Aphis glycines Matsumura; SBA) is the most economically damaging insect of soybean (Glycine max) in the United States. One previous study demonstrated that avirulent (biotype 1) and virulent (biotype 2) biotypes could co-occur and interact on resistant  and susceptible soybean resulting in induced susceptibility after 11 days of feeding. The main objective of this research was to employ RNA sequencing (RNA-seq) technique to compare the induced susceptibility effect of biotype 2 on susceptible and resistant soybean at day 1 and day 11 .Soybean aphid . Ten RNA datasets are reported with 266,535,654 sequence reads (55.2 GB) obtained from pooled samples derived from the leaves collected at day 1 and day 11 post SBA infestation. A comprehensive understanding of these transcriptome data will enhance our understanding of interactions among soybean and two different biotypes of soybean aphids at the molecular level.We investigated susceptible and  Aphis glycines Matsumura; SBA) is the most economically damaging insect pest of soybean (Glycine max) in the United States (US) [Rag1, biotype 3: virulent to Rag2, biotype 4: virulent to Rag1, Rag2 and Rag1 + Rag2) in the US [Rag1) and susceptible soybean, which is defined as induced susceptibility [Soybean aphid (tes (US) . In the tes (US) . Althougtes (US) . The deptes (US) , 5. Hostn the US –8. Initin the US –8. Howevn the US  demonstrtibility . Furthertibility  , and two SBA populations . A detaLeaf samples collected at day 1 and day 11 from resistant and susceptible cultivars  were used to isolate RNA using PureLink RNA mini kit . Isolated RNA was treated with TURBO™ DNase  to remove any DNA contamination, following the manufacturer’s instructions. The RNA samples from three replicates were pooled in equimolar concentration, and RNA-seq libraries were sequenced on an Illumina NextSeq 500 at 75 cycles. Ten RNA libraries were prepared and sequenced with the sequencing depth ranging from 24,779,816 to 29,72,4913 reads  were obtained from the Phytozome database and aligned using Salmon ver.0.9.1 [Quality control of reads was assessed using FastQC program (version 0.11.3) . The Faser.0.9.1  accesseder.0.9.1  . After trimming, over 99% of the reads were retained as the clean and good quality reads. Upon mapping these reads, we obtained high mapping rate ranging from 90.4 to 92.9%. Among the mapped reads, 85.8% to 91.9% reads were uniquely mapped. After filtering with 0.5 counts per million (CPM) in at least one sample and rlog transformation, a total of 37,468 genes  were retained for transformation (Data file 21). The hierarchical clustering based on 3000 most variable genes, sample distances  indicated that sample clustering followed the time points of sample collection . The correlation between the samples using the top 75% of genes showed in a range of 0.96–1 .https://www.qiagenbioinformatics.com/) and analysis guided by the reference genes could be used to study the differential gene expression for pooled samples with no replications.The quality filtering of downloadable raw fastq files is recommended before use. Kal’s z-test  integrat


Wickerhamomyces anomalus (strain KNU18Y3), Saccharomycopsis fibuligera (strain KNU18Y4), Papiliotrema flavescens (strain KNU18Y5 and KNU18Y6), Pichia kudriavzevii (strain KNU18Y7 and KNU18Y8), and Saccharomyces cerevisiae (strain KNU18Y12 and KNU18Y13). The pectin degradation index of S. fibuligera (strain KNU18Y4), W. anomalus (strain KNU18Y3), and P. flavescens (strain KNU18Y6) were higher compared to the others, at 178%, 160%, and 152%, respectively. The pectinase enzyme assays were made on two growth media: coffee pulp media (CPM) and synthetic pectin media (SPM). S. fibuligera (strain KNU18Y4) and W. anomalus (strain KNU18Y3) had great potential in producing polygalacturonase (PG) and pectin lyase (PL) compared to others in both media. However, S. cerevisiae strains (KNU18Y12 and KNU18Y13) produced higher pectin methylesterase (PME). Using MEGA 6 software, the phylogenetic trees were constructed to determine the evolutionary relationship of newly identified yeasts from our experiment and previously published yeast species. The sequences of the yeasts were deposited in the National Center for Biotechnology Information (NCBI) database.This experiment was carried out to identify and select pectinolytic yeasts that have potential use as a starter culture for coffee fermentation during wet processing. The coffee fruit was fermented for 48 h at 28 °C and a sample was taken from the fermented solution and spread onto yeast extract-peptone-dextrose agar (YPDA) media and incubated at 28 °C. A total of 28 yeasts were isolated, eight of which had the ability to produce pectinase enzymes. The species of those eight yeasts were molecularly identified and confirmed. These yeasts are  Coffee is one of the essential worldwide commodities, next to crude oil. Coffee is the major export commodity of around 60 tropical and subtropical countries ,2. EthioThe ultimate goal of fermentation is to remove the mucilage layer, which is made up of complex compounds. Mucilage is a sticky substance and adheres to the coffee pulp, and it comprised around 5% of the coffee cherries in dry matter basis . The mesThe microbial enzymes (pectinases) are responsible for the breaking down of pectin substances. Pectinases are enzymes, which degrade pectin substances and have great importance in the food industry. Reports indicate that microbial pectinases comprised the global food enzymes market by 25% . They hoThe search for microbial diversity during coffee processing is required to select microorganisms for starter cultures for the fermentation processes. The isolation and selection of microorganisms for coffee fermentation have significant scope in identifying additional source organisms. The ultimate objectives of this experiment were to isolate, identify, and characterize pectinolytic yeasts. We also evaluated their efficiencies in producing PG, PL, and PME using the synthetic pectin media (SPM) and the coffee pulp-culture media (CPM).−2, 10 −3, 10 −4, and 10 −5). Small droplets (30 µL) of the serially diluted solutions were plated onto YPDA (yeast extract-peptone-dextrose agar) media and spread using a glass rod. The cultures in Petri dishes were sealed with Parafilm to prevent contamination of undesired microorganisms. Then the cultures were incubated at 28 °C for four days. The pure culture was used to screen yeast isolates that have distinctive colonial morphologies. They were sub-cultured onto other new YPDA media. The morphological features of the yeast colony that were recorded were color (white and yellow), shape , surface , and elevation . The YPDA media was used to culture the yeast from all samples. The media compositions were: dextrose (20 gL −1), yeast extract (5 gL −1), peptone (10 gL −1), and agar (15 gL −1). To suppress the growth of bacteria, 0.1 gL −1 ampicillin powder was added into the media after autoclaving when the solution cooled to 50 °C. All chemicals for this experiment were purchased from Sigma Aldrich LLC .Ripened coffee cherries (20 kg) were harvested from well-managed coffee (Coffea arabica L.) trees that were grown in Chuncheon, Republic of Korea. The coffee cherries were depulped and naturally fermented in 50 mL plastic container at 28 °C without additional starter cultures for 48 h. Various wild yeasts responsible for enhancing spontaneous fermentation activity were expected on the coffee fruit. A sample solution was taken from the fermentation container and serially diluted (10 4 (0.05 gL −1), KH2PO4 (0.2 gL −1), (NH4)2SO4 (1 gL −1), CaCl2 (0.05 gL −1), MgSO4 (0.8 gL −1); yeast extract (1.0 gL −1); citric pectin (2.0 gL −1); and agar (15 gL−1). Enzyme activity was shown by the development of a clear color change (yellow color) around the colonies after flooding the plate with 50 mM potassium iodide–iodine solution.Pectinolytic activity was assessed using the protocol described by Schwan et al. . The yeaThe diameter of the yeast colonies and the pectin degradation zones were measured using a ruler after growing the yeasts on a Petri dish (YPDA + pectin) for five days. The degraded area showed a clear zone after flooding with iodine solution. The clear zone and colony diameters were used to compute the pectin degradation index (PDI), according to the following formula:7 cells. The yeasts were then identified by sequencing the 26S ITS rRNA region of the gene. The 26s rRNA universal primers were used (The yeasts were grown on yeast extract-peptone-dextrose (YPD) broth media for 48 h and the yeast cells were collected via centrifugation . The yeasts DNA that suitable for use as a template for polymerase chain reaction (PCR) amplification was extracted from approximately 1 × 10ere used . Purifie4, 1.0% KH2PO4, 1.0% (NH4)2SO4, and 0.5% CaCl2. The CPM was prepared by measuring 400 g of coffee pulp, including mucilage (Coffea arabica L.), and 0.5% glucose. The pulp was boiled using water for 10 min and adjusted to 1 L [4 cells mL −1 (4.0 Log colony forming unit (CFU) mL −1). The cultures were incubated at 28 °C for 96 h at 120 rpm and periodically sampled at 24, 48, 72, and 96 h. The supernatants were collected for PG, PL, and PME activity from both SPM and CPM growing conditions.The SPM was prepared with the following formulation: 10% citric pectin, 0.1% glucose, 0.5% MgSOd to 1 L . Active In addition, the fermentation characteristics of the CPM culture, such as yeast cells, pH, and °Brix, were regularly measured at 24-h intervals. Serial dilutions were prepared from the fermented solution and plated onto YPDA media. The living yeast colonies were counted using the Neubauer hemocytometer slide  and expressed in Log CFU value. A pH meter was used to measure the pH of the fermented solution. A refractometer  was used to estimate the °Brix of the media. All the above measurements were made in three replications regularly at 24-h intervals.The protein content of the coffee pulp used to make the CPM was analyzed using the protocol mentioned by Bradford , and bovw v−1) citrus pectin (85% esterified) in 0.5 M Tris–HCL, pH 6.8, and 1.0 mL of culture supernatant. The reaction mixture was incubated for 2 h at 40 °C. Then, 0.6 mL of 9% zinc sulfate and 0.6 mL of 0.5 M sodium hydroxide were added to discontinue the reaction. After that, using a centrifuge (6000 g for 5 min.), 5 mL of supernatant was collected from the mixture and combined with 3 mL of 0.04 M thiobarbituric acid, 2.5 mL of 0.1 M HCl, and 0.5 mL of distilled water. This mixture was boiled for 30 min then cooled to room temperature before reading the absorbance at 550 nm using a spectrophotometer. One unit of enzyme activity (U mL −1) of pectin lyase increased the absorbance by 0.01 units.The pectin lyase activity was estimated in the culture using the method described by Pitt  as modifw v−1) was added in 0.1 M citrate buffer, and the pH was adjusted to 5.0. Then, the reaction mixture was prepared using 1 mL of PG from the first buffer mixed with 1.5 mL of sample supernatant; this was followed by incubation for 1 h at 40 °C. The reaction was stopped by the addition of 1.5 mL of DNS [−1) was expressed as 1 mol of galacturonic acid liberated mL −1 min.The polygalacturonase activity was examined according to the protocol defined by Schwan et al. . A measuL of DNS . The mix−1 h −1.Pectin methylesterase was measured using the protocol introduced by Baracat et al.  with theAnalysis of variance (ANOVA) was computed for testing the significances of the experiment. Data were summarized in an Excel program and analyzed using SAS statistical software . Mean separation was done using Fisher’s Least Significant Difference.The fermentation of coffee cherries was done for 48 h with yeasts and other microorganisms that naturally existed on the coffee fruit. The samples were taken and spread on YPDA media to isolate the yeasts. A total of 28 yeasts were isolated during coffee fermentation using the wet-processing method. Among the isolated yeasts, eight of them showed pectinolytic activity after testing them on YPDA media enriched with citrus pectin. The isolated yeasts colonies were morphologically characterized according to their shape, color, elevation surface, and margin .S. fibuligera (strain KNU18Y4) at 178%. The PDIs of W. anomalus (strain KNU18Y3) and P. flavescens (strain KNU18Y6) were 160% and 152%, respectively  using universal primers . The phyp < 0.05) in living yeast cells were observed among the evaluated yeasts at different fermentation hours (S. cerevisiae KNU18Y13 were significantly higher (8.23 Log CFU mL−1) compared to other yeasts at 48 h fermentation. Among the tested yeasts, S. cerevisiae strain KNU18Y13 had a unique characteristic in terms of growth habit. It is a highly reproducible yeast compared to other yeasts and can ferment very quickly, with a noticeably high production of carbon dioxide. From the experimented yeasts, S. fibuligera showed low reproduction rates (at each fermentation period compared to others (p > 0.05) in living yeast cells at 72 and 96 h of fermentation among W. anomalus KNU18Y3, P. flavescens KNU18Y6, and S. cerevisiae KNU18Y13.The living yeast cells were counted at every 24-h interval. A significant difference (on hours . An incro others ). There S. fibuligera KNU18Y4 inoculated media. Comparatively, the pH of the CPM with the S. fibuligera KNU18Y4 continuously declined from the 24-h period to 96 h at a slow rate. In the P. flavescens KNU18Y5 inoculated treatment, the pH decreased from the initial fermentation until 48 h and began increasing at 72 and 96 h. During the first 24-h fermentation, the pH decreased at a higher rate compared to other fermentation hours.The protein content, the total sugar, and total pectin in the coffee pulp that was used to make the CPM were measured as dry matter, accounting for 14.30%, 12.45%, and 6.70%, respectively. The pH of fermented solutions was regularly monitored and recorded. The initial (0 h) pH of the CPM was adjusted at 5.72. The pH of the CPM continuously dropped starting from the initial hours of fermentation until 72 h and began increasing at 96 h in all yeasts except the W. anomalus KNU18Y3, S. fibuligera KNU18Y4, P. flavescens KNU18Y6, and S. cerevisiae (KNU18Y12 and KNU18Y13) strains inoculated CPM °Brix was declined below 1% at the end of 96 h fermentation. After 96 h fermentation, the °Brix of CPM was changed from 5.4 to nearly 1.0% in P. flavescens KNU18Y5 and P. kudriavzevii strains (KNU18Y7 and KNU18Y9). The lowest °Brix was recorded from W. anomalus KNU18Y3 inoculated CPM (0.40%) at the same time the pH was lower (4.75) compared to other treatments after 96 h fermentation.The °Brix of the CPM was measured from beginning to end of the fermentation process. The initial °Brix of the CPM was 5.4. There were significant differences among yeasts in reducing the °Brix contents during each fermentation period. The °Brix was continuously dropped in all fermentation treatments . During S. fibuligera KNUY18Y4 and W. anomalus KNU18Y3 were significantly (p < 0.05) higher compared to other yeasts during all fermentation periods in both CPM and SPM growth conditions , did not show a remarkable difference at 24 h in the CPM condition and it was 16.16 and 16.42 U mL −1, respectively  higher compared to the other yeasts at 24, 48, and 72 h fermentation, respectively, in both CPM and SPM  in producing PG at 48 and 96 h, respectively, in both media, and at 24 h in the SPM condition. However, at 72 h fermentation in both media and 24 h fermentation in the CPM condition, these two strains of P. flavescens did not show significant variation in producing the PG enzyme . Regardless of yeasts, the highest activity of P. kudriavzevii KNU18Y9 (6.98 and 6.67 U mL −1) and P. kudriavzevii KNU18Y7 (6.54 and 6.41 U mL −1) was found at 24-h fermentation in both media types  differences among the PME activity of yeasts at different fermentation hours in both the CPM and SPM growth conditions  in both media. The maximum PME activity of S. cerevisiae strains (KNU18Y12 and KNU18Y13) was 18.25 and 16.02 U mL−1 in CPM and it was 18.01 and 17.63 U mL−1 in SPM condition, respectively  in both media at 24, 48, 72, and 96 h of fermentation.There were significant (nditions . During ectively . Unlike th media . LikewisFermentation is an important step during coffee processing to remove the mucilage (sticky polysaccharide substance) form the parchment coffee. However, fermentation in wet processing is critical because it creates a diverse aroma and flavor beyond its natural flavor and taste. Pectinase enzyme accelerates tea fermentation by breaking down the pectin substance which presents in the tea leaves . PectinaXanthomonas sp., Bacillus sp. and in very few yeasts such as S. cerevisiae and Candida boidinii [Dioszegia sp., Phenoliferia glacialis and Tetracladium sp. isolates and the enzyme was identified as polygalacturonase [Bacillus subtilis strain Btk 27 was reduced as the incubation time extended more than 48 h. The pectinase enzyme production among yeasts was different. This indicated that the ability of the microorganism producing the pectinase enzyme varied among yeasts species and strains. We have identified a pectinase enzyme-producing S. cerevisiae (KNU18Y12 and KNU18Y13) during coffee fermentation by wet processing. Furthermore, we have identified two pectinolytic P. kudriavzevii yeast strains. Koffi et al. [S. cerevisiae YB14 and P. kudriavzevii YP13 yeasts that were able to produce the pectinase enzyme during cacao fermentation. However, pectinolytic P. kudriavzevii yeast was examined and showed a potential ability in producing PG enzymes during cacao mucilage fermentation [W. anomalus, was identified during a wet-processing method. The PL and PG activity W. anomalus in our experiment was significantly higher than other examined yeasts following S. fibuligera KNU18Y4. Martos et al. [W. anomalus from citrus peel. They also mentioned its maximal PG activity was at pH 4.5. However, in our experiment, we did not adjust the pH of the medium during fermentation activity, rather the pH and the enzyme activity was measured at 24 h interval. The pH was 4.93 after 24-h fermentation in W. anomalus inoculated media and the PG activity was higher compared to the rest other fermentation durations . The PG activity of yeasts produced in an optimum pH in the acidic region between 3.5 and 5.5 [W. anomalus is grouped as a biosafety level 1 organism that can grow under severe environmental stress conditions, such as high and low pH, high osmotic pressure, anaerobic conditions, and low water activity [Aspergilus niger pectinase enzyme production also increased [Pectinase enzyme is produced by several microorganisms. It was reported in bacteria such as boidinii . Pectinaturonase . In our turonase  the PL ai et al.  isolatedentation . In thiss et al.  reported and 5.5 . The W. activity . A studyncreased .S. fibuligera KNU18Y4 and two P. flavescens (KNU18Y5 and KNU18Y6) are being reported for the first time as pectinase enzyme-producing yeasts that are identified during coffee fermentation in the wet-processing method. The production of pectinase enzymes varies among the identified yeasts in our experiment. These variations might be associated with the difference of microorganism population  produce a higher PME. We have also identified two strains of P. flavescens (KNU18Y5 and KNU18Y6) and S. fibuligera KNU18Y4 that have not previously been reported as pectinase enzyme-producing yeast. Regarding the fermentation duration, the 24 and 48 h cultivation of the tested yeasts produced a higher PL enzyme in both media types. Comparatively, the PG and PME activity of all yeasts was high at 24 and 48 compared to 72 and 96 h fermentation. Generally, these yeasts have the potential to be used as a starter culture during fermentation of coffee. Additionally, these yeasts can also be used in the food industry for pectinase enzyme production. Isolation and identification of yeasts to develop starter cultures for coffee fermentation are relevant and should be continued in the future.In this study, we have isolated, identified, and characterized eight pectinase enzyme-producing yeasts during wet-processing methods of fermenting coffee. Out of the identified yeast,


The aim of this study was to investigate the effects of licorice extract supplementation on feed intake and digestibility, rumen function, blood indices and live weight gain of Karakul sheep. The results indicated that licorice extract supplementation in the diet at 4.5% of dry matter level had limited impact on rumen function but improved blood immunoglobulin and anti-oxidative status of Karakul sheep, without impairment of feed conversion efficiency or live weight gain.This study was designed to investigate the effects of licorice extract supplemented to a cottonseed hull-based diet on rumen function, blood indices and growth of Karakul sheep. Twelve rumen-fistulated 1.5-year-old sheep were blocked in pairs by live weight. Sheep within pairs were randomly allocated to feed either on a cottonseed hull basal diet (control group) or on a basal diet containing 4.5% of licorice extract on dry matter (DM) basis (supplemented group). Sheep were housed individually and fed for 60 days, with a 15-day adaptation period and a 45-day measurement period. Feed intake and live weight gain were quantified. Rumen and blood samples were taken during the measurement period. The DM intake was lower for the supplemented group than for the control group. The mean ruminal concentrations of total volatile fatty acid (VFA) and acetate and the ratio of acetate to propionate were lower, while the levels of propionate and butyrate were higher for the supplemented group than for the control group. Average daily live weight gain, digestible energy intake, apparent nutrient digestibility and feed conversion efficiency did not differ between the two treatments. The serum concentrations of immunoglobulin A and G were 2.1 and 1.8 times greater, and total antioxidant and superoxide dismutase increased by 1.8 and 1.2 times in the supplemented group compared with the control group. These results indicated that licorice extract supplementation in the diet at 4.5% of DM had a limited impact on rumen function but improved blood immunoglobulin and anti-oxidative status of Karakul sheep, without impairment of feed conversion efficiency or live weight gain. Glycyrrhiza uralensis) root extract as a feed additive, which has been investigated mainly in monogastrics over the last 15 years [−1 of licorice root extract  increased total immunoglobulin (Ig) concentration and, hence, improved the immunological status of Holstein heifer calves [The use of antibiotics as feed additives for livestock production has been restricted worldwide over the last decade. The restriction is due to the concerns over the spread of resistant pathological bacteria and the residues of antibiotics in animal products ,2. This 15 years ,7 and sc15 years . Furtherr calves . On the r calves . AlthougIn a previous in vitro study, we investigated the effects of adding a licorice extract (22% glycyrrhizin content) to the feed at different levels, i.e., 0.0%, 2.25%, 4.5%, 13.5%, 22.5% and 31.5% of dry matter (DM), on sheep rumen fermentation characteristics . The res4, 1% NaCl, 0.33% Na2SO4 and 0.1% vitamin premix  on DM basis  and (2) cottonseed hulls-based diet + 4.5% licorice extract on DM basis . The fistulae were made of silica gel with an internal diameter of 3.0 cm and length of 6.0 cm . All sheep were housed individually in metabolic cages (1.2 m × 1.5 m) and fed the experimental diet individually ad libitum twice a day at 8:00 a.m. and 8:00 p.m.. Sheep had free access to clean water throughout the experiment. The experiment was conducted over a period of 60 days, including 15 days for adaptation and 45 days for measurements.The experiment was conducted at the Animal Research Station, Tarim University , China, from 1 December 2009 to 30 January 2010. Twelve Karakul wethers with rumen fistulae installed when they were 1 year old, aged 1.5 ± 0.25 years (mean ± SD), were blocked in pairs by their initial live weights (29.4 ± 0.3 kg). Wethers within pairs were randomly assigned to one of two treatment groups: (1) cottonseed hull-based diet, containing 70% cotton seed hulls, 18.2% maize, 6.6% wheat bran, 3.0% soybean meal, 0.36% urea, 0.13% lime stone, 0.28% CaHPOglycyrrhizin content equivalent to 1.0% of DM. The licorice extract content of glycyrrhizin was determined using HPLC [The basal diet was formulated using typical feed ingredients sourced locally to meet animal requirements for 100 g of ADG, according to the Chinese Feeding Standard of Meat-Producing Sheep and Goats . A 50% ling HPLC .This study was approved by the Tarim University Animal Care and Use Committee. All procedures used in this study are in agreement with the Chinese Guidelines for the Care and Use of Animals for Research GB 14925, 2001) [925, 2001The DMI was measured daily for individual sheep by subtracting the feed refused from the feed offered and then correcting the result for DM content.Approximately 100 g of feed was sampled twice a day before each meal. Weekly samples were bulked, and a 10% subsample was oven-dried at 65 °C for 48 h to determine the DM content. The dried samples were ground through a 1 mm sieve  prior to chemical analysis. Gross energy was determined using the oxygen bomb calorimeter . Nitrogen (N) content was determined using the Kjeltec 8400 Analyzer Unit  and cupric sulfate and vitriolate of soda as catalyzers. Crude protein (CP) was calculated according to the equation of CP% = N% × 6.25. Neutral detergent fiber (NDF) and acid detergent fiber (ADF) were analyzed using the Fibertec M6 Fiber Analyzer . In NDF analysis, 3.0% lauryl sodium sulfate was used as a detergent, and 0.5 g of anhydrous sodium sulfate per 1.0 g sample was added. NDF and ADF were expressed ash-free [Over the measurement period of 45 days, fecal output was collected and quantified from each sheep twice a day before each meal. A metal mesh was installed under each pen to allow urine to drain through while collecting feces through an inclined net. The weekly feces were bulked for each sheep, subsampled and oven-dried at 65 °C for 48 h to quantify the DM content. Dried feces were ground through a 1 mm sieve  and analyzed for gross energy, N, NDF and ADF, using the same methods as described above for feed analysis.The live weights were measured before feeding in the morning on the first and final days of the measurement period. The ADG and feed conversion efficiency (FCE) were calculated for each sheep over the 45 days of the measurement period.g for 5 min at 4 °C, and the supernatants were then transferred into new tubes and frozen at −20 °C until analysis. For VFA analysis, 100 μL of the rumen supernatant was placed into a 2 mL Eppendorf tube, and 20 μL of the internal standard and 40 μL of metaphosphoric acid were added. The samples were then diluted 10 times with a 50:50 acetone/water diluent. The concentrations of acetate, propionate and butyrate were then determined as described by Chen and Lifschitz (1989) using a Gas Chromatographer  fitted with an SGE BP21 30 m × 530 μm × 1.0 μm wide-bore capillary column [2 pressure was 34.2 kPa, the column flow was 5.23 mL/min with 1:30 split ratio and N2 purge flow was 3.0 mL/min.A rumen fluid sample (~20 mL) was taken via a rumen fistula every two hours for 24 h on day 45 of the measurement period and filtered through two layers of cheesecloth. The pH of the filtered rumen fluid was measured immediately using a standard pH meter . A subsample (10 mL) was centrifuged at 20,000× y column . The GC g for 5 min at room temperature. Serum was collected and stored at 20 °C until analysis. Serum samples were thawed at 4 °C, bulked per sheep and analyzed using an Automatic Biochemical Analyzer  for total protein (TP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), immunoglobulin A(IgA), immunoglobulin G(IgG), total antioxidant capacity (T-AOC) and superoxide dismutase (SOD) using ELISA Kits  according to the instructions.Blood samples were collected from the vena jugularis before feeding at 8:00 a.m. on days 30 and 45 of the measurement period and then centrifuged at 1000× p < 0.05.GenStat 16 statistical software was used for statistical analysis. Initial live weight on day 0 of the measurement period was included as a covariate for the analysis of ADG and FCE using one-way ANOVA. Daily DMI, blood and feces measurements were averaged across the measurement days for each sheep, and the means were analyzed using one-way ANOVA. Rumen measurements at each sampling time were analyzed by repeated measurements in the animals as replicates. The significance of the treatment effect was declared when p < 0.001; p < 0.001), which was higher for the supplemented than for the control group at 2:00 a.m., 4:00 a.m., 10:00 a.m., 12:00 p.m, 2:00 p.m., 4:00 p.m. and 8:00 p.m., but lower at 10:00 p.m. and 12:00 a.m. , but both IgA and IgG were higher in the supplemented group than in the control group  in the supplemented than in the control group as well.No significant differences were found in TP, AST and ALT between the two groups (p < 0.05) in the control than in the supplemented group, whereas apparent nutrient digestibility, ADG and FCE did not differ between the two groups  , and a pBiophtum petersianum [Butyrivibrio fibrisolvens) and reduce the population of protozoa by reacting with cholesterol in the membrane of protozoa in the rumen [A licorice root extract supplementation reduced total VFA and acetate productions and increased propionate and butyrate productions compared to the control. Over a 24 h period, the supplemented group had a consistently higher butyrate content than the control group. This may be attributed to the high content of glycyrrhizin 22% of DM) in the licorice root extract fed to sheep. Similarly, Lila et al. 2005) reported a reduction in total VFA and acetate concentrations and an increase in propionate and butyrate concentrations in steers supplemented with saponin at 1.0% of DM . Further05 reporthe rumen , causing% of DM ihe rumen ,24. Thishe rumen   was added to a mouse diet. Furthermore, Sajjadi et al. (2014) showed that a 0.56% licorice (no saponin content reported) supplementation increased the immune response of female Holstein calves [In the current study, there were no differences observed in TP, AST and ALT between the two groups. Similar results were reported in serum AST and ALT when a 0.5% licorice root extract was supplemented . Immunogn calves . The higLicorice extracts have been known to improve the antioxidant capacity of animals . T-AOC a−1 licorice (~0.56% of the diet DM), compared with the un-supplemented group [In the present study, a licorice root extract supplemented to a cottonseed hull-based diet for Karakul sheep resulted in a decreased DMI. The reason behind this is unknown. A recent study showed no change in DMI of Hanwoo steers supplemented with 0.5% licorice compared with that of un-supplemented steers . Similared group . Howevered group ,31. TherDespite the reduction in DMI in the licorice root extract-supplemented group, no difference in ADG was observed between the two groups in this study. It is important to note that future work to investigate ADG should use young sheep in their growing phase. A higher number of sheep would also provide more power for the ADG analyses. Further, a 4.5% licorice root extract supplementation  had limited effects on the apparent digestibility of CP, NDF and ADF in the present study. This is in agreement with results of other plant extracts enriched in saponin supplemented to the diet of ruminants ,32,33.Supplementation of a 4.5% licorice root extract  to the diet of Karakul sheep reduced DMI without changing ADG, FCE, apparent nutrient digestibility and rumen fermentation and improved the immune and antioxidant status in sheep. Future studies are needed to confirm the effects of individual bioactive chemical compounds contained in licorice on sheep, as limited ruminant studies in the literature have reported the actual chemical composition of licorice or licorice extracts, making it difficult to compare different published studies.


Anemia is a common finding in cancer, which is caused by many factors. It is a major cause of morbidity in cancer patients, worsens disease status and impairs treatment outcome; however, little is known about the prevalence of anemia and associated factors among cancer patients during diagnosis in developing countries like Ethiopia. In response to this, we have conducted research with the aim of assessing the prevalence of anemia and associated factors among newly diagnosed patients with solid malignancy at Tikur Anbessa Specialized Hospital (TASH), Radiotherapy center, Addis Ababa, Ethiopia. p-value < 0.05 was taken as statistically significant.  Descriptive cross-sectional study was conducted from April to May 2014. A total of 422 newly diagnosed patients with solid malignancy attending Radiotherapy center, TASH were enrolled to assess anemia prevalence and associated factors. Data were coded, entered and analyzed using SPSS version16. Using logistic regression, chi squares, Odds ratio and 95% confidence intervals were computed to measure strength of association between variables. p-value < 0.05.  Out of 422 respondents, 285 (68%) were females and 153 (36%) of respondents fell into 35–49 age group with age range between 18 and 80 years and the median age of 45. Magnitude of solid cancers was gynecologic (28.9%), breast (22.7%), nasopharyngeal carcinoma (NPC) (7.6%), colorectal (7.1%), sarcoma (6.9%), head and neck (4.5%), thyroid (3.3%), hepatoma (1.9%), and others (17.1%). The overall prevalence of anemia across different tumor was 23% and higher anemia prevalence was noted in gynecologic (37.7%) and colorectal carcinomas (26.7%). The majority of the anemic patients (68%) remained untreated for anemia. The mean trigger hemoglobin for transfusion was 7.7 g/dl. About 83.5% of anemia was mild to moderate type. Performance status  and bleeding history  showed statistically significant association with occurrence of anemia with  Among solid cancers, gynecologic cancer remained the dominant one. Anemia prevalence was 23% in general, in which gynecologic and colorectal cancers were more prevalent. ECOG performance status and bleeding history showed a statistically significant association with the occurrence of anemia. Anemia is a condition that develops when there is no sufficient healthy red blood cell, which is characterized either by a reduction in HGB, RBC or HCT count below normal levels –4. As peCancer-related anemia may occur as a direct effect of neoplasm, by the sensitization of the immune system, or as a result of the cancer treatment whether surgery, radiotherapy or chemotherapy , 8. Cancγ, Il-6 and TNF-α that may be able to decrease HGB levels by hemolysis, suppression of erythropoiesis, and impairment of erythropoietin response of erythroid medullary precursors [Tumor cells are known to produce cytokines such as IL-1, interferon-ecursors , 12, 13.Blood loss can result from hemorrhage of the tumor itself  , 14 and Anemia is a major contributing factor to tumor hypoxia, which worsens the results of radiotherapy and chemotherapy, contributes to the progression of cancer and prolongs the duration of the treatment time and lessens the survival rate , 16, 18.The study was undertaken at Tikur Anbessa Specialized Hospital from April to May 2014, Addis Ababa, Ethiopia. Among the treatment-naïve newly diagnosed confirmed solid cancer patients visited the radiotherapy center during the study period, 422 study participants were determined with the help of a single population proportion. Patients on follow up for chemotherapy or radiotherapy or surgery, with confirmed hematologic malignancy, who took anemia correction treatment, were excluded from the study.Data on the socio-demographic and clinical characteristics of the study participants were collected using a pretested structured questionnaire by interview and review of medical records. About 4 ml of venous blood was collected by an experienced laboratory technologist from each study participant for HGB, MCV, MCH, and MCHC analyses. These parameters were determined using the hematology analyzer Cell-Dyn 1800 . To ensure the quality of data, pre-testing was done on patients being managed at the radiotherapy center before the study. The performance of the hematology analyzer was controlled by running quality control material alongside the study participant's sample. In addition, all flagged specimen was subjected to the manual differential to confirm the results.p-value < 0.05 was considered as statistically significant.The data were cleaned, edited, checked for completeness, processed, and then entered into Epi Info version 3.5.3 and transported to SPSS version 16 statistical software. Chi-square and Odd's ratio were computed to see association and relationships between prevalence and severity of anemia with risk factors. Ethical clearance and approval were obtained from Departmental Research and Ethical Review Committee of Addis Ababa University, Department of Medical Laboratory Science. Permission for the conduct of the study was also obtained from the University Hospital. After study participants were informed about the objectives of the study and assuring confidentiality of their data, written informed consent was taken from all the participants.Out of 422 respondents, 278 (66%) were females and the rest 144 (34%) were males. From the age category, the majority of respondents, 153 (36%) fell into 35–49 age group with age range between 18–80 years and a median age of 45. Two hundred twenty-seven (53.8%) and three hundred twenty-one (76.1%) respondents were urban dwellers and married, respectively. More than half of the respondents were illiterate and 156 (37.0%) patients were housewife .A total number of 422 cancer patients, who were first diagnosed at TASH, Radiotherapy center of Addis Ababa University during April–May 2014 were searched and enrolled for analysis. The types of cancer included were gynecologic (122 cases), Breast (96 cases), Nasopharyngeal (32 cases), colorectal (30 cases), Soft tissue sarcoma (29 cases), head and neck cancers (19 cases), thyroid (14 cases), hepatoma (8 cases), and other cancers (72 cases) .The hemoglobin level for the whole patients ranged from 4.6 g/dl to 18.9 g/dl with a mean of 12.6 ± 2.3 (mean ± SD). The mean hemoglobin for male patients was 13.3 ± 2.5 and for female patients, 12.2 ± 2.1 g/dl. More than 1/3 of the anemic patients (68%) remained untreated for anemia. Only 25.8% and 6.2 % of anemic patients were treated with transfusion and iron respectively. The mean trigger hemoglobin for transfusion was 7.7 ± 1.7  g/dl.Anemia was diagnosed in 97 of the 422 patients (23%) and mean concentration (± SD) of HGB was 13.5 ± 1.5 g/dl in 325 non anemic patients while that was 9.4 g/L ± 1.6 g/dl in 97 anemic patients. Overall, the prevalence of anemia at diagnosis of cancers was 23.0% in unclassified cancers, and higher anemia prevalence was noted in gynecologic (37.7%) and colorectal cancers (26.7%)  MajorityAmong the anemic solid cancer patients, anemia was morphologically categorized based on MCV and MCHC values using the cut off values in Accordingly, from the total anemic patients, half of anemia (50.5%) was normocytic anemia, in which normocytic normochromic is 22.7% and normocytic hypochromic is 26.8%, and others were (47.4%) microcytic anemia, in which microcytic hypochromic is 30.9% and microcytic normochromic is 16.5%), and macrocytic anemia (2.1%) .p-value < 0.05. Nevertheless, there was no statistically significant difference found in gender and age group among the severity of anemia .Patients with ECOG performance status of 3 were 3 times more prone to develop anemia than patients of 0 ECOG performance score  .Anemia in cancer patients observed as a result of the malignancy itself, anti-cancer treatment, blood losses, nutritional deficiencies, hemolysis, endocrine disorders, or inflammatory cytokines associated with chronic diseases. In our data, 422 treatment-naïve, newly diagnosed solid cancer patients in TASH, Radiotherapy center were included for this analysis. According to this study, the overall prevalence of anemia across different tumor was 23%, which is higher than the study conducted in China, 18.98% . HoweverAs our report revealed, the most common cases noted were gynecologic issues (28.9%) followed by breast carcinoma (22.7%), our results are similar to those of a study conducted in Thailand, where gynecologic (30.6%) and breast cancers (26.2%) scored the first two ranks among the observed tumor types .The prevalence of anemia was varied by tumor type. Our study demonstrated that 37.7% and 26.7% of gynecologic and colorectal cancer patients were anemic, respectively. This finding is lower with the report in Europe and Australia, which revealed 49.1% and 65% of gynecologic cancer patients were anemic at enrollment, respectively , 23. ThiFemales and elderly patients with ≥ 65 years ranked higher anemia prevalence rates. We found a similar result in China, Sudan, Belgium , 21, 26.Our study showed two factors were significantly associated with the occurrence of anemia, namely ECOG Performance score and bleeding history. Patients with ECOG Performance status 3 were 3.344 times at a higher risk of developing anemia than patients of 0 ECOG performance score, which is in agreement with the study done in the USA .Our study also indicated that patients with bleeding history were 4 times at a higher risk of developing anemia than those patients lacking bleeding history. This finding is similar to reports made in India and China , 19 whicIn our data, the majority of the anemia (83.5%) was mild to moderate type. The mean trigger hemoglobin level for initiating transfusion in our data was 7.7 g/dl, which is lower as compared to reports made in ACAS (9.5 g/dl), Thailand (8.6 g/dl), Thailand (9.3 g/dl) and ECAS (9.7 g/dl) , 23, 25.Regarding the anemia treatment patterns, our data showed that anemia was treated in 32% of patients with anemia. Our result was similar to the reports made in ECAS  and ACASAnemia prevalence was also varied by tumor types. Higher anemia prevalence was noted in gynecologic and colorectal carcinomas, 37.7% and 26.7%, respectively. The possible underlying justifications for this finding are because of the disorder of digestive function, unperceived and long term bleeding occurred in the colorectal tumor . The othp-value < 0.05. This finding is similar to a study done in China showing that patients with bleeding were more likely to have more severe anemia as compared to patients without bleeding [Our data also showed that bleeding history was found to be a risk factor for severity of anemia with bleeding . Gender The majority of the anemia in our study was hypochromic (59%), which was different from the study done in China , in whicOur study demonstrated that ECOG performance status and bleeding history showed a statistically significant association with the prevalence of anemia. This finding is similar to the result reported in China  (OR = 1.p < 0.05) with the occurrence and severity of anemia. The mean hemoglobin for initiating transfusion was 7.7 g/dl.In our study, the overall prevalence of anemia across different tumors is 23%. From the tumor types, gynecologic and colorectal scored higher anemia prevalence compared to others, which are 37.7% and 26.7%, respectively. Female and ≥ 65 aged patients showed a higher frequency of anemia when compared with male and < 65 aged patients. Our study also revealed that ECOG PS and bleeding history indicated statistically significant association (


Although histopathological diagnosis remains the gold standard; good clinical impression is potentially a key diagnostic tool in rural resource-limited settings. Thus, good concordance between clinical impression and histopathological diagnosis is thus a very crucial diagnostic oral pathology tool in low- and middle-income countries (LMICs).This retrospective study was performed at the Oral pathology and Oral diagnoses units of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Osun state. Clinicopathological reports of all biopsies between the period of 2008-2017 were retrieved and analyzed. Descriptive analysis of data was done using Stata 14. Frequency of oral lesions and rates of accurate clinical diagnoses were evaluated for lesional sites and clinician's qualification/specialization.In 592 biopsied cases, the mean age was 36.1years with higher female predilection (54.4%). Odontogenic tumors (OTs) were the most prevalent category of lesions , followed by reactive lesions . Absolute concordance was recorded for 54.6% (k=0.5) of the cases; with highest concordance observed in fibro-osseous lesions , and least in pulp/periapical lesions (3.5%). Concordance was higher in females  than males . Oral medicine specialists had the highest concordance index .The findings in this research indicate that, on a general note, the degree of concordance between clinical and histopathological diagnosis is poor. Hence, improvement in diagnostic skills  is important to improve treatment outcomes, particularly in LMICs. Continuous personnel training and utilization of advanced diagnostic techniques can potentially help bridge the diagnostic gaps. Patient management in the hospital usually entails a pipeline that commences with a comprehensive investigation of the presenting complaint followed by a thorough examination of various body systems. This enables the clinician to arrive at a provisional diagnosis for the condition with which the patient presented. This art of clinical diagnosis is also supplemented with laboratory investigations in order to validate the provisional impression of the clinician and to finally arrive at a definitive diagnosis. Regardless of the outcome of the physical examination, histopathology and advanced diagnostic techniques remain the gold standard of diagnosis; even though, not all oral lesions warrant further histopathological investigation, as a sizeable number of dental conditions can be diagnosed based on detailed information obtained from clinical features and/ or radiological presentations. Clinical oral examination (COE) remains a principal strategy and valuable means of detecting subtle alterations in the oral hard and soft tissues coupled with clinician's discretion in requesting appropriate investigations for arriving at an accurate diagnosis 1. Despite this, limitations of clinical oral examination in detecting dysplastic lesions, intra-bony lesions, cancers and recurrent mucosal lesions have been fully documented in scientific literature . TherefoIn order to avoid the occurrence of misdiagnosis and inappropriate management, American Academy of Oral and Maxillofacial Pathology (AAOMP) have recommended that all “abnormal tissue be submitted promptly for microscopic evaluation and analysis” underscoring the importance of histopathology as a gold standard at reaching a definitive diagnosis . HistoloStudy centre coverage and data capture: this retrospective study was performed at the Oral Pathology unit of Oral and Maxillofacial surgery and Oral pathology department and Oral Diagnosis unit of the department of Preventive dentistry of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Osun State, which is tertiary referral health institution in South-western part of Nigeria , while histopathology diagnosis was standardized using current terminologies. Demographic data obtained for each case included identification number, age, sex, date and type of biopsy, site of lesion, source of request (department), clinical impression and histopathological diagnoses. These were entered into a database by a single researcher. Exclusion criteria included reports with lack of adequate information, histodiagnostics ambiguity and lesions in which a clinical impression was not given. Repeat (and recurrent) biopsies were recorded singly if the histopathology diagnoses remained unchanged. Lesions were grouped by diagnostic category.Definition of concordance: concordance is recorded when clinical impression corresponds with the definitive histological diagnoses.Classification of diagnostic criteria: researchers have propounded different diagnostic criteria for orofacial lesions in both pediatric and adult populations [ulations ,13-16. HData analysis: descriptive statistics carried out were for socio-demographic variables such as age, gender, and location of tumour and prevalence of the lesions were determined. Absolute and relative frequencies were obtained and expressed as percentages. Means and standard deviations were used for continuous variables, while proportions and tables were used for categorical variables. Analysis of each diagnosis entailed: categories of lesions, male: female ratio, age range, mean age and standard deviation. The t-test and ANOVA were used to compare mean differences in the variables; this was after Shapiro-Wilk and Levene test had been used to confirm normality of data and homogeneity of variance respectively. The Chi-square test was used to compare the proportion of the different categories across the age groups and location. Frequency distribution of clinical impressions and histopathological diagnoses was used to describe the concordance rate between the two diagnoses. Sensitivity, specificity as well as positive and negative predictive values were calculated for each lesion: the gold standard being the histopathological diagnosis. 95% confidence intervals were also reported. Cohen's kappa coefficient (κ) between the clinical and histopathologic diagnosis of orofacial lesions was calculated. Cohen's kappa coefficient (κ) is a statistical measure of interrater agreement for categorical items. In general, the following scale was used to calculate concordance using Kappa values: . All tests were carried out with significance accepted at p < 0.05. The data were analyzed using Stata 14 .A total of 592 biopsied cases were retrieved from the archives of the oral maxillofacial pathology unit between the study period of 2008-2017 at OAUTHC, Osun State. In this period, over 90 differential diagnoses were arrived at from various categories of lesions from clinical examinations: prior to individual samples being sent to the oral histopathology unit. Ameloblastoma  and pyogenic granuloma  were the most commonly biopsied lesions followed by squamous cell carcinoma ; the 5 most commonly biopsied lesions , SSC (7.7%), ossifying fibroma (6.42%) and fibrous dysplasia (3.55%)) made up 46.5% of all the biopsied lesion.Age and sex: the mean age of presentation of all biopsied cases was 36.1years ± 18.7 ranging from 2-day old neonate to 94 years with a median age of 33.5 years. 251(42.4%) cases occurred between the third decade  and fourth decade  while the least observed is in the extreme of ages together presenting 41, 7% that is; first decade n=29, 4.9%, ninth decade 10, 1.7% and tenth decade 2,0.3%) The percentages of females recorded in this study was 54.4% (n=321) compared to the 45.6% (n=269) of males in a ratio of M: F, 1:1.2. Numerically, females were observed to be higher across all the decades of life except in the eighth decade which had a larger proportion of males and fifth decade with equal predilection. The mean age of presentation for males was 36.1years ± 18.4, which was higher than that of females with 35.9 years ± 18.6 although it was not statistically significant (p>0.05).Clinical symptom: swelling was the most frequent presentation in all biopsy cases, accounting for 478 cases (80.9%). 451 cases (76.3%) were of painless swelling while 27 cases (4.6%) were painful swelling. Symptoms commonly associated with swelling include ulceration  and purulent discharge . Ulceration was the second most common presentation with isolated ulcerative cases accounting for 5.8%(n=34). Isolated pain only occurred in 4 cases (0.68%) of all biopsied whilst spontaneous bleeding  was the least documented symptom. The mean age of presentation varies between presenting complaints with painless swelling having a mean age of 33.9years ±18.1, painful swelling 48.2 years ± 18.6, isolated ulcer 45.4 years ± 18.1 whilst swelling associated with ulceration has a mean age presentation of 52.3 years ± 14.7. The differences in mean age is very significant with a p value of 0.001. There are however no significant differences between presenting complaints of the sex (p=0.315), clinical signs and decades of life.Duration of lesions: the mean duration of lesions is 2.5 years ± 3.6 with range from 2 days to 25 years and a median duration of 1 year. The mean duration for males (2.6 years ± 3.9) approximated but slightly higher than that of females (2.5 years ± 3.6) whereas the mean duration per decades varies significantly (p=0.002). Patients within first decade present with a mean duration of 0.9±0.9 which increased progressively to 3years ± 4.9 in the fifth decade and then tailed down to 0.2±3.6 in the tenth decade. The mean duration of presentation with presenting complaints is also very significant (p=0.0002) with mean duration of 2.7years ± 3.6 for painless swelling, 0.8 ± 0.9 for ulcerated lesions, 2.93 years ± 4.7 for painful swelling, 0.9 ± 1.8 for swelling associated with ulceration and 3.9 years ± 4 for swelling associated with purulent discharge.Location: of the 26 documented biopsy sites, mandible was the most common accounting for 275(47.1%) cases. This is followed by the maxilla , the mandibular gingivae , palate  and the maxillary gingivae . the floor of the mouth and other oral mucosa accounted for the least biopsied sites with 5 biopsies each (0.85%) The mean ages of patients regarding location of the biopsy varies and it ranges from 35.2 years ± 16.8 of the mandibular site, 33.6 years ± 18.1 for the maxilla and 45.9 years ± 19.1 for the palate. Others include 23.4years ± 11.6 at the upper lip to 46.2years ± 19.9 at the buccal mucosa with very significant statistical correlation. Regarding gender, there were statistically significant higher female predilection for most of the biopsied locations as greater than 53.5% (maxilla) ± 56.2% (mandible) were observed in the females. This increased significantly to 67.4% and 69.2% in the mandibular and maxillary gingivae respectively and 80% in the lower lip (p=0.01). Higher male preponderance was however observed in the upper lip and tongue (58.3% respectively), floor of the mouth (60%) and palate (69.2%-78.6%). Variations in mean duration were also observed between 0.86 ± 0.7 observed in oral mucosa  and lesions affecting the facial bones (5.8years ± 5.5). The mean duration in respect to most common locations include 2.5 years ± 3.5 (maxilla), 2.9years ± 3.5 (mandible) 1 year for mandibular gingivae and palate and 2.3years ± 5.4 for the maxillary gingivae. This was also highly statistically significant (p=0.0001).Categories of lesions: odontogenic tumors (OTs) were the most commonly observed category of lesions with 25.3% (n=149), followed by reactive hyperplastic lesions which accounted for 12%(n=71) of all the biopsied cases. Biopsy of normal tissue and ulcerative lesions were the least encountered with 2(0.34%) cases and 6(1%) cases, respectively  of all biopsied lesions with mean age of 33.7 years ± 17.6. Female gender was observed to account for 58.6% of all benign lesions and the mean duration is 2.5years ± 3.6. The most common symptom for benign lesions is a painless swelling and most benign lesions occur in the mandible (including gingivae). The mean age of presentation of malignant lesions was 47.5 years ± 19.9, while the male sex accounted for 64.4% of all biopsied malignant lesions. The observed mean duration for malignant lesions was 1.8 years ± 3.2. The most common presentation being ulcerated swelling and favored malignant intra-oral sites are the palate and buccal mucosa. Biologic behavior for sex, mean age, site and mean duration were all statistically significant (p< 0.05).Source of requisition forms and biopsies: 95.3%(n=562) of all biopsied cases are from the departments in dentistry with 76.3% (n=450) from oral maxillofacial surgery followed by samples from Periodontology unit . Biopsy samples from surrounding secondary health institutions and general practice constitutes only 4.2% (n=25) of all cases , whereas in 269 cases (45.4%), there was discordance and hence misdiagnosis. The highest clinico-pathological concordance was found in fibro-osseous lesions (65.6%) and epithelial tumors (66.1%) and least in pulp/periapical lesions (3.5%). Concordance was also observed to be statistically higher with the female gender (59.5%) as against male, 48.3%(p=0.007); and also, significantly higher in benign lesions (57.2%) as compared to malignant lesions. Oral medicine specialists had the highest concordance index at 62.5% whilst outside-hospital specialists  had the least index at 20%  is important to improve treatment outcomes, particularly in low- and middle-income countries (LMICs);Good concordance between clinical impression and histopathological diagnosis is a crucial diagnostic oral pathology tool in LMICs;High index of concordance between oral pathology and other specialties with continuous personnel training and utilization of advanced diagnostic techniques can potentially help bridge the diagnostic gaps.The authors declare no competing interests.


IntroductionOcular syphilis is a sight-threatening condition. It can occur at any stage of syphilis infection, which present either with acute inflammation during the primary, secondary, and early latent stages or with chronic inflammation during tertiary infection, affecting virtually every ocular structure. This study was to report on the clinical presentation of ocular syphilis that presented to eye clinic Hospital Universiti Sains Malaysia.MethodologyThis was a retrospective study where medical records of ocular syphilis patients who attended eye clinic in Hospital Universiti Sains Malaysia from January 2013 to June 2017 were reviewed.ResultsA total of 10 patients (13 eyes) with ocular syphilis were identified out of 106 cases that presented with ocular inflammation. The mean age of presentation was 69.8 ± 6.4 years and seven of them (70%) were female. All patients were Malay and human immunodeficiency virus (HIV) was negative. The ocular manifestations included panuveitis , anterior uveitis , posterior uveitis  and optic neuritis . Seven (53.8%) eyes presented with visual acuity of worse than 6/60, five (38.5%) eyes had visual acuity between 6/15 to 6/60, and one (7.7%) eye had visual acuity of 6/12 or better. Nine patients received an intravenous benzylpenicillin regime and one patient received an intramuscular penicillin injection. Out of 13 eyes affected, 11 (84.6%) eyes had improved visual acuity of at least one Snellen line after treatment. Visual acuity of 6/12 or better increased to four (30.8%) eyes.ConclusionsPosterior uveitis was the commonest presentation of ocular syphilis in HIV-negative patients. Early detection and treatment of ocular syphilis can result in resolution of inflammation and improvement of vision. Treponema pallidum infection. Since the advent of antibiotics, the rate of ocular syphilis infection has decreased significantly, thus reducing the complications that arise from chronic syphilitic infection. In 1950, ocular syphilis was among the major causes of blindness, making up an estimated 10% to 15% of cases resulting in total blindness in the United States (US) [Ocular syphilis is an uncommon presentation of tes (US) . HoweverDiagnosing ocular syphilis proves to be challenging. This occurs as a result of its diverse clinical manifestations . In factOcular syphilis, which can manifest at any stage of the syphilis infection, occurs more frequently during the latent stage of syphilis infection than during the primary stage -5. In imThe most common ocular syphilis presentation is uveitis . HoweverWe conducted a retrospective study to review the clinical profiles and visual outcomes of 10 patients (presenting symptoms in 13 eyes) with ocular syphilis treated at the Hospital Universiti Sains Malaysia from January 2013 to June 2017. The follow-up period ranged from two months to 48 months.Treponema pallidum. Serological tests include rapid plasma reagin (RPR), fluorescent treponemal antibody absorption (FTA-ABS), T. pallidum particle agglutination (TP-PA), and electrochemiluminescence immunoassay (ECLIA) for syphilis. Patients presumed to have ocular syphilis were also investigated to exclude other possible causes of ocular infection, such as tuberculosis, toxoplasmosis, herpes simplex virus (HSV), and cytomegalovirus (CMV) and HIV. Cerebrospinal fluid (CSF) analysis was requested from our patients but none of them consented for the procedure.We selected patients diagnosed with ocular syphilis based on history, clinical evidence of ocular inflammation not attributable to any other cause, and positive serology for Data were collected on demographic features , history of high-risk sexual behavior, past medical history, past history of syphilis infection, onset and duration of ocular symptoms at presentation, visual acuity, anterior and posterior segment examination, treatment regime, and visual outcome. Visual outcome was evaluated based on best-corrected visual acuity at the latest follow-up ranged from two months to 48 months after completion of treatment. Good visual outcome is defined as visual acuity of 6/12 or better, while a poor outcome constitutes a visual acuity below 6/60.The data were analyzed using the Statistical Package for Social Science, version 22.0 . This study was performed in accordance with the ethical standards of The Human Research Ethics Committee of Universiti Sains Malaysia (reference number: USM/JEPeM/19010009) and was in line with the Declaration of Helsinki of 1975, as revised in the year 2000.A total of 10 patients (13 eyes) with ocular syphilis were identified within the study period (2013-2017). These cases comprised 9.4% of 106 new cases that presented with uveitis in our centre during the specified time period. Seven (70.0%) patients were female, and the mean age of presentation was 69.8 ± 6.4 years . All of them were from the Malay ethnic group. One patient had a history of multiple sexual partners, while the rest denied any high-risk sexual behavior or intravenous drug abuse. All patients were heterosexual and denied any homosexual activity.Three (30.0%) patients had both eyes involvement. The mean duration of ocular symptoms at the time of initial visit was 11.4 ± 16.7 months (ranged from one week to four years). At the time of presentation, blurring of vision was the commonest presenting complaint , followed by redness of eye  and eye pain . Seven (53.8%) eyes presented with visual acuity of worse than 6/60, while five (38.5%) eyes had visual acuity between 6/15 to 6/60. There was only one (7.7%) eye with visual acuity of 6/12 or better.Vitritis was the commonest finding during ocular examination and was found in five eyes (38.5%). This finding was followed by keratic precipitates , anterior chamber cells , and chorioretinitis . Other ocular findings included macular oedema , retinal scar or atrophy , posterior synechiae , optic disc swelling , ectropion uvea , Roth’s spot , vitreous hemorrhage  and retinal hemorrhages .Out of these 13 eyes involved, a large proportion of the eyes  had posterior uveitis. Four (30.8%) eyes had panuveitis and two (15.4%) eyes had anterior uveitis, while another two (15.4%) eyes had optic neuritis. Three patients with bilateral eye involvement were noted to have posterior uveitis. The above information is presented in Table All patients underwent both treponemal  and non-treponemal tests (RPR) to confirm the diagnosis. Eight patients (80.0%) were tested with ECLIA. Out of these eight patients, six (60.0%) of them were reactive for ECLIA and RPR, one patient case 2) had positive ECLIA but negative RPR and one patient (case 3) was tested negative for both ECLIA and RPR. In case 2, another treponemal test (TP-PA) was done in order to confirm the diagnosis of ocular syphilis. While in case 3, a repeat treponemal test (FTA-ABS) was done in view of clinical suspicion and was positive for syphilis. In cases 6 and 9, a different treponemal test was done for each patient (FTA-ABS for case 6 and TP-PA for case 9). Both patients tested positive for treponemal and RPR test. From the laboratory data, there was no statistical difference in the titer level of RPR and ECLIA with regard to the severity of visual acuity impairment. HIV testing in all patients was negative. Other blood investigations  were unremarkable. The relevant data are illustrated in Table  had posiTreatment of ocular syphilis was given in all patients. Nine patients were treated with intravenous (IV) benzylpenicillin 3.0 to 4.0 mega units (MU) for 14 days. One patient was given intramuscular (IM) penicillin 2.4 MU weekly for three weeks (case 1). However, this patient presented to us back again one year later with recurrence of ocular syphilis. She was then treated with IV benzylpenicillin regime and since then had no recurrence within three years' post-treatment. In addition, case 4 also had a recurrence after one year of treatment and was treated successfully with similar IV benzylpenicillin regime.Out of these 13 eyes, clinical improvement of visual acuity of at least one Snellen line was seen in 11 (84.6%) eyes. Eight (61.5%) eyes had an improvement of at least three Snellen lines. One eye had visual acuity deterioration post-treatment and another one eye had a static visual acuity post IV benzylpenicillin treatment, which was due to the presence of a Senile cataract. Patients with posterior uveitis had visual acuity improvement in six out of seven eyes, of which four (57.1%) eyes had an improvement of three or more Snellen lines. The result of visual acuity of worse than 6/60 reduced from seven (53.8%) eyes to four (30.8%) eyes after completion of treatment. Four (30.8%) eyes had visual acuity of 6/12 or better and five (38.5%) eyes had visual acuity between 6/15 to 6/60.Syphilis is an ancient disease that still lingers in our society. According to the Malaysian Annual Health report, the rate of syphilis infection has increased from 3.0 cases per 100,000 people in 2010 to 8.0 cases per 100,000 people in 2017 -13. A siOcular syphilis is a manifestation of the chronic syphilis infection. Our study showed that ocular syphilis occurs during the latent stage of syphilis. All patients were also noted to be older than 50, with a mean age of 69.8 ± 6.4. A retrospective study conducted in Korea of ocular syphilis in HIV-negative patients shows similar findings . A late Most ocular syphilis studies that include both HIV-positive and HIV-negative populations showed a substantial increase of ocular syphilis infection in male individuals. Table Although ocular syphilis can affect almost all structure of the eye, there were differences observed between HIV-negative and HIV-positive patients. Amaratunge et al. reviewed almost 143 descriptions of patients with uveitis caused by syphilis infection. The most important finding of the study was the rate of patients with isolated anterior uveitis, who had a relative risk 14.5 times higher of being diagnosed as HIV-positive as compared to the HIV-negative patients . This hiOn the other hand, Amaratunge et al. also noted that almost 62.0% of ocular syphilis cases in HIV-negative patients presented with posterior uveitis . This hiOcular syphilis is considered a neurosyphilis variant, meaning the primary treatment for ocular syphilis is administering IV benzylpenicillin for 14 days . This prIn our center, laboratory diagnosis of syphilis followed a reverse syphilis testing algorithm in which patients were investigated with a specific treponemal test , which was subsequently proceeded by quantitative non-treponemal (RPR) testing as confirmation. According to Man Li et al., the reverse syphilis testing algorithm had higher sensitivity and accuracy in detecting syphilis at any stage of infection compared to traditional algorithms (respectively with 99.85% vs. 75.81% sensitivity and 99.96% vs. 97.22% accuracy) [In Table The improvement of visual acuity post-IV benzylpenicillin treatment can be seen in all types of uveitis. General improvement in visual acuity was seen in 11 eyes 84.6%). Patients with isolated posterior uveitis (five eyes) and posterior uveitis with optic neuritis (two eyes) were observed to have poorer visual acuity during the presentation (worse than 6/60) when compared with visual acuity results of other types of uveitis. Out of seven eyes with posterior uveitis, four (57.1%) exhibited vision improvement quantified by more than three Snellen lines. This improvement shows the importance of diagnosing and treating ocular syphilis early. Appropriate and timely treatment is vital in anticipating good visual outcomes [%. PatienThis study has one important limitation. Due to the rare occurrence of the diseases, only a limited number of ocular syphilis cases were studied, which may not be enough for proper statistical analysis. This situation occurred in other similar studies as well. However, the contribution of this small amount of data may assist in future reviews of this disease, thus contributing to an accurate analysis of the presentation and outcomes of ocular syphilis. For future research, a multicentre study should also be conducted to accurately assess the prevalence of ocular syphilis.Diagnosis of ocular syphilis poses challenges as a result of its rarity and its diverse manifestations. A high index of suspicion with early diagnosis and treatment are crucial in achieving good visual outcomes and low recurrence rates. Sequential follow-up is also recommended because recurrence or relapse can occur despite completing treatments.


Objective: To assess the association between depressive symptoms and impaired glucose metabolism in the elderly population in arctic latitudes.Design: A population-based study. Setting. Community.Subjects: The study population consisted of 1,830 subjects born between the years 1915 and 1958 in the northernmost part of Finland, the Muonio-Enontekiö district, who participated in a health survey during 1974–1984. In 2014, a health questionnaire was sent to 1,037 subjects, and 757 participants (73%) answered it. Those (n = 629) living in the Muonio-Enontekiö district undergone a clinical examination in 2014 and 2015 including blood collections.Main outcome measures: Depressive symptoms defined by the Beck Depression Inventory II (BDI II) with a cut-off point of 14. Different diabetic states based on WHO’s classification criteria defined by fasting plasma glucose and ADA’s criteria by glycosylated haemoglobin (HbA1c) values.Results: According to logistic regression analysis, depressive symptoms (BDI-II ≥ 14) were associated statistically significantly with previously known type 2 diabetes, the odds ratio (OR) being 4.33 (95% CI 1.53–14.14). Regarding prediabetic fasting glucose/HbA1c values, the corresponding OR was 2.94 (95% CI 1.17–8.94). The prevalence of depressive symptoms (BDI-II ≥ 14) was 7.1%, (men 9.7% and women 5.4%) and 13.7% (men 9.9% and women 17.0%) in subjects living in Muonio-Enontekiö district and in those who had moved away from there, respectively.Conclusions: The association of depressive symptoms between prediabetes and diabetes seems to be present also in the northernmost latitudes of the world. Type 2 diabetes (T2D) is one of the most common and most serious medical conditions in modern healthcare. Furthermore, undiagnosed T2D is as common as diagnosed diabetes, and almost one-fourth of middle-aged people have pre-diabetes . What isT2D is often accompanied by troubling psychiatric conditions such as depression. Indeed, depression is known to be 2–3 times more prevalent in people with T2D compared to those without it . While TTo the best of our knowledge, there are no previous studies about the prevalence of depressive symptoms and its association with the glucose status among people living in the very rural district in the arctic areas of the world. The aim of the present study was to evaluate the association of impaired glucose metabolism and depressive symptoms in the elderly population living in the most northern part of Finland above Arctic Circle.The study population consists of persons born between the years 1915 and 1958 in the Muonio-Enontekiö district in the northernmost part of Finland (150–370 kilometres north of the arctic circle) who participated in regular health surveys from the year 1974 to 1984. In 1984, the total number of the cohort consisted of 1,830 subjects.n = 780), and 655 (84%) of them attended (mean age was 71.62 years). Total variable information was available from 629 (81%) individuals  of the subjects who participated in the studies from the year 1974 to 1984; Of these, 257 persons (mean age was 72.69 years) had moved away from the Muonio-Enontekiö district; 102 (40%) of those answered the questionnaire. An invitation to clinical examinations was sent along with postal questionnaires to those living in the Muonio-Enontekiö district  and glycosylated hemoglobulin (HbA1c) were performed after an overnight (12-h) fasting period. Glucose status was classified: (1) normal glucose (NGT) was defined as having FPG concentration < 6.1 mmol/l or glycosylated hemoglobulin (HbA1c) < 39 mmol/mol (5.7%); (2) prediabetes was defined as having FPG of 6.1–6.9 mmol/l (IFG) or HbA1c 39–47 mmol/mol (5.7–6.4%); and (3) type 2 diabetes (T2D) was defined as having FPG at least 7.0 mmol/l or HbA1c 48 mmol/mol (6.5%) or more. Previously diagnosed T2D was defined by self-reported diagnosis made by a physician.Participants reported their physical activity in a postal questionnaire: Subjects were asked ‘How many times per week was their physical activity at least 30 minutes per day’. In the statistical analyses, answers were dichotomized so that ‘physical activity’ was defined to be present if subject reported having had ‘Five times or more’ ‘physical activity at least 30 minutes per day’.2) based on measured height and weight and classified by the WHO definition .In the clinical examinations, participants (without clothes and shoes) were weighed (kg) using a digital scale. Height (cm) was measured  by a nurse. Body mass index (BMI) was calculated  methods that adjusted for non-responses. We calculated response probability by sex, age and place of residence, using a logistic regression model. The weight of each subject was given by the inverse of the predicted probability. We used logistic regression analysis to examine the association of glucose metabolism and depressive symptoms. Unadjusted and adjusted odds ratios (OR) and their 95% confidence interval (95% CI) are presented. Statistical analyses were performed using SAS 9.4 for WINDOWS, and Mean age of men was 71.9 (7.7) years and of women 70.5 (8.8) years; the detailed description of the whole study population is presented in Most of the participants were overweight (42.2%), 21.7% were obese, only 30,4% were of normal weight and 1.1% were underweight. Altogether, 3.7% were severe obese and 1.0% were very severe obese. Seven percent of the participants reported having had no physical activity at all because of injury or sickness, and 61% of participants exercised ‘daily at least 30 minutes and 5 times per week’. Finally, antidepressant medication was used by 5.3% of the participants.The prevalence of mild depression (BDI II at least 14 points) with subjects living still in the Muonio-Enontekiö district was 7.1%. Interestingly, depressive symptoms tended to be more common in men (9.7%) than in women (5.4%). The prevalence of moderate depression (BDI >20) among men was 4.6% and women 4.7%.Of those who had moved away from the Muonio-Enontekiö district, 102 subjects returned the BDI II questionnaire. The prevalence of depressive symptoms among them was 13.7% (men 9.9% and women 17%) ; The pren = 252) had a normal FPG level , and 48.0% (n = 302)  had a normal HbA1c level. The prevalence of IFG was 37.2% (n = 234) (men 44.6% and women 32.4%) according to FPG, and 39.7% (n = 249)  according to HbA1c. T2D was present in 22.8% (n = 143)  and in 11.8% (n = 74)  of the subjects according to FPG and HbA1c, respectively. The prevalence of self-reported previously diagnosed T2D was 15.2% (n = 97) (12.9% men and 17.1% women).Among individuals living in the Muonio-Enontekiö district, 40.0%  was 13.0% (95% Cl 6.8–19.2) and 6.3% (95% Cl 4.2–8.3) in the participants with previously diagnosed and undiagnosed T2D, respectively; the difference was statistically significant (p 0.0119). The corresponding prevalence was 9.1% and 9.5% in the participants with diabetic FPG and HbA1c values, respectively, while the prevalence of depressive symptoms was 8.1% and 7.6% in the participants with prediabetic FPG and HbA1c values, respectively. Only 2.7% of the participants with normal FPG and HbA1c values had depressive symptoms.According to logistic regression analysis, depressive symptoms (BDI-II ≥ 14) were associated statistically significantly with previously known T2D, the odds ratio OR being 4.33 (95% CI 1.53–14.14). Regarding prediabetic fasting glucose or HbA1c values, the corresponding OR was 2.94 (95% CI 1.17–8.94) . DepressIn the present study, we investigated the coexistence of depressive symptoms with glucose metabolism among elderly subjects living in the northernmost part of Finland. The prevalence of previously known T2D was two times higher in those with depressive symptoms than in those without depressive symptoms. Furthermore, prediabetic glucose and HbA1c values were associated with higher prevalence of depressive symptoms. Those with diabetic glucose and HbA1c values had more depressive symptoms than those with normal values. The prevalence of depressive symptoms was three times higher in women who had moved away from the Muonio-Enontekiö district. Participating actively in physical activity was two times more prevalent among those without depressive symptoms than among those with depressive symptoms.2). Thus, the people of this cohort are living in the rural district where the climate is cleanest in Europe (WHO’s follow up-report in the years 2008–2014) and winter lasts over half of a year. The main limitation of the present study is that we could not make the clinical examinations for those who had moved away from the Muonio-Enontekiö district.The strength of the present study is the high participation rate, which was 84% of those living in the Muonio-Enontekiö district. Unfortunately, the participation rate was low among those subjects who had moved away (40%). The strengths of our study are that our sample consists of about 60% of the population aged 65 or older and living in the same district in 2014. In 2014, a total of 4,257 inhabitants were living in the Muonio-Enontekiö district . The reason was long distances and not enough resources. According to previous studies OGTT would have diagnosed more T2D than using only fasting glucose and HbA1c test .Our results regarding previously diagnosed T2D is in line with earlier studies showing 1.6 to 2 times higher prevalence of depression symptoms among diabetics . Our finIn Finnish Health Study 2011 the prevalence of self-reported diabetes with men (aged 65–74) were 19.5% and women 14.4% [We did not find any study of the prevalence of depressive symptoms with elderly people above Arctic Circle. We found only studies of the seasonal affective disorders . The prevalence of SAD was 9% with adult people in Fairbanks in Alaska .Many studies have concluded that depression observed among people with diabetes would be the result of psychological distress created by the disease (diabetes distress), but it is not the only reason for depressive symptoms in people with T2D ,21,22. HIn our study, there were only 34 participants who had antidepressant medication, and only two of them had significant depressive symptoms. Unfortunately, we could not analyse the associations between antidepressant use and T2D or glucose metabolism due to this low number of subjects. A Danish study showed that people with diabetes are 65% more likely to fill prescriptions for antidepressants than those without diabetes . The incOur data was collected in the area where many people are still living by herding reindeers, hunting, fishing, gathering berries and making firewood. Consequently, in the past, they had plenty of physical activity just getting enough food. We suppose that today, people of this cohort do not have as much physical activity as before, and, therefore, they are more obese than before. It can also be hypothesized that they have more genetic insulin resistance like many other native populations .We were able to bring new information to the earlier literature concerning the issue under investigation. The association of depressive symptoms between prediabetes and diabetes seems to be present also in the northernmost latitudes of the world. Moving away from a rural area may increase the risk of depressive symptoms among women, but this should be evaluated in more detail in further studies.


The study aims to elucidate the spectrum, magnitude and determining factors of the major opportunistic infections in PLHIV patients currently receiving HAART.A retrospective cross-sectional study was conducted at Tercha Hospital from 744 patient cards. The overall all prevalence of opportunistic infection was 658 (88.4%) developed OIs. Pulmonary tuberculosis, 118 (18%), severe community acquired pneumonia 107 (16.3%) and oral candidiasis 103 (15.6%) were the most common opportunistic infections. Disease stage [AOR = 3.22:95% CI 1.76–5.66], CD4 level [AOR = 2.53:95% CI 1.19–5.37], drug adherence [AOR = 3.02:95% CI 1.57–5.77] and hemoglobin [AOR = 2.49:95% CI 1.34–4.62] showed significant association with OIs. Higher magnitude of opportunistic infection with considerable proportion of AIDS defining illness was detected. So empowerment of skilled man power, health education and provision of antimicrobials is mandatory.The online version of this article (10.1186/s13104-018-3707-9) contains supplementary material, which is available to authorized users. Human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS) is the world’s most serious health and development challenge, affecting approximately 36.9 million people . EthiopiHIV became responsible for significant morbidity and mortality due to underlying immune-suppression which leads to life threatening opportunistic infections (OIs) during the natural course of the disease . ScientiSince the advent of highly active antiretroviral treatment (HAART), the incidence of OIs in people living with HIV/AIDS, (PLHIV) reduced . HoweverOpportunistic diseases like Candida esophagitis, Pneumocystis Carinii pneumonia (PCP), active pulmonary tuberculosis, Mycobacterium avium complex (MAC) infection, cytomegalovirus (CMV), Cryptococcal meningitis (CRM), Kaposis sarcoma (KS), and herpes zoster were prevalent in HIV patients . In EthiOpportunistic infections lead to frequent morbidity and mortality which shortens the life span of people with HIV infections and requires expensive treatments which becomes a burden for a developing country .Timely intervention of OIs not only helps HIV positive persons to live longer but it also helps to prevent transmission spreading to others in the community . Since pThe study was conducted at Tercha Referral Hospital situated at Tercha Town which is a capital city of Dawro Zone in South Ethiopia. It is serving a population of about 2 million people coming from different nearby zones and woredas. It also provides care and treatment for HIV/AIDS patients including ART , voluntary counseling test, provider initiative counseling and testing. The hospital provides inpatient and outpatient services including ART services. As of 2013, the Federal ministry of health, Ethiopia adopted the 2013 World Health Organization recommendation, that all HIV positives are eligible for ART. The ideal time for ART initiation depends on the clinical condition and readiness of the client. All PLHIV start ART as early as possible to all adults with a confirmed HIV diagnosis ready and willing regardless of their WHO clinical stages and CD4 counts .Institution based cross-sectional study design was conducted from May 1 to August 30 2017.All people living with HIV/AIDS (PLHIV) ≥ 18 years old currently using HAART.Nine hundred sixty-four patients were following their routine treatment in the hospital, of these 87 of them were children aged < 18 years. Thirteen of them were lost to follow up, 19 of them dropped from their course of treatment and 65 PLHIV were transferred to another health care facility. Incomplete data were obtained from 36 patients. Finally, 744 patients who are on ART follow up taking HAART from 2013 to 2017 were our sampling participants.Adherence defined as good if adherence is > 95% (< 2 doses of 30 doses or < 3 dose of 60 dose is missed); poor if adherence is between 85 and 94% (3–5 doses of 30 doses or 3–9 dose of 60 dose is missed). Adherence was measured by pills count.Lost to follow up Not seen since ≥ 1 month < 3 months.Dropped Lost to follow up for > 3 months.SCAP is defined is acute infection of the pulmonary parenchyma, and patients will often present with multiple organ failure with symptom onset in the community within 48 h of hospital admission.Transferred A patient is referred to another health facility for care evidenced by his/her document.Data were collected using a standard checklist prepared in English, retrieved from the hospital’s ART registry document which is a standard format for sending comprised data to health monitoring information system. Socio-demographic variables, clinical information, type of OIs, prophylaxis usage, WHO clinical staging, CD4 count, hemoglobin level, and weight were collected from patent charts by experienced nurses. Patients’ clinical records that were not complete or were missing data were omitted. The data collection format was checked for its completeness and consistency with the patient’s clinical records by a supervisor and the investigators on a daily basis. Five nurses working in other government health centers were involved in the data collection procedure.Data were entered and cleaned in Epi-info version 3.5 and analyzed using SPSS version 20. Bivariate analysis was conducted primarily to check association of each variable with OIs. Variables found to have association with the dependent variable at P-value of 0.2 in the bi-variate analysis was entered into multiple logistic regression model. The variables that showed significant association with P-value < 0.05 in the multivariate logistic regression was independent factors.Out of 744 PLHIV, 443 (59.5%) were females and 254 (54.5%) were found in the age group of 18–30 years. Regarding to religion, majority of them 347 (46.6%), were orthodox. Among the participants, 587 (78.9%) of them were jobless and 432 (58.1%) were married. Urban dwellers in this study were 507 (68.1%).  were using alcohol, 11 (1.4%) were smoking cigarette, and 8 (1.1%) were chewing kchat. Regarding to the current status of the patients, majority of them 597 (80.2%) were in WHO stage I. In case of CD4 count, 381 (51.2%) of them had CD4 count of < 200. Concerning hemoglobin, 182 (24.5%) of them having < 10 g/dl and 371 (49.8%) were having < 60 kg weight. Most of them 592 (79.6%) had not been using condom and 606 (81.4%) of the individuals had good HAART adherences  developed OIs, of which 232 (35.2%), 157 (23.9%), 146 (22.2%), and 123 (18.7%) developed 2, 3, ≥ 4, and 1 OI respectively. The spectrum of OIs was ranging from the common oral candidiasis to the life threatening CNS toxoplasmosis and the fungal cryptococcal meningitis. Pulmonary tuberculosis, 118 (18%) was the most common OI. Next to TB, Severe community acquired pneumonia (SCAP) 107 (16.3%) and oral candidacies 103 (15.6%) were the most common OIs in this study. Only five and 2 individuals were affected by Toxoplasmosis and KS respectively  of them died of the OI. The main cause of death were bacterial meningitis which accounts 16 (28.6%) and pulmonary TB and SCAP accounted for 13 (23.8%) of death each  which is consistent with a study conducted in Cameroon 25%  and 31% Oral candidiasis prevalence (1.6%), which is the third most common OI in this study, corroborated with 16.4% prevalence rate in Zewditu memorial hospital . In the AIDS defining illness, like PCP, CRM, cryptosporidiosis and KS were identified in this study. Magnitude of PCP 3.9% observed in this study was higher than 2.1% in Zewditu memorial hospital , 1.5% prCryptosporidiosis finding of the present study 9.1% was corroborated with 13% prevalence detected in southern Ethiopia  but highGood HAART adherence became a predictor for the occurrence of OIs in this study which was corroborated with studies conducted in North western Ethiopia , NigeriaHuman immunodeficiency virus infection is frequently associated with anemia where patients with more advanced HIV disease or a lower CD4 cell count had higher rates of anemia. Severe anemia was associated with a much faster rate of HIV disease progression and confirmed that anemia is a strong independent predictor of death. In different study settings, the prevalence of anemia has been estimated to be 30% in patients with asymptomatic HIV infection and 63–95% in persons with AIDS . Hemoglo3 were found to be an independent predictor for developing OIs. This finding is in complete agreement with studies conducted in Gondar and India which reported high risk of developing OIs among this group [CD4 count < 200/mmis group –19. ThisAdvanced baseline WHO stage was also another factor associated with OI in this study which was also observed in different studies conducted in the country and elsewhere , 34, 35.The overall prevalence of OI in the era of HAART is higher as compared with previous studies in the country. Significant level of AIDS defining illness was noticed. WHO stage II–IV, CD4 level, ART adherence and hemoglobin level became predictors for the occurrence of OIs. So skilled health professionals for proper diagnosis and management of OIs are mandatory and provision of adequate and sustainable antimicrobials and close monitoring and follow-ups are of critical importance.The retrospective nature of the study makes some the finding less informative and as a cross sectional study, cause-effect relationships cannot be assessed.Additional file 1: Table S1. Frequency distribution of socio-demographic characteristics of PLHIV (n = 744) in Tercha Hospital in 2017. Table S2. Frequency distribution of outcomes of OIs of PLHIV in Tercha Hospital in 2017.


To better understand suicide among different occupational groups and inform suicide prevention efforts, CDC analyzed suicide deaths by Standard Occupational Classification (SOC) major groups for decedents aged 16–64 years from the 17 states participating in both the 2012 and 2015 National Violent Death Reporting System (NVDRS) (https://www.cdc.gov/violenceprevention/nvdrs). The occupational group with the highest male suicide rate in 2012 and 2015 was Construction and Extraction , whereas the group with the highest female suicide rate was Arts, Design, Entertainment, Sports, and Media (11.7 [2012] and 15.6 [2015]). The largest suicide rate increase among males from 2012 to 2015 (47%) occurred in the Arts, Design, Entertainment, Sports, and Media occupational group (26.9 to 39.7) and among females, in the Food Preparation and Serving Related group, from 6.1 to 9.4 (54%). CDC’s technical package of strategies to prevent suicide is a resource for communities, including workplace settings  increased 34%, from 12.9 per 100,000 population to 17.3 (https://wwwn.cdc.gov/nioccs3) was used to assign 2010 U.S. Census civilian occupation and industry codes to NVDRS decedent records based on decedents’ usual lifetime occupation and industry as reported on the death certificate. Results are reported by 2010 SOC major groups, converted from U.S. Census codes by NIOCCS. Records that could not be coded by NIOCCS were manually coded using the NIOCCS computer-assisted feature. All coding assignments were reviewed by industry and occupation coding experts for accuracy.NVDRS combines data on all violent deaths , including suicide, based on death certificates, coroner/medical examiner reports, and law enforcement reports. Data on usual lifetime occupation among 22,053 suicide decedents aged 16–64 years from the 17 statesSuicide counts are presented by year, sex, and usual lifetime occupational group. Suicide rates were calculated using annual civilian noninstitutionalized working population counts by occupational group  from the Current Population Survey Annual Social and Economic Supplement  of decedent records ; this coIn both 2012 and 2015, the largest percentage of male suicides (19%–20% of decedents) occurred among those in the Construction and Extraction group (SOC 47) ; the larThe 2012 and 2015 male suicide rates among Farmers, Ranchers, and Other Agricultural Managers  were 44.9 (CI = 34.2–57.9) and 32.2 (CI = 24.2–42.0) per 100,000, based on 59 and 54 suicides in 2012 and 2015, respectively. The 2012 and 2015 male suicide rates for Agricultural Workers  were 20.4 (CI = 13.8–29.1) and 17.3 (CI = 12.1–23.9), based on 30 and 36 suicides in 2012 and 2015, respectively.Suicide rates varied widely across occupational groups in both 2012 and 2015, and rates among males and females increased in many occupational groups. The etiology of suicide is multifactorial, and identifying the specific role that occupational factors might play in suicide risk is complicated; both work  and nonwork  factors are associated with psychological distress and suicide  adults increased 34% from 12.9 per 100,000 population to 17.3.2012 and 2015 National Violent Death Reporting System data from 17 states indicated the major occupational group with the highest male suicide rate was Construction and Extraction (43.6 [2012] and 53.2 [2015]). The Arts, Design, Entertainment, Sports, and Media major occupation group had the highest female suicide rate in 2012 (11.7) and 2015 (15.6).A comprehensive approach to suicide prevention, including workplace-based approaches, is needed. CDC’s technical package of strategies to prevent suicide is a resource for communities and workplaces to identify prevention strategies with the best available evidence.