Obstetric-Gynecological Complications in Neuromuscular Disorders

Background and Objective: The data on the obstetric and gynecological complications in patients diagnosed with neuromuscular diseases is very limited and is primarily obtained from various case reports, series, and small studies.  The objective of our study was to analyze the prevalence of these complications in a large cohort of patients with various neuromuscular diseases. Methods: This study is a retrospective chart review of patients diagnosed with various neuromuscular diseases at the University of Missouri, Columbia, from 2012 to 2017. We included patients who have at least one year follow up with us. We collected data on patient demographics, neuromuscular disease diagnosed, obstetric complications, and gynecologic complications. Data are reported as means ± SEM, and the results reported using prevalence rates. Results: Ninety-five female patients were identified. Among them, 97% were Caucasian, and 3% were African-American with a mean age of 47.96 years.  Neuromuscular diseases identified among them are Myasthenia Gravis (44%), Muscular Dystrophy (23%), Amyotrophic Lateral Sclerosis-ALS (16%), Charcot-Marie-Tooth disease-CMT (10%), and Spinal Muscular atrophy- SMA (7%). The majority of the patients reviewed have had no obstetric complications- (89.40%). The most common obstetric complication recorded was C-section (8.40%).  41% of women did not have any gynecological complaints. Urine incontinence (24.20%) is the most common complication. Conclusion: C-sections and urinary incontinence are common obstetric and gynecological events seen in women with neuromuscular disease

Effect of light intensity on carbohydrates, lipids contents, and bioethanol production in two algal species of Coelastrella saipanensis and Oscillatoria duplisecta

This study aimed to examine the feasibility of two algal species of Coelastrella saipanensis (Chlorophyceae) and Oscillatoria duplisecta (Cyanophyceae) to produce bioethanol production at different light intensities. In the present study, light-intensity treatments at 27, 36, and 67 µmol m-2 s-1 were used to stimulate bioethanol production from microalga. The effects of these treatments on C. saipanensis and O. duplisecta were investigated on their growth, carbohydrate and lipids contents. The results showed that the stationary phase of C. saipanensis started on the sixth day under light intensities of 27 and 36 µmol m-2 s-1 and on the eighth day under light intensity of 67 µmol m-2 s-1. The stationary stage of blue-green algae O. duplisecta started on day eight, sixth, and seventh under light intensities of 27, 36, and 67 µmol m-2 s-1, respectively. The highest amount of carbohydrate content was 0.182, and 0.310 mg/l for C. saipanensis and O. duplisecta under light intensity of 36 ?mol m-2 s-1. The highest amount of lipid was 0.95 g/l for C. saipanensis under a light intensity of 36 ?mol m-2 s-1, while 0.74 g/L was the highest amount of lipid for O. duplisecta under 67 µmol m-2 s-1 at a light intensity of 36 µmol m-2 s-1. The highest percentage of bioethanol in C. saipanensis and O. duplisecta were 11.35 and 10.23%, respectively. The 18S rRNA and 16S rRNA genes were used for the identification, and the sequences of algae matched those registered in the GenBank (MT375484.1 for C. saipanensis and MW405018.1 for O. duplisecta). The phylogenetic tree of the ITS area was analyzed inside the 18S rRNA and 16S rRNA and the sequences showed a strong resemblance to those species registered in the Genebank

Brain Drain: Post Graduation Migration Intentions and the influencing factors among Medical Graduates from Lahore, Pakistan

<p>Abstract</p> <p>Background</p> <p>The increasing migration of health professionals to affluent countries is not a recent phenomenon and has been addressed in literature. However the various facets of physician migration from Pakistan, the third leading source of International medical graduates has not been rigorously evaluated. The objective of the current study was to survey final year students and recent medical graduates in Lahore, Pakistan about their intentions to train abroad, their post training plans as well as to identify the factors responsible for their motivation for international migration.</p> <p>Method</p> <p>A self administered structured questionnaire was developed to collect respondents' demographic and educational characteristics, intention to train abroad, their preferred destination & post training intentions of returning to Pakistan. Various influencing factors which impact on medical graduate's motivation to train abroad or stay in Pakistan were explored using a 10 point scale. SPSS software was used for data entry and analysis.</p> <p>Results</p> <p>Of the 400 eligible respondents, 275 responded (response rate 68.7%). One hundred and sixty six respondents (60.4%) intended to train abroad either for a specialty (54.9%) or a subspecialty (5.5%) The United States and United Kingdom were the most preferred destination. While 14.2% intended to return to Pakistan immediately after training, a significant percentage (10%) never intended to return to Pakistan or wished to stay abroad temporarily (37%). Professional excellence and establishing quickly in the competitive market were the most important goal to be achieved by the respondents for intention for postgraduate training abroad. The most common reasons cited for training abroad were the impact of residency training on future career (mean score 8.20 ± 2.3), financial conditions of doctors (mean score 7.97 ± 2.37) and job opportunities (mean score7.90 ± 2.34).</p> <p>Conclusion</p> <p>An alarming percentage of medical graduates from Lahore, Pakistan intend to migrate for post graduate training, mainly to United States. A significant proportion wished to stay in the host country either temporarily or indefinitely. Impact of residency abroad on future career, financial conditions of doctors, job opportunities and better working conditions were some of the motivating factors behind the migration.</p

Detection of carbapenemases blaOXA48-blaKPC-blaNDM-blaVIM and extended-spectrum-β-lactamase blaOXA1-blaSHV-blaTEM genes in Gram-negative bacterial isolates from ICU burns patients

BACKGROUND AND OBJECTIVES: Burn patients are highly susceptible to invasion by multidrug-resistant Gram-negative bacteria (MDR-GNB) through post-burn damage. The prevalence of MDR-GNB isolated from burns patients has increased dramatically in the last decade, representing a serious risk to patients admitted to burns units worldwide. The challenges of managing infected burns patients are exacerbated in poor resource settings. This study was designed to develop a pathway for the rapid diagnosis of multidrug-resistant (MDR) Gram-negative infections and identify the bacterial genes including blaOXA1, blaTEM, and blaSHV encoding ESBLs and blaOXA48, blaKPC, blaNDM, and blaVIM encoding carbapenemases from the patient of post burns infection.  METHODS: Clinical isolates were collected (August 2017 to August 2018) from Intensive care unit (ICU) of Burn Centre. Antibiotic susceptibility testing and phenotypic detection of ESBLs and carbapenemases was performed by disk diffusion, double disk synergy test (DDST), combination disk test (CDT), and Imipenem + EDTA combined disk test (IMP + EDTA CDT). Polymerase chain reaction (PCR) detection was performed for ESBLs blaOXA1-blaSHV-blaTEM and carbapenemases genes blaOXA48-blaKPC-blaNDM-blaVIM RESULTS: In total, of 170 Gram-negative isolates, 104 (61.2%) were confirmed as multidrug-resistant (MDR); Pseudomonas aeruginosa was found to be the most prevalent 43/104 (41.4%), followed by Klebsiella pneumoniae 17/104 (16.4%), Acinetobacter baumannii12/104 (11.5%), and 6/104 Proteus mirabilis (5.8%). All isolates (100%) were resistant to cefotaxime and ceftazidime, while the meropenem resistance was 58.7%. ESBL and carbapenemase genotypes were found to be associated with higher MAR index (0.65-0.88) and MIC (> 32 µg/ml) values P. aeruginosa was the major ESBL and carbapenemase producer as determined by phenotypic testing and PCR. blaTEM positive isolates among ESBLs producers were predominant 81.8% (27/33), followed by 27.3% blaOXA1 and blaSHV, respectively. blaVIM positive isolates among carbapenemase producers were predominant 47.7% (21/44), followed by 27.3% blaKPC, 20.5% blaOXA48, and 11.4% blaNDM positive isolates. CONCLUSIONS: The predominant organism causing burn infections was ESBL and carbapenemase-producing Pseudomonas aeruginosa. There are only limited effective antibiotics against such strains. blaVIM and blaTEM individually and in co-existence with blaKPC, blaOXA48, blaSHV, and blaOXA1 confer antimicrobial resistance in burns patients. Rapid detection of ESBL and carbapenemase genes will inform treatment strategies improving the outcome for post-burn patients in ICU

Evaluation of Xpert MTB/RIF testing for rapid diagnosis of childhood pulmonary tuberculosis in children by Xpert MTB/RIF testing of stool samples in a low resource setting

Objective: Children with tuberculosis (TB) remain underdiagnosed due to difculty in testing for Mycobacterium tuberculosis (MTB) infection. We evaluated the Xpert MTB/RIF assay for respiratory and stool testing in children for pulmonary TB through a cross-sectional study at tertiary care facilities in Karachi, Pakistan. Fifty children aged 0–15 years screened by a modifed Kenneth-Jones (KJ) score were included. Mycobacterial culture of respiratory samples was the microbiological standard against stool Xpert TB results. All positive TB cases were compared against a treatment response standard (TRS).Results: Twelve study subjects were diagnosed by Xpert TB and nine by MTB culture. Compared with culture [gastric aspirates (GA)/sputum (spm)], stool Xpert TB had a sensitivity of 88.9% (95% CI 50.7–99.4) and a specifcity of 95% (95% CI 81.8–99.1). Xpert TB stool versus GA/spm had sensitivity of 81.8% (95% CI 47.8–96.8) and specifcity of 94.7% (95% CI 84.6–99.9). We found good agreement (kappa scores of \u3e0.8) between stool Xpert, GA/spm Xpert and GA/ spm culture. Stool Xpert PPV and NPV against TRS was 100 and 82.1% respectively. Stool Xpert TB is a relatively easy option for diagnosis for pulmonary childhood TB in a high burden low-resource setting

An integrated transcriptome analysis in T-cell acute lymphoblastic leukemia links DNA methylation subgroups to dysregulated TAL1 and ANTP homeobox gene expression

Classification of pediatric T-cell acute lymphoblastic leukemia (T-ALL) patients into CIMP (CpG Island Methylator Phenotype) subgroups has the potential to improve current risk stratification. To investigate the biology behind these CIMP subgroups, diagnostic samples from Nordic pediatric T-ALL patients were characterized by genome-wide methylation arrays, followed by targeted exome sequencing, telomere length measurement, and RNA sequencing. The CIMP subgroups did not correlate significantly with variations in epigenetic regulators. However, the CIMP+ subgroup, associated with better prognosis, showed indicators of longer replicative history, including shorter telomere length (P = 0.015) and older epigenetic (P <0.001) and mitotic age (P <0.001). Moreover, the CIMP+ subgroup had significantly higher expression of ANTP homeobox oncogenes, namely TLX3, HOXA9, HOXA10, and NKX2-1, and novel genes in T-ALL biology including PLCB4, PLXND1, and MYO18B. The CIMP- subgroup, with worse prognosis, was associated with higher expression of TAL1 along with frequent STIL-TAL1 fusions (2/40 in CIMP+ vs 11/24 in CIMP-), as well as stronger expression of BEX1. Altogether, our findings suggest different routes for leukemogenic transformation in the T-ALL CIMP subgroups, indicated by different replicative histories and distinct methylomic and transcriptomic profiles. These novel findings can lead to new therapeutic strategies.Peer reviewe

Genetic Variation of Trichomonas vaginalis Isolates from Iraqi Women: Association with Fertility and Cervical Abnormalities

الخلفية/ الهدف: داء المشعرات المهبلية هو واحد من أكثر الأمراض غير الفيروسية المنقولة جنسيا, يسببه طفيلي Trichomonas vaginalis. لا يعرف سوى القليل عن التنوع الوراثي والهيكل المعيشي لهذا الطفيلي. هدفت هذه الدراسة إلى تحديد التنوع الوراثي لعزلات طفيلي المشعرات المهبلية وارتباطه بالخصوبة وتشوهات عنق الرحم. الأساليب: تم تعيين مجموعة من 154 امرأة عراقية ممن يراجعن قسم الولادة والامراض النسائية في عدد من مستشفيات محافظة بغداد خلال الفترة من شباط 2013 إلى نيسان 2014 ، لهذه الدراسة. تم استخراج الحمض النووي لعزلات الطفيلي من مزروع المسحات المهبلية. تم إجراء طريقة التنميط التتابعي المتعدد المواقع (MLST) لستة من الجينات المرجعية لدراسة التغيرات الجينية. النتائج: ثلاث وخمسون امرأة (34.41 ٪) قد أعطت نتيجة موجبة للأصابة بالطفيلي T.vaginalis. أظهرت طريقة MLST وجود اليلات مختلفة. وكان للمورث glut أعلى درجة من التغايرات بين المورثات الستة. الاستنتاج: يمكن الاستنتاج أن التنوع الوراثي في ​​الكائن الحي نفسه في عزلات العراق ، يمكن أن يرتبط بالنتائج السريرية. هناك حاجة إلى مزيد من الدراسات MLST لمقارنة عدد أكبر من العزلات من مختلف المواقع ودراسة الطفرات المحددة في المورثات المرجعية لنساء&nbsp; اللاتي يعانين من العقم ومن تشوهات عنق الرحم. الكلمات المفتاحية: طفيلي المشعرات المهبلية. التغاير الوراثي, الخصوبة, تشوهات عنق الرحم, طريقة التنميط التتابعي المتعدد المواقع.Background: Trichomoniasis, is one of the most common non-viral sexually transmitted diseases caused by the parasite Trichomonas vaginalis. Little is known about the genetic diversity and population structure of this parasite. This study aimed to determine the genetic diversity of T. vaginalis isolated from Iraqi women and its association with the fertility and the cervical abnormalities. Methods: Overall, 154 Iraqi women attending the Gynecology Outpatient departments in Baghdad Province, Iraq from February 2013 to April 2014, were enrolled in this study. DNA of T. vaginalis isolates was extracted from the culture of high vaginal swabs. Multilocus sequence typing (MLST) method for six housekeeping genes was done in studying the genetic variations. Results: Fifty-three women (34.41%) were positive for T. vaginalis. MLST method resulted in different alleles. With glutaminase gene, the highest degree of variation was found among the six genes. Conclusion: The genetic diversity in the organism itself in Iraqi isolates can associate with clinical outcome. Further MLST studies are needed to compare a larger number of isolates from different localities and correlate the certain mutations in housekeeping genes to infertile women and patients with cervical abnormalities

A COMPARISON OF NALBUPHINE AND PENTAZOCINE IN CONTROLLING POSTOPERATIVE PAIN IN DOGS

Surgical success in most cases is governed by the quality of post-operative pain management. In Pakistan, most veterinary surgeons face a dire predicament as they fail astutely in this regard. Owing to the controlled dispensing of potent narcotics and their potential misuse, an imperative need for effective post-operative analgesic management of pain exists in dogs. 32 dogs were randomly divided into two groups. Group A was injected Nalbuphine @ 0.5 mg/kg post-operatively while Group B was injected Pentazocine @ 3mg/kg. Subjective and objective analysis of pain was conducted by unbiased observers. Vital signs (Temperature, pulse, respiration) were analyzed along with supplementation of hepatic and renal function tests. Objective and subjective analysis of both groups yielded results in the favor of pentazocine. In group A, temperature, pulse and respiration averaged 101.86±0.58oF, 83.46±2.75 per minute and 19.26±2.14 per minute respectively. Group 2 demonstrated temperature, pulse and respiration averages of 102.31±0.40oF, 83.41±2.74 per minute and 19.54±2.14 per minute respectively. Values of hepatic and renal function were also observed to be significantly higher in Nalbuphine treated group. All the results indicate that pentazocine is not only a significantly better analgesic but also has lower hepatotoxic and renal toxic effects

Assessing the antifungal activity of a soft denture liner loaded with titanium oxide nanoparticles (TiO2 NPs)

Aim: Soft denture lining materials are susceptible to be colonized by different microorganisms, especially by Candida albicans (C. albicans), causing denture-induced stomatitis. This study was designed to evaluate the effectiveness of incorporating titanium dioxide nanoparticles (TiO2 NPs) into a soft denture liner towards reducing microbial activity. Method: A total of 40 PEMA-TiO2 nanocomposites samples were fabricated by adding 0.0 wt.% (control), 1.0 wt.%, 1.5 wt.%, and 2 wt.% TiO2 NPs to a heat cured soft denture lining material (polyethyl methacrylate, PEMA). The prepared samples were divided into four groups (n = 10) according to the content of TiO2 NPs. The uniformity of TiO2 NPS distribution within the denture liner matrix was assessed using a Scanning Electron Microscope (SEM). The viable count of C. albicans was evaluated to test the antifungal resistance of the developed composite. Results: The SEM images showed fairly homogeneous dispersion, with patches of TiO2 NPs agglomeration within the PEMA matrix and an increasing concentration of NPs with higher NP content. The particle map and EDX analysis confirmed the evidence of the TiO2 NPs. The mean viable count results for the control (0.0 wt.%) and 1.0 wt.%, 1.5 wt.%, and 2 wt.% TiO2 groups were 139.80, 12.00, 6.20, and 1.00, respectively, with a significant difference from the control group (p < 0.05). The antifungal activity also increased with the increase in the concentration of TiO2 NPs. Conclusions: The addition of TiO2 NPs into a heat-cured soft denture liner provided antifungal activity as evidenced by the reduced colonization of C. albicans. The antimicrobial activity of the liner material increased with the increased concentration of TiO2 NPS

DNA methylation holds prognostic information in relapsed precursor B-cell acute lymphoblastic leukemia

Background: Few biological markers are associated with survival after relapse of B-cell precursor acute lymphoblastic leukemia (BCP-ALL). In pediatric T-cell ALL, we have identified promoter-associated methylation alterations that correlate with prognosis. Here, the prognostic relevance of CpG island methylation phenotype (CIMP) classification was investigated in pediatric BCP-ALL patients. Methods: Six hundred and one BCP-ALL samples from Nordic pediatric patients (age 1-18) were CIMP classified at initial diagnosis and analyzed in relation to clinical data. Results: Among the 137 patients that later relapsed, patients with a CIMP-profile (n = 42) at initial diagnosis had an inferior overall survival (pOS(5years) 33%) compared to CIMP+ patients (n = 95, pOS(5years) 65%) (p = 0.001), which remained significant in a Cox proportional hazards model including previously defined risk factors. Conclusion: CIMP classification is a strong candidate for improved risk stratification of relapsed BCP-ALL.Peer reviewe