Characteristics of pain and their relationship to disease activity in UK patients with Behçet's syndrome: a prospective cohort study

Background

Behçet's syndrome (BS) is a rare multi-systemic vasculitis of unknown aetiology. Fibromyalgia syndrome (FMS) is more prevalent in rheumatological conditions such-as BS, than the general population. However, there is limited research into the aetiology and characteristics of pain in BS.

Objectives

To describe the pain characteristics and incidence of FMS in people with BS and investigate their relationship with BS disease activity.

Methods

A cohort study of BS patients attending the Liverpool Behçet's Centre between February 2017 and March 2019. BS was defined using the International Study Group Criteria. BS severity was assessed using the Behçet's Disease Current Activity Form. FMS was determined from consultant diagnosis. Assessments of pain included: Pain Visual Analogue Scale (PVAS), Pain Mannequin, Brief Pain Inventory, EQ-5D-3L and Short Form McGill. Pain and FMS prevalence were compared between high and low disease activity.

Results

90% reported moderate-severe pain with a median PVAS score of 68/100 [38, 81]. 35.6% of participants had FMS and 46.5% experienced generalized pain. 76% of participants with high disease activity reported severe pain, compared to 39.1% with low disease activity (p = .003). Pain was more generalised in high disease activity (72%) compared to low disease activity (37.7%) (p = .003). FMS was more prevalent in the high disease activity group (52%) than the low disease activity group (29%) (p = .04).

Conclusions

This is the first study to explore pain in participants with BS in the United Kingdom. The majority of BS patients experience moderate-severe widespread pain. Severe widespread pain is more prevalent in those with high disease activity. We have demonstrated a relationship between high disease activity, worse pain intensity, and FMS. This paper contributes to the understanding of two conditions which remain to be fully understood, FMS and BS, and generates new hypotheses to describe the interplay between.

Health system factors related to COVID-19 mortality in Eastern India: Hospital-based cross-sectional study

Introduction

Mortality from coronavirus disease 2019 (COVID-19) pandemic has left footprints across all ages and socio-economic strata. The deaths because of COVID-19 are usually multi-factorial. The study aimed to assess the health system factors related to COVID-19-related deaths.

Materials and Methods

A hospital-based retrospective study was conducted at a tertiary care hospital of eastern India. A total of 272 COVID-19 deaths that occurred between April and November 2020 were investigated. Data were extracted from Medical Record Department, and telephonic interviews were conducted to assess the different delays related to death. Data were analysed using Statistical Package for Social Sciences. Travel time, travel distance, delay in testing, and delay in receiving quality care were presented as median with inter-quartile range.

Results

Complete information could be collected from 243 COVID deaths of the 272 deaths (89.3%). The duration of hospital stay was 1-7 days for 42% of the deceased. The median travel time was 120 min, and the median distance travelled was 60 km. The median time to receive first attention of health care workers was 10 minutes. There was hardly any delay in reporting of test results, whereas the median time from symptoms to test and the median time from symptoms to admission were 4 days each.

Conclusion

Health system factors related to death of COVID-19 need to be addressed to avoid the avoidable deaths during the pandemic situation. The resilience of the health system can be helpful in reducing death toll in a low-resource country like India.

Understanding Community Participation in Rural Health Care: A Participatory Learning and Action Approach

Community participation is one of the founding pillars of primary health care. However, due to various reasons, we are yet to achieve complete integration of this component into the health system functioning in India. The objective of our study was to do a formative assessment of community participation in a rural healthcare setting by adopting participatory learning action (PLA). technique. The study participants included frontline health workers and members from local governing institutions of rural areas. The study design is qualitative in nature with a participatory approach. A number of three PLA techniques have been used as a part of this study to recognize available resources for community participation, address its barriers and facilitators, and finally devise a time-line-based action plan. Based on the this, a conceptual framework for community participation pertaining to the rural healthcare system has been developed. This study highlights the importance of understanding the psychosocial aspects of community participation among various stakeholders involved in rural health care. Lessons learned from this PLA study will be helpful in the integration of community-based participatory approach within grassroot level healthcare planning and service delivery.

POS0022 CHARACTERISTICS OF PAIN IN UK PATIENTS WITH BEHÇET’S SYNDROME: A PROSPECTIVE OBSERVATIONAL COHORT STUDY

Background

Behçet’s syndrome (BS) is a rare multi-organ systemic vasculitis of unknown aetiology with hallmark manifestations of mucocutaneous ulcers and skin lesions. Morbidity is high in BS; with high prevalence of pain, fatigue and poor quality of life. Fibromyalgia syndrome (FMS), a common cause of widespread musculoskeletal (MSK) pain, is more prevalent in rheumatological conditions including BS. However, there is limited research into the aetiology and characteristics of pain in BS. To our knowledge, there are no studies describing pain in a UK BS population.

Objectives

To describe the pain characteristics and incidence of comorbid FMS in patients with BS, and investigate their relationship with disease activity.

Methods

This is a prospective observational study of patients with a diagnosis of BS attending the National Centre for BS in Liverpool between February 2017 and March 2019. Patients were defined as “Complete BS” if they satisfised the International Study Group criteria and “Incomplete BS” if they met one criterion plus genital ulcers. BS severity was assessed using the Behçet’s disease current activity form (BDCAF). High and low disease activity were defined as a BDCAF score ≥ 4 or < 4 respectively. FMS prevalence was determined from consultant diagnosis. To minimise inflation of disease severity in the FMS cohort, a modified BDCAF (with arthralgia and arthritis components removed) was calculated (mBDCAF). Assessments of pain included: The Pain Visual Analogue Scale (VAS), Pain Mannequin and Short Form McGill (SF-MPQ-2) questionnaires. Generalised pain data was imputed from the pain mannequin using the American College of Rheumatology 2016 definition, pain in all quadrants (upper left, upper right, lower left and lower right) plus axial distribution. Pain and FMS prevalence were compared between high and low disease activity using Chi-Square Test of Independence. The mean mBDCAF was compared between those with and without FMS using a student’s T-Test. Data analysis was conducted in Microsoft Excel and STATA.

Results

101 patients, 75 female and 26 male, of age 10-74 years were assessed. 81.2% of patients met the ISG criteria (Complete BS); The remaining 18.8% met Incomplete BS status. 90% of patients reported moderate-severe pain with a median VAS score of 68/100 [38, 81]. 35.6% of patients had a diagnosis of FMS and 46.5% experience generalized pain. 76% of patients with high disease activity reported severe pain, a VAS greater than 70, compared to 39.1% with low disease activity (p=.003). Pain was more generalised in high disease activity (72%) compared to low disease activity (37.7%) (p=.003). The qualitative assessment of pain (SF-MPQ-2) stratified by disease activity, Figure 1, demonstrates that pain intensity is higher in high disease activity. Continuous descriptive terms were most commonly selected indicating a chronic nature of the pain. Concomitant FMS diagnosis was more prevalent in the high disease activity group (52%) than the low disease activity group (29%) (p=0.04). The mean mBDCAF of patients with FMS was 2.09 ± 1.3 compared to 1.53 ± 1.3 in patients without FMS (p= 0.047).

Figure 1.

Pain descriptors from the SF-MPQ-2 stratified by high (BDCAF ≥4) and low disease activity (BDCAF <4). Descriptors are rated no pain to the worst pain ever (0 – 10). The median value for each descriptor is plotted. The descriptors are divided into four categories: affective, continuous, neuropathic and intermittent.

Conclusion

This the first study to describe the pain experience of a UK population of BS patients. The majority of patients experience moderate to severe chronic MSK pain. Severe generalised MSK pain is more prevalent in those with high BS disease activity. We have demonstrated a relationship between high disease activity, worse pain intensity, and comorbid FMS. Our findings pose new questions into the research of pain in BS. Further studies are required to explore the mechanism of generalised pain and its correlation with disease activity.

Disclosure of Interests

None declared

Hospital-Based Contact Tracing of Patients With COVID-19 and Health Care Workers During the COVID-19 Pandemic in Eastern India: Cross-sectional Study

Background

The contact tracing and subsequent quarantining of health care workers (HCWs) are essential to minimizing the further transmission of SARS-CoV-2 infection and mitigating the shortage of HCWs during the COVID-19 pandemic situation.

Objective

This study aimed to assess the yield of contact tracing for COVID-19 cases and the risk stratification of HCWs who are exposed to these cases.

Methods

This was an analysis of routine data that were collected for the contact tracing of COVID-19 cases at the All India Institute of Medical Sciences, Bhubaneswar, in Odisha, India. Data from March 19 to August 31, 2020, were considered for this study. COVID-19 cases were admitted patients, outpatients, or HCWs in the hospital. HCWs who were exposed to COVID-19 cases were categorized, per the risk stratification guidelines, as high-risk contacts or low-risk contacts

Results

During contact tracing, 3411 HCWs were identified as those who were exposed to 360 COVID-19 cases. Of these 360 cases, 269 (74.7%) were either admitted patients or outpatients, and 91 (25.3%) were HCWs. After the risk stratification of the 3411 HCWs, 890 (26.1%) were categorized as high-risk contacts, and 2521 (73.9%) were categorized as low-risk contacts. The COVID-19 test positivity rates of high-risk contacts and low-risk contacts were 3.8% (34/890) and 1.9% (48/2521), respectively. The average number of high-risk contacts was significantly higher when the COVID-19 case was an admitted patient (number of contacts: mean 6.6) rather than when the COVID-19 case was an HCW (number of contacts: mean 4.0) or outpatient (number of contacts: mean 0.2; P=.009). Similarly, the average number of high-risk contacts was higher when the COVID-19 case was admitted in a non–COVID-19 area (number of contacts: mean 15.8) rather than when such cases were admitted in a COVID-19 area (number of contacts: mean 0.27; P<.001). There was a significant decline in the mean number of high-risk contacts over the study period (P=.003).

Conclusions

Contact tracing and risk stratification were effective and helped to reduce the number of HCWs requiring quarantine. There was also a decline in the number of high-risk contacts during the study period. This indicates the role of the implementation of hospital-based, COVID-19–related infection control strategies. The contact tracing and risk stratification approaches that were designed in this study can also be implemented in other health care settings.

Prophylactic Role of Ivermectin in Severe Acute Respiratory Syndrome Coronavirus 2 Infection Among Healthcare Workers

Introduction Healthcare workers (HCWs) are vulnerable to getting infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Preventing HCWs from getting infected is a priority to maintain healthcare services. The therapeutic and preventive role of ivermectin in coronavirus disease 2019 (COVID-19) is being investigated. Based on promising results of in vitro studies of oral ivermectin, this study was conducted with the aim to demonstrate the prophylactic role of oral ivermectin in preventing SARS-CoV-2 infection among HCWs at the All India Institute of Medical Sciences (AIIMS) Bhubaneswar. Methods A prospective cohort study was conducted at AIIMS Bhubaneswar, which has been providing both COVID and non-COVID care since March 2020. All employees and students of the institute who provided written informed consent participated in the study. The uptake of two doses of oral ivermectin (300 μg/kg/dose at a gap of 72 hours) was considered as exposure. The primary outcome of the study was COVID-19 infection in the following month of ivermectin consumption, diagnosed as per Government of India testing criteria (real-time reverse transcriptase polymerase chain reaction [RT-PCR]) guidelines. The log-binomial model was used to estimate adjusted relative risk (ARR), and the Kaplan-Meier failure plot was used to estimate the probability of COVID-19 infection with follow-up time. Results Of 3892 employees, 3532 (90.8%) participated in the study. The ivermectin uptake was 62.5% and 5.3% for two doses and single dose, respectively. Participants who took ivermectin prophylaxis had a lower risk of getting symptoms suggestive of SARS-CoV-2 infection (6% vs 15%). HCWs who had taken two doses of oral ivermectin had a significantly lower risk of contracting COVID-19 infection during the following month (ARR 0.17; 95% CI, 0.12-0.23). Females had a lower risk of contracting COVID-19 than males (ARR 0.70; 95% CI, 0.52-0.93). The absolute risk reduction of SARS-CoV-2 infection was 9.7%. Only 1.8% of the participants reported adverse events, which were mild and self-limiting. Conclusion Two doses of oral ivermectin (300 μg/kg/dose given 72 hours apart) as chemoprophylaxis among HCWs reduced the risk of COVID-19 infection by 83% in the following month. Safe, effective, and low-cost chemoprophylaxis has relevance in the containment of pandemic alongside vaccine.

Advancements in AAV-mediated Gene Therapy for Pompe Disease

Pompe disease (glycogen storage disease type II) is caused by mutations in acid α-glucosidase (GAA) resulting in lysosomal pathology and impairment of the muscular and cardio-pulmonary systems. Enzyme replacement therapy (ERT), the only approved therapy for Pompe disease, improves muscle function by reducing glycogen accumulation but this approach entails several limitations including a short drug half-life and an antibody response that results in reduced efficacy. To address these limitations, new treatments such as gene therapy are under development to increase the intrinsic ability of the affected cells to produce GAA. Key components to gene therapy strategies include the choice of vector, promoter, and the route of administration. The efficacy of gene therapy depends on the ability of the vector to drive gene expression in the target tissue and also on the recipient's immune tolerance to the transgene protein. In this review, we discuss the preclinical and clinical studies that are paving the way for the development of a gene therapy strategy for patients with early and late onset Pompe disease as well as some of the challenges for advancing gene therapy.

Methemoglobin and the response to inhaled nitric oxide in persistent pulmonary hypertension of the newborn

BACKGROUND

We aimed to investigate whether the change in methemoglobin levels (ΔMHb) predicts oxygenation response to inhaled nitric oxide (iNO) in persistent pulmonary hypertension of the newborn (PPHN) with lung disease, with or without pulmonary hypoplasia.

METHODS

In this prospective observational study, infants were categorized based on ΔMHb and oxygenation response (ΔPaO2/FiO2) following iNO: ΔMHb ≤0 or ΔMHb>0, and ΔPaO2/FiO2 < 20 mmHg (Non-responder) or≥20 mmHg (Responder). ΔMHb levels were compared among infants with or without pulmonary hypoplasia.

RESULTS

Among infants with pulmonary hypoplasia (n = 28), ΔMHb was not associated with an oxygenation response to iNO or survival without ECMO. Among infants without hypoplasia (n = 29), subjects with ΔMHb>0 following iNO (n = 21) had a greater ΔPaO2/FiO2 (median, 64 mmHg; IQR, 127; p < 0.01) and 100% survival without extracorporeal membrane oxygenation (ECMO) when compared to infants with ΔMHb ≤0 (n = 8; median 10 mmHg; IQR, 33).

CONCLUSIONS

PPHN secondary to lung disease without hypoplasia with increased ΔMHb following iNO was associated with better oxygenation response and survival without ECMO compared to subjects without an increase in MHb.

Radiomics-Based Intracranial Thrombus Features on CT and CTA Predict Recanalization with Intravenous Alteplase in Patients with Acute Ischemic Stroke

BACKGROUND AND PURPOSE

Thrombus characteristics identified on non-contrast CT (NCCT) are potentially associated with recanalization with intravenous (IV) alteplase in patients with acute ischemic stroke (AIS). Our aim was to determine the best radiomics-based features of thrombus on NCCT and CT angiography associated with recanalization with IV alteplase in AIS patients and proximal intracranial thrombi.

MATERIALS AND METHODS

With a nested case-control design, 67 patients with ICA/M1 MCA segment thrombus treated with IV alteplase were included in this analysis. Three hundred twenty-six radiomics features were extracted from each thrombus on both NCCT and CTA images. Linear discriminative analysis was applied to select features most strongly associated with early recanalization with IV alteplase. These features were then used to train a linear support vector machine classifier. Ten times 5-fold cross-validation was used to evaluate the accuracy of the trained classifier and the stability of the selected features.

RESULTS

Receiver operating characteristic curves showed that thrombus radiomics features are predictive of early recanalization with IV alteplase. The combination of radiomics features from NCCT, CTA, and radiomics changes is best associated with early recanalization with IV alteplase (area under the curve = 0.85) and was significantly better than any single feature such as thrombus length (P < .001), volume (P < .001), and permeability as measured by mean attenuation increase (P < .001), maximum attenuation in CTA (P < .001), maximum attenuation increase (P < .001), and assessment of residual flow grade (P < .001).

CONCLUSIONS

Thrombus radiomics features derived from NCCT and CTA are more predictive of recanalization with IV alteplase in patients with acute ischemic stroke with proximal occlusion than previously known thrombus imaging features such as length, volume, and permeability.

A Randomized Study Comparing the Incidence of Postoperative Pain After Phrenic Nerve Infiltration Vs Nonphrenic Nerve Infiltration During Thoracotomy

Thoracotomy is a common surgical procedure performed worldwide for lung disease. Despite major advances in analgesia, patients still experience severe shoulder, central back and surgical incision site pain in the postoperative period. This study aimed to assess whether intraoperative phrenic nerve infiltration reduces the incidence of postoperative pain and improves peak flow volume measurements during incentive spirometry. 90 patients undergoing open lobectomy were randomly assigned to have phrenic nerve infiltration (n = 46) or not (n = 44). The phrenic nerve infiltration group received 10 mL of 0.25% bupivacaine into the periphrenic fat pad. Preoperative assessments of spirometry and pain scores were recorded (at rest and with movement). Postoperative assessments included peak flow and pain measurements at intervals up to 72 hours. Less shoulder pain was experienced with phrenic nerve infiltration up to 6 hours postsurgery at rest (P = 0.005) and up to 12 hours with movement (P < 0.001). Reduced back pain was reported in the phrenic nerve infiltration group up to 6 hours after surgery both at rest (P = 0.001) and with movement (P = 0.00). Phrenic nerve infiltration reduced pain at the incision site for up to 3 hours both at rest (P < 0.001) and with movement (P = 0.001). Spirometry readings dropped in both groups with consistently lower readings at baseline and follow-up in the PNI group (P = 0.007). Lower analgesic usage of patient controlled analgesia morphine (P < 0.0001), epipleural bupivacaine (P = 0.001), and oramorph/zomorph (P = 0.0002) were recorded. Our findings indicate that the use of phrenic nerve infiltration significantly reduced patient pain scores during the early postoperative period, particularly during movement. We believe that each technique has advantages and disadvantages; however, further studies with large sample size are warranted.

Aegle marmelos differentially affects hepatic markers of glycolysis, insulin signalling pathway, hypoxia, and inflammation in HepG2 cells grown in fructose versus glucose-rich environment

Fructose consumption is responsible for the onset of insulin resistance (IR), and metabolic syndrome. It possesses no functional utility in body and its detrimental effects on hepatic metabolic milieu are beyond those produced by glucose. The need of the hour is to identify fructose-induced IR as an unique pathological state to be managed differentially. The effect of aqueous leaf extract of Aegle marmelos (AM) on hepatic markers of insulin resistance using HepG2 cells cultured in either fructose or glucose-rich environment is investigated. Human hepatocellular carcinoma cells (HepG2) were grown under standard conditions in either-DMEM without glucose (NC), DMEM with high glucose 25 mM (Glu), DMEM-glucose+0.55 mM fructose (FC1), DMEM-glucose+1 mM fructose (FC2) or DMEM-glucose+1 mM fructose+0.1 µM insulin (FC3). The cells were treated with either AM, rutin, quercetin, metformin or pioglitazone and assessed for levels of hexokinase, phosphofructokinase (PFK), aldehyde dehydrogenase, phosphatidylinositol kinase (PI3K), signal transducer and activator of transcription-3 (STAT-3), mitochondrial target of rapamycin (mTOR), hypoxia-induced factor (HIF-1α), vascular endothelial growth factor (VEGF) and tumour necrosis factor (TNF-α). Summarily, when results from fructose- and glucose-rich environment were compared, then (1) IR was more pronounced in former; (2) AM performed better in former; (3) metformin and pioglitazone were equivocal in either; (4) rutin and quercetin showed deviant effects from AM; and lastly (5) effects of rutin were closer to AM than quercetin. We hypothesize that AM ameliorates fructose-induced IR through a mechanism which is distinct from standard drugs and not shared by individual phytoconstituents in toto.

Evaluation of canola meal derived from Brassica juncea and Brassica napus on rumen fermentation and nutrient digestibility by feedlot heifers fed finishing diets

Five yearling heifers (387 ± 6.5 kg) were utilized in a 5 × 5 Latin square to evaluate the substitution of canola meal (CM) derived from Brassica (B.) napus and B.juncea seed for barley grain on feed intake and nutrient utilization. The control diet (CONTROL) consisted of 88.3% barley grain, 4.4% barley silage, and 7.3% supplement [dry matter (DM) basis]. The four CM treatments included 10% and 20% B.napus or B.juncea meal, with CM replacing barley grain. Dry matter intake was not affected (P > 0.05) by treatment. Total duration and area under rumen pH 5.8, 5.5, and 5.2 increased (P < 0.05) with greater inclusion of CM, regardless of type. Cattle fed 20% CM had elevated rumen ammonia-N concentration and urinary N excretion. Cattle fed B. juncea meal exhibited greater (P < 0.05) apparent nutrient digestibility compared with those fed B. napus meal. In conclusion, meal derived from B. napus or B. juncea can be used to replace barley grain at levels up to 20% (DM) in finishing diets without compromising rumen fermentation or total tract nutrient digestibility. However, animal performance and possible economic benefits need to be balanced against the increasing N excretion resulting from over-feeding protein to cattle.

Hydroponic system for the treatment of anaerobic liquid

The effluent from anaerobic digestion process has high concentrations of nutrients, particularly nitrogen, essential for plant growth but is not suitable for direct disposal or application due to high chemical oxygen demand (COD), low dissolved oxygen (DO), odour issues and is potentially phytotoxic. This research explored the optimum conditions of anaerobic effluent for application and dilutions of the effluent required to obtain better plant growth. A small-scale hydroponic system was constructed in a glasshouse to test different concentrations of anaerobic effluent against a commercial hydroponic medium as the control for the growth of silverbeet. It was found that the survival of silverbeet was negatively affected at 50% concentration due to low DO and NH(4) toxicity. The concentration of 20% anaerobic liquid was found to be the most efficient with highest foliage yield and plant growth. The hydroponic system with 20% concentrated effluent had better utilisation of nutrients for plant growth and a COD reduction of 95% was achieved during the 50-day growth period. This preliminary evaluation revealed that the growth and development of silverbeet was significantly lower in anaerobic effluent compared with a commercial hydroponic plant growth solution. The nutrient quality of anaerobic effluent could be highly variable with the process and the waste material used and dilution may depend on the nutrient content of the effluent. It is recommended that, a pre-treatment of the effluent to increase DO and reduce ammonium content is required before plant application, and simple dilution by itself is not suitable for optimum plant growth in a hydroponic system.

Microbial inoculants for small scale composting of putrescible kitchen wastes

This research looked at the need for ligno-cellulolytic inoculants (EM bacteria and Trichoderma sp.) in small to medium scale composting of household wastes. A mixture of household organic waste comprised of kitchen waste, paper, grass clippings and composted material was subjected to various durations of thermo composting followed by vermicomposting with and without microbial inoculants for a total of 28days. The results revealed that ligno-celluloytic inoculants are not essential to speed up the process of composting for onsite small scale household organic waste treatment as no significant difference was observed between the control and those inoculated with Trichoderma and EM in terms of C:N ratio of the final product. However, it was observed that EM inoculation enhanced reproductive rate of earthworms, and so probably created the best environment for vermicomposting, in all treatment groups.

The impact of landfilling and composting on greenhouse gas emissions--a review

Municipal solid waste is a significant contributor to greenhouse gas emissions through decomposition and life-cycle activities processes. The majority of these emissions are a result of landfilling, which remains the primary waste disposal strategy internationally. As a result, countries have been incorporating alternative forms of waste management strategies such as energy recovery from landfill gas capture, aerobic landfilling (aerox landfills), pre-composting of waste prior to landfilling, landfill capping and composting of the organic fraction of municipal solid waste. As the changing global climate has been one of the major environmental challenges facing the world today, there is an increasing need to understand the impact of waste management on greenhouse gas emissions. This review paper serves to provide an overview on the impact of landfilling (and its various alternatives) and composting on greenhouse gas emissions taking into account streamlined life cycle activities and the decomposition process. The review suggests greenhouse gas emissions from waste decomposition are considerably higher for landfills than composting. However, mixed results were found for greenhouse gas emissions for landfill and composting operational activities. Nonetheless, in general, net greenhouse gas emissions for landfills tend to be higher than that for composting facilities.

The impact of landfilling and composting on greenhouse gas emissions--a review

Municipal solid waste is a significant contributor to greenhouse gas emissions through decomposition and life-cycle activities processes. The majority of these emissions are a result of landfilling, which remains the primary waste disposal strategy internationally. As a result, countries have been incorporating alternative forms of waste management strategies such as energy recovery from landfill gas capture, aerobic landfilling (aerox landfills), pre-composting of waste prior to landfilling, landfill capping and composting of the organic fraction of municipal solid waste. As the changing global climate has been one of the major environmental challenges facing the world today, there is an increasing need to understand the impact of waste management on greenhouse gas emissions. This review paper serves to provide an overview on the impact of landfilling (and its various alternatives) and composting on greenhouse gas emissions taking into account streamlined life cycle activities and the decomposition process. The review suggests greenhouse gas emissions from waste decomposition are considerably higher for landfills than composting. However, mixed results were found for greenhouse gas emissions for landfill and composting operational activities. Nonetheless, in general, net greenhouse gas emissions for landfills tend to be higher than that for composting facilities.

The risk of sodium toxicity from bed accumulation to key species in the vermifiltration wastewater treatment process

This study was undertaken to assess the toxicological risks from sodium accumulation in a vermifiltration wastewater treatment system to the key worm species, Eisenia fetida. The study found that sodium chloride (NaCl) is the more toxic of the common sodium salts found in wastewater to the worms. The research further found that the worms have an ability to detoxify NaCl although reproduction will be impaired if the worms are exposed to moderate concentrations of NaCl for a long period of time. The actual risk from NaCl toxicity in the vermifiltration process was low however. The low risk was due to the low solid-water partitioning constant of NaCl, which led to a very low predicted environmental concentration (PEC) for NaCl.

Typical signature of DNA damage in white blood cells: a pilot study on etheno adducts in Danish mother-newborn child pairs

The impact of DNA damage commonly thought to be involved in chronic degenerative disease causation is particularly detrimental during fetal development. Within a multicenter study, we analyzed 77 white blood cell (WBC) samples from mother-newborn child pairs to see if imprinting of DNA damage in mother and newborn shows a similar pattern. Two adducts 1,N(6)-ethenodeoxyadenosine (epsilondA) and 3,N(4)-ethenodeoxycytidine (epsilondC) were measured by our ultrasensitive immunoaffinity (32)P-post-labeling method. These miscoding etheno-DNA adducts are generated by the reaction of lipid peroxidation (LPO) end products such as 4-hydroxy-2-nonenal with DNA bases. Mean epsilondA and epsilondC levels when expressed per 10(9) parent nucleotides in WBC-DNA from cord blood were 138 and 354, respectively; in maternal WBC-DNA, the respective values were 317 and 916. Thus, the DNA-etheno adduct levels were reliably detectable and about two times lower in child cord blood, the difference being significant at P < 0.0004. Analysis of epsilondA and epsilondC levels in cord versus maternal blood WBC showed strong positive correlations (R(2) approximately 0.9, P < 0.00001). In conclusion, LPO-induced DNA damage arising from endogenous reactive aldehydes in WBC of both mother and newborn can be reliably assessed by epsilondA and epsilondC as biomarkers. The high correlation of etheno adduct levels in mother and child WBC suggests that a typical signature of DNA damage is induced similarly in fetus and mother. Prospective cohort studies have to reveal whether these two WBC-DNA adducts could serve as risk indicator for developing hematopoietic cancers and other disorders later in life.

The toxicity of ammonia/ammonium to the vermifiltration wastewater treatment process

This study was undertaken to assess the toxicity of ammonia/ammonium to key species within the vermifiltration process. The key species, the earthworm Eisenia fetida, was subjected to a series of tests in solid phase mesocosms and full-scale units. The solid phase tests showed a relatively low toxicity to ammonium with ammonium chloride having an LC50 for ammonium of 1.49 g/kg. Ammonium sulfate did not show an effect on mortality at 2 g/kg ammonium. The full-scale units showed that ammonia hydroxide can change the pH and concentration of ammonia in wastewater and while it caused some mortality to the worms its overall affect on system functioning was minimal with no significant difference in terms of worm survival found between treatments. The affect on nitrifying bacteria was also minimal with no linear trend shown with ammonia concentration.

Toxicity of domestic wastewater pH to key species within an innovative decentralised vermifiltration system

The development of innovative decentralised wastewater treatment systems is pertinent to environmental sustainability. However for their appropriate use they require significant research and design to ensure they can be relied upon in the future and in most cases they have received less attention and research than large-scale sewage systems. This study assessed the likelihood of biological inhibition and disruption from pH to key species for vermifiltration. The test firstly assessed the buffer capacity of a vermicompost + manure media finding it had a relatively high buffering capacity for pH. The toxicity after the buffer capacity experiment showed that the species would survive between pH levels of 6.2 and 9.7. At the higher and lower pH levels however the survival of juveniles was impaired, probably due to their ability to uptake greater amounts of soluble salts and inability to regulate them. Overall the study showed that the tolerance of the key vermifiltration species to pH was far less than their survival as previously proposed and further research assessing their long-term population dynamics in a vermifiltration system with pH is warranted.

New ultrasensitive 32P-postlabelling method for the analysis of 3,N4-etheno-2'-deoxycytidine in human urine

Etheno-DNA adducts are generated from exogenous carcinogens such as vinyl chloride and urethane and also from endogenous lipid peroxidation products such as trans-4-hydroxy-2-nonenal (HNE). The present authors and others have established that 1,N6-ethenodeoxyadenosine (epsilondA) and 3,N4-ethenodeoxycytidine (epsilondC) are present in human urine and could be explored as biomarkers for monitoring whole-body oxidative stress. The present study reports on a new ultrasensitive 32P-postlabelling/thin-layer chromatography (TLC) method for the analysis of epsilondC as deoxynucleoside in human urine. The urine samples were purified and enriched on a solid-phase silica C-18 column followed by a semi-preparative reverse-phase high-performance liquid chromatography. The purified sample was labelled with a multisubstrate deoxyribonucleoside kinase from Drosophila melanogaster (Dm-dNK) in the presence of 5'-bromo-2'-deoxyuridine (BrdU) as internal standard. The absolute sensitivity of the method was 0.1 fmol epsilondC detectable in 500 microl of human urine. The analysis of human urine samples from 15 healthy volunteers revealed a mean epsilondC level of 2.49+/-1.76 (SD) fmol micromol-1 creatinine (range 0.66-6.42). By this non-invasive method, epsilondC in human urine could be explored as a biomarker for oxidative stress-related human diseases.

Oxidative stress related DNA adducts in the liver of female rats fed with sunflower-, rapeseed-, olive- or coconut oil supplemented diets

Both animal and epidemiological studies support an effect of fatty acid composition in the diet on cancer development, in particular on colon cancer. We investigated the modulating effect of supplementation of the diet of female F344 rats with sunflower-, rapeseed-, olive-, or coconut oil on the formation of the promutagenic, exocyclic DNA adducts in the liver, an organ where major metabolism of fatty acids takes place. 1,N(6)-ethenodeoxyadenosine (etheno-dA), 3,N(4)-ethenodeoxycytidine (etheno-dC) and 1,N(2)-propandodeoxyguanosine from 4-hydroxy-2-nonenal (HNE-dGp) were determined as markers for DNA-damage derived from lipid peroxidation products and markers for oxidative stress. 8-Oxo-deoxyguanosine (8-Oxo-dG) was also measured as direct oxidative stress marker. The body weight of the rats was not influenced by the four diets containing the different vegetable oils during the 4-week feeding period. Highest adduct levels of etheno-dC (430 +/- 181 adducts/10(9) parent bases), HNE-dGp (617 +/- 96 adducts/10(9) parent bases) and 8-Oxo-dG (37,400 +/- 12,200 adducts/10(9) parent bases) were seen in rats on sunflower oil diet (highest linoleic acid content). Highest adducts levels of etheno-dA (133 +/- 113 adducts/10(9) parent bases) were found in coconut oil diet (lowest content of linoleic acid). Weakly positive correlations between linoleic acid content in the four diet groups were only observed for levels of HNE-dGp and 8-Oxo-dG. Neither the diet based on olive oil (which contains mainly oleic acid) nor the diet based on rapeseed oil (containing alpha-linolenic acid) exerted any significant protective effect against oxidative DNA damage. Our results indicate that a high linoleic acid diet may contribute to oxidative stress in the liver of female rats leading to a marginal increase in oxidative DNA-damage.

Digit preference in Goldmann applanation tonometry: the hedgehog effect

PURPOSE

Digit preference is a subconscious bias towards numbers that end in certain digits. We conducted a study to assess for digit preference in intraocular pressure measurement using the Goldmann applanation tonometer.

DESIGN

Prospective study with masked and unmasked phases.

METHODS

The study was conducted in general ophthalmic clinics in a District General Hospital in Blackpool, United Kingdom, by 6 clinical ophthalmologists. Consecutive right eye intraocular pressure measurements were collected for a 2-month period for the masked phase and were repeated for the unmasked phase. The proportion of even numbers was the main outcome measure.

RESULTS

Six ophthalmologists completed both phases: 555 of 917 readings were even in the masked phase (P = .075), and 679 of 1056 readings were even in the unmasked phase (P = .022).

CONCLUSIONS

Our results suggest that digit preference influences measurements from the Goldmann applanation tonometer and that this persists when observers are aware of digit preference. This bias may influence both clinical decision-making and trial results.

Hydrogen sulphide production tests and the detection of groundwater faecal contamination by septic seepage

The 'H2S test' is being advanced for microbiological water quality testing where conventional coliform based methods are impractical or too expensive. It involves ambient temperature incubation of water samples with nutrient formulated to generate hydrogen sulphide when 'faecal' bacteria are present. Recently a WHO review identified several concerns including the limited number of comparative studies, formulation variability, and false positives and negatives. In response we have compared the H2S test's ability to detect and quantify faecal contamination in an aquifer impacted by septic tank leachfields with measurements obtained concurrently using conventional bacterial indicators, coliphages, faecal sterol biomarkers, Cryptosporidium and Giardia. Like these other analytes, H2S testing detected a contamination gradient ranging from high (septic liquid) to moderate (exfiltration zones), to background (e.g. domestic bores), corresponding to indicator removal + dilution by factors > 10(6). Presence/absence tests could not distinguish between heavily and slightly contaminated waters, whereas multi-tube testing (e.g. 10 x 10 mL arrays) did. It was concluded that while the WHO review concerns are justified, the H2S test performance shows promise in sanitary survey work, can be improved by employing an mpn approach and has potential to aid in the protection of source water and identifying contaminated groundwater.

Monitoring of the process of composting of kitchen waste in an institutional scale worm farm

Vermicomposting provides an alternative method of managing waste that is ecofriendly and cost-effective. The Environmental Technology Centre (ETC) at Murdoch University and St. John of God Hospital (SJOG) signed a Memorandum of Understanding (MOU) to install a vermiculture system in SJOG to treat some of the organic waste generated by the on site kitchen facility. This is an effort made by SJOG to reduce the amount of organic waste sent to landfill each year and to treat the waste on site as part of a recycling/reuse program. The study is aimed at scientifically monitoring vermicomposting process and to understand the optimum management requirements to improve the operation of an institutional scale worm farm. In addition, an experiment was conducted to investigate the suitability of bedding materials: horse manure, cow manure, peat coir, and natural bedding (vermicast). The species of earthworms used in this experiment were Red (Lumbricus rubellus), Tiger (Eisenia fetida), and Blue (Lumbricus excavatus). The pH, temperature, worm population and quality of castings were tested in different beds. Results indicated that vermicast was the best bedding for vermicomposting, and there were no significant difference between the performances of the other three beds. However, it can be concluded that the bedding material of horse manure, cow manure, and peat coir were successfully established well within the experimental period of eight weeks, and cow manure with the lowest C:N ratio produced the best quality bedding. As using vermicast for the initial bedding creates a very high capital cost these organic substrates provide cost-effective alternative. Therefore they would be quite appropriate to initiate an institutional scale worm farm.

Recycling of treated domestic effluent from an on-site wastewater treatment system for hydroponics

An alternative method to conserve water and produce crops in arid regions is through hydroponics. Application of treated wastewater for hydroponics will help in stripping off nutrients from wastewater, maximising reuse through reduced evaporation losses, increasing control on quality of water and reducing risk of pathogen contamination. This study focuses on the efficiency of treated wastewater from an on-site aerobic wastewater treatment unit. The experiment aimed to investigate 1) nutrient reduction 2) microbial reduction and 3) growth rate of plants fed on wastewater compared to a commercial hydroponics medium. The study revealed that the chemical and microbial quality of wastewater after hydroponics was safe and satisfactory for irrigation and plant growth rate in wastewater hydroponics was similar to those grown in a commercial medium.

Vermiculture as a tool for domestic wastewater management

Organic waste management is a growing issue due to the unsustainable practices of its disposal. Sewage treatment plants are designed to treat wastewater to produce a safe effluent. However, one of the by-products, the sewage sludge which is disposed off in landfill or used as fertilizer in agricultural operation is high in pathogens. Sustainability can be achieved by Vermicomposting of organic matter which involves accelerated cycling of nutrients though a closed cycle whereby waste products are put to productive end use. Vermicomposting and vermifiltration are natural waste management processes relying on the use of worms to convert organic wastes to stable soil enriching compounds. Domestic wastewater management can be accommodated through these processes in a sustainable manner. A considerable reduction in pathogens has been noticed in the end product to a level that it can be safely applied to land. This paper provides an overview of the system characteristics of management systems utilising vermiculture, to manage wastewater. The process can be used in a small scale for household waste treatment to rural or urban waste management.

Comparison of multiple DNA adduct types in tumor adjacent human lung tissue: effect of cigarette smoking

Cigarette smokers inhale a broad range of carcinogens derived from tobacco and its pyrolysis products, including free radicals, which induce oxidative stress and subsequent lipid peroxidation (LPO). Miscoding carcinogen-DNA adducts are formed by cigarette smoke constituents and are thought to initiate lung carcinogenesis. The presence of various types of DNA damage was therefore analyzed in tumor adjacent uninvolved lung tissues of 13 smoking and 11 non-smoking operated lung cancer patients. O(4)-ethylthymidine (O(4)etT), 1,N(6)-ethenodeoxyadenosine ( epsilon dA) and 3,N(4)-ethenodeoxycytidine ( epsilon dC) were determined by immuno-enriched (32)P-postlabeling. Polycyclic aromatic hydrocarbon (PAH)-DNA adducts were measured as diagonal radioactive zones after nuclease P1 enriched (32)P-postlabeling. Mean O(4)etT and PAH-DNA adduct levels were higher in lung DNA of smokers than of non-smokers (O(4)etT/10(8) thymidine: 3.8 versus 1.6, P < 0.01; PAH-DNA adducts/10(8) nucleotides: 11.2 versus 2.2, P < 0.01). Pulmonary etheno-DNA adduct levels did not differ between smokers and non-smokers, but large inter-individual variations were observed (80- and 250-fold differences for epsilon dA and epsilon dC, respectively). As all smokers (except one) refrained from smoking at least for 1 week before surgery, our results demonstrate the persistence of O(4)etT and PAH-DNA adducts in human lung. A positive correlation obtained between O(4)etT and PAH-DNA adducts (R = 0.65, P < 0.01) suggests that both adducts are formed from cigarette smoke as the main exposure source. We conclude that in addition to the DNA adducts derived from PAH and tobacco-specific nitrosamines, miscoding O(4)etT lesions are formed by cigarette smoke that contribute to the increased genomic instability and increased lung cancer risk in smokers.

A neural network approach to identifying adolescent adjustment

This study examined the relationship between the quality of adjustment in adolescents and a set of psychiatric diagnoses, personality traits, parental bonding, and social support variables. One hundred fifty adolescents were administered the Millon Adolescent Personality Inventory, the Parental Bonding Questionnaire, the Social Support Questionnaire, and the Diagnostic Interview for Children and Adolescents. A neural network approach was then utilized, and it was found that several of the variables (e.g., Major Depressive Disorder, Conduct Disorder, and Societal Conformity) had a significant role in classifying adolescents into three groups: maladjusted, nominally adjusted, and well-adjusted.

Influence of dietary fatty acid, vegetable, and vitamin intake on etheno-DNA adducts in white blood cells of healthy female volunteers: a pilot study

Etheno-DNA adducts such as 1,N(6)-ethenodeoxyadenosine (epsilondA) and N(2),3-ethenodeoxycytidine (epsilondC) are formed as result of oxidative stress and lipid peroxidation via reactive alkenals (J. Nair et al., Mutat. Res., 424:59-69, 1999). High pi-6 polyunsaturated fatty acid intake markedly increased levels of WBCs in female volunteers on a controlled diet (J. Nair et al., Cancer Epidemiol. Biomark. Prev., 6:591-601, 1997). In healthy female volunteers we investigated possible correlations between dietary fatty acid intake (by questionnaire), concentration of linoleic acid (LA) and oleic acid (OA) in serum (n = 34), and etheno-DNA adduct levels in WBC (n = 42). Two groups of samples were selected according to dietary intake >15 g (group A) or <5 g (group B) LA/day. Serum samples were analyzed for free OA and LA by gas chromatography-mass spectroscopy and WBC-DNA for epsilondA and epsilondC adducts by immunoaffinity (32)P postlabeling. On a group level, serum LA and OA concentrations were higher in group A than group B, whereas the LA/OA ratios were similar. The mean epsilondA and epsilondC levels did not significantly differ in groups A and B, but a third of the individuals had more than twice the mean adduct levels than the rest. Correlation analyses revealed a significant inverse correlation for epsilondA in WBC-DNA and vegetable or vitamin E consumption. We conclude that etheno-DNA adduct levels are not determined by LA intake alone but might depend on the ratio of pi-6 polyunsaturated fatty acid:other fatty acids and of antioxidants consumed in the diet. This pilot study also indicated a protective effect of dietary vitamin E and vegetables against miscoding, lipid peroxidation-induced DNA lesions.

Ethanol enhances the formation of endogenously and exogenously derived adducts in rat hepatic DNA

To investigate the role of ethanol in chemically-induced carcinogenesis, we exposed Wistar rats to ethanol, either as an acute dose or for prolonged periods in a liquid diet and looked for effects on endogenously and exogenously derived DNA adducts. Changes in the cytochrome P450 protein (CYP 2E1) and its catalytic demethylase activity were also followed in order to provide a sequence of relatively well understood changes that are associated with free radical production and, therefore, potentially capable of affecting DNA. The exocyclic DNA adducts, ethenodeoxyadenosine (varepsilondA) and ethenodeoxycytidine (varepsilondC), known to arise from oxidative stress and lipid peroxidation (LPO) sources, were detected in the liver DNA of Wistar rats at background concentrations of 4-6 (varepsilondA) and 25-35 (varepsilondC) adducts per 10(9) parent bases. When rats were given either an acute dose of ethanol (5g/kg, i.g.) or exposed for 1 week to ethanol in a liquid diet (5%, w/v), etheno adduct levels were increased approximately 2-fold and this was statistically significant for varepsilondC (P<0.05 and P<0.02, respectively) for the two separate treatments.In N-nitrosodimethylamine (NDMA)-treated rats, acute ethanol treatment significantly increased the level of O(6)-methylguanine (O(6)-MeG) in hepatic DNA and this was paralleled by a decrease in O(6)-alkylguanine DNA alkyltransferase (ATase) activity; immunohistochemistry confirmed this increase of O(6)-MeG in both hepatic and renal nuclei. When rats were given ethanol in the diet and treated with NDMA, O(6)-MeG levels in hepatic DNA increased at 1 week which coincided with the peak of CYP 2E1-dependent NDMA-demethylase activity. Single cell gel electrophoresis of liver cells showed that after 1 week of exposure to ethanol, there was a small but significant increase in the frequency of DNA strand breaks induced by NDMA (P<0.05); after 4 weeks the increase was 1.4-fold (P<0.01). Our results indicate that exposures to ethanol, which resulted in blood ethanol concentrations similar to those seen in chronic alcoholics and increased levels of expression of the CYP 2E1 protein can exacerbate the DNA damaging effects of endogenous and exogenous alkylating agents. These observations provide indications of possible mechanisms for the carcinogenic or co-carcinogenic action of ethanol.

Suitability of the H2S method for testing untreated and chlorinated water supplies

Rainwater, borewater and catchment water are used for domestic water supply purposes with or without treatment in remote areas around the world. These places seldom have any facilities for routine testing of their drinking water. A simple on-site testing method is highly required in such areas. The H2S method has been tested for treated drinking water and was found to have a good correlation with the standard methods. The present study was aimed at assessing the suitability of the H2S method for testing different sources of drinking water. Since these types of water may contain H2S producing bacteria not of faecal origin the occurrence of false results in this method cannot be overruled. Therefore it was worthwhile to study whether the positive results are true positive results and what percentage of false positive and false negative results could be expected while using this test for routine analysis of water samples. Results were compared with the results using standard procedures for testing total coliforms, Escherichia coli and Salmonella spp. The present experiment analysed 121 rainwater samples, 17 borewater samples, 41 catchment water samples and 74 remote Aboriginal community water samples. Rainwater, borewater and catchment water samples gave true results of 78.5%, 82.3% and 80.5% respectively while the treated and untreated community samples gave true results of 93.7 and 84.6% respectively. It was concluded that in the developing countries where the acceptable level of total coliform is <10 MPN, the H2S method would be a good test to identify microbial contamination. In other regions, the H2S method could be used as a screening test for drinking water supplies.