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Sperm cryopreservation is the process of storing sperm for an extended period of time in order to maintain male fertility. Cryopreservation involves exposing germ cells to substances that prevent freezing, cooling them to below-freezing temperatures, storing, melting, and then removing the anti-freezing material when it has been used. It is helpful in cancer patients before chemotherapy and radiotherapy. Spermatozoa can be adversely impacted by reactive oxygen species by its detrimental effects on sperm membrane lipids, which cause ice crystal formation and the induction of oxidative stress (OS) during cryopreservation. Owing to the tight relationship between OS induction and cryopreservation, several recent researches have concentrated on the function of antioxidants in preserving male fertility. A variety of antioxidants have been developed for in vitro supplementation in an attempt to prevent the cellular harm brought on by cryopreservation. Examples of antioxidants include melatonin, catalase, superoxide dismutase, tocopherol, ascorbic acid, and carotenoids. When added to sperm extenders, melatonin, a natural hormone that plays a role in a number of sperm physiological processes, has frequently increased sperm viability and fertility. In order to determine whether it can protect human sperm from the damaging effects of cryopreservation, it was added to the sperm cryopreservation solution. Melatonin was added to freezing extenders in recent studies on mammals, and this increased the post-thaw activities of human sperm. Therefore, this study was aimed to review the background documents on the state-of-the-art scientific literature in this area of work. Also, this study reviewed the feasibility of employed melatonin in cryopreservation because it has antioxidant ability.

Background: This study was conducted in pursuit of gaining an understand effects of the low level laser irradiation on whole blood is very essential way in revealing the mechanisms of the action of laser radiation on biological tissues. Objective: The purpose of this study is to investigate the in vitroeffect of laser radiation on some hematological parameters and erythrocyte sedimentation rate. Subject and Method: Blood samples were obtained from 30 healthy volunteers, each sample was divided into four new samples, one of them was considered as control while the other three were exposed to three different laser doses. Thewavelength of532nm was used for irradiation with 4mm diameter beam spot on blood samples, with power density of 796.17mW/cm2. The irradiation times were 1.8, 3.7and 6.2 secand so the different doses of irradiation 1.5,3 and 5 J/cm2, respectively. Results: The erythrocyte sedimentation rate was measured after laser irradiation and compared with un-irradiated control sample. The results of this study showed thaterythrocyte sedimentation rate value increased significantly with a dose of 1.5J/cm² but not with the othertwo doses’ values in male persons but not in females. Moreover, the mean cell volume shows significant decrement post irradiation. Conclusion: Laser irradiation induces physical changes in red blood cell membrane permeability and blood viscosity and consequently alters erythrocyte sedimentation rate.

Introduction: Elizabethkingia meningoseptica (E. meningoseptica) is an emerging pathogen that causes bloodstream infections, especially among immunocompromised or critically ill patients. Due to its multidrug resistance, limited antibiotic treatments are available. Therefore, correct identification with a proper susceptibility report is compulsory to reduce mortality and morbidity caused by this rare pathogen. Aim: To analyse the clinical features, underlying comorbidity, outcomes, and antibiotic resistance potential of E. meningoseptica causing bacteraemia. Materials and Methods: This cross-sectional study was conducted in Department of Microbiology, Rajshree Medical Research Institute (RMRI), Bareilly, Uttar Pradesh, India. The study spanned three years from August 2020 to July 2023. All patients with E. meningoseptica bacteraemia were identified from blood culture reports and included in the study. As it was a duration-based study, all consecutive patients identified with E. meningoseptica bacteraemia were enrolled. The total sample size was 43. Blood samples growing gram negative, non fermenting, non motile isolates that were positive for the oxidase reaction were further identified using the Vitek 2 compact system (Biomerieux, France). All relevant data regarding demographic and clinical characteristics, underlying diseases, and antibiotic treatments were collected from the hospital information system. Patient demographics were presented as mean ± standard deviation. Clinical characteristics and co-morbid conditions were presented as frequency and percentages. Results: The majority of patients were elderly males admitted to the Intensive Care Unit (ICU). The most common underlying co-morbidity was malignancy in 12 (27.9%), and pneumonia in 12 (48.8%) was the major diagnosis among these bacteraemic patients. A total of 10 (23.25%) infections were polymicrobial, with common concomitant pathogens being Pseudomonas aeruginosa and Methicillin-Resistant Staphylococcus aureus (MRSA). Co-trimoxazole, fluoroquinolones, and Piperacillin/ Tazobactam were the most effective antibiotics. Thirty-nine (90.7%) patients recovered completely, while four patients (9.3%) died of complications. Conclusion: Improper antimicrobial therapy increases resistance and mortality among patients with E. meningoseptica infections. It is imperative that clinicians remain vigilant about this rare pathogen and advise antimicrobial susceptibility testing for appropriate treatment, leading to favourable outcomes.

Abstract Predicting clinical deterioration in COVID-19 patients remains a challenging task in the Emergency Department (ED). To address this aim, we developed an artificial neural network using textual (e.g. patient history) and tabular (e.g. laboratory values) data from ED electronic medical reports. The predicted outcomes were 30-day mortality and ICU admission. We included consecutive patients from Humanitas Research Hospital and San Raffaele Hospital in the Milan area between February 20 and May 5, 2020. We included 1296 COVID-19 patients. Textual predictors consisted of patient history, physical exam, and radiological reports. Tabular predictors included age, creatinine, C-reactive protein, hemoglobin, and platelet count. TensorFlow tabular-textual model performance indices were compared to those of models implementing only tabular data. For 30-day mortality, the combined model yielded slightly better performances than the tabular fastai and XGBoost models, with AUC 0.87 ± 0.02, F1 score 0.62 ± 0.10 and an MCC 0.52 ± 0.04 (p

Background: Dietary limitations and improper time of rest during Ramadan of expected mothers could influencethe health of newborns, especially the birth weight.Objective: To determine the effect of Ramadan fasting on fetal birth weight.Study type,settings& duration:This prospective study was conducted atJinnah Postgraduate Medical Centre (JPMC), Karachi duringMay-June 2019 (Ramadan 1440 Hijri).Methodology:After taking informed written consent,pregnant femalesvisiting the Obstetrics and Gynecology ward of JPMC in Ramadan for pre-natal examination were enrolled. A pretested questionnaire was used togather information regarding, demographics, medical history, family history, number of days of fasting and information of the fetus was recorded. Pregnant female were divided in three groups: Non-fasting (Group 1), Mothers with less than 19 days of fasting (Group2), and mothers with more than of 20 days of fasting (Group 3). Results:Complete information of 477 pregnant women was obtained. Amongst them,149 (31.2%) were in Group 1, 225 (47.2%) were in Group 2, and 103 (21.6%) were in Group 3. None ofthe demographic variable showed any significant association with fasting mothers of three groups, except history of hypertension. Mean birth weight of newborns of mothers of Group 2 was 83 grams lower and of mothers of Group 3 were 103 grams higher than the weight of newborn of the mothers of Group 1. But these differences were statistically insignificant. Statistically insignificant differences were also observed in each trimester.Conclusion:Fasting of pregnant mothers during Ramadan have no significanteffect on the weight of their newborns.

Objective: To evaluate the antibacterial activity of aloe-emodin isolated from aloe-vera against staphylococcus aureus from human patients and cows suffering from respiratory tract infection. Method: The experimental study was conducted at the A;-Kut Technical Institute, Iraq, from October 2021 to December 2021, and comprised human nasal swabs collected from Al-Zahraa Teaching Hospital and Al-Karama Teaching Hospital in Wassit, Iraq, in group A, cow nasal swabs collected from city centre, Al-Hay, Al-Bataar, Sheikh Saad, Al-Azizia and Al- Suwaira fields in group B. Aloe-vera was taken from the local market for which certification was obtained from the Directorate of Seed Testing and Certification, Ministry of the Agriculture, Iraq. The swab specimens were transferred to the laboratory under standard conditions. The specimens were inoculated to mannitol salt agar and blood agar media and were then incubated for 24-48hrs at 37°C under aerobic conditions. All the primary screened isolates were then subjected to various morphological and biochemical tests to ensure their identity. Data was analysed using the statistical analysis system, 2018. Results: Of the 200 samples, 100(50%) were in group A and 100 100(50%) in group B. Aloe-emodin was the most effective antibiotic that inhibited human and cow pathogenic bacteria with high inhibition zone range at (1%) which increased with increasing aloe-emodin extract concentrations at (2% ,4%). Staphylococcus isolates revealed a different response to the aloe-emodin antimicrobial activity. Conclusion: Aloe-emodin extract of alo-vera showed high antimicrobial activity against all human and cow pathogenic bacteria. Keywords: Cattle, Aloe, Emodin, Plant, Anti-bacterial, Anti-infective, Nose, Agriculture, Ethanol, Seeds.

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health.

Abstract This case report aims to present an unusual case of a plunging ranula that extended to the superior vertebral body of the T4 vertebrae, we will be elaborating on the patient presentation, investigations, diagnosis, and treatment of the lesion, while also talking about the adversities faced while diagnosing and treating the patient. The rarity of this condition and an atypical presentation makes this a difficult case to diagnose and vigilant treatment is needed to prevent any complications associated with the condition and ensure a successful treatment and recovery.

Introduction African, Caribbean and Black (ACB) adolescents are disproportionately affected by teen pregnancy in North America. Teen pregnancy poses risks to the quality of life of adolescent boys and girls, including physical, psychosocial and socioeconomic risks. Our review aims to explore this public health concern for ACB adolescents within North America. We aim to identify and analyse available evidence on the incidence and prevalence of, associated factors of and interventions to curtail teen pregnancy involvement (TPI) among ACB adolescent boys and girls in North America. This review will explore TPI, rather than teen pregnancy, to ensure a review of men’ involvement in teen pregnancy outcomes.Methods and analyses Health literature databases such as CINAHL, OVID (Medline and Embase) and CAB direct. Searches will be conducted for evidence published from 2001 to October 2021. Search results will be exported to Covidence for subsequent steps of the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines will be used to ensure reproducibility and transparency. We will include all study designs focused on ACB boys and girls between 10 and 19 years old, residing in North America. Studies with a mixed racial sample will be included if sample consists of greater than 50% ACB individuals.Ethics and dissemination TPI is a public health concern with socioeconomic and health consequences for ACB teens in North America. A scoping review such as this will provide direction for healthcare practice, policy changes, education and further research in reducing the incidence of TPI in North America. Study results will be disseminated via presentations at conferences, at target populations, communities and organisations and publications via peer-reviewed journals. As knowledge generated from this scoping review will stem from previously published evidence, an ethical approval is not needed

Objective: To examine the clinical severity and magnitude of COVID-19 patients after the second dose of the COVID-19 vaccine. Study Design: Cross-sectional study. Place and Duration of Study: Tertiary Care Hospital, Islamabad Pakistan, from Feb to Jun 2021. Methodology: The individuals who had two doses of the vaccine (dead inactivated- Vero Cell) and got COVID-19 at least two weeks after vaccination were included in the study. These patients were divided into Mild, Moderate and Severe categories based on their symptoms and Investigations. Results: Out of 5000 individuals vaccinated, 225(4.5%) got infected with COVID-19 later. Among these 225, 172(76.4%) had mild symptoms and recovered, with only 1(0.4%) death was reported. Conclusion: COVID-19 vaccination does not infer 100% immunity, but if someone gets infected with COVID after vaccination,there are remarkable chances of recovery.

Fluorine is characterized by high electronegativity and small atomic size, which provide this molecule with the unique property of augmenting the potency, selectivity, metabolic stability, and pharmacokinetics of drugs. Fluorine (F) substitution has been extensively explored in drug research as a means of improving biological activity and enhancing chemical or metabolic stability. Selective F substitution onto a therapeutic or diagnostic drug candidate can enhance several pharmacokinetic and physicochemical properties such as metabolic stability and membrane permeation. The increased binding ability of fluorinated drug target proteins has also been reported in some cases. An emerging line of research on F substitution has been addressed by using 18F as a radiolabel tracer atom in the extremely sensitive methodology of positron emission tomography (PET) imaging. This review aims to report on the fluorinated drugs approved by the US Food and Drug Administration (FDA) from 2016 to 2022. It cites selected examples from a variety of therapeutic and diagnostic drugs. FDA-approved drugs in this period have a variety of heterocyclic cores, including pyrrole, pyrazole, imidazole, triazole, pyridine, pyridone, pyridazine, pyrazine, pyrimidine, triazine, purine, indole, benzimidazole, isoquinoline, and quinoline appended with either F-18 or F-19. Some fluorinated oligonucleotides were also authorized by the FDA between 2019 and 2022.

Madam, allogeneic hematopoietic stem cell transplant (HSCT) remains a life altering cure to exceptionally challenging diseases ranging from hematologic malignancies to primary immunodeficiencies and blood cancers. One of its adversities includes graft versus host disease (GVHD), a lethal immunologically mediated condition wherein the donor's T-cells attack the host's tissues. The presentation can be classified as acute or chronic. Acute GVHD is divided into four grades. Despite current prophylaxis, including a combination of calcineurin inhibitor with either methotrexate or sirolimus, the incidence of grade-II or higher GVHD is between 30% to 80%, with grade-IV GVHD approaching mortality rates up to 90%.1 A recent phase II trial by Farag et al. addresses the issue by introducing a novel combination of sitagliptin – a specific DPP-4 inhibitor used to manage type 2 diabetes in adults – along with tacrolimus and sirolimus for prevention of GVHD.2 Using the new blend, an overall marked reduction in the risks of grade-II to IV (5%) and grade-III to IV (3%) acute GVHD was shown, compared to previous studies using only sirolimus and tacrolimus.3 Moreover, no adverse effects were associated with the drug during the period of study. Advancements in the field of HSCTs are particularly crucial in developing countries such as Pakistan. The high prevalence of consanguineous marriages and insufficient genetic counselling make the country especially vulnerable to diseases like thalassemia, bone marrow failure syndromes and immunodeficiency states. Up to 9000 children require transplantation each year due to the high prevalence of beta- thalassemia major.4 The situation is further complicated by limited resources and few stem cell transplant centres, which are limited to major cities. Although HSCT efficiently treats numerous life-threatening conditions, only 719 patients underwent HSCT till mid-2017 cumulatively in Pakistan.4 In accordance with the aforementioned factors, the number of transplants performed heavily outnumbers their demand, making it essential to tackle a complication as deadly as acute GVHD. In a 2005 study conducted in Rawalpindi by Hashmi et al., the overall incidence of acute GVHD grade-II to IV after standard immunosuppressive therapy was 44.2%.5 While the results were comparable to other studies, the high f morbidity and mortality rates necessitates alternate treatment courses. Sitagliptin, a locally manufactured, cost-effective drug, will be an appropriate choice of medication in Pakistan where average income amounts to a meagre US$1000 per year.4 However, randomized trials are needed to further investigate its role in the prevention of acute GVHD. Continue....

Maternal mortality is a serious health concern, with casualties amounting to 295,000 in 2017.[1] As of present, about 25% of all maternal deaths fall under a condition known as postpartum haemorrhage (PPH), which is defined as abnormal bleeding of more than 500 – ml post child birth; 80% of all PPH cases are attributed to an atonic uterus. Consequently, a stepwise progression is observed to achieve haemostasis, starting from compression therapy to uterotonics like oxytocin followed by uterine balloon tamponade and even surgical intervention as the last line of treatment.[2] In their study, Dalton et al. introduce The Jada System, a novel intrauterine vacuum induced haemorrhage control device and evaluate its safety and effectiveness. [3] This novel innovation uses low- level intrauterine vacuum to assist physiological forces, collapse the uterine cavity and occlude blood vessels to control excessive bleeding. Moreover, the study showcased successful definitive treatment in 94% of the patients within an average of 3 minutes, minimal low-grade adversities, 98% investigators deeming it easy to use and majority recommending it for future treatment.[3] The Jada System’s rapid and early use renders it an exceptional treatment to PPH in comparison with alternatives like balloon tamponade that can only be used after a significant blood loss. Furthermore, with a success rate of 87%, the balloon tamponade can take up to 24 hours to control bleeding and carries numerous risks like rupture of the overfilled balloon, infections, cervical tears and vaginal lacerations. [4] While tackling maternal mortality with the help of The Jada System, it is imperative to recognize that 94% of all maternal deaths occur in low and lower middle-income countries, therefore coherent and competent approaches to maternal health care must be introduced to developing countries around the world.[1] Pakistan is one such low-middle income country that reported a Maternal Mortality Rate (MMR) of 140 per 100000 deaths in 2017.[1] Additionally, in a 2002 study, Jafarey outlined lack of management, scarcity of medications, services, skills and blood banks to accommodate excessive blood loss as the major causes of continued maternal deaths due to PPH (52.9%) in the country.[5] Considering The Jada System's high success rate in managing PPH, low - middle income countries like Pakistan can invest in the local production of this device in a cost- efficient manner. Such an incentive can prove to be a feasible and swift solution to obstetric emergencies in the region.

Staphylococcus aureus (S. aureus) is a major causative agent of mastitis and is resistant to many antibiotics. Thus, there is a need to characterize the genetic determinants of S. aureus erythromycin resistance, such as ermA, ermB and ermC. The current study aimed to determine the phenotypic and genotypic erythromycin resistance profile and relatedness of S. aureus recovered from bovine mastitis and humans in close contact. A total of 14 mastitis-infected buffalo milk samples and 16 samples from their respective milkers were collected from different farms of Lahore, Pakistan. The antibiotic resistance profile was determined through the disk diffusion test. The overall prevalence of S. aureus in mastitis-affected buffaloes was found to be 75%, of which 52.1% were resistant to erythromycin and 42.8% to clindamycin. S. aureus isolates recovered from milker nasal samples showed 56.25% resistance to erythromycin and 44% resistance to clindamycin. Genotypic antibiotic resistance profiles were determined from 14 milk samples through PCR. Overall, eight (52.1%), three (21.4%) and five (35.7%) S. aureus isolates were positive for the ermA, ermB and ermC genes, respectively. Moreover, 16 milker nasal S. aureus isolates were also tested for the presence of ermA, ermB and ermC genes. The ermA, ermB and ermC genes were observed in nine(56.7%), five (31.3%) and seven (43.7%) isolates, respectively. A significant association was shown between phenotypic and genotypic erythromycin resistance. The results indicate both that there are sufficient genetic similarities, and the actual transmission of erythromycin resistance genes between these two hosts of S. aureus.

Objective: To determine the major stresses of house officers, causes of these stress and the coping strategies. Study Design: Descriptive cross sectional study. Place and Duration of Study: Study was conducted in 13 different tertiary care hospitals of Karachi in both government and private sectors from Oct to Nov 2017. Material and Methods: A descriptive cross sectional study with multistage random sampling technique was done in which a self-designed and self-explanatory questionnaire was used. Results were analyzed using statistical package for social sciences (SPSS) version 20. Results: About 300 questionnaires were distributed to interns. From the total, 83.9% participants were female. The mean age of the participants was 24 years. Out of the total respondents, 9.4% participants stated no any significant medical mistake. Issues arising due to lack of knowledge or incompetency leading to mis diagnosis of patients were reported by 20.5% respondents. One of the common mistakes reported was wrong drug administration; either route, dosage or incorrect medicine, committed by about 25.3% of doctors participated. The most reported reason thought to be the underlying cause of mistakes was work overload that was about 36.3%. Conclusion: It can be concluded by the present study that house officers are susceptible to stress which affects their overall work performance and it leads to significant medical mistake due to which patient suffer and because of this pressure it‟s very hard both physically and mentally for a doctor to cope up.

Congenital hepatic fibrosis (CHF) is a rare autosomal recessive disease derived from biliary dysgenesis secondary to ductal plate malformation; it often coexists with Caroli’s disease, von Meyenburg complexes, autosomal dominant polycystic kidney disease (ADPKD), and autosomal recessive polycystic kidney disease (ARPKD). Although CHF was first named and described in detail by Kerret al. in 1961, Its pathogenesis still remains unclear. The exact incidence and prevalence are not known, and only a few hundred patients with CHF have been reported in the literature to date. However, with the development of noninvasive diagnostic techniques such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), CHF may now be more frequently detected. Anatomopathological examination of liver biopsy is the gold standard in diagnosis of CHF. Patients with CHF exhibit variable clinical presentations, ranging from no symptoms to severe symptoms such as acute hepatic decompensation and even cirrhosis. The most common presentations in these patients are splenomegaly, esophageal varices, and gastrointestinal bleeding due to portal hypertension. In addition, in younger children, CHF often is accompanied by renal cysts or increased renal echogenicity. Great variability exists among the signs and symptoms of the disease from early childhood to the 5th or 6th decade of life, and in most patients the disorder is diagnosed during adolescence or young adulthood. Here, we present two cases of congenital hepatic fibrosis in 2-years-old girl and 12-year-old male who had been referred for evaluation of an abdominal distension with persistent hyper-transaminasemia and cholestasis, the diagnostic was made according to the results of medical imaging (CT or MRI), a liver biopsy, and genetic testing.

Approximately 15 million children under age 6 are in childcare settings, offering childcare providers an opportunity to influence children’s dietary intake. Childcare settings vary in organizational structure – childcare centers (CCCs) vs. family childcare homes (FCCHs) – and in geographical location – urban vs. rural. Research on the nutrition-related best practices across these childcare settings is scarce. The objective of this study is to compare nutrition-related best practices of CCCs and FCCHs that participate in the Child and Adult Care Food Program (CACFP) in rural and urban Nebraska. Nebraska providers (urban n = 591; rural n = 579) reported implementation level, implementation difficulty and barriers to implementing evidence-informed food served and mealtime practices. Chi-square tests comparing CCCs and FCCHs in urban Nebraska and CCCs and FCCHs in rural Nebraska showed sub-optimal implementation for some practices across all groups, including limiting fried meats and high sugar/ high fat foods, using healthier foods or non-food treats for celebrations and serving meals family style. Significant differences (p

Introduction and purpose: One of the problems of water distribution systems is loss of large volumes of water due to the occurrence of various events, which incurs a huge financial loss. Regarding this, the aim of the present study was to investigate the rate of events and water loss in the water distribution system and its related factors in Azna, Lorestan province, Iran, during 2008-2014. Methods: This cross-sectional study was conducted using census method, surveys, and field data collection. The amount of water production and consumption, the volumes of water loss, the number of accidents, type of pipe, pressure zone, as well as the age and length of the pipes recorded during 2008- 2014 were studied and analyzed. Results: According to the results, the highest (34.48%) and lowest (20.57%) amount of water losses happened in 2008 and 2014, respectively. High pressures in water systems had significant relationship with the number of events as well as the amount of water loss and water consumption. In addition, higher length and age of the pipes had a direct correlation with increased number of events and water loss. Furthermore, the maximum number of events were found to occur in the pipe embranchment and galvanized pipes. Conclusion: This study showed that of events was directly related to the length and age of the pipes, the water pressure, and number of branches. Also water loss quantity can be reduced by applying suitable management techniques in different sections. Furthermore, the water loss can be significantly controlled by taking such measures as reducing the pressure in the high-pressure zones, timely replacement of old and inappropriate pipes, appropriate fixing of the pipes, replacement of the galvanized pipe, and standard implementation of pipes and fittings.

Although cirrhosis is a key risk factor for the development of hepatocellular carcinoma (HCC), mounting evidence indicates that in a subset of patients presenting with non-alcoholic steatohepatitis (NASH) HCC manifests in the absence of cirrhosis. Given the sheer size of the ongoing non-alcoholic fatty liver disease (NAFLD) epidemic and the dismal prognosis associated with late-stage primary liver cancer there is an urgent need for HCC surveillance in the NASH population. Using serum levels of HCC biomarkers as vectors and biopsy-proven HCC or no HCC as outputs / binary classifier, a supervised learning campaign was undertaken to develop a minimally invasive technique for making a diagnosis of HCC in a clinically relevant model of NASH. Adult mice randomized to control diet or a fast food diet (FFD) were followed for up to 14 mo and serum level of a panel of HCC-relevant biomarkers was compared with liver biopsies at 3 and 14 mo. Both NAFLD Activity Score (NAS) and hepatic hydroxyproline content were elevated at 3 and 14 mo on FFD. Picrosirius red staining of liver sections revealed a filigree pattern of fibrillar collagen deposition with no cirrhosis at 14 mo on FFD. Nevertheless, 46% of animals bore one or more tumors on their livers confirmed as HCC in hematoxylin-eosin-stained liver sections. In this training set, receiver operating characteristic (ROC) curves analysis for serum levels of the HCC biomarkers osteopontin (OPN), alpha-fetoprotein (AFP) and Dickkopf-1 (DKK1) returned concordance-statistic/area under ROC curve of ≥ 0.89. Serum levels of OPN (threshold, 218 ng/mL; sensitivity, 82%; specificity, 86%), AFP (136 ng/mL; 91%; 97%) and DKK1 (2.4 ng/mL; 82%; 81%) diagnostic for HCC were confirmed in a test set comprising mice on control diet or FFD and mice subjected to hepatic ischemia-reperfusion injury. These data suggest that levels of circulating OPN, AFP and DKK1 can be used to make a diagnosis of HCC in a clinically relevant model of NASH.

Cocaine increases the risk of cardiovascular diseases, including myocardial infarction. We herein describe a case of a 22-year-old man with a long history of cocaine abuse. He presented at our institution because of acute coronary syndrome with ST segment elevation. Emergency coronary angiography revealed ostial occlusion of the left anterior descending artery, which required desobstruction and implantation of a bare metal stent. Angioplasty was complicated 4 months later by in-stent restenosis requiring reintervention. This case highlights myocardial infarction as a cocaine-induced effect. Appropriate treatment and cessation of cocaine abuse may prevent cardiovascular complications and recurrences.

The microtubule cytoskeleton is critical for muscle cell differentiation and undergoes reorganisation into an array of paraxial microtubules, which serves as template for contractile sarcomere formation. In this study, we identify a previously uncharacterised isoform of microtubule-associated protein MAP4, oMAP4, as a microtubule organising factor that is crucial for myogenesis. We show that oMAP4 is expressed upon muscle cell differentiation and is the only MAP4 isoform essential for normal progression of the myogenic differentiation programme. Depletion of oMAP4 impairs cell elongation and cell–cell fusion. Most notably, oMAP4 is required for paraxial microtubule organisation in muscle cells and prevents dynein- and kinesin-driven microtubule–microtubule sliding. Purified oMAP4 aligns dynamic microtubules into antiparallel bundles that withstand motor forces in vitro. We propose a model in which the cooperation of dynein-mediated microtubule transport and oMAP4-mediated zippering of microtubules drives formation of a paraxial microtubule array that provides critical support for the polarisation and elongation of myotubes.

OBJECTIVES: to identify the demographic factors that can make recipients vulnerable to develop poorer perceptions of health despite a healthy graft functioning and to evaluate recipients’ perceived health status (PHS) influences their coping and adjustment with the altered life styles and challenges after transplant. METHODS: In this longitudinal study, PHS was measured by a self-developed questionnaire that reflected the symptoms’ severity and frequency measured by the common immunosuppressant side effects. Actual physical health status was measured by the clinical data that comprised of kidney function tests (serum creatinine, blood urea nitrogen, uric acid) and general health indicators such as blood pressure, cholesterol and haemoglobin levels. RESULTS: There was significant correlation among sociodemographic factors and perceptions of health status after a successful renal transplant over time. Age had a significant negative association with PHS, indicating that older recipients tend to have poorer perceptions of health as compared to younger recipients. Single RTRs tend to have more a better PHS than those in a relationship. Time since transplantation showed a significant positive correlation with PHS reflecting that with the passage of time, perceptions of health tend to improve in most RTRs. In Sociodemographic factors, significant differences were found only in age and marital status. Older and single recipients tend to report better PHS. However, PHS did not differ significantly across gender, educational level, financial and work status. CONCLUSION: Socio-demographic factors do affect PHS to some extent and thus need to be considered as a part of transplant candidacy and psychological management accordingly. KEY WORDS: Perceived Health Status (Non-MeSH), Actual Physical Health Status (Non-MeSH), Renal Transplant Recipients (Non-MeSH), Socio-demographic (Non-MeSH), Quality of Life (MeSH).

L'association d'une communication interventriculaire post infarctus du myocarde et d'un anévrysme du ventricule gauche chez un même patient est extrêmement rare et survient habituellement durant la première semaine qui suit un infarctus du myocarde. Nous rapportons le cas insolite d'un patient âgé de 63 ans, admis pour choc cardiogénique en rapport avec une communication inter ventriculaire apicale et un anévrysme ventriculaire gauche causés par un infarctus du myocarde antérieur. La correction chirurgicale a consisté en une fermeture du défect septal par un patch en dacron via une ventriculotomie gauche associée à une anévrysectomie et un mono pontage coronaire. Cette observation illustre d'une part la rareté de l'association communication inter ventriculaire-anévrysme ventriculaire gauche post infarctus du myocarde, et d'autre part l'efficacité du traitement chirurgical qui reste la seule option salvatrice pour cette pathologie.

Background: Determination of biological age is a crucial challenge in gerontology. We studied the profile of variations in physical fitness factors in three groups of active, moderately active, and inactive Iranian women. Finally, a formula was produced to estimate biological age of women based on their physical fitness measures. Methods: This ex-post facto research was conducted in 2010. After signing informed consent forms, 107 women from Isfahan (Iran) were selected by purposeful stratified sampling. The subjects aged 18-65 years old and were categorized into age groups of 18-20, 21-25, 26-30, 31-35, 36-40, 41-45, 46-50, 51-55, 56-60, and 61-65 years old. From about 50 women who were asked to participate in each age group, at least 10 volunteers were evaluated. Physical fitness tests included vertical jump, modified pull-ups, sit and reach, Illinois agility test, 30-meter run, 20-meter shuttle run, sit-ups, and medicine ball throw. Statistical analyses were performed using SPSS16. Findings: Discriminant analysis revealed that 64% of physical fitness level was explained by physical activity level (P ≤ 0.01). Multiple regression analysis showed that chronological age had an inverse relationship with physical fitness factors. However, the rate of physical fitness reduction of subjects depended on their sporting activity level, i.e. higher sporting activity was associated with lower rate of physical fitness reduction. Conclusion: Similar to reports from developed countries, this study indicated that physical activity had positive effects on biological age. However, our subjects had lower levels of physical fitness. This study also provided a good opportunity to produce an equation to estimate biological age of Iranian women. Our findings are alarming, especially when considering aerobic fitness. This study could be more reliable, if the same data were collected from other provinces of the country. Keywords: Biological age, Physical fitness factors, Estimation of biological age