Efficacy and safety of itopride SR for upper gastrointestinal symptoms in patients with diabetic gastroparesis: real-world evidence from Pakistan

Background

Gastroparesis is a serious condition that can be caused by diabetes, surgery or infection, or can be idiopathic. When there is no mechanical obstruction, gastroparesis is characterized by delayed stomach emptying. Itopride, a prokinetic drug, inhibits acetylcholinesterase activity in addition to antagonizing dopamine D2 receptors.

Methods

This prospective, multicentre study is based on real-world data from 988 patients with a diagnosis of diabetic gastroparesis for index (PAGI-SYM2) evaluation at baseline and week 4 of treatment for upper gastrointestinal disorder symptoms.

Results

Upper gastrointestinal symptom severity scores improved significantly after 4 weeks of treatment (p<0.001), with significant improvement across all categories of gastroparesis (very mild (37-58.6%), mild degree (24.6-31.6%), moderate (29.3-7.3%) and severe (8.8-2.6%).

Conclusion

Itopride SR (Nogerd SR) in a 150 mg once-daily dose showed promising results in reducing the severity of upper gastrointestinal disorder symptoms associated with diabetic gastroparesis. Both statistical and clinical effectiveness were observed. Moreover, the treatment demonstrated a favourable tolerability profile, with a low incidence of adverse effects.

The versatility of nanocellulose, modification strategies, and its current progress in wastewater treatment and environmental remediation

Deterioration in the environmental ecosystems through the depletion of nonrenewable resources and the burden of deleterious contaminants is considered a global concern. To this end, great interest has been shown in the use of renewable and environmentally-friendly reactive materials dually to promote environmental sustainability and cope with harmful contaminants. Among the different available options, the use of nanocellulose (NC) as an environmentally benign and renewable natural nanomaterial is an attractive candidate for environmental remediation owing to its miraculous physicochemical characteristics. This review discusses the intrinsic properties and the structural aspects of different types of NC, including cellulose nanofibrils (CNFs), cellulose nanocrystals (CNCs), and bacterial cellulose (BC) or bacterial nanocellulose (BNC). Also, the different modification strategies involving the functionalization or hybridization of NC by using different functional and reactive materials aimed at wastewater remediation have been elaborated. The modified or hybridized NC has been explored for its applications in the removal or degradation of aquatic contaminants through adsorption, filtration, coagulation, catalysis, photocatalysis, and pollutant sensing. This review highlights the role of NC in the modified composites and describes the underlying mechanisms involved in the removal of contaminants. The life-cycle assessment (LCA) of NC is discussed to unveil the hidden risks associated with its production to the final disposal. Moreover, the contribution of NC in the promotion of waste management at different stages has been described in the form of the five-Rs strategy. In summary, this review provides rational insights to develop NC-based environmentally-friendly reactive materials for the removal and degradation of hazardous aquatic contaminants.

Molecular profiling of bacterial blight resistance in Malaysian rice cultivars

Bacteria blight is one of the most serious bacterial diseases of rice worldwide. The identification of genetic potential against bacterial blight in the existing rice resources is a prerequisite to develop multigenic resistance to combat the threat of climate change. This investigation was conducted to evaluate alleles variation in 38 Malaysian cultivars using thirteen Simple Sequences Repeats markers and one Sequence Tagged Sites (STS) marker which were reported to be linked with the resistance to bacterial blight. Based on molecular data, a dendrogram was constructed which classified the rice cultivars into seven major clusters at 0.0, 0.28 and 0.3 of similarity coefficient. Cluster 5 was the largest group comprised of ten rice cultivars where multiple genes were identified. However, xa13 could not be detected in the current rice germplasm, whereas xa2 was detected in 25 cultivars. Molecular analysis revealed that Malaysian rice cultivars possess multigenic resistance.

Evaluating potential delays and outcomes of patients undergoing surgical resection for locally advanced and recurrent colorectal cancer during a pandemic

INTRODUCTION

The COVID-19 pandemic resulted in a significant disruption of colorectal cancer (CRC) care pathways. This study evaluates the management and outcomes of patients with primary locally advanced or recurrent CRC during the pandemic in a single tertiary referral centre.

METHODS

Patients undergoing elective surgery for advanced or recurrent CRC with curative intent between March 2020 and March 2021 were identified. Following first multidisciplinary team discussion patients were broadly classified into two groups: straight to surgery (n=22, 45%) or neoadjuvant therapy followed by surgery (n=27, 55%). Primary outcome was COVID-19-related complication rate.

RESULTS

Forty-nine patients with a median age of 66 years (interquartile range: 54-73) were included. No patients developed a COVID-19 infection or related complication during hospital admission. Significant delays were identified in the treatment pathway of patients in the straight to surgery group, mostly due to delays in referral from external centres. Nine of 22 patients in the straight to surgery group had evidence of tumour progression compared with 3 of 27 in the neoadjuvant group (p=0.015839). Seven of 27 patients in the neoadjuvant group showed evidence of tumour regression. During the study, surgical waiting times were reduced, and more operations were performed during the second wave of COVID-19.

CONCLUSION

This study suggests that it is possible to mitigate the risks of COVID-19-related complications in patients undergoing complex surgery for locally advanced and recurrent CRC. Delay in surgical intervention is associated with tumour progression, particularly in patients who may not have neoadjuvant therapy. Efforts should be made to prioritise resources for patients requiring time-sensitive surgery for advanced and recurrent CRC.

Recovery of E. coli From Liver and Spleen of Broiler Birds and the Effects of Induced High Ammonia Level on Haematobiochemical Parameters and Its Amelioration by Different Modifiers

The poultry sector is one of the most vibrant segments of the agriculture industry of Pakistan. In addition to different infections, ammonia (NH₃) production from litter material of broiler is the most harmful pollutant and causes serious threats for the environment. To overcome this problem, different methods are proposed assuring poultry bird’s health and production. This study was carried out to evaluate the effect of toxic levels of NH₃ on the haematology and serum proteins of broiler birds and its amelioration by using different modifiers. The recovery of Escherichia coli (E. coli) from liver and spleen of broiler birds was also carried out. A total of 100 birds were divided into 5 separate groups (groups A–D). The groups C, D and E were treated with potassium aluminium sulphate, aluminium silicate and Yucca schidigera plant extract, respectively. Blood and tissue samples were collected after slaughtering the birds at 42 days of age. This study revealed increased RBC, total leucocyte count, Hb and heterophils percentage. Serum proteins were decreased in Yucca-treated and potassium aluminium sulphate–treated groups. This study concluded that NH₃ production was reduced by the application of different modifiers, and these modifiers also neutralized the changes in blood parameters induced by NH₃.

Comparative analysis of various sources of selenium on the growth performance and antioxidant status in broilers under heat stress

The supplementation of Selenium-enriched probiotics is effective in reducing oxidative stress and maintaining meat quality stability in broiler chicken especially under heat stress. An experimental study was conducted to perform Comparative analysis of Selenium yeast with inorganic Se in broilers under heat stress. A total of 120 broilers chicks of one day were assigned to 4 groups each consisting 30 chicks fed on same basal diet but different selenium sources. The basal diet of group D1 was not supplemented with Se source (Negative control), group D2 basal diet was supplemented with inorganic selenium (Sodium selenite 0.22mg/Kg starter phase and 0.15mg/Kg finisher phase), group D3 basal diet was supplemented with commercially available organic selenium (Seleno-methionine 0.22mg/Kg starter phase and 0.15mg/Kg finisher phase) and group D4 basal diet was supplemented with self-developed organic selenium (Se-enriched yeast 0.22mg/Kg starter phase and 0.15mg/Kg finisher phase). The performance parameters i.e. feed intake (FI), live body weight (BW) and FCR were not significantly (p>0.05) effected by selenium supplementation in the starter phase but were significantly (p<0.05) effected in the finisher phase. Selenium supplementation significantly (p<0.05) effected serum Se level in different supplemented groups. Higher serum Se value (58.20±0.06) was recorded in D4 group. Similarly significantly lower selenium value was recorded for D4 and higher was recorded for D1 (11.36±0.08). However lower serum Paraoxonase (PON) value was recorded for D4 (13.24±0.01) and higher for D1 (13.33±0.03). Comparatively self-developed Se enriched yeast increased the Se accumulation and improved antioxidant system. Glutathione peroxidase (GPx) was found higher in D4 (12.333±0.03) followed by D3, D2 and D1 respectively. Whereas superoxide dismutase (SOD) was significantly lower (p<0.05) in D4 (0.1437±0.003) followed by D3 (0.1457±0.002). Selenium supplementation increased the bird's survival rate. Birds fed on Se enriched yeast showed higher Se deposition and better antioxidant capacity as compared to other sources of selenium. Se-enriched yeast displayed an improved result on Se deposition in tissues, and oxidative capacity, meat tenderness and immune response level as compared to other sources of selenium.

Optimized biotransformation of acid-treated water melon peel hydrolyzate into ethanol

Today, global focus of research is to explore the solution of energy crisis and environmental pollution. Like other agricultural countries, bulk quantities of watermelon peels (WMP) are disposed-off in environment as waste in Pakistan and appropriate management of this waste is the need of hour to save environment from pollution. The work emphasizes the role of ethanologenic yeasts to utilize significant sugars present in WMP for low-cost bioethanol fermentation. Dilute hydrochloric acid hydrolysis of WMP was carried out on optimized conditions employing RSM (response surface methodology) following central composite design (CCD). This experimental design is based on optimization of ethanologenesis involving some key independent parameters such as WMP hydrolysate and synthetic media ratio (X1), incubation temperature (X2) and incubation temperature (X3) for maximal ethanol yield exploiting standard (Saccharomyces cerevisiae K7) as well as experimental (Metchnikowia cibodasensisY34) yeasts. The results revealed that maximal ethanol yields obtained from S. cerevisiae K7 was 0.36±0.02 g/g of reducing sugars whereas M. cibodasensisY34, yielded 0.40±0.01 g ethanol/g of reducing sugars. The yeast isolate M. cibodasensisY34 appeared as promising ethanologen and embodies prospective potential for fermentative valorization of WMP-to-bioethanol.

Era-like GTP protein gene expression in rice

The mutations are genetic changes in the genome sequences and have a significant role in biotechnology, genetics, and molecular biology even to find out the genome sequences of a cell DNA along with the viral RNA sequencing. The mutations are the alterations in DNA that may be natural or spontaneous and induced due to biochemical reactions or radiations which damage cell DNA. There is another cause of mutations which is known as transposons or jumping genes which can change their position in the genome during meiosis or DNA replication. The transposable elements can induce by self in the genome due to cellular and molecular mechanisms including hypermutation which caused the localization of transposable elements to move within the genome. The use of induced mutations for studying the mutagenesis in crop plants is very common as well as a promising method for screening crop plants with new and enhanced traits for the improvement of yield and production. The utilization of insertional mutations through transposons or jumping genes usually generates stable mutant alleles which are mostly tagged for the presence or absence of jumping genes or transposable elements. The transposable elements may be used for the identification of mutated genes in crop plants and even for the stable insertion of transposable elements in mutated crop plants. The guanine nucleotide-binding (GTP) proteins have an important role in inducing tolerance in rice plants to combat abiotic stress conditions.

Foliar Application of Salicylic Acid Improves Water Stress Tolerance in Conocarpus erectus L. and Populus deltoides L. Saplings: Evidence from Morphological, Physiological, and Biochemical Changes

Reforestation efforts are being challenged as water stress is hampering the sapling growth and survival in arid to semiarid regions. A controlled experiment was conducted to evaluate the effect of foliar application of salicylic acid (SA) on water stress tolerance of Conocarpus erectus and Populus deltoides. Saplings were watered at 90%, 60%, and 30% of field capacity (FC), and half of the saplings under 60% and 30% FC were sprayed with 1.0 mM SA. Results indicated that dry weight production decreased significantly in Populus deltoides under both water deficit conditions, and leaf gas exchange parameters decreased significantly in both the species under both soil water deficit conditions. Foliar application of SA resulted in a significant increase in leaf gas exchange parameters, and compatible solutes, thereby increasing the dry weight production in both of the species under soil water deficit. Oxidative stress (hydrogen peroxide and superoxide anions) increased under soil water deficit and decreased after the foliar application of SA and was parallel to the increased antioxidant enzymes activity (superoxide dismutase, catalase, peroxidase, and ascorbate peroxidase). Therefore, it can be concluded that foliar application of 1.0 mM SA can significantly improve the water stress tolerance in both species, however, positive impacts of SA application were higher in Conocarpus erectus due to improved photosynthetic capacity and increased antioxidant enzyme activity.

Comparison of effectiveness of muscle energy technique with Mulligan mobilization in patients with non-specific neck pain

OBJECTIVE

To compare the efficacy of muscle energy technique with Mulligan mobilisation in patients having non-specific neck pain.

METHODS

The quasi-experimental study was conducted at the Physiotherapy Department of Mayo Hospital, Lahore, Pakistan, from March to September 2017, and comprised patients of either gender having non-specific neck pain who ere divided into two groups. In group 1 patients, muscle energy technique was used, while group 2 patients had Mulligan mobilisation. Pain intensity, functional status of neck and cervical range of motion were measured before and after treatment. Data was analysed using SPSS 21.

RESULTS

Of the 56 patients, 28(50%) were in each of the two groups. The overall mean age was 36.89±9.28 years. Pain intensity, functional status and neck extension range of motion improved significantly more in group 2 (p<0.05).

CONCLUSIONS

Mulligan mobilisation was found to be a better option in managing patients with non-specific neck pain.

Impact assessment of urban development patterns on land surface temperature by using remote sensing techniques: a case study of Lahore, Faisalabad and Multan district

Urban Heat Island (UHI) is related to the theory of higher atmosphere and surface temperature taking place in the city area as compared to the nearby rural areas. The study results explain the advantages of green spaces in urban areas. Landsat TM/OLI concept of 1998 and 2017 years was attained from USGS for this work. To find out the land-use and land cover pattern supervised classification, the maximum prospect process is adopted. A total of four classes were mapped for the study area which includes built-up, barren land, vegetation, and water bodies. Effective sensor brightness temperature has been acquired from spectral radiance by using Plank's reverse function. On the basis of surface emissivity, Normalize Difference Vegetation Index (NDVI) classes are used to find out the ultimate temperature of the land surface (LST). The maximum temperature was recorded in the built-up area and barren land of the city and minimum temperatures were noted in areas with a greater cover of vegetation. The presence of UHI temperature is obvious from the land surface temperature views. An increase of 2 °C in surface temperature is recorded in district Lahore during the last two decades. Rise of 2.2 °C and 2.4 °C surface temperature has taken place in Faisalabad and Multan Districts in the last 19 years, respectively. In the establishment of a correlation among the LST, built-up, and vegetation, there is a positive sign present in their relation. With the increase in the built-up area, LST does increase as well. Moreover, with the reduction in vegetation cover, the LST is also raised. The study has revealed that there is a need for proper planning for the durable management of urbanization.

Identification of irrigation potential areas, using multi-criteria analysis in Khyber District, Pakistan

This study explores the opportunities for irrigated agriculture in Khyber District of Former Federally Administered Tribal Area (FATA). Agriculture continues to be most important economic activity in Pakistan and former FATA is no exception. However, agriculture in the semi-arid Khyber District continues to suffer a decline due to excessive reliance on rainfall, which is drastically insufficient. Khyber District have large expanses of fertile land; however, farmers depend on unpredictable rain-fed agriculture, which has low productivity and food insecurity. There are a number of rivers in the region where great prospects exist for irrigated farming. Geographical information systems (GIS)-based multi-criteria analysis can be used to map areas with irrigation potential. The current study focused on different variables including soil texture, perennial rivers, land cover, topography, and dams. For this study, data was collected from diverse sources which include Google earth images, top sheets, land use land cover, soil texture map of FATA, and SRTM 30 Meter. The collected data was analyzed by using multi-criteria analysis in Arc GIS 10.2.2 by using MIF technique. The results of this research indicate that there is great potential for irrigated farming in the study area. Potential land for this purpose were divided into three categories, i.e., highly suitable which consisted of 678 km², or 26% of the total area; 1044 km² representing 40% were moderately suitable to irrigation; while the remaining 698 km² representing 27% were considered least suitable for irrigation. Likewise, 204 km² representing 7% were deemed unsuitable for irrigated agriculture mostly consisting of barren rocks. The results also illustrate how GIS as a tool can be used in the exploration of water resources in a scientific approach, thus making decision-making easier and more accurate.

Development of DNA barcodes for selected Acacia species by using rbcL and matK DNA markers

Acacia species are very important tree species in tropical and subtropical countries of the World for their economic and medicinal benefits. Precise identification of Acacia is very important to distinguish the invasive species from rare species however, it is difficult to differentiate Acacia species based on morphological charcters. In addition, precise identification is also important for wood charcterization in the forest industry as these species are declining due to illegal logging and deforestation. To overcome thsese limitations of morphological identification, DNA barcoding is being used as an efficient and quick approach for precise identification of tree species. In this study, we selected two chloroplast and plastid base DNA markers (rbcL and matK) for the identification of five selected tree species of Acacia (A. albida, A. ampliceps, A. catechu, A. coriacea and A. tortilis). The genomic DNA of the selected Acacia species was extracted, amplified through PCR using specific primers and subsequently sequenced through Sanger sequencing. In matK DNA marker the average AT nucleotide contents were higher (59.46%) and GC contents were lower (40.44%) as compared to the AT (55.40%) and GC content (44.54%) in rbcL marker. The means genetic distance K2P between the Acacia species was higher in matK (0.704%) as compared to rbcL (0.230%). All Acacia species could be identified based on unique SNPs profile. Based on SNP data profiles, DNA sequence based scannable QR codes were developed for accurate identification of Acacia species. The phylogenetic analysis based on both markers (rbcL and matK) showed that both A. coriacea and A. tortilis were closely related with each other and clustered in the same group while other two species A. albida and A. catechu were grouped together. The specie A. ampliceps remained ungrouped distantly, compared with other four species. These finding highlights the potential of DNA barcoding for efficient and reproducible identification of Acacia species.

Laser depilation as adjuvant therapy in prevention of recurrence of pilonidal sinus disease: initial experience of a district general hospital in the UK

INTRODUCTION

Pilonidal disease is a chronic condition involving the sacrococcygeal area. It can have a significant impact on quality of life, social activities and occupation. Surgery is the mainstay of treatment. However, laser depilation has been proposed as an adjunct to surgery and has shown improved results in some studies. We present our experience of laser depilation in the treatment of pilonidal disease in a district general hospital setting in the UK.

MATERIALS AND METHODS

A prospectively maintained database of all consecutive patients who received laser depilation after elective surgery for pilonidal disease was analysed. Patients were offered a minimum of two sessions of laser depilation. The primary outcome measure was disease recurrence. Evidence of new symptoms or signs of pilonidal disease after one year from the latest surgical intervention was defined as recurrent disease. Data are presented as medians with interquartile ranges.

RESULTS

A total of 64 patients underwent laser depilation after elective surgery between 1 June 2013 and 1 June 2018; 57 were eligible for final analysis. Sixty-five per cent of patients received six or more sessions of laser treatment. There were no short- or long-term complications related to laser depilation. Patients who had more than two sessions of laser depilation showed an improved recurrence rate. Overall, recurrence rate in our series was 12% at a median follow-up of 172 weeks.

CONCLUSION

Laser depilation is a safe and effective adjunct to surgery in minimising the recurrence of pilonidal disease. Patients with primary pilonidal disease and those who are undergoing minimally invasive surgery may also benefit from adjuvant laser depilation. Further high-quality control trials are required to assess its efficacy and safety.

Velocimetry and response surface regression analysis of a swirling bed tested with mesh-coupled axial blade distributor

Fluidized bed technology is being used in several industrial processes. The well-controlled fluidization of a bed material is a prerequisite for successful implementation of this technology. Several variants of distributors are being tested for fluidized beds; however, scant information is available on their working regimes. In this study, an annular distributor was constructed by fixing blades between two concentric rings and covering the assembly with a wire mesh. This new distributor design was tested for fluidization of batches of a spherical bed material at different blade angles and superficial air velocities (SAVs). High-speed imaging and MATLAB supported velocimetry techniques were used to generate velocity vector fields of fluidized beds. These fields were analyzed further for bed velocity measurements at different bed zones. A response surface regression model was applied on the data to predict the response of the bed parameters. Statistically, the bed velocity was predicted to be about 0.497 m/s with the confidence interval in the range of 0.4948-0.4999. The experimental bed velocity remained between 0.531 m/s and 0.538 m/s under an optimized blade angle of 60°, SAV of 2.3 m/s, and bed weight of 500 g.

A numerical analysis of calendering of Oldroyd 4-constant fluid

We investigate the effects of non-Newtonian parameters on the exiting sheet thickness in the calendering of Oldroyd 4-constant fluid. The governing equations are first converted into dimensionless form and then simplified under lubrication approximation theory. A complete numerical approach is developed based on Matlab built-in routine “bvp4c” in order to obtain stream function and pressure gradient. The pressure is computed using Runge-Kutta method. The effects of involved material parameters on various quantities of interest are highlighted through graphs. The results indicate that Oldroyd 4-constant model predicts lower pressure in the nip region than that of the Newtonian model. The force and power for Oldroyd 4-constant model are also lower than their counterparts for Newtonian model. Moreover, the leave-off distance is nearly independent of the material parameters of the Oldroyd 4-constant model for larger value of the entering sheet thickness.

Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess

INTRODUCTION Pilonidal abscess is a common surgical emergency. Conventional treatment with incision and drainage is associated with significant postoperative morbidity. We report our initial experience of using minimally invasive endoscopic technique for the treatment of pilonidal abscesses, referred to as endoscopic pilonidal abscess treatment (EPAT). MATERIALS AND METHODS A prospective database of all patients undergoing EPAT between January 2015 and March 2016 at Whiston Hospital was maintained. Data regarding patient demographics, peroperative variables and postoperative follow-up were recorded. RESULTS Nineteen patients were included, male to female ratio was 53 : 47 and median age of the cohort was 24 years (interquartile range 22-25 years). EPAT was the primary procedure for 10 patients and 9 had EPAT for recurrent pilonidal abscesses. There were no readmissions and none needed further surgery within 6 weeks of having the procedure. In all patients, complete wound healing was achieved within 6 weeks; all reported minimal postoperative pain (median postoperative visual analogue scale score 1) and immediate return to the activities of daily life. Four of the nineteen patients (21%) required definitive intervention for pilonidal disease in the follow-up period. CONCLUSIONS EPAT is a novel, minimally invasive technique for the treatment of acute pilonidal abscesses. It is safe, associated with reduced postoperative morbidity, recurrence rate and quick wound healing. Initial encouraging results require further investigations on a larger group of patients in a multicentre setting.

Influence of carbon steel grade on the initial attachment of bacteria and microbiologically influenced corrosion

The influence of the composition and microstructure of different carbon steel grades on the initial attachment (≤ 60 min) of Escherichia coli and subsequent longer term (28 days) corrosion was investigated. The initial bacterial attachment increased with time on all grades of carbon steel. However, the rate and magnitude of bacterial attachment varied on the different steel grades and was significantly less on the steels with a higher pearlite phase content. The observed variations in the number of bacterial cells attached across different steel grades were significantly reduced by applying a fixed potential to the steel samples. Longer term immersion studies showed similar levels of biofilm formation on the surface of the different grades of carbon steel. The measured corrosion rates were significantly higher in biotic conditions compared to abiotic conditions and were found to be positively correlated with the pearlite phase content of the different grades of carbon steel coupons.

Size of metastatic deposits affects prognosis in patients undergoing pulmonary metastectomy for colorectal cancer

INTRODUCTION

Pulmonary metastectomy for colorectal cancer (CRC) is a well accepted procedure although data regarding indications and prognostic outcomes are inconsistent. This study aimed to analyse our experience with resection of pulmonary CRC metastases to evaluate clinically relevant prognostic factors affecting survival.

METHODS

A retrospective analysis was undertaken of the records of all patients with pulmonary metastases from CRC who underwent a thoracotomy between 2004 and 2010 at a single surgical centre.

RESULTS

Sixty-six patients with pulmonary metastases from the colon (n=34) and the rectum (n=32) were identified. The 30-day hospital mortality rate was 0%, with 63 patients undergoing a R0 resection and 3 having a R1 resection. The median survival was 45 months and the cumulative 3-year survival rate was 61%. Size of pulmonary metastasis and ASA (American Society of Anesthesiologists) grade were statistically significant prognostic factors (p=0.047 and p=0.009 respectively) with lesions over 20mm associated with a worse prognosis. Sex, age, site, disease free interval (cut-off 36 months), primary tumour stage, hepatic metastases, number of metastases (solitary vs multiple), type of operation (wedge vs lobe resection), hilar lymph node involvement and administration of adjuvant chemotherapy were not found to be statistically significant prognostic factors.

CONCLUSIONS

Pulmonary metastectomy has a potential survival benefit for patients with metastatic CRC. Improved survival even in the presence of hepatic metastases or multiple pulmonary lesions justifies aggressive surgical management in carefully selected patients. In our cohort, size of metastatic deposit was a statistically significant poor prognostic factor.

The effect of metal microstructure on the initial attachment of Escherichia coli to 1010 carbon steel

Metallurgical features have been shown to play an important role in the attachment of microorganisms to metal surfaces. In the present study, the influence of the microstructure of as-received (AR) and heat-treated (HT) 1010 carbon steel on the initial attachment of bacteria was investigated. Heat treatment was carried out with the aim of increasing the grain size of the carbon steel coupons. Mirror-polished carbon steel coupons were immersed in a minimal medium inoculated with Escherichia coli (ATCC 25922) to investigate the early (15, 30 and 60 min) and relatively longer-term (4 h) stages of bacterial attachment. The results showed preferential colonisation of bacteria on the grain boundaries of the steel coupons. The bacterial attachment to AR steel coupons was relatively uniform compared to the HT steel coupons where an increased number of localised aggregates of bacteria were found. Quantitative analysis showed that the ratio of the total number of isolated (i.e., single) bacteria to the number of bacteria in aggregates was significantly higher on the AR coupons than the HT coupons. Longer-term immersion studies showed production of extracellular polymeric substances by the bacteria and corrosion at the grain boundaries on both types of steel coupon tested.

Does the prophylactic administration of magnesium sulphate to patients undergoing thoracotomy prevent postoperative supraventricular arrhythmias? A randomized controlled trial

BACKGROUND

Supraventricular arrhythmias (SVA) are common after thoracic surgery and are associated with increased morbidity and mortality. This prospective, randomized, double-blind, placebo-controlled trial examined the effects of perioperative magnesium on the development of postoperative SVA.

METHODS

Two hundred patients undergoing thoracotomy for lobectomy, bi-lobectomy, pneumonectomy, or oesophagectomy were recruited and randomly allocated into two groups. The treatment group received magnesium (5 g daily) intraoperatively, and on days 1 and 2 after operation, the control group received placebo. The primary outcome of the study was the development of SVA within the first 5 days after operation.

RESULTS

There were 100 patients in each arm of the study, with one withdrawal and three lost to follow-up in the treatment group and four withdrawals in the control group. Ninety-six patients received magnesium and 96 received placebo. There was no difference in the incidence of SVA between the treatment and control groups, 16.7% (16/96) vs 25% (24/96), P=0.16. In the predefined subgroup analysis, patients at highest risk of arrhythmias (those undergoing pneumonectomy) had a significant reduction in the frequency of SVA, 11.1% (2/18) vs 52.9% (9/17), P=0.008. There were no differences in hospital length of stay or mortality. Patients receiving i.v. magnesium experienced a higher frequency of minor side-effects (stinging at injection site). The treatment was otherwise well tolerated.

CONCLUSIONS

Overall, prophylactic magnesium did not reduce the incidence of SVA in patients undergoing thoracotomy. However, it reduced the incidence of SVA in the high-risk cohort of patients undergoing pneumonectomy. (ISRCTN22028180.).

A modified live Mycoplasma gallisepticum vaccine to protect chickens from respiratory disease

The aim of this study was to assess the efficacy of a modified live Mycoplasma gallisepticum vaccine (GT5) for the protection of chickens against infection and respiratory disease. GT5 was constructed by the reconstitution of the avirulent high passage R (R(high)) strain with the gene encoding the major cytadhesin GapA. GT5 expressed GapA on its surface yet retained the phenotypic characteristics of the parental R(high) strain. Birds vaccinated with GT5 were protected upon challenge with the virulent low passage R (R(low)) strain as evidenced by a complete absence of tracheal lesions 2 and 4 weeks post-challenge, in contrast to sham immunized/challenged control birds. Modest amounts of IgG, and little, if any secretory IgA or IgM anti-M. gallisepticum were found in tracheal washings following vaccination. However, copious amounts of specific IgA were found following challenge, especially in sham immunized birds. This suggests that the tracheal IgG elicited by GT5 vaccination may have been responsible for blocking the initial colonization of R(low), thereby resulting in protection.

Isolation and characterization of a pseudomonas strain that degrades 4-acetamidophenol and 4-aminophenol

Though many microorganisms that are capable of using phenol as sole source of carbon have been isolated and characterized, only a few organisms degrading substituted phenols have been described to date. In this study, one strain of microorganism that is capable of using phenol (3,000 ppm), 4-aminophenol (4,000 ppm) and 4-acetamidophenol (4,000 ppm) as sole source of carbon and energy was isolated and characterized. This strain was obtained by enrichment culture from a site contaminated with compounds like 4-acetamidophenol, 4-aminophenol and phenol in Pakistan at Bhai Pheru. The contaminated site is able to support large bacterial community as indicated by the viable cell counts (2 x 10(4) - 5 x 10(8)) per gram of soil. Detailed taxonomic studies identified the organisms as Pseudomonas species designated as strain STI. The isolate also showed growth on other organic compounds like aniline, benzene, benzyl alcohol, benzyl bromide, toluene, p-cresol, trichloroethylene and o-xylene. Optimum growth temperature and pH were found to be 30 degrees C and 7, respectively, while growth at 4, 25 and 35 degrees C and at pH 8 and 9 was also observed. Non growing suspended cells of strain ST1 degraded 68, 96 and 76.8% of 4-aminophenol (1,000 ppm), phenol (500 ppm) and 4-acetamidophenol (1,000 ppm), respectively, in 72 hrs. The isolation and characterization of Pseudomonas species strain STI, may contribute to efforts on phenolic bioremediation, particularly in an environment with very high levels of 4-acetamidophenol and 4-aminophenol.

Suicidal symptoms in depressed Pakistani patients

Depressive patients are at a high risk for suicide. The data on the frequency of suicidal symptoms in depressed patients, however, varies widely. This paper describes the extent of these symptoms in a group of Pakistani patients. Contrary to the findings of other Muslim countries, forty five percent of our patients showed suicidal psychopathology. Female patients showed more suicidal ideation and significant association was found between severity and duration of depressive illness with these symptoms. These findings are also discussed in terms of their importance in early recognition of these symptoms.

Interaction of chlorpromazine with tricyclic anti-depressants in schizophrenic patients

Interaction of Chlorpromazine with tricyclic antidepressants was investigated in twenty schizophrenic patients after their concurrent administration. A significant increase in serum chlorpromazine concentration was observed when administered in combination with both amitriptyline and imipramine with chlorpromazine. If combined therapy is indicated, the dose of chlorpromazine should be reduced or the time of administration of other two drugs should be adjusted to maintain therapeutic levels of chlorpromazine.

Psychiatric morbidity among male students

An epidemiological study was conducted to assess the mental health problems of first year male students studying in two educational institutions. Based on the findings of general health questionnaire and hospital anxiety and depression scale, the estimated prevalence of psychological disturbance was found to be 33% for the whole sample. Present findings are discussed in terms of early identification and provision of better health facilities for the students population.

Agrotherapy--new concept of rehabilitation for chronic schizophrenics in Pakistan

The provision of comprehensive programme for mental health in the community setting has achieved an important place in the field of psychiatric rehabilitation. The concept of agrotherapy which is based on the philosophy of keeping patients occupied in a rural and agricultural setting with more structured activities has been found to be a promising innovation for the rehabilitation of chronic schizophrenics in this regard. This paper describes the results of a three years follow-up study conducted at Fountain House Farm, Farooqabad to evaluate the effectiveness of agrotherapy. The findings are discussed in terms of practical implications of this innovative approach in the rehabilitation of chronic schizophrenic patients.

Emotional and behavioural problems among school children in Pakistan

The prevalence of emotional and behavioural problems in school children using Rutters children behavioural questionnaire was 9.3% with antisocial disorders being the commonest one. These disorders are not only present in this culture but also differ in terms of psychopathology with different levels of schooling. The findings are discussed in terms of their relevance to mental health of children with comparison of results from other countries.

Risk factors for depression

The role of social factors in the causation of depression based on the aetiological model proposed by Brown and Harris was examined in a sample of 50 depressed female patients. Loss of mother before age 11 years and lack of confiding relationship was found to act as a vulnerability factor whereas employment status and having three or more children aged 14 or under were not found to have an increased vulnerability in these patients. These results which provide general support for Brown and Harris's causal model are discussed with their possible implications in our socio-cultural settings.