Assessments of some trace metals in water samples of nursery pond of Grass Carp (Ctenopharyngodon idella, Valenciennes, 1844) in Bannu Fish Hatchery of Khyber Pakhtunkhwa, Pakistan

Abstract The present investigation was aimed to examine the concentrations of trace metals including e.g copper (Cu), manganese (Mn), nickel (Ni), and zinc (Zn) in water samples collected from nursery pond of grass carp (Ctenopharyngodon idella) in Bannu Hatchery of Khyber Pakhtunkhwa during the period from April 2018 to January 2019. The temperature and pH of each water sample were measured for the whole study duration. The concentration of Copper (Cu), Manganese (Mn), Nickel (Ni), and Zinc (Zn) in collected water samples were measured in mg/liter by using Atomic Absorption Spectrophotometer. The blank and standard solutions for device calibration Standard solutions i.e., 2.0 mg, 4.0 mg, and 6.0 were used to measure the concentration of these metals in water samples to verify the measurements. The data was statistically analyzed on descriptive statistics (estimation of proportions and standard deviation) used to summarize mean concentration. The results obtained of both temperature and pH of water samples were found in ranged 10 to 36 0C and 7.0 to 8.44; whereas the size of fry stages was ranged from 4.0 to 56.0 mm in total length. The results of investigated metals found in pond water samples are in order of Zn>Mn>Ni>Cu, respectively. As optimum temperature and pH for grass carp were mostly between 15 0C and 30 0C and pH 6.5 to 8.0. It was concluded from obtained results that temperature, pH, and trace metals were found appropriate for the growth of Ctenopharyngodon idella from fry to fingerling stages, but the highest amount of zinc can cause its mortality. It is a preliminary study on grass carp culturing in Bannu fish hatchery so, it would provide useful information for model fish seed production unit in a hatchery.

Contusion Index is an Important Tool for the Management of Traumatic Intracerebral Hematoma

Objective This article evaluates outcome of traumatic intracerebral hematomas in terms of Glasgow Coma Scale (GCS) after medical or surgical management according to contusion index.

Materials and Methods This descriptive study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar, Pakistan from January 2017 to December 2018. Total number of patients with traumatic intracerebral contusions included in this study was 60 with age between 5 and 75 years. Both male and female were included. Patients with other coexisting traumatic intracranial hematomas like extradural hematoma, subdural hematoma, and polytrauma were excluded from this study. Contusion index of patients were calculated by noncontrast-enhanced computed tomography brain. On arrival patient GCS was documented. The management protocol, that is, conservative or surgical, was provided to individual patient according to contusion index as calculated. Outcome of management was assessed in terms of GCS.

Results Patients with contusion index of 0 to 4 were managed conservatively. Patients with contusion index of 6 were offered surgical management. Patients with contusion index of 9 had poor outcome with both conservative and surgical management.

Conclusion Contusion index can be used reliably as a tool for management of isolated traumatic intracerebral hematomas

Organic and Inorganic Mercury in Biological Samples of Flouresecent Lamp Industries Workers and Health Risks

OBJECTIVE

The present study aims to investigate the concentrations of Hg and its aspects methyl mercury (Me-Hg) and inorganic mercury (I-Hg) in the biological samples (BSs) of fluorescent lamp industries workers (FLIWs).

METHODOLOGY

Different BSs including red blood cells (RBCs), plasma, urine, hair and nails were collected from the workers exposed to Hg and unexposed persons were selected as control group to measure both the T-Hg concentration as well as its species in different biological samples through quantitative analysis. Health data was collected through questionnaire survey.

RESULTS

The mean concentrations of T-Hg (31.9 µg/L), Me-Hg (27.7 µg/L), and I-Hg (5.36 µg/L) in RBCs were found significantly ( P < 0.001) higher among the workers ( n = 40) as compared to the control group ( n = 40). Similarly the mean Hg concentrations in plasma, urine, hair and nails were also significantly higher among the workers than the control group. The statistical relation between Hg concentration and demographic characteristics observed that workers experience and fish consumption has increased the Hg concentration while age, weight and smoking found no significant effect on Hg concentration in the BSs.

CONCLUSION

The study observed that the workers were highly exposed to high concentration of Hg and they are at a high health risk.

Utility of baseline serum phosphorus levels for predicting remission in acromegaly patients

PURPOSE

High GH and IGF I levels increase tubular phosphate reabsorption in patients with acromegaly. We aimed to investigate the utility of serum phosphorus levels as an indicator for predicting chance of remission in acromegaly patients.

DESIGN

Fifty-one patients (n: 51; F: 24, M: 27) with diagnosis of acromegaly were included in the study. Plasma IGF-1, Phosphorus (P) and nadir GH levels on oral glucose tolerance test (OGTT) at the time of diagnosis were analysed retrospectively. Patients were classified into two groups according to their plasma P levels; P ≤ 4.5 mg/dl (Group-1, n: 23, 45.1%), P > 4.5 mg/dl (Group-2, n: 28, 54.9%). Two groups were compared according to remission status; remission (n: 27) and non-remission (n: 24). Remission was defined with absence of clinical symptoms, normal plasma IGF-1 (adjusted for age and gender) and GH levels (<1 mcg/dl) at least 3 months after initial treatment.

RESULTS

Serum P levels decreased significantly after treatment in both groups (p < 0.001). There was a significant correlation between baseline phosphorus levels and remission rates, nadir GH in OGTT, pituitary adenoma size and Ki-67 scores (p = 0.001, r: -0.51; p = 0.01, r: 0.44; p = 0.001, r: 0.52; p = 0.02, r: 0.71, respectively). Mean baseline P levels were significantly higher in patients with non-remission (4.8 vs 4.2, P < 0.001). Logistic regression analysis did not reveal an independent effect on remission with any of these risk factors.

CONCLUSION

High serum P levels may be an indicator for a low likelihood of onset of remission in acromegaly patients. Further studies with wider spectrum are needed to make specific suggestions.

INCIDENTAL PAGET'S DISEASE DISGUISED AS BONE METASTASIS IN A PATIENT WITH ENDOMETRIUM CARCINOMA

Paget's disease is a disorder of aging bone which occurs in the setting of accelarated bone remodelling. In the presented case we discuss the difficulties in the diagnosis of Paget's disease in a 77 year old patient with coexisting endometrium carcinoma. The patient was initially diagnosed with metastatic bone disease due to endometrium adenocarcinoma when she was admitted to oncology clinic with pelvic pain. Bone scintigraphy with Tc99 and (18)F fluorodeoxyglucose positron emission tomography/CT revealed an increased uptake on the bone lesions which were reported as metastatic bone involvement. Although the (18)F-FDG uptake was much higher than the levels that would generally be anticipated in a case with Paget's disease, high levels of bone turnover markers indicated further evaluation in the differential diagnosis and the definitive diagnosis of Paget's disease was established with the pathological evaluation of bone biopsy.

Quantification of Hg excretion and distribution in biological samples of mercury-dental-amalgam users and its correlation with biological variables

This is the first study conducted to quantify the excretion and distribution of mercury (Hg) with time (days) in the biological samples collected from Hg dental amalgam users (MDA). The individuals, with Hg-based dental filling were selected, and their biological samples (red blood cells (RBCs), plasma, urine, hair, and nails) were collected on first, third, and 12th day of fillings. The concentrations of Hg observed in the biological samples of MDA were also correlated with the biological variables such as age, weight, restoration, fish consumption, number, and surface area of fillings. The concentrations of Hg in the biological samples of MDA were found 6-8 times higher than the non-amalgam users (control). The concentrations of Hg in the RBCs (4.39 μg/L), plasma (3.02 μg/L), and urine (22.5 μg/L) on first day of filling were found comparatively higher than the concentrations observed on third day (2.15, 1.46, and 12.3 μg/L for RBCs, plasma, urine, respectively) and 12th day (3.05, 2.5, 9.12 μg/L for RBCs, plasma, urine, respectively), while Hg concentrations were found lower in the hair and nails on third day of fillings (1.53 μg/g for hair and 2.35 μg/g for nails) as compared to the 12th day (2.95 μg/g for hair and 3.5 μg/g for nails). The correlations were found significant (p ˂ 0.05) between Hg concentrations in the biological samples of MDA and biological variables (the number of restoration, fish consumption, number, and surface area of fillings), while no significant (p ˃ 0.05) correlations were observed for Hg concentrations in the biological samples with age and weight of MDA. These observations unveil the fact that the use of Hg-based dental filling is the undesirable exposure to Hg which should be replaced by composite (a safer filling material).

Utility of DN4 questionnaire in assessment of neuropathic pain and its clinical correlations in Turkish patients with diabetes mellitus

AIM

We aimed to assess the utility of DN4 questionnaire (Douleur Neuropathique en 4 questions) to define the frequency and severity of neuropathic pain (NP) and also its clinical correlation to daily clinical practice.

METHODS

We included 1357 patients with diabetes (56.5% women, 90.4% type 2 diabetes) who were followed up in our diabetes outpatient clinic. Presence of NP was evaluated by performing simultaneous DN4 questionnaires and physical examination. Those who had a DN4 score ≥4 were considered to have NP.

RESULTS

The mean age was 58.2±12.1 years, mean duration was 12.5±7.5; (min-max: 1-45) years, mean HbA1c level was 7.8±1.6% (min-max: 5-16.2%), (61.7±6.0mmol/mol; min-max: 31.1-153.6mmol/mol). Three hundred thirteen patients (23%) were diagnosed with NP using the DN4 tool. Male gender (p=0.01), receiving antihypertensive treatment (p=0.01), presence of retinopathy (p<0.001), cardiovascular disease (CVD) (p=0.01) and previously diagnosed neuropathy (p<0.001) were significantly associated with higher NP scores. Those who had increased DN4 scores were more likely to be on oral hypoglycemic agents (OHA)+insulin combinations (p<0.001), had longer diabetes duration (p<0.001) and higher HbA1c levels (p=0.001). Logistic regression model revealed that diabetes duration (OR: 1.02, 95% CI: 1.00-1.04, p=0.007), elevated HbA1c levels (1.11, 1.02-1.21, 0.015), presence of retinopathy (1.41, 1.20-1.64, <0.001), management with at least one OHA (1.47; 1.12-1.92; 0.004) or any insulin regimen (1.62; 1.16-2.27; 0.005) (compared with diet only-regimens) were significantly associated with NP.

CONCLUSION

Utilization of DN4 questionnaire in daily clinical practice is an effective tool in the identification of pain related with peripheral diabetic polyneuropathy.

Heavy metal uptake capacity of fresh water algae (Oedogonium westti) from aqueous solution: A mesocosm research

The green macroalgae present in freshwater ecosystems have attracted a great attention of the world scientists for removal of heavy metals from wastewater. In this mesocosm study, the uptake rates of heavy metals such as cadmium (Cd), nickel (Ni), chromium (Cr), and lead (Pb) by Oedogonium westi (O. westti) were measured. The equilibrium adsorption capabilities of O. westti were different for Cd, Ni, Cr, and Pb (0.974, 0.418, 0.620, and 0.261 mgg(-1), respectively) at 18 °C and pH 5.0. Furthermore, the removal efficiencies for Cd, Cr, Ni and Pb were observed from 55-95%, 61-93%, 59-89%, and 61-96%, respectively. The highest removal efficiency was observed for Cd and Cr from aqueous solution at acidic pH and low initial metal concentrations. However, the removal efficiencies of Ni and Pb were higher at high pH and high concentrations of metals in aqueous solution. The results summarized that O. westti is a suitable candidate for removal of selected toxic heavy metals from the aqueous solutions.

Mercury health effects among the workers extracting gold from carpets and dusted clays through amalgamation and roasting processes

Mercury (Hg) is a highly toxic metal which can cause serious health effects. The aim of this research was to determine the concentrations of total Hg (T-Hg), methyl Hg (Me-Hg), and inorganic Hg (I-Hg) in the biological samples (plasma, red blood cells (RBCs), urine, hair, and nails) of the exposed goldsmith workers. This is the first study that determines the detailed Hg concentrations in the biological samples (plasma, RBCs, urine, hair, and nails) of the exposed goldsmith workers and correlates them with the diseases noted among the workers in a single paper. Biological samples were collected from goldsmith workers (n = 40) and analyzed for T-Hg, Me-Hg, and I-Hg using atomic absorption spectrometer equipped with mercury hydride system. The mean T-Hg concentration in RBCs (33 μg L(-1)), plasma (11.8 μg L(-1)), urine (167 μg L(-1)), hair (4.21 μg g(-1)), and nails (5.91 μg g(-1)) were higher than the control RBCs (1.64 μg L(-1)), plasma (0.55 μg L(-1)), urine (2.72 μg L(-1)), hair (0.35 μg g(-1)), and nails (0.51 μg g(-1)). All workers participated in this study were suffering from physical and mental diseases. The concentration of Hg was found higher among the workers suffering from mental diseases as compared to those suffering from physical diseases. Among the physical diseases, the most serious diseases were sexual dysfunction, skin diseases, and fatigue because the workers suffering from these diseases had higher concentration of Hg than the workers with other diseases. The occurrence of physical diseases (88%) was greater than the mental diseases (53%) among the workers. The correlations of physical and mental diseases with experience (years of work) and exposure time were significant (p < 0.05), while nonsignificant (p > 0.05) correlation was observed between demographic parameters and Hg concentrations in the biological samples of the workers. The burning process of amalgamated gold is a significant source of Hg exposure to goldsmith workers; therefore, awareness and precautionary measures are needed to provide protection to them.

Contamination of soil, medicinal, and fodder plants with lead and cadmium present in mine-affected areas, Northern Pakistan

This study aimed to investigate the lead (Pb) and cadmium (Cd) concentrations in the soil and plants (medicinal and fodder) grown in chromite mining-affected areas, Northern Pakistan. Soil and plant samples were collected and analyzed for Pb and Cd concentrations using atomic absorption spectrometer. Soil pollution load indices (PLIs) were greater than 2 for both Cd and Pb, indicating high level of contamination in the study area. Furthermore, Cd concentrations in the soil surrounding the mining sites exceeded the maximum allowable limit (MAL) (0.6 mg kg(-1)), while the concentrations of Pb were lower than the MAL (350 mg kg(-1)) set by State Environmental Protection Administration (SEPA) for agriculture soil. The concentrations of Cd and Pb were significantly higher (P < 0.001) in the soil of the mining-contaminated sites as compared to the reference site, which can be attributed to the dispersion of toxic heavy metals, present in the bed rocks and waste of the mines. The concentrations of Pb and Cd in majority of medicinal and fodder plant species grown in surrounding areas of mines were higher than their MALs set by World Health Organization/Food Agriculture Organization (WHO/FAO) for herbal (10 and 0.3 mg kg(-1), respectively) and edible (0.3 and 0.2 mg kg(-1), respectively) plants. The high concentrations of Cd and Pb may cause contamination of the food chain and health risk.

A dose-finding study of temsirolimus and liposomal doxorubicin for patients with recurrent and refractory bone and soft tissue sarcoma

There are few effective therapies for high-risk sarcomas. Initial chemosensitivity is often followed by relapse. In vitro, mammalian target of rapamycin (mTOR) inhibition potentiates the efficacy of chemotherapy on resistant sarcoma cells. Although sarcoma trials using mTOR inhibitors have been disappointing, these drugs were used as maintenance. We conducted a Phase I/II clinical trial to test the ability of temsirolimus to potentiate the cytotoxic effect of liposomal doxorubicin and present here the dose-finding portion of this study. Adult and pediatric patients with recurrent or refractory sarcomas were treated with increasing doses of liposomal doxorubicin and temsirolimus using a continual reassessment method for escalation, targeting a dose-limiting toxicity rate of 20%. Blood samples were drawn before and after the first dose of temsirolimus in Cycles 1 and 2 for pharmacokinetic analysis. The maximally tolerated dose combination was liposomal doxorubicin 30 mg/m(2) monthly with temsirolimus 20 mg/m(2) weekly. Hematologic toxicity was common but manageable. Dose-limiting toxicities were primarily renal. Concurrent administration of liposomal doxorubicin resulted in increased exposure to sirolimus, the active metabolite of temsirolimus. Thus, the combination of liposomal doxorubicin and temsirolimus is safe for heavily pretreated sarcoma patients. Co-administration with liposomal doxorubicin did not alter temsirolimus pharmacokinetics, but increased exposure to its active metabolite.

Stability of asthma control with regular treatment: an analysis of the Gaining Optimal Asthma controL (GOAL) study

BACKGROUND

Uncontrolled asthma is characterized by variability. Current asthma guidelines recommend focussing on the achievement and maintenance of control but few studies have examined in detail, using composite measures of control, the stability and potential duration of control once achieved. In this post-hoc analysis of the results of the Gaining Optimal Asthma controL (GOAL) study, we examine the association between the level of asthma control achieved during the step-up phase of the study and the stability of control experienced during the maintenance phase.

METHODS

GOAL was a 1-year, randomized, stratified, double-blind study of 3421 patients with uncontrolled asthma, which compared salmeterol/fluticasone propionate combination with fluticasone propionate in achieving two composite, guideline-based measures of control: totally controlled and well-controlled asthma. We analysed the proportion and duration of time spent in control, the effect of treatment on asthma stability, and the impact of asthma control stability on unscheduled use of healthcare resources.

RESULTS

In patients achieving well-controlled or totally controlled asthma, at least well-controlled asthma was maintained for a median of almost 3 and 6 months, and for more than 85% and 95% of weeks of follow-up, respectively. A high level of stability was confirmed in a Markov analysis investigating transitional probability of change in control status. Variability in control was associated with increased probability of an unscheduled healthcare resource use (odds ratio: 1.06, P < 0.001).

CONCLUSIONS

Most patients achieving guideline-defined control can maintain at least a similar level of control with regular, stable dosing, with little likelihood of losing control.

Hypoglycemia due to ectopic release of insulin from a paraganglioma

Insulin-secreting pancreatic tumors and insulin-like growth hormone-secreting non-islet cell tumors can cause hypoglycemia. However, insulin-releasing paraganglioma or pheochromocytoma has almost never been reported. A 67-year-old female patient was admitted to our hospital because of headache, palpitation, perspiration, faintness, frequent sense of hunger and absent-mindedness. These intermittent symptoms had begun approximately a year before admission. On physical examination, she had high blood pressure of 150/90 mm Hg. Hormonal studies demonstrated increased urinary norepinephrine levels, and hyperinsulinemic hypoglycemia was confirmed while the patient was symptomatic. Abdominal MRI revealed a retroperitoneal mass measuring 4.5 cm in the pancreatic region. She was treated with an alpha-blocking agent to control blood pressure preceding the removal of the mass. Histopathological diagnosis was paraganglioma, and immunohistochemically insulin staining in the neoplastic cells was demonstrated. Her blood pressure normalized and hypoglycemia relieved after the operation. The patient did not have recurrence of hypoglycemia after a year of follow-up. Paraganglioma is a rare tumor of the neural crest, and co-secretion of insulin and catecholamines has been reported only by a single case report in the literature. The present patient is another case with this co-secretion.

Therapeutic plasmapheresis in patients with severe hyperthyroidism in whom antithyroid drugs are contraindicated

Four patients with Graves' disease in whom antithyroid drugs could not be used were treated by plasmapheresis preoperatively. On admission all patients had severe hyperthyroidism. All patients were treated by beta blockers, cholestyramine and inorganic iodine before plasmapheresis. Plasmapheresis course consisted of three sessions. Removed plasma was replaced by a synthetic colloid solution and human albumin other than fresh-frozen plasma. Plasmapheresis led to decreases in serum T3 concentrations >78-40% and free T4 concentrations >69%. Near-total thyroidectomy could be performed in all patients. Although screening coagulation tests were within normal limits, patients 1 and 4 experienced more blood loss than usual during the operative procedure. Plasmapheresis could be used as an alternative therapeutic option in the preoperative management of severe hyperthyroid patients with contraindications to antithyroid drugs. However, this is an invasive procedure and patients should be followed carefully for prolonged clinic/subclinic coagulopathy due to plasma exchange.

Hyperacute cerebral enhancement: the earliest predictor of hemorrhage by MR imaging?

A test to detect very early hemorrhage in acute cerebral infarct could offer a substantial increase in the safety and success of advanced stroke therapies, particularly when the use of thrombolytic therapies is contemplated. Currently, computed tomography is the standard test for the detection of cerebral hemorrhage but is not a valid predictor of potential areas of hemorrhagic transformation. A technique to evaluate the risk of hemorrhagic transformation in infarcted cerebral tissue has been conducted with contrast-enhanced magnetic resonance imaging in various animal stroke models. Knight demonstrated Gadolinium-DTPA enhancement in the territory of occluded vessels immediately in rats after reperfusion. Gadolinium enhancement was thought to predict areas of hemorrhagic transformation. Yenari and associates demonstrated in rabbit models that contrast-enhanced T1-weighted scans can reveal regions of blood-brain barrier disruption, characterized as hemorrhagic transformation in ischemic tissue. The authors report a clinical example in which hyperacute contrast-enhanced magnetic resonance imaging was the first indication of hemorrhagic transformation within 24 hours of onset of an acute cerebral infarct.