Search

Introduction The association between periodontitis and certain systemic diseases is well established; however, there is a distinct lack of research available on its awareness among medical students in the United Kingdom. Aims To determine the awareness of fourth-year undergraduate medical students concerning periodontitis including its risk factors, relationship with systemic health and students' attitudes towards oral diseases and further education. Methods We delivered an online survey via a weekly email news bulletin to 299 fourth-year medical students and received 101 completed responses. Results Medical students were largely aware of the most common features of periodontitis and recognised that systemic diseases may affect the periodontium. There was less awareness of the associations between certain systemic diseases and periodontitis and there appeared to be confusion with tooth decay. Perceived knowledge was generally reported to be poor and most students believed that further teaching would improve their medical practice. Conclusions Increased teaching on periodontitis within the medical curriculum would benefit students. This may be achieved using an integrated teaching approach. Future doctors should graduate with an adequate education on the interdisciplinary links and should be capable of signposting or referring patients early to the appropriate services where indicated to improve patient care.

Data sources Medline, Scopus, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov and OpenGrey databases were systematically searched to find studies comparing post-operative pain experienced following root canal treatment with ultrasonic and conventional irrigation (up to May 2021). Hand searching of selected journals was also performed.Study selection Randomised controlled trials assessing post-operative pain experienced following primary non-surgical root canal treatment using conventional versus ultrasonic irrigation were screened. Exclusion criteria included an unsuitable follow-up period, systemic disease among the participants, severe pain, acute apical abscess diagnoses and fewer than 12 patients per trial arm. English language only studies were included. Two reviewers independently screened the studies and disagreements were resolved by consulting a third reviewer.Data extraction and synthesis Data extracted included tooth type, root type, pre-operative diagnosis, pain recording, time of pain recording, number of patients requiring analgesics and study conclusions. Meta-analyses of different post-operative time periods (6h, 24h, 48h, 72h and 7 days) were performed using a fixed-effects model to obtain a mean difference (with 95% confidence intervals) for post-operative pain. Heterogeneity between studies was evaluated using the I2 statistic. Quality assessment of the included studies was performed according to the Cochrane Collaboration protocol for randomised controlled trials. Publication bias was assessed using a funnel plot and modified via the 'trim-and-fill' method.Results A total of six articles were included in the systematic review, of which four were included in the meta-analysis. Overall risk of bias was deemed to be 'low' with one study presenting an unclear risk with respect to selection bias. Meta-analysis demonstrated that ultrasonic agitation significantly reduced post-operative pain compared to conventional irrigation at 6, 24 and 48 hours (p0.05) but no significant differences were found at later time points.Conclusions Ultrasonic irrigation may lead to less post-operative pain compared to conventional irrigation techniques; however, the evidence base is limited and further research is needed to support these findings.

This study was aimed to develop and evaluate the efficacy of a health education program for increasing knowledge, changing attitudes, and promoting prevention practices to reduce the incidence of RTIs among Malaysian Hajj pilgrims. A quasi-experimental study was done among 130 Hajj pilgrims attending Hajj orientation course organized by a private Hajj tour companies. Hajj pilgrims assigned to intervention group (n = 65) and control group (n = 65). Data were collected baseline and after return from Hajj using a validated questionnaire. Mixed design repeated measure ANOVA was used to analyse the effect of group, time, and group-time interaction on the dependent variables. There was a significant improvement in knowledge, attitude and practice scores in the intervention group compared to the control group. Based on the findings of the interaction of time and group, there was a significant statistical difference for post intervention for knowledge (p = 0.005), attitude (p = 0.041), and practice (p = 0.002). The newly-established health education intervention smartphone application was effective in improving KAP toward RTIs prevention among pilgrims.

Data sources The online databases of Medline, Web of Science, Embase and Cochrane Library were systematically searched to identify articles published (up to October 2021) on the accuracy of microRNAs (miRNAs) in the diagnosis of oral squamous cell carcinoma (OSCC).Study selection Primary research studies involving human participants with the presence of healthy controls and sufficient data for statistical analysis were included. Exclusion criteria included review articles, letters, case reports and non-human trials. Two reviewers independently assessed the studies, and any conflicts were resolved by consulting a third reviewer. From 326 initially identified articles, 20 articles (all case-control studies) were included in the meta-analysis involving 1,106 cases and 732 controls.Data extraction and synthesis Data extracted included sensitivity, specificity, likelihood ratios and diagnostic odds ratios for blood and salivary miRNAs. A combined category of body fluid miRNAs was also synthesised. Heterogeneity between studies was evaluated using Cochran's Q test and I2 statistic. Quality assessment of the studies was performed using the Quality Assessment of Diagnostic Accuracy Studies criteria (QUADAS-2). Meta-analysis was performed based on a random-effects model. A comparison of the diagnostic accuracies between blood and salivary miRNAs was carried out using the summary receiver operator characteristic curve (SUROC) including the area under the curve (AUC). P0.05 was considered as statistically significant.Results Risk of bias was deemed to be moderate; however, patient selection bias was high due to 15 studies lacking randomisation. Heterogeneity between studies was high. Meta-analysis revealed that for body fluid miRNAs, sensitivity was 0.78 (95% CI: 0.73-0.83), specificity was 0.82 (95% CI: 0.77-0.86), AUC value was 0.87 (95% CI: 0.84-0.90), and positive and negative likelihood ratios were 4.3 (95% CI: 3.4-5.4) and 0.27 (95% CI: 0.22-0.34), respectively. The diagnostic odds ratio was 16 (95% CI: 11-23).Conclusions Body fluid miRNAs may provide moderate accuracy in diagnosing OSCC; however, the significant heterogeneity between studies and the lack of large-scale high-quality studies limits their diagnostic value.

We examine the time-frequency spillovers, contagion, and pairwise interrelations between the BRIC index and its constituents, and between BRIC and G7 economies. The extent of interdependencies between market blocs and their constituents needs to be ascertained in the time-frequency domain for efficient asset allocation and portfolio management. Accordingly, the Baruník and Křehlík spillover index is employed with daily data between 11th December 2015 and 28th May 2021. We find the overall and net spillovers between BRIC and G7 to be significant in the short-term, with France, Germany, and the UK transmitting the greatest shocks to BRIC markets. We find no significant evidence of any sporadic volatilities for the studied markets in the COVID-19 period across all frequencies. However, we reveal contagious spillovers between the BRIC and G7 economies across all time scales in 2017 and 2019, which respectively reflect the persistent effect of Brexit and the US-China trade tension. Our findings divulge that in the short-term (mid-to-long-term), France and the UK (Canada and the US), are the sources of contagion between the BRIC and G7 markets. From the net-pairwise spillovers, we report high connectedness between the BRIC index and its members. BRIC countries are found to be transmitters of net-pairwise spillovers to the G7 markets excluding Japan. We recommend portfolio diversification using BRIC and G7 stocks in the intermediate-to-long-term horizon, where spillovers are less concentrated. Additionally, since individual markets are impacted by their unique shocks, investors should pay close attention to these shocks when distributing assets. In the interim, policy-makers and governments across the globe should ensure effective liberalisation of their economies to encourage international trade flows to boost portfolio diversification.

Background The Community-based Health Planning and Services (CHPS) is a national health reform programme that provides healthcare at the doorsteps of rural community members, particularly, women and children. It seeks to reduce health inequalities and promote equity of health outcomes. The study explored implementation and utilization challenges of the CHPS programme in the Northern Region of Ghana. Methods This was an observational study that employed qualitative methods to interview key informants covering relevant stakeholders. The study was guided by the systems theory. In all, 30 in-depth interviews were conducted involving 8 community health officers, 8 community volunteers, and 14 women receiving postnatal care in four (4) CHPS zones in the Yendi Municipality. The data were thematically analysed using Atlas.ti.v.7 software and manual coding system. Results The participants reported poor clinical attendance including delays in seeking health care, low antenatal and postnatal care visits. The barriers of the CHPS utilization include lack of transportation, poor road network, cultural beliefs (e.g. taboos of certain foods), proof of women’s faithfulness to their husbands and absence of health workers. Other challenges were poor communication networks during emergencies, and inaccessibility of ambulance service. In seeking health care, insured members of the national health insurance scheme (NHIS) still pay for services that are covered by the NHIS. We found that the CHPS compounds lack the capacity to sterilize some of their equipment, lack of incentives for Community Health Officers and Community Health Volunteers and inadequate infrastructures such as potable water and electricity. The study also observed poor coordination of interventions, inadequate equipment and poor community engagement as setbacks to the progress of the CHPS policy. Conclusions Clinical attendance, timing and number of antenatal and postnatal care visits, remain major concerns for the CHPS programme in the study setting. The CHPS barriers include transportation, poor road network, cost of referrals, cultural beliefs, inadequate equipment, lack of incentives and poor community engagement. There is an urgent need to address these challenges to improve the utilization of CHPS compounds and to contribute to achieving the sustainable development goals.

Lung Ultrasound (LUS) has evolved considerably over the last few years. The aim of the current review is to conduct a systematic review reported from a number of studies to show the usefulness of (LUS) and point of care ultrasound for diagnosing COVID-19. A systematic search of electronic data was conducted, including the national library of medicine, and the national institute of medicine, PubMed Central (PMC), to identify the articles published on (LUS) to monitor COVID-19. This review highlights the ultrasound findings reported in articles before the occurrence of the pandemic (11), clinical articles before COVID-19 (14), review studies during the pandemic (27), clinical cases during the pandemic (5) and other varying aims articles. The reviewed studies revealed that ultrasound findings can be used to help in the detection and staging of the disease. The common patterns observed included irregular and thickened A-lines, multiple B-lines ranging from focal to diffuse interstitial consolidation, and pleural effusion. Sub-plural consolidation is found to be associated with the progression of the disease and its complications. Pneumothorax was not recorded for COVID-19 patients. Further improvement in the diagnostic performance of (LUS) for COVID-19 patients can be achieved by using elastography, contrast-enhanced ultrasound, and power Doppler imaging.

The study aimed at acknowledging the Six Sigma methodology and the existence of the essential components for the application, as well as reducing the time for completing the operations, reducing the error rate to the lowest possible level, and improving the quality of operations. For this objective, the analytical descriptive methodology was used on a sample consisted of 300 administrative and medical staff from Khartoum State Hospitals (Khartoum, Omdurman, Bahri). To this end, a questionnaire was used for collecting data and for analyzing it and achieving the results of the study by using the statistical analysis package (SPSS). The study deduced a number of results, the most important of which are that the items of commitment and supreme command support for the senior leadership and the methods of abundant human resources on quality control, and the application of the Six Sigma methodology in government hospitals in Khartoum state achieved a satisfactory level, while continuous improvement paragraphs, processes, and systems on quality control and the application of Six Sigma methodology achieved high quality. There is a significant effect on the extent of commitment and support of the higher leadership on quality control and the application of the Six Sigma methodology. Similarly, there is a statistically significant effect on the application of continuous improvement methods on quality control and Six Sigma methodology. Also, there is a statistically significant effect on the application of the abundance of human resources methods variable on quality control and the application of Six Sigma methodology in governmental hospitals in Khartoum state. The study recommended to take interest in the Six Sigma methodology and assure the possibility of using it in Khartoum State’s hospitals because of its scientific and practical importance in improving the quality of services and provided processes, and the need to provide qualified financial and human resources for using and developing Six Sigma methodology in hospitals, as well as great attention in training and providing departments heads with full knowledge of Six Sigma methodology and the fundamentals on which Six Sigma methodology, is based on its importance for hospitals. The study also recommended associating the promotions system in government hospitals in Khartoum state with the quality control program.

Background and Aim: Children with cleft lip and palate present with a wide range of dental and occlusal anomalies as a result of the cleft defect. These patients also present with oral habits which may affect their quality of life. The aim of this study was to compare the prevalence of oral habits in these children, with children without orofacial clefts. Methodology: This was a cross-sectional comparative study comparing children with repaired cleft lip and/or palate aged 3 to 12 years, with children without orofacial clefts. Ethical approval for the study was obtained from the institutional review boards of both centers. Data collection was via interviewer administered questionnaires given to the parents/guardians of the children in each group. Data analysis was carried out using SPSS version 23. The level of significance was set at P < .05. Results: A total of 107 respondents participated in the study, comprising 53 children with repaired cleft lip and/or palate 54 children without orofacial clefts. The mean age for the children with Cleft lip and/or palate/ was 6.81 (standard deviation [SD] 1.898) years, while that for the control group was 7.78 (SD 1.68) years. Two oral habits recorded a significantly higher prevalence ( P < .05) in the children with repaired clefts as compared to controls and these were lip sucking and bruxism. No significant difference in prevalence was recorded for all the other oral habits surveyed. Conclusion: A significantly higher prevalence ( P < .05) was observed in lip sucking and bruxism among children with cleft lip and palate, as compared to the children without orofacial clefts.

The prevalence of respiratory illness has continued to surge among Hajj pilgrims from different countries despite having some practices of preventive measures. Respiratory illnesses during Hajj could be due to many reasons and many factors that promote disease spread. These factors include overcrowding, cigarette smoking, and direct contact with infectious agents particularly viruses promote the spread of respiratory infections. However, due to the longer duration of the pilgrimage, there are high chances of pilgrims contracting various respiratory illnesses due to exposure to respiratory pathogens. Hajj pilgrims' knowledge, attitudes, and practices toward respiratory tract infections are used as the determinant of the effectiveness of the health education interventions. Knowledge and application of basic hygiene principles, use of face masks, following cough etiquettes, engaging in social distancing, and engaging in other measures are highly important. In this paper, we reviewed the various effective intervention strategies implemented to help prevent respiratory tract infections during Hajj.

Aims To investigate the presence of SARS-CoV-2, the virus responsible for COVID-19 infection, in the periodontal tissues of deceased individuals with a positive SARS-CoV-2 nasopharyngeal swab test. Sample selection Seven deceased individuals, who were admitted to the intensive care unit of the Hospital das Clínicas of the Medicine School of Sao Paulo University for invasive mechanical ventilation following a positive nasopharyngeal COVID-19 test result, underwent a post-mortem examination. Individuals with comorbidities were included. Exclusion criteria included a current smoking habit. Design A cross-sectional study involving a videoscope-guided autopsy to obtain a periodontal tissue sample. The plastic body wrapping was incised in the facial region, allowing the insertion of a video endoscope. A single sample of periodontal tissue (junctional epithelium, adjacent oral epithelium and underlying connective tissue) was obtained from the mesial interproximal papilla of the maxillary first molar (or if absent, the mesial tooth). The sample was cleaned using an enzymatic detergent (Riozyme) to mimic the effects of salivary flow and was collected using blunt dissection. The sample was divided into two samples for either histopathological analysis (haematoxylin and eosin stain) or molecular analysis. Real-time reverse transcriptase polymerase chain reaction (rRT-PCR) was used to test for the presence of the envelope (E) gene of SARS-CoV-2. Data on comorbidities, smoking status, period of hospitalisation and time from onset of symptoms to death were also collected. Data analysis Descriptive analysis was performed and results were presented as a cross tabulation. The presence of SARS-CoV-2 in samples was presented as the rRT-PCR cycle threshold value and the histopathological analysis results were Boolean (that is, presence/absence of vacuolisation or nuclear pleomorphism). Results A total of seven individuals were examined: four women and three men. The age range was 8-74 years and the range of periods between onset of symptoms and death was 10-31 days. SARS-CoV-2 was detected in five samples, with a mean cycle threshold of 31.38 (range 27.28-36.55). Nuclear pleomorphism and vacuolisation were found in two and three cases, respectively. Conclusions SARS-CoV-2 genetic material was present in most periodontal tissue samples of individuals with COVID-19. The sample size, however, was small and only included severely ill individuals with prolonged periods of hospitalisation. Consequently, the applicability of the findings to the general population is limited.

Objectives: To find the prevalence of uropathogenic Escherichia coli (E. coli)- producing extended spectrum beta lactamase (ESBL) at King Fahd Military Medical Complex in Dhahran (KFMMC) and to detect the genes responsible for its production. In addition, we determined the pattern of multi-drug resistance among isolates. Methods : A total of 117 uropathogenic E. coli isolates were collected from KFMMC over a period of 4 months from March 2014 to June 2014. These were received in the Microbiology Laboratory at Prince Sultan Military College of Health Sciences (PSMCHS), Dhahran, Saudi Arabia for analysis. The isolates were screened for ESBL using VITEK® 2 Compact. Polymerase chain reaction (PCR) examination was used to determine TEM, SHV, and CTX-M genes. Results : Our findings indicated that there is a high incidence of ESBLs among the E. coli isolated from UTI (23.1%). Our study also indicated that CTX-M genes are the most prevalent among the isolates at KFMMC followed by TEM class (6%), but there was also a higher percentage E. coli (3.4%) simultaneously harboring TEM and CTX genes. None of our isolates harbored the SHV genes. Conclusion : The findings document the threat of ESBL among E. coli isolates from UTI especially the CTX-M class in our hospital with the occurrence of these strains as etiologic agents of infection in the hospital and community. Saudi Med J 2017; Vol. 38 (8): 811-815 doi: 10.15537/smj.2017.8.18578 How to cite this article: Mashwal FA, El Safi SH, George SK, Adam AA, Jebakumar AZ. Incidence and molecular characterization of the extended spectrum beta lactamase-producing Escherichia coli isolated from urinary tract infections in Eastern Saudi Arabia. Saudi Med J . 2017 Jul;38(8):811-815. doi: 10.15537/smj.2017.8.18578.

Objectives The study aimed to assess the relationship between coffee intake, obstructive sleep apnea risk (OSA), and glycemic control among patients with diabetes mellitus. Results There were 110 patients with diabetes and 96 healthy control subjects (matched for age and sex) attending a diabetes center زinTabuk, Saudi Arabia during the period from June 2018–October 2019. Stop-Bang questionnaire was used to assess OSA risk, and Epworth Sleepiness Scale to investigate daytime sleepiness. OSA risk and daytime sleepiness were higher among patients with diabetes compared to controls (4.34 ± 1.61 vs. 2.86 ± 1.24, and 8.31 ± 4.40 vs. 6.39 ± 3.70 respectively, P 0.05). Women with diabetes were younger with short duration since the diagnosis of diabetes and consumed less coffee compared to men, P

Introduction: hain GenoType MTBDRsl is nucleic acid amplification assay based on reverse hybridization with specific oligonucleotide probes on nitrocellulose strips. MTBDRsl identifies M. tuberculosis complex and detects resistance to fluoroquinolone, second line injectable drugs and ethambutol evident as mutations of gyrA, rrs and embB genes respectively. This study aimed to evaluate the diagnostic performance of the Hain GenoType MTBDRsl Assay using 1% proportion method on LJ medium as gold standard. Methods: a total of 52 rifampicin resistant (RR) isolates were tested for second line drug sensitivity by 1% proportion method and by MTBDRsl assay. Results: two strains were identified as mycobacteria other than tuberculosis MOTT and the rest were Mycobacterium tuberculosis complex MTBC. Five of the MTBC isolates (5/50; 10%) showed resistance to at least one second line drug and one isolate (1/50; 2%) was XDR. XDR strain was concordantly detected by the two methods. One of two Kanamycin-resistant isolates showed discordant result. Ofloxacin showed one false positive and one false negative result. Most discrepancies were detected with Ethambutol. The sensitivity, specificity, positive and negative predictive values were respectively as follows: Ethambutol (63.3.4%, 85.7%, 94.4% and 62%): for Kanamycin (67%, 100%, 100% and 97.9%): for Amikacin and Capreomycin (100%, 100%, 100% and 100%): for Ofloxacin (75%, 97.5%, 75% and 97.8%). For XDR isolate the values were (100%, 100%, 100% and 100%) respectively. Conclusion: MTBDRsl showed high specificity and negative predictive values making it acceptable and time-saving for early presumptive detection of resistance to second-line drugs in Sudan.

Few studies have reported sporadic hepatitis E virus (HEV) infections during non‐outbreak periods in Africa. In this study, the prevalence of HEV infection in Sudan was investigated in 432 patients with acute hepatitis from 12 localities in North Kordofan, and from 152 patients involved in smaller outbreaks of hepatitis in the neighbouring Darfur. HEV infection was diagnosed in 147 (25%) patients: 98 from Kordofan and 49 from Darfur. The mortality was 10%; six of the patients who died from the infection were pregnant women. HEV RNA was detected by quantitative real‐time polymerase chain reaction (RT‐qPCR) in 38 (26%) patients: 22 from Kordofan and 16 from Darfur. Partial open reading frame (ORF) 1 and ORF2 were sequenced from HEV from nine and three patients, respectively. Phylogenetic analysis showed that the Sudanese strains belonged to genotype 1 (HEV1), and confirmed the segregation of African HEV1 strains into one branch divergent from Asian HEV1. It also revealed that the Sudanese strains from this study and from an outbreak in 2004 formed a separate clade with a common ancestor, distinct from strains from the neighbouring Chad and Egypt. This HEV strain has thus spread in a large area of Sudan, where it has caused both sporadic hepatitis E and outbreaks from at least 2004 and onwards. These data demonstrate that hepatitis E is a constant, on‐going public health problem in Sudan and that there is a need for hepatitis E surveillance, outbreak preparedness, and general improvements of the sanitation in these remote areas of the country.

Giardia lamblia and Cryptosporidium parvum are recognized as the most common protozoan infections in Saudi Arabia. Microscopic examination of stool samples, either direct or concentrated, for the recovery of G. lamblia cysts and trophozoites and C. parvum oocysts is still the most commonly used for the diagnosis of both parasites. We compared the conventional parasitological techniques of iodine-stained wet mount for G. lamblia and Kinyoun's acid-fast for C. parvum against ImmunoCard STAT® Cryptosporidium/Giardia and real-time polymerase chain reaction (PCR) detecting the 18S rRNA gene of G. lamblia and conventional PCR detecting the same gene of C. parvum at a tertiary hospital in Dhahran, Saudi Arabia. Out of 148 stool samples, 19 and 12 true positives were identified for G. lamblia and C. parvum, respectively, using a composite reference standard. In this case, true positives and negatives were considered as those with at least two positive or negative results out of the three tests. Both ImmunoCard STAT! and PCR methods were more sensitive than the microscopic tests of a single stool specimen of 85.7 % (CI = 62.6–96.2 %) and 85.7 % (CI = 56.2–97.5 %) for G. lamblia and C. parvum, respectively. However, specificity of microscopic tests was higher than other techniques for both parasites. Although PCR seems to be most sensitive for both G. lamblia and C. parvum, its low specificity may render its superiority over other techniques. When a single stool sample is used for detection of G. lamblia and C. parvum, better results can be obtained when coupled with serological testing. Although PCR is the most sensitive method for the detection of both G. lamblia and C. parvum, its use requires attention in relation to the increased possible false positives.

The genetics of Wilms' tumour (WT), a paediatric malignancy of the kidney, is complex. Inactivation of the tumour suppressor gene, WT1, is associated with tumour aetiology in approximately 10-15% of WTs. Chromosome 17p changes have been noted in cytogenetic studies of WTs, prompting us to screen 140 WTs for p53 mutations. When histopathology reports were available, p53 mutations were present in eight of eleven anaplastic WTs, a tumour subtype associated with poor prognosis. Amplification of MDM2, a gene whose product binds and sequesters p53, was excluded. Our results indicate that p53 alterations provide a molecular marker for anaplastic WTs.

Molecular genetic studies indicate that the etiology of Wilms tumor (WT) is complex, involving at least three loci. Germ-line mutations in the tumor suppressor gene, WT1, have been documented in children with WTs and urogenital developmental anomalies. Sporadic tumors constitute the majority (> 90%) of WT cases and previous molecular analyses of the WT1 gene have focused only on the DNA-binding domain. Using the single-strand conformational polymorphism (SSCP) assay, we analyzed the structural integrity of the entire WT1 gene in 98 sporadic WTs. By PCR-SSCP we find that mutations in the WT1 gene are rare, occurring in only six tumors analyzed. In one sample, two independent intragenic mutations inactivated both WT1 alleles, providing a singular example of two different somatic alterations restricted to the WT1 gene. This case is consistent with the existence of only one tumor suppressor gene at 11p13 involved in the pathogenesis of WTs. Our data, together with the previously ascertained occurrence of large deletions/insertions in WT1, define the frequency at which the WT1 gene is altered in sporadic tumors.

Background There is little knowledge regarding the prevalence and nature of renal impairment in African populations initiating antiretroviral treatment, nor evidence to inform the most cost effective methods of screening for renal impairment. With the increasing availability of the potentially nephrotixic drug, tenofovir, such information is important for the planning of antiretroviral programmes Methods (i) Retrospective review of the prevalence and risk factors for impaired renal function in 2189 individuals initiating antiretroviral treatment in a rural African setting between 2004 and 2007 (ii) A prospective study of 149 consecutive patients initiating antiretrovirals to assess the utility of urine analysis for the detection of impaired renal function. Severe renal and moderately impaired renal function were defined as an estimated GFR of ≤ 30 mls/min/1.73 m2 and 30–60 mls/min/1.73 m2 respectively. Logistic regression was used to determine odds ratio (OR) of significantly impaired renal function (combining severe and moderate impairment). Co-variates for analysis were age, sex and CD4 count at initiation. Results (i) There was a low prevalence of severe renal impairment (29/2189, 1.3% 95% C.I. 0.8–1.8) whereas moderate renal impairment was more frequent (287/2189, 13.1% 95% C.I. 11.6–14.5) with many patients having advanced immunosuppression at treatment initiation (median CD4 120 cells/μl). In multivariable logistic regression age over 40 (aOR 4.65, 95% C.I. 3.54–6.1), male gender (aOR 1.89, 95% C.I. 1.39–2.56) and CD4 Conclusion In this rural African setting, significant renal impairment is uncommon in patients initiating antiretrovirals. Urine analysis alone may be inadequate for identification of those with impaired renal function where resources for biochemistry are limited.

Prostaglandins (PGD{sub 2}, PGE{sub 2}, PGF{sub 2{alpha}}, and PGI{sub 2}) and thromboxane A{sub 2} (TXA{sub 2}) are biologically active molecules derived from the metabolism of arachidonic acid by cyclooxygenases. They produce a wide variety of physiological and pathophysiological effects mediated through specific G protein-coupled cell surface receptors. In this study, we have mapped the chromosomal positions of the human genes that encode the PGE{sub 2} receptor subtypes (PTGER1, PTGER2, and PTGER3), the PGF{sub 2{alpha}} receptor (PTGFR), the PGI{sub 2} receptor (PTGIR), and the TXA{sub 2} receptor (TBXA2R) using in situ hybridization. The PTGER1, TBXA2R, and PTGIR genes mapped to chromosome 19 at positions 19p13.1, 19p13.3, and 19q13.3, respectively. The PTGFR and PTGER3 genes mapped to chromosome 1 at positions 1p31.1 and 1p31.2, respectively, and PTGER2 gene mapped to chromosome band 5p13.1. 16 refs., 1 tab.

Stable cell lines that individually express the eight known human prostanoid receptors (EP(1), EP(2), EP(3), EP(4), DP, FP, IP and TP) have been established using human embryonic kidney (HEK) 293(EBNA) cells. These recombinant cell lines have been employed in radioligand binding assays to determine the equilibrium inhibitor constants of known prostanoid receptor ligands at these eight receptors. This has allowed, for the first time, an assessment of the affinity and selectivity of several novel compounds at the individual human prostanoid receptors. This information should facilitate interpretation of pharmacological studies that employ these ligands as tools to study human tissues and cell lines and should, therefore, result in a greater understanding of prostanoid receptor biology.

A 2.1-kb cDNA probe encoding the human SH2-domain containing protein-tyrosine phosphatase SH-PTP2 (PTPN11) was hybridized to human metaphase chromosomes in three independent experiments. In each instance, hybridization was maximal to chromosome 12q24.1-q24.3. The presence of SH-PTP2 cDNA crosshybridizing sequences located on a number of other chromosomes suggested that SH-PTP2-related genes or pseudogenes are present in the human genome.

To detect heterologous expression of receptors coupled via G proteins to the stimulation of adenylate cyclase in Xenopus laevis oocytes, the receptor of interest is coexpressed with the cystic fibrosis transmembrane conductance regulator (CFTR)--a cAMP-dependent Cl- channel. The binding of an agonist to the expressed receptor stimulates adenylate cyclase resulting in intracellular cAMP elevation, which in turn activates the CFTR. The CFTR-mediated Cl- current response is then measured using the standard two-electrode voltage-clamp technique. This method has allowed us to detect functional expression in oocytes of the human EP2 and IP prostanoid receptors. This method should prove valuable for expression and identification of putative G protein-coupled receptors signaling through stimulation of adenylate cyclase, for structure/function studies, and for analysis of receptor antagonists and agonists.

A cDNA clone encoding the human prostaglandin (PG) E2 receptor EP2 subtype has been isolated from a human lung cDNA library. The 1.9-kilobase pair cDNA, hEP2, encodes for a 488-amino acid protein with a predicted molecular mass of 53,115 and has the seven putative transmembrane domains characteristic of G protein-coupled receptors. The specific binding of [3H]PGE2 to COS cell membranes transfected with the hEP2 cDNA was of high affinity with an equilibrium dissociation constant (Kd) of 1 nM and the rank order of potency for prostaglandins in competition for [3H]PGE2 specific binding was PGE1 = PGE2 >> iloprost > PGF2 alpha > PGD2. In competition studies using more selective prostanoid-receptor agonist and antagonists, the [3H]PGE2 specific binding was competed by MB28767, an EP3 agonist, but not by the EP1-preferring antagonists AH6809 and SC19220, or by the EP2 agonist butaprost. Electrophysiological studies of Xenopus oocytes co-injected with hEP2 and cystic fibrosis transmembrane conductance regulator (cAMP-activated Cl- channel) cDNAs detected PGE2-specific inward Cl- currents, demonstrating that the hEP2 cDNA encoded a functional receptor which produced an increase in cAMP levels. Thus, we have cloned the human EP2 receptor subtype which is functionally coupled to increase in cAMP. Northern blot analysis showed that hEP2 is expressed as a 3.8-kilobase mRNA in a number of human tissues with the highest expression levels present in the small intestine.

Background The Erythrocyte Binding Antigen (EBA) 175 has been considered as one of the most important Plasmodium falciparum (P. falciparum) merozoite ligands that mediate invasion of the erythrocytes through their sialated receptor: Glycophorin A (GPA). The effect of the EBA 175 dimorphic alleles (F and C) on the severity of the disease is not yet fully understood. Therefore this study was designed to assess the distribution of the divergent dimorphic alleles of P. falciparum EBA-175 (F and C) in three different geographical areas in Sudan and the possible association of this dimorphism with the severity of the disease. Methods A sum of 339 field isolates of P. falciparum obtained from patients in three different geographical areas in Sudan were screened for the dimorphic alleles (F, C) of the EBA-175 using nested PCR. Results The percentage of F, C, and mixed F/C alleles were; 41%, 51%, and 8% respectively. F and C alleles showed significantly different distributions in the various geographic areas (p = 0.00). There was no significant association between malaria clinical manifestation and P. falciparum EBA-175 F and C alleles frequencies. Conclusions This study showed a significant differential distribution of F and C alleles in different geographical malaria endemic areas. No significant association was observed between F and C alleles and different malaria phenotypes.