Ovarian reserve in adolescent girls with autoimmune thyroiditis

ABSTRACT Objectives: To assess serum anti-Müllerian hormone (AMH) levels as an ovarian reserve marker in adolescent girls with autoimmune thyroiditis (AIT) and explore the relationship of this marker with autoimmunity and thyroid function biomarkers. Subjects and methods: This study included 96 adolescent girls with newly diagnosed AIT and 96 healthy, age- and sex-matched controls. All participants were evaluated with detailed history taking and physical examination, thyroid ultrasound, and measurement of levels of thyroid-stimulating hormone (TSH), free thyroxin (FT4), free triiodothyronine (FT3), antithyroid peroxidase antibodies (TPOAb), antithyroglobulin antibody (TGAb), estradiol, total testosterone, and anti-Müllerian hormone (AMH) levels. The LH/FSH ratio was also calculated. Among 96 patients evaluated, 78 were overtly hypothyroid and 18 were euthyroid. AMH levels were significantly lower in participants with overt hypothyroidism and euthyroidism compared with controls. Results: Serum levels of AMH correlated negatively with age, body mass index (BMI) standard deviation score (SDS), and TPOAb, TGAb, and TSH levels but positively with FT4 levels. In multivariate analysis, AMH levels correlated significantly with age (odds ratio [OR] = 1.65, 95% confidence interval [CI] 1.18-2.32, p = 0.05), BMI SDS (OR = 2.3, 95% CI, 2.23-3.50, p = 0.01), TSH (OR = 2.43, 95% CI 1.5-2.8, p = 0.01), and TPOAb (OR = 4.1, 95% CI 3.26-8.75, p = 0.001). Conclusions: Ovarian reserve of adolescent girls with AIT, as measured by serum AMH levels, is affected by thyroid autoimmunity and hypothyroidism, indicating a possible need for ovarian reserve monitoring in these patients.

A Single Centre Open Label Non-Randomized Phase-IV Post Marketing Surveillance Study to Evaluate the Efficacy and Safety of Roop Mantra Ayurvedic Medicinal Cream

Objectives: The objective of the study was to evaluate the efficacy and safety of a polyherbal Roop Mantra Ayurvedic Medicinal Cream in subjects with acne, facial scars, pimples, blemishes, dull and dry skin. Methods: This was a 60-day, single-centre, open-labelled, non-randomized phase-IV surveillance study with 120 subjects. Subjects were selected based on the study's inclusion criteria. The study included three scheduled clinical visits on days 0 (screening and baseline visit), 30 (follow-up visit), and 60 (final visit). Following an evaluation of baseline data, all subjects were given Roop Mantra Ayurvedic Medicinal Cream for 60 days. The primary outcome of the study was to assess the efficacy of Roop Mantra Ayurvedic Medicinal Cream based on changes in parameters such as skin texture, skin health, global acne assessment parameters and an investigator assessment scale. The secondary outcome of the study was the determination of local intolerance and adverse effects to Roop Mantra Ayurvedic Medicinal Cream . Results: The study findings revealed that the use of Roop Mantra Ayurvedic Medicinal Cream for 60 days improved skin texture and appearance while significantly reducing acne, pimples, blemishes, and skin dryness. Roop Mantra Ayurvedic Medicinal Cream was likewise dermatologically well tolerated and did not cause any adverse effects during the study period. Conclusion: Roop Mantra Ayurvedic Medicinal Cream showed highly satisfactory results in terms of skin texture, skin appearance and general acne parameters without having any adverse effects on the skin. Given the positive outcomes, Roop Mantra Ayurvedic Medicinal Cream is clinically effective and safe alternative for treating various skin problems.

Evaluation of The Three-Dimensional Endoscopy in Basic and Extended Nasal Procedures: A Clinical and Cadaveric Study

Abstract Introduction The three-dimensional (3D) endoscope is considered a new surgical tool used in different approaches in intranasal and anterior skull base surgical procedures. There are many advantages of 3D over two-dimensional (2D) endoscopy that have been demonstrated in clinical applications, surgical training, and different experimental studies. Objective To show the difference between using the 3D and 2D endoscopes during endonasal and anterior skull base surgery and its importance. Methods Our study is divided into two phases (clinical and cadaveric phases). In the clinical study we, have performed 52 endonasal and anterior skull base surgical procedures (26 study cases and 26 control cases). We recorded accuracy, duration, and intraoperative complication for each case. The cadaveric study was performed on three cadavers. Differences in accuracy and dissection time were recorded using 3D and 2D endoscopy for each side chosen by randomization. Results In the clinical study, the cases done by 3D endoscope were significantly faster and more accurate with less intraoperative complications compared with cases done using 2D endoscope. In cadaveric dissection, while using 3D endoscope, there was better depth of perception regarding the anatomical landmarks compared with 2D endoscope. Conclusion Three-dimensional endoscopy is an advanced instrument that allows better training for the coming generation of ear, nose, and throat surgeons. Both clinical and cadaveric studies offer a promising outcome in both endonasal and anterior skull base surgery.

Monitoring progress on antimicrobial resistance response in the WHO African Region: insights from the TrACSS 2021. Results for the Human Health Sector

Background: Antimicrobial resistance (AMR) is a major 21st Century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan (GAP). Objective: The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. Methods: This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Results: Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. 15 (37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for huBackground: Antimicrobial resistance (AMR) is a major 21st Century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan (GAP). Objective: The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. Methods: This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Results: Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. 15 (37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for Background: Antimicrobial resistance (AMR) is a major 21st Century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan (GAP). Objective: The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. Methods: This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Results: Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. 15 (37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Conclusion: Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanism sin the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical. human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Conclusion: Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical. man health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Conclusion: Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical.

Assessment of Children's Oral Health-Related Knowledge and Self-Efficacy in Expectant Mothers of Najran, Saudi Arabia

Abstract Objective: To assess the knowledge of pregnant women regarding their child's oral health. Material and Methods: A questionnaire was developed and the 1st section comprised sociodemographic variables. The second section contained questions about the eruption of teeth, fluoride importance, cariogenic food, and dental visits. The questionnaire was shared electronically via a link to the receptionist of the gynaecologist at different health centres of Najran to be filled by expectant mothers. The convenient sampling method was used to collect the responses. Data were presented using descriptive statistics. Results: A total of 572 pregnant women participated in this survey. Three hundred and fifteen (55.1%) knew that 1st primary tooth erupts at the age of 6 months. The majority of the respondents (n=332) agreed that toothbrushes and toothpaste could be used to clean a child's teeth; only 5.4%, 10%, and 24.5% preferred miswak, mouthwash, and toothbrush, respectively. Participants were well familiar with cariogenic food and occasionally allowed their children to take it. They have enough knowledge about fluoride toothpaste, but they were not familiar with the benefits of fluoride varnish. Almost 50% of the respondents agreed that the child should visit the dentist within six months, and 27.4% said they should visit the dentist whenever there is a problem. Conclusion: Almost 50% of participants showed a positive attitude towards most questions. However, there is a need to improve their behaviour and knowledge about many aspects of dental care.

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) ­ age groups 11­20 and 41­50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV.

Tissue trauma and inflammatory response following laparoscopic versus abdominal hysterectomy: a prospective randomized clinical trial

Background: Laparoscopic surgery is associated with more favorable clinical outcome than conventional open surgery. This might be related to the magnitude of tissue trauma and tissue stress response. This study compares the intensity of tissue injury by assessing plasma C-reactive protein (CRP), lactic dehydrogenase (LDH), and cancer antigen 125 (CA 125) in patients undergoing laparoscopic hysterectomy compared to abdominal hysterectomy.Methods: This study was conducted at Ain Shams University Maternity Hospital from May 2018 to February 2020. 74 women candidate for hysterectomy were recruited and randomized into two groups: group A included 37 cases who underwent abdominal hysterectomy, and group B included 37 cases that underwent laparoscopic hysterectomy.Results: CRP, LDH and CA125 significantly increased post-operatively in both groups. Postoperative mean serum CRP, LDH and CA125 were significantly higher in the laparotomy group (10.84±2.47, 262.21±76.77, and 13.41±2.6 respectively) compared to laparoscopy group (7.92±2.25, 148.53±43.56, 11.79±2.77 respectively) (p<0.05).Conclusions: Surgery is a significant cause of tissue injury that can be assessed by specific markers. We suggest that laparoscopic surgery causes less tissue damage as assessed by lower postoperative CRP and LDH values, which might account for the earlier recovery and reduced hospital stay in laparoscopic surgery.

Metformin as an Adjuvant Therapy Attenuates Dextran Sulphate Sodium-induced Acute Colitis in Rats

Aims: In numerous cases, patients with inflammatory bowel diseases (IBDs) are refractory to standard treatment. Sirolimus (SIR) and tacrolimus (TAC) are immunosuppressant drugs with encouraging outcomes. However, they have side effects causing limitations in their use. Metformin (MET), which is an antidiabetic drug, has promising anti-inflammatory effects. Thus, this study aimed to validate the effect of the concomitant administration of MET and SIR or TAC in the management of experimentally induced colitis.Study Design:Dextran sulphate (DSS) induced colitis model was used Methodology:Colitis was induced by administering 5% DSS in water twice daily via oral gavage for 9 days. MET 200 mg/kg alone or in combination with SIR 1 mg/kg or TAC 1 mg/kg was started on day 7 and was continuously administered for 12 days. Then, samples of distal colon tissues were collected for histopathological and immunohistochemistry staining. Then, the pro-inflammatory cytokine, tumour necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6, and IL-17A levels in tissue homogenates were measured.Results:MET,SIR or TAC significantly attenuated the effect of DSS and the levels of all pro-inflammatory cytokines. Moreover, adding MET reinforces the effect of SIR and TAC. Conclusion:MET had a strong anti-inflammatory effect against DSS-induced colitis. Hence, it could be a promising adjuvant therapy in the management of IBDs. The effect was mediated, in part, by inhibiting NF-κB activation. However, the results of this study must be further validated and translated to clinical implications

Optimizing the Use of Hydroxychloroquine in the Management of COVID-19 Given Its Pharmacological Profile

After the global pandemic of the new coronavirus, its rapid spreadand many victims, it is necessary to find an effective vaccine or drugs to overcome it. Most specialists consider that repositioning somemedications is the best, fastestand most reliable option for treating patients with the new coronavirus without delay. One of these drugs was an old antimalarial drug, hydroxychloroquine. The current review aimed to explore its potential mechanism, as well as its pharmacokinetics and toxicity, in an attempt to suggest a treatment protocol for its use in treating the COVID-19 virus effectively and safely. This study reviewed the published references on the popular search engines as well as the reference books regarding the pharmacological effects of HCQ.The results of this study suggested the following practical guidelines to optimize HCQ efficacy and safety in the management of COVID-19. HQC should be used as early as possible, i.e., once the viral infection is confirmed or suspected. A loading dose is recommended to be given in 3-4 divided doses to minimize cardiac toxicity. Maintenance daily dose (divided into two doses), should be continued until complete remission. Precautions,drug-interaction, contraindications, variable metabolic pathways in the particular population should be considered. This study suggests more clinical trials regarding the use of HCQ in the management of early identified COVID-19 patients under close medical observation to minimize HCQ cardiac toxicity

Type 2 Diabetes Mellitus Prediction In Malaysia Using Modified Diabetes Risk Assessment Tool

@#Type 2 diabetes mellitus (DM) is becoming major health threat worldwide and it is extremely common in clinical setting. Malaysia is one of the highest diabetic populations among Asian countries and the new cases are increasing day to day. Early detection of people with high risk of Type 2 DM by using simple, easy and cost-effective assessment tool is the better way to identify and prevent the community from this non-communicable disease. The objectives of the study were to identify those are high risk to become type 2DM among Malaysians by using risk scoring form and to educate them how to prevent it. Total 591 subjects were recruited from the health screening programs carried out by the collaboration of Petaling Jaya Development Council (MBPJ) and Lincoln University College, Malaysia. Modified form of Finnish Type 2 Diabetes Risk Assessment Tool was used to identify people at risk of becoming type 2 DM. Descriptive analysis was performed for all included variables in this study by using SPSS version 21. The study found out that almost half of the participants were found to have family history of DM, 60% of them were overweight and obese and 47% were having above normal waist circumference. We observed that nearly 60 % of participants in the study were having moderate to high risk of becoming type 2 DM in next 10 years. To conclude, the result of our study would be helpful in implementation of cost-effective, convenient Type 2 DM risk assessment tool which has yet to be implemented in Malaysia.

Tensile and transverse strength of novel copolymers for denture base

Objectives: Compare tensile and transverse strength of new copolymers for denture base. Materials and methods: The specimens were prepared from heat cured acrylic resin with three types of additives: Acryester B, Ethoxycarbonylethylene, and Propenoic acid at a percentage of 5% and 10%. The tensile and transverse strains were tested, recorded and compared. Results: The analysis of variance display statistically significant difference. The p-value was 0.001 for each of tensile and transverse strain tests. Conclusions: The tensile strength of the novel copolymers increased. The transverse strength of some of the novel copolymers increased.

Prevalence and Antibiotic Susceptibility of Salmonella Species among Food Handlers in Khartoum- State (Sudan)

Aims/Objectives: To screen the prevalence of Salmonella fecal carriage among healthy foodhandlers and to identify the common species of Salmonella among study population and its antibacterial susceptibility in Khartoum state by taking stool samples. Study Design: Cross-sectional study. Place and Duration of Study: Khartoum state, Sudan, from January 2009 to December 2009. Methodology: Stool samples were collected, processed and cultured on suitable bacterial culture media. Presence of colonies resembling (non-lactose fermenting) Salmonella species were further studied to identify the bacterium by using appropriate biochemical tests.Confirmation and serotyping of isolates were done by using Salmonella antisera. Antibacterial susceptibility test for common antibacterial drugs were also studied. Results: A total of 387 stool samples collected from apparently healthy food handlers werestudied. Salmonella fecal carriage among food handlers was 17 (4.4%) and the highest prevalence was noted in Umbada locality (5.1%). Salmonella Paratyphi B was the commonest 14 (3.6%), followed by Salmonella Typhi 2(0.5%) and Salmonella Cholerasuis 1 (0.3%). Our study revealed that 141 (36.4%) of food handlers were illiterate, 29 (7.5%) werepreschool, 134 (34.6%) were elementary school graduates 68 (17.6%) and 15 (3.9%) university graduates. Forty two (10.9%) of the studied cases mentioned that, they sometimes wash their hands by soap after defecation, while, 9 (2.3%) never washed theirhands. The study also, revealed that 3 (17.6%) of positive food handlers have had history ofprevious typhoid or gastroenteritis. The study demonstrated that Salmonella species isolated were sensitive to co-trimoxazole, ciprofloxacin, chloramphenicol, tetracycline, amoxicillin/ clavulanic acid, ceftriaxone and cefuroxime. Conclusion: This study demonstrated the presence of considerable number of Salmonella fecal carriage among food handlers in Khartoum state. Most of them were illiterate and had poor compliance of hand washing after toilet use. Study also revealed that isolated Salmonella species were highly susceptibility to the common first line antibiotics used in Sudan.

Knowledge, Attitude and Practice Regarding Diabetes among Saudi MOH Primary Healthcare Physicians in Jeddah: A Cross Sectional Study

Background: Role of primary care physicians in managementof diabetes mellitus is very essential. Their attitudes andpractices are influenced by their knowledge; therefore, theimportance of healthcare providers in promoting understandingand helpful attitudes about diabetes cannot be underestimated.Objective: To assess the level of knowledge, attitude andpractice of general physicians regarding diabetes in Jeddahcity.Subjects and Methods: A cross-sectional study wasconducted throughout the period 1st June to 31st August 2018among a representative sample of general practitionersworking at Ministry of Health (MOH) primary health carecentres in Jeddah city, Saudi Arabia. A structured selfadministered questionnaire was used to collect data. It iscomprised of four sections, starting with demographicinformation and clinical experience, 12 questions measuringthe respondent’s knowledge of diabetes diagnosis, treatmentand complications, 9 questions evaluating physician’s attitudetowards diabetes control and 6 questions measuring thephysician’s practices toward their diabetic patients.Results: The study included 171 physicians. Femalesrepresent 58.5% of them. Almost half of them (50.9%) agedbetween 30 and 39 years. Majority of the physicians (82.5%)were Saudis. Overall, the knowledge score percentage rangedbetween 8.33% and 100% with a mean of 69.7% and standarddeviation of ±9.4%. Female physicians (p=0.007), thoseworking at diabetic clinics (p<0.001) and have seenbetween 51 and 100 patients/ week (p = 0.005) were moreknowledgeable. Overall, based on median level of the attitudescore, more than half of the physicians (54.4%) had positiveattitude towards DM and its control. Overall, the practice scorepercentage ranged between 0% and 100% with a mean of67.3% and standard deviation of 22.8%. Physicians working atdiabetic clinics (p<0.001) and those without history of DMamong first degree relatives (p=0.036) expressed betterpractice than others.Conclusion: General practitioners had fair knowledgeregarding DM with deficiency in some important aspects. Theirattitude towards diabetic control is quite acceptable. However,their practice regarding some important aspects wassuboptimal.

Knowledge And Perception Towards Supplementary Immunization Activities (Sia) Among Mothers In Cheras, Kuala Lumpur

@#Among the main reasons for re-emergence of vaccine preventable diseases were missed or incomplete immunization schedule. The supplementary immunization activity (SIA) is an important intervention done to provide complete immunization coverage among those children. Better outcome came along with good knowledge and perception on the program. Thus, this study aims to assess the level of knowledge and perception of the mothers towards SIA program. A cross-sectional study was conducted among mothers with children ≤ 15 years old in Cheras, Kuala Lumpur. Data was collected by interview using the guided questionnaire consists of four sections to assess the socio demographic, socio economic, knowledge and perception regarding SIA. The questionnaire was validated for internal consistency with Cronbach’s alpha 0.461 for knowledge and 0.729 for perception. A total of 105 respondents with the median age of 33 years (IQR: 28-38) with majority of them are Malays (82.9%), Muslim (83.8%), married (97.1%) and (57.1%) with 1- 2 child in the family. Half of them were from low income family (46.7%) and had secondary education level (54.3%) and were housewives (47.6%). One third of the respondents (33%) never heard about SIA before. Overall had poor knowledge (82.9%) and perception (95.2%) towards SIA. There is a significant association between the level of knowledge on SIA with household income (χ

Prevalence Of Stress And Its Associated Factors Among Medical Students In Sabah, Malaysia Borneo

@#Stress is accepted as the accumulation of unpleasant state of physical, mental and emotion on a person. Medical education has been known as one of the most stressful academic curriculum. Hence, medical students may subjected to multiple psychological changes and challenges throughout the years of medical education. The aim of this study was to determine the prevalence of stress and its associated factors among medical students. This cross sectional study was conducted from April to May 2018 in medical school in Sabah. It involved 396 medical students through universal sampling. Self-administered questionnaires were used as an instrument for data collection. The questionnaires included were Sociodemographic Questionnaire, Depression, Anxiety and Stress Scales 21 (DASS-21) and Medical Student Stressors Questionnaire (MSSQ). Bivariate analysis (Chi Square test, Fisher’s Exact Test, Independent T test and Man-Whitney U test) were used to analyse the association. The response rate was 90.2%. The prevalence of stress among medical students were 33.3%. Significant associated factors include financial support inadequacy (p=0.010) and all categories of medical student stressors. The mean score of the academic related stressors was found to be at 2.117 (±0.758) which was the highest mean score among medical student stressors assessed by MSSQ. The result of this study can be used as a basis for implementation of preventive measures such as provision of comprehensive, integrated and responsive mental health care services in university-based settings.@*@#

Non-celiac gluten sensitivity: a systematic review

Non-celiac gluten sensitivity [NCGS] is a wheat associated disorder diagnosed by exclusion diagnosis. This review was conducted to collect current information about NCGS, clinical and pathologic manifestations, and problems faced by health professionals. It also highlights the obstacles faced when adopting a gluten-free diet. A search of international literature was conducted through PubMed and Google Scholar till September 2017. The heterogeneous groups of patients affected by NCGS are composed of a number of subgroups, and each demonstrates different clinical and pathological manifestations. The presence of certain underlying factors can be utilised to identify susceptible individuals, namely, incidence of food allergies in infancy, anti-gliadin IgG-antibodies, activation test for flow cytometric basophils, atopy, and increased intraepithelial duodenal eosinophil presence. There is urgent need for reliable biomarkers to decisively diagnose and differentiate NCGS from related disorders. Patients willing to adopt gluten-free products have to choose from products which have high fat and sugar content

Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017

Introduction: measles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia.Methods: we conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017.Results: from January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown.Conclusion: revitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible

Rapid response to meningococcal disease cluster in Foya district, Lofa County, Liberia January to February 2018

Introduction: early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods: the county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis.Results: sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered.Conclusion: this cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis

Synthesis and Development of BACE 1 Inhibitor for Alzheimer’s Diseases from Medicinal Plants

Medicinal plants have shown great promise in treating Alzheimer’s disease (AD), which significantly contributes to the production of pharmaceutical and cosmetic molecules with biologically efficient moieties. Plants derived bioactive compounds have been isolated from the medicinal plants and are used in brain diseases. Accountable for brain diseases. Plant extracts have undesirable effects such as acute or chronic toxicity; this could be involved in the delay or discouraging the adoption to the brain cells for proper and effective treatment. β-secretase is the primary protease in the process of producing Amyloid β (Aβ), which is an amyloid precursor protein in brain cells. This review is focused on the numerous different bioactive compounds present in medicinal plants such as Flavonoids, Phenyl propanoids, Prenylated flavones, Naphthoquinone, Resveratrol, Phlorotannins and Glycoside derivatives. Even though medicinal plants and their functional derivatives were reported to be good source of alternative medicines for long sought diseases like AD; but clinical trials on human are yet to be beyond the preliminary stages. The useful applications of these compounds, as bio-markers are also being explored, to further enrich control of Alzheimer’s.