Molecular detection and prevalence of Rotavirus with acute gastroenteritis among the children of rural and urban areas / Detecção molecular e prevalência de rotavírus com gastroenterite aguda entre as crianças de áreas rurais e urbanas

Rotavirus is the main infective agent of acute gastroenteritis (AGE) in children under the age of five years and causing significant morbidity as well as mortality throughout the world. The study was carried out to detect the prevalence rate, genotypes strain and risk factors of Rotavirus among the children of rural and urban areas of district Bannu Khyber Pakhtunkhwa Pakistan. A total of 180 stool samples were collected from children under the age of 5 years from two major hospitals of Bannu from January to December (2015). The samples were analyzed by Reverse-transcriptase Polymerase Chain Reaction (RT-PCR) for the detection of Rotavirus, positive samples were further processed for genotyping (G and P type) through specific PCR. Of the total, 41 (23%) samples were positive for Rotavirus. The most prevalent G genotypes found were: G3, G8, G9 (each 29%), followed by G10 (15%), and G11 (10%). Whereas the prevalent P genotypes were: P-8 (25%), P-4 and P-10 (each 20%), P-9 (15%), followed by P-6 and P-11 (each 10%). Moreover, Rotavirus infection was more prevalent in summer (23.73%) and winter (22.7%) than spring (20%) and autumn (21.4%). Rotavirus infection exhibited high frequency in June (14%), October (8%) and November (6%). It is concluded that Rotavirus is more prevalent in children and various genotypes (G and P) of Rotavirus are present in the study area. Lack of studies, awareness and rarer testing of Rotavirus are the principal reasons of virus prevalence in district Bannu, Pakistan.

O rotavírus é o principal agente infeccioso da gastroenterite aguda (AGE) em crianças menores de 5 anos e causa de morbidade e mortalidade significativas em todo o mundo. O estudo foi realizado para detectar a taxa de prevalência, cepa de genótipos e fatores de risco de rotavírus entre as crianças de áreas rurais e urbanas do distrito de Bannu Khyber Pakhtunkhwa, Paquistão. Um total de 180 amostras de fezes foi coletada de crianças menores de 5 anos de dois grandes hospitais de Bannu de janeiro a dezembro (2015). As amostras foram analisadas por reação em cadeia da polimerase transcriptase reversa (RT-PCR) para detecção de rotavírus; as amostras positivas foram posteriormente processadas para genotipagem (tipo G e P) através de PCR específica. Do total, 41 (23%) amostras foram positivas para rotavírus. Os genótipos G mais prevalentes encontrados foram: G3, G8, G9 (cada 29%), seguidos de G10 (15%) e G11 (10%). Considerando que os genótipos P prevalentes foram: P-8 (25%), P-4 e P-10 (cada 20%), P-9 (15%), seguido por P-6 e P-11 (cada 10%). Além disso, a infecção por rotavírus foi mais prevalente no verão (23,73%) e inverno (22,7%) do que na primavera (20%) e no outono (21,4%). A infecção por rotavírus apresentou alta frequência em junho (14%), outubro (8%) e novembro (6%). Conclui-se que o rotavírus é mais prevalente em crianças e vários genótipos (G e P) do rotavírus estão presentes na área de estudo. A falta de estudos, conhecimento e testes mais raros de rotavírus são as principais razões da prevalência do vírus no distrito de Bannu, Paquistão.

Molecular detection and prevalence of Rotavirus with acute gastroenteritis among the children of rural and urban areas

Abstract Rotavirus is the main infective agent of acute gastroenteritis (AGE) in children under the age of five years and causing significant morbidity as well as mortality throughout the world. The study was carried out to detect the prevalence rate, genotypes strain and risk factors of Rotavirus among the children of rural and urban areas of district Bannu Khyber Pakhtunkhwa Pakistan. A total of 180 stool samples were collected from children under the age of 5 years from two major hospitals of Bannu from January to December (2015). The samples were analyzed by Reverse-transcriptase Polymerase Chain Reaction (RT-PCR) for the detection of Rotavirus, positive samples were further processed for genotyping (G and P type) through specific PCR. Of the total, 41 (23%) samples were positive for Rotavirus. The most prevalent G genotypes found were: G3, G8, G9 (each 29%), followed by G10 (15%), and G11 (10%). Whereas the prevalent P genotypes were: P-8 (25%), P-4 and P-10 (each 20%), P-9 (15%), followed by P-6 and P-11 (each 10%). Moreover, Rotavirus infection was more prevalent in summer (23.73%) and winter (22.7%) than spring (20%) and autumn (21.4%). Rotavirus infection exhibited high frequency in June (14%), October (8%) and November (6%). It is concluded that Rotavirus is more prevalent in children and various genotypes (G and P) of Rotavirus are present in the study area. Lack of studies, awareness and rarer testing of Rotavirus are the principal reasons of virus prevalence in district Bannu, Pakistan.

Resumo O rotavírus é o principal agente infeccioso da gastroenterite aguda (AGE) em crianças menores de 5 anos e causa de morbidade e mortalidade significativas em todo o mundo. O estudo foi realizado para detectar a taxa de prevalência, cepa de genótipos e fatores de risco de rotavírus entre as crianças de áreas rurais e urbanas do distrito de Bannu Khyber Pakhtunkhwa, Paquistão. Um total de 180 amostras de fezes foi coletada de crianças menores de 5 anos de dois grandes hospitais de Bannu de janeiro a dezembro (2015). As amostras foram analisadas por reação em cadeia da polimerase transcriptase reversa (RT-PCR) para detecção de rotavírus; as amostras positivas foram posteriormente processadas para genotipagem (tipo G e P) através de PCR específica. Do total, 41 (23%) amostras foram positivas para rotavírus. Os genótipos G mais prevalentes encontrados foram: G3, G8, G9 (cada 29%), seguidos de G10 (15%) e G11 (10%). Considerando que os genótipos P prevalentes foram: P-8 (25%), P-4 e P-10 (cada 20%), P-9 (15%), seguido por P-6 e P-11 (cada 10%). Além disso, a infecção por rotavírus foi mais prevalente no verão (23,73%) e inverno (22,7%) do que na primavera (20%) e no outono (21,4%). A infecção por rotavírus apresentou alta frequência em junho (14%), outubro (8%) e novembro (6%). Conclui-se que o rotavírus é mais prevalente em crianças e vários genótipos (G e P) do rotavírus estão presentes na área de estudo. A falta de estudos, conhecimento e testes mais raros de rotavírus são as principais razões da prevalência do vírus no distrito de Bannu, Paquistão.

Clinical Profile of Severe Plasmodium falciparum and P. vivax Malaria in Jazan Region, Saudi Arabia

@#Introduction: Malaria is the most common and widely prevalent life-threatening infectious disease in tropical and subtropical regions where it causes high rates of morbidity and mortality. Despite the successful elimination of malaria transmission in most of Saudi Arabia, the Jazan region is still considered to be a malaria-endemic area. Therefore, this study aimed at investigating the clinical profile of severe Plasmodium falciparum and P. vivax malaria in Jazan region, southwestern Saudi Arabia. Methods: A total of 25 febrile patients who presented at Sabya General Hospital and were suspected of having severe malaria were included in this study. Blood samples were collected and examined for malaria by rapid diagnostic test and by Giemsa-stained thin and thick blood films. Clinical and laboratory analyses to identify severe malaria complications were performed at the hospital. Results: In all, 76% (19/25) of the participants were infected with P. falciparum and 24% (6/25) had P. vivax. The most common complications in both groups were prostration (48%) followed by jaundice (44%) and liver dysfunction (36%). The prevalence of severe anaemia was significantly higher (P = 0.031) among P. vivax-infected patients (50%) compared with P. falciparum-infected patient (5.3%). In falciparum-infected patients, those with severe parasitaemia had a higher risk of developing prostration compared with those with low-to-moderate parasitaemia (P = 0.038). Conclusion: Most cases were caused by P. falciparum which required proper monitoring and treatment. However, those with P. vivax exhibited severe symptoms similar to those with P. falciparum.

Genetic structure of the dengue vector Aedes albopictus (Skuse) from different developed settlements in Penang Island, Malaysia based on microsatellite markers

@#The medically important mosquito, Aedes albopictus is native to Asia and has become a major health concern in most Asian countries including Malaysia. Being recognized as a dengue vector, a clearer understanding of how mosquito populations are geographically connected, may therefore represent a profound yet significant understanding of control strategies. There are no documented reports on the genetic structure of Ae. albopictus populations from different developed settlements inferred from microsatellite DNA markers in Malaysia, particularly in Penang Island (Northern Peninsular Malaysia). Here, we assessed the molecular population genetics of Ae. albopictus in terms of their allelic variation, genetic diversity and population structure. A total of 42 mosquitoes were sampled from Jelutong, Batu Maung and Balik Pulau which represented urban, suburban and rural areas in Penang Island respectively and analysed for polymorphism at six microsatellite loci. All of the microsatellite markers were successfully amplified and were polymorphic, showing low genetic structure among geographic populations (FST= 0.0362). It is supported with admixture individuals observed in STRUCTURE and FCA and this suggests that high gene flow has been experienced between populations. These findings implicate passive dispersal through human-aided transportation; as a factor shaping the genetic structure of Ae. albopictus populations in Penang Island.

Endoscopic ultrasound-guided biliary drainage

Endoscopic ultrasound-guided biliary drainage (EUS-BD) is emerging as a safe and effective alternative for endoscopic BD. The advantage of multiple access points from stomach and duodenum allows EUS-BD in patients with altered surgical anatomy and duodenal stenosis. EUS-BD is also useful in patients with failed endoscopic retrograde cholangiopancreatography or difficult biliary cannulation. Depending on the access and exit route of the stent, a variety of EUS-BD procedures have been described. Trans-papillary as well as trans-luminal stent placements are possible with EUS-BD. Recent studies have shown a clinical success rate in excess of 90% and complication rates of < 15%. Prospective studies are needed to know the long-term results and relative efficacy of this technique.

A novel surgical procedure for papilla reconstruction using connective tissue graft and platelet rich fibrin: A case report

If the search for beauty is timeless, then having the perfect smile is always in style. One of the techniques to achieve that is regaining the lost interdental papilla. There has been a definitive void in the dental arena pertaining to papilla esthetic. Loss of interdental papilla prompts to phonetic, functional, and esthetic problems. Surgical techniques are multifarious, but are perplexing and very erratic. The refurbishment of the lost papilla is elusive. Previous attempts have been made to augment the interdental papilla using displaced flaps, connective tissue grafts and repeated inflammatory stimulation with diverse results. This clinical study was aimed to reconstruct the lost or blunted interdental papillae with connective tissue graft and plasma rich fibrin for esthetic purpose and for maintaining oral health with the objective to determine the extent to which the procedure can revert the maxillary esthetic.

Cytologic diagnosis of gastric submucosal lesions by endoscopic ultrasound‑guided fine‑needle aspiration: A single center experience in Saudi Arabia.

Background and Aims: Endoscopic ultrasound‑guided fine‑needle aspiration (EUS‑FNA) sampling has become standard practice for the diagnosis of submucosal gastrointestinal (GI) lesions. The aim of this study was to determine the utility of EUS‑guided FNA cytology in the diagnosis of deeply seated gastric mass lesions. Materials and Methods: Thirteen patients with deeply seated gastric mass lesions were diagnosed by EUS‑FNA. Adequate cytology material was present in all cases. Cell blocks were available in 10 cases. Surgical resections were performed in 8 cases. Immunohistochemical (IHC) studies were done on cell blocks in 9 cases and on 6 resected specimens. Seven cases has proved to be GI stromal tumors (GIST), in four of them, cell blocks were available, and resection for GIST was performed in 5 cases. IHC stains that were performed in cytology, as well as resection specimens, revealed similar results in each patient. Conclusion: EUS‑FNA cytology, when combined with a histologic assessment of cell blocks provides accurate and efficient tissue diagnosis of a wide variety of deeply seated gastric mass lesions.

Factors affecting albuminuria in diabetic patients at King Fahad Hospital in Almadinah Almunawwarah

To identify factors associated with development of albuminuria in diabetic patients. A hospital based case control study. Fifty diabetic nephropathy patients were compared with 100 diabetic patients without nephropathy. Data were collected using an interview questionnaire. Frequencies, percentages and mean were calculated. Chi-square test, T-test and Univariate logistic regression analysis were used. P < 0.05 was considered significant. An Univariate logistic regression analysis has shown significant associated factors including old age [OR = 8.1] [95%CI = 2.2-30.1], sex [male] [OR = 2.4] [95%CI = 1.18-4.99], the duration of diabetes mellitus above 10 years OR were 4.23 [95%C = 1.6-15.4], associated mild, moderate, and severe hypertension ORs were 5.2 [95%CI = 2.3-11.7], 5.1 [95%CI = 1.5-16.93] and 15.2 [95%CI = 1.4-158.1], respectively, cardiac disease [OR = 3.77] [95%CI = 1.6-8.7], using Angiotensin-Converting Enzyme Inhibitors [ACEIs] and Angiotensin II Receptor Blockers [ARBs] [OR = 8.1] [95% CI = 3.61-18.2], low triglyceride level [OR = 0.38] [95%CI = 0.10-0.81]. Six factors showed a significant positive relationship to the progression of albuminuria in diabetic patients. Older age and males were found to be predictors of high albuminuria. Also, cardiac disease, poor hypertension control, the use of ACEIs or ARBs were found to be predictors of higher albuminuria. Low triglyceride levels were significantly associated with low albuminuria. Higher levels of HbA1c showed less albuminuria while body mass index, smoking and retinopathy showed no association to the albuminuria

Nasal carriage of Methicillin‑resistant Staphylococcus aureus among healthy population of Kashmir, India.

Background: Nasal colonisation with community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is being increasingly reported, especially in places where people are in close contact and where hygiene is compromised. The aim of this study was to find out prevalence of methicillin resistant S.aureus (MRSA) colonising anterior nares of healthy subjects. Materials and Methods: Nasal swabs of healthy subjects were collected aseptically and cultured using standard microbiological protocols. Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method according to CLSI guidelines. Methicillin resistance was detected by cefoxitin disc diffusion method and confirmed by minimum inhibitory concentration (MIC) and amplification of mecA gene by PCR. Strain typing of MRSA strains was done by PFGE. Results: Out of 820 samples, S.aureus was isolated from 229 (27.92%) subjects. Of the 229 isolates, 15 were methicillin resistant. All S. aureus isolates were susceptible to vancomycin. Nasal carriage of MRSA was found to be 1.83% among healthy population. The isolates were found to be polyclonal by PFGE analysis. Conclusion: High prevalence of MRSA is a cause of concern and strategies to interrupt transmission should be implemented.

Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system

Open access endoscopy [OAE] decreases the waiting time for patients and clinical burden to gastroenterologist; however, the appropriateness of referrals for endoscopy and thus the diagnostic yield of these endoscopies has become an important issue. The aim of this study was to determine the appropriateness of upper gastrointestinal [GI] endoscopy requests in an OAE system. A retrospective chart review of all consecutive patients who underwent an upper gastroscopy in the year 2008 was performed and was defined as appropriate or inappropriate according to the American Society for Gastrointestinal Endoscopy [ASGE] guidelines. Endoscopic findings were recorded and classified as positive or negative. Referrals were categorized as being from a gastroenterologist, internist, surgeon, primary care physicians or others, and on an inpatient or out-patient basis. A total of 505 consecutive patients were included. The mean age was 45.3 [standard deviation 18.1], 259 [51%] of them were males. 31% of the referrals were thought to be inappropriate. Referrals from primary care physicians were inappropriate in 47% of patients while only 19.5% of gastroenterologists referrals were considered inappropriate. Nearly, 37.8% of the out-patient referrals were inappropriate compared to only 7.8% for inpatients. Abnormal findings were found in 78.5% and 78% of patients referred by gastroenterologists and surgeons respectively while in those referred by primary care physicians it was [49.7%]. Inpatients referred for endoscopy had abnormal findings in [81.7%] while in out-patients it was [66.6%]. The most common appropriate indications in order of frequency were "upper abdominal distress that persisted despite an appropriate trial of therapy "[78.9%],''persistent vomiting of unknown cause "[19.2%], upper GI bleeding or unexplained iron deficiency anemia [7.6%]. The sensitivity and specificity of the ASGE guidelines in our study population was 70.3% and 35% respectively. A large proportion of patients referred for endoscopy through our open-access endoscopy unit are considered inappropriate, with significant differences among specialties. These results suggest that if proper education of practitioners was implemented, a better utilization would be expected

Clinical predictors of resectability of pancreatic adenocarcinoma

Identifying patient-related factors as well as symptoms and signs that can predict pancreatic cancer at a resectable stage, which could be used in an attempt to identify patients at an early stage of pancreatic cancer that would be appropriate for surgical resection and those at an unresectable stage be sparred unnecessary surgery. A retrospective chart review was conducted at a major tertiary care, university hospital in Riyadh, Saudi Arabia. The study population included individuals who underwent a computed tomography and a pancreatic mass was reported as well as the endoscopic reporting database of endoscopic procedures where the indication was a pancreatic mass, between April 1996 and April 2012. Any patient with a histologically confirmed diagnosis of adenocarcinoma of the pancreas was included in the analysis. We included patients' demographic information [age, gender], height, weight, body mass index, historical data [smoking, comorbidities], symptoms [abdominal pain and its duration, anorexia and its duration, weight loss and its amount, and over what duration, vomiting, abdominal distention, itching and its duration, change in bowel movements, change in urine color], jaundice and its duration. Other variables were also collected including laboratory values, location of the mass, the investigation undertaken, and the stage of the tumor. A total of 61 patients were included, the mean age was 61.2 +/- 1.51 years, 25 [41%] were females. The tumors were located in the head [83.6%], body [10.9%], tail [1.8%], and in multiple locations [3.6%] of the pancreas. Half of the patients [50%] had Stage four, 16.7% stages two B and three, and only 8.3% were stages one B and two A. On univariable analysis a lower hemoglobin level predicted resectability odds ratio 0.65 [95% confidence interval, 0.42-0.98], whereas on multivariable regression none of the variables included in the model could predict resectability of pancreatic cancer. A CA 19-9 cutoff level of 166 ng/mL had a sensitivity of 89%, specificity of 75%, positive likelihood ratio of 3.6, and a negative likelihood ratio of 0.15 for resectability of pancreatic adenocarcinoma. This study describes the clinical characteristics of patients with pancreatic adenocarcinoma in Saudi Arabia. None of the clinical or laboratory variables that were included in our study could independently predict resectability of pancreatic adenocarcinoma. Further studies are warranted to validate these results.

accuracy of multi-detector row computerized tomography in staging rectal cancer compared to endoscopic ultrasound

Our aim was to evaluate the diagnostic accuracy of multi-detector row computerized tomography [MDCT] in staging of rectal cancer by comparing it to rectal endoscopic ultrasound [EUS]. We prospectively included all patients with rectal cancer referred to our gastroenterology unit for staging of rectal cancer from December 2007 until February 2011, 53 patients whose biopsy had proven rectal cancer underwent both MDCT scan of the pelvis and rectal EUS. Both imaging modalities were compared and the agreement between T- and N-staging of the disease was assessed. We staged 62 patients with rectal cancer during the study period. Of these, 53 patients met the inclusion criteria and were evaluated [25 women and 28 men]. The mean age was 57.79 +/- 14.99 years [range 21-87]. MDCT had poor accuracy compared with EUS in T-staging with a low degree of agreement [kappa = 0.26], while for N-staging MDCT had a better accuracy and a moderate degree of agreement with EUS [kappa = 0.45]. MDCT has a poor accuracy for predicting tumor invasion compared to EUS for T-staging while it has moderate accuracy for N-staging

Antioxidant and hepatorprotective activity of cordia macleodii leaves

This Investigation was undertaken to evaluate ethanolic extract of C.macleodii leaves for possible antioxidant and hepatoprotective potential. Antioxidant activity of the extracts was evaluated by four established, in vitro methods viz. 1,1-diphenyl-2picryl hydrazyl [DPPH] radical scavenging method, nitric oxide [NO] radical scavenging method, iron chelation method and reducing power method. The extract demonstrated a significant dose dependent antioxidant activity comparable with ascorbic acid. The extract was also evaluated for hepatoprotective activity by carbon tetrachloride [CCl[4]] induced liver damage model in rats. CCl[4] produced a significant increase in levels of serum glutamate pyruvate transaminase [GPT], serum glutamate oxaloacetate transaminase [GOT], Alkaline Phosphatase [ALP] and total bilirubin. Pretreatment of the rats with ethanolic extract of c. macleodii [100, 200 and 400 mg/kg po] inhibited the increase in levels of GPT, GOT, ALP and Total bilirubin and the inhibition was comparable with Silymarin [100mg/kg po]. The present study revealed that C. macleodii leaves have significant radical scavenging and hepatoprotective activities

Helicobacter pylori prevalence among medical students in a high endemic area

To evaluate the prevalence of Helicobacter pylori [H. pylori] among Saudi medical students. Volunteer medical students were randomly selected in the College of Medicine, King Saud University, Riyadh, Saudi Arabia from January 2005 to May 2005. A urea breath test [UBT] was performed for each medical student. Important demographic data was recorded. Each student had to answer a questionnaire on upper gastrointestinal [UGI] symptoms before the UBT. A total of 120 students were recruited [73 males [61%] and 47 females [39%]] with a mean age of 22.2 years [age varied from 18 to 28 years]. The prevalence of H. pylori was surprisingly low at 35%, compared to a previously reported high prevalence among the Saudi population [80%]. Thirty-one percent of medical students reported>/=1 UGI symptom with no significant differences between the positive and negative UBT results. Although there was a trend, there was no significant prevalence difference between the preclinical and the clinical group of students. We found a low prevalence of H. pylori in our young university medical student's population. The low prevalence of H. pylori in this young population may have important clinical and economic implications

Liaison psychiatry and referral rates among hospitalized patients

The study was conducted to assess the psychiatric co-morbidity among general hospital patients and their rate of referrals. Design: A hospital based descriptive observational study. place and duration of study: The study was conducted in a private teaching hospital for a period of 6 months. Method: All admitted patients in different disciplines were assessed on a structured proforma supplemented by detailed psychiatric interview on positive cases. Morbidity patterns were assessed on the basis of ICD-10 classification. The total referral record was also maintained and compared with the data of morbidity and the number of referred cases. Out of the total 487 patients seen, 180 patients were found to have psychiatric co-morbidity; depression outnumbered all psychiatric disorders followed by mixed anxiety depression and somatoform disorders. Married female formed the majority group and the vulnerable age was between 41 to 60 years. Large segment of patients belonged to the discipline of internal medicine with the lowest [12%] referral rate. Out of 121 patients, referred from department of psychiatry, 44% were seen by the department of medicine followed by the gynecology and other disciplines. There is generally a low referral rate despite significant mental health co-morbidity. Training is needed for non-psychiatrists and there is a need for development of consultation-liaison psychiatry services in hospitals

Accidental childhood poisoning in Ramadi city

A prospective study of 239 cases of accidental childhood poisoning admitted to Ramadi Maternity and Children Hospital in Ramadi City. Over 75% of cases were within 1-3 year age group with an equal male:female ratio. Kerosene was the most common substance ingested [45.6%], followed in decreasing order by drugs [30.96%], chemicals [12.13%], and unknown [11.3%]. Ingestion occurred with no symptoms in 25.5%, and mild-moderate and server clinical manifestations were 70.5% and 4.0% respectively. Twenty-eight [11.7%] of cases required antidotes. There was 1 fatal case. It is concluded that accidental childhood poisoning is an important cause of morbidity in Ramadi City. Appropriate preventive measures are recommended

study on the treatment of pulmonary tuberculosis in Al-Anbar governorate

Two antituberculosis, 6- and 9- month regimens were evaluated on 96 patients, from Al-Anbar governorate, with active tuberculosis. The patients received one of the two regimens and this was determined by the availability of drugs. 20 patients received the 9- month regimen [2SRH/7RH] which was based on daily administration of rifampicin [R, 600mg], isoniazid [H, 300mg] with addition of streptomycin [S, 0.75-1g] during the first two months. 76 patients received 6- month regiment [2SRHZ/4RH] which was based on the supplement of pyrazinamide [Z, 2g] during the first two months. 79 [82.3%] of patients were cured, with cure-rate of [85.5%] and [70%], defaulters 5 [6.6%] and 4 [20%], failure cases 5 [6.6%] and 1 [5%], and death 1 [1.3%] and 1 [5%] for the 6- and 9- month regimens respectively. It is concluded that the addition of pyrazinamide and giving treatment for 6 months rather than 9 months makes the treatment superior to the classical 9- month regimen without pyrazinamide in terms of efficacy and compliance