Fetal central nervous system development and alcohol - The evidence so far

This is the Author’s Original Manuscript of an article published by Taylor & Francis in Fetal and Pediatric Pathology on 23 March 2012 , available online: http://www.tandfonline.com/10.3109/15513815.2012.659398 Currently in the UK, there is no absolute guidance about alcohol consumption in pregnancy. The guidance for drinking during pregnancy is one or two units of alcohol one or two times weekly, but conservative advice is to abstain as a cautionary measure 1. Despite the lack of consensus about the safe levels of alcohol consumption in pregnancy, there is increasing evidence of the impact of alcohol on the developing central nervous system. This article explores the evidence regarding alcohol consumption and its effects on the developing fetal central nervous system. Copyright © Informa Healthcare USA, Inc

Role of plant growth regulators in preservation of Pyrus germplasm in vitro

In vitro established shoots of nine pear genotypes namely; Khurolli, Bagugosha, Pathar nakh, Desi nakh, Kotharnul, Btangi, Frashishi, Kashmiri nakh, and Raj btung, were preserved by lowering concentration of growth regulators [(0.00, 0.25 or 0.50mg l-1 6-benzyaminopurine (BAP) or adding growth retardants, 10 mg L-1 Alar (diaminazide or B-9), or abscisic acid (ABA)] in the culture medium. The cultures were assessed for their survival and regenerability percentages after 3, 6, 9 and 12 months of storage. The genotypes differed significantly for survival and regeneration percentage. The culture medium supplemented with 0.50 mg L-1 BAP was comparatively more effective and resulted in higher survival rate and re-growth after transferring onto the fresh medium. Storage for short duration (3 months) resulted in significantly higher survival and regeneration rates than other storage periods. As storage period was prolonged, survival and regenerability of shoots progressively decreased. Overall results indicated that the shoots of Desi nakh had the highest survival (73.33 %) and Pathar nakh showed the maximum regenerability (67.66 %) when cultured on the medium supplemented with 0.50 mg L-1 BAP and stored for 3 months. However, no shoots of Kotharnul survived when cultured on the medium without any growth regulator and kept for 12 months.Key words: Growth retardants, in vitro preservation, pear genotypes, slow growth

Malignant gliomas: Current perspectives in diagnosis, treatment, and early response assessment using advanced quantitative imaging methods

Malignant gliomas consist of glioblastomas, anaplastic astrocytomas, anaplastic oligodendrogliomas and anaplastic oligoastrocytomas, and some less common tumors such as anaplastic ependymomas and anaplastic gangliogliomas. Malignant gliomas have high morbidity and mortality. Even with optimal treatment, median survival is only 12-15 months for glioblastomas and 2-5 years for anaplastic gliomas. However, recent advances in imaging and quantitative analysis of image data have led to earlier diagnosis of tumors and tumor response to therapy, providing oncologists with a greater time window for therapy management. In addition, improved understanding of tumor biology, genetics, and resistance mechanisms has enhanced surgical techniques, chemotherapy methods, and radiotherapy administration. After proper diagnosis and institution of appropriate therapy, there is now a vital need for quantitative methods that can sensitively detect malignant glioma response to therapy at early follow-up times, when changes in management of nonresponders can have its greatest effect. Currently, response is largely evaluated by measuring magnetic resonance contrast and size change, but this approach does not take into account the key biologic steps that precede tumor size reduction. Molecular imaging is ideally suited to measuring early response by quantifying cellular metabolism, proliferation, and apoptosis, activities altered early in treatment. We expect that successful integration of quantitative imaging biomarker assessment into the early phase of clinical trials could provide a novel approach for testing new therapies, and importantly, for facilitating patient management, sparing patients from weeks or months of toxicity and ineffective treatment. This review will present an overview of epidemiology, molecular pathogenesis and current advances in diagnoses, and management of malignant gliomas. © 2014 Ahmed et al

Clinical Predictors and Outcome of Metabolic Acidosis in Under-Five Children Admitted to an Urban Hospital in Bangladesh with Diarrhea and Pneumonia

BACKGROUND: Clinical features of metabolic acidosis and pneumonia frequently overlap in young diarrheal children, resulting in differentiation from each other very difficult. However, there is no published data on the predictors of metabolic acidosis in diarrheal children also having pneumonia. Our objective was to evaluate clinical predictors of metabolic acidosis in under-five diarrheal children with radiological pneumonia, and their outcome. METHODS: We prospectively enrolled all under-five children (n = 164) admitted to the Special Care Ward (SCW) of the Dhaka Hospital of icddr, b between September and December 2007 with diarrhea and radiological pneumonia who also had their total serum carbon-dioxide estimated. We compared the clinical features and outcome of children with radiological pneumonia and diarrhea with (n = 98) and without metabolic acidosis (n = 66). RESULTS: Children with metabolic acidosis more often had higher case-fatality (16% vs. 5%, p = 0.039) compared to those without metabolic acidosis on admission. In logistic regression analysis, after adjusting for potential confounders such as age of the patient, fever on admission, and severe wasting, the independent predictors of metabolic acidosis in under-five diarrheal children having pneumonia were clinical dehydration (OR 3.57, 95% CI 1.62-7.89, p = 0.002), and low systolic blood pressure even after full rehydration (OR 1.02, 95% CI 1.01-1.04, p = 0.005). Proportions of children with cough, respiratory rate/minute, lower chest wall indrawing, nasal flaring, head nodding, grunting respiration, and cyanosis were comparable (p>0.05) among the groups. CONCLUSION AND SIGNIFICANCE: Under-five diarrheal children with radiological pneumonia having metabolic acidosis had frequent fatal outcome than those without acidosis. Clinical dehydration and persistent systolic hypotension even after adequate rehydration were independent clinical predictors of metabolic acidosis among the children. However, metabolic acidosis in young diarrheal children had no impact on the diagnostic clinical features of radiological pneumonia which underscores the importance of early initiation of appropriate antibiotics to combat morbidity and deaths in such population

Assessing short-term economic consequences of cow-calf contact systems in dairy production using a stochastic partial budgeting approach

Introduction: While early separation of dairy calves after birth has been debated from an ethical and animal welfare lens, the economic evidence surrounding alternative cow-calf contact (CCC) systems is scarce.Methods: To address this knowledge gap, we assessed the economic consequences of CCC systems using data from the Agri wise database as well as parameters from published literature in a stochastic partial budget model. Theimplementation of CCC is very diverse between farms, so in our study wetherefore selected a limited number of CCC systems to assess. The examinedCCC systems were: (i) dam rearing with limited contact at milking (15 minutestwice a day for 115 days) with no manual milk feeding; (ii) dam rearing with 21-dayfull contact, after which calves are manually fed 8 kg of whole milk for 94 days; and (iii) mixed calf rearing with using both dams and foster cows with full contact; calves are initially kept with their dams and then moved to foster cows at 9 daysof age.Results: We found that adoption of CCC systems was associated with decreases in contribution margins in the range of 1 to 5.4%, as compared to a rearing system here the calves were separated from their dams after one day and were that differences in milk sales, assumptions on changes in labor requirements, and changes in daily calf weight gain depending on CCC system were the main variables that governed the net impact on the contribution margins.Discussion: We did not include building costs in the analyses assuming that barn tructures may not change in the short-term. The study focused only on short-term pecuniary associations between changes in CCC systems and contribution margins. To strengthen the economic decision-making around CCC systems, future research should consider non-monetary impacts of different CCC systems, as well as long-term economic impacts of these production strategies manually fed 8 kg of milk for 12 weeks. These results illustrated that the costs associated with CCC systems may be fairly high under certain circumstances and may prohibit farmers from adopting this practice. Sensitivity analysis suggeste

Evaluation of early and late presentation of patients with ocular mucous membrane pemphigoid to two major tertiary referral hospitals in the United Kingdom

PURPOSE: Ocular mucous membrane pemphigoid (OcMMP) is a sight-threatening autoimmune disease in which referral to specialists units for further management is a common practise. This study aims to describe referral patterns, disease phenotype and management strategies in patients who present with either early or established disease to two large tertiary care hospitals in the United Kingdom.\ud \ud PATIENTS AND METHODS: In all, 54 consecutive patients with a documented history of OcMMP were followed for 24 months. Two groups were defined: (i) early-onset disease (EOD:<3 years, n=26, 51 eyes) and (ii) established disease (EstD:>5 years, n=24, 48 eyes). Data were captured at first clinic visit, and at 12 and 24 months follow-up. Information regarding duration, activity and stage of disease, visual acuity (VA), therapeutic strategies and clinical outcome were analysed.\ud \ud RESULTS: Patients with EOD were younger and had more severe conjunctival inflammation (76% of inflamed eyes) than the EstD group, who had poorer VA (26.7%=VA<3/60, P<0.01) and more advanced disease. Although 40% of patients were on existing immunosuppression, 48% required initiation or switch to more potent immunotherapy. In all, 28% (14) were referred back to the originating hospitals for continued care. Although inflammation had resolved in 78% (60/77) at 12 months, persistence of inflammation and progression did not differ between the two phenotypes. Importantly, 42% demonstrated disease progression in the absence of clinically detectable inflammation.\ud \ud CONCLUSIONS: These data highlight that irrespective of OcMMP phenotype, initiation or escalation of potent immunosuppression is required at tertiary hospitals. Moreover, the conjunctival scarring progresses even when the eye remains clinically quiescent. Early referral to tertiary centres is recommended to optimise immunosuppression and limit long-term ocular damage.\ud \u

UK medical students' perceptions, attitudes, and interest toward medical leadership and clinician managers

Background: We aimed to determine UK medical students’ perceptions and attitudes and interest toward medical leadership and clinician managers. Methods: A cross-sectional study was conducted during the academic year 2015–2016. An online questionnaire was distributed to 2,349 final-year students from 10 UK medical schools. Participants were asked to complete a 5-point Likert scale on their current perceptions, attitudes, and interest toward medical leadership and clinician managers. They were also asked to self-rate their leadership competences set by the Medical Leadership Competency Framework and to rate the quality of management and leadership training they received from their medical school. Results: In total, we received 114 complete responses. Only 7.9% of respondents were in agreement (strongly agree or agree) when asked whether they felt they were well informed about what a managerial position in medicine entails. When asked whether clinicians should influence managerial decisions within a clinical setting, 94.7% of respondents were in agreement with the statement. About 85% of respondents were in agreement that it is important for clinicians to have managerial or leadership responsibilities, with 63.2% of students in agreement that they would have liked more management or leadership training during medical school. Over half the respondents rated their management and leadership training they received during medical school as “very poor” or “poor” (54.4%). Conclusion: Our study suggests that UK medical students have an appetite for management and leadership training and appreciate its importance but feel that the training they are receiving is poor. This suggests that there is a gap between the demand for management and leadership training and the quality of training supplied by UK medical schools

Comparison of the airway microbiota in children with chronic suppurative lung disease

Rationale: The airway microbiota is important in chronic suppurative lung diseases (CSLD), such as primary ciliary dyskinesia (PCD) and cystic fibrosis (CF). This comparison has not previously been described but is important because difference between the two diseases may relate to the differing prognoses and lead to pathological insights and potentially, new treatments. Objectives: To compare the longitudinal development of the airway microbiota in children with PCD to that of CF and relate this to age and clinical status. Methods: Sixty-two age-matched children (age range 0.5–17 years) with PCD or CF (n=31 in each group) were recruited prospectively and followed for 1.1 years. Throat swabs or sputum as well as clinical information were collected at routine clinical appointments. 16S rRNA gene sequencing was performed. Measurements and Main Results: The microbiota was highly individual and more diverse in PCD and differed in community composition when compared with CF. Whilst Streptococcus was the most abundant genus in both conditions, Pseudomonas was more abundant in CF with Haemophilus more abundant in PCD (Padj=0.0005). In PCD only, an inverse relationship was seen in the relative abundance of Streptococcus and Haemophilus with age. Conclusions: Bacterial community composition differs between children with PCD and those with CF. Pseudomonas is more prevalent in CF and Haemophilus in PCD, at least until infection with Pseudomonas supervenes. Interactions between organisms, particularly members of Haemophilus, Streptococcus, and Pseudomonas genera appear important. Study of the interactions between these organisms may lead to new therapies or risk stratification