Partner or perish: tree microbiomes and climate change.

Understanding the complex relationships between plants, their microbiomes, and environmental changes is crucial for improving growth and survival, especially for long-lived tree species. Trees, like other plants, maintain close associations with a multitude of microorganisms on and within their tissues, forming a 'holobiont'. However, a comprehensive framework for detailed tree-microbiome dynamics, and the implications for climate adaptation, is currently lacking. This review identifies gaps in the existing literature, emphasizing the need for more research to explore the coevolution of the holobiont and the full extent of climate change impact on tree growth and survival. Advancing our knowledge of plant-microbial interactions presents opportunities to enhance tree adaptability and mitigate adverse impacts of climate changes on trees.

The academic progress of female general surgery and orthopaedic surgery trainees in South Africa.

BACKGROUND: Globally, medical institutes have seen an increase in female graduates, however surgical disciplines remain male-dominated. An epidemiological shift towards non-communicable diseases and trauma may result in a shortage of surgical specialists. One strategy to improve the surgical workforce is the recruitment of female graduates. METHODS: A non-validated questionnaire was administered to females registered for the Master of Medicine (MMED) degree in General and Orthopaedic Surgery at the University of KwaZulu-Natal (UKZN) between 2000 and 2015. The study evaluated reasons for choice of surgery as a career, challenges faced on the domestic and work front, as well as factors that assisted with successful completion of training. RESULTS: Seventy-two female trainees in General Surgery and Orthopaedics were identified from the UKZN databases. The contact details for 62 of these trainees were available. The overall response rate was 71.0% (44/62). A total of 95.5% (42/44) of participants selected surgery due to a passion for the field. Major challenges identified were a poor home and work-life balance (72.1%, 31/43) and poor working conditions (62.8%, 27/43). Female trainees perceived that they were viewed as inferior by patients (65.9%, 29/44). Successful trainees had a good home support system (89.3%, 25/28) and mentorship during training (60.7%, 17/28), and 85.7% (24/28) did not regret their career choice. CONCLUSION: The recruitment and retention of females in surgery will contribute to maintaining an adequate surgical workforce. Training programmes need to improve work-life balance without compromising on producing competent surgeons. Improved visibility of female surgeons in leadership roles should be encouraged to promote mentorship and recruitment of trainees.

Multi-organ segmentation of organ-at-risk (OAR's) of head and neck site using ensemble learning technique.

INTRODUCTION: This paper presents a novel approach to automate the segmentation of Organ-at-Risk (OAR) in Head and Neck cancer patients using Deep Learning models combined with Ensemble Learning techniques. The study aims to improve the accuracy and efficiency of OAR segmentation, essential for radiotherapy treatment planning. METHODS: The dataset comprised computed tomography (CT) scans of 182 patients in DICOM format, obtained from an institutional image bank. Experienced Radiation Oncologists manually segmented seven OARs for each scan. Two models, 3D U-Net and 3D DenseNet-FCN, were trained on reduced CT scans (192 × 192 x 128) due to memory limitations. Ensemble Learning techniques were employed to enhance accuracy and segmentation metrics. Testing was conducted on 78 patients from the institutional dataset and an open-source dataset (TCGA-HNSC and Head-Neck Cetuximab) consisting of 31 patient scans. RESULTS: Using the Ensemble Learning technique, the average dice similarity coefficient for OARs ranged from 0.990 to 0.994, indicating high segmentation accuracy. The 95% Hausdorff distance (mm) ranged from 1.3 to 2.1, demonstrating precise segmentation boundaries. CONCLUSION: The proposed automated segmentation method achieved efficient and accurate OAR segmentation, surpassing human expert performance in terms of time and accuracy. IMPLICATIONS FOR PRACTICE: This approach has implications for improving treatment planning and patient care in radiotherapy. By reducing manual segmentation reliance, the proposed method offers significant time savings and potential improvements in treatment planning efficiency and precision for head and neck cancer patients.

Bis(1-methylimidazol-2-yl) diselenide and its evaluation as a chemical radio-protector: role of kinetic rate constants for ROS scavenging and glutathione peroxidase like activity.

Bis(1-methylimidazol-2-yl) diselenide (MeImSe), a derivative of selenoneine, has been examined for bimolecular rate constants for scavenging of various radiolytically and non-radiolytically generated reactive oxygen species (ROS). Further, its potential to show glutathione peroxidase (GPx)-like activity and to protect in vitro models of DNA and lipid against radiation induced strand breakage and lipid peroxidation, respectively were studied. The results confirmed that MeImSe scavenged all major short-lived (hydroxyl radical) and long-lived (peroxyl radical, carbonate radical, nitrogen dioxide radical, hypochlorite and hydrogen peroxide) oxidants involved in the radiation toxicity either directly or through GPx-like catalytic mechanism. The rate constants of MeImSe for these oxidants were found to be comparable to analogous sulfur and selenium-based compounds. The enzyme kinetics study established that MeImSe took part in the GPx cycle through the reductive pathway. Further, MeImSe inhibited the radiation induced DNA strand cleavage and lipid peroxidation with half maximal inhibitory concentration (IC50) of ∼ 60 µM and ∼100 µM, respectively. Interestingly, MeImSe treatment in the above concentration range (>100 µM) did not show any significant toxicity in normal human lung fibroblast (WI26) cells. The balance between efficacy and toxicity of MeImSe as a chemical radioprotector was attributed to the formation of less reactive intermediates during its oxidation/reduction reactions as evidenced from NMR studies.HighlightsMeImSe, a derivative of selenoneine protects DNA and lipid from radiation damageMeImSe scavenges all major short- and long-lived oxidants involved in radiation toxicityRate constants of MeImSe for ROS scavenging determined by pulse radiolysis techniqueFirst organoselenium compound reported to scavenge nitrogen dioxide radicalMeImSe exhibits GPx-like activity through reductive pathway.

Spatio-temporal dynamics and distributional trend analysis of African swine fever outbreaks (2020-2021) in North-East India.

African swine fever (ASF) is a highly contagious, notifiable, and fatal hemorrhagic viral disease affecting domestic and wild pigs. The disease was reported for the first time in India during 2020, resulted in serious outbreaks and economic loss in North-Eastern (NE) parts, since 47% of the Indian pig population is distributed in the NE region. The present study focused on analyzing the spatial autocorrelation, spatio-temporal patterns, and directional trend of the disease in NE India during 2020-2021. The ASF outbreak data (2020-2021) were collected from the offices of the Department of Animal Husbandry and Veterinary Services in seven NE states of India to identify the potential clusters, spatio-temporal aggregation, temporal distribution, disease spread, density maps, and risk zones. Between 2020 and 2021, a total of 321 ASF outbreaks were recorded, resulting in 59,377 deaths. The spatial pattern analysis of the outbreak data (2020-2021) revealed that ASF outbreaks were clustered in 2020 (z score = 2.20, p < .01) and 2021 (z score = 4.89, p < .01). Spatial autocorrelation and Moran's I value (0.05-0.06 in 2020 and 2021) revealed the spatial clustering and spatial relationship between the outbreaks. The hotspot analysis identified districts of Arunachal Pradesh, Assam and districts of Mizoram, Tripura as significant hotspots in 2020 and 2021, respectively. The spatial-scan statistics with a purely spatial and purely temporal analysis revealed six and one significant clusters, respectively. Retrospective unadjusted, temporal, and spatially adjusted space-time analysis detected five, five, and two statistically significant (p < .01) clusters, respectively. The directional trend analysis identified the direction of disease distribution as northeast-southwest (2020) and north-south (2021), indicate the possibility of ASF introduction to India from China. The high-risk zones and spatio-temporal pattern of ASF outbreaks identified in the present study can be used as a guide for deploying proper prevention, optimizing resource allocation and disease control measures in NE Indian states.

Is Brucella excreted in cattle faeces? - Evidence from Punjab, India.

Brucellosis is a neglected zoonosis that affects animals and people in much of the underdeveloped world. The disease is endemic in cattle in Punjab, India and controlling it is a public health challenge. Dairy farmers and farm labour commonly handle cattle faeces with bare hands and personal protective equipments are not used. No studies have been conducted about the shedding of Brucella species in faeces of sero positive cattle in the state. This study aimed to isolate and identify the Brucella species from faeces of sero positive cattle in Punjab, India. Faecal samples were collected from 350 Brucella sero positive cattle in Ludhiana district of Punjab, India. Isolation was performed using a pre-enriched Brucella selective broth medium as well as Brucella selective medium agar plates containing horse serum and Brucella selective supplements. Isolates were identified using Gram staining technique and rapid slide agglutination test, and then confirmed by using bcsp31 and 16s rRNA genus specific PCR. Isolates were further identified up to species level by using Bruce-Ladder multiplex PCR. Fourteen Brucella species were isolated, all of which showed coccobacilli on gram staining, positive rapid slide agglutination test and amplification of bcsp31 and 16s rRNA genes. Of the 14 isolates, 11 were identified as Brucella abortus and 3 were identified as Brucella melitensis. The study demonstrates that animal faeces could pose a potential risk for animal and human health and faeces of seropositive cattle must be handled with care.

Evaluation of the accuracy of the Asanté assay as a point-of-care rapid test for HIV-1 recent infections using serum bank specimens from blood donors in South Africa, July 2018 - August 2021.

BACKGROUND: Point-of-care (POC) rapid recency testing can be used as a cost-effective tool to identify recently infected individuals (i.e. infected within the last 12 months) in near-real time, support epidemic control and identify hotspots for transmission as part of recent infection surveillance. OBJECTIVE: To evaluate the performance of the Asanté (HIV-1) rapid recency assay as a POC rapid test among blood donors in South Africa (SA). METHODS: The study was a cross-sectional and validity study of the Asanté HIV-1 Rapid Recency Assay performed on 715 consecutively archived plasma donor specimens from the SA National Blood Services to determine their recency and established HIV infection status. ELISA and rapid assays for HIV antibody detection were used as the reference-testing standard for confirming an infection, while the Maxim HIV-1 limiting antigen (LAg) avidity assay was used as a reference for comparing HIV recency status. Validity tests (sensitivity, specificity, negative and positive predictive values) and Cohen-Kappa tests of the agreement were conducted to compare the Asanté HIV-1 rapid recency assay results with the reference tests. RESULTS: Of the 715 studied blood samples, 63.1% (n=451/715) were confirmed to be HIV-positive based on the reference standard. The sensitivity and specificity of the Asanté HIV-1 rapid recency assay in diagnosing established HIV infection compared to the ELISA were 98.4% (95% CI 96.7 - 99.3) and 99.6% (95% CI 97.6 - 100), respectively. Compared with HIV rapid assay, the sensitivity and specificity of the Asanté HIV-1 rapid recency assay was 98.7% (95% CI 97.0 - 99.4) and 99.2% (95% CI 97.1 - 100), respectively. Of the 451 HIV-positive blood samples, 43% were confirmed as recent HIV infections by the Maxim HIV-1 LAg avidity assay. There was high agreement between the Asanté HIV-1 rapid recency assay and the Maxim HIV-1 LAg avidity assay (94.1%, k=0.879, p<0.0001). The sensitivity and specificity of the Asante HIV-1 assay was 89.4% (95% CI 84.0 - 93.0) and 97.7% (95% CI 94.8 - 99.0), respectively. CONCLUSION: The Asanté HIV-1 rapid recency assay test results demonstrated high accuracy (>90%) compared with the HIV ELISA and rapid assays for determining established infection and the Maxim HIV-1 LAg avidity assay for classifying recent HIV-1 infections. The assay's sensitivity for established infections was below the World Health Organization criteria (<99%) for POC devices. The Asanté HIV-1 rapid recency assay can be used to distinguish between recent and long-term infections, but may not be considered a POC test for determining HIV infection.

Prevalence of Brucella species in stray cattle, dogs and cats: A systematic review.

Stray animals are unowned free roaming, homeless, abandoned, street or sheltered animals, particularly dogs, cats and cattle. They could act as carrier of several zoonotic pathogens such as rabies virus, Mycobacterium and Brucella species. However, comprehensive information on the prevalence of zoonotic pathogens in stray animals is very limited. We conducted a systematic review as per Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines to estimate the prevalence of brucellosis in stray dogs, cats and cattle. Eligibility criteria for the study were determined using the PECOS classification (population, exposure, comparison, outcome, study design) as a tool to guide the research and adjust the search strategy. Major bibliographic databases [Web of Science, Medline, Scopus, ScienceDirect, Google Scholar and PubMed] were searched using predefined keywords for published epidemiological studies on brucellosis in stray animals (dogs, cats and cattle). Systematic assessments of all the studies since 1990-2022 were conducted and those reporting the prevalence of brucellosis in stray dogs, cats and cattle using appropriate diagnostic tests (culture, molecular, serological) were included. Studies reporting prevalence of brucellosis (Brucella infection or exposure) in kennel dogs, dairy herds, livestock farms, humans or marine species were excluded. The apparent individual test- wise prevalence along with 95% confidence intervals (CI) was estimated using Epitools. Out of 2689 studies, 37 met the inclusion criteria and were included in the systematic review. Of 37 studies, 28 (75.7%) were conducted in stray dogs, 7 (18.9%) in cattle and 2 (5.4%) in cats. Furthermore, only 21.62% studies (8/37) used probabilistic random sampling approaches and 13.51% studies (5/37) explained and justified the study sample size using appropriate methods for estimation of disease prevalence in the study populations. Higher sero-prevalence in stray dogs has been reported in studies conducted in Jordan (38.0% (95% CI: 24.0-54.0) and Pakistan (38.0% (95% CI: 31.0-45.0) whereas no sero-positivity was recorded in the studies conducted in Brazil, North Colombia, Cyprus, South Korea and USA. All studies on brucellosis (n = 7) in stray cattle were from India; conducted in stray cattle reared in cow-shelters. Sero-prevalence in the range of 4.3%- 64.3% was reported in stray cattle. Differences in diagnostic tests and host species, as well as limited number and non-randomized studies and high statistical heterogeneity did not allow us to determine combined meta-analysed prevalence estimates. Stray animals are likely to pose a zoonotic and disease spillover risk to human and livestock populations.

Prevalence and risk factor investigation for exposure to Brucella species in surrogate stray cattle population reared in cow shelters in Punjab, India.

Bovine brucellosis is endemic in cattle in India, however not much is known on the prevalence of this disease in stray cattle populations of the country. This study aimed to estimate the prevalence and identify risk factors associated with brucellosis in the stray cattle populations reared in cow shelters (gaushalas) of Punjab, India. Blood samples were collected from 587 cattle reared in 23 cow shelters in 23 districts (one per district) of the Punjab and were tested using Rose Bengal plate test (RBPT), standard tube agglutination test (STAT) and Indirect Enzyme Linked Immunosorbent Assay (i-ELISA). Information on the sex and breed of the animal, total cattle population and presence of a separate shed for parturition were collected. An animal was considered exposed to Brucella infection based on a positive RBPT or STAT test and a positive i-ELISA test. Explanatory variables for the animal level disease status outcome variable were sex and breed of the animal and at the shelter level were shelter cattle population size and presence of a separate shed for parturition. Univariable binomial exact logistic regression analysis was conducted to assess the association of each explanatory variable with the binary outcome variable. Sixty-two animals were seropositive on RBPT, with an apparent seroprevalence of 10.56% (95% confidence interval [CI]: 8.33%, 13.31%) and the estimated true seroprevalence of 11.48% (95% CI: 8.9%, 14.64%). Sixty three animals were seropositive using STAT [apparent seroprevalence of 10.73% (95% CI: 8.48%, 13.50%) and the estimated true seroprevalence of 10.69% (95% CI: 8.27%, 13.67%)], and 68 using i-ELISA [an apparent seroprevalence of 11.58% (95% CI: 9.24%, 14.43%) and the estimated true seroprevalence of 13.28% (95% CI: 10.50%, 16.66%)]. Cross bred cattle had a lower risk of being test positive (odds ratio 0.16, p = 0.04) as compared to indigenous cattle. Due to a ban on cow slaughter in the country, roaming stray cattle infected with brucellosis present a permanent risk of introduction of disease to the dairy farms and other vulnerable populations.

Microbiological analysis and predictors of gallbladder infection with antimicrobial susceptibility patterns in an HIV setting.

Background South Africa has a high prevalence of people living with human immunodeficiency virus (HIV; PLWH) who have shown to affect the prevalence and severity of infection and sepsis particularly gallbladder disease.  Empirical Antimicrobial (EA) therapy for acute cholecystitis (AC) is based largely on bacteria colonisation of bile (bacteriobilia) and antimicrobial susceptibility patterns (antibiograms) obtained from the developed world where the prevalence of PLWH is very low. In an ever-emerging era of increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored.  Objective Due to the paucity of data available locally to guide treatment we found it pertinent to examine gallbladder bile for bacteriobilia and antibiograms in a setting with a high prevalence of PLWH to determine if this may demand a review of our local antimicrobial policies for gallbladder infections for both EA and pre-operative antimicrobial prophylaxis (PAP) for laparoscopic cholecystectomies (LC). Methodology A retrospective observational descriptive study was undertaken at King Edward VIII Hospital, Durban, KwaZulu-Natal, South Africa. Hospital records were reviewed for all patients undergoing cholecystectomy over a 3-year period. Gallbladder bacteriobilia and antibiograms were assessed and compared between PLWH and HIV uninfected (HIV-U). Pre-operative age, ERCP, PCT, CRP and NLR were used as predictors for bacteriobilia. Statistical analyses were performed using R Project and p values of less than 0.05 were considered as statistically significant. Results There were no differences in bacteriobilia or antibiograms between PLWH and HIV-U. There was >30% resistance to amoxicillin/clavulanate and cephalosporins. Aminoglycoside-based therapy, had good susceptibility patterns whilst carbapenem-based therapy demonstrated the lowest resistance levels. ERCP and age were predictors of bacteriobilia (p<0.001 and 0.002 respectively). PCT, CRP and NLR were not. Conclusion PLWH should follow the same PAP and EA recommendations as HIV-U. For EA, we recommend, a combination of amoxicillin/clavulanate with aminoglycoside-based therapy (amikacin or gentamycin) or piperacillin/tazobactam as monotherapy. Carbapenem-based therapy should be reserved for drug resistant species. For PAP, we recommend the routine use in older patients and patients with history of ERCP undergoing LC.

A Novel Secure Authentication Protocol for e-Health Records in Cloud with a New Key Generation Method and Minimized Key Exchange.

In wake of covid19, many countries are shifting their paper-based health record management from manual processes to digital ones. The major benefit of digital health record is that data can be easily shared. As health data is sensitive, more security is to be provided to gain the trust of stakeholders. In this paper, a novel secure authentication protocol is planned for digitalizing personal health record that will be used by the user. While transacting data, a key is used to secure it. Many protocols used elliptic curve cryptography. In this proposed protocol, at an initial stage, an asymmetric and quantum-resistant crypto-algorithm, Kyber is used. In further stages, symmetric crypto-algorithm, Advanced Encryption Standard in Galois/Counter mode (AES-GCM) is used to secure transferred data. For every session, a new key is generated for secure transactions. The more interesting fact in this protocol is that transactions are secured without exchanging actual key and also minimized the key exchange. This protocol not only verified the authenticity of user but also checked rightful citizenship of user. This protocol is analyzed for various security traits using ProVerif tool and provided better results relating to security provisioning, cost of storage, and computation as opposed to related protocols.

Retaliation of Alstonia scholaris (L.) R.Br. to caesium and strontium in hydroponics: effect on morpho-physiology and induction of enzymatic defence.

The habitation and environment are affected by the stable isotopes of caesium (Cs) and strontium (Sr), as well as by their radioactive isotopes. The current work gives insight on Alstonia scholaris' capacity to phytoextract stable caesium (Cs) and strontium (Sr), as well as the plant's ability to protect against the toxicity of both elements. Experiments with Cs [0-5 mM (CsCl)] and Sr [0-3 mM (SrCl2. 6H2O)] dosing in controlled light, temperature, and humidity condition in greenhouse for 21 days were undertaken. Cs and Sr accumulation in different plant parts was quantified with atomic absorption spectroscopy (AAS) and inductively coupled plasma-optical emission spectrometry (ICP-OES) respectively. Hyper-accumulation capacity for Cs and Sr was estimated with indices like transfer factor (TF) and translocation factors (TrF). The uptake pattern of caesium in Alstonia scholaris is 5452.8-24,771.4 mg/kg DW (TF = 85.2-57.6) and in the case of Sr is 1307.4-8705.7 mg/kg DW (TF = 85.3-1.46). The findings demonstrated the plant's ability to transfer Cs and Sr to aboveground biomass on the basis of dry weight, with the majority of the metals being deposited in the shoot rather than the root portion of the plant. For Cs and Sr, with increasing concentration, the plants exhibited the enzymatic expression for defence against metal toxicity by free radicals compared to control. Field emission electron microscopy with energy-dispersive spectroscopy (FESEM with EDS) was employed to assess the spatial distribution of Cs and Sr in plant leaf, indicating the accumulation of Cs, Sr, and their homologous components.

Dynamics of reactive oxygen species and lignin biosynthesis during leaf spot disease of Withania somnifera (L.) Dunal.

Withania somnifera is an important medicinal plant, however, its cultivation and quality are compromised through infestation by leaf spot disease caused by the fungus, Alternaria alternata. To find suitable strategies against this disease, studies on post-infectional changes are important. ROS are critical as they interact with other defence signalling pathways. We analyzed ROS-generating and scavenging systems in healthy and diseased leaf samples of W. somnifera and ROS-driven downstream defence pathways. We used DAB and NBT assays for ROS detection, spectrophotometry and in-gel assays for ROS scavenging enzymes, a thioglycolic acid (TGA) based assay, histochemical staining for lignin, and qRT-PCR for transcript-level expression. Leaf spot infection in W. somnifera increased NADPH oxidase activity and ROS accumulation in infected leaves, together with enhanced antioxidant enzyme activity. Leaf spot-infected leaves had increased lignin content and higher expression of lignin biosynthesis genes. In addition, transcript levels of defence-related genes, NPR1 and PR, were also upregulated. The present work provides insights into responses to leaf spot disease through defence-related signalling in W. somnifera. It demonstrates crosstalk between ROS and lignin biosynthesis. This work identified potential targets for developing strategies to confer disease resistance against A. alternata in W. somnifera.

The supernumerary registrar experience in KwaZulu-Natal.

BACKGROUND: We sought to assess the experiences of trainees enrolled in the supernumerary registrar programme at the University of KwaZulu-Natal, South Africa, with a specific focus on their assimilation into host clinical units and their intentions to return to their home countries upon completion of the training. METHODS: This was a cross-sectional survey involving 50 supernumerary registrars attached to six academic hospitals affiliated with the University of KwaZulu-Natal. The survey collected information on registrar's demographics and financial support, speciality, opportunities for advanced training in their home country, assimilation into host clinical units and intentions to return home upon completing the training. The survey data were analysed using descriptive statistics. RESULTS: The majority of supernumeraries were < 36 years old (n = 32, 64%), male (n = 31, 62%), and self-funded (n = 31, 62%). Only a few supernumeraries were associated with a training facility in their home country (n = 9, 18%). Most supernumeraries (n = 44, 88%) reported not having an equivalent training programme in their home country. Awareness of the programme was predominantly acquired through self-research (n = 35, 70%), and the application process was perceived as problematic by many supernumeraries (n = 46, 92%). Most supernumeraries (n = 43, 86%) assimilated into their host clinical units, and nearly one-third (n = 16, 32%) did not plan on returning home upon completion of their training. CONCLUSION: Most supernumerary registrars assimilate into host clinical units and play an important role in service delivery during their training. Mechanisms should be put in place to facilitate retention of these individuals in their home countries upon completion of their training.

Gender differences in osteoporotic hip fractures in Sarawak General Hospital.

INTRODUCTION: Osteoporosis and osteoporotic fracture pose a major public health problem in our ageing population, and particularly concerning is the increased morbidity and mortality associated with osteoporotic hip fractures. While overall diagnosis and treatment for osteoporosis have improved, osteoporosis in men remains underdiagnosed and undertreated. We aim to describe the difference in clinical characteristics between elderly men and women with osteoporotic hip fractures in Sarawak General Hospital. MATERIALS AND METHODS: All patients diagnosed with osteoporotic hip fracture admitted to Sarawak General Hospital from June 2019 to March 2021 were recruited, and demographic data and clinical features were obtained. RESULTS: There were 140 patients with osteoporotic hip fracture, and 40 were men (28.6%). The mean age for males was 74.1 ± 9.5 years, while the mean age for females was 77.4 ± 9.1 years (p=0.06). The types of fracture consisted of neck of femur=78, intertrochanteric=61 and subtrochanteric=1. More men were active smokers (15% vs 1%, p<0.001). There were 20 men with secondary osteoporosis (50%), while 13 women (13%) had secondary osteoporosis (p<0.001). The causes of secondary osteoporosis among the men were hypogonadism, COPD, glucocorticoid-induced osteoporosis, renal disease, androgen deprivation therapy, thyroid disorder, prostate cancer and previous gastrectomy. There were two deaths among the men and four deaths among the women during the inpatient and 3 months follow-up period. There was no statistical significance between the mortality rates between male patients (5%) and female patients (4%) (p=0.55). CONCLUSION: There were more females with osteoporotic hip fractures, and there were significantly more males with secondary osteoporotic hip fractures.

Purification and Characterization of Novel Antihypertensive and Antioxidative Peptides From Whey Protein Fermentate: In Vitro, In Silico, and Molecular Interactions Studies.

OBJECTIVE: The goal of this research was to purify and characterize the novel angiotensin-converting enzyme (ACE)-inhibitory and antioxidant peptides from fermented whey protein concentrate produced by Lactobacillus paracasei and Saccharomyces cerevisiae in a co-fermentation system. METHOD: Whey protein fermented with lactic acid bacteria and yeast culture was analyzed for antioxidative, ACE inhibition, as well as anti-inflammatory activity followed by SDS-PAGE, isoelectric focusing, and 2-dimensional (2D) analysis. Anti-inflammatory activity of whey protein fermentate was also studied on the RAW 264.7 cell line. The bioactive peptides were separated from the whey protein fermentate using reverse-phase high-performance liquid chromatography (RP-HPLC) and reverse-phase liquid chromatography mass spectrometry (RPLC/MS), and thus identification and characterization of purified bioactive peptide was performed. RESULTS: Whey protein fermentate samples' bioactivity was analyzed at specific time intervals at 12, 24, 36, and 48 hours at 37 °C for M11 and at 25 °C for WBS2A. The development settings (incubation time [12, 24, 36, and 48 hours) and inoculation rates [1.5%, 2.0%, and 2.5%]) were optimized for peptide synthesis via the o-phthaldialdehyde (OPA) method (proteolytic activity). Maximum proteolytic activity was observed at 37 °C for M11 (6.50 mg/mL) and at 25 °C for WBS2A (8.59 mg/mL) for 48 hours of incubation. Protein profiling was carried out using SDS-PAGE and 2D gel electrophoresis, in which Sodium dodecyl-sulfate (SDS) exhibited protein bands in the 10- to 55-kDa range, while 2D showed protein bands varying from 10 to 70 kDa. Every spot from 2D was digested by trypsin and identified by RPLC/MS. Protein fractionations (3- and 10-kDa permeates) were carried out employing RP-HPLC. Whey protein fermentate has anti-inflammatory action in RAW 264.7 macrophages that have been exposed to lipopolysaccharide. A molecular docking system was also used to investigate the interactions of peptides (AFLDSRTR, ILGAFIQIITFR) with human myeloperoxidase enzyme. CONCLUSIONS: The antihypertensive and antioxidative peptides discovered from whey protein fermentate may be helpful in the design of pharmacologically active healthy ingredients in the upcoming years.

IMPLICATION OF THREAT FACTORS AND PREEXISTING DISORDERS IN DIFFERENT ISCHEMIC STROKE SUBGROUPS IN ELDERLY PEOPLE: A SYSTEMATIC STUDY.

Ischemic stroke is a major health issue, especially for the older population and it may have severe effects. Stroke diagnosis and treatment have advanced over the last 20 years, which has resulted in considerable reductions in death, long-term impairment, and the need for institutional care. Younger age groups have seen the majority of trials for acute, interventional, and preventive therapy. The purpose of this research was to identify distinct subgroups of older people who had suffered an ischemic stroke and examine the role that risk factors and previous illnesses played in their development. Ischemic stroke risk factors varied by age, gender and exhibited their own unique features. Smoking, cholesterol, and psychological/emotional stress were shown to have the greatest prevalence (p<0.06) among stroke patients aged 45-60. Smoking is associated with a significant (p<0.07) decline in health in elderly people. Our results imply that there are significant patterns of risk factors and preexisting illnesses among the various subgroups of older people who have had an ischemic stroke. Atherosclerotic (large-artery) and cardio embolic (small-artery) ischemic strokes were shown to be the most prevalent among the elderly. Strong associations were found between these subtypes and other risk factors, including higher cholesterol, diabetes, high blood pressure, and atrial fibrillation. This research emphasizes the need for individualized preventative methods and therapeutic therapy, as well as the need to recognize the variability of ischemic stroke in the elderly.

A prospective longitudinal study of clinical outcome and quality of life assessment in patients with chronic rhinosinusitis after functional endoscopic sinus surgery using sino nasal outcome test-22.

Chronic rhinosinusitis (CRS) significantly affect the quality of life (QoL) of patients. The study was conducted in CRS patients who were treated with functional endoscopic sinus surgery (FESS) after failure of medical treatment to analyze clinical outcome using prospectively collected data through a symptom-based rhinosinusitis outcome measure, the Sino-nasal Outcome Test-22 (SNOT-22). The aim of the study was to evaluate and compare the QoL in patients of chronic rhinosinusitis pre-operative and after FESS by SNOT-22. The prospective study was conducted on 40 patients of chronic rhinosinusitis with or without nasal polyposis. Demographic, clinical, diagnostic nasal endoscopy and radiological findings were recorded. Visual analogue scoring and SNOT-22 questionnaire scoring were done preoperatively and at 3rd and 6th months post-operatively. These scores were compared and a value of p < 0.01 was considered statistical significant. Nasal obstruction (80%) was the most commonly reported disabling condition followed by rhinorrhea (75%), facial pain-pressure (72.5%), headache and sneezing. The mean preoperative nasal endoscopy score was 8.08 ± 3.65. The mean preoperative Lund Mackay CT scan score was 11.725 ± 3.64. The mean preoperative SNOT-22 score was 46.25 ± 20.44. After FESS, nasal discharge was improved in 86% patients. Average VAS scores showed significant postoperative improvement at 6 months (p < 0.01). The mean postoperative diagnostic nasal endoscopy score improved to 2.80 ± 1.64 at 6 months (p < 0.01). The mean postoperative SNOT-22 scores decreased at postoperative follow up visits at 3 and 6 months to 14.58 ± 4.90 at 3 months and 22.38 ±7.93 at 6 months (p < 0.01). CRS patient refractory to medical treatment showed statistical significant improvement after FESS. The SNOT-22 scoring was easy to use scoring used for QoL assessment showed significant improvement after FESS.

Evaluation of Recurrence and Hearing Outcome for Inactive Squamosal Disease after Cartilage Strengthening Tympanoplasty

Abstract Introduction Inactive squamosal disease is unique for having a conflicting treatment protocol, with an age-old debate between early surgical intervention or keeping patients in a long-term follow-up. The shifting paradigm is early intervention to prevent further progress into active disease and improve hearing outcome in its nascent stage. Objective To evaluate recurrence and hearing outcome in cases of inactive squamosal disease after cartilage strengthening tympanoplasty. Methods The study was conducted on 50 patients with inactive squamosal disease. Detailed examination was done to grade the retraction. All patients underwent autologous conchal cartilage tympanomastoidectomy with temporalis fascia grafting. Recurrence and hearing evaluations were done by pure tone audiogram at regular intervals for one year. Results Hearing loss was the most common presenting symptom. Isolated pars tensa retractions were more common (54%) than pars flaccida (12%), or those involving both (34%). Ossicular status was normal in only 14% of the cases, and the most common ossicular damage was to the lenticular process of the incus (52%). Three of the patients (6%) had residual perforation at the 3rd month of follow-up. Subjective improvement in hearing was reported by 42% patients. Hearing improvement greater than 10 dB was found in 24 patients (48%). Air-bone gap reduced from 25.16 ± 8.15 dB preoperatively to 12.90 ± 6.20 at 1 year of follow-up. Recurrence was seen in three patients (6%). Conclusion Early intervention by cartilage strengthening of weakened tympanic membrane and ossicular reconstruction not only offers better hearing results, but also prevents progress to active disease.