The rapid uptake of mobile phones in low and middle-income countries over the past decade has provided public health programs unprecedented access to patients. While programs have used text messages ...to improve medication adherence, there have been no high-powered trials evaluating their impact on tuberculosis treatment outcomes.
To measure the impact of Zindagi SMS, a two-way SMS reminder system, on treatment success of people with drug-sensitive tuberculosis.
We conducted a two-arm, parallel design, effectiveness randomized controlled trial in Karachi, Pakistan. Individual participants were randomized to either Zindagi SMS or the control group. Zindagi SMS sent daily SMS reminders to participants and asked them to respond through SMS or missed (unbilled) calls after taking their medication. Non-respondents were sent up to three reminders a day.
Public and private sector tuberculosis clinics in Karachi, Pakistan.
Newly-diagnosed patients with smear or bacteriologically positive pulmonary tuberculosis who were on treatment for less than two weeks; 15 years of age or older; reported having access to a mobile phone; and intended to live in Karachi throughout treatment were eligible to participate. We enrolled 2,207 participants, with 1,110 randomized to Zindagi SMS and 1,097 to the control group.
The primary outcome was clinically recorded treatment success based upon intention-to-treat.
We found no significant difference between the Zindagi SMS or control groups for treatment success (719 or 83% vs. 903 or 83%, respectively, p = 0·782). There was no significant program effect on self-reported medication adherence reported during unannounced visits during treatment.
In this large-scale randomized controlled effectiveness trial of SMS medication reminders for tuberculosis treatment, we found no significant impact.
The trial was registered with ClinicalTrials.gov, NCT01690754.
Post COVID cerebellitis Hamza, Ali; Aamir, Khan
Journal of neurology, neurosurgery and psychiatry,
11/2023, Letnik:
94, Številka:
Suppl 1
Journal Article
Recenzirano
IntroductionCerebellitis is a rare condition and is mainly associated with preceding illness, mainly viral. Following is a case report of a young patient who presented with seizures, cerebellar signs ...following COVID-19 infection.Description27-year-old boy, otherwise generally of good health, presented with 3 days history of high grade fever, reduced consciousness and seizures. Initial MRI showed obstructive hydrocephalus and was moved to tertiary neurosurgery centre to have external ventricular drainage. Post drain, alertness improved but noted to have continuous head bobbing, dysarthric speech, resting and postural tremor and positive cerebellar signs with vertical nystagmus.Repeat MRI brain showed signs consistent with cerebellitis. Tests to rule out other causes of cerebellitis including EBV, viral screen, CT thorax abdomen and pelvis, CSF viral screen were negative. Other sources of infections including chest, urine, abdomen ruled out. Treated as post covid cerebellitis and given short course of IV steroids.ConclusionCerebellitis can present as a complication of covid 19 and should be considered as one of the differentials of CNS effects of COVID infection, especially in someone with cerebellar signs.
The pangenome provides genomic variations in the cultivated gene pool for a given species. However, as the crop’s gene pool comprises many species, especially wild relatives with diverse genetic ...stock, here we suggest using accessions from all available species of a given genus for the development of a more comprehensive and complete pangenome, which we refer to as a super-pangenome. The super-pangenome provides a complete genomic variation repertoire of a genus and offers unprecedented opportunities for crop improvement. This opinion article focuses on recent developments in crop pangenomics, the need for a super-pangenome that should include wild species, and its application for crop improvement.
Pangenome studies conducted so far have been limited mainly to one species and mostly cultivated accessions.The challenge with the current pangenomes is lack of representation of genomic diversity at the genus level.Crop wild relatives possess unearthed genetic diversity that has been lost during domestication and breeding.Pangenomics of crop wild relatives is the way forward to catalogue the complete gene repertoire of a genus.The super-pangenome is the approach of developing a pangenome of the pangenomes of different species for a given genus.Currently available methods and tools to develop pangenomes are mainly restricted to bacterial (prokaryotic) genomes. It is important now to develop novel, effective, and user-friendly tools for the development of super-pangenomes for crop (eukaryotic) genomes.
Drug delivery via aerosolization for localized and systemic effect is a non-invasive approach to achieving pulmonary targeting. The aim of this study was to prepare spray-dried proliposome (SDP) ...powder formulations to produce carrier particles for superior aerosolization performance, assessed via a next generation impactor (NGI) in combination with a dry powder inhaler. SDP powder formulations (F1-F10) were prepared using a spray dryer, employing five different types of lactose carriers (Lactose monohydrate (LMH), lactose microfine (LMF), lactose 003, lactose 220 and lactose 300) and two different dispersion media. The first dispersion medium was comprised of water and ethanol (50:50% v/v ratio), and the second dispersion medium comprised wholly of ethanol (100%). In the first dispersion medium, the lipid phase (consisting of Soya phosphatidylcholine (SPC as phospholipid) and Beclomethasone dipropionate (BDP; model drug) were dissolved in ethanol and the lactose carrier in water, followed by spray drying. Whereas in second dispersion medium, the lipid phase and lactose carrier were dispersed in ethanol only, post spray drying. SDP powder formulations (F1-F5) possessed significantly smaller particles (2.89 ± 1.24-4.48 ± 1.20 μm), when compared to SDP F6-F10 formulations (10.63 ± 3.71-19.27 ± 4.98 μm), irrespective of lactose carrier type via SEM (scanning electron microscopy). Crystallinity of the F6-F10 and amorphicity of F1-F15 formulations were confirmed by XRD (X-ray diffraction). Differences in size and crystallinity were further reflected in production yield, where significantly higher production yield was obtained for F1-F5 (74.87 ± 4.28-87.32 ± 2.42%) then F6-F10 formulations (40.08 ± 5.714-54.98 ± 5.82%), irrespective of carrier type. Negligible differences were noted in terms of entrapment efficiency, when comparing F1-F5 SDP formulations (94.67 ± 8.41-96.35 ± 7.93) to F6-F10 formulations (78.16 ± 9.35-82.95 ± 9.62). Moreover, formulations F1-F5 demonstrated significantly higher fine particle fraction (FPF), fine particle dose (FPD) and respirable fraction (RF) (on average of 30.35%, 890.12 μg and 85.90%) when compared to counterpart SDP powder formulations (F6-F10). This study has demonstrated that when a combination of water and ethanol was employed as dispersion medium (formulations F1-F5), superior formulation properties for pulmonary drug delivery were observed, irrespective of carrier type employed.
Zero hunger and good health could be realized by 2030 through effective conservation, characterization and utilization of germplasm resources
. So far, few chickpea (Cicer arietinum) germplasm ...accessions have been characterized at the genome sequence level
. Here we present a detailed map of variation in 3,171 cultivated and 195 wild accessions to provide publicly available resources for chickpea genomics research and breeding. We constructed a chickpea pan-genome to describe genomic diversity across cultivated chickpea and its wild progenitor accessions. A divergence tree using genes present in around 80% of individuals in one species allowed us to estimate the divergence of Cicer over the last 21 million years. Our analysis found chromosomal segments and genes that show signatures of selection during domestication, migration and improvement. The chromosomal locations of deleterious mutations responsible for limited genetic diversity and decreased fitness were identified in elite germplasm. We identified superior haplotypes for improvement-related traits in landraces that can be introgressed into elite breeding lines through haplotype-based breeding, and found targets for purging deleterious alleles through genomics-assisted breeding and/or gene editing. Finally, we propose three crop breeding strategies based on genomic prediction to enhance crop productivity for 16 traits while avoiding the erosion of genetic diversity through optimal contribution selection (OCS)-based pre-breeding. The predicted performance for 100-seed weight, an important yield-related trait, increased by up to 23% and 12% with OCS- and haplotype-based genomic approaches, respectively.
Uterine fibroids: current perspectives Khan, Aamir T; Shehmar, Manjeet; Gupta, Janesh K
International journal of women's health,
01/2014, Letnik:
6, Številka:
default
Journal Article
Recenzirano
Odprti dostop
Uterine fibroids are a major cause of morbidity in women of a reproductive age (and sometimes even after menopause). There are several factors that are attributed to underlie the development and ...incidence of these common tumors, but this further corroborates their relatively unknown etiology. The most likely presentation of fibroids is by their effect on the woman's menstrual cycle or pelvic pressure symptoms. Leiomyosarcoma is a very rare entity that should be suspected in postmenopausal women with fibroid growth (and no concurrent hormone replacement therapy). The gold standard diagnostic modality for uterine fibroids appears to be gray-scale ultrasonography, with magnetic resonance imaging being a close second option in complex clinical circumstances. The management of uterine fibroids can be approached medically, surgically, and even by minimal access techniques. The recent introduction of selective progesterone receptor modulators (SPRMs) and aromatase inhibitors has added more armamentarium to the medical options of treatment. Uterine artery embolization (UAE) has now been well-recognized as a uterine-sparing (fertility-preserving) method of treating fibroids. More recently, the introduction of ultrasound waves (MRgFUS) or radiofrequency (VizAblate™ and Acessa™) for uterine fibroid ablation has added to the options of minimal access treatment. More definite surgery in the form of myomectomy or hysterectomy can be performed via the minimal access or open route methods. Our article seeks to review the already established information on uterine fibroids with added emphasis on contemporary knowledge.
Tuberculosis (TB) is the leading infectious cause of mortality globally, with almost 4000 daily deaths. The treatment coverage and success rate are ongoing challenges for low- and middle-income ...countries (WHO, 2019). To effectively control the TB epidemic and meet the EndTB goals, the Zero TB Initiative was launched in October 2015. It aims to create ‘islands of TB elimination’ using a comprehensive approach of search, treat and prevent. Unfortunately, the COVID-19 pandemic has upended much of these activities. Reports from India, China and Pakistan suggest a daily decline in case notification of 75–80% in the last few months (Glaziou, 2020; Stop TB Partnership, 2020a) with testing in Pakistan decreasing up to 80%. COVID-19 has led to massive health system disruption with the cancellation of routine health services in many settings (Roberts, 2020; Riley et al., 2020). Physical distancing has been prescribed to contain the pandemic. This has major implications for TB service delivery. During the Ebola outbreak in Liberia, case notifications declined and the TB treatment success rate dropped from 80% to 69% (Konwloh et al., 2017; Desta et al., 2019). The success rate increased during the post-Ebola period, but remained low at 77%, indicating the impact on TB treatment outcomes (Desta et al., 2019). Some of the reasons for this decrease include closure of the health facilities and laboratories, healthcare workers becoming sick, stock out of medical supplies and repurposing of existing facilities and staff (Zachariah et al., 2015). During the outbreak, a modelling study estimated 10 632 deaths from TB, malaria and HIV/AIDS in West African countries with 50% reduction in health services (Parpia et al., 2016). These deaths would be more than those caused by Ebola itself. Likewise, the 1918 Spanish Flu pandemic had also resulted in increased mortality from TB by a factor of 1.5 (95%CI: 1.1–1.9) (Noymer, 2011; Zürcher et al., 2016).
Summary
Cicer arietinum L. (chickpea) is the third most important food legume crop. We have generated the draft sequence of a desi‐type chickpea genome using next‐generation sequencing platforms, ...bacterial artificial chromosome end sequences and a genetic map. The 520‐Mb assembly covers 70% of the predicted 740‐Mb genome length, and more than 80% of the gene space. Genome analysis predicts the presence of 27 571 genes and 210 Mb as repeat elements. The gene expression analysis performed using 274 million RNA‐Seq reads identified several tissue‐specific and stress‐responsive genes. Although segmental duplicated blocks are observed, the chickpea genome does not exhibit any indication of recent whole‐genome duplication. Nucleotide diversity analysis provides an assessment of a narrow genetic base within the chickpea cultivars. We have developed a resource for genetic markers by comparing the genome sequences of one wild and three cultivated chickpea genotypes. The draft genome sequence is expected to facilitate genetic enhancement and breeding to develop improved chickpea varieties.
Summary Accelerating progress in the fight against tuberculosis will require a drastic shift from a strategy focused on control to one focused on elimination. Successful disease elimination campaigns ...are characterised by locally tailored responses that are informed by appropriate data. To develop such a response to tuberculosis, we suggest a three-step process that includes improved collection and use of existing programmatic data, collection of additional data (eg, geographic information, drug resistance, and risk factors) to inform tailored responses, and targeted collection of novel data (eg, sequencing data, targeted surveys, and contact investigations) to improve understanding of tuberculosis transmission dynamics. Development of a locally targeted response for tuberculosis will require substantial investment to reconfigure existing systems, coupled with additional empirical data to evaluate the effectiveness of specific approaches. Without adoption of an elimination strategy that uses local data to target hotspots of transmission, ambitious targets to end tuberculosis will almost certainly remain unmet.
Summary
Terminal drought is a major constraint to chickpea productivity. Two component traits responsible for reduction in yield under drought stress include reduction in seeds size and root ...length/root density. QTL‐seq approach, therefore, was used to identify candidate genomic regions for 100‐seed weight (100SDW) and total dry root weight to total plant dry weight ratio (RTR) under rainfed conditions. Genomewide SNP profiling of extreme phenotypic bulks from the ICC 4958 × ICC 1882 population identified two significant genomic regions, one on CaLG01 (1.08 Mb) and another on CaLG04 (2.7 Mb) linkage groups for 100SDW. Similarly, one significant genomic region on CaLG04 (1.10 Mb) was identified for RTR. Comprehensive analysis revealed four and five putative candidate genes associated with 100SDW and RTR, respectively. Subsequently, two genes (Ca_04364 and Ca_04607) for 100SDW and one gene (Ca_04586) for RTR were validated using CAPS/dCAPS markers. Identified candidate genomic regions and genes may be useful for molecular breeding for chickpea improvement.
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