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Tashi Tobgay1, Ugen Dophu1, Cristina E Torres2, Kesara Na-Bangchang31Department of Public Health, Ministry of Health, Kawajangsa, Bhutan; 2Forum for Ethical Review Committees in Asian and Western Pacific Region, Clinical Coordination and Training Center, 3Thailand Center of Excellence on Drug Discovery and Development (TCEDDD), Thammasat University, Rangsit Campus, ThailandAbstract: Worldwide, contemporary measures of the success of health development programs have been mostly in terms of the reduction of mortality and morbidity as well as increasing longevity. While these goals have yielded much-needed health improvements, the subjective outcomes of these improvements, as experienced by individuals and the communities, have not been considered. Bhutan, under the overarching policy of Gross National Happiness, has provided due consideration to these subjective indicators. Here, we report on the current status of health and happiness in Bhutan as revealed by conventional objective indicators and subjective Gross National Happiness indicators. The current literature on health in Bhutan in relation to the Gross National Happiness Survey conducted by the Centre of Bhutan Studies has been reviewed. Bhutan has made great strides within a short period of modernization, as shown by both objective and subjective indicators. Tremendous challenges lie ahead to achieve the ultimate goal of health and happiness, and how Bhutan articulates its path to modernization may be a lesson for the rest of the world.Keywords: Bhutan, happiness, health, indicators

Background: Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses. Case Report: An 8‐year‐old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5 days), followed by oral trimethoprim‐sulphonamide (10 days) and then oral doxycycline (14 days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug‐resistant (MDR) Escherichia coli was confirmed. Although susceptible to enrofloxacin in vitro, 30 days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug‐resistant (XDR) gram‐negative microorganisms. Whole‐genome sequencing (WGS) revealed multiple sequence types of E. coli, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3 months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116. Conclusion: These non‐conventional therapeutics, antimicrobials and long‐term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of an herbal spray combining various essential oils, with a claim of mast cell stabilisation, antipruritic, anti‐inflammatory, and insect repellent effects on the clinical presentation of insect bite hypersensitivity (IBH) in horses. Design: Double‐blinded, placebo‐controlled, randomised, cross‐over clinical trial. Methods: Twenty adult horses with clinical IBH were treated with a daily application of herbal spray or placebo for 28 days in a randomised, cross‐over fashion, separated by a>28‐day washout period. Horses were examined and scored prior to and after the completion of each treatment. Histopathology was performed on four horses. Owners kept daily diaries of observations. Results: The herbal spray significantly reduced the severity of all assessed parameters (pruritus, excoriations, lichenification and alopecia; P < 0.05) compared with baseline values (pretreatment) and with placebo. Owners reported improvement of pruritus in 19/20 horses (95%) with complete resolution in 17 horses (85%) following treatment. Skin biopsies showed resolution of orthokeratosis in 4/4 horses, reduced thickness of the stratum spinosum in 2/4 horses and complete resolution of histopathological abnormalities in 1/4 horses after treatment, compared with either no change or deterioration of histopathologic lesions after placebo. No side effects were observed. Conclusions: The tested herbal spray may be an effective treatment for the management of equine IBH. [ABSTRACT FROM AUTHOR]

Extranodal MALT lymphomas are a type of lymphoproliferative syndrome belonging to non-Hodgkin's lymphomas. The most common affectation of these types of lymphomas is the digestive tract (80%), the lung being only 14% of cases. We present the case of a 73 years old woman who goes to progressive dyspnea, with a large right pleural effusion on the chest x-ray. After screening and differential diagnosis of the different types of pleural effusion and the clinical etiological processes involved in its production, the diagnosis of lymphoproliferative process was reached, starting chemotherapy treatment with good evolution of both the pleural effusion and the patient's clinic.

Las semillas vivas que no germinan fácilmente se conocen como latentes y en algunas ocasiones requieren tratamientos especiales para hacerlo. Hay especies para las que se desconoce la manera como logran la germinación e incluso se ignoran con frecuencia los mecanismos que convierten en latentes las semillas de una especie determinada. Con el propósito de desarrollar nuevas tecnologías que contribuyan al mejoramiento de la germinación, este trabajo examinó el efecto de campos magnéticos con intensidades de 5 mT y de 10 mT sobre la germinación de semillas de arroz (Oryza sativa L.) y tomate (Solanum lycopersicum L.). Igualmente se estudió el incremento de biomasa en plántulas de las mismas especies. Semillas de O. sativa y L. esculentum fueron expuestas a los campos magnéticos durante periodos de tiempo de 1, 10, 20 y 60 min, 24 y 48 h. Para los experimentos se utilizaron cajas de Petri y macetas de icopor. Se realizaron 14 tratamientos con 4 repeticiones cada uno para cada especie. Los resultados obtenidos indican efectos positivos en la germinación de las semillas de O. sativa para tiempos de exposición de 1 min y 48 h. En las semillas de S. lycopersicum el tiempo de exposición de 10 min mostró efectos positivos respecto al testigo. Las plántulas de S. lycopersicum presentaron un incremento más rápido de biomasa (longitud y peso) en la segunda semana con los tratamientos T3, T5, T6 y T10.

Abstract Background The use of transgenic bacteria has been proposed as a suitable alternative for mercury remediation. Ideally, mercury would be sequestered by metal-scavenging agents inside transgenic bacteria for subsequent retrieval. So far, this approach has produced limited protection and accumulation. We report here the development of a transgenic system that effectively expresses metallothionein (mt-1) and polyphosphate kinase (ppk) genes in bacteria in order to provide high mercury resistance and accumulation. Results In this study, bacterial transformation with transcriptional and translational enhanced vectors designed for the expression of metallothionein and polyphosphate kinase provided high transgene transcript levels independent of the gene being expressed. Expression of polyphosphate kinase and metallothionein in transgenic bacteria provided high resistance to mercury, up to 80 μM and 120 μM, respectively. Here we show for the first time that metallothionein can be efficiently expressed in bacteria without being fused to a carrier protein to enhance mercury bioremediation. Cold vapor atomic absorption spectrometry analyzes revealed that the mt-1 transgenic bacteria accumulated up to 100.2 ± 17.6 μM of mercury from media containing 120 μM Hg. The extent of mercury remediation was such that the contaminated media remediated by the mt-1 transgenic bacteria supported the growth of untransformed bacteria. Cell aggregation, precipitation and color changes were visually observed in mt-1 and ppk transgenic bacteria when these cells were grown in high mercury concentrations. Conclusion The transgenic bacterial system described in this study presents a viable technology for mercury bioremediation from liquid matrices because it provides high mercury resistance and accumulation while inhibiting elemental mercury volatilization. This is the first report that shows that metallothionein expression provides mercury resistance and accumulation in recombinant bacteria. The high accumulation of mercury in the transgenic cells could present the possibility of retrieving the accumulated mercury for further industrial applications.

Background The genetic mechanisms underlying interindividual blood pressure variation reflect the complex interplay of both genetic and environmental variables. The current standard statistical methods for detecting genes involved in the regulation mechanisms of complex traits are based on univariate analysis. Few studies have focused on the search for and understanding of quantitative trait loci responsible for gene × environmental interactions or multiple trait analysis. Composite interval mapping has been extended to multiple traits and may be an interesting approach to such a problem. Methods We used multiple-trait analysis for quantitative trait locus mapping of loci having different effects on systolic blood pressure with NaCl exposure. Animals studied were 188 rats, the progenies of an F2 rat intercross between the hypertensive and normotensive strain, genotyped in 179 polymorphic markers across the rat genome. To accommodate the correlational structure from measurements taken in the same animals, we applied univariate and multivariate strategies for analyzing the data. Results We detected a new quantitative train locus on a region close to marker R589 in chromosome 5 of the rat genome, not previously identified through serial analysis of individual traits. In addition, we were able to justify analytically the parametric restrictions in terms of regression coefficients responsible for the gain in precision with the adopted analytical approach. Conclusion Future work should focus on fine mapping and the identification of the causative variant responsible for this quantitative trait locus signal. The multivariable strategy might be valuable in the study of genetic determinants of interindividual variation of antihypertensive drug effectiveness.

Edward Molina,1 Camilo Ernesto Sarmiento Torres,2 Ricardo Salazar-Cabrera,1 Diego M López,1 Rubiel Vargas-Cañas2 1Telematics Department, Universidad del Cauca, Popayán, Cauca, Colombia; 2Department of Physics, Universidad del Cauca, Popayán, Cauca, ColombiaCorrespondence: Diego M López Tel +57 3015819362 Email dmlopez@unicauca.edu.coBackground: Availability and opportunity of epilepsy diagnostic services is a significant challenge, especially in developing countries with a low number of neurologists. The most commonly used test to diagnose epilepsy is electroencephalogram (EEG). A typical EEG recording lasts for 20 to 30 minutes; however, a specialist requires much more time to read it. Furthermore, no evidence was found in the literature on open-source systems for the cost-effective management of patient information using electronic health records (EHR) that adequately integrate EEG analysis for automatic identification of abnormal signals.Objective: To develop an integrated open-source EHR system for the management of the patients’ personal, clinical, and EEG data, and for automatic identification of abnormal EEG signals.Methods: The core of the system is an EHR and telehealth service based on the OpenMRS platform. On top of that, we developed an intelligent component to automatically detect abnormal segments of EEG tests using machine learning algorithms, as well as a service to annotate and visualize abnormal segments in EEG signals. Finally, we evaluated the intelligent component and the integrated system using precision, recall, and accuracy metrics.Results: The system allowed to manage patients’ information properly, store and manage the EEG tests recorded with a medical EEG device, and to detect abnormal segments of signals with a precision of 85.10%, a recall of 97.16%, and an accuracy of 99.92%.Conclusion: Digital health is a multidisciplinary field of research in which artificial intelligence is playing a significant role in boosting traditional health services. Notably, the developed system could significantly reduce the time a neurologist spends in the reading of an EEG for the diagnosis of epilepsy, saving approximately 65– 75% of the time consumed. It can be used in a telehealth environment. In this way, the availability and provision of diagnostic services for epilepsy management could be improved, especially in developing countries where the number of neurologists is low.Keywords: electroencephalogram, electronic health record, machine learning, diagnostic support system, EEG, EHR