Diagnostic accuracy of pelvic MRI for determination of the cervical involvement in endometrial cancer.

OBJECTIVE: To determine the diagnostic accuracy of pelvic MRI for assessment of the cervical involvement in endometrial cancer. STUDY DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Radiology Department of the Aga Khan University Hospital, Karachi from January 2014 to December 2015. METHODOLOGY: Patients with biopsy-proven endometrial cancer were included, who had both their MRI and histopathological diagnosis performed at our institution. Those patients treated with chemo/radiotherapy or had incomplete medical records, were excluded. The extent of cervical involvement by endometrial carcinoma was seen on T2WI images, and findings were correlated after surgery taking histopathology as the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. RESULTS: The mean age of the 56 patients was 60.87 ±8.80 years (range 37-84 years). The most common clinical indication was post-menopausal bleeding (n=37, 66.1%). The most common histological subtype was endometrioid adenocarcinoma (n=50, 89.3%). The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of MRI in the detection of cervical invasion were 92.85%, 88.09%, 89.28%, 72.22% and 97.36%, respectively. CONCLUSION: MRI is a highly sensitive and specific imaging modality for detection of cervical invasion in endometrial carcinoma

Relationship of Science Teachers’ Performance and their Attitude towards Science with Academic Achievement of their Students

The objective of this study was to uncover the relationship of the performance and attitude of science educators with their students’ academic achievements. For this purpose, a survey type questionnaire was set to find data regarding science educators’ academic/ professional qualifications and experience. To find the attitude of science educators towards science, a 50 items’ attitude scale containing five components was formulated and adapted from TOSRA. This questionnaire was completed by 80 secondary grade science educators located in 40 institutions with due consideration being paid to gender, urban/rural representation and inclusion of both private/public secondary institutions. Quantitative analysis of data specified an inverse correlation of educators’ academic as well as professional qualifications/teaching experience with their students’ academic performance. Most of the educators displayed an extremely positive attitude towards their respective subject. Also, a positive relationship was found between science educators’ attitude towards science and academic achievements of their pupils. More studies are required to ascertain the reasons for the negative correlation of educators’ academic/professional qualification/ experience with their students’ achievements and also to explore the variables that influence the attitude of educators towards science

Evaluación de semillas de canola procedentes de diferentes variedades con especial énfasis en la cuantificación de ácido erúcico y glucosinolatos

This study reports the characterization of the seeds and seed oils of five locally grown canola cultivars: Zafar-2002, Bulbul (Frontier), Dunkeld, Oscar and Con-11. The oil contents from canola seeds ranged from 34.3 to 39.3%. The levels of protein, fiber, ash and moisture were found to be 22.1-41.0, 12.0-14.0, 3.0-3.5 and 4.0-7.5%, respectively. The glucosinolate (GSL) contents in the canola seeds examined ranged from 49.7 to 78.1 mmol g-1. The extracted canola seed oils revealed an iodine value of 118.2-124.6 g of I/100g of oil; refractive index (40 °C), 1.460-1.464; density (24 °C), 0.914-0.919 mg mL–1; saponification value, 187-195; unsaponifiable matter, 0.51-1.10%; acidity (% as oleic acid), 0.40-1.40, and color (1-in. cell), 1.35-1.73 R + 21.0-38.0 Y. Peroxide value (meq/ kg of oil) and specific extinctions at 232 and 270 nm were determined to be 2.00-7.08, 2.17-3.16 and 0.44-0.91, respectively. The seed oils of the five canola cultivars mainly consisted of oleic (C18:1), linoleic (C18:2) and linolenic (C18:3) acids at levels of 49.16-62.14, 14.61, 23.45 and 6.97-9.10%, respectively. The concentrations of palmitic (C16:0), stearic (C18:0), erucic (C22:1) and gadoleic (C20:1) acids ranged from 3.47 to 6.00, 1.51 to 2.10, traces to 13.03 and 1.30 to 10.63%, respectively. A small amount of arachidic acid (20:0) with a contribution below 1% was also detected. The contents of tocopherols (α, γ, and δ) in the canola oils accounted for 77.1-270.3, 191-500, 3.5-15.6 mg kg-1, respectively.The presence of rather high levels of erucic acid and GSL in the present analysis of canola emphasized the need to further reduce the contents of these two antinutritional constituents in the investigated cultivars.Este estudio describe de la caracterización de semillas y de sus aceites de cinco cultivos locales de canola: Zafar2002, Bulbul (Frontier), Dunkeld, Oscar y Con 11. El contenido de aceite de las semillas de canola varió entre un 34.3 y un 39.3%. Los niveles de proteína, fibra, ceniza y humedad fueron 22.1-41.0, 12.0-14.0, 3.0-3.5 and 4.0-7.5%, respectivamente. El contenido de glucosinolatos (GSL) en las semillas de canola examinadas varió entre un 49.7 y un 78.1 mmol g-1. El aceite de canola extraído tuvo un índice de yodo de 118.2-124.6 g de I/100g de aceite; índice de refracción (40°C), 1.460-1.464; densidad (24°C), 0.914-0.919 mg mL–1; índice de saponificación, 187-195; materia insaponifiable, 0.51-1.10%; acidez (% como ácido oleico), 0.40-1.40, y color (cubeta de 1 pulgada), 1.35-1.73 R + 21.0-38.0 Y. El índice de peróxido (meq/ kg de aceite) y la extinción específica a 232 and 270 nm fueron 2.00-7.08, 2.17-3.16 and 0.440.91, respectivamente. El aceite de las semillas de los cinco cultivos de canola contenían principalmente ácido oleico (C18:1), ácido linoleico (C18:2) and ácido linolenico (C18:3) a unos niveles de 49.16-62.14, 14.61-23.45 and 6.97-9.10%, respectivamente. Las concentraciones de ácido palmítico (C16:0), ácido esteárico (C18:0), ácido erúcico (C22:1) y ácido gadoleico (C20:1) variaron entre 3.47 y 6.00, 1.51 y 2.10, trazas y 13.03, y 1.30 y 10.63%, respectivamente. Una pequeña cantidad de ácido araquídico (20:0) con una contribución por debajo del 1% fue también detectada. El contenido de tocoferoles (α, γ, y δ) en los aceites de canola fue de 77.1-270.3, 191-500, 3.5-15.6 mg kg-1, respectivamente. La presencia de niveles relativamente altos de ácido erúcico y GSL en el presente análisis de la canola incide en la necesidad de reducir el contenido de estos dos constituyentes anti-nutricionales en los cultivares investigados

Toxicity and bioaccumulation of heavy metals in spinach (spinacia oleracea) grown in a controlled environment

The impact of heavy metal toxicity on the shoot and root lengths, total protein, fiber characteristics, moisture content and nutrient composition of spinach (Spinacia oleracea) was evaluated. Plants were grown in pots containing soil and treated with different concentrations (mg/kg) of lead (Pb; 300, 400 and 500), cadmium (Cd; 0.5, 1 and 1.5) and zinc (Zn; 250, 500, and 700) as well as mixtures of Cd and Pb (0.5/300, 1/400, 1.5/500), Cd and Zn (0.5/250, 1/500, 1.5/700), and Pb and Zn (300/250, 400/500, 500/700). Soil contaminated by long-term irrigation with wastewater containing heavy metals was simulated. An increase in concentrations of heavy metals both individually and as mixtures significantly (p < 0.05) reduced the growth parameters and nutrient contents of S. oleracea. The uptake patterns of heavy metals in mixtures showed antagonistic impacts on each other. The toxicities of the mixtures Cd and Pb, Cd and Zn as well as Pb and Zn were higher than those observed in separate heavy metal applications but less than their additive sums. The toxicity caused by individual heavy metals was the highest for Cd followed by Pb and Zn. The highest toxicity was observed in plants grown in soil contaminated by Cd and Pb

Reading Comprehension and Behavior in Children Using E-books vs. Printed Books

The purpose of this research is to investigate the influence that personalized, gamified, and PDF electronic reading practices have on the attitudes which fifth-grade students possess toward e-reading experiences, as well as how these stances affect the students' motivation and reading comprehension while they are learning English as a second/foreign language (EFL). For the purpose of the study, there were a total of 84 fifth-grade kids from public schools in Greece, who participated. These students were split up into three different experimental groups and a control one. Participants in the experimental groups read throughout the treatment period according to a preset schedule using one of three diverse electronic reading formats (PDF, gamified, or customized), whilst participants in the control group read utilizing a paper guided reading plan. The participants' experiences playing video games online were analyzed via a technique called the quasi-experimental approach. According to the findings of the research, the experimental group and the control group did not significantly vary from one another in terms of their levels of reading comprehension. On the other hand, in comparison to the participants in the control group, those who took part in the experiments reported having more favorable sentiments regarding their electronic reading experiences and were more inspired to read. As indicated from the research findings, kids may experience an increase in their desire to read when they use electronic gadgets. This study has implications for educators and policymakers as they consider incorporating digital reading practices into their teaching methods, particularly when it comes to improving students' motivation to read

A retrospective study of laboratory-based enteric fever surveillance, Pakistan, 2012-2014

Introduction: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multisite surveillance study designed to capture morbidity and mortality burden of enteric fever (typhoid and paratyphoid) in Bangladesh, Nepal, and Pakistan. We aim to describe enteric fever disease burden, severity of illness, and antimicrobial resistance trends in Pakistan.Methods: In this retrospective, cross-sectional study, laboratory records of hospitalized patients who received a blood culture in any of 3 Aga Khan University hospitals in Karachi and Hyderabad, Pakistan, from 2012 to 2014 were reviewed. A case was defined as having a positive blood culture for Salmonella Typhi (S. Typhi) or Salmonella Paratyphi (S. Paratyphi). Antimicrobial sensitivity patterns were characterized for all S. Typhi and S. Paratyphi isolates. Medical records were available for abstraction (demographics, clinical features, complications) only among hospitalized cases.Results: Of the 133017 blood cultures completed during the study period, 2872 (2%) were positive-1979 (69%) for S. Typhi and 893 (31%) for S. Paratyphi. Fluoroquinolone resistance was present in \u3e90% of both the S. Typhi and the S. Paratyphi isolates; almost none of the isolates were resistant to cephalosporins. Multidrug resistance (resistance to ampicillin, chloramphenicol, and cotrimoxazole) was observed in 1035 (52%) S. Typhi isolates and 14 (2%) S. Paratyphi isolates. Among S. Typhi and S. Paratyphi isolates, 666 (23%) were linked to hospitalized patients with medical records. Of the 537 hospitalized S. Typhi cases, 280 (52%) were aged 5-15 years, 133 (25%) were aged 2-4 years, 114 (21%) were aged \u3e15 years, and 10 (2%) were aged 0-1 years. Among the 129 hospitalized S. Paratyphi cases, 73 (57%) were aged \u3e15 years, 41 (32%) were aged 5-15 years, 13 (10%) were aged 2-4 years, and 2 (2%) were aged 0-1 years. Significant differences in symptomology between S. Typhi and S. Paratyphi cases were observed for nausea/vomiting, diarrhea, loss of appetite, and headache. Leukopenia, thrombocytopenia, and encephalopathy were the most commonly reported complications among enteric fever cases. No deaths were reported.Conclusion: Evidence of high antimicrobial resistance levels and disease severity support the need for continued surveillance and improved diagnostics for typhoid. Further prospective studies on vaccination as a tool for prevention of enteric fever in Pakistan are needed to inform disease intervention strategies

Antimicrobial resistance in typhoidal salmonella: Surveillance for enteric fever in Asia project, 2016-2019

Background: Clinicians have limited therapeutic options for enteric as a result of increasing antimicrobial resistance, and therefore typhoid vaccination is recommended as a preventive measure. As a part of the Surveillance for Enteric Fever in Asia Project (SEAP), we investigated the extent measured the burden of antimicrobial resistance (AMR) among confirmed enteric fever cases in Bangladesh, Nepal, and Pakistan.Methods: From September 2016-September 2019, SEAP recruited study participants of all age groups from its outpatient, inpatient, hospital laboratory, laboratory network, and surgical sites who had a diagnosis of febrile illness that was either suspected or blood culture confirmed for enteric fever. Antimicrobial resistance of isolates was determined by disc diffusion using Clinical and Laboratory Standard Institute cut-off points. We reported the frequency of multidrug resistance (MDR)(resistance to ampicillin, cotrimoxazole, and chloramphenicol), extensive drug resistance (XDR) (MDR plus non-susceptible to fluoroquinolone and any 3rd generation cephalosporins), and fluoroquinolone (FQ) and azithromycin non-susceptibility.Results: We enrolled 8,705 blood culture confirmed enteric fever cases: 4,873 (56%) from Bangladesh, 1,602 (18%) from Nepal and 2,230 (26%) from Pakistan. Of these, 7,591 (87%) were Salmonella Typhi and 1114 (13%) were S. Paratyphi. MDR S. Typhi was identified in 17% (701/4065) of isolates in Bangladesh, and 1% (19/1342) in Nepal. In Pakistan, 16 % (331/2084) of S. Typhi isolates were MDR, and 64% (1319/2074) were XDR. FQ nonsusceptibility among S. Typhi isolates was 98% in Bangladesh, 87% in Nepal, and 95% in Pakistan. Azithromycin non-susceptibility was detected in 77 (2%) in Bangladesh, 9 (.67%) in Nepal and 9 (.59%) isolates in Pakistan. In Pakistan, three (2%) S. Paratyphi isolates were MDR; no MDR S. Paratyphi was reported from Bangladesh or Nepal.Conclusions: Although AMR against S. Paratyphi was low across the three countries, there was widespread drug resistance among S. Typhi, including FQ non-susceptibility and the emergence of XDR S. Typhi in Pakistan, limiting treatment options. As typhoid conjugate vaccine (TCV) is rolled out, surveillance should continue to monitor changes in AMR to inform policies and to monitor drug resistance in S. Paratyphi, for which there is no vaccine

Effect of 3 days of oral azithromycin on young children with acute diarrhea in low-resource settings: A randomized clinical trial

Importance: World Health Organization (WHO) guidelines do not recommend routine antibiotic use for children with acute watery diarrhea. However, recent studies suggest that a significant proportion of such episodes have a bacterial cause and are associated with mortality and growth impairment, especially among children at high risk of diarrhea-associated mortality. Expanding antibiotic use among dehydrated or undernourished children may reduce diarrhea-associated mortality and improve growth.Objective: To determine whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear growth.Design, setting, and participants: The Antibiotics for Children with Diarrhea (ABCD) trial was a multicountry, randomized, double-blind, clinical trial among 8266 high-risk children aged 2 to 23 months presenting with acute nonbloody diarrhea. Participants were recruited between July 1, 2017, and July 10, 2019, from 36 outpatient hospital departments or community health centers in a mixture of urban and rural settings in Bangladesh, India, Kenya, Malawi, Mali, Pakistan, and Tanzania. Each participant was followed up for 180 days. Primary analysis included all randomized participants by intention to treat.Interventions: Enrolled children were randomly assigned to receive either oral azithromycin, 10 mg/kg, or placebo once daily for 3 days in addition to standard WHO case management protocols for the management of acute watery diarrhea.Main outcomes and measures: Primary outcomes included all-cause mortality up to 180 days after enrollment and linear growth faltering 90 days after enrollment.Results: A total of 8266 children (4463 boys [54.0%]; mean [SD] age, 11.6 [5.3] months) were randomized. A total of 20 of 4133 children in the azithromycin group (0.5%) and 28 of 4135 children in the placebo group (0.7%) died (relative risk, 0.72; 95% CI, 0.40-1.27). The mean (SD) change in length-for-age z scores 90 days after enrollment was -0.16 (0.59) in the azithromycin group and -0.19 (0.60) in the placebo group (risk difference, 0.03; 95% CI, 0.01-0.06). Overall mortality was much lower than anticipated, and the trial was stopped for futility at the prespecified interim analysis.Conclusions and relevance: The study did not detect a survival benefit for children from the addition of azithromycin to standard WHO case management of acute watery diarrhea in low-resource settings. There was a small reduction in linear growth faltering in the azithromycin group, although the magnitude of this effect was not likely to be clinically significant. In low-resource settings, expansion of antibiotic use is not warranted. Adherence to current WHO case management protocols for watery diarrhea remains appropriate and should be encouraged.Trial registration: ClinicalTrials.gov Identifier: NCT03130114

Emergence of an Extensively Drug-Resistant Salmonella enterica Serovar Typhi Clone Harboring a Promiscuous Plasmid Encoding Resistance to Fluoroquinolones and Third-Generation Cephalosporins.

Antibiotic resistance is a major problem in Salmonella enterica serovar Typhi, the causative agent of typhoid. Multidrug-resistant (MDR) isolates are prevalent in parts of Asia and Africa and are often associated with the dominant H58 haplotype. Reduced susceptibility to fluoroquinolones is also widespread, and sporadic cases of resistance to third-generation cephalosporins or azithromycin have also been reported. Here, we report the first large-scale emergence and spread of a novel S Typhi clone harboring resistance to three first-line drugs (chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) as well as fluoroquinolones and third-generation cephalosporins in Sindh, Pakistan, which we classify as extensively drug resistant (XDR). Over 300 XDR typhoid cases have emerged in Sindh, Pakistan, since November 2016. Additionally, a single case of travel-associated XDR typhoid has recently been identified in the United Kingdom. Whole-genome sequencing of over 80 of the XDR isolates revealed remarkable genetic clonality and sequence conservation, identified a large number of resistance determinants, and showed that these isolates were of haplotype H58. The XDR S Typhi clone encodes a chromosomally located resistance region and harbors a plasmid encoding additional resistance elements, including the blaCTX-M-15 extended-spectrum β-lactamase, and carrying the qnrS fluoroquinolone resistance gene. This antibiotic resistance-associated IncY plasmid exhibited high sequence identity to plasmids found in other enteric bacteria isolated from widely distributed geographic locations. This study highlights three concerning problems: the receding antibiotic arsenal for typhoid treatment, the ability of S Typhi to transform from MDR to XDR in a single step by acquisition of a plasmid, and the ability of XDR clones to spread globally.IMPORTANCE Typhoid fever is a severe disease caused by the Gram-negative bacterium Salmonella enterica serovar Typhi. Antibiotic-resistant S Typhi strains have become increasingly common. Here, we report the first large-scale emergence and spread of a novel extensively drug-resistant (XDR) S Typhi clone in Sindh, Pakistan. The XDR S Typhi is resistant to the majority of drugs available for the treatment of typhoid fever. This study highlights the evolving threat of antibiotic resistance in S Typhi and the value of antibiotic susceptibility testing and whole-genome sequencing in understanding emerging infectious diseases. We genetically characterized the XDR S Typhi to investigate the phylogenetic relationship between these isolates and a global collection of S Typhi isolates and to identify multiple genes linked to antibiotic resistance. This S Typhi clone harbored a promiscuous antibiotic resistance plasmid previously identified in other enteric bacteria. The increasing antibiotic resistance in S Typhi observed here adds urgency to the need for typhoid prevention measures