Generation of an induced pluripotent stem cell line (BIORTCi001-A) from a healthy adult indigenous Nigerian participant.

Genetic backgrounds influence cellular phenotypes, drug responses, and health outcomes, yet most human iPSC lines are derived from individuals of European descent, with lines from indigenous Africans particularly scarce. Addressing this gap, we generated iPSCs from dermal fibroblasts of a healthy 60-year-old indigenous Nigerian male of the Babur ethnic group using Sendai virus. The iPSC line displayed a normal karyotype, was characterized for pluripotency markers and differentiated into neural progenitor cells and astrocytes. To enhance African representation in research, this iPSC line will be available to the scientific community, with ongoing efforts focused on creating an open-access African iPSC biobank. Resource Table.

Clinical presentation, diagnosis and management of multisystem inflammatory syndrome in children (MIS-C): a systematic review.

BACKGROUND: Knowledge about multisystem inflammatory syndrome in children (MIS-C) is evolving, and evidence-based standardised diagnostic and management protocols are lacking. Our review aims to summarise the clinical and diagnostic features, management strategies and outcomes of MIS-C and evaluate the variances in disease parameters and outcomes between high-income countries (HIC) and middle-income countries (MIC). METHODS: We searched four databases from December 2019 to March 2023. Observational studies with a sample size of 10 or more patients were included. Mean and prevalence ratios for various variables were pooled by random effects model using R. A mixed generalised linear model was employed to account for the heterogeneity, and publication bias was assessed via funnel and Doi plots. The primary outcome was pooled mean mortality among patients with MIS-C. Subgroup analysis was conducted based on the income status of the country of study. RESULTS: A total of 120 studies (20 881 cases) were included in the review. The most common clinical presentations were fever (99%; 95% CI 99.6% to 100%), gastrointestinal symptoms (76.7%; 95% CI 73.1% to 79.9%) and dermatological symptoms (63.3%; 95% CI 58.7% to 67.7%). Laboratory investigations suggested raised inflammatory, coagulation and cardiac markers. The most common management strategies were intravenous immunoglobulins (87.5%; 95% CI 82.9% to 91%) and steroids (74.7%; 95% CI 68.7% to 79.9%). Around 53.1% (95% CI 47.3% to 58.9%) required paediatric intensive care unit admissions, and overall mortality was 3.9% (95% CI 2.7% to 5.6%). Patients in MIC were younger, had a higher frequency of respiratory distress and evidence of cardiac dysfunction, with a longer hospital and intensive care unit stay and had a higher mortality rate than patients in HIC. CONCLUSION: MIS-C is a severe multisystem disease with better mortality outcomes in HIC as compared with MIC. The findings emphasise the need for standardised protocols and further research to optimise patient care and address disparities between HIC and MIC. PROSPERO REGISTRATION NUMBER: CRD42020195823.

Insights into population adaptation and biodiversity of lactic acid bacteria in challenged date palm leaves silaging, using MALDI-TOF MS.

The study focused on isolating indigenous Qatari lactic acid bacteria (LAB) from various challenged date palm tree leaf silages to construct a comprehensive strain collection, useful to study the diversity of these strains following their adaptation to the uncommon silage. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) was employed for strain identification and differentiation. The diversity of LAB populations and strains was assessed through principal component analysis (PCA) and dendrogram analyses. A total of 88 LAB isolates were obtained from silages of fresh palm leaves, silage of mixed leaves and dairy feed, along with fresh palm tree leaves, and dairy feed, adapted to local harsh environments. These isolates were categorized according to the new classification of 2020, belonging to genera of Pediococcus, Lactiplantibacillus plantarum, Lacticaseibacillus paracasei, Companilactobacillus farciminis, Limosilactobacillus oris, Limosilactobacillus vaginalis, Lactiplantibacillus pentosus and Lactobacillus johnsonii. Pediococcus was the most prevalent genus, falling mostly within the species Pediococcus lolii. MALDI-TOF MS protein profiles, PCA, and dendrogram analyses successfully grouped the LAB isolates into five distinctive clusters based on the protein's similarities. The high diversity of the indigenous LAB in spontaneous palm leaf silages demonstrated their adaptation and mutualistic interactions, forming robust consortia that ensure the quality of the silage. The straightforward, quick, and accurate identification of LAB in this silage using MALDI-TOF MS presents a valuable approach for formulating LAB consortia for silaging harsh agricultural by-products.

Setting up a state-of-the-art laboratory in resource limited settings: A case study of the biomedical science research and training centre in Northeast Nigeria.

African science has substantial potential, yet it grapples with significant challenges. Here we describe the establishment of the Biomedical Science Research and Training Centre (BioRTC) in Yobe State, Northeast Nigeria, as a case study of a hub fostering on-continent research and describe strategies to overcome current barriers. We detail the steps taken to establish BioRTC, emphasising the critical importance of stakeholder engagement, community involvement, resource optimisation and collaborations. With its state-of-the-art facilities and commitment to training African scientists, BioRTC is poised to significantly advance neuroscience research and training in the region. Although we are in the early stages of our journey, our model, emphasizing open access and inclusivity, offers a replicable blueprint for neuroscience research development in similar resource-limited settings, promising to enrich the global neuroscience community. We invite the support and collaboration of those who share our vision and believe in our potential.

The applications of MicroCT in studying age-related tooth morphological change and dental age estimation: A scoping review.

Conventional dental age estimation relies on destructive methods such as sectioning and staining, which are unpreferable when the tooth is required for evidential or archeological preservation. MicroCT is a non-destructive, high-resolution imaging technique that allows for accurate morphometrical measurement. Although microCT technology has been applied in a variety of dental studies, studies focusing on dental age-related change and dental age estimation based on microCT imaging remain lacking. Based on the question: "How has microCT technology been applied in studying human age-related tooth morphological change and dental age estimation studies?", the authors conducted a scoping review in accordance with the Arksey and O'Malley (2005) and the PRISMA-ScR guidelines. A literature search using five major scientific databases identified 452 articles, with 11 full-text articles being eligible to be included in the scoping review. Furthermore, 6 out of the 11 studies performed dental age estimation modeling. An overview of the parameters used in the selected articles revealed a variety of tooth characteristics, such as pulp cavity to whole tooth volume ratio, secondary dentin, as well as the diameter of root canal orifice. The findings of this scoping review highlight the extent microCT is used in studying dental age-related changes, as well as the effectiveness of microCT in dental age estimation studies. This review serves as a guide for future forensic odontology age estimation studies.

Evaluation of the Resources and Inequities Among Pediatric Critical Care Facilities in Pakistan.

OBJECTIVES: To evaluate nationwide pediatric critical care facilities and resources in Pakistan. DESIGN: Cross-sectional observational study. SETTING: Accredited pediatric training facilities in Pakistan. PATIENTS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A survey was conducted using the Partners in Health 4S (space, staff, stuff, systems) framework, via email or telephone correspondence. We used a scoring system in which each item in our checklist was given a score of 1, if available. Total scores were added up for each component. Additionally, we stratified and analyzed the data between the public and private healthcare sectors. Out of 114 hospitals (accredited for pediatric training), 76 (67%) responded. Fifty-three (70%) of these hospitals had a PICU, with a total of 667 specialized beds and 217 mechanical ventilators. There were 38 (72%) public hospitals and 15 (28%) private hospitals. There were 20 trained intensivists in 16 of 53 PICUs (30%), while 25 of 53 PICUs (47%) had a nurse-patient ratio less than 1:3. Overall, private hospitals were better resourced in many domains of our four Partners in Health framework. The Stuff component scored more than the other three components using analysis of variance testing ( p = 0.003). On cluster analysis, private hospitals ranked higher in Space and Stuff, along with the overall scoring. CONCLUSIONS: There is a general lack of resources, seen disproportionately in the public sector. The scarcity of qualified intensivists and nursing staff poses a challenge to Pakistan's PICU infrastructure.

Nanoparticles: The Plant Saviour under Abiotic Stresses.

Climate change significantly affects plant growth and productivity by causing different biotic and abiotic stresses to plants. Among the different abiotic stresses, at the top of the list are salinity, drought, temperature extremes, heavy metals and nutrient imbalances, which contribute to large yield losses of crops in various parts of the world, thereby leading to food insecurity issues. In the quest to improve plants' abiotic stress tolerance, many promising techniques are being investigated. These include the use of nanoparticles, which have been shown to have a positive effect on plant performance under stress conditions. Nanoparticles can be used to deliver nutrients to plants, overcome plant diseases and pathogens, and sense and monitor trace elements that are present in soil by absorbing their signals. A better understanding of the mechanisms of nanoparticles that assist plants to cope with abiotic stresses will help towards the development of more long-term strategies against these stresses. However, the intensity of the challenge also warrants more immediate approaches to mitigate these stresses and enhance crop production in the short term. Therefore, this review provides an update of the responses (physiological, biochemical and molecular) of plants affected by nanoparticles under abiotic stress, and potentially effective strategies to enhance production. Taking into consideration all aspects, this review is intended to help researchers from different fields, such as plant science and nanoscience, to better understand possible innovative approaches to deal with abiotic stresses in agriculture.

Lingual supplementation may not be required after articaine buccal infiltration anesthesia for lower molar extraction: a clinical comparative study / La suplementación lingual opcional después de la anestesia por infiltración bucal con articaína para la extracción de molares inferiores: un estudio clínico comparativo

Purpose: To investigate the anesthetic effectiveness of buccal infiltration (BI) versus buccal plus lingual infiltration (BI+LI) of 4% articaine for intra-alveolar extraction of erupted mandibular molar teeth. Material and Methods: Eighty patients were included in this prospective clinical study. They were randomly divided into 1 of 2 equal groups: the 1st group received BI of 4% articaine 1.8 ml and LI of 0.5 ml, while the 2nd group received 4% articaine 1.8 ml BI plus 0.5 ml LI of normal saline. Another 1.8 ml articaine BI was given if initial anesthesia was inadequate. Outcome variables included pain, which was rated by patients at 3 intervals using visual analogue scale, and lingual anesthesia and patients' satisfaction which were measured using 5-score verbal rating scale. Data analyses used were descriptive statistics, t test, χ2 test, and Pearson's correlation coefficient. P-value value less than 0.05 was considered significant. Results: There were 46 females and 34 males and the mean age was 35.3 years. All outcome variables were comparable between the two study groups (p˃0.05). Anesthesia was successful in 78% and 88% of cases in the (BI) and (BI+LI) groups respectively with no significant difference (p=0.2392). The mean articaine volume used was 2.5 ml and 2.87 ml respectively without significant difference (p=0.090). Conclusion: The anesthetic efficacy of (BI) alone and (BI+LI) of 4% articaine was comparable. When given in an adequate dose, articaine (BI) alone could be justified as an anesthetic option for the intra-alveolar extraction of mandibular molar teeth.

Objetivo: Investigar la efectividad anestésica de la infiltración bucal (BI) versus la infiltración bucal más lingual (BI+LI) de articaína al 4% para la extracción intraalveolar de molares mandibulares erupcionados. Material y Métodos: Ochenta pacientes fueron incluidos en este estudio clínico prospectivo. Se dividieron aleatoriamente en 1 de 2 grupos iguales: el primer grupo recibió BI de articaína al 4% 1,8 ml y LI de 0,5 ml, mientras que el segundo grupo recibió articaína al 4% 1,8 ml BI más 0,5 ml LI de solución salina normal. Se administró otro BI de articaína de 1,8 ml si la anestesia inicial era inadecuada. Las variables de resultado incluyeron el dolor, que los pacientes calificaron en 3 intervalos mediante una escala analógica visual, y la anestesia lingual y la satisfacción de los pacientes, que se midieron mediante una escala de calificación verbal de 5 puntos. Los análisis de datos utilizados fueron estadística descriptiva, prueba t, prueba χ2 y coeficiente de correlación de Pearson. Se consideró significativo el valor del valor de pinferior a 0,05. Resultados: Hubo 46 mujeres y 34 hombres y la edad media fue de 35,3 años. Todas las variables de resultado fueron comparables entre los dos grupos de estudio (p=0,05). La anestesia fue exitosa en el 78% y 88% de los casos en los grupos (BI) y (BI+LI) respectivamente sin diferencia significativa (p=0,2392). El volumen medio de articaína utilizado fue de 2,5 ml y 2,87 ml respectivamente sin diferencia significativa (p=0,090). Conclusión: La eficacia anestésica de (BI) solo y (BI+LI) de articaína al 4% fue comparable. Cuando se administra en una dosis adecuada, la articaína (BI) sola podría estar justificada para la extracción intraalveolar de molares mandibulares.

Assessing the Impact of Contact Tracing, Quarantine and Red Zone on the Dynamical Evolution of the Covid-19 Pandemic using the Cellular Automata Approach and the Resulting Mean Field System: A Case study in Mauritius.

A cellular automaton (CA) depicting the dynamics of the Covid-19 pandemic, is set up. Unlike the classic CA models, the present CA is an enhanced version, embodied with contact tracing, quarantine and red zones to model the spread of the Covid-19 pandemic. The incubation and illness periods are assimilated in the CA system. An algorithm is provided to showcase the rules governing the CA, with and without the enactment of red zones. By means of mean field approximation, a nonlinear system of delay differential equations (DDE) illustrating the dynamics of the CA is emanated. The concept of red zones is incorporated in the resulting DDE system, forming a DDE model with red zone. The stability analysis of both systems are performed and their respective reproduction numbers are derived. The effect of contact tracing and vaccination on both reproduction numbers is also investigated. Numerical simulations of both systems are conducted and real time Covid-19 data in Mauritius for the period ranged from 5 March 2021 to 2 September 2021, is employed to validate the model. Our findings reveal that a combination of both contact tracing and vaccination is indispensable to attenuate the reproductive ratio to less than 1. Effective contact tracing, quarantine and red zones have been the key strategies to contain the Covid-19 virus in Mauritius. The present study furnishes valuable perspectives to assist the health authorities in addressing the unprecedented rise of Covid-19 cases.

Performance of a Risk Analytic Tool (Index of Tissue Oxygen Delivery "IDO2") in Pediatric Cardiac Intensive Care Unit of a Developing Country.

Objective: To determine the performance of a commercially available risk analytic tool (IDO2) to estimate the risk for SVO2 < 40% in patients admitted in cardiac intensive care unit (CICU). Methods: Medical and T3 records of all patients (aged 1 day to 12 years, weight >2 kg) who received care in the CICU between October 1st, 2019 and October 1st, 2020, had SvO2 lab(s) drawn during CICU course and whose data was transmitted to T3, were included. The average IDO2 Index was computed in the 30-min period immediately prior to each SvO2 measurement and used as a predictor score for SvO2 < 40%. Results: A total of 69 CICU admissions from 65 patients, median age 9.3 months (interquartile range 20.8) were identified. Surgical and medical patients were 61 (88%) and 8 (12%) respectively; 4 (5.7%) patients had single ventricle physiology. Tetralogy of Fallot n = 23 (33.3%) and ventricular septal defects 17 (24.6%) were major cardiac diagnosis. Sixty-one (89.9%) of the admissions were successfully discharged from the hospital. Of the 187-total included SvO2 labs, 17 (9%) were <40%. The AUC of estimating SvO2 < 40% IDO2 was 0.87 [confidence interval (CI): 0.79-0.94]. Average IDO2 above 75 had the highest absolute risk (42.11, CI: 20.25-66.50) and highest RR (4.63, CI: 2.31-9.28, p-value < 0.0001) of SvO2 < 40%. Conclusion: IDO2 performed well in estimating low SvO2 (<40%) in pediatric patients presenting to a CICU in a low resource setting. Future work is needed to determine the effect of this risk analytic tool on clinical outcomes in such a setting.

Classification of movie reviews using term frequency-inverse document frequency and optimized machine learning algorithms.

The Internet Movie Database (IMDb), being one of the popular online databases for movies and personalities, provides a wide range of movie reviews from millions of users. This provides a diverse and large dataset to analyze users' sentiments about various personalities and movies. Despite being helpful to provide the critique of movies, the reviews on IMDb cannot be read as a whole and requires automated tools to provide insights on the sentiments in such reviews. This study provides the implementation of various machine learning models to measure the polarity of the sentiments presented in user reviews on the IMDb website. For this purpose, the reviews are first preprocessed to remove redundant information and noise, and then various classification models like support vector machines (SVM), Naïve Bayes classifier, random forest, and gradient boosting classifiers are used to predict the sentiment of these reviews. The objective is to find the optimal process and approach to attain the highest accuracy with the best generalization. Various feature engineering approaches such as term frequency-inverse document frequency (TF-IDF), bag of words, global vectors for word representations, and Word2Vec are applied along with the hyperparameter tuning of the classification models to enhance the classification accuracy. Experimental results indicate that the SVM obtains the highest accuracy when used with TF-IDF features and achieves an accuracy of 89.55%. The sentiment classification accuracy of the models is affected due to the contradictions in the user sentiments in the reviews and assigned labels. For tackling this issue, TextBlob is used to assign a sentiment to the dataset containing reviews before it can be used for training. Experimental results on TextBlob assigned sentiments indicate that an accuracy of 92% can be obtained using the proposed model.

Comprehensive Comparative Analysis of the GATA Transcription Factors in Four Rosaceae Species and Phytohormonal Response in Chinese Pear (Pyrus bretschneideri) Fruit.

The GATA gene family is one of the most important transcription factors (TFs). It extensively exists in plants, contributes to diverse biological processes such as the development process, and responds to environmental stress. Although the GATA gene family has been comprehensively and systematically studied in many species, less is known about GATA genes in Chinese pears (Pyrus bretschneideri). In the current study, the GATA gene family in the four Rosaceae genomes was identified, its structural characteristics identified, and a comparative analysis of its properties was carried out. Ninety-two encoded GATA proteins were authenticated in the four Rosaceae genomes (Pyrus bretschneideri, Prunus avium, Prunus mume, and Prunus persica) and categorized into four subfamilies (Ⅰ-Ⅳ) according to phylogeny. The majority of GATA genes contained one to two introns and conserved motif composition analysis revealed their functional divergence. Whole-genome duplications (WGDs) and dispersed duplication (DSD) played a key role in the expansion of the GATA gene family. The microarray indicated that, among P. bretschneideri, P. avium, P. mume and P. persica, GATA duplicated regions were more conserved between Pyrus bretschneideri and Prunus persica with 32 orthologous genes pairs. The physicochemical parameters, duplication patterns, non-synonymous (ka), and synonymous mutation rate (ks) and GO annotation ontology were performed using different bioinformatics tools. cis-elements respond to various phytohormones, abiotic/biotic stress, and light-responsive were found in the promoter regions of GATA genes which were induced via stimuli. Furthermore, subcellular localization of the PbGATA22 gene product was investigated, showing that it was present in the nucleus of tobacco (Nicotiana tabacum) epidermal cells. Finally, in silico analysis was performed on various organs (bud, leaf, stem, ovary, petal, and sepal) and different developmental stages of fruit. Subsequently, the expression profiles of PbGATA genes were extensively expressed under exogenous hormonal treatments of SA (salicylic acid), MeJA (methyl jasmonate), and ABA (abscisic acid) indicating that play important role in hormone signaling pathways. A comprehensive analysis of GATA transcription factors was performed through systematic biological approaches and comparative genomics to establish a theoretical base for further structural and functional investigations in Rosaceae species.

Articaine improves anesthetic achievement for exodontia performed by undergraduate dental students: A clinical comparative study.

PURPOSE/OBJECTIVES: To assess the clinical performance of undergraduate dental students in delivering inferior alveolar nerve block (IANB) with either articaine or lidocaine, and to compare the success rate of their IANBs between articaine and lidocaine for the extraction of mandibular molar teeth. METHODS: In this clinical trial, patients were randomly distributed into 2 study groups: articaine and lidocaine groups. In each group, dental students performed IANB followed by forceps extraction of 1 mandibular molar under close supervision. The operative parameters measured included: assessment of anesthetic technique (on 10 points visual analogue scale 'VAS-10'), onset and depth of anesthesia, intra-operative pain perceived by patients and their satisfaction level (on VAS-10), and the success rate of IANB (in terms of need to additional anesthesia). Data analyses used were descriptive statistics, t-test, χ2 test, and Pearson's correlation. RESULTS: One-hundred sixty patients were included in the final analysis, 80 in each group. The overall students' IANB technique was assessed as good (mean score 7.3). Articaine group showed significantly higher success rate of IANB (71%) compared to (55%) in lidocaine group, (P = 0.03). Patients also reported significantly higher satisfaction scores in the articaine group (P = 0.04). There were no significant difference in the onset of action and intra-operative pain level between the 2 groups. CONCLUSIONS: Students' IANBs were generally assessed as "good." Articaine IANBs performed by undergraduate students showed significantly higher success rate than lidocaine IANBs. By using articaine, the anesthetic achievement was greater for mandibular molar extraction performed by undergraduate students.

Eosinophilic lung disease as a sequela of MSSA pneumonia.

Eosinophilic lung diseases are a rare group of lung disorders with multiple known and unknown aetiologies and the diagnosis is often challenging. We present a case of a young man who was admitted with pneumonia due to methicillin-sensitive Staphylococcus aureus and was discharged on antibiotics. He presented to the emergency department approximately 2 weeks after discharge with high-grade fever, cough and shortness of breath associated with serum and bronchoalveolar lavage eosinophilia. He was then treated with steroids with complete resolution of disease process.

Effectiveness of Articaine Buccal Infiltration Anesthesia for Mandibular Premolar Extraction: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

PURPOSE: To evaluate the anesthetic adequacy of buccal versus buccal plus lingual infiltration of 4% articaine 1.8 mL for mandibular premolar teeth extraction. PATIENTS AND METHODS: A randomized, double-blinded, placebo-controlled clinical trial was conducted in which patients presented with a mandibular premolar for extraction under local anesthesia. The sample population was randomly divided into 2 equal groups: the first group received infiltration of 4% articaine 1.8 mL buccally and 0.4 mL lingually and the second group received infiltration of 4% articaine 1.8 mL buccally plus lingual injection of normal saline 0.4 mL. Pain was measured during anesthetic injection, 8 minutes after injection, and during extraction using a visual analog scale. Initial lingual anesthesia and patients' satisfaction were measured using a 5-score verbal rating scale. Statistical analyses included descriptive statistics, t test, and Pearson χ2 test. Significance was set at a P value less than.05. RESULTS: Seventy-two patients were included in this study (37 men and 35 women; average age, 49.8 yr). Mean pain scores during injection and extraction and satisfaction scores were comparable between study groups (P = .432, .240, and .478, respectively). Success rates were 100 and 89% in groups A and B, respectively, with no significant difference (P = .1145). CONCLUSIONS: The anesthetic parameters of 1 buccal infiltration of 4% articaine 1.8 mL with and without lingual supplementation were comparable. This result could justify the use of buccal articaine infiltration as an effective alternative to the standard inferior alveolar nerve block technique for extraction of lower premolar teeth.

Knowledge And Practice Regarding Dengue Fever And Acceptance Towards Wolbachia Among Universiti Kebangsaan Malaysia Medical Centre Healthcare Staff

@#Field trials of Wolbachia-transinfected mosquitoes, as a biological approach to curb dengue transmission, have been initiated. This study aimed to determine the knowledge regarding dengue fever (DF), practice of vector control, and acceptance of Wolbachia as a dengue control method among Universiti Kebangsaan Malaysia Medical Centre (UKMMC) healthcare staff. A questionnaire assessing knowledge regarding DF, vector control practices, and acceptance of Wolbachia was conducted among 330 UKMMC healthcare staff via convenience sampling. More than 70% of the respondents had good knowledge regarding DF, good vector control practice, and good acceptance of Wolbachia. Being female and having household income >MYR3000 had higher odds of having good knowledge regarding DF [(aOR 2.40; 95%CI 1.13, 5.12) and (aOR 3.86; 95%CI 1.91, 7.80)]. Having household income >MYR3000 had higher odds of having good vector control practice (aOR 2.33; 95%CI 1.20, 4.54) while academicians were three times (1-0.24) less likely to have good vector control practice than non-academicians (aOR 0.24; 95%CI 0.13, 0.48). Good acceptance of Wolbachia was associated with being academicians (aOR 8.83; 95%CI 2.60, 29.96) and having good knowledge regarding DF (aOR 6.07; 95% CI 2.89, 12.74). Gender, different income level and type of occupation have significant association with either good knowledge regarding DF or practice on vector control. Different type of occupation and level of knowledge also were notably significantly associated with good acceptance on Wolbachia as dengue biological control. These factors may be the focus for future plan to enhance the knowledge, acceptance and practice regarding DF and its control.

The future of pharmacogenetics in the treatment of heart failure.

Heart failure is a common disease with high levels of morbidity and mortality. Current treatment comprises ß-blockers, ACE inhibitors, aldosterone antagonists and diuretics. Variation in clinical response seen in patients begs the question of whether there is a pharmacogenetic component yet to be identified. To date, the genes most studied involve the ß-1, ß-2, α-2 adrenergic receptors and the renin-angiotensin-aldosterone pathway, mainly focusing on SNPs. However results have been inconsistent. Genome-wide association studies and next-generation sequencing are seen as alternative approaches to discovering genetic variations influencing drug response. Hopefully future research will lay the foundations for genotype-led drug management in these patients with the ultimate aim of improving their clinical outcome.

Acute spinal cord compression: a rare complication of dual antiplatelet therapy.

A 73-year-old woman presented with acute shortness of breath and exacerbation of chronic back pain. She was diagnosed with pulmonary oedema and a non-ST-elevation myocardial infarction following chest X-ray, ECG and high sensitivity troponin levels. She subsequently underwent coronary angioplasty with deployment of drug-eluting stents to her circumflex and left anterior descending arteries and was started on aspirin and clopidogrel for her dual antiplatelet therapy. Unfortunately, following the procedure, she gradually lost power and sensation in both lower limbs. MRI of her spine confirmed an extradural haematoma causing thoracic cord compression. She was managed conservatively following discussions with neurosurgeons and developed further complications secondary to her immobility.

5-Fluorouracil cardiotoxicity: reversible left ventricular systolic dysfunction with early detection.

A 33-year-old man presented to hospital with acute shortness of breath and evolving ST segment changes on ECG 3 days following a cycle of 5-fluorouracil (5-FU) for colon cancer. Despite no cardiac history, subsequent echocardiogram showed severe left ventricular systolic dysfunction. The patient was initially treated with heart failure medications and his coronary angiogram was normal. Chemotherapy was stopped and he was started on nitrates and calcium channel blockers. A repeat echocardiogram and cardiac MRI a week later showed complete resolution of his left ventricular dysfunction and he was discharged home. This case report summarises 5-FU cardiotoxicity, and emphasises the importance of early recognition and correct treatment, as left ventricular systolic dysfunction in this context is potentially reversible.

Risk factors and types of cerebral palsy.

OBJECTIVE: To determine the risk factors and associated types of cerebral palsy in a squatter settlement of Karachi. METHODS: The pilot cross-sectional study was conducted in Karachi during 2010 and 2011. Data was collected through an interviewed questionnaire from the mothers of cerebral palsy victims children from a population of 6000. Sample sizes of 20 pre-diagnosed victims were selected through snowball sampling. SPSS 20 was used for statistical significance. RESULTS: The mean age of the 20 children was 8.7 +/- 6.4 years. Of them, 16 (80%) were males and 4 (20%) were females. Major risk factors identified were; home and assisted delivery 5 (75%), consanguinity 10 (50%), infections 8 (40%) and lack of antenatal care 6 (30%). Out of 20 cases, 15 (75%) had spastic type of cerebral palsy, which was further classified as diplegia 7 (35%), quadriplegia 6 (30%) and hemiplegia 2 (10%). Mixed and dystonic types were found in 3 (15%) and 2 (10%) children respectively. CONCLUSION: Important risk factors identified were home delivery, consanguinity and infections during pregnancy. Spastic type of cerebral palsy was the most common type in the study population.