with pregnant women from the GenPop, but fewer APOs compared with pregnancies of women with SLE. In contrast, a similar rate of APOs was found when pre-RA pregnancies were compared with GenPop pregnancies. CONCLUSION: Our findings of an increased risk of APO in certain pre-ARDs highlights the relevance of taking an obstetric history during the first rheumatology appointment and the need for novel screening strategies for the prediction of APOs. Further research is required to elucidate the immune basis of APOs in preclinical and clinical ARD.

Adherence to inhalers and associated factors among adult asthma patients: an outpatient-based study in a tertiary hospital of Rajshahi, Bangladesh.

BACKGROUND: Adherence to inhaler medication is an important contributor to optimum asthma control along with adequate pharmacotherapy. The objective of the present study was to assess self-reported adherence levels and to identify the potential factors associated with non-adherence to the inhalers among asthma patients. METHODS: This facility-based cross-sectional study was conducted in the medicine outpatient department of Rajshahi Medical College Hospital from November 2020 to January 2021. A total of 357 clinically confirmed adult asthma patients were interviewed. Inhaler adherence was measured using the 10-item Test of Adherence scale (TAI).. Both descriptive and inferential statistics were used to express the socio-demographic of the patients and predictors of poor adherence to inhaler. RESULTS: A substantial number of participants were non-adherent (86%) to inhaler medication. Patients non-adherent to inhaler medication are often younger (23.15, 95% CI 3.67-146.08), lived in the rural area (23.28, 95% CI 2.43-222.66), less year of schooling (5.69, 95% CI 1.27-25.44), and belonged to the middle income (aOR 9.74, 95% CI 2.11-44.9) than those adherent with the inhaler. The presence of comorbidities (12.91, 95% CI 1.41-117.61), prolonged duration of inhaler intake (5.69, 95% CI 1.22-26.49), consulting non-qualified practitioners (13.09, 95% CI 3.10-55.26) were the significant contributor of non-adherence. CONCLUSION: Despite ongoing motivation and treatment, non-adherence to inhalation anti-asthmatic is high and several factors have been found to contribute. Regular monitoring and a guided patient-centered self-management approach might be helpful to address them in long run.

Comparing pregnancy outcomes in patients with criteria and non-criteria autoimmune disease: A systematic review.

BACKGROUND: Not all patients fulfil criteria for specific autoimmune rheumatic diseases (ARDs) and are then defined as having non-criteria (nc)ARD. It is uncertain whether well-recognised associations with adverse pregnancy outcomes in patients with criteria ARD also exist in patients with ncARD or undifferentiated connective tissue disease (UCTD). Therefore, we undertook a systematic review of the prevalence of adverse pregnancy outcomes in various ncARD and UCTD compared with criteria ARD to identify whether there are increased risks and to examine for any benefits of treatment. METHODS: This study was conducted in accordance with the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. A systematic literature review was performed using online databases including Medline and PubMed from inception to the beginning of April 2021 using appropriate keywords for various ARD and pregnancy outcomes. RESULTS: After screening 665 articles, 36 articles were chosen for full text review and 15 selected for final analysis. There were eight studies of nc antiphospholipid syndrome (APS) of more than 7000 pregnancies and seven studies of UCTD of more than 1000 pregnancies. No studies of any other ncARD in pregnancy were identified. We found that patients with either ncAPS or UCTD seem to have an increased burden of poor pregnancy outcomes compared with the general population. Despite the heterogeneity and poor quality of the studies, we also noted that ncAPS and criteria APS patients may have similar rates of obstetric complications with standard and/or non-standard APS treatment regimens. CONCLUSION: Our findings of increased risks of poor pregnancy outcomes in patients with ncAPS or UCTD will be helpful for pre-pregnancy counselling and management of these patients in pregnancy and support their referral to specialist obstetric-rheumatology and obstetric-haematology clinics.

A Systematic Review of the safety of non-TNF inhibitor biologic and targeted synthetic drugs in rheumatic disease in pregnancy.

INTRODUCTION: Despite increasing evidence to support safe use of tumour necrosis factor inhibitors (TNFi) and other biologic disease modifying anti-rheumatic drugs (bDMARDs) during pre-conception/pregnancy, there remains a paucity of evidence regarding the safety and compatibility of other non-TNFi and novel targeted synthetic (ts)DMARDs during pre-conception/pregnancy. Therefore, we conducted a systematic review to determine the compatibility of these drugs in pre-conception, during pregnancy and post-partum period. METHOD: Databases including; EMBASE, Pubmed (MEDLINE), and Cochrane were searched up to 23rd October 2020 to find relevant peer-reviewed papers, using keywords including; rheumatic disease, pregnancy, conception/pre-conception, lactation/breastfeeding, childhood and vaccination/infection, and commonly prescribed non-TNFi drugs and tsDMARDs. RESULTS: Our search yielded 1483 papers that were screened independently by two authors, and 109 full-text papers were eligible for final analysis. These studies reported 1291 maternal pregnancies exposed to non-TNFi bDMARDs and tsDMARDs with known outcomes, including 721 live births, 219 spontaneous miscarriages and 27 congenital abnormalities. Paternal exposures in 174 pregnancies had reassuring outcomes. A total of 48 breastfed infants were exposed to non-TNFi bDMARDs and no adverse events reported upon long-term follow-up. Fifteen infants exposed to bDMARDs received normal vaccination regimes, including live vaccines, and had normal developmental outcomes, without any complications or infections. CONCLUSION: Overall, the findings are reassuring and do not suggest a cause for any major concerns or an increased risk of adverse pregnancy outcomes for maternal or paternal exposures to non-TNFi bDMARDs or tsDMARDs. There were no major concerns for breastfeeding exposures to non-TNFi bDMARDs.

Average output polarization dataset for signifying the temperature influence for QCA designed reversible logic circuits.

Quantum-dot cellular automata (QCA) as nanotechnology is a pledging contestant that has incredible prospective to substitute complementary metal-oxide-semiconductor (CMOS) because of its superior structures such as intensely high device thickness, minimal power depletion with rapid operation momentum. In this study, the dataset of average output polarization (AOP) for fundamental reversible logic circuits is organized as presented in (Abdullah-Al-Shafi and Bahar, 2017; Bahar et al., 2016; Abdullah-Al-Shafi et al., 2015; Abdullah-Al-Shafi, 2016) [1-4]. QCADesigner version 2.0.3 has been utilized to survey the AOP of reversible circuits at separate temperature point in Kelvin (K) unit.

Comorbid Human Immunodeficiency Virus (HIV) and Muscle-Specific Kinase (MuSK) Myasthenia Gravis: A Case Report and Literature Review.

BACKGROUND HIV infections with concomitant immunologically-mediated disorders have been frequently described but there has been little research on the association between HIV and myasthenia gravis. MuSK myasthenia gravis coexisting with HIV is an even a rarer entity and can occur as a part of immune restoration disease. We report the case of a patient with asymptomatic HIV infection who presented with new-onset MuSK myasthenia gravis. CASE REPORT A 44-year-old African-American woman with HIV since 2004 and on highly active antiretroviral therapy (HAART) presented to the ED with complains of double vision and difficulty swallowing for 2 weeks. The patient was intermittently on HAART therapy. On examination, she had bilateral ptosis, weak orbicularis oris and orbicularis oculi, along with mild lateral gaze palsy of the left eye. Her CD4 count was 383 and the viral load was undetectable. An MRI of the brain produced normal results and a CT chest did not show thymus enlargement. Due to worsening symptoms and high suspicion for myasthenia gravis, she was started on IVIG at 0.4 mg/kg/day for 5 days, and her symptoms markedly improved. She was found to have strongly positive MuSK antibody and negative Ach receptor antibody. Repetitive nerve stimulation showed a 13% decrease in the right median nerve, which confirmed the diagnosis. She was subsequently discharged to home on pyridostigmine. Azathioprine was added at clinic follow-up. The patient continues to improve. CONCLUSIONS As the use of antiretroviral therapy increases, immune reconstitution syndromes have become more common. Rare associations like HIV and MuSK myasthenia gravis are being increasingly reported. The use of immunosuppressants in the treatment of these conditions should be carefully evaluated.

Polyradiculopathy and Gastroparesis due to Cytomegalovirus Infection in AIDS: A Case Report and Review of Literature.

BACKGROUND: Cytomegalovirus (CMV) infection has been well described as an opportunistic infection of patients with human immunodeficiency virus (HIV). To the best of our knowledge, this is the first case report of a patient with AIDS and lumbosacral polyradiculopathy, associated with gastroparesis resulting from CMV infection. CASE REPORT: A 46-year-old Hispanic woman with a history of HIV for 10 years was admitted to our hospital for nausea, vomiting, urinary retention, and generalized weakness. Bilateral lower extremity examination revealed flaccid paraplegia, decreased sensations from the groin downwards, bilateral lower extremity areflexia, and absent plantar reflexes, with enlarged urinary bladder. CMV was detected in CSF by PCR, and cervical and lumbar magnetic resonance imaging (MRI) revealed intense nodular leptomeningeal enhancement from the lower thoracic cord and extending along the conus medullaris/filum terminalis and nerve roots. Gastric emptying scintigraphy revealed severe delayed gastric emptying time. Ganciclovir was initiated and her neurological symptoms and gastrological symptoms gradually improved. Over 8 weeks, nausea and vomiting resolved and the patient was able to walk before being discharged from the hospital. CONCLUSIONS: Polyradiculopathy and gastroparesis can result from CMV infection in AIDS patients. Whether the mechanism is secondary to viral infection or immune systems remains unclear. It is important for physicians to be aware of this uncommon presentation in the antiretroviral therapy (ART) era. CMV treatment should be initiated immediately once diagnosis is confirmed.

Potential ecological risk of hazardous elements in different land-use urban soils of Bangladesh.

Soil pollution, influenced by both the natural and anthropogenic factors, significantly reduces environmental quality. In this study, six hazardous elements (Cr, Ni, Cu, As, Cd and Pb) in 12 different land-use urban soils from Bangladesh were assessed. The ranges of Cr, Ni, Cu, As, Cd and Pb in studied soils were 2.4-1258, 8.3-1044, 9.7-823, 8.7-277, 1.8-80 and 13-842 mg/kg, respectively. More than 70% of soil samples exceeded the Dutch target value for Ni, Cu, As, Cd and Pb concentration in soil, indicating a potential risk to the environment. Certain indices, including the enrichment factor (EF), pollution load index (PLI) and contamination factor (Cf(i)), were used to assess the ecological risk posed by hazardous elements in soils. The mean range of PLI was 1.5-10, indicating progressive deterioration of soil due to metal contamination. However, the Cf(i) values of Cd ranged from 3.7 to 35 revealed that the examined soils were strongly impacted by Cd. Considering the severity of potential ecological risk for single metal (Er(i)), the descending order of contaminants was Cd>As>Cu>Pb>Ni>Cr. In view of the potential ecological risk (PER), soils from all land uses showed considerable to very high potential ecological risk.

Heavy metal concentrations in some macrobenthic fauna of the Sundarbans mangrove forest, south west coast of Bangladesh.

Heavy metal concentrations in some macrobenthic fauna have been reported for the first time from the Sundarbans mangrove forest, south west coast of Bangladesh, in the northern part of Bay of Bengal. The concentration of Fe, Cu, Zn, Cd and Pb in macrobenthos ranged from 235 ± 10.11 to 1,051 ± 38.42, 3.66 ± 0.89 to 7.55 ± 1.29, 76.8 ± 8.55 to 98.5 ± 6.49, 0.46 ± 0.11 to 0.859 ± 0.2 and 4.66 ± 1.17 to 6.77 ± 2.1 µg/g, respectively. Significant variations (p ≤ 0.05) in heavy metal concentrations have been observed among the mud crab, mudskipper and gastropod. However, heavy metal burdens did not vary significantly among the hermit and horseshoe crabs. In mud crab, horseshoe crab and gastropod, heavy metal concentrations were recorded in the sequence: Fe > Zn > Pb > Cu > Cd. Hermit crab and mudskipper contained heavy metals in the order of Fe > Zn > Cu > Pb > Cd. Fe and Zn concentrations were found significantly (p ≤ 0.05) higher in macrobenthos. The lead (Pb) concentration found in the edible portion of macrobenthos exceeded the international permissible limits certified by the WHO. Bioconcentration factors >1.00 obtained for Fe (17.05 in mudskipper) and Cd (1.87 in gastropod) indicated that these metals were highly bioaccumulated and biomagnified in benthic fauna of Sundarbans. The findings of this study refer to the potential impact of heavy metals in the mangrove ecosystem of Bangladesh.

Extramammary Paget's disease in Chinese males: a 21-year experience.

BACKGROUND: Extramammary Paget's disease (EMPD) is a rare disease in Chinese males. Our objectives were to examine the results of our experience, to correlate them with the published literature, and thus to formulate improved management guidelines. METHODS: This was a retrospective analysis of all male patients with EMPD treated at our institution. We reviewed the patients and their case notes for data such as presenting symptoms, delay to diagnosis, incidence of concurrent malignancies, treatments given, and a variety of outcome measures, including the number of patients with recurrent or residual disease. RESULTS: The overall recurrence rate was 35%. The risk of recurrence was reduced if intraoperative frozen section analysis was used (25%) compared to simple wide local excision (60%). Wide local excision failed to excise the disease completely in 38%. There were no associated internal malignancies and no disease-related deaths in our sample. CONCLUSIONS: We recommend intraoperative frozen sections to reduce the risk of incomplete resection and to reduce the rate of recurrence. In our population, screening for internal malignancies can be restricted to select patients, e.g., those with perianal disease, those with invasive disease, and young patients.

Surgical reconstruction of attempted suicide charcoal burns.

Burning charcoal in an enclosed space is now the second most-common method of committing suicide in Hong Kong. When the suicide is unsuccessful, the patients can still sustain extensive tissue destruction from both direct and indirect thermal burns. We report a series of three patients who sustained deep injuries that, after débridement, left exposed bones and joints needing acute coverage. Free tissue transfer was required in each case to close the wounds. This short series illustrates the extensive destruction that can occur from both contact burns and radiant heat injury and the reconstructive challenges that can result. Of particular note was that serial débridment was necessary in the radiant heat injury because of the evolving and more extensive nature of the wound.

Decompression not escharotomy in acute burns.

The concept of escharotomy has long been associated with acute burns care. Nevertheless the practice of escharotomy is frequently flawed and there is considerable diversity in the teaching of the procedure. It is proposed that there should be a fundamental change in the teaching of acute burn management and the concept of decompression should be promoted. The justification for this change comes from a review of the present knowledge base using indexed, library and web-based information sources and also a review of a series of patients transferred to a regional burns unit over a five-year period which revealed that 37% of patients who required surgical decompression had not been appropriately treated prior to transfer. Based on relevant compartmental anatomy a change in the surgical decompression of limbs is proposed to allow safer and more effective management.