Effect of interaction of heavy metals on (Na+ -K+) ATPase and the uptake of 3H-DA and 3H-NA in rat brain synaptosomes

The effect of interaction of Mn2+, Pb2+ and Cd2+ on (Na+ -K+) ATPase and uptake of labelled dopamine (3H-DA) and labelled noradrenaline (3H-NA) were studied in vitro in rat brain synaptosomes. The inhibition of (Na+ -K+) ATPase by Pb2+ and Cd2+ alone was concentration dependent, however, Mn2+ had almost no effect on the activity of this enzyme. Interaction of Cd2+ with either Pb2+ or Mn2+ was most powerful in inhibiting the activity of synaptosomal transport ATPase. Lower concentrations of Pb2+ increased while higher concentrations inhibited synaptosomal uptake of 3H-DA and 3H-NA. Lower concentrations of Cd2+ increased the uptake of 3H-DA while at concentrations of 100 microM, the uptake was inhibited, this metal had strong inhibitory effect on the uptake of 3H-NA. Mn2+ had inhibited the uptake of labelled amines. Interaction of Mn2+ with Pb2+ or Cd2+ produced inhibition on the uptake of 3H-DA and 3H-NA. The results of the uptake of biogenic amines in the presence of metal ions apparently had no correlation with the activity of (Na+ -K+) ATPase which is involved in the active transport of cations across cell membranes.

Strategies to prevent airway complications: a survey of adult intensive care units in Australia and New Zealand

BACKGROUND

There is growing evidence that airway complications are relatively common in critical care. Strategies have been suggested to decrease their incidence.

METHODS

We conducted a telephone survey of all adult intensive care units (ICUs) in Australia and New Zealand to establish the current practice regarding strategies used to reduce airway complications in five key areas: (i) use of capnography; (ii) care of oral tracheal tubes; (iii) care of tracheostomy tubes; (iv) difficult and failed intubation; and (v) training and medical staffing.

RESULTS

Of 176 ICU meeting inclusion criteria, 171 agreed to participate. Capnography is used during tracheal intubation in 88% of ICUs and for continuous monitoring in 64%. Protocols for advancing or partially withdrawing malpositioned tracheal tubes are used by 54% of units, with most allowing repositioning by unaccredited nurses. A small minority of ICUs use bed head signs to identify patients with 'critical airways' or laryngectomy, while only 8% have specific protocols for the care of these high-risk patients. Tracheostomy emergency algorithms are available in 13% of ICUs. At night, a doctor is exclusively assigned to 73% of units, although in 72%, the night doctor is not required to have prior anaesthetic/airway training. In 97% of the institutions surveyed, the senior doctor relied upon for airway emergencies at night is either non-resident or working elsewhere in the hospital.

CONCLUSIONS

Our data suggest that several possible strategies for avoiding airway complications in ICU patients dependent on an artificial airway are poorly implemented. This may expose these patients to avoidable risk.

Long-term AAV vector gene and protein expression in mouse brain from a small pan-cellular promoter is similar to neural cell promoters

The neurogenetic, lysosomal enzyme (LSE) deficiency diseases are characterized by storage lesions throughout the brain; therefore, gene transfer needs to provide widespread distribution of the normal enzyme. Adeno-associated virus (AAV) vectors can be effective in the brain despite limited transduction because LSEs are exported to neighboring cells (cross-correction) to reverse the metabolic deficit. The extent of correction is determined by a combination of the total amount of LSE produced by a vector and the spatial distribution of the vector within the brain. Neuron-specific promoters have been used in the brain because AAV predominantly transduces neurons. However, these promoters are large, using up a substantial amount of the limited cloning capacity of AAV vector genomes. A small promoter that is active in all cells, from the LSE beta-glucuronidase (GUSB), has been used for long-term expression in AAV vectors in the brain but the natural promoter is expressed at very low levels. The amount of LSE exported from a cell is proportional to the level of transcription, thus more active promoters would export more LSE for cross-correction, but direct comparisons have not been reported. In this study, we show that in long-term experiments (>6 months) the GUSB minimal promoter (hGBp) expresses the hGUSB enzyme in brain at similar levels as the neuron-specific enolase promoter or the promoter from the latency-associated transcript of herpes simplex virus. The hGBp minimal promoter thus may be useful for long-term expression in the central nervous system of large cDNAs, bicitronic transcription units, self-complimentary or other designs with size constraints in the AAV vector system.

Development of a murine hematopoietic progenitor complementary DNA microarray using a subtracted complementary DNA library

With the goal of creating a resource for in-depth study of myelopoiesis, we have executed a 2-pronged strategy to obtain a complementary DNA (cDNA) clone set enriched in hematopoietic genes. One aspect is a library subtraction to enrich for underrepresented transcripts present at early stages of hematopoiesis. For this, a hematopoietic cDNA library from primary murine bone marrow cells enriched for primitive progenitors was used as tester. The subtraction used 10 000 known genes and expressed sequence tags (ESTs) as driver. The 2304 randomly picked clones from the subtracted cDNA libraries represent 1255 distinct genes, of which 622 (50%) are named genes, 386 (30%) match uncharacterized ESTs, and 247 (20%) are novel. The second aspect of our strategy was to complement this subtracted library with genes known to be involved in myeloid cell differentiation and function. The resulting cDNAs were arrayed on polylysine-coated glass slides. The microarrays were used to analyze gene expression in primary and cultured murine bone marrow-derived progenitors. We found expression of various types of genes, including regulatory cytokines and their receptors, signal transduction genes, and transcription factors. To assess gene expression during myeloid differentiation, we examined patterns of change during induced differentiation of EML cells. Several hundred of the genes underwent fluctuations in expression level during myeloid cell differentiation. The complete database, accessible on the World Wide Web at http://yale130132115135.med.yale.edu/, allows for retrieval of information regarding these genes. Our microarray allows for genomewide expression analysis of myeloid stem cells, which will help in defining the regulatory mechanisms of stem cell differentiation.

Macrophage accumulation within the cap of carotid atherosclerotic plaques is associated with the onset of cerebral ischemic events

PURPOSE

Macrophage accumulation is associated with aortic and coronary plaque instability. The macrophage content of carotid plaques removed at carotid endarterectomy (CE) was assessed, and the relevance to the onset of ipsilateral cerebral ischemic events (CIE) was examined.

METHODS

Carotid plaques from patients undergoing CE were examined (group I, symptomatic stenoses, n = 28; group II, high-grade asymptomatic stenosis, n = 7). The plaques were stained with monoclonal antimacrophage antibody (HAM56), and the interval since the last CIE was recorded. The percentage area of the cap, shoulder, and entire sclerotic region was quantified by computerized planimetry.

RESULTS

The macrophage content of the cap, shoulder, and sclerotic region in all 35 plaques was 1.14% (interquartile range, 0.56 to 3.86), 1.03% (0.51 to 2.15), and 0.49% (0.27 to 0.63), respectively (cap vs sclerotic, P <.01; shoulder vs sclerotic, P <. 01; cap vs shoulder, P =.23). In 18 plaques that were removed less than 180 days after the last CIE, the macrophage content of the cap, shoulder, and entire sclerotic region was 2.41% (0.95 to 4.81), 0. 83% (0.40 to 2.52), and 0.53% (0.38 to 0.71), respectively (cap vs sclerotic, P =.01; cap vs shoulder, P =.01). The content in the cap of these plaques was greater than in plaques removed more than 180 days after symptoms, or asymptomatic plaques (n = 17; 0.62% [0.44 to 1.25], P =.01). The cap macrophage content was inversely related to the time since the last CIE (r = -0.414, P =.029).

CONCLUSION

In patients requiring CE, macrophage accumulation was maximal within the cap of carotid plaques and greatest in plaques removed less than 180 days after the last CIE. These findings and the inverse relationship between macrophage content and the interval since symptoms support the hypothesis that macrophage accumulation is associated with plaque instability.

The Peterborough scheme for community specialist optometrists in glaucoma: a feasibility study

PURPOSE

This study assessed the role of specialist optometrists who were working in the community and sharing the care for glaucoma patients with, and under close supervision of, a consultant ophthalmologist working in the Hospital Eye Services (HES) to ensure high-quality standards, safety, and care.

METHODS

From February 2005 onwards, the majority of all new glaucoma referrals to our eye department were diverted to our specialist optometrists in glaucoma (SOGs) in their own community practices. Selected patients in the HES setting who were already diagnosed with stable glaucoma were also transferred to the SOGs. The completed clinical finding details of the SOGs, including fundus photographs and Humphrey visual field tests, were scrutinised by the project lead.

RESULTS

This study included 1184 new patients seen by specialist optometrists between February 2005 and March 2007. A total of 32% of patients were referred on to the hospital, leaving the remaining 68% patients to be seen for at least their next consultation in the community by the SOGs. The following levels of disagreement were observed between SOGs and the project lead: on cup:disc ratio (11%), visual field interpretation (7%), diagnosis (12%), treatment plan (10%), and outcome (follow-up interval and location) (17%).

CONCLUSION

This study indicates that there is potential for a significant increase in the role of primary care optometry in glaucoma management. The study also confirms a need for a significant element of supervision and advice from a glaucoma specialist. The important issue of cost effectiveness is yet to be confirmed.

Ethylene and hydrogen sulphide are essential for mitigating hexavalent chromium stress in two pulse crops

Chromium toxicity to crops is a major scientific problem of the present time. Thus, scientific attempts have been made for reducing chromium toxicity to crop plants. In this study, we examined the potential of ethylene (ET, 25 µM) and hydrogen sulphide (H₂ S, 10 µM) to alleviate hexavalent chromium [Cr(VI), 50 µM] stress in two pulse crops, black bean and mung bean, by assessing physiological and biochemical attributes. Cr(VI) reduced shoot and root length in black bean and mung bean in comparison to the control. Plants had increased accumulation of oxidative stress markers, i.e. superoxide radicals (SOR), hydrogen peroxide (H₂ O₂ ) and lipid peroxidation (as malondialdehyde, MDA). The addition of AVG (an inhibitor of ET biosynthesis) and PAG (an inhibitor of H₂ S biosynthesis) to Cr(VI)-treated plants further increased Cr(VI) toxicity, suggesting their endogenous levels are important for tolerating Cr(VI) toxicity. However, supplementation with either ET or H₂ S alleviated Cr(VI) toxicity. Interestingly, ET did not rescue negative effects of PAG under Cr(VI) stress but NaHS rescued negative effect of AVG. Overall, results indicate that, although both ET and H₂ S alleviate Cr(VI) stress, endogenous H₂ S is better. Furthermore, H₂ S appears to be a downstream signal for ET in alleviating Cr(VI) stress in these two pulse crops.

Applications of Autonomous Underwater Vehicles in Offshore Petroleum Industry Environmental Effects Monitoring

Abstract

Environmental Effects Monitoring (EEM) is an important tool in assisting Environmental Risk Assessment (ERA). EEM in the offshore petroleum industry has been conducted worldwide, but traditional approaches have struggled to keep apace as exploration and production activities move to frontier regions, such as increasingly deeper waters and Arctic regions. This paper proposes the use of autonomous underwater vehicles (AUVs) for environmental monitoring of offshore facilities as a means of improving and expanding the overall monitoring program. The paper provides a review of technical and procedural issues involved in this application of AUV technology, including the current status of offshore oil and gas EEM, a review of available AUVs and a survey of developments in in situ sensors.

Introduction

Offshore petroleum industry operations affect the marine environment in a variety of ways: high sound levels from seismic surveys that affect marine animals; exposure of marine organisms to drilling mud, produced water discharges and accidentally spilled oils; and the physical alteration of habitat due to the construction of submarine structures. The potential risks to the environment posed by offshore oil and gas operations support the need for effective Environmental Effects Monitoring (EEM) around the project development areas.

EEM is a central component of environmental protection and management strategies designed to minimize the consequences of anthropogenic activities(1). It is a very important tool in assisting Environmental Risk Assessment (ERA) which is seen from many studies that link EEM and ERA together(2, 3). EEM is required by regulations governing industry activities offshore, and by government agencies in relation to cumulative impact assessment studies(4).

The United States started the use of environmental monitoring programs in 1973. The Mineral Management Services (MMS) is currently responsible for managing oil and gas activities on the outer continental shelf (OCS). In the early stages of EEM programs, MMS monitored the effects of petroleum exploration activities on the George's Bank, Middle Atlantic OCS and the Gulf of Mexico. Early monitoring programs mainly focused on the effects of drilling wastes on benthic communities through a variety of sampling methods, such as camera transects, crab traps, bottom trawls and box corers. The MMS has also monitored the effects of petroleum development and production activities in the Gulf of Mexico, Santa Maria and Western Santa Barbara Channels off California, and in the Alaska Beaufort Sea. Trace metals and hydrocarbons in the water column, sediments, pore waters and biological tissues are collected and analyzed.

In Canada, both government agencies and operators have carried out EEM. For example, Petro-Canada collected sediment samples from 49 stations and water samples from 24 stations in an area located in the vicinity of the Terra Nova Oil Field during 2000 to 2001. Analyses of samples included hydrocarbon concentration, metal concentration, particle size and the presence of sulphur, sulphide and ammonia(5). Fisheries and Oceans Canada also conducts annual EEM missions at the Hibernia, Terra Nova and The baud fields off the east coast of Canada. Both sediment and water samples are collected and the biodiversity of benthic organisms are studied using underwater photography.

Characterization of human rotaviruses circulating in Iraq in 2008: atypical G8 and high prevalence of P[6] strains

Fecal samples from 976 children with gastroenteritis were collected and analyzed for group A rotavirus (RVA), in three different cities in Iraq between January 2008 and December 2008. RVA antigen was detected in 394 (40%) of the samples, and 98 samples were available for further genotype analyses using multiplex RT-PCR and sequence analyses for untypeable strains. The G/P-genotype combination was determined for 69 samples, and 19, 2 and 8 samples remained P-untypeable, G-untypeable and G/P-untypeable (UT), respectively. The most prevalent genotype was G2 (40%, 39/98) most often associated with P[6]. G1 was the second most common genotype (16%, 16/98) mainly associated with P[8] and P[UT]. G3, G4 and G9 were detected at a lower prevalence (3%, 11%, 3%, respectively), mainly associated with P[6]. Surprisingly, five G8P[6], and seven G12 RVA strains in combination with P[6] and P[8] were also detected for the first time in Iraq. Overall, a striking high prevalence of 47% of the analyzed samples possessed the P[6] genotype (65% of the P-typed RVA strains). Atypical genotype combinations such as G1P[4], G1P[6], G2P[8] or strains with mixed G-types were detected sporadically. The detection of unusual G8P[6] RVA strains prompted us to further analyze the NSP2, NSP3, NSP4 and NSP5 gene segments of three selected G8P[6] strains, resulting in their designation to the N2, T2, E2 and H2 genotypes, respectively. The VP7, VP4, NSP2, NSP3 and NSP5 gene segments clustered closely with common human RVA strains, whereas the NSP4 gene sequences were found to cluster with animal derived RVA strains, suggesting a potential reassortment event. The high prevalence of RVA strains with the G8, G12 and P[6] genotypes in combination with a DS-1-like genotype constellation in Iraq, needs to be monitored closely as these RVA strains might challenge the effectiveness of current RVA vaccines.

Respiratory health effects from occupational exposure to wood dust in sawmills

Spirometric lung functions were recorded for 109 workers (mean age 26.4 +/- 8.2 yr) occupationally exposed (mean exposure 8.9 +/- 7.7 yr) to soft wood dust in local sawmills along with 88 unexposed controls (mean age 28.7 +/- 9.9 yr) belonging to the same socioeconomic status to assess the prevalence of respiratory impairment in the exposed population. The results of the study showed a significantly higher prevalence of overall respiratory impairment in the exposed group even after standardizing for smoking habits (p less than 0.001). The adjusted rate for respiratory impairment in the exposed group was 29.4% as compared to 2.2% observed in the unexposed controls. The pattern of respiratory abnormality observed in the sawmill workers was predominantly the restrictive type (28.4%), indicating lower levels of forced vital capacity (FVC) in the exposed group; while in the control group, there were none with lung restriction The prevalence of airflow limitation, however, was similar in the exposed workers (1.8%) and controls (2.2%), thereby, indicating that bronchial obstruction was independent of wood dust exposure. It is concluded that the dust exposure in sawmills is associated mainly with restrictive type of pulmonary impairment in the exposed workers.

Study of respiratory impairment among pesticide sprayers in Mango plantations

Pulmonary function studies were conducted on 489 pesticide workers engaged in spraying operations on mango plantations. These workers were exposed to a variety of organochlorine and organophosphorus pesticides. A reference group consisting of 208 controls, belonging to the same socioeconomic stratum, was taken from the same area for purposes of comparison. The results of the study showed 36.5 and 41.5% prevalence of respiratory impairment in the exposed workers and in the controls, respectively. The most common pulmonary impairment among the exposed subjects (18.8%) and controls (16.9%) was of the restrictive type, followed by mixed ventilatory defect. Bronchial obstruction affected 2.5 and 3.7% of the exposed and control populations, respectively. In a comparison of the prevalence of total respiratory impairment in the pesticide workers and the controls, the nonsmokers did not show any significant difference in this study. The prevalence rate of respiratory impairment showed an increasing trend in different exposure groups (p less than 0.05), thereby clearly indicating a dose effect. The study revealed that occupational exposure to pesticides had a direct bearing on the respiratory impairment identified in the exposed workers.

A study of the prevalence of respiratory morbidity among agate workers

A random sample of 342 workers engaged in chipping and grinding of agate stones were surveyed in a cross-sectional study to assess the prevalence of respiratory morbidity in the agate industry. The findings were compared with those obtained in controls. The study showed a significantly higher prevalence of lung diseases among agate workers than among controls (63.4% vs 35.5%, P less than 0.001). The respiratory morbidity in agate workers and controls was maximal in the group aged 31+ years (83.3% and 42.2%, respectively). The prevalence of pneumoconiosis in agate workers (18.4%) was highly significant as compared with controls, in whom not a single case was found (P less than 0.001). However, there was no significant difference between the prevalence of pneumoconiosis in men and women of the exposed group (17.9% vs 19.6%). Among the cases of pulmonary diseases in agate workers, pneumoconiosis formed the largest group (18.4%), whereas among controls it was tuberculosis (12.1%). The prevalence of pulmonary tuberculosis was very high in both agate workers and controls (15.5% and 12.1%, respectively), probably because of poor socio-economic and unhygienic living conditions. The prevalence of chronic bronchitis was found to be higher among the control population as compared with the exposed group (6.7% vs 2.6%). It therefore appeared that agate dust had no role in precipitating chronic bronchitis. However, bronchial asthma appeared to have been aggravated due to agate dust, as the risk among agate workers was 7-fold that found among the controls. The prevalence of pneumoconiosis showed a dose-response relationship in both male and female agate workers.(ABSTRACT TRUNCATED AT 250 WORDS)

Genetic characterization of antimicrobial resistance of Shigella flexneri 1c isolates from patients in Egypt and Pakistan

Background

Shigella flexneri serotype 1c emerged as a critical isolate from children in Egypt and Pakistan. The pattern of antimicrobial susceptibility (AMS) and resistance genes of this serotype have yet to be characterized.

Findings

Sixty nine S. flexneri 1c isolates isolates were identified from both Egypt (n-46) and Pakistan (n = 23) and tested for AMS by disk diffusion method and minimal inhibitory concentrations were also determined. Isolates were genotyped by pulsed field gel electrophoresis (PFGE) and five relevant resistance genes (bla_TEM, bla_SHV, bla_OXA, sulI and sulII) were detected by polymerase chain reaction (PCR) and confirmed by DNA sequencing. High resistance was observed in all isolates for ampicillin (AM >96%); trimethoprim-sulphamethoxazole and tetracycline (>88%). Most AM-resistant isolates from Egypt (70%) harbored bla_TEM resistance, while 52% of isolates from Pakistan expressed bla_OXA. All isolates were closely related by PFGE, irrespective of source or time of collection. The sulII gene was present in 100% of isolates from pediatric cases in Egypt, 65% of Pakistan isolates, and 53% of isolates from older Egyptian patients.

Conclusions

While different Shigella serotypes gathered in specific genotypic groups, 1c serotype isolates formed multiple clusters. Although AMS was considerably high to most commonly used drugs, genetic determinants were variable between countries over time. The data stress the need for a more careful selection of antibiotics in the treatment of shigellosis.

A cross-sectional study of pulmonary function among workers exposed to multimetals in the glass bangle industry

Spirometric lung functions were evaluated in 220 asymptomatic glass bangle workers exposed to the salts of various heavy metals, such as arsenic, lead, zinc, copper, manganese, cobalt, cadmium, and selenium, which are used as coloring agents in the manufacture of glass bangles. The mean values of various spirometric variables (viz. FVC, FEV1, IMBC, and PEFR) were within normal range (more than 80% of the predicted values) in both smoking and nonsmoking glass bangle workers and did not reveal any significant differences in comparison with those observed in the unexposed controls. However, variables such as FEV1/FVC% ratio, FEF25-75 and FEF75-85 were reduced significantly (p less than 0.001) in the exposed group. The reduction was more marked in the smoking glass bangle workers indicating additive effect of cigarette smoking on the small airways. The exposed group showed a significantly higher prevalence (16.3%) of respiratory impairment in comparison to that observed in the controls (7.9%) as a result of exposure to various metals in the work environment (p less than 0.01). The respiratory impairment observed in the exposed group indicated primarily restrictive pattern of pulmonary abnormality (10.4%), while the controls revealed only 1.1% prevalence of this disease (p less than 0.001). The effect of the duration of exposure on the prevalence of respiratory impairment in the glass bangle industry revealed significantly higher prevalence (p less than 0.05) in those who worked for more than 10 years (23.0%) than in those who worked for less than 10 years (10.8%) thereby indicating that the duration of exposure is directly related to the prevalence of respiratory impairment.

A global comparison of predicting equations on spirometry in the male population

A multiple regression model considering dependent variables like vital capacity (VC), forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) and age and height as independent variables for the adult male population, which includes whites of European descent and non-whites was reviewed to evaluate the role of lung function status following standardization of age and height. Non-whites showed 0.19 litre decline in VC per decade of life as compared to 0.24 litres observed in the whites of European descent. Mean VC increased 0.05 litres per centimetre in non-whites and whites. The variation in the constant term in the regression equation determined the difference between the racial groups. Like VC, FEV1 showed ethnic differences similar to those of VC. However, the magnitude of the variation in the predicted values of FEV1 was found to be less than that observed in VC. When related to VC, FEV1 showed little difference between most European populations, New Guyanaese, Indians, Negroes, Africans and Chinese because FEV1/FVC ratio had a very narrow range between 77 and 80%.

Wet-bulb globe temperature index: a predictor of physiological strain in hot environments

The readings of the natural wet-bulb (tnwb) and globe thermometer for computing Twbg index (indoors) were taken between 08.00 to 17.00 h at two-hour intervals in different work locations in the glass bangle and brassware industries. For assessing the physiological reliability of the Twbg index for heat stress, the radial pulse rate was monitored at two-hour intervals in 60 brassware workers and 77 glass bangle workers (mean ages: 25.3 +/- 8.8 and 28.1 +/- 5.7 years) belonging to various occupations exposed to thermal radiation for 9.3 +/- 8.5 and 11.2 +/- 4.8 years respectively. The mean values of Twbg index observed in the brassware and glass bangle industries were found to be almost of the same order (34.4 +/- 3.0 degrees C and 35.2 +/- 1.1 degrees C). The radiant heat seemed to make the most significant contribution to the environmental heat stress in these industries. The globe temperature near the main melting furnace was as high as 53.8 +/- 3.0 degrees C and 59.2 +/- 4.02 0C in the glass bangle and brassware industries respectively. It was, therefore, expected that the exposed workers would show pronounced physiological strain. Surprisingly the pulse rates of these workers did not indicate any significant physiological strain since the maximal pulse rates recorded did not exceed the safe limits of circulatory strain recommended by the WHO.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective, up-down sequential allocation study investigating the effectiveness of vital capacity breaths using high-flow nasal oxygenation versus a tight-fitting face mask to pre-oxygenate term pregnant women

BACKGROUND

The role of high flow nasal oxygenation (HFNO) for pre-oxygenation before obstetric general anaesthesia remains unclear. This study aimed to determine the number of vital capacity breaths using HFNO required to pre-oxygenate 90% of parturients to an end-tidal oxygen concentration fraction (F_ETO₂) of ≥0.90 (termed EN90).

METHODS

Using up-down, sequential allocation trial design, volunteer term parturients undergoing caesarean delivery were investigated with HFNO with their mouth closed, followed by mouth open, and if F_ETO₂ ≥0.90 was not achieved after a maximum of 20 vital capacity breaths, pre-oxygenation was attempted with a face mask. The primary outcome was the number of vital capacity breaths required using HFNO (mouth open and closed) to achieve EN90. Secondary outcomes included assessment of EN90 using mouth open versus mouth closed and face mask pre-oxygenation, maternal satisfaction and evaluation of fetal cardiotocography.

RESULTS

Twenty women at term were recruited. Successful pre-oxygenation occurred in 4 (20%), 3 (15%) and 14 (70%) women with HFNO mouth closed, HFNO mouth open, and via face mask respectively. At up to 20 vital capacity breaths, face mask pre-oxygenation was more successful at achieving EN90 compared with both HFNO with a closed (P=0.006) or open (P=0.001) mouth. Closed mouth HFNO did not outperform open mouth pre-oxygenation.

CONCLUSION

Face mask pre-oxygenation is more effective at achieving EN90 compared with to HFNO within a clinically acceptable number of vital capacity breaths. Further studies are needed to determine the role of HFNO in optimising the time before desaturation and for apnoeic oxygenation in term parturients.

Respiratory symptoms and ventilatory capacity in metal polishers

To evaluate the long-term effects of metal dusts on the bronchopulmonary system and the synergistic effect of cigarette smoke, a comparative study of spirometric measurements in 104 polishers and 90 unexposed controls was carried out in 25 brass and steelware polishing industries at Moradabad in northern India. The two groups were comparable in terms of age, height, smoking habit and socio-economic status. A total of 58.6% of the polishers had one or more respiratory symptoms, compared to only 25.5% of the controls (P < 0.05). Chronic cough was present in 21 polishers (20.2%) as compared to 11.1% of the controls. However, this difference was insignificant. Chronic phlegm was nearly three times as frequent among the polishers as among the controls (17.5% vs 4.4%) (P < 0.005). The prevalence of dyspnoea of varying grades was also significantly higher (16.3% as opposed to 4.4%) among the exposed groups. Chronic bronchitis (6.7%) and occupational asthma (4.8%) were found to be confined to polishers. The polishers also experienced acute respiratory symptoms during the work shift. The prevalence of acute respiratory symptoms was recorded for cough in 19 workers (44.1%) followed by dyspnoea in 14 workers (32.5%) and throat irritation in 11 workers (25.5%). Comparison of the mean values of pulmonary function parameters in the polishers and the controls showed significant differences in the smoking and non-smoking groups (P < 0.001). The polishers exhibited significantly greater acute reductions in various lung functions over the work shift, particularly for forced expiratory flow over the 25-75% portion of the spirogram (FEF25-75%) FEF25% and FEF50%, than did the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Genetic mechanisms and correlated risk factors of antimicrobial-resistant ESKAPEE pathogens isolated in a tertiary hospital in Malaysia

BACKGROUND

Knowledge on the epidemiology, genotypic and phenotypic features of antimicrobial-resistant (AMR) ESKAPEE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli) and their association with hospital-acquired infections (HAIs) are limited in Malaysia. Therefore, we evaluated the AMR features and resistance mechanisms of the ESKAPEE pathogens collected in a tertiary hospital located in the capital of Malaysia.

METHODS

A total of 378 AMR-ESKAPEE strains were obtained based on convenience sampling over a nine-month study period (2019-2020). All strains were subjected to disk diffusion and broth microdilution assays to determine the antimicrobial susceptibility profiles. Polymerase chain reaction (PCR) and DNA sequence analyses were performed to determine the AMR genes profiles of the non-susceptible strains. Chi-square test and logistic regression analyses were used to correlate the AMR profiles and clinical data to determine the risk factors associated with HAIs.

RESULTS

High rates of multidrug resistance (MDR) were observed in A. baumannii, K. pneumoniae, E. coli, and S. aureus (69-89%). All organisms except E. coli were frequently associated with HAIs (61-94%). Non-susceptibility to the last-resort drugs vancomycin (in Enterococcus spp. and S. aureus), carbapenems (in A. baumannii, P. aeruginosa, and Enterobacteriaceae), and colistin (in Enterobacteriaceae) were observed. Both A. baumannii and K. pneumoniae harbored a wide array of extended-spectrum β-lactamase genes (blaTEM, blaSHV, blaCTX-M, blaOXA). Metallo-β-lactamase genes (blaVEB, blaVIM, blaNDM) were detected in carbapenem-resistant strains, at a higher frequency compared to other local reports. We detected two novel mutations in the quinolone-resistant determining region of the gyrA in fluoroquinolone-resistant E. coli (Leu-102-Ala; Gly-105-Val). Microbial resistance to ampicillin, methicillin, and cephalosporins was identified as important risk factors associated with HAIs in the hospital.

CONCLUSION

Overall, our findings may provide valuable insight into the microbial resistance pattern and the risk factors of ESKAPEE-associated HAIs in a tertiary hospital located in central Peninsular Malaysia. The data obtained in this study may contribute to informing better hospital infection control in this region.

A study of respiratory morbidity and pulmonary function among solderers in the electronics industry

Pulmonary function assessment of 197 solderers engaged in soldering printed circuit boards and other electronic components using lead-tin alloy impregnated solder in five major electronics workplaces in India was compared with the findings observed in 143 unexposed controls. Spirometry showed a significant impairment in the values of vital capacity (VC) and forced expiratory volume/forced vital capacity (FEV1/FVC) percent ratio in 47.2% of the solderers in comparison to 1.3% in the reference group (p less than 0.001). In the exposed group, female solderers particularly showed significantly higher (55.0%) prevalence of overall respiratory impairment in comparison to the 32.3% observed in their male counterparts (p less than 0.001). Bronchial obstruction was recorded in 7.6% of the solderers compared with 1.3% of the unexposed controls (p less than 0.01). The prevalence of restrictive and mixed ventilatory impairment was found to be 28.9 and 10.6%, respectively, among the exposed workers, while there was none among the control group. The solderers showed a predominantly restrictive pattern of pulmonary impairment that was mild in nature. Smoking caused no significant effect on the pulmonary impairment among the exposed workers. The study also did not show any significant differences in the prevalence of respiratory impairment between solderers exposed either less or more than 10 yr, thereby suggesting that there was no link between the respiratory impairment and duration of exposure. The industrial hygiene study conducted in the assembly section where soldering was done showed the mean concentration of lead to be 0.40 micrograms/m3 (range 0.12-0.43 micrograms/m3).(ABSTRACT TRUNCATED AT 250 WORDS)