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Background Cognitive improvement has been reported in patients receiving centrally acting angiotensin-converting enzyme inhibitors (C-ACEIs). Aims To compare cognitive decline and survival after diagnosis of Alzheimer's disease between people receiving C-ACEIs, non-centrally acting angiotensin-converting enzyme inhibitors (NC-ACEIs), and neither. Method Routine Mini-Mental State Examination (MMSE) scores were extracted in 5260 patients receiving acetylcholinesterase inhibitors and analysed against C-/NC-ACEI exposure at the time of Alzheimer's disease diagnosis. Results In the 9 months after Alzheimer's disease diagnosis, MMSE scores significantly increased by 0.72 and 0.19 points per year in patients on C-ACEIs and neither respectively, but deteriorated by 0.61 points per year in those on NC-ACEIs. There were no significant group differences in score trajectories from 9 to 36 months and no differences in survival. Conclusions In people with Alzheimer's disease receiving acetylcholinesterase inhibitors, those also taking C-ACEIs had stronger initial improvement in cognitive function, but there was no evidence of longer-lasting influence on dementia progression.

Diet and feeding behavior data are crucial to a deep understanding of the behavioral response and adaptation of primates to a high-altitude environment. From August 2019 to June 2021, we collected data on the feeding behavior of a high-altitude rhesus macaque Macaca mulatta group from Yajiang County, Western Sichuan Plateau, which has an altitude of over 3,500 m. The results showed that feeding (33.0 ± 1.8%) and moving (28.3 ± 2.6%) were the dominant behavior of rhesus macaques. Macaques ate 193 food items, comprising 11 food categories from 90 species. Our study found that plant roots (30.9 ± 30.1%) and young leaves (28.0 ± 33.1%) were the main foods eaten by macaques. The preferred foods of rhesus macaques were young leaves, fruits, and seeds, and the consumption of these items was positively correlated with its food availability. When the availability of preferred foods was low, macaques took plant roots, barks, and fallen leaves as fallback foods. In particular, roots were a dominant food item in winter, and this way of feeding became a key survival strategy. Our results suggest that, facing the relative scarcity and strong seasonal fluctuations of food resources in high-altitude habitat, macaques adopt active foraging strategies, relying on a variety of food species and adjusting flexibly their food choices based on food availability, which may help to maximize the energy efficiency of high-altitude macaques. [ABSTRACT FROM AUTHOR]

This study focuses on evaluating the resistance of polymer modified asphalt mixes and the role played by asphalt in the realm of construction is undeniably important. Addition of polymers(PB) as additives to asphalt helps to improve the strength and water repellent property of the mix and as well as helps environment in various ways and at the same time, analyzing its lower maintenance activities and service life is most important. The use of inexpensive polymers, in this case, waste polymers has without any doubt proven to be the most convenient way of reducing the cost of construction and at the same time maintaining quality. The main resolve for this research was to establish the effects of the use of plastic bottles on hot asphalt and its mixtures. In order to put this into perspective, varying percentages of asphalt mixtures were calculated and subjected to laboratory tests. The two-factor variance analysis (ANOVA) was conducted to determine the significance at various confidence limits. The results indicate that the inclusion of Polyethylene Terephthalate (PET) had a particularly substantial effect on the properties of asphalt. Consequently, it can encourage the re-utilization of waste in the manufacturing industry in an ecologically friendly and cost-effective way.

Plastic Bottles was used as the polymeric waste to investigate performance of asphalt mixture Aggregates obtained from Margalla, Burhan and Karak quarries. 12 samples were prepared for conventional asphalt mixtures and 48 samples were prepared for PB modified asphalt mixture of each quarries at various proportions of PB waste. The PB used for modification according to wet process are 15%, 20%, 25% and 30% by weight of Optimum Bitumen Content (OBC). OBC of 4.2 % was concluded for conventional asphalt mixtures. The stability and flow values of the conventional and modified Asphalt Mixture were compared. The average Stability of the modified Margalla asphalt mixtures when 15% PB was used was much higher as compared to conventional asphalt mixtures. But when PB was used beyond 15%, the Marshall stability showed a decreasing trend for Margalla aggregates, increasing trend for Karak aggregates and decreasing trend for Burhan aggregates. This decline in stability is attributed to a decline in interlocking of aggregates due to lubricating effect. The corresponding flow for the Modified asphalt mixtures first showed a decreasing trend for Margalla aggregates at 15% PB modification but beyond 15%, an increasing trend in flow as compared to conventional asphalt mixtures The decrease in flow or increase in Marshall Stability is attributed to improvement in interlocking and decline in flow or stability is attributed to a decline in interlocking offered by binder and PB coated aggregate particles in modified asphalt.

This research study aims to investigate the motivation of Sindhi speaking female students to learn English language, belonging to lower socio economic status. English is a language which is gateway to many opportunities. People globally have witnessed the worth of acquiring this language skills. This is the reason that despite having emotional attachment with their mother tongue language, the learner is motivated to learn this foreign/second language. She can be interactively or instrumentally motivated. It is worth researching that whether the Sindhi speaking female students from lower socio-economic status are motivated or not and what is their motivation orientation (integrative or instrument) to learn English. To conduct this research, quantitative research method was used. A questionnaire was developed by the researcher to collect data based on Attitude and Motivation Test Battery (AMTB). Total numbers of fifty Sindhi speaking female students from lower socio-economic class were chosen randomly as the participants of this study. All the participants were students. The data findings revealed that the participants were motivated to learn English irrespective of the socio economic issues faced by them. However; they were more instrumentally motivated than they had integrative motivation to learn English. Thus the results revealed that the participants gave more preference to the perceived practical benefits of learning English. [ABSTRACT FROM AUTHOR]

Background: Non-alcoholic fatty liver disease (NAFLD) is becoming a public health problem with increasing incidence and it has been shown to be associated with diabetes, dyslipidemia, obesity and metabolic syndrome and ultimately puts more than half the world's population at risk of developing NAFLD/NASH/cirrhosis in the coming decades. The importance of detection of patients with NAFLD is to intervene the associated factors and avoid transformation to more severe forms of the disease. Methods: An observational case control study was carried out at Medicine Department, Dhaka Medical College Hospital (DMCH), Dhaka, during the period of August, 2011 to June, 2012. A total number of 100 consecutive patients and 100 healthy controls was approaches DMCH were enrolled in this study. Out of 100 NAFLD patients only 20 patients gave consent for liver biopsy to see the extent of liver damage. Result: Less physical activity, Obesity, mean blood pressure, Diabetes, TG, TC were significantly (P<0.05) higher in NAFLD. Metabolic syndrome was 64% in NAFLD. According to NASH Activity Scoring system definite NASH (score >5) was found in 9(45%) of the NAFLD group. Conclusion: Significant proportion of NAFLD patient suffers from NASH which is alarming and they have potential for the development of advanced liver disease. So recognition of these risk factors inpatients of NAFLD can help in early implementation of strategies that halt the progression of this disease. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: There are paucity of information about prevalence and risk factor of hepatitis C virus (HCV) in Bangladesh. Methods: Blood was collected from 1018 randomly selected subjects from a semi-urban area of Bangladesh. Anti-HCVs were checked in the blood twice using a third-generation commercial kit. The data of the questionnaires were analyzed to find possible risk factors. Results: Nine of the 1018 subjects (88%) were tested positive for anti-HCV. The HCV-positive subjects were >28 years old. Major risk factors for HCV infection were treatment by unqualified and traditional practitioners, history of mass-vaccination against smallpox, hair cutting and shaving by barbers, and body piercing. However, known risk factors such as blood transfusion, surgery, invasive therapy, and intravenous drug use were not detected in any HCV-infected subjects. Conclusion: Control of HCV infection in Bangladesh may be difficult because the risk factors are related to normal tradition and culture of Bangladeshi people. [Copyright &y& Elsevier]

Acute hepatitis is seen sporadically round the year in Bangladesh. The incidence of acute viral hepatitis E increases after floods as this allows sewerage contamination of piped and groundwater. The aim of this retrospective study was to assess the burden of hepatitis E virus (HEV infection) in Bangladesh. Patients attending the Hepatology Unit III of the Bangabandhu Sheikh Mujib Medical University, during June 2004--December 2006, were included in the study. All viral markers were tested by enzyme-linked immunosorbent assay. The study population was divided in four groups. Group 1 included 144 patients with acute viral hepatitis. The inclusion criteria were: nausea and/or vomiting, loss of appetite, serum bilirubin >200 µmol/L, raised serum transaminases, and prothrombin time >3 seconds prolonged beyond control value. In Group 2, there were 31 pregnant women with acute viral hepatitis. All the patients had prodrome, icterus, raised serum bilirubin and raised serum transaminase levels. Group 3 included 23 patients presenting with fulminant hepatic failure. In Group 4, 69 patients with cirrhosis of liver were included. They presented with features of decompensation for the first time. The inclusion criteria were: patients with established cirrhosis with jaundice and/or ascites and/or hepatic encephalopathy. In Group 1, 58.33% of the 144 patients had acute viral hepatitis E. In Group 2, 45.16% of the pregnant women also had acute viral hepatitis E. HEV was responsible for 56.52% cases of fulminant hepatic failure in Group 3. In 21.7% cases in Group 4, decompensation of cirrhosis was due to HEV. Acute viral hepatitis E in the third trimester of pregnancy and HEV-induced fulminant hepatic failure were associated with 80% of mortality despite the best possible care. In this clinical context, acute viral hepatitis E is the leading cause of wide spectrum of liver disease ranging from severe acute viral hepatitis, fulminant hepatic failure, to decompensation of liver in cirrhotics in Bangladesh. Sewerage contamination of piped water following floods may contribute to the higher incidence of HEV infection. [ABSTRACT FROM AUTHOR]

Background and Aims: Hepatitis B virus (HBV) infection is common in Bangladesh. However, the characteristics of young patients incidentally detected with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B is yet to be studied in this country. Methods: We did percutaneous liver biopsies in 36 patients with chronic hepatitis B (CHB) aged between 8 and 20 years. They were all HBeA9-negative with persistently normal or raised serum alanine aminotransferase (ALT) values. Results: 56% of patients had significant necro-inflammation. Significant fibrosis was seen in 17.6% of patients. Serum ALT was raised in 38.2%. A high HBV DNA load was observed only in 26.5% of patients. HBeAg-negative CHB is assumed not to be present in the age group studied, since this is the age group that represents immunotolerance to CHB. Immunotolerant CHB patients are positive for HBeAg, have normal ALT with high HBV DNA load. However, our study not only documented that HBeAg-negative CHB is common in our young population, but the data were also in contrary to what was expected in such age group of CHB patients. Conclusions: HBeA9-negative CHB is an entity that can be seen in young population and a significant percentage of such patients may have considerable hepatic involvement. [ABSTRACT FROM AUTHOR]

Background: The prevalence of Metabolic dysfunction associated fatty liver disease (MAFLD) and its complication, MAFLD-related acute on chronic liver failure (MAFLD-ACLF), is rising. Yet, factors determining patient outcomes in MAFLD-ACLF remain understudied., Methods: Patients with MAFLD-ACLF were recruited from the AARC registry. The diagnosis of MAFLD-ACLF was made when the treating unit had identified the etiology of chronic liver disease (CLD) as MAFLD (or previous nomenclature such as NAFLD, NASH, or NASH-cirrhosis). Patients with coexisting other etiologies of CLD (such as alcohol, HBV, HCV, etc.) were excluded. Data was randomly split into derivation (n=258) and validation (n=111) cohorts at a 70:30 ratio. The primary outcome was 90-day mortality. Only the baseline clinical, laboratory features and severity scores were considered., Results: The derivation group had 258 patients; 60% were male, with a mean age of 53. Diabetes was noted in 27%, and hypertension in 29%. The dominant precipitants included viral hepatitis (HAV and HEV, 32%), drug-induced injury (DILI, 29%) and sepsis (23%). MELD-Na and AARC scores upon admission averaged 32±6 and 10.4±1.9. At 90 days, 51% survived. Non-viral precipitant, diabetes, bilirubin, INR, and encephalopathy were independent factors influencing mortality. Adding diabetes and precipitant to MELD-Na and AARC scores, the novel MAFLD-MELD-Na score (+12 for diabetes, +12 for non-viral precipitant) and MAFLD-AARC score (+5 for each) were formed. These outperformed the standard scores in both cohorts., Conclusion: Almost half of MAFLD-ACLF patients die within 90 days. Diabetes and non-viral precipitants such as DILI and sepsis lead to adverse outcomes. The new MAFLD-MELD-Na and MAFLD-AARC scores provide reliable 90-day mortality predictions for MAFLD-ACLF patients., (Copyright © 2024 by The American College of Gastroenterology.)

Background: Multiple predictive models of mortality exist for acute-on-chronic liver failure (ACLF) patients that often create confusion during decision-making. We studied the natural history and evaluated the performance of prognostic models in ACLF patients., Methods: Prospectively collected data of ACLF patients from APASL-ACLF Research Consortium (AARC) was analyzed for 30-day outcomes. The models evaluated at days 0, 4, and 7 of presentation for 30-day mortality were: AARC (model and score), CLIF-C (ACLF score, and OF score), NACSELD-ACLF (model and binary), SOFA, APACHE-II, MELD, MELD-Lactate, and CTP. Evaluation parameters were discrimination (c-indices), calibration [accuracy, sensitivity, specificity, and positive/negative predictive values (PPV/NPV)], Akaike/Bayesian Information Criteria (AIC/BIC), Nagelkerke-R 2 , relative prediction errors, and odds ratios., Results: Thirty-day survival of the cohort (n = 2864) was 64.9% and was lowest for final-AARC-grade-III (32.8%) ACLF. Performance parameters of all models were best at day 7 than at day 4 or day 0 (p < 0.05 for C-indices of all models except NACSELD-ACLF). On comparison, day-7 AARC model had the numerically highest c-index 0.872, best accuracy 84.0%, PPV 87.8%, R 2 0.609 and lower prediction errors by 10-50%. Day-7 NACSELD-ACLF-binary was the simple model (minimum AIC/BIC 12/17) with the highest odds (8.859) and sensitivity (100%) but with a lower PPV (70%) for mortality. Patients with day-7 AARC score > 12 had the lowest 30-day survival (5.7%)., Conclusions: APASL-ACLF is often a progressive disease, and models assessed up to day 7 of presentation reliably predict 30-day mortality. Day-7 AARC model is a statistically robust tool for classifying risk of death and accurately predicting 30-day outcomes with relatively lower prediction errors. Day-7 AARC score > 12 may be used as a futility criterion in APASL-ACLF patients., (© 2021. Asian Pacific Association for the Study of the Liver.)

Background: Hepatitis B virus (HBV) infection is a major cause of mortality and morbidity globally. The quest continues to identify viral factors that influence disease progression and severity as well as responses to treatment of HBV infection. Based on variations in HBV, the virus has been divided into a number of genotypes., Data Sources: Review of published literature on HBV genotypes., Results: HBV genotypes are likely to be important in determining the severity and progression of HBV-induced liver disease as well as responses to different anti-viral agents., Conclusion: Although HBV genotyping is not yet recommended for routine use in treating HBV infection, available data suggest that, as in hepatitis C virus infection, HBV genotyping is also likely to become a routine investigation for HBV treatment, perhaps in the not too distant future.