Fixation of Metacarpal Fractures Using Intramedullary Headless Compression Screws: A Tertiary Care Institution Experience

Introduction

Metacarpal fractures account for the majority of hand fractures. Inadequate management can cause functional deficit which can lead to loss of fine hand movements. Adequate management has proven to give good outcomes. The use of intramedullary screws has given better results than the use of Kirschner wires (K-wires).

Method

This study was conducted at Dr. Ruth Phau Civil Hospital, Karachi (CHK) between August 1, 2018 and January 31, 2019. A total of 32 patients presented with metacarpal fractures. They were surgically managed with intramedullary headless screw fixation. Post-operatively, grip strength, range of motion, and presence of any disabilities were recorded. Patients were followed up to three months.

Results

Out of 32 patients, six were females. Mean age was found to be 29.1 ± 10.5 years. Post-operatively the mean grip strength was found to be 37.8 ± 7.3 kilograms. The mean total active range of motion was found to be 242.8 ±14.5 degrees. The mean days to return back to work were 25 ± 5.4 days. The mean patient satisfaction score was 8.1 ± 0.79. Three patients developed post-operative stiffness of the joint.

Conclusion

Patients with intramedullary screw fixation have good post-operative results with early return to work.

Investigations of Machining Characteristics in the Upgraded MQL-Assisted Turning of Pure Titanium Alloys Using Evolutionary Algorithms

Environmental protection is the major concern of any form of manufacturing industry today. As focus has shifted towards sustainable cooling strategies, minimum quantity lubrication (MQL) has proven its usefulness. The current survey intends to make the MQL strategy more effective while improving its performance. A Ranque–Hilsch vortex tube (RHVT) was implemented into the MQL process in order to enhance the performance of the manufacturing process. The RHVT is a device that allows for separating the hot and cold air within the compressed air flows that come tangentially into the vortex chamber through the inlet nozzles. Turning tests with a unique combination of cooling technique were performed on titanium (Grade 2), where the effectiveness of the RHVT was evaluated. The surface quality measurements, forces values, and tool wear were carefully investigated. A combination of analysis of variance (ANOVA) and evolutionary techniques (particle swarm optimization (PSO), bacteria foraging optimization (BFO), and teaching learning-based optimization (TLBO)) was brought into use in order to analyze the influence of the process parameters. In the end, an appropriate correlation between PSO, BFO, and TLBO was investigated. It was shown that RHVT improved the results by nearly 15% for all of the responses, while the TLBO technique was found to be the best optimization technique, with an average time of 1.09 s and a success rate of 90%.

Molecular Responses of Maize Shoot to a Plant Derived Smoke Solution

Plant-derived smoke has effects on plant growth. To find the molecular mechanism of plant-derived smoke on maize, a gel-free/label-free proteomic technique was used. The length of root and shoot were increased in maize by plant-derived smoke. Proteomic analysis revealed that 2000 ppm plant-derived smoke changed the abundance of 69 proteins in 4-days old maize shoot. Proteins in cytoplasm, chloroplast, and cell membrane were altered by plant-derived smoke. Catalytic, signaling, and nucleotide binding proteins were changed. Proteins related to sucrose synthase, nucleotides, signaling, and glutathione were significantly increased; however, cell wall, lipids, photosynthetic, and amino acid degradations related proteins were decreased. Based on proteomic and immunoblot analyses, ribulose-1,5-bisphosphate carboxylase/oxygenase (RuBisCO) was decreased; however, RuBisCO activase was not changed by plant-derived smoke in maize shoot. Ascorbate peroxidase was not affected; however, peroxiredoxin was decreased by plant-derived smoke. Furthermore, the results from enzyme-activity and mRNA-expression analyses confirmed regulation of ascorbate peroxidase and the peroxiredoxinin reactive oxygen scavenging system. These results suggest that increases in sucrose synthase, nucleotides, signaling, and glutathione related proteins combined with regulation of reactive oxygen species and their scavenging system in response to plant-derived smoke may improve maize growth.

The apocarotenoid metabolite zaxinone regulates growth and strigolactone biosynthesis in rice

Carotenoid cleavage dioxygenases (CCDs) form hormones and signaling molecules. Here we show that a member of an overlooked plant CCD subfamily from rice, that we name Zaxinone Synthase (ZAS), can produce zaxinone, a novel apocarotenoid metabolite in vitro. Loss-of-function mutants (zas) contain less zaxinone, exhibit retarded growth and showed elevated levels of strigolactones (SLs), a hormone that determines plant architecture, mediates mycorrhization and facilitates infestation by root parasitic weeds, such as Striga spp. Application of zaxinone can rescue zas phenotypes, decrease SL content and release and promote root growth in wild-type seedlings. In conclusion, we show that zaxinone is a key regulator of rice development and biotic interactions and has potential for increasing crop growth and combating Striga, a severe threat to global food security.

Methylation at the C-3' in D-Ring of Strigolactone Analogs Reduces Biological Activity in Root Parasitic Plants and Rice

Strigolactones (SLs) regulate plant development and induce seed germination in obligate root parasitic weeds, e.g. Striga spp. Because organic synthesis of natural SLs is laborious, there is a large need for easy-to-synthesize and efficient analogs. Here, we investigated the effect of a structural modification of the D-ring, a conserved structural element in SLs. We synthesized and investigated the activity of two analogs, MP13 and MP26, which differ from previously published AR8 and AR36 only in the absence of methylation at C-3'. The de-methylated MP13 and MP26 were much more efficient in regulating plant development and inducing Striga seed germination, compared with AR8. Hydrolysis assays performed with purified Striga SL receptor and docking of AR8 and MP13 to the corresponding active site confirmed and explained the higher activity. Field trials performed in a naturally Striga-infested African farmer's field unraveled MP13 as a promising candidate for combating Striga by inducing germination in host's absence. Our findings demonstrate that methylation of the C-3' in D-ring in SL analogs has a negative impact on their activity and identify MP13 and, particularly, MP26 as potent SL analogs with simple structures, which can be employed to control Striga, a major threat to global food security.

True Aneurysm of the Uterine Artery in a Young Nulliparous Female: An Extremely Rare Vascular Entity

We present the first case of a large true uterine artery aneurysm, with a 5-cm diameter, in a 35-year-old nulliparous woman who presented with lower abdominal pain and dyspareunia. She underwent successful ligation and excision of the aneurysm using the Pfannenstiel approach. The diagnostic modalities and treatment option for such a case is discussed herein.

Chemical composition, antioxidant and antimicrobial potential of essential oils from different parts of Daphne mucronata Royle

This research work was executed to determine chemical composition, anti-oxidant and anti-microbial potential of the essential oils extracted from the leaves and stem of Daphne mucronata Royle. From leaves and stem oils fifty-one different constituents were identified through GC/MS examination. The antioxidant potential evaluated through DPPH free radical scavenging activity and %-inhibition of peroxidation in linoleic acid system. The stem's essential oil showed the good antioxidant activity as compared to leaves essential oil. Results of Antimicrobial activity revealed that both stem and leaves oils showed strong activity against Candida albicans with large inhibition zone (22.2 ± 0.01, 18.9 ± 0.20 mm) and lowest MIC values (0.98 ± 0.005, 2.44 ± 0.002 mg/mL) respectively. Leaves essential was also active against Escherichia coli with inhibition zone of 8.88 ± 0.01 mm and MIC values of 11.2 ± 0.40 mg/mL. These results suggested that the plant's essential oils would be a potential cradle for the natural product based antimicrobial as well as antioxidant agents.

Effect of the strigolactone analogs methyl phenlactonoates on spore germination and root colonization of arbuscular mycorrhizal fungi

Strigolactones (SLs), a novel class of plant hormones, are key regulator of plant architecture and mediator of biotic interactions in the rhizosphere. Root-released SLs initiate the establishment of arbuscular mycorrhizal (AM) symbiosis by inducing spore germination and hyphal branching in AM fungi (AMF). However, these compounds also trigger the germination of root parasitic weeds, paving the way for deleterious infestation. Availability of SLs is required for investigating of their functions and also for application in agriculture. However, natural SLs are difficult to synthesize due to their complex structure and cannot be isolated at large scale, as they are released at very low concentrations. Therefore, there is a need for synthetic SL analogs. Recently, we reported on the development of simple SL analogs, methyl phenlactonoates (MPs), which show high SL activity in plants. Here, we investigate the effect of MP1, MP3 and the widely used SL-analog GR24 on AMF spore germination and host root colonization. Our results show that MP1 and MP3 inhibit AMF spore germination, but promote the intra-radical root colonization, both more efficiently than GR24. These results indicate that field application of MP1 and MP3 does not have negative impact on mycorrhizal fungi. In conclusion, our data together with the previously reported simple synthesis, high activity in regulating plant architecture and inducing Striga seed germination, demonstrate the utility of MP1 and MP3 as for field application in combating root parasitic weeds by inducing germination in host's absence.

Multi-Objective Optimization for Grinding of AISI D2 Steel with Al₂O₃ Wheel under MQL

In the present study, the machinability indices of surface grinding of AISI D2 steel under dry, flood cooling, and minimum quantity lubrication (MQL) conditions are compared. The comparison was confined within three responses, namely, the surface quality, surface temperature, and normal force. For deeper insight, the surface topography of MQL-assisted ground surface was analyzed too. Furthermore, the statistical analysis of variance (ANOVA) was employed to extract the major influencing factors on the above-mentioned responses. Apart from this, the multi-objective optimization by Grey–Taguchi method was performed to suggest the best parameter settings for system-wide optimal performance. The central composite experimental design plan was adopted to orient the inputs wherein the inclusion of MQL flow rate as an input adds addition novelty to this study. The mathematical models were formulated using Response Surface Methodology (RSM). It was found that the developed models are statistically significant, with optimum conditions of depth of cut of 15 µm, table speed of 3 m/min, cutting speed 25 m/min, and MQL flow rate 250 mL/h. It was also found that MQL outperformed the dry as well as wet condition in surface grinding due to its effective penetration ability and improved heat dissipation property.

Genome-Wide Association Studies for Spot Blotch (Cochliobolus sativus) Resistance in Bread Wheat Using Genotyping-by-Sequencing

Spot blotch is a severe biotic menace of wheat caused by Cochliobolus sativus (syn. Bipolaris sorokiniana). Spot blotch is liable to major yield losses in warm humid regions. A genome-wide association study using genotyping-by-sequencing (GBS) markers was conducted to identify genomic regions associated with spot blotch resistance in a diversity panel of 159 spring wheat genotypes. In total, 87,096 GBS markers covering the whole genome, with an average polymorphism information content value of 0.276, were applied. Linkage disequilibrium (LD) analysis indicated that the LD decay extent was approximately 100 Mbp. The panel was evaluated for disease severity (DS) and area under disease progress curve (AUDPC) for 2 years. In total, 24 marker-trait associations (MTA) were identified for DS and AUDPC of spot blotch, with 11 on chromosome 5B, 3 on 3A, 2 on 6B, and 1 each on 1A, 2A, 1D, 2D, 4B, 5A, 7A, and 7B. A marker on chromosome 7B significantly explained 14% of the phenotypic variation of spot blotch severity as well as 11% of AUDPC. Five markers-three on chromosome 5B, one on 3A, and one on 7B-were associated with both DS and AUDPC with R² ranging from 8 to 12%. Significant MTA can be utilized to develop wheat germplasm with resistance to spot blotch.

Evaluation, Surgical Management and Outcome of Traumatic Extremity Vascular Injuries: A 5-year Level-1 Trauma Centres Experience

Objective: We aim to share our experience regarding the surgical management and outcome of extremity vascular trauma in level-1 trauma centres in Pakistan.

Patients and methods: All consecutive patients with traumatic extremity vascular injury (TEVI) fulfilling the inclusion criteria; between June 2012 and June 2017 were included. The demographics, clinical presentation, management, and outcome measures were recorded.

Results: The study included 81 patients. The mean age±standard deviation was 28.6±14.5 years and 81.5% (n=66) of the patients were males. Blunt TEVI was found in 65.4% (n=53) of the cases. Partial laceration was the most common type of arterial injury (64.2%, n=52) and autologous interposition venous grafting was the most common repair performed (60.5%, n=49). Fasciotomy was performed in 67.9% (n=55) of the patients. The limb salvage rate was 82.7%. The amputation rate was higher in the blunt trauma group when compared with that of the penetrating trauma group. The length of the intensive care unit stay and the use of polytetrafluoroethylene as interposition graft were two independent predictors of limb loss. The mortality rate in this series was 8.6%.

Conclusion: Blunt TEVI is associated with higher morbidity and limb loss. The use of synthetic graft should be discouraged. The liberal use of autologous interposition venous graft and the judicious use of fasciotomies are helpful to achieve favorable outcomes.

Engineering plant architecture via CRISPR/Cas9-mediated alteration of strigolactone biosynthesis

BACKGROUND

Precision plant genome engineering holds much promise for targeted improvement of crop traits via unprecedented single-base level control over the genetic material. Strigolactones (SLs) are a key determinant of plant architecture, known for their role in inhibiting shoot branching (tillering).

RESULTS

We used CRISPR/Cas9 in rice (Oryza sativa) for targeted disruption of CAROTENOID CLEAVAGE DIOXYGENASE 7 (CCD7), which controls a key step in SL biosynthesis. The ccd7 mutants exhibited a striking increase in tillering, combined with a reduced height, which could be rescued by application of the synthetic SL analog GR24. Striga germination assays and liquid chromatography-mass spectrometry analysis showed that root exudates of ccd7 mutants were also SL deficient.

CONCLUSIONS

Taken together, our results show the potential and feasibility of the use of the CRISPR/Cas9 system for targeted engineering of plant architecture and for elucidating the molecular underpinnings of architecture-related traits.

Burnout Among Orthopedic Surgeons and Residents in Pakistan

Objective

Burnout is exceptionally pervasive among medical professionals, especially surgeons, and is considered the main indicator of surgeons’ fulfillment with career choice. Our objectives are to discover the extent of orthopedic specialist burnout in Pakistan and to explore the clinical impact of burnout. The efficacy of surgeons may be enhanced by implementing burnout prevention and treatment plans.

Data collection

This observational study was conducted from April 2018 to May 2018 in various tertiary care hospitals in Pakistan and includes post-graduate trainees and consultants. Those who agreed to be part of this study were asked to complete a self-structured questionnaire about demographics and burnout. The questionnaire had 28 questions based on a standard questionnaire from the American Public Welfare Association.

Results

In our study, 15% (n=15) of respondents had advance burnout, 22% (n=22) had early burnout, and 43% (n=49) had a fair chance of burnout. All 15 participants suffering from advance burnout were consultants. Of participants suffering from early burnout, 36.3% (n=8) were consultants, and 63.7% (n=14) were post-graduate trainees.

Conclusion

Compared to other countries, the burnout rate is higher among Pakistani orthopedic surgeons. Special care and attention should be paid towards the stress and workload of surgeons.

Structural basis for specific inhibition of the highly sensitive ShHTL7 receptor

Striga hermonthica is a root parasitic plant that infests cereals, decimating yields, particularly in sub‐Saharan Africa. For germination, Striga seeds require host‐released strigolactones that are perceived by the family of HYPOSENSITIVE to LIGHT (ShHTL) receptors. Inhibiting seed germination would thus be a promising approach for combating Striga. However, there are currently no strigolactone antagonists that specifically block ShHTLs and do not bind to DWARF14, the homologous strigolactone receptor of the host. Here, we show that the octyl phenol ethoxylate Triton X‐100 inhibits S. hermonthica seed germination without affecting host plants. High‐resolution X‐ray structures reveal that Triton X‐100 specifically plugs the catalytic pocket of ShHTL7. ShHTL7‐specific inhibition by Triton X‐100 demonstrates the dominant role of this particular ShHTL receptor for Striga germination. Our structural analysis provides a rationale for the broad specificity and high sensitivity of ShHTL7, and reveals that strigolactones trigger structural changes in ShHTL7 that are required for downstream signaling. Our findings identify Triton and the related 2‐[4‐(2,4,4‐trimethylpentan‐2‐yl)phenoxy]acetic acid as promising lead compounds for the rational design of efficient Striga‐specific herbicides.

Proximal Arterio Venous Fistula Creation - A Gold Standard In Chronic Renal Failure Patients With Multiple Comorbidities

BACKGROUND

Patients with end stage renal disease need an accurate and effective vascular access for haemodialysis. This study was conducted to postulate a hypothesis that proximal arterio venous fistula (AVF) creation should be a gold standard in Chronic Renal Failure (CRF) patients with multiple co morbidities..

METHODS

A total of 230 patients reporting to Vascular Surgery Clinic in Combined Military Hospital Lahore and Peshawar from January 2014 to January 2016 for AVF creation, were included and equally divided into two groups by random draw method. Distal AVF created in Group A and proximal AVFs at elbow in Group B. The data regarding age, gender, atherosclerotic risk factors, body mass index (BMI) was recorded. The groups were compared for functional maturation of AVF and their patency at 6 and 12 months.

RESULTS

Mean age was 30±SD 6.5 years (31±SD 5.1 in Group A, 30±SD 6.9 in Group B) with a male to female ratio of 5.4:1. In terms of age (p-value 0.529), gender (p-value 0.716), diabetes (p-value 0.682), hypertension (p-value 0.659) and BMI; there was no difference between two groups. 85.2% (n=98) AVFs matured in Group B as compared to 44.3% (n=51) AVFs in Group A (pvalue= 0.0045). Furthermore, statistically significant differences between the two groups were found in terms of patency rates at 6 and 12 months (73.9% and 66% in Group B: 26.9% and 16.5% in Group A; p-value 0.0039 and 0.0007 respectively).

CONCLUSIONS

Proximal AVF creation in CRF patients with multiple co morbidities should be the gold standard as a primary procedure in terms of better long term primary patency..

Methyl phenlactonoates are efficient strigolactone analogs with simple structure

Strigolactones (SLs) are a new class of phytohormones that also act as germination stimulants for root parasitic plants, such as Striga spp., and as branching factors for symbiotic arbuscular mycorrhizal fungi. Sources for natural SLs are very limited. Hence, efficient and simple SL analogs are needed for elucidating SL-related biological processes as well as for agricultural applications. Based on the structure of the non-canonical SL methyl carlactonoate, we developed a new, easy to synthesize series of analogs, termed methyl phenlactonoates (MPs), evaluated their efficacy in exerting different SL functions, and determined their affinity for SL receptors from rice and Striga hermonthica. Most of the MPs showed considerable activity in regulating plant architecture, triggering leaf senescence, and inducing parasitic seed germination. Moreover, some MPs outperformed GR24, a widely used SL analog with a complex structure, in exerting particular SL functions, such as modulating Arabidopsis roots architecture and inhibiting rice tillering. Thus, MPs will help in elucidating the functions of SLs and are promising candidates for agricultural applications. Moreover, MPs demonstrate that slight structural modifications clearly impact the efficiency in exerting particular SL functions, indicating that structural diversity of natural SLs may mirror a functional specificity.

SPIROMETRY FINDINGS IN SUBJECTS PRESENTING WITH DYSPNEA IN BANNU DISTRICT, PAKISTAN

Background: Dyspnea is a common symptom in patients presenting to emergency departments worldwide. The objective of the study was to determine the pattern of spirometry findings in subjects presenting with dyspnea in Bannu, KP, Pakistan. Materials & Methods: This descriptive cross-sectional study was conducted in Bannu Medical College, Bannu, KP, Pakistan from 1st December 2015 to 31st march 2018. Sample size was 4300 selected through convenient sampling technique. All patients with acute and chronic dyspnea were included. Any patient unable to perform spirometry, recently diagnosed smear positive pulmonary tuberculosis (PTB), recent myocardial infarction and any infectious disease patient were excluded. A self-administered proforma was used for data collection. The demographic variables were sex and age groups. The research variables were type of lung pathology, severity of obstructive lung pathology, severity of restrictive lung pathology, causes of obstructive lung pathology and causes of restrictive lung pathology. All variables being categorical were analyzed through count and percentages using spss version17. Results: Out of 4300 subjects, (55.72%) were males and (44.28%) were females. Two thousands four hundered and forty five (52.32%) had obstructive, (22.49%) restrictive, (12.9%) with mixed pattern and (4.3%) had normal spirometry. In obstructive patients bronchial asthma were (35.13%), COPD 741(30.3%) asthma-COPD overlap syndrome (ACOS) (9.48%), acute bronchitis (05.64%), bronchiectasis 173(7.07%) and unclear diagnosis (04.17%). In restrictive patients post pulmonary tuberculous fibrosis (PTB) were (33.77%), cardiovascular disorders (28.35%), interstitial lung diseases (17.79%), chest wall disorders (6.47%) and unclear diagnosis in 143(13.6%). Conclusion: Ninety five percent of individuals were having an abnormal spirometeric pattern. mostly old males were having bronchial asthma & COPD as obstructive and PTB & CVDs as restrictive lung disease.

Tissue Culture Mediated Allelic Diversification and Genomic Enrichment of Wheat to Combat Production Constraints and Address Food Security

In view of the emerging population trends and that wheat crop is the major unequivocally recognized conduit towards addressing the food security challenges of 2050 this discourse embraces various research options that are viewed as possible solutions toward delivering those targets for providing nutritious food and meeting the aspirations that policy setters have debated on the subject for decades. The underlying strength for achieving these targets will require concerted efforts from plant researchers that are well integrated within effectively harnessing and utilizing prevalent genetic diversity of the wide array of alleles in a holistic pro‐active manner. We argue that the purists of basic and strategic research dimensions need to be thoughtfully defined, so that the vital target of delivering the “applied” gains are only realized from the outputs on farmer’s fields and measured by tons per hectare. In this quest, the pre‐breeding disciplines “classical mode” and its recently surfaced “modified sense” are pivotal, where within the former facet “tissue culture” (TC)/artificial culturing is embodied integrally. Taken for granted, TC has been the backbone of all wide hybridization studies and has made an enormous impact on the agricultural landscape spanning over the last six decades. With its intervention significant generic and specific incompatibilities have been overcome as well as allowing researchers to exploit the protocols for adding efficiency to breeding programs, facilitate operational technologies in running breeding programs and development of unique genetic stocks that preserve valuable allelic richness in user friendly forms for future free germplasmusage in global/private domains of plant improvement ventures.Plant Tissue Cult. & Biotech. 27(1): 89-140, 2017 (June)

Management of Arterial Injury in Children with Supracondylar Fracture of the Humerus and a Pulseless Hand

Objective: To share our experience regarding the management of arterial injuries in children with pulseless hand secondary to supracondylar fracture of the humerus (SFH). Patients and Methods: All consecutive children with pulseless hands after SFH who were being treated in the vascular surgery units of the Combined Military Hospital, Lahore and Peshawar between September 2011 and September 2016 were included. The type of fracture, mode and pattern of injury, time from injury to definitive treatment, operative treatment, and complications were recorded. Results: There were 55 [82% (n=45) male and 18% (n=10) female] patients with pulseless hand and SFH [Gartland type III: 18% (n=10) and IV: 82% (n=45)]. The hand was cold in 38.1% (n=21) patients and warm in 61.8% (n=34). The most common mode of injury was accidental fall [45% (n=25)], and the mean time from injury to presentation was 4±2.5 hours (mean±standard deviation). Overall, 71% (n=39) patients underwent vascular reconstruction: autologous interposition venous grafting was performed in 49% (n=19) and segmental resection and primary anastomosis in 25% (n=10) of the cases. There were no cases with amputation, fasciotomy, re-exploration, or long-term ischemic sequel. Conclusion: Immediate vascular exploration is the treatment of choice for cold, pulseless hand. A similar approach should be adopted for warm, pulseless hand if there is no immediate return of pulse.

Bacillus safensis with plant-derived smoke stimulates rice growth under saline conditions

Salinity is a worldwide environmental problem of agricultural lands. Smoke and plant growth-promoting bacteria (PGPR) are individually used to improve plant growth, but the combined effects of these have not been studied yet under saline conditions. The combined effect of plant growth-promoting bacteria Bacillus safensis and plant-derived smoke Cymbopogon jwarancusa was studied under different salinity level as 50, 100, and 150 mM on rice (cv. Basmati-385). Smoke dilutions of C. jwarancusa (C-500 and C-1000) and bacterial culture of B. safensis were used to soak seeds for 10 h. It was observed that the salt concentration decreases the germination percentage, vegetative growth, ion contents (K⁺ and Ca²⁺), and photosynthetic pigments (Chl "a," Chl "b," and carotene) while an increase occurred in Na⁺, total soluble protein (TSP), proline, total soluble sugar, catalase (CAT), and peroxidase (POD) contents. The combined effect of B. safensis and smoke primed seeds increased the germination percentage, seedling growth, ion contents (K⁺, Ca²⁺), and photosynthetic pigments (Chl "a," Chl "b," carotene) and reduced the Na⁺ ion content, total soluble protein, proline content, total soluble sugar, CAT, and POD activity by lowering the drastic effect of salt stress. It was concluded that combined effect of smoke and PGPR is more effective than individual effect.

Pb-induced changes in roots of two cultivated rice cultivars grown in lead-contaminated soil mediated by smoke

Nowadays, public concerns regarding deleterious effect of lead (Pb) is on rise due to its abundance and toxic effect on plants and other living organisms. In plants, it has no noticeable biological importance but can cause various morphological, physiological, and biochemical malfunctions. To evaluate the remediating potential of plant-derived smoke (Cymbopogon jwarancusa), a pot culture experiment was designed to investigate the physiological, biochemical, metabolic, and antioxidant parameters of roots in lead (0 (control), 500, 1000, and 1500 ppm)-contaminated soil. Under dark condition, seeds were primed in smoke solution with two dilutions (1:500 and 1:1000) for 24 h. With an increasing concentration of Pb stress, fresh and dry weight and total nitrogen and protein contents decreased significantly while an increase was observed in smoke-treated seed. With increasing Pb stress level, metabolites (i.e., proline, total soluble sugar, total soluble protein, glycine betaine), and antioxidants (i.e., superoxide dismutase, peroxidase, catalase, ascorbate peroxidase, malonyldialdehyde, and H₂O₂), contents of roots were increased in non-treated (without smoke treatment) samples, whereas comparatively, a low level of alteration in aforementioned metabolites and antioxidative parameters was observed in the seeds treated with smoke solution. These results suggest a positive role of smoke in alleviating lead-induced changes in roots of two cultivated cultivars of rice grown in Pb-contaminated soil.

Varietal Preferences and Within-Orchard and Tree Distribution of Newly Recorded Gall Midges, Dasineura amaramanjarae and Procontarinia mangiferae (Diptera: Cecidomyiidae), From Commercial Mango Cultivars in Pakistan

Gall midges (Diptera: Cecidomyiidae) damage mango by feeding on flowers and fruit tissues, inducing galls on leaves, and providing inoculums of anthracnose. Dasineura amaramanjarae Grover and Procontarinia mangiferae (Felt), two gall midges that damage flowers in all mango-growing areas of the world, have recently been recorded in Pakistan, and studies were conducted in 2011 and 2012 on the within-tree and orchard distribution patterns and cultivar preference of both species in Pakistan at one location (Rahim Yar Khan). Both gall midge species were found on all mango cultivars examined (Chaunsa, Fajri, Dusehri, Surkha, Sindhri, and Anwar Ratul), with the most damage occurring to Surkha and Dusehri. Research on midge distribution patterns in different parts of mango orchards (central, southern, northern, eastern, and western sides) showed these species to be found in all areas, with the greatest numbers in the central and southern regions. In addition, both species were most abundant on the lower parts of the mango tree canopy.

Feasibility of Ultrasound-Based Computational Fluid Dynamics as a Mitral Valve Regurgitation Quantification Technique: Comparison with 2-D and 3-D Proximal Isovelocity Surface Area-Based Methods

Current Doppler echocardiography quantification of mitral regurgitation (MR) severity has shortcomings. Proximal isovelocity surface area (PISA)-based methods, for example, are unable to account for the fact that ultrasound Doppler can measure only one velocity component: toward or away from the transducer. In the present study, we used ultrasound-based computational fluid dynamics (Ub-CFD) to quantify mitral regurgitation and study its advantages and disadvantages compared with 2-D and 3-D PISA methods. For Ub-CFD, patient-specific mitral valve geometry and velocity data were obtained from clinical ultrasound followed by 3-D CFD simulations at an assumed flow rate. We then obtained the average ratio of the ultrasound Doppler velocities to CFD velocities in the flow convergence region, and scaled CFD flow rate with this ratio as the final measured flow rate. We evaluated Ub-CFD, 2-D PISA and 3-D PISA with an in vitro flow loop, which featured regurgitation flow through (i) a simplified flat plate with round orifice and (ii) a 3-D printed realistic mitral valve and regurgitation orifice. The Ub-CFD and 3-D PISA methods had higher precision than the 2-D PISA method. Ub-CFD had consistent accuracy under all conditions tested, whereas 2-D PISA had the lowest overall accuracy. In vitro investigations indicated that the accuracy of 2-D and 3-D PISA depended significantly on the choice of aliasing velocity. Evaluation of these techniques was also performed for two clinical cases, and the dependency of PISA on aliasing velocity was similarly observed. Ub-CFD was robustly accurate and precise and has promise for future translation to clinical practice.

Comparative study of HbA1c and fasting plasma glucose vs the oral glucose tolerance test for diagnosis of diabetes in people with tuberculosis

AIM

To compare HbA_1c and fasting plasma glucose assessment, with the 2-h oral glucose tolerance test as reference, in screening for diabetes in people with turberculosis.

METHODS

Individuals (N=268) with newly diagnosed smear-positive tuberculosis were screened for diabetes at a tertiary hospital in Lahore, Pakistan. Diabetes diagnosis was based on WHO criteria: thresholds were ≥48 mmol/mol (≥6.5%) for HbA_1c and ≥7.0mmol/l for fasting plasma glucose.

RESULTS

The proportion of participants diagnosed with diabetes was 4.9% (n =13) by oral glucose tolerance test, while 11.9% (n =32) and 14.6% (n =39) were diagnosed with diabetes using HbA_1c and fasting plasma glucose criteria, respectively. The area under the receiver-operating characteristic curve was 0.79 (95% CI 0.64 to 0.94) for HbA_1c and 0.61 (95% CI 0.50 to 0.73) for fasting plasma glucose, with a borderline significant difference between the two tests (P=0.07).

CONCLUSIONS

HbA_1c and fasting plasma glucose performed equally in terms of diagnosing new diabetes cases in individuals with tuberculosis, but the proportion of participants falsely classified as positive was higher for fasting plasma glucose. This may be explained by acute blood glucose fluctuations when using fasting plasma glucose. HbA_1c may be a more reliable test in individuals with transient hyperglycaemia.

The effect of aspirin and anticoagulation on tyrosine kinase inhibitors induced thrombotic events in chronic myeloid leukemia: A retrospective cohort

e18550

Background: The newer Tyrosine Kinase Inhibitors (TKI) versus imatinib recently were called into question due to reported long-term toxic effects. These include cardiovascular adverse events, arterial and venous thrombosis. Our objective is to determine the effect of antiplatelet and anticoagulation on arterial and venous thrombotic events during the use of TKI for chronic myeloid leukemia (CML). Methods: Multi-center retrospective cohort based on the use of antiplatelet and anticoagulation medications. Chi square test was used and regression analysis for the recorded confounding variables applied. Results: a total of 968 patients were identified from 4 large cancer centers. Preliminary results on the first 168 entered are the following: Average age of the sample is 48 years. 41% were females and the rest were male patients. Average BMI was 29. Average duration of treatment on TKI was 66 months. 20 % of patients were using Aspirin and 11% were using anticoagulation with therapeutic INR. 8% were using dual therapy. 10% developed a thrombotic event during TKI use, namely: MI (2.4%), DVT (3.1%), PE (0.7%), Stroke (2.4%). Our results show that Aspirin or dual therapy decrease the thrombotic events excluding MI only in newer TKI (26% vs 11% P value = 0.002) Fig-1. Conclusions: This study is the first to investigate the effect of anticoagulation and antiplatelet medications on patients receiving TKI. Our main objective after completion of analysis of 968 patients is to answer the question whether patients receiving TKI should receive a prophylactic antiplatelet or anticoagulation therapy and if TKI mediated thrombotic event has “Vasculitis induced thrombosis” pathway that is resistant to anticoagulation/antiplatelet therapy.

Field evaluation of a blood based test for active tuberculosis in endemic settings

Over 9 million new active tuberculosis (TB) cases emerge each year from an enormous pool of 2 billion individuals latently infected with Mycobacterium tuberculosis (M. tb.) worldwide. About 3 million new TB cases per year are unaccounted for, and 1.5 million die. TB, however, is generally curable if diagnosed correctly and in a timely manner. The current diagnostic methods for TB, including state-of-the-art molecular tests, have failed in delivering the capacity needed in endemic countries to curtail this ongoing pandemic. Efficient, cost effective and scalable diagnostic approaches are critically needed. We report a multiplex TB serology panel using microbead suspension array containing a combination of 11 M.tb. antigens that demonstrated overall sensitivity of 91% in serum/plasma samples from TB patients confirmed by culture. Group wise sensitivities for sputum smear positive and negative patients were 95%, and 88%, respectively. Specificity of the test was 96% in untreated COPD patients and 91% in general healthy population. The sensitivity of this test is superior to that of the frontline sputum smear test with a comparable specificity (30–70%, and 93–99%, respectively). The multiplex serology test can be performed with scalability from 1 to 360 patients per day, and is amenable to automation for higher (1000s per day) throughput, thus enabling a scalable clinical work flow model for TB endemic countries. Taken together, the above results suggest that well defined antibody profiles in blood, analyzed by an appropriate technology platform, offer a valuable approach to TB diagnostics in endemic countries.

A method to study the hemodynamics of chicken embryo's aortic arches using optical coherence tomography

Congenital cardiovascular defects are the leading cause of birth defect related death. It has been hypothesized that fluid mechanical forces of embryonic blood flow affect cardiovascular development and play a role in congenital malformations. Studies in small animal embryos can improve our understanding of congenital malformations and can lead to better treatment. We present a feasibility study in which high-resolution optical coherence tomography (OCT) and computational fluid dynamics (CFD) are combined to provide quantitative analysis of the embryonic flow mechanics and the associated anatomy in a small animal model.

High Preoperative Neutrophil-Lymphocyte Ratio (NLR) and Red Blood Cell Distribution Width (RDW) as Independent Predictors of Native Arteriovenous Fistula Failure

Objective: To study the association between a high preoperative neutrophil lymphocyte ratio (NLR) and red cell distribution width (RDW) with arteriovenous fistula (AVF) failure, as well as to determine the cut-off values in a South Asian population.

Materials and Methods: A total of 150 consecutive patients with a failed fistula who presented in the Department of Vascular Surgery between January 2014 and January 2016. Patients fulfilling the inclusion criteria were selected as defined as Case. They were compared with 150 patients who had matured fistulae (Control).

Results: A significant difference was found between the Case and Control groups in mean preoperative NLR (3.3±0.5 versus 2.2±0.9, P value=0.011) and RDW (15.9±2.9 versus 13.6±1.1%, P value of 0.02), respectively. Multivariate analysis revealed that NLR (Odds Ratios (OR) 1.39; 95% Confidence Intervals (CI) 1.02 to 2.08; P<0.001) and RDW (OR 1.39; 95%CI 1.11 to 1.69; P<0.001) were strong independent predictors of AVF failure. A receiver operating characteristic curve analysis showed a cut-off value of 2.65 (specificity 80%, sensitivity 98%) and 15.1 (specificity 79%, sensitivity 98%) for NLR and RDW, respectively.

Conclusion: Increased preoperative NLR and RDW were associated with a high rate of AVF failure in a South Asian population.

Neurocognitive Improvement in Patients Undergoing Carotid Endarterectomy for Atherosclerotic Occlusive Carotid Artery Disease

Objectives: To assess the improvement in neurocognitive functions after carotid endarterectomy (CEA) under local anesthesia (LA) in patients with carotid bifurcation occlusive disease. Place and duration of study: Department of Vascular Surgery, Combined Military Hospital Lahore from January 2013 to January 2015. Patients and Methods: A total of 79 patients with carotid artery occlusive disease, having no history of major stroke, depression, or dementia underwent CEA under LA. Cognitive functions were assessed 3 days before surgery and then 4 weeks and 12 weeks after the surgery using the Addenbrookes cognitive examination (ACE) score and General Practitioner Assessment of Cognition (GPCOG) Score. Results: In ACE score, Attention, Memory, Fluency, Language, and Visuospatial orientation improved by 33.3%, 30.7%, 21.4%, 38.4%, and 31.2%, respectively, by the end of 12 weeks. An overall improvement in neurocognition was 32% (P = 0.03). In GPCOG score, Orientation, Recall, and Memory improved by 33%, 20%, and 100%, respectively, with an overall improvement of 33.3% at the end of 12 weeks (P = 0.02). Conclusion: Both scoring systems show an overall improvement in neurocognition as well as improvements in all the subcategories in each system. Hence, we conclude statistically significant improvement in neurocognitive functions after CEA.

Advantages of Selective Use of Intraluminal Shunt in Carotid Endarterectomy: A Study of 122 Cases

Objectives: To assess the advantage of selective use of shunt in carotid endarterectomy (CEA) under local anesthesia. Materials and Methods: A total of 122 consecutive patients fulfilling international guidelines were included. Shunt was used selectively only in cases of bilateral severe carotid artery occlusive disease or in those patients who developed neurological symptoms on clamping of carotid artery. Follow up was done weekly for one month; then every month for 3 months; and then every 3 months for a year. Results: Shunt was used only in 5% (n = 6) patients. Of these, 2.5% (n = 3) patients were those who developed neurological symptoms on clamping the internal carotid and deployment of shunt resulted in complete resolution of symptoms. 2.5% (n = 3) had severe bilateral carotid stenosis and shunt was deployed. One of these patients developed stroke which was permanent. There was no mortality. The mean procedure time was 170 min in patients in whom shunt was used, when compared with 100 min in patients without shunt (P = 0.003). Conclusion: Use of shunt in carotid endarterectomy under local anesthesia as selective policy has an advantage in terms of cost effectiveness, operation time and prevention of potential complications.

Efficacy of artemisinin-based combination therapies for the treatment of falciparum malaria in Pakistan (2007-2015): In vivo response and dhfr and dhps mutations

Artesunate+sulfadoxine-pyrimethamine (AS+SP) and artemether+lumefantrine (AL) are the first- and second line treatments, respectively, for the treatment of falciparum infections and dihydroartemsinin+piperaquine (DHA+PPQ) is a potential candidate in case AS+SP or AL fails in Pakistan. The therapeutic efficacies of AS+SP (5 sites in 2007, 2 sites in 2011 and 2 sites in 2012), AL (2 sites in 2012) and DHA+PPQ (2 sites in 2015) were evaluated in seven sentinel sites. Clinical and parasitological outcomes were evaluated among eligible patients. Mutations of the P. falciparum dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes were investigated. After PCR correction, a 98.5-100% adequate clinical and parasitological response (ACPR) for AS+SP and a 98.8-100% ACPR for AL were observed by day 28, as well as a 100% ACPR by day 42 for DHA+PPQ. The prevalences of mutants dhfr S108N (100%) and C59R (98%-100%) reached or were near fixation. The double dhfr (C59R/S108N) mutant was dominant (96%-100%) at all sites. The triple dhfr (N51I/C59R/S108N) mutant was rare (1.1%-2.3%). The prevalence of dhps A437G varied between 38% and 70%. A combination of triple dhfr/dhps (C59R/S108N+A437G or N51I/S108N+A437G) mutants was observed (38%-69%). A quadruple dhfr/dhps (N51I/C59R/S108N+A437G) mutation was very rare and no quintuple (N51I/C59R/S108N+A437G/K540E) mutations were detected. AS+SP remains highly effective in Pakistan. However, molecular data indicate that SP resistance is being established, although mutations that confer a high risk of SP treatment failure are rare or non-existent. This underscores the need for close monitoring of both in vivo AS+SP efficacy and dhfr and dhps mutations to inform national treatment policy. Trial registration numbers: ISRCTN21926128 (2007), ACTRN12611001244998 (2011), ACTRN12612001090808 (2012), ACTRN12615001248550 (2015).

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Tinmouth A, Van Walraven C, Montroy K, Ziegler J, Dupont Chouinard R, Carignan R, Dhaliwal A, Lum C, Sinclair J, Pagliarello G, McIntyre L, Groza T, Moreau N, Castanares-Zapatero D, Hantson P, Carbonara M, Ortolano F, Zoerle T, Magnoni S, Pifferi S, Conte V, Stocchetti N, Carteron L, Suys T, Patet C, Quintard H, Oddo M, Rubio JA, Rubio J, Sierra R, Spatenkova V, Pokorna E, Suchomel P, Ebert N, Jancik J, Rhodes H, Bylinski T, Hawthorne C, Shaw M, Piper I, Kinsella J, Kink AK, Rätsep IR, Boutin A, Moore L, Chasse M, Zarychanski R, Lauzier F, English S, McIntyre L, Lacroix J, Griesdale D, Lessard-Bonaventure P, Turgeon AF, Boutin A, Moore L, Green R, Lessard-Bonaventure P, Erdogan M, Butler M, Lauzier F, Chasse M, English S, McIntyre L, Zarychanski R, Lacroix J, Griesdale D, Desjardins P, Fergusson DA, Turgeon AF, Goncalves B, Vidal B, Valdez C, Rodrigues AC, Miguez L, Moralez G, Hong T, Kutz A, Hausfater P, Amin D, Struja T, Haubitz S, Huber A, Mueller B, Schuetz P, Brown T, Collinson J, 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Correa M, Carvalho RT, Forte D, Fernandez A, McBride C, Koonthalloor E, Walsh C, Webber A, Ashe M, Smith K, Jeanrenaud P, Marudi A, Baroni S, Ragusa F, Bertellini E, Volakli EA, Chochliourou E, Dimitriadou M, Violaki A, Mantzafleri P, Samkinidou E, Vrani O, Arbouti A, Varsami T, Sdougka M, Bollen JA, Van Smaalen TC, De Jongh WC, Ten Hoopen MM, Ysebaert D, Van Heurn LW, Van Mook WN, Sim K, Fuller A, Roze des Ordons A, Couillard P, Doig C, Van Keer RV, Deschepper RD, Francke AF, Huyghens LH, Bilsen JB, Nyamaizi B, Dalrymple C, Molokhia A, Dobru A, Marrinan E, Ankuli A, Molokhia A, McPeake J, Struthers R, Crawford R, Devine H, Mactavish P, Quasim T, Morelli P, Degiovanangelo M, Lemos F, MArtinez V, Verga F, Cabrera J, Burghi G, Rutten A, Van Ieperen S, De Geer S, Van Vugt M, Der Kinderen E, Giannini A, Miccinesi G, Marchesi T, Prandi E. Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Leaf-based physiological, metabolic, and ultrastructural changes in cultivated cotton cultivars under cadmium stress mediated by glutathione

Cadmium (Cd) pollution is present in the world over especially in the industrialized parts of the world. To reduce Cd accumulation in various crops especially food crops, alleviating agents such as reduced glutathione (GSH) can be applied, which are capable either to exclude or to sequester Cd contamination. This study investigated the leaf-based spatial distribution of physiological, metabolic, and microstructural changes in two cotton cultivars (Coker 312 and TM-1) under GSH-mediated Cd stress using single levels of Cd (50 μM) and GSH (50 μM) both separately and in mix along with control. Results showed that GSH revived the morphology and physiology of both cotton cultivars alone or in mix with Cd. Cd uptake was enhanced in all segments of leaf and whole leaf upon the addition of GSH. GSH alleviated Cd-induced reduction in the photosynthetic pigment compositions and chlorophyll a fluorescence parameters. Mean data of biomarkers (2,3,5-triphenyltetrazolium (TTC), total soluble protein (TSP), malondialdehyde (MDA), hydrogen peroxide (H2O2)) revealed the adverse effects of Cd stress on leaf segments of both cultivars, which were revived by GSH. The oxidative metabolism induced by Cd stress was profoundly influenced by exogenous GSH application. The microstructural alterations were mainly confined to chloroplastic regions of leaves under Cd-stressed conditions, which were greatly revived upon the GSH addition. As a whole, Cd stress greatly affected TM-1 as compared to Coker 312. These results suggest a positive role of GSH in alleviating Cd-mediated changes in different leaf sections of cotton cultivars.

In silico analysis of a disease-causing mutation in PCDH15 gene in a consanguineous Pakistani family with Usher phenotype

AIM

To map Usher phenotype in a consanguineous Pakistani family and identify disease-associated mutation in a causative gene to establish phenotype-genotype correlation.

METHODS

A consanguineous Pakistani family in which Usher phenotype was segregating as an autosomal recessive trait was ascertained. On the basis of results of clinical investigations of affected members of this family disease was diagnosed as Usher syndrome (USH). To identify the locus responsible for the Usher phenotype in this family, genomic DNA from blood sample of each individual was genotyped using microsatellite Short Tandem Repeat (STR) markers for the known Usher syndrome loci. Then direct sequencing was performed to find out disease associated mutations in the candidate gene.

RESULTS

By genetic linkage analysis, the USH phenotype of this family was mapped to PCDH15 locus on chromosome 10q21.1. Three different point mutations in exon 11 of PCDH15 were identified and one of them, c.1304A>C was found to be segregating with the disease phenotype in Pakistani family with Usher phenotype. This, c.1304A>C transversion mutation predicts an amino-acid substitution of aspartic acid with an alanine at residue number 435 (p.D435A) of its protein product. Moreover, in silico analysis revealed conservation of aspartic acid at position 435 and predicated this change as pathogenic.

CONCLUSION

The identification of c.1304A>C pathogenic mutation in PCDH15 gene and its association with Usher syndrome in a consanguineous Pakistani family is the first example of a missense mutation of PCDH15 causing USH1 phenotype. In previous reports, it was hypothesized that severe mutations such as truncated protein of PCDH15 led to the Usher I phenotype and that missense variants are mainly responsible for non-syndromic hearing impairment.

Analysis of Insect toxicity and repellent activity of Phytochemicals from "Skimmia laureola, Nair" against "Black garden ant, Lasius niger" of Pakistan

A study was conducted to evaluate the toxicity and repellency of essential oils from root, stem and leaves of Nazar panra, Skimmia laureola (DC.) Zucc. Ex Walp. of family (Sapindales: Rutaceae) ver. Nair of Pakistan. The oils were tested at three concentrations i.e. 1, 5 and 10%. Black garden ant, Lasius niger L. (Hymenoptera: Formicidae) of Pakistan were selected and exposed to essential oils at room temperature. All essential oils showed Insecticidal activity with LC(50)=10.15, while dose dependant effect was significant with R(2)=0.98. It can be concluded that the three Essential oils in this study have both Insecticidal as well as repellent effect.

Hepatitis-C virus infection among injecting drug users in Lahore, Pakistan: A cross sectional study

OBJECTIVES

To determine the prevalence and risk factors of hepatitis C virus among injecting drugs users, furthermore different genotypes of HCV infection and their effect on viral load were also found and subsequently most prevalent subtype was predicted.

METHODS

All samples were processed for Anti-HCV antibody detection through ELISA by using third generation ELISA Kit. The Anti-HCV positive serum samples were stored for RT-PCR to estimate the viral load and genotypes of HCV for study. Injecting drug users selected from in and around Lahore Metropolitan from July 2012 to August 2013 was included. The data analysis was completed by using SPSS version 16. A p-value of < 0.05 was considered to be significant.

RESULTS

A total of 241 Injecting drug users were enrolled and screened for Anti HCV in the study. Prevalence of HCV infection in IDUs from Lahore was found to be 36.09%. Education (p=0.000), low socioeconomic status (p=0.011), Blood transfusion (0.003), any tattoo on the body (p=0.002), use of injectable drugs with reused syringes (p=0.000) and sharing of syringes (p=0.001) in groups was significantly associated with HCV infection. Some utensils were also significantly associated with HCV status. The most common subtype of HCV genotype was 3a (n=65) followed by 2a (n=15) and 1a (n=6).

CONCLUSION

The study reveals that IDUs with reused syringes status and sharing of syringes in group had more chances to get HCV infection. The viral load in IDUs infected with different subtypes of genotype was significantly associated.