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Date palm is an important fruit bearing tree grown widely in the arid and semi-arid regions of the world. The date fruit and its by-products, such as seeds, have both nutritional and medicinal value. However, date fruit and seeds have not been fully considered as potential functional food ingredients to develop foods with promising health benefits. Based on the available information in the literature, fruit and seed of date palm are rich in phytochemicals, such as phenolics, anthocyanin, carotenoids, tocopherols, tocotrienols, phytosterols and dietary fiber. In addition, they were reported to possess several beneficial health properties explored under in-vitro and in-vivo conditions. Further research in this area would provide valuable information for the potential utilization of date fruit and seed as functional food ingredients. This review presents a comprehensive information about the bioactive compounds and nutraceutical properties of different varieties of date fruit and seed, as well as the potential for using them as functional food ingredients., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Novel bioactive peptides from camel milk protein hydrolysates (CMPH) were identified and tested for inhibition of cholesterol esterase (CEase), and their possible binding mechanisms were elucidated by molecular docking. Papain-generated CMPH showed the highest degree of hydrolysis. All CMPH produced upon enzymatic degradation demonstrated a dramatic enhancement of CEase inhibition compared with intact camel milk proteins, with papain-generated hydrolysate P 9 displaying the highest inhibition. Peptide identification and their modeling through PepSite 2 revealed that among 20 potential bioactive peptides in alcalase-generated hydrolysate A 9 , only 3 peptides, with sequences KFQWGY, SQDWSFY, and YWYPPQ, showed the highest binding toward CEase catalytic sites. Among 43 peptides in 9-h papain-generated hydrolysate P 9 , 4 peptides were found to be potent CEase inhibitors. Molecular docking revealed that WPMLQPKVM, CLSPLQMR, MYQQWKFL, and CLSPLQFR from P 9 hydrolysates were able to bind to the active site of CEase with good docking scores and molecular mechanics-generalized born surface area binding energies. Overall, this is the first study reporting CEase inhibitory potential of peptides generated from milk proteins., (Copyright © 2019 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Background: HIV/AIDS has emerged as a serious public health issue across the globe, and particularly in developing countries. Comprehensive knowledge and positive attitudes are cornerstones for the prevention, control and treatment of HIV/AIDS. However, there are various misconceptions associated with HIV/AIDS transmission, which lead to negative attitudes towards people living with AIDS. The present study aims to explore the effects of these determinants, related to socio-demographic characteristics and autonomy, on women's overall knowledge and attitudes regarding HIV/AIDS in Pakistan., Methods: Secondary data analysis was carried out using the national representative dataset of the 2012-13 Pakistan Demographic and Health Survey. A series of questions related to HIV/AIDS was asked of 13,558 ever-married women aged 15-49 years to assess respondents' knowledge regarding modes of HIV/AIDS transmission and preventative measures, as well as their attitudes towards people living with HIV/AIDS. Descriptive and bivariate statistics were used to identify associations with socio-demographic and autonomy-related variables. Furthermore, bivariate and multivariate logistic regression analyses were performed to assess the association between multiple factors and overall HIV/AIDS knowledge as well as attitudes towards people living with AIDS., Results: The results show that only 42% of Pakistani women have heard about HIV/AIDS. Amongst these women, the majority (68%) have good overall knowledge of HIV/AIDS and more than 55% have positive attitudes towards people living with AIDS. Furthermore, women residing in urban areas, having at least secondary-level education, with high autonomy, belonging to the richest wealth quintile and having exposure to mass media had high overall knowledge and positive attitudes towards people living with AIDS., Conclusion: The findings of this research support the relevance of women's autonomy, education and exposure to mass media, particularly in rural areas of Pakistan, to address the lack of knowledge and eliminate various myths and stigmatisation of people living with HIV/AIDS. Furthermore, it reveals a need to increase focused and targeted interventions to enhance women's knowledge and positive attitudes towards people living with HIV/AIDS. In this regard, the media can play a proactive role to gauge wider audience in creating awareness and eradicating the myths and misconceptions regarding HIV/AIDS.

Introduction: Stroke is a major cause of death with hypertension being identified as an important modifiable risk factor. Prompt identification of stroke symptoms and timely management is noted to be significant in lowering both morbidity and mortality. Baseline stroke knowledge in hypertensive patients is crucial to develop effectively targeted, and appropriate health promotion campaigns; thus, the main objectives of this study are to assess the awareness of stroke and to determine health-seeking practices among hypertensive patients., Materials and Methods: A standardized questionnaire survey regarding awareness and practices about stroke among hypertensive patients was conducted in a tertiary care hospital of Islamabad. The sample size was calculated as 384., Results: Out of 384 patients evaluated, 80.5% had heard about stroke, 71.6% knew someone with stroke, and 76% identified the brain as the organ affected. Sudden onset numbness of limb (66.9%) and hypertension (93.5%) were common warning symptom and risk factor identified. 87.5% would take stroke patients to a hospital. Only 45.1% of the patients took their medications regularly, and 38% checked their blood pressure., Conclusion: Majority of hypertensive patients were aware of stroke but the awareness of risk factors and warning signs was poor. Stroke prevention practices were also sub-optimal. There is a need to increase knowledge regarding risk factors, which will benefit the community at large., Competing Interests: The authors have declared that no competing interests exist.

Camel milk proteins contain dipeptidyl peptidase IV (DPP-IV) inhibitory peptides. A camel whey protein concentrate (WPC, 44.7 ± 3.4% (w/w) protein) was prepared and subsequently hydrolysed with trypsin at different temperatures, enzyme to substrate (E:S) ratios and hydrolysis times yielding fifteen hydrolysates (H1-H15). Their DPP-IV half maximal inhibitory concentrations (IC 50 ) ranged from 0.55 ± 0.05 to 1.52 ± 0.16 mg L -1 for H8 and H6, respectively. E:S was the only factor having a significant effect on the DPP-IV IC 50 value (p < 0.05). Relatively potent α-lactalbumin-derived DPP-IV inhibitory peptides (LAHKPL and ILDKEGIDY) were detected in selected hydrolysates. Additionally, three potent β-CN-derived peptides, VPV, YPI and VPF having DPP-IV IC 50 values of 6.6 ± 0.5, 35.0 ± 2.0 and 55.1 ± 5.8 µM, respectively, were identified. After IPI, VPV is the second most potent DPP-IV inhibitory peptide identified to date, which supports the role of camel milk as an antidiabetic agent., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

In-depth characterization of protein and lipid fractions from cow and camel milk (four breeds; CM-1 to 4), their functional and thermal properties and bioactivity upon simulated gastro-intestinal digestion was reported. Results revealed that proteins from cow and camel milk showed a noticeable separation on sodium dodecyl sulphate-polyacrylamide gel electrophoresis and high-performance liquid chromatography. Functional properties of whole milk proteins from cow and camel milk at different pH revealed that emulsifying activity index (EAI), foaming capacity (FC) and protein solubility was higher towards acidic and alkaline pH and lowest at isoelectric point (pH = 4). Moreover, the water absorption capacity (WAC) and solubility in water were higher in milk from cow (CW) compared to those from camel breeds (CM 1-4). Camel milk, which contains lower saturated and higher unsaturated fatty acids and demonstrated higher antioxidative and angiotensin-1 converting enzyme (ACE) inhibitory potential compared to cow milk upon simulated gastro-intestinal digestion, can be considered as a healthier option., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Novel starch-based nanoparticles from three sources: horse chestnut (HSC), water chestnut (WSC) and lotus stem (LSC) were prepared for nano-encapsulation of catechin. Average particle size of HSC, WSC and LSC based nano-particles were 322.7, 559.2 and 615.6 nm with encapsulation efficiency of 59.09, 48.30, and 55.00% and negative zeta potential of -18.05, -21.5 and -18.05 mv, respectively. Structural, physical and thermal properties were characterized by fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), X-ray diffraction (XRD) and differential scanning calorimetry (DSC). SEM revealed capsule formation with entrapped catechin, while broad characteristic peaks at 3475, 1650, 1383, 1148, 1083 and 790 cm -1 depicts encapsulation of catechin in starch nanoparticles without any evident interaction. XRD showed loss of crystallinity after encapsulation. Higher content of catechin in intestinal juice ensured controlled release in intestine. Bioactive properties were retained at higher level in encapsulated catechin compared to free catechin upon in-vitro digestion., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

This report describes an investigation of camel whey protein hydrolysates (CWPH) produced by gastric and pancreatic enzymes for their in vitro antidiabetic, anticancer, and anti-inflammatory properties. Degree of hydrolysis (DH) ranged from 8.54 to 47.53%, with hydrolysates generated using chymotrypsin for 6 h displaying the highest DH. Reverse phase-HPLC analysis showed that α-lactalbumin underwent complete degradation, with no intact α-lactalbumin detected in CWPH. The CWPH displayed enhanced antidiabetic activity compared with intact whey proteins; with pepsin- and chymotrypsin-generated CWPH displaying greater inhibition of dipeptidyl peptidase IV (DPP-IV), α-glucosidase, and α-amylase compared with trypsin-generated CWPH. The highest antiproliferative effect was observed for CWPH generated by chymotrypsin for 3 h, with only 4.5 to 6.5% viable liver cancer cells (HepG2) remaining when tested at concentrations from 400 to 1,000 µg/mL. The highest anti-inflammatory activity was manifested by CWPH generated by pepsin at 6-h hydrolysis. We report enhanced antiproliferative, antidiabetic, and anti-inflammatory activities upon hydrolysis of camel whey proteins, indicating their potential utilization as bioactive and functional ingredients., (Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Inside round muscles (Adductor) from camels treated with bromelain or ficin or papain at 50 or 100 ppm were subsequently stored at 4 °C for 4 days to study the impact on quality attributes, protein degradation and textural changes. Results revealed that papain (100 ppm) treated camel meat showed higher drip loss and lower water holding capacity compared to other treatments. Total protein, sarcoplasmic protein solubility, trichloroacetic acid (TCA)-soluble peptides and soluble collagen were higher in papain and bromelain treated samples at 100 ppm compared to other treatments. Electrophoretic profile of whole camel meat, isolated sarcoplasmic and myofibrillar proteins depicted a noticeable degradation of various proteins in enzyme treated samples, with papain and bromelain (100 ppm) displaying pronounced effect. Meat treated with papain at 100 ppm displayed lower hardness and shear force ( P  < 0.05). Thus, enzymes treatment at 100 ppm displayed good potential to tenderize camel meat with the papain being more effective among all., Competing Interests: Compliance with ethical standardsThe authors declare no conflict of interest.

In-vitro inhibitory properties of peptides released from camel milk proteins against dipeptidyl peptidase-IV (DPP-IV), porcine pancreatic α-amylase (PPA), and porcine pancreatic lipase (PPL) were studied. Results revealed that upon hydrolysis by different enzymes, camel milk proteins displayed dramatic increase in inhibition of DPP-IV and PPL, but slight improvement in PPA inhibition was noticed. Peptide sequencing revealed a total of 20 and 3 peptides for A9 and B9 hydrolysates respectively, obtained the score of 0.8 or more on peptide ranker and were categorized as potential DPP-IV inhibitory peptides. KDLWDDFKGL in A9 and MPSKPPLL in B9 were identified as most potent PPA inhibitory peptide. For PPL inhibition only 7 and 2 peptides qualified as PPL inhibitory peptides from hydrolysates A9 and B9, respectively. The present study report for the first time PPA and PPL inhibitory and only second for DPP-IV inhibitory potential of protein hydrolysates from camel milk., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Most of the hematological disorders are heterogenous with regard to morphology, immunophenotype, and genetic rearrangements. Multiple recurrent chromosomal aberrations have been identified by conventional cytogenetic analysis, which is now widely recognized as one of the most important diagnostic and prognostic determinants in these patients. Though rarer, complex karyotype has been associated with worst prognosis., Materials and Methods: A total of 1185 bone marrow or peripheral blood cytogenetics samples were taken with different hematological diseases. They included both benign and malignant disease entities. In each case, cells were cultured and conventional cytogenetic analysis was performed., Results: Among 1185 subjects, 41 (3.4%) patients possessed complex cytogenetic abnormalities. Out of these 41, 33 (80%) were males. The mean age was 37 years (median age 39 years). Myelodysplastic syndromes had the most numbers of complex karyotypes (8%), followed by acute myeloid leukemia (7%) and acute lymphoblastic leukemia (4%). Also we found few patients with acute promyelocytic leukemia, aplastic anemia , chronic myeloid leukemia, and diffuse large B cell Lymphoma possessing complex karyotype. Frequencies of different cytogenetic abnormalities were assessed with respect to disease as well as independently. Trisomy 21 was the most common chromosomal abnormality found in 28% of patients., Conclusion: Complex karyotype was most frequently associated with myelodysplastic syndromes and acute myeloid leukemia. Trisomy 21 and deletion 5q were the commonest cytogenetic abnormalities found. We also assessed complex karyotype in benign diseases and detected one patient of aplastic anemia with complex karyotype. This is the first study highlighting the presence of complex karyotypes in hematological disorders in our region.

Introduction: The rising incidence of oropharyngeal squamous cell carcinoma (OPSCC) in New Zealand is due to an increase in the numbers of human papilloma virus (HPV)-associated OPSCC. We evaluated the impact of positive p16 immunohistochemistry, as a surrogate for HPV positivity, on OPSCC outcomes after primary intensity-modulated radiotherapy (IMRT) with or without concurrent chemotherapy., Methods: Retrospective review was undertaken of electronic medical records of 90 patients with OPSCC who received primary IMRT with or without chemotherapy between 2008 and mid-2015 at the Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand., Results: Median age was 57.5 years. Immunohistochemistry for p16 was positive in 53 (59%) OPSCC while 37 (41%) had negative or unknown p16 status. Median radiotherapy dose was 70 Gy. Chemotherapy was administered to 78 (87%) patients, most receiving high-dose cisplatin. Nine patients had residual disease following treatment completion. Seven patients relapsed, and 26 died during the study period. Five patients with p16-positive OPSCC had persistent or recurrent disease. Actuarial 3-year locoregional control, disease-free survival, and overall survival for all patients were 80.7%, 74.7%, and 77.1%, respectively. Among p16-positive OPSCC patients, 3-year locoregional control, disease-free survival, and overall survival were 89.5%, 80.8%, and 90.9%, respectively., Conclusion: Outcomes after IMRT for OPSCC at Waikato Hospital are in line with the reported literature. Human papilloma virus-related OPSCC has better outcomes compared with patients with unknown or HPV-unrelated OPSCC. Trials are underway evaluating reduced intensity of treatment for HPV-related OPSCC., (© 2018 Wiley Periodicals, Inc.)

Nine novel dipeptidyl peptidase IV (DPP-IV) inhibitory peptides (FLQY, FQLGASPY, ILDKEGIDY, ILELA, LLQLEAIR, LPVP, LQALHQGQIV, MPVQA and SPVVPF) were identified in camel milk proteins hydrolysed with trypsin. This was achieved using a sequential approach combining liquid chromatography tandem mass spectrometry (LC-MS/MS), qualitative/quantitative structure activity relationship (QSAR) and confirmatory studies with synthetic peptides. The most potent camel milk protein-derived DPP-IV inhibitory peptides, LPVP and MPVQA, had DPP-IV half maximal inhibitory concentrations (IC 50 ) of 87.0 ± 3.2 and 93.3 ± 8.0 µM, respectively. DPP-IV inhibitory peptide sequences identified within camel and bovine milk protein hydrolysates generated under the same hydrolysis conditions differ. This was linked to differences in enzyme selectivity for peptide bond cleavage of camel and bovine milk proteins as well as dissimilarities in their amino acid sequences. Camel milk proteins contain novel DPP-IV inhibitory peptides which may play a role in the regulation of glycaemia in humans., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Obesity is a state of abnormal accumulation of fat in adipose tissues of the body to the level that one's health is adversely compromised. Tripathi et al. state (according to WHO) that obesity is now considered the fifth leading cause of mortality in the world. Caries is a multifactorial disease and one of the major oral health issues of the modern era affecting people around the globe. Rise in dental caries has been observed in developing countries as a result of factors including increased intake of carbohydrates. The present study aims for assessing the association of DMFT with BMI, age, and gender. This study was conducted in the dental OPD of the Dow University of Health Sciences, Karachi, from February 2016 till January 2017. A custom-made interview-based questionnaire was used to assess BMI, DMFT, and sociodemographics. The sample size was kept at 385. Age was reported as a strong predictor ( R 2 0.641) of DMFT followed by BMI and gender as the weakest predictors. Age and BMI had statistically significant association with DMFT scores, which shows that diet patterns may affect general health. High caloric intake over long periods affects BMI and also oral health.

Background: The definition of acute kidney injury (AKI) has evolved over the years, and three definitions have been adapted including pediatric risk injury failure, loss of kidney function (pRIFLE), Acute Kidney Injury Network (AKIN), and Neonatal Modified Kidney Disease Improving Global Outcomes (KDIGO). We sought to report the prevalence and outcome of (AKI) according to the three existing definitions in extremely low birth weight (ELBW) infants., Methods: In a retrospective cohort study, medical records of all ELBW infants (<1000 g) admitted to our neonatal intensive care unit (NICU) between Jan 2002 and Dec 2011 were reviewed. Infants' demographics, anthropometric measurements, and clinical characteristics were collected at the time of birth and at discharge from the NICU. Infants were staged according to the three different definitions., Results: During the study period, 483 ELBW infants met our inclusion criteria. The incidence of AKI was 56, 59, and 60% according to pRIFLE, AKIN, and KDIGO, respectively. Mortality, NICU length of stay, and serum creatinine (SCr) at NICU discharge were higher in infants with advanced AKI stages regardless of the definition. In addition, discharge NICU weight and length z scores were lower in infants with advanced AKI stages. SCr at 72 h of life and SCr peak were predictable of NICU mortality [AUC 0.667 (95% CI 0.604-0.731), p < 0.001 and AUC 0.747 (95% CI 0.693-0.801), p < 0.001, respectively]., Conclusion: Regardless of the definition, advanced AKI is associated with increased mortality, prolonged NICU length of stay, and poor growth in ELBW infants. SCr at 72 h of life and SCr peak may be predictable of NICU mortality.

Camel milk protein hydrolysates (CMPH) were generated using proteolytic enzymes, such as alcalase, bromelain, and papain, to explore the effect on the technofunctional properties and antioxidant potential under in vitro and in real food model systems. Characterization of the CMPH via degree of hydrolysis, sodium dodecyl sulfate-PAGE, and HPLC revealed that different proteins in camel milk underwent degradation at different degrees after enzymatic hydrolysis using 3 different enzymes for 2, 4, and 6 h, with papain displaying the highest degradation. Technofunctional properties, such as emulsifying activity index, surface hydrophobicity, and protein solubility, were higher in CMPH than unhydrolyzed camel milk proteins. However, the water and fat absorption capacity were lower in CMPH compared with unhydrolyzed camel milk proteins. Antioxidant properties as assessed by 2,2-azinobis(3-ethylbenzthiazoline-6-sulfonic acid) and 2,2-diphenyl-1-picrylhydrazyl radical scavenging activities and metal-chelating activity were enhanced after hydrolysis, in contrast to ferric-reducing antioxidant power which showed a decrease after hydrolysis. The CMPH were also tested in real food model systems for their potential to inhibit lipid peroxidation in fish mince and grape seed oil-in-water emulsion, and we found that papain-produced hydrolysate displayed higher inhibition than alcalase- and bromelain-produced hydrolysates. Therefore, the CMPH demonstrated effective antioxidant potential in vitro as well as in real food systems and showed enhanced functional properties, which guarantees their potential applications in functional foods. The present study is one of few reports available on CMPH being explored in vitro as well as in real food model systems., (Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Background: There is a considerably high prevalence of depression in post myocardial infarction (MI) patients. This study was designed with an aim to detect depression in patients with acute MI admitted to the CCU at Ayub Teaching Hospital Abbottabad.., Methods: This descriptive crosssectional study enrolled 246 male and female patients with acute MI. The patients were interviewed on the 3rd day of admission and their answers were marked according to the HADS-D scale., Results: With a cut-off score of 11, the frequency of depression in study participants was 27.24% (n=67). No statistically significant association was found between the age and sex of patients and depression., Conclusions: Depression is fairly common following acute MI and the management plans should include a consultation with psychiatric for individualized management of depression in post myocardial infarction patients..

Background and Purpose: Patients with hematological malignancies admitted to an intensive care unit (ICU) generally have a high mortality rate. The aim of our study was to assess the characteristics and outcomes of such patients and to identify factors predicting ICU mortality. Material and Methods: This retrospective chart review was conducted in the intensive care unit (ICU) of Shaukat Khanum Memorial Cancer Hospital and Research Centre over a period of 5 years, from January 2010 to January 2015. Results: Characteristics :A total of 213 patients were included in this study. There were 150 (70.4%) males and 63 (29.6%) females with the median age of 36 years (18-88 years). Main diagnosis was non- Hodgkin lymphoma in 127 (59.6%) followed by Hodgkin’s disease in 27 (12.7%) and acute myeloid leukemia in 16 (7.5%). Most of the patients 154 (72.3%) were on active chemotherapy at the time of admission to ICU, while 28 patients (13.1%) had newly diagnosed disease and 22 (10.3%) featured either relapsed or progressive disease. The most common reason for admission to ICU was a combination of respiratory failure with septic shock (29.6%) followed by septic shock alone (19.7%) and acute respiratory failure (13.1%). Other causes included acute renal failure, alone (7.5%) or in combination with respiratory or circulatory collapse (10.8%) and central nervous system involvement (5.6%). The majority of admissions to ICU occurred between days one and five of admission to a ward (46.5%, n=99) whereas 49 (23%) were taken directly to the ICU. Mainstay of treatment in 38.5% of patients included both invasive ventilation and vasopressor support along with other supportive care like fluids and antibiotics. 23.5% received only supportive management. Duration of stay for 150 (70.4%) patients was between one to seven days. Outcomes: A total of 119 (55.9 %) patients expired while in ICU, while 14 (6.6%) died in hospital after being transferred out of ICU. ICU survival was 44.1% whereas hospital survival was 37.5%. After discharge from hospital in a stable condition, 18 (8.5%) patients were lost to follow up and 62 (29%) patients were alive after thirty days. A total of 33 (15.4 %) of patients survived for at least one year after ICU admission. Some 21 (9.8%) are still alive and healthy after a minimum median follow up of one and a half years. Predictors of Mortality: Overall, mechanical ventilation was required in 61% of patients. Out of the patients who expired, 92.4% required intubation, in contrast to 21.3% for those who survived the ICU stay. Involvement of three or more organs was apparent in 12.8% of improved patients and 70.6% of those who died during ICU stay. Neutropenia did not appear to be a major discriminatory factor, with 33% of improved and 42.9% of expired patients being neutropenic at the time of admission to ICU. The majority of patients from both the improved and expired group required intubation and vasopressors from day one onwards. Conclusions: Admission of patients with hematological malignancies to the intensive care unit is associated with poor outcome and high mortality. Identifying the patients who can benefit from aggressive care and prolonged ICU support is important especially when it comes to countries like ours with limited resources and major financial restraints. Multi-organ damage and requirement of invasive ventilation are two main predictors of increased mortality. Neutropenia is also associated with adverse outcome; however, the difference is not as significant as for the other two factors., (Creative Commons Attribution License)

Objectives: This study aimed to evaluate the cognitive levels of Multiple Choice Questions (MCQs) & Short Answer Questions (SAQs) and types of Item Writing Flaws (IWFs) in MCQs in Medical Pharmacology internal assessment exams., Methods: This descriptive, study was conducted over a period of six months, from December 2015 to May 2016 and evaluated six internal assessment examinations comprising SAQs and MCQs. A total of 150 MCQs and 43 SAQs were analyzed. These questions were administered to third-year medical students in the year of 2015. All SAQs were reviewed for their cognitive levels and MCQs were reviewed for cognitive levels as well as for IWFs. Items were classified as flawed if they contained one or more than one flaw. The cognitive level of the questions was determined by the modified Bloom's taxonomy., Results: The proportion of flawed items out of 150 items in six exams ranged from 16% to 52%. While the percentage of total flawed items was 28%. Most common types of flaws were implausible distractors 19.69% (26), extra detail in correct option 18.18% (24), vague terms 9.85% (13), unfocused stem 9.09% (12) and absolute terms 9.09% (12). The two-third of MCQs 97(64.67%) were assessing the recall of information, while 29 (19.33%) and 24 (16%) were assessing the interpretation of data and problem-solving skills respectively. The majority of the SAQs (90.7%) were assessing recall of the information and only 9.3% were assessing interpretation of data while none of the questions was assessing the problem-solving skills., Conclusions: The cognitive level of assessment tools (SAQs & MCQs) is low, and IWFS are common in the MCQs. Therefore, faculty should be urged and groomed to design problem-solving questions which are devoid of any flaws., Competing Interests: Declaration of Interest: The Authors have no conflict of interest.

Objective: To study the outcome of extremely low birth weight (ELBW) infants with a history of acute kidney injury (AKI)., Method: In a retrospective, case control study, medical records of all ELBW infants admitted to the neonatal intensive care unit (NICU) between Jan 2002 and Dec 2011 were reviewed. Medical records were reviewed for infants' demographics, blood pressure (BP) at NICU discharge and at ≥3 years, and estimated glomerular filtration rate (eGFR) at ≥2 years., Results: During the study period, 222 patients met the inclusion criteria, of whom 10% (23 out of 222) had AKI stage 2 and 3, 39% (87 out of 222) had AKI stage 1, and the rest did not have AKI. At NICU discharge, there was a difference in diastolic BP (DBP) among infants who had AKI stages 2 and 3, those who had stage 1, and those who did not have AKI (53 ± 12 vs 46 ± 9 vs 46 ± 11 mmHg respectively; p = 0.007), and 11% (23 out of 209) had hypertension (HTN). Although there was a significant correlation between the rise in SCr and DBP at NICU discharge in infants with AKI (R = 0.304; p = 0.004), there was no difference in HTN between infants with and those without AKI. At ≥2 years of age, 4% (5 out of 120) across all groups had an eGFR < 90 ml/min/1.73m 2 or chronic kidney disease (CKD). At ≥3 years of age, 5% (11 out of 222) had HTN., Conclusion: At NICU discharge, infants with AKI stages 2 and 3 have a higher DBP than infants with stage 1 AKI and those who did not have AKI. However, there is no difference in the rate of HTN between the two groups. At ≥2 years ELBW infants are at risk for CKD independently of whether or not they develop neonatal AKI.

Characteristics and gel properties of spray-dried goat skin gelatin (SDGG) and freeze-dried counterpart (FDGG) were determined, in comparison with commercial bovine gelatin (BG). SDGG gel had the similar gel strength to FDGG gel and their gel strengths were higher than that of BG gel. SDGG gel showed slightly higher a* and b* values as well as the higher solution turbidity than those of FDGG. Both SDGG and FDGG solutions could set at room temperature (25-28 °C) within 18.52-19.30 min and showed the gelling and melting temperatures of 25.14-25.23 and 34.09-34.18 °C, respectively. Gels from SDGG and FDGG had the denser structure with smaller voids than that from BG. Therefore, drying methods affected the characteristics and gel properties of gelatin from goat skin to some degree.

Background: Pakistan, being a developing country, presents the dismal picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal deaths could be avoided if Continuum of Care (CoC) is provided in a structured pathway from pregnancy to birth and to the first week of life of the newborn child. This study aimed to analyse the trends of CoC at all three levels (antenatal care, skilled delivery and postpartum care) and to identify various factors affecting the continuation in receiving CoC in Pakistan during 2006 to 2012., Methods: Secondary data analysis was performed on nationally representative data from the last two iterations of Pakistan Demographic and Health Survey (PDHS), conducted during 2006/07 to 2012/13. The analysis is limited to women of the reproductive age group (15-49 years) who gave birth during the last five years preceding both surveys. This leads to a sample size of 5,724 and 7,461 respondents from PDHS 2006/07 and 2012/13 respectively. The association between CoC and several factors, including individual attributes (reproductive status), family influences, community context, as well as cultural and social values was assessed in bivariate analyses in a first step. Furthermore, odds ratios and adjusted odds ratios with 95% confidence intervals using a binary and multivariable logistic regression were calculated., Results: Our research presents the trends of a composite measure of CoC including antenatal care, delivery assistance and postpartum care. The largest gap in CoC was observed at antenatal care followed by delivery and postnatal care within 48 h after delivery. Results show that CoC completion rate has increased from 15% to 27% amongst women in Pakistan over time from 2006 to 2012. Women with high age at first birth, having less number of children, with higher education, belonging to richest quintile, living in Sindh province and urban areas, having high autonomy and exposure to mass media were most likely to avail complete CoC., Conclusions: The findings show that women in Pakistan still lack the CoC. This calls for attention to develop and implement tailored interventions, focusing on the needs of women in Pakistan to provide CoC in an integrated manner, involving both public and private sectors by appropriately addressing the factors hindering CoC completion rates.

Background: Tephrosia apollinea is a leguminous plant and is native to southwest Asia, Arabia, northwestern India and northeast Africa. In traditional system, it is used for medicinal and coloring purpose. The present study aims to explore the phytochemical, proximate analysis, element contents and antioxidant potential of T. apollinea extract., Methods: The phytochemical screening was done with qualitative methods. Proximate analysis and elemental composition were performed from powdered sample. In vitro antioxidant assays such as 1,1-diphenyl-2-picrylhydrazyl (DPPH) radicals and reducing power-scavenging assays were used for evaluating the antioxidant properties., Results: Qualitative screening of methanolic extract of T. apollinea showed the presence of alkaloids, phenolics, flavonoids, terpenoids, glycosides and saponins. The methanolic extract of T. apollinea exhibited a significant dose dependent inhibition of DPPH activity, with a 50% inhibition (IC 50 ) at a concentration found to be 29.41 µg/ml, which was compared with standard GAE (IC 50  = 31.09 μg/ml). The reducing power shows good linear relationship in both standard gallic acid (R 2  = 0.956) and T. apollinea extract (0.984)., Conclusions: The results of our study clearly suggested that the methanolic extract of T. apollinea may serve as potential source of natural antioxidant for nutraceutical application.

Impact of tannic acid (TA), date seed extract (DSE), catechin (CT) and green tea extract (GTE) on lipid oxidation, microbial load and textural properties of camel meat sausages during 12 days of refrigerated storage was investigated. TA and CT showed higher activities in all antioxidative assays compared to DSE and GTE. Lipid oxidation and microbial growth was higher for control sausages when compared to other samples. TA and CT at a level of 200 mg/kg were more effective in retarding lipid oxidation and lowering microbial count (P < 0.05). Sausages treated with TA and DSE were found to have higher hardness, gumminess and chewiness values compared to other treatments (P < 0.05). Addition of different phenolic compounds or extract did not influence the sensory color of sausages. Furthermore, sensory quality was also found to be superior in TA and CT treated sausages. Therefore, pure phenolic compounds (TA and CT) proved to be more effective in retaining microbial and sensorial qualities of camel meat sausages compared to phenolic extracts (GTE and DSE) over 12 days of storage at 4°C., (© 2016 Japanese Society of Animal Science.)

Characteristics and properties of gelatin from goat skin pretreated with NaOH solutions (0.50 and 0.75 M) for various times (1 to 4 days) were investigated. All gelatins contained α-chains as the predominant component, followed by β-chain. Gelling and melting temperatures of those gelatins were 23.02°C to 24.16°C and 33.07°C to 34.51°C, respectively. Gel strength of gelatins increased as NaOH concentration and pretreatment time increased (p<0.05). Pretreatment for a longer time yielded gelatin with a decrease in L*-value but an increase in b*-value. Pretreatment of goat skin using 0.75 M NaOH for 2 days rendered the highest yield (15.95%, wet weight basis) as well as high gel strength (222.42 g), which was higher than bovine gelatin (199.15 g). Gelatin obtained had the imino acid content of 226 residues/1,000 residues and the gelatin gel had a fine and ordered structure. Therefore, goat skin gelatin could be used as a potential replacer of commercial gelatin.

Background: Goat skin can be used as an alternative raw material for gelatin production, in which pretreatment conditions can determine the characteristics or properties of the resulting gelatin. The present study aimed to investigate the effect of pretreatment using sodium sulfate (Na2SO4) and hydrogen peroxide (H2O2) on properties of goat skin gelatin., Results: Pretreatment of skin using Na2SO4 (0-1 mol L(-1)) increased the yield of gelatin in a concentration-dependent manner. When skins with prior Na2SO4 treatment were bleached using H2O2 (0-2 mol L(-1)), the resulting gelatin showed higher yield and gel strength than those without prior Na2SO4 treatment. All gelatins had α-chain as a major component, followed by β-chain. The degradation induced by H2O2 was lower in gelatin with prior Na2SO4 treatment. L* values increased with increasing H2O2 concentrations (P < 0.05) due to the bleaching effect of H2O2. With Na2SO4 and H2O2 pretreatments, gelatin gel had a finer and more ordered microstructure. Gelatin had an imino acid content of 217 residues/1000 residues with gelling and melting temperature of 22.49 and 32.28 °C, respectively., Conclusion: The optimal pretreatment conditions for gelatin extraction from goat skin included soaking the skin in 0.75 mol L(-1) NaOH, followed by treatment using 0.75 mol L(-1) Na2SO4 and subsequent bleaching with 2 mol L(-1) H2O2. This resulted in gelatin with superior quality to the untreated counterpart., (© 2015 Society of Chemical Industry.)

Cyclin dependent kinase (Cdk)9 acts through the positive transcription elongation factor-b (P-TEFb) complex to activate and expand transcription through RNA polymerase II. It has also been shown to regulate cardiomyocyte hypertrophy, with recent evidence linking it to cardiomyocyte proliferation. We hypothesised that modification of CDK9 activity could both impair and enhance the cardiac response to injury by modifying cardiomyocyte proliferation. Cdk9 expression and activity were inhibited in the zebrafish (Danio rerio) embryo. We show that dephosphorylation of residue Ser2 on the C-terminal domain of RNA polymerase II is associated with impaired cardiac structure and function, and cardiomyocyte proliferation and also results in impaired functional recovery following cardiac laser injury. In contrast, de-repression of Cdk9 activity, through knockdown of La-related protein (Larp7) increases phosphorylation of Ser2 in RNA polymerase II and increases cardiomyocyte proliferation. Larp7 knockdown rescued the structural and functional phenotype associated with knockdown of Cdk9. The balance of Cdk9 and Larp7 plays a key role in cardiomyocyte proliferation and response to injury. Larp7 represents a potentially novel therapeutic target to promote cardiomyocyte proliferation and recovery from injury., (© 2015. Published by The Company of Biologists Ltd.)

Milk proteins were hydrolyzed by papain and their effect on the rheological, textural and sensory properties of bread were investigated. Water absorption capacity, emulsification capacity, foam volume, foam stability and solubility of Whey and casein protein concentrates and their hydrolysates were determined. The farinograph parameters of wheat flour and blends of wheat flour with casein and whey protein and their hydrolysates were determined to evaluate changes in water absorption capacity, dough development time, dough stability time and mixing tolerance index. The incorporation of WPC, casein and their hydrolysates up to the level of 5 % showed dough properties comparable to control. It was also found that 5 % level incorporation of milk proteins and their hydrolysates have no drastic effect on physical and sensory attributes of bread. The pasting properties showed significant decrease (p ≤ 0.05) when compared with wheat flour at all levels of addition of whey and casein protein concentrates and hydrolysates. Scanning electron microscopy of bread samples shows disruption in the well-defined protein - starch complex of wheat flour bread and the structure of gluten was weak as the concentration of whey protein increases in the wheat flour bread.

Buckwheat flour was incorporated into wheat flour at different levels (0, 20, 40, 60, 80, and 100 %) and the physicochemical, functional and antioxidant properties of the blended flour were studied. This study also investigated the effect of buckwheat on the retention of antioxidant properties of cookies during baking. The results showed significant variation in physicochemical and functional properties of the blended flour. The addition of buckwheat flour into wheat flour also increased the antioxidant properties of blended flour proportionally, but metal chelating properties decreased. The incorporation of buckwheat in wheat flour helped in better retention of antioxidant potential of cookies during baking process as buckwheat cookies (100 % buckwheat) showed greater percentage increase in antioxidant properties than control (100 % wheat). Quality characteristics of cookies such as hardness and spread ratio decreased, while as non-enzymatic browning (NEB) increased significantly with increase in the proportion of buckwheat flour in wheat flour. The Overall acceptability of cookies by sensory analysis was highest at 40 % level of blending. This study concluded that addition of buckwheat in wheat flour, may not only improve the physico-chemical and functional properties of the blended flour but may also enhance the nutraceutical potential of the product prepared from it.

Intense noise exposure causes hearing loss by inducing degeneration of spiral ganglia neurites that innervate cochlear hair cells. Nicotinamide adenine dinucleotide (NAD(+)) exhibits axon-protective effects in cultured neurons; however, its ability to block degeneration in vivo has been difficult to establish due to its poor cell permeability and serum instability. Here, we describe a strategy to increase cochlear NAD(+) levels in mice by administering nicotinamide riboside (NR), a recently described NAD(+) precursor. We find that administration of NR, even after noise exposure, prevents noise-induced hearing loss (NIHL) and spiral ganglia neurite degeneration. These effects are mediated by the NAD(+)-dependent mitochondrial sirtuin, SIRT3, since SIRT3-overexpressing mice are resistant to NIHL and SIRT3 deletion abrogates the protective effects of NR and expression of NAD(+) biosynthetic enzymes. These findings reveal that administration of NR activates a NAD(+)-SIRT3 pathway that reduces neurite degeneration caused by noise exposure., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Button batteries are commonly used in many household electronic items and are a potential health hazard, especially in children. We present the case of a 2-year-old girl presented with swelling and redness of her right eye of 3 hours' duration. Examination revealed a button battery that had became lodged in the superior fornix of her right eye. After the intact battery was removed, the patient was found to have suffered an alkali burn to the underlying conjunctiva and sclera. The burn healed with symblepharon formation., (Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Mammalian models of cardiac disease have provided unique and important insights into human disease but have become increasingly challenging to produce. The zebrafish could provide inexpensive high-throughput models of cardiac injury and repair. We used a highly targeted laser, synchronized to fire at specific phases of the cardiac cycle, to induce regional injury to the ventricle, atrioventricular (AV) cushion, and bulbus arteriosus (BA). We assessed the impact of laser injury on hearts of zebrafish early larvae at 72 h postfertilization, to different regions, recording the effects on ejection fraction (EF), heart rate (HR), and blood flow at 2 and 24 h postinjury (hpi). Laser injury to the apex, midzone, and outflow regions of the ventricle resulted in reductions of the ventricle EF at 2 hpi with full recovery of function by 24 hpi. Laser injury to the ventricle, close to the AV cushion, was more likely to cause bradycardia and atrial-ventricular dysfunction, suggestive of an electrical conduction block. At 2 hpi, direct injury to the AV cushion resulted in marked regurgitation of blood from the ventricle to the atrium. Laser injury to the BA caused temporary outflow tract obstruction with cessation of ventricle contraction and circulation. Despite such damage, 80% of embryos showed complete recovery of the HR and function within 24 h of laser injury. Precision laser injury to key structures in the zebrafish developing heart provides a range of potentially useful models of hemodynamic overload, injury, and repair.

Extracts of brown lead (Leucaena leucocephala) seed prepared using different extraction solvents were determined for antioxidative activities using different assays. The highest yield (3.4-4.0%) was obtained when water was used as an extraction solvent, compared with all ethanolic extracts used (1.2-2.0 %) (P < 0.05). Much lower chlorophyll content was found in the water extract. When hot water was used, the resulting extract contained lower total phenolic and mimosine contents (P < 0.05). In general, 60-80 % ethanolic extracts had higher 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical scavenging activities, ferric reducing antioxidant power (FRAP) and metal chelating activity than water extracts (P < 0.05). When brown lead seed was dechlorophyllised prior to extraction, the water extract had slightly increased yield with lower chlorophyll content. Nevertheless, prior chlorophyll removal resulted in the increase in antioxidative activities but lower total phenolic and mimosine contents (P < 0.05). Generally, phenolic compounds and mimosine were more released when water was used as the extraction solvent, while the lower amount of chlorophyll was extracted. Oven-drying exhibited the negative effect on antioxidative activities and mimosine content. The higher antioxidative activities with concomitant higher total phenolic and mimosine contents were found in water extract dried by freeze drying. Thus, extraction solvent, dechlorophyllisation and drying methods directly influenced the yield and antioxidative activity of lead seed extract.

Background: Suicide behaviour in psychosis is a significant clinical and social problem. There is a dearth of evidence for psychological interventions designed to reduce suicide risk in this population., Aims: To evaluate a novel, manualised, cognitive behavioural treatment protocol (CBSPp) based upon an empirically validated theoretical model., Methods: A randomly controlled trial with independent and masked allocated and assessment of CBSPp with TAU (n=25, 24 sessions) compared to TAU alone (n=24) using standardised assessments. Measures of suicide probability, and suicidal ideation were the primary outcomes and measures of hopelessness, depression, psychotic symptoms, functioning, and self-esteem were the secondary outcomes, assessed at 4 and 6 months follow-up., Results: The CBSPp group improved differentially to the TAU group on two out of three primary outcome measures of suicidal ideation and suicide probability, and on secondary outcomes of hopelessness related to suicide probability, depression, some psychotic symptoms and self-esteem., Conclusions: CBSPp is a feasible intervention which has the potential to reduce proxy measures of suicide in psychotic patients., (Copyright © 2014 Elsevier B.V. All rights reserved.)

The zebrafish is increasingly used for cardiovascular genetic and functional studies. We present a novel protocol to maintain and monitor whole isolated beating adult zebrafish hearts in culture for long-term experiments. Excised whole adult zebrafish hearts were transferred directly into culture dishes containing optimized L-15 Leibovitz growth medium and maintained for 5 days. Hearts were assessed daily using video-edge analysis of ventricle function using low power microscopy images. High-throughput histology techniques were used to assess changes in myocardial architecture and cell viability. Mean spontaneous Heart rate (HR, min(-1)) declined significantly between day 0 and day 1 in culture (96.7 ± 19.5 to 45.2 ± 8.2 min-1, mean ± SD, p = 0.001), and thereafter declined more slowly to 27.6 ± 7.2 min(-1) on day 5. Ventricle wall motion amplitude (WMA) did not change until day 4 in culture (day 0, 46.7 ± 13.0 µm vs day 4, 16.9 ± 1.9 µm, p = 0.08). Contraction velocity (CV) declined between day 0 and day 3 (35.6 ± 14.8 vs 15.2 ± 5.3 µms(-1), respectively, p = 0.012) while relaxation velocity (RV) declined quite rapidly (day 0, 72.5 ± 11.9 vs day 1, 29.5 ± 5.8 µms(-1), p = 0.03). HR and WMA responded consistently to isoproterenol from day 0 to day 5 in culture while CV and RV showed less consistent responses to beta-agonist. Cellular architecture and cross-striation pattern of cardiomyocytes remained unchanged up to day 3 in culture and thereafter showed significant deterioration with loss of striation pattern, pyknotic nuclei and cell swelling. Apoptotic markers within the myocardium became increasingly frequent by day 3 in culture. Whole adult zebrafish hearts can be maintained in culture-medium for up to 3 days. However, after day-3 there is significant deterioration in ventricle function and heart rate accompanied by significant histological changes consistent with cell death and loss of cardiomyocyte cell integrity. Further studies are needed to assess whether this preparation can be optimised for longer term survival.

Objectives: To evaluate the diagnostic accuracy of C1q autoantibodies in identifying lupus nephritis (LN) in patients with systemic lupus erythematosus (SLE)., Data Sources and Methods: Citation indexes were searched and 370 articles published from 1977 to 2013 were evaluated. The 31 selected studies included in the meta-analysis were cross-sectional in design. Among the 31 studies, 28 compared anti-C1q antibodies in 2769 SLE patients with (n=1442) and without a history of LN (n=1327). Nine studies examined anti-C1q in 517 SLE patients with active (n=249) and inactive LN (n=268). Hierarchical summary receiver operating characteristic (HSROC) random effects models were fitted to pool estimates of accuracy across the studies., Results: Anti-C1q antibodies discriminated between patients with and without a history of LN, with a median specificity of 73.5%. The HSROC model estimated the corresponding sensitivity to be 70.4%. A hypothetical patient with a 55% prior probability of having a history of LN as opposed to no history (the median prevalence across 28 eligible studies) would have a post-test probability of 76.4% following a positive test result (positive predictive value) or 33.0% following a negative test result (negative predictive value). For discriminating active from inactive LN the median specificity of anti-C1q antibodies was 80%, with a corresponding estimated sensitivity value 75.7% based on the HSROC model. A hypothetical patient with a 56% prior probability of active as opposed to inactive LN (the median prevalence across the 9 eligible studies) would have a post-test probability of 82.8% following a positive test result or 27.9% following a negative test result., Conclusions: Although C1q antibodies are associated with lupus nephritis the post-test probabilities are not sufficiently convincing to provide reasonable certainty of the presence or absence of history of disease/active disease.

L. acidophilus is a homofermentative, microaerophilic, short chain gram positive microorganism with rod morphology having its bacteriocins belonging to class II a. Several bacteriocins of L. acidophilus have been isolated and characterized. These are structurally similar, but their molecular weight varies as well as their spectrum of antimicrobial activity. They exhibit important technical properties, i.e., thermostability and retaining of activity at a wide pH range along with strong inhibitory actions against food spoilage and pathogenic bacteria make them an important class of biopreservatives. L. acidophilus can be added as an adjunct in many food fermentation processes contributing to unique taste, flavor, and texture. It also preserves the products by producing lactic acid and bacteriocins. A lot of new information regarding the bacteriocins of L. acidophilus has emerged during the last few years. In this review, an attempt has been made to summarize and discuss all the available information regarding the sources of bacteriocins production, their characteristics, and their antimicrobial action along with their application.

Systemic lupus erythematous (SLE) is a relatively rare disorder with prevalence rates between 5 and 50 per 100,000 population. This means performing any epidemiological analysis in a specific research center is difficult, due to the low number of cases within any one location. There is a need for biomarkers and diagnostic aids to monitor SLE disease activity and severity prior, during, and after treatment. Many specialist lupus clinics worldwide have published trials following in detail small numbers of patients that have been monitored for a disease biomarker, e.g., an autoantibody against a self-molecule in prospective and retrospective studies. They have then attempted to correlate autoantibody levels against an autoantigen with disease activity, e.g., nephritis development. The results are often inconclusive with the conclusion "the autoantibody may be useful in monitoring disease activity." Meta-analysis is a statistical technique that can be used for combining the findings of multiple studies to add power to any tentative conclusion proposed by individual studies. Here, we describe a method for analyzing biomarkers of interest as predictors of disease activity, using anti-C1q autoantibodies as an example.

Antioxidant activity of brown lead (Leucaena leucocephala) seed extracts with and without prior chlorophyll removal was studied in comparison with mimosine. Both extracts showed similar hydroxyl radical (HO(•)) scavenging activity, hydrogen peroxide (H2O2) scavenging activity, singlet oxygen inhibition and hypochlorous acid (HOCl) scavenging capacity (p > 0.05). Nevertheless, the extract without prior chlorophyll removal had higher oxygen radical absorbance capacity than that with prior chlorophyll removal (p < 0.05). Generally, lead seed extracts with and without prior chlorophyll removal possessed a lower antioxidant activity, compared with mimosine. When lead seed extract without prior chlorophyll removal (100 and 200 ppm) was used in different lipid oxidation model systems, including β-carotene-linoleic acid and lecithin liposome systems, the preventive effect toward lipid oxidation was dose-dependent. At the same level of use, mimosine exhibited a higher efficacy in prevention of lipid oxidation in both systems as indicated by the lower increases in thiobarbituric acid reactive substances. A similar result was obtained in minced mackerel. Therefore, lead seed extract containing mimosine could act as a natural antioxidant to prevent lipid oxidation in foods.

Context: Annular pancreas is one of the rare congenital anomalies that can manifest itself in adulthood also. No specific guidelines and protocols exist about management of such cases. We hereby discuss our experience with two such cases along with a brief review of literature about the subject., Case Reports: The first patient was a male aged 27 years and presented with features of duodenal obstruction. He underwent duodenoduodenostomy . The second patient, a male aged 32 years, also presented with features of gastric outlet obstruction. He underwent Billroth type 2 reconstruction. Both patients had an uneventful recovery., Conclusion: Annular pancreas in adults is a rare clinical scenario. Advancements in imaging modalities have brought to forefront an even larger number of such cases. In adults it is diagnosed mainly because of the complications that arise thereof. Gastroduodenal tuberculosis can be an important differential diagnosis in endemic areas. Treatment and operative protocols have to be individualized.

This paper examines the prevalence and correlates of depressive symptoms among older persons of Punjab, the largest Province of Pakistan. Data were gathered from 4191 older persons aged 60+ using Probability Proportional to Size (PPS) of population. A version of the CES-D Scale adapted for low-literate populations was used to measure self reported depressive symptoms. Various independent factors, including socioeconomic factors, self-reported health conditions, and functional impairments were examined to see their net effect on depressive symptoms among older persons. Results of logistic regression analysis showed that region, area, living index, independent source of income, self-reported health conditions, and functional impairment were significant factors affecting self-reported depressive symptoms among older persons in Punjab. An important cross-cultural difference was a lower risk of depressive symptoms among older women, which may reflect the buffering effects of family co-residence and the position of seniors in extended families.

Chemical and microbiological deteriorations are principal causes of quality loss of fish and fish products during handling, processing, and storage. Development of rancid odor and unpleasant flavor, changes of color and texture as well as lowering nutritional value in fish can be prevented by appropriate use of additives. Due to the potential health hazards of synthetic additives, natural products, especially antioxidants and antimicrobial agents, have been intensively examined as safe alternatives to synthetic compounds. Polyphenols (PP) are the natural antioxidants prevalent in fruits, vegetables, beverages (tea, wine, juices), plants, seaweeds, and some herbs and show antioxidative and antimicrobial activities in different fish and fish products. The use of phenolic compounds also appears to be a good alternative for sulphiting agent for retarding melanosis in crustaceans. Phenolic compounds have also been successfully employed as the processing aid for texture modification of fish mince and surimi. Thus, plant polyphenolic compounds can serve as potential additives for preventing quality deterioration or to retain the quality of fish and fish products.

Over 3,900 water samples from 688 cooling towers were tested for Legionella in 2008 in New Zealand. Of 80 (2.05% isolation rate) Legionella isolates, 10 (12.5%) were L. pneumophila serogroup 1; 10 (12.5%) were L. anisa; nine (11.2%) were L. pneumophila serogroup 8; and one (1.2%) was L. longbeachae serogroup 2. Forty-one (51.2%) Legionella isolates were L. pneumophila serogroups. Over 3,990 water samples from 606 cooling towers were tested for Legionella in 2009 in New Zealand. Of 51 (1.28% isolation rate) Legionella isolates, 18 (35.3%) were L. pneumophila serogroup 1, and 39 (76.4%) were other L. pneumophila serogroups. L. pneumophila serogroups were significantly associated with legionellosis cases in 2008 and 2009. L. longbeachae serogroups were equally significantly associated with legionellosis cases. This significant association of L. longbeachae with legionellosis particularly of L. longbeachae serogroup 1 is unique in that part of the world. The authors' study also showed that the aqueous environment of the cooling tower is not a natural habitat for pathogenic L. longbeachae. Regular monitoring and maintenance of cooling towers have prevented outbreaks of legionellosis.

Impact of different pretreatments on chemical compositions of Indian mackerel mince was studied. Mince prepared using washing/membrane removal/alkaline solubilisation process (W-MR-Al) contained the lowest remaining myoglobin and haem iron content and also showed the lowest total lipid and phospholipid contents. When mince and W-MR-Al were hydrolysed using Alcalase for up to 120 min, a higher degree of hydrolysis (DH) was found in W-MR-Al after 30 min of hydrolysis. Furthermore, hydrolysate from W-MR-Al had lower peroxide value (PV), thiobarbituric acid reactive substances (TBARS) and non-haem iron content throughout hydrolysis period (P<0.05). When hydrolysate powder produced from mince and W-MR-Al (0-0.3%w/v) were fortified in milk, the former resulted in the lower likeness score (P<0.05) at all levels used. The addition of the latter, for up to 0.2%, had no effect on likeness of all attributes, compared with milk without fortification (P>0.05). Therefore, the appropriate pretreatment of mince yielded hydrolysate with lower fishy odour., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Fish oil is known to be an important source of highly unsaturated n-3 polyunsaturated fatty acids (PUFA) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which play an important role in the prevention of different human diseases. Fortification of foods with such fatty acids is, thus, increasingly recommended. A growing public awareness about the benefits and the limited dietary sources of PUFA has created a substantial interest in the production of PUFA concentrate. Thus, ecofriendly extraction and purification techniques, exhibiting higher yield and minimum degradation of the nutrient, are of prime focus among the researchers. Due to the presence of these highly unsaturated PUFA, fish oil is highly prone to oxidation, leading to the production of off-odors and off-flavors. Presently, synthetic antioxidants have been replaced by natural ones for stabilizing the fish oil against oxidation. This article reviews major research and patents that have been published on fish oil extraction, purification and its stability.

Objective: To find the prevalence of malignant pathology in women with postmenopausal bleeding (PMB)., Methods: An observational cross section study was conducted in the Department of Obstetrics and Gynaecology at Peoples Medical College and Hospital Nawabshah from 1st January 2006 to 31st December 2006. All patients with a typical history of post-menopausal bleeding were evaluated under anaesthesia and diagnostic dilatation and curettage was done for histopathological assessment of endometrial lining. Cervical biopsy was taken in selected patients., Results: Total 50 patients were included. Benign lesion was found in 24 (48%) cases, followed by malignant pathology in 15 (30%), premalignant lesion was responsible for PMB in 7 (14%) cases, while pathology remained undetermined in 4 (8%) patients., Conclusion: Malignancy has an important role in the etiology of PMB which needs a careful evaluation. This study showed a high prevalence of malignant disorders (30%) with carcinoma of cervix and endometrium having an equal contribution. Multiparity was the most significant factor for carcinoma of endometrium.

Background: Hepatic encephalopathy is an extra hepatic complication of impaired liver function and is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liver disease in the absence of other neurological disorders. There are numerous factors of hepatic encephalopathy. The main objective of this study was to analyse the precipitating factors of hepatic encephalopathy in cases seen in Pakistan Institute of Medical Sciences Islamabad., Methods: Fifty admitted patients with acute or chronic liver diseases complicating to hepatic encephalopathy were probed into for precipitating factors, based on history, clinical examination and laboratory methods from September 2005 to December 2005. The associated biochemical laboratory data analysis and prognostic stratification through Child's Pugh classification was also done., Results: Infection (44%), gastrointestinal bleeding (38%) and constipation (38%), stood out as the most common factors. Usage of drugs with ammonium salts, tranquilizers and large volume paracentesis were least common factors. Most patients were in grade III (52%), and grade IV (22%), of hepatic encephalopathy. Other common associations were ascites (64%), Child's class C (62%), hyponatremia (50%), low haemoglobin (70%), hepatitis C (62%), and high mortality rate (30%)., Conclusion: Infection, gastrointestinal bleeding and constipation being the most important precipitating factors must be prevented and hospital funds, medicines and human efforts should lay emphasis, on these factors to decrease the incidence of hepatic encephalopathy. This also includes effective control measures against rising cases of hepatitis C, as it is the leading cause of liver cirrhosis in Pakistan.