Epidemiological profile and surveillance activity of tuberculosis in South Batinah, Oman, 2017 and 2018.

Background: Understanding the current surveillance activity and the challenges is important to ensure a continuous success toward the elimination goal for tuberculosis (TB). South Batinah Governorate (SBG) ranked the fourth on the top reporting governorates in the period 2010-2016 in Oman. The objective of this study is to describe the epidemiological profile and activities of the surveillance program of TB in the SBG in the years 2017 and 2018. Methods: A retrospective quantitative analysis and a qualitative review were performed to the surveillance data present in the department of disease surveillance and control in the SBG in the years 2017 and 2018. Results: A total of 39 pulmonary TB (PTB) and 21 extrapulmonary TB (EPTB) cases were diagnosed in 2017 and 2018. More Omanis (22, 56.4%) were diagnosed with PTB compared to non-Omanis; however, the EPTB was solely diagnosed among Omanis (P < 0.001). Majority of the TB patients (35%) were between 30 and 49 years. More than 50% of the TB cases of both the types were diagnosed in <3 months, and the median of diagnosis delay was 33.5 (standard deviation = 95.5). Bacillus Calmette-Guérin vaccine scar was present in only 20.5% of the PTB patients, compared to 57.1% of EPTB (P = 0.004). Patients with PTB presented mainly with cough (31, 79.5%), loss of weight and appetite (25, 64.1%), and fever (22, 56.4%). Enlarged lymph nodes and loss of weight and appetite were the common symptoms among EPTB patients, 38.1 for each (P < 0.001). Staffing, incomplete notifications, difficulty in tracing the results, and absence of regular feedbacks are the major existing challenges. Conclusion: SBG continues to sustain low incidence rate of tuberculosis; however, additional strategies are urgently required for further reduction. Hence, the priority is to enhance all essential components of the surveillance system at this stage.

Is the hygiene hypothesis relevant for the risk of multiple sclerosis?

The hygiene hypothesis, suggesting that low exposure to pathogens early in life can increase the risk for immune-mediated diseases, has been proposed as an explanation for the increase in incidence of allergy and autoimmune diseases in industrialized countries during the last decades. Several aspects of the hygiene hypothesis have been related to MS. Already in 1966, the risk of MS was suggested to be higher in individuals with high hygienic standard during childhood. Further, an episode of infectious mononucleosis is an independent risk factor for MS and can be regarded as an indicator of low exposure to pathogens early in life, as infection with Epstein-Barr virus often is asymptomatic when it occurs in young children. Conflicting results have been reported regarding number of siblings, attendance in a day care center and exposure to animals during childhood in relation to MS risk, but common childhood infections and vaccinations do not seem to influence the risk of MS. In line with the hygiene hypothesis, two large meta-analyses have recently shown that infection with Helicobacter pylori is negatively correlated with MS. Moreover, a protective influence of helminth infection on MS has been observed in several, small clinical studies, but more knowledge is needed before a potential role of helminth-derived therapy in MS is determined. Also, it has been hypothesized that infection with the parasite Toxoplasma gondii could be protective against MS.

The relationship between motor competence, physical fitness and self-perception in children.

AIM: The aim of the current research was to explore the relationship between motor competence, physical fitness and self-perception, and to study to which extent this relationship may vary by gender. METHODS: A sample of 67 children (mean age 11.46 years, SD 0.27) completed Harter's Self-Perception Profile for Children (SPPC), the Movement Assessment Battery for Children (MABC) and the Test of Physical Fitness (TPF) to assess self-perception, motor competence and physical fitness. RESULTS: The SPPC was stronger related to total score on TPF than to total score on MABC. However, when looking at boys and girls separately, this result was found for the boys only. In the group in general, total scores on both TPF and MABC correlated significantly with three of the domains of SPPC (social acceptance, athletic competence and physical appearance) and general self-worth. This relationship varied by gender. Interestingly, TPF was highest correlated with perception of athletic competence in boys but with perception of social acceptance in girls. A high and significant correlation was found between physical fitness and motor competence for both genders. CONCLUSION: The results indicated a strong relationship between physical fitness, motor competence and self-perception in children that varied by gender. This implies that all these factors are essential contributions in order to facilitate participation in physical activity in children.

Research on children with developmental coordination disorder--some challenges! Commentary on C. L. Tsai and S. K. Wu (2008).

This commentary focuses on the need for proper inclusion criteria for research on children who have motor problems. Researchers must be aware of the large range of individual differences found in samples used in research on children with Developmental Coordination Disorder. New theoretical perspectives in development and learning are a basis for research and practice.

The behavior of PLGA microspheres containing rifampicin in alveolar macrophages.

We have developed a pulmonary drug delivery system for the treatment of tuberculosis using rifampicin (RFP) encapsulated in poly-(lactic-co-glycolic acid) microspheres (RFP-PLGA MS), which is a biocompatible polymer. In this study, the behavior of RFP-PLGA MS and the metabolism of RFP were investigated after their uptake by macrophages using the rat alveolar macrophage cell line, NR8383. The prepared RFP-PLGA MS were spherical with an average diameter of 1.9microm and were taken up effectively by NR8383 cells in an energy-dependent manner. It was shown by fluorescent microscopic studies that the RPF-PLGA MS taken up by the cells were localized in phago-lysosomes and then degraded. Although a small amount of 3-formylrifamycin SV (3-FRSV) was generated by the metabolism of RFP, almost all RFP remained unchanged. It was considered, therefore, that RFP was released into the cytosol with drug potency intact. Based on these results, RFP-PLGA MS will be effective for the delivery of anti-tuberculosis drugs such as RFP, and will be a potentially useful drug delivery tool for pulmonary and possibly other tissues as well.

Protective mechanism of ultrafiltration against cardiopulmonary bypass-induced lung injury.

BACKGROUND: We previously demonstrated a negative effect of cardiopulmonary bypass (CPB) in a canine model of single-lung graft function and an improved effect with ultrafiltration during CPB. OBJECTIVE: To investigate the mechanism of these effects, focusing on cytokines and pulmonary surfactants using real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). MATERIALS AND METHODS: Fifteen left-sided single-lung transplant procedures were performed in pairs of dogs. The animals were divided into 3 groups. In one group, transplantation was performed without CPB (non-CPB group); in a second group, transplantation was performed with CPB and CPB flow was decreased slowly and pulmonary artery pressure was controlled (CPB group; and in the third group, transplantation was performed with CPB and ultrafiltration (CPB+UF group). Grafted lung specimens were harvested for RT-PCR of cytokines (IL-6, IL-8, and IL-10) and surfactant proteins (SP-A, SP-B, and SP-C). RESULTS: Real-time quantitative RT-PCR demonstrated increased IL-6 expression in the CPB group compared with the non-CPB group. IL-6 gene expression was suppressed and pulmonary surfactant restored using ultrafiltration. Gene expression of surfactant protein (SP)-A, SP-B, and SP-C was decreased in the CPB group compared with normal lung and ultrafiltration groups, which demonstrated sustained gene expression of SP-A and SP-B. CONCLUSION: Cardiopulmonary bypass has negative effects on grafts; however, ultrafiltration attenuates acute lung dysfunction by decreasing the inflammatory response and increasing pulmonary surfactant.

A new spectrophotometric method for the determination of methyldopa.

A new, simple and low cost spectrophotometric method for the determination of methyldopa in pharmaceutical preparations was developed. The method was based on the coupling of methyldopa with 2,6-dichloroquinone-4-chlorimide (DCQ). The absorbance maximum (λ max) of the resulted colored product was at 400 nm. Different buffers were used to determine the optimal pH for the reaction. About 1% w/v acetate buffer with pH 8.0 gave the optimal pH required for the reaction. Of the different solvents tried, water and ethanol were found to be the most suitable solvents. Beer's law was obeyed in concentration range of 4-20 µg/ml methyldopa. The correlation coefficient was found to be (r = 0.9975). The limit of detection and limit of quantification were 1.1 µg/ml and 3.21 µg/ml, respectively. The reaction ratio between methyldopa and DCQ was studied and found to be 1:3. The work included the study of the possible interference of hydrochlorothiazide found in combination with methyldopa tablets. The method was validated and results obtained for the assay of two different brands of methyldopa tablets were compared with the BP method (colorimetric). The repeatability and reproducibility of the developed method were evaluated and the obtained results quoted. The derivative formed as a result of the reaction of methyldopa with DCQ was isolated and its possible mechanistic pathway was suggested.

The relationship between physical fitness and motor competence in children.

BACKGROUND: This study examined the relationship between physical fitness and motor competence in children aged 9-10 years. METHODS: A sample of 67 children (mean age 9.7, SD 0.3 year) participated in the study. To assess motor competence, each child completed the Movement Assessment Battery for Children. Physical fitness was measured by the Test of Physical Fitness, comprising nine different tasks including running, jumping, throwing and climbing. RESULTS: The results show a strong and significant correlation between motor competence and physical fitness within the sample. CONCLUSIONS: These results are relevant to the work of maintaining and developing both sufficient physical fitness and motor competence in children as these factors are important contributors to their health and well-being.

Interrelationship among selected measures of motor skills.

BACKGROUND: This study set out to explore the interrelationship among selected measures of motor skills. METHODS: Ninety-one 4-year-old children from 10 nursery schools were tested using eight motor tasks from the Movement Assessment Battery for Children test. RESULTS: The most striking finding was that there were very low correlations between the motor tasks. CONCLUSIONS: In relation to these findings, it is possible to argue that learning of particular motor skills is specific to that task. This is discussed in relation to the principle of task specificity of learning.

[Vacuum-assisted wound closure in the management of deep sternal wound infection].

We herein present a case who underwent vacuum-assisted wound closure (VAC) therapy for post-sternotomy mediastinitis. A 71-year-old female with chronic renal failure on dialysis underwent a graft replacement of the ascending aortic aorta for the treatment of an acute aortic dissection. After she was discharged from the hospital, a purulent discharge was noted to occur from the median sternal wound. The wound was therefore reopened and all sternal wires were removed. Thereafter, polyurethane foam which was shaped to fit the defect was placed within the cavity. The area was covered with adhesive drape and suction drainage was carried out at -100 mmHg. The polyurethane foam was replaced every few days. The wound was finally closed using a muscle flap at 49 days after surgery. VAC therapy is therefore considered to be a useful treatment modality for deep sternal wound infections.

Venous blood flow through vein grafts before harvesting minimizes endothelial cell desquamation immediately after implantation.

AIM: The aim of this paper was to examine effectiveness of maintaining venous blood flow through dissected, but not harvested, grafts on prostaglandin I2 production and endothelial cell regeneration after implantation. METHODS: Using 10 dogs, 8-cm-long bilateral jugular veins were dissected; 1 was harvested, and immersed in heparinized blood for 60 or 120 min. The other was left in situ with retained blood flow until harvest after 60 or 120 min. Two 1-cm-long specimens were obtained from these 4 graft types and subjected to PGI2 assay or silver nitrate staining for measurement of endothelial cell coverage area. The remaining 6-cm portions of the 120-min grafts were autogenously implanted into the abdominal aorta, retrieved after 7 days and assayed and measured. RESULTS: Comparisons between groups suggested beneficial effects of preserving venous blood flow until implantation on endothelial coverage and PGI2 production (p<0.05). CONCLUSION: Venous blood flow through dissected vein grafts effectively helps preserve PGI2 production.

[Venovenous extracorporeal membrane oxygenation in neonatal systemic artery-to-pulmonary artery shunt operations using a double lumen catheter].

The right atrium of the neonate may be too small for direct insertion of 2 venous catheters during intraoperative life support. We inserted a double lumen catheter into the right atrium, and venovenous (V-V) extracorporeal membrane oxygenation (ECMO) was instituted. The patient's arterial oxygen saturation was maintained at 70% to 90%, and hemodynamic stability was obtained during V-V ECMO. V-V ECMO using a double lumen catheter can be easily established in a small neonate, and is an effective support technique for untolerable hypoxemia during systemic-to-pulmonary artery shunt operations.

Radiographic damage in rheumatoid arthritis correlates with functional disability but not direct medical costs.

OBJECTIVE: Few longitudinal data exist on the relationship between radiographic damage and self-reported functional disability and direct medical costs in rheumatoid arthritis (RA). We assessed these relationships. METHODS: One hundred thirty patients with RA (at time of the first available radiograph, mean age 56.6 yrs, 16.9% male, mean disease duration 16.8 yrs) were followed for up to 13.4 years. Semiannually, they reported on functional disability (0 = no difficulty, 3 = unable to do), global severity (0 = very well, 100 = very poor), pain (0 = no pain, 3 = severe pain), and health services utilization through completion of the Stanford Health Assessment Questionnaire (HAQ). Concurrent hand radiographs were scored for erosions and joint space narrowing using the Genant method and a single score summing both erosions and joint space narrowing for both hands was calculated (0 = no damage, 200 = maximum damage). The univariate association of functional disability, global severity, pain, or direct medical costs with concurrent radiographic damage was assessed through Spearman correlations and hierarchical regression models. The hierarchical models permit exploitation of the between-patient and within-patient variation present in our longitudinal data. RESULTS: At the time of the first available radiograph, mean (SD) levels of functional disability, global severity, and pain were 1.3 (0.7), 39.4 (21.0), and 1.1 (0.7), respectively. At entry into the study, the average radiograph score was 49.7 and upon leaving the study it was 66.9. Patients were followed an average of 6.7 years, with radiograph scores increasing at an average rate of 2.5 units/yr. The Spearman correlation [95% confidence interval (CI)] between average per-patient radiograph score and average per-patient HAQ disability index, average per-patient global severity, average per-patient pain score, and average per-patient direct medical costs was, respectively, 0.42 (0.26, 0.55), 0.23 (0.06, 0.39), 0.20 (0.03, 0.36), and 0.06 (-0.11, 0.23). The mean slope (95% CI) for disability on radiograph score was 0.0186 (0.0132, 0.0226), for severity on radiographs 0.1889 (0.1295, 0.2498), and for pain on radiographs 0.0057 (0.0027, 0.0084). As an example, over 10 years, a 25 unit (i.e., 50%) increase in radiograph scores would, on average, be associated with a 0.46 unit (i.e., 35%) increase in disability, a 4.72 unit (12%) increase in global severity score, and a 0.14 unit (13%) increase in pain, all expressed on the HAQ scales. There was little association between radiograph score and direct medical costs. CONCLUSION: A clinically meaningful association exists between radiographic damage and self-reported functional disability, suggesting that interventions that slow radiographic progression may improve the patient's health status. Such a relationship was not observed between radiographic damage and direct medical costs.

Active oxygen radicals induce peroxidase activity in rice blade tissues.

The relationship between active oxygen radicals and peroxidase induction on disease resistance in rice blades was investigated. Nitric oxide was produced in the whole blade stimulated by blast fungus elicitor. The induction of peroxidase activity was detected in active oxygen radical-treated rice blades 1 hour after treatment and thereafter. These results suggest that active oxygen radicals produced by stimulation with the elicitor could trigger peroxidase induction.

[Determination of 4-O-methylpyridoxine (MPN) by HPLC with diode-array detector].

We have developed a simple and rapid method for measuring 4-O-methylpyridoxine (MPN) in the serum of an acute poisoning patient by high-performance liquid chromatograph (HPLC) with a diode-array detector. MPN, a poisonous ingredient of ginkgo seeds was extracted using an Isolute C18 solid-phase extraction column. Equal volumes of the extract were injected into a C18 HPLC column using acetonitrile-10 mM phosphate buffer (pH 3) as the mobile phase. Excellent linearity was obtained over the range of 1-1000 ng at a wavelength of 290 nm, and its detection limit of approximately 0.5 ng was considered to be satisfactory. The mean recovery of MPN in the serum was 92.9 +/- 6.1%. The method was used successfully in a case of acute poisoning.

Evaluation of an internal thoracic artery as a coronary artery bypass graft by intercostal duplex scanning ultrasonography.

OBJECTIVES: Although angiography is often used to determine whether the internal thoracic artery is appropriate as a coronary bypass graft, but use of duplex scanning ultrasonography for this purpose is not yet widespread. METHODS: The internal diameter and flow of the internal thoracic artery were measured using intercostal duplex scanning in 100 patients during April 1995. The ultrasonographic device (sonos 2000, Hewlett Packard) used had a linear probe delivering a frequency of 7.5 MHz. Bilateral internal thoracic arteries and their blood flow were imaged clearly in all subjects. Diameter was compared by angiography and duplex scanning ultrasonography in 20 patients. RESULTS: The average internal diameter of internal thoracic artery was 2.19 +/- 0.46 mm (right) or 2.13 +/- 0.32 mm (left) in men and 2.05 +/- 0.44 mm (right) or 2.09 +/- 0.42 mm (left) in women. The gender difference was statistically significant (p = 0.05). The maximum systolic blood flow velocity through the internal thoracic artery was 0.85 +/- 0.34 m/s (right) or 0.84 +/- 0.36 m/s (left) in men and 0.87 +/- 0.28 m/s (right) or 0.82 +/- 0.28 m/s (left) in women. The average internal thoracic arterial blood flow (F) was 54.6 +/- 29.0 ml/min (right) or 50.9 +/- 28.8 ml/min (left) in men and 56.8 +/- 38.2 ml/min (right) or 58.2 +/- 33.4 ml/min (left) in women. Duplex scanning ultrasonography using an intercostal approach enables easy imaging of bilateral internal thoracic arteries and visualizes entire internal thoracic artery structure by simply changing the probe position. CONCLUSION: Intercostal duplex scanning ultrasonography is thus recommended for reliable evaluation of the internal diameter and blood flow of the internal thoracic artery.

Systemic lupus erythematosus and the risk of malignancy.

The objective of this study was to determine the relative risks of malignancy and of site-specific malignancies in patients with systemic lupus erythematosus (SLE). A cohort of 297 patients (91% Caucasian) with SLE were seen between 1975 and 1994 and followed for a mean of 12 years at the University of Saskatchewan Rheumatic Disease Unit. Expected cancer incidence rates were determined based on Province of Saskatchewan population statistics matched to each study patient for age, sex and calendar year of follow-up. Standardized incidence ratios (SIRs) of observed to expected cancers and 95% confidence intervals (95% CI) were calculated. A total of 27 cases of cancer were observed, whereas only 16.9 were expected (SIR 1.59 (95% CI 1.05-2.32)). For site-specific malignancies, an excess of cancer of the cervix (SIR 8.15 (95% CI 1.63-23.81)) as well as hemopoietic malignancy (SIR 4.9 (95% CI 1.57-11.43)) was found. The hemopoietic cancers were predominantly non-Hodgkin's lymphoma (SIR 7.01 (95% CI 1.88-17.96)). We did not find an association of malignancy with known risk factors, including use of cytotoxic agents. Increased risk of malignancy, notably non-Hodgkin's lymphoma and perhaps cervical cancer, should be regarded as a complication of SLE.

Successful implantation of a cardioverter defibrillator in an infant.

We report the successful implantation of a cardioverter defibrillator (ICD) in a 12-month-old infant. A single-lead ICD using an epicardial patch and a cathodal pulse-generator titanium shell electrode was very useful for implantation in this infant.

[Children and motor competence]. / Barn og motorisk kompetanse.

Recently, the topic of motor competence has figured prominently in the media. The claims made are many, but the research that support the statements is seldom cited. The aim of this review article is to address that deficiency by documenting what is really known about the motor competence of children. Motor competence not only allows children to carry out everyday practical tasks, but it is also an important determinant of their level of self-esteem and of their popularity and status in their peer group. While many studies have shown a significant correlation between motor problems and other problems in the social sphere, it has been difficult to establish causal relationships with any degree of confidence, as there appear to be several interactions which need to be taken into account. Research has shown that 6-10% of Norwegian children in the 7 to 10 year age group have a motor competence well below the norm. It is unusual for motor problems to simply disappear over time. In the absence of intervention the syndrome is likely to continue to manifest itself. More recent research points to some of the circularity in this causal network, children with motor problems having been shown to be less physically active than their peers. In a larger health perspective this in itself can have very serious consequences for the child.

Ionotropic glutamate receptors expressed in human retinoblastoma Y79 cells.

Mammalian retinal photoreceptors and pinealocytes have common characteristic that they secrete melatonin and L-glutamate as chemical transmitters. Although pinealocytes express glutamate receptors and receive glutamate signals, whether or not photoreceptors express glutamate receptors is unknown. Here, we investigated the expression of the glutamate receptors in cultured Y79 clonal human retinoblastoma cells, as model systems of photoreceptors. Reverse transcription-polymerase chain reaction (RT-PCR) analysis indicated that GluR1, GluR5, GluR7, EAA2, NR1, NR2A and NR2D mRNAs were present in the cultured cells. Northern analysis confirmed the presence of GluR7, EAA2, NR1, NR2A and NR2D mRNAs, while other mRNAs were under the detection limit. Addition of (RS)-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid or kainate increases intracellular (Ca(2+)) in Fura-2 loaded cells, which is blocked by 6-cyano-7-nitroquinoxaline-2,3-dione. N-methyl-D-aspartate also increases intracellular (Ca(2+)). These results demonstrated the presence of functional ionotropic receptors in Y79 cells.