931 Timeline in Management of Urinary Retention: Trial Without Catheter (TWOC) Clinic – Single Centre Outcomes of District General Hospital

Aim

Urinary retention is a common urological emergency, but the management is not standardised due to lack of clinical guidelines & various options available to a complex problem. We aim to assess the timeline of patients going into acute urinary retention & their first/second TWOC appointment until clinic appointment and decision for definitive treatment as-well as to reduce waiting time&improve patients’ safety/experience.

Method

Using retrospectively collected data, all TWOC admissions from June 2019-December 2019 and June 2020-December 2020 were included. Data was extracted from various sections across our e-system. Outpatient letter appointments also checked to complete the timeline.

Results

Total of 93-TWOC admissions in total, 45 of which were in2019 and 48 in2020. 26%(n=24) of patients have passed their TWOC. 74%(n=69) of patients have failed their TWOC necessitating re-catheterisation/consideration for TURP/re-TWOC.

Time from urinary retention/catheterisation to TWOC admission in 2019 had an average of 36.2days, whereas it was 37.9days in 2020.

Time from urinary catheterisation to clinic also showed variation with an average of 83.9days in 2019 and 56.3days in 2020, ultimately resulting in long waiting-period for an operation.

Conclusions

A TWOC-clinic, where patients can be seen once-a-week to reduce clinic waiting time & improve safety by performing DRE & checking PSA in timely-manner, was proposed. It allows effective use of TWOC slots & timely decision of suitable patients for surgery rather than simply-listing patients for unnecessary further TWOC. It also serves as a platform to safety-net patients with possible underlying prostate-cancer by checking PSA & performing DRE early in their journey for early-management.

459 Timeline in Management of Muscle Invasive Bladder Cancer (MIBC): Single Centre Outcomes of District General Hospital

Aim

According to the European Association of Urology (EUA) guidelines, patients with muscle invasive bladder cancer (MIBC) have better overall survival outcome if they receive definitive treatment within 90 days from point of referral. Our objective was to assess the average timeline of these patients from their 2 week wait (2WW) referral to definitive treatment.

Method

This was a retrospective study in all patients diagnosed with MIBC from 1st January 2018 to 31st December 2019 at Furness General Hospital (UHMBT). Treatment delay was defined as delay in more than 90 days from initial referral to definitive treatment (radical cystectomy /radical radiotherapy with or without adjuvant chemotherapy).

Results

47 patients met the inclusion criteria. Patients had imaging within 27 days, with 32 patients (68%) having a computed tomography (CT) scan and 15 patients (32%) having magnetic resonance imaging (MRI). The duration from referral point to transurethral resection of bladder tumour (TURBT) was 40 days. Multidisciplinary team (MDT) discussion took place within 12 days post-surgery. On average, the journey from date of referral to MDT was 52 days. From MDT discussion to the first tertiary centre appointment took another 27 days making it a total of approximately 79 average days for the patient to have a definitive treatment plan.

Conclusions

12 patients (26%) exceeded the 90-day mark from duration between referral to having treatment. This is mainly due to TURBT being used as the ‘stop the clock’ treatment. The trust has, thus, created a departmental standard operating procedure (SOP) with the aim of minimising this duration.

Molecular epidemiology of Burkholderia mallei isolates from India (2015-2016): New SNP markers for strain tracing

Glanders, caused by a bacterium called B. mallei, is primarily an infectious horse and human disease. Although its incidence is rare in developed countries, it is nonetheless prevalent in several geographical areas of the world. There is a lack of cost-effective, rapid and specific molecular typing tools for epidemiological tracing of glanders cases. We previously reported an SNP-based typing method that categorizes global B. mallei strains into three lineages (L1 to L3), as well as additional branches, sub-branches and groups. However, further discrimination of the Indian and Pakistani isolates within the L2B2sB2 sub-branch was not possible due to the lack of sufficient epidemiological markers. In this study, 10 B. mallei strains isolated from four states in India during 2015-2016 were whole genome sequenced; SNP analysis further confirmed their position in the L2B2sB2 branch. To better track the strains, four new markers targeting Indian or Pakistani strains, and specifically targeting sub-groups within the Indian strains, were identified. The new SNP markers were tested and validated on the 10 Indian isolates included in this study as well as on 6 contemporary B. mallei Pakistani strains. These rapid and discriminating typing tools will contribute to the epidemiological monitoring of B. mallei infections, particularly in South Asia and the Middle East, endemic regions of the disease.

Development of a microsphere-based immunoassay for the serological detection of glanders in equids

Burkholderia mallei is the etiologic agent of glanders, an infectious disease of solipeds, with renewed scientific interest due to its increasing incidence in different parts of the world. More rapid, sensitive and specific assays are required by laboratories for confirmatory testing of this disease. A microsphere-based immunoassay consisting of beads coated with B. mallei recombinant proteins (BimA, GroEL, Hcp1, and TssB) has been developed for the serological diagnosis of glanders. The proteins' performance was compared with the OIE reference complement fixation test (CFT) and an indirect enzyme-linked immunosorbent assay (iELISA) on a large panel of sera comprised of uninfected horses (n=198) and clinically confirmed cases of glanders from India and Pakistan (n=99). Using Receiver Operating Characteristics (ROC) analysis and adjusting the cutoff levels, Hcp1 (Se=100%, Sp=99.5%) and GroEL (Se= 97%, Sp=99.5%) antigens exhibited the best specificity and sensitivity. Neither Hcp1 and GroEL proteins, nor iELISA reacted with doubtful and positive CFT samples from glanders free countries which further confirmed the false positive reactions seen in CFT.

High-resolution melting PCR analysis for rapid genotyping of Burkholderia mallei

Burkholderia (B.) mallei is the causative agent of glanders. A previous work conducted on single-nucleotide polymorphisms (SNP) extracted from the whole genome sequences of 45 B. mallei isolates identified 3 lineages for this species. In this study, we designed a high-resolution melting (HRM) method for the screening of 15 phylogenetically informative SNPs within the genome of B. mallei that subtype the species into 3 lineages and 12 branches/sub-branches/groups. The present results demonstrate that SNP-based genotyping represent an interesting approach for the molecular epidemiology analysis of B. mallei.

Association of BCL-2 with oxidative stress and total antioxidant status in pediatric acute lymphoblastic leukemia

B-Cell Lymphoma protein-2 (BCL-2) is one of the most studied proteins with substantial regulatory potential for both apoptosis and autophagy. BCL-2 confer chemoresistance through influencing cancer pathophysiology. Serum level of lactate dehydrogenase (LDH) predicts increased anaerobic glycolysis and is associated with metabolic modulation in cancer cells. In the present research, the interplay of BCL-2, total oxidative status (TOS) and LDH was investigated in patients with acute lymphoblastic leukemia (ALL). The studied parameters, BCL-2 protein (p less than 0.001), TOS (p less than 0.001) and LDH (p less than 0.001) were significantly elevated in the ALL group compared to the normal group (N-group). However, the total antioxidant status (TAS) was reduced significantly (p less than 0.01) in ALL patients. In the ALL group, the TOS had significant negative correlation with TAS (p less than 0.01). Furthermore, non-significant positive correlations were found between BCL-2 and LDH, BCL-2 and TAS and LDH and TAS (each with; p>0.05). However, a negative non-significant correlation was observed between BCL-2 and TOS and LDH and TOS (each with; p>0.05).

Isolation, characterization, virulence and immunogenicity testing of field isolates of Pasteurella multocida, Staphylococcus aureus, and Streptococcus agalactiae in laboratory settings

The present study was designed to investigate isolation, characterization, virulence and immunogenicity testing of field isolates of Pasteurella multocida, Staphylococcus aureus, and Streptococcus agalactiae in rabbits and mice. Isolates of P. multocida, S. aureus and Str. agalactiae recovered from field cases of Hemorragic septicemia and mastitis were scrutinized for virulence/pathogenicity and immunogenicity. Mouse LD₅₀ of P. multocida showed that P. multocida isolate No.1 was more virulent than isolates No. 2 and 3. Virulence of isolate No.1S. aureus and Str. agalactiae revealed that 100, 80% rabbits died within 18h of inoculation. Seven-digit numerical profiles of these 4 isolates with API^® Staph test strips isolates, No.1 (6736153) showed good identification (S. aureus id=90.3%). Indirect ELISA-based serum antibody titers to P. multocida isolate No.1, S. aureus No.1, Str. agalactiae, isolate No.1 elicited high antibody titers 1.9, 1.23, 1.12 respectively.

CONCLUSION

All the pathogens of Isolate No. 1 (P. multocida, S. aureus Str. agalactiae), were high antibody than others isolates.

In vitro antioxidant potential of selected aphrodisiac medicinal plants

The present study aimed to evaluate the antioxidant activity of six selected aphrodisiac medicinal plants. Useful parts of the selected medicinal plants were collected and extracted in methanolic solvent. The antioxidant activity of selected plant extract was determined through different antioxidant assays, namely DPPH radical scavenging assay and ferric reducing antioxidant assay. Moreover, antioxidant compounds, like total phenolics and total flavonoids contents, were also determined. Results showed that Mucuna pruriens seed extract displayed high contents of phenolic compounds with total phenolic content of 683.15±4.28 mg GAE/g dry plant material while the least phenolic content was observed in Asparagus racemosus (195.5±3.02 mg GAE/g dry plant material). Highest total flavonoids content was found in Anacyclus pyrethrum roots (156.58±4.01 μg CE/g) and the least content was found in Asparagus racemosus roots. Among the studied plant extracts, the highest radical scavenging activity was shown by Mucuna pruriens seed extract (82.05±0.55%) and the least percent scavenging activity was observed in Tribulus terrestris extract (36.40±2.01%). Vitamin C was used as positive control for antioxidant assays showing 93.54±0.9% radical scavenging activity. The plant extract also exhibited a strong reducing potential against free radicals. Therefore, the present study concluded that all the studied medicinal plants possess varying concentrations of secondary active metabolites responsible for the antioxidant properties of the tested plant extracts.

Sero-epidemiology of equine toxoplasmosis using a latex agglutination test in the three metropolises of Punjab, Pakistan

Toxoplasmosis is a serious threat for livestock in addition to being of zoonotic significance. In this study, serodiagnosis of equine toxoplasmosis was conducted in a randomly selected population from the 3 metropolises of Punjab, Pakistan. To this end, 272 draught equines were screened using a commercial latex agglutination assay kit. Association of probable risk factors of equine toxoplasmosis was also documented. A total of 91 (33.5%) equines were found sero-positive for Toxoplama (T.) gondii having antibody titers ranging between 1:32 to 1:612. The highest rates of seropositive cases were observed in donkeys (58.7%) followed by mules (28.6%) and horses (23.5%). Age, sex and species of draught equines were found not to be statistically (p>0.05) associated with the distribution of T. gondii antibodies. The results of the study provided a baseline data for the exposure of equine population in this area. In addition, it is recommended that the contiguous population of domestic ruminants and possible reservoirs such as feral cats should be screened in order to explore the potential risk for the human population in Pakistan.

Effect of incubation temperature on the diagnostic sensitivity of the glanders complement fixation test

The complement fixation test (CFT) is the only serological test prescribed by the World Organisation for Animal Health (OIE) for the diagnosis of glanders in international trading of equids. However, false-positive reactions have caused financial losses to the animal owners in the past, and false-negative tests have resulted in the introduction of glanders into healthy equine populations in previously glanders-free areas. Both warm (incubation at 37°C for 1 h) and cold (overnight incubation at 4°C) procedures are recommended by the OIE for serodiagnosis of glanders. In a comparison of the sensitivity and specificity of the two techniques, using the United States Department of Agriculture antigen, warm CFT was found to be significantly less sensitive (56.8%; p < 0.0005) than the cold CFT (83.6%). Cold CFT thus increases the detection rate of glanders but a lower diagnostic specificity has to be accepted. The immunoblot was used as the gold standard.

Diffused idiopathic skeletal hyperostosis in a fighting Bulldog: a case report

This case report illustrates the presence of diffuse idiopathic skeletal hyperostosis (DISH) in a fighting Bulldog. The dog was referred to the Veterinary Teaching Hospital, University of Agriculture Faisalabad Pakistan, with the presenting complaint of slowly progressing staggering gait, inability to stand on hind limbs and muscle stiffness in lumbo-sacral region. Hematological, sero-biochemical and clinical examination were insignificant except presence of extensive new bone formation in the radiograph on the ventral of last 4 consecutive body lumbar vertebras (L4-L8) in lumbar region, running parallel to nuchal ligament. Diagnosis of DISH was made on the basis of clinical signs and radiographical examination which were suggestive of DISH. This report documents the first case of DISH in fighting Bulldog in Pakistan.

Glanders in animals: a review on epidemiology, clinical presentation, diagnosis and countermeasures

Glanders or farcy, caused by Burkholderia mallei, is an infectious and zoonotic disease of solipeds. Horses, donkeys and mules are the only known natural reservoir of B. mallei. Although glanders has been eradicated from most countries, it has regained the status of a re-emerging disease because of the numerous recent outbreaks. Pre-symptomatic or carrier animals are the potential source of infection for the healthy equine population and play a crucial role in the spreading of the infectious agent. Glanders is characterized by ulcerating nodular lesions of the skin and mucous membrane. Generalized symptoms include fever, malaise, depression, cough, anorexia and weight loss. Burkholderia mallei can invade its host through mucous membranes, gastrointestinal tract and the integument. Its virulence mechanisms and pathogenesis are not yet completely understood. A major problem when using serological tests for diagnosing glanders is the occurrence of false-positive and false-negative results leading to difficulties in international trade with equids and to the spread of glanders to disease-free regions. Moreover, poor tests critically result in poor control of disease. These tests are not only incapable of discriminating between B. mallei and B. pseudomallei antibodies, they are also unable to differentiate between malleinized and naturally infected animals. Combined use of both serological and molecular detection methods increases the detection rate of glanders. Countermeasures against glanders include early detection of disease in susceptible animals, stringent quarantine measures, testing and safe destruction of infected carcasses, adequate compensation to the animal owners, disinfection of infected premises and awareness about glanders and the zoonotic implications through veterinary extension services. An account of the clinical picture and successful experimental therapy of spontaneous equine glanders is also given.

Comparative evaluation of three commercially available complement fixation test antigens for the diagnosis of glanders

The sensitivity and specificity of three commercially available complement fixation test (CFT) antigens from c.c.pro (c.c.pro), Central Veterinary Institute of Wageningen UR (CIDC) and the United States Department of Agriculture (USDA) were comparatively evaluated by testing 410 sera collected from glanders-endemic and non-endemic areas (200 true-negative randomly collected sera and 210 sera collected from experimentally immunised animals (12 rabbits, 19 horses), clinically positive (135) and culture-positive (44) horses, donkeys and mules). Immunoblotting (IB) was used as the gold standard test. Highest sensitivity was shown for the CIDC antigen (100 per cent) followed by the c.c.pro antigen (99.39 per cent). However, the USDA antigen showed substantially less (p<0.05) sensitivity (62.19 per cent). Highest specificity was found for the USDA antigen (100 per cent) followed by the CIDC (97.5 per cent) and c.c.pro antigen (96.5 per cent). Positive and negative predictive values (assumed glanders prevalence of <0.1 per cent) for each antigen were calculated to be 95.88 and 99.48 (c.c.pro), 97.04 and 100 (CIDC), 100 and 76.33 per cent (USDA), respectively. Almost perfect agreement (0.96) was found between CFT using either c.c.pro or CIDC and IB.

TRYPANOSOMA EVANSI INFECTIONS IN HIMALAYAN BLACK BEARS (SELENARCTOS THIBETANUS)

The Asiatic or Himalayan black bear (Selenarctos thibetanus) is an endangered species. In South Asian countries, captive tamed Himalayan bears are commonly used by roving bear-charmers to entertain the people in rural and urban areas. In captivity, this species confronts several psychophysical traumas and communicable diseases, which are prevalent in other domestic species. The present report describes four cases of Trypanosoma evansi infection in live Himalayan charming bears, which originated from the Faisalabad and Jhang districts of Pakistan. The condition was characterized by pyrexia, accelerated pulse, tachypnea, depression, anemic mucous membranes, and ataxia (n = 3). Microscopic examination of peripheral blood films revealed moderate (n = 2) or high (n = 2) numbers of T. evansi. All four bears were treated twice at 3-day intervals with suramin sodium by using almost twice the dosage recommended for common domestic animals (10 mg/kg). The treated bears were found aparasitemic on repeat blood testing on days 5, 7, and 10 post-treatment. No adverse effects were noted and all four cases recovered in 3-7 days after completion of the second round of treatment. One bear died 8 days after the second treatment (day 11). This is the first report of T. evansi in bears.

Distribution of lead in relation to size of airborne particulate matter in Islamabad, Pakistan

Airborne particulate matter (PM) collected from two sampling stations in Islamabad, Pakistan, was analyzed for lead content and size gradation. A high volume air sampler was used to trap particulates on glass fiber filters for 8-12 h on a daily basis. Lead was estimated using a nitric acid digestion based AAS method on 44 samples from station 1 and 61 samples from station 2. Particle size fractions were categorized as <2.5, 2.5-10, 10-100 and >100 microm. The correlation between lead concentration and particle size was investigated. The results from two stations indicated average airborne lead concentrations of 0.505 and 0.185 microg/m3. Enhanced levels of lead were measured at a maximum of 4.075 microg/m3 at station 1 and 4.000 microg/m3 at station 2. PM < 2.5 and PM > 100 were found to constitute the local atmosphere in comparable proportions. A comparison of the lead levels is made with the existing permissible levels of this element laid down by different international agencies.

Use of neostigmine in massive ivermectin toxicity in cats

Over-the-counter availability of drugs in developing countries poses the risk of their abuse and overdosing in animals by the owners. This report describes ivermectin toxicosis and its treatment with neostigmine methylsulfate in 2 kittens and an adult cat that had been massively overdosed by their owners. Of two 4-w-old 300 g kittens, one was injected with 1.5 ml ivermectin (15 mg; corresponding to 250 times the recommended dose) by the owner and became comatose, started salivation and died after 2 1/2 h. The other kitten was treated with about 0.75 ml ivermectin (7.5 mg; corresponding to 125 times the recommended dose) by the same owner and developed ataxia and salivation after 2 h, went into coma the next morning and was presented for treatment with mydriasis, coma, slight fever (102.4 F), tachypnea (48/min) and severe tachycardia. This kitten was treated twice at a half hourly interval with neostigmine methylsulfate (25 microg) and 5% dextrose (20 ml) iv showed a transient improvement but died 12 h later. A 2-y-old, 4.5 kg male cat was treated s.c. with 1.5 ml ivermectin (15 mg; corresponding to 16.6 times the recommended dose) by its owner and developed slight salivation, lacrimation. mydriasis, protrusion of third eye-lid, tachypnea (42 breaths/min), tachycardia (128 beats/min) and ataxia. The patient was treated with neostigmine methylsulfate (150 microg) and 5% dextrose (100 ml) i.v., and 200 ml of Heartmann's solution i.v. Treatment was repeated after 6 h Follow up treatment over next 2 d was with daily i.v. administration of neostigmine and dextrose. The patient completely recovered 5 d after initiation of treatment.