971 Impact Of COVID-19 Surgical Guidelines on Sternal Wound Infections During The COVID-19 Pandemic in A Large London Hospital: An Unexpected Benefit

Introduction

Sternal wound infections (SWI) are typically associated with a high morbidity and mortality. Rigorous peri-operative guidelines were instituted during the pandemic. The impact of these measures on SWI was investigated.

Method

We performed a retrospective analysis of all patients who underwent cardiac surgery at our institution since March 2020 post intervention (new COVID-19 peri-operative guidelines). A retrospective analysis of all patients who underwent cardiac surgery in the 12 months preceding the lockdown was also performed as a baseline cohort group.

Results

A total of 2,600 patients (493 during the COVID-19 pandemic) were included in this study. Urgent/emergency procedures accounted for more than 60% of procedures performed during the lockdown compared to 39% previously. 67 (2.6%) surgical wound infections occurred in the study population. During the COVID pandemic, there were 4 SWIs with an overall incidence rate of 0.8%. Patients who underwent cardiac surgery during the COVID pandemic had a lower than expected rate of surgical wound infections (P = 0.006). Other significant predictors of surgical wound infections included a diagnosis of diabetes and being a smoker.

Conclusions

This report suggests that a significant proportion of SWI’s are iatrogenic related and can be avoided through a rigorous attention to detail in the peri-operative setting.

Cutaneous leishmaniasis-Awareness, knowledge and practices among general population in rural and urban areas in Malakand region, Pakistan

Malakand region is an endemic area for cutaneous leishmaniasis (CL). However, there are limited number of studies of this disease in Pakistan. Therefore, a study was conducted to understand the level of awareness attitude and practice among the residents of Makaland towards CL and the disease vectors. This study adopted a cross-sectional approach with a total of 400 respondents (n=93 rural and n= 307 urban). Overall, the population in Malakand region (61.2%) were well-informed in the role of sand fly in transmitting diseases, but most lack knowledge on the vector's behavior and almost a quarter (24.5%) were unable to provide knowledge on proper control measures. Alarmingly, the practice and attitudes of the general population was not satisfactory as close to half (49.8%) of the population did adopt any control method. This study calls for increase in awareness through health education campaign to reduce the risk of cutaneous leishmaniasis outbreaks in the future.

Behaviour, welfare, and tibia traits of fast- and slow-growing chickens reared in intensive and free range systems

The behaviour, welfare, and tibia characteristics of fast- and slow-growing chickens were evaluated in free-range and intensive production systems. A total of 720 birds of three strains were subjected to these systems after 21 days of rearing under the same intensive environment. Each treatment was replicated six times with 20 birds in each replicate. Data were collected for welfare aspects, including feather condition, footpad, hock joint and tonic immobility, behavioural features, especially feeding or foraging, sitting, walking, scratching, pecking and dust-bathing, and tibia characteristics, including weight, length, width, medullary canal diameter and robusticity index (4 - 8 weeks). Production system had significant effects on all welfare and behaviour aspects of the birds. However, tibia characteristics were not influenced by production system, except for medullary canal diameter. The strains differed significantly in welfare, tibia characteristics and behaviour. For example, the slow-growing strains had better feather condition,  footpad and hock joint scores. Significant interactions of strain and production system were noted for all characteristics. It was recommended that Rhode Island Red chickens could be raised under either production system without compromising their welfare or causing adverse effects on leg health.

Pharmacy students can deliver services in general practices: a longitudinal work-based learning model for integrated clinical teaching

Introduction

Collaboration between healthcare providers and higher education institutions enable service delivery using the student workforce.(1) This is significant as access to an appropriately skilled workforce can broaden the delivery of pharmacy services.(1) Pharmacy students may have knowledge and communication skills to be able to contribute to service delivery.(2) However, models that integrate pharmacy students into pharmacy services in general practice are limited.

Aim

to explore a new model of work-based learning in general practice for pharmacy students.

Methods

A qualitative design is appropriate and was used for this exploratory study. Thirty-two students were recruited from third year of an MPharm programme at one University to provide services via a Pharmacy Hub for three general practices in England. Each student attended the Hub for one 3-hour session, each fortnight, for 12 weeks between September 2019 and February 2020. Students completed ‘tasks’ using read-only access to patient records on SystmOne and recorded their activity on clinical worksheets. Students and stakeholders from the Hub were invited to take part in an interview covering what students did and what the long-term impact of the initiative might be via email. A convenience sample of fifteen students, four general practitioners, two pharmacists, two pharmacy technicians, one general practice manager, and two receptionists, completed semi-structured interviews. Data was also extracted from a convenience sample of 51/105 clinical worksheets to identify the types of tasks completed by students. Content analysis of transcribed interview data and extracted clinical data was completed by both authors until theoretical data saturation was reached. Institutional ethics approval was received for this study.

Results

Four themes were identified which included i) what activities students completed, ii) impact of working in general practice on student learning iii) impact on recruitment to general practice and iv) concerns. Concerns had three sub-themes relating to indemnity cover for students, a lack of face-to-face patient contact and repetition of simple tasks. See Table 1 for extracts of data. Clinical worksheets indicated students reviewed repeat medication requests (76%, n= 39) and acute medication requests (12%, n=6), for a wide range of products, such as analgesia, antifungal treatment, statin therapy and H.pylori eradication. Students also answered medication-related queries (12%, n=6) such as identifying the porcine content of medications and how to switch from insulin glargine to insulin levemir.

Conclusion

Findings suggest pharmacy students can contribute to service delivery in general practice by providing supporting roles. However, models must ensure students have access to progressively more complex tasks to facilitate learning. These findings should prompt further research evaluating the role of the pharmacy student workforce to establish key activities students can be trusted to complete. A strength of the study is the combination of data from qualitative interviews and clinical worksheets which provide rich, contextual data. A weakness of the study is that participant validation was not used to confirm the study findings.

References

1. Bates I, John C, Seegobin P, al. e. An analysis of the global pharmacy workforce capacity treands from 2006 to 2012. Hum Resour Health. 2018;16.

2. Bullen. K, Davison K, Hardisty J. Community pharmacy as an effective teaching and learning environment: student perspecives from a UK Mpharm programme. Currents in Pharmacy Teaching and Learning. 2019;11(9):902–8.

Distribution of commensal rodents in rain-fed and irrigated areas of Swat district, Khyber Pakhtunkhwa, Pakistan

Distribution pattern and relative abundance of the agricultural rodent pests of rain-fed and irrigated areas of district Swat Khyber Pakhtunkhwa, Pakistan were recorded from April 2011 to November 2013 using wire mesh live traps. A total of 350 rodents (269 Rattus rattus and 81 Mus musculus) were captured under 2268 trap nights (trap success: 0.15). Regression of daily captures on cumulative captures revealed an estimate of 350 rodents from all the sampled structures with an average of 21.8 rodents per crop field. House rats (R. rattus; 76.8% of captures) were numerically dominant in almost all types of agricultural fields, and were significantly different from the mice (Mus musculus; 23.1% of captures). Both species were found together in some fields. The sex ratio revealed that males outnumbered the females in both of the reported species.

Primary and Secondary Metabolite Profiles of Lodgepole Pine Trees Change with Elevation, but Not with Latitude

Climate change has a large influence on plant functional and phenotypic traits including plant primary and secondary metabolites. One well-established approach to investigating the variation in plant metabolites involves studying plant populations along elevation and latitude gradients. We considered how two space-for-time climate change gradients (elevation and latitude) influence carbohydrate reserves (soluble sugars, starches) and secondary metabolites (monoterpenes, diterpene resin acids) of lodgepole pine trees in western Canada. We were particularly interested in the relationship of terpenes and carbohydrates with a wide range of tree, site, and climatic factors. We found that only elevation had a strong influence on the expression of both terpenes and carbohydrates of trees. Specifically, as elevation increased, concentrations of monoterpenes and diterpenes generally increased and soluble sugars (glucose, sucrose, total sugars) decreased. In contrast, latitude had no impact on either of terpenes or carbohydrates. Furthermore, we found a positive relationship between concentrations of starch and total terpenes and diterpenes in the elevation study; whereas neither starches nor sugars were correlated to terpenes in the latitude study. Similarly, both terpenes and carbohydrates had a much greater number of significant correlations to site characteristics such as slope, basal area index, and sand basal area, in the elevational than in the latitude study. Overall, these results support the conclusion that both biotic and abiotic factors likely drive the patterns of primary and secondary metabolite profiles of lodgepole pine along geographical gradients. Also, presence of a positive relationship between terpenes and starches suggests an interaction between primary ad secondary metabolites of lodgepole pine trees.

Morphometrics of the indian false vampire bat (Megaderma lyra) from district Jhelum, Pakistan

During the present study thirteen Megaderma lyra bats were observed roosting in dark, domed shaped room of Rohtas Fort, district Jhelum. Out of these, six specimens were captured from the roosting site, using hand net. All captured specimens were male. These bats were identified through their unique facial features, an erect and elongated nose-leaf, large oval ears that joined above the forehead and no tail. Mean head and body length of captured specimens was 80 mm, forearm length was 67 mm while average lengths of 3rd, 4th and 5th metacarpals were 51.73 mm, 55.17 mm and 60.42 mm, respectively. Mean skull length was 29.84 mm, breadth of braincase was 12.77 mm. Average Penis length of two specimens was 6.6 mm and total bacular length was 3.08 mm respectively. This is the first record of Megaderma lyra from district Jhelum.

Prospect of microbial food borne diseases in Pakistan: a review

Nowadays food borne illness is most common in people due to their epidemic nature. These diseases affect the human digestive system through bacteria, viruses and parasites. The agents of illness are transmitted in our body through various types of food items, water and uncooked. Pathogens show drastic changes in immunosuppressant people. This review gives general insights to harmful microbial life. Pakistan is a developed country and because of its improper food management, a lot of gastrointestinal problems are noted in many patients. Bacteria are most common agents to spread diarrhoea, villi infection, constipation and dysenteric disease in human and induce the rejection of organ transplant. Enhancement of their lifestyle, properly cooked food should be used and to overcome the outbreak of the diseases.

Identification of operative dose of NPK on yield enhancement of desi and kabuli chickpea (Cicer arietinum L.) in diverse milieu

The effect of fertilizer on yield and yield related traits studied in two consecutive years at two different locations. Three different doses of fertilizer (NPK) applied at the rate of 9:23:0, 18:46:12 and 27:69:25 respectively on sixteen chickpea, genotypes (Desi and Kabuli advance lines and commercial varieties). Data recorded for days to 50% flowering, plant height, primary and secondary branches, pods per plant, 100-grain weight and grain yield (kg/ha). In Desi chickpea highest grain yield (kg/ha) in both years was produced by advance line D-12026 and in Kabuli advance line K-70005 at Faisalabad location. Grain yield kg/ha had significant positive correlation with all the considered parameters except days to 50% flowering and days to 50% maturity. The treatment comparison manifested that fertilizer doses 9:23:0 enhanced grain yield. The high dose of fertilizer is not recommendable. The grain yield of Desi and Kabuli chickpea at two locations Pulses Research Institute (PRI) Faisalabad and GBRSS (Gram Breeding Research Sub Station) Kallurkot had significant variation. The grain yield (kg ha^-1) was significant high in research area of PRI, Faisalabad in both years. The NPK 9:23:0 found operative dose of fertilizer for chickpea.

The effect of the nucleus random location on the cellular S-values - Based on Geant4-DNA

INTRODUCTION

The nucleus is the most crucial target in cell micro-dosimetry. At cell division time, cells do not have concentric geometry synchronously. This issue will be more essential for the low-energy electron emitters. This study investigates the variety of mean absorbed dose (S-value) in the non-concentric cell-nucleus model and random nucleus location within the cell.

METHODS

The S-values were calculated by Geant4-DNA for the cell and nucleus with different radius (with the R_C/R_N ratio = 1.2, 2, 3) and the cell geometry contains nuclei with varying positions inside the cell. Two important components, cytoplasm to the nucleus (N←Cy) and the cell surface to the nucleus (N←Cs) are considered in this work for mono energetic electrons (10-100 keV). To eliminate the effect of the nucleus position (during cell division) on the S-value, the nucleus location in each run was randomly selected inside the cell to represent the cell in a floating state.

RESULTS

As the nucleus becomes closer to the cell membrane the differences are more noticeable especially for electrons with energy less than 20 keV as for R_N/R_C = 1.2, 2, and 3 about 18, 70, and 200%, respectively.

CONCLUSION

Due to the variable position of the nucleus in cell division, using a random place defined in Geant4, the calculations are getting closer to the reality while there is not such possibility for analytical method used by MIRD.

Clinical reporting of radiographs by radiographers: Policy and practice guidance for regional imaging networks

OBJECTIVES

Radiographer reporting is an essential component of imaging across the United Kingdom. Since the previous policy and practice guidance in 2004 the role and contribution of reporting radiographers has changed significantly. The move to imaging networks further reinforces the need for consistency in scope of practice and clinical governance for radiographer reporting.

KEY FINDINGS

This guidance provides a consistent, evidence-based template for planning a reporting service, resourcing, clinical governance, preceptorship, volume and frequency of reporting, a peer learning framework and expected standards.

CONCLUSION

Developed for North Central and East London, this framework and standards will help reduce unwarranted variation.

IMPLICATIONS FOR PRACTICE

Consistency in practice could help maximise the contribution of radiographer reporting.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Comparative toxicity assessment of nano- and bulk-phase titanium dioxide particles on the human mammary gland in vitro

There is a major concern that exposure to titanium dioxide (TiO₂) nanoparticles (NPs) can have degrading effects on human health as well as mammary gland because of the increased use in numerous sorts of nanotech-based health care and food merchandise. Also, there is a scarcity in NP toxicity studies on the mammary gland; therefore, the aim of the present study was to compare toxicity caused by nano- and bulk-phase TiO₂ particles on the human mammary gland in vitro. In comparison to bulk-TiO₂ particles, nano-TiO₂ cause a significant (p < 0.05) reduction in viability and increased reactive oxygen species generation in the human mammary epithelial cells after a dose- (1, 2, 5, 10, 20, 50, and 100 µg/mL) and time (6, 12, 24, and 48 h)-dependent exposure. Further, an increase in genotoxicity in the mammary epithelial cells was observed as percent tail DNA and comet area was increased significantly (p < 0.05) at 12 h of exposure (10 and 100 µg/mL) with nano-TiO₂. The scanning electron microscopic examination showed that a 50 µg/mL dose of both nano-TiO₂ and bulk-TiO₂ particles cause morphological changes and retarded growth pattern of mammary epithelial cells at 12 h. Moreover, a significant (p < 0.05) increase in apoptosis at 10 µg/mL and necrosis at 50 µg/mL concentrations of nano-TiO₂ in comparison to bulk-TiO₂ was observed in mammary epithelial cells. Finally, we can conclude that the toxicity caused by nano-TiO₂ particles on the human mammary gland cells was comparatively higher than the bulk-TiO₂ particles.

Reduction of visual acuity decreases capacity to evaluate radiographic image quality

INTRODUCTION

To determine the impact of reduced visual acuity on the evaluation of a test object and appendicular radiographs.

METHODS

Visual acuity was reduced by two different magnitudes using simulation glasses and compared to normal vision (no glasses). During phase one phantom images were produced for the purpose of counting objects by 13 observers and on phase 2 image appraisal of anatomical structures was performed on anonymized radiographic images by 7 observers. The monitors were calibrated (SMPTE RP133 test pattern) and the room lighting was maintained at 7 ± 1 lux. Image display and data on grading were managed using ViewDEX (v.2.0) and the area under the visual grading characteristic (AUC_VGC) was calculated using VGC Analyzer (v1.0.2). Inferential statistics were calculated using SPSS.

RESULTS

For the evaluation of appendicular radiographs the total interpretation time was longer when visual acuity was reduced with 2 pairs of simulation glasses (15.4 versus 8.9 min). Visual grading analysis showed that observers can lose the ability to detect anatomical and contrast differences when they have a simulated visual acuity reduction, being more challenging to differentiate low contrast details. No simulation glasses, compared to 1 pair gives an AUC_VGC of 0.302 (0.280, 0.333), that decreases to 0.197 (0.175, 0.223) when using 2 pairs of glasses.

CONCLUSIONS

Reduced visual acuity has a significant negative impact on the evaluation of test objects and clinical images. Further work is required to test the impact of reduced visual acuity on visual search, technical evaluation of a wider range of images as well as pathology detection/characterization performance.

IMPLICATIONS FOR PRACTICE

It seems that visual performance needs to be considered to reduce the risks associated with incomplete or incorrect diagnosis. If employers or professional bodies were to introduce regular eye tests into health screening it may reduce the risk of misinterpretation as a result of poor vision.

Alpha-tocopheryl Succinate in Extender Improves the Post Thaw Quality of Water Buffalo Spermatozoa

BACKGROUND

Alpha-tocopheryl succinate, a major chain-splitting antioxidant, is the most effective form of vitamin E and may be used in the semen extender for cryopreservation of buffalo spermatozoa.

OBJECTIVE

To use different concentrations of alpha-tocopheryl succinate (T1, 0.3 mM, T2, 0.6 mM, and T3, 0.9 mM) and control (0.0 mM) in extender for dose optimization and hence improve the frozen-thawed quality of water buffalo spermatozoa.

MATERIALS AND METHODS

Semen samples were collected from three mature buffalo bulls with artificial vagina (42°C) and this study was replicated for five times. Semen was cryopreserved by conventional method which included filling of semen per experimental treatment into 0.5 mL French straws, sealing with polyvinyl alcohol powder and keeping them 5 cm above the liquid nitrogen vapors for 12 min and storing in liquid nitrogen tank. Frozen-thawed semen was also processed for total antioxidant capacity content (TAC) and lipid peroxidation (LPO) level by thiobarbituric acid (TBA). Computer-assisted semen analysis (CASA) and other assays were also performed.

RESULTS

TAC levels were higher (P<0.05) with T2 and T3 as compared to T1 and control. LPO levels were lower (P<0.05) with T2 and T3 as compared to T1 and control. Sperm progressive motility (%) and rapid velocity (%) were higher (P<0.05) with T2 and T3 as compared to control. The extender containing T3 had higher (P<0.05) sperm average path velocity (μm/s) and straight line velocity (μm/s) as compared to control. At 1 and 2 h incubation period (37 °C) T2 and T3 in extenders had higher (P<0.05) progressive motility and rapid velocity compared to control. Sperm supra vital plasma membrane integrity (%), mitochondrial transmembrane potential (%), viable and intact acrosome (%) and DNA integrity (%) were higher (P<0.05) with T2 and T3 as compared to T1 and control, respectively.

CONCLUSION

The supplementation of alpha-tocopheryl succinate in extender, either at 0.6 (T2) or 0.9 (T3) mM concentrations improves the post thaw quality of water buffalo spermatozoa by sustaining the TAC levels and keeping the LPO levels lower as compared to the control. It is suggested that future study should be aimed to explore the influence of these optimal concentrations of alpha-tocopheryl succinate on in vivo fertility of buffalo bull spermatozoa.

Postnatal distribution of ZnO nanoparticles to the breast milk through oral route and their risk assessment for breastfed rat offsprings

Various studies in rodents have shown that nanoparticles are transferred to the breast milk. Under the present study, lactating Wistar rats were repetitively gavaged 5, 25, and 50 mg/kg bw of zinc oxide nanoparticles (ZnO-NPs) and 50 mg kg^-1 bw of bulk zinc oxide (bZnO) for 19 days after parturition. The results showed that ZnO-NPs were absorbed in the small intestine of dams and distributed to the liver. Furthermore, ZnO-NPs were distributed to the intestine and liver of rat pups through dam's milk. No significant change in body weight was observed in the dams treated with ZnO-NPs or bZnO and their offsprings as compared to the control group. The spleen weight significantly increased in the rat dams treated with 50 mg kg^-1 of ZnO-NPs. ZnO-NPs were mostly excreted through feces. The levels of liver cytochrome P450 reductase and serum total antioxidant capacity significantly decreased in the rat dams treated with ZnO-NPs (50 mg kg^-1) and their offsprings. The levels of serum cytokines (tumor necrosis factor-alpha and interleukin-1 beta) and liver injury marker enzymes (alanine aminotransferase and aspartate aminotransferase) significantly increased in the rat dams treated with ZnO-NPs (25 and 50 mg kg^-1) and their offsprings. The level of immunoglobulin A secretion in the intestinal fluid of rat dams and their offsprings is significantly increased by increasing the dose of ZnO-NPs. Histopathology of intestine and liver of offsprings whose rat dams were treated with ZnO-NPs (50 mg kg^-1) showed gross pathological changes. These results provide information for the safety evaluation of ZnO-NPs use during lactation. In conclusion, a dose-dependent postnatal transfer of ZnO-NPs is hazardous to the breastfed offsprings.