Conservation tillage is an energy efficient and low cost tillage system to improve soil environment compared with conventional tillage systems. However, the rice residue management becomes an “impossible to achieve” task due to high soil moisture content at harvest time and the thickness of rice straw. Disc type furrow openers are used for both seed drilling as well as straw cutting during no tillage sowing. A study was conducted to evaluate the draft requirement and straw cutting performances of different sized furrow openers in no-till paddy soil conditions. Double disc furrow opener was tested on an in-field traction bench for three working depths, i.e. 30, 60 and 90 mm, and three forwarding speeds, i.e. 0.1, 0.2 and 0.3 m/s. The draft and vertical forces on the disc were recorded with load cells. These sensors were connected to a data acquisition system developed with hardware and software. The results revealed that the size of the furrow opener, operating depth and the forwarding speed had significant effects (P<0.05) on the horizontal and vertical forces, and the straw cutting performance. Mean values of the draft were 648.9, 737.2 and 784.6 N for the opener with diameters of 330, 450 and 600 mm respectively, and the vertical forces for similar openers were 904.7, 1553.9 and 1620.4 N, respectively. Furthermore, the mean straw cutting efficiencies for the double disc opener with diameters of 330, 450 and 600 mm were 39.36, 78.47 and 65.46%, respectively. The opener with 450 mm diameter provided higher straw cutting efficiency as compared to 600 mm diameter disc, while lowest straw cutting efficiency was observed with 330 mm diameter disc. The 450 mm diameter opener provided the highest straw cutting efficiency (88.6%) at 90 mm working depth and expressed optimum performance compared with other furrow openers. Tillage operations consume a major portion of energy for crop production to modify soil physical, structural and ecological status for a better production of crops . HoweverDifferent types of furrow openers are used for conservation tillage systems such as hoe, chisel and disc furrow openers. These openers have their merits and demerits in terms of soil disturbance and force requirements . The disIn the past, most studies investigated the performance of furrow openers under low moisture content in soil bins and their effect on soil physical properties , 20, seeThe performance of the disc type furrow opener  is significantly affected by the degree of soil compaction (shear strength and cone index), residue density, coulter type and rotational speed of the furrow opener . Magana Due to opener geometry and soil-straw conditions, furrow openers generally have problems of low residue cutting capacity. Paddy soil requires a high draft force for tillage  and resiA field experiment was conducted at the Jiangpu Experimental Farm, Nanjing Agricultural University, China (32.34°N and 118.36°E) in a post-paddy soil during December 2013. According to the international soil textural triangle, experimental field soil was clay loam having clay (<0.002 mm) 21.30%, silt (0.2–0.002) 39.84%, sand (>0.2mm) 38.85% and organic matter 3.18%. Soil plastic limit was 26.7% and liquid limit was 47.3%. The soil of the experimental area has a long history of rice-wheat rotation. Soil physical properties are presented in Three double disc furrow openers as DD330 (double disc opener with diameter 330 mm), DD450 (double disc opener with diameter 450 mm) and DD600 (double disc opener with diameter 600 mm) were selected for the experiment . A test Before the start of experiment, undisturbed soil cores (50 mm diameter and 30 mm long) were collected from the test site. Collected soil cores were brought to the laboratory, weighed, oven-dried at 105°C for 24 h, and then weighed again to measure the soil moisture content (dry basis) and dry bulk density using gravimetric method . Direct 3 factorial design was carried out at three different sizes of double disc furrow openers , three depths  and at three speeds . Each treatment was replicated three times. To examine the straw cutting ability and mechanism, freshly harvested rice straw of 200 g/m2 was uniformly spread in front of the furrow opener on the field surface under no-till condition following Kushwaha et al. [An experiment with a completely randomized 3a et al.  who applA statistical software package Satistix  was used for data analysis. Analysis of variance (ANOVA) was performed to determine the significance of experimental factors  as well as their interactions. The LSD test was applied to find out a significant difference between the means and pairwise comparison at 5% probability level .Mean values of factors and their levels are presented in P<0.05) influenced by the size of furrow opener, working depth and speed in no-till paddy soil (P<0.05). But the interaction effects of furrow opener × speed and furrow opener × depth × speed on draft force were not significant (P<0.05). The mean values of draft were 648.9, 737.2 and 784.6 N for DD330, DD450 and DD600, respectively   test of recorded data, the vertical force was also significantly increased by p<0.05) diameter of furrow openers, working depth and speed . The mea) Tables  and 4. T diameter) Tables  and 4. KFurthermore, the typical nature of the draft and vertical force on the double disc furrow opener in paddy soil at plastic phase (moisture content 33.34%) is presented in the P<0.05). The DD450 furrow opener showed maximum straw cutting efficiency among all three types of furrow openers with a mean value 78.5% in paddy soil at a soil moisture content of 33.3% for all working depth and speed levels; having the cutting efficiency range from 60.8 to 88.6% while working depth varied from 30 to 90 mm. The DD330 showed straw cutting efficiency with mean values 26.8, 35.5 and 54.7% for working depths of 30, 60 and 90 mm, respectively. The DD600 expressed lower straw cutting efficiency than the DD450 but higher than the DD330 with mean values of 46.6, 63.0 and 86.5% for working depth 30, 60 and 90 mm  also affect the cutting performance of furrow openers of all types . Accordind 90 mm . The strnd 90 mm . FurtherBy increasing the diameter of the double disc furrow opener from 450 to 600 mm, probably the magnitude of tensile force on straw was reduced and the disc pair of the DD600 furrow opener inserted the more bending and shear forces as compared with the tensile forces on the straw and soil which increased the amount of un-cut straw and increased the hair pinning. Previous studies  concludeλ>1.27 and λ = 1.5) cut larger amount of straw compared with that in the case of inactive disc coulter (λ = 1.0). It was found that inactive disc coulters (λ = 1.0) cut approximately 30% of the natural moisture (W = 10.1%) winter wheat straw while it cut 12% of humid straw (W = 22.3%). Magalhães et al. [As the furrow opener speed increased, its straw cutting efficiency also increased. The straw cutting performance of the DD330 from 35 to 44%), the DD450 (from 72 to 87%) and the DD600 (from 58 to 86%) was measured as the speed changed from 0.1 m/s to 0.3 m/s . The ints et al.  observed to 44%, Straw cutting efficiency and soil forces were significantly affected by the opener diameter, working depth and speed in no-till paddy soil conditions. Based on our results, it can be concluded that DD450 showed a superior straw cutting efficiency compared with that of the DD330 and DD600 openers while the opener with diameter 330 mm was noted to have the poorest straw cutting efficiency among the three openers used in this study. On the other hand, the DD330 showed less draft and vertical force than the DD450 and DD600 at all depths and speeds. Therefore, overall it can be concluded that DD450 expressed optimum performance in no-till paddy soil considering straw cutting efficiency, draft force and vertical force. Thus, this study will be useful in making the proper selection of a furrow opener for no-till tillage machinery and its applicability in paddy soil.


In the 1990s, resistance rates of 15% for streptomycin-resistance and 0.6% for multidrug-resistance (MDR) were reported from the Central Region of Cameroon. This work assesses drug resistant tuberculosis in this region 12 years after reorganization of the National Tuberculosis Control Program (NTCP).This cross-sectional study was conducted from April 2010 to March 2011 in Jamot Hospital in Yaoundé, Cameroon. Only patients with smear positive pulmonary tuberculosis were included. Sputa were cultured and subsequently underwent drug susceptibility testing (DST). All consenting individuals were tested for their HIV status.Mycobacterium tuberculosis complex species, DST results were obtained for 576. The overall resistance rate was 10.9% (63/576). The overall resistance rates for single drug resistance were: isoniazid-resistance 4.7% (27/576), streptomycin-resistance 3.3% (19/576), rifampicin-resistance 0.2% (1/576), kanamycin-resistance 0.2% (1/576) and ofloxacin-resistance 0.2% (1/576). The MDR rate was 1.1% (6/576) and no extensively drug resistant tuberculosis (XDR) was detected.A total of 665 smear positive pulmonary tuberculosis patients were enrolled. The HIV prevalence was 28.5% (95%CI [25.2–32.1]). Of the 582 sputa that grew The data show that reorganization of the NTCP resulted in a strong decrease in streptomycin-resistance and suggest that it prevented the emergence of XDR in the Central Region of Cameroon. Tuberculosis, the second leading cause of death among infectious disease worldwide, is responsible for an estimated 1.4 million deaths each year Effective control of tuberculosis is specifically threatened by the emergence of multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis Cameroon has been classified as a moderate tuberculosis burden country according to the WHO Ethical clearance and administrative authorization were respectively obtained from the Cameroon National Ethic Committee and the Cameroonian Ministry of Public Health. Signed informed written consent was obtained from each enrolled patient. Patients under 18 years were able to be included into the study provided that an informed consent was signed by their guardians.This was a cross-sectional study involving all pulmonary smear positive patients, age ≥15 years attending Jamot hospital from April 2010 to March 2011. All patients underwent physical examination and their histories were recorded. Jamot Hospital, the largest urban reference centre for tuberculosis in the Central Region of Cameroon, is situated in Yaoundé, the capital of Cameroon. This study site is among the 223 diagnostic and treatment centres for tuberculosis patients coordinated by the Cameroon National Tuberculosis Control Program. All the sputa collected from the enrolled patients were evaluated for acid fast bacilli (AFB). Sample processing, confirmatory microscopy, serology, culture, drug susceptibility testing and quality control  were performed at the Mycobacteriology laboratory of the Centre Pasteur of Cameroon in Yaoundé (CPC).A study questionnaire was designed for patient data collection at the study site including gender, age, marital status, educational level, place of residence , previous incarceration and clinical data .Samples were collected from each participant with productive cough on two consecutive days following standard procedures. Ziehl-Neelsen and/or auramine smear examinations HIV testing was performed using a microparticle enzyme immunoassay (AxSYM HIV Ag/Ab Combo) (Abbot Laboratories) for all consenting participants. Each participant received appropriate counselling prior to blood collection.M. tuberculosis was based on growth rate and colony morphology observation. The para-nitrobenzoïc acid (PNB) test was used to distinguish atypical mycobacteria from M. tuberculosis complex strains.After centrifugation, the sediment of the decontaminated product was used to inoculate three Löwenstein Jensen (LJ) media slants, of which one was supplemented with a 0.4% pyruvate. Cultures were incubated at 37°C, read weekly for growth and considered negative when no colony was obtained after 8 weeks of incubation. Final species identification of For all positive cultures, drug susceptibility testing was performed using the indirect proportion method on LJ medium at the following drug concentrations: isoniazid (INH) (0.2 µg/ml and 1 µg/ml), rifampicin (RIF) (40 µg/ml), ethambutol (EMB) (2 µg/ml) and streptomycin (SM) (4 µg/ml), ofloxacin (OFX) (2 µg/ml) and kanamycin (KAN) (20 µg/ml).Drug resistance was defined as growth on a drug containing medium greater than or equal to 1% for INH and RIF, and 10% for SM and EMB M. tuberculosis in patients who, in response to direct questioning, deny having had any prior anti-TB treatment (for at least 1 month), whereas resistance among previously treated cases is defined as the presence of resistant isolates of M. tuberculosis in patients who, in response to direct questioning, admit of having been treated for tuberculosis for 1 month or more.According to WHO/IUATLD All data were encoded and entered into Epi-info software with restricted access . Continuous variable (age) was summarized by mean ± SD. Proportions were compared using the chi-square test or the Fischer’s exact test when necessary. Univariate analysis using logistic regression was performed to evaluate the association between drug resistance and socio-demographic and clinical characteristics. p values less than 0.05 were considered to be statistically significant.Mycobacterium other than tuberculosis (MOTT) were excluded after identification. The patient data collected and the proportion of positive cultures are shown in From April 2010 to March 2011, 665 consecutive smear positive pulmonary tuberculosis cases were enrolled at Jamot Hospital. They were 390 (58.5%) males and 275 (41.5%) females. Patient’s age ranged from 15 to 85 years with a mean of 33.9±12.3 years. Of the 665 cases, 656 (98.7%) consented for HIV testing out of which 187 were HIV infected giving a rate of HIV-TB coinfection of 28.5% (95%CI [25.2–32.1]). A total of 595 (89.5%) cases had no history of TB treatment, whereas 70 (10.5%) had previously undergone anti-tuberculosis treatment. Positive cultures were obtained for 589 (88.6%) sputum specimens. Of these, 7 (1.1%) M. tuberculosis complex  of the 582 strains of  complex . Sixty t complex .The overall rate of MDR-tuberculosis cases was 1.1% (6/576). The overall poly-resistance rate found in our study was 1.4% (8/576). No XDR was observed in the entire study population.Among the 576 patients with available DST results, 517 (89.8%) were new cases. A total of 54 (10.4%); (95%CI [8.1%–13.3%]) were resistant to at least one drug. Mono-resistance was encountered in 44 (8.5%) isolates. INH-resistance and SM-resistance were observed in 4.8% (25/576) and 3.1% (16/576) respectively. Of the 25 INH-resistant tuberculosis patients, 10 exhibited high level resistance whereas 15 had low level resistance. Single resistance to EMB was not observed. MDR was detected in 0.8% (4/576) of cases and poly-resistance in 1.2% (6/576).Of the 576 patients with valid DST, 59 (10.2%) had previously undergone anti-tuberculosis treatment. Drug resistance was observed in 15.3% (9/59) among which 8.5% (5/59) showed single drug-resistance and 3.4% (2/59) showed MDR and 3.4% (2/59) showed poly-resistance. . Single The overall rate of drug resistance among TB-HIV coinfected patients was 10.5% (17/162) and 11.2% (46/412) among HIV negative patients. Isolates from previously treated patients were more likely to be mono-resistant against SM, however this was not statistical significant. The MDR rate among previously treated cases was higher than among new cases, but this difference was also not statistically significant. Drug resistance tended to be more frequent in individuals older than 25 years of age compared to individuals between 15–24 years of age but this was not statistically significant. No statistical association was noted with regard to education, gender, previous incarceration, place of residence, HIV serostatus and marital status .Monitoring the magnitude and trends of anti-tuberculosis drug resistance provides an indicator of the quality and performance of the national tuberculosis control program In 1994/95 an investigation of 516 consecutive pulmonary tuberculosis patients at Jamot hospital reported an overall drug resistance rate in new cases of 31.8% Mycobacterium tuberculosis complex strains. Recently SM was reintroduced as part of the nationwide retreatment plan during the first two months of retreatment  The decrease in drug resistance among new cases appears to be primarily a consequence of the reduction in SM-resistance from 15.1% in 1994/5 to 3.1% in 2011 and a reduction of poly-resistance from 6% to 1.2%. Prior to 1996, SM was widely used for the treatment of tuberculosis in Cameroon M. tuberculosisM. tuberculosis isolates from the Central Region of Cameroon. Among the 8 MDR strains identified in this investigation, none were OFX-resistant. Given the overall low number of MDR strains it is difficult to extrapolate this finding but it suggests that OFX can be used as second line drug in the Central Region of Cameroon.Fluoroquinolones (FQ) have been recommended for the treatment of drug sensitive and drug resistant tuberculosis The prevalence of MDR-tuberculosis in the current study was 0.8% among the new cases. This is essentially unchanged compared to the 0.6% of MDR-tuberculosis observed among new cases in 1994/5. This indicates that even with the implementation of a NCTP along with a DOTS policy it is difficult to decrease the prevalence of initial MDR in a population highlighting the need for second line drug treatment programs.We also noted a decrease in MDR tuberculosis rate among previously treated cases from 31.8% in 1997/98 to 3.4% in the current study. The relatively low numbers of previously treated patients included in the study resulted in larger 95% confidence interval. However, it is worth pointing out that since 2010 all retreatment sputum samples from the Central, South and East regions of Cameroon are sent to the CPC for culture and DST. If MDR is detected the patient is referred to specialized centers such as Jamot hospital. Therefore it appears unlikely that the decreased rate of MDR among previously treated cases is due to decreased referral of previously treated cases to Jamot hospital. In addition the centralized nature of TB management in 1995 might have resulted in increased loss to follow-up rates No XDR was detected within the entire study population. Together with the absence of MDR strains resistant against all baseline tuberculosis drugs these findings indicate that the reorganization of the NTCP prevented the occurrence of this type of resistant tuberculosis in the Central Region of Cameroon.In this context it is important to note that a recent retrospective study of retreatment pulmonary tuberculosis in the Littoral Region revealed an overall prevalence of acquired MDR-tuberculosis of 12% M. tuberculosis strains in high HIV and MDR burden is often dominated by strains of the Beijing family M. tuberculosis strains on isolates from the 10 regions of Cameroon.In this study, HIV-TB coinfection was observed in 28.4% cases compared to 16.6% reported for the Central Region in 1997 The high rate of drug resistance in previously treated patients (15.3%), compared to new cases (10.4%) that was observed in this study is consistent with others studies conducted in sub-Saharan Africa and elsewhere. Previous treatment for tuberculosis has been identified in many settings as an important risk factor for drug resistant tuberculosis acquisition The present study has demonstrated a significant drop in overall SM-resistance and an absence of XDR in the Central Region of Cameroon 12 years after reorganization of the NTCP. These results clearly indicate that efficient control of drug resistant tuberculosis is possible in sub-Saharan Africa despite the dual burden of HIV and tuberculosis.CANTAM is a network sponsored by the EDCTP with the objective is to conduct baseline investigations on TB, HIV and Malaria in Central Africa in preparation for clinical trials in its members states Gabon, Cameroon and the Republic of Congo


To describe and to characterize clinical features of latent autoimmune diabetes in adults (LADA) compared to type 1 and type 2 diabetes in the UAE.In this cross-sectional study a dataset including 18,101 subjects with adult-onset (>30 years) diabetes was accessed. 17,072 subjects fulfilled the inclusion/exclusion criteria. Data about anthropometrics, demographics, autoantibodies to Glutamic Acid Decarboxylase (GADA) and to Islet Antigen 2 (anti-IA2), HbA1c, cholesterol and blood pressure were extracted. LADA was diagnosed according to GADA and/or anti-IA2 positivity and time to insulin therapy.437 (2.6%) patients were identified as LADA and 34 (0.2%) as classical type 1 diabetes in adults. Mean age at diagnosis, BMI, waist circumference, systolic blood pressure and HbA1c significantly differed between, LADA, type 2 and type 1 diabetes, LADA showing halfway features between type 2 and type 1 diabetes. A decreasing trend for age at diagnosis and waist circumference was found among LADA subjects when subdivided by positivity for anti-IA2, GADA or for both antibodies . There was a gradual downward trend in autoantibody titre in LADA subjects requiring insulin within the first year from diagnosis to subjects not requiring insulin after 10 years of follow-up (p<0.001).This is the first study describing the clinical features of LADA in the UAE, which appear to be different from both type 1 and type 2 diabetes. Furthermore, we showed that the clinical phenotype of LADA is dependent on different patterns of antibody positivity, influencing the time to insulin requirement. Prevalence of diabetes is continuously increasing worldwide. In particular Middle East and North Africa region experienced a marked increase in the prevalence of diabetes. This has been quite dramatic among the affluent Gulf States. Specifically, the United Arab Emirates (UAE) has one of the highest prevalence rates of diabetes and pre-diabetes worldwide with official figures of 19.0% and 16.6% respectively in 2013 [Even though type 2 diabetes is the most common form of adult-onset diabetes, autoimmune diabetes can also be diagnosed in the adulthood . As a foAutoimmune diabetes has been described in Caucasian and Asian adults –12. As gIn this study we aim to define the presence of adult-onset autoimmune diabetes in the UAE and to characterize clinical features of patients affected by LADA compared to type 1 diabetes and type 2 diabetes.This single center study was conducted at the Imperial College London Diabetes (ICLDC). More than 50% of patients registered at the ICLDC are from Abu Dhabi, 26% from Al Ain and the remaining from other UAE cities including Bani Yas, Ras Al Khaimah, Sharjah, Al Shamkha and Dubai .All patients attending the ICLDC are assessed by trained nurses and parameters, including the following anthropometric information, are obtained and recorded in the ICLDC database. Weight is recorded to the nearest 0.1 kg; height is measured with a stadiometer and recorded to nearest 0.5 cm; body mass index (BMI) as the ratio between weight in kg and the squared height in meters; waist circumference is measured using a metric non-stretching measuring tape, midway between the inferior margin of the lowest rib and the iliac crest in the horizontal plane at the end of normal expiration and recorded at the nearest 1.0 cm.ICLDC patient database  includes all patients attending the centre , including those with diabetes mellitus  and was accessed to identify patients with LADA.18,101 subjects were identified as affected by adult-onset (>30 years) diabetes. Of these, we included in the study only those subjects with all the following information available at the time of the analysis (October 2013): measurement of autoantibodies to Glutamic Acid Decarboxylase (GADA) and to Islet Antigen 2 (anti-IA2); date of diabetes diagnosis; HbA1c, total cholesterol and blood pressure levels; time to insulin therapy; demographics and anthropometrics . Subjects with age at diagnosis >70 years or with insufficient dataset were excluded from the study.To determine factors influencing the initiation of insulin therapy in LADA subjects a sub-analysis was also conducted on subjects affected by LADA who started insulin before the date of data extraction or with disease duration longer than 10 years. Time to insulin therapy was calculated as the time between the date of diagnosis and the date of the first insulin treatment, as recorded in the database (need for insulin therapy was based on standard guidelines ).Type 2 diabetes was diagnosed as non-autoimmune diabetes according to standard criteria . Cases oGADA and anti-IA2 were measured at the ICLDC Pathology Laboratory using enzyme-linked immunosorbent assays , with the optimal cut-off value set at 10U/ml for both autoantibodies. Both assays have demonstrated good performance when tested in the Diabetes Antibody Standardization Program (DASP) Workshops 2005 .Data are shown as mean ± standard deviation (SD) or standard error (SE) for continuous variables and as proportions for categorical variables. Student t-test and ANOVA test have been used to compare continuous variables between groups and Chi-square test to compare categorical variables. The non parametric Kruskal-Wallis test and the Fisher exact test have been used when appropriate. A p-value of less than 0.05 was considered statistically significant at 80% power. SPSS 21.0 for Windows was used to compute the analysis.The study was conducted according to the principles expressed in the Declaration of Helsinki. All ICLDC patients signed a consent form allowing their anonymized information to be used for data analysis. Patient records were anonymized and de-identified prior to analysis.2; mean waist circumference 100.7 ± 12.6 cm; mean HbA1c at diagnosis 8.5 ± 2.1)  .The prevalence of autoimmune diabetes was 2.8%. More specifically, 437 (2.6%) patients were identified as LADA and 34 (0.2%) as classical type 1 diabetes in adults. The highest proportion of diabetes diagnosis was made in subjects aged 40–49 years . Differently, the highest proportion of LADA diagnosis was in the third as opposed to fourth, fifth or sixth decade of life; LADA and type 1 diabetes were respectively diagnosed in 3.2% and 0.4% of all subjects diagnosed when they were in their thirties. The proportion of subjects affected by LADA and type 1 diabetes progressively decreased through forties (2.5% and 0.1% respectively), fifties (2.2% and 0.1%) and sixties (1.9% and 0.1%).64.9% of LADA subjects were positive for GADA only, 31.0% for anti-IA2 only and 4.1% for both autoantibodies. A trend for age at diagnosis and waist circumference similar to the one described in type 2 diabetes, LADA and type 1 diabetes was also found among LADA subjects when subdividing by positivity for anti-IA2, GADA or for both antibodies (p = 0.013 for trend of age at diagnosis and p = 0.011 for trend of waist circumference) .When comparing LADA subgroups by autoantibody with subjects affected by type 1 and type 2 diabetes we found that subjects simultaneously positive for both anti-IA2 and GADA did not differ from subjects with type 1 diabetes. On the contrary, subjects positive for GADA only and subjects positive for anti-IA2 only significantly differed from type 1 diabetes for higher systolic blood pressure , waist circumference (p<0.001 and p<0.001), BMI (p = 0.009 and p = 0.005), age at diagnosis (p = 0.05 and p<0.001) and for lower HbA1c (p = 0.002 and p<0.001).Similarly, subjects positive only for anti-IA2 did not differ from patients with type 2 diabetes, while subjects positive for both autoantibodies did in lower systolic blood pressure (p = 0.008) and waist circumference (p = 0.004). Subjects positive only for GADA also differed from subjects with type 2 diabetes as they showed higher HbA1c (p<0.001), lower systolic blood pressure (p = 0.001) and age at diagnosis (p<0.001) .At the time of data extraction 42.6% of LADA were on insulin. Glargine insulin was used by 63.2% of LADA subjects on insulin (detemir 8.2%); aspart insulin was used by 33.5% (lispro 11.0% glulisine 7.1%). 27.5% used premixed insulin. Before starting insulin therapy, metformin  was used by 71.7% of LADA subjects, sulphonylureas by 44.2%, glinides by 1.2%, dipeptidyl peptidase-4 inhibitors by 48.0%, incretin analogues by 20.4% and acarbose by 1.9%.To identify factors influencing time to insulin therapy in LADA we subdivided our population of LADA subjects into four groups according to the elapsed time to insulin therapy. 167 subjects were not included in this sub-analysis because they did not start insulin before data extraction and had a disease duration shorter than 10 years Among the remaining 270 subjects with LADA, 10 (3.7%) started insulin during the first year from diagnosis (<1y group), 49 (18.1%) between the first and the fifth year after diagnosis (1-5ys group), 60 (22.2%) between the fifth and the tenth year after diagnosis (5-10ys group) and 151 (55.9%) did not start insulin therapy within ten years from diagnosis (>10ys group).2 vs 30.8 ± 5.6, p = 0.036). Mean HbA1c at diagnosis was significantly higher in 5-10ys group than in >10ys group , but did not differs between the other groups. A significant trend in both autoantibodies titre was found: serum levels of GADA (<1y group showed lower age at diagnosis (36.0 ± 6.5 years) than 1-5ys , 5-10ys  and >10ys groups ; they also had lower waist circumference than 5-10ys  and >10ys groups  and lower BMI than >10ys group Click here for additional data file.S1 Table(DOCX)Click here for additional data file.S2 Table#p<0.001 vs LADA; ^p = 0.007 vs LADA; °p = 0.004.GADA = autoantibodies to Glutamic Acid Decarboxylase; Anti-IA2 = autoantibodies to Islet Antigen 2. Unit of measure is IU/ml for both antibodies. *p = 0.001 vs LADA; (DOCX)Click here for additional data file.S3 Table(DOCX)Click here for additional data file.


Women's autonomy in health-care decision is a prerequisite for improvements in maternal and child health. Little is known about women’s autonomy and its influencing factors on maternal and child health care in Ethiopia. Therefore, this study was conducted to assess women’s autonomy and identify associated factors in Southeast Ethiopia.th until March 28th, 2011. A total of 706 women were selected using stratified sampling technique from rural and urban kebeles. The quantitative data were collected by interviewer administered questionnaire and analyzed using SPSS for window version 16.0. Descriptive statistics, bivariate and multiple logistic regression analyses were carried out to identify factors associated with women’s autonomy for health care utilization.A community based cross-sectional study was conducted from March 19Out of 706 women less than half (41.4%) had higher autonomy regarding their own and their children’s health. In the multiple logistic regression model monthly household income >1000 ETB [adjusted odds ratio(AOR):3.32(95% C.I: 1.62-6.78)], having employed husband [AOR: 3.75 (95% C.I:1.24-11.32)], being in a nuclear family structure [AOR: 0.53(95% C.I: 0.33-0.87)], being in monogamous marriage [AOR: 3.18(95% C.I: 1.35-7.50)], being knowledgeable and having favorable attitude toward maternal and child health care services were independently associated with an increased odds of women’s autonomy.Socio-demographic and maternal factors (knowledge and attitude) were found to influence women’s autonomy. Interventions targeting women’s autonomy with regards to maternal and child health care should focus on addressing increasing awareness and priority should be given to women with a lower socioeconomic status. The power balance between men and women plays an important role in the treatment seeking behavior of women. The power relationship that impedes women’s attainment of healthy and fulfilling lives operates at personal, society and to highly public levels . AlthougIn many parts of Africa, women’s decision making power regarding reproduction and sexuality is extremely limited. Decisions on maternal health care are often made by husbands or other family members, which negatively influences maternal and child health service utilization . A studyConsidering the making of large purchases as one indicator for women’s decision making autonomy, 42% and 44% of Ethiopian and Eritrean women respectively had no autonomy to make large purchases. The study also considered women’s attitude toward wife beating as indicator because women with high autonomy would not accept obvious gender power inequalities and any justification of husband to beat his wife. However, 83% of Ethiopian and 73% of Eritrean women believed that wife beating is justifiable for some occasional reasons .Gender based power inequalities have been challenges to open communication between partners about reproductive health decisions and women's access to reproductive health care services which would contribute to poor health outcomes . In EthiThe Ethiopian government has been striving to achieve Millennium Development Goal three (MDG-3), to promote gender equality and empower women, through designing and implementing policies and strategies giving emphasis on increasing women’s access to education and health care services. Furthermore, safeguarding women’s rights such as access to land, credit, and increasing the number of women benefiting from government programs and strategies, giving women leadership training have been the strategic turning points for women’s autonomy .However, these programmatic level interventions especially on health care services have been based on inadequate systematic evidence that depicts the determinant factors of women’s autonomy regarding their own and their under-five children’s health care utilization which might be due to scarcity of data on women’s autonomy. Therefore, the objective of this study was to assess the level of women’s autonomy and predictors of women autonomy regarding their own and their under-five children’s health care utilization in the Goba District, Southeast Ethiopia.A community based cross sectional study using quantitative methods of data collection was conducted in the Goba District in March 2011. The Goba district is one of the 18 districts in Bale Zone, Oromia Region of Ethiopia and located 444 km from Addis Ababa. The district has 24 rural and 4 urban kebeles with an estimated total population of 73,653 (including the Goba administrative town) of whom 37,427 were females; 32,916 (44.7%) of its population were urban dwellers . A totalThe sample size was determined using a single population proportion formula considering 95% confidence level, 5% margin of error and 66% (p = 0.66) estimated proportion of married women who were able to decide on their own health matters with full or partial autonomy . These fWhere: ni is initial sample sizes, Zα/2 is critical value for normal distribution at 95% confidence level which equals to 1.96 , P is national level proportion of women who participate in decision making regarding their own health care (0.66)  and 0 otherwise; the sum of the scores were made to represent an overall index of a woman’s decision-making power as indicated by different studies -17. The The index for control over finance was composed of four items: whether the woman had regular access to a source of money (including both wages earned and gifts or support from family) and whether she stated that she could spend this money without consulting anyone, who decides how the money she earned and her husband’s earnings were used. A score to each of the factors was given as that of index of decision-making power responses, except that 1 and 0 for items with binary responses (i.e. yes or no response). The total score on control over finance was 6. Those women with a score of three and above were considered as having high control over finance, while those women who scored less than three had low control over finance.The index of freedom of movement consisted of three items pertaining to the woman's ability to leave the house without the company of another adult: whether she could go out to take a child to health facility, to visit family or relative and go to health facility for her own health care. These items were with binary responses (yes or no). Hence, those with ‘yes’ response scored 1 while those with ‘no’ response scored 0. The total score on freedom of movement was 3. Those women who scored one & half and above were considered as high freedom of movement whereas those who scored less than one and half were categorized as low freedom of movement.Knowledge of women on MCH was assessed by considering knowledge regarding the components of maternal and child health care mainly that addresses ANC, delivery, child immunization services and key danger signs during labor and childbirth. The desired answer were coded as 1; otherwise 0. The total knowledge score was 32. Hence, those mothers who scored above 84% (≥27) were knowledgeable, 50-84% (16–26) moderately knowledgeable and less than 50% (<16) less knowledgeable.To assess mother’s attitude towards MCH service: eleven items which were positively stated on attitude towards MCH were developed with possible response of agree, undecided and disagree. The measurement scales were given for each item: 3 for agree, 2 for undecided and 1 for disagree. The total attitude score was computed and this value was used for subsequent analysis.Women’s autonomy: is a reflection of women's degree of freedom, relative to men, regarding control over financial resources (economic autonomy); freedom of movement ; opportunity to participate in decisions (decision-making autonomy) about maternal and child health care utilization.Decision making power: the ability of women to make decision on what to do for their own and children’s health care need.Freedom of movement: the women’s ability to move to health care facility without seeking permission from other adult (husband’s/partner or someone else) for their own and children’s health care.Control over financial resources: women’s access to sources of money  and ability to spend it without consulting anyone for their own and children’s health care concern.The data were checked for completeness and inconsistencies, edited, coded and entered into SPSS for window version 16.0 . Descriptive statistics, bivariate and multiple logistic regression analyses were carried out. All explanatory variables that showed statistically significant association in the bivariate logistic regression analysis with the outcome variable (women’s autonomy) were entered to the multiple logistic regression model. Hence, the variables entered to the multiple logistic regression analysis were age of the mother, residence, household monthly income, women’s educational status, women’s employment status, family structure, marriage type, husband’s educational status, husband’s employment status, women’s knowledge on MCH and women’s attitude towards MCH. All variables were entered into the model adjusting one another. All tests were two sided and statistical significance level was declared at p-value <0.05.A letter of ethical approval was obtained from Institutional Review Board (IRB) of Jimma University. Letters of cooperation were obtained from Goba district and Goba town administrative health offices. All women were informed about the purpose of the study and oral informed consent was sought before interview. Additionally, the women were informed about the potential risk and benefits of participating in the study including the right to withdraw from the study at anytime they want. The women were assured about the confidentiality of the information they provided.Of the total 759 eligible women, 706 completed the questionnaire making the response rate 93.1%. The average (±SD) family size for the study population was 5.5(±2.1). The mean (±SD) age of women was 28.3(±5.9) years while the mean (±SD) age of children was 22.9(±15.6) months. Eighty-six percent (86.7%) of women were living in rural areas. Eighty-four percent (84.8%) of women were Oromo by ethnicity. Eighty-one percent (80.9%) of women reported that their husbands have attended formal education. Most (85.7%) of the women were living in nuclear family. Ninety-four percent (94.5%) of the women were living in monogamous type of marriage (Table Sixty-five percent (65.2%) of women had regular access to a source of money, of which 38.1% were able to use the money by their independent decision. In this study, 49.6% of women were autonomous to take their child to health facilities while 43.9% of women were free to go to health facility for their own health care service consumption. The mean (±SD) score of women on decision making power index was 8.9(±3.2). Concerning women’s freedom of movement, 56.7% of women had lower freedom of movement. The mean (±SD) score of women on control over financial resource was 2.6(±1.2) and 52.7% of women had higher financial control. The overall women’s autonomy mean (±SD) score was 12.6 (±4.6) indicating that 58.6% of the women had lower autonomy while the remaining 41.4% had higher autonomy :3.6 (95% C.I: 1.03-12.04)]. Women residing in urban areas were about 2 times more likely to have higher autonomy than their counterparts in rural areas [COR: 1.7(95% C.I: 1.12-2.69)]. Women’s education was statistically significant with their autonomy. Those women who have attended primary education [COR: 1.8 (95% C.I: 1.27-2.62)], and secondary and above (9+) education [COR: 3.9 (95% C.I: 2.38-6.32)] were about 2 and 4 times more likely to have higher autonomy as compared to those women with no formal education, respectively. Those women who did not earn their own income were less autonomous (Table Women who were in a monogamous marriage were 2.5 times more likely to be highly autonomous as compared to women engaged in a polygamous marriage [COR: 2.5(95% C.I: 1.15-5.26)]. Meanwhile, those women living in a nuclear family were 41% less likely to be highly autonomous as compared to those women in an extended family [COR:0.59(95% C.I: 0.39-0.90)] ] and husband’s employment status (being employed) [COR: 5.3(95% C.I: 2.66-10.61) were significantly associated with women’s autonomy to seek health care services for themselves and their children. Women who were knowledgeable about maternal and child care services were10 times more likely to be highly autonomous as compared to those who were not knowledgeable [COR: 10.3 (95% C.I: (6.08-17.28)] ]. Women who were in a monogamous marriage had a higher odds of increased autonomy as compared to women engaged in a polygamous marriage [AOR: 3.2 (95% C.I: 1.35-7.50)]. Women who had employed husband had higher odds of increased autonomy as compared to women who had an unemployed husband [AOR: 3.7 (95% C.I: 1.24-11.32)] (Table Those women who were knowledgeable [AOR: 6.3 (95%C.I: 3.46-11.43)] and moderately knowledgeable [AOR: 3.0 (95% C.I: 1.94-4.48)] about maternal and child health services respectively were 6 and 3 times higher odds of increased autonomy as compared to their counterparts. Similarly, women who had a favorable attitude score had higher odds of autonomy as compared to those women with a lower attitude score towards MCH [AOR:1.12(95% C.I: 1.05-1.20)]  activities that are directed in increasing awareness and improving attitude towards maternal and child health care services are recommended to empower women to seek these services.All authors declare that they have no competing interests.DN conceived and designed the study, participated in the process of data collection on the field, performed the data analysis, interpreted the data, and drafted the manuscript and critically reviewed it. AG, MA, TS and KD assisted in designing, analysis, interpretation, manuscript preparation and reviewed the manuscript critically. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6874/14/79/prepub


The choice of medical staffing in helicopter emergency systems (HEMS) is continuously under debate. Many studies have attempted to demonstrate the benefit of one profession over the other. Only one RCT-study on staffing models in HEMS randomized patient care to either a physician and nurse or nurse and paramedic . None ofThe HEMS Medical Crew Survey was designed to collect data on different HEMS crew compositions and the rationale behind them. We here present data from this survey describing the diversity of formal competence for physicians, nurses and paramedics that are part of the regular crew in HEMS.TM). The survey was open between June 1st and October 15th, 2014. All respondents were blinded to the researcher. The study was approved by the Data Protection Official in Norway and exempted from ethical approval.Medical directors of HEMS-services in Europe, North America, Australia, New Zealand and Japan were invited to complete a web-based questionnaire , followed by emergence medicine (59.2%), surgery (22.4%), internal medicine (20.4%) and a range of other specialties (16.3%). Some service had physicians with different specialities. Only board certified physicians were allowed to work in 63.3% of the services, 34.7% used both certified specialists and physicians in training.The survey defined Registered Nurses (RN) as nurses with education corresponding a Bachelor's Degree, and certified nurses as RN with an additional exam to be certified.RNs without additional education were part of the crew in 20.0% of the responding HEMS. Crews were staffed by Certified Flight Nurses in 57.1%, Certified Emergency Nurses (CEN) in 51.4%, Certified Critical Care Nurses in 37.1%, Intensive Care Nurses in 28.6%, Certified Transport Nurses in 25.7%, Nurse Anaesthetists in 14.3%, Neonatal Nurses in 11.4%, Certified Paediatric Nurses in 5.7% and Acute Care Nurse Practitioners in 5.7%.The titles “paramedic” and “Emergency Medical Technician” (EMT) are poorly defined and based on many different educational models. For the purpose of the survey we categorized these professional groups according their airway skills: (1) ”Only supraglottic airway device” (14.8% in this survey), (2) ”Endotracheal intubation but not rapid sequence induction (RSI)” (25.9%), (3) ”Endotracheal intubation including RSI” (59.3%) and (4) ”May use mechanical ventilator” (59.3%).A HEMS Crew Member (HCM) is defined as medical professional that also acts as pilot assistant and often rescue specialist. Their medical training is EMT, paramedic or nurse. In this study the HCM had background as EMT/paramedic with only “supraglottic airway skills” in 38.5% of the services, with “intubation skills” in 38.5% and “RSI-skills” 26.9%. In 26.9% the services used RN as HCM, 15.4% used Nurse Anaesthetists and 7.7% nurse with CEN certification.Because we could not get access to databases of the medical directors in all the countries surveyed we cannot evaluate the response rate of our survey. This implies that our results cannot be fully representative of the countries surveyed.This study shows the variety of educations and level of competence in the medical crews in HEMS. For future research on staffing models a more precise definition and description of competence of all professions is needed. Using airway skills is one way to do this for paramedics and emergency medical technicians.


Tuberculosis (TB) is a major public health problem in Bangladesh since long. The present incidence and prevalence rates of all forms of TB are 227 and 404/100,000 population respectively. The aim of this study was to find out the clinical characteristics of involved cervical lymph nodes, demographic characteristics of the patients and response to treatment of Cervical Tuberculous Lymphadenitis (CTL) cases.A prospective study was performed in Shaheed Shamsuddin Ahmed Hospital, Sylhet, Bangladesh from June 2012 to June 2014. Total 65 patients having CTL attending outpatient department of the hospital were enrolled.Age of the patients ranged from 5 to 60 years with a mean of 25.6 years. Two third (67.7%) of the patients were female. Male: Female ratio was 1:2.1. More than half of the patients came from rural areas (53.8%) and from low socio-economic conditions (58.5%). Most of the patients presented with unilateral (87.7%), multiple (82.3%), matted (68.6%) lymph nodes, <3cm diameter (54%), commonly in right side (57.9%). Abscess was found in 21.5% cases. Discharging sinus was found in 9.2% cases. Most commonly involved lymph node group was level V (59.4%) followed by level II (42.2%). Systemic features were found in 63.07% patients. Associated lung lesion was found in 3.1% cases. FNAC was found positive for tuberculosis in 83.9% cases. Most of the patients (78.46%) were cured with six months anti-tubercular chemotherapy.Early diagnosis and treatment is critical in reducing the overall prevalence. It is essential to have awareness regarding common presentations of cervical tuberculous lymphadenitis among the general population as well as healthcare professionals working in the resource poor primary and secondary level hospitals. Tuberculosis (TB) is a major public health problem in Bangladesh since long. In 2014, the incidence of all forms of TB for all age groups was 227/100,000 population, while the prevalence rate was 404/100,000 population. Globally in 2014, TB killed 1.5 million of people and 9.6 million of people estimated to have fallen ill with TB. TB now ranks alongside HIV as a leading cause of death worldwide.1scrofulae meaning brood sow. In the Middle ages, it was believed that the ‘royal touch’ of the sovereign of England or France could cure the disease. It was therefore known as the King’s evil.Extra-pulmonary TB constitutes 15-20% of all cases of Tuberculosis.A prospective study was performed in Shaheed Shamsuddin Ahmed Hospital, Sylhet, Bangladesh, from June 2012 to June 2014. We selected 65 patients having CTL attending outpatient department of the hospital.After a detailed history and clinical examination, FNAC was performed in all patients. Excision biopsy was performed when FNAC was negative or doubtful and clinical suspicion was high for tuberculosis. Abscess was diagnosed by incision and drainage of abscess with taking biopsy from abscess wall. Routine investigations including ESR, Chest Radiograph was done in all the patients. HIV screening was not performed in any of the patients as there was no clinical suspicion regarding AIDS.For describing socio-economic status, we arbitrarily divided the patients into low (monthly household income <10000 taka), lower-middle (10000-20000 taka) and middle (>20000 taka). The age group was also subdivided in to four groups; less than 15, 16-30, 31-45 and 46- 60 years.For describing lymph nodes in the neck we used the system which originates from Memorial Sloan- Kettering Hospital, New York and adopted by the American Academy of Otolaryngology Head and Neck Surgery: Level I, Sub-mental and Sub-mandibular lymph nodes; Level II, Cervical jugular chain nodes above the level of hyoid; Level III, Cervical jugular chain nodes from the level of hyoid to the level of Cricoid; Level IV, Cervical jugular chain nodes from the level of Cricoid to the supra-sternal notch; Level V, Posterior triangle lymph nodes; Level VI, Central compartment nodes.5After confirming diagnosis of CTL all patients were treated according to national guidelines: Category one for new cases , Category II for default cases . Along with medical treatment, surgical treatment was given in the form of excision of the large lymph nodes (>6cm) suspected not to respond by medical treatment only, incision and drainage of abscess and excision of sinus tract along with associated lymph nodes. All patients were followed up at least six months to one year (2 monthly for six months than 3 monthly for next six months) and progress was assessed by clinical examination. In this study we defined ‘cure’ as complete disappearance of lymph nodes or decrease in size of <1cm.Data were analyzed by Statistical Package for Social Sciences [SPSS version 20]. They were presented as table with percentage and proportion. Bivariate analysis with gender was done in some of the variables. Chi-square and fisher’s exact test was done. P value was used to show the level of significance.Total 65 patients of CTL were included in this study. The age of the patients ranged from 5 to 60 years with a mean age of 25.6 years (SD=13.26). The commonest age group was 16-30 years (61.5%). Two third (67.7%) of the patients were female. Male:Female ratio was 1:2.1. Female patients were mostly housewives (56.8%). The other occupations include student 24.6%(16), day labor 10.8%(7), business 9.2%(6), house maid 6.2%(4) and unemployed 10.8%(7). More than half of the patients came from rural areas (53.8%). Socio-economic condition was low in 58.5% and lower-middle in 36.9% patients. Only 4.6% patients came from middle class family. Previous history of TB exposure was found in 26.2% cases . 16-30 yAmong the 65 patients, 45 (69.2%) presented with solid lymph nodes, 14 (21.5%) with abscess and 6 (9.2%) with discharging sinus. Unilateral involvement was found in 87.7% cases. Right side represented more  than left side . Multiple lymph nodes were found in 82.3% cases. Of them 68.6% (35) were matted and 31.4% (16) were discrete. Size of the largest lymph node was<3cm diameter in 54.8%, 3-6 cm in 37.1% and >6cm in 8.1% cases. Commonly involved lymph node group was level V (59.4%) followed by level II (42.2%) and level III (18.8%). Systemic features were found in 41 (63.07%) cases. Fever , Weight loss , Night sweat  and Loss of appetite  were the common systemic features . Site ofst hour) in 70.76% cases with a limit of 5-87 and mean was 39.28mm/1st hour (SD=23.21). Category I treatment was given in 60 cases. Most of the cases  cured within 6 months, few  needed 9 months and very few  needed one year treatment for their delayed response. Category II treatment was given in five (7.6%) cases. Surgical intervention was needed in 33 (50.8%) cases. No case was found ‘resistant’ or ‘relapse’ during the period of 6-12 months follow-up (FNAC was done in 62 cases and found significantly (p= < 0.01) positive in 52 (83.9%) cases. Chest radiograph was done in all cases and was normal (p= <0.01) in 96.9% (63) cases. ESR was raised  and Jha BC et al in India , but inconsistencies were found with the studies done by Magsi PB et al in Pakistan  and Choudhury N et al in UK .et al found the age of the patients ranged from 9 months to 62 years with a mean age of 23.7 years and commonest age group affected was 11-20 years (41.07%).et al, revealed the age of the patients ranged from 21 years to 75 years with a mean age of 40 years.12Sex distribution of the patients  in this study was quite consistent with the studies done by Ahmed I Demographic profiles of this study were similar with a Bangladeshi study (66.2%) and some other regional studies (in India 62.5% and in Pakistan 70%)where majority of the patients belonged to rural areas and from lower socio-economic group.14Systemic features found in this study (63.07%) were similar to another Bangladeshi study.17et al treated 56 patients successfully with short course chemotherapy for six months where surgery was required rarely.Anti-tuberculous chemotherapy is the mainstay in the management of TB lymphadenitis.Cervical tuberculous lymphadenitis usually presents with unilateral, multiple, matted neck swelling in young adults. Female and low income group people affected more. FNAC could be a reliable tool for diagnosis. Anti-tuberculous chemotherapy is the mainstay of treatment. Surgical treatment is more useful in selected cases. Early diagnosis and treatment is critical in lowering the overall prevalence. Therefore, it is essential to have awareness regarding common presentations of CTL among the general populations as well as healthcare professionals working in the resource poor primary and secondary level hospitals.


Rosmarinus officinalis L.) essential oil(REO) and modified-atmosphere packaging (MAP) on the survival of certainpathogens  in poultry fillets and on their meat quality during7 days of refrigerated storage were investigated. Because REO at 0.05% and 0.1%had weak antibacterial activity and REO at 0.3%, 0.5% and 1.0% impartedunacceptable organoleptic properties, only REO at 0.2% was used to treat thepoultry meat. The results showed that adding 0.2% REO to poultry fillets did notreduce the size of the population of S. Typhimurium andL. monocytogenes. However, REO treatment significantlydecreased the L* (lightness) value and increased the a*(redness) value of stored fillets, and adding REO in combination with MAPreduced the level of lipid oxidation. In conclusion, in a suitable combination,REO can be applied to improve the quality of meat, but further studies should beconducted to determine the appropriate commercial level for different meatproducts.The effect of rosemary ( The production of poultry meat products has increased throughout the world due to itsspecific sensory attributes and the consumer's belief that white meat is healthierthan red meat. Poultry products are highly perishable foods. Therefore, the industryis focused on methods to increase the shelf-life and the overall safety and qualityof poultry products  oilis widely used for preservation by the food industry. Studies have demonstrated thebeneficial effects of rosemary essential oil (REO) as a natural antioxidant thatprevented color deterioration and/or lipid oxidation  .S. Typhimurium and L.monocytogenes) in poultry fillets and on their meat quality.The aim of this study was to determine the effect of REO and MAP on the survival ofcertain pathogens plants in the Aegean region of Turkey were air dried at room temperature (20 ± 2°C), and their essential oils were obtained by a 3-h continuous steamdistillation using a Clevenger-type apparatus. The essential oil was collected,dried over anhydrous sodium sulfate and stored at 4 °C until analysis.Leaves collected from rosemary  equipped with an HP-5MS capillary column (30 m x 0.25mm) with a 0.25-μm film thickness was used for this study. The detector andinjector were maintained at 275 °C and 200 °C, respectively. Helium was used asthe carrier gas, at a flow rate of 1.0 mL/min, and the split ratio was set to100:1. The column temperature was programmed as follows: isothermal at 60 °C for1 min, ramp to 300 °C at 3 °C/min and isothermal for 1 min. The constituentswere identified by comparing their mass spectra with those in the computerlibrary and those of authentic compounds. The identifications were confirmed bycomparing their retention times (RT) with those of authentic compounds.The chemical composition of the REO was determined from gas chromatography-massspectrometry (GC-MS) analysis. Thermo Finnigan Trace DSQ system , equipped with an HP-5MS capillary column (30 m x 0.25mm) with a 0.25-μm film thickness was used. The chromatographic conditions wereidentical to those used for the gas chromatographic analysis.S. Typhimurium (ATCC 14028) and L.monocytogenes (ATCC 7644) strains were obtained fromMicrobiologics® . Both strains were stored in glycerol (30%) at−80 °C. Samples were streaked on Tryptone Soya Agar  plates and were incubated at 35 °C overnight. After 24 h,S. Typhimurium and L. monocytogenes weregrown in aerobically Tryptone Soya Broth  at 37 °C untilused.Samples of the 8 cfu/mL) were inoculated into 10 mL of TSB.Appropriate amounts of the REO solution were added to TSB to achieve finalconcentrations of 0.05%, 0.1%, 0.2%, 0.3%, 0.5% and 1.0% (w/v). Broth samples ofall the tested treatments were incubated at 37 °C for 24 h. To determine theinhibitory effects of REO, samples of the inoculated broth were taken formicrobiological analysis at 0, 4, 8, 12 and 24 h of incubation; all of theanalyses were performed in duplicate. The antibacterial activity was determinedfrom the growth of viable S. Typhimurium and L.monocytogenes cells on Xylose Lysine Deoxycholate Agar (OxoidCM469) or Chromogenic Listeria Agar (Oxoid CM1080) for  at 4 °C for 10 min, washed usingsterile phosphate-buffered saline (PBS) and serially diluted using PBS to aconcentration capable of providing approximately 104 cfu/g of poultrysamples.The S. Typhimurium andthose in the second group were contaminated with only L.monocytogenes. The samples in the non-inoculated group were usedfor physicochemical and sensorial analyses. The samples of poultry fillets wereplaced in stomacher bags and were inoculated with a single pathogenic strain.The inoculated samples were manually massaged for 10 min at room temperature (20± 2 °C) to ensure proper distribution of the pathogens. Prior to inoculation,the fillets were examined for contamination by the tested pathogens.Poultry breast meat  was obtained from a poultry (broiler)processing plant within 12 h of slaughter. Immediately after delivery, the meatwas filleted in small pieces (20 g). The poultry fillets were divided into threeequal groups, and each portion was placed in a polyethylene bag. The samples inthe first group were contaminated with only S. Typhimurium, L. monocytogenes and nobacterial inoculum) were treated using four different methods. The treatmentswere (1) air packaging (2) air packaging + the addition of REO at 0.2%, (3) MAP,(4) MAP + the addition of REO at 0.2%. REO levels of 0.05% and 0.1% were notfurther tested due to their weak antibacterial activities against the selectedpathogens. In addition, 0.3%, 0.5% or 1.0% REO solutions were not applied in theexperimental design because of the unacceptable organoleptic properties theyimparted to the poultry meat.Following homogenization, the inoculated and non-inoculated samples(2-permeable (8–12 cm3/m2/24 h at STP)polystyrene/ethylvinylalcohol (EVOH)/polyethylene (PE) trays. For air packaging,the PE trays were over-wrapped using non-barrier polyvinylchloride (PVC) clingfilm but not sealed to allow exposure to the atmospheric air. For MAP, the PEtrays were over-wrapped using oxygen-permeable (6000–8000cm3/m2/24 h at STP) polyvinyl-chloride film  into which a gas mixture of 30%CO2/70% N2 was injected using a Ponapack packagingmachine . The packages were stored at 4°C and were analyzed at 0, 1, 3, 5 and 7 days to determine the microbiological,physico-chemical  and sensorial  characteristics, using six packages from each group on each samplingdate.Immediately after treatment, all of subgroup samples (300–350 g) were placed inlow-O2, O2 andN2 contents within the packages were determined by injecting 0.5mL of gas that had been removed from the headspace using a syringe  into a PDI gas chromatography system  fitted with a thermal-conductivity detector.The headspace gas levels were calculated by subtracting the O2% andCO2% after a single direct reading of each package'satmosphere.Gas analyses of the atmosphere within the packages were conducted in duplicate at1, 3, 5 and 7 days of storage. The COS. Typhimurium and L. monocytogenes,respectively (Samples (25 g) were added to 225 mL of buffered peptone water (Oxoid CM509) insterile stomacher bags  and were homogenized for 2min using a stomacher device .Following homogenization, 10-fold serial dilutions were prepared using sterilethe Maximum Recovery Diluent (Oxoid CM317), and the diluted samples (0.1 mL)were streaked onto Xylose Lysine Deoxycholate Agar (Oxoid CM469) and ChromogenicListeria Agar (Oxoid CM1080) supplemented with Listeria Selective Supplement(Oxoid SR227) and Listeria Differential Supplement (Oxoid SR228) for enumerationof the ectively . The mic2O) andmeasuring the value using a pH meter  equipped with acombined electrode (AOAC 1984).The pH value of each poultry sample was determined after each exposure period byblending it with 100 mL of distilled-deionized water (ddHL*(lightness), a* (redness), and b* (yellowness)values were determined based on the average of five readings that were performedat different locations on the surface of the sample. The color was evaluatedusing diffuse illumination (D65 2° observer) with an 8-mm viewing aperture and a25-mm port size, with the specular component excluded . Beforeeach measurement, the apparatus was calibrated using a white, a black and areference standard. Color coordinate values, including the The thiobarbituric acid (TBA) content was determined according to the methoddescribed by The sensorial attributes of the poultry fillets were evaluated by eightexperienced panelists ranging from 26 and 45 years of age  who were trained according to the The panelists evaluated the perceived intensity of each sensory attribute on10-cm long unstructured linear scales that were verbally anchored at each end.Simultaneously, the overall acceptability of the poultry meat was assessed usinga 5-point descriptive scale in which 1 referred to "dislike extremely" and 5referred to "like extremely".The panel members were seated in individual booths in a temperature- andlight-controlled room  and were given a set of six samples in a completely randomized order.Before the evaluations were performed, the poultry samples were removed from thepackages and wrapped in aluminum foil and then were individually cooked in anoven (at 220 °C) for 20 min. Each of the samples was served warm in a dishencoded using a three-digit number. Unsalted crackers and water were served tothe panelists to freshen their mouths between assessing each sub-sample. Thesensory evaluations of the fillets were performed at 1, 3, 5 and 7 days ofrefrigerated storage at 4 °C.An analysis of variance was conducted for each variable to investigate the effectof the antibacterial activities of REO during the storage period. The trialswere performed in triplicate, and the General Linear Model procedure (PROC GLM)of the SPSS 13.0 package was used to analyze the data , with siThe main volatile components of the REO that was used to treat the poultry filletswere characterized according to the contents of the prominent (> 1%) components,including those of 1.8-cineole (44.80%), α-pinene (13.17%), camphor (10.43%),2α-pinene (8.08%), camphen (5.16%) and caryophyllene (5.07%). In the present study,1.8-cineole and α-pinene were found to be the major constituents of the REO. Similarresults were found in previous studies .S. Typhimurium andL. monocytogenes were inhibited by the REO at 0.2%, 0.3%, 0.5%and 1.0%. Consistent with this result, it has been reported that REO at variousconcentrations was effective in preventing the growth of food-borne pathogens, suchas S. Typhimurium  of the fillets that had been treated usingREO at 0.2% were assessed by the panelists, who gave scores above (p < 0.001) therejection limit (a score of 5), whereas the scores given samples that had beentreated using the REO at 0.3%, 0.5% and 1.0% were scored below the rejection limit(p < 0.001). Based on these sensory scores, treatment using 0.2% REO yielded thehighest acceptability scores between 5 and 7 days of storage. Due to the very strongodor and taste of the REO when used at a concentration of 0.3%, 0.5% or 1.0% duringstorage, these concentrations were not utilized in the further experiments. S. Typhimurium and L. monocytogenes in poultryfillets are shown in S. Typhimurium orL. monocytogenes (p > 0.05). Our results are agree withthose of S. Typhimurium by 43.2%. L. monocytogenes in a pork liver sausage. Moreover,Extracts of volatile compounds obtained from plants are widely used in the foodindustry due to their ability to inhibit the growth and reduce the number offood-borne pathogens .Adding REO significantly decreased the L* values (p < 0.001),whereas a significant increase in the a* values (p < 0.001) wasobserved at 5 and 7 days of storage; the b* values of the samplesin the groups remained more similar (p > 0.05) throughout the entire storageperiod. The results indicated that the MAP conditions had no additional effects onthe color-parameter values (p > 0.05). a* values of frozen pork patties and porcineliver pate, respectively. b* (more yellow) value. The differences among theresults may be due to differences in the oxidation pattern of oxymyoglobin in thesamples, the storage temperature used, the particular muscle type, the lightintensity and the meat species .th day of storage. It is well known that the development ofrancidity as a result of lipid oxidation is one of the major factors limiting thestorage life of meat products (2 concentration is the determining factor for lipidoxidation in chicken meat (The TBA assay is used to measure of the content of MDA, one of the degradationproducts of lipid hydroperoxides that is formed through the oxidation of unsaturatedfatty acids , with TBproducts , poultryS. Typhimurium or L.monocytogenes at 4 °C during a 7-day storage period. During storage,the presence of REO significantly decreased the L* values andincreased the a* values of the fillets. Adding REO in combinationwith MAP resulted in lower TBA values in the fillets. In conclusion, in a suitablecombination, REO can be applied to improve the quality of meat because it retardedlipid oxidation and prevented the development of rancidity; however, REO did notaffect the growth of pathogens when used at the lower levels. Further studies shouldtherefore be conducted to determine the commercial level of REO appropriate fordifferent meat products to allow its application by the food industry.The results of this study showed that adding 0.2% REO to poultry meat did not reducethe growth rate of


Introduction: The antimicrobial efficacy of root canal irrigant plays an important role in increasing the success of root canal treatment (RCT). The aim of the present experimental study was to compare the antimicrobial activity of Triphala (a plant-derived solution) with 0.5, 1, 2.5 and 5% concentrations of sodium hypochlorite (NaOCl), against Enterococcus faecalis . Methods and Materials: Two hundred plates of cultured E. faecalis, were divided into 5 experimental groups (n=38) and two positive and negative control groups. The antimicrobial activity of the test solutions was determined by measuring the zone of inhibition in the culture media. The mean diameter of inhibited zones between the study groups was compared using the Kruskal-Wallis test and the Mann-Whitney U test was used for the two-by-two comparison of the groups with the level of significance set at 0.05. Results: The Kruskal-Wallis test showed significant differences between the study groups (P<0.05). According to the Mann-Whitney U test the mean diameter of inhibition zones in Triphala group was significantly higher compared to 0.5 and 1% NaOCl (P<0.05). Conclusion: In this study, Triphala exhibited better antimicrobial activity against E. faecalis compared to 0.5 and 1% NaOCl (P<0.05). The principal aim of endodontic treatment is to debride and disinfect the root canal system. Mechanical instrumentation does not achieve this aim alone. Therefore, chemical disinfection by means of several irrigation solutions is recommended -4. An idEnterococcus faecalis  is one of the most commonly isolated microorganisms from the failed endodontic treatments. Because of its adhesion to dentin and penetration into the dentinal tubules and resistance to the antimicrobial effects of calcium hydroxide (CH), elimination of this microorganism is very difficult, if not impossible  is a plant-derived composition developed in India; the powder is a combination of three dried plants naming stituent -13. It hstituent -16. Initstituent . The mos°C under aerobic conditions and were then divided into 5 experimental groups (n=38) and two positive and negative control groups; group 1; Triphala, group 2; 0.5% NaOCl, group 3; 1% NaOCl, group4; 2.5 % NaOCl and group 5; 5% NaOCl.Two hundred plates containing agar medium, Mueller-Hinton broth (MHB)  and 5% sterile sheep blood were prepared. To confirm the sterility of the culture media, the plates were incubated for 24 h at 37Triphala powder  was dissolved in 10% dimethylsulfoxid  to prepare an irrigation solution at a concentration of 5 mg/ml. Different concentrations of NaOCl were prepared by dilution of 5.25% solution with sterile water without preservatives.E. faecalis bacterium (ATCC 299212) was prepared in the brain-heart infusion (BHI) broth  culture media and inoculated onto the prepared culture media. The culture was then kept at -20°C in a freezer. Single-well plates with the diameter of 6 mm and depth of 4 mm were prepared and 10 mL of the each test solution was pipetted into each well. The cultured E. faecalis was then defrozen and carried on the solid BHI agar enriched with 7% sterile sheep blood and incubated at 37°C and 5% CO2 gas for 24 h. The formed colonies were again transferred into MHB and incubated at 37°C under aerobic conditions for 24 h. Subsequently, spectrophotometry was used to prepare a standard suspension of E. faecalis in the MHB containing 1.5×108 (CFU/mL) bacteria in each mm equivalent to 0.5 McFarland standard. The suspension was homogeneously spared onto the surface of MHB agar containing sheep blood by using a sterile cotton swab. Positive and negative controls were also prepared, maintaining the plates inoculated and without inoculum and sterile saline as irrigant solution, for similar time intervals and under identical incubation conditions. All assays were carried out under aseptic conditions. The plates were incubated for 1 week at 37°C in a moist environment with 5% CO2 gas. Finally, the diameter of the halo formed around each disk (zone of inhibition) was measured using a glass ruler in mm by calculating the shortest distance between the outer margin of the material and the initial point of bacterial growth. The Kruskal-Wallis test was used to compare the mean diameter of the inhibition zones among the tested materials and the Mann-Whitney U test was used for the two-by-two comparison of the groups. The level of significance was set at 0.05.A 0.5 McFarland suspension of the reference P=0.002). The Mann-Whitney U test also showed significant differences in antibacterial activity of Triphala compared with 0.5% (P=0.003) and 1% NaOCl solution (P=0.001). However, there were no significant differences in the antimicrobial properties of Triphala and 2.5% (P=0.20) and 5% NaOCl solutions (P=0.28).The mean diameters of microbial inhibition zone was 7.3±1.3, 4.6±1.6, 6.3±1.2, 7±1 and 7.6±1.1 mm in the Triphala and 0.5, 1, 2.5 and 5% NaOCl groups, respectively. All positive samples displayed microbial growth and all negative samples yielded negative cultures. The Kruskal-Wallis test showed significant differences between the groups  with different concentrations of NaOCl on E. faecalis is a gram-positive facultative anaerobic microorganism, which has been isolated from almost 38% of teeth with failed endodontic treatment [E. faecalis can survive even in obturated canals without support from other microorganisms or with very small amounts of nutrients [The principal aim of endodontic treatment is to prevent or eliminate microbial contamination of the root canal system , 2, and reatment . It is rreatment , 10. Thiutrients .Enterococci, Acitinomycetes and Candida albicans [NaOCl is currently the most commonly used intracanal irrigation solution at various concentrations , 11. It albicans , 18. It albicans . In anotalbicans . Studiesalbicans , 11. In albicans , 8, 21.In recent years, there has been an increased tendency to use plant-derived alternative irrigation solutions with pharmaceutical properties. Previous studies regarding the comparison of antimicrobial activities of Triphala and NaOCl have used 3 and 5% concentrations of NaOCl , 14. In  E. faecalis. Biofilms are more resistant to antibacterial agents compared to planktonic bacteria [ of E. faecalis is suggested in order to compare the antimicrobial activity of Triphala with lower concentrations of NaOCl solution.The results of the present study showed higher antimicrobial activity of Triphala compared to 0.5 and 1% NaOCl and that it can be used as an appropriate irrigation solution in endodontics given the advantages of natural medications and the disadvantages of NaOCl. This claim needs more investigation. Another difference between this study and previous studies is the fact that previous studies have not used the biofilms ofbacteria . Therefoin vitro study, Triphala was more effective on cultures of E. faecalis compared to 0.5 and 1% NaOCl.Under the circumstances of this


Objective. This study aimed to examine the effectiveness of the use of oral anticoagulation (OAC) medication, recommended by national guidelines for stroke prevention but reportedly underused in AF patients with moderate to high stroke risk. Method. A multicentre and cross-sectional study of undiagnosed AF among out-of-hospital patients over 60 years old was carried out, visiting 3,638 patients at primary health centres or at home for AF diagnosis using the IDC-10 classification. The main outcome measures were CHA2DS2VASC, HAS-BLED scores, cardiovascular comorbidity, pharmacological information, TTR, and SAMe-TT2R2 scores. Results. The main findings were undiagnosed AF in 26.44% of cases; 31.04% registered with AF but not using OAC despite 95.6% having a CHA2DS2VASC ≥ 2 score; a risk of bleeding in important subgroups using OAC without indication (37.50% CHA2DS2VASC < 2 score); the use of OAC with TTR < 60% (33.1%), of whom 47.6% had a HAS-BLED score ≥3. Thus, 35.4% of the expected AF prevalence achieved an optimal time in the therapeutic range. Conclusions. The expected AF prevalence was 10.9% (n 5267), but the registered prevalence was 7.5% (n 3638). Only 35.04%  of AF patients treated with vitamin K antagonists (VKAs) achieve the goal of TTR > 60%. Atrial fibrillation (AF) is a common cardiac arrhythmia  that affDue to the associated increased morbidity, mortality, and cost, challenges in the identification of patients at risk for thromboembolic events from AF must be addressed. AF is often only detected with the onset of severe AF-related complications such as stroke or heart failure , 9. AlthThe aim of the study is to document the quality of anticoagulant control in primary care, considering the potential impact of undiagnosed AF, the underutilization of VKAs, and results related to TTR. The challenges include compliance with performance measures, adherence to guidelines, adequate prevention, and early control of comorbidities that affect the progression of AF and associated risks, early initiation of treatment, and successful evaluation of the associated risks of bleeding, primary or recurrent stroke, and patient awareness and compliance , 8, 13.The AFABE , 13 stud(1) Patient Identification Code. It includes individualized TIS number .(2) Sociodemographic Information. It includes age, gender, and place of residence.(3) Cardiovascular Information. We described clinical comorbidities included in the cardioembolic CHA2DS2VASC rule , as well as current tobacco use (2 points) and race . The SAME-TT2R2 score was calculated for all patients with a diagnosis of AF, but as it makes a simple prediction of which AF patients are likely to do well on VKAs (with an average time in therapeutic range ≥ 60%), the TTR percentage included just those patients using VKAs. We tested the hypothesis that the new SAME-TT2R2 score was a predictor for good average time in therapeutic range and, second, that this would translate into adverse events in a “real-world” cohort of patients with AF.χ2 test or Fisher's exact test depending on the application conditions. Continuous variables were compared using Student's t-test or the Mann-Whitney U test depending on the normal distribution assumption. Normal distribution was checked using the Shapiro-Wilk test. A logistic regression analysis was performed to find possible risk factors that characterize the population with AF. A P value of less than 0.05 was considered to indicate statistical significance in all statistical tests. The analysis was carried out using the SPSS statistical software package (version 19).In the descriptive analysis, the data for categorical variables are expressed as number of cases and percentages and the data for continuous variables are expressed as means with standard deviations and/or IC95%. Categorical variables were compared using a The Ebro Lands study population  comprise2DS2VASC and HAS-BLED scores; these are stratified by age in 2DS2VASC score was 3.6 and 95.6% of subjects had a CHA2DS2VASC score ≥ 2. The older the patient (increasing up to 85 years), the higher the CHA2DS2VASC score.The average HAS-BLED score was registered in 69.5% of patients. The average score was 2-3 and 47.6% of subjects treated with VKAs had HAS-BLED ≥ 3. The proportions of subjects with abnormal renal function and abnormal hepatic function were 14.4% and 15.1%, respectively. Risk factors related to a history of or predisposition to bleeding (2.3%) and chronic concomitant use of antiplatelet and/or anti-inflammatory (5.2%) treatment were less frequent. The older the patient (increasing up to 85 years), the higher the HAS-BLED score.P = 0.031), while the incidence of ischemic stroke was similar among men and women (P = 0.612). There were no differences in the overall incidence of CVC by gender. Patients who had suffered ischemic stroke or ischemic cardiomyopathy previously were at greater risk (OR = 2.63) of suffering AF than those who had not. Mortality was higher (P = 0.05) among those ones who had been diagnosed with ≥ 2 CVCs before the AF. On other hand, mortality was significantly lower among those who were treated with statins (P = 0.032).Before the AF diagnosis, 36.8%  had been diagnosed with some cardiovascular complication (CVC). Almost half of the overall CVCs were ischemic cardiomyopathy (24.2%) and ischemic stroke (23.2%). The incidence of ischemic cardiomyopathy was significantly higher among men (P = 0.037). The five-year survival rate with a diagnosis of CHF is lower (0.69 ± SD 0.09) than when there is no CHF present (0.96 ± DE 0.01). The main predictor of mortality is a nontreatment with OAC, with significantly lower mortality in patients treated with OAC (P = 0.003) versus antiplatelet treatment  were diagnosed with new vascular complications. The most frequent vascular complication was congestive heart failure , the incidence of which was significantly higher among women /1000 patients ≥ 60 years old per year. Of 565 incidents of ischemic stroke, 359 (63.5%) occurred at ≥ 80 years . OverallThe overall percentage of patients not treated with OAC was 26.9% . In all, 4.2% were treated with NOACs  and 18.9% with antiplatelet drugs. In terms of the expected AF prevalence , the per2R2 score ≥ 2 and the percentage gradually increased in patients from 60 to 64 years (36.8%) up to > 85 years (57.6%). Of these, 54.6% had TTR < 60% and the ROC curve results were 0.48 , sensitivity 0.62, and specificity 0.29.The percentage of patients with time in therapeutic range (TTR) < 60% was 33.1%  for those using VKAs. This research identified a high rate of patients with anticoagulant therapy in primary healthcare (>90%). Most patients take coumarins and the quality of OAC control is reasonably high. In all, 50.5% had a SAME-TT2DS2VASC ≥ 2 and there being a group at special risk (70–74 years) of whom 47.6% had a score ≥ 3 for HAS-BLED. Furthermore, there is a risk of bleeding in important subgroups using OAC without indication . In this study, one-third (33.1%) of AF patients using OAC showed a time in therapeutic INR range < 60%; the older the patient, the higher the risk of TTR < 60%. According to the panel data [It is possible to improve patients' control of their VKA serum levels in various ways, but clearly it is necessary to address risk conditions reflecting poor anticoagulation control and labile INRs among patients with AF given that OAC treatment seems to depend solely on these. This study has found a gap (30.9%) between expected and registered AF prevalence and registered AF with no use of OAC treatment (26.9%) despite 95.6% having a score of CHAthird 33.% of AF pThis paper focuses in particular on the overall prevalence of AF increasing with age and its related possible consequences, that is, more undiagnosed AF. Furthermore, the potential increase in the percentage of AF not treated with OAC carries the foreseeable threat of an increase in cardiovascular morbidity and associated costs, primarily caused by ischemic stroke, stroke, and CHF with the requirement for chronic use of medication. Our main conclusion, unlike other studies, is not much the relative underuse of the VKA treatment in high risk AF patients but the low efficiency resulting from the association between its underuse and undiagnosed AF.The rate of undiagnosed AF for subjects over 60 years old was 3.4%, representing 31% of the overall AF prevalence in our study, compared to a percentage between 25% and 35% in other studies –26. AlthThe prevalence of AF is high and rising. This work has paid particular attention to the alarming increase in overall AF prevalence, especially in people >70 years, the prevalence of AF being > 20% at age ≥ 80 years. Similar results have been found  suggesti2DS2VASC risk scores [2DS2VASC score ≥ 2 should receive anticoagulation even if at high risk of falls. The risk scores, CHA2DS2VASC and HAS-BLED, rise with age up to 85 years, but, as the risk of stroke increases, the rate of anticoagulation use does not differ or decrease. This may be due to the concerns of providers regarding the risk of bleeding and the risk-benefit trade-off of treatment for higher-risk populations.The percentage of undiagnosed AF should be added to the percentage of known AF not treated with OAC, representing 40–50%  of the ok scores , resultik scores . The pank scores . Patient2R2 score, including investigations in different local cultural conditions, leading to new quality criteria based on the results.The reasons for the underuse of anticoagulation are poorly understood. There is a complex interaction between patient-, physician-, and healthcare system-related factors , in whicIt is important to understand whether there are appropriate reasons for the apparent underuse of warfarin therapy in the elderly , 36, 37 A prior history of falls has been associated with increased risk of stroke/thromboembolism, bleeding, and mortality, but not haemorrhagic stroke in the presence of anticoagulation . It is nP < 0.001). There has been an increase in patients on warfarin and 40% of haemorrhagic strokes occurred at ≥ 80 years. In our study, 47.6% of AF patients treated with VKAs scored ≥ 3 for HAS-BLED. A tendency towards an increasing frequency of stroke has been observed for increasing bleeding risk within cardioembolic risk categories and vice versa [2R2 score.Epidemiologically and clinically, an increase in the percentage of haemorrhagic stroke can be observed, progressing from 7.9% (2006–2008) to 14.8%  , it is possible that a higher frequency of AF patients or patients with AF risk factors could have produced an artificial increase in the prevalence described. The strengths of the present study include a population-based design and its reflection of routine clinical practice. Minimal exclusions were employed as the exclusion of patients with missing data would potentially have introduced selection bias. The risk of referral bias was low as it can be assumed that all patients with acute symptoms of stroke are referred to the public healthcare system if hospitalized. The weaknesses of the present study include the retrospective design and the risk of misclassifications during data collection in routine clinical settings.n 5267), but the registered prevalence was just 7.5% (n 3638). Although the “gold standard” for anticoagulation is warfarin, only 68.9% (n 2506) of patients were treated with VKAs and only 67.3% attained a TTR > 60%. A relatively high rate of patients with anticoagulant therapy in primary healthcare has been found in this research, but the INR control remains suboptimal. Thus, only 35.4% of the expected AF prevalence achieved an optimal TTR. It seems clear that the providers of care and the systems within which they work have a profound effect on the quantity and quality of anticoagulation treatment.The expected AF prevalence was 10.9% (


Approximately one third of epileptic children are resistant to anticonvulsant drugs. This study evaluates the effectiveness, safety, and tolerability of pregabalin as adjunctive therapy in epileptic children relative to Zonisamide. From April 2012 to November 2012,121 children were referred to Mofid Children’s Hospital with intractable epilepsy and enrolled in the study. The patients were divided into two groups (A and B) randomly. Group A was treated with Zonisamide and group B was treated with Pregabalin in addition to prior medication. We assessed seizure frequency and severity during a 4-week interval from the beginning of the drug treatment and compared the efficacy of each in these two groups. Group A consists of 61 patients, 26 (42.6%) girls, and35 (57.4%) boys with an age range from 1.5 months–14 years . Group B consists of 60 patients, 31(51.7%) girls, 29 (48.3%) boys with an age range from 6 months–16 years . Age, gender, seizure onset, seizure frequency, seizure type, and previous antiepileptic medications showed that there was no significant difference between the groups (P>0.05). Zonisamide and pregabalin reduced more than 50% of seizure intensity in 40.2%; 45.8% of patients also had a seizure frequency decline between35.8–44.4%, respectively and there was no significant superiority between these two novel anticonvulsants (P>0.05). In this survey both pregabalin and Zonisamide were impressive for seizure control in children with intractable epilepsy and well sustained with mild complications that were completely reversible.  Every year about 40 out of 100,000 children under 16 years of age are affected by epilepsy as one of the most widespread neurologic disorders worldwide -3. ElectAs there is an insignificant amount of information regarding new AEDs utility in treatment of children with refractory epilepsy, the current assay was carried out to evaluate the effectiveness, safety, and tolerability of pregabalin as an adjunctive therapy relative to that of Zonisamide. From April 2012 to November 2012,121 children were referred to Mofid Children’s Hospital with intractable epilepsy (failure of seizure recovery in spite of two or more antiepileptic drugs) and were enrolled in the study. Exclusion criterion was hypersensitivity to anticonvulsants and having a neurodegenerative disease. All parents endorsed a written informed consent. The initial assessment included history taking , general and neurologic physical examination, electroencephalography (EEG), and magnetic resonance imaging (MRI) performance. Then, the patients were divided into two groups randomly (A and B).Group A was treated with Zonisamide while patients in group B received Pregabalin. We treated group A with capsules of ZNS (2–12 milligram per kilogram daily) as group B were treated with capsules of PGB (5–15 milligram per kilogram daily)divided in two or three doses in addition to prior medication. We assessed seizure frequency, severity, and duration during the 4 week interval from the beginning of treatment and compared the efficacy of each drug in the two groups. During follow-ups, seizure frequency or severity reduction equal and greater than 50%istermedas a response to the drug. A paired sample T-test, Z-test, and chi-square have been used in the statistical analysis. All of the ethical perspectives of this study have been confirmed by the Ethics Committee of Shahid Beheshti University of Medical Sciences. This study was registered in the Iranian Registry of Clinical Trial (IRCT) as IRCT2012091210508N4. In this study, 137 patients were enrolled and121 patients reached the final stage. After one and six months of ZNS usage, daily seizure frequency decreased to 2.95±3.54as 45.7% reduction and 3.73±3.5 as 31.3% reduction, respectively. PGB after one and six months reduced seizure frequency up to 2.41±2.38as a 48% reduction and 2.75±2.38 as a 40.86% reduction respectively. According to improvements in seizure severity and duration after one month, 17(27.9%),30(49.2%), and 14 (22.9%) patients of group A toward 15(25%),32(53.33%), and 13 (21.66%) patients of group B had no change, greater than 50% recovery, and reduction less than 50%, respectively . Also,25This study showed that ZNS and PGB reduced greater than 50% of the seizure intensity in 40.2% and 45.8% of patients also had seizure frequency declinesof35.8% and 44.4%, respectively in which there was no significant superiority between these two novel anticonvulsants. Brodie et al, Sackellares et al, Faught et al, and Schmidt et al reported a response rate (greater than 50% seizure reduction) of 28–47% with ZNS as an add-on therapy for intractable epilepsy through four clinical studies . ZNS effIn conclusion, in this survey both pregabalin and Zonisamide were impressive for seizure control in children with intractable epilepsy and well sustained with mild complications that were completely reversible.