Human-black bear conflict: crop raiding by Asiatic black bear (Ursus thibetanus) in Azad Jammu and Kashmir, Pakistan

Abstract Asiatic black bear has long been in conflict with human beings crop raiding is a major cause of this conflict frequently noted in South Asia. Crops raided by black bears affected by temporal, spatial and anthropogenic attributes. Insight in this conflict and its mitigation is vital for the conservation of this threatened species. Present study aimed to evaluate crop raiding by black bears in the mountainous region of Azad Jammu and Kashmir. Field surveys were carried out to observe spatial and temporal crop raiding features between 2015-2020 and data gathered using designed questionnaires randomly tailored in villages nearby the forests. Results revealed that maize was the sole crop raided by black bears. A total of 28-acre area was raided by black bear in the fall season (Aug-November) resulting in a damage of 51 metric tons, whole raiding was carried out at night. Each respondent received crop damage on 0.09 acre with a loss of 0.17 metric ton yield. Crop quantity and area were significantly correlated to each other. District Neelum shared 49% of the total crop loss, while 47% of the maize was raided at the altitudinal range of 2100-2500 m. crop raiding was highly significantly ( χ 2 = 1174.64 ; d f = 308 ; p < 0.01) dependent upon distance to the forest. Linear regression revealed that maize quantity was determined by area, time and the total field area. Farmers faced 3.8 million PKRs loss due to crop damage by black bears. Despite the huge loss, the majority (23%) of the respondents did not respond to the query on mitigation measures indicating a poor adaptation of preventive measures. Preferred strategy to avoid crop damage was making noise (27.8%) when bears attacked their crops. A start of compensation scheme to the farmers is recommended that will have turned their negative attitude into a positive one toward the wildlife and black bear particularly. Study provides a new insight in human-bear conflict, particularly in spatial and temporal context of crop raiding in AJ&K.

Aneurysmal growth in type-B aortic dissection: assessing the impact of patient-specific inlet conditions on key haemodynamic indices

Type-B aortic dissection is a cardiovascular disease in which a tear develops in the intimal layer of the descending aorta, allowing pressurized blood to delaminate the layers of the vessel wall. In medically managed patients, long-term aneurysmal dilatation of the false lumen (FL) is considered virtually inevitable and is associated with poorer disease outcomes. While the pathophysiological mechanisms driving FL dilatation are not yet understood, haemodynamic factors are believed to play a key role. Computational fluid dynamics (CFD) and 4D-flow MRI (4DMR) analyses have revealed correlations between flow helicity, oscillatory wall shear stress and aneurysmal dilatation of the FL. In this study, we compare CFD simulations using a patient-specific, three-dimensional, three-component inlet velocity profile (4D IVP) extracted from 4DMR data against simulations with flow rate-matched uniform and axial velocity profiles that remain widely used in the absence of 4DMR. We also evaluate the influence of measurement errors in 4DMR data by scaling the 4D IVP to the degree of imaging error detected in prior studies. We observe that oscillatory shear and helicity are highly sensitive to inlet velocity distribution and flow volume throughout the FL and conclude that the choice of IVP may greatly affect the future clinical value of simulations.

Purification and characterization of novel isoforms of the polyphenol oxidase from Malus domestica fruit pulp

Polyphenol oxidases (PPOs), belong to the group of oxidoreductases that are copper containing enzymes and are responsible for plant browning. PPOs are extensively distributed in plant kingdom and can oxidize wide range of aromatic compounds of industrial importance. The aim of this study was purification and characterization of PPO isoforms from the fruit pulp of Golden delicious apple. High performance liquid chromatography was used to purify the two novel isoforms of PPO and further their molecular weights (45 and 28 kDa) were determined using sodium dodecyl sulfate polyacrylamide gel electrophoresis. The purified isoforms have optimum pH (6.5), optimum temperature (40°C), the Vmax (4.45 μM/min) and Km (74.21 mM) with catechol substrate. The N-terminal microsequences of both PPO isoforms were determined using a pulse liquid protein sequencer and found to be AKITFHG (28 kDa) and APGGG (45 kDa). Polyphenol oxidases are efficiently used in the pharmaceutical, paper and pulp, textiles and food industries. Recently, the PPOs have been used for bioremediation and in the development of biosensors.

The 21st century disaster: The COVID-19 epidemiology, risk factors and control

The 21st century will be indelible in the world as ruin of the outbreak of COVID-19 was arose in Wuhan, China has now spread all over the world, up to August 2020. This study was based on the factors affecting the epidemiology of this virus in human societies of global concern. We studied the articles published in journals on various aspects of nCoVID19. The Wikipedia and WHO situation reports have also been searched out for related information. Outcomes were followed up until 2020. The COVID-19 is a virus with pandemic potential which may continue to cause regular infection in human. The pandemic outbreak of COVID-19 threatened public health across the globe in form of system as reflected in the shape of emergency. Approximately 21 million humans are infected and 759,400 have lost their lives till 2020 in all over the world. We have described epidemiological features, reservoirs, transmission, incubation period, rate of fatality, management including recent clinical chemotherapeutic approach and preventive measurements and masses which are at risk of COVID19. This virus causes viral pneumonia when it attacks on respiratory system and multiple failure which can leads to life threatening complications. It is believed to be zoonotic importance although it is not clear from which animal and how it is transmitted. Zoonotic transmission of COVID-19 has not yet known by science. The current study will help to establish a baseline for early effective control of this rapidly spreading severe viral illness. The available data on COVID-19 indicates that older males with comorbidities would have been more infected, which can result in severe respiratory complications. Implementation of preventive measurements, investigation of proper chemotherapeutics and detection of cross species transmission agents must be ensured.

Computational Assessment of Microrotation and Buoyancy Effects on the Stagnation Point Flow of Carreau-Yasuda Hybrid Nanofluid with Chemical Reaction Past a Convectively Heated Riga Plate

The present framework deliberated the mixed convection stagnation point flow of a micropolar Carreau-Yasuda hybrid nanoliquid through the influence of the Darcy-Forchheimer parameter in porous media toward a convectively heated Riga plate. In this investigation, blood is used as a base liquid and gold (Au) and copper (Cu) are the nanoparticles. The main novelty of the present investigation is to discuss the transmission of heat through the application of thermal radiation, viscous dissipation, and the heat source/sink on the flow of a micropolar Carreau-Yasuda hybrid nanoliquid. Further, the results of the chemical reaction are utilized for the computation of mass transport. Brownian motion and thermophoretic phenomena are discussed in the current investigation. The current problem is evaluated by using the connective and partial slip conditions and is formulated on the basis of the higher-order nonlinear PDEs which are converted into highly nonlinear ODEs by exploiting the similarity replacement. In the methodology section, the homotopic analysis scheme is employed on these resulting ODEs for the analytical solution. In the discussion section, the results of the different flow parameters on the velocity, microrotation, energy, and mass of the hybrid nanofluid are computed against various flow parameters in a graphical form. Some of the main conclusions related to the present investigation are that the velocity profile is lowered but the temperature is augmented for both nanoparticles volume fractions. It is notable that the skin friction coefficient is reduced due to the higher values of the Darcy-Forchheimer parameter. Further, the rising performance of the hybrid nanofluid Nusselt number is determined by the radiation parameter.

Prevalence of drug-resistant microbes in sepsis cases of catheter and fistula based haemodialysis

Background

Chronic stage renal disease is a severe disease of the kidney which affects people globally. According to the global burden of diseases in 2010, this disease has caused more deaths worldwide and due to the high death rate, the ESRD (end-stage renal disease) is now ranked up from 27th to 18th range in the list.

Methodology

Dialysis samples were collected from the Haripur city and surrounding areas. Samples were inoculated on different selective media for bacterial growth. In addition, different biochemical tests were also performed for identification, where as the resistance genes were identified through a polymerase chain reaction.

Result

Out of the total 100 dialysis patient’s blood samples, only 17 showed the presence of gram-positive bacteria i.e., Staphylococcus aureus while two shown the presence of gram-negative bacteria i.e., Klebsiella pneumoniaeee and Pseudomonas aeruginosa. While in molecular identification two antibiotic resistance genes muc and mecA belong to the staphylococcus strain shown their presence.

Conclusion

A high infection rate has been observed in fistula-based hemodialysis (17(77.27%)) as compares to catheter-based hemodialysis (5(22.3%) with no significant difference of incidence between the groups (p > 0.05).

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

Bioaccumulation of heavy metals in the tissues of Schizothorax plagiostomus at River Swat

Snow trout (Schizothorax plagiostomus) is an economically important freshwater fish, mostly found in northern areas of water reservoirs of Pakistan. The current study was conducted in River Swat to analyze the bioaccumulation of heavy metals (Pb, Cr, Ni, and Zn) in tissues of Schizothorax plagiostomus. Tissues were extracted and dissolved in perchloric acid (HClO4) and nitric acid (HNO3) along with hotplate. The heavy metals, zinc (Zn), lead (Pb), chromium (Cr), and Nickel (Ni) were determined using Perkin Elmer 2380 atomic absorption spectrophotometer. Results shows great variation in the content of the metal related to tissue type and sampling sites. A high concentration of bioaccumulation was reported at Charbagh, whereas lowest at Odigram: Charbagh>Landakai>Odigram. In the same way, Cr was the most accumulated heavy metal followed by lead, nickel, and Zinc.

ProGlide venous closure device facilitates early ambulation following cryoablation of atrial fibrillation

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Heart Foundation

Background

Same-day discharge following atrial fibrillation (AF) ablation is increasingly common. ProGlide device suture-mediated vascular closure (PD) offers a technique that may expedite mobilisation following large-bore (&gt;12F) venous access. The utility of PD closure following cryoablation of AF has not been reported.

Purpose

We sought to evaluate haemostasis and early ambulation outcomes in patients receiving the ProGlide compared with conventional techniques.

Methods

104 consecutive patients undergoing cryoballoon pulmonary vein isolation (PVI) for paroxysmal or persistent at a single high-volume institution were included. PVI was  performed via a standardised approach including sedation, ultrasound-guided vascular access for 14F Cryosheath and second 7F sheath, anticoagulation protocol, transeptal puncture, 28mm cryoballoon and nurse-led same-day discharge protocol. Haemostasis was achieved using the Perclose Proglide device (PD) in the 14F access point ("pre-closure" technique) plus 5 minutes manual pressure at the 7F sheath site. Alternatively, a figure-of-eight/Z-suture (ZS) was employed for closure according to operator preference. Protamine was used for heparin reversal in all patients. Safety outcomes of major bleeding, haematoma and minor bleeding were assessed. Time to ambulation (TTA), time to discharge (TTD), same-day discharge and complications at initial follow-up were measured.

Results

Overall, mean age was 64 ± 11 years, 65 (64%) were male and 52 (50%) of patients had paroxysmal AF, there were no significant differences between group demographics, with 31 patients (30%) in the PD group and 73 (70%) in the ZS group. All patients had uninterrupted oral anticoagulation throughout the periprocedural period. No major femoral bleeding complications requiring intervention occurred in either group. Haematomas occurred in none of the PD group compared with 2 (2.8%) in the ZS group. Incidence of minor bleeding was not significantly different between groups (PD: 3 [9.7%] vs ZS: 2 [2.7%], p = 0.155). Mean TTA was significantly shorter in the PD group (3.3 ± 1.1 vs 4.1 ± 1.7 hrs, p = 0.025). However, there was no significant difference in same-day discharge (PD: 25 [81%] vs ZS: 53 [73%], p = 0.386) and TTD (5.0 ± 3.6 vs 6.1 ± 4.2 hrs, p = 0.275) between groups. 1 patient complained of groin pain which delayed discharge in the ZS group not seen in the PD group. After a mean follow-up of 2.2 ± 1.4 months, there were no differences in major or minor complications.

Conclusion

Use of the Proglide closure device was associated with significant reductions in time to ambulation compared with Z-suture haemostasis following cryoablation of AF, and groin access complications were uncommon across groups.  PD closure may contribute to further streamlining patient pathways in day-case AF ablation.

Antihyperglycemic effect and phytochemical investigation of Rubia cordifolia (Indian Madder) leaves extract

Medicinal plants are used as an important source of medicines in pharmaceutical industry. Rubia cordifolia is widely used to cure diabetes mellitus. Present study was aimed to investigate the antihyperglycemic effects of different fractions of R. cordifolia leaves and to analyze its antioxidant effect and phytochemical composition. Male albino mice were randomly distributed into seven groups (n = 7). Group-I was normal control, group-II was Alloxan (100 mg/kg)-induced diabetic control, and group-III was standard drug (Glibenclamide 0.5 mg/kg)-treated group. Animals in groups IV–VII were treated with n-hexane fraction, ethyl acetate fraction, n-butanol fraction and aqueous fraction of R. cordifolia, orally administered (100 mg/kg) once daily up to 28 days after Alloxan induction, respectively. Methanolic extract (ME) and fractions of R. cordifilia were analyzed for antioxidant activity and quantification of total phenolic content and total flavonoid content. HPLC of ME and most active fractions were performed. The results showed that RCEF (G-V) and RCBF (G-VI) have significantly (P < 0.05) reduced the increased level of glucose as compared to toxicant control group. It was further revealed that EF and BF have higher antioxidant activity (having IC50 34.9, 36.86 (µg/mL)) owing to phenolic and flavonoid identified by HPLC.

Clinical and Laboratory Characteristics of Primary Immunodeficiency Patients from a Tertiary Care Center in Pakistan

OBJECTIVE

The aim of this study was to describe and identify clinical presentation of primary immunodeficiency disorders (PIDs). Characteristic quantitative and qualitative immunological abnormalities have been described which help in establishing a definitive PID diagnosis.

METHODS

This was a cross sectional study conducted in the Immunology department of the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from Jan 2016 to Dec 2018. Sixty patients of different PIDs including humoral defects, combined immunodeficiency, phagocytic defects and other miscellaneous disorders, were diagnosed over a period of 3 years in our institute. Their clinical presentation and laboratory data are presented in this study.

RESULTS

In 3 years, 40 (66%) males and 20 (33%) females were diagnosed, with 13 (21.6%) patients of humoral deficiency, 22 (36.6%) of severe combined immunodeficiency, 18 (30%) of phagocytic defects and 7 (11.6%) of other miscellaneous disorders. Maximum patients belonged to Punjab province, i.e., 23 (38.3%). Their mean age for initiation of symptoms was 7±12.6 months, while diagnosis was made at mean age of 26±39.28 months, in all groups combined. Respiratory infections were commonest presentation, in 46 (76.6%) patients. Also 46 (76.6%) patients had consanguineous parents. Presence of family history of PID in 27 (45%) patients was not associated with an earlier diagnosis (p 0.955). Each group of patients carried characteristic laboratory findings.

CONCLUSIONS

PIDs should be suspected in offsprings with warning signs coming from consanguineous parents. There is a need to introduce genetic diagnosis of PIDs in order to timely diagnose less characteristic PID presentations.

Systematic analysis of leisler's bat Nyctalus leisleri (Kuhl, 1817) captured from FATA region, Pakistan

Extensive field surveys were carried out to explore the distribution of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) in selected area of FATA regions, Pakistan. Specimens of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) (n5) were collected from Kurram Agency (Shublan) (N33.8229788 E70.1634414) at elevation 1427m and Khyber Agency (Landi Kotel) (N34.0909899 E71.1457517) at elevation 1091m for two years survey extending from May 2013 through August 2015. The mean head and body length, hind foot length, ear length and tail length the Nyctalus leisleri specimens captured from the study area was 65.08 ± 1.58 mm, 44.06 ± 0.52 mm, 8.38 ± 0.60 mm, 13.20 ± 0.99 mm and 39.46 ± 1.46 mm, respectively. For molecular analysis the sequences of COI gene were obtained and analyzed. The mean intraspecific divergences of Nyctalus leisleri was 0.04%. The mean interspecific divergences of Nyctalus noctula and Nyctalus leisleri was 0.2%. The mean concentration of each nucleotides was A = (26.3%), T = (32.8%), G = (15.9%) and C = (25.0%). The mean A+T contents were 59.2%and C+G were 40.9%. In the phylogenetic tree Nyctalus leisleri and Nyctalus noctula clustered with significant bootstrap support value.

Effect of different protein based feed on the growth of mahseer

For the proper growth of fish, it is necessary to feed the fish with a proper and balanced diet. A study was conducted to find out the effect of different protein-based diets on fingerlings of Tor putitora (mahseer). A feed with dietary protein levels of 35%, 40%, 45%, and 50% were prepared. The effect of different protein-based feed on weight gain, standard growth rate (SGR), food conversion ratio (FCR), percent weight gain, food conversion efficiency (FCE), and protein efficiency ratio (PER) was studied. An increase was observed in the growth rate with an increase in protein concentration up to 45%. The fingerlings fed a 45% protein diet shown the highest growth, followed by 50%, 40%, and 35%. The SGR value was greatest for 45% protein diet (8.56) followed by 50% and 40%, while the least values were observed for 35% protein feed (1.57). The same trend was observed for FCE. The highest PER values was observed in fishes fed 45% protein-based feed (0.65) followed by 50% (0.56), 40% (0.38) and35% (0.17). The food conversion ratio was lowest for 45% protein diet (3.41), while the greatest for 35% protein feed (16.85). It was concluded that a 45% protein-based diet was the best feed formulation for higher production of Tor putitora. However, research on the same percentage of protein diet is recommended for yearlings.

Bioherbicidal ability and weed management of allelopathic methyl esters from Lantana camara

Allelochemicals are secondary metabolites which are not edible and can be used as growth regulators and bio-herbicides. The goal of current study was to assess allelopathic ability of Lantana camara (Sage-plant) flowers against weeds viz. Avena fatua (Wild oat), Euphorbia helioscopia (Sun-spurge), Chenopodium album (Goosefoot), Phalaris minor (Canary-grass), and Rumex dentatus (Knotweed). Bioassay analysis of three methanolic fractions of the Combiflash from L. camara was performed at 50%, 75% and 100% concentration using germination percentage parameters, inhibition of plumule and radicle size. The fraction II of Combiflash strongly suppressed all weeds with negligible effect on T. aestivum. Gas chromatography-mass spectroscopy was conducted for the fraction, and isolated compounds were used to perform bioassays. From fraction II GC-MS detected four methyl esters of allelopathic fatty acid viz. Methyl oleate, methyl palmitate, methyl stearate and methyl linoleate. The evaluation of physiological effects of the bioassay revealed substantial suppression of chlorophyll, antioxidant enzymes (superoxide, dismutase peroxidase) and protein material in all weeds by methyl palmitate. Bioassay activity and study of physiological parameters revealed that the effective bio-herbicidal compound in Lantana camara flowers is methyl palmitate. This is the first time that methyl palmitate (a fatty acid methyl ester) has been related to herbicidal activity in L. camara flowers. It is proposed that field studies based on hormesis research and the mechanism of action of this compound be carried out.

Identification of Lead Compounds against Scm (fms10) in Enterococcus faecium Using Computer Aided Drug Designing

(1) Background: Enterococcus faecium DO is an environmental microbe, which is a mesophilic, facultative, Gram-positive, and multiple habitat microorganism. Enterococcus faecium DO is responsible for many diseases in human. The fight against infectious diseases is confronted by the development of multiple drug resistance in E. faecium. The focus of this research work is to identify a novel compound against this pathogen by using bioinformatics tools and technology. (2) Methods: We screened the proteome (accession No. PRJNA55353) information from the genome database of the National Centre for Biotechnology Information (NCBI) and suggested a potential drug target. I-TASSER was used to predict the three-dimensional structure of the protein, and the structure was optimized and minimized by different tools. PubChem and ChEBI were used to retrieve the inhibitors. Pharmacophore modeling and virtual screening were performed to identify novel compounds. Binding interactions of compounds with target protein were checked using LigPlot. pkCSM, SwissADME, and ProTox-II were used for adsorption, distribution, metabolism, excretion, and toxicity (ADMET) properties. (3) Results: Novel selected compounds have improved absorption and have better ADMET properties. Based on our results, the chemically identified inhibitor ZINC48942 targeted the receptor that can inhibit the activity of infection in E. faecium. This research work will be beneficial for the scientific community and could aid in the design of a new drug against E. faecium infections. (4) Conclusions: It was observed that novel compounds are potential inhibitors with more efficacy and fewer side effects. This research work will help researchers in testing and identification of these chemicals useful against E. faecium.

Mechanically interlocked 3D multi-material micromachines

Metals and polymers are dissimilar materials in terms of their physicochemical properties, but complementary in terms of functionality. As a result, metal-organic structures can introduce a wealth of novel applications in small-scale robotics. However, current fabrication techniques are unable to process three-dimensional metallic and polymeric components. Here, we show that hybrid microstructures can be interlocked by combining 3D lithography, mold casting, and electrodeposition. Our method can be used to achieve complex multi-material microdevices with unprecedented resolution and topological complexity. We show that metallic components can be combined with structures made of different classes of polymers. Properties of both metals and polymers can be exploited in parallel, resulting in structures with high magnetic responsiveness, elevated drug loading capacity, on-demand shape transformation, and elastic behavior. We showcase the advantages of our approach by demonstrating new microrobotic locomotion modes and controlled agglomeration of swarms.

Mechanically interlocking dissimilar materials, such as metals and polymers, is a challenging yet promising pathway for designing and fabricating complex systems on the small scale. Here, the authors report a novel interlocking fabrication scheme and showcase the fabrication of microrobots via 3D-lithography.

P250 Evaluation of coronary endothelial dysfunction by positron emission tomography: does gender make a difference

Funding Acknowledgements

None

Introduction

Endothelial dysfunction (ED) manifested as abnormality of coronary microvasculature is associated with poor prognosis in patients presenting with chest pain. ED can be noninvasively evaluated by assessment of coronary flow reserve with positron emission tomography (PET). Studies directly comparing ED in men and women are limited. The aim of this study is to compare gender differences in ED as measured by CFR on PET myocardial perfusion imaging.

Methods

All the consecutive patients referred to PET-MPI between May 2011 and June 2018 were reviewed. Patient without known CAD who had normal perfusion were included in the analysis. Patient with abnormal electrocardiogram, significant transient ischemic dilatation, low left ventricular ejection fraction and high calcium score (&gt;1000 AU) and renal failure were excluded. CFR is calculated as the ratio of stress/rest myocardial blood flow. CFR &lt; 2 was considered as abnormal indicating the presence of ED.

Results

1711 patients were included in the analysis (mean age 60.2 ± 10 year, 68% females). Females were older and had higher BMI and diabetes (DM). Both resting and peak myocardial blood flow (MBF) was higher in females (1.16 vs 1.02 (p &lt; 0.0001)) and 3.26 vs 2.9 (p &lt; 0.001)0 respectively.  Around 68% of males had abnormal CFR (&lt;2) compared to 63% of females (p = 0.05). After adjusting for the confounders, female gender was associated with higher peak MBF (Hazard ratio 0.29, 95% CI 0.19 –0.40, p &lt; 0.001) and lower chance of having ED (Hazard ratio -0.15, 95% CI -0.29 - -0.005, p = 0.049)

Conclusions

Endothelial dysfunction as measured noninvasively by CFR on PET is prevalent among both sexes. Higher level of peak MBF in females may call for a different cut-off for abnormal CFR in women. Outcome studies are required to evaluate the clinical utility and prognostic value of such a cut-off.

P6158Prognostic value of non-obstructive coronary artery disease detected on coronary computed tomography angiography among subjects with suspected coronary artery disease

Introduction

Coronary Computed Tomography Angiography (CTA) is an established technique for the detection of coronary artery disease (CAD). However, the prognostic value of non-obstructive CAD is not well defined. Thus, the aim of this analysis is to determine the prognostic value of non-obstructive CAD detected on CTA.

Methods

In the Multi-Center Multi-Ethnic Coronary Computed Tomography Angiography (MECCA) Study, 3209 subjects without known CAD underwent CTA. Patients with obstructive CAD were excluded from this analysis. Patients with ≤70% luminal coronary artery stenosis in vessels other than the left main were classified to have non-obstructive CAD while patients without any plaque were considered to have normal CTA. Patients were followed up for a median duration of 3.4 years for all-cause mortality (ACM). Multivariable Cox models were used to determine the independent predictors of event-free survival.

Results

A total of 1455 subjects had non-obstructive CAD and 1382 subjects had normal coronary arteries. Subjects with non-obstructive CAD were older (55.9±11 vs 46.2±11 years, p<0.001) and more likely to be males (56.8% vs 50.5%, p=0.001) and had more prevalent traditional risk factors. A total of 83 ACM were observed (4.4% in the non-obstructive group and 1.3% in the normal group, p<0.001). Patients with clinical events were older (61.8±14 vs 50.9±12 years, p<0.001) and have more prevalence of DM (42.2% vs 31.4%, p=0.031) and HTN (72.3% vs 54.3%, p=0.001). In Multivariable Cox models, non-obstructive CAD was associated with increased event rate (Hazard ratio 1.75, 95% CI 1.01–3.01, p=0.45).

Kaplan-Meier Survival Curves

Conclusions

Patients with non-obstructive CAD on CTA have a higher rate of all-cause mortality. Non-obstructive CAD on CTA enhances risk stratification among subjects suspected with CAD and should call for more aggressive guidelines directed medical therapy.

Acknowledgement/Funding

None

Immunophenotypic characterisation of morphologically diagnosed cases of Acute Myeloid Leukaemia (AML)

Objective:

To determine immunophenotypic pattern in newly diagnosed cases of acute myeloid leukaemia by flow cytometry and its correlation with morphological findings.

Methods:

This study was conducted at Haematology (Pathology) department, Army Medical College, in collaboration with Immunology Department Armed Forces Institute of Pathology, Rawalpindi from 16 November 2016 to 16 November 2017. One hundred and six patients of both genders and all age groups diagnosed as acute myeloid leukaemia were included in the study. Demographic data was noted. Complete blood counts, bone marrow examination and cytochemical stains were carried out and evaluated microscopically for blast percentage and morphology. Immunophenotyping was performed by flow cytometry using standard panel on peripheral blood or bone marrow samples. The surface and cytoplasmic antigens of interest were analysed and correlated with morphological findings.

Results:

The most commonly expressed antigens were CD13, CD33, CD45 and HLA-DR. Almost all blasts expressed CD45 with no remarkable difference among the subtypes of AML. The mean positivity for CD13 among all AML subtypes was 57% and for CD33 was 67%. Aberrant expression of CD7 and CD19 were expressed in 26.4% and 1.1% of all cases respectively. There was concordance rate of 90% between morphology and FCM in our study.

Conclusion:

Flow cytometric analysis of acute leukaemia done by a combination of patterns and intensity of antigen expression improves diagnostic yield in AML. CD13, CD33 and CD45 are the most frequently expressed antigens in AML. Our findings suggest a 90% concordance between morphology and flow cytometry. It is pertinent to conclude that flow cytometry results interpreted with morphology are complementary.

Evaluation of Serum Free Light Chain in Diagnosis and Monitoring of Plasma Cell Disorders

OBJECTIVE

To determine diagnostic accuracy of serum free light chain assay compared to serum and urine protein electrophoresis in plasma cell disorders.

STUDY DESIGN

Descriptive cross-sectional study.

PLACE AND DURATION OF STUDY

This study was conducted in the Immunology Department, Armed Forces institute of Pathology (AFIP), Rawalpindi, from May 2017 to May 2018.

METHODOLOGY

Patients referred to AFIP for diagnosis of plasma cell disorders or for monitoring while receiving treatment were included in study. They were tested for serum protein electrophoresis (SPE), urine protein electrophoresis (UPE), immunofixation (IF), and serum free light chain assay (sFLC). IF was used as the reference standard. Test results were compared in terms of sensitivity, specificity, positive or negative predictive value, and accuracy index.

RESULTS

During the study period 220 patients were tested for plasma cell disorders. One hundred and sixty-seven patients tested positive. One hundred twenty-nine patients had multiple myeloma, 13 plasmacytoma, 11 monoclonal gammopathy of undetermined significance, 6 amyloidosis, 6 POEMS, and 2 Waldenstrom macroglobulinemia. SPE had a sensitivity of 70.5%, specificity of 100%; sFLC had a sensitivity of 87%, specificity of 81%; and UPE had a sensitivity of 23.5%, specificity of 97%. Accuracy index was 80.5% for SPE, 85% for sFLC, and 54% for UPE. When taken together, SPE and UPE had a combined sensitivity of 72%, specificity 97%, and accuracy index 80.5%. SPE and sFLC had combined sensitivity of 98.6%, specificity 84.3%, and accuracy index 94%.

CONCLUSION

Combination of SPE and sFLC had the highest sensitivity and accuracy index for diagnosis and monitoring of plasma cell disorders compared with conventional tests.

Prevalence of Metallo-β-lactamase Producing Non-fermentative Pseudomonas Species from Clinical Isolates in Dhaka, Bangladesh

Antimicrobial drug resistance, a global concern, has been increasing unpredictably in microorganism causing human infections specially among Gram negative non-fermenting Pseudomonas spp. Carbapenems, a beta lactam antibiotics, are the most potent and effective drug usually kept reserved for treating the multi-drug resistant Psedomonas spp and other infections caused by organisms producing Extended Spectrum Beta Lactamase (ESBL) and AmpC. Clinical utility of carbapenem will reduce when resistant bacteria evolve due to production of carbapenem hydrolyzing Metallo-β-lactamase (MBL) which confers high-level resistance to all beta-lactam antibiotics except aztreonam. The various reports on the prevalence of MBLs are available from many countries but few from Bangladesh. We investigated the prevalence of MBL production in these Pseudomonads obtained from clinical sources in an uraban setting in Dhaka, Bangladesh. A total of 29,136 specimens were processed for culture from January 2011 and December 2015 from non duplicated patients attending diagnostic unit of icddr,b from different settings of Bangladesh. The specimens included urine 14,323; blood 11,378; other body fluid 2,487; sputum 535 and tracheal aspirate 413. All specimens were processed for culture following standard bacteriological methods and the Pseudomonas spp were identified following defined standard biochemical procedures. Metallo-β-lactamase (MBL) was determined by EDTA disk synergy (EDS) test. Antimicrobial susceptibility test was performed by disk diffusion method and susceptibility pattern was interpreted and reported following Clinical Laboratory Standard Institute (CLSI) guideline. From 29,136 specimens a total of 2,340(8%) were isolated and identified as Pseudomonas spp. Of the identified Pseudomonas spp, 238(57.6%) were from tracheal aspirate, 216(40.4%) from sputum, 902(36.7%) from other body fluids, 463(4.1%) from blood and 521(3.6%) from urine samples. From 2,340 Pseudomonas spp, by selective sampling, imipenem-meropenem resistant and intermediate susceptible 100 strains were tested for MBL production and 92 were found positive. Tracheal aspirate showed 38%, other body fluids 30%, Urine 17%, sputum 4% and blood 3% MBL production respectively. Irrespective of the sources of specimens, Pseudomonas spp showed 71% resistance to cefixime, 70% to ceftriaxone, 64% to gentamicin, 56% to piperecillin+tazobactam, 50% to ciprofloxacin, 49% to amikacin, 46% to netilmicin, 45% to ceftazidime, 30% to meropenem, 26% to imipenem and 19% to polymyxin B. As multi-drug resistant Pseudomonas showed high level of (92%) MBL production, so MBL detection testing facility may be a useful battery to determine MDR producing Pseudomonas from clinical isolates.

Capsular genotype and lipooligosaccharide locus class distribution in Campylobacter jejuni from young children with diarrhea and asymptomatic carriers in Bangladesh

Campylobacter jejuni-related diarrheal diseases is one of the major health issues among young children (0-59 months old) in low-income countries. Monitoring of the capsular (capsule polysaccharide, CPS) types of virulent C. jejuni strains in regions where the disease is endemic is of great importance for the development of a customized capsule-based multivalent vaccine. Therefore, we aimed to determine the prevalence of CPS genotypes among C. jejuni strains isolated from young children with enteritis (n = 152) and asymptomatic carriers matched by age, sex, and residence defined as the control group (n = 215) in Bangladesh. CPS genotyping was performed using a newly established multiplex polymerase chain reaction (PCR) method and lipooligosaccharide (LOS) locus classes (A-E) were characterized using PCR as well. We identified 24 different CPS genotypes among the 367 isolates. Four prevalent capsular types, HS5/31 complex (n = 27, 18%), HS3 (n = 26, 17%), HS4A (n = 10, 7%), and HS8/17 (n = 10, 7%) covered almost 50% of the strains from enteritis patients and 43% of the isolates from controls. In combination, the CPS genotype and LOS class was not discriminative between cases and controls. Dominant capsular types previously identified in C. jejuni strains isolated from patients with Guillain-Barré syndrome in Bangladesh were rarely detected in strains isolated from the young children. A similar distribution was evident among enteritis- and control-related strains when comparison was done between CPS types and LOS classes. This is the first systematic study presenting the distribution of CPS genotypes of C. jejuni strains isolated in Bangladesh from children with diarrhea and controls, with capsular genotypes HS5/31 complex, HS3, HS4A, and HS8/17 being prevalent in both. In conclusion, systematic studies are required to develop a multivalent capsule-based vaccine for children in low-income countries.

In silico identification of epitopes from house cat and dog proteins as peptide immunotherapy candidates based on human leukocyte antigen binding affinity

The objective of this descriptive study was to determine Felis domesticus (cat) and Canis familiaris (dog) protein epitopes that bind strongly to selected HLA class II alleles to identify synthetic vaccine candidate epitopes and to identify individuals/populations who are likely to respond to vaccines. FASTA amino acid sequences of experimentally validated allergenic proteins of house cat and dog were identified using International Union of Immunological Societies (IUIS) allergen nomenclature database. NetMHCII 2.2 server was used to determine binding affinities in the form of 1-log 50 k and in nM with commonly found HLA II alleles. Screening of house cat and dog allergenic proteins identified 4 (with 2 isoforms for chain 1 and 3 isoforms for chain 2 for fel d 1) and 6 proteins, respectively. Number of strong binders from each protein against each HLA type was determined as potential candidate for allergen immunotherapy. HLA-DRB1*0101 bound maximum number of epitopes (207 and 275 from house cat and dog, respectively) while HLA-DRB1*0802 bound none. We conclude that HLA specific epitope prediction can help identify synthetic peptide vaccine candidates and predict response as well.

Sharps injuries among health care workers in Cairo University Hospitals

BACKGROUND

Health care workers (HCWs) are exposed to blood borne pathogens, through job-related risk factors like sharps injuries (SIs). Sharps injuries can be prevented by safer devices and through education and training of universal precautions and safe work practices.

OBJECTIVES

The present study aims to examine the current situation of infection control at Cairo University Hospitals in Egypt, through studying SIs among health care workers and evaluating the preventive measures.

SUBJECTS AND METHODS

The first part of this study was cross-sectional in design. A self-administered Arabic questionnaire was designed for this study based on EPINet (Exposure Prevention Information Network) Needle Stick and Sharps injuries reporting Sheet. The second part of the study was an interventional design to evaluate the effectiveness of preventive measures which were introduced since the beginning of 2011.

RESULTS

Forty percent of the participants (416/1036) reported at least one sharps injury in the preceding year (2010), of which more than 70% (293/416) experienced more than one injury. 88.9% (370/416, p < 0.001) of HCWs did not report their injury. Following intervention measures injury rates were significantly reduced from 36.9/100 person in 2010 in the intensive care units, to 12.4/100 person during 2011, (X2 = 21.419 and P value < 0.001).

CONCLUSION

There is a high occurrence of sharps injuries in Cairo University Hospitals. Implementation of safety devices and adequate training will lead to reduction of SIs among HCWs.

Presence of enterotoxigenic Escherichia coli in biofilms formed in water containers in poor households coincides with epidemic seasons in Dhaka

AIMS

The objective of this study was to investigate if biofilms may be potential reservoirs for the waterborne pathogen enterotoxigenic Escherichia coli (ETEC) in household water in Dhaka, Bangladesh.

METHODS AND RESULTS

Biofilms formed on submerged glass slides. Mature biofilms were found significantly more often on glass slides collected in the monsoon period between the two annual ETEC peaks in Bangladesh, that is, between May and August than the rest of the year (P < 0.03). Sixty-four per cent (49/77) of all biofilms analysed by quantitative real-time PCR were positive for ETEC. Significantly more ETEC-PCR positive biofilms were found during the epidemic peaks and during flooding periods than the rest of the year (P < 0.008). Planktonic ETEC was present in the household water during all seasons, but there was no correlation between presence or numbers of ETEC in water and the epidemic peaks.

CONCLUSIONS

We conclude that ETEC is continuously present in water and biofilms in household water reservoirs in Dhaka, which has a high prevalence of ETEC diarrhoea. The frequency of biofilms with ETEC was significantly associated (P < 0.008) with seasonal epidemic peaks of ETEC diarrhoea.

SIGNIFICANCE AND IMPACT OF THE STUDY

We show for the first time that enterotoxigenic Escherichia coli (ETEC), the causative agent of acute watery diarrhoea and travellers' diarrhoea is present in biofilms in household water tanks in Dhaka, Bangladesh.

Inhibition of sphingosine kinase 1 enhances cytotoxicity, ceramide levels and ROS formation in liver cancer cells treated with selenite

High doses of selenite have been shown to induce cell death in acute myeloid leukemia and lung cancer cells. In this study, we combined selenite treatment with modulators of sphingolipid metabolism in the hepatocellular carcinoma cell line Huh7. Treatment with 20 μM of selenite reduced the viability of Huh7 cells by half and increased the levels of long chain C14-, C16-, C18- and C18:1- ceramides by two-fold. Inhibition of neutral sphingomyelinase with 3-O-methylsphingosine significantly reduced the cytotoxic effect of selenite. In line with this result, selenite caused a 2.5-fold increase in the activity of neutral sphingomyelinase. The sphingosine kinase 1 (SK1) inhibitor 2-(p-hydroxyanilino)-4-(p-chlorophenyl)thiazole (SK1-II) sensitized the cells to the cytotoxic effects of selenite. Preincubation with 10 μM of SK1-II prior to treatment with 10 μM of selenite caused induction of apoptosis and gave rise to a 2.5-fold increase in C14-, C16-, C18- and C18:1- ceramides. Instead, 50 μM of SK1-II combined with 10 μM of selenite caused accumulation of cells in G1/S phases, but less apoptosis and accumulation of ceramides. The formation of reactive oxygen species (ROS) after treatment with 10 μM of selenite was maximally enhanced by 1 μM of SK1-II. Moreover, combined treatment with SK1-II and 10 μM of selenite synergistically reduced the number of viable Huh7 cells, while the non-tumorigenic hepatocyte cell line MIHA remained unaffected by the same treatment. These results raise the possibility that a combination of selenite and SK1 inhibitors could be used to treat liver cancer cells, that are regarded as drug resistant, at doses that are non-toxic to normal liver cells.

Emergence of multidrug-resistant NDM-1-producing Gram-negative bacteria in Bangladesh

The main objective of this study was to investigate the prevalence of bla (NDM-1) in Gram-negative bacteria in Bangladesh. In October 2010 at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) laboratories, 1,816 consecutive clinical samples were tested for imipenem-resistant Gram-negative organisms. Imipenem-resistant isolates were tested for the bla (NDM-1) gene. Among 403 isolates, 14 (3.5 %) were positive for bla (NDM-1), and the predominant species were Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. All bla (NDM-1)-positive isolates were resistant to multiple antibiotics. Among β-lactamase genes, bla (CTX-M-1-group) was detected in ten isolates (eight bla (CTX-M-15)), bla (OXA-1-group) in six, bla (TEM) in nine, bla (SHV) in seven, and bla (VIM) and bla (CMY) in two isolates each. The 16S rRNA methylase gene, armA, was detected in five K. pneumoniae isolates and in one E. coli isolate. rmtB and rmtC were detected in a Citrobacter freundii and two K. pneumoniae isolates, respectively. qnr genes were detected in two K. pneumoniae isolates (one qnrB and one qnrS) and in an E. coli isolate (qnrA). Transferable plasmids (60-100 MDa) carrying bla (NDM-1) were detected in 7 of the 11 plasmid-containing isolates. Pulsed-field gel electrophoresis (PFGE) analysis grouped K. pneumoniae isolates into three clusters, while E. coli isolates differed significantly from each other. This study reports that approximately 3.5 % of Gram-negative clinical isolates in Bangladesh are NDM-1-producing.

Incidence and predictors of infection in patients undergoing primary isolated coronary artery bypass grafting: a report from a tertiary care hospital in a developing country

AIM

Infection following coronary artery bypass grafting (CABG) is a leading cause of morbidity, mortality, and increased length of hospital stay. Many studies have investigated the predictive value of known risk factors for infection in patients following CABG and conclusions have been variable and may reveal regional or institution-specific influence. The purpose of this prospective study was to determine the pre- and peri-operative risk factors for infection in patients undergoing coronary artery bypass surgery in a developing country.

METHODS

A prospective study was undertaken to collect data on 12 reported risk factors for all patients undergoing CABG during a five-year period at The Aga Khan University Hospital, Pakistan. The relationship of these risk factors to infection following CABG was evaluated.

RESULTS

Out of 767 consecutive patients admitted for CABG, a total of 73 (9.51%) developed 92 infections following surgery. Sternal Surgical Site Infection (SSI) developed in 30 patients (3.91%), of which 29 (96.7%) were superficial and 1 (3.33%) was deep. There were 37 leg wound infections at the site of conduit harvest, and 2 cases of infection at the intra-aortic balloon pump. There were 12 cases of sepsis and 11 urinary tract infections. There were 26 cases (35.6%) of leukocytosis and 17 patients (23.3%) showed elevated erythrocyte sedimentation rate (ESR). Staphylococcus aureus was the most frequently isolated pathogen (39.7%). Bacteremia data was not collected. Of the total cases of infection following CABG, 59 required prolonged hospitalization or readmission. Univariate analysis was performed using a p-value of <0.2 as the inclusion criteria for further analysis using logistic regression. Multivariate analysis with adjusted Relative Risk (RR) showed that diabetes (P=0.002, RR=2.3, 95% CI=1.4-4.0), obesity (P=0.036, RR=2.2, 95% CI=1.0-4.4), use of an intra-aortic balloon pump (P=0.001, RR=3.6, 95% CI=1.7-7.7), female gender (P=0.004, RR=2.5, 95% CI=0.2-0.8) and prolonged mechanical ventilation (P=<0.0001, RR=6.7, 95% CI=2.8-15.5) were independent predictors of infection in the study population.

CONCLUSION

This study suggests that diabetes, obesity, use of an intra-aortic balloon pump and female gender are independent predictors of infection in patients undergoing CABG. Early and strict diabetic control and pre-operative weight reduction may reduce the incidence of infection following CABG. Contamination of these patients may occur before, during and after the operation and efforts to curb such contamination must be intensive. Further prospective studies need to be undertaken to identify and establish these and other risk factors for infection in the region and elsewhere.