Electrochemical detection and removal of brilliant blue dye via photocatalytic degradation and adsorption using phyto-synthesized nanoparticles

Herein, we report a sensitive electrochemical platform prepared by modifying the electrode surface with copper-doped zinc oxide nanoparticles; these nanoparticles were prepared via a green synthetic approach using the extract of Cassia fistula leaves and multiwalled carbon nanotubes (MWCNTs). For the best response of the electrode modifier, a number of experimental conditions were optimized to obtain the most intense signal of the target analyte Coomassie brilliant blue using a rapid analysis technique square wave voltammetry. The designed sensor displayed remarkable sensitivity for Coomassie brilliant blue with a detection limit of 0.1 nM under the optimized conditions. Moreover, the repeatability, specificity and reproducibility of the designed sensor demonstrated its potential for practical applications. The sensing platform was also used for monitoring the degradation kinetics of the Coomassie brilliant blue dye. Catalytic degradation of the dye was performed using the synergistic effect of Cu-ZnO NPs together with Fenton reagent. The dye degraded by 96% in 60 minutes under neutral conditions, which is one of the main achievements of this work that has never been reported. The photocatalytic breakdown of Coomassie brilliant blue was also monitored using UV-visible spectroscopy. The degradation kinetics results of both techniques agreed well. The adsorption of Coomassie brilliant blue using ZnO NPs was monitored spectrophotometrically. The adsorption data were fitted in a pseudo-second order kinetic model by following the Langmuir isotherm at lower concentration and Freundlich isotherm at higher concentration.

Green synthesis of silver nanoparticles by using Allium sativum extract and evaluation of their electrical activities in bio-electrochemical cell

An electrical application of green synthesized silver nanoparticles (Ag NPs) by developing a unique bio-electrochemical cell (BEC) has been addressed in the report. Here, garlic extract (GE) has been used as a reducing agent to synthesize Ag NPs, and as a bio-electrolyte solution of BEC. Ag NPs successfully formed into face-centered cubic structures with average crystallite and particle sizes of 8.49 nm and 20.85 nm, respectively, according to characterization techniques such as the UV-vis spectrophotometer, XRD, FTIR, and FESEM. A broad absorption peak at 410 nm in the UV-visible spectra indicated that GE played a vital role as a reducing agent in the transformation of Ag+ions to Ag NPs. After that four types of BEC were developed by varying the concentration of GE, CuSO4. 5H2O, and Ag NPs electrolyte solution. The open circuit voltage and short circuit current of all cells were examined with the time duration. Moreover, different external loads (1 Ω, 2 Ω, 5 Ω, and 6 Ω) were used to investigate the load voltage and load current of BEC. The results demonstrated that the use of Ag NPs on BEC played a significant role in increasing the electrical performance of BEC. The use of GE-mediated Ag NPs integrated the power, capacity, voltage efficiency, and energy efficiency of BEC by decreasing the internal resistance and voltage regulation. These noteworthy results can take a frontier forward to the development of nanotechnology for renewable and low-cost power production applications.

Immunomodulatory and anti-cancer potential of cloves (Syzygium aromaticum) bud extract and its phytogenic silver nanoparticles

Clove plant (Syzygium aromaticum) is one of the Myrtaceae family. It's a common flavor in food and the traditional medicine. The study's objective was to ascertain whether the clove bud aqueous extract (CAE) and CAE + nanosilver have any biological effects on immune cells and HT-29 colon cancer cell line. Nanosilver was produced through green synthesis approach using CAE. Produced nanosilver was characterized via electron microscope (scanning, SEM) and ultraviolet-visible spectroscopy. CAE and CAE + nanosilver were examined for their active biomolecules using FTIR analysis, p53 contents using real-time PCR, apoptosis and cell cycle arrest power on HT-29 cancer cell line via flow cytometerty and immunomodulatory potential utilizing MTT assay. Results cleared that a spherical nanosilver with a diameter range of 53 nm was formed by CAE. There were several active biomolecules in CAE and CAE + nanosilver. CAE and CAE + nanosilver increased the p53 protein expression and apoptotic cell number in HT-29 colon cancer cells. CAE and CAE + nanosilver could arrest HT-29 cells at the phase G2/M. CAE and CAE + nanosilver stimulated quiescent and PHA-pre-treated splenic cells at higher concentrations, and CAE suppressed quiescent splenic cell when diluted. In conclusion, the safe edible Syzygium aromaticum plant can be utilized to make anti-tumor agent, essentially for colon tumor. As Syzygium aromaticum plant could stimulate immune cells, it can be used as immune-stimulatory agent that can help fight tumor and tumor development.

Photocatalytic Degradation of Food and Juices Dyes via Photocatalytic Nanomaterials Synthesized through Green Synthetic Route: A Systematic Review

The unavailability of non-poisonous and hygienic food substances is the most challenging issue of the modern era. The uncontrolled usage of toxic colorant moieties in cosmetics and food manufacturing units leads to major threats to human life. The selection of environmentally benign approaches for the removal of these toxic dyes has gained the utmost attention from researchers in recent decades. This review article's main aim is the focus on the application of green-synthesized nanoparticles (NPs) for the photocatalytic degradation of toxic food dyes. The use of synthetic dyes in the food industry is a growing concern due to their harmful effects on human health and the environment. In recent years, photocatalytic degradation has emerged as an effective and eco-friendly method for the removal of these dyes from wastewater. This review discusses the various types of green-synthesized NPs that have been used for photocatalytic degradation (without the production of any secondary pollutant), including metal and metal oxide NPs. It also highlights the synthesis methods, characterization techniques, and photocatalytic efficiency of these NPs. Furthermore, the review explores the mechanisms involved in the photocatalytic degradation of toxic food dyes using green-synthesized NPs. Different factors that responsible for the photodegradation, are also highlighted. Advantages and disadvantages, as well as economic cost, are also discussed briefly. This review will be advantageous for the readers because it covers all aspects of dyes photodegradation. The future feature and limitations are also part of this review article. Overall, this review provides valuable insights into the potential of green-synthesized NPs as a promising alternative for the removal of toxic food dyes from wastewater.

Integrated management of charcoal rot disease in susceptible genotypes of mungbean with soil application of micronutrient zinc and green manure (prickly sesban)

Charcoal rot disease is incited by the soil-borne fungus Macrophomina phaseolina (Tassi). Goid is a challenging disease due to long-term persistence of fungus sclerotia in the soil. This study assessed the potential of zinc (Zn: 1.25, 2.44, and 5 mg/kg) and green manure (GM: 1 and 2%) in solitary and bilateral combinations to alleviate infection stress incited by M. phaseolina on disease, growth, physiology, and yield attributes in mungbean. A completely randomized design experiment was conducted in potted soil, artificially inoculated with the pathogen, and sown with surface-sterilized seeds of mungbean genotypes (susceptible: MNUYT-107 and highly susceptible: MNUYT-105). Concealment of plant resistance by M. phaseolina in both genotypes resulted in 53-55% disease incidence and 40-50% plant mortality, which contributed in causing a significant reduction of 30-90% in attributes of growth, biomass, yield, photosynthetic pigment, and total protein content with an imbalance of production of antioxidant enzymes (polyphenol oxidase, superoxide dismutase, catalase, and peroxidase). Soil application with Zn-based fertilizer (ZnSO4: 33%) in combination with GM significantly managed up to 80% of the charcoal rot disease, hence improving growth (50-100%) and physiochemical (30-100%) attributes and sustainably enhancing grain average yield (300-600%), biological yield (100-200%), and harvest index (100-200%) in mungbean plants. The heat map and principal component analyses based on 19 measured attributes with 16 treatments separated Zn (2.44 or 5 mg/kg) combined with 2% GM as the best treatments for alleviating charcoal rot disease stress by improving growth, yield, and biological attributes to an extent to profitable farming in terms of harvest index (HI) and benefit-cost ratio (BCR).

Fast investigative lung cancer pathway and endobronchial ultrasound procedure supported by rapid on-site evaluation

INTRODUCTION

EBUS is a well-established tool for diagnosis and staging of lung cancer in a fast track investigative pathway. However, impact of ROSE in conjunction with EBUS on reduction of time to treatment decision (TTD) for cancer patients is less well known.

AIMS

Our aim was to determine TTD which was defined as the number of working days from EBUS procedure to the discussion at sector lung multidisciplinary team meeting (MDT). Moreover, concordance of ROSE with final diagnosis was evaluated.

METHODS

A retrospective analysis was performed of a prospective data collection in a busy teaching hospital over a four months study period (September to December 2018).

RESULTS

Data from 112 patients was analyzed. There were 61 (54%) males. Mean age was of 70 years (range 43-91). WHO performance status was 0 in 20 (23%), 1 in 57 (51%), 2 in 22 (20%) and 3 in 7 (6%) patients. In total 522 needle passes were performed from 242 sampling sites. Average working days to discuss at MDT after optimal EBUS sampling was 2.087 (range 0-13 working days). ROSE concordance with final cytological diagnosis was 98.4%. The number of needle passes per site for adequate sample and diagnosis in malignant (4.929) vs non-malignant (2.776) involvement was significantly different (p value <0.0001). There was 100% sample adequacy for preliminary diagnosis, immunohistochemistry and predictive molecular testing.

CONCLUSION

ROSE supported fast-investigative pathway by reducing the time to treatment decision (TTD) making at MDT. High concordance with final cytological diagnosis makes it an effective tool to inform meaningful decision making.

Genetic similarities and phylogenetic analysis of Muntjac (Muntiacus spp.) by comparing the nucleotide sequence of 16S rRNA and cytochrome B genome

This study aimed to identify the phylogenetic similarities among the muntjac (Muntiacus spp.). The phylogenetic similarities among seven major muntjac species were studied by comparing the nucleotide sequence of 16s rRNA and cytochrome b genome. Nucleotide sequences, retrieved from NCBI databases were aligned by using DNASTAR software. A phylogenetic tree was created for the selected species of muntjac by using the maximum likelihood method on MEGA7 software. The results of nucleotide sequences (16s rRNA) showed phylogenetic similarities between, the M. truongsonensis and M. rooseveltorum had the highest (99.2%) while the lowest similarities (96.8%) found between M. crinifrons and M. putaoensi. While the results of nucleotide sequences (Cty b) showed the highest similarity (100%) between M. muntjak and M. truongsonensis and the lowest s (91.5%) among M. putaoensis and M. crinifrons. The phylogenetic tree of muntjac species (16s rRNA gene) shows the main two clusters, the one including M. putaoensis, M. truongsonensis, M. rooseveltorum, and M. muntjak, and the second one including M. crinifrons and M. vuquangensis. The M. reevesi exists separately in the phylogenetic tree. The phylogenetic tree of muntjac species using cytochrome b genes shows that the M. muntjak and M. truongsonensis are clustered in the same group.

Major threats and habitat use status of Demoiselle crane (Anthropoides virgo), in district Bannu, Pakistan

Cranes are the large and attractive Creatures of nature with long necks, legs, and life-span. Adults of both sexes are the same with similar color patterns. Demoiselle cranes spend most of their lifespan on dry grasses. They are also found around the stream, rivers, shallow lakes, natural wetlands, and depressions. To evaluate the current status of habitat use and major threats a study was conducted in tehsil Domel district Bannu. Line transect method and water quality tests (temperature, PH, contamination of E-coli bacteria) were used. To determine the major threats questionnaire method was used. The whole data was analyzed by using SPSS 21 version. Based on the distribution four study sites were selected and four water samples from each study site were taken. Most sites were moderate to highly degraded except Kashoo and kurram river mixing point which was low degraded with livestock grazing and human activities. Water quality tests showed PH ranges from 7-9, temperature 6.5-8.5, and contamination of E-coli in all samples. The social survey revealed that hunting, habitat degradation, and pollution as major threats. Effective long-term conservation and management in the study area are needed to focus on the protection of disturbance-free habitat.

Identification and crop damage assessment of indian crested porcupine (Hystrix indica) in selected zones of Abbottabad, Pakistan

Indian crested porcupine is the largest rodent pest that damages a wide variety of crops, vegetables, and tree species which ultimately causes huge economic loss in Pakistan, which is an agricultural country. It prefers to live in hilly terrain but common in temperate and tropical forests, shrublands, and grasslands. This study focused on the identification and assessment of crops damaged along with the main precautionary measures used by the local farmers. The data was collected from twenty-four villages of two union councils i.e. Chamhad and Slahad of district Abbottabad. Two types of data (primary and secondary) were collected from the study area. Primary data was collected for identification and estimation calculation of total crop damaged through direct field observation by taking random quadrates in each village of the study area. The damage in the crop was assessed by randomly selecting a quadrate of 1x1 m2 for the wheat, pearl millet, and Sorghum fields. While 4x4 m2 quadrates were taken for maize and vegetables. At least three quadrate samples were taken from each field including one quadrate taken from the center of the field area. In union council Chamhad, damage to maize (11.31%) and wheat (0.73%) by the Indian crested porcupine while in union council Salhad, damage of maize (6.95%) and wheat (1.6%) was observed. In the entire study area, overall damage to maize crop (8.01%) and wheat (0.88%) was calculated. Based on information obtained from the farmers, the Indian porcupine inflicted damage to potato, tomato, cauliflower, chili pepper, turnip, radish, pea, and onion, etc. Secondary data obtained through a questionnaire survey to explore the human porcupine conflict and precautionary measures used by the farmers and landowners. Open and close-ended questionnaires (159) highlighted the presence of Indian crested porcupine in the study area and 96% of the respondents have seen porcupine directly. Many types of precautionary measures were used by the farmers such as fencing, night stay, night firing, and dogs to decrease the crop damage, respondents (63.91%) use guns for hunting. however, due to the largely agricultural area and nocturnal behavior of Indian crested porcupine majority of the respondents (51.57%) did not use any precautionary measure. Biological control of Indian porcupine is recommended in the study area. Farmers should be encouraged and provide incentives and killing through current should be banned while proper hunting license should be issued to overcome overhunting. Scientific studies are required to control the reproduction of porcupine specifically in the more damaged areas.

Seasonal distribution and habitat use preference of Barking deer (Muntiacus vaginalis) in Murree-Kotli Sattian-Kahuta National Park, Punjab Pakistan

Microhabitat factors associated with the habitat of barking deer (Muntiacus vaginalis) were examined and compared between summer and winter seasons. Habitat characteristics and preferred habitat were measured by locating direct and indirect signs. To quantify the habitat utilization of barking deer, each selected study site was sampled for floral diversity from 2015 to 2017. Quadrats were deployed along transect lines to determine seasonal distribution. Barking deer were not evenly distributed across vegetation types in the study area; they occurred more often in the broad-leaved forest than in Chir pine forest, at an elevational range of 550-850 m, in thick vegetation on steep slopes. The most preferred habitat included trees and shrubs with 30% and 69% cover, respectively. Barking deer avoided thicker tree cover, possibly as it hinders movement and escape from predators. No significant difference (χ2 = 6.37, df = 3, p = 0.19) in seasonal vegetation cover was recorded.

Estimating The Possible Role Of Testing Capacity And Social Distancing In Predicting The Growth Rate Of Daily Covid-19 Cases

BACKGROUND

The purpose of this study was to estimate the effect of social distancing (days since the imposition of a lock-down) and the number of daily tests conducted per million population on the daily growth rate of COVID-19 cases.

METHODS

After excluding the first 30 days since the announcement of an index case in a country, relevant data for the next forty days was collected from four countries: Belgium, Italy, South Korea and United Kingdom. Two online databases: Our World in Data and worldometer were used for the collection of data which included the number of new COVID-19 cases and the number of tests conducted on a given day. The acquired figures were transformed into per million population of the given country. The growth rate of daily COVID-19 cases was derived and was used as the regress and in a multiple linear regression with the number of tests per million population per day and the number of days since a lock-down was imposed as the regressors.

RESULTS

It was found that the growth rate of daily COVID-19 cases decreased by .051% when the number of daily tests conducted per million population increased by 1. A .532% decrease in the growth rate of daily COVID-19 cases was observed with each passing day of a lock-down, which essentially represented the most effective form of social distancing. A significant regression was calculated (F (2, 155) = 35.191, p=.014), with an R2 of .054. Neither the daily number of tests conducted per million population nor the number of days of maintaining social distancing (lock-down) was individually significant contributors to the prediction of the growth rate of daily COVID-19 cases (p=.267 and p=.554 respectively).

CONCLUSION

An extensive and rapid increase in the daily number of testing capacity and maintaining social distancing can decrease the growth rate of daily COVID-19 cases. Depending on the availability of the required resources, timely implementation of these measures can lead to better outcomes for a given population.

51 Working Collaboratively: Geriatrician Input in Older Patients Undergoing Emergency Laparotomy Reduces Overall Length of Stay - A Complete Audit Loop

Background

Great Western Hospital is a busy district general hospital with a catchment population of 340,000. Target population of this study was elderly patients aged &gt;70 undergoing Emergency Laparotomy (EL).

Introduction

Approximately 8% of the population is aged over 75 years and operations in this patient group account for 23% of all surgical procedures. The 2010 National Confidential Enquiry into Patient Outcome and Death report “An Age Old Problem”, suggested routine daily input from Geriatrics should be available to elderly patients undergoing surgery.

This study focuses at the impact of Geriatrician input for EL patients with primary outcome of reduction in Length of Stay (LoS).

Methods

The service was designed with allocation of 4 hours per week of Consultant Geriatrician and 2.5 days per week of a Clinical Innovation Fellow (CIF) time. The existing team of surgical junior doctors, nursing and allied health professionals carried out plans suggested by the geriatrician.

Retrospective data (Prior to service initiation) for the emergency laparotomy patients &gt;70 years, was collected from December 2015-May 2016.

Prospective data collected from February 2018 – July 2018 for EL patients aged &gt; 70, patients with inpatient stay &gt; 7 days, patients with delirium/ inpatient falls.

Length of stay and Inpatient mortality were compared between the two cohorts.

Intervention

Prior to the establishment of this service the medical support was provided on ad-hoc basis. Funding was obtained from local postgraduate medical education for CIF and twice weekly consultant led ward rounds were carried out.

Patients were recruited from hospital database and from a referrals book kept at surgical ward.

Results

45 patients were included in prospective study and Mean LoS was 17.8 days, which was reduced from 22.5 days prior to Geriatrician involvement (N=56).

Average 4.7 days per patient were saved.

IP mortality was 8.8% (2/4 deaths were palliative resections) after geriatrician input compared to 8.9% previously.

6.6% of patients had a new medical diagnosis, 24.4% patients were followed up in prospective cohort.

Conclusions

This study suggests the regular geriatrician input reduces the inpatient LoS. A day stay at surgical ward costs roughly £250, for 45 patients in last six months it saved approximately £52,875.

Crosstalk of Zn in Combination with Other Fertilizers Underpins Interactive Effects and Induces Resistance in Tomato Plant against Early Blight Disease

The present study was undertaken to evaluate the integrated effect of zinc (Zn) with other nutrients in managing early blight (EB) disease in tomato. A pot experiment was carried out with basal application of the recommended level of macronutrients [nitrogen, phosphorus and potassium (NPK)] and micronutrients [magnesium (Mg) and boron (B)] in bilateral combination with Zn (2.5 and 5.0 mg/kg) in a completely randomized deigned in replicates. Results revealed that interactive effect of Zn with Mg or B was often futile and in some cases synergistic. Zn with NPK yield synergistic outcome, therefore EB disease was managed significantly (disease incidence: 25% and percent severity index: 13%), which resulted in an efficient signaling network that reciprocally controls nutrient acquisition and uses with improved growth and development in a tomato plant. Thus, crosstalk and convergence of mechanisms in metabolic pathways resulted in induction of resistance in tomato plant against a pathogen which significantly improved photosynthetic pigment, total phenolics, total protein content and defense-related enzymes [superoxide dismutase (SOD), catalase (CAT), peroxidase (POX), polyphenol oxidase (PPO) and phenylalanine ammonia-lyase (PAL)]. The tremendous increase in total phenolics and PAL activity suggesting their additive effect on salicylic acid which may help the plant to systemically induce resistance against pathogen attack. It was concluded that interactive effect of Zn (5.0 mg/kg) with NPK significantly managed EB disease and showed positive effect on growth, physiological and biochemical attributes therefor use of Zn + NPK is simple and credible efforts to combat Alternaria stress in tomato plants.

Influence of salinity and Fusarium oxysporum as the stress factors on morpho-physiological and yield attributes in onion

Occurrence of salt stress with the soil borne fungus Fusarium oxysporum f. sp. cepa (FOC) are potential threat to the crop yield. This investigation reports effect of the concurrent stresses (salinity and FOC) on morpho-physiological and yield attributes in onion. In vitro growth tests revealed proliferation of FOC biomass at different levels of salinity (2-8 dS m-1). A greenhouse pot experiment with the proposed levels of salinity (2.5, 3.5 and 4.5 dS m-1) in combination with FOC inoculation showed more drastic effect of combined stress on disease severity, plant growth and bulb as compared to the individual stress. In general, osmotic potential, total chlorophyll content, membrane stability index and total protein content of the leaf were decreased, while total phenolics were increased due to the given stress/s. Total sugar content decreased due to effect of the  individual stress of FOC, while it increased under the individual stress of salinity and in combination with FOC. FOC infection did not change activity of polyphenol oxidase (PPO), while it improved peroxidase (POX) and phenylalanine ammonia lyase (PAL) and decreased catalase (CAT) activity. Activities of POX and PPO increased, however PAL and CAT declined under individual as well as simultaneous stress of salinity  and  FOC. The research work concluded that FOC will be a more severe disease threat for onion cultivation in saline soils.

Loss of flexion during bronchoscopy: a physical experiment and case study of commercially available systems

During routine endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedures, especially with biopsy of lymph nodes in or around the left upper lobe, frequent reports have noted the loss of ultrasound image and needle angulation leading to an inability to biopsy nodes visualised by EBUS. The aim of this research was to investigate and compare this loss of angulation with commercially available scopes. Bench-top experiments and a clinical case study demonstrated the varying loss of scope angulation, flexibility and manoeuvrability with different scopes and biopsy instruments leading to procedural implications. Improvements in both the EBUS scope and needle characteristics are required to overcome this limitation which has implications in bronchoscope navigation and the diagnostic yield of EBUS-TBNA.

Predicting Neonatal Hyperbilirubinemia Using First Day Serum Bilirubin Level in Late Preterm and Term Healthy Newborn

Hyperbilirubinemia is a common problem during the neonatal period and is the most common reason for readmission after early hospital discharge of the healthy near term and term infants. This early discharge policy along with limited follow-up facilities in developing countries and inadequate communication between physicians and parents necessitates a prognostic test to predict hyperbilirubinemia in these newborns; for early and effective management and prevention of potential complication before it occurred. This observational analytical study was done to determine the predictability of day1 total serum bilirubin (TSB) level as a screening test and identify the best cutoff value which would predict neonates likely to develop significant hyperbilirubinemia. The study was carried out in the Department of Neonatology and Department of Gynecology and Obstetrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from 1st April 2013 to 31st March 2014. A TSB level of ≥17mg/dl after 72 hours was defined as significant hyperbilirubinemia. By purposive sampling method, 100 healthy late preterm and term neonates fulfilling the inclusion criteria were enrolled and 89 were finally analyzed. Among 89 neonates 14(15.74%) developed significant hyperbilirubinemia (Group II) and 75(84.26%) did not develop hyperbilirubinemia (Group I). Mean time of sample collection was similar in both groups. Mean TSB level on day1 was significantly higher in Group II (5.97±1.74mg/dl) than Group I (3.19±1.4mg/dl). By using ROC (Receiver Operating Characteristic) analysis, TSB level of 5.65mg/dl on day 1 has the best combination of sensitivity (86%) and specificity (91%) to predict neonates at risk of significant hyperbilirubinemia (AUC-0.880, p=0.001). At this cut-off PPV was 63% and NPV 97%. Total serum bilirubin level on first day of life predicts neonates at risk of subsequent significant hyperbilirubinemia and late preterm and term babies with TSB level of ≥5.65mg/dl on day 1 of life should be followed up strictly either in the hospital or in the outpatient department on day 5.

Comparison of Serum Bilirubin with Transcutaneous Bilirubinometry in Late Preterm and Term Newborn

Neonatal jaundice or hyperbilirubinemia is a common occurrence in newborns. It can progress to develop kernicterus unless intervention is initiated. Severity and decision for management are usually based on serum bilirubin which needs blood sampling. Transcutaneous bilirubin measurement is a noninvasive technique and correlates closely with serum bilirubin. This Cross sectional study was done in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University from March 2013 to August 2014 to evaluate the transcutaneous bilirubin in comparison to serum bilirubin. Total 160 infants with ≥35 weeks were purposively included over a period of 16 months. Neonates with less than 35 weeks, previously exposed to phototherapy, serious illness which leads to impaired circulation, who have had exchange transfusion, having major congenital malformation were excluded. Transcutaneous bilirubin measurement was performed within 30 minutes of obtaining sample for total serum bilirubin measurements. Of the enrolled infants, mean birth weight was 2631±520 grams, postnatal age was 4.99±3.02 days ranging from 2 to 25 days and mean transcutaneous bilirubin and serum bilirubin value was 14.59±2.55 and 13.62±2.86mg/dl respectively. Mean difference of transcutaneous bilirubin and serum bilirubin was 0.97±1.01mg/dl. In the total enrolled infant, transcutaneous bilirubin and serum bilirubin values showed significant correlation (r = 0.93, r2 = 0.876, p<0.001) and this was not affected by sex, gestational age, postnatal age, and birth weight. The area under ROC curve for transcutaneous bilirubin was 87% (p value <0.001). If the cut off value of transcutaneous bilirubin was set at 15 mg/dl, then a sensitivity of 77%, specificity of 88% and accuracy of 82% were obtained. Use of transcutaneous bilirubin can reduce need for serum bilirubin in assaying neonatal jaundice; as it showed significantly high correlation with serum bilirubin. Predictive accuracy of transcutaneous bilirubin was found to be statistically significant in comparison to serum bilirubin.

Evaluation of Endoscopically Deployed Radiopaque Tumor Models in Bronchoscopy

BACKGROUND

Radiopaque markers and soft tissue models have been used extensively in clinical applications to target cancerous lesions and to calibrate and characterize imaging systems. However, the development of radiopaque, soft tissue models for pulmonary lesions is yet to be optimized. Such a material may improve endoscopic training techniques and also be useful to evaluate bronchoscopy navigation systems by the targeting and sampling of tumor models with computed tomography.

METHODS

This study investigates a modified agarose-based model and a novel contrast-infused tripe model to create clinically relevant pulmonary tumor models. An iodine-enhanced agarose model presents an injectable solution with high image contrast under computed tomography capable of reaching distal bronchial airways. The tripe solution presents a cheap and easily deployed method to quickly establish a fiducial marker that may be used during bronchial imaging system training and evaluation.

RESULTS

The iodine-enriched agarose model demonstrates desirable mechanical characteristics ex vivo, but has a number of limitations when administered in a live setting. The tripe solution presents a far more effective in vivo pulmonary tumor model and offers an effective radiopaque marker. However, the size of the tripe tumor samples required for effective insertion limits its ability to reach more distal airways. An iterative testing process was used to optimize the model composition, culminating in live animal investigations (n=3).

CONCLUSION

Both contrast-infused agarose and tripe models present a promising analog to a pulmonary lesion and may act as a radiopaque marker for bronchoscopic training and biopsy evaluation.

Navigational Bronchoscopy for Early Lung Cancer: A Road to Therapy

Peripheral lung nodules remain challenging for accurate localization and diagnosis. Once identified, there are many strategies for diagnosis with heterogeneous risk benefit analysis. Traditional strategies such as conventional bronchoscopy have poor performance in locating and acquiring the required tissue. Similarly, while computerized-assisted transthoracic needle biopsy is currently the favored diagnostic procedure, it is associated with complications such as pneumothorax and hemorrhage. Video-assisted thoracoscopic and open surgical biopsies are invasive, require general anesthesia and are therefore not a first-line approach. New techniques such as ultrathin bronchoscopy and image-based guidance technologies are evolving to improve the diagnosis of peripheral lung lesions. Virtual bronchoscopy and electromagnetic navigation systems are novel technologies based on assisted-computerized tomography images that guide the bronchoscopist toward the target peripheral lesion. This article provides a comprehensive review of these emerging technologies.

Salt Losing Variety of Congenital Adrenal Hyperplasia--A Case Report

Congenital adrenal hyperplasia is a genetic endocrinologic disorder. The severe classic form occurs in one in 15,000 births worldwide. Twenty-one-hydroxylase deficiency (21-OHD) is the most common cause in this autosomal recessive disease. It can cause virilization, ambiguous genitalia at birth and severe life threatening condition due to salt wasting. In this report we describe the clinical course of a male neonate presenting with lethargy, failure to thrive (FTT), genital pigmentation, electrolytes imbalance and high serum 17-hydroxy-progesterone (17-OHP) level and subsequently diagnosed as Congenital Adrenal Hyperplasia. After the initial crises management, the child was continued on replacement therapy. During the follow up, he was found to grow appropriately and achieving normal milestones for age.

Economic costs associated with moderate and late preterm birth: a prospective population-based study

OBJECTIVE

We sought to determine the economic costs associated with moderate and late preterm birth.

DESIGN

An economic study was nested within a prospective cohort study.

SAMPLE

Infants born between 32(+0) and 36(+6)  weeks of gestation in the East Midlands of England. A sample of infants born at ≥37 weeks of gestation acted as controls.

METHODS

Data on resource use, estimated from a National Health Service (NHS) and personal social services perspective, and separately from a societal perspective, were collected between birth and 24 months corrected age (or death), and valued in pounds sterling, at 2010-11 prices. Descriptive statistics and multivariable analyses were used to estimate the relationship between gestational age at birth and economic costs.

MAIN OUTCOME MEASURES

Cumulative resource use and economic costs over the first two years of life.

RESULTS

Of all eligible births, 1146 (83%) preterm and 1258 (79%) term infants were recruited. Mean (standard error) total societal costs from birth to 24 months were £12 037 (£1114) and £5823 (£1232) for children born moderately preterm (32(+0) -33(+6)  weeks of gestation) and late preterm (34(+0) -36(+6)  weeks of gestation), respectively, compared with £2056 (£132) for children born at term. The mean societal cost difference between moderate and late preterm and term infants was £4657 (bootstrap 95% confidence interval, 95% CI £2513-6803; P < 0.001). Multivariable regressions revealed that, after controlling for clinical and sociodemographic characteristics, moderate and late preterm birth increased societal costs by £7583 (£874) and £1963 (£337), respectively, compared with birth at full term.

CONCLUSIONS

Moderate and late preterm birth is associated with significantly increased economic costs over the first 2 years of life. Our economic estimates can be used to inform budgetary and service planning by clinical decision-makers, and economic evaluations of interventions aimed at preventing moderate and late preterm birth or alleviating its adverse consequences.

TWEETABLE ABSTRACT

Moderate and late preterm birth is associated with increased economic costs over the first 2 years of life.

Blockade of BFA-mediated apoptosis in macrophages by the HIV-1 Nef protein

HIV-1 Nef protein has key roles at almost all stages of the viral life cycle. We assessed the role of Nef and of the translation elongation factor eEF1A in primary human macrophages. Nuclear retention experiments and inhibition of the exportin-t (Exp-t) pathway suggested that cytoplasmic relocalization of eEF1A, mediated by Exp-t occurs in Nef-treated monocyte-derived macrophages (MDMs). We observed the presence of tRNA in the Nef/eEF1A complexes. Nucleocytoplasmic relocalization of the Nef/eEF1A complexes prevented stress-induced apoptosis of MDMs treated with brefeldin A. Blockade of stress-induced apoptosis of MDMs treated with HIV-1 Nef resulted from enhanced nucleocytoplasmic transport of eEF1A with decreased release of mitochondrial cytochrome c, and from increased tRNA binding to cytochrome c, ultimately leading to an inhibition of caspase activation. Our results indicate that HIV-1 Nef, through the nucleocytoplasmic relocalization of eEF1A and tRNAs, enhances resistance to stress-induced apoptosis in primary human macrophages.

Evaluation of a novel tracking system in a breathing lung model

We present the evaluation of an electromagnetic position tracking system for use with virtual bronchoscopy systems. Our system utilises a planar magnetic coil array and commercially available search coil sensors. Experimental results show the EM tracking accuracy to be in the range of 11.5mm, which is comparable to both commercial and research systems. The use of a bench-top breathing lung model is used to verify system operation in the in vitro setting. A novel fiducial-free registration method is implemented to reduce errors resulting from inaccurate landmark identification commonly associated with point-based registration. After registration, there is good agreement between the measured position of the sensor probe during endoscopic navigation and the lung airways as visualised in a 3D model of the phantom.

Fasciolopsiasis in a five year old girl

A 5 year old girl hailing from Keraniganj, presented with the complaints of fever, periumbilical pain and vomiting. In vomitus, Fasciolopsis buski worm in adult form was identified by naked eye examination. In stool, ova of Fasciolopsis buski were also observed under microscope. Clinically she was pale and had hepatomegaly. Microcytic hypochromic anaemia with normal liver function test was found on lab investigation. She was diagnosed as a case of Fasciolopsiasis and treated with Praziquantel and on follow up visit she was found to be free of symptom.

Bilateral micronodular pulmonary infiltrate: is it important to make a histological diagnosis?

Pulmonary alveolar microlithiasis is a rare disease characterized by the deposition of calcium phosphate within the alveoli. We report the case of a 20-year-old man with a 6-week history of cough and shortness of breath on exertion. The chest radiograph demonstrated a bilateral symmetrical micronodular pattern. High-resolution computed tomography revealed bilateral diffuse fine nodular shadowing involving the mid zones, with sparing of the apices. The patient underwent a transbronchial lung biopsy, which confirmed the diagnosis of pulmonary alveolar microlithiasis.

Inhibition of ER stress-mediated apoptosis in macrophages by nuclear-cytoplasmic relocalization of eEF1A by the HIV-1 Nef protein

HIV-1 Nef protein has key roles at almost all stages of the viral life cycle. We assessed the role of the Nef/eEF1A (eukaryotic translation elongation factor 1-alpha) complex in nucleocytoplasmic shuttling in primary human macrophages. Nuclear retention experiments and inhibition of the exportin-t (Exp-t) pathway suggested that cytoplasmic relocalization of eEF1A, mediated by Exp-t, occurs in Nef-treated monocyte-derived macrophages (MDMs). We observed the presence of tRNA in the Nef/eEF1A complexes. Nucleocytoplasmic relocalization of the Nef/eEF1A complexes prevented stress-induced apoptosis of MDMs treated with brefeldin-A. Blockade of stress-induced apoptosis of MDMs treated with HIV-1 Nef resulted from enhanced nucleocytoplasmic transport of eEF1A with decreased release of mitochondrial cytochrome c, and from increased tRNA binding to cytochrome c, ultimately leading to an inhibition of caspase activation. Our results indicate that HIV-1 Nef, through the nucleocytoplasmic relocalization of eEF1A and tRNAs, enhances resistance to stress-induced apoptosis in primary human macrophages.

The use of computerised tomography guided percutaneous fine needle aspiration in the evaluation of solitary pulmonary nodules

The evaluation of a solitary pulmonary nodule (SPN) has changed over the years with increased access to percutaneous computerised tomography (CT) guided fine needle aspiration (FNA), where bronchoscopy is unhelpful. The aim of our study was to evaluate the sample adequacy, diagnostic and complication rate of CT-FNA of a SPN at our academic teaching hospital over an 18 month period. CT-FNA was performed by a radiologist, with a cytopathologist in attendance to confirm the adequacy of the sample obtained. The size of the nodule, sample material and adequacy, diagnosis and complications were recorded. A total of 101 patients were included, 54 male and the mean age was 68 +/- 11 years. The mean size of the SPN was 2.3 cm (range 1-11 cm). 56 (56%) patients had a right SPN, 45 (45%) had a left SPN. CT-FNA was diagnostic in 80 (80%) patients and non-diagnostic in 21 (20%) patients. The sample was insufficient for immunocytochemistry, although the morphological appearance was diagnostic in 20 (25%) of the 80 patients. Pneumothorax occurred in 26/101 (26%) patients post CT-FNA, of these 7 (27%) required chest drain insertion, while 19 (73%) were managed conservatively. CT FNA is a useful tool for the diagnosis of a SPN, with our diagnostic accuracy comparable to that reported in the literature. However, CT-FNA may not provide adequate sample volume to perform ancillary testing and has a moderate complication rate.

Sharp dissection of the Weiss ring to induce a posterior vitreous detachment

Removal of the posterior hyaloid is an important aspect of pars plana vitrectomy surgery in cases including but not limited to macular holes. A surgical technique is described in which the Weiss ring can be easily detached from the optic nerve with little to no trauma.

Oyster mushroom reduced blood glucose and cholesterol in diabetic subjects

It has been postulated that mushroom has beneficial effect of lowering blood glucose and cholesterol in diabetic subjects. The literature so far searched and found that there was no published data in this regard. This study was undertaken to assess the effect of reducing blood glucose, cholesterol and triglycerides in diabetic patients. Additionally, this study addressed whether there was any hepatic and renal toxicity of mushroom. This clinical investigation was conducted in BIRDEM hospital from July 2005 to January 2006. Eighty-nine subjects were recruited. Baseline investigations included height, weight, blood pressure (SBP, DBP), plasma glucose for fasting (FPG) and 2-h after-breakfast (2hPG), total cholesterol (T-chol), triglycerides (TG) and high-density lipoprotein (HDL-c). Twenty- four days' study constitutes 7-days mushroom, 7-days no mushroom and then 7-days mushroom. Investigations were done at the start and each after every 7-days. Thirty subjects (M / F = 17 / 13) followed to ensure full compliance with the designed protocol for 24 days. The mean (SD) age of the participants was 46.3 (10) years. Mushroom significantly reduced systolic and diastolic blood pressure (SBP, p<0.01; DBP, p<0.05). It also lowered both plasma glucose significantly (FPG & 2-hPG, p<0.001). Mushroom also lowered total cholesterol and TG significantly; whereas, there was no significant change in weight and HDL-c. When mushroom was withdrawn, there were significant increases of DBP, FPG, 2hPG, T-cholesterol and TG, whereas, no significant change was observed in weight, SBP and HDL-c. Restarting mushroom there was again significant reduction of blood glucose, TG and cholesterol. We conclude that mushroom significantly reduced blood glucose, blood pressure, TG and cholesterol of diabetic subjects without any deleterious effect on liver and kidney. The effect of mushroom may be investigated in a large sample for a longer duration to evaluate its efficacy and toxicity.

Viral anti-inflammatory reagents: the potential for treatment of arthritic and vasculitic disorders

Inflammatory and immune responses are inherent in the development of progressive arthritic or vasculitic disorders. Arthritis is frequently associated with accelerated forms of vasculitis; atherosclerosis being one form of accelerated vasculitis that blocks blood flow causing heart attacks and strokes. The arterial supply is central to maintaining normal articular function and acts as a conduit for inflammatory (innate) and immune (antigen dependent) cell trafficking in joints. The vasculature in some cases can become inflamed in the disease process. While treatment of severely debilitating arthritic disorders has improved, some current treatments are limited to reducing symptoms while others act as disease modifying drugs (DMARDs), but may have limited success. Many current treatments also have reported adverse side effects. Vasculitic disorders are similarly debilitating with high associated morbidity and mortality and current therapy for these disorders is only partially successful. Immune-modifying agents, which alter vascular inflammation, thus have potential for application in rheumatologic diseases. Viral immune modulating proteins reduce early arterial inflammatory responses with associated reductions in atherosclerotic plaque development and transplant rejection in a wide range of animal models. A clinical trial utilizing one such viral reagent, a secreted myxomaviral serpin, is currently in progress, assessing treatment of acute coronary syndrome, a vascular syndrome with marked up-regulation of systemic inflammatory responses. In this review we examine viral anti-inflammatory proteins as potential therapeutic reagents for arthritic and vasculopathic disorders.

Spinal cord stimulation modulates intraspinal colorectal visceroreceptive transmission in rats

Previous studies have shown that spinal cord stimulation (SCS) of upper lumbar segments decreases visceromotor responses to mechanical stimuli in a sensitized rat colon and reduces symptoms of irritable bowel syndrome in patients. SCS applied to the upper cervical spinal dorsal column reduces pain of chronic refractory angina. Further, chemical stimulation of C1-C2 propriospinal neurons in rats modulates the responses of lumbosacral spinal neurons to colorectal distension. The present study was designed to compare the effects of upper cervical and lumbar SCS on activity of lumbosacral neurons receiving noxious colorectal input. Extracellular potentials of L6-S2 spinal neurons were recorded in pentobarbital anesthetized, paralyzed and ventilated male rats. SCS (50 Hz, 0.2 ms) at low intensity (90% of motor threshold) was applied to the dorsal column of upper cervical (C1-C2) or upper lumbar (L2-L3) ipsilateral spinal segments. Colorectal distension (CRD, 20 mmHg, 40 mmHg, 60 mmHg, 20s) was produced by air inflation of a latex balloon. Results showed that SCS applied to L2-L3 and C1-C2 segments significantly reduced the excitatory responses to noxious CRD from 417.6+/-68.0 to 296.3+/-53.6 imp (P<0.05, n=24) and from 336.2+/-64.5 to 225.0+/-73.3 imp (P<0.05, n=18), respectively. Effects of L2-L3 and C1-C2 SCS lasted 10.2+/-1.9 and 8.0+/-0.9 min after offset of CRD. Effects of SCS were observed on spinal neurons with either high or low-threshold excitatory responses to CRD. However, L2-L3 or C1-C2 SCS did not significantly affect inhibitory neuronal responses to CRD. C1-C2 SCS-induced effects were abolished by cutting the C7-C8 dorsal column but not by spinal transection at cervicomedullary junction. These data demonstrated that upper cervical or lumbar SCS modulated responses of lumbosacral spinal neurons to noxious mechanical stimulation of the colon, thereby, proved two loci for a potential therapeutic effect of SCS in patients with irritable bowel syndrome and other colonic disorders.

Cellular automata and its advances to drug therapy for HIV infection

This paper gives an over view of the use of cellular automata (CA) model of drug therapy for HIV infection. Nonuniform CA is employed to simulate drug treatment of HIV infection, where each computational domain may contain different CA rules, in contrast to normal uniform CA models. Ordinary (or partial) differential equation models are insufficient to describe the two extreme time scales involved in HIV infection (days and decades), as well as the implicit spatial heterogeneity. Zorzenon and Coutinho [Phy Rev Lett, 16 (2001) 1] reported a cellular automata approach to simulate three-phase patterns of human immunodeficiency virus (HIV) infection consisting of primary response, clinical latency and onset of acquired immunodeficiency syndrome (AIDS). But here we present a related model, based on non-uniform CA to study the dynamics of drug therapy of HIV infection. The main aim in this model is to simulate the four phases (acute, chronic, drug treatment responds and onset of AIDS). The results shown here indicate that both simulations (with and without treatments) evolve to the relatively same steady state (characteristics of Wolfram's class II behavior). Different kinds of drug therapies can also be simulated in this model, which can be found useful for developing a proper drug therapy.

Surface-reconstruction-switched adsorbate photofragmentation dynamics

Energy-resolved angular distributions of neutral fragments ejected during photoinduced electron transfer reaction of CH3Br on GaAs(100) exhibit three distinct methyl-radical ejection channels. These undergo marked changes when the termination is switched from the Ga-rich c(8 x 2) to the As-rich c(2 x 8). Our observations are consistent with a strong adsorption-site dependence of the dynamics.

Hepatitis B vaccination among health care workers and students of a medical college

OBJECTIVE

To study the vaccination status against Hepatitis B among health care workers and students of a medical school.

MATERIALS AND METHODS

It is a descriptive study done at Allama Iqbal Medical College, Lahore. The participants comprised of 206 health care workers of various categories and 327 medical students. The main outcome measure was vaccination status and reasons for non-vaccination.

RESULTS

Only 49% health care workers and 42.20% medical students were vaccinated. The main reasons for non-vaccination (47.7%) among health care workers was the high cost of vaccination, while the most often cited reason (33.7%) among medical student was the belief that they were not at risk. This belief was also prevalent among nurses (36.4%), laboratory workers (38.6%) and paramedics (33.2%).

CONCLUSION

In a low-income country like Pakistan the health institutions should bear the cost for vaccinating their staff. Efforts should also be made to impart appropriate health education regarding hepatitis B infection.

Pulmonary function profile in chronic congestive heart failure and the effect of ipratropium bromide

Twenty-five symptomatic patients of chronic heart failure were subjected to spirometry to detect abnormalities of pulmonary function and to assess the effect of ipratropium bromide in reversing or minimising these abnormalities. All the patients exhibited abnormal pulmonary function manifesting as obstructive (15/25) or restrictive (10/25) ventilatory defect. There was overall improvement in lung functions with ipratropium bromide especially in those with obstructive ventilatory defects and mostly comprised of smokers. Forced expiratory volume in one second increased by 47.7 percent (p < 0.02), forced expiratory volume in one second/forced vital capacity ratio by 14.1 percent (p < 0.001) and maximal voluntary ventilation by 40.6 percent (p < 0.05) in these patients. It is concluded that ipratropium bromide can prove as a promising adjunctive therapeutic intervention in improving quality of life in patients of chronic congestive heart failure who are incapacitated by dyspnoea and have clearly documented ventilatory defects.

Development and evaluation of a multiple-unit oral sustained release dosage form for S(+)-ibuprofen: preparation and release kinetics

Mini-matrix tablets containing S(+)-ibuprofen have been prepared by the wet granulation method. The hydrophilic matrix was formed with either xanthan gum, karaya gum or hydroxymethylcellulose (HPMC) together with a choice of additives from lactose, Encompress(R), Avicel(R) PH101, talc and Lubritab(R). Multiple unit dosage forms (MUDFs) were subsequently obtained by encapsulating the mini-matrix tablets into hard gelatin capsules. Preparation, in vitro release profiles and release kinetics are presented.