A modified empirical criterion for strength of transversely anisotropic rocks with metamorphic origin

A modified empirical criterion is proposed to determine the strength of transversely anisotropic rocks. In this regard, mechanical properties of intact anisotropic slate obtained from three different districts of Iran were taken into consideration. Afterward, triaxial rock strength criterion introduced by Rafiai was modified for transversely anisotropic rocks. The criterion was modified by adding a new parameter α for taking the influence of strength anisotropy into consideration. The results obtained have shown that the parameter α can be considered as the strength reduction parameter due to rock anisotropy. The modified criterion was compared to the modified Hoek–Brown (Saroglou and Tsiambaos) and Ramamurthy criteria for different anisotropic rocks. It was concluded that the criterion proposed in this paper is a more accurate and precise criterion in predicting the strength of anisotropic rocks

B3GALNT2 mutations associated with non-syndromic autosomal recessive intellectual disability reveal a lack of genotype-phenotype associations in the muscular dystrophy-dystroglycanopathies.

BACKGROUND: The phenotypic severity of congenital muscular dystrophy-dystroglycanopathy (MDDG) syndromes associated with aberrant glycosylation of α-dystroglycan ranges from the severe Walker-Warburg syndrome or muscle-eye-brain disease to mild, late-onset, isolated limb-girdle muscular dystrophy without neural involvement. However, muscular dystrophy is invariably found across the spectrum of MDDG patients. METHODS: Using linkage mapping and whole-exome sequencing in two families with an unexplained neurodevelopmental disorder, we have identified homozygous and compound heterozygous mutations in B3GALNT2. RESULTS: The first family comprises two brothers of Dutch non-consanguineous parents presenting with mild ID and behavioral problems. Immunohistochemical analysis of muscle biopsy revealed no significant aberrations, in line with the absence of a muscular phenotype in the affected siblings. The second family includes five affected individuals from an Iranian consanguineous kindred with mild-to-moderate intellectual disability (ID) and epilepsy without any notable neuroimaging, muscle, or eye abnormalities. Complementation assays of the compound heterozygous mutations identified in the two brothers had a comparable effect on the O-glycosylation of α-dystroglycan as previously reported mutations that are associated with severe muscular phenotypes. CONCLUSIONS: In conclusion, we show that mutations in B3GALNT2 can give rise to a novel MDDG syndrome presentation, characterized by ID associated variably with seizure, but without any apparent muscular involvement. Importantly, B3GALNT2 activity does not fully correlate with the severity of the phenotype as assessed by the complementation assay

Diagnostic Accuracy of Age and Alarm Symptoms for Upper GI Malignancy in Patients with Dyspepsia in a GI Clinic: A 7-Year Cross-Sectional Study

<div><h3>Objectives</h3><p>We investigated whether using demographic characteristics and alarm symptoms can accurately predict cancer in patients with dyspepsia in Iran, where upper GI cancers and <em>H. pylori</em> infection are common.</p> <h3>Methods</h3><p>All consecutive patients referred to a tertiary gastroenterology clinic in Tehran, Iran, from 2002 to 2009 were invited to participate in this study. Each patient completed a standard questionnaire and underwent upper gastrointestinal endoscopy. Alarm symptoms included in the questionnaire were weight loss, dysphagia, GI bleeding, and persistent vomiting. We used logistic regression models to estimate the diagnostic value of each variable in combination with other ones, and to develop a risk-prediction model.</p> <h3>Results</h3><p>A total of 2,847 patients with dyspepsia participated in this study, of whom 87 (3.1%) had upper GI malignancy. Patients reporting at least one of the alarm symptoms constituted 66.7% of cancer patients compared to 38.9% in patients without cancer (p<0.001). Esophageal or gastric cancers in patients with dyspepsia was associated with older age, being male, and symptoms of weight loss and vomiting. Each single predictor had low sensitivity and specificity. Using a combination of age, alarm symptoms, and smoking, we built a risk-prediction model that distinguished between high-risk and low-risk individuals with an area under the ROC curve of 0.85 and acceptable calibration.</p> <h3>Conclusions</h3><p>None of the predictors demonstrated high diagnostic accuracy. While our risk-prediction model had reasonable accuracy, some cancer cases would have remained undiagnosed. Therefore, where available, low cost endoscopy may be preferable for dyspeptic older patient or those with history of weight loss.</p> </div

Prevalence and burden of HBV co-infection among people living with HIV:A global systematic review and meta-analysis

Globally, in 2017 35 million people were living with HIV (PLHIV) and 257 million had chronic HBV infection (HBsAg positive). The extent of HIV-HBsAg co-infection is unknown. We undertook a systematic review to estimate the global burden of HBsAg co-infection in PLHIV. We searched MEDLINE, Embase and other databases for published studies (2002-2018) measuring prevalence of HBsAg among PLHIV. The review was registered with PROSPERO (#CRD42019123388). Populations were categorized by HIV-exposure category. The global burden of co-infection was estimated by applying regional co-infection prevalence estimates to UNAIDS estimates of PLHIV. We conducted a meta-analysis to estimate the odds of HBsAg among PLHIV compared to HIV-negative individuals. We identified 506 estimates (475 studies) of HIV-HBsAg co-infection prevalence from 80/195 (41.0%) countries. Globally, the prevalence of HIV-HBsAg co-infection is 7.6% (IQR 5.6%-12.1%) in PLHIV, or 2.7 million HIV-HBsAg co-infections (IQR 2.0-4.2). The greatest burden (69% of cases; 1.9 million) is in sub-Saharan Africa. Globally, there was little difference in prevalence of HIV-HBsAg co-infection by population group (approximately 6%-7%), but it was slightly higher among people who inject drugs (11.8% IQR 6.0%-16.9%). Odds of HBsAg infection were 1.4 times higher among PLHIV compared to HIV-negative individuals. There is therefore, a high global burden of HIV-HBsAg co-infection, especially in sub-Saharan Africa. Key prevention strategies include infant HBV vaccination, including a timely birth-dose. Findings also highlight the importance of targeting PLHIV, especially high-risk groups for testing, catch-up HBV vaccination and other preventative interventions. The global scale-up of antiretroviral therapy (ART) for PLHIV using a tenofovir-based ART regimen provides an opportunity to simultaneously treat those with HBV co-infection, and in pregnant women to also reduce mother-to-child transmission of HBV alongside HIV

Prevalence and Risk Factors of Gastroesophageal Reflux Disease in Tabriz, Iran

&quot;nBackground: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal problems in the west while different reports indicate an increase in the prevalence in Iran. The aim of this study was to estimate the preva&amp;shy;lence and clinical spectrum of GERD in staff of a referral hospital and evaluate the risk factors.&quot;nMethods: This cross-sectional study using a modified Mayo clinic questionnaire was performed on staff of Imam Hospi&amp;shy;tal, Tabriz, Iran on a pilot of 50 subjects, and a randomly selected group consisted of 522 subjects in the year 2005. GERD symptoms were defined as at least weekly heartburn and/or acid regurgitation during the past year.&quot;nResults: Response rate was 95%. Mean age of responders was 40.02&amp;plusmn;10.72 yr. The prevalence of recurrent heart&amp;shy;burn and/or acid regurgitation experienced at least weekly and monthly was 26.8% and 34.1%, respectively. They were not related to age and gender. The severity of symptoms was mainly reported of a mild to moderate degree. 45% of the cases reported at least one of the atypical symptoms. There was no relation between marriage status and preva&amp;shy;lence of GERD. On the other hand, GERD was less common among cases with no family history of upper gas&amp;shy;trointestinal disease. The prevalence of frequent GERD was more common among medical staff. Increased BMI (but no recent weight gain or lose) was associated with higher prevalence of GERD symptoms only in women. In&amp;shy;terestingly 33% of our population had a history of using antacid or PPIs which was more among cases with frequent GERD symptoms.&quot;nConclusion: This study revealed a high prevalence of frequent GERD symptoms in a selected population of Tabriz. Atypi&amp;shy;cal symptoms should be considered in this area. &amp;nbsp