The household economic burden of non-communicable diseases in 18 countries

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. METHODS: Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. RESULTS: The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. CONCLUSIONS: Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs. (AU)

Source of metal contamination in sediment, their ecological risk, and phytoremediation ability of the studied mangrove plants in ship breaking area, Bangladesh.

Samples for sediment and two species of native mangrove plants were collected from seven sampling sites for assessing the level of metal contamination. Results of the studied metals displayed the order of pollution as Fe > Ti > Zr > Rb > Zn > Sr > Pb > Y > Cu > Cr > As accordingly. Geoaccumulation index and contamination factor revealed that the sediment samples were unpolluted to moderately polluted by Zn, Fe, Ti, Rb, Y, and Zr. Ecological risk factor depicted a pollution-free condition in the study areas. PCA, CA, and correlation coefficient indicated that the source of the metals in the environment was anthropogenic. Bioconcentration factor values were found to be below 1 in both plant species. Conversely, transfer factor values for most heavy metals were found to be >1 in both plant species, which reflects the phytoremediation ability of plants.

A prototype of novel agro-waste based column bed device for removal of textile dye Optilan Red.

The aim of the study was to assess the potentiality of an agro-waste (sugarcane bagasse) for removal of the textile dye (Optilan Red) using novel column based filtration unit with a packed column of chemically treated sugarcane bagasse. The treated and untreated sugarcane bagasse (biosorbent) were characterized by Fourier transform infrared (FT-IR) spectroscopy. Effect of initial dye concentration on percentage removal of dye, equilibrium adsorption of sugarcane bagasse, kinetic studies, breakthrough point equilibrium and desorption of dye from the column material were studied. An inverse dependence of initial dye concentration on percent removal of dye was observed, whereas the equilibrium adsorption (qe) showed a direct relationship with dye concentration. The time required for reaching breakthrough point was 120 min. Desorption of dye through alkali wash resulted in complete desorption after 1 h washing of the column for its reuse for next cycle. FT-IR analysis shows vibration in valence bands of the hydrogen bond of OH group, and the bands of intra-molecular and intermolecular hydrogen bonds, which results in interaction of treated bagasse with Optilan Red textile dye. The present study showed that more than 93% removal of the dye can be achieved in the concentration range 10-50 ppm (aqueous solution). The removal efficiency of the column remained almost unchanged for the treatment of dye-house wastewater spiked with the dye. The agro-waste based treatment process shows a considerable potential for a low-cost treatment of dye contaminated water.

The spectrum of pathological changes in breast cancer following neoadjuvant chemotherapy.

Breast cancer with advanced stage is common in Bangladeshi women. For the treatment of this deadly disease neoadjuvant chemotherapy (NAT) is the recent standard of care. NAT is useful for down-staging and to prevent micro-metastasis of tumour, on the other hand it causes variable clinical and pathological responses. This observational study was aimed to evaluate the morphological changes in neoplastic, nonneoplastic breast tissue and in the lymph nodes after NAT. To identify the clinical response and post operative histologic changes, this study prospectively selected 35 patients with locally advanced breast cancer treated with NAT. In these patients clinical response was assessed based on tumour size. Mastectomy specimens were collected and samplings were done in specific method. Majority (68%) of patients presented with breast lump measuring over 5cm with enlarged lymph nodes. After NAT the lump size reduced to <5cm and lymph nodes became nonpalpable in most (60%) of the patient. Complete clinical response (cCR) was observed in five patients. For histopathological evaluation, the tumour cellularity was semi quantitatively measured. Seventeen percent (17%) patient presented with 50% tumour cellularity in tumour bed. Most striking cytologic atypia was nuclear changes. The characteristic patterns of stomal changes were observed. Only 8 patients showed nonneoplastic breast tissue changes. In lymph nodes hyaline stromal scar was most commonly (23%) seen. This study observed that 2 patients had pathological complete response out of 5 clinically complete response patients. This study concluded that the knowledge of morphologic spectrum of treatment-induced breast tissue change is important for the pathologist to avoid misdiagnosis. This will help the clinician to take rational decision for management of the locally advanced breast cancer.

Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study.

Acute kidney injury (AKI) is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI) in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years) of either gender who developed AKI based on RIFLE criteria (using serum creatinine), 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively (P < 0.0001). There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward (P = 0.001). RIFLE-R was the most common AKI in medical (39.2%) and ICU (50%) wards but in the surgical ward, it was RIFLE-F that was most common (52.6%). Acute tubular necrosis was more common in ICU (P = 0.043). Most common etiology of HAAKI in medical unit was drug induced (39.2%), whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively). Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively (P = 0.003). Length of hospital stay in surgical, ICU and medical units were different (P = 0.007). This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

Von Hippel-Lindau disease in a pregnant lady.

Von Hippel-Lindau disease is a rare genetic disorder characterized by various tumours and cysts in the central nervous system and other viscera. Here a case was described in a young female who was pregnant at the time of initial presentation with the complaints of occasional headache, low back pain and pain in the upper abdomen. After the birth of a healthy baby she was admitted to the hospital and the CT scan of upper abdomen suggested a multiloculated pancreatic cyst. MRI of thoracolumbar spine revealed an intracanalicular extradural mass and CT scan of brain revealed a cerebellar cystic mass. The spinal and cerebellar masses both were diagnosed histologically as haemangioblastoma. After a month she underwent laparotomy with near total pancreatectomy. Microscopically it was a microcystic cystadenoma. Based on the clinical presentation, imaging and histopathology of spinal, cerebellar and pancreatic lesions as well as a family history of her father's death due to brain tumour the final diagnosis was Von Hippel-Lindau disease.

Nitrite reductase in Streptoccocus mutans plays a critical role in the survival of this pathogen in oral cavity.

BACKGROUND/AIMS: The mechanisms of nitric oxide (NO) production by bacteria in the oral cavity are still not clearly defined but salivary streptococci have been reported to generate NO. The aim of this study was to clarify the mechanism of nitrite metabolism and generation of NO by Streptococcus mutans, a major pathogen of dental caries. METHODS: We searched the genomic database of oral pathogens for nitrite reductase and used a polymerase chain reaction (PCR) to clone the nirJ gene from S. mutans GS5. His-tagged recombinant NirJ protein was expressed in Escherichia coli BL21 and characterized. We constructed a nirJ gene-disrupted mutant strain of S. mutans (DeltanirJ) to analyze the physiological significance of nirJ. RESULTS: S. mutans generates NO from nitrite, probably as a result of the possession of nitrite reductase. We cloned the nirJ gene from S. mutans GS5 by PCR. The recombinant NirJ protein catalyzed the reduction of nitrite with a K(m) value of 3.37 microM and a specific activity of 2.5 micromol/min/mg of protein at 37 degrees C. Biochemical analysis revealed that the nitrite-reducing activity of the mutant (DeltanirJ) strain was significantly lower than that of the wild-type strain. The growth of the mutant strain, but not of the wild-type strain, was strongly suppressed by the presence of physiological levels of nitrite ( approximately 0.2 mM) in saliva. CONCLUSION: These observations suggest that the elimination of nitrite and/or the generation of NO are important for the survival of S. mutans in the oral cavity.

Clinical experience of galantamine in dementia: a series of case reports.

OBJECTIVE: To use case studies to add the benefit of personal experience with galantamine to published literature and to demonstrate the type of patients that may benefit from this treatment. METHODS: We describe eleven patients, aged 57-90 years, fulfilling the consensus diagnostic criteria for probable Alzheimer's disease, mixed dementia, vascular dementia, Lewy body dementia or Parkinson's dementia. All patients were treated with galantamine that may enhance cholinergic function in the brain by inhibiting acetylcholinesterase and potentiating the effects of acetylcholine at nicotinic acetylcholine receptors. Clinical features were rated according to eight assessment scales in old age psychiatry and additional information was obtained from family and other carers. In some cases caregiver distress was measured. RESULTS: All patients described showed a general improvement in cognition and neuropsychiatric symptoms, although observed improvements and effects were not always reflected by the results of formal assessments. Several patients became more independent, particularly in their activities of daily living, and treatment was felt to have helped maintain independence in their home environment, either alone or with their family or carers. One man continued in employment. Adverse events included nausea and vomiting. CONCLUSIONS: Outcomes in this case series indicate that galantamine is well tolerated and highlight aspects of the different side-effect profiles of the anticholinesterase inhibitors. Subjective benefits were not always apparent from objective measures. These case studies demonstrate the type of patients that may benefit from galantamine.

Stromal sarcoma of breast: a case report.

A 34 years unmarried female was admitted with an ulcerated foul smelling growth in her right breast. On examination the fungating mass measured 17.5 cm x 15 cm in central and lower part of right breast involving the nipple and areola. The ulcer was covered with slough and rest part of the breast appeared bosselated. Her Hb was 4 g/dl and incision biopsy from the margin of the tumour showed histology of sarcoma. The patient was infused 6 units of blood and right sided total mastectomy was done. Histopathological examination confirmed it was a case of stromal sarcoma of breast. Chemotherapy was started with vincristine, adriamycin and cylophosphamide. The patient was doing well in next follow-up.

Protective effect of erythropoietin on the oxidative damage of erythrocyte membrane by hydroxyl radical.

Treatment of red blood cells with the copper (II) ascorbate system causes increased lipid peroxidation, increased membrane microviscosity, and phospholipid translocation with a concurrent decrease in cytosolic catalase and glutathione peroxidase activities. All these changes are prevented if the cells are treated with erythropoietin prior to the exposure to copper (II) ascorbate. The present investigation further indicates that the oxidative damage brought about by copper (II) ascorbate is due to generation of hydroxyl radical and that erythropoietin plays a unique role in protecting the membrane from oxidative damage.

Effect of oxidative stress and erythropoietin on cytoskeletal protein and lipid organization in human erythrocytes.

Phenylhydrazine (PHX)-mediated damage in human red blood cells has been assessed by monitoring the release of tyrosine from cell proteins as well as using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). PHX-treated red blood cells exhibited concentration- and time-dependent tyrosine release. ATP has no effect on the release of tyrosine. This observation is supported by SDS-PAGE pattern of RBC membrane proteins, which shows a correlation between tyrosine release and cytoskeletal protein degradation. PHX requires the presence of erythrocyte cytosolic fraction for the degradation, possibly due to the presence of a proteolytic enzyme in the cytosol. PHX treatment renders the membrane proteins susceptible to the proteolytic attack. Treatment of PHX-exposed erythrocyte with bee venom phospholipase A2 induces the translocation of phosphatidylserine (PS) and phosphatidylethanolamine (PE) to the outer surface of the cell membrane. At the same time, phosphatidylcholine (PC) was translocated towards the inner surface, altering the membrane phospholipid asymmetry. Interestingly, increased tyrosine production followed by translocation of phospholipids across the red blood cell membrane by PHX treatment is completely inhibited by 0.2 units of erythropoietin (EP). Our findings suggest that exposure of red blood cells to an oxidant like PHX causes degradation of cytoskeletal protein by an ATP-independent proteolytic pathway and this in turn allows the transbilayer movement of phospholipids across the cell membrane. EP, by scavenging the hydroxyl radicals produced during interaction of PHX with red blood cells, protects the erythrocytes from oxidative attack.

Periampullary carcinoma with bilateral ovarian cystadenoma in pregnancy.

We report a 30-year-old woman with periampullary cancer and a large left ovarian cystadenoma presenting during pregnancy with features of duodenal obstruction. She had a right benign ovarian tumor removed a year back. She delivered an intrauterine-growth-retarded live baby. Laparotomy in the postpartum period revealed an unresectable periampullary growth with hepatic metastasis and a left ovarian cystadenoma. The ovarian tumor was removed and a palliative gastrojejunostomy performed.

Determination of ammonia, ethanol and acetic acid in solution using membrane introduction mass spectrometry.

Methods have been developed to allow applications of membrane introduction mass spectrometry (MIMS) to monitor solution phase components of fermentation broths using electron ionization. The solutions are transported by flow injection analysis (FIA) through a direct insertion membrane probe, fitted with a silicone membrane in the sheet configuration. Analytes of interest pass through the membrane and are ionized by electron implant ionization. The compounds monitored are ammonia, acetic acid, and ethanol, with ammonia being detected as the monochloramine derivative which is generated at pH 10 upon addition of hypochlorite. Quantitation is achieved using external standard solutions. The dynamic range for the quantification of ammonia is 2-8000 ppm, and for ethanol and acetic acid 10-1000 ppm. This method provides rapid detection of analytes of interest, on-line monitoring capabilities, and the advantage of electron ionization. The introduction of samples into the mass spectrometer is achieved readily and automatically, the response time is a few seconds, and there are no memory effects.

Metronidazole hypersensitivity.

OBJECTIVE: To report a case of a possible hypersensitivity reaction induced by metronidazole. CASE SUMMARY: An Asian woman with a history of recurrent vaginitis had previously developed localized erythema while on intravaginal metronidazole and nystatin. While receiving oral metronidazole for treatment of a current bacterial vaginosis, she developed chills, fever, generalized erythema, and a rash within 60 minutes of the first dose. Treatment with diphenhydramine was instituted. The following day while in the hospital, the patient's condition worsened; she experienced shortness of breath and increased edema of the extremities. Methylprednisolone was administered with diphenhydramine and her condition improved over the next 5 days. The patient's vaginitis was treated with gentian violet and she was discharged on a tapering dosage of prednisone. DISCUSSION: Metronidazole-induced cutaneous reactions and systemic hypersensitivity reactions are reviewed. Alternatives to metronidazole and other potential cross-reactive drugs are suggested for the treatment of recurrent vaginitis. CONCLUSIONS: Although the patient's initial reaction to metronidazole represented a rare event, written documentation and communication in the patient's native language may have prevented the subsequent severe hypersensitivity reaction.

Effect of Cu(2+)-ascorbic acid on lipid peroxidation, Mg(2+)-ATPase activity and spectrin of RBC membrane and reversal by erythropoietin.

The effect of erythropoietin (Ep), a glycoprotein hormone, has been studied on lipid peroxidation induced by Cu2+ and ascorbate in vitro, Mg2+ ATPase activity and spectrin of RBC membrane. Our present investigation reveals that Cu2+ and ascorbic acid increases lipid peroxidation of RBC membrane significantly. It has further been observed that under the same experimental condition spectrin, a major cytoskeleton membrane protein, and Mg(2+)-ATPase activity of RBC membrane decrease significantly. However, exogenous administration of Ep completely restores lipid peroxidation and Mg(2+)-ATPase activity and partially recovers spectrin of RBC membrane.

Analysis of acrolein and acrylonitrile in aqueous solution by membrane introduction mass spectrometry.

Acrolein and acrylonitrile can be quantified directly at low levels in aqueous solution using membrane introduction mass spectrometry. Electron impact was used to generate positively charged ions and electron capture of the O-(2,3,4,5,6-pentafluorobenzyl)hydroxyl amine (PFBOA) derivative was used to generate negatively charged ions of acrolein in aqueous solutions. The origins of all ions in the mass spectra and product MS/MS spectra recorded using both ionization methods were assigned and a reaction scheme is given which accounts for the fragmentation of the PFBOA derivative. Detection limits were measured using multiple reaction monitoring in both the methods. With electron capture detection, acrolein could be detected without preconcentration at 10 ppb levels. Electron impact ionization and multiple reaction monitoring both allowed the measurement of acrylonitrile at levels as low as 10 ppb.

Detection of low molecular weight aldehydes in aqueous solution by membrane introduction mass spectrometry.

Membrane introduction mass spectrometry (MIMS) is used to detect low molecular weight aldehydes in aqueous solutions. The best sensitivity was obtained by aqueous phase derivatization of aldehydes with O-(2,3,4,5,6-pentafluorobenzyl)-hydroxylamine (PFBOA) and electron capture detection. This negative chemical ionization mass spectrometry procedure allowed the measurement of C(1)C(6) aldehydes at low concentrations in mixtures. The characteristic ion signals in the mass spectrum of the mixture were verified by examining the full mass spectra and product ion MS/MS spectra of the derivatives of individual aldehydes. A reaction scheme is proposed to explain the fragmentation pattern of the molecular anions (M(-.)) of the derivatives. The processes observed include loss of HF to form (MHF)(-.) ions which then competitively fragment by elimination of H(R)CN and NO(.) to produce ions of m/z 178 and (M-50)(-.), respectively. Multiple reaction monitoring was applied to establish the lower limits of detection. Formaldehyde could be detected without preconcentration at 1 ppb with S/N = 3/1. The detection limits of acetaldehyde, propanal and butanal were found to be 10 ppb and that of pentanal and hexanal were found to be 20 ppb. Response curves vs. concentration are linear in the ppb range. This method is not as readily applicable to the corresponding ketones.