Zinc containing dental fixative causing copper deficiency myelopathy

A 62-year-old male, previously well, was referred to neurology clinic following 6 months history of worsening lower limbs instability, paraesthesia, pain and weakness rendering him housebound. Examination revealed upper motor neuron pattern of weakness of the lower limbs and loss of proprioception. Serum analysis revealed reduced caeruloplasmin and copper levels with raised zinc. Spinal imaging revealed subtle dorsal column intensity changes in C2-C7, confirmed with 3T MRI. A copper deficiency myeloneuropathy was diagnosed secondary to chronic use of a zinc-containing dental fixative paste. The paste was discontinued and a copper supplementation was started. Resolution of symptoms was not achieved with intensive physiotherapy. The patient remains a wheelchair user though progression of symptoms has halted. Prompt recognition and treatment of hyperzincaemia-induced hypocupraemia earlier in the disease course may have prevented any irreversible neurological deficit

First derivative prediction of raw broiler shear force using visible short wave near infrared spectroscopy

A non-destructive,fast, reliable and low cost technique which is Near-Infrared Spectroscopy (NIRS) is required to replace conventional destructive texture analyser in shear force measurement. The combination of visible and shortwave near infrared (VIS-SWNIR) spectrometer and principal component regression (PCR) to assess the quality attribute of raw broiler meat texture (shear force value (kg)) was investigated. Wavelength region of visible and shortwave 662-1005 nm was selected for prediction after pre-processing. Absorbance spectra was pre-processed using the optimal Savitzky-Golay smoothing mode with 1st order derivative, 2nd degree polynomial and 31 filter points to remove the baseline shift effect. Potential outliers were identified through externally studentised residual approach. The PCR model were trained with 90 samples in calibration and validated with 44 samples in prediction datasets. From the PCR analysis, correlation coefficient of calibration (RC), the root mean square calibration (RMSEC), correlation coefficient of prediction (RP) and the root mean square prediction (RMSEP) of visible and shortwave (662-1005 nm) with 4 principal components were 0.4645,0.0898, 0.4231 and 0.0945. The predicted results can be improved by applying the 2nd order derivative and the non-linear model

Near infrared spectroscopy (NIRS) applications in medical: non-invasive and invasive leukemia screening

Near Infrared Spectroscopy (NIRS) has been applied as analytical tool in numerous field of study due to its ability in non-invasive application. NIRS with the ability in providing the information on biological molecules shows a high potential as a diagnosis tool in medical as diseased related to biochemistry changes of the cell and tissue. This paper reviewed the application of NIR spectroscopy in leukemia screening and in other medical application. General comparison between invasive and non-invasive NIR spectroscopy method is provided. The author also proposed a new non-invasive NIRS method in leukemia screening and compared it with the previous invasive NIRS method

Applying the Bayesian Technique in Designing a Single Sampling Plan

 The Bayesian sampling plans for production inspection are considered a technique of sampling inspection techniques for determining the characteristics of the sampling plan based on the assumption that the rate of defectives is a random variable that varies from one production batch to the next, resulting in a probability distribution f(p) that could be determined based on experience and the available quality information available. As part of this study, the parameters of a single Bayesian sampling plan (n,c) were derived by using the Beta-Binomial distribution and compared with those of other single sampling plans. Researchers have identified (ALA company for soft drinks), which handles product quality control. 120 production batches were selected, and the size of the batch and the number of defective items were used to determine the proportion of defective items, given that the variable varies randomly from one production batch to the next. Bayesian and decision-making models can be implemented to create a single sampling inspection process that is close to the actual quality level. The researchers discovered that when the decision-making model was used, the sample size was minimal compared to other inspection plans, leading to a low inspection cost

Glucose detection in blood using near-infrared spectroscopy: significant wavelength for glucose detection

World Health Organization (WHO) stated in 2004, about 347 million people suffered from diabetes and from this statistic, about 3.4 million died from the complication of kidney failure, heart attack, body part amputation and adequately reported suffered from blindness. There are several non-invasive techniques in measuring the blood glucose level developed nowadays and among the popular technique is the near-infrared (NIR) measurement, ultrasonic sensor implementation, multisensory systems, absorbance of transmittance, bio-impedance, voltage intensity, and thermography. Among these techniques, there are several approaches that displayed a lot of potential, nonetheless some of them have produced unsatisfying results. The NIR technique has been applied in some of previous research, however the wavelength used vary for different researcher. There are several points of views on the significant wavelength range that contains suitable information regarding the peaks of glucose in blood. This paper is focusing on the experimental data collection using the near-infrared spectroscopy technique. This paper furthermore discussing on determine the significant peaks of glucose that is suitable to be used as the indicator of the glucose in blood. The highest significant peaks of blood glucose detected from the range around 1450nm and 1930nm

Stroke aetiological classification reliability and effect on trial sample size : systematic review, meta-analysis and statistical modelling

BackgroundInter-observer variability in stroke aetiological classification may have an effect on trial power and estimation of treatment effect. We modelled the effect of misclassification on required sample size in a hypothetical cardioembolic (CE) stroke trial.MethodsWe performed a systematic review to quantify the reliability (inter-observer variability) of various stroke aetiological classification systems. We then modelled the effect of this misclassification in a hypothetical trial of anticoagulant in CE stroke contaminated by patients with non-cardioembolic (non-CE) stroke aetiology. Rates of misclassification were based on the summary reliability estimates from our systematic review. We randomly sampled data from previous acute trials in CE and non-CE participants, using the Virtual International Stroke Trials Archive. We used bootstrapping to model the effect of varying misclassification rates on sample size required to detect a between-group treatment effect across 5000 permutations. We described outcomes in terms of survival and stroke recurrence censored at 90days.ResultsFrom 4655 titles, we found 14 articles describing three stroke classification systems. The inter-observer reliability of the classification systems varied from fair' to very good' and suggested misclassification rates of 5% and 20% for our modelling. The hypothetical trial, with 80% power and alpha 0.05, was able to show a difference in survival between anticoagulant and antiplatelet in CE with a sample size of 198 in both trial arms. Contamination of both arms with 5% misclassified participants inflated the required sample size to 237 and with 20% misclassification inflated the required sample size to 352, for equivalent trial power. For an outcome of stroke recurrence using the same data, base-case estimated sample size for 80% power and alpha 0.05 was n=502 in each arm, increasing to 605 at 5% contamination and 973 at 20% contamination.ConclusionsStroke aetiological classification systems suffer from inter-observer variability, and the resulting misclassification may limit trial power.Trial registrationProtocol available at reviewregistry540.Peer reviewe

Stroke and the heart: A focus on atrial fibrillation and heart failure

Cardio-embolic stroke accounts for nearly a third of all ischaemic strokes. The most clinically important cardio-embolic sources are non-valvular atrial fibrillation (AF) and chronic heart failure. Strokes due to these conditions are associated with greater disability and more mortality, as compared to stroke of other aetiology. This thesis is aimed at addressing some of the challenges faced by clinicians when dealing with stroke in patients with AF or heart failure, using an extensive range of historical data. Chapter 1 provides an introduction to stroke, AF and heart failure, including current prevalences, aetiology, and their complex intertwine relationship. The current acute stroke management in patients with AF or heart failure is also outlined within the chapter. In chapter 2, the data sources and statistical methods that were common to the studies in the thesis are outlined. The justifications of using historical data in the absence of evidence from robust clinical trials are also detailed. Chapter 3 explores the relevance of antithrombotic treatment on patterns and outcomes of acute stroke patients with AF. A non-randomised cohort analysis was conducted using data from the Virtual International Stroke Trials Archive (VISTA). The associations of antithrombotic treatment with the modified Rankin scale (mRS) outcome, and the occurrence of recurrent stroke and symptomatic intracerebral haemorrhage, at 90 days after stroke were described. Combined sequential antithrombotic therapy (i.e. oral anticoagulant and antiplatelet treatment), was associated with favourable outcome on ordinal mRS and significantly lower risk of recurrent stroke, symptomatic intracerebral haemorrhage and mortality by day 90, compared to the patients who did not receive any antithrombotic treatment. The relative-risk of recurrent stroke and symptomatic intracerebral haemorrhage appeared highest in the first 2 days after stroke before attenuating to become constant over time. Thus, early introduction of oral anticoagulant treatment (2-3 days after stroke), and to a lesser extent antiplatelet agents, was associated with substantially fewer recurrent stroke events over the following weeks but with no excess risk of symptomatic intracerebral haemorrhage. Chapter 4 seeks to describe the current prescribing patterns in stroke survivors with AF, with particular emphasis on socio-demographic associations. A cross-sectional analysis of city-wide Glasgow primary care data for the year 2010, was conducted. This chapter highlights that oral anticoagulant treatment was under-used in this high risk population, especially those of older age and affected by deprivation. Strategies need to be developed to improve prescription of oral anticoagulant treatment. Chapter 5 investigates the incidence of stroke within the available heart failure trials spanning a 30 year period, according to AF status at baseline. Individual patient data were pooled from 11 trials conducted in patients with heart failure and reduced ejection fraction (HF-REF); and, 3 trials performed in patients with heart failure and preserved ejection fraction (HF-PEF). Stroke incidence has not significantly declined over time in patients with HF-REF enrolled to trials, despite greater use of evidence-based heart failure and oral anticoagulant therapies. However, anticoagulation proportions remain under 70% among HF-REF patients with documented AF. Similar trends of stroke incidence were observed for patients enrolled in HF-PEF trials. Some patients with heart failure but without atrial fibrillation may be at high risk of stroke and may potentially benefit from oral anticoagulant treatment. Chapter 6 provides a comprehensive description of the current incidence of and risk factors for stroke in patients with HF-REF but without AF. Data from two large and contemporary heart failure trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiac- Heart Failure trial (GISSI-HF), were pooled to enable the analysis. The new simple clinical predictive model for stroke showed that about one-third of patients without AF have a risk of stroke similar to patients with AF. The predictive model was also validated in an independent large data set. The high risk of stroke in patients without AF might be reduced by individualised and safer oral anticoagulant treatment. Correspondingly, Chapter 7 explores the risk-model for stroke in a contemporary cohort of patients with HF-PEF but without AF. Data were pooled from the Candesartan in Heart failure Assessment of Reduction in Mortality and Morbidity- Preserved trial (CHARM-Preserved) and the Irbesartan in Heart Failure with Preserved Systolic Function trial (I-Preserve), for patients with ejection fraction ≥45% only. The analysis showed that the simple clinical model developed in Chapter 6, for patients with HF-REF, is also applicable to patients with HF-PEF. There are concerns that systemic thrombolysis might not achieve clinically-important outcome among chronic heart failure patients with acute ischaemic stroke. Chapter 8 evaluates the relevance of chronic heart failure on the outcome of acute stroke patients who received thrombolysis. A non-randomised cohort analysis was conducted using data obtained from the Virtual International Stroke Trials Archive (VISTA). The associations of outcome among chronic heart failure patients with thrombolysis treatment using the mRS distribution at day 90, stratified by presence of AF, were evaluated. Chronic heart failure was associated with a worse outcome with or without thrombolysis. However, acute stroke patients who received thrombolysis had more favourable outcome regardless of heart failure status, compared to their untreated peers. The findings should reassure clinicians considering systemic thrombolysis treatment in hyper-acute ischaemic stroke patients with chronic heart failure. This thesis has summarised and extended our knowledge of the complex relationship between stroke and the heart, focusing on atrial fibrillation and heart failure. It has answered many questions and generated many more. The reported studies may assist clinicians who are dealing with stroke in patients with atrial fibrillation or heart failure. These conditions are common and each carry poor prognosis. Thus, even small advances in their treatment may have a useful societal impact

Molecular characterization (PCR-Based Methods) of Staphylococcus aureus isolated on dogs and cats

A total of 36 isolates of Staphylococcus aureus from hospitalised and out patient dogs and cats were typed by RAPD-PCR, and 36 isolates were selected for further typing by ERIC-PCR and Coagulase gene-PCR and Coagulase gene RFLP, indicating a low degree of polymorphism in the coagulase genes. In this study, it is noticeable that RAPD-PCR displayed desirable typing quality by its ability to group the apparently related isolates from outpatient and hospitalised cats and dogs, whereas ERIC-PCR has the tendency to group the isolates into a single major cluster

SDS PAGE OF WHOLE CELL PROTEIN, IMMUNOBLOTTING AND PROTEIN A ASSAY FOR TYPING OF STAPHYLOCOCCUS AUREUS ISOLATED ON DOGS AND CATS

A total of 36 isolates of Staphylococcus aureus from hospitalised and out patient dogs and cats were typed using SDS PAGE of whole cell protein, immunoblotting and protein A assayment by ELISA test. 15/24 and 14/24 profiles were recognised using SDS PAGE and immunoblotting respectively. It is concluded that SDS PAGE of whole cell protein and immunoblotting could be used as a typing methods for the characterisation of S. aureus strains. Protein A assayment could be used for the detection of S. aureus strains in samples but could not be used to differentiate between different strains. &nbsp