Unresolved laboratory issues of the heterozygous state of β-thalassemia: a literature review

Although considered a mild clinical condition, many laboratory issues of the carrier state of β-thalassemia remain unresolved. Accurate laboratory screening of β-thalassemia traits is crucial for preventing the birth of a β-thalassemia major child. Identification of carriers in the laboratory is affected by factors that influence red cell indices and HbA2 quantification. Silent mutations and co-inheriting genetic and non-genetic factors affect red cell indices which decreases the effectiveness of the conventional approach. Similarly, the type of β mutation, co-inheriting genetic and non-genetic factors, and technical aspects, including the analytical method used and variations in the HbA2 cut-off values, affect the HbA2 results, leading to further confusion. However, the combination of mean corpuscular volume, mean corpuscular hemoglobin, and hemoglobin analysis increases the diagnostic accuracy. Diagnostic problems arising from non-genetic factors can be eliminated by carefully screening the patient’s clinical history. However, issues due to certain genetic factors, such as Krüppel-like factor 1 gene mutations and α triplication still remain unresolved. Each laboratory should determine the population-specific reference ranges and be wary of machine-related variations of HbA2 levels, the prevalence of silent mutations in the community

Adjusted treatment COMPArisons between guSelkumab and uStekinumab for treatment of moderate-to-severe plaque psoriasis : the COMPASS analysis

Guselkumab is an interleukin-23 inhibitor indicated for the treatment of moderate-to-severe plaque psoriasis in adults. Guselkumab has demonstrated additional benefit in patients with early inadequate response to ustekinumab. Long-term efficacy comparisons of guselkumab and ustekinumab are currently lacking among ustekinumab-naive patients. To assess the relative efficacy of guselkumab and ustekinumab for maintenance therapy of moderate-to-severe plaque psoriasis, using individual patient data (IPD) from randomized controlled trials. IPD for guselkumab from the VOYAGE 1 and 2 trials were pooled and compared with IPD for ustekinumab from the NAVIGATE trial. Multivariable logistic regression analyses compared guselkumab 100 mg and ustekinumab 45 mg or 90 mg for the achievement and maintenance of Psoriasis Area and Severity Index (PASI) 90, 75 and 100 responses up to 40 weeks. The regression models accounted for a range of clinically relevant covariates (e.g. age, sex, psoriasis duration). Relative efficacy was expressed using odds ratios (ORs) and predicted probability of treatment response associated with each intervention. Patients receiving guselkumab had significantly higher probabilities of achieving a PASI 90 response than patients receiving ustekinumab, at both week 16 [70·4% vs. 46·0%, OR 2·79, 95% confidence interval (CI) 2·22-3·45] and week 40 (74·2% vs. 54·5%, OR 2·40, 95% CI 1·89-3·13]. Guselkumab was also associated with a significantly increased likelihood of achieving both PASI 75 and PASI 100 responses at weeks 16 and 40, compared with ustekinumab. Conclusions: Adjusted analyses leveraging IPD demonstrate that guselkumab has a significantly higher probability of achieving and maintaining PASI treatment responses through week 40 than ustekinumab does

Sustainable development through proper land utilization Case study Ratnapura, Sri Lanka

Since the land is a scarce resource, the utilization of land effectively would be directly affected to thesustainable development of any country. A proper system ofland uti Iization is very essential especiallyfor a country like Sri Lanka which is very small in size and the majority of the people are dependingon the land related activities such as farming, grazing etc. as their major source of income. Unfortunately,land is in the state of under utilization in Sri Lanka. This paper attempts to study the importance of theeffective land utilization using Geographical Information Systems (GIS) for the sustainable development.The study was mainly based on the data gathered from Ratnapura Divisional Secretary area, Thearea is consisting with natural vegetations such as forests, shrubs. and man -rnade cultivation such astea, rubber, paddy. Also the area has a high economic value and it is well known for natural disasterssuch as floods and earth slips. Primary data was collected using semi-structured questionnaires,interviewing people and relevant officers and field surveying using hand held Global Positioning System(GPS). The study supplemented with secondary data such as remote sensing satellite images, existingmaps. GIS technique was used for the data analyses.The study identified 4 major issues in the specified areaI. 20 % of the total area is under utilization2. 25 % of the total area is misused3. 05 % of the total area is over utilized4. Continuous loss of land due to the natural disastersAccording to the results, the land has not used effectively in the area. 45% of the area is not usedeffectively. Since the country is very small, proper land utilization is very important. The study suggestthat an immediate action should be taken to overcome the matter. And also it is very important to getthe active participation of the general public to stop the loss ofland due to natural disasters and forfuture decision making. 

Nitrate supply routes and impact of internal cycling in the North Atlantic Ocean inferred from nitrate isotopic composition

In this study we report full‐depth water column profiles for nitrogen and oxygen isotopic composition (δ15N and δ18O) of nitrate (NO3‐) during the GEOTRACES GA01 cruise (2014). This transect intersects the double gyre system of the subtropical and subpolar regions of the North Atlantic separated by a strong transition zone, the North Atlantic Current. The distribution of NO3‐ δ15N and δ18O shows that assimilation by phytoplankton is the main process controlling the NO3‐ isotopic composition in the upper 150 m, with values increasing in a NO3‐ δ18O versus δ15N space along a line with a slope of one towards the surface. In the subpolar gyre, a single relationship between the degree of NO3‐ consumption and residual NO3‐ δ15N supports the view that NO3‐ is supplied via Ekman upwelling and deep winter convection, and progressively consumed during the Ekman transport of surface water southward. The co‐occurrence of partial NO3‐ assimilation and nitrification in the deep mixed layer of the subpolar gyre elevates subsurface NO3‐ δ18O in comparison to deep oceanic values. This signal propagates through isopycnal exchanges to greater depths at lower latitudes. With recirculation in the subtropical gyre, cycles of quantitative consumption‐nitrification progressively decrease subsurface NO3‐ δ18O toward the δ18O of regenerated NO3‐. The low NO3‐ δ15N observed south of the Subarctic Front is mostly explained by N2 fixation, although a contribution from the Mediterranean outflow is required to explain the lower NO3‐ δ15N signal observed between 600 and 1500 m depth close to the Iberian margin

Empowering aged - a system for the reintegration of the elderly into workforce

The increase of the elderly population has become a major issue all over the world. This increase affects the society in social, political and economic terms. By absorbing elders back into the active workforce several issues can be resolved easily. When reabsorbing them, they may require special attention due to their age and deteriorating health conditions. Information and Communication Technology (ICT) can play a major role in helping this elderly population to adapt according to the demanding working conditions of today fast moving world. In this paper the authors present the implementation of a desktop computer application for the purpose of tracking the health condition by detecting the stress and performance levels. When a user’s stress level goes up or performance level comes down, the early detection of such symptoms will make the professional help more effective

Minimizing flood damage and augmenting dry season water availability: prospects for floodwater harvesting and underground storage in Sri Lanka

Flood water harvesting and underground storage is a concept that has received significant attention in many regions of the world. Its intention is to capture floodwater from currently flooded areas and to store it for later use, in order to both, reduce damage caused by floods, as well as to satisfy demands for water during drier periods. This paper presents a preliminary analysis of the prospects for its realization in Sri Lanka. A coarse scale suitability index is constructed and mapped at district level in order to identify the districts having higher prospects for its implementation. Preliminary results indicate three main clusters of highly suitable districts, subject to favourable geological conditions. Cluster 1 consists of Ampara and Batticalao, Cluster 2 of Kurunegala, Anuradhapura and Mannar, and Cluster 3 of Ratnapura. The potential for groundwater recharge of the highly suitable clusters need special investigation prior to arriving at concrete conclusions. If successfully implemented, this concept may prove a valuable intervention for adapting to current and future floods and droughts