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Introduction: In high-income countries, vomiting often impedes oral rehydration therapy, leading to intravenous rehydration fluid administration to children with acute gastroenteritis. Ondansetron administration reduces vomiting and intravenous fluid administration in this population. We evaluated whether ondansetron is similarly effective when employed in Pakistan. Methods: In this 2-hospital, double-blind, placebo-controlled, emergency department-based, randomized trial, we recruited children aged 0·5 to 5·0 years, without dehydration, who had diarrhea and 1 episode of vomiting within 4 hours of arrival. Patients were randomly assigned (1:1), via an internet-based randomization service, using a stratified, variable block randomization scheme, to receive a single dose of oral ondansetron or placebo. The primary endpoint was intravenous rehydration (administration of 20 ml/kg over 4 hours of an isotonic fluid) within 72 hours of randomization. All randomized children were analysed. Results: From July 3, 2014, to January 12, 2017, 626 children were randomized. Intravenous rehydration was provided to 10.8% (34/314) and 10.3% (27/312) of children administered placebo and ondansetron, respectively (OR: 0.946; 95% CI: 0.564, 1.587; P=0.834). A regression model fitted with treatment group and adjusted for antiemetic administration and vomiting frequency in the preceding 24 hours, yielded similar results; OR=0.952; 95% CI: 0.570, 1.589; P=0.850. There was no evidence of interaction between treatment group and age (P=0.974), 3 diarrheal stools in the preceding 24 hours (P=0.983) or 3 vomits in the preceding 24 hours (P=0.554). During the 4-hour study observation period, 24.0% (75/314) and 19.6% (61/312) of children in the placebo and ondansetron groups vomited, respectively; OR: 0.774; 95%CI: 0.528, 1.133; P=0.187. Conclusion: Ondansetron administration did not significantly reduce intravenous rehydration use, suggesting that in children without dehydration, ondansetron administration does not significantly alter the disease course and should not be administered to this group of children.
Blood eosinophil count is associated with a variety of common complex outcomes in epidemiological observation. The aim of this study was to explore the causal association between determined blood eosinophil count and 20 common complex outcomes (10 metabolic, 6 cardiac, and 4 pulmonary). Through Mendelian randomization, we investigated genetic evidence for the genetically determined eosinophil in association with each outcomes using individual-level LifeLines cohort data (n = 13,301), where a weighted eosinophil genetic risk score comprising five eosinophil associated variants was created. We further examined the associations of the genetically determined eosinophil with those outcomes using summary statistics obtained from genome-wide association study consortia (6 consortia and 14 outcomes). Blood eosinophil count, by a 1-SD genetically increased, was not statistically associated with common complex outcomes in the LifeLines. Using the summary statistics, we showed that a higher genetically determined eosinophil count had a significant association with lower odds of obesity (odds ratio (OR) 0.81, 95% confidence interval (CI) [0.74, 0.89]) but not with the other traits and diseases. To conclude, an elevated eosinophil count is unlikely to be causally associated to higher risk of metabolic, cardiac, and pulmonary outcomes. Further studies with a stronger genetic risk score for eosinophil count may support these results.
This experimental trial aims to describe the experiences felt by a group of patients diagnosed with different psychotic disorders (schizophrenia, delusional chronic disorder, etc.) in which the use of Benzodiazepine derivatives were related to emergence of lucid dreaming and dissociative events (to see oneself out of your one body, etc.), and to a lesser extent had subsequent depressive symptoms. Fifty-six patients were monitored and linked to the emergence of depressive symptoms related to the use of Benzodiazepines or sedative-hypnotic. While on this treatment, they had vivid or lucid dreaming.
To explore the relationship between occurrence of drug dreams (DDs) and daytime negative affect with lucid awakening during the course of a 9-week treatment.
Using the dream journal methodology, 56 participants reported occurrence of dreams, dream content, and ratings of affect. The relationships between the experience of DD, dream content (“active” vs “passive”), and affect were analysed using mixed model methods.
The experience of DD was associated with higher levels of negative affect (P < 0.001). The occurrence of DD did not decrease significantly over the 9 weeks of the study. Benzodiazepine users reported a higher occurrence of Lucid Awakening (P < 0.05) than the other drug groups (zolpidem and clometiazol).
These results are consistent with the hypothesis that DD can act as drug-conditioned stimuli to elevate negative affect. Although correlational, such findings support the implementation of psychological and pharmacological interventions aimed at minimizing the impact of DD on patients with lucid awakening and psychosis.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Africa is experiencing a rapid increase in adult obesity and associated cardiometabolic diseases (CMDs). The H3Africa AWI-Gen Collaborative Centre was established to examine genomic and environmental factors that influence body composition, body fat distribution and CMD risk, with the aim to provide insights towards effective treatment and intervention strategies. It provides a research platform of over 10 500 participants, 40–60 years old, from Burkina Faso, Ghana, Kenya and South Africa. Following a process that involved community engagement, training of project staff and participant informed consent, participants were administered detailed questionnaires, anthropometric measurements were taken and biospecimens collected. This generated a wealth of demographic, health history, environmental, behavioural and biomarker data. The H3Africa SNP array will be used for genome-wide association studies. AWI-Gen is building capacity to perform large epidemiological, genomic and epigenomic studies across several African counties and strives to become a valuable resource for research collaborations in Africa.
This study presents the influence of heat and mass transfer on peristaltic transport of Finitely Extensible Nonlinear Elastic Peterlin (FENE-P) fluid in the presence of chemical reaction. It is assumed that all the fluid properties, except the density are constant. The Boussinesq approximation which relates density change to temperature and concentration changes is used in formulating buoyancy force terms in the momentum equation. Moreover, we neglect viscous dissipation and include diffusion-thermal (Dufour) and thermal-diffusion (Soret) effects in the present analysis. By the consideration of such important aspects the flow equations become highly nonlinear and coupled. In order to make the problem tractable we have adopted widely used assumptions of long wave length and low Reynolds number. An exact solution of the simplified coupled linear equations for the temperature and concentration has been obtained whereas numerical solution is obtained for dimensionless stream function and pressure gradient. The effects of different parameters on velocity field, temperature and concentration fields and trapping phenomenon are highlighted through various graphs. Numerical integration has been performed to analyze pressure rise per wavelength.
We review clinical, neuroimaging, and genetic information on six individuals with isolated sulfite oxidase deficiency (ISOD).
All patients were examined, and clinical records, biochemistry, neuroimaging, and sulfite oxidase gene (SUOX) sequencing were reviewed.
Data was available on six individuals from four nuclear families affected by ISOD. Each individual began to seize within the first week of life. neurologic development was arrested at brainstem reflexes, and severe microcephaly developed rapidly. neuroimaging within days of birth revealed hypoplasia of the cerebellum and corpus callosum and damage to the supratentorial brain looking like severe hypoxic-ischemic injury that evolved into cystic hemispheric white matter changes. Affected individuals all had elevated urinary S-sulfocysteine and normal urinary xanthine and hypoxanthine levels diagnostic of ISOD. Genetic studies confirmed SUOX mutations in four patients.
ISOD impairs systemic sulfite metabolism, and yet this genetic disease affects only the brain with damage that is commonly confused with the clinical and radiologic features of severe hypoxic-ischemic encephalopathy.
Considerable inhibitory antibacterial actions were exerted by the soybean 11S subunit comparable with nisin on the proliferation of total viable count, Pseudomonas count and Enterobacteriaceae count in bovine milk stored at 4 or 25 °C for 30 d and 48 h, while 7S and lysozyme were much less effective. The maximum magnitudes of bacterial reduction by 11S and nisin were in the range 2–4 log CFU/ml. The proliferation of 3 pathogenic bacteria (Listeria monocytogenes, Salmonella Enteritidis and Escherichia coli O157:H7) artificially inoculated into raw milk stored at 4 or 25 °C were particularly and significantly (P<0·05) reduced by 11S subunit and nisin (0·5% w/v), but only slightly by 7S and moderately by lysozyme. Lactose consumption, acidity development and casein degradation during storage of bovine raw milk were attenuated during storage at 4 or 25 °C and sensorial traits were better maintained by supplementation with 11S (0·5% w/v). 11S subunit may be used a safely food preservative, if permitted.
Nanoparticles (NPs) with either plasmonic or upconverting properties have been selectively coated onto the surfaces of polystyrene (PS) spheres, imparting their optical properties to the PS colloids. These NP coated PS spheres have many potential applications, such as in medicine as drug-delivery systems or diagnostic tools. To prepare the NP coated PS spheres, gold or core-shell NaYF4Tm0.5Yb30/NaYF4 NPs were synthesized and separately combined with amino-functionalized PS spheres. The mechanism by which the NPs adhered to the PS spheres is attributed to interactions of the NP and a polyvinylpyrrolidone additive with the surfaces of the PS spheres. Two-photon fluorescence microscopy and SERS analysis demonstrate the potential applications of these NP coated PS spheres.
We analysed the data from the control group in a typhoid vaccine trial in Karachi to assess the differences in individual-, household- and cluster-level characteristics for developing typhoid fever. The annual incidence of typhoid in children aged 2–16 years in the control arm of the vaccine trial was 151/100 000 population. After adjustment, the risk of typhoid was lower with increasing age [risk ratio (RR) 0·89, 95% confidence interval (CI) 0·83–0·95], was higher with an increase in population density (RR 1·13, 95% CI 1·05–1·21) and was lower in the households using a safe drinking-water source (RR 0·63, 95% CI 0·41–0·99). Typhoid fever affects younger children living in areas of high population density and lack of access to safe water in Pakistan. A combination of environmental and biological interventions is required to prevent the continued epidemiological and economic impact of typhoid fever in high-risk areas of Pakistan.
The Schottky barriers that forms on the interface between aluminum and organic semiconductor of polymer heterojunction photodiodes based on poly(3-hexylthiophene): [6,6]-phenyl-C61-butyric acid methylester blend, has been investigated according to Mott-Schottky curves. We focused on the effect of light intensity on the Schottky barrier widths and I-V characteristics of the devices. Comparison of the mathematical models and experimental data measured under different light intensities indicate a dependency of Schottky barrier to the light intensity.
In late 2002, health professionals from the ministries of health and academia of Jordan, the Palestinian Authority and Israel formed the Middle East Consortium on Infectious Disease Surveillance (MECIDS) to facilitate trans-border cooperation in response to infectious disease outbreaks. The first mission of MECIDS was to establish a regional, laboratory-based surveillance network on foodborne diseases. The development of harmonized methodologies and laboratory capacities, the establishment of a common platform of communication, data sharing and analysis and coordination of intervention steps when needed were agreed upon. Each of the three parties selected the microbiological laboratories that would form the network of sentinel laboratories and cover the different districts of each country and also designated one laboratory as the National Reference Laboratory (NRL). Data analysis units have been established to manage the data and serve as a central point of contact in each country. The MECIDS also selected a regional data analysis unit, the Cooperative Monitoring Centre (CMC) located in Amman, Jordan, and established a mechanism for sharing data from the national systems. Joint training courses were held on interventional epidemiology and laboratory technologies. Data collection started in July 2005 with surveillance of salmonellosis as the first target. This network of collaboration and communication established in an area of continuous dispute represents an important step towards assessing the burden of foodborne diseases in the region and is expected to be fundamental for coordination of public health interventions and prevention strategies.
A total of 439 individuals with diabetes mellitus were examined for carriage of yeasts by the oral rinse and palatal swab techniques. Eighteen genetic or environment variables were assessed for their contribution to carriage of yeasts. The factor contributing to palatal and oral carriage of yeasts among individuals with insulin dependent diabetes mellitus (IDDM) was age (P < 0·01). The factor contributing to palatal carriage of yeasts among individuals with non-insulin dependent diabetes mellitus (NIDDM) was poor glycaemic control (glycosuria P < 0·01); carriage in the oral cavity as a whole was influenced additionally by non-secretion of ABH blood group antigens (P < 0·05). Introduction of a denture altered the above risk factors. For individuals with IDDM, oral carriage was associated with the presence of retinopathy (P < 0·05); palatal carriage was influenced by poor glycaemic control (HbA1P < 0·01, plasma glucose levels P < 0·05) and age (P < 0·05). For those with NIDDM, palatal carriage was associated with continuous presence of the denture in the mouth (P < 0·01); oral carriage was associated with plasma glucose levels (P < 0·05).
Non-diabetic individuals who are non-secretors of blood group antigens are prone to superficial infections by Candida albicans. In this study, 216 patients with diabetes mellitus who were denture wearers were examined for the presence or absence of denture stomatitis. There was an overall trend for non-secretors to be prone to denture stomatitis compared with secretors. Stepwise linear discriminant analysis was used to dissect the contribution of secretor status and other variables to the development of the disease. Secretor status was found to be a contributory factor among patients with non-insulin dependent diabetes but not among those with insulin-dependent diabetes. The possible reasons for this are discussed.
We report herein the results of density functional theory calculations of the geometric and electronic structure for a series of fused heterocyclic compounds. These molecules were compared with the corresponding carbocyclic oligoacenes, which are currently being experimentally investigated for use as organic semiconductors. The impact of various structural modifications on this class of compounds on the calculated structures is examined. The results of our calculations reveal that such materials hold exceptional promise as organic semiconductors.