A dynamical measure of the black hole mass in a quasar 11 billion years ago

Tight relationships exist in the local Universe between the central stellar properties of galaxies and the mass of their supermassive black hole (SMBH)1-3. These suggest that galaxies and black holes co-evolve, with the main regulation mechanism being energetic feedback from accretion onto the black hole during its quasar phase4-6. A crucial question is how the relationship between black holes and galaxies evolves with time; a key epoch to examine this relationship is at the peaks of star formation and black hole growth 8-12 billion years ago (redshifts 1-3)7. Here we report a dynamical measurement of the mass of the black hole in a luminous quasar at a redshift of 2, with a look back in time of 11 billion years, by spatially resolving the broad-line region (BLR). We detect a 40-μas (0.31-pc) spatial offset between the red and blue photocentres of the Hα line that traces the velocity gradient of a rotating BLR. The flux and differential phase spectra are well reproduced by a thick, moderately inclined disk of gas clouds within the sphere of influence of a central black hole with a mass of 3.2 × 108 solar masses. Molecular gas data reveal a dynamical mass for the host galaxy of 6 × 1011 solar masses, which indicates an undermassive black hole accreting at a super-Eddington rate. This suggests a host galaxy that grew faster than the SMBH, indicating a delay between galaxy and black hole formation for some systems.

The impact of heavy metal concentrations on aquatic insect populations in the Asan Wetland of Dehradun, Uttarakhand

This study, centered on the Asan Wetland in Uttarakhand, examines the ecological impact of heavy metals on aquatic insects biodiversity. It highlights the detrimental effects of metals like chromium, mercury, and lead, stemming from natural and anthropogenic sources, on aquatic insects diversity. Aquatic insects, particularly sensitive to water quality, are emphasized as key indicators of environmental health, illustrating the importance of understanding and managing the influences on wetland ecosystems. Wetland ecosystems are vulnerable to various environmental stressors, including pollution from heavy metals. These toxic substances can alter water quality parameters, disrupt nutrient cycling, and negatively impact the biodiversity and ecological balance of the system. This study aimed to evaluate the impact of several heavy metals (namely Cd, As, Cu, Fe, Pb, Ni, Zn, Al, Cr) on the distribution and biodiversity of various aquatic insect species, including Coeleoptera, Diptera, Ephemeroptera, Odonata, Plecoptera, and Trichoptera. The research utilized data collected between November 2021 and October 2022 from specifically chosen sites (S1, S2, S3) within the Asan Wetland in Dehradun, Uttarakhand. After collecting and identifying samples, various statistical (Sorenson, Shannon-Weiner diversity index, Margelef index) and multivariate tests (CCA, PCA, One-way Anova), have been applied to show the effects of these parameters. This study offers significant findings regarding the distribution patterns of heavy metals, the abundance of aquatic insects, and their interconnectedness within the ecosystem of the Asan Wetland. The abundance of aquatic insects, represented by 13 genera belonging to 6 orders, was assessed at three different sites (S1, S2, and S3) within the wetland. It was concluded that the heavy metals concentration and aquatic insects' density increases and decreases vice-versa in monsoon and winter seasons might be due to unfavourable factors. These findings contribute to the understanding of ecological dynamics and potential impacts of heavy metals on aquatic biota in wetland environments.

Identifying canonical and replicable multi-scale intrinsic connectivity networks in 100k+ resting-state fMRI datasets

Despite the known benefits of data-driven approaches, the lack of approaches for identifying functional neuroimaging patterns that capture both individual variations and inter-subject correspondence limits the clinical utility of rsfMRI and its application to single-subject analyses. Here, using rsfMRI data from over 100k individuals across private and public datasets, we identify replicable multi-spatial-scale canonical intrinsic connectivity network (ICN) templates via the use of multi-model-order independent component analysis (ICA). We also study the feasibility of estimating subject-specific ICNs via spatially constrained ICA. The results show that the subject-level ICN estimations vary as a function of the ICN itself, the data length, and the spatial resolution. In general, large-scale ICNs require less data to achieve specific levels of (within- and between-subject) spatial similarity with their templates. Importantly, increasing data length can reduce an ICN's subject-level specificity, suggesting longer scans may not always be desirable. We also find a positive linear relationship between data length and spatial smoothness (possibly due to averaging over intrinsic dynamics), suggesting studies examining optimized data length should consider spatial smoothness. Finally, consistency in spatial similarity between ICNs estimated using the full data and subsets across different data lengths suggests lower within-subject spatial similarity in shorter data is not wholly defined by lower reliability in ICN estimates, but may be an indication of meaningful brain dynamics which average out as data length increases.

Healthcare-associated infections among neonates and children in Pakistan: findings and the implications from a point prevalence survey

BACKGROUND

Healthcare-associated infections (HAIs) increase morbidity, mortality and costs. The overall prevalence of HAIs is greater in low- and middle-income countries due to poor resources and infrastructure, with the incidence of HAIs greater among neonates and children. There is a need to understand the current situation in Pakistan including key drivers to improve future care.

METHODS

Point prevalence survey (PPS) of HAIs in the children's wards of 19 public sector secondary- and tertiary-care hospitals of Pakistan and associated key drivers.

RESULTS

A total of 1147 children were included in the PPS. 35.7% were neonates with 32.8% aged >1-5 years. 35.2% were admitted to the intensive care units (ICUs). Peripheral, central venous and urinary catheters were present in 48%, 2.9% and 5.6% of the patients, respectively. A total of 161 HAIs from various pathogens were observed in 153 cases, giving a prevalence of 13.3%. The majority of HAIs were caused by Staphylococcus aureus (31.7%) followed by Klebsiella pneumoniae (22.9%) and Escherichia coli (17.4%). Bloodstream infections were identified in 42 cases followed by lower-respiratory-tract infections in 35. Increased length of hospital stays and being admitted to the ICU, 'rapidly fatal' patients under the McCabe and Jackson criteria, central and peripheral catheterization, and invasive mechanical ventilation were, associated with higher HAIs (P<0.001). 99.7% of HAI patients fully recovered and were discharged from the hospital.

CONCLUSION

There is a high prevalence of HAIs among neonates and children admitted to health facilities in Pakistan. Infection prevention and control measures should be implemented to help prevent future HAIs.

The role of delay in vaccination rate on Covid-19

The role of vaccination in tackling Covid-19 and the potential consequences of a time delay in vaccination rate are discussed. This study presents a mathematical model that incorporates the rate of vaccination and parameters related to the presence and absence of time delay in the context of Covid-19. We conducted a study on the global dynamics of a Covid-19 outbreak model, which incorporates a vaccinated population and a time delay parameter. Our findings demonstrate the global stability of these models. Our observation indicates that lower vaccination rates are associated with an increase in the overall number of infected individuals. The stability of the corresponding time delay model is determined by the value of the time delay parameter. If the time delay parameter is less than the critical value at which the Hopf bifurcation occurs, the model is stable. The results are supported by numerical illustrations that have epidemiological relevance.

Spread of Mesalazine Rectal Foam after Single Dose in Mild Ulcer Patients

Background: The rectal foam enemas were used for ulcerative colitis of distal regions due to its desired efficacy and less side effects. The spread and persistence of the drug plays a key role in the treatment. Therefore, the objective of the present study is to study the spread and persistence of Salofalk (Mesalazine foam Enema), manufactured by Dr. Falk Pharma GmbH (mesalazine) rectal foam in mild ulcerative colitis patients. Methods: This is an open label, uncontrolled prospective study in ulcerative colitis patients. The patients received 2 g of mesalazine rectal foam (labelled with Tcm99) in two actuations (30 mL). The spread of the radiolabeled formulation was assessed over a period of 4 h by gamma scintigraphy. Results: The formulation was retained by the patients till 4 h imaging period. The foam spread in rectum, sigmoid colon and descending colon. The percentage radioactive dose exposed is more in sigmoid colon compared to rectum and descending colon in 4 h imaging period. The spread of the foam extended till descending colon for two out of 4 patients. Conclusion: The study results are consistent with the previous studies, and it supports the label indication. The obtained data of the present study provides in vivo evidence of the spread of formulation in the desired site of action.

Reproductive performance following hysteroscopic treatment of intrauterine adhesions: single surgeon data

Background

Intrauterine adhesions can negatively affect reproductive outcomes by causing infertility, miscarriage and preterm birth in women. Hysteroscopic surgery is now widely accepted as the treatment of choice in symptomatic women to restore reproductive function.

Objectives

To analyse the patient characteristics and long-term reproductive outcomes of women who received treatment for intrauterine adhesions under the care of a single surgeon.

Materials and Methods

In this retrospective analysis, all women who underwent hysteroscopic surgery for intrauterine adhesions under the care of the same surgeon between January 2001 and December 2019 were identified and their data were evaluated. Relevant demographic, diagnostic and reproductive outcome data was procured from patient notes. Referring doctors and patients were contacted to obtain missing information.

Main outcome measures

Live birth and miscarriage rates.

Results

126 women were treated for intrauterine adhesions. Of those women who were trying to conceive, 71.4% (65/91) achieved pregnancy, 58.2% (53/91) had live births and 13.2% (12/91) had miscarriages. No statistically significant difference was found in the live birth rates when data was analysed in subgroups based on age, reason for referral/aetiology and severity of pathology.

Conclusions

Hysteroscopic surgery leads to live birth in the majority of women with intrauterine adhesions. The lack of statistically significant difference in live birth rates across subgroups, including advanced age and severe pathology, suggests that surgery in all women wanting to conceive can be justified.

What is new?

Hysteroscopic treatment can lead to successful outcomes even in the presence of severe adhesions and in older women with appropriate treatment.

259 Effect of Telegram Videos on Anatomy Education Among 2nd Year Medical Students, University of Khartoum, 2021

Aim

COVID-19 had major effect on the health and medical education. In order to oblige with the social distancing and quarantine, universities shifted to online learning. This study aimed to assess the effect of online education on anatomy DR (dissection room) teaching by the use of telegram software.

Method

This was a cross-sectional, prospective interventional study, which was carried out among 2nd year medical students in University of Khartoum. Students undertook initial tests on the heart and anterior abdominal wall modules. Telegram videos, prepared by the author, on the anatomy of the heart and the anterior abdominal wall were distributed to students. Students took a second test after watching the videos. A total number of 41 students attended heart sessions and 40 students attended the anterior abdominal wall sessions were included.

Results

The pre-test mean score for the heart and abdomen modules were 4.56 ± 2.335 and 6.15 ± 2.94, respectively. The post-tests means were 9.98 ± 2.877 and 8.95 ± 3.14, respectively. 90% and 75% of the students were satisfied with these videos, respectively.

Conclusions

This study revealed that Telegram videos as a method of online teaching had a positive effect on the students' performance, which was evidenced by the significant improvement in student's scores after watching the videos. Additionally, most of the students were satisfied with the videos and give positive feedback.

Pharmacist-directed Sputnik V (GAM-COVID-VAC) surveillance program: a prospective observational study in Southern India

OBJECTIVES

The study underwent to evaluate the adverse events, the incidence of COVID-19 and the participant's attitude and perception towards the vaccine following Sputnik V administration through an active surveillance program.

METHODS

The prospective observational study was conducted four months in the Sputnik V vaccination center that enrolled 700 participants. Sociodemographic details, medical histories, COVID-19 incidences and adverse events following immunization (AEFI) of each sample were collected through face-to-face interviews and a telephonic feedback system. A self-prepared and validated questionnaire addressed their acceptances and perceptions towards the vaccination drive.

RESULTS

Our study reported 42.1% of AEFIs after the first dose and 9.1% after the second. Fever, pain at the injection site, body pain, headache and fatigue were predominant, while dizziness and diarrhoea were rare. However, AEFIs were not influenced by the presence of comorbidities (p > 0.05). On the other hand, there were limited post immunization (1.8%) COVID-19 patients and that too with minor severity (p < 0.01). Our participants were overall satisfied with the Sputnik V immunization. However, those presented with AEFIs on the consecutive three days depicted slightly declined gratification (p < 0.05).

CONCLUSIONS

Our pharmacist-directed surveillance program on Sputnik V showed fewer events of AEFIs and negligible occurrence of COVID19 following immunization. Moreover, the population had appreciable attitude and positive perceptions towards Sputnik V vaccination.

Meningitis following cerebrospinal fluid-cutaneous fistula secondary to combined spinal-epidural anaesthesia for elective caesarean delivery

Cerebrospinal fluid-cutaneous fistula is a rare complication associated with neuraxial procedures. Here, we describe a case of fistula formation related to combined spinal-epidural anaesthesia for elective caesarean delivery, where the epidural catheter was removed only two hours later. The clear fluid leaking persistently from the site of the skin puncture associated with the epidural insertion site was confirmed to be cerebrospinal fluid with an increased beta-trace protein, and the fistula was closed with skin sutures. Subsequently, the patient presented with neurological signs and symptoms consistent with meningitis and she was treated empirically with intravenous antibiotics. Cerebrospinal fluid-cutaneous fistula formation with secondary meningitis is an exceptionally rare event in obstetric anaesthesia.

1255 Crowdedness and Consequences of Long Waiting Time in Public and Private Health Centers Among Patients in Khartoum State, Sudan - 2016

Aim

Waiting time (WT) reflects quality of services delivered by Primary health care level. Long waiting time is due to various causes, among which crowdedness is a main cause. This prolonged time has negative impacts on PHC services utilization as well as patients’ outcomes. The aim of this study is to measure the total WT, assess the crowdedness in PHC centers, and to determine the possible consequences of this long waiting time.

Method

Descriptive cross sectional– health institution-based study done in 40 Health centres across Khartoum state using randomized multi-stage sampling. Patients, doctors and lab technicians were interviewed using three different pre-tested structured questionnaires.

Results

A total of 477 patients were included in the study. The average waiting time was found to be 168 minutes. Crowdedness was one of the main causes of delay in waiting time. The lab was the most perceived crowded service (74.4% of the respondents). This long WT had health consequences on patients, ranging from backache, joint pain, and headaches to hypoglycemic symptoms. These symptoms affected patients' willingness to return to the same center. 36.4% of the affected patients were unwilling to revisit the same center.

Conclusions

WT in this study is longer compared to studies from other countries. Crowdedness is one of the main causes of long WT. Due to this prolonged time, patients experienced physical symptoms. It also affected their future attitude regarding PHC centers utilization. There is a need to understand the underlying causes of this issue and address them appropriately.

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries

BACKGROUND

There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates.

METHODS

We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020.

RESULTS

Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country.

CONCLUSIONS

BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.

Unusual presentation of an insulinoma in an elderly male patient

Insulinoma is a rare neuroendocrine tumor originating from hypersecreting beta-cells of islets of Langerhans in the pancreas. We report a case of 72-year-old male, with chronic alcohol abuse, presenting with atypical features like refractory recurrent secondary generalized seizures and behavioral disturbances with increased irritability, initially mistreated as alcohol withdrawal. Detailed history, particularly the relationship of the symptoms with food intake, made us think of other causes of seizures. Fasting biochemical investigations and localizing studies helped clinch the diagnosis. The tumor was localized with the help of endoscopic ultrasonography and whole-body Ga68-DOTANOC PET-CT. The patient was treated conservatively with diazoxide and is doing well on follow-up. The present case report emphasizes the importance of detailed clinical history, more so in atypically presenting cases of refractory seizures. Insulinoma can be medically managed despite surgery being the gold standard curative treatment.

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries

BACKGROUND

There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates.

METHODS

We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020.

RESULTS

Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country.

CONCLUSIONS

BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.

388 Detection of Cytomegalovirus Infection in Infants with Biliary Atresia: A Meta-analysis

Introduction

Biliary atresia (BA) is the most common indication of liver transplantation in children. Several reports attributed BA to both prenatal and perinatal aetiologies, including a viral infection-induced auto-immune response that targets the bile ducts. Cytomegalovirus (CMV) remains the most common virus being linked to BA. This meta-analysis estimates to what extent CMV infection is detected in patients with BA.

Method

This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), ScienceDirect, and Google Scholar were used for the systematic search. Random effects model was used to estimate the pooled prevalence estimate with the corresponding 95% confidence interval (CI) using StatsDirect statistical software.

Results

A total of 13 studies (covering 419 patients) that fulfilled the eligibility criteria were included in the meta-analysis. The pooled overall prevalence of CMV infection in patients with BA was 24.5% (95% CI 11.9 %– 33.9%).

Conclusions

The available data demonstrate that the detection of CMV infection is common in infants with BA. There is still a need for large studies with appropriate controls to examine various aspects of the association between CMV infection and BA.

Safety and efficacy of the cystic fibrosis transmembrane conductance regulator potentiator icenticaftor (QBW251)

Background:

This is the first-in-human study of icenticaftor, an oral potentiator of the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) channel. Restoration of CFTR activity has shown significant clinical benefits, but more studies are needed to address all CFTR mutations.

Methods:

Safety, pharmacodynamics/pharmacokinetics of icenticaftor were evaluated in a randomized, double-blind, placebo-controlled study in healthy volunteers. Efficacy was assessed in adult CF patients with ≥1 pre-specified CFTR Class III or IV mutation (150 and 450 mg bid), or homozygous for F508del mutation (450 mg bid). Primary efficacy endpoint was change from baseline in lung clearance index (LCI_2.5). Secondary endpoints included %predicted FEV₁ and sweat chloride level.

Results:

Class IV mutations were present in 22 patients, Class III in 2 (both S549N), and 25 were homozygous for F508del. Icenticaftor was well-tolerated in healthy and CF subjects with no unexpected events or discontinuations in the CF groups. The most frequent study-drug related adverse events in CF patients were nausea (12.2%), headache (10.2%), and fatigue (6.1%). Icenticaftor 450 mg bid for 14 days showed significant improvements in all endpoints versus placebo in patients with Class III and IV mutations; mean %predicted FEV₁ increased by 6.46%, LCI_2.5 decreased by 1.13 points and sweat chloride decreased by 8.36 mmol/L. No significant efficacy was observed in patients homozygous for a single F508del.

Conclusions:

Icenticaftor was safe and well-tolerated in healthy volunteers and CF patients, and demonstrated clinically meaningful changes in lung function and sweat chloride level in CF patients with Class III and IV CFTR mutations.

ClinicalTrials.gov: NCT02190604

Effect of vitamin A as a neoadjuvant agent in chemotherapy and photodynamic therapy of Rhabdomyosarcoma cells

Combinational therapy is among the most used treatment modality's to increase cancer treatment efficacy. It may also reduce side effects, treatment time, and development of drug resistance. The effects of different analogues of vitamin A (VA) as neoadjuvant agent were observed in this study with chemotherapeutic drugs (doxorubicin and methotrexate) and photodynamic therapy (PDT) using 5-ALA and Photogem as photosensitizers in RD cells. The uptake time of photosensitizer was optimized by means of spectrophotometric measurements. Diode laser (λ = 635 nm ± 1 nm) was used as an illumination source for PDT. Responses of administered drugs were assessed by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. VA and its analogues exert prophylactic and therapeutic effects. Protective or antagonistic effects (CI > 1) were observed in each of the case. These results propose that the use of VA as a neoadjuvant agent in combinational therapeutic modalities may reduce the efficacy of cancer treatment protocols as well as the existing side effects. Thus, VA is not the successful drug for combinational therapies and under treatment cancer patients should try to avoid its use with oxidative stress induction therapies (e.g. PDT, Radiotherapy, chemotherapy).

"Before the training I just assumed they've done something bad": Reporting on professional training for pharmacy assistants and pharmacy dispensary technicians on medically assisted treatment of opioid dependence

BACKGROUND

A study that examined the lived experiences of Medically Assisted Treatment of Opioid Dependence (MATOD) consumers suggested that they had experienced discrimination and stigma in pharmacies in regional Victoria, Australia. To address this, the need for professional training opportunities for Pharmacy Assistants (PAs) and Pharmacy Dispensary Technicians (PTDs) had been emphasised. A research project was undertaken to develop training modules using Social Determinants of Health (SDH) for PAs and PDTs involved in providing MATOD pharmacy services in regional Victoria, and to evaluate their effectiveness.

OBJECTIVES

The study aimed to examine and evaluate changes in attitudes and practices amongst PAs and PDTs involved in MATOD services in regional Victoria, Australia and who had undertaken the training modules.

METHODS

The paper reports primarily on the in-depth qualitative interviews that were completed after the training with PAs and PTDs. Thematic analysis was employed to code the data.

RESULTS

Thematic analysis generated five themes: understanding of the professional role of PAs and PTDs, initial judgements concerning MATOD consumers, reflection on the SDH, training content analysis, and the post-training impact upon Professional Practice. These themes reflected participants' insights with regards both to MATOD consumers and the impact the training itself had had on their professional practice.

CONCLUSION

"Consciousness-raising" from participation in the training can positively influence the development of participants' professional attitudes and practices with regards to MATOD service delivery. This development supports that training informed by SDH and ideas of critical reflection can help facilitate the creation of knowledge around the social construction of health and increased understanding of the impacts of language-use, attitudes and behaviour.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Stability-indicating RP-HPLC assay for simultaneous determination of chlorpheniramine maleate and prednisolone in veterinary injection

The present work described a simple, rapid, sensitive, accurate, and precise method for simultaneous determination of chlorpheniramine maleate (CHRM) and prednisolone acetate (PRED) in injection samples by high-performance liquid chromatography (HPLC) coupled with UV–Vis detection. Chromatographic separation was accomplished, employing isocratic mode and a mobile phase comprised of acetonitrile and a phosphate buffer (50:50, v/v, 30 °C), adjusted to pH 3.0. The flow rate used was 1.0 mL/min on a Thermo Hypersil ODS C18 column (5 μm, 4.6 × 250 mm), and the injection volume of sample was 20 μL. Analysis of CHRM and PRED was performed at a wavelength of 254 nm. The runtime for analysis was 12.5 min, and the retention times of CHRM and PRED were found to be 2.81 and 5.07 min, respectively. The calibration graph showed linearity over the concentration range 10–70 μg/mL for CHRM and 20–140 μg/mL for PRED with a coefficient of determination (R2) ≥0.9986. Repeatability and reproducibility (expressed as % RSD) were lower than 1.72 and 1.47%, respectively. The proposed HPLC method was demonstrated to be simple and rapid for the determination of CHRM and PRED in injection formulation, providing recoveries between 101.6–102.3%, whereas complete separation of degradation products, from analyte under investigation, provided the specificity of the proposed HPLC method.

Chlorogenic acid attenuates kidney fibrosis via antifibrotic action of BMP-7 and HGF

BACKGROUND

Kidney fibrosis, characterised by tubulointerstitial fibrosis, is a histological landmark of chronic kidney disease. The body attempts to compensate for progressive detrimental process of kidney fibrosis by producing antifibrotic substances, such as bone morphogenetic protein-7 (BMP-7) and hepatocyte growth factor (HGF). Chlorogenic acid is known to have renoprotective and antifibrotic properties. This study aims to evaluate the effect of chlorogenic acid on unilateral ureteral obstruction (UUO)-induced kidney fibrosis mice model.

METHODS

This study was a quasi-experimental with posttestonly control group design. Twenty-five adult male Swiss Webster mice were randomly divided into five groups: shamoperated group (SO), UUO-control day-7 (U7), UUO-control day-14 (U14), UUO-chlorogenic acid day-7 (UC7), and UUOchlorogenic acid day 14 (UC14). Myofibroblasts were identified by immunohistochemical staining of alphasmooth muscle actin (α-SMA) while collagen fibers were identified by Sirius Red staining. Both data were presented as area fraction. BMP-7 and HGF mRNA expressions were assessed by reverse transcription PCR (RT-PCR). Data were quantified using ImageJ software.

RESULTS

UUO-control groups (U7 and U14) showed higher α- SMA-immunopositive (6.52±1.33, 18.24±1.39 vs. 0.22±0.01; p<0.05) and Sirius Red-positive area fractions (6.61±0.8, 12.98±2.31 vs. 0.62±0.10; p<0.05), lower BMP-7 (1.02±0.47, 1.18±0.65 vs. 2.09±0.87; p<0.05) and HGF mRNA expressions (1.06±0.31, 0.89±0.14 vs. 1.88±0.81; p<0.05) compared to SO group. UUO-chlorogenic acid groups (UC7 and UC14) showed lower α-SMA-immunopositive (1.24±0.37, 4.58±0.61; p<0.05) and Sirius Red-positive area fractions (4.76±1.03, 3.72±0.54; p<0.05), higher BMP-7 (1.84±0.49, 2.19±0.43; p<0.05) and HGF (1.58±0.38; p>0.05, 1.84±0.42; p<0.05) mRNA expressions compared to UUO-control groups. UUOchlorogenic acid groups showed BMP-7 and HGF mRNA expressions that were not significantly different from the SO group.

CONCLUSION

Chlorogenic acid administration prevents kidney fibrosis in UUO mice model through modulating antifibrotic pathway.

A multicentre, randomized, double-masked, parallel group, vehicle-controlled phase IIb study to evaluate the safety and efficacy of 1% and 3% topical minocycline gel in patients with papulopustular rosacea

Background

Papulopustular rosacea is characterized by chronic facial erythema and inflammatory facial lesions. Minocycline has anti‐inflammatory properties which may be effective in the treatment of rosacea inflammatory lesions.

Objectives

To assess the safety and efficacy of once‐daily topical minocycline gel 1% and 3% in patients with papulopustular rosacea.

Methods

This was a prospective, 12‐week, double‐blinded study conducted at 26 sites in the United States; 270 patients with papulopustular rosacea and 12–40 inflammatory lesions were randomized to minocycline 1%, minocycline 3% or vehicle. The primary endpoint was the mean change in inflammatory lesions at week 12. Key secondary endpoints included success on an Investigator's Global Assessment (IGA).

Results

Baseline mean lesion counts were 24·6, 25·1 and 24·3 in the minocycline 1%, minocycline 3% and vehicle groups, respectively; at week 12, the counts had decreased by 12·6, 13·1 and 7·9, respectively. Minocycline significantly decreased lesions, compared with the vehicle [P = 0·01, 95% confidence interval (CI) 7·9 to 0·9, for minocycline 1%; P = 0·007, 95% CI 8·3 to 1·3, for minocycline 3%]. The proportion of patients achieving IGA success was 39% in the minocycline 1% arm [P = 0·34, odds ratio (OR) 1·396 and OR 95% CI 0·71 to 2·75 vs. vehicle], 46% in the minocycline 3% arm (P = 0·04, OR 2·03 and OR 95% CI 1·04 to 3·95 vs. vehicle) and 31% in the vehicle arm.

Conclusions

Minocycline topical gel appears to be safe and tolerable at concentrations of 1% and 3%, and both concentrations significantly decreased inflammatory lesion counts, with a significantly larger proportion of patients achieving IGA success at week 12 in the minocycline 3% arm. These findings support further evaluation of minocycline gel for treating inflammatory lesions associated with papulopustular rosacea.

Linked Comment: Hampton. Br J Dermatol 2020; 183:412–413.

What is already known about this topic?

Papulopustular rosacea is characterized by inflammatory facial lesions and chronic erythema of the face.

Oral minocycline has been reported to have efficacy in the treatment of inflammatory lesions of papulopustular rosacea.

What does this study add?

The study shows that a topical gel preparation of minocycline significantly decreased the number of inflammatory lesions and significantly improved the Investigator's Global Assessment score in patients with papulopustular rosacea.

This may offer a topical therapeutic alternative to oral doxycycline or oral minocycline for the treatment of inflammatory lesions in papulopustular rosacea, with potentially fewer systemic side‐effects, owing to lower systemic drug exposure.

Linked Comment: Hampton. Br J Dermatol 2020; 183:412–413.

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Comparison of activity levels derived from two accelerometers in dogs with osteoarthritis: Implications for clinical trials

Accelerometer measurements are frequently reported as total weekly activity counts (AC). Methods of utilizing activity parameters to allow differentiation of activity intensities (i.e., manually derived cut-points) have been described. While this information may provide valuable data for researchers, only few investigators have utilized these methods. This may, in part, be due to the challenge associated with data processing. Some devices, however, generate activity intensity data automatically. This study was conducted to evaluate a novel accelerometer that allows for remote download of data via Wi-Fi (Heyrex), to compare automatically generated parameters quantifying activity levels to previously established cut-points (Actical) and to describe the variability of accelerometer data in dogs with osteoarthritis. Twelve client-owned dogs with osteoarthritis were fitted with a collar with two accelerometers (Heyrex and Actical). Accelerometer data were recorded for 28 days. Pearson bivariate correlations and coefficient of variation (CV%) were calculated for accelerometer data. There was a strong correlation between the AC reported by Heyrex and Actical devices. Several automatically generated parameters showed strong correlations to previously validated cut-points and displayed lower CV% than weekly AC. The activity intensity derived from the Heyrex was associated with the lowest CV% of all parameters from both accelerometers. Automatically generated activity intensity parameters should be considered as potential outcome measures in clinical trials for dogs with osteoarthritis. This novel technology may allow for convenient acquisition of activity intensity data in companion animals. However, technical difficulties (e.g., lack of Wi-Fi connectivity) may pose challenges when using this novel device.

Prevalence and predictors of lower urinary tract symptoms in Pakistani men: A cross-sectional study

Objective:

The purpose of this study was to investigate the prevalence and severity of the condition of lower urinary tract symptoms in Pakistani men, determine its predictors and assess its impact on the quality of life.

Methods:

A cross-sectional, population-based study was conducted among men aged 30 years and over in three districts of Punjab province, Pakistan. The modified Urdu version of the International Prostate Symptom Score was used to assess the prevalence and severity of lower urinary tract symptoms. Individuals with total symptom score ⩾8 were considered as having lower urinary tract symptoms. The data were analysed using SPSS version 22. The chi-square test and Mann-Whitney U test were used to assess the difference among categorical and continuous variables, respectively. Moreover, binary logistic regressions were performed to determine the predictors of lower urinary tract symptoms.

Results:

The overall prevalence of lower urinary tract symptoms in our sample was 33.7%. The frequency of individuals having mild, moderate and severe lower urinary tract symptoms was 66.3, 30.3 and 3.4%, respectively. Storage symptoms were more common than voiding symptoms (35.6% vs 28.2%, respectively). Increasing age (one-decade interval age stratum), higher education levels, working status (currently not working), smoking, hypertension, diabetes and renal impairment were positive predictors of lower urinary tract symptoms. Moreover, the condition of lower urinary tract symptoms was associated with a significant reduction in an individual’s quality of life.

Conclusion:

Around one-third of adult Pakistani men suffer from clinically relevant urinary symptoms, with lower urinary tract symptoms sufferers having poor quality of life as compared to non-sufferers. We recommend that the aging population should be made aware of conventional measures to mitigate mild urinary symptoms affecting their routine activities. Level of evidence: 2c

Updated results from the phase 3 HELIOS study of ibrutinib, bendamustine, and rituximab in relapsed chronic lymphocytic leukemia/small lymphocytic lymphoma

We report follow-up results from the randomized, placebo-controlled, phase 3 HELIOS trial of ibrutinib+bendamustine and rituximab (BR) for previously treated chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) without deletion 17p. Overall, 578 patients were randomized 1:1 to either ibrutinib (420 mg daily) or placebo, in combination with 6 cycles of BR, followed by ibrutinib or placebo alone. Median follow-up was 34.8 months (range: 0.1-45.8). Investigator-assessed median progression-free survival (PFS) was not reached for ibrutinib+BR, versus 14.3 months for placebo+BR (hazard ratio [HR] [95% CI], 0.206 [0.159-0.265]; P < 0.0001); 36-month PFS rates were 68.0% versus 13.9%, respectively. The results are consistent with the primary analysis findings (HR = 0.203, as assessed by independent review committee, with 17-month median follow-up). Median overall survival was not reached in either arm; HR (95% CI) for ibrutinib+BR versus placebo: 0.652 (0.454-0.935; P = 0.019). Minimal residual disease (MRD)-negative response rates were 26.3% for ibrutinib+BR and 6.2% for placebo+BR (P < 0.0001). Incidence of treatment-emergent adverse events (including grades 3-4) were generally consistent with the initial HELIOS report. These long-term data support improved survival outcomes and deepening responses with ibrutinib+BR compared with BR in relapsed CLL/SLL.

An Evaluation of Three Different Cranial Cruciate Ligament Surgical Stabilization Procedures As They Relate to Postoperative Meniscal Injuries

Cranial cruciate ligament (CrCL) rupture is the most commonly diagnosed stifle condition in the dog. Meniscal injury, in conjunction with CrCL rupture is also common in both man and dogs. There is a growing concern regarding meniscal injuries, whether unrecognized at the time of CrCL surgical stabilization or subsequent to stabilization, and the relationship to poor postoperative functional outcome. However, current literature is not specific as to an actual number of dogs subsequently requiring a second arthrotomy/meniscectomy.

Three different CrCL stabilization operations in dogs were compared, retrospectively, for the occurrence of post-operative meniscal damage requiring a second arthrotomy and meniscectomy. Additional information concerning: signalment, weight, history of injury, CrCL ruptured, surgeon, type of CrCL rupture and amount of arthritis present was recorded in 665 cases. It was found that 13.8% of the stifles at risk (i. e. those stifles that did not have the meniscus removed at the time of initial surgical stabilization) returned for a second arthrotomy/meniscectomy. A significant difference in outcome was not found between the results when initially performed by different surgeons. The number of dogs which returned for a second arthrotomy/ meniscectomy whose weight were ≤ 15 kg was significant, when compared to the total number of dogs considered at risk for this weight range. There was a significantly lower rate of return, in those dogs at risk, which had received fibular head transposition stabilization.

A retrospective study of 665 canine cranial cruciate ligament rupture cases documents the incidence (13.8%) of those dogs requiring a second arthrotomy, and subsequent meniscectomy, after one of three initial surgical stabilization procedures. Of the three procedures, the fibular head transposition technique had a significantly lower return rate requiring subsequent meniscectomy.

Prevalence and risk factors associated with intestinal parasitic infections among schoolchildren in Punjab, Pakistan

Intestinal parasitic infections (IPIs) are a major cause of morbidity worldwide and have been described as an important public health concern. The present study aimed to determine the prevalence and identification of risk factors associated with IPIs among 3-15 years old school age children residing in Mandi Bahauddin, Pakistan from 2011- 2013. A cross sectional school-based study was conducted using a structured pre-tested questionnaire. Anthropometric tools and stool tests were used to obtain epidemiological and disease data. The direct wet mount preperation in saline/iodine/haematoxylin stain and Kato-Katz methods were used for stool examination. Data were analysed using appropriate descriptive, univariate and multivariable logistic regression methods. Of the 1,434 children studied (mean age of 8.6±3.6 years) the overall prevalence rate for intestinal parasitic infections was found to be 33.3%. Children infected with single parasite accounted for 27.6% and 5.7% were detected with poly-parasitism. The study showed that helminths (21.4%) were more prevalent than protozoans (17.9%). Ascaris lumbricoides (17.5%), Giardia lamblia (9.8%), Entamoeba histolytica (8.2%), Hymenolepis nana (2.0%), Trichuris trichiura (1.3%) and Taenia saginata (0.7%) were identified in children living in irrigated areas. The multiple logistic regression model indicated that age of the child, gender, family size, source of drinking water, type of milk used, house condition, feeding habit, personal hygiene and socioeconomic status were significantly (p<0.05) associated with the IPIs. Intestinal parasites were prevalent in varying magnitude among the schoolchildren located in irrigated areas. We conclude that there is a need for mass scale campaigns to create awareness regarding health and hygiene in children, and the need for development of effective poverty control programmes because deworming alone is not adequate to control parasitic infections.

First characterization of immunogenic conjugates of Vi negative Salmonella Typhi O-specific polysaccharides with rEPA protein for vaccine development

Efficacious typhoid vaccines for young children will significantly reduce the disease burden in developing world. The Vi polysaccharide based conjugate vaccines (Vi-rEPA) against Salmonella Typhi Vi positive strains has shown high efficacy but may be ineffective against Vi negative S. Typhi. In this study, for the first time, we report the synthesis and evaluation of polysaccharide-protein conjugates of Vi negative S. Typhi as potential vaccine candidates. Four different conjugates were synthesized using recombinant exoprotein A of Pseudomonas aeruginosa (rEPA) and human serum albumin (HSA) as the carrier proteins, using either direct reductive amination or an intermediate linker molecule, adipic acid dihydrazide (ADH). Upon injection into mice, a significantly higher antibody titer was observed in mice administrated with conjugate-1 (OSP-HSA) (P=0.0001) and conjugate 2 (OSP-rEPA) (P≤0.0001) as compared to OSP alone. In contrast, the antibody titer elicited by conjugate 3 (OSPADH-HSA) and conjugate 4 (OSPADH-rEPA) were insignificant (P=0.1684 and P=0.3794, respectively). We conclude that reductive amination is the superior method to prepare the S. Typhi OSP glycoconjugate. Moreover, rEPA was a better carrier protein than HSA. Thus OSP-rEPA conjugate seems to be efficacious typhoid vaccines candidate, it may be evaluated further and recommended for the clinical trials.