15 In 2007, Stevens and his colleagues5 noticed that the activation of internal oblique (IO), rectus abdominis, and multifidus muscles increased during the four-point kneeling position.

Comparison between the local abdominal and back muscles demonstrated higher activation in local abdominal muscles in bird-dog and four-point kneeling exercises.17 Furthermore, the activation of rectus abdominis, TrA, and internal and external oblique muscles was investigated during abdominal hollowing in four different positions. The results suggested that Inhibitors,research,lifescience,medical all the four positions could facilitate the activation of TrA, IO, and rectus abdominis muscles, while external oblique muscles had minimal activation.18 Another study reported the increased activation of local and global muscles during the Selleck Paclitaxel stabilization exercise on unstable surfaces.19 The appropriate type of exercise and the importance of the role of each muscle in these exercises have never Inhibitors,research,lifescience,medical been investigated. However, it has been suggested that the exercises which improve muscle stiffness should be encouraged

in rehabilitation programs.20 Therefore, the present study aimed to compare Inhibitors,research,lifescience,medical the level of contraction between abdominal and lumbar muscles in order to clarify the role of the trunk (core) muscle activation during the four-point kneeling exercise. The effects of the motion of the upper and lower extremities on the trunk muscle activation were evaluated as well. Inhibitors,research,lifescience,medical Materials and Methods This quasi-experimental study was carried out in the Research Center of Shiraz Rehabilitation Department, Shiraz University of Medical Sciences, Shiraz, Iran. Considering a power of 0.8

with an alpha of 0.05, the sample size was calculated as 30 healthy subjects. The study Inhibitors,research,lifescience,medical population was, therefore, comprised of 30 healthy, right-handed women aged between 20 and 30 years with no known neuromuscular, orthopedic, or cardiovascular conditions. Also, the subjects had Fossariinae no previous experience of stabilization exercises. All the subjects signed written informed consents for participation in the study. Past recurrent LBP, Body Mass Index greater than 27, current neurological deficits, pain or disability of the upper or lower limbs, and left-handedness were the exclusion criteria. Equipment The study data were collected using MegaWin software (Mega Electronics Ltd., Finland [v. 2.5 a 16]). Electromyography (EMG) signals were recorded using 6 pairs of self-adhesive disposable disc surface electrodes (Medico Lead-Lok) with an electrical contact of one cm² and a centre-to-centre distance of 2 cm.

They were told that they would be tested on their recollection of the selleck chemicals llc second word of each pair on a later test. During the encoding phase of the word-pairs task, subjects were administered word pairs on a computer screen. Thirty of the word pairs were provided entirely

during the read condition (e.g., “hammer–nail”), and subjects were instructed to overtly read the second word of each pair within the 5 sec of word-pair presentation. The remaining 30 word pairs were Inhibitors,research,lifescience,medical part of the generate condition in which the first word of the pair was presented along with only the first letter of the second word followed by asterisks for the remaining letters (e.g., “spider- w**”). Subjects were instructed Inhibitors,research,lifescience,medical to generate the second word and verbalize it aloud within 5 sec of word-pair presentation. The order of read and generate trials was pseudorandom, but constant for all subjects; the word pairs assigned to each condition were presented in random order. Overt responses for each subject were recorded throughout the word-pairs task. Within 30 min of completing Inhibitors,research,lifescience,medical the task, the subjects performed a self-paced recognition

memory task (i.e., during the recognition phase) with 60 trials. The second word from every pair presented in the earlier word-pairs task (i.e., during the encoding phase) was presented simultaneously with two foil words in a forced-choice recognition task on a computer screen. Subjects were instructed to indicate which of the three words they recognized from the previous task by pressing a key corresponding Inhibitors,research,lifescience,medical to the word. The items were presented in the same order for all subjects, and the order was different from the random order of word-pair presentation they received on Inhibitors,research,lifescience,medical the earlier word-pairs task. Data management

and analysis Recordings of intrascanner overt responses for both the read and generate conditions were transcribed and scored to determine the proportion of correct responses during the encoding phase for each linguistic relationship and each condition. Responses for the recognition memory task were similarly scored to determine the proportion of correct responses (i.e., words correctly remembered) during the recognition phase for each ADAMTS5 linguistic relationship and each condition. The proportion of correctly remembered words came from the total list of previously presented words in the encoding phase, not simply the words read and generated aloud correctly, because subjects had the opportunity to subconsciously encode other possible responses, such as the correct word even if the incorrect word was verbally expressed aloud.

Postpartum depression The months following childbirth have been recognized throughout history as a period of increased risk of depression for vulnerable women, although diagnostic criteria have emerged only in recent decades, and there are few well-designed controlled studies of treatment efficacy. Two defining characteristics of PPD are its occurrence at a time of large hormonal shifts and its high likelihood of recurrence with subsequent pregnancies. Inhibitors,research,lifescience,medical Prevalence PPD is a nonpsychotic depression that meets the diagnostic criteria for major depression and occurs within several months of delivery as defined in the DSM-IV.6 The point-prevalence of PPD within 6 to 9 weeks of delivery

is about 12%. 140,141 Postpartum psychosis is uncommon, but potentially lethal to the woman or the infant, and occurs in 1 to 2 per 1000 women following childbirth, with onset usually within 2 to 4 weeks of delivery.142 Mood lability, or “baby blues” within the initial days following delivery is very common, with estimates up to 80% for brief periods of symptoms such Inhibitors,research,lifescience,medical as

tearfulness, fatigue, and insomnia that occur within the first 2 weeks of childbirth, peaking at about Inhibitors,research,lifescience,medical 5 days postpartum.143 It was long believed that women were at decreased risk of depressive disorders during pregnancy, and few studies examined associations between depression during pregnancy and the postpartum period. However, studies show that depression can increase steadily from the second trimester of pregnancy to 9 weeks postpartum,140,143 with little GW786034 price difference in prevalence (9% in the second trimester; 12% postpartum) or even Inhibitors,research,lifescience,medical greater prevalence during pregnancy than postpartum.144,145 Data also indicate that the depressive symptoms differ when compared during pregnancy and in early and later postpartum periods, corroborating both the occurrence of depressive symptoms during pregnancy and identifying differing vulnerabilities to depression throughout

pregnancy and the postpartum period.146 PPD is strongly associated with previous depressions. A recent review indicated that the increased risk was 25% for women with a history of depression, 50% Inhibitors,research,lifescience,medical for women with previous PPD, and 75% for women with depression during the current pregnancy.58 Twenty-nine percent of women diagnosed with late luteal phase disorder and 43% of women diagnosed with PMS had experienced PPD, suggesting possible association with premenstrual tuclazepam syndromes.147,148 Other risk factors for PPD include poor social support and chronic stressors.149 Treatment of postpartum depression Reported treatments for PPD include antidepressants, hormones, and psychotherapy, but there is a paucity of well-designed controlled studies, samples are small and there are no definitive conclusions. Antidepressants Sertonergic antidepressants with reported efficacy for PPD include fluoxetine in double -blind study,150 and sertraline, venlafaxine, and fluvoxamine in open studies.

The coagulation cascade leads to formation

of fibrin polymers which consolidate the platelet plug formed during primary hemostasis.20 Abnormalities in tests measuring the function of primary hemostasis and clotting cascade (coagulation) have been reported in case reports and cohort studies in patients treated with antidepressants. During primary hemostasis, the platelets form a plug at a site of injury in order to stop bleeding. This phase, which is the functional response of activated platelets, comprises four different processes: adhesion, aggregation, secretion, and procoagulant activity.21 During the vascular phase, vasoconstriction occurs Inhibitors,research,lifescience,medical and procoagulant (von Willebrand factor [vWF], tissue factor) as well as anticoagulant substances prostaglandin I2 [PGI2], thrombomodulin, urokinase, tissue plasminogen activator [tPA], antithrombin, nitric oxide [NO], and endotheliumderived relaxing factor [EDRF]) are secreted by the endothelium. The most potent platelet activators Inhibitors,research,lifescience,medical are collagen and thrombin, whereas ADP and epinephrine are weak activators. 5-HT itself is a weak platelet agonist, but it amplifies the effect of other platelet agonists.22 The process comprises successive steps, illustrating the central role of platelets (Figure 1): Figure 1. Diagrammatic representation of primary hemostasis. 5-HT, serotonin; vWF, von Willebrand factor; ADP, adenosine diphosphate;

Inhibitors,research,lifescience,medical βTG, β-thromboglobulin; PF4, platelet factor 4; MLC, selleck inhibitor myosine light chain; MLCK, myosine light chain kinase; PGG … Adhesion: Platelets change shape in response to activation, allowing adhesion to subendothelial matrix. This process is mediated by the binding of platelet surface receptor GPIb/IX/V complex to vWF. Binding Inhibitors,research,lifescience,medical of collagen to platelet collagen receptor GPIa/IIa also plays a role in platelet adhesion. Aggregation: Both conformational and exposure changes in the GPIIb/IIIa Inhibitors,research,lifescience,medical on the platelet surface due to activation, result in binding of vWF and

fibrinogen. Secretion: Substances are secreted from platelet granules upon stimulation. ADP and 5-HT stimulate and recruit other platelets. Fibronectin stabilizes 3-mercaptopyruvate sulfurtransferase platelet aggregates. Secreted fibrinogen provides a source of fibrinogen at sites of endothelial injury in that present in the plasma. Thromboxane A2 (TXA2, from arachidonic acid [AA] release) stimulates platelet aggregation and causes vasoconstriction. Platelet-derived growth factor (PDGF) mediates tissue reparation. Procoagulant activity: Exposure of procoagulant phospholipids and the subsequent assembly of the enzyme complexes on the platelet surface represent procoagulant activity. Among others, the following laboratory tests explore primary hemostasis: platelet count, bleeding time, platelet function analyzer (PFA), platelet functional assessment, medullogram, and vWF (Table I). Normal values are not mentioned, since they are provided by the laboratory when these examinations are requested. Table I.

This dose was selected to be comparable to the amount of PLY used on a weight basis. In selleck chemical contrast to the antibody response to eGFP, the response to carrier protein pneumolysin was limited (Fig. 2b). No response was observed after a single dose of the toxin and low but a statistically significant (p < 0.05) response against both the conjugated PLY (in the case of eGFPPLY) and unconjugated PLY were detectable after two doses of the toxin were given. For the mutant toxin, responses were detectable but not significant. Mucosal responses to the antigens were also tested (Fig. 3) and indicated that in addition to systemic responses

observed, mucosal IgA to eGFP was detectable in all animals immunised with eGFPPLY (p < 0.01) when compared to unconjugated vaccinations or eGFP alone. These responses were present in both the nasal (nasal wash – Fig. 3a) and pulmonary tract (lung wash – Fig. 3b). In contrast, no eGFP IgA was observed in animals given either eGFP alone or eGFP admixed with the PLY protein. Small responses to eGFP were also observed in the lung washes KU-55933 cell line of those animals given LT as an adjuvant. Together these results suggest that PLY is able to efficiently deliver fused antigens to the mucosal surface of the respiratory tract, resulting in the rapid production of antibodies to the conjugated antigen both in the blood and at the mucosal surface. Whilst the response to the active eGFPPLY was impressive, translation

of this type of technology into the clinic maybe limited by the range of activities promoted by pneumolysin in the body. To address this, we tested the non-toxic derivative eGFPΔ6PLY using increased doses to determine whether the limited responses observed in the first experiment could be overcome by increasing the total from vaccine dose. In this experiment, mice were immunised either with the active

toxin eGFPPLY at the same Libraries concentrations used in the first experiment or 10-fold higher concentrations for both eGFPΔ6PLY and LT. The eGFP given as a control was administered at the equivalent equimolar concentration as that delivered at the higher dose. Using proteins at these concentrations, anti-eGFP responses were detectable in the serum of animals after a single dose of the active eGFPPLY conjugate and following three doses with eGFP and LT (Fig. 4). This data more closely resembles that previously published for the adjuvant activity of LT and probably reflects the higher dose given. Importantly, after four doses the non-toxic eGFPΔ6PLY induced antibodies to the eGFP protein. Mucosal responses to eGFP also confirmed previous observations with high levels of eGFP IgA present in both the nasal and pulmonary tracts of animals immunised with the eGFPPLY fusion (data not shown). To establish the efficacy of this form of vaccination in protection against disease we immunised animals with the recombinant proteins PsaA, PsaAPLY and PsaAΔ6PLY.

These separable features are detected in parallel and can often be identified without actually being located (Treisman and Gelade 1980). Neural processing of the feature search task begins with basic visual processing in the occipital lobe and then transfers to a frontoparietal attentional network

(Corbetta and Shulman 2002). Recent research into feature search using sophisticated model-based analysis Inhibitors,research,lifescience,medical has further identified contributions from specific neural regions in parietal and occipital cortical structures, as well as the temporoparietal junction (TPJ) in the response to the relevant saliency of targets (Mavritsaki et al. 2010). Conjunctive visual search (CVS) is a low-capacity serial search process in which the search target is defined by two or more unique features. CVS Inhibitors,research,lifescience,medical requires conscious processing and engagement

of additional higher level neural resources (Kristjansson et al. 2002). The anatomical locations of these additional resources vary to some extent in the literature, with increased activation being found in the superior parietal cortex (Corbetta et al. 1995), a superior region of the frontal cortex associated Inhibitors,research,lifescience,medical with working memory (Leonards et al. 2000), and frontoparietal regions that include the frontal eye fields (O’Shea et al. 2006). More generally, conjunction is associated with a significantly higher slope of the search time versus number of distractors Inhibitors,research,lifescience,medical curve (Wolfe 1998) compared with feature search, and thus may generate greater activation in basic visual processing regions (Nobre et al. 2003). Furthermore, Kahneman and Henik (1981) have shown that selective attention is impacted by the spatial distribution of objects BEZ235 molecular weight during VS, and that it is not possible to distribute selective attention over a subset of items which have a random spatial distribution. This work was further confirmed by Treisman (1982), and indicates that the size and shape of the visual attention “spotlight” are constrained (Eriksen and Hoffman 1972). The enhanced activation properties of

the CVS are also useful in clinical fMRI for presurgical Inhibitors,research,lifescience,medical planning in which already decreased activation and neural function may be present due to necrosis, Non-specific serine/threonine protein kinase edema, or tumor mass effect. Although a number of studies have developed and evaluated CVS tasks for fMRI, the majority have used low numbers of distractors (typically less than 10, maximum of 24). The number of distractors is directly related to task difficulty, and it is of interest to evaluate higher numbers of distractors for mimicking complex and challenging work environments. Furthermore, the majority of previous methods have used contrast conditions that represent different implementations of VS tasks or simply lack visual stimuli. An optimal CVS task for human performance evaluation and clinical fMRI involves a contrast condition which mimics the visual stimuli of the CVS, but does not allow searching.

Given how well Professor Complexicus does in explaining the time patients needed to recover in the past, it seems intuitive that his estimations should also fare better than those of Doctor Heuristicus when it comes to predicting future patients’ time to recover. Yet this is not necessarily the case. Goodness-of fit measures alone cannot Inhibitors,research,lifescience,medical disentangle the variation in the observations due to the relevant variables from the variation

due to random error, or noise. In fitting past observations, models can end up taking into account such noise, thus mistakenly attributing meaning to mere chance. As a result, a model can end up overfitting these observations. (Figure 5). illustrates a corresponding situation in which one model, Model A (thin line) overfits already existing, past observations (filled circles; eg, old patients) by chasing after noise in those observations. As can Inhibitors,research,lifescience,medical be seen, this model fits the past observations perfectly but does a relatively poor job of predicting new observations (filled triangles; eg, new patients). Model B (thick line), while not fitting the past observations as well as Model A, captures the main trends in the data

and ignores the noise. This makes it better equipped Inhibitors,research,lifescience,medical to predict new observations, as can be seen from the deviations between the model’s predictions and the new observations, which are indeed smaller than the deviations for Model A. Figure 5. Illustration of how two models fit past observations (filled circles) and how they predict new obsen/ations (triangles). The complex Model A (thin line) overfits

the past observations and is not as accurate in predicting the new observations as the simple … Importantly, the degree to which a model Inhibitors,research,lifescience,medical is susceptible to overfitting is related to the model’s complexity. One factor that contributes to a model’s complexity is its number of free parameters. As is illustrated Inhibitors,research,lifescience,medical in Figure 5, the complex, information-greedy Model A overfits past observations; Model B, in turn, which has fewer free parameters and which takes into account less information, captures only the main trends in the past observations, but better predicts the new observations. The same is likely to hold secondly true with respect to Professor Complexicus’ and Doctor Heuristicus’ strategies: Professor Complexicus’ complex AZD2281 clinical trial strategy is likely to be more prone to overfitting past observations than Doctor Heuristicus’ simple one. As a result, Dr. Heuristicus’ strategy is likely to be better able to predict new observations than Professor Complexicus’ strategy. In short, when data are not completely free of noise, increased complexity (eg, integrating as much information as possible) makes a model more likely to end up overfitting past observations, while its ability to predict new ones decreases (although see Box 4).

86, 95% confidence interval, 1 .78-2.94). This finding suggests that although

duration of amnesia appears protective of development of intrusive traumatic memories, MTBI nonetheless confers risk for developing PTSD. It is for this reason that whereas mild TBI appears to increase risk for PTSD, presence of PTSD after more severe TBI (in which there is limited encoding of trauma memories) is less common. Delayed-onset PTSD Post-traumatic stress symptoms typically occur in Inhibitors,research,lifescience,medical the initial days and weeks after trauma exposure, and then gradually abate in most people; a minority of trauma survivors can suffer persistent PTSD.88 Delayed-onset Inhibitors,research,lifescience,medical PTSD refers to cases of PTSD in which the Raf inhibitor condition develops at least 6 months after the trauma. Most studies indicate that delayed-onset PTSD is rare. Although uncommon

following civilian trauma, it has been reported to occur more frequently in troops returning home from deployment.89,90 Inhibitors,research,lifescience,medical A review of delayed-onset PTSD studies found that it was rare for PTSD to develop outside military samples, with up to one third of military cases presenting as delayed-onset91; specifically, it is reported in 38% of military cases compared with 15% in civilian cases. To date, there has not been any systematic study of delayed-onset PTSD following MTBI. It is possible that sustaining Inhibitors,research,lifescience,medical an mild TBI may contribute to delayed-onset PTSD in the military, and this may be one factor in the increased rates of delayed-onset PTSD in the military. It is possible that following MTBI sustained in combat, one feels the need to fill the gap of knowledge of the events that affected them. Consistent with reports of TBI patients confabulating events in order to make sense of what occurred to them during the loss of consciousness,61 it is possible that one explanation of delayed-onset PTSD, especially in the military, is the pattern of subsequently reconstructing the traumatic

Inhibitors,research,lifescience,medical events in the wake of impaired consciousness. The possibility that trauma memory reconstruction in the post-deployment period contributes to PTSD needs to be studied in military populations, and points to the potential importance of ensuring that adaptive, rather than maladaptive, reconstructions of events occur out in the months after injury. Impairment following MTBI There is enormous concern in the wake of the Iraq/Afghanistan wars over the impairment caused by MTBI. Many millions of dollars arc being devoted to rehabilitation procedures to minimize the potential adverse effects of MTBI on soldiers affected by it. Recent studies are indicating, however, that MTBI itself is responsible for minimal impairment.

Their mean age was 67 ± 13 years. The mean value of initial maximum aortic jet velocity in total patients was 2.92 ± 0.81 m/s. The AVS was mild in 207 of 326 patients (63%), moderate in 81 (25%), and severe in 37 (12%). One hundred ninety three patients (59%) had hypertension, 93 (29%) were dia-betics, 53 (17%) were current smokers, and 144 (45%) had hypercholesterolemia. There were no significant differences among the three groups in terms of age, gender, hypertension, smoking, and hypercholesterolemia. The LVMI Inhibitors,research,lifescience,medical was larger in severe AVS (125.4 ± 34.5 g/m2) compared to moderate (121.7 ± 34.1 g/m2) and mild (111.6 ± 32.3 g/m2) (p = 0.013). BAV was present in 41 (13%) and more frequent

in severe AVS than in moderate Inhibitors,research,lifescience,medical and mild AVS (32% vs. 19% vs. 7%, p < 0.001). Table 1 and ​and22 show initial clinical and echocardiographic

characteristics in each group, respectively. Table 1 Clinical characteristics Table 2 Echocardiographic parameters Progression rate of aortic valvular stenosis The mean interval of the echocardiographic studies was 28 ± 13 months. Over this period of time, the maximum aortic jet velocity increased from 2.92 Inhibitors,research,lifescience,medical ± 0.81 to 3.19 ± 0.99 m/s and the annual progression rate of maximum aortic jet velocity was 0.12 ± 0.23 m/s/yr, indicating a wide Duvelisib variability in AVS progression. The annual progression rate was more rapid in severe AVS (0.28 ± 0.36 m/s/yr) compared to moderate (0.14 ± 0.25 m/s/yr) and mild AVS (0.09 ± 0.18 m/s/yr) (p < 0.001) (Fig.

1). The progression rate in bicuspid AVS was significantly higher Inhibitors,research,lifescience,medical than that of tricuspid AVS (0.23 ± 0.35 vs. 0.11 ± 0.20 m/s/yr, p = 0.001) (Fig. 2). Fig. 1 Progression rate of maximum aortic jet velocity according to AVS severity. Bars, mean ± SD. A p value indicates difference between groups based on scheffe’s multiple comparison test. AVS: aortic valvular stenosis. Fig. 2 Progression rate of maximum aortic jet velocity with and without bicuspid aortic Inhibitors,research,lifescience,medical valve. Bars, mean ± SD. AVS: aortic valvular stenosis. Comparison of rapid and slow progressors At a mean increase in maximum aortic jet velocity per year of 0.12 m/s, the patients were dichotomously divided into rapid (≥ 0.12 m/s/yr) and slow progressors (< 0.12 m/s/yr). As shown Megestrol Acetate in Table 3, the rapid progressor had higher initial maximum aortic jet velocity (p = 0.002), higher mean transvalvular gradient (p < 0.001), smaller AVA (p = 0.007), and lower E velocity (p = 0.018). Table 3 Comparison of rapid versus slow progressors of aortic valvular stenosis Multiple regression analysis for factors associated with AVS progression A stepwise multiple regression analysis was carried out to identify the factors which were associated with the increase in maximum aortic jet velocity per year. In univariate analysis, the progression rate of AVS was significantly related to BAV, creatinine, initial maximum aortic jet velocity, LV end-diastolic dimension, left atrial dimension, and E velocity.

4%, 14.8%, 4.9% and 19.4%, respectively, although G1P[8] and G2P[4] prevalence was Afatinib price relatively less during the present study. Among the other unusual G–P combinations, we found relatively similar percentages of rotavirus strains during the two study periods. Among the G genotypes, G12 and G9 were dominant during 2007–2012 with 21.2% and 20.6% prevalence respectively in comparison with 2000–2007

study which found G1 and G2 most common with 25.8% and 22.3% prevalence, respectively [17]. Among the P genotypes, we found P[4], P[6] and P[8] widely circulating during both the study periods. The striking difference was a high increase in the percentage of non-typeables which increased from 12.5% in 2000–2007 to 32.6% in 2007–2012. During the last 12 years, the surveillance study at AIIMS, Delhi has found

a seasonal distribution of rotavirus at varying frequency (Fig. 3). During autumn (Sep–Nov) and winter (Dec–Feb) we observed relatively high percentages of rotavirus infections in comparison with spring (Mar–May) and summer (Jun–Aug). In the winters of 2000–2004, 2005–2008 and 2009–2012 rotavirus infection rates peaked with detection rates of 58% (19/33), 82% (55/67) and 49% (64/131), respectively. In comparison, rotavirus prevalence during summer and spring season overall ranged from 16–44% to 12–39%, respectively. Studies have shown that worldwide rotavirus, like norovirus, is predominant during the dry winter period [18]. In the present study we observed year SCH772984 purchase round detection of rotavirus strains with distinct peaks during the winter season. Several other studies have reported similar observations [15], [19], [20] and [21]. A study from India by Chakarvati et al [22] reported high

detection of RV during the early winter months. Two more studies from Western India by Kelkar et al. [23] and [24] also reported winter season peaks for rotavirus gastroenteritis. Rotavirus genotyping data obtained in this study helps establish the Modulators genotypes prevalent in Delhi during the last 12 years. We observed continued predominance of G1, G2 and G9 genotypes with emergence of G12 as the fourth most common genotype during 2007–2012. A review by Miles et al [14] also on rotavirus diversity in the Indian subcontinent showed emergence of G9 and G12 with decline in percent detection of G3 and G4 strains. We observed similar results with rare detection of G3 and G4 genotypes during the last 12 years in Delhi. Although G1 and G2 have been globally prevalent, genotypes G9 and G12 are now emerging as dominant strains in various parts of the world [25], [26], [27], [28] and [29]. Among the P genotypes, all three common P types P[4], P[6] and P[8] were frequently detected as in our earlier studies [6] and [17]. Although P[4] and P[8] genotypes are common worldwide, P[6] genotype is commonly found in Africa and Asia [12], [13], [14] and [15].