A Visit to Jakarta’s Bayt al-Qur’an

Nearly one hundred years ago the Dutch scholar C. Snouck Hurgronje, writing in the Netherlands Indies, published his article 'Islam and phonography' in which he described a contemporary interest in recordings of suras of the Qur'an made available for the phonograph. At the time, this innovation caused both interest and debate among Muslim scholars as to whether the use of this medium was Islamic, although it soon became accepted. The phonograph was later succeeded by the audiocassette. Now there are many interactive products available for the computer-literate Muslim- from various indexed and hyper-linked Qur'ans accessible through the internet, to CD-ROM packages designed for users who wish to learn to recite the Qur'an at home. Perhaps the most astounding aspect of the CD-ROM is its capacity to join the visual and aural experiences of the Qur'an. Yet, like its bakelite predecessor, the CDROM has evoked a modern debate over the application of such technology and the Islamic qualifications of its creators

Should we abandon the APTT for monitoring unfractionated heparin?

INTRODUCTION: The activated partial thromboplastin time (APTT) is commonly used to monitor unfractionated heparin (UFH) but may not accurately measure the amount of heparin present. The anti-Xa assay is less susceptible to confounding factors and may be a better assay for this purpose. MATERIALS AND METHODS: The validity of the APTT for monitoring UFH was assessed by comparing with an anti-Xa assay on 3543 samples from 475 patients (infants [n=165], children 1-15years [n=60] and adults [n=250]) receiving treatment dose UFH. RESULTS: Overall concordance was poor. The highest concordance (66%; 168/254) was seen in children. Concordance (51.8%) or discordance (48.4%) was almost equal in adult patients. Among adult patients whose anti-Xa level was within 0.3-0.7IU/mL, only 38% had an APTT in the therapeutic range whilst 56% were below and 6% were above therapeutic range. Children and adult patients with anti-Xa of 0.3-0.7IU/mL but sub- therapeutic APTT had significantly higher fibrinogen levels compared to those with therapeutic or supra-therapeutic APTT. CONCLUSIONS: When the anti-Xa level was 0.3-0.7IU/mL, the majority of samples from infants demonstrated a supra-therapeutic APTT, whilst adults tended to have a sub-therapeutic APTT. This may lead to under anticoagulation in infants or over anticoagulation in adults with risk of bleeding if APTT is used to monitor UFH. These results further strengthen existing evidence of the limitation of APTT in monitoring UFH. Discordance of APTT and anti-Xa level in adults and children may be due to elevation of fibrinogen level

What is the appropriate anticoagulation strategy for thrombotic antiphospholipid syndrome?

Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disorder mediated by a heterogeneous group of autoantibodies collectively known as antiphospholipid antibodies (aPL). They include lupus anticoagulant (LA), IgG and IgM anticardiolipin antibodies (aCL) and anti‐β2‐glycoprotein I (anti‐β2GPI) antibodies. It has been shown that those patients with all three aPL (triple positive) are at highest risk of both a first thrombotic event and of a recurrence, despite anticoagulation. In response to publication of a meta‐analysis and a randomised controlled trial assessing the safety and efficacy of rivaroxaban versus warfarin in triple‐positive APS with venous and/or arterial thrombosis, the Medicines and Healthcare Products Regulatory Agency (MHRA) and European Medicines Agency (EMA) issued recommendations that direct‐acting oral anticoagulant (DOACs) should not be used for secondary prevention of thrombosis in all APS patients (although they did draw specific attention to the high risk of triple‐positive patients). As there is less evidence for patients with single‐ or dual‐positive patients with APS, this may be an over‐interpretation of the data. In this review, we explore the available evidence on safety and efficacy of DOACs in thrombotic APS, the problem of detecting LA while on DOAC, and provide some practical guidance for managing this problem

Respiratory patient experience of measures to reduce risk of COVID-19: findings from a descriptive cross-sectional UK wide survey

Objectives: To assess the experience of people with long-term respiratory conditions regarding the impact of measures to reduce risk of COVID-19. Design: Analysis of data (n=9,515) from the Asthma UK and British Lung Foundation partnership COVID-19 survey collected online between 1st and 8th of April 2020. Setting: Community Participants: 9,515 people with self-reported long term respiratory conditions. 81% female, age ranges from <17 years to 80 and above, from all nations of the UK. Long term respiratory conditions reported included asthma (83%), Chronic Obstructive Pulmonary Disease (COPD) (10%), bronchiectasis (4%), Interstitial Lung Disease (ILD) (2%), and ‘other’ (<1%) (e.g. lung cancer and pulmonary endometriosis). Outcome measures: Study responses related to impacts on key elements of health care, as well as practical, psychological and social consequences related to the COVID-19 pandemic and social distancing measures. Results: 45% reported disruptions to care, including cancellations of appointments, investigations, pulmonary rehabilitation, treatment, and monitoring. Other practical impacts such as difficulty accessing healthcare services for other issues, and getting basic necessities such as food, were also common. 36% did not use online prescriptions and 54% had not accessed online inhaler technique videos. Psycho-social impacts including anxiety, loneliness and concerns about personal health and family were prevalent. 81% reported engaging in physical activity. Among the 11% who were smokers, 48% reported they were planning to quit smoking because of COVID-19. Conclusions: COVID-19 and related social distancing measures are having profound impacts on people with chronic respiratory conditions. Urgent adaptation and signposting of services is required to mitigate the negative health consequences of the COVID-19 response for this group

Impact of thromboprophylaxis on hospital acquired thrombosis following discharge in patients admitted with COVID-19: multicentre observational study in the UK

Post-discharge thromboprophylaxis in patients admitted with COVID-19 remains controversial. We aimed to determine the impact of thromboprophylaxis on hospital acquired thrombosis (HAT) in patients (≥18 years) discharged following admission for COVID-19 in an observational study across 26 NHS Trusts in the UK (01.04.2020-31.12.2021). Overall, 8895 patients were included to the study: 971 patients were discharged with thromboprophylaxis and propensity score matched (PSM) with a desired ratio of 1:1, from patients discharged without thromboprophylaxis. Patients with heparin induced thrombocytopenia, major bleeding during admission and pregnant women were excluded. As expected from 1:1 PSM, no difference was observed in parameters between the two groups, including duration of hospital stay, except the thromboprophylaxis group had a significantly higher proportion who had received therapeutic dose anticoagulation during admission. There were no differences in the laboratory parameters especially D-dimers between the two groups at admission or discharge. Median duration of thromboprophylaxis following discharge from hospital was 4 weeks (1-8 weeks). No difference was found in HAT in patients discharged with TP versus no TP (1.3% vs. 0.92%, p = 0.52). Increasing age and smoking significantly increased the risk of HAT. Many patients in both cohorts had raised D-dimer at discharge but D-dimer was not associated with increased risk of HAT

A hairy situation: Plant species in warm, sunny places are more likely to have pubescent leaves

Aim: Leaf pubescence has several important roles, including regulating heat balance, reducing damage from UV radiation, minimizing water loss and reducing herbivory. Each of these functions could affect a plant's ability to tolerate the biotic and abiotic stresses encountered in different parts of the world. However, we know remarkably little about large scale biogeographic patterns in leaf pubescence. Our aims were: (a) to determine whether a higher proportion of species have pubescence at sites where it is hot, dry and solar radiation is high, and (b) to quantify the latitudinal gradient in pubescence. Location: Australia. Taxon: Vascular land plants. Methods: We compiled data on the presence/absence of pubescence on mature photosynthetic organs for 4,183 species, spanning 107 families. We combined these data with over 1.9 million species occurrence records from the Atlas of Living Australia to calculate the proportion of species with pubescence in 3,261 grid cells spanning the Australian continent. Results: The proportion of pubescent species was most closely related to solar radiation (R2 = 0.33), followed by maximum temperature in the warmest month (R2 = 0.30). Mean annual precipitation was very weakly related to pubescence (R2 = 0.01). We found a significant negative relationship between latitude and pubescence (R2 = 0.19), with the average percentage of species with pubescence dropping from 46% at 10° S to 35% at 44° S. This cross-species relationship remained significant after accounting for phylogenetic relationships between species. We found that a quadratic model explained more variation in pubescence across latitudes than did a linear model. The quadratic model shows a peak in the proportion of pubescent species at 19° S (within the tropics). Main conclusions: Our findings are consistent with the idea that leaf pubescence may have a protective function in areas with high solar radiation and high temperatures. Our data are also consistent with the idea that species towards the tropics should be better defended than are species at higher latitudes

Proteolysis of the endothelial cell protein C receptor by neutrophil proteinase 3

BACKGROUND: The endothelial cell protein C receptor (EPCR) presents protein C to the thrombin:thrombomodulin complex on the endothelium of large vessels, and enhances the generation of activated protein C (APC) and activation of protease-activated receptor-1. A previous report has demonstrated binding of soluble (s) EPCR to activated neutrophils via surface proteinase 3 (PR3). METHODS: We now report further characterization of this interaction. Activated neutrophils and purified PR3 both decrease endothelial cell (EC) surface EPCR, suggestive of its proteolysis. RESULTS: When added to purified recombinant sEPCR, PR3 produced multiple cleavages, with early products including 20 kDa N-terminal and C-terminal (after Lys(176)) fragments. The binding of active site blocked PR3 to sEPCR was studied by surface plasmon resonance. Estimates of the K(D) of 18.5–102 nm were obtained with heterogeneous binding, suggestive of more than a single interaction site. CONCLUSIONS: This work demonstrates PR3 binding to and proteolysis of EPCR and suggests a mechanism by which anticoagulant and cell protective pathways can be down-regulated during inflammation