Can We Restart the First-Line Antibiotic as Empirical Choice When Enteric Fever is Suspected?

Enteric fever is a major health problem in Bangladesh. Antibiotic resistance especially against first-line antibiotics is a major concern in the management and thereby not practicing by physician as first choice thinking their resistance. This retrospective study was carried out in the Department of Microbiology, Bangladesh Medical College Hospital, Dhaka, Bangladesh from January of 2017 to December of 2019 to identify the year wise sensitivity pattern of first-line antibiotics like Amoxycillin, Cotrimoxazole and Chloramphenocol against Salmonella typhi and Salmonella paratyphi. All the blood samples sent for culture and sensitivity were evaluated to see the microbiom and their sensitivity pattern. Salmonella typhi and paratyphi were the major isolates in last 3 years which were 73.74% and 15.32% respectably. Sensitivity pattern of Amoxycillin, Cotrimoxazole and Chloramphenocol for Salmonella typhi is increased from 2017 to 2019 which were 66.0 to 83.0%, 80.0 to 83.0% and 84.0 to 85.0% respectively. Similar increasing pattern of sensitivity found in Salmonella paratyphi which was 82.5 to 89.2%, 76.2 to 95.4%, 98.7 to 98.5% respectively. They were also found highly sensitive (>90.0%) to 3rd generation cephalosporin. This study recommends the use of first-line antibiotics as empirical agent of choice in enteric fever as they are still highly sensitive against Salmonella typhi and Salmonella paratyphi.

SARS-CoV-2 Infection after Vaccination: A Comparative Profile between Dose 1 and Dose 2.

Since the initial shipment of vaccination campaign against SARS-CoV-2 infection, it was a major concern all over the world regarding appropriate gapping between the first and second dose and also the necessity of booster dose after being vaccinated with the second dose. This cross-sectional type of comparative study was conducted at Kuwait Bangladesh Friendship Government Hospital, from the period of March 01 2021 to August 31 2021, on 148 hospitalized patients who were vaccinated with Astra Zeneca. They were divided into two groups on the background of 1st dose and 2nd dose. Collected data were entered into SPSS-26 version and after data cleaning, descriptive analysis was done with frequency distribution. To find out the significant difference between the two groups considering clinico-demographic information, disease severity, and duration of the last dose of vaccine; the Pearson Chi-square test was done with a significance level ≤0.05. The patients from both groups were mostly male and above 60 years. There were no significant age or sex variations between the two groups. SARS-CoV-2 infection was common after 38 days of dose 1 and after 63 days of dose 2. Fever, cough, running nose, shortness of breath, fatigue, nausea, vomiting, lower oxygen saturation, radiological involvement were comparatively more in patients who got only a single dose. Mild pneumonia (70.7%) was the commonest presentation in both doses of vaccinated patients and single dose vaccinated patients mostly (45.5%) presented with severe pneumonia. Elderly clinically risks group patients were mostly hospitalized with infection after 1 month of the 1st dose and on the other hand after 2 months of completing the 2nd dose. Symptomatic infection and disease severity were more in 1st dose vaccine recipients in comparison to 2nd dose.

Impact of methodological choices in comparative effectiveness studies: application in natalizumab versus fingolimod comparison among patients with multiple sclerosis.

BACKGROUND: Natalizumab and fingolimod are used as high-efficacy treatments in relapsing-remitting multiple sclerosis. Several observational studies comparing these two drugs have shown variable results, using different methods to control treatment indication bias and manage censoring. The objective of this empirical study was to elucidate the impact of methods of causal inference on the results of comparative effectiveness studies. METHODS: Data from three observational multiple sclerosis registries (MSBase, the Danish MS Registry and French OFSEP registry) were combined. Four clinical outcomes were studied. Propensity scores were used to match or weigh the compared groups, allowing for estimating average treatment effect for treated or average treatment effect for the entire population. Analyses were conducted both in intention-to-treat and per-protocol frameworks. The impact of the positivity assumption was also assessed. RESULTS: Overall, 5,148 relapsing-remitting multiple sclerosis patients were included. In this well-powered sample, the 95% confidence intervals of the estimates overlapped widely. Propensity scores weighting and propensity scores matching procedures led to consistent results. Some differences were observed between average treatment effect for the entire population and average treatment effect for treated estimates. Intention-to-treat analyses were more conservative than per-protocol analyses. The most pronounced irregularities in outcomes and propensity scores were introduced by violation of the positivity assumption. CONCLUSIONS: This applied study elucidates the influence of methodological decisions on the results of comparative effectiveness studies of treatments for multiple sclerosis. According to our results, there are no material differences between conclusions obtained with propensity scores matching or propensity scores weighting given that a study is sufficiently powered, models are correctly specified and positivity assumption is fulfilled.

Social inclusion, intersectionality, and profiles of vulnerable groups of young people seeking mental health support.

BACKGROUND: headspace centres provide enhanced primary mental healthcare for young people. A priority is to provide services for all young people irrespective of a range of social disadvantages or social exclusion. The aims of this study were to: (i) delineate extent of social inclusion across domains of housing, studying/employment, functioning, alcohol, and other drug use; and (ii) map profiles of young people deemed vulnerable to experiencing additional barriers to accessing services based on their social inclusion domains (e.g., those living in unstable housing, not in employment/education, and/or experiencing intersecting or multiple forms of disadvantage or difficulties), including detailing their clinical characteristics. METHODS: Young people were recruited from five headspace centres. Data relevant to social inclusion were examined. Multivariate logistic regression models were used to determine overlap between vulnerable groups, functional, social, clinical, and behavioural factors. RESULTS: 1107 young people participated, aged 12-25 years (M = 18.1 years, SD = 3.3), most living in stable housing (96.5%) and engaged in studying/employment (84.8%). Specific vulnerabilities were evident in young people with NEET status (15.2%); in unstable accommodation (3.5%); of culturally diverse backgrounds (CALD) (12.2%); living in regional areas (36.1%); and identifying as lesbian, gay, bisexual, transgender, intersex, queer/questioning, and asexual plus (LGBTIQA+; 28.2%). Higher levels of distress, substance use, functional impairment, and lower social support were reported by those who were NEET and/or in unstable housing. LGBTIQA+ status was associated with high distress, depressive symptoms, and suicidal ideation. CONCLUSIONS: Most participants reported good social support, stable housing, and engagement in work or education. Those deemed vulnerable were likely to experience social exclusion across multiple domains and reported more mental health problems. The co-occurrence of mental ill-health and social exclusion highlights the importance of integrated mental healthcare.

"Screen and Treat" Approach among VIA Positive Women during Cervical Cancer Screening Program: Experience at Low Resource Setting.

Cancer of the uterine cervix is one of the leading causes of mortality and morbidity among women in poor countries. It is the most common reproductive cancer among women in Bangladesh and most women are diagnosed at advanced stage when appropriate treatment is not possible. But this cancer is preventable through proper screening and simultaneous treatment of premalignant lesions. The same day "Screen and Treat" approach is an endeavour to reach the goal especially at low resource settings. Ablation of precancerous lesions by thermo-coagulation is a promising mode of complete cure as this method is easy to apply, effective and relatively cheaper than other procedures. To avoid the issue of overtreatment, an intermediate approach- colposcopy can be used. Aim of this study was to diagnose premalignant lesions of cervix during screening procedure and to treat the lesions by thermo-coagulation at the same sitting. This prospective study was carried out at Upzilla Health Complex (UHC), Rangunia, from 3rd February 2018 to 6th February 2018 in a campaign of cervical cancer screening program by visual inspection of cervix with 5.00% acetic acid (VIA). About 1000 women attending the outpatient department were enrolled in this study by consecutive sampling technique according to inclusion and exclusion criteria. Informed consent was taken after explaining the screening method, thermo-coagulation procedure and follow up schedule. VIA was found positive in 22 cases. Colposcopy was done in VIA positive cases by Gynocular colposcope. Punch biopsy was taken when colposcopy revealed positive in 12 women. Then thermo-coagulation was done. Histopathology report revealed, CIN1 (cervical intraepithelial neoplasia 1)- in 6 cases (50.00%); CIN 2 (cervical intraepithelial neoplasia 2)- in 01 case (8.33%); Chronic cervicitis with squamous metaplasia- in 05 cases (41.67%). Sensitivity and specificity of colposcopy was calculated considering colposcopy directed biopsy as gold standard, which was 100.00% and 75.00% respectively in CIN-1. While in CIN-2 it was 100.00% and 95.20% respectively. VIA is an effective screening tool for cancer cervix. Main advantage is the "screen and treat" approach can be attempted for at risk women in low resource setting by thermo-coagulation which is accepted by women while guaranteeing satisfactory cure rates. Thus, reduces loss to follow-up and have an impact on cervical cancer control.

Clinical and functional characteristics of a subsample of young people presenting for primary mental healthcare at headspace services across Australia.

PURPOSE: Headspace services provide treatment options to young people seeking mental healthcare. To obtain a better understanding of needs and characteristics of this population, and effectively evaluate services, we require novel youth-specific outcome measures. As part of our broad research program to establish such measures, a sample of young people were recruited and assessed. The study describes (i) methodology used to obtain clinical, functioning, and substance use characteristics of young people presenting to headspace services; and (ii) an overview of these characteristics. METHODS: Young people presenting to headspace centres were recruited. Multidimensional information was obtained relating to clinical and functional outcomes, demographic information, and lifestyle factors. RESULTS: 1107 young help-seeking individuals were recruited. Participants were most likely young adults aged M = 18.1 years, SD = 3.3, with diagnoses of depression and/or anxiety (76.6%, n = 801), engaged in work and study (84.9%, n = 890), and living with parent(s) (68.9%, n = 736). Impairments in functioning were moderate as indicated by the Social and Occupational Functioning Assessment Scale (M = 65.2, SD = 9.5), substance use was common (alcohol 62.7%, n = 665; illicit substances 30.5%, n = 324), and current suicidal ideation was reported by a third (33.6%, n = 358). CONCLUSIONS: A broad dataset was obtained providing an insight into key clinical, functional and quality of life characteristics of these individuals. We observed that young people present with complex problems, comorbid diagnoses, moderate levels of symptomatology, impairments in functioning, substance use, and suicidal ideation. This work provides the foundation for our broader research program aiming to develop novel, relevant and youth-specific, change and outcome measures.

Early Versus Delayed Enteral Feeding for Achieving Full Feeding in Preterm Growth-Restricted Infants: A Randomized Clinical Trial.

Optimal enteral nutrition is essential for growth restricted preterm infants because if nutrition remains suboptimal during early days of life, physical and neuro-developmental outcome might be in danger. However, chronic hypoxia during antenatal period makes them susceptible for feeding intolerance and necrotising enterocolitis during post natal period. So this randomized clinical trial was conducted in the department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2018 to June 2019; to evaluate the effect of early versus delayed enteral feeding on preterm growth-restricted infants. During the study period, out of 127 infants with small for gestational age, 50 babies were enrolled and randomly assigned to either early feeding group (n=25) or late feeding group (n=25). Clinical characteristics at trial entry were well balanced between groups. Newborn enrolled in early feeding group reached full feed significantly faster than late feeding group (p=0.001; Hazard ratio 1.24). Early feeding group regained birth weight faster; experienced lesser incidence of neonatal sepsis, experienced less number of feed intolerance, had shorter mean duration of hospital stay and achieved higher weight on post natal age 16th days. All values were statistically significant. Early enteral feeding found to be safe and beneficial in reducing the time to reach full enteral feeding and better weight gain in growth restricted preterm infants.

Fish-borne trematode infections in wild fishes in Bangladesh.

Fish-borne liver and intestinal flukes are helminth pathogens that have a negative impact on public health worldwide. We herein investigated the status of infection by the metacercariae (MC) of fish-borne trematodes (FBTs) in randomly selected freshwater wild fishes. Five species of fishes were collected and digested artificially using digestion fluid to recover MC. All fish species, namely, ticto barb (Puntius ticto) (14/16, 87.5%), banded gourami (Colisa fasciata) (8/12, 66.7%), freshwater garfish (Xenentodon cancila) (9/14, 64.3%), flying barb (Esomus danricus) (5/12, 41.7%), and reba carp (Cirrhinus reba) (7/11, 63.7%), were infected with FBTs. The overall infection rate was 66.2% and the mean intensity was 748.3 ± 2947.5 MC/100 g of fishes. The loads of MC in ticto barb, reba carp, freshwater garfish, banded gourami, and flying barb per 100 g of fishes were 1978.8 ± 5053.7, 268.3 ± 440.7, 140 ± 105.4, 134.3 ± 109.2, and 117.6 ± 102.3, respectively. The infection rate was significantly higher (P < 0.05) in the body (55.4%) than in the head (40%) of fishes. Morphological and morphometrical analyzes identified the MC of Clonorchis spp., Opisthorchis spp., Metorchis spp., Metagonimus spp., and Echinostoma spp. Collectively, the present results suggest that wild freshwater fishes are important intermediate hosts for FBTs, and play a critical role in the transmission cycle of these parasites in Bangladesh. The results also indicate that people of the country are at risk of these infections.

Reducing Potentially Inappropriate Medications in Older Adults: A Way Forward.

La réduction des médicaments potentiellement inappropriés (MPI) chez les personnes âgées est un enjeu important selon de nombreux cliniciens et chercheurs à travers le monde, car ces médicaments accroissent significativement la morbidité et la mortalité dans la population plus âgée. La prévalence des MPI est un problème répandu malgré l'existence de plusieurs critères explicites et implicites de réduction des MPI chez les personnes âgées, les plus courants étant les critères de Beers, les critères STOPP/START et plusieurs critères nationaux spécifiques. Cette revue non systématique visait à examiner les critères de référence pour la réduction des MPI et à clarifier le rôle de certaines mesures, dont la déprescription, pour optimiser la prescription des médicaments chez les personnes âgées. Des recherches par mots-clés et termes MeSH ont été menées dans des bases de données électroniques. Les nombreux critères disponibles ont chacun leurs avantages et inconvénients. La déprescription, qui vise à réduire l'utilisation des MPI, a considérablement gagné en importance dans les initiatives associées à l'amélioration des pratiques de prescription. La déprescription est une approche méthodique qui implique l'arrêt graduel, éclairé et individualisé des médicaments inappropriés, avec un suivi rigoureux des patients pour assurer la détection d'événements indésirables ou de symptômes de rebond. Une approche combinée centrée sur le patient et le soignant favorise la collaboration entre les prescripteurs et les pharmaciens afin de réduire le nombre de MPI chez les personnes âgées.Reducing potentially inappropriate medications (PIMs) in older adults is an area of sustained interest for many clinicians and researchers across the globe, as PIMs contribute to a significant burden of morbidity and mortality in the aging population. The prevalence of PIMs is a pervasive problem despite the presence of several explicit and implicit criteria for reducing PIMs in older adults, the most common being the Beers criteria, the Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment (STOPP/START) criteria, and several country-specific criteria. This narrative review aims to discuss the frequently used published criteria for reducing PIMs, and elucidates the role of certain measures, especially de-prescribing, to optimise medication prescription in older adults. Electronic databases were searched using keywords and MeSH terms. The numerous available criteria have their specific advantages and drawbacks. De-prescribing, an initiative to reduce the use of PIMs, has gained significant importance in improving appropriate prescribing practices. De-prescribing is a methodical approach to gradually stopping inappropriate medications judiciously for each patient and simultaneously monitoring the patient carefully for the onset of adverse events or rebound symptoms. A combined caregiver­patient-centred approach encourages the collaboration between prescribers and pharmacists to reduce PIMs in older adults.

Estimation of salivary pH and viability of Streptococcus mutans on chewing of Tulsi leaves in children.

BACKGROUND: The current concepts of dental caries focus on cariogenic bacteria such as Streptococcus mutans fermenting carbohydrates to form organic acids, which cause a drop in pH, resulting in demineralization of the tooth surface.[l] Studies show that Tulsi has broad-spectrum antimicrobial activity.[2] Hence, this study aimed at estimating the change in salivary pH and viability of S. mutans on chewing of Tulsi leaves, in children. AIMS: This study aimed to estimate the change in salivary pH and viability of S. mutans on chewing of Tulsi leaves. MATERIALS AND METHODS: The study was carried out on thirty children aged 9-12 years. Oral prophylaxis was performed prior to sample collection. Three samples were collected per child, one before and two after chewing of Tulsi leaves. The change in salivary pH and viability of S. mutans was assessed. STATISTICAL ANALYSIS: The obtained data were analyzed using Friedman test and Wilcoxon's test. The level of significance was set at P < 0.05. RESULTS: The results obtained showed no significant difference in the pH values obtained from the samples, but there was a significant difference in the S. mutans' colony counts. CONCLUSION: Based on the results obtained from this study, it may be concluded that Tulsi (Ocimum sanctum) has the potential to be developed into an antimicrobial agent against cariogenic bacteria, specifically S. mutans.

Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment.

OBJECTIVE: To identify the prevalence and predictors of prescribing potentially inappropriate medications (PIMs) in a nationwide cohort of community dwellers with dementia requiring complex care needs. METHODS: A cross-matched data of the International Resident Assessment Instrument-Home Care (9.1) (interRAI-HC) and prescribing data obtained from the Pharmaceutical Claims Data Mart (Pharms) extract files for older adults (≥65 y) requiring complex care needs were utilized for this study. The 2015 Beers criteria were applied to identify the prevalence of PIMs in older adults with dementia. Sociodemographic and clinical predictors of PIMs were analysed using a logistic regression model. RESULTS: The study population consisted of 16 568 individuals who had their first interRAI assessment from 1 January 2015 to 31 December 2015. The estimated prevalence of dementia was 13.2% (2190/16 568). 66.9% (1465/2190) of the older adults diagnosed with dementia were prescribed PIMs, of which anticholinergic medications constituted 59.6% (873/1465). Males and individuals who were prescribed a greater number of medications were more likely to be prescribed PIMs. Individuals over 85 years of age, Maori ethnic group of individuals, older adults who were being supervised with respect to their activities of daily living, and individuals who reported good or excellent self-reported health had a lesser likelihood of being prescribed PIMs. CONCLUSION: We found that PIMs are prescribed frequently in older adults with dementia. Comprehensive geriatric assessments can serve as a potential tool to decrease the occurrence of PIMs in vulnerable groups with poor functional and cognitive status.

Factors associated with inappropriate prescribing among older adults with complex care needs who have undergone the interRAI assessment.

AIM: To identify factors associated with prescribing potentially inappropriate medications (PIMs) in older adults (≥65 years) with complex care needs, who have undertaken a comprehensive geriatric risk assessment. METHODS: A nationwide cross-sectional (retrospective, observational) study was performed. The national interRAI Home Care assessments conducted in New Zealand in 2015 for older adults were linked to the national pharmaceutical prescribing data (PHARMS). The 2015 Beers criteria were applied to the cross-matched data to identify the prevalence of PIMs. The factors influencing PIMs were analyzed using a multinomial logistic regression model. RESULTS: In total, 16,568 older adults were included in this study. Individuals diagnosed with cancer, dementia, insomnia, depression, anxiety, and who were hospitalized in the last 90 days were more likely to be prescribed PIMs than those who were not diagnosed with the above disorders, and who were not hospitalized in the last 90 days. Individuals over 75 years of age, the Maori ethnic group among other ethnicities, individuals who were diagnosed with certain clinical conditions (diabetes, chronic obstructive pulmonary disease, stroke, or congestive cardiac failure), individuals requiring assistance with activities of daily living, and better self-reported health, were associated with a lesser likelihood of being prescribed PIMs. CONCLUSION: The study emphasizes the identification of factors associated with the prescription of PIMs during the first completed comprehensive geriatric assessment. Targeted strategies to reduce modifiable factors associated with the prescription of PIMs in subsequent assessments has the potential to improve medication management in older adults.

Potentially inappropriate medications in community-dwelling older adults undertaken as a comprehensive geriatric risk assessment.

PURPOSE: The prescription of potentially inappropriate medications (PIMs) is associated with an increase in adverse events, prescribing cascades, high health-care costs, morbidity, and mortality in the elderly. The overarching objective of this study is to examine the prevalence of PIMs in the elderly, applying the 2012 American Geriatrics Society Beers criteria for the study period 2012-2014, and the updated 2015 Beers criteria for 2015. METHODS: The study population (N = 70,479) included a continuously recruited national cohort of community-dwelling older (aged ≥ 65 years) New Zealanders who had undertaken the International Resident Assessment Instrument-Home Care (interRAI-HC) assessments between September 2012 and October 2015. Exposure of PIMs 90 days before and after assessment, and 90-180 days after assessment are reported. RESULTS: Exposure to PIMs was highest in individuals aged over 95 years and in males. The average number of PIMs prescribed 90 days before assessment during the period 2015 was marginally higher compared to 2012-2014 (0.19 versus 0.04), and a greater number of individuals were exposed to one or more PIMs in 2015 compared to 2012-2014 (7.13 versus 2.17%). The prevalence of PIMs 90 days before and after assessment was 2.17 and 6.92% for 2012-2014, and 7.13 and 24.7% for 2015, respectively. The percent change in PIMs in 2012-2014 and 2015 after 90 days of assessment were 4.70% (confidence interval (CI) 4.50%, 5.00%, p < 0.001) and 17.60% (95% CI 16.80%, 18.30%, p < 0.001), respectively. The majority of PIMs prescribed belonged to the therapeutic class of medications acting on the central nervous system and the gastrointestinal system. CONCLUSION: Geriatric risk assessments may provide a vital opportunity to review medication lists by multidisciplinary teams with a view to reducing PIMs and unnecessary polypharmacy in older adults. Comprehensive geriatric risk assessment has the potential to reduce adverse medication outcomes and costs associated with inappropriate prescribing in a vulnerable population of older adults.

SplitAx: A novel method to assess the function of engineered nucleases.

Engineered nucleases have been used to generate knockout or reporter cell lines and a range of animal models for human disease. These new technologies also hold great promise for therapeutic genome editing. Current methods to evaluate the activity of these nucleases are time consuming, require extensive optimization and are hampered by readouts with low signals and high background. We have developed a simple and easy to perform method (SplitAx) that largely addresses these issues and provides a readout of nuclease activity. The assay involves splitting the N-terminal (amino acid 1-158) coding region of GFP and an out-of-frame of C-terminal region with a nuclease binding site sequence. Following exposure to the test nuclease, cutting and repair by error prone non-homologous end joining (NHEJ) restores the reading frame resulting in the production of a full length fluorescent GFP protein. Fluorescence can also be restored by complementation between the N-terminal and C-terminal coding sequences in trans. We demonstrate successful use of the SplitAx assay to assess the function of zinc finger nucleases, CRISPR hCAS9 and TALENS. We also test the activity of multiple gRNAs in CRISPR/hCas9/D10A systems. The zinc finger nucleases and guide RNAs that showed functional activity in the SplitAx assay were then used successfully to target the endogenous AAVS1, SOX6 and Cfms loci. This simple method can be applied to other unrelated proteins such as ZsGreen1 and provides a test system that does not require complex optimization.

Injection of embryonic stem cell derived macrophages ameliorates fibrosis in a murine model of liver injury.

Chronic liver injury can be caused by viral hepatitis, alcohol, obesity, and metabolic disorders resulting in fibrosis, hepatic scarring, and cirrhosis. Novel therapies are urgently required and previous work has demonstrated that treatment with bone marrow derived macrophages can improve liver regeneration and reduce fibrosis in a murine model of hepatic injury and fibrosis. Here, we describe a protocol whereby pure populations of therapeutic macrophages can be produced in vitro from murine embryonic stem cells on a large scale. Embryonic stem cell derived macrophages display comparable morphology and cell surface markers to bone marrow derived macrophages but our novel imaging technique revealed that their phagocytic index was significantly lower. Differences were also observed in their response to classical induction protocols with embryonic stem cell derived macrophages having a reduced response to lipopolysaccharide and interferon gamma and an enhanced response to IL4 compared to bone marrow derived macrophages. When their therapeutic potential was assessed in a murine, carbon tetrachloride-induced injury and fibrosis model, embryonic stem cell derived macrophages significantly reduced the amount of hepatic fibrosis to 50% of controls, down-regulated the number of fibrogenic myofibroblasts and activated liver progenitor cells. To our knowledge, this is the first study that demonstrates a therapeutic effect of macrophages derived in vitro from pluripotent stem cells in a model of liver injury. We also found that embryonic stem cell derived macrophages repopulated the Kupffer cell compartment of clodronate-treated mice more efficiently than bone marrow derived macrophages, and expressed comparatively lower levels of Myb and Ccr2, indicating that their phenotype is more comparable to tissue-resident rather than monocyte-derived macrophages.

Erratum: Author Correction: Injection of embryonic stem cell-derived macrophages ameliorates fibrosis in a murine model of liver injury.

[This corrects the article DOI: 10.1038/s41536-017-0017-0.].

Exchange-Induced Spin Blockade in a Two-Electron Double Quantum Dot.

We have experimentally identified the exchange-induced spin blockade in a GaAs double quantum dot. The transport is suppressed only when the eigenstates are well-defined singlet and triplet states, and thus sensitive to dynamic nuclear-spin polarization that causes singlet-triplet mixing. This gives rise to unusual current spectra, such as a sharp current dip and an asymmetric current profile near the triplet resonance of a double quantum dot. Numerical simulations suggest that the current dip is a signature of identical nuclear-spin polarization in the two dots, which is attractive for coherent spin manipulations in a material with nuclear spins.

Association of Immunofluorescence pattern of Antinuclear Antibody with Specific Autoantibodies in the Bangladeshi Population.

Antinuclear antibody (ANA) is useful in the diagnosis of connective tissue disorder (CTD). Association of specific autoantibodies with the immunofluorescence pattern of ANA in CTD, noted in western literature has been considered as reference in all over the world. However, in Bangladesh no such research work or data correlating the autoantibodies and their ANA patterns is found. Objective of the study was to identify an association between immunofluorescence patterns of antinuclear antibody on HEp-2 cell and more specific antinuclear reactivities (e.g. anti-dsDNA and anti-extractable nuclear antigen) in the serum samples of CTD patients. Serum samples of 152 CTD patients (Systemic lupus erythematosus, Rhumatoid arthritis, Sjogren's syndrome, Systemic sclerosis, Polymyositis, Mixed connective tissue disease) were diagnosed clinically, attending at Bangabandhu Sheikh Mujib Medical University (BSMMU) during the study period of January, 2010 to December, 2010. Samples were subjected for ANA testing by Indirect Immunofluorescence (IIF) on HEp-2 cell (ALPHADIA) in dilution of 1:40, anti-dsDNA by ELISA and anti- extractable nuclear antigen (anti-ENA) by Dot Immunoblot. Dot blot strips were tested for anti-Sm, anti-RNP, anti-SSA/Ro, anti-SSB/La, anti-Scl-70 and anti-Jo-1. Out of 152 patients 110 (72.3%) cases were ANA positive by IIF on HEp-2 cell. ANA positive sera exhibited four fluorescence patterns such as speckled (50.8%), peripheral (21.6%) , homogenous (18.1%) and nucleolar pattern (9%). Peripheral pattern and homogenous pattern was predominantly associated with anti-dsDNA (p < 0.05). Speckled pattern was significantly associated with anti-ENA (p < 0.05).The most commonly identified antinuclear autoreactivity was directed towards anti-RNP (25.7%) then anti-Scl-70 (20%), anti-SSA (14.2%) and anti-SSB (5.7%). Multiple anti-ENA reactivities were identified in 34.28% cases. Peripheral and homogenous pattern is strongly associated with anti-dsDNA and speckled pattern may predict anti-ENA (specially ribonucleoprotiens). As a definite correlation between the ANA patterns and the group of antibodies was detected by dot immunoblot, one could predict presence of certain specific auto antibodies for a particular ANA pattern identified. This may restrict on the cost of laboratory investigations in a developing country like Bangladesh. Thus, ANA-IIF method may reduce the expense of detailed immunological work-up with minimal loss in diagnostic accuracy.

Histological scoring and associated risk factors of non-alcoholic fatty liver disease.

Non alcoholic steatohepatitis is a hepatic disorder with histological features of alcohol induced liver disease that occurs in individual who do not consume significant alcohol. Liver biopsy is an important part of the evaluation in term of both grade & stage. A cross sectional study was carried out in the department of Pathology, Dhaka Medical College, Dhaka & department of Hepatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2007 to June 2009. Total 55 adult subjects of both sex were included on the basis of predefined inclusion & exclusion criteria in this study to evaluate the histological pattern of non alcoholic fatty liver disease (NAFLD) and its correlation with risk factors. Liver biopsy was done and H & E and Masson's Trichrome stain slides were examined to evaluate the grade and stage of NAFLD. Scoring and semiquantitative assessment of steatosis and NAFLD severity was done according to Kleiner scale known as NAFLD activity score (NAS). The results of Pearson correlation showed only BMI and triglyceride level significantly correlated with NAS score. The results of Spearman's rank correlation showed that BMI, central obesity, triglyceridaemia and age significantly correlated with staging of fibrosis. The results of multiple regression analysis showed that variation of NAS depend on BMI and triglyceride level. The study also revealed that risk factors contributed about 29% risk for the occurrence of non alcoholic steatohepatitis.

Anti-snake venom: use and adverse reaction in a snake bite study clinic in Bangladesh

Snakebites can present local or systemic envenomation, while neurotoxicity and respiratory paralysis are the main cause of death. The mainstay of management is anti-snake venom (ASV), which is highly effective, but liable to cause severe adverse reactions including anaphylaxis. The types of adverse reaction to polyvalent anti-snake venom have not been previously studied in Bangladesh. In this prospective observational study carried out between 1999 and 2001, in the Snake Bite Study Clinic of Chittagong Medical College Hospital, 35 neurotoxic-snake-bite patients who had received polyvalent anti-snake venom were included while the ones sensitized to different antitoxins and suffering from atopy were excluded. The common neurotoxic features were ptosis (100%), external ophthalmoplegia (94.2%), dysphagia (77.1%), dysphonia (68.5%) and broken neck sign (80%). The percentage of anti-snake venom reaction cases was 88.57%; pyrogenic reaction was 80.64%; and anaphylaxis was 64.51%. The common features of anaphylaxis were urticaria (80%); vomiting and wheezing (40%); and angioedema (10%). The anti-snake venom reaction was treated mainly with adrenaline for anaphylaxis and paracetamol suppository in pyrogenic reactions. The average recovery time was 4.5 hours. Due to the danger of reactions the anti-snake venom should not be withheld from a snakebite victim when indicated and appropriate guidelines should be followed for its administration.(AU)