Placenta accreta spectrum disorders - detection rate and maternal outcomes following implementation of an institutional protocol.

Placenta accreta spectrum (PAS) disorders have been on the rise in recent years with increasing caesarean rates. The purpose of this prospective observational study was to describe our detection rates and to review outcomes in PAS after the introduction of an institutional screening and management protocol. Twenty-one patients with suspected PAS over 5 years were identified. 20/21 patients had an accurate determination of placental invasion and positive correlation with surgical and histopathological examination. Early morbidity (massive haemorrhage) was found in 7/21 patients, whilst late morbidity (hospital readmission) was found in 5/21 patients. There were no maternal deaths and admissions to intensive therapy unit (ITU). In summary, our centre demonstrated a high antenatal detection rate for PAS using an evidence-based protocol. This has led to timely intervention by an experienced multidisciplinary team and excellent outcomes. Immediate and delayed postoperative counselling was effective for optimal patient understanding and experience.Impact StatementWhat is already known on this subject? With rising caesarean section rates, the incidence of placenta accreta spectrum (PAS) disorders is increasing. Despite this, most obstetricians have personally managed only a small number of patients with PAS. Moreover, there appears to be some debate over the optimal diagnostic and management strategy.What do the results of this study add? As the incidence increases, development of institutional screening and management protocol is a necessity for large units. Timely diagnosis, extensive pre and postoperative counselling and multidisciplinary teamwork ensure reduced early and late morbidity.What are the implications of these findings for clinical practice and/or further research? Evidence based screening protocols for PAS disorders reduce the likelihood of undiagnosed cases and should be developed in every unit. Consideration must also be given to standardisation of the diagnostic and management protocols, including contingency plan for emergencies.

The effect of Kinesio taping on cervical proprioception in athletes with mechanical neck pain-a placebo-controlled trial.

BACKGROUND: Neck proprioception is critical in maintaining neuromuscular control in and around cervical joints. Kinesio™ tape may assist in rehabilitating joint position sense. The current study compares Kinesio™ tape's effects versus a placebo on proprioception in college athletes experiencing mechanical neck pain. METHODS: This study randomized sixty-six athletes with mechanical neck pain into a Kinesio™ tape group (n = 33, mean age = 22.73 years) or placebo group (n = 33, mean age = 23.15 years). The Kinesio™ tape group received standard Kinesio™ taping applications with appropriate tension, while the placebo group received taping applications without tension. OUTCOME MEASURES: The study assessed cervical joint position errors with a cervical range-of-motion (CROM) device, pain intensity with a visual analog scale (VAS), and neck functional disability with a neck disability index (NDI). It tested joint position errors through cervical flexion, extension, rotation left, and rotation right. All the outcome measures were recorded at the baseline and twice more following 3 and 7 days of tape applications. RESULTS: Multivariate analysis of variance test demonstrated a significant reduction in joint position errors in flexion, extension and right rotation following 3 days and 7 days of tape application among the Kinesio™ tape group. There was a significant main effect of time (P < 0.05) for joint position errors in left rotation and VAS after 3 days (p > 0.05), NDI after 3 and 7 days (p > 0.05). CONCLUSIONS: The Kinesio™ tape application after 3 and 7 days effectively decreased joint position errors and neck pain intensity in mechanical neck pain participants compared to placebo, while there was no difference between both groups in the NDI. TRIAL REGISTRATION: ( CTRI/2011/07/001925 ). This study was retrospectively registered on the 27th July, 2011. LEVEL OF EVIDENCE: IIB.

Formulation and screening of analgesic activity of different analgesic gel preparations.

This study was aimed to investigate the dermal irritant test and the central analgesic effects of topical application of seven different formulations (A-G) of analgesic gel prepared from locally available raw material in animal model. The results of dermal irritant test revealed that no animal showed any kind of toxic effect i.e. redness, irritation, itching, inflammation, skin infection or any other injurious effects. All animals remained healthy, active, alert showing normal behavior and no mortality was observed during the claimed period. The analgesic activity was performed by tail flick test. The analgesic activity against tail flick test revealed that all samples of test gel had analgesic effect at 15, 30 and 60 minutes after sample application but sample D had highest analgesic effects (193%) followed by sample E (155%), sample C (122%), sample G (85%), sample B (84%),sample F (81%) while sample A exhibited (73%) analgesic activity. Wintogeno was run as standard drug and it showed 168% analgesic activity.

Aldosterone, Methylglyoxal, and Glycated Albumin Interaction with Macrophage Cells Affects Their Viability, Activation, and Differentiation.

BACKGROUND: The inflammatory response in diabetes is strongly correlated with increasing amounts of advanced glycation end products (AGEs), methylglyoxal (MGO), aldosterone (Aldo), and activation of macrophages. Aldo is known to be associated with increased pro-inflammatory responses in general, but its significance in inflammatory responses under glycated circumstances has yet to be understood. In the current work, the aim of our study was to study the macrophage immune response in the presence of AGEs, MGO, and Aldo to comprehend their combined impact on diabetes-associated complications. METHODS AND RESULTS: The viability of macrophages upon treatment with glycated HSA (Gly-HSA) promoted cell growth as the concentration increased from 100 to 500 µg/mL, whereas MGO at a high concentration (≥300 µM) significantly hampered cell growth. At lower concentrations (0.5-5 nM), Aldo strongly promoted cell growth, whereas at higher concentrations (50 nM), it was seen to inhibit growth when used for cell treatment for 24 h. Aldo had no effect on MGO-induced cell growth inhibition after 24 h of treatment. However, compared to MGO or Aldo treatment alone, an additional decrease in viability could be seen after 48 h of treatment with a combination of MGO and Aldo. Treatment with Aldo and MGO induced expression of TNF-α independently and when combined. However, when combined, Aldo and MGO significantly suppressed the expression of TGF-ß. Aldo, Gly-HSA, and MGO strongly induced the transcription of NF-κB and RAGE mRNA and, as expected, also promoted the formation of reactive oxygen species. Also, by inducing iNOS and MHC-II and suppressing CD206 transcript expression, Gly-HSA strongly favored the differentiation of macrophages into M1 type (pro-inflammatory). On the other hand, the combination of Aldo and MGO strongly induced the expression of MHC-II, CD206, and ARG1 (M2 macrophage marker). These findings suggest that Gly-HSA, MGO, and Aldo differently influence macrophage survival, activation, and differentiation. CONCLUSIONS: Overall, this study gives an insight into the effects of glycated protein and MGO in the presence of Aldo on macrophage survival, activation, differentiation, and inflammatory response.

Outbreak of Pseudomonas aeruginosa on a neonatal intensive care unit: Lessons from a Qatari setting.

Background: Pseudomonas aeruginosa is a major cause of morbidity and mortality in neonatal intensive care units (NICUs). Robust infection prevention and control is key to reducing risk. Aims: We describe lessons learnt from an NICU outbreak of P.aeruginosa in the main maternity hospital in the country. Methods: Cases were identified from clinical samples and active screening. Clinical information was collected from the electronic patient record. Infection prevention and control (IPC) practice observations were made using organisational checklists and unit observations. Microbiological testing was by conventional microbiological methods. Statistical analyses were performed using R program. Associations were assessed using the Mann-Whitney U or Fisher exact test. Isolates were typed by pulsed field gel electrophoresis; gel was analysed in Bionumerics software from Applied Maths, Belgium. Results: Five cases were identified - one was excluded as maternal acquisition. Typing showed a polyclonal outbreak. Widespread contamination of tap outlets of handwashing sinks in clinical areas was found. Main contributing factors were extensive misuse of hand wash sinks for waste disposal, improper sink cleaning, poor hand hygiene compliance and inadequate environmental cleaning. Discussion: Successful management required a multi-disciplinary approach. All potential water sources and moist environments within and outside the unit were investigated. Interventions successfully addressed the main contributing factors, supported by good communication and robust auditing. With a diverse workforce, the challenge was to ensure housekeeping staff understood handwash sink cleaning procedures; existing training programmes were delivered in multiple languages tailored to the workforce.

Isolation and characterization of irritant components of Euphorbia pilulifera L.

Euphorbia pilulifera is commonly found weed along road sides and loamy soils. This weed is commonly used as treatment of female disorders and respiratory problems. The latex of this weed causes irritation on hand on contact. To evaluate its irritant potentials, the dermatological investigation of irritant principles from locally occurring Euphorbia pilulifera was carried out. For this purpose, after collection and drying, a series of solvents with increasing polarity were used for the successive extraction of non-polar compounds (petroleum ether extract), constituents of intermediate polarities (chloroform extract) and polar constituents (methanol extract) from the whole herb of Euphorbia pilulifera. The chloroform extract of this weed was found most irritant to rabbit ' s skin. Chloroform extract was further subjected to column chromatography; four fractions Ep 1 to Ep 4 were isolated from active chloroform extract by column and thin layer chromatography. The irritant potentials of these isolated fractions were evaluated on rabbit 's skin. Two fractions out of the four, Ep 1 and Ep 3 appeared to be the most irritant than others. A possible structure activity relationship of these active compounds was discussed in order to establish their activity.

Short-Term Pulmonary Rehabilitation Among Post-Pulmonary Tuberculosis Patients During Coronavirus Disease 2019 Pandemic.

OBJECTIVE: Coronavirus disease 2019 is expected to have a widespread and significant impact on pulmonary tuberculosis services. This study aims to investigate the effect of comprehensive short-term, outpatient pulmonary rehabilitation program among treated pulmonary tuberculosis patients during the coronavirus disease 2019 pandemic. MATERIAL AND METHODS: Forty-five pulmonary tuberculosis patients who completed their tuberculosis treatment were randomly allocated to the outpatient pulmonary rehabilitation group and the other 45 were allocated to the control group for 4 weeks. The pulmonary rehabilitation program comprised supervised endurance and resistance training, breathing techniques, self-management strategies, and patient education. The outcome measures evaluated in both groups were functional capacity assessed by a 6-minute walk test, healthrelated quality of life (short-form 36 questionnaire), pulmonary function (forced expiratory volume in 1 second/forced vital capacity, forced vital capacity, and forced expiratory volume in 1 second), and dyspnea by modified Medical Research Council dyspnea scale. All measurements were performed at enrolment and after completion of 4 weeks protocol in both the groups. RESULTS: There was a significant improvement in 6-minute walk distance in meters (P = .001) and percentage predicted (P = .014) in the pulmonary rehabilitation group compared to the control group. All domains of the short-form 36 questionnaire showed significant improvement post-pulmonary rehabilitation (P < 0.05), and modified Medical Research Council dyspnea scale also significantly improved in the pulmonary rehabilitation group (P < .001). However, no significant differences were observed in any of the pulmonary function measures (P > .05) between the groups after 4 weeks. CONCLUSION: Short-term pulmonary rehabilitation program in pulmonary tuberculosis demonstrated improvement in functional capacity, quality of life, and dyspnea. However, it failed to register changes in pulmonary function. The study results provide motivation to consider the implementation of a short-term pulmonary rehabilitation program after pulmonary tuberculosis treatment to reduce the impairment the patient may suffer even after microbiological cure.

Effects of jasmonic acid in foliar spray and an humic acid amendment to saline soils on forage sorghum plants' growth and antioxidant defense system.

Salinity is one of the primary abiotic stresses that cause negative physiological and biochemical changes due to the oxidative stress caused by the generation of reactive oxygen species (ROS). The effect of jasmonic acid (JA) as foliar spray and humic acid (HA) as soil amendment on the growth and biochemical attributes of forage sorghum plants exposed to salinity stress was investigated. Soil treated with NaCl at levels of 0, 2, and 4 g NaCl kg-1 dry soil (designated as S0, S1, and S2) and soil amendment with humic acid at 0, 3, and 6 g HA kg-1 dry soil (designated as HA0, HA1, and HA2). The plants were sprayed with three JA levels, including 0, 5, and 10 mM JA. Salinity stress increased carotenoid and soluble protein content, superoxide dismutase (SOD) activity, and malondialdehyde (MDA) content. In contrast, salinity stress reduced plant height, leaf area, relative growth rate, proline content, and the activity of peroxidase (POD), catalase (CAT), and ascorbate peroxidase (APX). At the S2 salinity level, HA2 rate increased plant high by 9.7%, relative growth rate by 70.8% and CAT by 45.5, while HA1 increased leaf area by 12.5%, chlorophyll content by 22.3%, carotenoid content by 38.1%, SOD activity by 20.9%, MDA content by 18.0%, POD activity by 24.6% and APX value by 21.7%. At the S2 salinity level, the highest plant height, chlorophyll content, soluble protein content and APX value were recorded at 5 mM JA, while the highest leaf area, the content of carotenoid, proline, and MDA, and the activity of POD and CAT were achieved at 10 mM JA. Generally, 10 mM JA and 3 g HA kg-1 dry soil produced the best positive effects on forage sorghum plants physiological responses. Our study suggested that jasmonic acid and humic acid at appropriate rates can successfully mitigate the adverse effects of salinity stress on forage sorghum.

The Impact of COVID-19 on the Psychological Well-Being of Surgeons in Pakistan: A Multicenter Cross-Sectional Study.

Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic left a profound and pervasive impact on the healthcare infrastructure on a global scale. Since its onset, the pattern of reported cases and its associated mortality had shown variability with intermittent peaks causing a significant effect on the psychological well-being of the surgeons of Pakistan. The aim of this study was to assess the effects of the COVID-19 pandemic on the mental well-being of surgeons in Pakistan. Methods This multicenter cross-sectional study was carried out to assess the impact of COVID-19 on the psychological well-being of surgeons in Pakistan. The validated Self-Reporting Questionnaire-20 (SRQ-20) tool was circulated electronically via Google Forms (Google, Inc., Mountain View, CA, USA) in the practicing surgical fraternity across all five regions of Pakistan, i.e., Sindh, Punjab, Baluchistan, Khyber Pakhtunkhwa (KPK), and Azad Jammu and Kashmir (AJK). Results This study showed that the female gender, having fewer years of working experience, non-satisfaction with the available personal protective equipment (PPE), and working in the public sector were the factors affecting the psychological well-being of surgeons during the pandemic. Conclusion Considering the continuous rise in new cases during the ongoing pandemic, the mental health of surgeons working in low- and middle-income countries (LMIC) such as Pakistan has been significantly affected. There is an undeniable need to pay close attention to their psychological well-being. Measures need to be undertaken to ensure their physical and mental health and wellness.

Viability and Volumetric Analysis of Free Autogenous Dermis Fat Graft as Interpositional Material in TMJ Ankylosis: A Long-Term MRI Study.

AIMS AND OBJECTIVES: Dermis fat graft has shown good clinical results as an interpositional material in temporomandibular joint (TMJ) ankylosis and prevents heterogeneous calcification following gap arthroplasty. However, survival of the graft and volume retention is still debatable. The main purpose of our study was to assess the viability of the graft, tissues changes associated with the graft and volume retention using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Fifteen patients with TMJ ankylosis underwent gap arthroplasty followed by placement of abdominal dermis fat graft and were randomly divided into two groups. Group 1 was subjected to MRI analysis of the graft at 3-6 months and Group 2 was analyzed at 1-2 years post-operatively. The graft was evaluated using T1- and T2-weighed images along with fat suppression (FS) sequences in all the three planes and the volume was also calculated. RESULTS: Both Group 1 (7 patients and 11 joints) and Group 2 (8 patients and 13 joints) showed the presence of viable fat on T1 and T2 images, confirmed by FS images. Minor tissue changes were observed at the center of the graft in 5 patients of Group 1 and 3 patients of Group 2. Average volume of the graft was 4.154 cm3 at 3-6 months and 4.269 cm3 at 1-2 years, respectively, and when compared to the original volume of the graft (4.583 cm3 in Group 1 and 4.712 cm3 in Group 2), the difference was statistically insignificant (p > 0.005). CONCLUSION: MRI shows long-term survival of autogenous dermis fat graft without significant volumetric reduction. This along with positive clinical results make dermis fat an excellent choice as an interpositional material for TMJ ankylosis.

Severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP syndrome and acute kidney injury following SARS-CoV-2 infection.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.

Maternal COVID-19 infection, clinical characteristics, pregnancy, and neonatal outcome: A prospective cohort study.

OBJECTIVE: To study the effect of COVID-19 on pregnancy and neonatal outcomes. STUDY DESIGN: Prospective cohort study in a large tertiary maternity unit within a university hospital with an average annual birth of over 10,000 births. We prospectively collected and analysed data for a cohort of 23 pregnant patients including singleton and multiple pregnancies tested positive for COVID-19 between February 2020 and April 2020 inclusive to assess the effect of COVID-19 on pregnancy, and neonatal outcomes. RESULTS: Twenty-three pregnant patients tested positive for COVID-19, delivering 20 babies including a set of twins, with four ongoing pregnancies at the time of manuscript submission. 16/23 (70 %) whom tested positive were patients from Asian (Indian sub-continent) background. The severity of the symptoms ranged from mild in 13/23 (65.2 %) of the patients, moderate in 2/23 (8.7 %), and severe in 8/23 (34.8 %). Four out of total 23 COVID-19 pregnant patients (17.4 %) developed severe adult respiratory distress syndrome complications requiring ICU support, one of whom led to maternal death 1/23 (4.3 %). 11/23 (48 %) of the patients had pre-existing co-morbidities, with morbid obesity 5/23 (21.7 %) and diabetes 4/23 (17.4 %) being the more commonly represented. Of the 23 pregnant patients 19 were in their third trimester of pregnancy and delivered; 7/19 (36.8 %) had preterm birth, 3/19 (15.8 %) developed adult respiratory distress syndrome before delivery, and 2/19 (10.5 %) had pre-eclampsia. 16/19 (84 %) of patients delivered by C-section. Out of the 20 new-borns, 18 were singletons with a set of twin. CONCLUSION: COVID-19 is associated with high prevalence of preterm birth, preeclampsia, and caesarean section compared to non-COVID pregnancies. COVID-19 infection was not found in the newborns and none developed severe neonatal complications.

Intercessory prayer for the alleviation of ill health.

BACKGROUND: Prayer is amongst the oldest and most widespread interventions used with the intention of alleviating illness and promoting good health. Given the significance of this response to illness for a large proportion of the world's population, there has been considerable interest in recent years in measuring the efficacy of intercessory prayer for the alleviation of ill health in a scientifically rigorous fashion. The question of whether this may contribute towards proving or disproving the existence of God is a philosophical question lying outside the scope of this review of the effects of prayer. This revised version of the review has been prepared in response to feedback and to reflect new methods in the conduct and presentation of Cochrane reviews. OBJECTIVES: To review the effects of intercessory prayer as an additional intervention for people with health problems already receiving routine health care. SEARCH STRATEGY: We systematically searched ten relevant databases including MEDLINE and EMBASE (June 2007). SELECTION CRITERIA: We included any randomised trial comparing personal, focused, committed and organised intercessory prayer with those interceding holding some belief that they are praying to God or a god versus any other intervention. This prayer could be offered on behalf of anyone with health problems. DATA COLLECTION AND ANALYSIS: We extracted data independently and analysed it on an intention to treat basis, where possible. We calculated, for binary data, the fixed-effect relative risk (RR), their 95% confidence intervals (CI), and the number needed to treat or harm (NNT or NNH). MAIN RESULTS: Ten studies are included in this updated review (7646 patients). For the comparison of intercessory prayer plus standard care versus standard care alone, overall there was no clear effect of intercessory prayer on death, with the effect not reaching statistical significance and data being heterogeneous (6 RCTs, n=6784, random-effects RR 0.77 CI 0.51 to 1.16, I(2) 83%). For general clinical state there was also no significant difference between groups (5 RCTs, n=2705, RR intermediate or bad outcome 0.98 CI 0.86 to 1.11). Four studies found no effect for re-admission to Coronary Care Unit (4 RCTs, n=2644, RR 1.00 CI 0.77 to 1.30).Two other trials found intercessory prayer had no effect on re-hospitalisation (2 RCTs, n=1155, RR 0.93 CI 0.71 to 1.22). AUTHORS' CONCLUSIONS: These findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer,the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.

Extraction in Patients on Oral Anticoagulant Therapy With and without Stopping the Drug: A Comparative Study.

AIM AND OBJECTIVE: The aim of this study was to compare postoperative hemorrhagic complications after dental extractions in two groups of patients receiving oral anticoagulants with one group receiving oral anticoagulant without interruption and another group stopping the drug 3 days prior to extraction. MATERIALS AND METHODS: A control group consisted of 30 patients who had stopped the oral anticoagulant 3 days before undergoing dental extractions, resulting in a reduction in the average preoperative international normalized ratio (INR) from 2.8 to 1.6. The study group of 30 patients received the anticoagulant drug without any alteration before extractions and had an average preoperative INR of 2.7. All extractions were done under local anesthesia on an outpatient basis, and local measures consisting of gelfoam and sutures were used in all cases to control postoperative bleeding from extraction sockets. RESULTS: None of the patients had any immediate postoperative bleeding, and only one patient from the control group and two patients from the study group had mild delayed hemorrhage which was easily managed with local measures. CONCLUSION: There is no need to alter the dosage of oral anticoagulants prior to dental extractions provided the INR is within the therapeutic range of 2.0-4.0, extractions are done in least traumatic manner and local measures are used to control postoperative hemorrhage, thereby reducing the risk of thromboembolic episodes in these patients.

A Comparative Study of Depression in Elderly Institutional Residents and Elderly Home Residents

When people experience aging, their need for care and institutionalization rises. Sending Parents to elderly or nursing homes has been prevalent in western countries while not a standard practice in Eastern communities. The present study based on a cross-sectional study design aspired to compare the depression in elderly institutional residents and elderly home residents. A purposive sample of 150 elderly were assessed for depression by using the Beck Depression Inventory-II. The results indicated that the level of depression was significantly higher in institutionalized elderly compared to the elderly living in their homes with families. Further, elderly females reported higher depression in comparison to elderly male respondents. Moreover, findings indicate that the institutionalized elderly had moderate to severe levels of depression and that the elderly home residents had no to a mild mood disturbance. The elderly may feel more psychological health living with families. The study concludes that elderly individuals living in institutional homes were much more suffering from depression as compared to elderly individuals living at home with families. The concerned authorities should devise strategies to enhance the mental health and quality of life of the elderly which may contribute to reduce the prevalence of depression (AU)

Ancestral European roots of Helicobacter pylori in India.

BACKGROUND: The human gastric pathogen Helicobacter pylori is co-evolved with its host and therefore, origins and expansion of multiple populations and sub populations of H. pylori mirror ancient human migrations. Ancestral origins of H. pylori in the vast Indian subcontinent are debatable. It is not clear how different waves of human migrations in South Asia shaped the population structure of H. pylori. We tried to address these issues through mapping genetic origins of present day H. pylori in India and their genomic comparison with hundreds of isolates from different geographic regions. RESULTS: We attempted to dissect genetic identity of strains by multilocus sequence typing (MLST) of the 7 housekeeping genes (atpA, efp, ureI, ppa, mutY, trpC, yphC) and phylogeographic analysis of haplotypes using MEGA and NETWORK software while incorporating DNA sequences and genotyping data of whole cag pathogenicity-islands (cagPAI). The distribution of cagPAI genes within these strains was analyzed by using PCR and the geographic type of cagA phosphorylation motif EPIYA was determined by gene sequencing. All the isolates analyzed revealed European ancestry and belonged to H. pylori sub-population, hpEurope. The cagPAI harbored by Indian strains revealed European features upon PCR based analysis and whole PAI sequencing. CONCLUSION: These observations suggest that H. pylori strains in India share ancestral origins with their European counterparts. Further, non-existence of other sub-populations such as hpAfrica and hpEastAsia, at least in our collection of isolates, suggest that the hpEurope strains enjoyed a special fitness advantage in Indian stomachs to out-compete any endogenous strains. These results also might support hypotheses related to gene flow in India through Indo-Aryans and arrival of Neolithic practices and languages from the Fertile Crescent.

genoBASE pylori: a genotype search tool and database of the human gastric pathogen Helicobacter pylori.

Helicobacter pylori is the pathogenic bacterium linked to gastric and duodenal ulcers and gastric carcinoma. Genomic diversity of the organism has enabled new insights into its population biology through comparative genomics. genoBASE pylori is an online databank of several virulence-linked and phylogenetic markers of H. pylori strains obtained from different human populations. This knowledgebase is built upon a relational database management system which is connected to visualize the presence of known, pathogenicity markers such as the co-ordinates within the cag pathogenicity island (cagPAI), the cagA gene and motifs surrounding it, the vacA allotypes and the oipA gene frame status, together with genotypic details in the form of DNA profiling traces and candidate gene sequences for individual strains. This flexible search tool allows inter-laboratory comparison of DNA fingerprinting data in the form of fluorescent amplified fragment length polymorphism (FAFLP), enterobacterial repetitive intergenic consensus (ERIC) and repetitive extragenic palindromic (REP) signature profiles. Besides this, the database also displays diversity of strains based on nucleotide sequences of several house keeping genes and two membrane proteins. Being the first of its kind, genoBASE pylori is expected to be a helpful online tool in strengthening the concept of 'geographic genomics' and will be useful to molecular epidemiologists, clinical laboratory scientists and those interested in diagnostic development for H. pylori. The database can be accessed through its website (http://www.cdfd.org.in/amplibase/HP).

Risk factors associated with poor outcome in diabetic foot ulcer patients.

BACKGROUND/AIM: Diabetic foot ulcers and related complications are a major cause of morbidity and hospital admissions. Our aim was to evaluate the risk factors associated with poor outcome in diabetic foot ulcers. MATERIALS AND METHODS: A prospective study was conducted on patients with diabetic foot ulceration attending the Madinah Teaching Hospital from June 2014 to December 2015. Potential risk factors and laboratory test results at presentation were recorded and their association with outcome (healing vs. amputation) was analyzed using IBM SPSS Statistics for Windows, Version 22.0. RESULTS: In total, 112 patients were studied during our study period. The majority of the patients were male (60.7%) and aged 50 years and older (62.5%). Regarding the outcome, 68% healed completely, 27.7% underwent amputation, and 4.5% died during this period. Patient age of 50 and older, long duration of diabetes (>10 years), rural origin, and heel ulcers were significantly associated with poor outcome (P < 0.05). CONCLUSION: Patients with diabetes should have a detailed annual foot examination; those having risk factors for poor outcome require more frequent foot care, patient education, and early referral to tertiary care centers.