An efficient synthesis and characterization of La@MOF-808: A promising strategy for effective arsenic ion removal from water

Addressing serious waterborne arsenic issues, for the first time, lanthanum-doped MOF-808 (La@MOF-808) has been developed to remove total arsenic (Total As) and arsenite [As(III)] from water. This study involves the solvothermal synthesis of La@MOF-808, its characterization via FTIR, XRD, TGA, and SEM, in which distinct physicochemical attributes were identified, and the adsorption capacity of arsenic ions. The saturated adsorption capacity of La@MOF-808 for Total As and As(III) reached 282.9 mg g-1 and 283.5 mg g-1, as compared to 229.7 mg g-1 and 239.1 mg g-1 for pristine MOF-808, respectively. XRD and ATR-FTIR analyses underscored the central roles of electrostatic interactions and hydroxyl groups in the pollutant adsorption process. The impact of temperature, concentration, pH, and exposure duration times on adsorption performance was thoroughly investigated. The Langmuir model showed the maximum adsorption capacities (qmax) of La@MOF-808 was 307.7 mg g-1 for Total As and 325.7 mg g-1 for As(III), surpassing those of MOF-808 adsorbent, which suggests that monolayer adsorption occurred. Optimal adsorption was observed in a pH range of 2.0-7.0, and thermodynamic studies classified the process as spontaneous and endothermic. The adsorbent retains high capacity across repeated cycles, outperforming many standard adsorbents. Lanthanum doping markedly enhances MOF-808's arsenic removal, underscoring its potential for water treatment.

Clinicopathological profile of peritoneal tuberculosis and a new scoring model for predicting mortality: an international ID-IRI study

Existing literature about peritoneal tuberculosis (TBP) is relatively insufficient. The majority of reports are from a single center and do not assess predictive factors for mortality. In this international study, we investigated the clinicopathological characteristics of a large series of patients with TBP and determined the key features associated with mortality. TBP patients detected between 2010 and 2022 in 38 medical centers in 13 countries were included in this retrospective cohort. Participating physicians filled out an online questionnaire to report study data. In this study, 208 patients with TBP were included. Mean age of TBP cases was 41.4 ± 17.5 years. One hundred six patients (50.9%) were females. Nineteen patients (9.1%) had HIV infection, 45 (21.6%) had diabetes mellitus, 30 (14.4%) had chronic renal failure, 12 (5.7%) had cirrhosis, 7 (3.3%) had malignancy, and 21 (10.1%) had a history of immunosuppressive medication use. A total of 34 (16.3%) patients died and death was attributable to TBP in all cases. A pioneer mortality predicting model was established and HIV positivity, cirrhosis, abdominal pain, weakness, nausea and vomiting, ascites, isolation of Mycobacterium tuberculosis in peritoneal biopsy samples, TB relapse, advanced age, high serum creatinine and ALT levels, and decreased duration of isoniazid use were significantly related with mortality (p < 0.05). This is the first international study on TBP and is the largest case series to date. We suggest that using the mortality predicting model will allow early identification of high-risk patients likely to die of TBP.

Role of meteorological parameters with the spread of Covid-19 in Pakistan: application of autoregressive distributed lag approach

This research focuses on the impacts of different meteorological parameters (temperature, humidity, rainfall, and evapotranspiration) on the transmission of Covid-19 in the administrative regions and provinces of Pakistan, i.e., Azad Jammu and Kashmir, Gilgit Baltistan, Khyber Pakhtunkhwa, Islamabad, Punjab, Sindh, and Balochistan from June 10, 2020, to August 31, 2021. This study analyzes the relation between Covid-19-confirmed cases and the meteorological parameters with the help of the autoregressive distributed lag model. In this research, additional tools (t-statistics, f-statistics, and time series analysis) are used for the motive of examining the linear relationship, the productivity of the model, and for the significant association between dependent and independent variables, lnccc and lnevp, lnhum, lnrain, lntemp, respectively. Values of t-statistics and f-statistics reveal that variables have a connection and individual significance for the model exist. Time series display that the Covid-19 spread increased from June 10, 2020, to August 31, 2021, in Pakistan. Temperature positively influenced the Covid-19-confirmed cases in all provinces of Pakistan in the long run. Evapotranspiration and rainfall influenced positively, while specific humidity influenced negatively on the confirmed Covid-19 cases in Azad Jammu Kashmir, Khyber Pakhtunkhwa, and Punjab. Specific humidity had a positive impact, while evapotranspiration and rainfall had the negative impact on the Covid-19-confirmed cases in Sindh and Balochistan. Evapotranspiration and specific humidity influenced positively, while rainfall influenced the Covid-19-confirmed cases negatively in Gilgit Baltistan. Evapotranspiration influenced positively, while specific humidity and rainfall influenced negatively on the Covid-19-confirmed cases in Islamabad.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13762-023-04997-4.

Transesophageal Echocardiogram Before Cardioversion in Atrial Fibrillation Patients

Transesophageal echocardiography (TEE) offers an invaluable, non-invasive avenue for diagnosing and managing various cardiac conditions, including atrial fibrillation (AF). As the most common cardiac arrhythmia, AF affects millions and can lead to severe complications. Cardioversion, a procedure to restore the heart's normal rhythm, is frequently conducted on AF patients resistant to medication. Due to inconclusive data, TEE's utility prior to cardioversion in AF patients remains ambiguous. Understanding TEE's potential benefits and limitations in this population could significantly influence clinical practice. This review aims to scrutinize the current literature on the use of TEE before cardioversion in AF patients. The principal objective is to understand TEE's potential benefits and limitations comprehensively. The study seeks to offer a clear understanding and practical recommendations for clinical practice, thereby improving the management of AF patients before cardioversion using TEE. A literature search of databases was conducted using the keywords "Atrial Fibrillation," "Cardioversion" and "Transesophageal echocardiography," resulting in 640 articles. These were narrowed to 103 following title and abstract reviews. After applying exclusion and inclusion criteria with a quality assessment, 20 papers were included: seven retrospective studies, 12 prospective observational studies, and one randomized controlled trial (RCT). Stroke risk associated with direct-current cardioversion (DCC) potentially results from post-cardioversion atrial stunning. Thromboembolic events occur post cardioversion, with or without prior atrial thrombus or cardioversion complications. Generally, cardiac thrombus localizes in the left atrial appendage (LAA), a clear contraindication to cardioversion. Atrial sludge without LAA thrombus in TEE is a relative contraindication. TEE before electrical cardioversion (ECV) in anticoagulated AF individuals is uncommon. In AF patients planned for cardioversion, contrast enhancement facilitates thrombus exclusion in TEE images, reducing embolic events. Left atrial thrombus (LAT) frequently occurs in AF patients, necessitating TEE examination. Despite the increased use of pre-cardioversion TEE, thromboembolic events persist. Notably, patients with post-DCC thromboembolic events had no LA thrombus or LAA sludge. The use of TEE-guided DCC has grown due to its ability to detect atrial thrombi pre-cardioversion, aiding risk stratification. Thrombus in the left atrium also signals an elevated risk of future thromboembolic events in AF patients. While atrial stunning post cardioversion detected by TEE is a significant risk factor for future thromboembolic events, further evidence is required. Therapeutic anticoagulation is essential during and post cardioversion, even if no atrial thrombus is detected. Current data recommends cardioversion guided by TEE, particularly in outpatient settings.

Spectrum of hollow visceral injury due to isolated blunt trauma abdomen presented in tertiary care trauma hospital of Pakistan

Objective: To evaluate the spectrum of isolated hollow visceral perforations in patients presenting with abdominal blunt trauma. Method: The observational, analytical, cross-sectional study was conducted at the surgical ward of Mayo Hospital, Lahore, Pakistan from July 1, 2020, to June 31, 2021, and comprised patients who presented in the emergency department after blunt trauma to abdomen without any open wound. Findings of hollow visceral injury were confirmed on exploration laparotomy. Data was analysed using SPSS 26. Results: Of the 216 patients, 173(80.9%) were male and 43(19.9%) were female. The overall mean age was 42±9.7 years. Most of the blunt trauma abdomen cases were caused by motor vehicle accidents 59(27.3%). The most common hollow viscus affected was jejunum 42(19.4%), followed by transverse colon 29(13.4%). The most common type of injury observed was single complete disruption of hollow viscus 74(34.2%). Conclusion: The most common hollow organ affected by blunt trauma to the abdomen was jejunum, followed by transverse colon, and motor vehicle accidents were the major cause of these injuries. Key Words: Blunt trauma abdomen, Hollow viscera, Perforation, Motor vehicles, Peritonitis, Tertiary care hospital.

Comparative effectiveness of EDTA and citric acid assisted phytoremediation of Ni contaminated soil by using canola (Brassica napus)

Phytoremediation is an ecofriendly technique to clean heavy metals from contaminated soil by the use of high biomass producing plant species. Chelators can help to improve this biological technique by increasing metal solubility. Therefore, a pot experiment was conducted to determine the effect of the chelators EDTA and citric acid (CA) in phytoremediation of Ni contaminated soil by using Brassica napus (canola). Two cultivars of B. napus, Con-II (tolerant) and Oscar (sensitive), were selected after screening and exposed to NiSO4 at 30 ppm at the time of sowing. CA (10 mM) and EDTA (1.5 mM) were applied either alone or in combination with each other after two weeks of Ni treatments. Different parameters like morpho-physiological and biochemical data were recorded after 15 days of chelate application. The results highlighted the successful use of chelating agents (CA and EDTA) not only to ameliorate Ni stress but also to enhance Ni accumulation which is prerequisite for phytoremediation. The basal application of 10 mMCA and 1.5 mM EDTA concentration proved to be effective for the growth of plants. The combination of chelating agents failed to show any synergistic effects.

Leukoencephalopathy due to inhalational and trans-conjunctival heroin abuse: First case report from Pakistan

Introduction

and importance: Heroin-induced leukoencephalopathy (HLE) is a rare illness that causes diffuse white matter destruction, leading to acute or subacute development of neurological signs and symptoms. Physicians must be aware of the likely clinical presentation to properly evaluate and diagnose this clinical entity.

Case presentation

We report the case of a young gentleman who presented with acute stupor following his first instance of heroin vapor inhalation. He later confessed to trans-conjunctival application of the drug as well. His Glasgow Coma Scale (GCS) score improved within four days of admission, however, the neurologic sequalae such as cognitive impairment, spastic paraparesis and urge incontinence only partially resolved at three months. Abnormal white matter hyperintensities with restricted diffusion on brain magnetic resonance imaging and history of heroin abuse led to diagnosis of toxic leukoencephalopathy.

Clinical discussion

Leukoencephalopathy with heroin is mostly observed after inhalation (i.e., “chasing the dragon”) but other routes of abuse have also been reported. Although a large spectrum of presentations exists, altered mental status, cerebellar dysfunction and fecal/urinary incontinence are the most commonly seen presenting features. Anti-oxidant therapy has shown promising results in terms of treatment.

Conclusion

The growing rates of opioid use disorders require physicians to be aware of and counsel the patients regarding dangerous neurological sequelae of these drugs.

•

Heroin-induced leukoencephalopathy (HLE) is a rare entity that can present with neurobehavioral symptoms and focal neurological deficits.

•

It is most common after inhalation but trans-conjunctival abuse may cause it as well.

•

The growing rates heroin abuse require physicians to be aware of and counsel the patients regarding HLE.

Neonatal hyperbilirubinemia: Background and recent literature updates on the diagnosis and treatment

Hyperbilirubinemia or jaundice has been studied by many researchers because of its diverse causes and potential for toxicity especially in the neonate but to a lesser extent beyond the neonate as well. Several studies have been performed on the normal metabolism and metabolic disorders of bilirubin in last decades of the 20th century. The recent advancement in research and technology facilitated for the researchers to investigate new horizons of the causes and treatment of neonatal hyperbilirubinemia. This review gives a brief introduction to hyperbilirubinemia and jaundice and the recent advancement in the treatment of neonatal hyperbilirubinemia. It reports modifications in the previously used methods and findings of some newly developed ones. At present, ample literature is available discussing the issues regarding hyperbilirubinemia and jaundice, but still more research needs to be done.

Comparison of surface enhanced Raman spectroscopy and Raman spectroscopy for the detection of breast cancer based on serum samples

In this study, surface enhanced Raman spectroscopy (SERS) and Raman spectroscopy (RS), are employed for the classification of different stages of breast cancer using clinically diagnosed serum samples from breast cancer patients and healthy individuals. These serum samples are compared for their spectral features acquired by SERS and RS to establish spectral features that can be considered as spectral markers of breast cancer diagnosis and classification. SERS features related to DNA, proteins and lipids were observed which are solely observed in the serum samples of patients at different stages of breast cancer as compared to healthy samples. In order to explore the capability of SERS and RS and their comparison as an analytical tool for the efficient understanding of the progression of breast cancer, Principal Component Analysis (PCA) is done for the SERS and RS spectra of control, stage 2, stage 3 and stage 4. Furthermore, the Partial Least Squares-Discriminant Analysis (PLS-DA) was performed to compare the diagnostic performance of SERS and Raman spectroscopy for the classification of disease positive samples and healthy ones. The sensitivity and specificity and area under receiver operating characteristic (AUROC) curve values for SERS data were 90%, 98.4%, and 94% respectively which were higher as compared to Raman spectral data for which these values were found to be 88.2%, 97.7%, and 83.4% respectively.

Raman spectroscopy of blood plasma samples from breast cancer patients at different stages

Raman spectroscopy was employed for the characterization of blood plasma samples from patients at different stages of breast cancer. Blood plasma samples taken from clinically diagnosed breast cancer patients were compared with healthy controls using multivariate data analysis techniques (principal components analysis - PCA) to establish Raman spectral features which can be considered spectral markers of breast cancer development. All the stages of the disease can be differentiated from normal samples. It is also found that stage 2 and 3 are biochemically similar, but can be differentiated from each other by PCA. The Raman spectral data of the stage 4 is found to be biochemically distinct, but very variable between patients. Raman spectral features associated with DNA and proteins were identified, which are exclusive to patient plasma samples. Moreover, there are several other spectral features which are strikingly different in the blood plasma samples of different stages of breast cancer. In order to further explore the potential of Raman spectroscopy as the basis of a minimally invasive screening technique for breast cancer diagnosis and staging, PCA-Factorial Discriminant Analysis (FDA) was employed to classify the Raman spectral datasets of the blood plasma samples of the breast cancer patients, according to different stages of the disease, yielding promisingly high values of sensitivity and specificity for all stages.

Principal components analysis of Raman spectral data for screening of Hepatitis C infection

In the current study, Raman spectroscopy is employed for the identification of the biochemical changes taking place during the development of Hepatitis C. The Raman spectral data acquired from the human blood plasma samples of infected and healthy individuals is analysed by Principal Components Analysis and the Raman spectral markers of the Hepatitis C Virus (HCV) infection are identified. Spectral changes include those associated with nucleic acidsat720 cm^-1, 1077 cm^-1 1678 (CO stretching mode of dGTP of RNA), 1778 cm^-1 (RNA), with proteins at 1641 cm^-1(amide-I), 1721 cm^-1(CC stretching of proteins) and lipids at 1738 cm^-1(CO of ester group in lipids). These differences in Raman spectral features of blood plasma samples of the patients and healthy volunteers can be associated with the development of the biochemical changes during HCV infection.

Raman spectral analysis for rapid screening of dengue infection

Infection with the dengue virus is currently clinically detected according to different biomarkers in human blood plasma, commonly measured by enzyme linked immunosorbent assays, including non-structural proteins (Ns1), immunoglobulin M (IgM) and immunoglobulin G (IgG). However, there is little or no mutual correlation between the biomarkers, as demonstrated in this study by a comparison of their levels in samples from 17 patients. As an alternative, the label free, rapid screening technique, Raman spectroscopy has been used for the characterisation/diagnosis of healthy and dengue infected human blood plasma samples. In dengue positive samples, changes in specific Raman spectral bands associated with lipidic and amino acid/protein content are observed and assigned based on literature and these features can be considered as markers associated with dengue development. Based on the spectroscopic analysis of the current, albeit limited, cohort of samples, Principal Components Analysis (PCA) coupled Factorial Discriminant Analysis, yielded values of 97.95% sensitivity and 95.40% specificity for identification of dengue infection. Furthermore, in a comparison of the normal samples to the patient samples which scored low for only one of the biomarker tests, but high or medium for either or both of the other two, PCA-FDA demonstrated a sensitivity of 97.38% and specificity of 86.18%, thus providing an unambiguous screening technology.

Exogenous protease supplementation of poultry by-product meal-based diets for broilers: Effects on growth, carcass characteristics and nutrient digestibility

An experiment was conducted to investigate the effects of three levels (0%, 3% and 6%) of poultry by-product meal (PBM) with or without protease on broiler growth, carcass characteristics and nutrient digestibility from 1 to 35 days. Two hundred and forty birds (n = 240) were fed equi-caloric and equi-nitrogenous (ME 2850 kcal/kg; CP 20%) diets throughout the experiment. The enzyme supplementation increased feed intake (p < .01) and body weight gain (p < .01), but feed:gain remained unaffected (p > .05) from 1 to 21 days. Increasing level of PBM decreased feed intake (p < .05), but body weight gain was improved (p < .05) at 3% PBM level during 1 to 21 days. The feed:gain was improved (p < .05) in birds fed diets containing 3% PBM. The feed:gain was also improved in birds fed diets containing 3% PBM from 1 to 35 days. However, feed intake and body weight gain in birds fed diets containing PBM remained unaffected. An interaction (p < .01) on feed intake between enzyme and PBM was noticed during 1 to 21 days. However, no interaction was recorded for body weight gain and feed:gain. The per cent carcass yield improved (p < .01) in birds fed diets supplemented with enzyme. The per cent breast meat yield was depressed (p < .005) in birds fed diets containing PBM. Apparent metabolizable energy (p < .001), nitrogen retention (p < .01), apparent metabolizable energy corrected for nitrogen (p < .001), and apparent digestibility coefficient for nitrogen (p < .01) improved in birds fed diets containing enzyme; however, a reverse was noticed in those fed diets containing only PBM. In conclusion, inclusion of 3% PBM along with supplementation of exogenous protease improved performance and nutrient digestibility in broilers.

Comparative performance of semi-absolute k 0-instrumental neutron activation analysis and Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES) for compositional decoding of aluminum base alloys

Samples of certified aluminum base alloys were analyzed by semi-absolute, standardless k 0-instrumental neutron activation analysis (k 0-INAA) for compositional decoding. Irradiations were performed at two research reactors located at Pakistan Institute of Nuclear Science and Technology having nominal thermal neutron fluxes of 1013 and 1012 cm−2 s−1. The experimentally optimized parameters for NAA suggest a maximum of three sets of irradiations for the quantification of 8 major and minor elements. Moreover, the same conditions provided quantitative results for 10 other elements as impurities, which were not reported by the supplier of the reference material. The same alloys were analyzed by inductively coupled plasma optical emission spectrometry (ICP-OES) where all impurity elements, quantified by k 0-INAA, were below the detection limits. A comparison of % relative deviation of the results obtained by k 0-INAA and ICP-OES revealed that the former has better accuracy than ICP-OES, but k 0-INAA has poor limits of detection for Mg, Si and Ti in aluminum base alloy.

Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis

OBJECTIVE

To determine the effectiveness of school-based strategies for obesity prevention and control using methods of systematic review and meta-analysis.

METHODS

Peer-reviewed studies published between 1966 and October 2004 were considered for review. Studies meeting eligibility criteria were published in English, targeted children aged 3-18 in a school setting, reported weight-related outcomes, included a control measurement and had at least a 6-month follow-up period. Studies employed interventions related to nutrition, physical activity, reduction in television viewing or combinations thereof. Weight related data were analyzed using RevMan software.

RESULTS

Sixty-four studies were considered for inclusion. Fourteen did not meet inclusion criteria; 29 were excluded due to poor methodological quality. Twenty-one papers describing 19 studies were included in the systematic review and 8 of these were included in the meta-analysis. Nutrition and physical activity interventions resulted in significant reductions in body weight compared with control ((standardized mean difference, SMD=-0.29, 95% confidence interval (CI)=-0.45 to -0.14), random effects model). Parental or family involvement of nutrition and physical activity interventions also induced weight reduction ((SMD=-0.20, 95%CI=-0.41 to 0.00), random effects model).

CONCLUSION

Combination nutrition and physical activity interventions are effective at achieving weight reduction in school settings. Several promising strategies for addressing obesity in the school setting are suggested, and warrant replication and further testing.

Determining the risk factors and prevalence of osteoporosis using quantitative ultrasonography in Pakistani adult women

INTRODUCTION

Osteoporosis-related bone fractures are a significant public health problem. The aim of this study was to determine the prevalence of osteoporosis among Pakistani women and identify modifiable risk factors.

METHODS

A cross-sectional study was conducted in an obstetrics / gynaecology setting during March-April 2007 in Quetta, Pakistan. A total of 334 women older than 20 years of age underwent quantitative ultrasonography and were interviewed to find out the risk factors for osteoporosis. Bone mineral density was assessed by the speed of sound using a quantitative ultrasound device. The sociodemographic characteristics of normal, osteopenic and osteoporotic women were compared using the chi-square test for categorical variables and ANOVA for continuous variables. Binary logistic regression was used to determine the independent predictors of being osteopenic or osteoporotic.

RESULTS

146 (43.7 percent) women were reported to be normal, 145 (43.4 percent) were osteopenic and 43 (12.9 percent) were osteoporotic. The mean age and standard deviation of the participants were 36.7 years +/- 13.0 years, with a body mass index (BMI) of 25.81 (standard deviation 5.10) kg per square metre. In the univariate analysis, factors that were associated with osteoporosis / osteopenia included age, parity, BMI, smoking (pack years), consumption of calcium-rich food/week, personal and family history of osteoporosis, education and socioeconomic status (p-value is less than 0.05). Using binary logistic regression with osteoporosis / osteopenia as an outcome compared to normal individuals, BMI, smoking pack years, a family history of osteoporosis / fracture and house ownership were found to be independent predictors of the outcome.

CONCLUSION

The prevalence of osteoporosis and osteopenia is high, especially among young Pakistani women, and is associated with modifiable risk factors.

1,1,1,3,3,3-Hexafluoro-2,2-bis[4-(4-nitrophenoxy)phenyl]propane

In the title compound, C₂₇H₁₆F₆N₂O₆, the nitro groups are almost coplanar with the aromatic rings to which they are attached [dihedral angles = 3.5 (5) and 6.2 (3)°]. The dihedral angles between adjacent aromatic rings are 78.07 (8) and 71.11 (8)° for nitro­phen­yl/phenyl and 69.50 (8)° for phen­yl/phenyl. An inter­molecular C—H⋯π inter­action seems to be effective in the stabilization of the structure.

Raloxifene, soy phytoestrogens and endothelial function in postmenopausal women

OBJECTIVE

To compare the effects of raloxifene and soy phytoestrogens on endothelial function in healthy, postmenopausal women.

DESIGN

Randomized, double-blind, placebo-controlled, cross-over trial. Subjects (n = 22; mean age 58.5 years) underwent endothelial function testing at baseline and following 6 weeks of daily raloxifene 60 mg, soy phytoestrogens 55 mg, and placebo in random sequence with intervening 6-week wash-out periods. Endothelial function was assessed as flow-mediated vasodilatation (FMD) of the brachial artery using high-resolution ultrasound; digital flux was measured with laser Doppler velocimetry.

RESULTS

Baseline (pretreatment) FMD was almost within normal range at 9.6% (+/-6.4). FMD did not change from baseline within any treatment group, and no between-group differences were detected. FMD values following treatment with raloxifene, soy, and placebo were 10.3% (+/-12.3), 8.3% (+/-7.7), and 9.5% (+/-4.4), respectively. Area under curve ratios showed no treatment differences for digital velocimetry.

CONCLUSIONS

In this study, neither raloxifene nor soy enhanced endothelial function in postmenopausal women. However, the cohort had relatively normal endothelial function at baseline. Further study is required to determine if particular subgroups of postmenopausal women derive vascular benefit from the use of selective estrogen receptor modulators or soy phytoestrogens.

Influence of Canola Meal-Based Diets Supplemented with Exogenous Enzyme and Digestible Lysine on Performance, Digestibility, Carcass, and Immunity Responses of Broiler Chickens

The response of broiler chickens to 2 levels of endo-1,4-beta xylanase and endo-1,3-beta glucanase combination (with and without), 3 levels of digestible Lys (0.8, 0.9, and 1.0%), and 2 levels of canola meal (CM; 20 and 30%) were evaluated in 2 x 3 x 2 factorial arrangement. A total of 2,448 male Hubbard broiler chicks were fed on practical mash diets having 2,750 kcal of ME.kg(-1) and 19.6% CP from 1 to 42 d of age. The BW gain was significantly reduced when 30% CM was added in the diets during 1 to 21 d. Feed:gain and mortality were also observed to be high. No significant effect of enzyme addition or Lys level was observed on feed intake, BW gain, feed:gain, and mortality during the starter phase. When the data were pooled for 42 d, BW gain and feed:gain were unaffected by enzyme addition or Lys levels. A depression in breast weight was observed due to 30% CM or 0.8 and 0.9% digestible Lys at 43 d. Leg weights were significantly depressed by enzyme addition or increasing digestible Lys to 1.0% of the diets. The AME, nitrogen digestibility, and antibody titers against Newcastle and infectious bursal diseases were also unaffected by the dietary treatments. In conclusion, the 30% CM is not recommended in broiler diets especially during starter phase (1 to 21 d). However, the CM may be used up to 30% of the diets during finishing phase. The digestible Lys can be lowered to 0.8% when amino acids in proportion to digestible Lys follow the ideal AA ratio. The glucanase and xylanase cocktail have no pronounced effect on the growth performance, nutrient digestibility, and carcass characteristics.

Smoking habits and beliefs of future physicians of Pakistan

OBJECTIVE

To assess the habits, knowledge and attitudes towards smoking among Pakistani medical students.

METHODS

A cross-sectional study was conducted from March 2004 to July 2005 at three medical colleges using a World Health Organization (WHO) questionnaire. A total of 1,029 medical students participated in the study.

RESULTS

The prevalence of smoking was found to be 11.2%. Smoking was more prevalent among males, hostel residents and first year medical students. Almost half of the smokers had tried to quit smoking. A family member or a friend was considered to be the most likely person to help quit smoking. The majority believed that passive smoking was harmful to health and were generally supportive of legislative measures to reduce tobacco use, such as the restriction of smoking in public places and the prohibition of sale of tobacco to children. Lesser but significant numbers thought that there should be a complete ban on smoking advertisements and that the price of tobacco products should be increased.

CONCLUSION

The study shows a high prevalence of tobacco use in future physicians in spite of adequate knowledge about and a satisfactory attitude towards smoking.

WITHDRAWN: Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis

The authors hereby retract the e-publication dated July 31, 2007, entitled, 'Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis,' and are submitting a revised version with the same title. A secondary review of the manuscript took place following its initial acceptance, resulting in additional statistical analyses along with some pertinent revisions to the accompanying narrative.

Proximal femoral focal deficiency as a manifestation of Antley-Bixler syndrome: a case report

We report a case of the Antley-Bixler syndrome in an 11-year-old girl. She presented with bilateral proximal femoral focal deficiency, right clubfoot, left radiohumeral synostosis, bilateral ear hypoplasia, cleft palate, tongue tie, missing teeth, congenital heart disease, a pelvic kidney with hydronephrosis, and mental retardation. Proximal femoral focal deficiency has never been reported before as a manifestation of Antley-Bixler syndrome. Her mother was exposed to radiation during an intravenous urogram done in the first trimester of pregnancy. Exposure to radiation has not been implicated as a cause of Antley-Bixler syndrome.

Effect and interactions of dietary sodium and chloride on broiler starter performance (hatching to twenty-eight days of age) under subtropical summer conditions

One-day-old Starbro male broiler chicks (n = 360) were used to determine the effect of increasing levels of Na+ and Cl- above the NRC (1994) recommendations for growing broilers diets (hatching to 28 d) in extremely hot weather. The average maximum and minimum temperatures recorded were 39 and 32 degrees C, respectively. An average relative humidity was 58.2% during the experimental period. Three levels of dietary Na+ (0.20, 0.25, and 0.30%) and Cl- (0.30, 0.40, and 0.50%) were used in 3 x 3 factorial arrangement while maintaining a dietary electrolyte balance (DEB) of 250 mEq/kg. Higher weight gain (P < 0.002) and maximum water consumption (P < 0.05) were observed for birds fed diets containing 0.25 and 0.30% Na+, respectively. Litter moisture was significantly higher (P < 0.05) for birds fed diets containing 0.25% Na+ and 0.40 and 0.50% Cl-. High dietary Na+ (0.30%) tended to increase breast yield (P < 0.003) and decreased abdominal fat (P < 0.001). There was no effect of Na+ on blood pH or serum HCO3-. Diets containing 0.40% Cl- increased the dressing percentage (P < 0.001) and leg yield (P < 0.001) and decreased serum HCO3- (P < 0.001). There was no effect of dietary Cl- on blood pH, feed intake, weight gain, feed:gain, water intake, water:feed intake, or mortality. Significant dietary effect of Na+ x Cl- was noted only for litter moisture (P < 0.001), dressing percentage (P < 0.05), breast (P < 0.05) and leg (P < 0.001) yields, abdominal fat (P < 0.002), and serum HCO3- (P < 0.001). Birds fed diet containing 0.25% Na+ and 0.30% Cl- performed as well as those fed other diets when the cyclic temperature ranged from 32 to 39 degrees C.

Technical skills for weight loss: 2-y follow-up results of a randomized trial

OBJECTIVE

To investigate the sustained effectiveness of a novel skill-based intervention for weight loss.

DESIGN

Randomized, controlled trial.

SUBJECTS

A total of 80 overweight/obese women living in Connecticut.

MEASUREMENTS

Absolute weight difference measured in pounds and absolute change in body mass index (BMI). Secondary outcomes included changes in food frequency questionnaire (FFQ) data and waist-to-hip ratio.

RESULTS

In all 61, 35, and 34% of study participants completed the 6-, 12-, and 24-month assessments, respectively. At 6 months postintervention, both counseling-based (CBI) and skill-based (SBI) intervention groups had statistically significant decreases in absolute weight (4.0+/-3.6 and 1.7+/-3.0 kg, respectively). Compared to their baseline values, both CBI and SBI groups still maintained weight losses at 24 months (1.1+/-5.8 and 0.59+/-3.3 kg, respectively); however, the differences were not statistically significant. FFQ results showed that, within the SBI group, there was a significant decrease (P<0.05) in percent fat from baseline to 12 months and a nearly significant decrease in saturated fat from baseline to 24 months (P=0.07).

CONCLUSIONS

Both the novel SBI and conventional dietary counseling demonstrated some residual weight loss benefit at 2 y. Effects of the SBI on dietary intake patterns are encouraging, and warrant further study.

Effects of oat and wheat cereals on endothelial responses

BACKGROUND

This study was undertaken to determine the effects of month-long whole grain oat and wheat cereal supplementation on endothelial function following a fatty meal as measured by brachial artery reactivity studies.

METHODS

Fifty healthy adult subjects underwent brachial artery reactivity studies before and after a high-fat meal along with alpha-tocopherol (vitamin E), oats, or a comparable bowl of wheat cereal and were again tested after the high-fat meal following month-long supplementation with oat or wheat cereal in a random crossover with interim washout.

RESULTS

In the acute phase, the fatty meal attenuated the hyperemic brachial artery flow response when administered concurrently with wheat cereal (-13.4%; P = 0.02), whereas hyperemic flow was maintained by concurrent administration of either oatmeal or alpha-tocopherol. Following month-long supplementation, postprandial peak flow (wheat +3.88 +/- 5.62%; oat -10.78 +/- 7.15%), and peak diameter (wheat -1.40 +/- 0.96%; oat -0.86 +/- 0.88%) did not differ from preprandial values. Oat and wheat treatments did not differ when directly compared.

CONCLUSIONS

Month-long, daily supplementation with either whole-grain oat or wheat cereal may prevent postprandial impairment of vascular reactivity in response to a high-fat meal.

Health risk behaviors and health perceptions in the Peruvian Amazon

Behavioral health risk factor and health belief data for the indigenous population of the Peruvian Amazon are unavailable. Therefore, we conducted structured interviews of adults living in 5 towns in the remote Amazon region of Peru. Respondents (n = 179) were 67% women with a mean age of 35.4 years. The average household size was 6.7 people. A majority (72%) were unable to see a doctor when needed because of lack of money and distance. Only 6% reported excellent health, and nearly half (49%) reported fair health. Forty-eight percent drank alcohol and 73% smoked. Only 34% thought mosquitoes cause malaria, but 98% were using mosquito nets. In conclusion, our findings indicate the indigenous population of the Peruvian Amazon has limited access to basic health care. Although most of those surveyed use mosquito netting, few know that mosquitoes transmit malaria. Tobacco and alcohol use are major behavioral health risk factors.

The activated partial thromboplastin time in early diagnosis of myocardial infarction

Intracoronary thrombosis is fundamental to the pathogenesis of acute myocardial infarction (MI), yet few studies have examined the diagnostic value of routine coagulability markers, such as the activated partial thromboplastin time (aPTT), in patients with chest pain. We hypothesized that the initiation of thrombosis early in MI would shorten the aPTT, and conducted a retrospective cohort study of patients admitted with a diagnosis of chest pain through the emergency department of one community hospital between 1 January and 30 August 1998. Patients were diagnosed as MI positive or negative based on World Health Organization (WHO) criteria. The aPTT obtained on arrival (prior to anticoagulation therapy) was retrieved from the electronic medical record. Of 120 eligible patients (49% female, mean age 63.7 years), 27 (23%) were diagnosed with MI. Patients with an aPTT <or= control (n = 73, 61%) were significantly more likely to be diagnosed with MI than those with an aPTT > control (RR = 2.83, 95% confidence interval 1.15 to 6.96, P = 0.013). A shortened aPTT (<or= control) on presentation in patients with chest pain is associated with increased risk of acute MI. This information is available before other serum markers of MI, and may facilitate early treatment decisions. Further study is warranted.

American College of Preventive Medicine Practice Policy statement. Weight management counseling of overweight adults

On the basis of a review of the current literature and recommendations, the American College of Preventive Medicine presents a practice policy statement on weight management counseling of overweight adults.

Self-reported weight and height: implications for obesity research

BACKGROUND

Self-reported weight and height are under- and over-reported, respectively, in epidemiologic studies. This tendency, which may adversely affect study operations, has not been evaluated among subjects being enrolled into a weight-loss program.

METHODS

Self-reported weight, height, and body mass index (BMI) were compared to measured values in 97 overweight or obese (BMI>27.3) women being enrolled into a randomized, controlled trial of two behavioral interventions for weight loss. The effects of demographic factors, baseline weight, baseline height, and baseline BMI on weight and height reporting were assessed.

RESULTS

There was a significant difference between measured and reported weight (mean difference=-3.75 lb, p=0.0001) and height (mean difference=+0.35 in., p=0.0007). The mean difference between measured and reported BMI was -1.14 kg/m(2) (p=0.0001). Unemployed, retired, or disabled women were more likely to under-report their BMI than employed women (p=0.001). Six percent of subjects who were initially considered eligible for the study on the basis of the self-report were eventually excluded from the study because they did not meet the inclusion criterion for BMI.

CONCLUSIONS

Obese women who seek weight-loss assistance tend to under-report their weight and over-report their height, suggesting that self-reported data are likely to be inaccurate. Misreporting is apparently influenced by employment and disability and has the potential to complicate recruitment of subjects for research studies.

Community health promotion and the randomized controlled trial: approaches to finding common ground

The randomized controlled trial is the model against which research designs are judged. Concurrent with rising standards of evidence, however, is a trend toward greater inclusiveness in community-based research, exemplified by the Centers for Disease Control and Prevention-funded Prevention Research Centers, a nationwide network of academic-community partnerships engaged in community-based health promotion and disease prevention research. The Yale-Griffin Prevention Research Center developed a replicable process for devising randomized trials in the context of community collaboration. Several examples of trials developed this way and their interim results are provided.

Acute effects of oats and vitamin E on endothelial responses to ingested fat

OBJECTIVE

To assess the effects of oats and vitamin E on endothelial function following a high-fat meal in healthy adults as measured by brachial artery reactivity studies (BARS).

METHODS

A total of 25 men and 25 women (N=50) were recruited from a community population to participate in this randomized, crossover study. All subjects were free of known vascular disease, and female subjects were postmenopausal. Subjects underwent BARS before and after a high-fat meal (50 gm fat) on three occasions 1 week apart, one each with vitamin E 800 IU, oatmeal containing 3 gm beta-glucan, or a comparable bowl of wheat cereal serving as a placebo, in random sequence. The ultrasonographer was blinded to treatment status.

RESULTS

Endothelial function, as measured by brachial artery peak flow during one minute of post-occlusive hyperemia, declined significantly from baseline when the high-fat meal was consumed with the wheat cereal (-13.4%; p=0.02). There was no difference in brachial artery flow change before and after a high-fat meal with oats (+0.37%; p=0.77) or a high-fat meal with vitamin E (+1.87%; p=0.42). No significant differences in flow-mediated vasodilation before and after the high-fat meal were detected among the three supplements.

CONCLUSIONS

Endothelial dysfunction induced by acute fat ingestion in healthy adults is apparently prevented by concomitant ingestion of oats or vitamin E, but not wheat. Nutrient distribution and meal composition may have important implications for cardiovascular health.

Physician-patient interactions regarding diet, exercise, and smoking

OBJECTIVES

The objectives were to determine the rate of physician/patient discussions regarding diet, exercise, and smoking and to assess the effect of such discussions on behavior change.

METHODS

In a telephone survey of Connecticut adults, respondents who had a routine checkup in the past year (n = 433) were asked whether their physicians had asked them about their dietary habits, exercise, or smoking, and about any efforts to modify these behaviors during the preceding year.

RESULTS

Diet was addressed with 50% of the subjects, exercise with 56%, and smoking status with 77%. Respondents who were asked about their diet were more likely to have changed their fat or fiber intake in the past year than those not asked (64 vs. 48%, P = 0.002) and were somewhat more likely to have lost weight (46 vs. 37%; P = 0.061); the differences were even greater among 94 overweight subjects (64 vs. 47%; P = 0.099). No behavior change was associated with discussions of exercise or smoking.

CONCLUSIONS

Physicians have the potential to impact health behaviors, especially those related to diet, through simple discussions during routine checkups, but only about half are using this opportunity.

Concordance of clinical findings and clinical judgment in the diagnosis of streptococcal pharyngitis

OBJECTIVE

It is uncertain how reliably clinicians apply clinical predictors of group A beta hemolytic streptococcal pharyngitis (GABHSP) to form a clinical impression, and how reliably this impression predicts culture results. The objective was to study clinician accuracy in diagnosing GABHSP.

METHODS

This was a prospective cohort study, conducted at an urgent care center of a major university. A convenience sample of 218 patients, aged 9-83 years, presenting with sore throat, was enrolled. Symptoms and signs of pharyngitis were documented on a standardized form; the likelihood of GABHSP was plotted on a visual analog scale; and throat culture was obtained. A comparison was then made between the clinical impression on presentation and the throat culture result.

RESULTS

Throat cultures were positive for GABHSP in 41 patients (19%). The probability of GABHSP was related to node size and tenderness, tonsillar exudate and hypertrophy, and pharyngeal erythema (p<0.05); but not throat soreness, degree of fever, or cough. A strong clinical impression of GABHSP (>50% on the visual analog scale) was associated with tonsillar exudate and hypertrophy, tender nodes, and pharyngeal erythema. Together, these four predictors had a sensitivity of 71%, a specificity of 77%, and a positive predictive value of 46%.

CONCLUSIONS

Clinicians in this study based their impression of GABHSP on the most reliable symptoms and signs. While a strong clinical suspicion of GABHSP predicted a greater probability of positive culture, the clinicians consistently overestimated the probability of GABHSP. Symptoms and signs predict GABHSP unreliably when used alone; they are helpful in modifying estimates of disease probability to facilitate optimal use of laboratory tests and antibiotics.

Peri-operative aspirin can prevent post-operative ischemia and thrombosis

Of the 30 million patients in the USA who undergo non-cardiac surgery every year, approximately 1.5 million suffer post-operative cardiovascular events. Surgical trauma and associated catecholamine release leads to platelet activation in the immediate post-operative period, as evidenced by a rise in circulating platelet release products. Platelet activation promotes platelet aggregation and hypercoagulability. Aspirin is widely used for its platelet inhibiting effects to prevent myocardial infarction and stroke. However, aspirin is not routinely started in the immediate peri-operative period, and even in high-risk patients already taking aspirin, aspirin is generally discontinued before elective surgery to improve intra-operative hemostasis. The risk-to-benefit ratios of administering vs withholding aspirin in the immediate peri-operative period have never been assessed and compared. We hypothesize that aspirin given pre-, intra- or immediately post-operatively will reduce post-operative ischemia and thrombotic events, including myocardial infarction and stroke, and that risk-benefit analysis would favor the administration of aspirin. This hypothesis can and should be tested in a prospective, randomized trial.

An integrated residency in internal and preventive medicine

The importance of preventive and population-based principles in clinical practice is widely acknowledged. The challenge of imparting these principles in either undergraduate or postgraduate medical education has, however, not been fully met. The necessary skills are provided comprehensively by preventive medicine residency programs, but at the expense of clinical training. Sequential residencies in primary care and preventive medicine, the currently available means of obtaining thorough preparation in both clinical and population-based principles, represent an inefficient, generally unappealing, and non-integrated approach. In response to these concerns, and in an effort to make preventive medicine training appeal to a wider audience, the authors developed and implemented a residency program fully integrating internal and preventive medicine. The program meets, and generally exceeds, the requirements of both specialty boards over a four-year period. The program provides extensive training in clinical, preventive, and public health skills, along with case management and cost-effective care, conferring the MPH degree and leading to dual board eligibility. The model is ideally wed to the demands of the modern health care environment in the United States, is extremely attractive to applicants, and may warrant replication both to train academic and administrative leaders and to raise the standards of preventive and public health practice in primary care.

Preventable inpatient time: adequacy of electronic patient information systems

OBJECTIVES

This study assessed hospital electronic patient information systems (EPIS) for inclusion of variables associated with avoidable and extended hospitalization (preventable inpatient time).

METHODS

We searched MEDLINE and HealthSTAR databases to identify predictors of preventable inpatient time. We then audited the admissions process and the handwritten medical record at 1 hospital, and the EPIS at all hospitals, affiliated with the Yale University School of Medicine for inclusion of the predictors.

RESULTS

Whereas the written medical record included all 58 predictors, the EPIS of the 10 hospitals surveyed included an average of only 38% of the predictors.

CONCLUSIONS

The conventional approach to information gathering during hospital admission is highly inefficient. Revising EPIS to include predictors of preventable inpatient time could enhance efficiency and quality, while reducing costs, of hospital care.

American College of Preventive Medicine Practice Policy Statement: perimenopausal and postmenopausal hormone replacement therapy

Based on a review of current literature and recommendations, the American College of Preventive Medicine presents a practice policy statement on perimenopausal hormone replacement therapy.

Weight loss counseling by health care providers

OBJECTIVES

This study explores the pattern of weight loss counseling by health care providers in Connecticut and the associated weight loss efforts by patients.

METHODS

Data from the 1994 Connecticut Behavioral Risk Factor Surveillance System survey were analyzed to determine (1) the frequency of weight management counseling by health care providers of overweight adults with and without additional cardiovascular risk factors and (2) the current weight loss practices of overweight subjects.

RESULTS

Only 29% of all overweight respondents and fewer than half with additional cardiovascular risk factors, reported that they had been counseled to lose weight.

CONCLUSIONS

The findings suggest a need for more counseling of overweight persons, especially those with cardiovascular disease risk factors.

Experience with indwelling "J.J" ureteral stents

J.J stents provide free drainage from the kidney to the bladder, reduce or eliminate urine leakage and provide stenting of the ureter. They were used in a total of 200 cases. In 158 to prevent ureteric obstruction before extracorporeal shock wave lithotripsy (ESWL), in 25 to bypass obstruction and in 12 as an adjunct to complicated upper urinary tract surgery. Majority (97%) of the stents were placed endoscopically under local anaesthesia (71.5%). In all the cases stents were successful to provide free drainage. No mortality was attributable to the use of stents but certain complications were encountered. Encrustation of the stents occurred in 21 (10.5%) and migration in 11 (5.5%) cases. Stents were removed easily under local anaesthesia by cystoscope. "J" stents thus provide an effective means to reduce complications and enhance effectiveness specially of ESWL therapy.

Natural history of left ventricular performance at rest and during exercise after aortic valve replacement for aortic regurgitation

Previous studies of left ventricular performance in aortic regurgitation uniformly indicate improvement within the year after aortic valve replacement but differ regarding the likelihood of additional later improvement. To resolve this difference, to more precisely define the pattern of postoperative left ventricular performance variation, and to assess the impact of valve replacement on ejection fraction during exercise, we evaluated radionuclide cineangiograms obtained annually or nearly annually for approximately 5 years in 21 prospectively studied patients who had undergone valve replacement for aortic regurgitation. Ejection fraction rose from less than 8 months before operation to 5-11 (average 7) months after operation and continued to rise for 1 additional year (rest) and 2 additional years (exercise) before reaching a stable plateau until the final study 54-72 (average 63) months postoperatively. Mean ejection fractions at rest were 45% preoperatively, 50% less than 1 year postoperatively (p = 0.12), 54% at year 1-2 (p = 0.01 versus less than 1 year), 56% at year 2-3 (NS versus year 1-2) and year 4-6 (NS versus year 1-2 or 2-3), and during exercise were 39% preoperatively, 49% less than 1 year postoperatively (p less than 0.01), 54% at year 1-2 (p less than 0.01 versus less than 1 year, NS versus year 2-3, p less than 0.05 versus year 4-6), 60% at year 2-3, and 61% at year 4-6 (NS versus year 2-3). Late improvement was found most consistently among patients with relatively depressed performance before operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetaminophen induced pancreatitis

This is the fourth reported case of acute pancreatitis associated with acetaminophen overdose. The patient had ingested the smallest amount of acetaminophen (9.75-13 g) that has been reported to produce acute pancreatitis. This patient also suffered liver and renal impairment and developed an ileus and ascites. Despite late therapy and laboratory tests that indicated a poor prognosis the patient made a complete recovery without sequelae.