Pervasiveness of intestinal protozoan and worm incursion in IDP's (North Waziristan agency, KPK-Pakistan) children of 6-16 years

OBJECTIVE

To evaluate the prevalence of intestinal protozoan and worm infestation in children of families having migrated due to military operation.

METHODS

The cross-sectional, descriptive study was conducted in Cantonment Military Hospital, Bannu, from August 4 to October 24, 2014, and comprised children of either gender aged 6-16 years belonging to families of internally displaced persons belonging to Miraliand Miranshah in North Waziristan Agency. Stool specimens were collected and examined by direct light microscopy for the assessment of intestinal protozoan and worm infestation.

RESULTS

Of the 150 children examined, 52(34.66%) didn't show any cyst/ova in their stool examination and were marked negative, whereas 98(65.33%) tested positive for numerous intestinal parasites that included Ascaris Lumbricoides 27(18%), Hymenolepis nana 22(15%), Pin worm 18(12%), Taenia saginata 14(9%), Entamoeba histolytica 9(6%), Giardia Lamblia 5(3%) and Ankylostomaduodenal 3(2%).

CONCLUSIONS

Poor hygiene, outdoor open field defecation, and unclean standing water source are risk factors for high prevalence of intestinal worm infestation.

Quantitative PCR measurements of Escherichia coli including shiga toxin-producing E. coli (STEC) in animal feces and environmental waters

Quantitative PCR (qPCR) assays were used to determine the concentrations of E. coli including shiga toxin-producing E. coli (STEC) associated virulence genes (eaeA, stx1, stx2, and hlyA) in ten animal species (fecal sources) and environmental water samples in Southeast Queensland, Australia. The mean Log10 concentrations and standard deviations of E. coli 23S rRNA across fecal sources ranged from 1.3 ± 0.1 (horse) to 6.3 ± 0.4 (cattle wastewater) gene copies at a test concentration of 10 ng of DNA. The differences in mean concentrations of E. coli 23S rRNA gene copies among fecal source samples were significantly different from each other (P < 0.0001). Among the virulence genes, stx2 (25%, 95% CI, 17-33%) was most prevalent among fecal sources, followed by eaeA (19%, 95% CI, 12-27%), stx1 (11%, 95% CI, 5%-17%) and hlyA (8%, 95% CI, 3-13%). The Log10 concentrations of STEC virulence genes in cattle wastewater samples ranged from 3.8 to 5.0 gene copies at a test concentration of 10 ng of DNA. Of the 18 environmental water samples tested, three (17%) were positive for eaeA and two (11%) samples were also positive for the stx2 virulence genes. The data presented in this study will aid in the estimation of quantitative microbial risk assessment (QMRA) from fecal pollution of domestic and wild animals in drinking/recreational water catchments.

System Identification and Control of a Biotrickling Filter

This paper studies empirical modeling and control of a biotrickling filter (BTF) used for air pollution control. Step response transfer function (TF) with first-order-plus-time-delay model and steady-state artificial neural network (NN) model were developed for BTF based on input–output (I/O) data obtained from simulation of a rigorous model. These simple models offer fast predictions compared to the rigorous model and render control implementation for BTF feasible. Gas velocity and inlet concentration of hydrogen sulfide (H2S) (target pollutant) were considered as the main process inputs while outlet concentration of H2S was selected as the BTF performance variable (output). The TF and NN models fitted well with the I/O data and the resulting regression coefficient values were above 0.97. Different simulations with the fitted NN model were performed and compared with the rigorous model data at steady state. The NN model perfectly captured the steady-state behavior of the BTF process. Two control strategies were implemented, namely proportional–integral/feedback control and model predictive control, also known as receding-horizon control. The controllers were based on the fitted TF model representation of BTF under study. For the control structure, gas velocity, inlet concentration, and outlet concentration were selected as manipulated, disturbance and controlled variables, respectively. Through set-point and disturbance change tests, it was observed that the model predictive controller offered superior set-point tracking capabilities while the feedback controller showed better control in dealing with disturbances. However, both controllers provided adequate control in general.

Total synthesis of a thromboxane receptor antagonist, terutroban

Synthesis of terutroban (2) is achieved following a non-Diels–Alder approach using cost-effective chemicals.

Monitoring of oil pollution at Gemsa Bay and bioremediation capacity of bacterial isolates with biosurfactants and nanoparticles

Fifteen crude oil-degrading bacterial isolates were isolated from an oil-polluted area in Gemsa Bay, Red Sea, Egypt. Two bacterial species showed the highest growth rate on crude oil hydrocarbons. From an analysis of 16S rRNA sequences, these isolates were identified as Pseudomonas xanthomarina KMM 1447 and Pseudomonas stutzeri ATCC 17588. Gas Chromatographic (GC) analysis of the crude oil remaining in the culture medium after one week at 30°C showed that the optimum biodegradation of crude petroleum oil was demonstrated at 50% in medium containing biosurfactant with two types of nanoparticles separately and two bacterial species. The complete degradation of some different members of polyaromatics and the percentage biodegradation of other polyaromatics increased in microcosm containing two different types of nanoparticles with biosurfactant after 7 days. In conclusion, these bacterial strains may be useful for the bioremediation process in the Gemsa Bay, Red Sea decreasing oil pollution in this marine ecosystem.

Opportunistic pathogens in roof-captured rainwater samples, determined using quantitative PCR

In this study, quantitative PCR (qPCR) was used for the detection of four opportunistic bacterial pathogens in water samples collected from 72 rainwater tanks in Southeast Queensland, Australia. Tank water samples were also tested for fecal indicator bacteria (Escherichia coli and Enterococcus spp.) using culture-based methods. Among the 72 tank water samples tested, 74% and 94% samples contained E. coli and Enterococcus spp., respectively, and the numbers of E. coli and Enterococcus spp. in tank water samples ranged from 0.3 to 3.7 log₁₀ colony forming units (CFU) per 100 mL of water. In all, 29%, 15%, 13%, and 6% of tank water samples contained Aeromonas hydrophila, Staphylococcus aureus, Pseudomonas aeruginosa and Legionella pneumophila, respectively. The genomic units (GU) of opportunistic pathogens in tank water samples ranged from 1.5 to 4.6 log₁₀ GU per 100 mL of water. A significant correlation was found between E. coli and Enterococcus spp. numbers in pooled tank water samples data (Spearman's rs = 0.50; P < 0.001). In contrast, fecal indicator bacteria numbers did not correlate with the presence/absence of opportunistic pathogens tested in this study. Based on the results of this study, it would be prudent, to undertake a Quantitative Microbial Risk Assessment (QMRA) analysis of opportunistic pathogens to determine associated health risks for potable and nonpotable uses of tank water.

Photocatalytic, sonocatalytic and sonophotocatalytic degradation of Rhodamine B using ZnO/CNTs composites photocatalysts

A series of ZnO nanoparticles decorated on multi-walled carbon nanotubes (ZnO/CNTs composites) was synthesized using a facile sol method. The intrinsic characteristics of as-prepared nanocomposites were studied using a variety of techniques including powder X-ray diffraction (XRD), high resolution transmission electron microscope (HR-TEM), transmission electron microscope (TEM), scanning electron microscope (SEM) with energy dispersive X-ray analysis (EDX), Brunauer Emmett Teller (BET) surface area analyzer and X-ray photoelectron spectroscopy (XPS). Optical properties studied using UV-Vis diffuse reflectance spectroscopy confirmed that the absorbance of ZnO increased in the visible-light region with the incorporation of CNTs. In this study, degradation of Rhodamine B (RhB) as a dye pollutant was investigated in the presence of pristine ZnO nanoparticles and ZnO/CNTs composites using photocatalysis and sonocatalysis systems separately and simultaneously. The adsorption was found to be an essential factor in the degradation of the dye. The linear transform of the Langmuir isotherm curve was further used to determine the characteristic parameters for ZnO and ZCC-5 samples which were: maximum absorbable dye quantity and adsorption equilibrium constant. The natural sunlight and low power ultrasound were used as an irradiation source. The experimental kinetic data followed the pseudo-first order model in photocatalytic, sonocatalytic and sonophotocatalytic processes but the rate constant of sonophotocatalysis is higher than the sum of it at photocatalysis and sonocatalysis process. The sonophotocatalysis was always faster than the respective individual processes due to the more formation of reactive radicals as well as the increase of the active surface area of ZnO/CNTs photocatalyst. Chemical oxygen demand (COD) of textile wastewater was measured at regular intervals to evaluate the mineralization of wastewater.

Prevalence of enterococcus species and their virulence genes in fresh water prior to and after storm events

Enterococcus spp. isolates (n = 286) collected from six surface water bodies in subtropical Brisbane, Australia, prior to and after storm events, were identified to species level and tested for the presence of seven clinically important virulence genes (VGs). Enterococcus faecalis (48%), Enterococcus faecium (14%), Enterococcus mundtii (13%), and Enterococcus casseliflavus (13%) were frequently detected at all sites. The frequency of E. faecium occurrence increased from 6% in the dry period to 18% after the wet period. The endocarditis antigen (efaA), gelatinase (gelE), collagen-binding protein (ace), and aggregation substance (asa1) were detected in 61%, 43%, 43%, and 23% of Enterococcus isolates, respectively. The chances of occurrence of ace, gelE, efaA, and asa1 genes in E. faecalis were found to be much higher compared to the other Enterococcus spp. The observed odds ratio of occurrence of ace and gelE genes in E. faecalis was much higher at 7.96 and 6.40 times, respectively. The hyl gene was 3.84 times more likely to be detected in E. casseliflavus. The presence of multiple VGs in most of the E. faecalis isolates underscores the importance of E. faecalis as a reservoir of VGs in the fresh water aquatic environment. Consequently, if contaminated surface water is to be used for production of potable and nonpotable water some degree of treatment depending upon intended use such as detention in basins prior to use or chlorination is required.

Clinico-radiological profile of arrhythmogenic right ventricular dysplasia at a tertiary care center: Two year experience

BACKGROUND

Arrythmogenic right ventricular dysplasia (ARVD/C) refers to fibro fatty infiltration replacement of ventricular myocardium especially that of right ventricle. The clinical presentation varies from asymptomatic state to ventricular tachycardia, heart failure and even sudden death. Diagnosis is established using modified ARVD/C taskforce criteria. Among all the various modalities of diagnosis, magnetic resonance imaging (MRI) gives most comprehensive evaluation of both morphological and functional abnormalities in this disease. MRI may not only obviate need for myocardial biopsy but also give insights into the nature of disease like presence of left ventricular myocardial involvement. We present our 2 years experience of ARVD/C patents who were admitted in our center and in whom diagnosis of ARVD/C was supported by excellent MR imaging.

MATERIALS AND METHODS

This study was conducted by Department of Radiology and Cardiology SKIMS, a tertiary care center for a period of 2 years. Patients with suspected ARVD/C based on clinical, electrophysiological and echocardiographic findings were subjected to MR imaging. Patients were excluded if they had history metallic implants, claustrophobia or were uncooperative. In this study stress was laid on diagnostic role of MRI in ARVD/C.

RESULTS

The median age at presentation was 31 years (range 21-43 years). 80% of patients were males. Most common clinical presentation was palpatations (40%). Syncope was present in 27% and heart failure in 13%. EKG suggestive of ARVD was seen in 87%. Echocardiographic features suggestive of ARVD/C was seen in all 15 patients. Family history of premature sudden death less than 35 years old was present in one patient only. MRI evidence classical for ARVD/C was seen in 80%.

CONCLUSION

Demographic features and mode of presentation of our patients is consistent with what has been rest of the world. We performed MRI in all patients to increase the specificity of our diagnosis. MR imaging allows a three-dimensional evaluation of the right ventricle and provides the most important anatomic, functional, and morphologic criteria for diagnosis of ARVD/C within one single study. MR imaging appears to be the optimal imaging technique for detection and follow-up of clinically suspected ARVD/C.

Closed reductions and percutaneus 'k' wire fixation for adolescent intercondylar fractures of the distal humerus

INTRODUCTION

Intercondylar (T-Condylar) fractures of the humerus are very rare in children. The usual mechanism of the injury which is involved is a fall on a flexed elbow. The treatment options vary, depending upon the degree of the displacement and the amount of comminution and; they may range from a simple application of traction to open reduction and internal fixation with plates and screws. Open reduction is associated with significant post-operative stiffness of the elbow and subsequent less than satisfactory functional results. In this publication, we are presenting our experience of treating seven adolescent T-Condylar fractures of the distal humerus with closed reductions and internal fixations with the percutaneus Kirchner ('K') wire.

METHOD

Seven patients (M:F-6:1) with an average age of 14(range 12-16) years were treated by closed reduction and internal fixation with a 2.0 mm 'K' wire fixation under an image intensifier. Following the surgery, all the elbows were immobilised in plaster of Paris (POP) splints for three weeks. At three weeks after the surgery, the pop splints were removed and gentle elbow exercises were started. Five weeks after the surgery, the 'K' wires were removed, based on the radiological evidence of a bridging callus formation.

RESULTS

Six patients (85%) out of seven showed satisfactory functional results on the Mayo Elbow Performance Score (MEPS), with a good range of motion at the elbow joint. Three (42%) patients had mild elbow stiffness, which resolved on subsequent treatment, while one (14%) had a mild pin tract infection, who was managed conservatively. There was one patient (14%) who was lost to follow-up, who ultimately had a painful and a stiff elbow. The remaining six patients were able to return to the premorbid sate.

CONCLUSION

We recommend closed reduction and percutaneous 'K' wire fixation for adolescent T- Condylar fractures of the humerus as an easy and inexpensive procedure with satisfactory functional results.

Sewage pollution in urban stormwater runoff as evident from the widespread presence of multiple microbial and chemical source tracking markers

The concurrence of human sewage contamination in urban stormwater runoff (n=23) from six urban catchments across Australia was assessed by using both microbial source tracking (MST) and chemical source tracking (CST) markers. Out of 23 stormwater samples human adenovirus (HAv), human polyomavirus (HPv) and the sewage-associated markers; Methanobrevibacter smithii nifH and Bacteroides HF183 were detected in 91%, 56%, 43% and 96% of samples, respectively. Similarly, CST markers paracetamol (87%), salicylic acid (78%) acesulfame (96%) and caffeine (91%) were frequently detected. Twenty one samples (91%) were positive for six to eight sewage related MST and CST markers and remaining two samples were positive for five and four markers, respectively. A very good consensus (>91%) observed between the concurrence of the HF183, HAv, acesulfame and caffeine suggests good predictability of the presence of HAv in samples positive for one of the three markers. High prevalence of HAv (91%) also suggests that other enteric viruses may also be present in the stormwater samples which may pose significant health risks. This study underscores the benefits of employing a set of MST and CST markers which could include monitoring for HF183, adenovirus, caffeine and paracetamol to accurately detect human sewage contamination along with credible information on the presence of human enteric viruses, which could be used for more reliable public health risk assessments. Based on the results obtained in this study, it is recommended that some degree of treatment of captured stormwater would be required if it were to be used for non-potable purposes.

Fecal indicators and bacterial pathogens in bottled water from Dhaka, Bangladesh

Forty-six bottled water samples representing 16 brands from Dhaka, Bangladesh were tested for the numbers of total coliforms, fecal indicator bacteria (i.e., thermotolerant Escherichia coli and Enterococcus spp.) and potential bacterial pathogens (i.e., Aeromonas hydrophila, Pseudomonas aeruginosa, Salmonella spp., and Shigella spp.). Among the 16 brands tested, 14 (86%), ten (63%) and seven (44%) were positive for total coliforms, E. coil and Enterococcus spp., respectively. Additionally, a further nine (56%), eight (50%), six (37%), and four (25%) brands were PCR positive for A. hydrophila lip, P. aeruginosa ETA, Salmonella spp. invA, and Shigella spp. ipaH genes, respectively. The numbers of bacterial pathogens in bottled water samples ranged from 28 ± 12 to 600 ± 45 (A. hydrophila lip gene), 180 ± 40 to 900 ± 200 (Salmonella spp. invA gene), 180 ± 40 to 1,300 ± 400 (P. aeruginosa ETA gene) genomic units per L of water. Shigella spp. ipaH gene was not quantifiable. Discrepancies were observed in terms of the occurrence of fecal indicators and bacterial pathogens. No correlations were observed between fecal indicators numbers and presence/absence of A. hydrophila lip (p = 0.245), Salmonella spp. invA (p = 0.433), Shigella spp. ipaH gene (p = 0.078), and P. aeruginosa ETA (p = 0.059) genes. Our results suggest that microbiological quality of bottled waters sold in Dhaka, Bangladesh is highly variable. To protect public health, stringent quality control is recommended for the bottled water industry in Bangladesh.

Angiographic Estimation of Culprit Vessel Disease Severity in Acute ST- Segment Elevation Myocardial Infarction after Thrombolysis

Introduction: To study the angiographic disease severity of the infarct vessel after thrombolysis in patients with acute ST-elevation myocardial infarction and their 90 days outcome.  Methods: We conducted a retrospective analysis of a prospectively maintained cardiology database at Shifa International Hospital from February 2011 to August 2011. A total of 57 patients who underwent thrombolysis for acute ST elevated Myocardial Infarction and subsequent coronary angiographies within 24 hours of hospitalization were studied. Angiographic disease severity in the infarct vessel was quantified as mild (<50%), moderate (50-70%), severe (70-99%) and total occlusion (100%). Secondary outcomes of recurrent ischemia/reinfarction, target lesion revascularization and death were also assessed at three months follow up.  Results: Thrombolysis was successful in 48 patients. All nine cases of failed thrombolysis underwent rescue PCI. Mean time of catheterization from thrombolysis was 16 ±4 hours. Total 56 (98.2%) patients had severe (>70%) and 1 patient had moderate (50-70%) angiographic disease of the infarct vessel. Left anterior descending artery was the infarct vessel in 32 (56%) cases and right coronary artery in 20 (35%). Total 15 (26%) patients had double vessel and 11 (19%) had triple vessel coronary artery disease. Percutaneous coronary intervention was performed in all patients using bare metal stents or drug eluting stents. At three month follow-up, only one patient had recurrent myocardial infarction due to stent thrombosis.  Conclusions: The overwhelming majority of patients presenting with ST elevation myocardial infarction have angiographic evidence of severe underlying disease in the infarct vessel despite clinically successful hrombolysis. Keywords: acute coronary syndrome; coronary angiography; myocardial infarction; thrombolysis.

Prevalence of human pathogens and indicators in stormwater runoff in Brisbane, Australia

Elevated numbers of enteric pathogens in the receiving waters following a storm event can be a serious public health concern. The purpose of this study was to conduct a preliminary investigation into the presence of human pathogens of concern in urban stormwater runoff. The involvement of a human sewage as a potential source of contamination was also investigated by using microbial source tracking methods. Water samples (20 L) were collected after storm events and during the dry weather from six sites in Brisbane, Australia. Collected samples were analyzed for fecal indicator bacteria (FIB), and then concentrated using hollow fiber ultrafiltration followed by molecular detection of selected enteric pathogens. The levels of FIB were found to frequently exceed the upper limit of Australian guidelines for managing risks in recreational water, during the dry periods and by further several orders of magnitude in the stormwater runoff. Enterococcus spp. numbers as high as 3×10(4) 100 mL(-1) were detected in the stormwater runoff at the Fitzgibbon site. Human adenovirus and polyomavirus were frequently detected from all six sampling sites during wet and dry weather conditions suggesting their wide spread presence in the urban aquatic environments. Campylobacter jejuni, Campylobacter coli and Salmonella enterica were also detected during both dry and wet weather conditions. Presence of human-specific HF183 Bacteroides marker in most of the samples tested suggests ubiquitous sewage contamination in the urban environment. Since stormwater runoff routinely contains high numbers of FIB and other enteric pathogens, some degree of treatment of captured stormwater would be required if it were to be used for non-potable purposes.

Escherichia coli and Enterococcus spp. in rainwater tank samples: comparison of culture-based methods and 23S rRNA gene quantitative PCR assays

In this study, culture-based methods and quantitative PCR (qPCR) assays were compared with each other for the measurement of Escherichia coli and Enterococcus spp. in water samples collected from rainwater tanks in Southeast Queensland, Australia. Among the 50 rainwater tank samples tested, 26 (52%) and 46 (92%) samples yielded E. coli numbers as measured by EPA Method 1603 and E. coli 23S rRNA gene qPCR assay, respectively. Similarly, 49 (98%) and 47 (94%) samples yielded Enterococcus spp. numbers as measured by EPA Method 1600 and Enterococcus spp. 23S rRNA gene qPCR assay, respectively. The mean E. coli (2.49 ± 0.85) log(10) and Enterococcus spp. (2.72 ± 0.32) log(10) numbers as measured by qPCR assays were significantly (P < 0001) different than E. coli (0.91 ± 0.80) log(10) and Enterococcus spp. (1.86 ± 0.60) log(10) numbers as measured by culture-based method. Weak but significant correlations were observed between both EPA Method 1603 and the E. coli qPCR assay (r = 0.47, P = 0.0009), and EPA Method 1600 and the Enterococcus spp. qPCR assay (r = 0.42, P = 0.002). Good qualitative agreement was found between the culture-based method and the Enterococcus spp. qPCR assay in terms of detecting fecal pollution in water samples from the studied rainwater tanks. More research studies, however, are needed to shed some light on the discrepancies associated with the culture-based methods and qPCR assays for measuring fecal indicator bacteria.

Angiographic estimation of culprit vessel disease severity in acute ST-segment elevation myocardial infarction after thrombolysis

INTRODUCTION

To study the angiographic disease severity of the infarct vessel after thrombolysis in patients with acute ST-elevation myocardial infarction and their 90 days outcome.

METHODS

We conducted a retrospective analysis of a prospectively maintained cardiology database at Shifa International Hospital from February 2011 to August 2011. A total of 57 patients who underwent thrombolysis for acute ST elevated Myocardial Infarction and subsequent coronary angiographies within 24 hours of hospitalization were studied. Angiographic disease severity in the infarct vessel was quantified as mild (<50%), moderate (50-70%), severe (70-99%) and total occlusion (100%). Secondary outcomes of recurrent ischemia/reinfarction, target lesion revascularization and death were also assessed at three months follow up.

RESULTS

Thrombolysis was successful in 48 patients. All nine cases of failed thrombolysis underwent rescue PCI. Mean time of catheterization from thrombolysis was 16±4 hours. Total 56 (98.2%) patients had severe (>70%) and 1 patient had moderate (50-70%) angiographic disease of the infarct vessel. Left anterior descending artery was the infarct vessel in 32 (56%) cases and right coronary artery in 20 (35%). Total 15 (26%) patients had double vessel and 11 (19%) had triple vessel coronary artery disease. Percutaneous coronary intervention was performed in all patients using bare metal stents or drug eluting stents. At three month follow-up, only one patient had recurrent myocardial infarction due to stent thrombosis.

CONCLUSIONS

The overwhelming majority of patients presenting with ST elevation myocardial infarction have angiographic evidence of severe underlying disease in the infarct vessel despite clinically successful thrombolysis.