Association of Thyroid Nodules with Various Elements in Urine and Blood Serum: A Case-Control Study

Thyroid nodules are a common clinical problem caused by various factors,including environmental and nutritional factors and genetic background.The environment can modulate and influence not only the risk of thyroid nodules but also the severity of disease in humans[1].The environment is awash with elements,and all mineral elements,including heavy metals and trace elements,are considered potentially toxic.A significantly higher incidence of thyroid cancer has been reported in populations exposed to low doses of metallic elements in volcanic areas over a long period[2].As research on thyroid disorders continues,it is becoming clear that abnormalities in trace elements in the body can affect the development of thyroid-related disorders.

Levels of Polycyclic Aromatic Hydrocarbons (PAHs) in Healthcare Waste Incinerators’ Bottom Ash from Five County Hospitals in Kenya

Health-care waste contains potentially harmful microorganisms and compounds which can infect and affect hospital patients, healthcare workers, the general public and environment. Therefore, management of health care waste requires safe handling, treatment and disposal procedures. While incineration reduces the volume and quantity of waste for final disposal, it leads to the production of fly and bottom ashes laden with toxic incomplete combustion products such as Polycyclic Aromatic Hydrocarbons (PAHs), dioxins, furans and heavy metals. This exposes workers who handle and dispose the bottom ashes, hospital patients, the general public and environment. The goal of this study was to determine the total and individual levels of 16 most prevalent and toxic PAHs. Bottom ash samples were collected from incinerators in five county hospitals in Kenya, namely;Moi-Voi, Narok, Kitale, Makindu and Isiolo. Bottom ash samples were collected over a period of six months from the five hospitals. The samples were then sieved, homogenised and stored at 4°C in amber coloured glass containers. The PAHs were extracted using 30 ml of a hexane-acetone solvent (1:1) mixture by ultrasonication at room temperature (23°C) for 45 minutes. The PAHs were then analyzed with a GC-MS spectrophotometer model (Shimadzu GCMS-QP2010 SE) connected to a computer work station was used for the PAHs analysis. The GC-MS was equipped with an SGE BPX5 GC capillary column (30 m × 0.25 mm × 0.25 μm) for the separation of compounds. Helium was used as the carrier gas at a flow rate of 15.5 ml/minute and 14.5 psi. 1 μl of the sample was injected at 280°C, split mode (10:1). The oven programming was set for a total runtime of 40 minutes, which included: 100°C (2-minute hold);10°C /min rise to 200°C;7°C /min rise to 249°C;3°C /min rise to 300°C (2-minute hold). The interface temperature was set at 290°C. Analysis was done in Selected Ion Monitoring (SIM) mode and the peak areas of each of the PAHs were collected from the chromatograph and used for quantification of the 16 PAHs listed by the U.S. Environmental Protection Agency (EPA) which included, BaA (benz[a]anthracene: 4 rings), BaP (benzo[a]pyrene: 5 rings), BbF (benzo [b]fluoranthene: 5 rings), BkF (benzo[k]fluoranthene: 5 rings), Chr (chrysene: 4 rings), DbA (dibenz[a,h]anthracene: 5 rings), InP (indeno[1,2,3 - cd] pyrene: 6 rings) and Acp (acenaphthene: 3 rings), Acpy (acenaphthylene: 3 rings), Ant (anthracene: 3 rings), BghiP (benzo[g,h,i]perylene: 6 rings), Flu (fluorene: 3 rings), FluA (fluoranthene: 4 rings), Nap (naphthalene: 2 rings), PhA (phenanthrene: 3 rings) and Pyr (pyrene: 4 rings). Ion source-interface temperature was set at 200°C - 250°C. Internal standards from Sigma Aldrich were used in the analysis and the acquired mass spectra data were then matched against the NIST 2014 library [1] [2]. The mean PAHs concentration in the bottom ashes of each hospital varied broadly from 0.001 mg/kg to 0.4845 mg/kg, and the mean total concentration levels of individual PAHs ranged from 0.0072 mg/kg to 1.171 mg/kg. Low molecular weight PAHs (Phenanthrene, Naphthalene and Fluorene) were predominant in all the hospital wastes whereas Kitale and Narok presented the lowest PAHs concentrations and the lowest number of individual PAHs. Moi/Voi recorded the highest total PAHs concentration at 1.3129 ± 0.0023 mg/kg from a total of 11 PAHs being detected from the bottom ash samples. Narok had only three PAHs being detected at very low concentrations of 0.0041 ± 0.00 mg/kg, 0.0076 ± 0.00 mg/kg and 0.012 ± 0.00 mg/kg for phenanthrene, anthracene and chrysene respectively. This study presents hospital incinerator bottom ash as containing detectable levels of both carcinogenic and non-carcinogenic PAHs. Continued unprotected exposure of hospital workers (waste handlers) to the bottom ash PAHs could be hazardous to their health because of their cumulative effect. Preventive measures e.g. the use of Personal protective equipment (PPE) should be prioritised to minimise direct contact with the bottom ash. The study recommends an upgrade on incinerator technology for efficient combustion processes thus for better pollution control.

Development and Application of Integrated Indicators for Assessing Healthcare Waste Management Systems in Kenyan Hospitals

Healthcare waste management (HCWM) is an important aspect of healthcare delivery globally because of its hazardous and infectious components that have potential for adverse health and environmental impacts. The paper introduces a set of indicators for assessing HCWM systems in hospitals. These indicators are: HCWM policies and standard operating procedures, management and oversight, logistics and budget support, training and occupational health and safety, and treatment, disposal and waste treatment equipment housing. By plotting a mark on a continuum which is defined as good and poor on the extremes and is connected with all other marks in a spoke arrangement, it’s possible to describe a baseline for HCWM in any specific hospital. This baseline can be used to improve awareness of the actors and policy-makers, compare the same hospital at a different point in time, to compare observations by different evaluators and to track improvements. Results suggest that in Kenya, the application of such indicators is useful for evaluating which priorities should be addressed to improve outcomes in HCWM systems. Systematic sampling technique was used to identify and collect data by use of observational checklist, interviews, visual verification and review of documents and a HCWM assessment tool. The objective is to suggest an integrated management tool as a method to identify prevailing problems with a HCWM system. The method can be replicated in other contexts worldwide, with a focus on the developing world. The integrated indicators focus on management of HCW and not its potential impact on human health and environment, an area recognized to be critical for future research.

ABCC8 is correlated with immune cell infiltration and overall survival in lower grade glioma

ATP binding cassette subfamily C member 8(ABCC8)encodes a protein regulating the ATP-sensitive potassium channel.Whether the level of ABCC8 mRNA in lower grade glioma(LGG)correlates with immune cell infiltration and patient outcomes has not been evaluated until now.Comparisons of ABCC8 expression between different tumors and normal tissues were evaluated by exploring publicly available datasets.The association between ABCC8 and tumor immune cell infiltration,diverse gene mutation characteristics,tumor mutation burden(TMB),and survival in LGG was also investigated in several independent datasets.Pathway enrichment analysis was conducted to search for ABCC8-associated signaling pathways.Through an online database,we found that ABCC8 expression in LGG was lower than in normal tissues.Then,the association of ABCC8 expression and immune cell infiltration in LGG was discussed.As we expected,the ABCC8 mRNA levels were negatively associated with non-T immune cell infiltration levels in all datasets.Consistently,TCGA_LGG RNA-seq data revealed that ABCC8 downregulated several non-T immune cell-associated signaling pathways in gene set enrichment analysis.Different ABCC8 expression groups showed diverse gene mutation characteristics and TMB.The high expression of ABCC8 was linked to improved survival of LGG patients.A pathway enrichment analysis of ABCC8-associated genes indicated that the GABAergic synapse signaling pathway might be involved in regulating immunity in LGG.Our findings show that ABCC8 reflects LGG tumor immunity and is an ideal prognostic biomarker for LGG.

Pien Tze Huang alleviates Concanavalin A-induced autoimmune hepatitis by regulating intestinal microbiota and memory regulatory T cells

BACKGROUND Traditional Chinese medicine has used the drug Pien Tze Huang(PTH),a classic prescription,to treat autoimmune hepatitis(AIH).However,the precise mode of action is still unknown.AIM To investigate the mechanism of PTH in an AIH mouse model by determining the changes in gut microbiota structure and memory regulatory T(mTreg)cells functional levels.METHODS Following induction of the AIH mouse model induced by Concanavalin A(Con A),prophylactic administration of PTH was given for 10 d.The levels of mTreg cells were measured by flow cytometry,and intestinal microbiota was analyzed by 16S rRNA analysis,while western blotting was used to identify activation of the toll-like receptor(TLR)2,TLR4/nuclear factor-κB(NF-κB),and CXCL16/CXCR6 signaling pathways.RESULTS In the liver of mice with AIH,PTH relieved the pathological damage and reduced the numbers of T helper type 17 cells and interferon-γ,tumor necrosis factor-alpha,interleukin(IL)-1β,IL-2,IL-6,and IL-21 expression.Simultaneously,PTH stimulated the abundance of helpful bacteria,promoted activation of the TLR2 signal,which may enhance Treg/mTreg cells quantity to produce IL-10,and suppressed activation of the TLR4/NF-κB and CXCL16/CXCR6 signaling pathways.CONCLUSION PTH regulates intestinal microbiota balance and restores mTreg cells to alleviate experimental AIH,which is closely related to the TLR/CXCL16/CXCR6/NF-κB signaling pathway.

Effective Skin Care Guidance for Patients with Acne Vulgaris after Standard Treatment

With the introduction of new drugs, the treatment of acne vulgaris has improved dramatically;however, there remains a considerable gap between treatment outcomes and patients’ treatment goals. This study aimed to determine whether dermatologists’ guidance on appropriate skincare for skin symptoms such as post-inflammatory erythema and post-inflammatory hyperpigmentation (PIH), which are not covered by acne treatment, leads to an improvement in patients’ skin condition and patient satisfaction. Japanese women who had completed standard treatment for acne vulgaris and those with mild symptoms not requiring treatment were included in the study. The participants received instructions about skin care at the beginning of the study, which they continued to apply for 6 weeks. At the start and end of the study, participants were examined by a dermatologist;afterward, skin measurements, including skin color, skin surface lipid content, and image analysis by VISIA® Evolution, analysis of stratum corneum obtained from the skin surface, and Skindex-16 questionnaire for assessing quality of life (QOL), were performed. The following showed significant improvements: PIH score, number of inflammatory acne lesions, and number of non-inflammatory acne lesions observed via skin examination;skin surface lipid content and values of L* and a* obtained via instrumental measurement;n number of pore, texture, red spot, and pigmented spot obtained via by image analysis;and degree of multilayer exfoliation and interleukin-1α determined by analysis of epidermal stratum corneum. QOL measurement using Skindex-16 also improved significantly. Appropriate skin care guidance following standard acne vulgaris treatment is helpful in achieving patients’ treatment goals. .

Changes in proteins related to early nerve repair in a rat model of sciatic nerve injury

Peripheral nerves have a limited capacity for self-repair and those that are severely damaged or have significant defects are challenging to repair. Investigating the pathophysiology of peripheral nerve repair is important for the clinical treatment of peripheral nerve repair and regeneration. In this study, rat models of right sciatic nerve injury were established by a clamping method. Protein chip assay was performed to quantify the levels of neurotrophic, inflammation-related, chemotaxis-related and cell generation-related factors in the sciatic nerve within 7 days after injury. The results revealed that the expression levels of neurotrophic factors(ciliary neurotrophic factor) and inflammationrelated factors(intercellular cell adhesion molecule-1, interferon γ, interleukin-1α, interleukin-2, interleukin-4, interleukin-6, monocyte chemoattractant protein-1, prolactin R, receptor of advanced glycation end products and tumor necrosis factor-α), chemotaxis-related factors(cytokine-induced neutrophil chemoattractant-1, L-selectin and platelet-derived growth factor-AA) and cell generation-related factors(granulocyte-macrophage colony-stimulating factor) followed different trajectories. These findings will help clarify the pathophysiology of sciatic nerve injury repair and develop clinical treatments of peripheral nerve injury. This study was approved by the Ethics Committee of Peking University People's Hospital of China(approval No. 2015-50) on December 9, 2015.

Intraoperative single administration of neutrophil peptide 1 accelerates the early functional recovery of peripheral nerves after crush injury

Neutrophil peptide 1 belongs to a family of peptides involved in innate immunity. Continuous intramuscular injection of neutrophil peptide 1 can promote the regeneration of peripheral nerves, but clinical application in this manner is not convenient. To this end, the effects of a single intraoperative administration of neutrophil peptide 1 on peripheral nerve regeneration were experimentally observed. A rat model of sciatic nerve crush injury was established using the clamp method. After model establishment, a normal saline group and a neutrophil peptide 1 group were injected with a single dose of normal saline or 10 μg/mL neutrophil peptide 1, respectively. A sham group, without sciatic nerve crush was also prepared as a control. Sciatic nerve function tests, neuroelectrophysiological tests, and hematoxylin-eosin staining showed that the nerve conduction velocity, sciatic functional index, and tibialis anterior muscle fiber cross-sectional area were better in the neutrophil peptide 1 group than in the normal saline group at 4 weeks after surgery. At 4 and 8 weeks after surgery, there were no differences in the wet weight of the tibialis anterior muscle between the neutrophil peptide 1 and saline groups. Histological staining of the sciatic nerve showed no significant differences in the number of myelinated nerve fibers or the axon cross-sectional area between the neutrophil peptide 1 and normal saline groups. The above data confirmed that a single dose of neutrophil peptide 1 during surgery can promote the recovery of neurological function 4 weeks after sciatic nerve injury. All the experiments were approved by the Medical Ethics Committee of Peking University People's Hospital, China(approval No. 2015-50) on December 9, 2015.

Inflammatory bowel disease: A descriptive study of 716 local Chilean patients

AIM: To demographically and clinically characterize inflammatory bowel disease(IBD) from the local registry and update data previously published by our group.METHODS: A descriptive study of a cohort based on a registry of patients aged 15 years or older who were diagnosed with IBD and attended the IBD program at Clínica Las Condes in Santiago, Chile. The registry was created in April 2012 and includes patients registered up to October 2015. The information was anonymously downloaded in a monthly report, and the information on patients with more than one visit was updated. The registry includes demographic, clinical and disease characteristics, including the Montreal Classification, medical treatment, surgeries and hospitalizations for crisis. Data regarding infection with Clostridium difficile(C. difficile) were incorporated in the registry in 2014. Data for patients who received consultations as second opinions and continued treatment at this institution were also analyzed. RESULTS: The study included 716 patients with IBD: 508 patients(71%) were diagnosed with ulcerative colitis(UC), 196 patients(27%) were diagnosed with Crohn's disease(CD) and 12 patients(2%) were diagnosed with unclassifiable IBD. The UC/CD ratio was 2.6/1. The median age was 36 years(range 16-88), and 58% of the patients were female, with a median age at diagnosis of 29 years(range 5-76). In the past 15 years, a sustained increase in the number of patients diagnosed with IBD was observed, where 87% of the patients were diagnosed between the years 2001 and 2015. In the cohort examined in the present study, extensive colitis(50%) and colonic involvement(44%) predominated in the patients with UC and CD, respectively. In CD patients, nonstricturing/non-penetrating behavior was more frequent(80%), and perianal disease was observed in 28% of the patients. There were significant differences in treatment between UC and CD, with a higher use of corticosteroids, and immunosuppressive and biological therapies was observed in the patients with CD(P < 0.05 and P < 0.01). Significant surgical differences were also observed: 5% of the UC patients underwent surgery, whereas 38% of the CD patients required at least one surgery(P < 0.01). The patients with CD were hospitalized more often during their disease course than the patients with UC(55% and 35% of the patients, respectively; P < 0.01). C. difficile infection was acquired by 5% of the patients in each group at some point during the disease course. Nearly half of the patients consulted at the institution for a second opinion, and 32% of these individuals continued treatment at the institution. CONCLUSION: IBD has continued to increase in the study cohort, slowly approaching the level reported in developed countries.

Identification of four differentially expressed genes associated with acute and chronic spinal cord injury based on bioinformatics data

Complex pathological changes occur during the development of spinal cord injury(SCI),and determining the underlying molecular events that occur during SCI is necessary for the development of promising molecular targets and therapeutic strategies.This study was designed to explore differentially expressed genes(DEGs)associated with the acute and chronic stages of SCI using bioinformatics analysis.Gene expression profiles(GSE45006,GSE93249,and GSE45550)were downloaded from the Gene Expression Omnibus database.SCI-associated DEGs from rat samples were identified,and Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed.In addition,a protein-protein interaction network was constructed.Approximately 66 DEGs were identified in GSE45550 between 3–14 days after SCI,whereas 2418 DEGs were identified in GSE450061–56 days after SCI.Moreover,1263,195,and 75 overlapping DEGs were identified between these two expression profiles,3,7/8,and 14 days after SCI,respectively.Additionally,16 overlapping DEGs were obtained in GSE450061–14 days after SCI,including Pank1,Hn1,Tmem150c,Rgd1309676,Lpl,Mdh1,Nnt,Loc100912219,Large1,Baiap2,Slc24a2,Fundc2,Mrps14,Slc16a7,Obfc1,and Alpk3.Importantly,3882 overlapping DEGs were identified in GSE932491–6 months after SCI,including 3316 protein-coding genes and 567 long non-coding RNA genes.A comparative analysis between GSE93249 and GSE45006 resulted in the enrichment of 1135 overlapping DEGs.The significant functions of these 1135 genes were correlated with the response to the immune effector process,the innate immune response,and cytokine production.Moreover,the biological processes and KEGG pathways of the overlapping DEGs were significantly enriched in immune system-related pathways,osteoclast differentiation,the nuclear factor-κB signaling pathway,and the chemokine signaling pathway.Finally,an analysis of the overlapping DEGs associated with both acute and chronic SCI,assessed using the expression profiles GSE93249 and GSE45006,identified four overlapping DEGs:Slc16a7,Alpk3,Lpl and Nnt.These findings may be useful for revealing the biological processes associated with SCI and the development of targeted intervention strategies.

Efficacy and Tolerability of Long-Acting Injectable Formulation of Nalmefene (Nalmefene Consta 393.1 mg) for Opioid Relapse Prevention: A Multicentre, Open-Label, Randomised Controlled Trial

Objective: To determine the efficacy and tolerability of a long-acting intramuscular formulation of Nalmefene (Nalmefene Consta 393.1 mg) for the treatment of opioid-dependent patients. Design, Setting, and Participants: A 12 weeks, open-label, randomised controlled trial conducted between June 2009-July 2011, at 14 Hospital-based drug clinics, in the 12 countries. Participants were 18 years or older, had Diagnostic and Statistical Manual of Mental Disorders-5 opioid use disorder. Of the 3200 individuals screened, 3000 (93.7%) adults were randomized 1500 participants to receive injections of Long-acting depot formulations ofNalmefene (Nalmefene Consta 393.1 mg) given intramuscularly once in 12 weeks and 1500participants to receive extended-release Naltrexone (Vivitrol 380 mg), administered intramuscularly every fourth week for 12 weeks. Main Outcomes and Measures: The primary endpoints (protocol) were: Confirmed Opioid abstinence (percentage i.e. the number of patients who achieved complete abstinence during week 12). Confirmed abstinence or “opioid-free” was defined as a negative urine drug test for opioids and no self-reported opioid use. Weeks 1 - 4 were omitted from this endpoint to allow for stabilization of abstinence. Secondary end points included a number of days in treatment, treatment retention and craving. The study also investigated, on 275 participants, degree and time course of mu-opioid receptor occupancy following single doses of Nalmefene extended-release injection (Nalmefene Consta 393.1 mg) as well as the plasma concentration of Nalmefene and Nalmefene-3-O-glucuronide. Safety was assessed by adverse event reporting. Results: Of 3000 participants, mean (SD) age was 27.1 (±4.8) years and 831 (27.7%) were women. 1500 individuals were randomized to receive injections of Long-acting depot formulations of Nalmefene (Nalmefene Consta 393.1 mg) and 1500 to receive injections of extended-release Naltrexone (Vivitrol 380 mg);2088 participants (69.6.0%) completed the trial. Primary endpoints: Confirmed Opioid Abstinence: Complete abstinence was sustained by 86% (n = 1290) of Nalmefene patients (patients treated with Nalmefene Consta 393.1 mg, long-acting depot formulations) compared with 43% (n = 645) of patients treated with extended-release Naltrexone 380 mg (Vivitrol), during weeks 5 - 12 (χ2 = 672.34, P Secondary Endpoint: Craving: A statistically and clinically significant reduction in opioid craving was observed with Nalmefene (Nalmefene Consta 393.1 mg, long-acting depot formulations) vs. Naltrexone (extended-release Naltrexone, Vivitrol 380 mg) by week 4 (P =0.0048), which persisted every week through 12 (P < 0.0001). Patients given Nalmefene (Nalmefene Consta 393.1 mg, long-acting depot formulations) had a 75% decrease in craving from baseline to week 12. Patients given a Naltrexone (extended-release Naltrexone, Vivitrol 380 mg) had a 3% increase in craving from baseline to week 12 (Mean change in self-reporting craving). Secondary Endpoint: Treatment Retention: Long-acting intramuscular formulation of Nalmefene (Nalmefene Consta 393.1 mg) helped significantly more patients complete 12 weeks treatment (n = 1245, 83%) compared with extended-release Naltrexone (Vivitrol 380 mg) (n = 570, 38%) (χ2 = 635.53, P < 0.0001). Patients on long-acting intramuscular formulation of Nalmefene (Nalmefene Consta 393.1 mg) had longer treatment retention than patients on extended-release Naltrexone (Vivitrol 380 mg). Concentrations of Nalmefene and Nalmefene-3-O-Glucuronide in Plasma: Analyses were made of 275 study sample. There was no statistically significant difference for plasma nalmefene concentrations between days 2 and 84 (p = 0.416). The plasma concentration of Nalmefene were 20.3 and 28.5 ng/ml and concentrations of nalmefene-3-O-glucuronide were 2.1 and 4.1 ng/ml, respectively. Plasma levels of Nalmefene remained above 20 ng/ml for approximately 12 weeks after administration of Nalmefene, long-acting depot formulations (Nalmefene Consta 393.1 mg). PET Assessments: Very high mu-opioid receptor occupancy by Nalmefene was detected 1 day after treatments at which time point the occupancy was 100.0% after Nalmefene injection (Nalmefene Consta 393.1 mg). Nalmefene Consta 393.1 mg injection (long-acting intramuscular formulation of Nalmefene) led to a very high occupancy ofmu-opioid receptors in all brain areas examined;the thalamus, caudate nucleus, and frontal cortex. Depending on the brain area mu-opioid receptor occupancy varied between 83.0% and 85.8% 84 days after dosing. Adverse Reactions: Adverse events were similar in opioid-dependent patients treated with long-acting intramuscular formulation of Nalmefene (Nalmefene Consta 393.1 mg) vs. patients treated with extended-release Naltrexone (Vivitrol 380 mg). Conclusions and Relevance: Long-acting depot formulations of Nalmefene (Nalmefene Consta 393.1 mg) was more effective then extended-release Naltrexone (Vivitrol 380 mg) in maintaining short-term abstinence from heroin and should be considered as a treatment option for opioid-dependent individuals.

Operating Experience of Country’s Agricultural Science and Technological Park

Through the analysis of the operation of China’s agricultural science technological and development process, the paper summed up the basic experience of agricultural science technological park and operation mode, in order to run at all levels of agricultural science technological park of science and regional some beneficial references for the development of agricultural economy.

Prevalence of Self-Reported Respiratory Symptoms, Asthma and Chronic Bronchitis in Slum Area of a Rapidly Developing Indian City

Background: Poverty is an important surrogate marker for obstructive airway diseases (OAD). Slum constitutes a habitat wherein various poverty related parameters are perpetually prevalent in the ambience. 1/6th of world population lives in slums yet there is no information regarding their health status in context to asthma and COPD. Aims: We investigated the prevalence of asthma and chronic-bronchitis symptoms and associated risk-factors in slum habitats of Pune city. Methodology: 7062 adult slum-dwellers living in 12 slums of Pune city were cross-sectionally interviewed by local healthcare workers with respiratory health questionnaire which was designed using respiratory symptoms of validated European Community Respiratory Health Survey (ECRHS II) questionnaire and International Union against Tuberculosis and Lung Disease (IUATLD) bronchial symptoms questionnaire. Results: The overall prevalence of selfreported asthma symptoms was 10% (18 - 40 years: 6.5%;>40 years: 13.5%). The overall prevalence of chronic bronchitis was 8.5% [18 - 40 years: 7% (males: 7%, females: 7%);>40 years: 10% (males: 10%, females: 10%)]. Increasing age (p = 0.00), female gender (p = 0.001), unemployment (0.00) current smoking (p = 0.00) and ex-smoking (p = 0.004) emerged as significant risk factor for asthma. While, ex-smoking (p = 0.004) and low-education status (p = 0.00) emerged as significant risk factors for chronic bronchitis. Conclusion: In slums reporting of asthma and chronic-bronchitis symptoms was much higher than what has been reported earlier from India. Asthma was commonly seen in females, old age, unemployed and ever-smokers. While chronic bronchitis was commonly seen in ex-smokers and illiterate subjects. Chronic bronchitis was equally distributed amongst male and females, despite 0% prevalence of smoking in females.

Liver kidney crosstalk:Hepatorenal syndrome

The dying liver causes the suffocation of the kidneys,which is a simplified way of describing the pathophysiology of hepatorenal syndrome(HRS).HRS is characterized by reversible functional renal impairment due to reduced blood supply and glomerular filtration rate,secondary to increased vasodilators.Over the years,HRS has gained much attention and focus among hepatologists and nephrologists.HRS is a diagnosis of exclusion,and in some cases,it carries a poor prognosis.Different classifications have emerged to better understand,diagnose,and promptly treat this condition.This targeted review aims to provide substantial insight into the epidemiology,pathophysiology,diagnosis,and management of HRS,shed light on the various milestones of this condition,and add to our current understanding.

Adsorption of Cu(II), Ni(II), Zn(II), Cd(II) and Pb(II) onto Kaolin/Zeolite Based- Geopolymers

This work deals with geopolymers based on local Jordanian resources, namely, kaolin and zeoltitic (phillipsite) tuff. The geopolymers were prepared from these two materials by a reaction with an alkali solution at 80oC. The research group of the present work has demonstrated in previous work that addition of zeolitic tuff to kaolin based-geopolymers increases the adsorption capacity toward Cu(II) metal ion compared to zeolite-free geopolymers, while retaining high mechanical strength. The aim of the present work is to extend our work and to study the effect of changing geopolymers components (zeolitic tuff and kaolin) on their adsorption properties toward Cu(II), Ni(II), Zn(II), Cd(II) and Pb(II) metal ions. Both isothermal and kinetic studies revealed that increasing the zeolitic tuff: kaolin ratio improves the adsorption capacity of geopolymer toward metal ions. The adsorption capacity of the geopolymers of 150: 50 zeolites: kaolin content was found to be higher than that of the raw materials themselves. The rate of adsorption of geopolymers was found to be lower than that of raw materials due to kinetic limitations imposed by the formation of geopolymerization network. The selectivity of geopolymers toward adsorption of? metal ions was found to be distinct from raw zeolite and kaolin where the adsorption onto geopolymers was found to be more preferential for small size metal ions (Cu(II), Ni(II), Zn(II)) than for large size metal ions (Pb(II), Cd(II)). The adsorption of Cu(II) and Pb(II) onto geopolymers did not decrease with competition with other metal ions, which indicates cooperative adsorption. The adsorption process of metal ions onto geopolymers was found to be reversible that indicates that metal ions are bound by physical cation exchange to the exchangeable sites of unreacted phillipsite and new amorphous geopolymer sites. Leaching of metal ions from raw kaolin was much more effective than geopolymers and zeolite because of compact structure of geopolymers.

Fatty liver disease,an emerging etiology of hepatocellular carcinoma in Argentina

AIM To investigate any changing trends in the etiologies of hepatocellular carcinoma(HCC) in Argentina during the last years. METHODS A longitudinal cohort study was conducted by 14 regional hospitals starting in 2009 through 2016. All adult patients with newly diagnosed HCC either with pathology or imaging criteria were included. Patients were classified as presenting non-alcoholic fatty liver disease(NAFLD) either by histology or clinically, provided that all other etiologies of liver disease were ruled out, fatty liver was present on abdominal ultrasound and alcohol consumption was excluded. Complete follow-up was assessed in all included subjects since the date of HCC diagnosis until death or last medical visit.RESULTS A total of 708 consecutive adults with HCC were included. Six out of 14 hospitals were liver transplant centers(n = 484). The prevalence of diabetes mellitus was 27.7%. Overall, HCV was the main cause of liver disease related with HCC(37%) including cirrhotic and non-cirrhotic patients, followed by alcoholic liver disease 20.8%, NAFLD 11.4%, cryptogenic 9.6%, HBV 5.4% infection, cholestatic disease and autoimmune hepatitis 2.2%, and other causes 9.9%. A 6-fold increase in the percentage corresponding to NAFLDHCC was detected when the starting year, i.e., 2009 was compared to the last one, i.e., 2015(4.3% vs 25.6%; P < 0.0001). Accordingly, a higher prevalence of diabetes mellitus was present in NAFLD-HCC group 61.7% when compared to other than NAFLD-HCC 23.3%(P < 0.0001). Lower median AFP values at HCC diagnosis were observed between NAFLD-HCC and non-NAFLD groups(6.6 ng/m L vs 26 ng/m L; P = 0.02). Neither NAFLD nor other HCC etiologies were associated with higher mortality.CONCLUSION The growing incidence of NAFLD-HCC documented in the United States and Europe is also observed in Argentina, a confirmation with important Public Health implications.

Serum Procalcitonin and Neutrophil Toxic Granules Guided Management of Post-Operative <i>K. pneumoniae</i>Septic-Shock in Laminectomy—A Case Report

Introduction: We still rely on clinical diagnosis for initiating empirical antibiotic therapy and await blood culture for confirmation of infection, species identification and drug sensitivity. Differential blood cell count (WBC and neutrophils) and recording of toxic granules in the neutrophils are established methods for indirect diagnosis of infection though they are not used in the diagnosis of sepsis per se. Serum Procalcitonin is considered as a good biomarker in the management of sepsis. Materials and Methods: Whole blood and serum were used for laboratory analysis. We have combined the detection of toxic granules in the peripheral blood smear and serum PCT levels for diagnosis and monitoring the recovery of a patient with septic shock. A 63 year old laminectomy patient was transferred 2 days after the surgery to our hospital with several co-morbidities and complications. He was in septic shock and was put on Continuous Renal Replacement Therapy, with ionotropic support and IV fluids via nasogastric feeding and administration of Activated Protein C. Blood culture and daily measurements of serum Procalcitonin, differential blood cells count, and observation of toxic granules in neutrophils were done. Results: The blood culture showed infection due to K. pneumoniae resistant to carbapenems. WBC and Neutrophil counts were quite variable and showed incoherent response to treatment. Serum PCT was 24.57 ng/mL on the next day of admission and it peaked at 30.2 ng/mL on day 3. Its level started decreasing from the 4th day. Toxic granules disappeared when serum PCT levels reached < 1 ng/mL. The patient responded well to treatment and he was discharged on the 16th day upon request. Conclusion: This case is presented as an example of managing sepsis with a combination of a conventional hematology marker and a modern biomarker. Resource poor hospitals with inadequate microbiology services, may evaluate and use these two biomarkers not only for the total management of sepsis but also to reduce the cost of critical care.

Current systematic reviews and meta-analyses of COVID-19

BACKGROUND Coronavirus disease 2019(COVID-19)has left a significant impact on the world's health,economic and political systems;as of November 20,2020,more than 57 million people have been infected worldwide,with over 1.3 million deaths.While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence,highlight gaps in knowledge,and elucidate further meta-analyses and umbrella reviews that are yet to be performed.METHODS We explored studies based on systematic reviews and meta-analyses with the keyterms,including severe acute respiratory syndrome(SARS),SARS virus,coronavirus disease,COVID-19,and SARS coronavirus-2.The included studies were extracted from Embase,Medline,and Cochrane databases.The publication timeframe of included studies ranged between January 01,2020,to October 30,2020.Studies that were published in languages other than English were not considered for this systematic review.The finalized full-text articles are freely accessible in the public domain.RESULTS Searching Embase,Medline,and Cochrane databases resulted in 1906,669,and 19 results,respectively,that comprised 2594 studies.515 duplicates were subsequently removed,leaving 2079 studies.The inclusion criteria were systematic reviews or meta-analyses.860 results were excluded for being a review article,scope review,rapid review,panel review,or guideline that produced a total of 1219 studies.After screening articles were categorized,the included articles were put into main groups of clinical presentation,epi-demiology,screening and diagnosis,severity assessment,special populations,and treatment.Subsequently,there was a second subclassification into the following groups:gastrointestinal,cardiovascular,neurological,stroke,thrombosis,anosmia and dysgeusia,ocular manifestations,nephrology,cutaneous manifestations,D-dimer,lymphocyte,anticoagulation,antivirals,convalescent plasma,immunosuppressants,corticosteroids,hydroxychloroquine,renin-angiotensin-aldosterone system,technology,diabetes mellitus,obesity,pregnancy,children,mental health,smoking,cancer,and transplant.CONCLUSION Among the included articles,it is clear that further research is needed regarding treatment options and vaccines.With more studies,data will be less heterogeneous,and statistical analysis can be better applied to provide more robust clinical evidence.This study was not designed to give recommendations regarding the management of COVID-19.

Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate

BACKGROUND Right hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn’s disease(CD)and malignant ones like colon cancer(CC).AIM To investigate differences in pre-and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODS This is a sub-group analysis of the European Society of Coloproctology’s prospective,multi-centre snapshot audit.Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included.Primary outcome measure was 30-d post-operative complications.Secondary outcome measures were post-operative length of stay(LOS)at and readmission.RESULTS Three hundred and seventy-five patients with CD and 2,515 patients with CC were included.Patients with CD were younger(median=37 years for CD and 71 years for CC(P<0.01),had lower American Society of Anesthesiology score(ASA)grade(P<0.01)and less comorbidity(P<0.01),but were more likely to be current smokers(P<0.01).Patients with CD were more frequently operated on by colorectal surgeons(P<0.01)and frequently underwent ileocecal resection(P<0.01)with higher rate of de-functioning/primary stoma construction(P<0.01).Thirty-day post-operative mortality occurred exclusively in the CC group(66/2515,2.3%).In multivariate analyses,the risk of post-operative complications was similar in the two groups(OR 0.80,95%CI:0.54-1.17;P=0.25).Patients with CD had a significantly longer LOS(Geometric mean 0.87,95%CI:0.79-0.95;P<0.01).There was no difference in re-admission rates.The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSION Patients with CD were younger,with lower ASA grade,less comorbidity,operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complications'rate was not different between the two groups.

The Prevalence of Auto-Medication among Pregnant Women in a Conflict Affected, North West Region, Cameroon

Background: The excessive use of medicines and generally self-medication is considered as one of the major health and socio-economic problems in different countries. There is increasing evidence that self-medications among pregnant women are common in many developing countries. Despite the adverse impact on pregnancy, there are few programs available for their control. The Northwest region of Cameroon has been affected by socio-political crisis since 2016, which has slowed down economic activities and have grievous effects on the economy. It was therefore necessary to evaluate the prevalence of auto-medication amongst pregnant women. Aim: The aim of this study is to ascertain the knowledge, prevalence and practice of auto medication among pregnant women in Cameroon especially in the North West Region. Method: A community based cross-sectional study was conducted among 500 pregnant women, aged between 15 - 45 years in the Bamenda Health District between January to October 2019. A structured questionnaire based interview was used to collect data from each study subject. Then, data were categorized and analyzed using SPSS version 20 software. Results: The prevalence of auto-medication (allopathic and herbal medicines) in this study was 337 (67.4%) and was predominant during the first trimester 246 (72.86%) of pregnancy. 98 (29.09%) previous experience, 70 (20.77%) that they did not have money for consultation, 70 (20.77%) non-severity of ailments and 75 (22.25%) high cost of medication in hospital/pharmacy were the most common reason pregnant women auto medicate. 96 (28.48%) antiemetic, 72 (21.36%) analgesics and 58 (17.21%) antacids were the most frequent drugs used for auto-medication and the main symptoms for which pregnant women practice auto-medication were: 72 (21.36%) fever/headache, 63 (18.69%) constipation and 58 (17.21%) nausea/vomiting. 116 (34.42%) friends/family/neighbors were the main source of recommendation in auto medication. 96 (28.49%) of the self-medicating pregnant women, self-medicate with local herbs and 40 (41.66%) blood leaves (iron supplement) was the most used plant (herbs) in our study. Conclusion: We conclude that after 3 years of crisis in this region, the prevalence of auto-medication is increasing at a geometric rate and becoming a practical routine. Adequate counselling of reproductive age girls by healthcare professionals about the potential risks of self-medication with herbal medicine and allopathic drugs during pregnancy is strongly recommended.