A non-inferiority trial comparing two killed, whole cell, oral cholera vaccines (Cholvax vs. Shanchol) in Dhaka, Bangladesh.

Bangladesh remains cholera endemic with biannual seasonal peaks causing epidemics. At least 300,000 severe cases and over 4,500 deaths occur each year. The available oral cholera vaccineshave not yet been adopted for cholera control in Bangladesh due to insufficient number of doses available for endemic control. With a public private partnership, icddr,b initiated a collaboration between vaccine manufacturers in Bangladesh and abroad. A locally manufactured Oral Cholera Vaccine (OCV) named Cholvax became available for testing in Bangladesh. We evaluated the safety and immunogenicity of this locally produced Cholvax (Incepta Vaccine Ltd) inexpensive OCV comparatively to Shanchol (Shantha Biotechnics-Sanofi Pasteur) which is licensed in several countries. We conducted a randomized non-inferiority clinical trial of bivalent, killed oral whole-cell cholera vaccine Cholvax vs. Shanchol in the cholera-endemic area of Mirpur, Dhaka, among three different age cohorts (1-5, 6-17 and 18-45 years) between April 2016 and April 2017. Two vaccine doses were given at 14 days apart to 2,052 healthy participants. No vaccine-related serious adverse events were reported. There were no significant differences in the frequency of solicited (7.31% vs. 6.73%) and unsolicited (1.46% vs. 1.07%) adverse events reported between the Cholvax and Shanchol groups. Vibriocidal antibody responses among the overall population for O1 Ogawa (81% vs. 77%) and O1 Inaba (83% vs. 84%) serotypes showed that Cholvax was non-inferior to Shanchol, with the non-inferiority margin of -10%. For O1 Inaba, GMT was 462.60 (Test group), 450.84 (Comparator group) with GMR 1.02(95% CI: 0.92, 1.13). For O1 Ogawa, GMT was 419.64 (Test group), 387.22 (Comparator group) with GMR 1.12 (95% CI: 1.02, 1.23). Cholvax was safe and non-inferior to Shanchol in terms of immunogenicity in the different age groups. These results support public use of Cholvax to contribute for reduction of the cholera burden in Bangladesh. ClinicalTrials.gov number: NCT027425581.

The Effectiveness Of An Incentive-Based Weight Reducing Technique Among University Pendidikan Sultan Idris (UPSI) Students, Malaysia

@#Increasing overweight and obesity prevalence are growing health concerns globally and in Malaysia due to various contributing factors such as life style, dietary intake (high sugar & high fat diets), less physical activities etc. In order to explore an effective weight reducing strategy for overweight and obese students; this study aimed to examine the significance of offering a monetary reward to students for weight reduction at the University Pendidkan Sultan Idris (UPSI), Malaysia. An experimental study was conducted among Forty Eight (48) University students selected based on criteria of Body Mass Index (BMI) above 25. The convenient sampling was used for 3-months weight reduction experimental program comprised of "repeated measure design" which involved multiple measurement of each subject and their exposure to all study conditions. Participants were divided into two groups: 12-pairs and 24-individuals to further compare results. Three introductory lectures were given to students by a nutritionist to educate both groups on ' nutritional aspects of everyday eating'. Participants were requested to attend follow-ups every two weeks to record their weight. ANOVA repeated measure with fixed effects were used to analyze data. Results indicated that "offering monetary reward" brought significant change in both groups students' weight reduction (F (3.09, 142.24) = 18.16, p <0.05.), and hasn't found significant comparative difference between two groups' weight reduction (F (1, 46) =2.74, p =0.10). The study reveals that offering monetary incentive or reinforcement to University-level students is an effective strategy in weight reduction either incentive is given to the groups or individuals. A similar long-term research project needs to be implemented and/or further research is required with large sample size to examine sustainability of weight loosing behavior reinforced by monetary incentives.

Exploration of the Factors in Treatment Adherence to Coronary Heart Diseases Diagnosis Among the Multi-Ethnic Patients: A Qualitative Study

Abstract@#Introduction: Introduction: Coronary heart disease (CHD) is the leading cause of death in Malaysia. This study aims to explore the treatment experiences of patients with recurrent coronary heart disease during hospital admission and after discharge. This research also attempts to understand patients’ adherence to the prescribed treatment. Method: The main sample for this study includes inpatients and outpatients with recurrent CHD who have undergone secondary prevention treatment at certain tertiary hospitals which were purposively sampled. The transcripts of one-to-one semi-structured interviews (N=22) were analyzed using the Interpretative Phenomenological Analysis (IPA). Results: Three themes emerged in the analysis of treatment adherence among multi-ethnic patients with CHD: (i) doctor-patient relationships; (ii) information-seeking behaviour; and (iii) psychosocial beliefs. Other factors that influence treatment adherence include patients’ cultural, religious, or spiritual beliefs-based complementary alternative medicines (CAM), if these factors were inadequately addressed by their respective heath professional. Conclusion: The results demonstrate that for future cardiac rehabilitation program development, health professionals must not only focus on the patient’s care improvement but must also be knowledgeable on the patient’s preferred alternative treatment.

Improvement of production of lipopeptide antibiotic iturin A using fish protein.

To enhance the production of lipopeptide antibiotic iturin A, nutrient contents of the culture mediums were investigated in both submerged and biofilm fermentations. As a carbon source maltose and as nitrogen source, fish protein was used. In submerged fermentation maltose uptake was found lower (12%) compared to biofilm fermentation (15%) that was associated with higher cellular growth in biofilm. However, requirement of nitrogen (fish protein) concentration was found similar in both submerged and biofilm fermentations. Production of iturin A in submerged fermentation with 12% maltose and 5% fish protein was 4450 mg/L, and in biofilm fermentation it was 5050 mg/L when 15% maltose and 5% fish protein was used.

Production of surfactin using pentose carbohydrate by Bacillus subtilis.

Interest in microbial surfactants has been steadily increasing in recent years due to their diversity, mass production possibility, selectivity, performance under extreme conditions and potential applications in environmental protection. In this study two pentose sugars (xylose and arabinose) were investigated for the submerged fermentation (SmF) of Bacillus subtilis in surfactant production medium for bio-surfactant surfactin production. An excellent vegetative growth of B. subtilis (× 10(10) CFU/mL) was observed for xylose and arabinose containing medium which were comparable to glucose supplemented medium. Low growth (× 10(8) CFU/mL) was found when medium was not supplemented with any of the sugars. Surfactin production in xylose, arabinose and glucose containing medium was 2700, 2600 and 2000 mg/L, respectively, whereas, medium without any sugar showed low surfactin (700 mg/L) production. These results clearly indicate the effect of pentose sugars on production of surfactin. Gradual depletion of the xylose and arabinose were confirmed by HPLC analysis during the growth phase of the strain that ultimately produced the surfactin.

Application of malt residue in submerged fermentation of Bacillus subtilis.

Malt residue is a common waste or byproduct from beer industries after brewing and milling of malted barley. In this work, Bacillus subtilis RB14 was used to study the microbial growth and production of secondary metabolites like lipopeptide antibiotic iturin A in the malt residue for its effective recycling. B. subtilis RB14 could grow in submerged fermentation of malt residue and significant growth (10(9) CFU/mL) was observed without any supplementation. In submerged fermentation iturin A production using malt residue was about 170 mg/L, which was found to be higher than its production in No.3 (Polypepton, glucose, KH2PO4, MgSO4·7H2O) medium where production was about 120 mg/L. More than 600 mg/L of iturin A production was observed when malt residue was combinedly used with No.3 medium. This production was significantly higher than their summation of their individual production. However, the growth of B. subtilis in combined medium was found to be similar to that of the submerged fermentation in simple malt residue. Therefore, the remarkable enhancement in production of iturin A in supplemented malt residue was attributed to the nutrients supplied from No.3 medium.

Anabolic agents: a new chapter in the management of osteoporosis.

Osteoporosis in postmenopausal women has until now been treated with antiresorptive agents, reducing the incidence of fragility fracture by approximately 50%. Clinical research has led to the development of new anabolic therapies capable of increasing the production of bone matrix by osteoblasts and reversing microarchitectural deterioration, resulting in major improvements in both bone quality and bone quantity. Teriparatide, a recombinant human parathyroid hormone consisting of the first 34 of 84 amino acids in human parathyroid hormone, has been shown to reduce significantly the risk of both vertebral and non-vertebral fractures in postmenopausal women. This agent was recently approved for use in Canada. Strontium ranelate is a new oral agent capable of uncoupling bone resorption from bone formation, which results in increases in bone formation with reductions in bone resorption. This agent has also been shown to reduce the risk of both vertebral and non-vertebral fracture while improving bone structure. Anabolic therapies represent a major advance in the management of postmenopausal osteoporosis, and they may provide significant benefit to those patients with severe osteoporosis in whom antiresorptive therapy has proven insufficient. Anabolic therapies should complement the antiresorptive treatments currently available for use in women with postmenopausal osteoporosis.

Arsenic removal with iron(II) and iron(III) in waters with high silicate and phosphate concentrations.

Arsenic removal by passive treatment, in which naturally present Fe(II) is oxidized by aeration and the forming iron(III) (hydr)oxides precipitate with adsorbed arsenic, is the simplest conceivable water treatment option. However, competing anions and low iron concentrations often require additional iron. Application of Fe(II) instead of the usually applied Fe(III) is shown to be advantageous, as oxidation of Fe(II) by dissolved oxygen causes partial oxidation of As(III) and iron(III) (hydr)oxides formed from Fe(II) have higher sorption capacities. In simulated groundwater (8.2 mM HCO3(-), 2.5 mM Ca2+, 1.6 mM Mg2+, 30 mg/L Si, 3 mg/L P, 500 ppb As(III), or As(V), pH 7.0 +/- 0.1), addition of Fe(II) clearly leads to better As removal than Fe(III). Multiple additions of Fe(II) further improved the removal of As(II). A competitive coprecipitation model that considers As(III) oxidation explains the observed results and allows the estimation of arsenic removal under different conditions. Lowering 500 microg/L As(III) to below 50 microg/L As(tot) in filtered water required > 80 mg/L Fe(III), 50-55 mg/L Fe(II) in one single addition, and 20-25 mg/L in multiple additions. With As(V), 10-12 mg/L Fe(II) and 15-18 mg/L Fe(III) was required. In the absence of Si and P, removal efficiencies for Fe(II) and Fe(III) were similar: 30-40 mg/L was required for As(II), and 2.0-2.5 mg/L was required for As(V). In a field study with 22 tubewells in Bangladesh, passive treatment efficiently removed phosphate, but iron contents were generally too low for efficient arsenic removal.