Menstrual care for individuals with disability: a case report

Individuals with disabilities have different needs and concerns at different stages of life. The arrival of puberty brings about new challenges especially for females with issues related to menstrual care involving both the patient and their caregivers. This case report is about a 13-year-old girl with Down syndrome who was cared for by her widowed father since the age of six. She was suffering from severe mental disability. Her father was concerned, because she was unable to maintain personal hygiene during menses such as changing sanitary napkins and managing stains, hence requested for menstrual manipulation. Options for menstrual manipulation for individuals with disabilities include both medical and surgical interventions. Hormonal therapy options include oral contraceptive pills, depo-provera, progestin implants and progesterone release intra-uterine contraceptive devices. Surgical options such as hysterectomy or endometrial ablation may be considered as a last resort as it is more invasive and irreversible, involving ethical and legal implications. Selection of the suitable therapy involves shared decision making between health care provider and caregiver taking into consideration the patient’s best interest. This case report also highlights the role of family physicians in managing and coordinating care on delicate issues related to menstrual care for people with disabilities. This case report may serve as a guide to physicians and families with special needs children, while approaching issues on menstrual care

Seasonal Abundance of Economically Important Fruit Flies (Diptera: Tephritidae: Dacinae) in Bangladesh, in Relation to Abiotic Factors and Host Plants

Fruit fly monitoring traps baited with male lures (cue lure, methyl eugenol, zingerone) were maintained for two years (Nov 2016–Oct 2018) at ten sites (reduced to three on year two), in village-style subsistence agriculture envi- ronments, at the Atomic Energy Research Establishment campus, Savar, Dhaka, Bangladesh. A total of 15 species and 135,034 flies were collected, dominated by polyphagous fruit pest Bactrocera dorsalis (58.0% of all trapped flies), cu- curbit pests Zeugodacus cucurbitae (23.6%) and Z. tau (13.5%), and non-pest B. rubigina (3.6%). Three other pest species, collected in much smaller numbers, were polyphagous fruit pests B. zonata and B. correcta and cucurbit pest Dacus longicornis. Data was used to document the seasonal abundance of the above- mentioned species, in relation to host fruit availability and abiotic factors. Seasonal abundance of B. dorsalis, with peaks during wet summer months, was positively correlated with rainfall (r=0.70), temperature (r=0.66) and host availability (r=0.72). Seasonal trends in captures of B. zonata and B. rubigina were similar to those of B. dorsalis. Captures of Z. cucurbitae peaked in March 2017, early in the rainy season, and May 2018, in the middle of the rainy summer season, with no clear correlation with rainfall, humidity, or host availability. Captures of the two other cucurbit pests were inversely related to rainfall, with abundance peaks during the dry winter months. Data on seasonal abundance of these species will be utilized in formulating an area-wide pest management strategy in the agro-ecological system under consideration

Self-perceived stigma and its effect on quality of life among Malaysians living with human immunodeficiency virus

Human Immunodeficiency Virus (HIV) epidemic remains a significant burden in Malaysia. Stigma related to HIV and its effect on the quality of life (QOL) of persons living with HIV (PLHIV) remains under-reported. The aim of the present study was to assess self-perceived stigma amongst PLHIV attending an urban community clinic and its influence on their QOL. Data was collected using HIV Stigma Scale and WHO-QOL HIV BREF Scale. The overall stigma experienced by PLHIV in this community was higher than previous studies (mean ± SD; 103.37 ±18.14). Majority participants had fear disclosing their disease status, while personalized stigma or the experience of prejudice and rejection was the least experienced. The overall QOL was low and was significantly impaired in social relationship domain (mean ± SD; 12.72 ± 3.59). However, their ability to perform daily activities was not affected by the illness (mean ± SD; 14.48 ± 2.91). PLHIV with higher spiritual values demonstrate lower perception of negative self-image and inferiority (r= -0.54). This finding was unique to PLHIV in this study and suggested the importance of spirituality and personal beliefs on their self-esteem. In conclusion, stigma remains as a significant problem among PLHIV in this community. Primary care offers the best platform to promote a holistic management of PLHIV, where the integration between counselors, religious experts, family and non-governmental associations could come together. The management of PLHIV is unique in every community, hence individualized approach based on cultural norms and beliefs could assist in the overall management of PLHIV

Identification of density and breeding places of Aedes mosquito and prevalence of dengue in Rajshahi city corporation of Bangladesh

Background: There are various varieties of habitats that have specific characteristics of water for the breeding of mosquito. A house-to-house cross-sectional entomological survey used to be carried out at per domestic area to become aware of larval breeding sites. Aedes aeygypti used to be primary vector and Aedes albopictus used to be predominant species in container-breeding habitats. Most breeding habitats have been category into excessive stage of larval density. Turbidity, pH, TOC, magnesium, calcium and sodium is amongst the characteristics that indicates a significant difference with larval density and species composition respectively. This study personal based entomological research and funding carried out by corresponding author. Students of zoology department of Rajshahi university involved in this research. Students were working as a research assistant for this study. Aim of this study was to assess determination of prevalence, density and breeding place of Aedes mosquito in Rajshahi city corporation. Methods: This observational study carried out 30 wards in Rajshahi city corporation areas have been surveyed in department of communicable diseases control, director general of health services, Dhaka, Bangladesh. Duration of study 3 years. Total 3 surveys were conducted in each year; pre monsoon, monsoon and post monsoon total 9 surveys conducted by this 3 years survey period. Data entered in MS excel and statistical analysis done by SPSS trial version. Results: This study shows that according to breeding area of 2020-2022. Here, total surveyed household were 8100. Total positive Wet container were 474 and positive place were 473 in these three years survey. Conclusions: Aedes aegypti and Aedes albopictus are properly established inside urban places. Meteorological variables additionally affected mosquito populations. Characteristics of mosquito breeding area can affect larval density and give impact quality of life

Experimental Investigation of Metal-Based Calixarenes as Dispersed Catalyst Precursors for Heavy Oil Hydrocracking

Slurry-phase hydrocracking utilizing metal-containing oil-soluble compounds as precursors of dispersed catalysts is an effective approach for heavy oil upgrading. We propose applying metal-based p-tert-butylcalix[6]arene (TBC[6]s) organic species as dispersed catalyst precursors to enhance catalytic hydrogenation reactions involved in the upgrading of vacuum gas oil (VGO). Co- and Ni-based TBC[6]s were synthesized and characterized by SEM-EDX, ICP, XRD, and FT-IR. The thermogravimetric and calorimetric behaviors of the synthesized complexes, which are key properties of dispersed hydrocracking catalysts, were also explored. The experimental evaluation of the synthesized catalyst precursors show that the synthesized metal-based TBC[6] catalyst precursors improved the catalytic hydrogenation reactions. A co-catalytic system was also investigated by adding a commercial, first-stage hydrocracking supported catalyst in addition to the dispersed catalysts. The naphtha yields increased from 10.7 wt.% for the supported catalyst to 11.7 wt.% and 12 wt.% after adding it along with Ni-TBC[6] and Co-TBC[6], respectively. Mixing the metal-based precursors resulted in elevated yields of liquid products due to the in situ generation of highly active Co–Ni bimetallic dispersed catalysts.This research was funded by Deanship of Research Oversight and Coordination (DROC) at King Fahd University of Petroleum and Minerals (KFUPM), grant number DF181018

Salbutamol in acute organophosphorus insecticide poisoning - a pilotdose-response phase II study

Treatment of acute organophosphorus (OP) insecticide poisoning is difficult, with many patients dying despite best care. Pre-clinical studies have shown benefit from salbutamol, possibly due speeding alveolar fluid clearance or reducing bronchoconstriction. In this small pilot dose-response study, we aimed to explore whether addition of nebulized salbutamol to standard care might improve resuscitation.We performed a single-blind phase II study comparing the effect of two different doses of nebulized salbutamol versus saline placebo, in addition to standard treatment. Primary outcome was oxygen saturations over the first 60 min of resuscitation; secondary outcomes included heart rate, incidence of dysrhythmias, time to 'atropinization', atropine dose required, and mortality.Seventy-five patients were randomized to receive 5 mg (Salb5, n = 25) or 2.5mg (Salb2.5, n = 25) of salbutamol, or saline placebo (NoSalb, n = 25), by nebulizer. Oxygen saturations did not differ between groups over the first 60 min of resuscitation (median AUC NoSalb: 1376 [95% CI 1282 to 1470], Salb2.5: 1395 [1305 to 1486], Salb5: 1233 [1100 to 1367]; p = .9898). Heart rate was also similar across the three arms. Median time to full atropinization, and atropine dose required, were the same for all three arms (NoSalb 15.0 [10-16] min and 12.6 [8.0-13.4] mg, Salb2.5 15.0 [10-16] min and 12.6 [9.3-16.8] mg, and Salb5 15.0 [10-20] min and 12.6 [10.7-20.6] mg; p = .4805 and p = .1871, respectively). Three (12%) patients died in the Salb2.5 and Salb5 groups and two (8%) in the NoSalb group.This pilot study, within the limitations of its small size and variation between patients, found no apparent evidence that administration of nebulized salbutamol improved resuscitation of patients with acute OP insecticide self-poisoning. The data obtained provides a basis to design further studies to ultimately test the role of salbutamol in OP insecticide poisoning

Chemical and structural changes of pretreated empty fruit bunch (EFB) in ionic liquid-cellulase compatible system for fermentability to bioethanol

The pretreatment of empty fruit bunch (EFB) was conducted using an integrated system of IL and cellulases (IL-E), with simultaneous fermentation in one vessel. The cellulase mixture (PKC-Cel) was derived from Trichoderma reesei by solid-state fermentation. Choline acetate [Cho]OAc was utilized for the pretreatment due to its biocompatibility and biodegradability. The treated EFB and its hydrolysate were characterized by the Fourier transform infrared spectroscopy, scanning electron microscopy, and chemical analysis. The results showed that there were significant structural changes in EFB after the treatment in IL-E system. The sugar yield after enzymatic hydrolysis by the PKC-Cel was increased from 0.058 g/g of EFB in the crude sample (untreated) to 0.283 and 0.62 ± 06 g/g in IL-E system after 24 and 48 h of treatment, respectively. The EFB hydrolysate showed the eligibility for ethanol production without any supplements where ethanol yield was 0.275 g ethanol/g EFB in the presence of the IL, while lower yield obtained without IL-pretreatment. Moreover, it was demonstrated that furfural and phenolic compounds were not at the level of suppressing the fermentation process

Biallelic Variants in Seven Different Genes Associated with Clinically Suspected Bardet-Biedl Syndrome

Bardet-Biedl syndrome (BBS) is a rare clinically and genetically heterogeneous autosomal recessive multi-systemic disorder with 22 known genes. The primary clinical and diagnostic features include six different hallmarks, such as rod-cone dystrophy, learning difficulties, renal abnormalities, male hypogonadism, post-axial polydactyly, and obesity. Here, we report nine consanguineous families and a non-consanguineous family with several affected individuals presenting typical clinical features of BBS. In the present study, 10 BBS Pakistani families were subjected to whole exome sequencing (WES), which revealed novel/recurrent gene variants, including a homozygous nonsense mutation (c.94C>T; p.Gln32Ter) in the IFT27 (NM_006860.5) gene in family A, a homozygous nonsense mutation (c.160A>T; p.Lys54Ter) in the BBIP1 (NM_001195306.1) gene in family B, a homozygous nonsense variant (c.720C>A; p.Cys240Ter) in the WDPCP (NM_015910.7) in family C, a homozygous nonsense variant (c.505A>T; p.Lys169Ter) in the LZTFL1 (NM_020347.4) in family D, pathogenic homozygous 1 bp deletion (c.775delA; p.Thr259Leufs*21) in the MKKS/BBS5 (NM_170784.3) gene in family E, a pathogenic homozygous missense variant (c.1339G>A; p.Ala447Thr) in BBS1 (NM_024649.4) in families F and G, a pathogenic homozygous donor splice site variant (c.951+1G>A; p?) in BBS1 (NM_024649.4) in family H, a pathogenic bi-allelic nonsense variant in MKKS (NM_170784.3) (c.119C>G; p.Ser40*) in family I, and homozygous pathogenic frameshift variants (c.196delA; p.Arg66Glufs*12) in BBS5 (NM_152384.3) in family J. Our findings extend the mutation and phenotypic spectrum of four different types of ciliopathies causing BBS and also support the importance of these genes in the development of multi-systemic human genetic disorders

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes