Studying biodiversity of spiders species in seven different localities of Charsadda District, Khyber Pakhtunkhwa, Pakistan

Abstract The current research work aims to provide knowledge about the diversity of spiders’ fauna and their occurrence throughout the year from District Charsadda Khyber Pakhtunkhwa, Pakistan. Research data were collected from March-2015 to January-2017 from seven different localities of Charsadda District by using the camera, bottle, plastic bags, paraffin films, field book and 70% of ethylene alcohol and 20% of glycerine were used as chemicals. By using special identification keys, spiders were differentiated into families, genera and species. During the study time, a total of 2734 specimens of spiders were collected belonging from 35 genera, 15 families and 44 species were identified. Salticidae was the dominant family according to genera studied plus spiders samples numbers collected with 10 genera and 616 species specimens count. The high occurrence of spiders was studied during July. The result of the current study also shows a reduction of spider’s species in December due to lowering the temperature. The current study shows that Salticidae were the dominant family as capered to other species. The occurrence of spiders species greatly depends on changing the weather condition. The present study also shows great fluctuation in spider’s occurrence with changing of hot climate to colder during the study duration. Moreover, the wet season plays a great role in spiders’ population increase and growth.

Identify Breast Cancer Risk Factors Using the Gail Assessment Model in Iraq

The prevalence of breast cancer (BC) has increased significantly in the last 50 years worldwide. This increase may be because more women today have mammograms and, as a result, are more known to have cancers. At the same time, the theory is growing that many other factors contribute to the increase in cancer rates. The current study tried applying the Gail assessment model to identify hormonal and familial risk factors that may be important for BC in Iraq. Patients aged 30 years and over with all known risk factors for BC were selected for the study group. The selected patients were divided into two groups. Group 1: Patients diagnosed with non-proliferative lesions who have had a breast biopsy performed at least three years before; Group 2: Controlled patients. The individual risk of BC for patients in groups 1 and 2 was calculated using the Gale model. In addition to groups 1 and 2, we identified two other groups. Group 3: Groups 1 and 2 of patients without BC at the end of the 3-year follow-up period; Group 4: Patients who have undergone BC surgery. Multiple regression tests assessed all known risk factors in groups 3 and 4 to determine the risk factors for the development of BC in Iraq. The results show that Gail's assessment model is a reliable example of calculating the risk of developing BC. The model results show that the significant risk factor for BC in Iraq is not hormonal but genetic or familial. Current research also shows that the risk of developing BC increases significantly with age. It was concluded that there are genetic factors, and the risk of developing BC increases with age, but hormonal features do not cause a significant increase in risk. Identifying risk factors in causing disease in the community makes it possible to prepare codified plans to control and treat the disease.

Effect of arginine supplementation on the production of milk fat in dairy cows

Arginine, one of the conditionally essential AA, has been reported to affect fat synthesis and metabolism in nonruminant animals by influencing adenosine monophosphate activated protein kinase (AMPK) in some organs. In dairy cows, the effect of Arg on milk fat production is not clear, and any potential mechanism that underlies the effect is unknown. We tested the hypothesis that Arg infusion would improve the production of milk fat, and explored possible mechanism that might underlie any effect. We used 6 healthy lactating cows at 20 ± 2 d in milk, in fourth parity, with a body weight of 508 ± 14 kg, body condition score of 3.0 ± 0, and a milk yield of 30.6 ± 1.8 kg/d (mean ± standard deviation). The cows were blocked by days in milk and milk yield and each cow received 3 treatments in a replicated 3 × 3 Latin square design, with each of the experimental periods lasting 7 d with a 14-d washout between each period. The treatments, delivered in random order, were (1) infusion of saline (control); (2) infusion of 0.216 mol/d of l-Arg in saline (Arg); (3) infusion of 0.868 mol/d of l-Ala in saline (the Arg and Ala treatments were iso-nitrogenous) through a jugular vein. On the last day of each experimental period, blood was sampled to measure insulin, nitric oxide, glucose, and nonesterified fatty acid, and the liver and mammary gland were biopsied to measure the expression of genes. Milk yield was recorded, and milk fat percentage was measured daily during each of the experimental periods. The yield and composition of fatty acid (FA) in milk was measured daily on the last 3 d during each of the experimental periods. The data were analyzed using a mixed model with treatment as a fixed factor, and cow, period, and block as random factors. The daily milk yield and milk fat yield when the cows were infused with Arg were 2.2 kg and 76 g, respectively, higher than that in control, and 1.8 kg and 111 g, respectively, higher than that in Ala. When the cows were infused with Arg they had higher concentration and yield of de novo synthesized FA, than when they received the control or Ala infusions, although milk fat percentage, daily feed intake, and the digestibility of nutrients were not affected by treatment. The serum concentration of nitric oxide and insulin were higher during Arg than during control or Ala, with no difference between control and Ala. In the liver, the expression of the genes coding for AMPK (PRKAA1, PRKAB1, and PRKAG1) and genes related to the oxidation of FA were higher during Arg than during control or Ala, whereas in the mammary gland the expression PRKAB1 was lowest, and the expression of genes involved in the synthesis of milk fat were highest, during Arg infusion. The results suggest the intravenous infusion of Arg enhanced the production of milk fat by promoting the de novo synthesis of FA and increasing milk yield.

Influence of Bioconvection and Thermal Radiation on MHD Williamson Nano Casson Fluid Flow with the Swimming of Gyrotactic Microorganisms Due to Porous Stretching Sheet

An analysis is performed for electrical MHD flow of Williamson Nano Casson fluid with heat transfer. The fluid is positioned toward a porous stretching sheet along with mass flux. The impact of chemical diffusion and nonlinear thermal Radiation are further discussed. A highly nonlinear partial differential equations presenting the Williamson Nano Casson fluid flow over permeable extending plate is transformed to ordinary differential equations through appropriate similarity transformation and solved them with a shooting method-using package ND-Solve on Mathematica. The ascendency of arising physical interpretation of thermo-physical parameter on energy field, highly concentration field and density field are perceived. The valuations are achieved graphically for numerous protuberant terms like non Newtonian Williamson parameter, bio convection, Peclet number, mixed convection Hartman number, Casson parameter, thermophoresis diffusion, bio convection Rayeigh number, Brownian motion and mixed convection terms. These diverse terms are applied on dimensionless velocity function, concentration function, temperature function and density of the motile microorganism and analyzed numerically in detail. It is detected that through rising the value of bio-convection and Peclet number, the microorganism field diminishing. Graphical diagrams are illustrating the consistency of the latest outcomes.

Snapshot of a Child and Adolescent Psychiatric ER during Pandemic

Introduction

The COVID-19 pandemic has disrupted numerous fundamental systems ranging from businesses to education system. The long-term consequences of the Pandemic, namely virtual learning and prolonged social isolation are coming to fruition in Child/Adolescent-Psychiatric Emergency-Rooms (CAP-ER). Discontinuity of in-person attendance of schools has poorly impacted the mental health of children and adolescents (C&A) of low-socioeconomic areas, who often rely on schools for meals, physical activity, and mental-health support. An increase in agitation, suicidal ideation, and a declining school performance has been observed in such situations.

Objectives

The primary objective of this study is to explore the increase in these symptoms as the presenting complaint in the psychiatric ER.

Methods

Between April to June 2021 a cross-sectional quality improvement (QI) study was done on children presenting to CAP-ER BronxCare-Hospital NY with psychiatric complaints. Concomitant substance use disorder was determined using CRAFT questionnaire.

Results

Our data comprised 209 patients (84 M/125 F) with 79 children and 130 adolescents. Ethnicity: 116 Hispanics (56%), 84 African Americans (40%), and 9 others. The most common presenting complaints were aggression (111, 53%), suicidal ideation/suicide attempt (50, 24%), acute exacerbation of chronic illness (7, 3.3%), accidental overdosage (5, 2.3%) and others (36, 17.4). Marijuana was the most used substance (34 patients).

Conclusions

There has been a surge in severity of presentation of psychiatric disorders among children and adolescents, aggression so far, the most prevalent. Further studies are needed to delineate the social links with this high emergent load and pandemic.

Disclosure

No significant relationships.

Psychotic-like Experiences during COVID-19 Outbreak: A survey from Pakistan

Introduction

Despite the fact that adolescents have been at higher risk of distress during the COVID-19 pandemic, the effect of pandemic on psychotic-like experiences (PLEs) is not well described.

Objectives

The study’s objective is to evaluate if PLEs are induced in young individuals aged 18-24 during the pandemic.

Methods

A total of 201 college students from Pakistan (ages 18-24) were recruited for a cross-sectional research. We investigated the incidence of PLEs in Pakistan during the pandemic, their links to socio-demographic factors, COVID-19-related characteristics, depression, anxiety, and sleep difficulties. Community Assessment of Psychic Experience’s positive symptom component (CAPE), Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and IBM SPSS 25 were used.

Results

CAPE-Frequency and CAPE-stress were positively associated with PHQ total (p<0.0010); GAD total (p<0.001); time spent indoors due to COVID-19 (p<0.001). Psychiatric disorder other than bipolar disorder or psychosis (p<0.001 for CAPE-frequency and stress), family history of psychiatric disorders (p<0.001 for CAPE-frequency and stress), chronic medical disease (p=0.021 CAPE-frequency and p=0.026 CAPE-stress), illegal drug usage (p<0.001 for CAPE-frequency and stress) were associated with CAPE-Frequency and CAPE-stress. In linear stepwise regression analysis, the best model predicted CAPE-Frequency explained 77.4% of variance with the following variables: PHQ total (B=0.552, SE= 0.08, t=6.909, p<0.001), GAD total (p<0.001), duration at home (p<0.001), and psychiatric disorder in family (p<0.001).

Conclusions

PLEs have been linked with anxiety and depression during the pandemic. Individuals with a mental condition, family history of psychiatric disorder, chronic medical illness, illicit drug use, and increased time spent at home experienced more PLEs and stress.

Disclosure

No significant relationships.

Stimulant induced Dermatological and Vascular Complications in patients with ADHD: A literature review

Introduction

Methylphenidate and amphetamine are the two most widely used stimulants in managing Attention Deficit Hyperactivity Disorder (ADHD)¹. Reynaud’s phenomenon (RP) is a reversible distal vasoconstriction presenting with various dermatological symptoms. RP can secondarily develop after certain medications as well².

Objectives

The review was undertaken to synthesize the incidence of RP within ADHD population treated with stimulants, and any causal relation of RP and stimulant-use.

Methods

PubMed, Psych-Info and Google Scholar were searched using these keywords: skin change, Raynaud, stimulants and methylphenidate. All relevant study types were included. Results were synthesized narratively.

Results

Initial search yielded 240 articles with 5 articles fulfilling our inclusion criteria. One was retrospective case-controlled study while remaining 4 were case reports. Six cases were identified with an age of 12-19 years, who presented with RP after being treated with methylphenidate-or-dextroamphetamine. In one case, multiple clinical signs of RP were seen with cold distal fingers, transient color changes and even frank ulceration^3–6. In two cases, it was seen that RP was dose-dependent with stimulant use and got resolved after decreasing the dosage respectively. In case-control study, 32 cases with RP and 32 controls were enrolled. The results showed a statistically significant association (χ² =5, p=0.01) between RP and past-or-current stimulant usage.⁷

Conclusions

The literature review suggests weak evidence of the association between RP and stimulant use but no evidence of any causal link. Further studies are needed to identify characters that can predict this adverse effect in vulnerable ADHD individuals.

Disclosure

No significant relationships.

Perceived Stress Among Students of Private and Public Sector Medical Colleges of Pakistan: A Cross Sectional Study

Introduction

Medical-education is associated with high overall stress and it is important to identify relevant factors.

Objectives

The study was aimed to discern the differences in perceived stress among the students of public and private medical colleges of Pakistan and to identify factors subservient to any hypothesized difference.

Methods

This cross-sectional study was conducted at different private and public medical colleges of Pakistan using validated tools: PSS-14 (Perceived Stress Scale) to find out the levels of stress faced by each sector and MSSQ (Medical Student Stressor Questionnaire) to determine the factors associated with increased stress.

Results

Total of 424 medical students from various public and private medical colleges of Pakistan (212 each) filled the questionnaires. The mean score +/- SD of PSS-14 was 36.17 ± 6.096 for the public sector and 36.29 ±5.732 for the private sector. Hence, there was no difference between the two comparative means of PSS score, t(422)=-0.213,p=0.831.The results for both sectors were classified as high perceived stress (27-40 score is high perceived stress). Out of 40 individual stress-causing factors in MSSQ, the students from private-sector scored higher as compared to public-sector: Quota System in examination t(422)=-3.951,p=0.000, stress caused by lack of time for friends and family t(422)=-3.225,p=0.001, stress caused by Tests/Examination t(422)=-2.131,p=0.034, stress caused by the parental wish for them to study medicine t(422)=-2.346,p=0.019 and stress caused by fear of getting poor marks t(422)=-2.183,p=0.030.

Conclusions

There exists no overall difference in the perceived-stress among the medical students of public and private medical colleges despite private-sectors having significantly more operational financial resources.

Disclosure

No significant relationships.

Does thrombolysis for pulmonary embolism reduce the risk of chronic complications?

We assessed the efficacy of thrombolysis in avoiding long-term complications. Notes of patients thrombolysed for PE in the 2-year period were reviewed. The initial CTPA and echocardiogram results before thrombolysis were compared to the results of follow up imaging repeated after 6 months. Twenty-two patients were thrombolysed for PE. 14 patients had sub-massive PE and 8 patients had massive PE. The right ventricle (RV) was dilated on pre-thrombolysis echocardiogram in 16 patients. On follow up echocardiography all patients with massive PE (6 studies) had a normal RV size, with pulmonary artery pressures (PAP) of 29mmHg. Follow up echocardiography of patients with submassive PE (13 studies) showed 11 patients with a normal RV, with PAP of 28 mmHg.

Spigelian Hernia: A Complication of Laparoscopic Cholecystectomy

Spigelian hernia is a rare abdominal wall hernia. It constitutes about 0.12% of all abdominal wall herniae; the peak occurrence being between the ages of 40-70 years with a male to female ratio of 1:1.18. Owing to the rarity of the disease, lack of physician experience and absence of typical hernia-like symptoms, it is a fairly difficult condition to diagnose. There is a 20% incidence of strangulation reported in the literature. The elective treatment of a Spigelian hernia is surgical: open or laparoscopic. The latter is preferred due to reduced mortality, shorter hospital stay, better cosmetic result and perhaps a lower recurrence rate. Reported here is a case of Spigelian hernia that presented to our institution, a level 1 trauma centre, as a complication of laparoscopic abdominal surgery.

Risk for surgical complications after previous stereotactic body radiotherapy of the spine

OBJECT

Stereotactic body radiotherapy (SBRT) for vertebral metastases has emerged as a promising technique, offering high rates of symptom relief and local control combined with low risk of toxicity. Nonetheless, local failure or vertebral instability may occur after spine SBRT, generating the need for subsequent surgery in the irradiated region. This study evaluated whether there is an increased incidence of surgical complications in patients previously treated with SBRT at the index level.

METHODS

Based upon a retrospective international database of 704 cases treated with SBRT for vertebral metastases, 30 patients treated at 6 different institutions were identified who underwent surgery in a region previously treated with SBRT.

RESULTS

Thirty patients, median age 59 years (range 27-84 years) underwent SBRT for 32 vertebral metastases followed by surgery at the same vertebra. Median follow-up time from SBRT was 17 months. In 17 cases, conventional radiotherapy had been delivered prior to SBRT at a median dose of 30 Gy in median 10 fractions. SBRT was administered with a median prescription dose of 19.3 Gy (range 15-65 Gy) delivered in median 1 fraction (range 1-17) (median EQD2/10 = 44 Gy). The median time interval between SBRT and surgical salvage therapy was 6 months (range 1-39 months). Reasons for subsequent surgery were pain (n = 28), neurological deterioration (n = 15) or fracture of the vertebral body (n = 13). Open surgical decompression (n = 24) and/or stabilization (n = 18) were most frequently performed; Five patients (6 vertebrae) were treated without complications with vertebroplasty only. Increased fibrosis complicating the surgical procedure was explicitly stated in one surgical report. Two durotomies occurred which were closed during the operation, associated with a neurological deficit in one patient. Median blood loss was 500 ml, but five patients had a blood loss of more than 1 l during the procedure. Delayed wound healing was reported in two cases. One patient died within 30 days of the operation.

CONCLUSION

In this series of surgical interventions following spine SBRT, the overall complication rate was 19%, which appears comparable to primary surgery without previous SBRT. Prior spine SBRT does not appear to significantly increase the risk of intra- and post-surgical complications.

Treating tobacco dependence: guidance for primary care on life-saving interventions. Position statement of the IPCRG

Tobacco smoking is the world's leading cause of premature death and disability. Global targets to reduce premature deaths by 25% by 2025 will require a substantial increase in the number of smokers making a quit attempt, and a significant improvement in the success rates of those attempts in low, middle and high income countries. In many countries the only place where the majority of smokers can access support to quit is primary care. There is strong evidence of cost-effective interventions in primary care yet many opportunities to put these into practice are missed. This paper revises the approach proposed by the International Primary Care Respiratory Group published in 2008 in this journal to reflect important new evidence and the global variation in primary-care experience and knowledge of smoking cessation. Specific for primary care, that advocates for a holistic, bio-psycho-social approach to most problems, the starting point is to approach tobacco dependence as an eminently treatable condition. We offer a hierarchy of interventions depending on time and available resources. We present an equitable approach to behavioural and drug interventions. This includes an update to the evidence on behaviour change, gender difference, comparative information on numbers needed to treat, drug safety and availability of drugs, including the relatively cheap drug cytisine, and a summary of new approaches such as harm reduction. This paper also extends the guidance on special populations such as people with long-term conditions including tuberculosis, human immunodeficiency virus, cardiovascular disease and respiratory disease, pregnant women, children and adolescents, and people with serious mental illness. We use expert clinical opinion where the research evidence is insufficient or inconclusive. The paper describes trends in the use of waterpipes and cannabis smoking and offers guidance to primary-care clinicians on what to do faced with uncertain evidence. Throughout, it recognises that clinical decisions should be tailored to the individual's circumstances and attitudes and be influenced by the availability and affordability of drugs and specialist services. Finally it argues that the role of the International Primary Care Respiratory Group is to improve the confidence as well as the competence of primary care and, therefore, makes recommendations about clinical education and evaluation. We also advocate for an update to the WHO Model List of Essential Medicines to optimise each primary-care intervention. This International Primary Care Respiratory Group statement has been endorsed by the Member Organisations of World Organization of Family Doctors Europe.

Stochastic and Statistical Analysis of Utility Revenues and Weather Data Analysis for Consumer Demand Estimation in Smart Grids

In smart grid paradigm, the consumer demands are random and time-dependent, owning towards stochastic probabilities. The stochastically varying consumer demands have put the policy makers and supplying agencies in a demanding position for optimal generation management. The utility revenue functions are highly dependent on the consumer deterministic stochastic demand models. The sudden drifts in weather parameters effects the living standards of the consumers that in turn influence the power demands. Considering above, we analyzed stochastically and statistically the effect of random consumer demands on the fixed and variable revenues of the electrical utilities. Our work presented the Multi-Variate Gaussian Distribution Function (MVGDF) probabilistic model of the utility revenues with time-dependent consumer random demands. Moreover, the Gaussian probabilities outcome of the utility revenues is based on the varying consumer n demands data-pattern. Furthermore, Standard Monte Carlo (SMC) simulations are performed that validated the factor of accuracy in the aforesaid probabilistic demand-revenue model. We critically analyzed the effect of weather data parameters on consumer demands using correlation and multi-linear regression schemes. The statistical analysis of consumer demands provided a relationship between dependent (demand) and independent variables (weather data) for utility load management, generation control, and network expansion.

Parental smoking and exposure to environmental tobacco smoke are associated with waterpipe smoking among youth: results from a national survey in Lebanon

OBJECTIVES

Waterpipe tobacco smoking (WTS) is a growing public health concern worldwide yet little is known about the epidemiology of use among young people. The objectives of this study were to examine the prevalence, patterns and correlates of WTS among students across Lebanon.

STUDY DESIGN

The study design was a cross sectional survey.

METHODS

126-item tobacco questionnaire was conducted among 1128 sixth and seventh grade students across Lebanon. Current patterns of use were descriptively analysed, and logistic regression models examined correlates of WTS.

RESULTS

Ever WTS prevalence was 44.3%, current WTS prevalence was triple that of cigarettes (22.1% vs 7.4%), and 40.0% of current users were at least weekly or daily smokers. Initiation and patterns of use, as well as addiction and cessation attitudes have been reported. Significant correlates of current WTS included older age, reduced religiosity, peer and parent tobacco use, recent waterpipe advertisement exposure, increased pluralistic ignorance and current cigarette use. Significant correlates of ever WTS were similar to current WTS, but included second hand waterpipe tobacco smoke exposure at home and did not include recent waterpipe advertisement exposure. Neither gender nor socio-economic status were significant correlates of current or ever WTS.

CONCLUSIONS

Waterpipe is the most common form of tobacco smoking, and is used regularly, among sixth and seventh grade Lebanese students. It should be considered a public health priority with increased tobacco surveillance and legislation. Widespread educational and policy interventions might help denormalize the social acceptability of WTS. Meanwhile, more research is needed to understand the changing paradigm of WTS epidemiology and the health outcomes among young smokers.

Safety and efficacy of stereotactic body radiotherapy as primary treatment for vertebral metastases: a multi-institutional analysis

Purpose

To evaluate patient selection criteria, methodology, safety and clinical outcomes of stereotactic body radiotherapy (SBRT) for treatment of vertebral metastases.

Materials and methods

Eight centers from the United States (n = 5), Canada (n = 2) and Germany (n = 1) participated in the retrospective study and analyzed 301 patients with 387 vertebral metastases. No patient had been exposed to prior radiation at the treatment site. All patients were treated with linac-based SBRT using cone-beam CT image-guidance and online correction of set-up errors in six degrees of freedom.

Results

387 spinal metastases were treated and the median follow-up was 11.8 months. The median number of consecutive vertebrae treated in a single volume was one (range, 1-6), and the median total dose was 24 Gy (range 8-60 Gy) in 3 fractions (range 1-20). The median EQD2₁₀ was 38 Gy (range 12-81 Gy). Median overall survival (OS) was 19.5 months and local tumor control (LC) at two years was 83.9%. On multivariate analysis for OS, male sex (p < 0.001; HR = 0.44), performance status <90 (p < 0.001; HR = 0.46), presence of visceral metastases (p = 0.007; HR = 0.50), uncontrolled systemic disease (p = 0.007; HR = 0.45), >1 vertebra treated with SBRT (p = 0.04; HR = 0.62) were correlated with worse outcomes. For LC, an interval between primary diagnosis of cancer and SBRT of ≤30 months (p = 0.01; HR = 0.27) and histology of primary disease (NSCLC, renal cell cancer, melanoma, other) (p = 0.01; HR = 0.21) were correlated with worse LC. Vertebral compression fractures progressed and developed de novo in 4.1% and 3.6%, respectively. Other adverse events were rare and no radiation induced myelopathy reported.

Conclusions

This multi-institutional cohort study reports high rates of efficacy with spine SBRT. At this time the optimal fractionation within high dose practice is unknown.

A qualitative analysis among regular waterpipe tobacco smokers in London universities

BACKGROUND

Waterpipe smoking is popular in the West despite the significant harm associated with its use. Little is known about the habits and practices of British smokers.

DESIGN

A total of 32 regular waterpipe smokers attended focus groups, where trained facilitators explored knowledge, belief and attitudes to waterpipes. Transcripts were thematically analysed and grouped into seven broad categories.

RESULTS

Waterpipes played a clearly defined social role, accentuated by reduced harm perception and greater social acceptance than cigarettes. Knowledge about waterpipes was lacking, partly due to the lack of media attention. Addiction was described as a 'social addiction', although this may mask true nicotine addiction. Waterpipe smokers were less interested in quitting due to intermittent smoking patterns, reinforcing the belief of reduced exposure to harm. Legislative issues were explored, including the need to legislate on waterpipes on a par with cigarettes.

CONCLUSION

Waterpipe smokers exhibited specific habits and attitudes not traditionally seen in cigarette smokers. It is important to encourage education to dispel the myths surrounding reduced harm perception and addiction to tackle its strong social acceptance. Legislation should play a more active role in prevention and education, and more emphasis should be placed on gathering nationwide epidemiological data to gauge the potential for escalation.

Waterpipe smoking: prevalence and attitudes among medical students in London

Although waterpipe smoking is growing in popularity worldwide, its epidemiology remains poorly understood. The purpose of this study was to determine the prevalence and attitudes of waterpipe smoking among 489 medical students (54.6% female; mean age 20.4 ± 2.0 years) in the United Kingdom by conducting a cross-sectional survey. Waterpipe smoking was more common than cigarette smoking (current 11.0% vs. 6.3%, ever 51.7% vs. 16.8%). Mean age at waterpipe smoking initiation was 16.1 ± 2.6 years. Sex, ethnicity and sociodemographic factors did not predict current/ever waterpipe smoking. Tobacco control efforts need to consider waterpipe smoking in the light of this high prevalence.

Instrumental neutron activation analysis for the study of size-fractionated airborne particulate matter samples

In order to devise methodology to study various environmental matrices 28 pairs of coarse and fine air particulate samples were collected in the vicinity of an automotive workshop located at Tasmasipabad on Chaklala Road, Rawalpindi. The samples were collected using a Gent sampler and polycarbonate filters during the period 7 to 27 April 2009. These samples were analyzed using instrumental neutron activation analysis (INAA) using the low power Pakistan Atomic Research Reactor-2 (PARR-2). Reference materials (RMs) IAEA-SL1 and IAEA-S7 were used for calibration and quality assurance (QA) purpose. The gravimetric data for these samples were found to exceed the PM2.5 and PM10 national limits. Up to 34 elements were measured using the INAA optimized procedure.

Self removal of unwanted tattoos

Tattooing has been around since early civilisation, with origins that can be traced back to Otzi the ice man dating from the fourth to fifth millennium bc (Renaut, 2004). Various methods of tattoo removal are described in the literature ranging from salabrasion as described by Aetius, a Greek physician, in 543ad (Scutt, 1972) to laser treatment in the late 20th century (Goldman et al, 1967).

Resistance to FLT3 inhibition in an in vitro model of primary AML cells with a stem cell phenotype in a defined microenvironment

Relapse in acute myeloid leukaemia (AML) is mediated by survival of leukaemic stem cells following remission-induction chemotherapy. It would therefore be useful to identify therapeutic agents that target leukaemic stem cells. We devised a flow cytometric chemosensitivity assay allowing 48 h culture of leukaemic blasts in a defined microenvironment followed by enumeration of viable CD34+CD38-CD123+ leukaemic stem and progenitor cells (LSPC). The assay was used to investigate the LSPC response to cytosine arabinoside (Ara-C) and to the FLT3 inhibitor AG1296. There was a 3.6-fold increase in Ara-C-treated LSPC survival under defined 'niche-like' conditions compared to culture without microenvironmental support. Nine AML samples with internal tandem duplications of FLT3 (FLT3/ITDs) were treated with AG1296. Three samples were very sensitive (>50% kill) and 4 were moderately sensitive (10-50% kill) in bulk suspension culture without microenvironmental support. However, under defined 'niche-like' conditions, the survival of LSPC was enhanced rather than inhibited by AG1296 treatment. We conclude that an interaction between LSPC and a defined in vitro microenvironment models a chemoresistant niche. Our data point to a need to investigate more novel chemotherapeutic agents under these stringent conditions to identify agents that may be suitable to target minimal residual disease in AML.

Target cell frequency is a genetically determined risk factor in radiation leukaemogenesis

Whole body exposure to ionizing radiation increases the risk of radiation-induced acute myeloid leukaemia (r-AML). r-AML is the result of the accumulation of mutations in a single haemopoietic stem cell, so risk is therefore a function of the number of mutations required to transform the stem cell and the mutation rate. There is a genetic component to the risk of AML within the general population, and low penetrance variant alleles encoding DNA repair enzymes have been genetically implicated in therapy-related AML susceptibility. However, what is largely ignored is that target cell number, which defines the number of genomes at risk from DNA damaging agents, is also part of the equation that defines risk. We will review the evidence from genetic studies of inbred mouse models that target cell frequency is a risk factor in radiation leukaemogenesis. Inbred mouse strains that differ in their susceptibility to radiation-induced r-AML and thymic lymphoma (r-TL), spontaneous TL and pristane-induced plasmacytoma (PCT) have been exploited to identify susceptibility loci. The target cell in AML is the haemopoietic stem cell, whereas TLs and PCT arise from more mature lymphoid progenitor cells. Inbred mice also differ significantly in all aspects of haemopoiesis, and these differences have been used to identify quantitative trait loci (QTL) that determine the frequency of specific haemopoietic stem, progenitor or mature blood cells. The co-localization of QTL that determine risk and target cell frequency in all three haemopoietic malignancies is strong evidence that target cell frequency is a risk factor in radiation leukaemogenesis.

Mouse bone marrow and peripheral blood erythroid cell counts are regulated by different autosomal genetic loci

Erythropoiesis is under fine control and genetic loci that affect it are likely to be important in a range of conditions. To assess the relative contributions of different genetic loci to parameters of erythropoiesis, we have measured RBC counts in the peripheral circulation and committed erythroid cells (RBC and small normoblasts) in the bone marrow in a cohort of (CBA/H x C57BL/6) F2 mice to map quantitative trait loci (QTL). Candidate genes were assessed using bioinformatics and DNA sequencing. Different autosomal loci affect bone marrow (chromosomes 5, 11 and 19) and peripheral blood (chromosome 4) erythroid cell counts but there may be a common chromosome X locus. Spleen weight QTL were found on chromosomes 3, 15 and 17. Surprisingly, erythropoietin (Epo) is the best candidate quantitative trait gene (QTG) in the chromosome 5 locus that affects bone marrow but not peripheral blood erythroid cell counts. Epo gene expression is known to be genetically regulated in mice, but our data suggest a tissue-specific role for epo in mouse erythropoiesis that is also genetically determined. The identity of the other QTG will be important both to further knowledge of the control of erythropoiesis and as potential modifier genes for haematological disorders.

Efficacy of a paracetamol-pseudoephedrine combination for treatment of nasal congestion and pain-related symptoms in upper respiratory tract infection

OBJECTIVE

This study compared the efficacy of 1000 mg of paracetamol combined with 60 mg of pseudoephedrine, with that of either paracetamol or pseudoephedrine alone and placebo for the treatment of symptomatic URTI.

RESEARCH DESIGN AND METHODS

A double-blind, parallel group study was performed on 305 patients with URTI (nasal airflow resistance [NAR] of > 0.25 Pa cm3 s and a global pain score of at least moderate intensity). NAR and pain relief/intensity scores were measured over 4 h after initial dose. Patients then dosed up to three times daily for 3 days and recorded nasal congestion and pain intensity scores.

MAIN OUTCOME MEASURES

Nasal airflow conductance (NAC) and pain relief after the initial dose were primary objectives. NAC was calculated from NAR. Pain relief was measured on a 5-point verbal rating scale (VRS) and pain intensity and nasal congestion on a 4-point VRS. Data were analysed using analysis of covariance. Safety was assessed by adverse events.

RESULTS

A single dose of the combination was superior to paracetamol and placebo for NAC (p = 0.0001) and was superior to pseudoephedrine and placebo for pain relief (p < or = 0.048). Multiple doses of the combination were also superior to paracetamol and placebo for decongestion (p < or = 0.021) and were superior to pseudoephedrine and placebo for pain reduction (p < or = 0.0057). All treatments were well tolerated.

CONCLUSIONS

The combination treatment provided a greater decongestant effect than either paracetamol or placebo and better pain relief than either pseudoephedrine or placebo. The additive effect of the combination was apparent for both single and multiple doses.

Changes in unilateral nasal airflow in patients with seasonal allergic rhinitis measured in and out of season

OBJECTIVE

Nasal congestion is a common complaint of patients suffering from seasonal allergic rhinitis yet there are very few investigations which have studied the objective changes in nasal airflow in and out of season. The aim of this study was to investigate the changes in nasal airflow in and out of season.

METHODS

In the present study unilateral nasal airflow was measured in and out of the pollen season in 13 patients with seasonal allergic rhinitis. Unilateral nasal airflow was measured using posterior rhinomanometry at an inspiratory reference pressure of 75 Pa.

RESULTS

There was no significant difference between median total nasal airflow in season (325 cm3/s) and out of season (324 cm3/s) (P = 0.15, n = 13) yet there was a significant difference between maximum unilateral airflow in season (278 cm3/s) and out of season (234 cm3/s) (P = 0.007, n = 26).

CONCLUSION

The results of the present study indicate that although patients with seasonal allergic rhinitis may experience a sensation of nasal congestion at the start of the pollen season there is little or no change in total nasal airflow and unilateral nasal airflow may be increased.

Lack of effect of codeine in the treatment of cough associated with acute upper respiratory tract infection

Codeine is often used as a standard antitussive against which new antitussives are compared. However there is little information available about the effects of codeine on cough associated with upper respiratory tract infection. The present study investigated the effects of codeine syrup B.P. (30 mg/10 ml, q.d.s.) or syrup vehicle on cough frequency and the subjective severity of cough during a 3-h laboratory phase and a 4-day home phase of treatment. Cough frequency and subjective scores of cough severity were significantly decreased during the 3-h laboratory phase but at no time point was there a significant difference between the codeine- and placebo-treated groups. The results of the 4-day home phase diary were similar to those of the laboratory phase as at no time point was there a significant difference between the mean scores for the codeine- and placebo-treated groups. The results indicate that codeine, either as a single 30-mg dose or in a total daily dose of 120 mg, is no more effective than the syrup vehicle in controlling cough associated with acute upper respiratory tract infection.

Sepsis and hypothermia in the newborn infant: value of gastric aspirate examination

Bacteriologic examination of blood, urine, CSF, and gastric aspirate was performed in 88 babies admitted with hypothermia (rectal temperature less than 35 degrees C) during the neonatal period. Infection was common in infants older than 3 days (late-onset hypothermia). In 36 of the 44 (81.8%) infected babies, the gastric aspirate was abnormal, whereas it was abnormal in only three of the 23 (13%) not infected. Infection was much less common in babies younger than 3 days (early-onset hypothermia), and in these the gastric aspirate was mostly normal. Two babies had RDS-like symptoms, and streptococci were cultured from the gastric aspirate. Examination of the gastric aspirate is a quick, efficient method of diagnosing severe infection, not only immediately after birth but throughout the neonatal period.