Ustekinumab as Induction and Maintenance Therapy for Crohn’s Disease

BACKGROUND Ustekinumab, a monoclonal antibody to the p40 subunit of interleukin-12 and inter-leukin-23, was evaluated as an intravenous induction therapy in two populations with moderately to severely active Crohn’s disease. Ustekinumab was also evaluated as subcutaneous maintenance therapy. METHODS We randomly assigned patients to receive a single intravenous dose of ustekinumab (either 130 mg or approximately 6 mg per kilogram of body weight) or placebo in two induction trials. The UNITI-1 trial included 741 patients who met the criteria for primary or secondary nonresponse to tumor necrosis factor (TNF) antagonists or had unacceptable side effects. The UNITI-2 trial included 628 patients in whom conventional therapy failed or unacceptable side effects occurred. Patients who completed these induction trials then participated in IM-UNITI, in which the 397 patients who had a response to ustekinumab were randomly assigned to receive subcutaneous maintenance injections of 90 mg of ustekinumab (either every 8 weeks or every 12 weeks) or placebo. The primary end point for the induction trials was a clinical response at week 6 (defined as a decrease from baseline in the Crohn’s Disease Activity Index [CDAI] score of ≥100 points or a CDAI score <150). The primary end point for the maintenance trial was remission at week 44 (CDAI score <150). RESULTS The rates of response at week 6 among patients receiving intravenous ustekinumab at a dose of either 130 mg or approximately 6 mg per kilogram were significantly higher than the rates among patients receiving placebo (in UNITI-1, 34.3%, 33.7%, and 21.5%, respectively, with P≤0.003 for both comparisons with placebo; in UNITI-2, 51.7%, 55.5%, and 28.7%, respectively, with P<0.001 for both doses). In the groups receiving maintenance doses of ustekinumab every 8 weeks or every 12 weeks, 53.1% and 48.8%, respectively, were in remission at week 44, as compared with 35.9% of those receiving placebo (P = 0.005 and P = 0.04, respectively). Within each trial, adverse-event rates were similar among treatment groups. CONCLUSIONS Among patients with moderately to severely active Crohn’s disease, those receiving intravenous ustekinumab had a significantly higher rate of response than did those receiving placebo. Subcutaneous ustekinumab maintained remission in patients who had a clinical response to induction therapy. (Funded by Janssen Research and Development; ClinicalTrials.gov numbers, NCT01369329, NCT01369342, and NCT01369355.

Ficus nitida L . THE EFFECT SUN LIGHT INTENSITY AND CUTTING TYPE IN ROOTING ABILITY

This study was carried out to investigate the effect of cutting type and sun light exposure. Terminal middle and basal cuttings were taken from upwar dowrward shoots. Based on results obtained , the medial cuttings and sun light exposure significantly exceeded by increasing rooting percentage(3.67 , 3.33)% roots length (12.77, 11.2) cm, chlorophyll percentage (22.7, 23.7)% ,leaves number (7.11, 6.92) leaf/plant and shoots number (2.77 , 2.47 )shot/plant , respectively Moreover , the interaction between medial cutting and sunlight exposure significantly increased rooting and vegetative growth characteristics

Physiological and Molecular Study for Uromodulin Gene Effect and its Relation with Recurrent UTI in Sample of Anbar Province Females

The current study Included (100) women suffering from recurrent infection of the urinary tract revisions for hospitals and civil laboratories in Anbar province, the category of age among women (10-50 years), in addition to (40) women do not have any history of infection in the same age group as a control sample for comparison. The study achieved in period between 03/09/2013 to 27/12/2014 .The highest recorded rate of infection in the age ranged between (21-35 years) (48%), also the high incidence observed were among married women (62%), and most infection were in women of villages and rural areas(67%). The current study involved measuring the level of concentration of Tamm horsfall protein (THP) the study showed a significant decrease at P≤0.05 in (43%) and the rate of individuals (6.2 ± 38.3) Ng / ml compared with control sample, which was (7.4 ± 256.2) Ng / ml. The study also included molecular tests (for women suffering from UTI and THP concentration disorders) using Polymerase Chain Reaction technique and using three specific primers for the detection of any trouble in Uromodulin gene and its relationship to UTI. The results showed a significant increase P≤0.05 for the study sample represents (24,19,18) absence time of primers bands in some cases to appear different bands from the expected size compared with the control sample that did not show any of the previous cases

A comparative signaling cost analysis of macro mobility scheme in NEMO with mobility management protocol

NEMO BSP is an upgraded addition to Mobile IPv6 (MIPv6). As MIPv6 and its enhancements (i.e. HMIPv6) possess some limitations like higher handoff latency, packet loss, NEMO BSP also faces all these shortcomings by inheritance. Network Mobility (NEMO) is involved to handle the movement of Mobile Router (MR) and it’s Mobile Network Nodes (MNNs) during handoff. Hence it is essential to upgrade the performance of mobility management protocol to obtain continuous session connectivity with lower delay and packet loss in NEMO environment. The completion of handoff process in NEMO BSP usually takes longer period since MR needs to register its single primary care of address (CoA) with home network that may cause performance degradation of the applications running on Mobile Network Nodes. Moreover, when a change in point of attachment of the mobile network is accompanied by a sudden burst of signaling messages, "Signaling Storm" occurs which eventually results in temporary congestion, packet delays or even packet loss. This effect is particularly significant for wireless environment where a wireless link is not as steady as a wired link since bandwidth is relatively limited in wireless link. Hence, providing continuous Internet connection without any interruption through applying multihoming technique and route optimization mechanism in NEMO are becoming the center of attention to the current researchers. In this paper, we propose a handoff cost model to compare the signaling cost of MM-NEMO with NEMO Basic Support Protocol (NEMO BSP) and HMIPv6.The numerical results shows that the signaling cost for the MM-NEMO scheme is about 69.6 % less than the NEMO-BSP and HMIPv6

Effect of spraying humic acid and potassium fertilization on growth and yield of lettuce plant Lsuctuca Sativa L

A field experiment was conducted in &nbsp;season 2019-2020 to study the effect of different levels &nbsp;fertilization using humic acid and potassium on the growth of &nbsp;lettuce plant. The experiment was conducted according to Complete Randomized Blocks Design(RCBD) and with two factors: the first is the ground fertilization factor using compound fertilization with levels of 200, 100 and 50 kg /ha and the second factor is foliar fertilization with humic acid with three concentrations (50, 25 and 12.5 ppm).&nbsp; The results showed &nbsp;increased in &nbsp;root length, wet, dry weight and chlorophyll content &nbsp;with higher values reached (16.1 and 16.7 / g), (97.7 and 101.1 / cm) ,(11.9 and 10.6 / g) and (76.52 and 70) using treatment&nbsp; 200 kg / ha &nbsp;potassium and 50 ppm humic acid respectively. While the lowest rates were recorded with control treatment for all treatment. Vegetative characteristics recorded same response for &nbsp;fertilization with level of 200 kg / ha and 50 ppm, the highest averages for stem length, leaf area, head diameter, head weight and head diameter with values (44.5 and 47.7), (8114 and 7255), (72.4 and 67.5), (1123 and 3.781) and (4.72 and 5.67) / c

Effect of Spraying Humic Acid and Potassium Fertilization on Growth and Yield of Lettuce Plant Lsuctuca Sativa L

A field experiment was conducted in &nbsp;season 2019-2020 to study the effect of different levels &nbsp;fertilization using humic acid and potassium on the growth of &nbsp;lettuce plant. The experiment was conducted according to Complete Randomized Blocks Design(RCBD) and with two factors: the first is the ground fertilization factor using compound fertilization with levels of 200, 100 and 50 kg /ha and the second factor is foliar fertilization with humic acid with three concentrations (50, 25 and 12.5 ppm).&nbsp; The results showed &nbsp;increased in &nbsp;root length, wet, dry weight and chlorophyll content &nbsp;with higher values reached (16.1 and 16.7 / g), (97.7 and 101.1 / cm) ,(11.9 and 10.6 / g) and (76.52 and 70) using treatment&nbsp; 200 kg / ha &nbsp;potassium and 50 ppm humic acid respectively. While the lowest rates were recorded with control treatment for all treatment. Vegetative characteristics recorded same response for &nbsp;fertilization with level of 200 kg / ha and 50 ppm, the highest averages for stem length, leaf area, head diameter, head weight and head diameter with values (44.5 and 47.7), (8114 and 7255), (72.4 and 67.5), (1123 and 3.781) and (4.72 and 5.67) / c

Framework for assessing governance of the health system in developing countries: Gateway to good governance

Governance is thought to be a key determinant of economic growth, social advancement and overall development, as well as for the attainment of the MDGs in low- and middle-income countries. Governance of the health system is the least well-understood aspect of health systems. A framework for assessing health system governance (HSG) at national and sub-national levels is presented, which has been applied in countries of the Eastern Mediterranean. In developing the HSG framework key issues considered included the role of the state vs. the market; role of the ministries of health vs. other state ministries; role of actors in governance; static vs. dynamic health systems; and health reform vs. human rights-based approach to health. Four existing frameworks were considered: World Health Organization's (WHO) domains of stewardship; Pan American Health Organization's (PAHO) essential public health functions; World Bank's six basic aspects of governance; and United Nations Development Programme (UNDP) principles of good governance. The proposed HSG assessment framework includes the following 10 principles--strategic vision, participation and consensus orientation, rule of law, transparency, responsiveness, equity and inclusiveness, effectiveness and efficiency, accountability, intelligence and information, and ethics. The framework permits 'diagnoses of the ills' in HSG at the policy and operational levels and points to interventions for its improvement. In the case of Pakistan, where the framework was applied, a positive aspect was the growing participation and consensus orientation among stakeholders, while weaknesses were identified in relation to strategic vision, accountability, transparency, effectiveness and efficiency and rule of law. In using the HSG framework it needs to be recognized that the principles are value driven and not normative and are to be seen in the social and political context; and the framework relies on a qualitative approach and does not follow a scoring or ranking system. It does not directly address aid effectiveness but provides insight on the ability to utilize external resources and has the ability to include the effect of global health governance on national HSG as the subject itself gets better crystallized. The improved performance of the ministries of health and state health departments is at the heart of this framework. The framework helps raise the level of awareness among policymakers of the importance of HSG. The road to good governance in health is long and uneven. Assessing HSG is only the first step; the challenge that remains is to carry out effective governance in vastly different institutional contexts.Governance Health system Assessment framework

A global perspective on irritable bowel syndrome: a consensus statement of the world gastroenterology organisation summit task force on irritable bowel syndrome

Irritable bowel syndrome (IBS) is common in western Europe and North America, and many aspects of its epidemiology, risk factors, and natural history have been described in these regions. Recent data suggest, however, that IBS is also common in the rest of the world and there has been some evidence to suggest some differences in demographics and presenting features between IBS in the west and as it is experienced elsewhere. The World Gastroenterology Organization, therefore, established a Task Force comprising experts on the topic from all parts of the world to examine IBS from a global perspective. IBS does, indeed, seem to be common worldwide though with some significant variations in prevalence rates between regions and countries and there may well be some potentially interesting variations in presenting symptoms and sex distribution. The global map of IBS is far from complete; community-based prevalence data is not available from many areas. Furthermore, while some general trends are evident in terms of IBS impact and demographics, international comparisons are hampered by differences in diagnostic criteria, study location and methodology; several important unanswered questions have been identified that should form the basis for future collaborative research and have the potential to shed light on this challenging disorder