SERUM ZINC LEVELS IN SUDANESE PATIENTS WITH ACUTE LYMPHOCYTIC LEUKEMIA

Background: Zinc acts as growth protector for neoplastic cells and its deficiency was contributed to carcinogenesis. However, the determinations of serum zinc in acute lymphocytic leukemia (ALL) prediction and prognosis requires more investigations. Objective: To evaluate and compare serum zinc in ALL patients and healthy controls and to correlate the serum zinc levels with hematological prognostic markers. Materials and methods: The study was conducted in Khartoum state-Sudan during the period from December 2013 to September 2014, it involved a case group of ALL patients (N=100) matched for age and gender with a control group (N=100). Serum copper and zinc levels and full blood count were investigated. Results: The ALL patients showed lower levels of Zn 0.73 ± 0.18 mg/dl compared to controls 1.01 ± 0.25 mg/dl [P = 0.003]. The serum Zn levels were inversely correlated with total white cell (-0.804, P < 0.0001) and blast counts (-0.935, P < 0.0001). Conclusion: These findings ALL associated with lower serum zinc levels and higher serum copper levels. The determination of serum zinc and copper could be used as ALL prognostic markers. KEYWORDS: Acute lymphoblastic leukemia; Zinc; Carcinogenesis

SERUM ZINC LEVELS IN SUDANESE PATIENTS WITH ACUTE LYMPHOCYTIC LEUKEMIA

Background: Zinc acts as growth protector for neoplastic cells and its deficiency was contributed to carcinogenesis. However, the determinations of serum zinc in acute lymphocytic leukemia (ALL) prediction and prognosis requires more investigations. Objective: To evaluate and compare serum zinc in ALL patients and healthy controls and to correlate the serum zinc levels with hematological prognostic markers. Materials and methods: The study was conducted in Khartoum state-Sudan during the period from December 2013 to September 2014, it involved a case group of ALL patients (N=100) matched for age and gender with a control group (N=100). Serum copper and zinc levels and full blood count were investigated. Results: The ALL patients showed lower levels of Zn 0.73 ± 0.18 mg/dl compared to controls 1.01 ± 0.25 mg/dl [P = 0.003]. The serum Zn levels were inversely correlated with total white cell (-0.804, P < 0.0001) and blast counts (-0.935, P < 0.0001). Conclusion: These findings ALL associated with lower serum zinc levels and higher serum copper levels. The determination of serum zinc and copper could be used as ALL prognostic markers. KEYWORDS: Acute lymphoblastic leukemia; Zinc; Carcinogenesis

Enhancing Parkinson's disease diagnosis accuracy through speech signal algorithm modeling

Parkinson's disease (PD), one of whose symptoms is dysphonia, is a prevalent neurodegenerative disease. The use of outdated diagnosis techniques, which yield inaccurate and unreliable results, continues to represent an obstacle in early-stage detection and diagnosis for clinical professionals in the medical field. To solve this issue, the study proposes using machine learning and deep learning models to analyze processed speech signals of patients' voice recordings. Datasets of these processed speech signals were obtained and experimented on by random forest and logistic regression classifiers. Results were highly successful, with 90% accuracy produced by the random forest classifier and 81.5% by the logistic regression classifier. Furthermore, a deep neural network was implemented to investigate if such variation in method could add to the findings. It proved to be effective, as the neural network yielded an accuracy of nearly 92%. Such results suggest that it is possible to accurately diagnose early-stage PD through merely testing patients' voices. This research calls for a revolutionary diagnostic approach in decision support systems, and is the first step in a market-wide implementation of healthcare software dedicated to the aid of clinicians in early diagnosis of PD

Alternative railway tools and sustainability in RAMS: A review

RAMS is a tool and methodology that combines reliability engineering, availability, maintainability, and safety in a way that is tailored to the system’s goals. A comprehensive view on RAMS’s components and theory behind the underlying mathematical model is not to be found in journal publication. This paper would also discuss several benefits and sustainability of RAMS. Life Cycle Cost (LCC) would also being introduce as a complementary discipline in term of costing that normally regarded parallel to RAMS. There are a series of methods that being utilized at every discipline of the RAMS component such as Fault Tree Analysis (FTA), Failure Mode Effect Critical Analysis (FMECA), Reliability Block Diagram and many more. Some commonly used methods would be highlighted in this paper. RAMS application and implementation will aid asset owners, contractors, and operators in efficiently procuring, developing, and operating their assets. However, further research and analysis is needed in the railway industry to build a viable framework for project and operation implementation using both tools

Bio-energy generation in an affordable, single-chamber microbial fuel cell integrated with adsorption hybrid system: effects of temperature and comparison study

A microbial fuel cell (MFC) integrated with adsorption system (MFC-AHS) is tested under various operating temperatures with palm oil mill effluent as the substrate. The optimum operating temperature for such system is found to be at ∼35°C with current, power density, internal resistance (Rin), Coulombic efficiency (CE) and maximum chemical oxygen demand (COD) removal of 2.51 ± 0.2 mA, 74 ± 6 mW m−3, 25.4 Ω, 10.65 ± 0.5% and 93.57 ± 1.2%, respectively. Maximum current density increases linearly with temperature at a rate of 0.1772 mA m−2 °C−1, whereas maximum power density was in a polynomial function. The temperature coefficient (Q10) is found to be 1.20 between 15°C and 35°C. Present studies have demonstrated better CE performance when compared to other MFC-AHSs. Generally, MFC-AHS has demonstrated higher COD removals when compared to standalone MFC regardless of operating temperatures. Abbreviations: ACFF: activated carbon fiber felt; APHA: American Public Health Association; CE: Coulombic efficiency; COD: chemical oxygen demand; ECG: electrocardiogram; GAC: granular activated carbon; GFB: graphite fiber brush; MFC: microbial fuel cell; MFC-AHS: microbial fuel cell integrated with adsorption hybrid system; MFC-GG: microbial fuel cell integrated with graphite granules; POME: palm oil mill effluent; PTFE: polytetrafluoroethylene; SEM: scanning electron microscope. © 2017 Informa UK Limited, trading as Taylor & Francis Group

Baseline Trachoma Surveys in Kaskazini A and Micheweni Districts of Zanzibar: Results of Two Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project.

PURPOSE: Based on health care records and trachoma rapid assessments, trachoma was suspected to be endemic in Kaskazini A and Micheweni districts of Zanzibar. This study aimed to investigate the prevalence of trachomatous inflammation-follicular (TF), and trachomatous trichiasis (TT) in each of those districts. METHODS: The survey was undertaken in Kaskazini A and Micheweni districts on Unguja and Pemba Islands, respectively. A multi-stage cluster random sampling design was applied, whereby 25 census enumeration areas (clusters) and 30 households per cluster were included. Consenting eligible participants (children aged 1-9 years and people aged 15 years and older) were examined for trachoma using the World Health Organization simplified grading system. RESULTS: A total of 1673 households were surveyed and 6407 participants (98.0% of those enumerated) were examined for trachoma. Examinees included a total of 2825 children aged 1-9 years and 3582 people aged 15 years and older. TF prevalence in 1-9-year-olds was 2.7% (95% confidence interval, CI, 2.7-4.1%) in Kazkazini A and 11.4% (95% CI 6.6-16.5%) in Micheweni. Among people aged 15 years and older, TT prevalence was 0.01% (95% CI 0.00-0.04%) in Kazkazini A and 0.21% (95% CI 0.08-0.39%) in Micheweni. CONCLUSION: Trachoma is a public health problem in Micheweni district, where implementation of all four components of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement), including mass drug administration with azithromycin, is required. These findings will facilitate planning for trachoma elimination

Pastoralism and delay in diagnosis of TB in Ethiopia

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB) is a major public health problem in the Horn of Africa with Ethiopia being the most affected where TB cases increase at the rate of 2.6% each year. One of the main contributing factors for this rise is increasing transmission due to large number of untreated patients, serving as reservoirs of the infection within the communities. Reduction of the time between onset of TB symptoms to diagnosis is therefore a prerequisite to bring the TB epidemic under control. The aim of this study was to measure duration of delay among pastoralist TB patients at TB management units in Somali Regional State (SRS) of Ethiopia.</p> <p>Methods</p> <p>A cross sectional study of 226 TB patients with pastoralist identity was conducted in SRS of Ethiopia from June to September 2007. Patients were interviewed using questionnaire based interview. Time between onset of TB symptoms and first visit to a professional health care provider (patient delay), and the time between first visits to the professional health care provider to the date of diagnosis (medical provider's delay) were analyzed. Both pulmonary and extrapulmonary TB patients were included in the study.</p> <p>Result</p> <p>A total of 226 pastoralist TB patients were included in this study; 93 (41.2%) were nomadic pastoralists and 133 (58.8%) were agro-pastoralists. Median patient delay was found to be 60 days with range of 10–1800 days (83 days for nomadic pastoralists and 57 days for agro-pastoralists). Median health care provider's delay was 6 days and median total delay was 70 days in this study. Patient delay constituted 86% of the total delay. In multivariate logistic regression analysis, nomadic pastoralism (aOR. 2.69, CI 1.47–4.91) and having low biomedical knowledge on TB (aOR. 2.02, CI 1.02–3.98) were significantly associated with prolonged patient delay. However, the only observed risk factor for very long patient delay >120 days was distance to health facility (aOR.4.23, CI 1.32–13.54). Extra-pulmonary TB was the only observed predictor for health care providers' delay (aOR. 3.39, CI 1.68–6.83).</p> <p>Conclusion</p> <p>Patient delay observed among pastoralist TB patients in SRS is one of the highest reported so far from developing countries, exceeding two years in some patients. This long patient delay appears to be associated with patient's inadequate knowledge of the disease and distance to health care facility with nomadic pastoralists being the most affected. Regional TB control programmes need to consider the exceptional circumstances of pastoralists, to maximise their access to TB services.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries:A multicountry analysis of survey data

BackgroundCardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care.Methods and findingsWe did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases ('NCD readiness indicators' from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08-3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09-4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02-1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06-1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11-1.32], p ConclusionIn this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries' preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care