bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of Obesity to Adverse Events Among Patients With Mean 10‐Year History of Type 2 Diabetes Mellitus: Results of the ACCORD Study
Authors: Xing Zhenhua , Pei Junyu , Huang Jiabing , Peng Xiaofan , Chen Pengfei , Hu Xinqun
Published: December 2018

Background

Recent evidence from cohort studies and meta‐analyses suggests that the obesity paradox phenomenon may exist in patients with diabetes mellitus. The goal of this study was to assess the association between adverse events and obesity by using 2 different measures of obesity, body mass index (BMI; kg/m
2
) and waist circumference, in patients with a mean 10‐year history of type 2 diabetes mellitus.

Methods and Results

We used data from the
ACCORD
(the Action to Control Cardiovascular Risk in Diabetes) study to evaluate the relationship between obesity and adverse events in patients with a mean 10‐year history of type 2 diabetes mellitus. The primary outcome of this study was all‐cause mortality. Secondary outcomes were cardiac death, nonfatal myocardial infarction, and stroke. Patients who were class
III
obese with
BMI
≥40 had the highest risk of all‐cause mortality, followed by patients with class
II
obesity, whereas overweight patients had the lowest risk. We found significant correlations between
BMI
and waist circumference (
r
=0.802). We observed that the relationships between waist circumference and primary and second end points were much like the relationships between
BMI
and primary and second end points (J‐shaped relationship for all‐cause mortality, V‐shaped relationship for cardiac death, U‐shaped relationship for nonfatal myocardial infarction, and reverse linear relationship for noncardiac death).

Conclusions

No evidence of the obesity paradox was observed in patients with a 10‐year history of diabetes mellitus. Class
III
obese patients showed the highest risk of adverse events (all‐cause mortality, cardiac death, nonfatal myocardial infarction, and noncardiac death).
BMI
and waist circumference showed similar relationships with adverse events.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
00000620.
Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index
Authors: McCracken Courtney , Spector Logan G. , Menk Jeremiah S. , Knight Jessica H. , Vinocur Jeffrey M. , Thomas Amanda S. , Oster Matthew E. , St Louis James D. , Moller James H. , Kochilas Lazaros
Published: December 2018

Background

Prior research has focused on early outcomes after congenital heart surgery, but less is known about later risks. We aimed to determine the late causes of death among children (<21 years of age) surviving their initial congenital heart surgery.

Methods and Results

This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a US‐based registry of interventions for congenital heart defects (CHD). Excluding patients with chromosomal anomalies or inadequate identifiers, we matched those surviving their first congenital heart surgery (1982–2003) against the National Death Index through 2014. Causes of death were obtained from the National Death Index to calculate cause‐specific standardized mortality ratios (SMRs). Among 31 132 patients, 2527 deaths (8.1%) occurred over a median follow‐up period of 18 years. Causes of death varied by time after surgery and severity of CHD but, overall, 69.9% of deaths were attributed to the CHD or another cardiovascular disorder, with a SMR for CHD/cardiovascular disorder of 67.7 (95% confidence interval: 64.5–70.8). Adjusted odds ratios revealed increased risk of death from CHD/cardiovascular disorder in females [odds ratio=1.28; 95% confidence interval (1.04–1.58);
P
=0.018] with leading cardiovascular disorder contributing to death being cardiac arrest (16.8%), heart failure (14.8%), and arrhythmias (9.1%). Other major causes of death included coexisting congenital malformations (4.7%, SMR: 7.0), respiratory diseases (3.6%, SMR: 8.2), infections (3.4%, SMR: 8.2), and neoplasms (2.1%, SMR: 1.9).

Conclusions

Survivors of congenital heart surgery face long‐term risks of premature mortality mostly related to residual CHD pathology, heart failure, and arrhythmias, but also to other noncardiac conditions. Ongoing monitoring is warranted to identify target factors to address residual morbidities and improve long‐term outcomes.
Hemispheric Asymmetry of White Matter Hyperintensity in Association With Lacunar Infarction
Authors: Ryu Wi‐Sun , Schellingerhout Dawid , Ahn Hee‐Seung , Park Soo‐Hyun , Hong Keun‐Sik , Jeong Sang‐Wuk , Park Man‐Seok , Choi Kang‐Ho , Kim Joon‐Tae , Kim Beom Joon , Han Moon‐Ku , Lee Jun , Cha Jae‐Kwan , Kim Dae‐Hyun , Nah Hyun‐Wook , Lee Soo Joo , Cho Yong‐Jin , Lee Byung‐Chul , Yu Kyung‐Ho , Oh Mi‐Sun , Park Jong‐Moo , Kang Kyusik , Lee Kyung Bok , Park Tai‐Hwan , Park Sang‐Soon , Smith Eric E. , Lee Juneyoung , Bae Hee‐Joon , Kim Dong‐Eog
Published: December 2018

Background

White matter hyperintensities (
WMHs
) are commonly asymmetric between hemispheres but for unknown reasons. We investigated asymmetric
WMHs
associated with lacunar infarcts.

Methods and Results

A total of 267 consecutive patients with small first‐ever supratentorial infarcts (≤20 mm) were included. None had a relevant vascular stenosis.
WMH
asymmetry was measured based on the hemispheric difference of a modified Scheltens scale score (≥3 defined as asymmetric). We analyzed the association of the hemispheric
WMH
asymmetry with old silent lacunar infarcts or acute lacunar infarcts. We compared lesion frequency maps between groups and generated t‐statistics maps. The mean age of patients was 64 years, and 63% were men. Asymmetric
WMH
was more than 3‐fold as frequent (
P
<0.001) in the group with old silent lacunar infarcts (42%, 43/102) than in the group without old silent lacunar infarcts (15%, 24/165). In patients with left hemispheric dominance of
WMHs
, an acute lacunar infarct was more likely to be located in the left (versus right) hemisphere (74% versus 26%,
P
<0.001). In patients with right hemispheric dominance of
WMHs
, an acute lacunar infarct was more likely to be located on the right (versus left) hemisphere (81% versus 19%,
P
<0.001). Mapping studies showed that the side of hemispheric dominance of
WMHs
was associated with acute and silent lacunes on the same side.

Conclusions

These are the first data to show that asymmetric
WMH
s are associated with both old silent lacunar infarcts and acute lacunar infarcts ipsilateral to the greatest
WMH
burden. This suggests that the hemisphere with relatively large
WMHs
is more vulnerable to ischemia.
Role of ADTRP (Androgen‐Dependent Tissue Factor Pathway Inhibitor Regulating Protein) in Vascular Development and Function
Authors: Patel Maulin M. , Behar Amanda R. , Silasi Robert , Regmi Girija , Sansam Christopher L. , Keshari Ravi S. , Lupu Florea , Lupu Cristina
Published: December 2018

Background

The physiological function of
ADTRP
(androgen‐dependent tissue factor pathway inhibitor regulating protein) is unknown. We previously identified
ADTRP
as coregulating with and supporting the anticoagulant activity of tissue factor pathway inhibitor in endothelial cells in vitro. Here, we studied the role of
ADTRP
in vivo, specifically related to vascular development, stability, and function.

Methods and Results

Genetic inhibition of
Adtrp
produced vascular malformations in the low‐pressure vasculature of zebrafish embryos and newborn mice: dilation/tortuosity, perivascular inflammation, extravascular proteolysis, increased permeability, and microhemorrhages, which produced partially penetrant lethality. Vascular leakiness correlated with decreased endothelial cell junction components
VE
‐cadherin and claudin‐5. Changes in hemostasis in young adults comprised modest decrease of tissue factor pathway inhibitor antigen and activity and increased tail bleeding time and volume. Cell‐based reporter assays revealed that
ADTRP
negatively regulates canonical Wnt signaling, affecting membrane events downstream of low‐density lipoprotein receptor‐related protein 6 (
LRP
6) and upstream of glycogen synthase kinase 3 beta.
ADTRP
deficiency increased aberrant/ectopic Wnt/β‐catenin signaling in vivo in newborn mice and zebrafish embryos, and upregulated matrix metallopeptidase (
MMP
)‐9 in endothelial cells and mast cells (
MCs
). Vascular lesions in newborn
Adtrp

−/−

pups displayed accumulation of
MCs
, decreased extracellular matrix content, and deficient perivascular cell coverage. Wnt‐pathway inhibition reversed the increased
mmp9
in zebrafish embryos, demonstrating that
mmp9
expression induced by Adtrp deficiency was downstream of canonical Wnt signaling.

Conclusions

Our studies demonstrate that
ADTRP
plays a major role in vascular development and function, most likely through expression in endothelial cells and/or perivascular cells of Wnt‐regulated genes that control vascular stability and integrity.
Exercise Treadmill Testing in Moderate or Severe Aortic Stenosis: The Left Ventricular Correlates of an Exaggerated Blood Pressure Rise
Authors: Saeed Sahrai , Mancia Giuseppe , Rajani Ronak , Seifert Reinhard , Parkin Denise , Chambers John B.
Published: December 2018

Background

Exaggerated blood pressure response during exercise predicts future hypertension and cardiovascular events in general population and different patients groups. However, its clinical and prognostic implications in patients with aortic stenosis have not been previously evaluated.

Methods and Results

We retrospectively studied 301 patients with moderate to severe asymptomatic aortic stenosis (aged 65±12 years) who underwent echocardiography and a modified Bruce exercise treadmill test. An exaggerated blood pressure response was defined as peak systolic blood pressure ≥190 mm Hg. An abnormal blood pressure response (either blunted or exaggerated) was found in 58% of patients and abnormal left ventricular geometry in 82%. There was no difference in the rates of abnormal blood pressure responses between patients with moderate and severe aortic stenosis ([exaggerated blood pressure response: 21% versus 22%,
P
=0.876] and [blunted blood pressure response: 35% versus 40%,
P
=0.647]). Patients with exaggerated blood pressure response (21%) were more likely to be older, have hypertension, higher pretest systolic blood pressure, left ventricular ejection fraction and mass, and increased arterial stiffness (all
P
<0.05). In a multivariate logistic regression analysis, an exaggerated blood pressure response was associated with higher pulse pressure/stroke volume index (odds ratio 2.45, 95% confidence interval 1.02–6.00,
P
=0.037) and left ventricular mass (odds ratio 2.04, 95% confidence interval 1.23–3.38,
P
=0.012) independent of age, hypertension, aortic annulus and left atrium diameter, and left ventricular ejection fraction.

Conclusions

In those with aortic stenosis, exaggerated blood pressure was strongly related to higher resting blood pressure values, left ventricular mass, and increased arterial stiffness independent of hypertension.
Presentation, Management, and Outcomes of Acute Stroke in Palestine
Authors: Khatib Rasha , Jawaadah Assef M. , Khammash Umaieyh , Babiker Ahmed , Huffman Mark D. , Prabhakaran Shyam
Published: December 2018

Background

Stroke is a leading cause of death and disability in the Middle East. Data on the uptake of evidence‐based practices are limited in the region. We aimed to examine patterns of stroke presentation, management, and outcomes at public Palestinian hospitals.

Methods and Results

Comprehensive data from all patients with acute stroke admitted to 2 public hospitals in the West Bank of Palestine were prospectively collected. Acute stroke presentation patterns, in‐hospital evaluation and management, mortality, and stroke complications were evaluated. Data were available for 150 patients with acute stroke between September 2017 and May 2018. The mean (
SD
) age was 65 (14) years and 49% were women. Only 25% of patients utilized ambulance services for transportation to the hospital. All patient received head computed tomography scans, although few received other investigations such as magnetic resonance imaging (8%) or carotid Doppler (4%). Most patients with ischemic stroke received antiplatelet therapy (98%), although none received thrombolysis. Only 17% received physical therapy evaluation. In‐hospital mortality was 12%, 23% of patients had at least 1 poststroke complication, and the median modified Rankin Score at discharge was 4 (interquartile range, 2–5).

Conclusions

We identified high stroke mortality and discharge disability rates in Palestine. Key evidence‐based gaps were highlighted, suggesting opportunities for quality improvement.
Duration of Heightened Ischemic Stroke Risk After Acute Myocardial Infarction
Authors: Merkler Alexander E. , Diaz Ivan , Wu Xian , Murthy Santosh B. , Gialdini Gino , Navi Babak B. , Yaghi Shadi , Weinsaft Jonathan W. , Okin Peter M. , Safford Monika M. , Iadecola Costantino , Kamel Hooman
Published: December 2018

Background

The duration of heightened stroke risk after acute myocardial infarction (
MI
) remains uncertain.

Methods and Results

We performed a retrospective cohort study using claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries aged ≥66 years. Both acute
MI
and ischemic stroke were ascertained using previously validated
International Classification of Diseases, Ninth Revision, Clinical Modification
(
ICD‐9‐CM
), diagnosis codes. To exclude periprocedural strokes from percutaneous coronary intervention, we did not count strokes occurring during an acute
MI
hospitalization. Patients were censored at the time of ischemic stroke, death, end of Medicare coverage, or September 30, 2015. We fit Cox regression models separately for the groups with and without acute
MI
to examine its association with ischemic stroke after adjustment for demographics, stroke risk factors, and Charlson comorbidities. We used the corresponding survival probabilities to compute the hazard ratio in each 4‐week interval after discharge. Confidence intervals were computed using the nonparametric bootstrap method. Among 1 746 476 eligible beneficiaries, 46 182 were hospitalized for acute
MI
and 80 466 for ischemic stroke. After adjustment for demographics, stroke risk factors, and Charlson comorbidities, the risk of ischemic stroke was highest in the first 4 weeks after discharge from the
MI
hospitalization (hazard ratio: 2.7; 95% confidence interval, 2.3–3.2), remained elevated during weeks 5 to 8 (hazard ratio: 2.0; 95% confidence interval, 1.6–2.4) and weeks 9 to 12 (hazard ratio: 1.6; 95% confidence interval, 1.3–2.0), and was no longer significantly elevated afterward.

Conclusions

Acute
MI
is associated with an elevated risk of ischemic stroke that appears to extend beyond the 1‐month window that is currently considered the at‐risk period.
Just Price for PCSK9 Inhibitors: No less, No More
Authors: Nasir Khurram
Published: December 2018

See Article by
Ko et al
.
Using Ticagrelor to Prevent Recurrent Type 1 and Type 2 Myocardial Infarctions: Boon or Bane?
Authors: Bittl John A.
Published: December 2018

See Editorial by
Bonaca et al
Renal Biomarker and Angiostatic Mediator? Cystatin C as a Negative Regulator of Vascular Endothelial Cell Homeostasis and Angiogenesis
Authors: Benndorf Ralf A.
Published: December 2018

See Article by
Li et al
.
Post–Pericardiotomy Syndrome: Beware or Just Be Aware?
Authors: Pattakos Gregory , Omer Shuab , Jimenez Ernesto
Published: December 2018

See Article by
Lehto et al
.
Spark That Lights the Fire: Infection Triggers Cardiovascular Events
Authors: Santos‐Gallego Carlos G. , García‐Ropero Álvaro , Badimon Juan J.
Published: December 2018

See Article by
Cowan et al
The contribution of Ghanaian patients to the reporting of adverse drug reactions: a quantitative and qualitative study
Authors: Jacobs Tom G. , Hilda Ampadu H. , Hoekman Jarno , Dodoo Alexander N. O. , Mantel-Teeuwisse Aukje K.
Published: December 2018

Background

Under-reporting of adverse drug reactions (ADRs) is a major challenge for pharmacovigilance in Africa. This study sets out to assess the level of awareness of Ghanaian patients about ADRs and ADR-reporting and explores how different patients in Ghana recognize an ADR and the steps they take when they experience an ADR.

Methods

This was a two-part study consisting of a survey to quantify the awareness of Ghanaian patients on ADRs and ADR-reporting, and in-depth interviews to explore how patients recognize an ADR and the steps they take thereafter. Participants were selected from 28 health care facilities (HCF) in rural and urban areas in 4 out of the 10 administrative regions of Ghana. Chi-square tests were used to examine associations between demographic variables and i) awareness of ADRs and ADR-reporting, ii) ADR experience and iii) awareness of the Ghana Food and Drug Authority (Ghana-FDA) and its patient reporting system (PRS). Only participants that indicated they experienced an ADR were included for the in-depth interviews. Data was investigated for participants’ awareness of ADRs, ADR reporting and steps taken when they experience ADRs.

Results

Of the total 572 participants enrolled in the study, 14% indicated they were unaware of ADRs and were excluded. Of the remaining 491 participants, 38% had experienced an ADR, of which 67% reported the ADR, 68% of them reported it to a doctor. Only 3% of the 491 participants were aware of the Ghana-FDA’s PRS. The interview phase consisted of 33 patients who had experienced an ADR. Three key findings from the interview phase were; most participants recognized an ADR themselves, the symptoms of the ADR were the most mentioned reason for reporting and participants experienced a wide variety of obstacles in ADR-reporting.

Conclusions

Most Ghanaian patients appear unaware of or unable/unwilling to use formal national channels for ADR reporting like the Ghana-FDA PRS. Motivation for ADR reporting appeared mainly personal and not communal. These findings warrant further attention in order to increase patient reporting of ADRs.
Proximate and antioxidant activities of bio-preserved ogi flour with garlic and ginger
Authors: Olaniran Abiola F. , Abiose Sumbo H.
Published: December 2018

Background: Ogi from locally available cereals remains a relatively affordable complementary food in West Africa, but has a tendency to spoil due it high moisture content. This study explored effects of garlic and ginger as biopreservatives in ogi flour.

Methods: Ogi flour was prepared from sorghum and quality protein maize grains with different concentrations of garlic and ginger powder (2 and 4% w/w) by fermentation technique. These samples were stored for 16 weeks during which the total titratable acidity, pH, proximate composition, mineral content and total antioxidant activities were determined.

Results: The proximate compositions of bio-preserved ogi samples were relatively stable throughout storage. The addition of garlic and ginger slightly increased the ash (0.04%), crude protein and mineral contents (mg/ 100g) of the samples.  Magnesium (10.85-13.13 and 5.17-9.72); zinc (1.37-1.78 and 7.01-8.50), manganese (1.30-1.71 and 0.45-0.86) and iron (1.53-1.77 and 0.68-2.77) contents increased on addition (of garlic and ginger) to maize ogi and sorghum ogi flours respectively. The free radical scavenging activity; total phenolic and flavonoid contents increased correspondingly with the antioxidants activity.

Conclusion: Although not well known to ogi consumer, the bio-preserved ogi flours showed better nutritional values and have potential as a health food.
Nrf2-Mediated Antioxidant Activity of the inner bark extracts obtained from Tabebuia rosea (Bertol) DC and Tabebuia chrysantha (JACQ) G. Nicholson.
Authors: Garzón-Castaño Sandra C. , Lopera-Castrillón Iván A. , Jiménez-González Francisco J. , Siller-López Fernando , Veloza Luz A. , Sepúlveda-Arias Juan Carlos
Published: December 2018

Background: Several ethnobotanical and ethnopharmacological studies have shown the therapeutic potential of plants from the genus Tabebuia, which have long been used in traditional medicine in rural areas of South America, for the treatment of several human diseases. This study aimed to evaluate the Nrf2-mediated antioxidant activity of the inner bark extracts obtained from Tabebuia rosea and Tabebuia chrysantha.

Methods: The antioxidant activity of extracts obtained from the inner bark of T. rosea and T. chrysantha was evaluated using the Oxygen radical absorbance capacity (ORAC) technique. The effect of extracts on the viability of HepG2 cells was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) method. The translocation of Nrf2 to the nucleus after exposure of HepG2 cells to the extracts and controls (α-lipoic acid, curcumin and hydrogen peroxide) was evaluated using the Nrf2 transcription factor kit. Induction of the Nrf2-mediated antioxidant response gene (NQO1) was evaluated by real-time PCR.

Results: The ethyl acetate extract obtained from both species displayed the highest ORAC activity (12,523 and 6,325 µmoles Eq Trolox/g extract, respectively). In addition, the extracts had the ability to activate and to translocate Nrf2 to the nucleus, as well as to induce the expression of NQO1.

Conclusion: These results indicate that the ethyl acetate extracts obtained from the inner bark of T. chrysantha and T. rosea have an important antioxidant effect mediated by Nrf2 activation, and could be used as a new source of natural antioxidants.
Factors affecting age-appropriate timeliness of vaccination coverage among children in Lebanon
Authors: Mansour Ziad , Said Racha , Brandt Lina , Khachan Joseph , Rady Alissar , Fahmy Kamal , Danovaro-Holliday M. Carolina
Published: December 2018

Background: The effect of immunization does not only depend on its completeness, but also on its timely administration. Routine childhood vaccinations schedules recommend that children receive the vaccine doses at specific ages. This article attempts to assess timeliness of routine vaccination coverage among a sub-sample of children from a survey conducted in 2016.

Methods: This analysis was based on data from a cross-sectional multistage cluster survey conducted between December 2015 and June 2016 among caregivers of children aged 12-59 months in all of Lebanon using a structured survey questionnaire. The analysis used Kaplan–Meier curves and logistic regression to identify the predictors of age-appropriate immunization.

Results: Among the 493 randomly selected children, timely administration of the third dose of polio vaccine, diphtheria-tetanus-pertussis (DTP)-containing vaccine and hepatitis B (HepB) vaccine occurred in about one-quarter of children. About two-thirds of children received the second dose of a measles-containing vaccine (MCV) within the age interval recommended by the Expanded Programme on Immunization (EPI). Several factors including socio-demographic, knowledge, beliefs and practices were found to be associated with age-appropriate vaccination; however, this association differed between the types and doses of vaccine. Important factors associated with timely vaccination included being Lebanese as opposed to Syrian and being born in a hospital for hepatitis B birth dose; believing that vaccination status was up-to-date was related to untimely vaccination.

Conclusions: The results suggest that there is reason for concern over the timeliness of vaccination in Lebanon. Special efforts need to be directed towards the inclusion of timeliness of vaccination as another indicator of the performance of the EPI in Lebanon.
Dual sensory impairment among a cohort of older adults living in Ireland: A nested case-control study of the Irish Longitudinal Study on Ageing cohort
Authors: Cleary Eimear , McCallion Philip , McCarron Mary
Published: December 2018

Background: Little information is available on the implications of hearing loss, visual impairment and dual sensory impairment among older adults with an intellectual disability (ID) living in Ireland and this paper aims to address the health concerns associated with sensory impairment among this population. 

Methods: A representative sample of 753 persons aged 40 years and older at all levels of ID and full range of residential circumstances from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA) participants were matched with general older population TILDA participants on age, sex and geographic location within Ireland. Demographic data on samples included age, sex, visual impairment (yes/no), hearing impairment (yes/no) and dual sensory impairment (yes/no). For those with intellectual disability (ID) data was also gathered on level of intellectual disability, residence, needing assistance with activities of daily living (ADL) and instrumental activities of daily living, self-rated health, loneliness, doctor’s diagnosis of endocrine disease and of dementia and doctor’s report of two or more chronic health conditions. Bivariate analysis of associations between visual, hearing and dual sensory impairment with the measures of physical and mental health was completed and logistic regression analysis to generate adjusted odds ratios for associations between sensory impairment and physical and mental health conditions.

Results: As compared to the matched general population participants, in participants with ID dual sensory impairment was more often associated with poor self-rated health, limitations with two or more ADLs, loneliness and multimorbidity. People with ID were 4.4 times more likely to be multimorbid if they were visually impaired compared with an odds ratio of 2.4 in TILDA participants.

Conclusion: Previous studies found significant associations between hearing and visual impairment among older populations. Analysis here also suggests the burden of sensory impairment increases both with ID and then with level of ID
The epidemiology of tick in transmission of Enterobacteriaceae bacteria in buffaloes in Marshes of the south of Iraq
Authors: Khalaf Jenan Mahmood , Mohammed Ibrahim Abbas , Karim Abdulkarim Jafar
Published: December 2018

Aim: This study aimed to investigate the role of ticks in transmission of Enterobacteriaceae bacteria in buffaloes in marshes of the south of Iraq. Materials and Methods: This survey included 255 healthy and clinically ill buffaloes in marshes of the south of Iraq (Thi- Qar, Basra, and Misan provinces) between the periods from May 2017 to April 2018. Animals were clinically examined. Ticks, isolated from perineum and under tail, sent to the Department of Parasitology, College of Veterinary Medicine, University of Baghdad and University of Thi-Qar for taxonomy. Ticks were dissected, and all internal organs were removed aseptically by forceps to sterile tubes containing brain heart infusion broth and incubated at 37°C for 36 h and subcultured on blood and MacConkey agars at 37°C for 36 h. Biochemical tests including citrate, methyl red, indole, urease, triple sugar iron (H2S), motility tests, and Gram stain were performed. Results: Two species of ticks were identified. Hyalomma spp. (175; 68.63%) were significantly higher than Rhipicephalus spp. (80; 31.37%). Conversely, pathogenic bacteria in Rhipicephalus spp. (55; 68.75%) was higher than detected from Hyalomma spp. (113; 64.57%), but non-significant. The prevalence of Enterobacteriaceae bacteria in ticks on diseased buffaloes (110; 88.00%) was significantly higher than non-diseased (58; 44.61%). Escherichia coli (123; 73.21%) showed a significantly higher prevalence than Salmonella spp. (25; 14.88%) and Klebsiella spp. (15; 8.92%). There was no significant variation between Salmonella spp. and Klebsiella spp. The latter was significantly higher than Enterobacter spp. (5; 2.97%). The isolation rate of infected tick collected from buffaloes inhabiting marshes was 65 (66.32%), 45 (69.23%), and 58 (63.40%) from Thi-Qar, Basra, and Misan provinces, respectively, with no significant variation. July and August (71.05% and 72.97%) reported the highest among months, while November, December, January, and February recorded nil (0.00%). The summer season was significantly higher (72.72%) followed by autumn (62.06%) and spring (59.77%), while winter reported no any bacterial isolation (0.00%). Conclusion: The high prevalence of Enterobacteriaceae bacteria isolated from hard ticks supports the probability of transmitting these bacteria to buffaloes in marshes of the south of Iraq.
Phenotypic and genotypic drug resistance profile of Salmonella serovars isolated from poultry farm and processing units located in and around Mumbai city, India
Authors: Waghamare R. N. , Paturkar A. M. , Vaidya V. M. , Zende R. J. , Dubal Z. N. , Dwivedi A. , Gaikwad R. V.
Published: December 2018

Background and Aim: The extensive use of antimicrobials in poultry has led to an increase in bacterial multidrug resistance, and the emergence of multidrug-resistant nontyphoidal Salmonella is a global problem. This study was performed to detect antibiotic-resistant Salmonella serovars in poultry farming and processing environment.

Materials and Methods: A total of 956 various samples, comprising 432 farm origin, 324 poultry processing stage wise and environmental, and 154 product processing stages and environmental samples, were collected from poultry farms and processing units located in and around Mumbai city. Of a total of 71 recovered isolates, 42 randomly selected Salmonella isolates were subjected for antibiotic susceptibility testing by disk diffusion method and serotyping. A total of 31 serotypically confirmed isolates were characterized for the presence of tetA, tetB, blaTEM, and CTX-M gene.

Results: Higher resistance was recorded against Doxycycline (100%), followed by Oxytetracycline (97.62%), Neomycin (88.10%), Erythromycin (83.33%), Tetracycline (78.57%), and Ceftizoxime (35.71%). Resistance from 0.00 to 26.19 percent was found to antimicrobials, namely Norfloxacin (26.19%), Ampicillin (21.43%), Azithromycin (21.43%), Ciprofloxacin (19.05%), Colistin (4.76%), Streptomycin (16.67%), Cefotaxime (14.19%), Enrofloxacin (14.29%), Amoxyclav (14.29%), Gentamicin (7.14%), Chloramphenicol (4.76%), Amikacin (4.76%), and Ceftazidime (0.0%). Results demonstrate that the Salmonella Virchow dominated and all serotypes were found to carry Tetracycline resistance gene tetA, 5 isolates were found to be positive for blaTEM, whereas none of the isolates were carrying tetB and CTX-M gene.

Conclusion: This study revealed that there is a significant rise of Tetracycline resistance with the presence of tetA gene in Salmonella spp. which indicates selective pressure for adopting resistance against tetracycline group of antibiotics.
Nutrition quality and microbial content of buffalo, cow, and goat milk from West Sumatera
Authors: Melia S. , Yuherman . , Ferawati . , Jaswandi . , Purwanto H. , Purwati E.
Published: December 2018

The aim of this research was to determine the quality of fresh milk physically, chemically and microbiologically obtained from cow, goats and buffalo in West Sumatra. The research method applied was laboratory experimental to analyze nutritional value, the number of aerobic bacteria and lactic acid bacteria, isolating and identifying lactic acid bacteria. Results showed that the nutritional value of milk had meet the requirements of Indonesian National Standardization, but the total colony of aerobic bacteria was above the allowed threshold of 1 x 106 CFU/ml. In addition, each sample had a total colony of varied lactic acid bacteria (LAB). The lowest total LAB value obtained in cow's milk was 0.84±0.18 x107 CFU/ml, in contrast to buffalo milk and goat milk which had a higher total LAB of 36.8±17.57 x107 CFU/ ml and 57.25±8.89 x107 CFU/ml. However, all the colonies showed almost identical morphology of LAB isolates. It is concluded that fresh milk from West Sumatra contains LAB therefore sanitation control is still needed during handling of milk.
Ultrasonographic and vaginal cytological diagnostics of the Queen
Authors: Pertiwi A. P. , Tumbelaka L.I.T. A. , Ulum M. F.
Published: December 2018

Ultrasonography is a diagnostic method to image the conditions of reproductive organs and it could be supported by vaginal cytology to identify the activities of the ovaries by the types of vaginal exfoliate cells. The aims of this study was to observe reproduction organ through ultrasonography with supportive diagnostic with vaginal cytological assessment. A total of 10 individual queens were used in this study and then grouped into intact group (n=5) and spayed (ovariohysterectomy) group (n=5) based on the anamneses or their medical history. The vagina, cervix, uterus body and horns, and ovaries were imaged and measured by ultrasound. Vagina, uterine body and horn seem as pipe-like structures with hyperechoic outer lines. The lumen in uterine body and horn seem as a hyperechoic structure. The ovaries seem as round- or oval-shaped structures with anechoic follicles. The corpus luteal has thick wall and seen as anechoic in its centre part. The corpus albicans seems as a hyperechoic structure. The vagina of spayed queens seemed more corrugated than those intact queens. The cervix is seen as a hyperechoic structure linking the vagina and uterine body. Exfoliate vaginal epithelial cell types were then also be identified and counted on each queens. The results of vaginal cytology showed that proestrus occured in 3 intact queens, late metestrus in 1 intact and 3 spayed queens, anestrus in 1 spayed queen, and unidentifiable estrus stage in 1 intact and 1 spayed queens. Moreover, the morphology of cervix and uterine was affected by the activity of ovary.
Effectiveness of bioactive combinations of several plant substances to inhibit the growth of Escherichia coli and Salmonella sp.
Authors: Pasaribu T. , Sinurat A. P. , Wina E. , Purwadaria T. , Haryati T. , Susana I.W. R.
Published: December 2018

The use of antibiotic growth promoters (AGP) has been banned as feed additives in many countries, therefore the alternatives need to be found.  An in vitro experiment  was conducted to study the potential of combination of some plant extract to inhibit growth of pathogen bateria that normally occur in the poultry gastro intestinal tract.The combination of three plants bioactives (liquid smoke of cashew shells of Anacardium occidentaleor CLS, Phyllanthus niruri L. extract (EM), and Synzygium aromaticum extract (EDC) were formulated and evaluated for its effectiveness to inhibit growth of Escherichia coli and Salmonella sp. in vitro.The mixtures (KE) were then made in 3 different concentrations, i.e. 100 % KE, 50% KE, and 25% KE and studied their effectiveness to inhibit growth of E. coli or Salmonella sp. using microplate reader method. The results showed that the higher the concentration of the bioactive combination (KE100) the higher the ability to inhibit the growth of E. coli or Salmonella sp. The combination of bioactive substances CAM, EM, and EDC more effectively than Zn-bacitracin antibiotics to inhibit the growth of E. coli and Salmonella sp. The optimum concentration of KE with the similar effectiveness as the AGP was 25%. It was concluded that the combination of CAM, EM, and EDC was able to inhibit the growth of E. coli and even capable to eliminate the presence of Salmonella sp. In the biological assay, a combination of CAM, EM, and EDC either extract or powder form, high dose, medium or low does not affect the weight of the spleen, bursa fabricius, and blood profile. The best combination of CAM, EM, and EDC extracts to decreases the total bacterial population and E. coli was middle dose ie 0.0625% (extract) and 0.625% (powder). Likewise for live weight gain that was a good dose of extract or powder form can replace antibiotics. It was concluded that combinations of CAM, EM, and EDC had potential as a substitute for AGP in poultry feed, especially chickens.
Vaccination and diabetes mellitus type 1 in children
Authors: Vitebskaya Alisa V. , Malahov Alexander B. , Rtishchev Alexey Y.
Published: December 2018

Influence of vaccination on the risk of developing diabetes mellitus type 1 (DM1) has been studied by different researchers for several decades. In rodents, vaccination can prevent development of DM1. This review summarises existing literature and discusses the results of a 2016 meta-analysis, pertaining to vaccination and DM1. No vaccines appear to increase the risk of DM1. Additional investigations are needed to determine if vaccines can be considered protective against DM1.
Patients with DM1 are at increased risk of morbidities from controllable infections. Children with DM1 should receive regularly-scheduled vaccinations; choice of vaccines and inoculation with non-regular vaccines should be determined on an individual basis. We present basic principles surrounding vaccination in patients with DM1 and analyse the role of the paediatric endocrinologist in increasing vaccination uptake in children with DM1.
Autoimmune gastritis: comorbid pathology in type 1 diabetes
Authors: Derevyanko Olga S. , Ibragimova Liudmila I. , Ragimov Magomedkerim R. , Nikonova Tatiana V.
Published: December 2018

In recent years noted an increased number of patients with autoimmune diseases (AID), and the special attention deserves combination of several autoimmune pathologies collected in one patient, because such patients requires special tactics of management. Autoimmune diseases of the gastrointestinal tract are less researched and, nevertheless, prognostically unfavorable. Autoimmune gastritis (AIG) has a special place in other stomach diseases, which develops in the aggregate with type 1 diabetes. AIG is a chronic inflammation of the mucous membrane of the body of the stomach, leading to the appearance of atrophy and hypoxecretion. AIG is found in 510% of individuals in general population, with a higher incidence of AIG in patients with diabetes and other established autoimmune pathology.
AIG is asymptomatic at the early stage of the disease and clinical manifestations appear after the atrophic changes in the mucous membrane of the stomach develop. Since autoimmune gastritis does not have pathognomonic signs, it can manifest itself in hematological and oncological complications at later stages. This is why screening, early diagnosis, prevention and treatment are very important. Early diagnosis and prevention of AIG and its complications play the main role. This article provides an overview of the worldwide data dedicated to this issue.
Electrical activity in rat retina in a streptozotocin-induced diabetes model
Authors: Klochihina Ekaterina M. , Erdyakov Aleksey K. , Morozova Maria P. , Gavrilova Svetlana A. , Akhapkina Elena S. , Ivanov Evgeniy V. , Dzhemilova Zera N. , Artemova Ekaterina V. , Tokmakova Alla Y. , Koshelev Vladimir B. , Galstyan Gagik R.
Published: December 2018

Objectives: Diabetic retinopathy remains the major cause of blindness among the working-age population of developed countries. Considering this, experimental models of diabetes involving laboratory animals are important for assessing clinically significant methods to determine early pathologic alterations of the retina. The early detection of diabetic retinopathy in combination with a search for new pathogenetic targets will enable focusing on new strategies to limit the development of critical changes in the retina and to prolong retinal functioning during the development of diabetes mellitus.
Aim: This study aimed to define parameters of electroretinography test that identifies changes due to retinal impairment in diabetes.
Methods: Experimental diabetes was induced in Wistar rats by intraperitoneally injecting streptozocin (65 mg/kg; group DM). The control group (CB) received intraperitoneal injections of the vehicle, i.e. citric buffer. On each consecutive day of the experiment, all rats received insulin detemir (2 u/kg). Ophthalmoscopy and electroretinography were conducted before initiating the experiment and after 50, 58 and 66 days of injectin sptreptozocin.
Results: Amid 2u\kg insulin injection the glucose level in venous blood in DM group amounted to 30-40 mM. The ophthalmoscopy showed that the optic nerve disk paled by the 50th day, with its line erasing. During electroretinography, wave amplitude in oscillatory potential test tended to decrease. -wave latency of photopic system increased with -wave latency of photopic system and - and -waves latency of scotopic system not altering. In addition, the amplitude of rhythmic stimulation of 8 and 12 Hz decreased.
Conclusion: The most apparent parameters of electroretinography for modelling streptozocin-induced diabetes are wave amplitude during the oscillatory potential test, photopic B-wave latency and the amplitude of rhythmic stimulation. These results suggest that in diabetes, ischaemic injury is an important cause of early dysfunction of inner retinal layers.
Effectiveness prediction of Evogliptin treatment in type 2 diabetes mellitus in russian-korean population
Authors: Mosikian Anna A. , Babenko Alina Y. , Sevastyanova Yulia A. , Drai Roman V. , Shlyakhto Evgenij V.
Published: December 2018

Background: Individualized treatment has already become a part of a routine clinical care. Many data on the effectiveness prediction of commercially available DPP-4 inhibitors had been published, but not on the effectiveness prediction of evogliptin.
Aim: To reveal the clinical characteristics and metabolic predictors of better hypoglycemic response to evogliptin. Matherials and methods: We have conducted a retrospective study, based on the data of a randomized clinical trial comparing effectiveness and safety of evogliptin and sitagliptin in Russian and Korean subpopulations. We provide univariate linear regression models for separate subpopulations and a multivariate stepwise regression model for the combined subpopulation. HbA1c change after 24 weeks of evogliptin treatment was a primary endpoint and a dependent variable in the analysis.
Results: The decrease of HbA1c after 24 weeks of treatment with evogliptin in Russian subpopulation negatively correlates with triglycerides/HDL level (p = 0,046). In South Korean subpopulation it correlates positively with HbA1c level at baseline (p 0,0001). In order to increase the statistical power of the analysis the data of both populations were combined. According to the combined data, the decrease of HbA1c after 24 weeks of treatment with evogliptin positively correlates with HbA1c level at baseline (p0.0001) and log(HOMA-B) (p=0.0042), and it negatively correlates with log(triglycerides/HDL) (p=0.0057), blood phosphorous concentration (p=0.014) and statin treatment (p=0.044). No correlation of HbA1c change at week 24 was observed with body mass index, diabetes duration and blood C-peptide concentration. Patients able to achieve HbA1c7,0 % had higher HOMA-B (53.22 36.95 и 39.67 24.74, respectively, р=0.033) and were tend to have higher HDL concentration (1.36 0.28 и 1.26 0.26 mmol/l, respectively, р=0.076) and lower triglycerides to HDL ratio (0.87 0.70 и 1.48 0.95, respectively, р=0.079).
Conclusion: A patient, who benefits more when treated with evogliptin, has higher HOMA-B, lower triglycerides to HDL ratio and phosphorous concentration in the 1-2 quartiles of the normal range. Triglycerides to HDL ratio is, probably, a specific effectiveness predictor for Russian, but not for Korean subpopulation. These data prove the difference in effectiveness prediction for different drugs of DPP-4 inhibitors group and reveal the need of further investigation.
In vitro fertilization as a method of infertility treatment in women with type 1 diabetes mellitus
Authors: Misharina Elena V. , Tiselko Alena V. , Yarmolinskaya Maria I. , Kogan Igor U. , Abashova Elena I. , Borovik Natalia V.
Published: December 2018

Some patients with type 1 diabetes have anovulation, tubal occlusion, male factor and other causes of infertility which require IVF procedure.
We examined 20 women with type 1 diabetes, in which pregnancy occurred as a result of ART, at the stage IVF protocol planning, during pregnancy course and delivery. One of the patients underwent IVF procedure twice. Mean age of the patients who applied to the Department of assisted reproductive technologies was 336 years, duration of infertility varied from 3 to 15 years. Two patients were performed donor oocytes transfer (patients with Turner Syndrome and Swyer Syndrome). In 70% of patients the method of CSII was used. Assessment of carbohydrate metabolism was based on the level of glycated hemoglobin A1c (HbA1c), plasma glucose level measured at least 8 times a day and results of continuous glucose monitoring (CGM).
18 singleton pregnancies and three multiple gestations (dichorionic diamniotic twins) occurred as a result of IVF. In 12 women delivery occurred on the 3739th weeks of gestation, in 9 patients pregnancy was terminated on the 3436th weeks. In all the cases it was live birth. Birth weight above the 90th percentile had 6 newborns.
The role of newly diagnosed diabetes mellitus for poor in-hospital prognosis of coronary artery bypass grafting
Authors: Sumin Alexei N. , Bezdenezhnykh Natalia A. , Bezdenezhnykh Andrey V. , Osokina Anastasia V. , Gruzdevа Olga V. , Belik Ekaterina V. , Barbarash Olga L.
Published: December 2018

Background: The management of coronary artery disease in patients with type 2 diabetes (T2DM) who need myocardial revascularization is a great challenge.
Aims: To study the role of newly diagnosed T2DM in the development of in-hospital adverse outcomes after coronary artery surgery (CABG).
Methods: 708 consecutive patients underwent CABG were included. All patients without history of T2DM and with border fasting hyperglycemia underwent an oral glucose tolerance test.
Results: The screening allowed to diagnose T2DM in 8.9% and prediabetes in 10.4% of the study population. The the number of patients with T2DM increased from 15.2% to 24.1%, and with prediabetes from 3.0% to 13.4%. The total number of patients with carbohydrate metabolism disorders increased from 18.2% to 37.5%. The trend towards higher rate of in-hospital complications after CABG was defined among patients with newly diagnosed and previously diagnosed T2DM. The regression analysis demonstrated the presence of the relationships between the previously diagnosed T2DM and the total number of significant complications (odds ratio (OR) 1.350, 95% confidence interval (CI): 1.0571.723, p=0.020) and prolonged in-hospital stay (OR 1.609, 95%CI 1.2022.155, p=0.001). The significance of these relationships increased with the addition of newly diagnosed T2DM to the regression model (for in-hospital complications: OR 1.731, 95% CI 1.1312.626, p=0.012; for prolonged in-hospital stay: OR 2.229, 95%CI 1.4123.519, p0.001). Moreover, additional associations between T2DM and the risk of developing multiple organ dysfunction (OR 2.911, 95% CI 1.0727.901, p=0.039), urgent lower extremity surgery (OR 1.638, 95%CI 1.00915.213, p=0.020) and the need for extracorporeal correction of hemostasis (OR 3.472, 95%CI 1.04211.556, p=0.044) have been defined. Importantly, the presence of these associations would not have been identified without including newly diagnosed DM in the regression model.
Conclusion: The newly diagnosed T2DM affects the prognosis of CABG as well as the previously diagnosed T2DM. The obtained results suggest the importance of active preoperative T2DM screening.