Toxicity evaluation of nanocrystalline silver-impregnated coated dressing on the life cycle of worm Caenorhabditis elegans.

In recent times, however, due to the emergence of bacterial strains with resistance to conventional antibiotics, silver has again gained attention as an alternative for developing new efficient bactericides, including the use of silver nanoparticles (AgNPs). However, the improper disposal of these items after use may cause toxicological effects on organisms in the environment. To evaluate the potential environmental hazard of nanosilver-coated dressings, the nematode Caenorhabditis elegans was chosen as a test organism. The assays were conducted in 24-well plates that contain four different sizes of coated dressing to obtain different concentrations. L1 and L4 C. elegans larval stages were exposed to these nanosilver concentrations. Dressing cutouts were arranged between two layers of agar for 3 days and Escherichia coli (OP 50 strain) was added as food source for the worms. After the exposure period, growth, reproduction, fertility, silver concentration in the medium and the concentration of reactive oxygen species (ROS) in the worms were evaluated. Scanning and transmission electron microscopy analyses were performed on the coated dressings, as well as analyses of zeta potential, ionic release and antibacterial power in two bacterial strains (Pseudomonas aeruginosa and Staphylococcus aureus). It was verified the antibacterial power of the coated dressing, in both bacteria strains tested. Characterization of the coated dressing indicated heterogeneous nanoparticles, as well as distinct zeta potentials for the medium in water and saline medium (0.9% NaCl). L1 larval worms exposed to nanosilver-coated dressing showed a high ROS concentration and reductions in growth, fertility and reproduction. Worms exposed to the coated dressing during the L4 stage showed almost no response. Overall, the obtained results indicate the potential environmental hazard of nanosilver-coated dressings.

The relationship between thyroid function and bone health in euthyroid healthy adult Nigerians

There is a dearth of reports on variation in thyroid function within the reference range on bone health in euthyroid healthy adults in Nigeria This study evaluated the variation in thyroid function within reference range on biochemical bone markers and bone mineral density in healthy adults. This prospective study was carried out among 40 healthy participants above 21 years of age but less than 50 years by systematic random sampling. Exclusion criteria included subjects with acute or chronic disease states, previous fractures, any drug use, history of alcohol or smoking. Interviewer ­questionnaire was administered. Anthropometric indices determined. Blood samples for thyroid function tests included triiodothyronine (FT3), thyroxine(FT4), Thyroid Stimulating Hormone(TSH-thyrotropin), osteocalcin (OC), and Alkaline phosphatase (ALP), serum calcium adjusted for albumin, inorganic phosphorus, and urine sample for calcium and creatinine were collected after 10 - 12 hours fast. 24 hour calcium excretion was calculated (CaE). Bone mineral Density determined by Dual X - ray Absorptiometry scan. Statistical analysis done,< 0.05 set as level of significant. The mean age 34.10 years (7.8), with BMI 26.32kg/m2 (4.02),waist circumference 76.60cm (17.07). The mean levels of bone markers were osteocalcin 17.68ng/ml (10.67), alkaline phosphatase70.60 IU/L (16.56) and 24hour calcium excretion 396.10mg/dl (101.89). OC and ALP inversely correlated with age but CaE did not. TSH positively correlates OC( r =0.35,p=0.029), but not CaE, p > 0.05. FT4 correlates bone formation markers OC,ALPand CaE p <0.05. Neither FT3,FT4 or TSH neither correlates with zscore BMD. Normal variation in the levels of ft4 and TSH has an early impact on biochemical bone markers compared to bone mineral density. Biochemical bone markers are thus suggested as screening tools for early detection of metabolic bone diseases in euthyroid healthy adults

Patrones de tratamiento con agentes biológicos: Eficacia y sobrevida a largo plazo en pacientes con artritis reumatoidea / Treatment patterns with biological agents: Efficacy and long-term survival in patients with rheumatoid arthritis

En nuestro país existen pocos datos acerca de los patrones de tratamiento y la sobrevida de las Drogas Modificadoras de la Artritis Reumatoidea biológicas (DMARb) en pacientes con Artritis Reumatoidea (AR). El objetivo de nuestro estudio fue estimar la sobrevida del 1° y 2° agente biológico, determinar sus causas de suspensión y evaluar factores que influyan en la sobrevida de estos agentes. Material y métodos: Se realizó un estudio multicéntrico retrospectivo. Se incluyeron pacientes ≥18 años de edad que cumplieran con criterios ACR/EULAR 2010 para AR y que iniciaron su 1° y/o 2° DMARb entre 01/2006 y 06/2017, la recolección de datos se realizó mediante la revisión de historias clínicas. Se consignaron variables sociodemográficas y clínicas. Resultados: Se incluyeron 347 pacientes con edad mediana de 57,8 años, 89,6% mujeres, 96,5% tenían Factor Reumatoideo (FR) positivo. El 53,9% de los pacientes discontinuaron el tratamiento con la 1°DMARb, treinta y ocho pacientes (41,3%) discontinuaron el 2° DMARb. La causa más frecuente de suspensión del primer biológico fue la falta de provisión, mientras que la del segundo biológico fue la ineficacia. Las supervivencias medianas fueron: para la 1° DMARb 31 meses (IC 95%: 21,8-40,1) y para 2° DMARb 11 meses (IC 95%: 4-17,9), no observamos diferencias significativas en la supervivencia entre los distintos agentes, los factores independientemente asociados a menor supervivencia del 1° DMARb fueron el tabaquismo y menor edad y del 2° DMARb fue haber discontinuado el primer agente biológico debido a evento adverso. Conclusión: Las supervivencias medianas del 1° DMARb y del 2° DMARb fueron 2,6 años y menor a 1 año, respectivamente. A diferencia de otras cohortes de países desarrollados, la causa más frecuente de suspensión del primer biológico fue la falta de provisión de la medicación por parte del pagador, mientras que la del segundo biológico fue la ineficacia.

In our country there are few data about the treatment patterns and the survival of the Biologic Disease Modifying Antirheumatic Drugs (bDMARD) in patients with Rheumatoid Arthritis (RA). The objective of our study was to evaluate the survival of the 1st and 2nd biological agent, determine the causes of suspension and factors that influence on the survival of these agents. Material and methods: A retrospective multicenter study was conducted. We included patients ≥18 years of age who met the ACR/EULAR 2010 criteria for RA and who started in 1st and/or 2nd bDMARD between 01/2006 and 06/2017, the data collection was done by reviewing clinical charts The sociodemographic and clinical variables were recorded. Results: We included 347 patients with a median age of 57.8 years, 89.6% women, 96.5% had positive Rheumatoid Factor (RF). 53.9% of patients discontinued treatment with 1st bDMARD, thirty-eight patients (41.3%) discontinued the 2nd bDMARD. The most frequent cause of suspension of the first biological was the lack of provision, while the second biological was inefficacy. The median survivals were: for the 1st bDMARD 31 months (95% CI: 21.8-40.1) and for the 2nd bDMARD 11 months (95% CI: 4-17.9), we did not observe significant differences in survival between the different agents. The independent factors associated with lower survival of the 1st bDMARD were smoking and lower age and the 2nd bDMARD was to have discontinued the first biological agent due to an adverse event. Conclusion: The median survivals of the 1st bDMARD and the 2nd bDMARD were 2.6 years and less than 1 year, respectively. Unlike other cohorts of developed countries the most frequent cause of suspension of the first biological was the lack of provision of the drug by the payer, while the second biological was inefficacy.

Understanding the burden of disease in Nepal: a call for local evidence.

The burden of disease, most commonly expressed in terms of Disability-Adjusted Life Years, has become a crucial component in decision making processes within the health sector. In Nepal, however, burden of disease estimates are scarce and lack representativeness. To improve our understanding of the burden of disease in Nepal and thereby increase the efficiency of health policies, there is an urgent need to strengthen the local evidence base. All relevant stakeholders should therefore collaborate to generate new data, improve existing data generation mechanisms, make generated data available, and optimize the use of available data.

Laparoscopic surgery in a Nigerian teaching hospital for 1 year: challenges and effect on outcomes.

BACKGROUND: Laparoscopic surgery has developed rapidly in developed nations within a relatively short time to become a major method of treating surgical diseases, with increasing application across specialties. However this is not the situation in developing countries like Nigeria. This may be as a result of local challenges to the performance of laparoscopic procedures. It is important to identify what these challenges are. METHODOLOGY: We prospectively studied problems encountered during the performance of laparoscopic procedures, and their effects on the procedure in a Nigerian teaching hospital for a year. Demographic information, laparoscopic procedure, problems encountered and effect on procedure, and outcomes were analyzed using descriptive statistics. RESULTS: Our sample consisted of 21 patients who had laparoscopic procedures performed by the authors; 12 (57%) were therapeutic procedures. Average age was 34.1 years (range 18-50 years) and majority (61.9%) were female. Problems encountered included non functioning/malfunctioning equipment (76.2%), power outages (33.3%), and dead light source bulbs (14.3%). There were 5 (23.8%) conversions to open surgery as a result of problems encountered; another conversion (4.8%) was to tackle an ascending colon tumour discovered at laparoscopy. CONCLUSION: The performance of laparoscopic procedures in a Nigerian public hospital is affected largely by inadequate and often malfunctioning equipment, and attention to these may reduce rates of conversion to open surgery.

Knowledge and practices of pig farmers regarding Japanese encephalitis in Kathmandu, Nepal.

Japanese encephalitis (JE) is the single largest cause of viral encephalitis in the world and has been endemic in Nepal since the early 1980s. Since then, it has spread from its origins in lowland plains to the Kathmandu Valley as well as in hill and mountain districts. Pigs are amplifying hosts for the virus. The Nepal government has been encouraging the development of pig farming as a means of poverty alleviation. Whereas other countries have reduced JE through vaccination programmes and improvements in pig husbandry, these options are not economically possible in Nepal. The objective of this study was to examine the occupational risk of pig farmers in Nepal and to determine their level of knowledge and practice of JE prevention techniques. We surveyed 100 randomly selected pig farmers in the Kathmandu District and found that pig farmers were exposed to many JE risk factors including poverty and close proximity to pigs, rice paddy fields and water birds, which are the definitive hosts for the virus. Forty-two percent of the farmers had heard of JE, 20% associated it with mosquito bites and 7% named pigs as risk factors. Few protective measures were taken. None of the farmers were vaccinated against JE nor were any pigs, despite an ongoing human vaccination campaign. This farming community had little ownership of land and limited education. JE education programmes must consider gender differences in access to public health information as there were an equal number of male and female farmers. We provide findings that can inform future JE education programmes for this vulnerable population.

Lateral approach in mammary implants.

The lateral approach in mammary implants is recommended, especially in patients with a marked hypomastia. In these patients, submuscular implants are mandatory. Routinely, hyaluronidase is injected in situ before implantation to favor immediate reabsorption of possible bleeding that could lead to capsular contraction. A circular pattern has been designed to reach symmetry both in incisions and the surgical pocket. Advantages of the lateral approach are described.