Assessing atrial fibrillation ablation priority during COVID-19 -does use of patient questionnaires help in stratification above physician assessment?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Catheter ablation for atrial fibrillation (AF) is largely offered for symptomatic relief. The ORBIT registry has shown that patients with a higher EHRA class and lower quality of life (QoL) scores (AFEQT score <65.7) are more likely to suffer emergency hospital admissions. To help prevent unplanned AF admissions and to best utilise the reduced capacity for elective work during the COVID-19 pandemic, it has become even more important to prioritise the most symptomatic AF patients for ablation. Purpose: To evaluate the accuracy of a subjective symptom-based clinician prioritisation schema compared to objective patient-completed quality of life (QoL) scores. Methods: In July 2020, all elective cases awaiting AF ablation at our institution were categorised by their cardiologist as either category 1 (C1-urgent), category 2 (C2–priority, procedure to be done during the ongoing COVID-19 pandemic) or category 3 (C3–routine, procedure may be delayed until post pandemic). This categorisation was based on review of clinic letters where EHRA AF symptom class or PROMS are not routinely recorded.  All patients in C2 and C3 were then posted an AF specific (AFEQT) and a generic (EQ5D) QoL questionnaire to complete. Physicians were blinded to patient responses on the QoL questionnaires. Results: Details of physician prioritisation and completed questionnaires were available for 85 patients (62 ± 10 years, PAF in 61%, males 66%). The 18 patients that had been categorised in C2 (priority) group were found to have a significantly lower AFEQT score (30.4, IQR 17.2-51.9) compared to the 67 patients classed in C3 (routine) group (56.5, IQR 32.1-74.1; p < 0.01)(Figure 1a). EQ5D scores also tended to be lower in the C2 patients (0.7, IQR 0.4-0.8) compared to C3 (0.8, IQR 0.6-0.9; p = 0.056) (Figure 1c). 16 (89%) patients in C2 had significant AF-related impact on QoL (as defined as AFEQT score <65.7) compared to 42 (63%) of patients in C3.  However, there was significant overlap between groups (Figure 1b). 4 patients in C3 had unplanned AF related hospital admissions while awaiting ablation, as compared to none in C2. The median AFEQT score of these 4 patients was 23.3, indicating that they were highly symptomatic despite being classified in C3 by their cardiologist. Conclusion : Physician assessments are moderately accurate in prioritising patients awaiting AF ablation. The addition of formal patient-completed QoL assessment such as with AFEQT, helps to identify the most symptomatic patients at risk of emergency hospital admission, and physicians should consider using these as part of routine assessment, especially during the COVID pandemic.

Attitude toward personal genomics: A nation-wide survey of public and professionals in Pakistan

With the emergence of modern genetic testing and profiling techniques, it has become imperative to assess the general public awareness and attitudes toward such developments. The public's perspective and possible responses are necessary for planning commercial, legal, medical, or healthcare initiatives. The purpose of this study was to assess the perception of the general public and professionals about the personal genome testing and genetic profiling. A questionnaire-based survey was conducted to investigate the attitudes of 2954 adults (56.4% male and 43.6% female) from more than 120 different educational, research, and professional organizations of Pakistan. The aim of the study was to assess interest in genomic testing. The findings of this survey will feed into the larger Genome Projects in Pakistan and will be helpful for the national bioethical committee, healthcare agencies, diagnostic companies, and other institutions for making policy decisions.

1.3 µm dissipative soliton resonance generation in Bismuth doped fiber laser

In this work, a Figure-9 (F9) bismuth-doped fiber laser (BiDFL) operating in the dissipative soliton resonance (DSR) regime is presented. The 1338 nm laser used a BiDF as the active gain medium, while a nonlinear amplifying loop mirror (NALM) in an F9 configuration was employed to obtain high energy mode-locked pulses. The wave breaking-free rectangular pulse widened significantly in the time domain with the increase of the pump power while maintaining an almost constant peak power of 0.6 W. At the maximum pump power, the mode-locked laser delivered a rectangular-shaped pulse with a duration of 48 ns, repetition rate of 362 kHz and a radio-frequency signal-to-noise ratio of more than 60 dB. The maximum output power was recorded at around 11 mW with a corresponding pulse energy of 30 nJ. This is, to the best of the author's knowledge, the highest mode-locked pulse energy obtained at 1.3 μm as well as the demonstration of an NALM BiDFL in a F9 configuration.

Taming the pandemic? The importance of homemade plant-based foods and beverages as community responses to COVID-19

Household responses to COVID-19 in different corners of the world represent the primary health care that communities have relied on for preventing and mitigating symptoms. During a very complex and confusing time, in which public health services in multiple countries have been completely overwhelmed, and in some cases even collapsed, these first-line household responses have been quintessential for building physical, mental, and social resilience, and for improving individual and community health. This editorial discusses the outcomes of a rapid-response preliminary survey during the first phase of the pandemic among social and community contacts in five metropolises heavily affected by the COVID-19 health crisis (Wuhan, Milan, Madrid, New York, and Rio de Janeiro), and in twelve rural areas or countries initially less affected by the pandemic (Appalachia, Jamaica, Bolivia, Romania, Belarus, Lithuania, Poland, Georgia, Turkey, Pakistan, Cambodia, and South Africa). We summarized our perspectives as 17 case studies, observing that people have relied primarily on teas and spices ("food-medicines") and that there exist clear international plant favorites, popularized by various new media. Urban diasporas and rural households seem to have repurposed homemade plant-based remedies that they use in normal times for treating the flu and other respiratory symptoms or that they simply consider healthy foods. The most remarkable shift in many areas has been the increased consumption of ginger and garlic, followed by onion, turmeric, and lemon. Our preliminary inventory of food medicines serves as a baseline for future systematic ethnobotanical studies and aims to inspire in-depth research on how use patterns of plant-based foods and beverages, both "traditional" and "new", are changing during and after the COVID-19 pandemic. Our reflections in this editorial call attention to the importance of ethnobiology, ethnomedicine, and ethnogastronomy research into domestic health care strategies for improving community health.

Enhanced Biosynthesis Synthesis of Copper Oxide Nanoparticles (CuO-NPs) for their Antifungal Activity Toxicity against Major Phyto-Pathogens of Apple Orchards

PURPOSE

The present study made an attempt to develop copper nanoparticles (Cu-NP) with antifungal property using green synthesis method. Copper oxide nanoparticles (CuO-NPs) botanically synthesized using Neem leaf extract (Azadirachta indica A. Juss) were characterized by using different techniques like; UV-visible spectrophotometry, FTIR, XRD, SEM and TEM.

METHODS

Materials were chosen the disease free and fresh Azadirachta indica A. Juss were collected and identified at Center of Biodiversity and Taxonomy. The plant samples were vigorously washed with distilled water then shade dried followed by sterilization with 0.1% mercuric chloride for 20 s and again it was washed with distilled water. 15 g powder form of plant material was added to 200 ml double distilled, CO₂ free and deionized water and kept in shaker at 80°C and 1500 rpm for six hours. After agitation, the extract was separated by regular centrifugation at 10,000 rpm followed by filtration by using whatmann filter paper. The final volume of 100 ml of supernatant was collected as pure extract and stored in cool place for further use.

RESULTS

The final results confirm a significant inhibition of CuO-NPs for the test fungi. Additionally, CuO-NPs demonstrated an enhanced effect when combined with Neem leaf extract. A total of 20-30% improvement in activity was noticed after combination, which correlates with commonly used synthetic fungicides. The toxicity results reveal that A. indica extract and their combined fractions with CuO-NP were less toxic to the test seeds of experimental plant while as bulk Cu followed by biosynthesized CuO-NPs influenced the germination rate as compared to control pots.

CONCLUSIONS

The study drops a concern of research and offers a promising route of developing Copper based green fungicides that can help to combat with modern issues of synthetic fungicides. An average size of 80 ± 15 nm monoclinic cupric oxide (CuO) and cubic cuprous oxides (Cu₂O) nanocrystals that existed in mixed form were successfully developed.

Analyses of mitogenomic markers shed light on the divergence, population dynamics, and demographic history of Pakistani chickens

Pakistan is one of a few sites, associated with the earliest known independent domestication event in the evolutionary history of chicken, which is socio-economically and historically the most important poultry bird in the country. However, the divergence, past population dynamics, and demographic history of Pakistani chickens have not been addressed so far. Therefore, we herein investigated the indigenous Pakistani chickens using mitogenomic markers. We first prepared individual DNA samples from the chicken feathers, and generated nucleotide sequence data, which was then subjected to various population genetics analyses. In molecular phylogenetic analysis, the Pakistani chickens were clustered under nine different clades. Among the wild fowls, the Indian red jungle fowl (IRJF) shared very close affinities to Pakistani chickens. The Bayesian skyline plot showed an increase in the effective population size of Pakistani chickens during the last 50 years. Finally, a time-calibrated phylogeny inferred molecular divergence of the Pakistani chickens. A molecular rate of 3.6 × 10^-6 mutations/site/year (95% HPD interval: 2.28 × 10^-8 to 9.32 × 10^-6) was estimated for the data set. In a rooted tree with root-age of 12058 years (95% HPD interval: 1161-38411), the Pakistani chicken haplotypes showed divergence from IRJF haplotypes around 6987 years (95% HPD interval: 1132-20746) ago, and they shared their most recent common ancestor with Gallus gallus spadiceus, and G. g. jabouillei at the root of the tree. Overall, these results suggest that Pakistani chicken haplotypes share their ancestral gene pool with the IRJF as compared to other red jungle fowl subspecies.

Comprehensive Analysis of Metal Modulated Epitaxial GaN

While metal modulated epitaxy (MME) has been shown useful for hyperdoping, where hole concentrations 40 times higher than other techniques have been demonstrated, and the ability to control phase separation in immiscible III-nitrides, the complexity of the dynamically changing surface conditions during the cyclic growth is poorly understood. While MME is capable of superb crystal quality, performing MME in an improper growth regime can result in defective material. These complications have made the transfer of MME knowledge challenging. This work provides a comprehensive study of the conditions necessary for achieving the benefits of MME while avoiding undesirable defects. The effects of growth temperature, Ga/N ratio, and excess Ga dose per MME growth cycle on the morphological, structural, electronic, and optical properties of unintentionally doped (UID) MME grown gallium nitride (GaN) have been investigated. Optimal structural and electrical quality were achieved for GaN films grown at ∼650 °C, at pre-bilayer Ga coverage and at the moderate droplet regime. However, high defect concentrations were observed at the lowest growth temperatures, and counter to traditional MBE, as the excess Ga dose transitioned from bilayer coverage to the low droplet regime. Optoelectronic properties were optimal for films grown at intermediate growth temperatures, an excess Ga dose condition just before the droplet formation, and, at a III/V ratio of 1.3. Optimization of growth temperatures, Ga/N ratios, and excess Ga dose results in a range of growth conditions achieving smooth surfaces, step-flow surface morphology, and high crystalline quality films with low threading dislocation densities, allowing researchers to utilize the extensive advantages of MME.

Mitochondrial DNA diversity in the Khattak and Kheshgi of the Peshawar Valley, Pakistan

The strategic location of Pakistan and its presence at the crossroads of Asia has resulted in it playing a central role in both prehistoric and historic human migratory events, thereby linking and facilitating contacts between the inhabitants of the Middle East, Central Asia, China and South Asia. Despite the importance of this region and its inhabitants for our understanding of modern human origins and population dispersals, the nature of mitochondrial DNA (mtDNA) variation among members of the myriad populations of this area has largely been unexplored. Here, we report mtDNA control region sequences in 58 individuals from the Khattak and the Kheshgi, two major Pakhtun tribes residing within the Peshawar Valley of northwestern Pakistan. The results reveal that these ethnic groups are genetically heterogeneous, having 55.7% West Eurasian, 33.9% South Asian and 10.2% East Asian haplogroups. The genetic diversity observed for the Kheshgi was somewhat higher than that of the Khattak. A multidimensional scaling plot based on haplogroup frequencies for the Khattak, Kheshgi and neighboring populations indicates that the Khattak have close affinities with Baluch, Uzbek and Kazak populations but are only distantly related to the Kheshgi and other Pakistani populations. By contrast, the Kheshgi cluster closely with other Pakhtun or Pathan populations of Pakistan, suggesting a possible common maternal gene pool shared amongst them. These mtDNA data allow us to begin reconstructing the origins of the Khattak and Kheshgi and describe their complex interactions with populations from the surrounding regions.

Generation of Q-switched Pulses in Thulium-doped and Thulium/Holmium-co-doped Fiber Lasers using MAX phase (Ti3AlC2)

A MAX phase Ti3AlC2 thin film is demonstrated as a saturable absorber (SA) to induce Q-switching in the 2.0 μm region. The Ti3AlC2 thin film is sandwiched between two fiber ferrules and integrated into thulium doped fiber laser (TDFL) and thulium-holmium doped fiber laser (THDFL) cavities. Stable Q-switched pulses are observed at 1980.79 nm and 1959.3 nm in the TDFL and THDFL cavities respectively, with repetition rates of 32.57 kHz and 21.94 kHz and corresponding pulse widths of 2.72 μs and 3.9 μs for both cavities. The performance of the Ti3AlC2 based SA for Q-switching operation indicates the high potential of other MAX phase materials to serve as SAs in future photonics systems.

Origin, Potential Therapeutic Targets and Treatment for Coronavirus Disease (COVID-19)

The ongoing episode of coronavirus disease 19 (COVID-19) has imposed a serious threat to global health and the world economy. The disease has rapidly acquired a pandemic status affecting almost all populated areas of the planet. The causative agent of COVID-19 is a novel coronavirus known as SARS-CoV-2. The virus has an approximate 30 kb single-stranded positive-sense RNA genome, which is 74.5% to 99% identical to that of SARS-CoV, CoV-pangolin, and the coronavirus the from horseshoe bat. According to available information, SARS-CoV-2 is inferred to be a recombinant virus that originated from bats and was transmitted to humans, possibly using the pangolin as the intermediate host. The interaction of the SARS-CoV-2 spike protein with the human ACE2 (angiotensin-converting enzyme 2) receptor, and its subsequent cleavage by serine protease and fusion, are the main events in the pathophysiology. The serine protease inhibitors, spike protein-based vaccines, or ACE2 blockers may have therapeutic potential in the near future. At present, no vaccine is available against COVID-19. The disease is being treated with antiviral, antimalarial, anti-inflammatory, herbal medicines, and active plasma antibodies. In this context, the present review article provides a cumulative account of the recent information regarding the viral characteristics, potential therapeutic targets, treatment options, and prospective research questions.

Safety of hospital discharge before return of bowel function after elective colorectal surgery

BACKGROUND

Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.

METHODS

A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.

RESULTS

A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110).

CONCLUSION

Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.

A Whole Genome Re-Sequencing Based GWA Analysis Reveals Candidate Genes Associated with Ivermectin Resistance in Haemonchus contortus

The most important and broad-spectrum drug used to control the parasitic worms to date is ivermectin (IVM). Resistance against IVM has emerged in parasites, and preserving its efficacy is now becoming a serious issue. The parasitic nematode Haemonchus contortus (Rudolphi, 1803) is economically an important parasite of small ruminants across the globe, which has a successful track record in IVM resistance. There are growing evidences regarding the multigenic nature of IVM resistance, and although some genes have been proposed as candidates of IVM resistance using lower magnification of genome, the genetic basis of IVM resistance still remains poorly resolved. Using the full magnification of genome, we herein applied a population genomics approach to characterize genome-wide signatures of selection among pooled worms from two susceptible and six ivermectin-resistant isolates of H. contortus, and revealed candidate genes under selection in relation to IVM resistance. These candidates also included a previously known IVM-resistance-associated candidate gene HCON_00148840, glc-3. Finally, an RNA-interference-based functional validation assay revealed the HCON_00143950 as IVM-tolerance-associated gene in H. contortus. The possible role of this gene in IVM resistance could be detoxification of xenobiotic in phase I of xenobiotic metabolism. The results of this study further enhance our understanding on the IVM resistance and continue to provide further evidence in favor of multigenic nature of IVM resistance.

Wide multiwavelength Brillouin-Raman fiber laser assisted by an arc-shaped fiber attenuator

A wide bandwidth, single-spacing half-open-cavity multiwavelength Brillouin-Raman fiber laser (MWBRFL) is demonstrated. The laser cavity contains a fiber loop mirror (FLM) with an arc-shaped optical fiber attenuator that is used to control the mirror reflectivity, thereby suppressing gain competition from longitudinal cavity modes. A tuning range of 45 nm with 632 lines at Raman and 1525 nm Brillouin pump powers of 1.2 W and 12 dBm can be achieved using the 10 dB arc-shaped optical fiber attenuator in the cavity. This is in comparison to 433 Stokes lines obtained over a 31 nm tuning range for the half-open MWBRFL cavity without any feedback power optimization. The MWBRFL has low power fluctuations of less than 0.1 dB over a 1 h test period. The inclusion of the arc-shaped optical fiber attenuator in the MWBRFL provides substantial control over the reflectivity of the FLM as well as improving the laser's tuning range to generate a high number of Brillouin Stokes signals.

Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery

BACKGROUND

Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery.

METHODS

A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury.

RESULTS

A total of 4164 patients were included, with a median age of 68 (i.q.r. 57-75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1-3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001).

CONCLUSION

NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.

A triangulation for passive design strategies in public hospital

This study touches on passive design elements used at the preparatory design stage of public hospital in Malaysia. Passive design is an aspect of sustainable architecture that needs to be understood and adopted in an environmentally sensitive architectural design. The most common problem is that the designers do not have proper guidelines for passive design to help them in designing a public hospital. Currently there is no comprehensive guidelines on passive design or sustainable architecture that may help designers. This consequently affects the increase of energy usage in hospitals. The intent of this study is to furnish evidence that the initial process of systematic design and guidance is essential in planning for a sustainable public hospital environment. In this study, the researcher uses a mixed method to obtain outcome for guideline. Through this method, a combination of qualitative and quantitative metadata to foster effective interventions to improve the quality of environmental friendly hospital design. The conclusions obtained from this study are to assist in the process of more efficient public hospital design. In addition to making these passive design guidelines as helpful in providing explanations and working to ensure that the guideline produced has credibility and meet the criteria.

Amanitaahmadii, a new species of Amanita subgenus Amanitina section Validae from Pakistan

A new species from coniferous forests in Pakistan, Amanitaahmadii, is described on the basis of morpho-anatomy and molecular data set analyses. This species is characterized by its medium-sized to large basidiomata, grayish brown to brown pileal surface and rimose pileus margin with gray to dark brown verrucose veil remnants, a cream stipe with bulbous base having grayish brown or brown longitudinal striations above the annulus, a scaly surface towards the base, globose to broadly ellipsoid and amyloid basidiospores, and the absence of clamped septa in all tissues. Molecular phylogenetic analyses based on ITS and LSU sequences confirmed its identity as a new taxon nested within subgen. Amanitinasect.Validae.