Towards quantifying biomarkers for respiratory distress in preterm infants: Machine learning on mid infrared spectroscopy of lipid mixtures

Neonatal respiratory distress syndrome (nRDS) is a challenging condition to diagnose which can lead to delays in receiving appropriate treatment. Mid infrared (IR) spectroscopy is capable of measuring the concentrations of two diagnostic nRDS biomarkers, lecithin (L) and sphingomyelin (S) with the potential for point of care (POC) diagnosis and monitoring. The effects of varying other lipid species present in lung surfactant on the mid IR spectra used to train machine learning models are explored. This study presents a lung lipid model of five lipids present in lung surfactant and varies each in a systematic approach to evaluate the ability of machine learning models to predict the lipid concentrations, the L/S ratio and to quantify the uncertainty in the predictions using the jackknife + -after-bootstrap and variant bootstrap methods. We establish the L/S ratio can be determined with an uncertainty of approximately ±0.3 mol/mol and we further identify the 5 most prominent wavenumbers associated with each machine learning model.

Effectiveness of Upadacitinib for Patients With Acute Severe Ulcerative Colitis: A Multicenter Experience

INTRODUCTION

A significant proportion of patients with acute severe ulcerative colitis (ASUC) require colectomy.

METHODS

Patients with ASUC treated with upadacitinib and intravenous corticosteroids at 5 hospitals are presented. The primary outcome was 90-day colectomy rate. Secondary outcomes included frequency of steroid-free clinical remission, adverse events, and all-cause readmissions.

RESULTS

Of the 25 patients with ASUC treated with upadacitinib, 6 (24%) patients underwent colectomy, 15 (83%) of the 18 patients with available data and who did not undergo colectomy experienced steroid-free clinical remission (1 patient did not have complete data), 1 (4%) patient experienced a venous thromboembolic event, while 5 (20%) patients were readmitted.

DISCUSSION

Upadacitinib along with intravenous corticosteroids may be an effective treatment for ASUC.

Opioid Legislation in Patients With Inflammatory Bowel Disease: A State-wide Retrospective Cohort Study

BACKGROUND

Indiana State opioid prescription legislation has been shown to decrease overall opioid prescriptions. However, this effect has not been studied in specific diseases associated with chronic pain such as inflammatory bowel disease (IBD). We aimed to determine the effect of state opioid prescription legislation on opioid prescribing patterns in IBD.

METHODS

A retrospective cohort analysis using an interrupted time-series from December 15, 2010 to July 1, 2018, with 2 time periods separated by Title 844 of the Indiana Administrative Code, in a statewide health care system capturing the majority of the state's population including all adult patients with IBD. The primary outcome was opioid prescription rate per person-year.

RESULTS

In total, 9436 patients met inclusion criteria. After legislation, the total number of opioid orders per patient-year continued to increase (0.543, 95% CI, 0.528-0.558, to 0.663, 95% CI, 0.654-0.672), with fewer scripts from the emergency department (0.113, 95% CI, 0.106-0.120, to 0.092, 95% CI, 0.088-0.095) and more from outpatient providers (0.303, 95% CI, 0.292-0.314 to 0.432, 95% CI, 0.424-0.439). There were increases in biologic (0.206, 95% CI, 0.197-0.215 to 0.517, 95% CI, 0.509-0.525) and steroid (0.182, 95% CI, 0.173-0.190 to 0.237, 95% CI, 0.232-0.243) prescriptions per person-year following legislation. Factors associated with heavy opioid use included chronic steroids (odds ratio, 5.030; 95% CI, 4.176-6.054), history of IBD-related surgery (odds ratio, 2.807; 95% CI, 2.367-3.323) and current smoking (odds ratio, 2.650; 95% CI, 2.223-3.158).

CONCLUSIONS

Despite legislation and the increased use of disease-modifying drugs, statewide opioid prescriptions continued to increase. The increase in opiate use, high steroid use, and significant health care utilization suggests poor underlying disease control.

The Relationship Between the Endoscopic Healing Index, Fecal Calprotectin, and Magnetic Resonance Enterography in Crohn's Disease

INTRODUCTION

The serum-based endoscopic healing index (EHI) test identifies endoscopic Crohn's disease (CD) activity. Data are lacking on the relationship between EHI with other endpoints. We assessed the relationship between EHI and the simplified Magnetic Resonance Index of Activity.

MATERIALS AND METHODS

Data were prospectively collected on patients with CD with either an EHI or fecal calprotectin (FCAL) within 90 days of magnetic resonance enterography (MRE). Diagnostic accuracy was assessed using area under the receiver operator characteristics. Proportions with any, severe, and terminal ileum MR inflammation were compared above/below identified thresholds for both EHI and FCAL.

RESULTS

A total of 241 MREs paired to either EHI or FCAL from 155 patients were included. Both EHI and FCAL had similar accuracy to diagnose inflammation (area under the receiver operator characteristics: EHI: 0.635 to 0.651, FCAL: 0.680 to 0.708). Optimal EHI values were 42 and 26 for inflammation on MRE and endoscopy, respectively. Patients with EHI ≥42 (100% vs. 63%, P=0.002), FCAL >50 µg/g (87% vs. 64%, P<0.001) and FCAL >250 µg/g (90% vs. 75%, P=0.02) had higher rates of simplified Magnetic Resonance Index of Activity ≥1 compared with lower values. EHI differentiated ileitis numerically more than FCAL (delta: 24% to 25% vs. 11% to 21%). Patients with FCAL ≥50 µg/g had higher rates of severe inflammation compared with FCAL <50 µg/g (75% vs. 47%, P<0.001), whereas smaller differentiation existed for EHI threshold of 42 (63% vs. 49%, P=0.35).

CONCLUSION

Both EHI and FCAL were specific in their confirmation of inflammation and disease activity on MRE in patients with CD. However, MRE-detected inflammation was frequently present in the presence of low EHI and FCAL in similar proportions.

Niche suitability and spatial distribution patterns of anurans in a unique Ecoregion mosaic of Northern Pakistan

The lack of information regarding biodiversity status hampers designing and implementing conservation strategies and achieving future targets. Northern Pakistan consists of a unique ecoregion mosaic which supports a myriad of environmental niches for anuran diversity in comparison to the deserts and xeric shrublands throughout the rest of the country. In order to study the niche suitability, species overlap and distribution patterns in Pakistan, we collected observational data for nine anuran species across several distinct ecoregions by surveying 87 randomly selected locations from 2016 to 2018 in Rawalpindi District and Islamabad Capital Territory. Our model showed that the precipitation of the warmest and coldest quarter, distance to rivers and vegetation were the greatest drivers of anuran distribution, expectedly indicating that the presence of humid forests and proximity to waterways greatly influences the habitable range of anurans in Pakistan. Sympatric overlap between species occurred at significantly higher density in tropical and subtropical coniferous forests than in other ecoregion types. We found species such as Minervarya spp., Hoplobatrachus tigerinus and Euphlyctis spp. preferred the lowlands in proximal, central and southern parts of the study area proximal to urban settlements, with little vegetation and higher average temperatures. Duttaphrynus bengalensis and D. stomaticus had scattered distributions throughout the study area with no clear preference for elevation. Sphaerotheca pashchima was patchily distributed in the midwestern extent of the study area as well as the foothills to the north. Microhyla nilphamariensis was widely distributed throughout the study area with a preference for both lowlands and montane terrain. Endemic frogs (Nanorana vicina and Allopaa hazarensis) were observed only in locations with higher elevations, higher density of streams and lower average temperatures as compared to the other seven species sampled. It is recommended to provide legal protection to amphibians of Pakistan, especially endemic species, through revision in the existing wildlife laws. We suggest studying the effectiveness of existing amphibian tunnels and corridors or designing new ones tailored to the needs of our species to prevent their local extinction due to ongoing or proposed urban development which might affect their dispersal and colonization.

Analysis of exhaled breath to identify critically ill patients with ventilator-associated pneumonia

Ventilator-associated pneumonia commonly occurs in critically ill patients. Clinical suspicion results in overuse of antibiotics, which in turn promotes antimicrobial resistance. Detection of volatile organic compounds in the exhaled breath of critically ill patients might allow earlier detection of pneumonia and avoid unnecessary antibiotic prescription. We report a proof of concept study for non-invasive diagnosis of ventilator-associated pneumonia in intensive care (the BRAVo study). Mechanically ventilated critically ill patients commenced on antibiotics for clinical suspicion of ventilator-associated pneumonia were recruited within the first 24 h of treatment. Paired exhaled breath and respiratory tract samples were collected. Exhaled breath was captured on sorbent tubes and then analysed using thermal desorption gas chromatography-mass spectrometry to detect volatile organic compounds. Microbiological culture of a pathogenic bacteria in respiratory tract samples provided confirmation of ventilator-associated pneumonia. Univariable and multivariable analyses of volatile organic compounds were performed to identify potential biomarkers for a 'rule-out' test. Ninety-six participants were enrolled in the trial, with exhaled breath available from 92. Of all compounds tested, the four highest performing candidate biomarkers were benzene, cyclohexanone, pentanol and undecanal with area under the receiver operating characteristic curve ranging from 0.67 to 0.77 and negative predictive values from 85% to 88%. Identified volatile organic compounds in the exhaled breath of mechanically ventilated critically ill patients show promise as a useful non-invasive 'rule-out' test for ventilator-associated pneumonia.

Post-Harvest Problems of Strawberry and Their Solutions

Strawberry is a fruit with a short season of harvest. Strawberry is well-known among people all over the world for its distinct flavour, nutritional value, and delicacy. While on the other hand, preserving strawberry and shelf life extension has been a huge difficulty due to their perishable nature. Making effective and sustainable use of already available food processing and preservation technology needs time. Researchers must use advanced techniques like a cool store, modified atmospheric packaging (MAP), cool store, controlled atmospheric storage (CA), various packaging methods, and a variety of chemical and physical treatments to retain commodities for a longer period due to strategic market sales following harvest. Except for the preserving techniques, there is some polysaccharide-based edible coating which has a crucial role in delaying fruit softening, fruit decay, maintaining the increased levels of ascorbic acid and phenols, enhancing the activities of antioxidant enzymes, and reducing membrane damage. During the postharvest stages, there are numerous threats to keep in view regarding the safety and quality of strawberries. In this chapter, we will discuss the benefits and drawbacks of some of the various preservation technologies, as well as how they might be utilised to preserve and a prolonged period of freshly harvested strawberries.

Cutaneous presentation of metastatic pancreatic cancer

Pancreatic cancer typically presents with a cholestatic picture of jaundice, bloating and bowel changes, secondary to the obstruction of the biliary system. In tail of pancreas metastases, this clinical presentation may be absent, meaning that the disease progression can be more insidious. Cutaneous spread in pancreatic malignancies is often iatrogenic due to direct spread from the tumour site during diagnostic sampling or surgery. Rarely, cutaneous spread can be noted at distant sites, which is associated with widespread disease dissemination and poor prognostic outcomes. Our case focusses on a patient who developed metastatic spread to the chin, as a first presentation, with no other significant associated symptoms identified.

Utility of Therapeutic Drug Monitoring for Tumor Necrosis Factor Antagonists and Ustekinumab in Postoperative Crohn's Disease

BACKGROUND

In postoperative Crohn's disease (POCD), data are lacking on relationships between serum biologic concentrations and treatment outcomes. We assessed if established threshold concentrations of infliximab (IFX), adalimumab (ADA), and ustekinumab (UST) impact outcomes in POCD.

METHODS

Data were extracted from POCD patients with serum biologic concentration measurements using Weill Cornell Medicine biobanks. The primary outcome compared rates of deep remission (achieving both objective [endoscopic or biomarker] and clinical [Harvey-Bradshaw index or Crohn's Disease Patient Reported Outcome-2] remission), using established serum drug level cutoffs of IFX ≥3 µg/mL, ADA ≥7.5 µg/mL, and UST ≥4.5 µg/mL.

RESULTS

In 130 patients, median IFX, ADA, and UST concentrations were 10 (interquartile range [IQR], 2.9-26.9) µg/mL, 10.5 (IQR, 4.9-14.9) µg/mL, and 6.9 (IQR, 5.1-10.2) µg/mL, respectively. In patients with IFX ≥3 µg/mL, higher rates of deep remission (39% vs 0%; P = .02) existed compared with those with IFX <3 µg/mL. Similar differences existed for clinical (44% vs 9%; P = .04) and objective (83% vs 62%; P = .1) remission. In patients with ADA ≥7.5 µg/mL, rates of deep (42% vs 0%; P = .02), clinical (42% vs 0%; P = .02), and objective (88% vs 40%; P = .007) remission were higher than patients with lower concentrations. For UST, rates of deep (28% vs 17%; P = 1.0), clinical (33% vs 33%; P = 1.0), and objective (70% vs 67%; P = 1.0) remission were similar between patients regardless of drug concentration.

CONCLUSIONS

In POCD, established anti-tumor necrosis factor concentrations were associated with improved outcomes. No relationship between UST concentrations and postoperative outcomes existed.

Comparison of Minimally Invasive Carpal Tunnel Release with Open Carpal Tunnel Release

Objective: To compare the long-term results of conventional treatment [open carpal tunnel release (OCTR)] with the results of mini-open carpal tunnel release surgery (MCTR), performed through the palmar approach. Study design: retrospective study Place and Duration: This study was conducted at Pakistan Institute of Medical Sciences Islamabad from June 2020 to June 2022 Methodology: This research involves a total of 40 patients who were divided into 2 groups. Each group contained 20 patients respectively. One group was treated with mini-open carpal tunnel surgery and the other was treated with conventional treatment. Each patient had to conduct follow-ups for at least one years. The results were evaluated through SSS (Symptom Severity Scale), VAS (Visual Analogue Scale), DASH Score (Disability of arms, shoulder and hand), and FSS (Functional Status Scale). For a statistical analysis, confidence interval of 95% was set and significance was 0.05. Results: In the long-term follow-up, both groups showed comparable results. The mean follow-up for MCTR and conventional method was 2 years. The DASH score was 4.2 and 8.9, SSS was 1.2 and 1.1, VAS was 0.5 and 0.9, and the FSS was 1.4 and 1.1. The scar sensitivity was lower in MCTR. It was 5 percent in MCTR while 12 percent in conventional treatment. The pain, time taken in surgery, and recovery time were also lower in the MCTR group. Both groups showed less complications and there was not a single recurrence. Practical implication : To compare the long-term results of conventional treatment [open carpal tunnel release (OCTR)] with the results of mini-open carpal tunnel release surgery (MCTR), performed through the palmar approach. Practically less invasive surgery (minimal invasive) is more beneficial for patient in terms of wound complications Conclusion: Mini-open carpal tunnel release is a better option than the conventional treatment. It is a fast, reliable, and simple process which relieves the patient from scar sensitivity. Keywords: Mini-open carpal tunnel release, open carpal tunnel release, carpal tunnel syndrome

Plasma-Assisted Synthesis of Surfactant-Free and D-Fructose-Coated Gold Nanoparticles for Multiple Applications

The excellent optical properties of gold nanoparticles (AuNPs) make them promising for numerous applications. Herein, we present a facile synthesis of both surfactant-free (SF-AuNPs) and non-toxic D-fructose (DF)-coated gold nanoparticles (DF-AuNPs) via the plasma-liquid interactions (PLIs) method. Moreover, we demonstrate that both SF-AuNPs and DF-AuNPs are potential candidates for trace detection via surface-enhanced Raman scattering (SERS) and catalytic degradation of toxic dyes. However, SF-AuNPs have superior SERS and catalytic performance compared to the DF-AuNPs due to their surfactant-free nature. Moreover, SF-AuNPs have also been shown to quench the fluorescence of analyte molecules, making their SERS-based trace detection more efficient. In particular, SERS enhancement of rhodamine 6G (R6G) and catalytic reduction of a toxic dye methylene blue (MB) have been explored.

The Remediation in Enzyme’s Activities in Plants: Tea Waste as a Modifier to Improve the Efficiency of Growth of Helianthus annuus in Contaminated Soil

The remediation in plant enzymatic activities in Cd-contaminated soil was monitored through tea waste. Tea is an extensively used beverage worldwide with the release of a high quantity of tea waste utilized in the growing condition of Helianthus annuus on Cd metal contaminated soil. The study was a plan for the natural environmental condition in the greenhouse. For this purpose, four sets of plants were cultivated in triplicate and marked as (i) control, (ii) Cd stress plants, (iii) dry tea waste and Cd stress, and (iv) fresh tea waste and Cd stress. The improved efficiency of biochemical reactions in plants under Cd stress with tea waste treatment was the consequence of blocking Cd movement in the soil through adsorption on tea waste, showing that the tea waste effectively controls the mobility of Cd from the soil to the roots of the plants. Scan electron microscopy (SEM) validates the recovery of the leaves of the plants. The remediation of plant growth and enzyme activities such as amylase, peroxidase, nitrate reductase (NR), and nitrite reductase (NiR) under Cd metal-contaminated soil through tea waste was investigated. The source of tea waste in contaminated soil resulted in the recovery of the photosynthetic process and an improvement in amylase, NR, NiR, and peroxidase activities, thereby resulting in the recovery of pigments coupled with an increase in the biomass of the plants. It was suggested that tea waste acts as a good biosorbent of Cd and energy provider to the plants for normal enzyme activity under Cd stress and may be used by farmers in the future for safe and healthy crops as a cost-effective technology.

Natural and commercial antibiotic comparison with drugs modeling Cell Integrity Cell Stability of Bio-Kinetics Changes under Morphological Topographies cells with lower Toxicological Characteristics for multidrug resistances problem

Antibacterial drug-resistant strains are a serious problem of bacterial treatments nowadays and have a concern. The plant exacts of Adhatoda vasica and Calotropis procera are well-known for their role as antibiotic agents. The extraction of novel antibiotic compounds was done by HPLC-DAD, their yield is quantified by numerous solvents. The complete biological activity with antioxidants, bio-kinematicof four compounds of B-Sitosteryl linoleate, Myristyl diglucoside, D-Triglucopyranoside, and S- allylcysteine acids were studied. The supercritical fluid extraction techniques were the best strategies for higher yield, accuracy clarity, and inter, intra process of all four compounds. A. vasica and C. procera samples and investigated in six different solvents. D-Triglucopyranoside (13.81 ± 0.48%), Myristyl diglucoside (11.81 ± 0.41%), B- Sitosteryl linoleate (12.81 ± 0.48%), and s-allylcysteine acids (14.81 ± 0.31%) were higher. The design and action of compounds were applied to proper compartmental pharmacokinetic modelling for in-depth design understanding. The morphology and structure of bacterial cells with the extracted compounds upheld the permeability of cell membranes, membrane integrity, and membrane potential and lower the bacterial binding capacity the infectious index was measured in transmission electron microscopy (TEM) and their alteration process. Plants have well upheld the cellular permeability The toxicity test was performed on both extracted samples with concentrations (1, 0.4, and 0.8%). The areas under plasma half-life of compounds with their solubility, abortion level were higher in four compounds showed the potential of novel antibiotics. The novel medicinal plants used as antibiotics could be the best sources of infection control as a source of future medicines with antibacterial potential solving multidrug issues of bacteria in the world.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Movement Paradigm for Hazara Torrent Frog Allopaahazarensis and Murree Hills Frog Nanoranavicina (Anura: Dicroglossidae)

Endemic anurans are particularly vulnerable to environmental changes, and are susceptible to population declines because of their restricted distribution ranges. The Murree Hills Frog Nanoranavicina and Hazara Torrent Frog Allopaahazarensis are associated with the torrential streams and nearby clear water pools in subtropical chir pine forest and other forest types, at elevations higher than 1000 m in Pakistan. In this study, we have provided data on the extent of movement of these frog species for the first time. We installed radio transmitters on a total of 13 Murree Hills Frogs and 13 Hazara Torrent Frogs during eight consecutive days in September 2017 and 2018. Our results showed that these frogs did not move long distances along the stream or away from the stream into the forest. All the radio-tracked frogs showed movement of < 3 m. We found a significant differences only in the distance moved by Murree Hills Frogs between the two years studied. Based on our findings, we propose a movement paradigm that focuses on conservation implications for these endemic frogs.

The impact of COVID-19 pandemic on type A aortic dissection care

Funding Acknowledgements

Type of funding sources: None.

Introduction

COVID-19 created a challenging situation for cardiac surgery and associated acute care programs around the world. While non-urgent cases might be postponed, operating on life-threatening conditions, including type A aortic dissection (TAAD), must be sustained despite the ongoing pandemic. Therefore, we investigated the impact of the COVID-19 pandemic on our urgent aortic program.

Methods

36 individuals presenting with TAAD in a single centre were analysed from the pre-pandemic period (2019, n=16) and the pandemic era (2020, n=20). Retrospective data review was conducted on patient characteristics, TAAD presenting symptoms, operative techniques, postoperative outcomes and length of stay. A comparison was made between both eras applying appropriate testing methods, and a p-value <0.05 was considered statistically significant.

Results

A 25% increase in TAAD referrals occurred during the pandemic era. Patients were featured by younger age of presentation in contrast to Western data (pre-pandemic group: 47.6 ± 18.7, and the pandemic group: 50.6 ± 16.2 years, p=0.6) but showed similar male predominance (4:1) in both groups. There was no statistical difference in baseline comorbidities between the groups. Length of hospital and intensive care unit stays were comparable between both groups. Low rates of postoperative complications were registered in both groups with no significant between-group difference.

Conclusion

Emergent surgical management remains essential in patients with TAAD regardless of the pandemic. Furthermore, temporary structural departmental re-configuration and optimal personal protective equipment utilisation warrant maintained satisfactory outcomes in such critical healthcare scenarios.

Predictors of non-invasive ventilation failure in adult patients with cardiac dysfunction presenting with community acquired pneumonia; an Egyptian multicenter prospective study

Funding Acknowledgements

Type of funding sources: None.

Background

Non-invasive ventilation (NIV) might be successful if properly selected in adult patients with cardiac dysfunction presenting with community acquired pneumonia. The main objective was to identify contributing factors to NIV failure.

Methods

All adult patients with LV EF less than 50% admitted to the ICU with community acquired pneumonia and acute respiratory failure were enrolled in our multicenter prospective study after getting informed consents . The study was registered and given a number (ID ISRCTN14641518). Non-invasive ventilation failure was defined as requirement of intubation after institution of NIV intervention.

Results

We prospectively enrolled 177 patients between February 2019 to July 2020. Fifty-three patients (29.9%) were considered failed NIV. The mean age of studied patients was 64.1±12.6 years with a male predominance (73.4%) and a mean left ventricle EF of 36.4±7.8%. There were insignificant differences between the NIV success and NIV failure groups regarding the underlying morbidities nor the inflammatory markers. The patients who failed NIV were significantly older with higher mean SOFA and APACHE II scores compared to the patients with succeeded NIV. Non-invasive Ventilation failure was associated with longer ICU stay (p&lt;0.001), higher SOFA at 48 hours (p&lt;0.001) and higher mortality (p&lt;0.001) compared to the NIV success group. NIV failure was independently predicted with APACHE II (OR:1.420, p 0.01, 95% CI:1.224 – 1.647), SOFA (OR:17.6 , p &lt;0.001, 95% CI: 4.148-74.68), baseline HACOR (OR:2.041, P 0.026, 95% CI:1.225 –3.401), lung ultrasound score (OR:1.209,P 0.017,95% CI:1.014–1.441) and blood lactate (OR:9.702,P &lt;0.001,95%CI:1.357–69.37).Conclusion: High initial APACHE II and SOFA scores , hindered lactate clearance as well as non-decrementing patterns of HACOR and LUS scores were associated with early NIV failure in patients with heart failure presenting with community acquired pneumonia.

Effect of Different Fertilizations on the Plant-Available Nitrogen in Soil Profile (0-100 cm): A Study on Chinese Cabbage

The aim of this study is to analyze the variations in the plant-available nitrogen (PAN) concentrations in the soil profile. Different fertilizers were applied for Chinese cabbage plantation (CCP) in the experimental fields of the Shunyi region. The treatments used for the comparative analysis are (i) no fertilizer and plantation (NVP), (ii) no fertilizer with CCP (CTP), (iii) fertilization as urea (URP), and (iv) potassium nitrate (KNP) and chicken manure (CMP) with CCP. It was concluded that the yield was significantly high in URP, CMP, and KNP as compared to CTP. In URP, maximum PAN in soil layers 0-60 cm was recorded during crop production and in 60-100 cm after harvesting as compared to other treatments. Significant variations in soil pH and electrical conductivity (EC) for the soil profile (0-100 cm) from the initial values with respect to time and treatments were observed. CMP showed maximum ammonium in the upper layers of 0-60 cm throughout the season, whereas minimum PAN was observed in NVP but increased in lower layers of 60-100 cm. In general, all fertilizers raised the PAN below the soil 60-100 cm which indicates their potential for nitrate leaching (NL).

Isolation and Identification of Bioactive Compounds from Bidens spp. Using HPLC-DAD and GC-MS Analysis and Their Biological Activity as Anticancer Molecules

The genus Bidens a member of family Compositae, is widely documented as an ethno-medicinally important genus of plants. In the present study, anticancer potential of three ethno-medicinally important species i.e., B. bipinnata, B. biternata and B. pilosa were tested. For in-vitro evaluation, an MTT (Thiazolyl blue tetrazolium bromide) assay was performed against cervical cancer cells (HeLa), hepatocellular carcinoma (HepG), and adenocarcinoma human alveolar basal epithelial cells (A549). For in vivo evaluation, Artemia salina, Danio rerio, and Caenorhabditis elegans were used. Among all the tested extracts, the ethanol extract of B. biternata appeared to have highest anticancer activity, and the compounds responsible for this activity were identified to be Tris (2,4-di-tert-butylphenyl), 4-hydroxy-2,4′-dimethoxychalcone, and 2,4-di-tert-butylphenol. This is the first report of the isolation of Tris (2,4-di-tert-butylphenyl) phosphate from the genus Bidens and the first report of 4-hydroxy-2,4′-dimethoxychalcone and 2,4-di-tert-butylphenol from B. biternata. Among the isolated compounds, 4-hydroxy-2,4′-dimethoxychalcone showed the highest anticancer activity with an LD50 value of 236.7 µg/mL. Therefore, this compound carries promising potential for being established as a pharmaceutical for chemoprevention and chemotherapy.

Dual Biologic or Small Molecule Therapy for Treatment of Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

BACKGROUND AND AIMS

We conducted a systematic review and meta-analysis to summarize emerging data on the safety and effectiveness of dual biologic therapy in combination or with tofacitinib in patients with refractory inflammatory bowel disease (IBD).

METHODS

Through a systematic search of multiple electronic databases through November 9, 2020, we identified cohort studies or case series (>10 patients) reporting the safety and effectiveness of simultaneous use of biologic agents in combination or with tofacitinib in patients with IBD. Rates of adverse events, clinical remission, and endoscopic remission were synthesized using pooled data, and we identified factors associated with successful dual therapy.

RESULTS

We identified 30 studies reporting 288 trials of dual biologic or small molecule therapy in 279 patients (76% Crohn's disease; median duration of treatment 24 weeks (IQR₂₅-IQR₇₅ 1332)). The main indications for dual therapy included medically refractory IBD (81%) and concurrent extra-intestinal manifestations or rheumatologic disease (12%). The most common combinations of dual therapy included tumor necrosis factor-α antagonists & anti-integrins (48%), ustekinumab & anti-integrins (19%); 61% of patients had previously failed at least one of the two therapies used in combination. Over a median follow-up of 32 weeks (IQR₂₅-IQR₇₅ 24-52), pooled rates of adverse and serious adverse events were 31% (95% CI, 13%-54%) and 6.5% (95% CI, 2.1%-13.1%); pooled rates of clinical and endoscopic remission were 59% (95% CI, 42%-74%), and 34% (95% CI, 23%-46%), respectively. 12% (95% CI, 4%-24%) of patients required surgery. Rates of success were higher in patients on dual therapy due to EIM. Heterogeneity was not significant for endoscopic response (P = .88, I² = 0%), endoscopic remission (P = .44, I² = 0%), and malignancy (P = .87, I² = 0%). However, significant heterogeneity existed for other outcomes.

CONCLUSIONS

Dual biologic or small molecule therapy may be a possible option in highly selected, refractory IBD patients at specialized centers. Higher quality combination of therapies with a significant improvement in the quality of data is required prior to more widespread use.

MiRNA fine tuning for crop improvement: using advance computational models and biotechnological tools

MiRNAs modulate target genes expression at post-transcriptional levels, by reducing spatial abundance of mRNAs. MiRNAs regulats plant metabolism, and emerged as regulators of plant stress responses. Which make miRNAs promising candidates for fine tuning to affectively alter crop stress tolerance and other important traits. With recent advancements in the computational biology and biotechnology miRNAs structure and target prediction is possible resulting in pin point editing; miRNA modulation can be done by up or down regulating miRNAs using recently available biotechnological tools (CRISPR Cas9, TALENS and RNAi). In this review we have focused on miRNA biogenesis, miRNA roles in plant development, plant stress responses and roles in signaling pathways. Additionally we have discussed latest computational prediction models for miRNA to target gene interaction and biotechnological systems used recently for miRNA modulation. We have also highlighted setbacks and limitations in the way of miRNA modulation; providing entirely a new direction for improvement in plant genomics primarily focusing miRNAs.

Therapeutic Potential of Selected Medicinal Plant Extracts against Multi-Drug Resistant Salmonella enterica serovar Typhi

Salmonella enterica serovar Typhi is Gram negative, rod shaped, facultative anaerobic bacterium, belongs to enterobacteriaceae family that causes typhoid fever in humans. This bacterium has become a super bug due to acquisition of multi drug resistance. Bacteria is transmitted through food and water contaminated with human feaces. Present study reports the screening of Adhatoda vasica, Amaranthus hybridus and Aloe barbadensis and their evaluation against multi-drug resistant Salmonella enterica serovar Typhi. Qualitative analysis of ten phytochemicals was conducted using chemical method and Gas Chromatography-Mass Spectrometry (GCMS). Antibacterial activity of plants was carried out by agar well diffusion method on Mueller Hinton agar. Total tannins, total alkaloids and total flavonoids of different parts of three plants were estimated through spectrophotometer. Total tannins content in different parts of plants was present in the given order Amaranthus hybridus leaf > Aloe barbadensis leaf > Adhatoda vasica leaf > Adhatoda vasica flower > Adhatoda vasica stem. Whereas, the order of total flavonoid concentration was Amaranthus hybridus leaf > Aloe barbadensis leaf > Adhatoda vasica leaf > Amaranthus hybridus seed. Total alkaloids have order, Adhatoda vasica leaf > Amaranthus hybridus leaf > Adhatoda vasica flower > Amaranthus hybridus seed > Aloe barbadensis leaf. Results of phytochemical analysis suggested that plants have strong profile of antioxidants, total phenolic contents and various enzymes proposing them best alternate to cure bacterial infections. GC-MS analysis further confirmed stronger phytochemical profile that can be utilized as antagonists to Salmonella enterica serovar Typhi.

Fungicidal synergistic effect of biogenically synthesized zinc oxide and copper oxide nanoparticles against Alternaria citri causing citrus black rot disease

Citrus black rot disease being caused by Alternaria citri is a major disease of citrus plants with 30–35% economic loss annually. Fungicides had not been effective in the control of this disease during last few decades. In the present study, antifungal role of green synthesized zinc oxide (ZnO) and copper oxide (CuO) nanoparticles (NPs) were studied against Alternaria citri. Alternaria citri was isolated from disease fruits samples and was identified by staining with lacto phenol cotton blue. Furthermore, CuO and ZnO NPs were synthesized by utilizing the lemon peels extract as the reducing and capping agent. Nanoparticles were characterized by X-ray diffraction (XRD) and scanning electron microscopy (SEM) techniques. From the XRD data, the calculated size of CuO NPs was to be 18 nm and ZnO NPs was16.8 nm using Scherrer equation. The SEM analyses revealed the surface morphology of all the metal oxide NPs synthesized were rounded, elongated and or spherical in the shape. The zone of inhibition was observed to be 50 ± 0.5 mm by CuO NPs, followed by 51.5 ± 0.5 mm by ZnO NPs and maximum zone of antifungal inhibition was observed to be 53 ± 0.6 mm by mix metal oxide NPs. The results of minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of the synthesized nanoparticles showed that at the certain concentrations (80 mg ml⁻¹), these NPs were capable of inhibiting the fungal growth, whereas above that specified concentrations (100 mg ml⁻¹), NPs completely inhibited the fungal growth. Based on these findings, the green synthesized NPs can be used as alternative to fungicide in order to control the citrus black rot disease.

Influence of Scion/Rootstock reciprocal effects on post-harvest and metabolomics regulation in stored peaches

Peach is an important stone fruit crop cultivated at commercial scale in Pakistan. While, appropriate selection of rootstock has significant impact on the quality of peach fruit. Therefore, in the current study the influence of three rootstocks viz. ‘GF-677′, ‘Peshawar Local’ and ‘Swat Local’ were evaluated on the quality of ‘Flordaking’ peaches following cold storage during two consecutive years. The fruit from these rootstocks were kept at 0 °C for five weeks were studied for various fruit physical (weight loss, colour, firmness) and biochemical (pH, soluble solids content (SSC), titratable acidity (TA), SSC:TA ratio, fruit juice pH, sugars (total, reducing and non-reducing sugars), ascorbic acid (vitamin C) and free radicals scavenging activities) were evaluated. During both years, fruit harvested form trees grafted on ‘GF-677′ exhibited reduced fruit weight loss, changes in Chroma (C*) and highest fruit firmness, Lightness (L*), ascorbic acid contents and radical scavenging activities as compared to fruit harvested from tree grafted on other rootstocks. In conclusion, the post-harvest quality of scion ‘Flordaking’ peach fruit was significantly influenced and best quality can be obtained when it is grafted on ‘GF-677′ rootstock.

Adhatoda vasica and Calotropis procera as a resource of novel chemical compounds, their biological bioluminescence assay, and investigation of morphological features of bacterial growth through advanced technologies

This article reports the three principal groups of compounds for the first time from Adhatoda vasica and Calotropis procera plants species using nuclear magnetic resonance methods in which aliphatic, oxy heterocyclic, and tannins compounds were detected from these plants. The leaves of both species were subjected to testing tyrosinase inhibition and antioxidant activities. ATP bioluminescence use for indirect measurement of the amount of organic residue on the surface of the leaves that provide support to microbial growth. The distinguishing characteristics and intraoperative findings of bacterial diseases involved in treatments were conducted against the positive and negative microbial strains using a scanning electron microscope (SEM). The methanolic extracts of leaves of both species were applied to bacterial strains through broth microdilution method to determine the minimum inhabitation concentrations (MICs) for both species. It was concluded that both plants are a rich resource of bioactive compounds. Their extract may also be used to treat various bacterial diseases and in drug manufacturing. HIGHLIGHTS: New chemical compounds of oxy-heterocyclic, aliphatic, and tannins derivatives are isolated from herbal plants as a source of various drugs. ¹ H NMR spectrum and ¹³ C NMR spectrum of each new derivate were calculated. NMR-spectral analysis of new compound of chemistry class was studied and further applied in various bacterial strains. Tyrosinase inhibition property of bacteria strains by application of active compounds on these strains. Agar overlay bioassays were used to evaluate intercellular morphological features of strains applied on extracts by electron microscope (SEM). a-Glucosidase inhibition assay determined with antioxidants activity through FRAP assay methods.

Isolation, Characterization, and Efficacy of Three Lytic Phages Infecting Multidrug-Resistant Salmonella Serovars from Poultry Farms in Egypt

Multidrug-resistant (MDR) Salmonella serovars are considered a significant threat to veterinary and public health. Developing new antimicrobial compounds that can treat the infection caused by these notorious pathogens is a big challenge. Bacteriophages can be adsorbed on and inhibit the growth of bacteria, providing optimal and promising alternatives to chemical antimicrobial compounds against foodborne pathogens due to their abundance in nature and high host specificity. The objective of the current study was to isolate and characterize new phages from poultry farms and sewage and to evaluate their efficacy against S. Enteritidis isolates. The study reports three lytic phages designated as ϕSET1, ϕSET2, and ϕSET3 isolated from poultry carcasses and sewage samples in Qalubiya governorate Egypt. The effectiveness of phages was evaluated against multidrug-resistant S. Enteritidis strains. Electron microscopy showed that these phages belong to the Siphoviridae family. Phages were tested against 13 bacterial strains to determine their host range. They could infect four S. Enteritidis and one S. Typhimurium; however, they did not infect other tested bacterial species, indicating their narrow infectivity. The bacteriophage's single-step growth curves revealed a latent period of 20 min for ϕSET1 and 30 min for ϕSET2 and ϕSET3. The isolated Salmonella phages prevented the growth of S. Enteritidis for up to 18 hrs. The findings revealed that Salmonella phages could be used as alternative natural antibacterial compounds to combat infection with MDR S. Enteritidis in the poultry industry and represent a step forward to using large panels of phages for eliminating Salmonella from the food chain.

Antioxidant potential and α-glucosidase inhibitory activity of onion (Allium cepa L.) peel and bulb extracts

Allium cepa L. is a commonly consumed vegetable that belongs to the Amaryllidaceae family and contains nutrients and antioxidants in ample amounts. In spite of the valuable food applications of onion bulb, its peel and outer fleshy layers are generally regarded as waste and exploration of their nutritional and therapeutic potential is still in progress with a very slow progression rate. The present study was designed with the purpose of doing a comparative analysis of the antioxidant potential of two parts of Allium cepa, i.g., bulb (edible part) and outer fleshy layers and dry peels (inedible part). Moreover, the inhibitory effect of the onion bulb and peel extracts on rat intestinal α-glucosidase and pancreatic α-amylase of porcine was also evaluated. The antioxidant potential of onion peel and bulb extracts were evaluated using 2,2-diphenyl- 1-picryl hydrazyl (DPPH), ferric-reducing antioxidant power assay (FRAP), 2,2'-azino-bis- 3-ethylbenzothiazoline-6-sulfonic acid (ABTS) radical scavenging assay, H2O2 radical scavenging activity and Fe2+ chelating activity. Total flavonoids and phenolic content of ethanolic extract of onion peel were significantly greater as compared to that of onion bulb. Ethanolic extract of onion peel also presented better antioxidant and free-radical scavenging activity as compared to the ethanolic extract of bulb, while the aqueous extract of bulb presented weakest antioxidative potential. Onion peel extract's α-glucosidase inhibition potential was also correlated with their phenolic and flavonoid contents. The current findings presented onion peel as a possible source of antioxidative agents and phenolic compounds that might be beneficial against development of various common chronic diseases that might have an association with oxidative stress. Besides, outer dry layers and fleshy peels of onion exhibited higher phenolic content and antioxidant activities, compared to the inner bulb. The information obtained by the present study can be useful in promoting the use of vegetable parts other than the edible mesocarp for several future food applications, rather than these being wasted.

Amphibian fauna of Pakistan with notes on future prospects of research and conservation

Research on amphibians and their conservation have gained worldwide attention, as the group includes the highest number of threatened and Data Deficient species when compared to other vertebrates. However, amphibians have long been neglected in wildlife conservation, management decisions, policy making, and research agendas in Pakistan. In this paper, an annotated checklist of the 21 amphibian species of Pakistan, a key to their identification, and detailed discussions on variation in species, including the genera Minervarya and Sphaerotheca, are provided. We found a statistically significant difference in the morphometric measurements of males but non-significant difference in the females of the two forms (rusty dorsum and dotted dorsum) of S.maskeyi. Some genera, such as Microhyla, Uperodon, Minervarya, Allopaa, Chrysopaa, Euphlyctis, Nanorana, and Sphaerotheca, in Pakistan are in need of additional data for molecular and morphological comparisons with taxa in other South Asian countries. The predicaments of amphibian research in Pakistan are discussed, gaps identified, and suggestions are made. Although the occurrence of chytrid fungus in Pakistan is predicted of low likelihood, a lack of data merits studying the prevalence of the fungus, particularly in the northern regions of the country which exhibit complex and dynamic ecosystems. It is recommended that systematic and coordinated surveys are conducted throughout the country to build a database of species occurrences and distributions. Additionally, the monitoring of wild populations and threat mitigation, as well as appropriate legislation, are suggested as long-term measures. By adopting an inclusive wildlife conservation approach in Pakistan, amphibians could be integrated into wildlife conservation and management efforts.

Foliar Application of Salicylic Acid at Different Phenological Stages of Peach Fruit CV. 'Flordaking' Improves Harvest Quality and Reduces Chilling Injury during Low Temperature Storage

Peaches are well-liked amongst the stone fruits in Pakistan. The peach industry faces significant losses, from harvesting to marketing. The objective of this study was to investigate the effectiveness of foliar sprays of salicylic acid (SA) on the fruit quality of peaches (cv. 'Flordaking') at the harvest and postharvest life or stages. Different concentrations of SA (control, 1, 2 and 3 mM) were sprayed on the plants at three growth stages of fruit, i.e., the cell division, cell enlargement and pit-hardening stages. In general, all the SA treatments improved the fruit quality at harvest and maintained higher levels of flesh firmness, titratable acidity and ascorbic acid during storage. However, fruit weight loss, soluble solid contents, membrane leakage, chilling injury, color development, disease and decay incidence and the climacteric peak of ethylene were lowered by SA treatment after six weeks of low-temperature storage. SA at a 3-mM concentration was proven to be the most effective in maintaining the quality for a longer period of time during low-temperature storage. Based on the results, it can be concluded that the application of SA at fruit development stages can improve the harvest quality and storability of 'Flordaking' peaches.

Molecular Epidemiology of Plasmodium species in Conflicted Federally Administered Tribal Area (FATA) Pakistan

Military conflicts have been significant obstacles in detecting and treating infectious disease diseases due to the diminished public health infrastructure, resulting in malaria endemicity. A variety of violent and destructive incidents were experienced by FATA (Federally Administered Tribal Areas). It was a struggle to pursue an epidemiological analysis due to continuing conflict and Talibanization. Clinical isolates were collected from Bajaur, Mohmand, Khyber, Orakzai agencies from May 2017 to May 2018. For Giemsa staining, full blood EDTA blood samples have been collected from symptomatic participants. Malaria-positive microscopy isolates were spotted on filter papers for future Plasmodial molecular detection by nested polymerase chain reaction (nPCR) of small subunit ribosomal ribonucleic acid (ssrRNA) genes specific primers. Since reconfirming the nPCR, a malariometric study of 762 patients found 679 positive malaria cases. Plasmodium vivax was 523 (77%), Plasmodium falciparum 121 (18%), 35 (5%) were with mixed-species infection (P. vivax plus P. falciparum), and 83 were declared negative by PCR. Among the five agencies of FATA, Khyber agency has the highest malaria incidence (19%) with followed by P. vivax (19%) and P. falciparum (4.1%). In contrast, Kurram has about (14%), including (10.8%) P. vivax and (2.7%) P. falciparum cases, the lowest malaria epidemiology. Surprisingly, no significant differences in the distribution of mixed-species infection among all five agencies. P. falciparum and P. vivax were two prevalent FATA malaria species in Pakistan's war-torn area. To overcome this rising incidence of malaria, this study recommends that initiating malaria awareness campaigns in school should be supported by public health agencies and malaria-related education locally, targeting children and parents alike.

Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients

Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.

COMPLICATIONS OF TRACHEOSTOMY AND LEADING FACTORS AMONG PATIENTS PRESENTING AT A TERTIARY CARE HOSPITAL, KARACHI

Objective: To look for the complications of tracheostomy and factors correlated with presence of these complications at a tertiary care teaching hospital of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: ENT department, Operation Theater, Emergency department and Critical Care Unit of Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Apr to Oct 2019. Methodology: Sixty nine patients who underwent tracheostomy were included in the analysis. Final decision regarding offering the procedure of tracheostomy to the patient was made by consultant ENT specialist in liaison with the primary treating physician. Patients were assessed for the complications during the procedure, immediately after the procedure, 48 hours after the procedure and one week after the procedure. Results: Out of sixty nine patients included in the study, 8 (11.6%) patients underwent emergency tracheostomy while 61 (88.4%) underwent elective tracheostomy. Ten (14.5%) had undergone percutaneous procedure while 59 (85.5%) had undergone open surgical procedure. Hemorrhage was the commonest complication reported followed by dislodgement. With Pearson chi-square test, we found that increasing age (45 years) and emergency tracheostomy had strong association with the presence of complications among the patients undergoing tracheostomy. Conclusion: Tracheostomy emerged as a safe procedure with mostly minor self-limiting complications. Surgeon performing this procedure should be aware of these common complications and should give information care to the patients prior to the procedure. Patients who are elderly or undergoing emergency tracheostomy should be dealt with special care while doing this life saving procedure.

Assessment of complications of the open treatment of mandibular condylar fractures

The objective of our study was to analyze the complications of open treatment of mandibular condylar fractures operated via various surgical approaches. Thirtyeight patients with 42 fracture sides having moderate to severely displaced condylar fractures were studied. Open treatment was performed, and patients were assessed for complications of open treatment in terms of facial nerve paresis, unaesthetic scar, salivary fistula/sialocele. Facial nerve paresis was noted in 13 (31%) cases, mostly transient in nature (n=9, 69.2%), that recovered within 8 weeks. Furthermore, 5 (11.9%) patients had unaesthetic scar formation, while just 1 (2.4%) case of salivary fistula was observed. Facial nerve paresis was the most common complication of open treatment of mandibular condylar fractures and most of them were observed in cases operated by preauricular approach.

DOP76 No durable impact of COVID-19 on disease activity and microbiome composition in patients with IBD

Background

Although patients with inflammatory bowel disease (IBD) reported an increased frequency of gastrointestinal (GI) symptoms following infection, the durable impact of COVID-19 on underlying IBD is not well defined.

Methods

In 118 IBD patients with COVID-19, clinical and endoscopic IBD activity, laboratory markers (ESR, CRP, hemoglobin (Hb), fecal calprotectin(FCP)), and medication utilization was assessed up to 6 months post-infection and compared to during infection or up to 6 months prior to infection. Active disease was defined by a Harvey Bradshaw Index > 4, Mayo Score ≥2, SES-CD ≥2, Mayo endoscopic score ≥1. 16S rRNA analysis was used to evaluate microbiome composition in a subset of 12 patients before and after COVID-19.

Results

Although upper respiratory (86.6%) and new GI symptoms (39.1%) were common in patients with IBD, there was no significant change in IBD clinical disease activity (Pre vs. Post-COVID-19 HBI: 4.7 vs. 4.9; partial Mayo: 3.0 vs. 2.1), endoscopic evaluation (Pre vs. Post-COVID-19 SES-CD: 7.2 vs. 8.9, Mayo endoscopic score: 1.5 vs. 1.7), or laboratory markers (Pre vs. Post-COVID-19 CRP: 1.2 vs. 1.3; ESR: 25 vs. 26; Hb 12.8 vs. 13.2; FCP: 388 vs. 250) up to 7 months post-COVID-19 compared to the 6 months prior to infection (Table 1). Overall active disease was present in 60% of the cohort prior to COVID-19 and 55% and 59% during and post-COVID-19, respectively. More subjects (8.5%) reported a delay in medical therapy during COVID-19, but there were no differences in the need for corticosteroids, a change in medical therapy, or IBD-related surgery or hospitalization during or post-COVID-19 compared to the prior 6 months. Microbiome composition stratified by underlying IBD disease activity, but did not show significant change post-COVID-19 (Figure 1).

Conclusion

COVID-19 showed no durable impact on clinical IBD disease activity or microbiome composition supporting guidelines for continued maintenance care.

A review of the impact of hearing interventions on social isolation and loneliness in older people with hearing loss

PURPOSE

Hearing loss affects many older people and is associated with social isolation and loneliness. The impact of hearing interventions however has not been established. The objective of this review is to determine the impact of hearing interventions in older people with hearing loss on social isolation and loneliness.

METHODS

A literature review using PubMed, EMBASE and CINAHL databases was performed. Search terms included older people, elderly, aging, ageing, hearing aid, hearing rehabilitation, social isolation, loneliness and social interaction. English-language studies with participants aged over 60 years diagnosed with hearing loss comparing outcomes pre- and post-hearing interventions were included.

RESULTS

A total of 176 articles were identified of which seven met the inclusion criteria. Five studies examined the impact of traditional hearing aids whilst two articles examined outcomes after cochlear implantation. Several outcome measures were used. Loneliness outcomes were reported in three studies and social isolation outcomes in four. All studies reported improved social isolation and loneliness scores following hearing intervention.

CONCLUSIONS

Small sample sizes, a lack of high-quality evidence, heterogenicity between studies and the presence of confounding factors limits interpretation of the literature. At present, there is inadequate evidence to support the use of hearing interventions in the treatment of social isolation and loneliness in older people. Given the ageing population, the significance of this health burden cannot be underestimated, emphasising the need for further research.

Rise in temperature causes decreased fitness and higher extinction risks in endemic frogs at high altitude forested wetlands in northern Pakistan

The larvae of some amphibian species grow and develop more slowly at lower temperature and attain larger body size at the end of metamorphosis, but this is not true for all amphibians. We have for the first time provided empirical data by using a combination of field and lab-based studies with a robust sample size (360 adults, 1000 tadpoles) for Hazara Torrent Frog (Allopaa hazarensis) and Murree Hills Frog (Nanorana vicina). In this study, we examined how tadpoles responded to different temperatures through metamorphosis, body size, developmental complications or deformities, fitness and survival. We found that the tadpoles of A. hazarensis and N. vicina showed the same response to elevated temperatures under laboratory conditions including faster metamorphosis, reduction in the body size, more frequent developmental complications or deformities such as edema and tail kinks, lower fitness and higher mortality at elevated temperatures (>26 °C). The comparison of thermal sensitivity between the two species showed that N. vicina was more sensitive to higher temperatures. Pakistan has been experiencing changes in climatic patterns, and the ecosystems in northern Pakistan are losing biodiversity due to increasing temperature, frequency of drought and intensity of floods. It is feared that these frogs may experience local extinction in future. Our findings contribute to filling the information gap regarding impacts of temperature increase on biodiversity of high altitude forested montane ecosystems and is an important contribution to future studies associating biodiversity and climate change.

The tadpoles of Murree Hills Frog Nanorana vicina (Anura: Dicroglossidae)

The genus Nanorana, also called Yunnan Slow Frogs (Frank Ramus 1995), belongs to the family Dicroglossidae. Murree Hills Frog N. vicina, is an endemic species of Southeast Asian uplands in Pakistan and India and was first reported by Stoliczka (1872) from Murree, Punjab Province, Pakistan. Later Rais et al. (2014) recaptured it from its type locality and described morphology of one juvenile female and one adult male. The species is listed as Least Concern in IUCN Red List of Threatened Species while the EDGE (Evolutionarily Distinct and Globally Endangered) score is 2.64. In Pakistan, it is reported from brook water springs and streams of Murree, Galiat (North Punjab), Ayubia (Khyber Pakhtunkhwa), and parts of Azad Jammu and Kashmir (Rais et al. 2014). Although the adult form has been characterized (Khan 2006; Rais et al. 2014), the morphology of the tadpoles have not yet been described. The current study aimed to describe external morphology and morphometry of tadpoles of N. vicina.

Systematic Review of Round Window Operations for the Treatment of Superior Semicircular Canal Dehiscence

A review of the literature is presented to consider the role of round window (RW) operations in superior semicircular canal dehiscence (SSCD). Primary (PubMed) and secondary sources (TRIP, Cochrane database, Best Practice, and PubMed Clinical Queries) were used to identify relevant studies. Four original studies (three case series and one case report) were identified. All were retrospective reviews and used a number of subjective and objective outcome measures to assess the efficacy of a minimally invasive, transmeatal approach to perform RW surgery for SSCD. The current evidence suggesting that RW operations for SSCD are unlikely to replace more established surgical procedures as first-line treatment may be appropriate in a select group of patients. Further multicenter, randomized controlled trials are required to establish their efficacy in patients with SSCD.