May Measurement Month 2018: an analysis of blood pressure screening results from Pakistan.

The May Measurement Month (MMM) screening campaigns comprise an opportunistic assessment of the arterial blood pressure (BP) of Pakistani adults (≥18 years old) and evaluate the level of awareness and spectrum of the problem of hypertension and the associated risk factors. The prospective study was carried out in May 2018 in multiple medical screening camps at hospitals, pharmacies, and public areas with the help of local health care workers under ethical guidelines. The volunteers took BP measurements using OMRON digital BP devices, in a seated position, and three successive readings were noted after 5 min rest. The mean values of the second and third readings were attained. Data were analysed centrally by the MMM project management team and multiple imputations were performed, where BP readings were missing. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or in those taking antihypertensive medication. This study included 25 076 participants, of whom 14 726 (58.7%) were hypertensive. Among all hypertensives, only 11 681 were aware of their hypertension status. After imputation, age and gender standardization, mean systolic and diastolic BP were 129.8 mmHg and 82.9 mmHg, respectively. MMM17 data revealed that 55.2% of those screened were hypertensive in Pakistan, while in 2018 the proportion rose slightly to 58.7%. The prevalence of hypertension among those screened for MMM in Pakistan was high in both years. Although most patients with hypertension were treated, the majority remained uncontrolled. Further efforts to improve awareness and control are needed.

Effect of prosthetic framework material, cantilever length and opposing arch on peri-implant strain in an all-on-four implant prostheses.

AIM: To evaluate the effect of prosthetic framework material and cantilever length on peri-implant strain in mandibular all-on-four implant-supported prostheses with different types of arch antagonist forces. MATERIALS AND METHODS: Models simulating a completely edentulous mandibular arch fabricated in heat-cured acrylic resin were used. On the acrylic models, four implants were placed at regions 34, 32, 42, and 44 simulating all-on-four implant placements. Implant-supported screw-retained fixed prosthesis frameworks were fabricated using three different materials (cobalt-chromium, zirconia, and polyetheretherketone) and with three different cantilever lengths (zero mm, 15 mm, and 25 mm). Strain gauges were attached on the model at the buccal and lingual positions of each implant. Forces simulating opposing natural dentition, conventional complete denture, and the parafunctional habit were applied to the models. The peri-implant strain in each strain gauge was recorded. RESULTS: Least peri-implant strains (67 microstrains) were observed when forces simulating conventional complete dentures were applied on the models and the highest peri-implant strains (9091 microstrains) were observed when forces simulating parafunctional habit were applied. One-way ANOVA test followed by Tukey's post hoc analysis was performed to compare the mean deformation scores between different materials at 50 N load. The level of significance [P-value] was set at P < 0.05. Tests showed significant differences between zero mm and the other types in all the different materials, and also between 1.5 x AP and 2.5 x AP for Zirconia and Peek material at P = 0.02 & P = .008, respectively. The results showed that the type of framework material, cantilever length, and occlusal forces from the opposing arch influence the peri-implant strain in the bone in all-on-four implant-supported prostheses. CONCLUSION: Rehabilitation of a single, completely edentulous arch with implant-supported prostheses should consider the situation of the opposing arch. The choice of framework material, as well as the cantilever length, should be altered based on the forces from the opposing arch.

Renal Involvement as a Presenting Feature of Multiple Myeloma.

Renal involvement may be the presenting feature in a vast majority of patients with multiple myeloma and is one of the key for clinical manifestations of symptomatic multiple myeloma. The purpose of the study was to find out the pattern of renal involvement at the time of presentation of multiple myeloma and to explore its association with clinical, laboratory and pathologic features of these cases. This cross sectional study was conducted in the Department of Nephrology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from February 2016 to September 2017. Forty seven (47) patients of newly diagnosed multiple myeloma having renal involvement were included in the study. Multiple myeloma was diagnosed as per criteria proposed by the International Myeloma Working Group, 2003. Renal involvement was considered to be present when any one of proteinuria, microscopic haematuria, renal impairment or urinary tract infection (UTI) was found in the patient. Renal biopsy was done in suitable patients under ultrasound guidance after taking informed written consent. The pattern of renal involvement was detected and status of renal function was assessed and its clinical, laboratory and pathologic associations were analyzed. Data were managed by using computer based software, the Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp.). Median age at presentation was 59 years with the range of 37-76 years. Female (53.2%) was slightly predominant than male (46.8%) and male to female ratio was 1:1.14. Renal impairment, microscopic haematuria, proteinuria, nephrotic range proteinuria, urinary Bence Jones protein and UTI were found in 70%, 19%, 79%, 25%, 19% and 17% of patients respectively. Median serum creatinine and proteinuria were 256µmol/l and 1.24gm/day. Hypercalcaemia and Bence Jones proteinuria were detected in 36% and 27% of patients respectively with renal impairment which were statistically significant. The precipitating factors for renal impairment were NSAIDs use (67%), hyperuricaemia (49%), hypercalcaemia (36%), dehydration (27%), UTI (18%) and no identifiable factor (3%). Dialysis was required in 15% new myeloma patient. Renal biopsy and histopathological examination revealed myeloma cast nephropathy (30%), amyloidosis (30%), glomerulosclerosis (chronic kidney disease) (20%), monoclonal immunoglobulin deposition disease (MIDD) (10%) and interstitial nephritis with fibrosis (10%). Renal involvement was a common and severe complication of multiple myeloma. Renal impairment was strongly associated with hypercalcaemia, NSAIDs use, hyperuricaemia, Bence Jones proteinuria etc.

Chronic Inflammation and Cancer: Paradigm on Tumor Progression, Metastasis and Therapeutic Intervention.

As early as the 19th century, inflammation has been perceived to have a link with cancer but this perception has waned through the passing of time. In recent years however a renewed interest on inflammation and cancer connection stemming from different lines of work has been evolved that leads to a generally-accepted paradigm. In the tumor microenvironment, smouldering inflammation contributes to the proliferation and survival of malignant cells, angiogenesis, metastasis, subversion of adaptive immunity, reduced response to hormones and chemotherapeutic agents. Thus, this review will try to unravel and explain molecular events, mediators and regulators linking inflammation to cancer.

Supramolecular interaction of 6-shogaol, a therapeutic agent of Zingiber officinale with human serum albumin as elucidated by spectroscopic, calorimetric and molecular docking methods.

BACKGROUND: 6-Shogaol, one of the main bioactive constituents of Zingiber officinale has been shown to possess various therapeutic properties. Interaction of a therapeutic compound with plasma proteins greatly affects its pharmacokinetic and pharmacodynamic properties. PURPOSE: The present investigation was undertaken to characterize the interaction between 6-shogaol and the main in vivo transporter, human serum albumin (HSA). METHODS: Various binding characteristics of 6-shogaol-HSA interaction were studied using fluorescence spectroscopy. Thermal stability of 6-shogaol-HSA system was determined by circular dichroism (CD) and differential scanning calorimetric (DSC) techniques. Identification of the 6-shogaol binding site on HSA was made by competitive drug displacement and molecular docking experiments. RESULTS: Fluorescence quench titration results revealed the association constant, Ka of 6-shogaol-HSA interaction as 6.29 ± 0.33 × 10(4) M(-1) at 25 ºC. Values of the enthalpy change (-11.76 kJ mol(-1)) and the entropy change (52.52 J mol(-1) K(-1)), obtained for the binding reaction suggested involvement of hydrophobic and van der Waals forces along with hydrogen bonds in the complex formation. Higher thermal stability of HSA was noticed in the presence of 6-shogaol, as revealed by DSC and thermal denaturation profiles. Competitive ligand displacement experiments along with molecular docking results suggested the binding preference of 6-shogaol for Sudlow's site I of HSA. CONCLUSION: All these results suggest that 6-shogaol binds to Sudlow's site I of HSA through moderate binding affinity and involves hydrophobic and van der Waals forces along with hydrogen bonds.

Risk factors of hemorrhagic and ischemic stroke among hospitalized patients in Bangladesh--A case control study.

The risk factor profiles, management and outcome have significant difference between stroke subsets. Aim of this study was to investigate the risk for the two most common subtypes of stroke in Bangladeshi population. Seventy cases of hemorrhagic stroke (HS) and 105 cases of confirmed ischemic stroke (IS) were recruited from the Shaheed Suhrawardy Medical College Hospital (ShSMCH) and Dhaka Medical College Hospital between January-June 2011. Total 171 age, sex matched controls were selected from the hospitalized patients with history of no stroke ever. Average hemorrhagic stroke patients (60.4 ± 12.3 years) were younger than both ischemic strokes (63.5 ± 13 years). Family history of premature cardiovascular death was found more in HS patients (p = 0.001). Multivariate logistic regression showed, in IS model 'less fruit consumption (OR 4.6), table salt intake (OR 8.15), psychosocial stress (OR 3.5), abnormal ECG (OR 3.6) and Increased WHR (OR 6.9) appeared as significant predictors adjusted for all potential candidate confounders. In HS model less fruit consumption (OR 5.0), table salt intake (OR 9.9), Stress (OR 4.1), family history of cardiovascular disease (CVD) death (OR 11.3), hypertension (OR 43), aspirin intake (OR 4.5) and increased WHR (OR 3.7) remained as significant predictors.

Evaluation and comparison of dimensional accuracy of newly introduced elastomeric impression material using 3D laser scanners: an in vitro study.

AIM: Aim of the present study was to comparatively evaluate dimensional accuracy of newely introduced elastomeric impression material after repeated pours at different time intervals. MATERIALS AND METHODS: In the present study a total of 20 (10 + 10) impressions of master model were made from vinyl polyether silicone and vinyl polysiloxane impression material. Each impression was repeatedly poured at 1, 24 hours and 14 days. Therefore, a total of 60 casts were obtained. Casts obtained were scanned with three-dimensional (3D) laser scanner and measurements were done. RESULTS: Vinyl polyether silicone produced overall undersized dies, with greatest change being 0.14% only after 14 days. Vinyl polysiloxane produced smaller dies after 1 and 24 hours and larger dies after 14 days, differing from master model by only 0.07% for the smallest die and to 0.02% for the largest die. CONCLUSION: All the deviations measured from the master model with both the impression materials were within a clinically acceptable range. CLINICAL SIGNIFICANCE: In a typical fixed prosthodontic treatment accuracy of prosthesis is critical as it determines the success, failure and the prognosis of treatment including abutments. This is mainly dependent upon fit of prosthesis which in turn is dependent on dimensional accuracy of dies, poured from elastomeric impressions.

A comparative evaluation of flexural strength of commercially available acrylic and modified polymethylmethacrylate: an in vitro study.

AIM: The purpose of this study was to evaluate and compare the flexural strength of commercially available acrylic (trevalone) and modified polymethylmethacrylate (PMMA). MATERIALS AND METHODS: Four groups were tested; Group 1- control group regular MMA, group 2-2% methacrylic acid, 88% MMA, group 3-16% methacrylic acid, 84% MMA group 4- 20% methacrylic acid, 80% MMA 15 resin specimens of each group were polymerized. After processing, the specimens were subjected for flexural strength testing using three point bending test in a Universal Testing Machine. All data was statistically analyzed with one-way ANOVA, differences within the groups were analyzed by Scheffe's analysis. RESULTS: As the ratio of incorporated methacrylic acid to PMMA increased, the flexural strength decreased. Analysis of data revealed a significant decrease in flexural strength of specimens (p < 0.000) after incorporation of 12%, 16%, 20% methacrylic acid to heat polymerized acrylic resin, when compared with the control group. Lowest flexural strength was observed with specimens containing 20% methacrylic acid and highest flexural strength was observed with specimens containing conventional monomer without methacrylic acid. CONCLUSION: It was observed that as the concentration of methacrylic acid in heat polymerized acrylic resin increases, the flexural strength decreases. Lowest flexural strength was observed with specimens containing 20% methacrylic acid and highest flexural strength was observed with specimens containing conventional monomer without methacrylic acid. CLINICAL SIGNIFICANCE: The major advantages of addition of methacrylic acid to polymethylmethacrylate could be for the elderly people with restricted manual dexterity or cognitive disturbances, especially for patients who do not follow an adequate denture cleansing protocol and diabetic patients who are more susceptible for denture stomatitis.

Stand stratification and woody species diversity of a subtropical forest in limestone habitat in the northern part of Okinawa Island.

Stand stratification and woody species diversity were studied in a subtropical forest in limestone habitat in the northern part of Okinawa Island, Japan. The forest stand consisted of four architectural layers. Cinnamomum japonicum Sieb. was the most dominant species as it had the highest importance value in all layers, especially in the lower three layers. Although Rhus succedanea L. was a major top-layer species, it might disappear because of its absence in the lower two layers. The lower two layers had similar floristic composition, while the composition of the top layer differed greatly from that of the lower two layers. The value of H' in each layer increased from the bottom to the second layer and then decreased, and the value of J' in each layer consistently increased from the bottom layer upward. The values of Shannon's index H' and Pielou's index J' were 4.27 bit and 0.74, respectively, at the stand level. The trends of H' and J' based on the cumulative height range from the top layer downward were, respectively, the same as those in each layer for the present forest in limestone habitat. However, these trends were opposite from those of a nearby subtropical forest in silicate habitat, where the values of H' and J' based on the cumulative height range decreased steadily from the bottom layer upward.

Stand structure and woody species diversity in relation to stand stratification in a subtropical evergreen broadleaf forest, Okinawa Island.

Stand structure and woody species diversity in a subtropical evergreen broadleaf forest grown in a silicate habitat, Okinawa Island, have been investigated on the basis of stand stratification. The forest stand consisted of four layers. The floristic composition of the top and the lower three layers was only slightly similar, although approximately one-third of the species were common to them. Mean tree weight decreased from the top toward the bottom layer whereas tree density increased from the top downward. This trend resembled the mean weight-density trajectory of self-thinning plant populations. The relationship between mean tree height and tree density for the upper two layers supported Yamakura's quasi -1/2 power law of tree height. The values of the Shannon-Wiener index, H', and the equitability index, J', tended to increase from the top layer downward except for the bottom layer. The values of H' and J' were, respectively, 4.83 bit and 0.82 for trees taller than 0.10 m. The lower layers contained many species of smaller height. High species diversity of the forest depended on small trees in the lower layers. Conservation of small trees in the lower layers, especially the bottom layer, is indispensable for sound maintenance of Okinawan evergreen broadleaf forests.

Treatment of metallic effluents using coconut shell coke.

The effect of various parameters on the removal of metal ions (Zinc and Cadmium) by adsorption using coconut shell coke is investigated. The time of contact, initial metal ion concentration, adsorbent dosage, volume of the adsorbate solution, size of the adsorbent particle and the effect of the presence of another metal at various concentrations are the parameters studied. The adsorption isotherms so obtained in this study followed the Freundlich and Langmuir isotherms showing a marginal average deviation.