Chromosomal study in newborn infants with congenital anomalies in Assiut University hospital: Cross-sectional study

In 40–60% of congenital malformations, the cause is unknown. Genetic factors account for approximately 15%; environmental factors produce approximately 10%; a combination of genetic and environmental influences produces 20–25%. The study aims to document prevalenceand patterns of congenital malformations detected at birth in Assiut University hospital and clarify underlying chromosomal abnormalities of such malformations. Also possible predisposing factors will be studied.Newborns with apparent congenital anomalies were selected from 5000 newborn infants delivered consecutively at the department of Obstetrics and Gynecology within 7 months. Full maternal history, family history, perinatal history, pedigree construction as well as clinical examinations andinvestigations including karyotype were done. Congenital anomalies were found in 103 cases with a prevalence of 2.06% with male to female ratio of 1.7:1. Skeletal system anomalies had the highestfrequency (37.9%), followed in descending order by chromosomal abnormalities (27.2%), circulatory system anomalies (22.3%), central nervous system (CNS) anomalies (19.4%), genital organs anomalies (16.5%), gastrointestinal tract (GIT) anomalies (14.6%), eye and ear anomalies (8.7%), and lastly urinary system and others anomalies in 3.9% each. Breech presentation, perinatal asphyxia, incubator admission and the need for resuscitation were significantly associated with the presence of congenital anomalies. Higher prevalence of congenital anomalies was observed in neonatesof grand multiparous women, diabetic mothers delivery by CS, cases with oligohydramnios and with positive consanguinity. Chromosomal abnormalities were found in 28 cases (27.18% of malformed cases) (5.6/1000). Numerical abnormalities were found in 22 cases (21.35%) (4.4/1000), Down syndrome in 16 cases, Edward syndrome in two cases, Patau syndrome in one case and Turner syndrome (monosomy) inthree cases. Structural abnormalities were present in six cases (5.83%) (1.2/1000), Down syndrome in two cases, Turner syndrome in two cases, balanced translocation [(12;13)(q15;q34)] with dysmorphic features and undescended testis in one case and deletion 9(q11;q31) with disorder of sex development in one case. To conclude karyotype should not be done routinely for all malformed cases as many of them are due to genetic syndromes. So, it is more useful to consult expert dysmorphologists for proper syndrome identification and for the decision to use more recent molecular techniques for diagnosis

Missed vaccination opportunities at a secondary health facility in Ilorin, Nigeria

Background: Immunization remains a key strategy in the control of childhood diseases, with a child expected to have five visits according to the current National Programme on Immunization. The study aimed to identify missed vaccination visits and the associated factors in children presenting at the general out-patient clinic of a secondary health facility in Ilorin, Nigeria.Method: Through a descriptive cross-sectional study, the vaccination data of all children seen at the out-patient clinic were critically reviewed over a period of one month. Socio-demographic and immunization details were obtained and reasons for missed vaccination documented. Those that had missed vaccination were commenced on the needed vaccine(s) after counselling of their parent(s), and adequate follow-up was instituted.Results: Eighty-two (5.1%) children out of 1603 seen had missed at least one vaccine visit. The mean (SD) age of the children was 20.1(14.9) months. The male to female ratio was 1.1:1. Thirty-nine (47.2%) children had missed one visit while 43(52.7%) had missed two or more visits; 16(19.5%) had missed all five visits. Major reasons for missed visits were ill child(26.8%), ignorance about routine vaccine but received vaccine during the National Immunization Days(NID) (19.5%), mother travelled (14.6%), forgot(9.8%), and reaction to previous vaccine(6.1%).Conclusion: The missed opportunity for immunization is high therefore health care providers should enquire about the vaccination status of children at all contact. There is a need to increase awareness on illnesses that are not contra-indications to vaccination, and routine vaccine status should be checked during NID.Keywords: Missed, Opportunity, Vaccination, Children, Routine, Immunizatio

Phytochemical screening, antioxidant and antimicrobial activities of Prunella vulgaris for oral thrush

Plant imitative products have been used for medicinal purposes for centuries. In traditional Indian medicine or Ayurveda, Prunella Vulgaris and many other herbs have been used as medicine. Traditional uses of plants have led to investigating their bioactive compounds, which have resulted in the detection of a significant number of therapeutic properties. The aim of present investigation was carried out to evaluate the phytochemical, antioxidant and antimicrobial activity of chloroform and hydroalcoholic leaves extracts of Prunella Vulgaris against microbial strains causing oral infections. Both chloroform and hydroalcoholic extracts revealed the presence of carbohydrate, triterpenoids/ steroids, flavonoids, tannin, phenolic compound and saponins were absent in only the chloroform extract. The bioactivities of the leaf extracts were qualified to their phytochemical constituents. Quantitative analysis of phenolic and flavonoids was carried out by Folins Ciocalteau reagent method and aluminium chloride method respectively. The In vitro antioxidant activity of chloroform and hydroalcoholic leaves extracts of Prunella Vulgaris was assessed against 2,2-diphenyl-1-picryl- hydrazyl (DPPH) radical scavenging activity, reducing power assay using standard protocols. The antimicrobial activity of chloroform and hydroalcoholic extracts of medicinal plants was evaluated using well diffusion method against Escherichia coli and Candida albicans. The TPC in chloroform extract was higher than that of the hydroalcoholic extract with concentration being 0.443 mg/g equivalent to gallic acid. The TFC in hydroalcohoilc extract was higher than that of the chloroform extract with concentration being 0.358 mg/g equivalent to rutin.  The present study recognized leaves extract of Prunella vulgaris as a promising antioxidant and antimicrobial agent. However, further investigations are needed to understand the mechanistic basis of this effect of the extract and its chemical constituents thereof. Keywords: Prunella vulgaris, Phytochemical, Antioxidant, Antimicrobial activity, Folins Ciocalteau reagent, Quantitative analysi

Left ventricular non-compaction: clinical features and cardiovascular magnetic resonance imaging

Background: It is apparent that despite lack of family history, patients with the morphological characteristics of left ventricular non-compaction develop arrhythmias, thrombo-embolism and left ventricular dysfunction. METHODS: Forty two patients, aged 48.7 +/- 2.3 yrs (mean +/- SEM) underwent cardiovascular magnetic resonance (CMR) for the quantification of left ventricular volumes and extent of non-compacted (NC) myocardium. The latter was quantified using planimetry on the two-chamber long axis LV view (NC area). The patients included those referred specifically for CMR to investigate suspected cardiomyopathy, and as such is represents a selected group of patients. RESULTS: At presentation, 50% had dyspnoea, 19% chest pain, 14% palpitations and 5% stroke. Pulmonary embolism had occurred in 7% and brachial artery embolism in 2%. The ECG was abnormal in 81% and atrial fibrillation occurred in 29%. Transthoracic echocardiograms showed features of NC in only 10%. On CMR, patients who presented with dyspnoea had greater left ventricular volumes (both p < 0.0001) and a lower left ventricular ejection fraction (LVEF) (p < 0.0001) than age-matched, healthy controls. In patients without dyspnoea (n = 21), NC area correlated positively with end-diastolic volume (r = 0.52, p = 0.0184) and end-systolic volume (r = 0.56, p = 0.0095), and negatively with EF (r = -0.72, p = 0.0001). CONCLUSION: Left ventricular non-compaction is associated with dysrrhythmias, thromboembolic events, chest pain and LV dysfunction. The inverse correlation between NC area and EF suggests that NC contributes to left ventricular dysfunction

In-situ upgrading of Napier grass pyrolysis vapour over microporous and hierarchical mesoporous zeolites

This study presents in-situ upgrading of pyrolysis vapour derived from Napier grass over microporous and mesoporous ZSM-5 catalysts. It evaluates effect of process variables such catalyst–biomass ratio and catalyst type in a vertical fixed bed pyrolysis system at 600 °C, 50 °C/min under 5 L/min nitrogen flow. Increasing catalyst–biomass ratio during the catalytic process with microporous structure reduced production of organic phase bio-oil by approximately 7.0 wt%. Using mesoporous catalyst promoted nearly 4.0 wt% higher organic yield relative to microporous catalyst, which translate to only about 3.0 wt% reduction in organic phase compared to the yield of organic phase from non-catalytic process. GC–MS analysis of bio-oil organic phase revealed maximum degree of deoxygenation of about 36.9% with microporous catalyst compared to the mesoporous catalysts, which had between 39 and 43%. Mesoporous catalysts promoted production olefins and alkanes, normal phenol, monoaromatic hydrocarbons while microporous catalyst favoured the production of alkenes and polyaromatic hydrocarbons. There was no significant increase in the production of normal phenols over microporous catalyst due to its inability to transform the methoxyphenols and methoxy aromatics. This study demonstrated that upgrading of Napier grass pyrolysis vapour over mesoporous ZSM-5 produced bio-oil with improved physicochemical properties

Case-mix and the use of control charts in monitoring mortality rates after coronary artery bypass

BACKGROUND: There is debate about the role of crude mortality rates and case-mix adjusted mortality rates in monitoring the outcomes of treatment. In the context of quality improvement a key purpose of monitoring is to identify special cause variation as this type of variation should be investigated to identify possible causes. This paper investigates agreement between the identification of special cause variation in risk adjusted and observed hospital specific mortality rates after coronary artery bypass grafting in New York hospitals. METHODS: Coronary artery bypass grafting mortality rates between 1994 and 2003 were obtained from the New York State Department of Health's cardiovascular reports for 41 hospitals. Cross-sectional control charts of crude (observed) and risk adjusted mortality rates were produced for each year. Special cause variation was defined as a data point beyond the 99.9% probability limits: hospitals showing special cause variation were identified for each year. Longitudinal control charts of crude (observed) and risk adjusted mortality rates were produced for each hospital with data for all ten years (n = 27). Special cause variation was defined as a data point beyond 99.9% probability limits, two out of three consecutive data points beyond 95% probability limits (two standard deviations from the mean) or a run of five consecutive points on one side of the mean. Years showing special cause variation in mortality were identified for each hospital. Cohen's Kappa was calculated for agreement between special causes identified in crude and risk-adjusted control charts. RESULTS: In cross sectional analysis the Cohen's Kappa was 0.54 (95% confidence interval: 0.28 to 0.78), indicating moderate agreement between the crude and risk-adjusted control charts with sensitivity 0.4 (95% confidence interval 0.17–0.69) and specificity 0.98 (95% confidence interval: 0.95–0.99). In longitudinal analysis, the Cohen's Kappa was 0.61 (95% confidence interval: 0.39 to 0.83) indicating good agreement between the tests with sensitivity 0.63 (95% confidence interval: 0.39–0.82) and specificity 0.98 (95% confidence interval: 0.96 to 0.99). CONCLUSION: There is moderate-good agreement between signals of special cause variation between observed and risk-adjusted mortality. Analysis of observed hospital specific CABG mortality over time and with other hospitals appears to be useful in identifying special causes of variation. Case-mix adjustment may not be essential for longitudinal monitoring of outcomes using control charts

An empirical approach towards the efficient and optimal production of influenza-neutralizing ovine polyclonal antibodies demonstrates that the novel adjuvant CoVaccine HT(TM) is functionally superior to Freund's adjuvant

Passive immunotherapies utilising polyclonal antibodies could have a valuable role in preventing and treating infectious diseases such as influenza, particularly in pandemic situations but also in immunocompromised populations such as the elderly, the chronically immunosuppressed, pregnant women, infants and those with chronic diseases. The aim of this study was to optimise current methods used to generate ovine polyclonal antibodies. Polyclonal antibodies to baculovirus-expressed recombinant influenza haemagglutinin from A/Puerto Rico/8/1934 H1N1 (PR8) were elicited in sheep using various immunisation regimens designed to investigate the priming immunisation route, adjuvant formulation, sheep age, and antigen dose, and to empirically ascertain which combination maximised antibody output. The novel adjuvant CoVaccine HT™ was compared to Freund’s adjuvant which is currently the adjuvant of choice for commercial production of ovine polyclonal Fab therapies. CoVaccine HT™ induced significantly higher titres of functional ovine anti-haemagglutinin IgG than Freund’s adjuvant but with fewer side effects, including reduced site reactions. Polyclonal hyperimmune sheep sera effectively neutralised influenza virus in vitro and, when given before or after influenza virus challenge, prevented the death of infected mice. Neither the age of the sheep nor the route of antigen administration appeared to influence antibody titre. Moreover, reducing the administrated dose of haemagglutinin antigen minimally affected antibody titre. Together, these results suggest a cost effective way of producing high and sustained yields of functional ovine polyclonal antibodies specifically for the prevention and treatment of globally significant diseases.Natalie E. Stevens, Cara K. Fraser, Mohammed Alsharifi, Michael P. Brown, Kerrilyn R. Diener, John D. Haybal

Contribution of magnetic resonance imaging in the diagnosis of talus skip metastases of Ewing's sarcoma of the calcaneus in a child: a case report

<p>Abstract</p> <p>Introduction</p> <p>Ewing's sarcoma of the calcaneus is rare. About thirty cases with calcaneus involvement have been reported in the literature. Talus skip metastases have rarely been described in the available literature</p> <p>Case presentation</p> <p>We report a case of a 14-year-old Moroccan boy, who presented with Ewing's sarcoma of his right calcaneus, diagnosed by swelling of the calcaneus evolving over a year. Radiography, computed tomography and magnetic resonance imaging showed an important tumoral process of the calcaneus and talus skip metastases. The diagnosis was confirmed with histology after a biopsy. In spite of amputation and postoperative chemotherapy, our patient died six months later due to secondary respiratory distress after lung metastasis.</p> <p>Conclusion</p> <p>Imaging, especially magnetic resonance, is important in the diagnosis of Ewing sarcoma and skeletal skip metastases. Treatment of Ewing's sarcoma consists of chemotherapy, radiation therapy and surgical resection depending on the stage and extent of the disease. With the exception of lesions in the calcaneus, the prognosis for disease-free survival of Ewing's sarcoma of the foot is excellent.</p

Electrical characterization and nanoscale surface morphology of optimized Ti/Al/Ta/Au ohmic contact for AlGaN/GaN HEMT

Good ohmic contacts with low contact resistance, smooth surface morphology, and a well-defined edge profile are essential to ensure optimal device performances for the AlGaN/GaN high electron mobility transistors [HEMTs]. A tantalum [Ta] metal layer and an SiNx thin film were used for the first time as an effective diffusion barrier and encapsulation layer in the standard Ti/Al/metal/Au ohmic metallization scheme in order to obtain high quality ohmic contacts with a focus on the thickness of Ta and SiNx. It is found that the Ta thickness is the dominant factor affecting the contact resistance, while the SiNx thickness affects the surface morphology significantly. An optimized Ti/Al/Ta/Au ohmic contact including a 40-nm thick Ta barrier layer and a 50-nm thick SiNx encapsulation layer is preferred when compared with the other conventional ohmic contact stacks as it produces a low contact resistance of around 7.27 × 10-7 Ω·cm2 and an ultra-low nanoscale surface morphology with a root mean square deviation of around 10 nm. Results from the proposed study play an important role in obtaining excellent ohmic contact formation in the fabrication of AlGaN/GaN HEMTs

Bilateral testicular self-castration due to cannabis abuse: a case report

<p>Abstract</p> <p>Introduction</p> <p>The self-mutilating patient is an unusual psychiatric presentation in the emergency room. Nonetheless, serious underlying psychiatric pathology and drug abuse are important background risk factors. A careful stepwise approach in the emergency room is essential, although the prognosis, follow-up, and eventual rehabilitation can be problematic.</p> <p>We present a unique and original case of bilateral self-castration caused by cannabis abuse.</p> <p>Case Presentation</p> <p>We report a case of a 40-year-old Berber man, who was presented to our emergency room with externalization of both testes using his long fingernails, associated with hemodynamic shock. After stabilization of his state, our patient was admitted to the operating room where hemostasis was achieved.</p> <p>Conclusion</p> <p>The clinical characteristics of self-mutilation are manifold and there is a lack of agreement about its etiology. The complex behavior associated with drug abuse may be one cause of self-mutilation. Dysfunction of the inhibitory brain circuitry caused by substance abuse could explain why this cannabis-addicted patient lost control and self-mutilated. To the best of our knowledge, this is the first case report which presents an association between self-castration and cannabis abuse.</p