Better outcome of splenectomy in younger patients suffering from chronic immune thrombocytopenia

Abstract Immune thrombocytopenia purpura (ITP) may need splenectomy after failure of medical treatment. The aim of this study was to explore the outcome of splenectomy in chronic ITP and to point out factors which can predict better response to splenectomy. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised adult patients who underwent splenectomy for ITP from October 2005 to December 2015. Of the 51 patients, 37(72.5%) were females and 14(27.5%) were males. The overall median age was 32 years (interquartile range: 18-65 years). Complete response was seen in 43(84.3%) patients, 2(4%) had response and 6(11.7%) had no response. Relapse rate of ITP at 1 year was 4(8.8%). Multivariate analysis showed that failure rate of splenectomy in the 41(80.4%) patients aged \u3c50 years was 3(7%) as opposed to 3(30%) in the 10(19.6%) patients aged \u3e50 years (p=0.04). Splenectomy was found to be a safe and effective option for treatment of ITP. Young age at the time of surgery was associated with good response to surgery

Photopyroelectric spectroscopy of Sb2O3 - ZnO ceramics

Photopyroelectric spectroscopy is used to study the band-gap energy of the ceramic (ZnO + xSb2O3), x = 0.1 - 1.5 mol% and the ceramic (ZnO + 0.4 mol%  Bi2O3 + xSb2O3), x = 0 - 1.5 mol% sintered at isothermal temperature, 1280 °C, for 1 and 2 hours. The wavelength of incident light, modulated at 9 Hz, is kept in the visible range and the photopyroelectric spectrum with reference to doping level is discussed. The band-gap energy is reduced from 3.2 eV, for pure ZnO, to 2.86, 2.83 eV for the samples without Bi2O3at 0.1 mol% of Sb2O3 for 1 and 2 hours of sintering time, respectively. It is reduced to 2.83, 2.80 eV for the samples with Bi2O3 at 0 mol% of Sb2O3 for 1 and 2 hours of sintering time, respectively. The steepness factor σA which characterizes the slop of exponential optical absorption is discussed with reference to the doping level. The phase constitution is determined by XRD analysis; microstructure and compositional analysis of the selected areas are analyzed using SEM and EDX

Photopyroelectric spectrum of MNO2 Doped Bi2O3 - TiO2 - ZnO ceramic combination

Photopyroelectric spectroscopy is used to study the energy band-gap of the ceramic (ZnO 0.25 Bi2O3 +0.25 TiO2 + x MnO2), x = 0 - 1.3 mol%, sintered at isothermal temperature 1190 and 1270°C for 2 hours in air. The wavelength of incident light, modulated at 9 Hz, is kept in the range of 300 to 800 nm and the photopyroelectric spectrum with reference to the doping level is discussed. The energy band-gap is estimated from the plot (phv)2 vs hv and is 2.80 eV for the samples without MnO2 at both sintering temperatures. It decreases to 2.08 eV with a further increase of MnO2. The phase constitution is determined by XRD analysis. Microstructure and compositional analysis of the selected areas are analyzed using SEM and EDX. The maximum relative density, 91.4 %, and the grain size, 47 µm, were observed in this ceramics combination

Effect of sintering temperature on the photothermal spectrum of Bi2O3 - TiO2 - Co3O4 - ZnO ceramics

Photopyroelectric spectroscopy is used to study the band‐gap energy of the ceramic ZnO+0.5 Bi2O3+0.5 TiO2+0.4 Co3O4 (mol%), sintered at the isothermal temperature 1180 and 1210, 1240, 1270, 1300° C for 1 and 2 hours in air. The wavelength of incident light, modulated at 9 Hz, is kept in the range 300 to 800 nm and the photopyroelectric spectrum with reference to the doping level is discussed. The band‐gap energy is estimated from the plot (ρhν)2 vs hν and is 2.30 eV at 1180° C for 1 hour sintering time and is reduced to 2.15 eV at 1300° C sintering temperature. Eg is constant at about 2.8 eV at all sintering temperatures for 2 hours sintering time. The steepness factor σA (in A region) and σB (in B region) which characterizes the slop of exponential optical absorption is discussed with reference to the sintering temperature. The phase constitution is determined by XRD analysis. Microstructure and compositional analysis of the selected areas are analyzed using SEM and EDAX. The maximum relative density 87.5% and the grain size 44.6 μm are observed in this ceramics combination

Cutaneous Leishmaniasis in Khyber Pakhtunkhwa Province of Pakistan: Clinical Diversity and Species-Level Diagnosis.

This study primarily aimed to identify the causative species of cutaneous leishmaniasis (CL) in the Khyber Pakhtunkhwa Province of Pakistan and to distinguish any species-specific variation in clinical manifestation of CL. Diagnostic performance of different techniques for identifying CL was assessed. Isolates of Leishmania spp. were detected by in vitro culture, polymerase chain reaction (PCR) on DNA extracted from dried filter papers and microscopic examination of direct lesion smears from patients visiting three major primary care hospitals in Peshawar. A total of 125 CL patients were evaluated. Many acquired the disease from Peshawar and the neighboring tribal area of Khyber Agency. Military personnel acquired CL while deployed in north and south Waziristan. Leishmania tropica was identified as the predominant infecting organism in this study (89.2%) followed by Leishmania major (6.8%) and, unexpectedly, Leishmania infantum (4.1%). These were the first reported cases of CL caused by L. infantum in Pakistan. PCR diagnosis targeting kinetoplast DNA was the most sensitive diagnostic method, identifying 86.5% of all samples found positive by any other method. Other methods were as follows: ribosomal DNA PCR (78.4%), internal transcribed spacer 2 region PCR (70.3%), culture (67.1%), and microscopy (60.5%). Clinical examination reported 14 atypical forms of CL. Atypical lesions were not significantly associated with the infecting Leishmania species, nor with "dry" or "wet" appearance of lesions. Findings from this study provide a platform for species typing of CL patients in Pakistan, utilizing a combination of in vitro culture and molecular diagnostics. Moreover, the clinical diversity described herein can benefit clinicians in devising differential diagnosis of the disease

Determination of the energy band-gap of the ceramic ZnO -xTiO₂ using photopyroelectric spectroscopy

Photopyroelectric (PPE) spectroscopy is a useful tool for examining optical properties in semiconductor materials. The ceramic (ZnO - xTiO₂) was sintered at 1270⁰C for 1 and 3 hours to investigate the variations of energy band-gap with respect to mol % of dopant TiO₂. The X-ray diffractrometry shows that the crystal structure of ZnO doped at low level remains to be of hexagonal type but has developed second phase, Zn₂TiO₄, at high level. Microstructure and compositional analysis of the selected areas are analyzed using SEM and EDAX. The maximum grain size obtained were 26.8, 52.4 µm at 0.4 mol % of TiO₂ for 1 and 3 hours sintering time, respectively. The band-gap determined from the photopyroelectric spectrum has the value of 2.82 ± 0.01 eV for samples sintered for 1 and 3 hours at the doping level of 0.4 mol % of TiO₂ and decreases with the increase of TiO₂

Use of a Reflectance Spectroscopy Accessory for Optical Characterization of ZnO-Bi2O3-TiO2 Ceramics

The optical band-gap energy (Eg) is an important feature of semiconductors which determines their applications in optoelectronics. Therefore, it is necessary to investigate the electronic states of ceramic ZnO and the effect of doped impurities under different processing conditions. Eg of the ceramic ZnO + xBi2O3 + xTiO2, where x = 0.5 mol%, was determined using a UV-Vis spectrophotometer attached to a Reflectance Spectroscopy Accessory for powdered samples. The samples was prepared using the solid-state route and sintered at temperatures from 1140 to 1260 °C for 45 and 90 minutes. Eg was observed to decrease with an increase of sintering temperature. XRD analysis indicated hexagonal ZnO and few small peaks of intergranular layers of secondary phases. The relative density of the sintered ceramics decreased and the average grain size increased with the increase of sintering temperature

Tamarindus indica Extract Alters Release of Alpha Enolase, Apolipoprotein A-I, Transthyretin and Rab GDP Dissociation Inhibitor Beta from HepG2 Cells

Background: The plasma cholesterol and triacylglycerol lowering effects of Tamarindus indica extract have been previously described. We have also shown that the methanol extract of T. indica fruit pulp altered the expression of lipid-associated genes including ABCG5 and APOAI in HepG2 cells. In the present study, effects of the same extract on the release of proteins from the cells were investigated using the proteomics approach. Methodology/Principal Findings: When culture media of HepG2 cells grown in the absence and presence of the methanol extract of T. indica fruit pulp were subjected to 2-dimensional gel electrophoresis, the expression of seven proteins was found to be significantly different (p<0.03125). Five of the spots were subsequently identified as alpha enolase (ENO1), transthyretin (TTR), apolipoprotein A-I (ApoA-I; two isoforms), and rab GDP dissociation inhibitor beta (GDI-2). A functional network of lipid metabolism, molecular transport and small molecule biochemistry that interconnects the three latter proteins with the interactomes was identified using the Ingenuity Pathways Analysis software. Conclusion/Significance: The methanol extract of T. indica fruit pulp altered the release of ENO1, ApoA-I, TTR and GDI-2 from HepG2 cells. Our results provide support on the effect of T. indica extract on cellular lipid metabolism, particularly that of cholesterol

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic