Xylooligosaccharide supplementation in rice protein concentrate based diets: A comprehensive analysis of performance and health of Labeo rohita

The primary aim of this study was to examine the impact of xylooligosaccharide (XOS) in rice protein concentrate (RPC) based diets on the growth performance, body composition, digestive enzymes, intestinal morphology and blood biochemistry of Labeo rohita fingerlings. Four different XOS levels (0%, 0.5%, 1% and 2%) were used at each RPC (75% and 100%) level. Twenty-five fish per tank with an average initial weight of 25 ± 0.05 g were randomly assigned (Randomised complete block design) to each of the 8 groups in triplicate aquaria (36 × 16 × 12″) and then fed with respective diets @ 3% body weight for 90 days. The results showed significant improvements in growth performance, such as increased weight gain %, specific growth rate, and protein efficiency ratio and improved feed conversion ratio in 1% XOS supplemented diet at 75% RPC. A significant decrease in serum alkaline phosphatase activity (ALP) and plasma melanodialdehyde (MDA) were observed at 1% XOS level in 75% RPC based diets, respectively. Meanwhile, the lowest total cholesterol and highest lysozyme activity were observed in 1% XOS supplemented diet at 75% RPC levels. Moreover, the serum (alanine aminotransferase and aspartate transaminase) and plasma (superoxide dismutase, triglyceride, high density and low density lipoprotein) activities showed nonsignificant effects among the treatments. Furthermore, the digestive enzymes (protease & lipase) and intestinal morphology were significantly influenced at 1% XOS in the 75% RPC-based diet. Polynomial regression analysis showed that 1.25% XOS is the optimum requirement for the growth of rohu fingerlings when fed at 75% RPC based diets. Overall, it was concluded that the 75% RPC diet was efficiently replaced by fishmeal along with 1% XOS addition in L. rohita fingerlings without any negative effect on growth performance and intestinal health.

Feasibility of replacing fish oil with sunflower oil on the growth, body composition, fatty acid profile, antioxidant activity, stress response, and blood biomarkers of Labeo rohita

A 90-day study was conducted to investigate the effects of substituting sunflower oil (SFO) for fish oil (FO) on various parameters in Labeo rohita (initial weight 18.21 ± 0.22 g). Five experimental diets with different levels of SFO (up to 7%) substitution for FO (0%, 25%, 50%, 75%, and 100%) were formulated, ensuring equal levels of nitrogen and lipids. The results indicated that even with 100% substitution of SFO with FO, there were no significant differences (P>0.05) were observed in growth performance. The survival rate (SR), hepato-somatic index (HSI), and viscero-somatic index (VSI) as well as whole-body composition were also nonsignificant by SFO substitution. However, the fatty acid profiles in both muscle and liver were influenced (P<0.05) by dietary substitution. Saturated fats (SFA) decreased, while monounsaturated fats (MUFA), and linoleic acid (LA) increased (P<0.05). On the other hand, the contribution of linolenic acid (ALA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) decreased (P<0.05) as the amount of SFO in the diet increased. Hematology parameters, including red blood cells (RBCs), hemoglobin (Hb), and hematocrit (Hct), were not affected. Globulin (GLO) levels decreased significantly (P<0.05), while alanine transaminase (ALT) and aspartate transaminase (AST) activity showed nonsignificant increases (P>0.05). Total protein (TP) increased (P<0.05) at 100% SFO inclusion in the diet, and albumin (ALB) levels increased (P<0.05) at 75% and 100% SFO inclusion in the diet. Cholesterol (CHOL), triacylglycerol (TG), and high-density lipids (HDL) were not significantly affected (P>0.05), while low-density lipids (LDL) were significantly increased (P<0.05) compared to the control group. Cortisol (CORT) and glucose (GLU) levels showed nonsignificant (P>0.05) changes. Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) activities in the liver and serum were not significantly (P>0.05) affected, while malondialdehyde (MDA) status was significantly (P<0.05) reduced. In conclusion, the fatty acid profile of the muscle and liver of fish was modified by the diets, and FO can be substituted with SFO up to 100% for L. rohita, which is beneficial for growth and immunity while marinating the lipid contents in fish. Our study revealed that fully replacing fish oil with SFO shows promise in fully replacing FO without compromising the growth and overall health status of the fish.

Enhancing farmed striped catfish (Pangasianodon hypophthalmus) robustness through dietary β-glucan

β-glucan is a well-documented feed additive for its potent immunostimulatory properties in many farmed fish species. This study examined how it can also be a promising growth promoter, modulate antioxidant enzyme activities, and act as an anti-stress agent in striped catfish (Pangasianodon hypophthalmus). A 12-week feeding experiment was untaken to determine the effects of dietary β-glucan supplementation at graded levels (0, 0.5, 1.0, and 1.5 g kg-1). Measured indicators suggest that a dietary inclusion level of 1.5 g kg-1 β-glucan gave the highest positive responses: weight gain (120.10 g fish-1), survival (98.30%), and lower FCR (1.70) (P<0.05). Whole body proximate analysis had only revealed that crude protein was significantly affected by the dietary inclusion of β-glucan (P<0.05), with the highest protein content (19.70%) being in fish that were fed with 1.5 g kg-1 β-glucan. Although other inclusion levels (i.e., 0.5 and 1 g kg-1) of β-glucan did not enhance body protein content (P>0.05). The assessment of fatty acid composition in muscle, liver, and adipose tissues showed modifications with the inclusion of β-glucan. Antioxidative-related enzyme activities (inc. catalase, glutathione peroxidase, and superoxide dismutase) that were measured in the liver had higher levels when fed with β-glucan inclusion diets (P<0.05). Following the feed trial, fish were subjected to crowding stress treatment. It was subsequently found that catfish fed with β-glucan-based diet groups had lower levels of blood stress-related indicators compared to the control group with no dietary β-glucan. The use of 1.5 g kg-1 of dietary β-glucan resulted in the lowest measured levels of cortisol (43.13 ng mL-1) and glucose (50.16 mg dL-1). This study has demonstrated that the dietary inclusion of β-glucan can have functional benefits beyond the immunological enhancements in striped catfish. Furthermore, its use can increase production levels and mitigate the stress associated with intensive farming practices.

Nature and correlates of self-esteem in young adult survivors of childhood traumatic brain injury

Despite growing research linking childhood traumatic brain injury (TBI) with reduced wellbeing, self-esteem, and psycho-social health, very few studies have examined self-esteem and its correlates in young adult survivors of childhood TBI. This very-long-term follow-up study evaluated self-esteem in 29 young adults with a history of childhood TBI (M time since injury = 13.84 years; SD = 0.74), and 10 typically developing controls (TDCs). All participants were originally recruited into a larger, longitudinal case-control study between 2007 and 2010. In the current follow-up study, both groups completed well-validated measures of self-esteem and mental health in young adulthood. Although group means for self-esteem did not significantly differ between TBI and TDC groups, a higher proportion of TBI participants rated their self-esteem in the clinical range (TBI group = 17%; TDC group = 0%). While self-esteem was not significantly associated with injury or pre-injury child or family characteristics, lower self-esteem was significantly correlated with greater concurrent feelings of loneliness (p = 0.007) and higher concurrent mood symptoms (p < 0.001).Our results suggest that social isolation and low mood may represent meaningful targets for psycho-social interventions to address poor self-worth in young adults with a history of childhood TBI.

Interactive effects of temperature and protein levels on the growth performance, proximate composition, digestive enzyme activity and serum biochemistry of Labeo rohita

The current study was performed to investigate the impact of different temperatures and protein levels on the growth performance, proximate composition and digestive and hepatic enzyme activities of Labeo rohita fingerlings. For this purpose, healthy fingerlings (average initial weight of 6.40 ± 0.02 g) were acclimatized for 15 days, then reared at three temperatures (25°C, 30°C and 35°C) and fed three levels of crude protein (25%, 30% and 35% crude protein (CP)) twice daily until satiation for 60 days. The results of the study revealed that the highest growth performance was observed in fish fed 35% protein and reared at 30°C. Similarly, fish reared at 35°C and 25°C water temperature showed comparatively better growth performance in fish fed with 35% protein. Furthermore, a significant enhancement in feed intake was observed with increasing culture temperature and increasing CP levels, but at 25°C, increasing CP levels significantly decreased the feed intake. Sligh variations were also observed in proximate composition in terms of moisture, CP, crude fat (CF) and ash contents in fish fed with different CP levels and reared at different temperatures. The hepatosomatic index and viscerosomatic index decreased significantly with increasing levels of protein and temperature. Amylase activities were significantly reduced with increasing culture temperature at each protein level. Increasing culture temperature did not affected the lipase activities. However, lipase activities were enhanced with increasing CP levels at 25°C and activities decreased with increasing CP levels at 30-35°C. Protease activity was enhanced with increasing temperature and CP levels. Significant increases were also observed in serum total proteins and liver functioning enzymes such as alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase in response to increased temperature, and protein had a reciprocal effect. It is concluded that increasing the CP levels increased the growth performance independent of temperature. However, similar growth performance at 30 CP (30°C) and 35 CP (35°C) indicates that L. rohita requires more protein at higher temperature for optimum growth.

SMT-738: a novel small-molecule inhibitor of bacterial lipoprotein transport targeting Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CREs) are described by the Centers for Disease Control as an urgent threat, and there is a critical need for new therapeutic agents able to treat infections caused by these pathogens. Herein, we describe the microbiological profile, the mechanism f action, and the in vitro safety as well as the pharmacokinetic (PK)/PD profile of SMT-738, a small molecule belonging to a new chemical class. SMT-738 is active against Enterobacterales [including multi-drug-resistant Escherichia coli with 90% of isolates having a minimum inhibitory concentration (MIC90) of 1 µg/mL and Klebsiella pneumoniae 2 µg/mL] and inactive against a broad panel of Gram-negative and Gram-positive pathogens. SMT-738 displays rapid bactericidal activity (2-4 h) and has a low propensity for resistance development (less than ~10-9). Characterization of resistant mutants following exposure to SMT-738 identified mutations within the lipoprotein transport complex (LolCDE), a clinically unexploited and essential bacterial molecular target in Gram-negative bacteria. SMT-738 has a promising in vitro toxicology profile. Furthermore, PK studies demonstrated that when dosed intravenously, SMT-738 maintained exposure levels across infection sites (bloodstream/urinary tract/lung). Proof-of-concept studies across multiple murine in vivo infection models (bloodstream/pneumonia/urinary tract) demonstrated that SMT-738 significantly reduced the bacterial burden compared to baseline and vehicle control. SMT-738 represents a promising novel drug candidate being developed to address clinically challenging serious life-threatening infections caused by highly resistant Enterobacteriaceae including CRE.

Post-traumatic headache pathophysiology in paediatric concussion: A systematic review

Post-traumatic headache (PTH) represents the most common acute and persistent symptom following concussion in children, yet the underlying pathophysiology remains unclear. This systematic review sought to: (i) rigorously examine the current evidence of PTH pathophysiology in paediatric concussion (0-18 years), (ii) assess the quality of evidence, and (iii) provide directions for future research in accordance with PRISMA guidelines. Eligible studies (n = 19) totalling 1214 concussion participants investigated cerebrovascular function (n = 6), white matter integrity (n = 3), functional connectivity (n = 3), electrophysiology (n = 1), neurometabolics (n = 2), biological fluid markers (n = 4), vestibular and oculomotor function (n = 4); two studies used a multi-modal approach. Majority of studies were rated as fair quality (90%) and Level 3 evidence (84%). The true underlying mechanisms of PTH following paediatric concussion remain unclear. Overall quality of the available evidence is generally weak with a fair risk of bias and characterised by relative scarcity and lack of specificity of PTH pathophysiology. Future research is required to rigorously isolate pathophysiology specific to PTH with strict adherence to clinical definitions and standardised measurement tools of PTH.

Dietary phosphorus requirement of silver CARP (Hypophthalmichthys molitrix) fingerlings

The aim of this study was to determine the optimal dietary phosphorus (P) requirement and its effects on growth performance, body composition, mineralization and alkaline phosphate (ALP) activity in silver carp (Hypophthalmichthys molitrix). A total of 360 fish with an average initial weight of 7.0 ± 0.15 g were divided into 18 tanks (70 L capacity each) with a stocking density of 20 fish per tank in triplicate. The fish were fed diets containing six levels of P (3.3, 4.4, 5.5, 6.5, 7.5 and 8.6 g/kg) up to satiation for 90 days twice daily at 09:00 and 16:00. The results showed that fish fed diets containing 6.5 and 7.5 g/kg dietary P had significantly higher (p < 0.05) growth performance in terms of final weight gain, average weight gain (AWG), weight gain% (WG%), protein efficiency ratio (PER) and specific growth rate (SGR) than fish fed other diets. The best value of the feed conversion ratio (FCR) was observed in fish fed the 6.5 g/kg P diet, which was not significantly different from the 7.5 g/kg P diet. Increasing P supplementation above 6.5 g/kg significantly reduced (p < 0.05) the feed intake of silver carp. Whole-body composition analysis indicated that increasing P levels resulted in a decrease (p < 0.05) in crude fat (CF) and an increase (p < 0.05) in crude ash (CA) content, while crude protein (CP) and moisture content remained unaffected (p > 0.05). Fish fed diets containing ≥6.5 g/kg P had significantly higher (p < 0.05) Ca content in the whole body, bones and scales compared to those fed diets containing ≤5.5 g/kg P. A similar trend was observed for P and Mg contents in the whole body, bones and scales. The Zn content tended to decrease (p < 0.05) with increasing P supplementation in the whole body and bones, but fish fed diets containing ≥6.5 g/kg P had significantly higher (p < 0.05) Zn content compared to fish fed diets containing ≤5.5 g/kg P. The Ca/P ratio was significantly affected by P supplementation. Fish fed diets containing ≥6.5 g/kg P had significantly higher (p < 0.05) Ca and P contents in the serum than fish fed other diets. ALP activity increased (p < 0.05) with increasing P levels up to 6.5 g/kg P and decreased (p < 0.05) thereafter. In conclusion, supplementing P up to 6.35 g/kg is recommended for the optimal growth of silver carp.

Black cardamom (Amomum subulatum) extract improves growth potential, antioxidant status, immune parameters and response to crowding stress in Catla catla

Natural herbs are excellent alternatives to synthetic compounds to enhance the growth performance and health status of fish. This study was conducted to evaluate the efficacy of black cardamom (Amomum subulatum) extract (BCE) as an herbal supplement in improving the growth, antioxidant status, haematology, and serum biochemistry of Catla catla. The acclimatized fish (N = 900; average initial weight = 14.44 ± 0.33 g) were allocated into five groups (60 fish/group in triplicate) in hapas (4 × 2 × 2.5 ft) and provided with feed containing 0 (control), 0.5, 1, 2 and 4 g/kg BCE for 90 days before being subjected to 8 days of crowding stress. After 90 days, significantly higher feed utilization and growth were observed in all BCE-fed treatments compared to the control; however, the maximum values of these parameters were noted in the 2 g/kg BCE-fed treatment. Moreover, the BCE-fed groups exhibited a significant increase in antioxidant indices (glutathione peroxidase, superoxide dismutase and catalase), with a significant reduction in malondialdehyde levels, indicating a higher antioxidant capacity compared to the control. Significant improvements in haematological parameters, such as an increase in haematocrit, haemoglobin and red blood cells and a decrease in white blood cells, were observed in BCE-fed treatments compared to the control. Furthermore, BCE-fed groups showed a significant decrease in serum glucose, cortisol and triglycerides, while total protein, globulin and albumin levels were significantly higher compared with the control. During the feeding trial of 90 days, no mortality was observed; however, the lowest cumulative mortality was noted in the 2 g/kg BCE group after crowding stress of 8 days. In conclusion, the use of BCE in feed can enhance the growth performance, antioxidant status, haematology, and serum biochemistry of C. catla and improve the resistance against crowding stress. The optimum levels of BCE for C. catla were estimated based on weight gain % (1.78 g/kg; R2  = 0.97), feed conversion ratio (1.65 g/kg; R2  = 0.98), MDA content (1.66 g/kg; R2  = 0.93) and serum lysozyme activity (1.72 g/kg; R2  = 1) using broken-line regression analysis.

Strategic replacement of soybean meal with local cotton seed meal on growth performance, body composition, and metabolic health status indicators in the major South Asian carp Catla catla for aquaculture

This study assessed the effect of substituting soybean meal (SBM) with cotton seed meal (CSM) on different biological traits in thaila (Catla catla). Fish (n = 225) with an average initial body weight of 41.53±0.68 g were shifted into hapas (3 (L) x 2 (W) x 1 (D) m) in triplicate (15 fish/replicate). Hapas were divided into five dietary groups: 0CSM, 25CSM, 50CSM, 75CSM, and 100CSM diet treatments were administered diets for a period of 90 days. SBM was replaced by CSM at the levels of 0, 25, 50, 75, and 100%. The results showed that fish survival and growth performance were not affected by the inclusion of CSM in the fish diet up to 50% as a replacement of SBM, but higher replacement levels showed a negative effect. Similarly, body composition and most of the muscle amino acid profiles were not affected significantly (P>0.05) by replacing SBM with CSM. Digestive enzyme activities were significantly (P<0.05) decreased by increasing the level of CSM in the fish diet. Alanine transaminase (ALT) and aspartate transaminase (AST) levels increased significantly (P<0.05) with increasing dietary CSM levels, while alkaline phosphatase (ALP) levels remained the same. Malondialdehyde (MDA) and catalase (CAT) activity decreased significantly (P<0.05), but superoxide dismutase (SOD) activity showed no change. For the intestine, the villus height to villus width ratio and thickness of Tunica muscularis were also better in 25CSM, and their values decreased as the CSM inclusion level increased in the fish diet. In conclusion, SBM could be replaced partially (up to 50%) with CSM without compromising growth performance, whole body proximate composition or immunity of C. catla.

Associations Between Peer Relationships and Self-Esteem After Childhood Traumatic Brain Injury: Exploring the Mediating Role of Loneliness

Pediatric traumatic brain injury (TBI) can impact psycho-social functioning, including friendships and experiences of loneliness; however, few studies have explored associations between these factors and self-esteem. To address this gap, the objective of this study was to document inter-relationships between friendship quality, peer-related loneliness, and self-esteem 12 months post-injury. The sample in this prospective, longitudinal observational study consisted of 135 children, including 92 children with TBI (57 mild, 35 moderate-severe TBI) and 43 typically developing control (TDC) children. Children rated their friendship quality, loneliness, and self-esteem. Parents completed questionnaires measuring socioeconomic status and children's pre-injury functioning. At 12-month follow-up, ratings of friendship quality (perceived support and satisfaction with friendships), peer-related loneliness, and self-esteem were comparable between TBI and TDC participants. In mediation models, poorer quality friendships were associated with greater peer-related loneliness, and greater peer-related loneliness was related to reduced athletic and social self-esteem, at 12 months post-TBI. Loneliness with peers mediated the effects of both friendship support and friendship satisfaction on children's social self-esteem. Our preliminary findings suggest that regular monitoring of social interactions post-TBI might facilitate early identification of children who are likely to benefit from interventions targeting peer-related loneliness, which in turn may lower risk for poorer self-esteem.

Determination of heavy metals (Pb, Cr, As, Hg, and Cd) into the body organs of selected fish, water, sediment, and soil samples from Head Punjnad and Head Taunsa, Punjab, Pakistan

The present study was conducted on Head Punjnad (HP) and Head Taunsa (HT) to evaluate the contamination of Pb, Cr, As, Hg, and Cd in water, soil, sediment, fish as a whole and fish organs. Fish, water, soil and sediment samples were collected from different sites of HT and HP on a monthly basis for 8 months. Heavy metals in water, soil, and sediment were determined by a polarized Zeeman atomic absorption spectrophotometer and in fish and fish organs by an atomic absorption spectrophotometer. Contamination of Cd, Hg, and As was significantly (P<0.05) higher in water of HP as compared to HT, while Cr showed a non-significant (P>0.05) difference at HP and HT. Pb was significantly (P<0.05) higher in water of HT as compared to HP. In the case of soil, Cd, Hg, and Pb were higher at HT as compared to HP, while As and Cr were significantly (P<0.05) higher at HP as compared to HT. In sediment, contamination of Cd, Hg, and As were significantly (P<0.05) higher at HP as compared to HT, while the Cr difference was non-significant (P>0.05) but Pb showed a significantly (P<0.05) higher value at HT than HP. Cd accumulation in different fish species was recorded as R. rita ˃O. niloticus ˃C. marulius ˃S. sarwari ˃C. idella ˃C. catla ˃N. notopterus ˃E. vacha ˃L. rohita ˃C. carpio, respectively. Hg as O. niloticus ˃S. sarwari ˃R. rita ˃C. marulius ˃C. catla ˃N. notopterus ˃E. vacha ˃L. rohita ˃C. carpio ˃C. idella, respectively. As as O. niloticus ˃R. rita ˃S. sarwari ˃C. marulius ˃C. catla ˃C. carpio ˃N. notopterus ˃C. idella ˃E. vacha ˃L. rohita, respectively. Cr accumulation recorded as L. rohita ˃C. idella ˃O. niloticus ˃C. marulius ˃E. vacha ˃R. rita ˃C. catla ˃C. carpio ˃S. sarwari ˃N. notopterus, respectively. Pb accumulation in different fish species was recorded as C. idella ˃C. carpio ˃N. notopterus ˃L. rohita ˃O. niloticus ˃C. marulius ˃R. rita ˃S. sarwari ˃E. vacha ˃C. catla, respectively. Cd accumulation in different organs was recorded as kidney ˃liver ˃gills ˃muscle ˃skin ˃scale. Hg accumulation in different organs was recorded as kidney ˃gills ˃liver ˃skin ˃muscle ˃scale. As accumulation in different organs was recorded as kidney ˃liver ˃gills ˃muscle ˃skin ˃scale. Cr accumulation in different organs was recorded as gills ˃ liver ˃skin ˃muscle ˃kidney ˃scale. Pb accumulation in different organs was recorded as gills˃ kidney˃ skin˃ liver˃ muscle˃ scale.

National and Sub-National Estimates of Household Coverage of Iodized Salt and Urinary Iodine Status among Women of Reproductive Age in India: Insights from the India Iodine Survey, 2018-19

BACKGROUND

Iodine deficiency is a significant public health problem for many populations worldwide, including India, particularly during the "first 1000 days" of life. Though Universal Salt iodization (USI) is mandatory in India, prior to 2018-19, there was no state-wide survey with estimates of iodine concentrations in salt using iodometric titration. Taking cognizance of this fact, Nutrition International commissioned the first-of-its-kind national-level survey in India, titled the India Iodine Survey 2018-19.

OBJECTIVES

The study was conducted across the country to provide national and subnational estimates of iodine concentrations in household salt using iodometric titration and iodine nutrition status among women of reproductive age (15-49 y).

METHODS

The survey adopted a multi-stage randomcluster probability proportional to size sampling design, covering 21,406 households in all the states and union territories (UTs) of India.

RESULTS

At the national level, the household coverage of edible salt with adequate iodine (content ≥15 parts/million) was 76.3%. At the sub-national level, the coverage varied, with 10 states and 3 UTs achieving USI and 11 states and 2 UTs falling below the national average, with the highest among all the states and UTs, being Jammu and Kashmir and the lowest being Tamil Nadu. At the national level, the median urinary iodine concentration for pregnant women was 173.4 μg/L, for lactating women was 172.8 μg/L, and for non-pregnant, non-lactating women, it was 178.0 μg/L, which is within the adequate iodine nutrition range according to the WHO guidelines.

CONCLUSIONS

The survey results can be widely used by various stakeholders, including government, academia, and industry, to understand the iodine nutrition status of the population, enable the scale-up of sustained efforts toward consolidating gains and achieving USI, leading to the reduction and elimination of Iodine Deficiency Disorders.

Resistance Patterns of Frequently Applied Antimicrobials and Occurrence of Antibiotic Resistance Genes in Edwardsiella Tarda Detected in Edwardsiellosis-Infected Tilapia Species of Fish Farms of Punjab in Pakistan

Edwardsiella tarda is one of the most significant fish pathogens, causes Edwardsiellosis in a variety of freshwater fish species, and its antibiotic resistance against multiple drugs has made it a health risk worldwide. This study aimed to investigate antibiotic resistance (ABR) genes of E. tarda and to establish its antibiotic susceptibility. Thus 540 fish (299 Oreochromis niloticus, 138 O. mossambicus, and 103 O. aureus) were collected randomly from twelve fish farms in three districts of Punjab in Pakistan. E. tarda was recovered from 147 fish showing symptoms of exophthalmia, hemorrhages, skin depigmentation, ascites, and bacteria-filled nodules in enlarged liver and kidney. Antimicrobial susceptibility testing proved chloramphenicol, ciprofloxacin, and streptomycin effective but amoxicillin, erythromycin, and flumequine ineffective in controlling Edwardsiellosis. Maximum occurrence of qnrA, blaTEM, and sul3 gene of E. tarda was detected in 45% liver, 58%, and 42% respectively in the intestine; 46.5%, 67.2%, and 55.9% respectively in O. niloticus; 24%, 36%, and 23% respectively in summer with respect to fish organs, species and season respectively. Motility, H2S, indole, methyl red, and glucose tests gave positive results. Overall E. tarda infected 27.2% of fish which ultimately caused overall 7.69% mortality. The Chi-square test of independence showed a significant difference in the occurrence of ABR genes of E. tarda with respect to sampling sites. In conclusion misuse of antibacterial agents causes the emergence of ABR genes in E. tarda which in association with high temperature causes multiple abnormalities in infected fish ultimately causing massive mortality.

The influence of dietary protein concentration on digestive enzyme activities, growth, and body composition in juvenile bullseye snakehead (Channa marulius)

The bullseye snakehead (Channa marulius) is considered as an affordable and robust freshwater fish for farming in Asia. However, there is limited knowledge on the species' full nutritional requirements to date with extensive gaps in our knowledge and particularly in precision aspects of protein requirements. Therefore, a three-month feeding trial was conducted under semi-intensive farming conditions to determine the protein requirement of bullseye snakehead using test diets containing 40 (P40), 45 (P45), 50 (P50), and 55% (P55) crude protein levels. The growth performance results revealed that the 55% dietary protein group (P55) had the highest final mean weight (14.09 g fish-1), and net weight gain (12.82 g fish-1). When compared to other dietary treatments, the final weight (R2 = 0.921), and weight gain (R2 = 0.913), displayed a linear increasing trend as dietary protein is raised. The lowest FCR was observed in 50% (1.94±0.01) and 55% (1.97±0.01) CP diet groups compared to dietary treatments. Further analysis has shown that the body protein content also significantly increased as dietary protein was raised to 55%. Although, a reverse trend was found in body lipid levels with increasing protein in the diet. The incremental dietary protein also elevated proximal intestinal protease activity but decreased amylase and lipase activity. The overall essential and non-essential amino acids levels of snakehead fillet muscle reflected an increase in dietary protein. Overall, this study has shown that the fish fed a diet with 55% crude protein attained the highest growth performance and nutrient profile of the whole fish when compared to other dietary treatments tested. It would appear we did not obtain the maximum potential for growth under the present experimental conditions due to the upper protein constraint of 55% in the diet. Further quantitative studies are suggested.

Summary of fifth annual public MCBK meeting: Mobilizing computable biomedical knowledge (CBK) around the world

The massive growth of biomedical knowledge in computable formats poses a challenge for organizations as they consider mobilizing artifacts to be findable, accessible, interoperable, reusable, and trustable. Formed in 2016, the Mobilizing Computable Biomedical Knowledge (MCBK) community is taking action to ensure that health organizations have the infrastructure in place to access and apply computable knowledge; to develop national policies and standards that require all data to be discoverable and available for safe and fair use; and to promote the widespread adoption and implementation of health knowledge in support of healthcare, biomedical research, public health, and education. This report summarizes the main outcomes of the Fifth Annual MCBK meeting, also considered the first manifestly global MCBK meeting, which was held virtually July 12 to 13, 2022. Over 200 participants from diverse domains around the world joined this meeting to frame and address important dimensions for mobilizing CBK.

Reviewing and renewing the use of beneficial root and soil bacteria for plant growth and sustainability in nutrient-poor, arid soils

A rapidly increasing human population coupled with climate change and several decades of over-reliance on synthetic fertilizers has led to two pressing global challenges: food insecurity and land degradation. Therefore, it is crucial that practices enabling both soil and plant health as well as sustainability be even more actively pursued. Sustainability and soil fertility encompass practices such as improving plant productivity in poor and arid soils, maintaining soil health, and minimizing harmful impacts on ecosystems brought about by poor soil management, including run-off of agricultural chemicals and other contaminants into waterways. Plant growth promoting bacteria (PGPB) can improve food production in numerous ways: by facilitating resource acquisition of macro- and micronutrients (especially N and P), modulating phytohormone levels, antagonizing pathogenic agents and maintaining soil fertility. The PGPB comprise different functional and taxonomic groups of bacteria belonging to multiple phyla, including Proteobacteria, Firmicutes, Bacteroidetes, and Actinobacteria, among others. This review summarizes many of the mechanisms and methods these beneficial soil bacteria use to promote plant health and asks whether they can be further developed into effective, potentially commercially available plant stimulants that substantially reduce or replace various harmful practices involved in food production and ecosystem stability. Our goal is to describe the various mechanisms involved in beneficial plant-microbe interactions and how they can help us attain sustainability.

Administration of vitamin E and C enhances immunological and biochemical responses against toxicity of silver nanoparticles in grass carp (Ctenopharyngodon idella)

The aim of the current study was to evaluate the toxic effect of silver nanoparticles (Ag-NPs) on biochemical biomarkers, immune responses, and the curative potential effects of vitamin C and E on grass carp. Fish (n = 420) with an average initial body weight of 8.045 ± 0.13 g were shifted to glass aquaria (36 x 18 x 18 inches, filled with 160-L tap water) in triplicates. Aquaria were randomly designated as A, B, C, D with alone Ag-NPs (Control (0), 0.25, 0.50, 0.75 mg/L) and E, F, G with Ag-NPs + Vit. C + Vit. E (0.25+0.25+0.25, 0.50+0.50+0.50, 0.75+0.75+0.75 mg/L). NPs particles were administrated viz, oral and intravenous routes for 7 days. The results indicated that both routes had non-significant effect, but levels of Ag-NPs had significant effect. Treatments C, D and G showed significant decrease in levels of RBC, HGB and HCT except for WBC and NEUT levels, which significantly increased. ALT, ALP, AST, urea, and creatinine showed significant increase in activity in the C, D, and G groups. CAT, SOD decreased significantly in all Ag-NPs alone groups, while significantly increased with vitamin E and C. LYZ, TP, ALB, GLB showed significant low activity in the B, C, and D groups while significantly high activity in the E, F, and G groups. Cortisol, glucose and triglycerides showed significant increase in the B, C, and D groups, while E, F, and G groups showed significant low levels of triglycerides, COR, and GLU. Cholesterol level was same across all treatment groups. In conclusion, vitamin E and C as powerful antioxidants protect the fish against Ag-NPs except high dose level of 0.75mg/L, while 0.25mg/L of Ag-NPs was presumably safe for C. idella.

Consumer attitude toward Halal food in the case of the United Kingdom: the role of product attributes and marketing stimuli

The Halal market in the United Kingdom is worth $4.5 billion and is anticipated to grow at a rate of 5% each year. In the United Kingdom, there is a growing demand for Halal food, which has resulted in the formation of various unregulated Halal Certification Bodies. In the halal food market, the problem of halal authenticity has recently become a serious concern. The purpose of the paper was to determine the effect of product attributes and marketing stimuli on customer attitudes toward halal food among Muslim customers in the U.K. A cross-sectional study was adopted for this study. The sample of the study included the Muslim customers who have consumed halal food in the U.K. The authors used a survey method to collect the quantitative data. A total of 384 responses were received and data were analysed using SPSS. The findings of the study revealed that product attributes such as country of origin have a significantly greater influence on the customer attitude towards halal food compared to other product attributes. The findings further showed that marketing stimuli such as sales’ location impact on customer attitude however advertisement did not have any impact on customer attitude towards halal food. The finding held perspectives from Muslim customers in the U.K and contributes to the stimulus-organism-response theory by incorporating product attributes and marketing as stimulus factors that affect the internal psychological state i.e., customer’s attitude in the case of the U.K. The implication of this study was to recommend Halal enterprises import halal food from Islamic countries for U.K customers, research the strategic location and select the hypermarkets, that handle halal food with care.

National audit of non-melanoma skin cancer excisions performed by plastic surgery in the UK

A national, multi-centre audit of non-melanoma skin cancer excisions by plastic surgery.

Adult outcomes of complex pulmonary atresia, ventricular septal defect and major aortopulmonary collaterals following repair during childhood, a single centre experience

Background

Complex pulmonary atresia with a ventricular septal defect and major aortopulmonary collateral arteries (PA VSD MAPCA) is a rare and complex form of congenital heart disease. Staged surgical palliation is carried out in childhood, and in expert centres, is associated with good medium term survival. Adult outcomes following transition to adult care are not known.

Purpose

To establish adult outcomes of PA VSD MAPCA following repair during childhood in our institution

Methods

Review of clinical records for outcome data including life status, NYHA class, employment status, re-intervention in adult life, arrhythmia, pregnancy, exercise capacity and mode of death, where known. We predefined our population into two groups based on their status at transition to adult care, A) complete repair with RV-PA conduit and VSD closed and B) repaired but VSD left open.

Results

188 patients from our series have transitioned to adult services. As many were tertiary referrals (nationally and internationally) the local follow up population was 53 adults (54.7% male), mean age of those alive under follow up is 27.2±6.5 years, with a mean follow up of 25.3±6.1 years. There were 43 in group A and 10 in group B. Mortality in the total population was 18.9% (10/53), group A (16.3%), group B (30.0%), mean age at death 37.5±10.3 years and 29.9±8.4 years, 6/10 deaths were sudden. 22.6% of the whole group had DiGeorge/22q11 microdeletion, with a learning deficit in 32.7% of the cohort, where this could be assessed. Reinterventions included RV-PA conduit change, coil occlusion, pacemaker implantation, ICD implantation and ablation procedures, overall 39.6% underwent reintervention in adult life. Pregnancy occurred in 33.3% of 24 female patients. 50% of individuals were found to have undertaken some form of paid work and of these 11.5% had DiGeorge.

Conclusions

Complex PA VSD MAPCA is associated with good late survival with late attrition including sudden death and heart failure. 22q11 is associated with learning deficit and consequent lack of employment. Non 22q11 have good educational outcomes and there is less observed deficit regarding employment. Successful pregnancy is possible within this population.

Funding Acknowledgement

Type of funding sources: None.

The Impact of Living with INOCA

Background

There is limited literature available on the impact of myocardial ischemia but no obstructive coronary arteries (INOCA) on patients' lives.

Purpose

We sought to determine how INOCA impacts the physical, social, and mental health of persons with this diagnosis.

Methods

A survey was made available to all members of the patient support group from INOCA International over a 3-month time period. Fitness was estimated using the Duke Activity Status Index (DASI), assessing levels of activities performed prior to the onset of INOCA symptoms, and after the diagnosis of INOCA. The formula to estimate fitness in metabolic equivalents (METs) = 0.43 × DASI + 9.6 / 3.5

Results

A total of 297 patients with INOCA responded to the survey; 91.2% were women. The most common diagnosis was coronary microvascular dysfunction (64.3%) and coronary artery spasm (50.5%) (Table 1). 34.4% reported living with symptoms for ≥3 years before their diagnosis of INOCA was made. 77.8% who had been told their symptoms were not cardiac. The symptoms the respondents experienced were numerous, but 92.9% reported symptoms of chest pain, pressure, or discomfort. Fitness levels prior to the onset of INOCA symptoms were significantly higher compared to after diagnosed with INOCA (8.6±1.8 METs vs 5.6±1.8 METs; P&lt;0.0001). Most respondents reported an adverse impact on their home life (80.5%), social life (80.1%), mental health (70.4%), outlook on life (69.7%), sex life (55.9%), and their partner/spouse relationship (53.9%). Work life was also affected once living with INOCA: approximately three-quarters had reduced their work hours or stopping work completely, 47.5% retired early, and 38.4% applied for disability. While living with INOCA, for each 1-MET decrease in fitness, there was a loss of 3.0±0.6 days/months of physical health, 1.8±0.6 days/month of mental health, and 2.9±0.7 days/months of inability to perform recreational activities (p&lt;0.0001) (Figure 1).

Conclusions

Living with INOCA has significant impact on physical, mental and social health. Significant physical fitness declines are seen in those living with INOCA and are lower in those experiencing any adverse impact of living with INOCA. Additionally, the impact of INOCA on the ability to work has important economic consequences to both the patient and society. Increased recognition of the impact of INOCA on these aspects of health need to be recognized and further work is needed to better diagnosis and treat the symptoms of INOCA to improve the quality of life, cardiovascular outcomes, and overall health of this frequently encountered cardiovascular disorder.

Funding Acknowledgement

Type of funding sources: None.

Comparative Study between Acacia Nilotica versus Povidone Iodine in Topical Treatment of Omphalocele Major

Well established and common practice in conservative management of omphalocele major is escharotics therapy with different topical agents. Among them mercurochrome, alcohol, silver salts, povidone iodine, acacia nilotca paste are commonly used. It is a comparative study between application of acacia nilotica paste and povidone iodine solution as a primary non surgical treatment of omphalocele major regarding efficacy and safety of these two topical agents. A double blind randomized controlled study was conducted at the department of Paediatric Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2016 to June 2019. In this study 20 cases of omphalocele major and randomly divided into two equal groups. Group A and Group B treated with acacia nilotica paste and povidone iodine solution respectively. Gastroschisis, ruptured-omphalocele major or omphalocele minor excluded in this study. The size of the fascial defect in cm, time required for full oral feeding tolerance and duration of hospital stay were evaluating parameters. Patients with Group A tolerated full oral feeding earlier, shorter total hospital stay duration and low mortality rate than those from Group B. Application of acacia nilotica is a safe and effective treatment of omphalocele major regarding rapid full oral feeding tolerance, shorter hospital stay and low mortality rate.

Evaluation of dietary selenium methionine levels and their effects on growth performance, antioxidant status, and meat quality of intensively reared juvenile Hypophthalmichthys molitrix

The objective of this study was to optimize the organic selenium (Se) requirements of intensively reared silver carp (Hypophthalmichthys molitrix). A total of n = 300 juveniles silver carp 11.40±0.52 cm long, and average weighing 25.28±0.18 grams were randomly assigned to 15 aquaria (20 fish/100L aquaria) and subjected to five different dietary Se levels in a completely randomized design. The diets were pelleted supplemented with exogenous Se methionine @ 0.0, 0.3, 0.6, 0.9 and 1.2 mg/kg of the diet. The fourteen days of aquaria acclimatization was given to fish and then an 84-day feeding trial was conducted. The group supplemented with 0.9 mg/kg Se had greater feed intake, gain in length, body weight %, and specific growth rate with a better feed conversion ratio as compared to those fed on the rest of the dietary levels or control (P<0.05). The deposition of Se was greater in the liver, and kidneys of the fishes fed on diets containing 0.9 and 1.2 mg Se levels than in the rest of the treatments (P<0.05). However, dietary Se levels had no effects on the bioaccumulation of Se in muscle tissues (P>0.05). The proximate analysis showed that dry matter, crude protein, and fat contents of meat were not changed (P>0.05) by dietary treatments. Similarly, values of TBARS, RBCs, Hb, and blood glucose contents were similar (P>0.05) across the treatments. However, the concentration of WBCs, HCT, and MCHC was greater in those groups fed on 0.9 and 1.2 Se levels than in those fed on 0.6, 0.3, and 0.0 Se levels respectively (P<0.05). The activities of ALT, AST, and ALP were lowered in the 0.9 mg Se supplemented fishes compared with the rest of the treatments (P<0.05). The SOD, catalases, and GPx levels for muscle, liver, and whole body were greater (P<0.05) in the Se-supplemented groups than in the control. These outcomes indicated that up to 0.9 mg/kg inclusion of methionine-based Se in the diet of juvenile silver carp improved the growth performance, feed conversion ratio, organs Se enrichment, and antioxidant status without any compromise on meat quality.

363 A Comparative Analysis of Night-Time General Surgical Training

Aim

The aim of surgical training is to ensure trainees acquire competencies to perform as a Day 1 Consultant. The last decade has seen the introduction of European Working Time Directive, NELA guidelines and the revised Junior Doctor Contract. All of these, as well as the COVID 19 pandemic, have caused concerns regarding training. Our aim was to examine any changes to night-time on call activity during this time.

Method

We retrospectively analysed prospectively collected data from 2011, 2018, and 2021, in a busy District General Hospital. The data collection period was 31 days, looking at night-time (8pm to 8am) operative experience, supervision, and non-operative activity. A regression analysis was conducted to compare outcomes. A qualitative survey was used to assess attitudes and confidence.

Results

On average, trainees spent 11% of their time operating independently, 2% operating supervised, 11% attending trauma-calls and 73% clerking/non-educational activities. There was a significant difference between the hours spent on operative versus non-operative activity (P 0.00046) with no differences over the years. Junior trainees did not feel confident operating at night and only 33% of all trainees found night-time training effective.

Conclusions

Nightshifts comprise a substantial proportion of potential training opportunities and managing the unselected emergency take is one of the Capabilities in Practice. Effective solutions must be implemented to help improve night-time surgical experience and confidence in order for this time to be effective for training of both operative and non-operative competency attainment.

Awareness, Social Media, Ethnicity and Religion: are they Responsible for Vaccination Hesitancy? A Systematic Review with Annotated Bibliography

Vaccination is not only a medical term rather it is framed under socio-cultural perspectives and debates as well. Human history is full of illnesses caused bacteria and viruses killing millions of people including children and adults. Technological development in the health sector enabled to combat pathogenic illnesses through different methods whereby vaccination is one of them. However, it is a dilemma that vaccination has faced many barriers including logistical but most importantly sociocultural and religious. In 2019, WHO revealed vaccine hesitancy as a leading threat to health throughout the globe even in the top 10. This study looks to analyze peer reviewed literature to explore barriers to vaccination. Methodologically, this is desk research and systematic review. Numerous databases were searched with key words and purposively studies were selected for this study. A total of 17 most relevant studies were sampled. Findings show that there are four major factors hindering vaccination. 1st cultural and ethnic background matters whereby religion and the belief system are predominant factors. 2nd awareness and educational variables are also there, for instance, it is noted that many people are not aware of vaccination process specifically in case of HPV vaccination. 3rd social media plays a pivotal role whereby misinformation internalizes negative attitudes and misperceptions about vaccines. 4th social media is a key dimension whereby disinformation and misinformation are communicated through platforms whereby some are intentionally circulated. It is suggested that culturally relativism perspective can be helpful in increasing vaccination percentages. It pertains to intervention through culturally approved methods, for example, sensitizing the ethnic backgrounds through their leadership. In addition, vaccination tracking, media campaigns, focus on school level education to include health related course can be helpful.

Spreading Terrorism, Militancy, and Radicalization in Malakand Division Khyber Pakhtunkhwa Pakistan: An Analysis of the Economic Factors

The current study is to analyze the causes of militancy, terrorism, and radicalization where multifarious factors are contributing towards spreading such behavior. However, the study is delimited to focus on the economic factors, including poverty, unemployment and other such factors that lead towards militancy, terrorism, and radical behavior in society. The field information was collected from 200 respondents using purposive sampling technique with stratified approach from 3 strata of the society including businessmen, teachers and clergy or religious class of age 20 and above. The data was collected through a structured interview schedule, and the analysis was made in the form of tables, discussion and the findings have been verified through chi-square test. The findings show that militancy, terrorism, and radicalization have their roots in deep rooted poverty, unemployment, and lack of other life facilities in the area. The study suggests proper planning for provision of jobs, equal distribution of resources among people and provision of life facilities to the masses.

POS0685 LONG-TERM SAFETY AND EFFICACY OF UPADACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS: FINAL RESULTS FROM THE BALANCE-EXTEND OPEN-LABEL EXTENSION STUDY

Background

Upadacitinib (UPA) was previously evaluated in two Phase 2, randomized, controlled trials (RCTs) in patients (pts) with rheumatoid arthritis (RA) and inadequate response to tumor necrosis factor inhibitors (BALANCE-1) or methotrexate (BALANCE-2).

Objectives

To assess the final safety and efficacy of UPA in BALANCE-EXTEND, a 312-week open-label extension (OLE) enrolling pts who completed either BALANCE-1 or BALANCE-2.

Methods

All pts initially received UPA 6 mg twice daily (BID). Increase to 12 mg BID was required for pts with <20% improvement in swollen or tender joint counts (S/TJC) at Week 6 or 12, and permitted for those not achieving Clinical Disease Activity Index (CDAI) low disease activity (LDA). Pts with <20% improvement in SJC or TJC 6 weeks after escalation, or at any two consecutive visits, discontinued. Return to 6 mg BID was permitted for safety or tolerability reasons. After January 2017, the 6 and 12 mg BID doses were replaced by 15 and 30 mg once-daily (QD) extended-release equivalents. As-observed efficacy data are shown at Week 312 for three subgroups: pts who received 6 mg BID/15 mg QD throughout (“Never titrated”), those titrated up to 12 mg BID/30 mg QD for efficacy (“Titrated up”), and those titrated up to 12 BID/30 mg QD and then back to 6 mg BID/15 mg QD due to safety concerns (“Titrated up and down”). Exposure-adjusted adverse events (EAERs) per 100 patient-years (PY) of exposure were summarized from OLE Day 1 in all pts who received UPA (Any UPA).

Results

Overall, 493 pts entered the OLE, receiving UPA for ≤6.2 years (Never titrated, n=306; Titrated up, n=149; Titrated up and down, n=38), and 270 pts (54.8%) discontinued, mostly due to withdrawal of consent (16.8%; n=83) or AEs (14.6%; n=72). Mean (standard deviation) duration of UPA exposure was 3.8 (2.4) years (range <1–6.2 years); cumulative exposure was 1863 PY. The AE profile in pts receiving UPA 15 mg was generally similar to the Any UPA population, and to that observed in the Phase 3 UPA 15 mg clinical trial population (Table 1). Efficacy was maintained to Week 312, with 84.5% and 86.6% of pts in the Never titrated group achieving DAS28-CRP ≤3.2 and CDAI LDA, respectively (Figure 1).

Table 1.

Summary of AEs in pts who received UPA 6 mg BID/15 mg QD in the OLE and in the UPA 15 mg Phase 3 study program

BALANCE-EXTEND (UPA 6 mg BID/15 mg QD)UPA 15 mg – Phase 3 programbEvents/100 PY (95 CI)aEvents/100 PY (95% CI)aN=493, PY=1277N=3209, PY=9079Any AE138.4 (132.0, 145.0)205.5 (202.5, 208.5)Any SAE7.9 (6.4, 9.6)12.4 (11.7, 13.2)AE leading to discontinuation4.2 (3.2, 5.5)4.9 (4.4, 5.3)Death0.4 (0.1, 0.9)0.5 (0.4, 0.7)cInfection49.2 (45.5, 53.2)63.9 (62.3, 65.6) Serious infection1.4 (0.8, 2.2)2.8 (2.4, 3.1) Opportunistic infection0.2 (0.0, 0.6)0.3 (0.2, 0.4) Herpes zoster2.0 (1.3, 3.0)3.0 (2.6, 3.3)Anemia1.1 (0.6, 1.8)3.0 (2.7, 3.4)Neutropenia1.3 (0.8, 2.1)2.1 (1.8, 2.5)Lymphopenia1.7 (1.1, 2.6)1.7 (1.4, 1.9)Gastrointestinal perforation0<0.1 (0.0, 0.1)Any malignancy1.2 (0.7, 1.9)1.1 (0.9, 1.4)Non-melanoma skin cancer (NMSC)0.4 (0.1, 0.9)0.4 (0.3, 0.5) Excluding NMSC0.8 (0.4, 1.4)0.7 (0.6, 0.9)Creatinine phosphokinase elevation3.4 (2.5, 4.6)4.4 (4.0, 4.9)Hepatic disorder4.1 (3.0, 5.3)10.2 (9.5, 10.8)Venous thromboembolism0.5 (0.2, 1.0)0.4 (0.3, 0.6)Major adverse cardiovascular event0.5 (0.2, 1.0)0.4 (0.3, 0.5)

aMultiple events occurring in the same pts are counted in the calculation of events/100 PY. bCut-off, June 30, 2021. cBased on 9080 PY.

Conclusion

In this OLE, UPA treatment over ~312 weeks showed sustained long-term efficacy in pts with RA who had completed Phase 2 RCTs. Overall safety results showed that UPA was well tolerated over time; the types and frequencies of AEs were consistent with those in pts with similar populations of moderately to severely active RA receiving Janus kinase inhibitors.

Acknowledgements

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. AbbVie and the authors thank all study investigators for their contributions and the patients who participated in this study. No honoraria or payments were made for authorship. Medical writing support was provided by Dan Booth, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests

Alan Kivitz Shareholder of: Amgen, Gilead, GlaxoSmithKline, Novartis, Pfizer, and Sanofi (stocks or options), Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Eli Lilly, Flexion, Genzyme, Gilead, Horizon, Janssen, Merck, Novartis, Pfizer, Regeneron, Sanofi, Sanofi Aventis, SUN Pharma Advanced Research, and UCB, Grant/research support from: AbbVie (his institution received fees for his role as a Principal Investigator in the study), Alvin F. Wells Consultant of: AbbVie, Juan Ignacio Vargas Consultant of: AbbVie, Grant/research support from: AbbVie (as a Principal Investigator in the study), Herbert S.B. Baraf Consultant of: Gilead and Janssen, Grant/research support from: AbbVie, Eli Lilly, Genentech, Gilead, and Janssen, Maureen Rischmueller Consultant of: AbbVie, Bristol-Myers Squibb, CSL Behring, Eli Lilly, Gilead Sciences, Janssen Global Services, Pfizer, Sanofi US Services, and UCB Biosciences, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Eli Lilly, Janssen Global Services, Novartis, Pfizer, Sanofi Pasteur Biologics, and UCB Biosciences, Justin Klaff Shareholder of: AbbVie (may own stocks or options), Employee of: AbbVie, Nasser Khan Shareholder of: AbbVie (may own stocks or options), Employee of: AbbVie, Yihan Li Shareholder of: AbbVie (may own stocks or options), Employee of: AbbVie, Kyle Carter Shareholder of: AbbVie (may own stocks or options), Employee of: AbbVie, Alan Friedman Shareholder of: AbbVie (may own stocks or options), Employee of: AbbVie, Patrick Durez Speakers bureau: Eli Lilly and Galapagos

AB0652 Prevalence of Interstitial lung disease and pulmonary arterial hypertension in systemic sclerosis patients cohort at a rheumatology referral centre in the United Arab Emirates

Background

Scleroderma, also known as Systemic Sclerosis (SSc), is a connective tissue disease that affects multiple organ systems, including the cardiovascular and respiratory systems, namely, pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD) as the leading causes of death in this patient population.

Objectives

The purpose of this study is to determine the prevalence of PAH and ILD in a cohort of patients diagnosed with SSc.

Methods

We performed a retrospective chart review of clinical characteristics of all patients diagnosed with SSc Cleveland Clinic Abu Dhabi between April 2015 and April 2020. PAH was estimated by echocardiographic findings and diagnosed based on right heart catheterization (RHC) using 2019 World Symposium on Pulmonary Hypertension. The CT scan of the chest was read by a board-certified radiologist in chest radiology.

Results

Fifty individuals were diagnosed with SSc, with 46% having diffuse cutaneous systemic sclerosis and 54% having limited cutaneous systemic sclerosis. The majority of the patients (88%) were female, with a mean age of 41 ±13 years. The average period from presentation to diagnosis was 5 ±5.4 years. The majority of the cohort (86%) were from the United Arab Emirates. The average BMI was 26.0 kg/m2. Patients’ most prevalent symptoms are fatigue (80%), gastrointestinal symptoms (72%) followed by shortness of breath (58%) and cough (50%). Twenty-six out of fifty patients (52%) underwent a CT chest scan, with 19 (38%) having ILD. Eight patients had more than 30% fibrotic alterations, four patients had 10-30% fibrotic changes, and seven patients had less than 10% fibrotic abnormalities. Patients with more than 10% fibrotic changes were more likely to have usual interstitial pneumonia, whereas those with less than 10% fibrotic changes were more likely to have none specific fibrosis. The majority of patients (92%) had echocardiogram. All except one patient had a normal ejection fraction, and five had grade 1 left ventricular diastolic dysfunction. Five patients were described as having mild, 1 moderate and 2 severe PAH. Only 4 patients underwent RHC. One patient had group II PAH based on elevated wedge pressure. One had group 1 PAH with systemic sclerosis as the only cause for her PAH and two patients had group III PAH due to having more than 30 % pulmonary fibrosis and severe restrictive defect on spirometry. Therefore, the precapillary PAH prevalence was 6% (3/50).

Conclusion

While the prevalence of pulmonary fibrosis in our SSc patients reflects what has been reported in the literature, the prevalence of PAH is significantly lower than the reported 15-20%.1 This is likely due to underdiagnosis of PAH considering the number of years of systemic sclerosis diagnosis on presentation to our clinic. A systematic approach is needed to assess for the presence and severity of PAH using tools as in Detect algorithm which has been validated and commonly used in Europe and North America to screen for PAH.2 Validation of such algorithm is likely needed in middle eastern population before it is universally adopted.

References

[1]Screening for pulmonary arterial hypertension in an unselected prospective systemic sclerosis cohort. Vandecasteele E, Eur Respir J. 2017;49(5) Epub 2017 May 11.

[2]Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study, Coghlan et al. Ann Rheum Dis 2014;73:1340–1349. doi:10.1136/annrheumdis-2013-203301.

Disclosure of Interests

None declared

POS0540 CLINICAL OUTCOMES ASSOCIATED WITH GLUCOCORTICOID DISCONTINUATION AMONG PATIENTS WITH RHEUMATOID ARTHRITIS RECEIVING UPADACITINIB OR ADALIMUMAB

Background

Patients (pts) with rheumatoid arthritis (RA) are often administered glucocorticoids (GCs) as bridging therapy when initiating or adjusting disease-modifying antirheumatic drugs (DMARDs). Due to their systemic effects, short-term use of GCs at the lowest possible dose is recommended with rapid tapering.1

Objectives

We describe GC discontinuation patterns and the associated clinical outcomes in pts with RA receiving upadacitinib (UPA) or adalimumab (ADA).

Methods

SELECT-COMPARE is a randomized phase 3 trial of UPA vs placebo and ADA with a 48-week (wk) double-blind treatment period and a 10-year long-term extension in pts with RA receiving concomitant methotrexate (MTX) who had an inadequate response to MTX.2 Background GCs (≤10 mg/day prednisone or equivalent) were permitted and could be tapered or discontinued starting at wk 26 per physician discretion. This post hoc analysis included pts who received ≥1 dose of UPA 15 mg once daily or ADA 40 mg every other wk while on concomitant GCs at baseline. The proportion of pts with disease worsening (Clinical Disease Activity Index [CDAI] >2 and Disease Activity Score 28-joint count C-reactive protein [DAS28-CRP] >0.6) following GC discontinuation through follow-up is described. Maintenance of clinical response, including remission and low disease activity based on CDAI ≤2.8 and ≤10, respectively, as well as DAS28-CRP <2.6 and ≤3.2, were assessed among pts who discontinued GCs. Adverse events (AEs) were assessed before and after GC discontinuation through follow-up. Data were analyzed descriptively.

Results

Of 1,629 pts randomized, 978 (60%) used GCs at baseline; 128 (13%) discontinued use at/after wk 26 (UPA, n=97; ADA, n=31). Baseline demographics and clinical characteristics were broadly similar between pts who continued or discontinued GCs. Median follow-up time after GC discontinuation was 60 wks for UPA and 84 wks for ADA. At the time of GC discontinuation, a numerically higher proportion of pts treated with UPA vs ADA were in disease control (CDAI ≤2.8: 55% vs 32%; CDAI ≤10: 85% vs 68%; DAS28-CRP <2.6: 71% vs 48%; DAS28-CRP ≤3.2: 87% vs 62%) (Table 1). Few pts receiving UPA experienced disease worsening following GC discontinuation (1% CDAI increase >2; 7% DAS28-CRP increase >0.6) and none on ADA (Table 1). At 6 months follow-up after GC discontinuation, most pts treated with UPA and ADA maintained CDAI ≤2.8 (74% vs 88%) and ≤10 (92% vs 95%) and DAS28-CRP <2.6 (89% vs 85%) and ≤3.2 (91% vs 94%), respectively (Table 1). GCs were reintroduced (albeit usually temporarily) in 14% of pts on UPA and 19% on ADA (Figure 1). AEs were generally similar across treatment groups. Rates of serious infection before and after GC discontinuation were 0.8 (95% CI 0.0–4.2) and 1.5 (0.2–5.4) events per 100 patient-years (E/100 PY) for UPA and 7.7 (1.6–22.4) and 0 E/100 PY for ADA, respectively. Interpretation of results is limited by small pt numbers and different exposure times.

Table 1.

Clinical outcomes of pts who discontinued GCs at/after wk 26

n/N (%)Pts who discontinued GCs N=128UPAn=97ADAn=31CDAI≤10 at discontinuation79/93 (85%)21/31 (68%) Maintained at 6 months post discontinuationa61/66 (92%)18/19 (95%)≤2.8 at withdrawal51/93 (55%)10/31 (32%) Maintained at 6 months post discontinuationa32/43 (74%)7/8 (88%)Increase >2 any visit after withdrawal1/93 (1%)0DAS28-CRP≤3.2 at withdrawal78/90 (87%)18/29 (62%) Maintained at 6 months post discontinuationa58/64 (91%)15/16 (94%)<2.6 at withdrawal64/90 (71%)14/29 (48%) Maintained at 6 months post discontinuationa47/53 (89%)11/13 (85%)Increase >0.6 any visit after withdrawal6/92 (7%)0

aAs a proportion of pts achieving outcome at GC discontinuation and with observed data 6 months post GC discontinuation.

Conclusion

In pts who achieved disease control and discontinued GCs, disease control was maintained in almost all without worsening disease activity over time following GC discontinuation.

Conclusion

In pts who achieved disease control and discontinued GCs, disease control was maintained in almost all without worsening disease activity over time following GC discontinuation.

References

[1]Smolen JS, et al. Ann Rheum Dis. 2020;79:685–99.

[2]Fleischmann R, et al. Ann Rheum Dis. 2019;78:1454–62.

Acknowledgements

AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, review, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing assistance was provided by Julia Zolotarjova, MSc, MWC of AbbVie Inc.

Disclosure of Interests

Roy M. Fleischmann Consultant of: AbbVie, Amgen, BMS, Galvani, Gilead, GSK, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Astra-Zeneca, BMS, Flexion, Galvani, Gilead, GSK, Janssen, Eli Lilly, Novartis, Noven, Pfizer, Samumed, Selecta, Teva, UCB, Viela, and Vorso., Bernard Combe Speakers bureau: AbbVie, BMS, Celltrion, Eli Lilly, Gilead-Galapagos, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, and Roche-Chugai, Consultant of: AbbVie, BMS, Celltrion, Eli Lilly, Gilead-Galapagos, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, and Roche-Chugai, Grant/research support from: Pfizer and Roche-Chugai, Andrew Ostor Consultant of: AbbVie, BMS, Eli Lilly, Gilead, Janssen, Novartis, Paradigm, Pfizer, Roche, and UCB., Cesar Francisco Pacheco Tena Consultant of: AbbVie, Astra-Zeneca, Eli Lilly, Gilead, Janssen, Pfizer, Roche, R-Pharm, Sanofi Regeneron, and UCB., Grant/research support from: AbbVie, Astra-Zeneca, Eli Lilly, Gilead, Janssen, Pfizer, Roche, R-Pharm, Sanofi Regeneron, and UCB., Nasser Khan Shareholder of: May own AbbVie stock or stock options, Employee of: AbbVie, Jessica Suboticki Shareholder of: May own AbbVie stock or stock options, Employee of: AbbVie, Anna Shmagel Shareholder of: May own AbbVie stock or stock options, Employee of: AbbVie, Yanna Song Shareholder of: May own AbbVie stock or stock options, Employee of: AbbVie, Ivan Lagunes-Galindo Shareholder of: May own AbbVie stock or stock options, Employee of: AbbVie, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Pfizer, Roche, Sanofi, and UCB., Consultant of: AbbVie, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Pfizer, Roche, Sanofi, and UCB.

Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: a multicentre 6-month randomised controlled trial

BACKGROUND

Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population.

METHODS

In a multicentre, multinational, parallel randomised controlled trial, participants aged 6-18 years using insulin pump therapy were recruited at seven UK and five US paediatric diabetes centres. Key inclusion criteria were diagnosis of type 1 diabetes for at least 12 months, insulin pump therapy for at least 3 months, and screening HbA1c levels between 53 and 86 mmol/mol (7·0-10·0%). Using block randomisation and central randomisation software, we randomly assigned participants to either closed-loop insulin delivery (closed-loop group) or to usual care with insulin pump therapy (control group) for 6 months. Randomisation was stratified at each centre by local baseline HbA1c. The Cambridge closed-loop algorithm running on a smartphone was used with either (1) a modified Medtronic 640G pump, Medtronic Guardian 3 sensor, and Medtronic prototype phone enclosure (FlorenceM configuration), or (2) a Sooil Dana RS pump and Dexcom G6 sensor (CamAPS FX configuration). The primary endpoint was change in HbA1c at 6 months combining data from both configurations. The primary analysis was done in all randomised patients (intention to treat). Trial registration ClinicalTrials.gov, NCT02925299.

FINDINGS

Of 147 people initially screened, 133 participants (mean age 13·0 years [SD 2·8]; 57% female, 43% male) were randomly assigned to either the closed-loop group (n=65) or the control group (n=68). Mean baseline HbA1c was 8·2% (SD 0·7) in the closed-loop group and 8·3% (0·7) in the control group. At 6 months, HbA1c was lower in the closed-loop group than in the control group (between-group difference -3·5 mmol/mol (95% CI -6·5 to -0·5 [-0·32 percentage points, -0·59 to -0·04]; p=0·023). Closed-loop usage was low with FlorenceM due to failing phone enclosures (median 40% [IQR 26-53]), but consistently high with CamAPS FX (93% [88-96]), impacting efficacy. A total of 155 adverse events occurred after randomisation (67 in the closed-loop group, 88 in the control group), including seven severe hypoglycaemia events (four in the closed-loop group, three in the control group), two diabetic ketoacidosis events (both in the closed-loop group), and two non-treatment-related serious adverse events. There were 23 reportable hyperglycaemia events (11 in the closed-loop group, 12 in the control group), which did not meet criteria for diabetic ketoacidosis.

INTERPRETATION

The Cambridge hybrid closed-loop algorithm had an acceptable safety profile, and improved glycaemic control in children and adolescents with type 1 diabetes. To ensure optimal efficacy of the closed-loop system, usage needs to be consistently high, as demonstrated with CamAPS FX.

FUNDING

National Institute of Diabetes and Digestive and Kidney Diseases.

Linking COVID-19 with Suicide: Suggestions for Future Research

COVID-19 has impacted the world socio-economically. Unemployment, poverty, social stigma, social isolation, domestic violence and mental illnesses are the notable social issues related to COVID-19 pandemic. Framed under a review based approach, the current study searches for the link between COVID-19 pandemic and an increased vulnerability to suicide across the globe. Linking the current situation with researched determinants of suicide shows that COVID-19 pandemic is exacerbating various socio-economic and psychological causes of suicide. In near future or even during the pandemic, suicide will be a key challenge for the public health sector across the globe. Besides, future research suggestions are given in light of the discussion in order to provide an impetus to researching the impact of the COVID-19 pandemic on suicide.

Phytochemical screening and evaluation of antioxidant, total phenolic and flavonoid contents in various weed plants associated with wheat crops

This study explores the antioxidant activity, phytochemical screening, total phenolic and flavonoids contents in the extracts of four locally available weeds plants namely Convolvulus arvensis, Chenopodium murale, Avena fatua and Phalaris minor with different solvents. The antioxidant activities of these extracts were determined via various in-vitro methods such as total antioxidant activity (TAA), reducing power (RP), DPPH (2,2-Diphenyl-1-Picrylhydrazyl) free radical scavenging and hydrogen peroxide scavenging assays. Phytochemical screening was performed both qualitatively as well as quantitatively. Total phenolic content (TPC) and total flavonoid content (TFC) were determined through Folin- Ciocalteu reagent and aluminium chloride methods respectively. Methanol-chloroform solvent showed the presence of a high amount of TPC in milligram of gallic acid equivalent per gram of dry weight (mg of GAE/g of DW) in the extracts of all weeds. Their descending sequence was Avena fatua (74.09) ˃ Phalaris minor (65.66) ˃ Chenopodium murale (64.04) ˃ Convolvulus arvensis (61.905), while, chloroform solvent found to be best solvent for the extraction of TFC. Methanol-chloroform solvent was also found to be best solvent for TAA (Total antioxidant activity assay) which showed values in milligram of ascorbic acid equivalent per gram of dry weight (mg of AAE /g of DW), for DPPH scavenging activity, reducing power (antioxidant activity) and hydrogen peroxide scavenging activity. Phytochemical screening indicated the presence of polyphenols, flavonoids, tannins, saponins, alkaloids and glycosides in these weeds.

Global and domain-specific self-esteem after pediatric traumatic brain injury: Contribution of injury characteristics and parent mental health

This prospective, longitudinal case-control study examined global and domain-specific aspects of self-esteem 6-months following pediatric traumatic brain injury (TBI) and evaluated the contribution of injury-related factors and parent mental health to child self-esteem. Participants included 103 children with mild-severe TBI representing consecutive admissions to the emergency department of the Royal Children's Hospital, Melbourne, Australia. Forty-three age-and-sex matched typically developing controls were recruited for comparison. Information regarding injury characteristics including age at injury and clinical indicators of TBI severity were collected for participants at recruitment, with research magnetic resonance imaging conducted 2-8 weeks later. At 6 months post-injury, children rated their global and domain-specific self-esteem (Harter Self-Perception Profile for Children), and ratings of parent mental health were collected (General Health Questionnaire). Self-esteem for behavioural and academic domains was significantly poorer for children with TBI relative to TD children. In the TBI group, higher child-rated scores of global and domain-specific aspects of self-esteem were associated with more severe TBI, presence of frontal neuropathology, younger age at injury, and lower parental symptoms of anxiety/insomnia. Given the psychological status of parents represents a potentially modifiable risk factor, it may form the target of clinical interventions designed to bolster child self-esteem following pediatric TBI.

Radiology of Castleman disease: the pivotal role of imaging in diagnosis, staging, and response assessment of this rare entity

Castleman Disease (CD) is a rare entity that typically presents as an enhancing nodal mass in the mediastinum or head and neck region on computed tomography (CT). It may manifest as unicentric or multicentric regions of lymph node enlargement. A key clinical issue in the context of CD is delayed diagnosis, which contributes adversely to patient outcome, given that accurate diagnosis facilitates earlier treatment of this curable disease. This article will address relevant imaging aspects, with reference to typical and atypical imaging features of CD, illustrated using examples from our specialist centre; the imaging journey for patients with CD; and will provide practical pointers to radiologists in differentiating CD from other benign and malignant causes of enhancing lymphadenopathy, including lymphoma and neoplastic adenopathy. We will also review current classification tools and staging challenges with reference to World Health Organization guidelines, International Working Group guidelines as well as the Lugano classification. Finally, we will discuss the potential role of additional imaging techniques in CD, highlighting novel imaging methods and expanded utilities from our specialist centre.

The association of preoperative dialysis with troponin trends and short term outcomes among advanced kidney disease patients undergoing coronary artery bypass grafting

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronary artery disease continues to be the leading cause of death in patients with stage IV-V chronic kidney disease (CKD IV-V). However, the prognosis and early outcomes for advanced CKD patients undergoing coronary artery bypass grafting (CAB) worsen as the estimated glomerular filtration rate (eGFR) deteriorates. Therefore, we compared postoperative clinical outcomes and troponin trends in patients having advanced CKD according to preoperative dialysis status in a single centre experience.

Methods

A total of 51 patients with CKD IV and V who underwent CAB between 2016-2021 were included in the study. Data on patient characteristics and postoperative outcomes were collected retrospectively, and independently for our Society of Thoracic Surgeons database. Characteristics were compared between patients having CKD IV vs. CKD V. The differences in postoperative cardiac troponin trends and outcomes were evaluated between patients who did vs. did not undergo preoperative dialysis. The statistical analysis was conducted applying appropriate parametric or non-parametric (for skewed variables) testing methods, and a p value &lt; 0.05 was considered to be statistically significant.

Results

47% (24) of subjects had CKD IV, while the rest featured CKD V. Patients with CKD IV tended to be older (61.8 ± 9.2 vs. 56.3 ± 11.5 years, p = 0.07), more obese (BMI: 31.4 ± 6.8, 27.4 ± 4.9 kg/m2, p = 0.02) and had significantly higher preoperative GFR (23 ± 4.9 vs. 9 ± 3.3 mL/min, p &lt; 0.001) (Table.1). When comparing patients who underwent preoperative dialysis vs. those who did not, troponin levels were the highest at 18h postoperative in both groups, however, troponin levels were comparable between both groups at all time points (Table.2). Although, there was no difference in hospital length of stay and mortality between these groups, patients who did not undergo preoperative dialysis had longer intensive care unit length of stay (ICU LOS).

Conclusion

In this single centre experience preoperative dialysis was not associated with a significant difference in trends of postoperative cardiac enzymes. Although preoperative dialysis was associated with shorter ICU LOS, complex pre-procedural surgical risk assessment remains paramount in reducing complications and mortality in this high-risk population. Abstract Figure.  Abstract Figure.

A randomised controlled trial of a novel tramadol chewable tablet: pharmacokinetics and tolerability in children

Tramadol is a bitter atypical opioid analgesic drug and is prescribed to treat postoperative pain in children. However, in many countries there is no licensed paediatric tramadol formulation available. We have formulated a novel chewable chocolate-based drug delivery system for the administration of tramadol to children. This pilot, single-centre, open-label, randomised clinical study assessed the taste tolerability and comparative population pharmacokinetics of the novel tramadol chewable tablet against a compounded tramadol hydrochloride oral liquid, at a dose of 1 mg.kg^-1 . A 5-point facial hedonic scale was used by the children, parents and nurses to assess tolerability. One hundred and forty-one children aged 3-16 years were given tramadol 30 min before general anaesthesia. Blood samples were taken following the induction of anaesthesia and for up to 5 h following tramadol administration. Tramadol and its active metabolite O-desmethyltramadol were analysed using reversed-phase high-performance liquid chromatography. A population pharmacokinetic model was built using non-linear mixed effects modelling. The relative bioavailability for the tablet was 1.25 times higher (95%CI 1.16-1.35) than for tramadol hydrochloride oral liquid, while the absorption rate constant for the tablet was significantly lower (1.97 h^-1 vs. 3.34 h^-1 , p < 0.001). Larger inter-individual variability in absorption rates were observed with the liquid tramadol. The tramadol chewable tablet was more acceptable in taste to children when assessed by the children, parents and nurses (all p < 0.001). We conclude that the novel tramadol chewable tablet has favourable acceptability and more reliable relative bioavailability in children compared with tramadol hydrochloride oral liquid.

Sublethal toxicity of carbofuran in cattle egret (Bubulcus ibis coromandus): hematological, biochemical, and histopathological alterations

This study was aimed to investigate Carbofuran (CF)-induced pathological changes in cattle egret. Two hundred cattle egrets were reared and equally divided into four groups and given different CF concentrations (0.03 mg/L, 0.02 mg/L, 0.01 mg/L and 0 mg/L (control group)). Hematology, serum biochemistry, histopathology, and immunological markers were studied. Our results confirm that CF induces anemic conditions, leukocytosis, elevated liver enzymatic activity, and alterations in renal biomarkers. Moreover, specific microscopic lesions such as multifocal necrosis, pyknotic nuclei, hemorrhages, congestion, and inflammatory cell proliferation were observed in the liver, kidney, spleen, and thymus. These findings suggest that CF can induce harmful effects, so the application of this pesticide in the field must be strictly monitored to mitigate the possibility of exposure to non-target species.

Environmental sustainability assessment of wooden furniture produced in Pakistan

Life cycle assessment was carried out for a conventional wooden furniture set produced in Mardan division of the Khyber Pakhtunkhwa province of Pakistan during 2018-19. Primary data regarding inputs and outputs were collected through questionnaire surveys from 100 conventional wooden furniture set manufacturers, 50 in district Mardan and 50 in district Swabi. In the present study, cradle-to-gate life cycle assessment approach was applied for a functional unit of one conventional wooden furniture set. Production weighted average data were modelled in the environmental impacts modelling software i.e., SimaPro v.8.5. The results showed that textile used in sofa set, wood preservative for polishing and preventing insects attack and petrol used in generator had the highest contribution to all the environmental impact categories evaluated. Total cumulative energy demand for wooden furniture set manufactured was 30,005 MJ with most of the energy acquired from non-renewable fossil fuel resources.

Vitamin K Deficiency in the Setting of Blenderized Tube Feeding Regimen in a Teenager: A Case Report

Vitamin K acts a cofactor for the gamma-carboxylation of several proteins in the coagulation cascade. The clinical spectrum of vitamin K deficiency (VKD) can be asymptomatic to a significant bleeding. VKD is classically seen in newborns. However, this can manifest later in patients with risks such as sub-optimal nutrition, fat malabsorption, medications including antibiotics. A 17-year-old male with spinal muscular atrophy (SMA) Type 1, tracheostomy with ventilator dependent, gastrostomy tube feeding was seen by the gastroenterologist following treatment for small intestinal bacterial overgrowth (SIBO). Investigations showed coagulopathy following which he was transferred to the Pediatric ICU. Labs revealed prothrombin time (PT) 114 s [Normal 9.4-12.5 s], INR (International normalized ratio) 12.6 [Normal < 1.1] and partial thromboplastin time (PTT) 90 s [Normal 25.1-36.5 s]. Mixing studies and coagulation assays were consistent with VKD (low Factor VII and Factor IX with normal Factor V). His home blenderized feeding regimen met the caloric requirement but not the adequate intake (AI) values for vitamin K and other minerals. He received intravenous vitamin K (phytonadione) for five consecutive days with resolution of the coagulopathy (PT 13.2 s, PTT 37.1 s, INR 1.2). The patient was discharged on enteral vitamin K and additional supplements following dietary review by a nutritionist. Clinicians should be cognizant of VKD in patients on blenderized tube feeds which may not meet the adequate intake (AI) goals. In patients who are not receiving nutritionally complete formulas or receiving inadequate volumes, it is important to monitor macro and micronutrients.

Performance evaluation of the commercial aquafeeds available in the market of Pakistan on Channa marulius (Sole)

The present study aimed to determine the effect of different levels of protein on the growth, body composition, amino acid profile and serology of Channa marulius fingerlings. The experiment was conducted in ten happas installed in earthen ponds, each stocked with 10 fishes for 90 days. Four commercial fish feeds having 25%, 30%, 32% and 40% crude protein (CP) levels were fed to fish at 3% of their wet body weight three times a day. The results of the study revealed that highest weight gain, feed conversion ratio and survival rate were observed in 30% protein feed. Meanwhile, moisture content was higher in fish fed with 30% CP feed while highest crude protein was recorded in 40% CP fed fish. Lowest fat content was observed in 32% CP feed. Amino acid profile of fish revealed better results in 30% CP feed. Total protein, glucose and globulin were also highest in fish feeding 30% CP feed, while albumin was highest in 40% CP feed. It is concluded that 30% CP feed showed better results in terms of growth, amino acid profile and serological parameters without effecting fish body composition.

Purchase intention towards dietary supplements during COVID-19 pandemic: consumers’ perspective

The consumption of dietary supplements (DSs) has been steadily increasing in the wake of the COVID-19 outbreak in most countries. Consumer purchase intention towards DSs is expected to be of concern to many companies in the pharmaceutical industry. This study extends the Theory of Planned Behaviour by adding health consciousness and perceived price in the model to investigate its effect on consumer purchase intention towards DSs during the COVID-19 outbreak. A questionnaire-based survey was distributed via an online survey to 207 respondents. Results from multiple regression analysis revealed that consumer attitudes, subjective norms, perceived behavioural control, and health consciousness contributed significantly to purchase intention towards DSs. Perceived price did not have an impact on intention. Further investigation revealed that favourable attitudes towards DSs were the most important contributor towards purchasing DSs during the COVID-19 pandemic.