Usher syndrome: clinical features, molecular genetics and advancing therapeutics

Usher syndrome has three subtypes, each being clinically and genetically heterogeneous characterised by sensorineural hearing loss and retinitis pigmentosa (RP), with or without vestibular dysfunction. It is the most common cause of deaf–blindness worldwide with a prevalence of between 4 and 17 in 100 000. To date, 10 causative genes have been identified for Usher syndrome, with MYO7A accounting for >50% of type 1 and USH2A contributing to approximately 80% of type 2 Usher syndrome. Variants in these genes can also cause non-syndromic RP and deafness. Genotype–phenotype correlations have been described for several of the Usher genes. Hearing loss is managed with hearing aids and cochlear implants, which has made a significant improvement in quality of life for patients. While there is currently no available approved treatment for the RP, various therapeutic strategies are in development or in clinical trials for Usher syndrome, including gene replacement, gene editing, antisense oligonucleotides and small molecule drugs

Effect of modified starch on the shelf life of frozen fish Kamaboko with prepared spinach

Fish kamaboko with spinach was prepared by mixing fish kamaboko with spinach prepared with different combinations of ordinary starch (OS) and modified starch (MS), viz., 40:60, 50:50, 60:40, 100%) MS and 100% OS. The products were frozen at -40°C and stored at -20°C, and subjected to biochemical (peroxide value, total titratable acidity, pH and moisture) organoleptic (appearance, taste and colour), microbiological (total plate count) and physical (folding and expressible water) tests at monthly intervals. Among the different combinations tried, it was observed that fish kamaboko with spinach prepared with 50:50 and 60:40 combinations of OS and MS could be stored for six months at-20°C

The timing of auditory sensory deficits in Norrie disease has implications for therapeutic intervention

Norrie disease is caused by mutation of the NDP gene, presenting as congenital blindness followed by later onset of hearing loss. Protecting patients from hearing loss is critical for maintaining their quality of life. This study aimed to understand the onset of pathology in cochlear structure and function. By investigating patients and juvenile Ndp-mutant mice, we elucidated the sequence of onset of physiological changes (in auditory brainstem responses, distortion product otoacoustic emissions, endocochlear potential, blood-labyrinth barrier integrity) and determined the cellular, histological, and ultrastructural events leading to hearing loss. We found that cochlear vascular pathology occurs earlier than previously reported and precedes sensorineural hearing loss. The work defines a disease mechanism whereby early malformation of the cochlear microvasculature precedes loss of vessel integrity and decline of endocochlear potential, leading to hearing loss and hair cell death while sparing spiral ganglion cells. This provides essential information on events defining the optimal therapeutic window and indicates that early intervention is needed. In an era of advancing gene therapy and small-molecule technologies, this study establishes Ndp-mutant mice as a platform to test such interventions and has important implications for understanding the progression of hearing loss in Norrie disease

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Peer-assisted learning: a medical student perspective

Mohammad Amre Fallaha, Aalia Pagarkar, Nicholas LucasFaculty of Medicine, Imperial College London, London, UKWe read the paper by Kazzazi et al1 with great interest. The original paper was informative, and as penultimate year medical students at Imperial College, we want to share our unique perspective regarding student learning and the benefits of peer-assisted learning (PAL). We find that many subjects, including embryology as outlined in the paper,1 are complex and typically taught through lecture-based formats. While this may be understandable to readers of respective specialties, students may find certain concepts abstract and not easily grasped through lectures alone.View the original paper by Kazzazi and Bartlett

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Not AvailableCurrently, fish consumption is growing worldwide, especially due to the demand for healthier foods and also the improvement of processes, increasing the shelf life and providing easiness in the preparation and consumption of these products. The fisheries sector is a powerful income and employment generation for maritime nation. Fish dressing operation is one of the most important operations in fish processing industry. However, doing various fish dressing operations several occupational health problems such as injuries, skin and respiratory allergic manifestations occurs among fish processing workers. These occupational health problems result in increased incapacity and absenteeism among affected workers. To prevent these problems, performance and suitability of five different types of hand protection devices viz., finger coats, medical examination, sterile surgical, cotton and combination of medical examination and cotton gloves on women workers were tested during fish dressing operation. The present study subjected to ten female workers. The highest mean working capacity was found for combination of medical examination gloves and cotton gloves as 42.4 kilogram per hour with more acceptability, very fast to work, no injuries in hands. The significant difference was observed among different types of hand protection. Hence, the present study suggest that combination of medical examination gloves and cotton gloves are better as a first line of defense in order to protect the hand from ice and cold water shocks, injuries and peeing of hand during fish dressing operation.Not Availabl

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Impact of sight and hearing loss in patients with Norrie disease: advantages of Dual Sensory clinics in patient care

Norrie disease (ND) is a rare, X-linked condition of visual and auditory impairment, often presenting with additional neurological features and developmental delays of varying severity. While all affected patients are born blind, or lose their vision in infancy, progressive sensorineural hearing loss develops in the majority of cases and is typically detected in the second decade of life. A range of additional symptoms of ND, such as seizure disorders, typically appear from a young age, but it is difficult to predict the range of symptoms ND patients will experience. After growing up without vision, hearing loss represents the greatest worry for many patients with ND, as they may lose the ability to participate in previously enjoyed activities or to communicate with others. Dual sensory loss has a physical, psychosocial and financial impact on both patients with ND and their families. Routine monitoring of the condition is required in order to identify, treat and provide support for emerging health problems, leading to a large burden of medical appointments. Many patients need to travel long distances to meet with specialists, representing a further burden on time and finances. Additionally, the rare nature of dual sensory impairment in children means that few clinical environments are designed to meet their needs. Dual Sensory clinics are multidisciplinary environments designed for sensory-impaired children and have been suggested to alleviate the impact of diseases involving sensory loss such as ND. Here, we discuss the diagnosis, monitoring and management of ND and the impact it has on paediatric patients and their caregivers. We describe the potential for dual sensory clinics to reduce disease burden through providing an appropriate clinical environment, access to multiple clinical experts in one visit, and ease of monitoring for patients with ND