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BACKGROUND: The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain. METHODS: We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale. RESULTS: A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P=0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P=0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS: Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. Fil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; Argentina Fil: Vogel, Joshua P.. Organizacion Mundial de la Salud; Argentina Fil: Piaggio, Gilda. Organizacion Mundial de la Salud; Argentina Fil: Nguyen, My-Huong. Organizacion Mundial de la Salud; Argentina Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Metin Gülmezoglu, A.. Organizacion Mundial de la Salud; Argentina Fil: Bahl, Rajiv. Organizacion Mundial de la Salud; Argentina Fil: Rao, Suman P.N.. Organizacion Mundial de la Salud; Argentina Fil: de Costa, Ayesha. Organizacion Mundial de la Salud; Argentina Fil: Gupta, Shuchita. Organizacion Mundial de la Salud; Argentina Fil: Shahidullah, Mohammod. No especifíca; Fil: Chowdhury, Saleha B.. No especifíca; Fil: Ara, Gulshan. No especifíca; Fil: Akter, Shaheen. No especifíca; Fil: Akhter, Nasreen. No especifíca; Fil: Dey, Probhat R.. No especifíca; Fil: Abdus Sabur, M.. No especifíca; Fil: Azad, Mohammad T.. No especifíca; Fil: Choudhury, Shahana F.. No especifíca; Fil: Matin, M.A.. No especifíca; Fil: Goudar, Shivaprasad S.. No especifíca; Fil: Dhaded, Sangappa M.. No especifíca; Fil: Metgud, Mrityunjay C.. No especifíca; Fil: Pujar, Yeshita V.. No especifíca; Fil: Somannavar, Manjunath S.. No especifíca; Fil: Vernekar, Sunil S.. No especifíca; Fil: Herekar, Veena R.. No especifíca; Fil: Bidri, Shailaja R.. No especifíca; Fil: Mathapati, Sangamesh S.. No especifíca; Fil: Patil, Preeti G.. No especifíca; Fil: Patil, Mallanagouda M.. No especifíca; Fil: Gudadinni, Muttappa R.. No especifíca; Fil: Bijapure, Hidaytullah R.. No especifíca; Fil: Mallapur, Ashalata A.. No especifíca; Fil: Katageri, Geetanjali M.. No especifíca; Fil: Chikkamath, Sumangala B.. No especifíca; Fil: Yelamali, Bhuvaneshwari C.. No especifíca; Fil: Pol, Ramesh R.. No especifíca; Fil: Misra, Sujata S.. No especifíca; Fil: Das, Leena. No especifíca

Epilepsy is associated with impaired physical, psychological and social functioning. Assessing its impact on these parameters is important to improving the wellbeing of those with the disorder.To assess the impact of epilepsy on the physical, psychological and social status of adolescents in a rural community.Adolescents with epilepsy (Subjects) were identified in a community house to house survey. Controls (adolescents without epilepsy) matched for age and sex were randomly selected from the community. Information obtained from the subjects, controls and their care givers using a structured questionnaire included: Age, Sex, Social Class, Knowledge of epilepsy, Characteristics of epilepsy, Treatment options utilized, Health-Related Quality of Life (HRQOL), Body Mass Index (BMI), Academic performance and Epilepsy related problems.Eighteen subjects, 10.5/1000 of the adolescent (10-19 years) population, had epilepsy. The mean age was 16.7± 2.6 years and 16.3± 2.6 years for the subjects and controls respectively. Most of the subjects were males (83.3%). All the subjects had generalized epilepsy, were on traditional medication and none was on orthodox medical therapy. Occurrence of seizures, cost of accessing orthodox medical treatment and stigma were the major problems identified. Ingestion of traditional medication was the commonest modality for overcoming the major problems identified. Seven (38.8%) were underweight but it was not significant (p0.05). Epilepsy was significantly associated with impaired HRQOL, academic performance and social relationships (p0.05).Epilepsy had a negative impact on the psychosocial and academic status of adolescents. It highlights the need to provide comprehensive adolescent health and social services in epilepsy management.

Introduction: Medial and lateral “dog ear” deformities are a common problem with mastectomy incisions. The challenges include different skin tensions superiorly and inferiorly and variable BMI. Also, the standard mastectomy incision is also not in the optimal place for sentinel node biopsy access. No published technique is universally applicable and some advanced techniques require excess dissection and operative time. Aims: 1) To perform a literature search for all published techniques 2) To pilot test a new, simple incision Methods: A literature search using PubMed was performed that revealed eight previous techniques (1). A new, simple technique was developed to incorporate most of the historical principles. Circles of different sizes are marked out medially (small) and laterally (large). The lateral circle incorporates the optimal position for access to the axilla for sentinel node biopsy or axillary clearance. These circles are joined by asymmetrical superior and inferior lines to encourage rotation during closure. Tumour size and position are taken into consideration. Wound closure begins from the centre which allows the wound to "choose" its own corners and tuck them inwards therefore minimising "dog ear" formation. Results: Seventy- five consecutive patients had the procedure by a single surgeon over an 18 month period. At the conclusion of each procedure there was no residual "dog ear" deformity at either wound end. Of the 36 patients seen for 12 month follow up only one (BMI 42) has required revision of the wound. Conclusion: The "Penny Farthing" incision is a novel, simple and promising technique to deal with "dog ear" deformity in mastectomy. Reference: 1. Thomas R, Mouat C, King B. Mastectomy flap design: the ‘waisted teardrop’ and a method to reduce the lateral fold. ANZ Journal of Surgery. 2012; 82: 329-333. Citation Format: Poole G, Sheikh L. The “penny farthing” incision for mastectomy: A novel technique to reduce “dog ear” deformity and improve access to the axilla. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-21.

Introduction Following reports of respiratory symptoms among service members returning from deployment to South West Asia (SWA), an expert panel recommended pre-deployment spirometry be used to assess disease burden. Unfortunately, testing with spirometry is high cost and time-consuming. The airflow perturbation device (APD) is a handheld monitor that rapidly measures respiratory resistance (APD-Rr) and has promising but limited clinical data. Its speed and portability make it ideally suited for large volume pre-deployment screening. We conducted a pilot study to assess APD performance characteristics and develop normative values. Materials and methods We prospectively enrolled subjects and derived reference equations for the APD from those without respiratory symptoms, pulmonary disease, or tobacco exposure. APD testing was conducted by medical technicians who received a 10-min in-service on its use. A subset of subjects performed spirometry and impulse oscillometry (iOS), administered by trained respiratory therapists. APD measures were compared with spirometry and iOS. Results The total study population included 199 subjects (55.8% males, body mass index 27.7 ± 6.0 kg/m2, age 49.9 ± 18.7 yr). Across the three APD trials, mean inspiratory (APD-Ri), expiratory (APD-Re), and average (APD-Ravg) resistances were 3.30 ± 1.0, 3.69 ± 1.2, and 3.50 ± 1.1 cm H2O/L/s. Reference equations were derived from 142 clinically normal volunteers. Height, weight, and body mass index were independently associated with APD-Ri, APD-Re, and APD-Ravg and were combined with age and gender in linear regression models. APD-Ri, APD-Re, and APD-Ravg were significantly inversely correlated with FEV1 (r = -0.39 to -0.42), FVC (r = -0.37 to -0.40), and FEF25-75 (r = -0.31 to -0.35) and positively correlated with R5 (r = 0.61-0.62), R20 (r = 0.50-0.52), X5 (r = -0.57 to -0.59), and FRES (r = 0.42-0.43). Bland-Altman plots showed that the APD-Rr closely approximates iOS when resistance is normal. Conclusion Rapid testing was achieved with minimal training required, and reference equations were constructed. APD-Rr correlated moderately with iOS and weakly with spirometry. More testing is required to determine whether the APD has value for pre- and post-deployment respiratory assessment.

Background Symptomatic osteoarthritis poses a major challenge to primary health care but no studies have related accessing primary care ("detection"), receiving recommended treatments ("treatment"), and achieving adequate control ("control").\ud \ud Objective To provide estimates of detection, treatment, and control within a single population adapting the approach used to determine a Rule of Halves for other long-term conditions.\ud \ud Setting General population.\ud \ud Participants 400 adults aged 50+ years with prevalent symptomatic knee osteoarthritis.\ud \ud Design Prospective cohort with baseline questionnaire, clinical assessment, and plain radiographs, and questionnaire follow-up at 18 and 36 months and linkage to primary care medical records.\ud \ud Outcome measures "Detection" was defined as at least one musculoskeletal knee-related GP consultation between baseline and 36 months. "Treatment" was self-reported use of at least one recommended treatment or physiotherapy/hospital specialist referral for their knee problem at all three measurement points. Pain was "controlled" if characteristic pain intensity \ud \ud Results In 221 cases (55.3%; 95%CI: 50.4, 60.1) there was evidence that the current problem had been detected in general practice. Of those detected, 164 (74.2% (68.4, 80.0)) were receiving one or more of the recommended treatments at all three measurement points. Of those detected and treated, 45 (27.4% (20.5, 34.3)) had symptoms under control on at least two occasions. Using narrower definitions resulted in substantially lower estimates.\ud \ud Conclusion Osteoarthritis care does not conform to a Rule of Halves. Symptom control is low among those accessing health care and receiving treatment.

Background: The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis (ARC). To inform the development of recommendations, we sought to critically assess the systematic review evidence on the effectiveness, safety and cost-effectiveness of AIT for ARC. Methods: We undertook a systematic overview, which involved searching nine international biomedical databases from inception to October 31, 2015. Studies were independently screened by two reviewers against pre-defined eligibility criteria and critically appraised using the Critical Appraisal Skills Programme (CASP) Systematic Review Checklist for systematic reviews. Data were descriptively synthesized. Results: Our searches yielded a total of 5932 potentially eligible studies, from which 17 systematic reviews met our inclusion criteria. Eight of these were judged to be of high, five moderate and three low quality. These reviews suggested that, in carefully selected patients, subcutaneous (SCIT) and sublingual (SLIT) immunotherapy resulted in significant reductions in symptom scores and medication requirements. Serious adverse outcomes were rare for both SCIT and SLIT. Two systematic reviews reported some evidence of potential cost savings associated with use of SCIT and SLIT. Conclusions: We found moderate-to-strong evidence that SCIT and SLIT can, in appropriately selected patients, reduce symptoms and medication requirements in patients with ARC with reassuring safety data. This evidence does however need to be interpreted with caution, particularly given the heterogeneity in the populations, allergens and protocols studied. There is a lack of data on the relative effectiveness, cost-effectiveness and safety of SCIT and SLIT. We are now systematically reviewing all the primary studies, including recent evidence that has not been incorporated into the published systematic reviews. © 2017 The Author(s).

Background: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis. Methods: We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses. Results: We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD −0.53, 95% CI −0.63, −0.42), medication (SMD −0.37, 95% CI −0.49, −0.26), and combined symptom and medication (SMD −0.49, 95% CI −0.69, −0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores. Conclusions: AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

SleepMapper is a mobile, web-based system that allows patients to self-monitor their positive airway pressure therapy, and provides feedback and education in real time. In addition to the usual, comprehensive support provided at our clinic, we gave the SleepMapper to 30 patients initiating positive airway pressure. They were compared with patients initiating positive airway pressure at our clinic without SleepMapper (controls) to determine whether SleepMapper affected adherence. A total of 61 patients had polysomnographic and adherence data analysed, 30 were given SleepMapper and 31 received our standard of care. The two groups were well matched at baseline to include no significant differences in age, apnea-hypopnea index, percentage receiving split-night polysomnographs and starting pressures. Patients in the control group received significantly more non-benzodiazepine sedative hypnotics the night of their polysomnography and during positive airway pressure initiation. At 11 weeks, patients in the SleepMapper group had a greater percentage of nights with any use (78.0 ± 22.0 versus 55.5 ± 24.0%; P 0.001) and4 h positive airway pressure use (78.0 ± 22.0 versus 55.5 ± 24.0%; P = 0.02). There was a trend toward more patients in the SleepMapper group achieving4 h of use for at least 70% of nights [9/30 (30%) versus 3/31 (9.7%); P = 0.06]. In multivariate linear regression, the SleepMapper remained significantly associated with percentage of nights4 h positive airway pressure use (β coefficient = 0.18; P = 0.02). Added to our usual, comprehensive programme to maximize positive airway pressure adherence in new users, the SleepMapper was independently associated with an 18% increase in nights4 h of use.

Objective Poisoning is the fourth leading cause of unintentional injury and a common paediatric emergency in children under 5 years of age. The objective of this study was to determine the factors associated with unintentional poisoning among children under 5 years of age presenting to emergency rooms at tertiary care hospitals in Karachi, Pakistan. Setting Children were recruited from the emergency rooms of the three biggest tertiary care hospitals in Karachi. Design A matched case–control study was conducted on 120 cases and 360 controls, with matching done on gender and age. Parents were interviewed using a structured questionnaire containing information on sociodemographic factors, the child9s behaviour, and the storage practices of hazardous substances of caregivers in the homes. Conditional logistic regression was performed to analyse the data. Results Accessibility to hazardous chemicals and medicines due to unsafe storage (adj mOR=5.6, 95% CI 1.9 to 16.7), child9s behaviour reported as usually aggressive (adj mOR=8.2, 95% CI 4.6 to 16.1), storage of kerosene oil and petrol in soft drink bottles (adj mOR=3.8, 95% CI 2.0 to 7.3), low socioeconomic status (adj mOR=9.2, 95% CI 2.8 to 30.1), low level of mother9s education (adj mOR=4.2, 95% CI 1.8 to 9.6), and history of previous poisoning (adj mOR=8.6, 95% CI 1.7 to 43.5) were independently related to unintentional poisoning. Conclusion The practice of storing kerosene and petroleum in soft drink bottles and the easy accessibility of chemicals and medicines are potentially modifiable. Health messages focusing on the safe storage of chemicals and medicines and the use of child resistant containers may play a key role in decreasing the burden of childhood poisoning in Karachi, Pakistan.

We analyzed mutation and expression status of human epidermal growth factor receptor 2 (Her2) in head and neck squamous cell carcinoma (HNSCC) using single strand conformation polymorphism (SSCP) mutation analysis and immunohistochemistry (IHC). Mutations were absent in all 85 cases. Out of 57 cases available for IHC, Her2 protein expression was negative (0) in 40 tumors (70%). Seventeen tumors (29.8%) expressed Her2, among these 13 tumors (22.8%) showed a weak (+1) expression and 4 (7%) showed a moderate expression (+2), none showed a strong (+3) expression. There was not a significant association between expression and any of the patients' clinical variables or prognosis. Our results suggest that Her2 may not be useful as a molecular target in HNSCC.

Loss of heterozygosity (LOH) in the ING family members has been shown in head and neck squamous cell carcinoma (HNSCC) except for ING2. Like all the other members of ING family, ING2, which is located at chromosome 4q35.1, is a promising tumor suppressor gene (TSG). In this study, we performed LOH analysis of ING2 in HNSCC and compared it with clinicopathological variables.We performed LOH analysis in DNAs from 80 paired of normal and HNSCC tissues, using a specifically designed microsatellite marker on chromosome 4q35.1, which detects allelic loss of ING2. TP53 mutation analysis and its relationship with ING2 chromosomal deletion were also performed in available 68 of the samples. The correlation between LOH status and clinicopathological characteristics was evaluated by using statistical methods. The overall survival (OS) and disease free survival (DFS) were also determined.LOH was detected in 54.6% (30/55) of the informative samples. Statistical significance was obtained between LOH and tumor (T) stage (P = 0.02), application of radiotherapy and chemotherapy. Positive node status (N) appeared to be the only independent prognostic factor for both OS (P = 0.031) and DFS (P = 0.044).Our study showed allelic loss of 4q35.1 in HNSCC. The high percentage of LOH suggests ING2 as a candidate TSG in HNSCC. High LOH frequency was statistically associated with advanced T stage, suggesting that ING2 LOH might occur in late stages during HNSCC progression.

Epilepsy is a common neurological illness in Nigeria with a prevalence of 5-37 per 1000 in a rural population. Several studies suggest that the prevalence of epilepsy is higher in developing than developed countries due to the preponderance of more risk factors in the former. This study investigated the aetiological factors and precipitants of epileptic seizures among patients attending outpatient clinics of two tertiary hospitals in Kaduna State, Northern Nigeria from October 2008 to April 2013.Two hundred and forty two consecutive adult patients with history of at least 2 unprovoked afebrile seizures were investigated for seizure patterns, aetiological and precipitating factors through history, physical examinations, laboratory tests and electroencephalography.The male to female ratio of study population was 3 (69%): 1(31%), with respective mean ages of 29.5±12.4and 30.7 ± 16.0years. Their respective mean ages of onset of first seizures were 18.6 ±14.0and 20.9 ±17.4 years. 88% of seizures were of focal origin (complex partial, 80%; simple partial, 8%). Although the causes and precipitants were unknown in 41% and 68% of cases respectively; head injury, neonatal asphyxia and psychoactive substance abuse were prominent aetiological factors.Although majority of epileptic seizures in Kaduna State, Northern Nigeria were of focal origin, majority of causes and precipitants remained largely unknown.

Studies on psychoactive substance use in Nigeria had focused on prevalence and rarely on treatment implication(s) of large rates reported. Further challenge was to find suitable instruments to monitor change readiness as well as predict treatment outcomes along motivation continuum and according to resilience characteristics. Such ability will not only help to match treatment strategy with stage of change but also come with a more satisfactory outcome. This study therefore provided psychometric properties of one of such measuring scales: Stage of Change Readiness and Treatment Eagerness Scale version 8 (SOCRATES-8) and the accompanying change in resilience among Nigerians using psychoactive substances. Participants were 111 psychoactive substance dependent users in three treatment centers in Northern Nigeria. All respondents filled sociodemographic questionnaire, SOCRATES-8 and 14-item Resilience Scale. The study found overall motivation for change among participants to be medium on the three subscales of SOCRATES-8: ambivalence (median=14.00; range=7-20); recognition (median=31.00; range=7-35); and taking steps (median=35.00; range=12-40). More than half (61.3%) scored moderately on resilience. The Internal reliability of SOCRATES-8's subscales fell into acceptable range (ambivalence=0.54; recognition=0.87; taking steps=0.84). Pearson correlation coefficients of subscales with resilience are positive and in moderate range except for ambivalence with very low coefficient. Hierarchical cluster analysis based on participants' resilience characteristics yields five distinct profiles corresponding to five stages of motivational change. ANOVA of these five profiles based on SOCRATES' 3 subscales was significant. The study demonstrates utility of SOCRATES-8 to assess change readiness and treatment eagerness of psychoactive substance abusers according to stages of change and their resilience characteristics. This will aid treatment planning and can also measure treatment outcome.

Objectives Epilepsy is a complex chronic illness with variable treatment outcomes determined by factors specific to each affected person. We investigated prognostic factors for epileptic seizure outcome after 2 years of anti-epileptic drug (AED) monotherapy. Materials and methods Two hundred and thirty-four AED naive epilepsy patients were started on AED monotherapy and monitored for 2 years for seizure control. Patients on AED polytherapy were excluded. Prognostic factors investigated were socio-demographics characteristics, age of onset of epilepsy, etiology and precipitants of seizures, presenting seizure types, duration of epilepsy before initiation of AED, family support for treatment, compliance to AED, and clinic attendance. Results Patients were 160 (68.4%) males and 74 (31.6%) females, with mean ages of 26.2 ± 10.4 and 30.7 ± 16.0 years, respectively. Mean age of onset of epilepsy was 19.0 ± 15.0 years. None of the patients was treated with AED for first seizures, although 75% received traditional and spiritual therapy. Majority were single and of low socioeconomic background, and treatment was funded mainly by parents/guardians. About 88% presented with partial seizures, and carbamazepine was the commonest AED used followed by phenytoin sodium. At the end of 2 years of AED, 147 (63%) achieved complete seizure control, and significant prognostic factors were female sex, age older than 20 years at presentation, secondary and tertiary education attainment, being employed, family support, regular clinic attendance, AED compliance, and generalized epilepsy. Conclusions Patients with epilepsy are more likely to achieve complete seizure control when they are older, educated, and employed or supported by family members to buy their AEDs and attend clinics regularly.

Controlled size, shape and dispersibility of superparamagnetic iron oxide nanoparticles (SPIONs), has been achieved in a protein-polymer colloidal dispersion. Stable ferrofluid (FF) is synthesized in an aqueous medium of collagen, bovine serum albumin and poly(vinyl) alcohol that equilibrates with time, at ambient conditions, into an organized matrix with iron oxide particles sterically caged at defined sites. It mimics a biomineralization system; hence the process is termed biomimetics. Though the exact mechanism is not understood at this stage, we have established, with serial dilution of the protein-polymer solution that the SPIONs are formed inside the self-contained clusters of the two proteins and the polymer, which show a tendency to self assemble. More than the interparticle dipolar attractions of magnetic particles, electrostatic interactions play a role in cluster formation and collagen is responsible for the overall stability, supported by systematic dynamic light scattering data. The basic aim of this study was to increase magnetization of a previously synthesized ferrofluid without hampering stability, by reducing the total macromolecular concentration. Thrice the magnetization was achieved and in addition, the synthesized FFs exhibited very high transverse relaxivity and showed good contrast in mice liver, in the in vivo studies.

Ageing population in all parts of the world has make dementia in the elderly an important public health issue. Behavioural and Psychological symptom of dementia like urinary incontinence seldom attract the attention of clinicians providing care for the elderly.To determine the prevalence of dementia among elderly male patients presenting with urinary incontinence to a urology clinic.We recruited consecutive elderly patients and their caregivers presenting to the urology clinic of Ahmadu Bello University Teaching Hospital for the treatment of urinary incontinence. The patients were assessed using Socio-demographic data collecting sheet, Consortium to Establish Registry for Alzheimer's Disease (CERAD), Stick Design Test and physical examination. While the caregivers were interviewed using the Blessed Dementia Scale. A consensus diagnosis was made for each of the patients based on criteria for dementia in both Diagnostic and Statistical Manual 4th edition (DSM-IV) and International Classification for Diseases 10 edition( ICD-10). All test of statistics were carried out at 5%level of probability.A total of 121 patients participated in the study. The mean age of the patients was 70.58 ± 5.47 years (95% CI=69.10-71.55). A total of 11 patients (9.10%, 95% CI=3.98-14.22) have dementia based on the consensus diagnosis. Dementia among this cohort is significantly associated with advancing age and enuresis.Dementia is common among elderly patients with urinary incontinence in Africa but remains large undetected and unrecognised.

Chronic myeloid leukaemia (CML), with a median age of 40 years, is one of the commonest haematological malignancies in Nigeria. Cytoreductive agents, which were hitherto the mainstay of treatment, neither induce cytogenetic nor haematologic remission. Alphainterferon (á-IFN), an endogenous glycoprotein with cytotoxic and natural killer cell enhancer effects has been found to induce haematologic and cytogenetic remission in patients with CML, but neuro-psychiatric complications of á -interferon (á-IFN) usage were not reported in Nigeria.To report a case of deliberate self-harm in University Lecturer as a side effect of á-IFN in the treatment of CML METHOD: Clinical and laboratory follow up of a patient receiving á-IFN in the management of CML from the time of diagnosis of CML to the point of loss of contact.Severe depression is a complication that may adversely influence the clinical outcome of á-IFN usageAlthough interferon related depression is uncommon, it is suggested that pre-therapy interferon assays and neuro-psychiatric assessment are carried out in prospective users of á-IFN.

The epidermal growth factor receptor (EGFR)-RAS-RAF-mitogen-activated protein kinase signaling cascade is an important pathway in cancer development and recent reports show that EGFR and its downstream signaling molecules are mutated in a number of cancers. We have analyzed 91 Japanese head and neck squamous cell carcinomas (HNSCC) and 12 HNSCC cell lines for mutations in EGFR, ErbB2, and K-ras. Exons encoding the hot-spot regions in the tyrosine kinase domain of both EGFR (exons 18, 19, and 21) and ErbB2 (exons 18-23), as well as exons 1 and 2 of K-ras were amplified by polymerase chain reaction and sequenced directly. EGFR expression was also analyzed in 65 HNSCC patients using immunohistochemistry. Only one silent mutation, C836T, was found in exon 21 of EGFR in the UT-SCC-16A cell line and its corresponding metastasic cell line UT-SCC-16B. No other mutation was found in EGFR, ErbB2, or K-ras. All tumors showed EGFR expression. In 21 (32%) tumors, EGFR was expressed weakly (+1). In 27 (42%) tumors it was expressed (+2) moderately, and in 17 (26%) tumors high expression (+3) was detected. Overexpression (+2, +3) was found in 44 tumors (68%). A worse tumor differentiation and a positive nodal stage were significantly associated with EGFR overexpression (P = 0.02, P = 0.032, respectively). Similar to patients from western ethnicity, mutations are absent or rare in Japanese HNSCC. Protein overexpression rather than mutation might be responsible for activation of the EGFR pathway in HNSCC.

Objective. To estimate the proportion of pharmacies meeting licensing requirements and to identify factors associated with these pharmacies in urban Rawalpindi, Pakistan. Design. Cross-sectional questionnaire survey conducted during July–September 2001, of 311 pharmacies selected from a drug company list of 506. Setting. Free-standing licensed and unlicensed pharmacies in urban Rawalpindi. Study participants. A pharmacist or (if unavailable) the most experienced drug seller. Results. The proportion of pharmacies meeting licensing requirements was 19.3% [95% C.I (confidence interval): 15.1, 24.2], with few qualified persons (22%). Only 10% had a temperature-monitoring device and 4% an alternative power supply for refrigerators (present in 76% of pharmacies). Associated with pharmacies meeting licensing requirements was the knowledge of not giving co-trimoxazole, a prescription drug, without prescription [OR (odds ratio) = 2.0; 95% CI: 1.1, 3.6], knowledge of the temperature range for vaccines (OR = 2.6; 95% CI: 1.4, 4.8), availability of vaccines (OR = 2.8; 95% CI: 2.8, 18.4), and alternative power supply for the refrigerator (OR = 6.0; 95% CI: 1.5, 23.7). The practice of selling drugs without prescription was not found to have a significant association (OR = 1.1; 95% CI: 0.5, 2.3); however, it did show a trend indicating discrepancy between knowledge and practice. Conclusions. Most drug sellers had fragmentary knowledge regarding drug dispensing and storage, and improper dispensing practices. There is a need to enforce existing legislation with training programmes directed towards drug sellers and to involve the pharmaceutical industry, which plays an important role in influencing pharmacy knowledge and practices.

In this study, we sought to establish a correlation between consumption of flouoroquinolones in our hospital and the emergence of ofloxacin resistant strains of E. coli in the urinary specimens. Data of all urinary samples, received at Aga Khan University Hospital between January 1995 and December 2002, was retrieved and analyzed. Specimens yielding E-coli as an isolate were included in this study.E. coli Isolates showing103 colonies were identified using standard microbiological techniques. Antibiotic susceptibility of E. coli was tested using Kirby Bauer disc diffusion method. Antimicrobial usage data, obtained through hospital Pharmacy as unit utilized per year for Quinolones in different medical and surgical units was available only for the period of 1997- 2002.Among 32,722 urinary specimens E. coli (53%) was the most frequent isolate. Steady increase in the number of ofloxacin resistant E. coli was noted, 24% in 1995 to 55% in 2002. Maximum quinolone resistant E. coli have been observed in Medical units, 41% in 1997 increasing to 70% in 2002, followed by Surgery units (35% to 54%) and Pediatrics (12 to 38%). Sharp increase in ofloxacin consumption in our hospital, 1997 (28613 units) to 2002 (96880 units) has been observed. Trends in quinolone resistance correlate significantly with utilization in the same period as shown by linear regression.E. coli resistance against most antibiotics has been on a rise particularly for quinolones. The utilization of quinolones correlates with increasing resistance in our hospitalized patients.