The association between epidural labour analgesia and postpartum depression: a randomised controlled trial

There is conflicting evidence regarding the association between epidural labour analgesia and risk of postpartum depression. Most previous studies were observational trials with limited ability to account for confounders. We aimed to determine if epidural analgesia was associated with a significant change in the incidence of postpartum depression in this randomised controlled trial. We enrolled women aged 21-50 years old with a singleton fetus ≥ 36 weeks gestation. Patients were advised regarding available labour analgesic modalities during enrolment (epidural block; intramuscular pethidine; nitrous oxide; or intravenous remifentanil). On request for analgesia, patients were offered the modality that they had been allocated randomly to first. Blinded investigators recorded patient and obstetric characteristics within 24 h of delivery and assessed for postpartum depression at 6-10 weeks following delivery using the Edinburgh Postnatal Depression Scale (score ≥ 13 considered positive for postpartum depression). The modified intention-to-treat population consisted of all patients who received any form of labour analgesia, while per-protocol consisted of patients who received their randomised modality as their first form of labour analgesia. Of 881 parturients allocated randomly (epidural n = 441, non-epidural n = 440), we analysed 773 (epidural n = 389, non-epidural n = 384); 62 (15.9%) of women allocated to epidural group developed postpartum depression compared with 65 (16.9%) women allocate to the non-epidural group. There were no significant differences in the incidence of postpartum depression between the two groups (adjusted risk difference (95%CI) 1.6 (-3.0-6.3%), p = 0.49). Similar results were obtained with per-protocol analysis (adjusted risk difference (95%CI) -1.0 (-8.3-6.3%), p = 0.79). We found no significant difference in the risk of postpartum depression between patients who received epidural labour analgesia and those who utilised non-epidural analgesic modalities.

Coordination polymer gel mediated spectrophotometric, ICP-AES and spectrofluorimetric methods for trace As(III) determination in water and food samples

Herein, a coordination polymer gel is proposed for the determination of As(III) in real samples through multispectroscopic techniques viz. spectrophotometry, spectrofluorimetry, and inductively coupled plasma atomic emission spectroscopy (ICP-AES). Taguchi L32 (46 21) design and adaptive neuro fuzzy inference system (ANFIS) optimized the controllable factors affecting the extraction yielding an experimental S/N ratio of 39.94 dB. The fluorescence quenching (KSV = 2.63 × 106 L mol-1) was static with photoelectron transfer being the main mechanism confirmed by the density functional theory calculations. The limits of detection (LODs), limits of quantification (LOQs) and linear ranges were 0.038 μg L-1, 0.13 μg L-1 and 1.67-116.67 μg L-1, 0.40 μg L-1, 1.21 μg L-1 and 1.67-33.33 μg L-1, 1.07 μg L-1, 3.24 μg L-1 and 3.32-35.37 μg L-1 for the developed enrichment coupled ICP-AES, spectrophotometry and fluorescence sensing methods. Among these methods, the enrichment - ICP-AES method has the lowest LOD, LOQ and the widest linear range followed by the enrichment - spectrophotometry and fluorescene sensing methods. Spectrofluorimetry offers high sensitivity, selectivity, and possible real time monitoring, spectrophotometry provides a cost-effective and versatile option, while ICP-AES manifests multi-element analysis with high sensitivity and low interference. The developed methods were validated and employed for the successful determination of trace As(III) in real samples. The employment of these methods enhances the overall analytical capability for a wide range of sample types and concentrations.

High performance liquid chromatographic method optimized by Box-Behnken design model to determine caffeine in pharmaceutical preparations and urine samples

A UV-HPLC method optimized by Box-Behnken design model was developed to determine caffeine in pharmaceutical preparations and urine samples. The chromatographic conditions followed were mobile phase: methanol/water/ citrate buffer (pH 4.6) (40:25:35, v/v/v),AcclaimTMDionex C18 column (ODS 100A˚, 5 µm; 4.6 × 250 mm),flow rate (0.9 mL min-1), column temperature (30 °C) and UV-detection wavelength (204 nm). The chromatographic variables: pH (A), % methanol fraction (B), flow rate(C) and column temperature (D) were optimized at 50 μg mL-1caffeine using BBD model. The chromatogram resulted in the asymmetry factor (1.23), theoretical plate 13,786 and retention time (5.79 min). The proposed HPLC method's greenness point was assessed byAnalytical Eco-scale and found to be 78 (as per guidelines, ranked as excellent). The linearity was ranged from2.0 to 70 µg mL-1 with coefficient of correlation (r = 0.999) and detection limit of 0.19 µg mL-1. The proposedmethod was developed successfully and applied for the assay of active caffeine in pharmaceutical preparations and urine samples. The % recovery obtained by both (proposed and reference) methods ranged from 99.98 to 100.05 % followed the compliance (100 ± 2 %) with Canadian Health Protection regulatory guidelines. The performance of the proposed method was compared with published papers and found to be acceptable and superior. The proposed method was quite effective as the reference method, and hence can be used as an alternative method for the assay of active caffeine in pharmaceutical preparations and urine samples.

Adsorption of Cd(II) ions on magnetic graphene oxide/cellulose modified with β-cyclodextrin: Analytical interpretation via statistical physics modeling and fractal like kinetic approach

In the present study, β-cyclodextrin modified magnetic graphene oxide/cellulose (CN/IGO/Cel) was fabricated for removal of Cd(II) ions. The material was characterized through various analytical techniques like FTIR, XRD, TGA/DTA, SEM, TEM, and XPS. The point of zero charge of the material was obtained as 5.38. The controllable factors were optimized by Taguchi design and optimum values were: adsorbent dose-16 mg, equilibrium time-40 min, and initial concentration of Cd(II) ions-40 mg/L. The material shows high adsorption capacity (303.98 mg/g). The good fitting of Langmuir model to adsorption data (R2 = 0.9918-0.9936) revealed the monolayer coverage on adsorbent surface. Statistical physics model M 2 showed best fitting to adsorption data (R2 > 0.997), suggesting the binding of Cd(II) ions occurred on two different receptor sites (n). Stereographically n > 1 confirming vertical multi-molecular mechanisms of Cd(II) ions adsorption on CN/IGO/Cel surface. The adsorption energies (E1 = 23.71-28.95 kJ/mol; E2 = 22.69-29.38 kJ/mol) concluded the involvement of physical forces for Cd(II) ions adsorption. Kinetic data fitted well to fractal-like pseudo first-order model (R2 > 0.9952), concluding the adsorption of Cd(II) ions occurred on energetically heterogeneous surface. The kinetic analysis shows that both the film-diffusion and pore-diffusion were responsible for Cd(II) ions uptake. XPS analysis was utilized to explain the adsorption mechanism of Cd(II) ions onto CN/IGO/Cel.

Disorders of Sex Development: Experience at a Tertiary Care Hospital in Bangladesh

In newborns, it is an emergency to decide the appropriate sex for rearing and eventual prevention associated metabolic disturbances. The birth of a baby with ambiguous genitalia inevitably precipitates a crisis for the baby and its family. This retrospective analysis of hospital data was designed to determine the chromosomal and etiological diagnosis of children presented with suspected disorders of sex development (DSD) according to the newer DSD consensus document. We retrospectively analyzed the available medical records of all patients admitted into the inpatient departments of Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh from January 2014 to December 2019, and all patients with the diagnosis of DSD in the hospital record were initially selected for the study. A total of 60 admitted cases with a disorder of sex development were classified according to the new DSD classification. 46XX DSD were 63.3% (n=38), 46XY DSD were 33.3% (n=20), sex chromosome DSD were 3.3% (n=2). Among 38 cases of 46XX DSD, the most common cause was congenital adrenal hyperplasia (97.0%, n=37), one was 46XX testicular DSD. However, among 46XY DSD cases, partial androgen insensitivity/5α-reductase deficiency (50.0%, n=10) was most common disorder. Other causes of 46XY DSD included congenital adrenal hyperplasia (20.0%, n=4), testosterone synthesis defect (20.0%, n=4), testicular regression syndrome (n=1) and persistent Mullerian duct syndrome (n=1). Sex chromosome disorders are mixed gonadal dysgenesis (n=1), chimeric ovotesticular DSD (n=1). In this study, 46XX DSD was the commonest of all, showing the predominance of congenital adrenal hyperplasia, especially salt-losing type. Early detection and prompt treatment may help reduce mortality and morbidity from these acute life-threatening conditions.

Role of Rehabilitation Exercise on Myofascial Pain Syndrome Causing Upper Back Pain

Upper back pain is as painful or troublesome as the pain in the lower back or the neck. Myofascial pain syndrome which is most common cause of upper back pain is characterized by localized musculoskeletal pain and tenderness in association with trigger points. The aim of the study was to correlate the improvement of myofascial pain syndrome patients with proper and timely physical therapy. This quasi experimental study was conducted in the department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from 1st January 2008 to 31st August 2008 to see the role of rehabilitation exercise on myofascial pain syndrome causing upper back pain. Sixty (60) patients of myofascial pain syndrome causing upper back pain were randomly assigned for treatment; out of which 23(38.33%) were male and 37(61.66%) were female. The male and female ratio was 1:1.6. The patients selected for the trial were divided into two groups: Group A and Group B. In group A (n=28) the patients were treated with thermotherapy- Microwave diathermy, non-steroidal anti inflammatory drugs and activities of daily living instructions and in Group B (n=32) with same interventions in addition to rehabilitation exercises. Treatment duration was 6 weeks. The difference of treatment improvement was statistically significant (p<0.05) from 1st week up to 6th week. After complete course of treatment 67.86% patients in Group A and 78.13% patients in group B reported improvement. So rehabilitation exercises can be a valuable adjunct to other modalities of treatment of myofascial pain syndrome causing upper back pain.

Knowledge, Attitude and Practice of Undergraduate Medical Students of Bangladesh Regarding COVID-19 and its Vaccination

Medical students are one of the socially active, reliable, and persuading population of information, prevention and control, and incentive of vaccination to stop the current pandemic situation. Consequently, knowing the status of medical students' knowledge, about symptoms, and transmission of disease, prevention of COVID-19 and their attitudes towards a vaccine is important. This multi-center cross-sectional descriptive study was one of the first ones in Bangladesh among the undergraduate medical students who completed pathology, microbiology, and pharmacology. The study was conducted from March to April 2021, using a convenience sampling method in twelve government and non-government medical colleges. Among 1132 who completed the questionnaire, and 15 students from different centers were excluded from the pre-testing and face validation. The age of the 1117 respondents were 22 to 23 years, of which the majority of the respondents were female 749 (67.0%), and 368 (33.0%) were male. Almost all participants had correct knowledge (84.1%) about the symptoms of COVID-19. But 59.2% had wrong knowledge about transmission of disease by an afebrile person. Above 60.0 % of the participants have worn a facial mask when contacting people, refrained from shaking hands, washed hands, avoided people with signs and symptoms suggestive of COVID-19, and avoided crowded places as a practice of prevention. 37.6% of medical students showed positive attitudes about the participation of management of a COVID-19 patient. Most of the participants' decided to have a vaccine depending on its availability. But 31.5% had trust in natural immunity rather than vaccination. Most undergraduate Medical college students understood the basic information, possessed a positive attitude, and presented good practice towards the COVID-19 and vaccination. They play a crucial role in motivation and acceptance of vaccines among the general citizen to fight back against the pandemic in the country with limited resources.

Insights into the statistical physics modeling and fractal like kinetic approach for the adsorption of As(III) on coordination polymer gel based on zirconium(IV) and 2-thiobarbituric acid

A novel coordination polymer gel based on zirconium(IV) and 2-thiobarbituric (ZrTBA) was synthesized and explored its potential to remediate As(III) from water. Box-Behnken design with desirability function and genetic algorithm yielded the optimized conditions (initial concentration=194 mg L^-1, dosage = 42.2 mg, time= 95 min and pH = 4.9) for maximum removal efficiency (99.19 %). The experimental saturation capacity for As(III) was 178.30 mg g^-1. The steric parameter n > 1 of the best fitted statistical physics model: monolayer with two energies (R² = 0.987-0.992) suggested multimolecular mechanism with vertical orientation of As(III) molecules onto the two active sites. XPS and FTIR confirmed the two active sites being zirconium and oxygen. The adsorption energies (E₁ = 35.81-37.63 kJ/mol; E₂ = 29.50-36.49 kJ/mol) and isosteric heat of adsorption indicated that physical forces governed the As(III) uptake. DFT calculations implied that the weak electrostatic interaction and hydrogen bonding were involved. The best fitted (R²>0.99) fractal like pseudo first order model established energetic heterogeneity. ZrTBA showed excellent removal efficiency in the presence of potential interfering ions and could be used up to 5 cycles of adsorption-desorption with < 8 % loss in the efficiency. ZrTBA removed ≥96.06 % As(III) from real water samples spiked at different levels of As(III).

Characterization of sulfasalazine-bovine serum albumin and human serum albumin interaction by spectroscopic and theoretical approach

The interaction of sulfasalazine (SZ) with the carrier proteins bovine serum albumin (BSA) and human serum albumin (HSA) was explored by fluorescence, absorption and circular dichroism (CD) spectroscopy along within silicotechniques. The spectral alteration observed in fluorescence, absorption and CD spectra upon the addition of SZ confirmed the complex formation of SZ with BSA and HSA. The inverse temperature dependence behaviour of theK_svvalues as well as the increase in the protein's absorption signals after the addition of SZ indicate that SZ triggered quenching of BSA/HSA fluorescence as the static quenching. The binding affinity (k_b) of the order of 10⁶ M^-1 was reported towards the BSA-SZ and HSA-SZ association process. Interpretation of thermodynamic data (enthalpy change = -93.85 kJ mol^-1and entropy change = -200.81 J mol^-1K^-1for BSA-SZ system; enthalpy change = -74.12 kJ mol^-1and entropy change = -123.90 J mol^-1K^-1for HSA-SZ system) anticipated that hydrogen bond and van der Waals forces were the main intermolecular forces in the complex stabilization. Inclusion of SZ to BSA/HSA produced microenvironmental perturbations around Tyr and Trp residues. The UV, synchronous and 3D analysis confirmed the structural alteration of proteins after SZ binding, which was supported by CD results. The binding location of SZ in BSA/HSA was detected in Sudlow's site I (subdomain IIA) and the same was revealed by competitive site-marker displacement investigations. Density functional theory study was done to comprehend the feasibility of the analysis and to optimize the structure and energy gap that validated the experimental results. This study is expected to provide deep information about the pharmacology of SZ with its pharmacokinetic properties.

Response surface methodology combined Box-Behnken design optimized green kinetic spectrophotometric and HPLC methods to quantify angiotensin receptor blocker valsartan in pharmaceutical formulations

The high-performance liquid chromatographic (HPLC) and kinetic spectrophotometric methods were established to compute valsartan (VAL) in pharmaceutical formulations. The spectrophotometric procedures adopted initial rate, fixed time, and equilibrium strategies to assess VAL. The method was based on the carboxylic acid group of the oxidized VAL with a mixture of potassium iodate (KIO₃) and potassium iodide (KI) at room temperature, producing a stable, yellow-coloured absorb at 352 nm. The critical parameters were optimized using green process optimization methodology such as Box-Behnken design (BBD) which belongs to response surface methodology (RSM). After the screening, experiments identified them as significant, and then three crucial factors were optimised: KI volume, KIO₃ volume, and reaction time against response as absorbance. The HPLC procedure was also optimized based on the desirability function on RSM-BBD. The parameters such as pH, methanol (%), and flow rate (ml/min) were optimized with the best responses: peak area, symmetry, and theoretical plates. The linearity of spectrophotometric and HPLC methods was within the range of 2-24 and 0.25-11.25 µg/ml, respectively. The developed procedures produced excellent accuracy and precision. The design of the experiment (DoE) setting explained and discussed the individual steps and the importance of independent and dependent variables used to develop the model and optimization. The method was validated as per the International Conference on Harmonization (ICH) guidelines. Furthermore, Youden's robustness study was applied with factorial combinations of the preferred analytical parameters and explored their influence with alternative conditions. The analytical Eco-Scale score was calculated and was found a better option as green methods to quantify VAL. The results were reproducible with the analysis completed with biological fluid and wastewater samples.

Optimized Box-Behnken Design Combined Response Surface Methodology to Determine Calcium and Iron Contents Using Visible, Atomic Emission and Atomic Absorption Spectrophotometry in Vegetables and Wastewater Samples

BACKGROUND

Calcium and iron are crucial essential minerals. Iron is mainly responsible for transporting oxygen in the body and the immune system. In comparison, calcium's primary function is in human bones and teeth. Due to that, it is vital to quantify the amount in vegetables.

OBJECTIVE

Optimization and validation of three analytical procedures, visible, atomic emission spectrophotometry (AES), and atomic absorption spectrophotometry (AAS), were developed to determine calcium and iron in vegetables and wastewater samples using response surface methodology (RSM) via Box-Behnken design (BBD). The design helps to reduce experiment trials with selected variables to find a correlation between them and their respective dependent variables.

METHODS

Method I was developed to quantify calcium in vegetables mixed with concentrated 3M HNO3 and heated to reflux as per the BBD. Then it was cooled, filtered, and completed with 3M HNO3 to be carried out utilizing AES and AAS. For method II, vegetables were mixed with nitric acid and sulfuric acid solution with an optimized 5M KSCN solution, which was computed using the AAS and visible spectrophotometry.

RESULTS

First, percentage of water content was calculated for all vegetables, higher in malabar spinach and lower in peas. The calcium and iron contents were present within 0.59-2.68 mg and 35.8-211.5 mg, respectively, in 100 g of vegetables. The results showed a higher amount of iron was available in spinach and a lower amount in okra. In contrast, the highest calcium amount was present in broccoli and the lowest amount was in peas. The calcium and iron content were between 0.015-137.25 and 0.01-147.85 µg/mL in the wastewater samples.

CONCLUSIONS

These methods can help to determine the amount of calcium and iron for the quality control samples in research and development, food, and the environmental industry.

HIGHLIGHTS

Three validated analytical techniques quantify calcium and iron in vegetables and wastewater samples. The RSM-BBD optimized the method and determined its crucial factors.

Effects of Non-Thermal Processing Methods on Physicochemical, Bioactive, and Microbiological Properties of Fresh Pineapple (Ananas comosus L. Merr.) Juice

Background: Pineapple juice processing is an art of preservation, and the processing technologies play important role in pineapple juice quality. Therefore, this study aimed to explore the potential impacts of non-thermal processing methods on the physicochemical, bioactive, and microbiological properties of fresh pineapple juice. Methods: Extracted juices were subjected to several non-thermal processes including microwave processing, vacuum evaporation, mild pasteurization, pulsed electric field, and ultra-sonication. Physicochemical properties including Total Soluble Solids (TSS), pH, titratable acidity, and color; Total Phenolic Content (TPC); Total Anthocyanin Content (TAC); antioxidant capacity; and microbiological properties were evaluated. Data were statistically analyzed by Minitab statistical software (version: 18.1). Results: TSS, pH, acidity (%) of processed juices ranged from 11.03-12.03, 4.07-4.27, and 0.42-0.49, respectively. In terms of color properties both ultra-sonication and microwave processing showed the highest values of L (luminosity), a* (redness), and b* (yellow). The highest TPC was reported in ultra-sonication treatment 11.996±0.002 mg Gallic Acid Equivalents (GAE)/100 ml. The TAC varied from 0.179-0.235 mg Total Anthocyanin (TA)/100 ml, where ultra-sonication and mild pasteurization treatment yielded the highest and lowest contents, respectively. Conclusion: Perfect phenolic content, antioxidant capacity, retention of anthocyanin content, and attractive color in pineapple juices when treated with non-thermal techniques.

Fabrication of graphene oxide/inulin impregnated with ZnO nanoparticles for efficient removal of enrofloxacin from water: Taguchi-optimized experimental analysis

A novel nano-adsorbent zinc oxide impregnated graphene oxide/inulin (ZGI) was prepared for the investigation of the removal efficiency of enrofloxacin. Characterization of the nano-adsorbent was accomplished through Fourier transform Infrared (FTIR) spectroscopy, X-ray diffraction (XRD), scanning electron microscopy (SEM) coupled with EDS, transmission electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS) and Raman spectroscopy. The average crystallite size of nanomaterial (ZGI) calculated from XRD data was 14.82 nm. The adsorption of enrofloxacin onto ZGI was performed in batch mode. The variables of adsorption process such as adsorbent dose, pH, contact time and initial concentration of enrofloxacin were optimized by Taguchi method to achieve the maximum removal efficiency. The optimum values of variables were: adsorbent dose = 25 mg, pH = 7, contact time = 60 min and initial concentration = 50 mg/L. The maximum adsorption capacity and removal efficiency of the material for enrofloxacin were 317.83 mg/g and 98.60%, respectively at 303 K. Redlich-Peterson isotherm model was the best fitted among the various isotherm models based on highest R² values (0.9978-0.9981) and lowest χ² (3.43 ×10^-4-2.00×10^-3). Kinetic data followed pseudo-second order model (R² ≥ 0.9974) more accurately as compared to pseudo-first order model (R²≤0.9772). The adsorption mechanism was illustrated on the basis of XPS and Raman studies. Reusability investigation showed that the nano-adsorbent ZGI could be used up to 5 adsorption-desorption cycles with greater than 90% removal efficiency.

Development of a Citric-Acid-Modified Cellulose Adsorbent Derived from Moringa peregrina Leaf for Adsorptive Removal of Citalopram HBr in Aqueous Solutions

A citric-acid-modified Moringa peregrina leaf substrate was prepared and studied as an effective adsorbent for the adsorptive removal of citalopram HBr (CTM). FTIR spectra were utilized to characterize the prepared solid. The effects of experimental variables on the percentage removal of citalopram HBr were investigated using response surface methodology. The optimum conditions selected for removal of CTM were 7 and 4 min, 0.17 g per 50 mL and 35 mg·L⁻¹ for pH, contact time, adsorbent dose and initial concentration of CTM, respectively. Under the optimized experimental conditions, 82.59% CTM (35 mg·L⁻¹) was removed. The Langmuir isotherm, Freundlich isotherm, pseudo second-order kinetic model and diffusion-chemisorption model explained the adsorption data successfully. The maximum adsorption capacity at 298 K was 8.58 mg·g⁻¹. A thermodynamic study illustrated that CTM adsorption was spontaneous and endothermic in nature.

Tuberculous meningitis in the elderly

OBJECTIVE

Although the elderly population remains at high risk for tuberculosis, studies addressing tuberculous meningitis (TBM) in this age group are scarce. The present study aimed to evaluate the spectrum and outcome of geriatric TBM and document differences between older and young patients.

METHODS

A prospective cohort study was conducted in the adult TBM patients admitted at PGIMER, Chandigarh (India). Consecutive older patients aged 60 years and above were enrolled from January 2019 to December 2020, and young adults aged 18-59 years were enrolled from July 2019 to December 2019.

RESULTS

Fifty-five older patients with a mean age of 66.6 years and 73 young patients with a mean age of 35.1 years were enrolled. At admission, older patients were more likely to have altered mental status (96.4% vs. 78.1%, P = 0.003) and advanced disease with British medical research council staging 2 or 3 (98.2% vs. 89.0%, P = 0.043); however, headache (38.2% vs. 67.1%, P = 0.001), vomiting (18.2% vs. 35.6%, P = 0.030) and fever (80.0% vs. 91.8%, P = 0.052) were less common. Cerebrospinal fluid (CSF) abnormalities were less marked in older patients, with a significant difference in median total cells (70 vs. 110/µl, P = 0.013). Hydrocephalous and infarct were common neuroimaging abnormalities in both groups; however, tuberculomas were significantly less in the elderly (15.1% vs. 35.2%, P = 0.012). Older patients had a significantly low survival rate (56.4% vs. 76.7%, P = 0.021).

CONCLUSION

Significant differences in clinical, CSF and radiological characteristics exist between elderly and young TBM patients, with survival remains dismal in the elderly.

Current Trend of Aerobic Bacteria and Their Antimicrobial Susceptibility Pattern in Burn Wound Infection of A Tertiary Care Hospital, Rajshahi

Burn injury is still a life-threatening event, associated with high mortality and morbidity inspite of recent advances and infection control practices. This cross sectional study was conducted at Microbiology department of Rajshahi Medical College (RMC), Bangladesh with the objective to provide an insight into the current trend of aerobic bacteria with their antibiogram in burn wound infected patients admitted in Burn and Plastic Surgery Unit of RMCH from 1st January 2016 to 31st December 2016. A total of 212 wound swabs were collected and processed as per standard protocol. The isolates were identified by standard microbiological techniques and antimicrobial susceptibility was performed by Modified Kirby-Bauer disk diffusion method. Burn injurywas highest (44.81%) in age group 21-30 years in fire related burn patients (41.98%) and female were predominant (59.91%). Among 212 samples 89.62% yielded growth and 196 bacterial species were isolated in which P. aeruginosa were the predominant organism (34.18%) followed by Proteus spp. (23.47%), Klebsiella spp. (14.80%), E. coli (11.73%), S. aureus (10.71%), Acinetobacter spp. & CoNS (2.04%) and Enterobacter spp. (1.03%). In this study meropenem, amikacin and vancomycin were highly sensitive drugs but 3rd generation cephalosporin and ciprofloxacin showed resistance. Therefore continuous microbiological surveillance and careful in vitro testing prior to antibiotic treatment is required to reduce the emergence of multidrug resistant pathogens.

Differing radiation exposure in scrub technicians and rotating staff in cardiac catheterization laboratory: occupation matters

Funding Acknowledgements

Type of funding sources: None.

Background

Radiation exposure of cardiac catheterization lab personnel is an evolving area of concern, due to long term, repetitive exposure causing deterministic and stochastic effects(1,2). Current radiation protection measures are based on increasing distance, shielding from fluoroscopy source and depend on primary operator behavior(3)

Effective dose(ED) in micro Sieverts( μSv) as a measure of individual absorbed radiation dose provides feedback as to occupational exposure and risks. Dosimeter badges worn over equipment measure ED correlating with radiation exposure of areas unprotected by standard lead apron such as head, neck, lens and upper limbs. (4)

Most studies focus on primary operator exposure (5,6,7), overlooking non physician staff comprising scrub technicians working as assistants to primary operator physicians, and rotating staff involved in peri-procedural care of patients.

Purpose

This study aimed to find out ED acquired by scrub technicians(ED.S) and rotating staff(ED.R) in interventional cardiology and invasive electrophysiology procedures, utilizing external dosimeters worn over lead aprons.

Methods

We prospectively collected radiation data over forty six invasive Cardiology procedures from 15th March 2021 to 1st June 2021 comprising fourteen diagnostic coronary and graft angiograms, seventeen combined diagnostic and interventional cardiology procedures, nine sole percutaneous coronary interventions and six electrophysiology procedures. Nine staff members: two female and seven male members participated as scrub technicians and rotating staff, provided with external dosimeter badges. ED was obtained by logging in dosimeter badges into pre calibrated monitors.

Results

Significantly high mean ED was acquired by rotating staff as compared to scrub technicians, mean ED.R:21.04 μSv( SD: +/-39.64) and mean ED.S: 7.54 μSv( SD:+/- 17.23), this three fold difference in radiation exposure was statistically significant with a p-value of 0.03.

This was consistent across procedure groups, with rotating staff acquiring higher ED compared to their scrub technician colleagues in diagnostic, interventional and electrophysiology cases. Statistically significant differences in radiation exposure of both staff groups were demonstrated in diagnostic and interventional cardiology procedures, with p-values of 0.04 and 0.01 respectively.(See Table)

Conclusion

This small, single center study highlights occupational role as a significant factor in varying radiation exposure amongst non-physician staff . Higher ED was attributed to rotating staff duties involving proximity and mobility around fluoroscopy source and patient, devoid of protective lead shields.

Based on these findings, avoiding fluoroscopy use while staff performs duties involving proximity to patient such is mandatory. Other essential measures should include accessory left sided leads shields, mandatory protective lens and head shields for rotating staff. Abstract Table

1170 Outcome of Various Fixation Techniques for Talo-Navicular Arthrodesis

Aim

The talonavicular (TN) forms part of the medial joint complex, which is involved in maintaining stability during the gait cycle Arthrodesis can be used to manage a range of deformities and to treat degenerative and inflammatory changes of the joint. The most significant complication is non-union, but chronic pain due to complex regional pain syndrome, or progressive arthritic changes can also occur. The aim was to evaluate the outcome of different methods of fixation used for TN arthrodesis in adults within the trust.

Method

This was a quality improvement project, looking retrospectively at inpatient surgeries over a 6-year period. Inpatient notes, operative notes, clinic letters and imaging were analysed. Treatment methods included IOFIX devices, cannulated screws, staples, plates and screws, and combined staples and screws. The sample included a total of 57 patients (42 females and 15 males).

Results

IOFIX had a 93% fusion rate, and a 27% complication rate. Cannulated screws had a 79% fusion rate, and a 46% complication rate. Screws and staples had a 75% union rate, and a 13% complication rate. Only one sample used plates and screws, which resulted in union and no complications. Using staples alone had a 78% union rate and a 11% complication rate.

Conclusions

The greatest union rate was achieved with IOFIX devices, followed by cannulated screws. Greatest complication rate was with cannulated screws, and lowest with the combined use of staples and screws. Highest rate of revision surgery was with cannulated screws. Recommendations included a switch to IOFIX devices for TN arthrodesis.

Effective removal of doxycycline from aqueous solution using CuO nanoparticles decorated poly(2-acrylamido-2-methyl-1-propanesulfonic acid)/chitosan

The primary focus of the present study was to synthesize CuO nanoparticles decorated poly(2-acrylamido-2-methyl-1-propanesulfonic acid)/chitosan to explore its potential for uptake of doxycycline (DXN) from water. The composite material was characterized using Fourier transform infrared spectroscopy, scanning electron microscopy with energy dispersive X-ray spectroscopy, X-ray diffraction and thermogravimetric analysis-differential thermal analysis. Central composite design under response surface methodology was opted to optimize the process variables (pH, adsorbent dosage, contact time and initial concentration of DXN) for obtaining the highest removal efficiency. The removal of DXN reached 98.84% at 303 K under the optimum conditions of pH 7.0, equilibrating time of 70 min, adsorbent dose of 20 mg/25 mL and initial concentration of 50 mg L-1. The Langmuir isotherm and pseudo-second-order kinetic models fitted best with the experimental data. The values of ΔG° (- 29.159 to - 31.997 kJ mol-1), ΔH° (56.768 kJ mol-1) and ΔS° (283.382 J mol-1 K-1) demonstrated the spontaneous and endothermic nature of adsorption process. The adsorption/desorption study revealed the reusability of the prepared composite material for DXN uptake up to six cycles.

Bioethical perspective of convalescent plasma therapy for COVID-19: A systematic review

Convalescent plasma therapy (CP) has long been used to prevent and treat various infectious diseases before COVID-19 such as SARS, MERS, and H1N1. Because the viral and clinical characteristics of COVID-19 share the similarities between SARS and MERS, CP treatment could be a promising treatment option to save COVID-19. With only low quality medical evidence, but massive media support and a very significant public demand for the use of convalescent plasma for COVID-19, we are now faced with an ethical dilemma. Therefore, this paper uses a structured analysis that focuses on the preferred reporting items for a systematic review of ethical issues regarding the use of Convalescent Plasma Therapy for COVID-19. The use of convalescent plasma must meet the ethical principles of autonomy; such as voluntary, informed consent, and confidentiality. Consideration of the risk-benefit ratio for potential donor recipients also needs to be considered in order to meet the beneficence and non-maleficence principles. The principle of justice also needs to be applied both to donors, donor recipients and health workers, such as determining the priority of donor recipients, due to the increasing demand for convalescent plasma amid the limited circumstances of patients who have recovered from Covid-19 who voluntarily donate.

Optimization for synthesis of silver nanoparticles through response surface methodology using leaf extract of Boswellia sacra and its application in antimicrobial activity

In the present work, leaf extract of Boswellia sacra was used as reductant for synthesis of silver nanoparticles (AgNPs). The variables such as volume of Boswellia sacra leaf extract (1%), volume of silver nitrate (1 mM), and temperature were optimized by response surface methodology via Box-Behnken design for the synthesis of AgNPs. Design-Expert software generated the optimum conditions for the highest yield of silver nanoparticles as 8 mL of 1 mM AgNO₃, 8 mL of 1% Boswellia sacra leaf extract, and temperature = 55 °C. The formed AgNPs were isolated and purified by centrifugation process using ethanol/ distilled water. AgNPs were characterized using FTIR, SEM, TEM, EDX, and XRD. AgNPs showed surface plasmon resonance absorption band at 422 nm. XRD pattern indicated the crystalline nature of the particles (diameter 11.17 to 37.50 nm) with face-centered cubic structure. SEM and TEM images highlighted the formation of spherical AgNPs. The energy dispersive spectroscopic spectrum confirmed the presence of elemental silver. The microbial activity of AgNPs was evaluated against bacteria and fungi. Synthesized AgNPs were very effective against Gram-positive E. coli bacterial strains and fungal strains (Penicillium chrysogenum).

Evaluation of Histopathological Risk Model in a Cohort of Oral Squamous Cell Carcinoma Patients Treated with Accompanying Neck Dissection

To investigate the applicability of the validated histological risk model in a cohort of oral cavity squamous cell carcinoma patients treated concurrently with neck dissections. Primary tumours from 85 patients with primary excision of T1 and T2 Oral Squamous Cell Carcinomas (TNM 7th edition) including neck dissection were scored by three pathologists in consensus according to the validated risk model. The risk score data, along with traditional dataset values, were analysed to determine possible association with nodal metastasis and extracapsular spread. Seventy-two patients (54%) were classified with low or intermediate risk and 62 (46%) patients were 'high risk'. A chi squared test showed that cases with nodal metastasis were highly statistically significant with the overall risk model score (X² = 22.62 p = 0.0001). None of the neck dissections from tumours with low risk score showed evidence of metastasis (NPV = 100%) suggesting the risk score may also be a useful tool for predicting an absence of metastasis. Risk assessment of low-stage oral squamous cell carcinoma primary tumours may be predictive of the presence or absence of metastasis at presentation. Knowledge of the risk score and its constituent parts may inform treatment decisions at multidisciplinary meetings. Low risk squamous cell carcinoma may be a rare variant with low metastatic potential and excellent long-term survival.

Evaluation of liquid-phase thermometry in impinging jet sprays using synchrotron x-ray scattering

Liquid thermometry during primary and secondary breakup of liquid sprays is challenging due to the presence of highly dynamic, optically complex flow features. This work evaluates the use of x-ray scattering from a focused, monochromatic beam of the Advanced Photon Source at Argonne National Laboratory for the measurement of liquid temperatures within the mixing zone of an impinging jet spray. The measured scattering profiles are converted to temperature through a previously developed two-component partial least squares (PLS) regression model. Transmitive mixing during jet merging is inferred through spatial mapping of temperatures within the impingement region. The technique exhibits uncertainties of ±2K in temperature and 2% in capturing the correct scattering profile, showing its potential utility for probing liquid temperature distributions in multiphase flows.

Assessment of ampicillin removal efficiency from aqueous solution by polydopamine/zirconium(iv) iodate: optimization by response surface methodology

Polydopamine/zirconium(iv) iodate was prepared by incorporating polydopamine into zirconium iodate gel and studied as an effective adsorbent for ampicillin. In order to characterize the prepared composite, FTIR, XRD, TGA-DTA, SEM and TEM were used. The effects of experimental variables on ampicillin removal were examined using response surface methodology. The optimum conditions for ampicillin removal were 7, 130 min, 20 mg/20 mL and 50 mg L-1 for pH, contact time, adsorbent dose and initial ampicillin concentration, respectively. Under the optimum conditions, the maximum ampicillin removal percentage was found to be 99.12%. The Langmuir isotherm and pseudo-second-order kinetic models explained the removal process more appropriately. The maximum adsorption capacity at 303 K was 100.0 mg g-1. Thermodynamic study revealed that the ampicillin adsorption was spontaneous and endothermic in nature. The reusability of the prepared material was also explored.

4D spatiotemporal evolution of liquid spray using kilohertz-rate x-ray computed tomography

Four-dimensional (x,y,z,t) x-ray computed tomography was demonstrated in an optically complex spray using an imaging system consisting of three x-ray sources and three high-speed detectors. The x-ray sources consisted of high-flux rotating anode x-ray tube sources that illuminated the spray from three lines of sight. The absorption, along each absorption path, was collected using a CsI phosphor plate and imaged by a high-speed intensified CMOS camera at 20 kHz. The radiographs were converted to a quantitative equivalent path length (EPL) of liquid using a variable attenuation coefficient to account for beam hardening. The EPL data were then reconstructed using the algebraic reconstruction technique into high-speed time sequences of the three-dimensional liquid mass distribution.

Circular Dichroism Spectroscopy: A Facile Approach for Quantitative Analysis of Captopril and Study of Its Degradation

Simple and selective zero- and second-order derivative circular dichroism (CD) spectroscopic methods have been designed for the assay of captopril in commercially available dosage forms. A normal CD spectroscopic scan (zero order) exhibits a negative band at 208 nm (method A) in distilled water. The calibration curve shows a linear response over the concentration range of 10-80 μg mL^-1. The second-order derivative (D2) CD spectrum shows one positive band at 208 nm (method B) and one negative band at 225 nm (method C). Linear calibration curves were obtained in the concentration range of 10-70 μg mL^-1 for both the methods (B and C). The detection limits were found to be 1.26, 1.48, and 2.38 μg mL^-1 for methods A, B, and C, respectively. The study under stressed acidic, basic, and oxidative conditions showed the degradation of captopril. The proposed methods were validated as per ICH guidelines. All the proposed methods were compared with the reference method to demonstrate its suitability for quality control of captopril in its dosage forms.

N-(((2-((2-Aminoethyl)amino)ethyl)amino)methyl)-4-sulfamoylbenzamide Impregnated Hydrous Zirconium Oxide as a Novel Adsorbent for Removal of Ni(II) from Aqueous Solutions: Optimization of Variables Using Central Composite Design

In this study, N-(((2-((2-aminoethyl)amino)ethyl)amino)methyl)-4-sulfamoylbenzamide was impregnated into the hydrous zirconium oxide matrix to yield N-(((2-((2-aminoethyl)amino)ethyl)amino)methyl)-4-sulfamoylbenzamide/hydrous zirconium oxide composite (AESB/HZO). The composite material was used to remove Ni(II) from aqueous environment. AESB/HZO was characterized using Fourier transform infrared, scanning electron microscopy with energy dispersive X-ray, and thermogravimetry-differential thermal analyses. An experimental design approach was utilized to model and optimize the variables of adsorption of Ni(II) onto the AESB/HZO composite. Four experimental parameters were selected as independent variables: contact time, pH, adsorbent dose, and initial Ni(II) concentration. A multivariable experimental design was used to establish quadratic model to describe the relationship between percent removal of Ni(II) and four independent variables. At the optimum conditions (contact time: 85 min, pH: 6, adsorbent dose: 10 mg/20 mL, and initial Ni(II) concentration: 20 mg L-1), high removal efficiency (99.35%) was achieved, which is reasonably well predicted by the quadratic model. The sorption of Ni(II) is dependent on pH and ionic strength at pH < 6.0. At low pH, -NH and -NH2 groups are protonated, whereas the -SO2- group is available for binding with Ni(II) and the sorption of Ni(II) is mainly governed by outer sphere surface complexation. In the pH range 6.0-7.5, -NH, -NH2, and -SO2- groups are available for binding with Ni(II) and the sorption is mainly governed by inner-sphere surface complexation. Adsorption isotherm data fitted well to the Langmuir model and the maximum adsorption capacity was found to be 96.03 mg g-1 at 303 K. The results of present investigation demonstrated that AESB/HZO has a good potential for Ni(II) removal from aqueous solution.

Frequency of BRCA1 and BRCA2 Germline Variants in Women With Ovarian Cancer in Malaysia

Background: Germline BRCA1 or BRCA2 pathogenic variants in ovarian cancer patients may be informative in risk management and treatment, with the advent of poly(ADP-ribose) polymerase inhibitors. In the era of precision medicine, companion diagnostics for BRCA1 and BRCA2 genes have been featured as a strategy in the Malaysia National Strategic Plan for Cancer Control Program (2016-2020). To facilitate this strategy, frequency data from Malaysia's understudied multiethnic population will be required. Aim: To determine the prevalence of BRCA1 and BRCA2 germline variants in a population-based cohort of ovarian cancer patients in Malaysia. Methods: From August 2016, women with nonmucinous epithelial ovarian, peritoneal or fallopian tube carcinoma are prospectively recruited to the Malaysia-wide population-based MaGiC Observational Study. DNA were tested using a Hi-Plex next generation sequencing method and multiplex ligation-dependent probe amplification to detect < 10 bp alterations and exon deletions or duplications in the BRCA1 and BRCA2 genes. Results: Interim results from 325 patients tested until March 2018 have identified BRCA1 and BRCA2 pathogenic variants in 9.8% (32/325) and 3.1% (10/325) patients, respectively. Variants of uncertain significance were detected in 13.2% (43/325) patients and no pathogenic variants were detected in 73.8% (240/325) patients. Taken together, the frequency of BRCA1/2 pathogenic variants in ovarian cancer patients is approximately 12.9% (42/325). Conclusion: The identification of BRCA1 or BRCA2 carriers across the country have enabled the concentration of efforts from limited genetic counseling resources to high risk families. Results arising from the completion of this study will supplement cancer control programs and genetic services in Malaysia.

Application of Box-Behnken design and desirability function in the optimization of Cd(II) removal from aqueous solution using poly(o-phenylenediamine)/hydrous zirconium oxide composite: equilibrium modeling, kinetic and thermodynamic studies

In this research work, poly(o-phenylenediamine) was incorporated into the hydrous zirconium oxide matrix to form poly(o-phenylenediamine)/hydrous zirconium oxide composite which is used for the removal of Cd(II) from aqueous solution. The characterization of the material was done based on FTIR, XRD, SEM, and TGA-DTA. The effects of contact time, pH, adsorbent dose, and initial concentration of Cd(II) on the removal of Cd(II) were studied by performing 29 sets of sorption runs using Box-Behnken design combined with response surface methodology (RSM). Various isotherm models were tested to describe the adsorption equilibrium. The adsorption equilibrium data fitted well with Freundlich isotherm model. The maximum adsorption capacity of 66.66 mg g^-1 was obtained from Langmuir isotherm. The pseudo-second-order kinetic model described the adsorption kinetics more accurately. Diffusion-based kinetics such as intraparticle diffusion and Bangham's model suggested that both film and intraparticle pore diffusion were involved in the adsorption process. The Elovich model pointed towards the chemisorption. The investigation of desorption and regeneration suggested that the material can be used as an effective sorbent for removal of Cd(II) from aqueous system.

First description of a cefixime- and ciprofloxacin-resistant Neisseria gonorrhoeae isolate with mutations in key antimicrobial susceptibility-determining genes from the country of Georgia

Antimicrobial resistance in Neisseria gonorrhoeae is a global health problem. Enhanced international collaborative surveillance and disease control are needed to reduce the global burden of this important pathogen. Currently the antimicrobial resistance properties and molecular mechanisms of multidrug-resistant N. gonorrhoeae in the Republic of Georgia represent a significant knowledge gap. Here we report the isolation of a strain of N. gonorrhoeae exhibiting resistance to cefixime and ciprofloxacin with reduced susceptibility to penicillin and tetracycline from a patient being treated at a Georgian medical centre. Notably, this isolate was found to contain a mosaic penA allele and to harbour mutations in genes conferring susceptibility to the β-lactam, cephalosporin, fluoroquinolone, macrolide and penicillin classes of antibiotic. To our knowledge, this is the first report to describe the key mutations conferring the antimicrobial resistance properties of an isolate of N. gonorrhoeae from Georgia.