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

Aim

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

Method

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

Results

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

Conclusions

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

414 Informed Consent for Neck of Femur Fracture Surgery During the Covid-19 Pandemic: An Evidence-Based Approach

Background

Surgical intervention for neck of femur fractures continues to be prioritised during the Covid-19 pandemic. However, there remains a lack of clarity for clinicians during the consent process. This study quantifies additional perioperative risks for Covid-19 positive patients undergoing neck of femur fracture surgery and establishes an evidence-based framework for facilitating informed consent during the Covid-19 pandemic.

Method

259 patients undergoing neck of femur fracture surgery in four hospitals at the epicentre of the United Kingdom’s first wave of Covid-19 were recruited. 51 patients were positive for Covid-19. Predefined outcomes were recorded in a 30-day postoperative period.

Results

Odds of intensive care admission were 4.64 times higher (95% CI 1.59-13.50, p = 0.005) and odds of 30-day mortality were 3 times higher (95% CI 1.22-7.40, p = 0.02) in Covid-19 positive patients. 74.5% of Covid-19 positive patients suffered post-operative complications. 35.3% of Covid-19 positive patients developed lower respiratory tract infection with 13.7% progressing to acute respiratory distress syndrome. 9.8% of Covid-19 positive patients experienced symptomatic thromboembolic events with a 3.9% incidence of pulmonary emboli.

Conclusions

The implications of Covid-19 on the informed consent process for neck of femur fracture surgery are profound. Covid-19 positive patients should be consented for increased risk of postoperative complications (including lower respiratory tract infection, acute respiratory distress syndrome and thromboembolic events), longer inpatient stay, increased frequency of intensive care admission and higher risk of mortality.

1268 Pathology Pick up Rate in Routine Preoperative Endoscopy and its Impact on Patients Undergoing Gastric Bypass Surgery

Aim

Preoperative OGD in patients undergoing bariatric surgery, has been a subject for debate for decades. The aim of this study is to evaluate the pathology pick up rate in routine preoperative endoscopy in patients undergoing Gastric Bypass surgery (LRYGB) in our unit.

Method

Retrospective review of patients’ records who underwent LRYBG in our unit from February 2009 to March 2020. Patients were divided into two groups according to the presence or absence of symptoms prior to bariatric surgery: Group A (Asymptomatic) and Group B (Symptomatic). Data from prospectively kept electronic OGD reports, CLO test results, histology reports and the changes in management plan were collected and analysed.

Results

114 patients were included in the analysis, 85 (74.56%) were in group A and 29 in group B. OGD detected pathology in 34 patients in group A and 21 in group B (p = 0.004). Those included hiatus hernia (HH) (17.65% group A, 44.83% group B, p = 0.006); stomach ulcer (7.06% group A, 3.45% group B, p = 0.676), H.pylori infection (12.86% group A, 29.41% group B). This led to change of management in 22 patients in group A and 12 of group B (p = 0.157) excluding PPI prescription. Those changes included H.pylori eradication (10.59% group A, 17.24% group B, p = 0.153), HH repair (3.53% group A, 24.14% group B, p = 0.002). There was no cancellation or change in bariatric surgery offered in both groups.

Conclusions

Preoperative OGD has only significantly impacted the bariatric patient’s pathway in symptomatic patients. However, in Asymptomatic patients, OGD could be replaced by cheaper and non-invasive alternatives.

74 Does the SPIKES Protocol and Formal Teaching Increase Clinician Confidence When Breaking Bad News During the COVID Pandemic?

Background

Breaking bad news is often a daunting and complex task that we must all perform as part of our clinical duties. Given the current climate with the coronavirus, this task has unfortunately become an even bigger part of the day-to-day practice of many of us.

Aim

To establish how confident clinicians felt they were at breaking bad news, their familiarity with the SPIKES protocol and if they had a consistent approach they employed. Additionally, to ascertain if formal training in this, at any stage, corresponded to increased confidence with this task.

Method

A questionnaire was distributed to doctors and surgeons of all grades, primarily within the hospital. The questionnaire asked the responders how confident they felt at breaking bad news, how frequently they had to break bad news in an average month, if they had had any formal training in breaking bad news, and their familiarity with the SPIKES protocol.

Results

There were 58 responses. 60.4% had to break bad news 2 or more times in an average month. 86.2% had received formal training in breaking bad news. 60.3% felt confident or very confident. 53.4% had a consistent strategy and 58.6% were aware of the SPIKES protocol. 69% expressed they would like additional teaching with the SPIKES protocol.

Conclusions

Formal training does not guarantee knowledge of the SPIKES protocol or a consistent approach but has some impact on perceived confidence with the task. This task is, however, one most feel requires continued training to perform well.

Morphology and molecular phylogeny of Heterobothrium lamothei (Monogenea: Diclidophoridae), a gill parasite infecting the tiger puffer fish Lagocephalus sceleratus (Tetraodontidae)

ABSTRACT Members of the family Diclidophoridae are potentially dangerous species for the puffer fish aquaculture worldwide. They are parasitic polyopisthocotyleans, with a posterior haptor equipped with clamps for attachment to the host's surface, allowing the worm to resist the flow of water to maintain its position on gills. The anterior body of the worm is deformable, allows the worm to feed on blood sucked from fish gills. The present study is the first description of a Heterobothrium species from the gills of the tiger puffer Lagocephalus sceleratus (Tetraodontidae) from the coasts of the Arabian Gulf at Jubail, Saudi Arabia morphologically by light microscopy as well as by molecular analysis of the parasite partial 28S rRNA through multiple sequence alignments and phylogeny by maximum likelihood analysis which is provided for the first time for the described species. Seventeen tiger puffer fish were captured alive from marine water off Saudi Arabia; gills were separated and further examined for parasitic infection. Nine fish were found infected with a monogenean parasite which was robust, equipped by two buccal organs at the tapered anterior end; the posterior haptor was rectangular with four symmetrically arranged clamps, with no isthmus. Marginal hooks absent. Ovary elongated, U-shaped, testes numerous, irregularly shaped and extended from the posterior part of the ovary to the anterior margin of the haptor. Copulatory organ muscular, as a spherical cup armed with 12 to 15 genital hooks. The molecular analysis of the parasite 28s rRNA and phylogeny revealed a percentage of identities between 87.47-89.09%, with Diclidophoridae species within the monophyletic clade of Mazocraeidea where a maximum percentage of 89.09% were obtained for the morphologically different sister taxon H. okamotoi. The results obtained from molecular analysis are consistent with the conclusions drawn from morphological classification where that the parasite recorded was morphologically similar to H. lamothei which was not characterized by molecular analysis before. The recovered sequences were deposited into the GeneBank under accession number MT322610.

The impact of cow dung augmentation on soil restoration and bio-accumulation of metals (Lead and Cadmium) in Pheretima posthuma (Annelida: Clitellata)

To investigate the role of cow dung in soil reclamation and bio assimilation along with bio accumulation of heavy metals in earthworm (P. posthuma) (N=900) earthworms were used and treatment groups of CD-soil mixture of different proportion of cow dung were designed. Nonlethal doses of lead acetate and cadmium chloride were added in treatment groups. Mature P. posthuma were released in each experimental pot maintaining the favorable conditions. The pH, carbon, nitrogen, phosphorus, exchangeable cations, and heavy metal level of each mixture was evaluated. The results indicated that bio-assimilation of Pb and Cd by P. posthuma were significantly (P ˂ 0.01) higher in different soil-CD treatments compared to control. Highest bio-assimilation of both metals was observed in T1 of both groups (Pb = 563.8 mg/kg and Cd = 42.95 mg/kg). The contents of both metals were significantly (P ˂ 0.05) lowered in casting. The nutrient concentration in the final castings of all soil-CD treatments were also equally transformed from less or insoluble to more soluble and available for plants, except for carbon level which increased with CD proportion. It is concluded that cow dung as organic matter has a positive effect on soil reclamation and bio-assimilation of metals by P. posthuma.

Identification of terrestrial gastropods families found in district Swat, Pakistan

Very little is known about the malacofauna in district Swat of Khyber Pakhtunkhwa province, situated in the Northern part of Pakistan. The Swat valley possesses a variety of suitable environmental conditions, providing different types of habitats for both flora and fauna. Taken into consideration these points, the present study was conducted to explore the terrestrial snails diversity in agricultural and non-agricultural fields in the lower Swat valley. A total of 417 shells were collected from three sites: Kokarai, Kanju Township, and Deolai. Based on conchological features, three families: Bradybaenidae, Hygromiidae, and Zonitidae were identified using different terrestrial snail keys. In Kokarai and Deolai, shells of members of all the above-mentioned families were found from agricultural fields. In Kanju Township, shells of members of the family Bradybaenidae and Zonitidae were found. From these findings, it was concluded that district Swat possesses a significant malacofauna which was unexplored before and aided more to the existing literature on malacofauna. It also supports the idea that the agroecosystem is rich in species diversity. Further in-depth and extensive study is recommended to be carried out for a detailed taxonomy of the described terrestrial gastropod families.

Design and Fabrication of a Fast Response Resistive-Type Humidity Sensor Using Polypyrrole (Ppy) Polymer Thin Film Structures

In this research article, an organic polymer based polypyrrole (Ppy) composite material has been synthesized and analyzed for the design and fabrication purposes of a fast-responsive, highly sensitive, and an economical resistive-type novel humidity detection sensor. This humidity sensor most suitably serves the purpose for industrial humidity (i.e., values ranging from low to high) detection applications. First, a polypyrrole composite material (a mixture of polypyrrole, polypyrrole-NiO, polypyrrole-CeO₂, and polypyrrole-Nb₂O₅) has been synthesized by chemical oxidative polymerization method, and then is treated at various temperatures, i.e., 100, 150 and 200 °C, respectively. After this treatment, the synthesized samples were then characterized by using FTIR, SEM, and DTA/TGA techniques for analyzing humidity sensing properties. The polypyrrole samples with the best morphological structure and properties were then incorporated on interdigitated electrodes. For the fabrication purposes of this thin film structure, at first a few drops of polyvinyl alcohol (PVA) were placed over interdigitated electrodes (IDE) and then the synthesized polypyrrole composite was uniformly deposited in the form of a thin film over it. The plots show that this is a good resistive-type humidity detection device for the relative humidity range of 30% to 90%. The response and recovery times of this newly fabricated humidity sensor were reported to be the same as 128 s at room temperature. Additionally, the stability and the repeatability response behavior of this Ppy sensor were verified up to five cycles of multiple repetitions. This presents an excellent stability and repeatability performance of the sensor. Furthermore, the capacitances versus humidity response and recovery properties of the designed sensor were studied too. This illustrates an excellent capacitive verses humidity response and shows a linear and an active behavior. Lastly, the experimental result proves that polypyrrole composite thin film shows a reasonable best performance up to a temperature of 100 °C.

Phylogeography of cliff racer (Platyceps rhodorachis Jan, 1865) from Punjab, Pakistan

The present study reports the existence of cliff racer, Platyceps rhodorachis from the plains of Punjab, Pakistan. A total of 10 specimens were captured during the field surveys from June to September, 2018 from different sites of Punjab. Platyceps rhodorachis was identify on the basis of morphology and confirmed through COI gene sequences. The obtained DNA sequences have shown reliable and exact species identification. Newly produced DNA sequences of Platyceps rhodorachis were submitted to GenBank and accession numbers were obtained (MK936174.1, MK941839.1 and MT790210.1). N-J tree based on COI sequences of Platyceps rhodorachis clearly separated as out-group with other members of family Colubridae based on p-distance. The intra-specific genetic variation ranges from 12% to 18%. The DNA sequences of Platyceps rhodorachis kashmirensis, Platyceps rhodorachis ladacensis, Platyceps ventromaculatus, Platyceps ventromaculatus bengalensis and Platyceps ventromaculatus indusai are not available at NCBI to validate their taxonomic positions. In our recommendations, a large scale molecular based identification of Pakistan's herpetofauna is required to report more new or subspecies from country.

Variations in nutritional profile of honey produced by various species of genus Apis

The medicinal attributes of honey appears to overshadow its importance as a functional food. Consequently, several literatures are rife with ancient uses of honey as complementary and alternative medicine, with relevance to modern day health care, supported by evidence-based clinical data, with little attention given to honey's nutritional functions. The moisture contents of honey extracted from University of Veterinary and Animal Sciences, Lahore honey bee farm was 12.19% while that of natural source was 9.03 ± 1.63%. Similarly, ash and protein contents of farmed honey recorded were 0.37% and 5.22%, respectively. Whereas ash and protein contents of natural honey were 1.70 ± 1.98% and 6.10 ± 0.79%. Likewise fat, dietary fiber and carbohydrates contents of farmed source documented were 0.14%, 1.99% and 62.26% respectively. Although fat, dietary fiber and carbohydrates contents of honey taken from natural resource were 0.54 ± 0.28%, 2.76 ± 1.07% and 55.32 ± 2.91% respectively. Glucose and fructose contents of honey taken out from honeybee farm were 27% and 34% but natural source were 22.50 ± 2.12% and 28.50 ± 3.54%. Glucose and fructose contents of honey taken out from honeybee farm were 27% and 34% but natural source were 22.50 ± 2.12% and 28.50 ± 3.54%. Similarly, sucrose and maltose contents of farmed honey were 2.5% and 12% while in natural honey were 1.35 ± 0.49% and 8.00 ± 1.41% respectively. The present study indicates that such as moisture, carbohydrates, sucrose and maltose contents were higher farmed honey as compared to the natural honey. In our recommendation natural honey is better than farmed honey.

Occurrence of Hymenolepis diminuta: a potential helminth of zoonotic importance in murid rodents

The study reveals the prevalence of a potential rodent-borne zoonotic helminth species, Hymenolepis diminuta in commensal rodents caught from irrigated and rain-fed areas of Swat, Pakistan. Three hundred and fifty rodents (269 rats and 81 mice) trapped during vegetative, flowering/fruiting and mature/harvesting stages of crops were studied from 2011-2013. Hymenolepisdiminuta eggs were identified on the basis of their shape, size, colour and markings on the surface of the egg shell and three pairs of embryonic hook-lets. Overall prevalence of H. diminuta was 3.14% (n=11/350). The highest prevalence 3.49% (n=5/143) of H. diminuta was noted at harvesting stages of the crops whereas the lowest 2.59% (n=2/77) during vegetative stage. Infection was higher in males 3.25% (n=7/215) than females 2.96% (n=4/135). Adult rodents were highly infected while no sub-adult was found infected. Infection was higher in mice 3.70% (3/81) than rats 2.69% (8/269) while no significance (p=1.0000:0.1250 to 32.00 CI). Rats and mice appears to show the most suitable reservoirs by hosting H. diminuta a zoonotic helminth. The presence of these rodents in all possible habitats can act as a main channel of transferring parasites through various habitats and can pose a hazard to humans in the area.

Distribution and abundance of dinoflagellates from the coastal waters of Karachi, Pakistan, northern part of the Arabian Sea

The present study reports on seasonal and spatial variations in diversity, distribution and abundance of dinoflegellates and indicates the presence of HAB species in Pakistan waters. A total of 179 taxa, recorded in this study from offshore and near-shore waters, belong to 41 genera in 26 families and 10 orders. The high species count (149 species) was recorded from Manora Island offshore station (MI-1) and 105 spp, 109 spp and 115 spp were encountered from the Mubarak village offshore station (MV-1), Manora near shore station (MI-2) and Mubarak Village near-shore station (MV-2) respectively. Tripos furca was the dominant and frequently occurring species (> 1 x103 to > 25 x103 cells L-1 from coastal and >1x 105 cells L-l from near-shore stations) in addition to less abundant Alexandrium catenella, Alexandrium sp., Alexandrium minutum, and Prorocentrum micans (>103 to 25x 103cells/L). Another 44 species occurred in relatively low numbers (<103 cell L-l). Seventy species were found throughout the study period at all four stations. High number of species in three genera (Tripos (38), Protoperidinium (34) and Prorocentrum (20) was recorded. Potently toxic (16 genera 43 species) and HAB related (19 genera and 30 species) dinoflagellate taxa were also recorded. The percent contribution of dinoflagellates in total phytoplankton population generally remained below 20% except for a few instances. Manora Island stations had comparatively higher Shannon index and equitability and slightly lower dominance index. The PCA plot showed strong positive correlation among chlorophyll-a concentration, dissolved oxygen, total number of phytoplankton and dinoflagellates.

PERCEPTRON: an open-source GPU-accelerated proteoform identification pipeline for top-down proteomics

PERCEPTRON is a next-generation freely available web-based proteoform identification and characterization platform for top-down proteomics (TDP). PERCEPTRON search pipeline brings together algorithms for (i) intact protein mass tuning, (ii) de novo sequence tags-based filtering, (iii) characterization of terminal as well as post-translational modifications, (iv) identification of truncated proteoforms, (v) in silico spectral comparison, and (vi) weight-based candidate protein scoring. High-throughput performance is achieved through the execution of optimized code via multiple threads in parallel, on graphics processing units (GPUs) using NVidia Compute Unified Device Architecture (CUDA) framework. An intuitive graphical web interface allows for setting up of search parameters as well as for visualization of results. The accuracy and performance of the tool have been validated on several TDP datasets and against available TDP software. Specifically, results obtained from searching two published TDP datasets demonstrate that PERCEPTRON outperforms all other tools by up to 135% in terms of reported proteins and 10-fold in terms of runtime. In conclusion, the proposed tool significantly enhances the state-of-the-art in TDP search software and is publicly available at https://perceptron.lums.edu.pk. Users can also create in-house deployments of the tool by building code available on the GitHub repository (http://github.com/BIRL/Perceptron).

Comparison of Nutritional Status of Children with Congenital Heart Diseases with Minor Illness of Other Children in a Tertiary Level Hospital

This cross sectional comparative analytical study was undertaken with the objectives to find out the nutritional status of children with congenital heart disease by anthropometric measurement and was compared it with those of children having minor illness and without any congenital heart disease in indoor and outdoor Department of Paediatrics of Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from December 2015 to November 2016. Purposive sampling was done. One hundred children aged 6 to 60 months with congenital heart disease confirmed by echocardiogram were taken as Group A and one hundred children of same age and sex matched having minor illness and without any congenital heart disease were taken as Group B. Age of the patients ranged from 6 to 60 months. There was no obvious difference of socio-demographic status between two groups. Most of the patient (64.0%) had acyanotic congenital heart disease among them VSD was commonest (68.8%). Thirty-six percent (36.0%) patient had cyanotic congenital heart disease and among them Tetralogy of Fallots (83.3%) was commonest. There were significant differences regarding weight, height and MUAC values in between two Groups. Underweight (51%), Stunting (50%) and Wasting (29%) all were higher in congenital heart disease than that of Group B where they were 28%, 31% and 13% respectively and the differences were statistically significant (p<0.05). The findings of this study imply that malnutrition is very common among children with congenital heart disease. So, anthropometric measurement should be done in each and every child with congenital heart disease.

Treatment of Keloid by Implantation of Tissue Expander beneath the Keloid Tissue

Keloids always remain a great challenge due to limited surgical treatment options. Most treatments e.g. surgery, drug therapy, radiotherapy, laser therapy, and cryotherapy for managing keloids have very limited effectiveness, for keloids grow slowly but progressively and the recurrence rate is inappreciably high. Skin expansion constitutes a potential treatment option in the treatment of large keloid. This study was intended to determine the clinical outcome of 'Tissue Expander beneath the Keloid Surgery' for repair of wound formed as a result of excision of relatively large keloids. This retrospective study was done in the Department of Dermatology and Venereology of Nantong University-affiliated Hospital, China. Using a quasi-experimental design, from August 2006 to August 2017, 75 keloids in 70 patients were implanted with tissue expanders, the capacity of which was 70-600ml. After 50-126 days of implantation, the intralesional excision with flap advancement surgery was carried out. During intraoperative period, keloid lesions were treated with beta methasone injection as 0.2ml per sq. cm of lesion and the total dose should not normally over 1-2ml per dose and postoperative superficial electron beam irradiation. Post-operative follow-up ranged from 12 to 50 months. All patients underwent keloid resection followed by radiation at postoperative day 1 and 8 with a total dose 16-18 Gy. The patient and observer scar assessment scales (POSAS) were used to evaluate changes in keloids pre- and post-operatively. Among 75 keloids, 71(94.7%) (Including 11 keloids combined with the infected site) demonstrated successful outcome, 4(5.3%) expanders in the chest failed. Infection occurred in 4(5.3%) keloids during expansion process which led to early removal of expander resulting in failure of the operation, while in the remaining 71 sites, the entire treatment process was successfully completed. Follow-up was done for more than 12 months, when 14 sites (all anterior chest) exhibited local recurrence. There was no recurrence in the 14 sites of pubic region. The total POSAS scores before surgery were 59.3±13.6 which significantly reduced to 17.7±9.1 after 12 months of surgery (p<0.001). Soft tissue expanders implantation beneath the keloid is one of the ideal methods to treat relatively large keloids, formed as a result of excision of relatively large keloids, provided the patients are carefully selected based on knowledge about possible complications.

Shoulder Function Assessment After Head And Neck Reconstruction With Pedicled Supraclavicular Flap

The supraclavicular artery flap is used for reconstruction of defects of the head and neck. One of the major implications of this procedure is injury to the nerve roots of C3 and C4 of the superficial cervical plexus, which provides sensation over the clavicle, shoulder and proximal chest, thereby causing problems in overall shoulder function. The objective of this study was to assess shoulder function, range of motion, pain, daily activities and overall satisfaction of the patient after using this flap. This study was conducted at the Department of Plastic & Reconstructive Surgery, Dow University of Health Sciences & Dr. Ruth KM Pfau Civil Hospital Karachi, Pakistan, from May 2015 to November 2018. Supraclavicular flap was used in 35 patients who underwent soft tissue reconstruction of defect of the neck after release of post burn contracture. Penn Shoulder Score and Constant Murley Score were used as assessment tools. Assessment by Penn Shoulder Score resulted in 25 (71.4%) patients within the upper quartile and 10 (18.6%) patients within the lower quartile. Constant Murley Score showed 19 (54.2%) of patients had 161°-180° shoulder abduction and lateral elevation. Forward flexion of 161°-180° was seen in 17 (48.5%) patients, 17 (48.5%) had internal rotation till the inter scapular region, 15 (42.8%) had no impairment of external rotation, 19 (54.2%) patients had no impairment of work/recreation, 25 (71.4%) had felt no change in their sleep and 22 (62.8%) were able to position their arm above their head. Overall parameters indicate better function, good range of motion, less pain, resumption of daily activities, and overall satisfaction.

Statistical modeling for analyzing grain yield of durum wheat under rainfed conditions in Azad Jammu Kashmir, Pakistan

One of the most important traits that plant breeders aim to improve is grain yield which is a highly quantitative trait controlled by various agro-morphological traits. Twelve morphological traits such as Germination Percentage, Days to Spike Emergence, Plant Height, Spike Length, Awn Length, Tillers/Plant, Leaf Angle, Seeds/Spike, Plant Thickness, 1000-Grain Weight, Harvest Index and Days to Maturity have been considered as independent factors. Correlation, regression, and principal component analysis (PCA) are used to identify the different durum wheat traits, which significantly contribute to the yield. The necessary assumptions required for applying regression modeling have been tested and all the assumptions are satisfied by the observed data. The outliers are detected in the observations of fixed traits and Grain Yield. Some observations are detected as outliers but the outlying observations did not show any influence on the regression fit. For selecting a parsimonious regression model for durum wheat, best subset regression, and stepwise regression techniques have been applied. The best subset regression analysis revealed that Germination Percentage, Tillers/Plant, and Seeds/Spike have a marked increasing effect whereas Plant thickness has a negative effect on durum wheat yield. While stepwise regression analysis identified that the traits, Germination Percentage, Tillers/Plant, and Seeds/Spike significantly contribute to increasing the durum wheat yield. The simple correlation coefficient specified the significant positive correlation of Grain Yield with Germination Percentage, Number of Tillers/Plant, Seeds/Spike, and Harvest Index. These results of correlation analysis directed the importance of morphological characters and their significant positive impact on Grain Yield. The results of PCA showed that most variation (70%) among data set can be explained by the first five components. It also identified that Seeds/Spike; 1000-Grain Weight and Harvest Index have a higher influence in contributing to the durum wheat yield. Based on the results it is recommended that these important parameters might be considered and focused in future durum wheat breeding programs to develop high yield varieties.

Recent advances in the use of phytochemicals to manage gastrointestinal oxidative stress in poultry and pigs

Plants are integral components of pig and poultry feed, and aside from their raw nutritive value, some phytochemicals contain bioactive compounds. The aim of the present paper is to review recent advances in the use of some phytochemicals in pig and poultry feed, focusing on the examples of isoquinoline alkaloids, polyphenol rich sugarcane extracts and superoxide dismutase-rich melon pulp extracts. As gut health is critical for efficient production, the review will focus on recent results modulating oxidative stress within the gastrointestinal tract and the potential mechanisms of action.

Episode of Hepatitis C viral infection in the people of Swat, Pakistan

Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.

PCR-RFLP Based genetic diversity of Plasmodium vivax genotypes in district Mardan, Pakistan

Plasmodium vivax is the most common human malaria parasite in Asian countries including Pakistan. Present study was designed to explore the genetic diversity of plasmodium vivax genotypes based on Pvmsp-3α and Pvmsp-3βgenes using allelic specific nested PCR and RFLP assays markers from field isolates in district Mardan, Pakistan. Blood samples of 200 P. vivax malarial patients were collected after taking their written informed consent. Genetic diversity in nested PCR products was determined by Restriction Fragment Length Polymorphism (RFLP) utilizing Alu1 and PstI restriction enzymes for alpha and beta gene products digestion, respectively. For analysis the genetic diversity of the sub allelic variants of Pvmsp3α and Pvmsp3β genes, Chi-Square test was performed by utilizing Minitab programming software 18. The P value 0.05 was considered as statistically significant. For Pvmsp-3α genes after gel electrophoresis of digested products, four distinct genotypes were obtained from total of 50 samples; type A: 35 (70%) (1.5-2.0 kb), 12 of type B (24%) (1.5-1.7 kb), 2 of type C (4%) (0.5-1.5) and one for type D (2%) (0.5-0.65 kb) which could be characterized into 9 allelic pattern (A1-A4, B1-B3, C1, D), in which A3 remained the most predominant. For Pvmsp-3βgenes, three distinct genotypes were obtained from 50 samples; 40(80%) of type A (1.5-2.5 kb), 9 (18%) of type B (1.0-1.5kb) and 1(2%) of type C (0.65 kb) which could be characterized into 6 allelic patterns (A1-A3, B1-B2, and C1). Most dominant one in Type A was A1 alleles which were noted (46%), while in Type B, the most dominant were B1 (10%).This study is the first ever report of molecular epidemiology and genetic variation in Pvmsp-3α and Pvmsp-3β genes of P. vivax isolates by using PCR/RFLP from District Mardan and showed a remarkable level of genetic diversity in the studied genes of circulating parasites in the study area. The results of this study will contribute in future studies about the genetic structure of parasite and vaccine development against the malaria.

AB0039 AGRIN REPAIRS BONE AND CARTILAGE IN VIVO

Background:

Cartilage defects in the joints are reported in 61% of all arthroscopies1&2. The size of the cartilage repair market is estimated to be $2.195 million by 20253. Cartilage defects can evolve into osteoarthritis, in which abnormal load results in cartilage breakdown, joint pain and reduced mobility. Osteoarthritis is the leading cause of permanent disability and absenteeism and affects up to 1/3 of the people over 60yrs. In western countries osteoarthritis costs 1.5-2% of the GDP4. Joint replacement with a prosthesis restores some degree of independence but in up to 20% of patients it does not meet expectations 5 and has a limited life span. There is no pharmacological intervention that arrests or reverts the course of osteoarthritis, despite the desperate need.

We previously published that agrin plays an important role in cartilage homeostasis6. The addition of agrin to chondrocytes in vivo resulted in enhanced cartilage formation, suggesting a potential role for agrin in cartilage repair.

Objectives:

Investigate the potential of agrin for use in cartilage repair.

Methods:

Critical size osteochondral defects were generated in mice and sheep and injected intraarticularly with type I collagen gel containing agrin or vehicle. Animals were monitored for 8 weeks or 6 months respectively. MicroCT, histological analysis, qPCR, linage tracking, reporter assays, chondrogenesis assay, immunohistochemistry were performed.

Results:

A single intraarticular administration of agrin induced regeneration of critical-size osteochondral defects in mice, restoring the tissue architecture and bone-cartilage interface. Agrin stem cells to the site of injury and, through simultaneous activation of CREB and suppression of canonical WNT signalling, induced GDF5 expression and differentiation into stable articular chondrocytes, forming stable articular cartilage. In sheep, agrin treatment resulted in regeneration of bone and cartilage, which promoted increased ambulatory activity.

Conclusion:

Agrin orchestrates repair morphogenesis at the joint surface by modulating multiple signalling pathways, supporting the therapeutic use of agrin for joint surface regeneration.

References:

[1]Curl, W. W. et al. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 13, 456–460 (1997).

[2]Hjelle, K., Solheim, E., Strand, T., Muri, R. & Brittberg, M. Articular cartilage defects in 1,000 knee arthroscopies. Arthrosc. J. Arthrosc. Relat. Surg. Off. Publ. Arthrosc. Assoc. N. Am. Int. Arthrosc. Assoc. 18, 730–734 (2002).

[3]Cartilage Repair Market Size, Share, Industry Analysis 2018-2025 | AMR. Allied Market Research https://www.alliedmarketresearch.com/cartilage-repair-market.

[4]Hiligsmann, M. et al. Health economics in the field of osteoarthritis: an expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin. Arthritis Rheum. 43, 303–313 (2013).

[5]Dieppe, P., Lim, K. & Lohmander, S. Who should have knee joint replacement surgery for osteoarthritis? Int. J. Rheum. Dis. 14, 175–180 (2011).

[6]Eldridge, S., et al. Agrin mediates chondrocyte homeostasis and requires both LRP4 and α-dystroglycan to enhance cartilage formation in vitro and in vivo. Annals of the rheumatic diseases 75 (6), 1228-1235 (2016).

Acknowledgements:

We thank the technical staff in the ARM Lab and Staff at the University of Aberdeen’s Animal Facility and Microscopy and Histology Facility for support. Funding: We gratefully acknowledge funding support of this work by the MRC (MR/L022893/1, MR/N010973/1,and MR/P026362/1), Versus Arthritis (19667, 21515, 20886, and 21621), Rosetrees Trust (A1205), the Medical College of St Bartholomew’s Hospital Trust, and the William Harvey Research Foundation.

Disclosure of Interests:

Suzanne Eldridge: None declared, Aida Barawi: None declared, Hui Wang: None declared, Anke Roelofs: None declared, Magdalena Kaneva: None declared, Zeyu Guan: None declared, Helen Lydon: None declared, Bethan Thomas: None declared, Anne-Sophie Thorup: None declared, Beatriz F Fernandez: None declared, Sara Caxaria: None declared, Danielle Strachan: None declared, Ahmed Ali: None declared, Kanatheepan Shanmuganathan: None declared, Costantino Pitzalis: None declared, James Whiteford: None declared, Fran Henson: None declared, Andrew McCaskie: None declared, Cosimo De Bari: None declared, Francesco Dell’Accio Consultant of: F.D. has received consultancy fees from Samumed and UCB.

Interspecific variations in external and internal egg quality among various captive avian species from Punjab, Pakistan

Present study was planned to determine variations in external and internal quality egg parameters of different avian species including ostrich Struthio camelus, ducks Anas platyrhynchos, chicken Gallus gallus, turkeys Meleagris gallopavo and grey francolin Francolinus pondicerinus. All the birds were kept under similar rearing conditions. A total of 150 eggs were collected for each species to record external features of these eggs. Statistically significant (p<0.05) variations were recorded in egg weight, egg length and egg width between ostrich, ducks, chicken, turkey and quail eggs. Significantly (p<0.05) higher egg weight, egg length and egg width was observed for ostrich eggs while the same was lowest for grey francolin eggs. Similarly, significantly (p<0.05) greater shape index and egg volume values were observed for ostrich eggs while lowest shape index values were recorded for turkey eggs and egg volume was lowest for grey francolin. Significantly, higher (p<0.05) values of egg density were noted for eggs of the quail and the same were lowest for ostrich eggs. Non-significant variations in egg density values were observed between eggs of the ducks, chicken, turkey and grey francolin. It has been concluded that the positive correlations between the internal and external egg quality traits indicated that the traits can be improved through selection.

Probiotic Escherichia coli Nissle inhibits IL-6 and MAPK-mediated cardiac hypertrophy during STZ-induced diabetes in rats

Escherichia coli Nissle (EcN), a probiotic bacterium protects against several disorders. Multiple reports have studied the pathways involved in cardiac hypertrophy. However, the effects of probiotic EcN against diabetes-induced cardiac hypertrophy remain to be understood. We administered five weeks old Wistar male (271±19.4 g body weight) streptozotocin-induced diabetic rats with 10⁹ cfu of EcN via oral gavage every day for 24 days followed by subjecting the rats to echocardiography to analyse the cardiac parameters. Overexpressed interleukin (IL)-6 induced the MEK5/ERK5, JAK2/STAT3, and MAPK signalling cascades in streptozotocin-induced diabetic rats. Further, the upregulation of calcineurin, NFATc3, and p-GATA4 led to the elevation of hypertrophy markers, such as atrial and B-type natriuretic peptides. In contrast, diabetic rats supplemented with probiotic EcN exhibited significant downregulated IL-6. Moreover, the MEK5/ERK5 and JAK2/STAT3 cascades involved during eccentric hypertrophy and MAPK signalling, including phosphorylated MEK, ERK, JNK, and p-38, were significantly attenuated in diabetic rats after supplementation of EcN. Western blotting and immunofluorescence revealed the significant downregulation of NFATc3 and downstream mediators, thereby resulting in the impairment of cardiac hypertrophy. Taken together, the findings demonstrate that supplementing probiotic EcN has the potential to show cardioprotective effects by inhibiting diabetes-induced cardiomyopathies.

Tissue-Nonspecific Alkaline Phosphatase in Central Nervous System Health and Disease: A Focus on Brain Microvascular Endothelial Cells

Tissue-nonspecific alkaline phosphatase (TNAP) is an ectoenzyme bound to the plasma membranes of numerous cells via a glycosylphosphatidylinositol (GPI) moiety. TNAP's function is well-recognized from earlier studies establishing its important role in bone mineralization. TNAP is also highly expressed in cerebral microvessels; however, its function in brain cerebral microvessels is poorly understood. In recent years, few studies have begun to delineate a role for TNAP in brain microvascular endothelial cells (BMECs)-a key component of cerebral microvessels. This review summarizes important information on the role of BMEC TNAP, and its implication in health and disease. Furthermore, we discuss current models and tools that may assist researchers in elucidating the function of TNAP in BMECs.

A moderated mediation model linking transactive memory system and social media with shared leadership and team innovation

This study examines how and to what extent social and technological factors promote shared leadership that leads to team innovation in knowledge work teams. It hypothesizes that a transactive memory system influence team innovation and shared leadership conduits the relationship between them. Additionally, the relationship effectiveness between the transactive memory system and shared leadership increases with the use of social media by team members. Time-lagged, multi-sourced data are collected from the information technology industry in China. In addition, we used a network-based measure to assess the level of shared leadership in teams. Empirical analysis found support for the hypotheses of this study. The results reveal that transactive memory system is a significant predictor of team innovation and the shared leadership channels the relationship between transactive memory system and team innovation. Furthermore, use of social media by team members amplifies the relationship between transactive memory system and shared leadership. The implications of the study are discussed in the later sections.

Abusive supervision and job outcomes: a moderated mediation model

Purpose

This study examined the link between abusive supervision and subordinates’ turnover intentions via job dissatisfaction. In addition, this study examined the moderating effect of continuance commitment in this process.

Design/methodology/approach

The authors collected three-wave time lagged data (N = 190) from the hospitality industry in China.

Findings

The analysis showed that abusive supervision predicts subordinates’ turnover intentions both directly and indirectly via job dissatisfaction. Moreover, continuance commitment was considered to be a boundary condition such that the mediated link was weaker when higher levels of continuance commitment were present.

Practical implications

This study explains how and when abusive supervision leads to turnover intentions in the hospitality industry. This study also helps hospitality managers to understand the abusive supervision prevalence and provide interventions that can reduce detrimental effects of abusive supervision in hospitality organizations.

Originality/value

Prior research examining the influence of supervisor abuse in hospitality organizations was scant. To bridge this noteworthy gap, this study examined the influence of abusive supervision in Chinese hospitality organizations. This study also discussed the theoretical and practical implications for the hospitality industry.

988 The Prevalence and Incidence of Gender Bias and Sexual Discrimination in Orthopaedics, and Mitigating Strategies: A Systematic Review

Background

The aim of this systematic review was to outline the prevalence and impact of Gender bias and sexual discrimination (GBSD) in orthopaedics, and to investigate interventions countering such behaviours.

Method

Original research papers pertaining to the prevalence and impact of gender bias or sexual discrimination, or mitigating strategies in orthopaedics, were suitable for inclusion. PRISMA guidelines were adhered to in this review.

Results

Of 570 papers, 27 were eligible for inclusion. A total of 13 papers discussed the prevalence of GBSD, whilst 13 related to the impact of these behaviours, and 6 discussed mitigating strategies. GBSD were found to be prevalent in the orthopaedic workplace, with all sources showing females to be the victims. The impact of GBSD includes poor workforce representation, lower salaries, barriers to career progression, and reduced academic output for females in orthopaedics. Mitigating strategies in the literature are focussed on encouraging females to apply for orthopaedic training programmes, by providing female role models, mentors, and educational interventions.

Conclusions

GBSD are highly prevalent in orthopaedic surgery, impacting females at all stages of their careers. Mitigating strategies have been tested but are limited in their scope. As such, the orthopaedic community as a whole is obliged to do more to tackle GBSD.

36 A Randomised Trial to Compare How Undergraduates Diagnose Common Ear Pathology Using A Smartphone Otoscope and Standard Otoscope in A Simulated Setting

Introduction

Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate’s confidence to perform otoscopy is reported as low. This study aimed to evaluate whether a smartphone-otoscope could enhance medical undergraduates recognition of common ear pathology.

Method

52 medical students were randomised into a standard group (traditional otoscope) and an intervention group (smartphone-otoscope). Following a short didactic presentation, participants were asked to diagnose four simulated pathologies. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope.

Results

The smartphone-group (n = 20) had higher overall rates of correct diagnosis compared to control (n = 22) (84% vs 39%, p = &lt;0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs 91%, p = 0.49). 90% (n = 20) of participants felt the smartphone-otoscope was preferential for their learning. The same number expressed they want to use it in future learning. The remainder were indifferent.

Conclusions

The smart-phone otoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.

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

Introduction

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

Method

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

Results

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

Conclusions

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

73 Using the Gold Standards Framework to Identify Opportunities for Advance Care Planning

Introduction

Departmental discharge data (January 2017–January 2018) suggested a high number of “Day 1 Deaths” i.e. an individual who was readmitted 24 hours after discharge, and subsequently died during their readmission. We wondered if this was due to a lack of Advance Care Planning (ACP).

Methods

We undertook a retrospective case note audit of 50 cases from the “readmissions who died” (total 176/7421) subgroup, to understand whether or not they were predictably within the last days, weeks or months of life and whether there was ACP in place. We reviewed all Day 1 Deaths (16/50), and a random selection of cases across the Day 2–30 (34/50) data set.

We used the Gold Standards Framework (GSF) as a prognostic tool, by use of the intuitive “surprise question” (“would you be surprised if this person died within the next days, weeks, months?”) and the disease-specific Prognostic Indictors (PI).

Results

Using the GSF we (retrospectively) predicted death in 94% of the Day 1 deaths and 63% of the Day 2–30 deaths.

There was evidence of ACP in 32/50 patients (64%), predominantly in the form of a DNAR CPR (61%). There was very little evidence of other forms of ACP.

Readmissions were justified on the basis of a medical condition in 100% of cases; this was infective in 60% (30/50).

There were few interactions with secondary care in the 12 months prior to death (mode was 2 admissions in the month prior to death, 4 in the 12 months prior to death).

Conclusions

We must consider our discharge processes and medical decision making at the front door.

A Prognostic indicator Tool would be useful to focus medical decision making.

We must recognise infections as end stage disease in advanced ill health, including advanced frailty.

We need to consider how we facilitate meaningful involvement of older people in their medical care towards the end of life.

Cost of Serving Others: A Moderated Mediation Model of OCB, Ego Depletion, and Service Sabotage

Taking support from ego-depletion theory, this study examines ego depletion as a mechanism that explains how employees' organizational citizenship behavior (OCB) leads to antagonistic consequences, i.e., service sabotage. Employees' positive psychological capital (PsyCap) is considered a moderator. PROCESS macro was used to test all the hypotheses using time-lagged, dyadic data collected from 420 employees and their 112 their supervisors associated with the service industry in China. This study finds that employees' exhibition of OCB is positively linked to ego depletion, which in turn drives service sabotage behavior. Furthermore, employees' PsyCap weakens the effect of OCB on employees' ego depletion. This study highlights the dark side of OCB, the mechanism through which it causes adverse effects, and the moderating effect of PsyCap. It also provides insights to the organizations for managing service sector employees to effectively interact with customers.

Seroprevalence and risk factors of Toxoplasma gondii infection in women with recurrent fetal loss from the province of Khyber Pakhtunkhwa, Pakistan

BACKGROUND

In women with a bad obstetric history (BOH), infection is an established cause of recurrent fetal loss. A common infecting agent is the protozoan parasite Toxoplasma gondii (T. gondii). The aim of this study was to measure the prevalence of toxoplasmosis in women with recurrent fetal loss from the Khyber Pakhtunkhwa province of Pakistan.

METHODS

The study included 360 females aged 16-40 years, of which 180 had a bad obstetric history (study group) and the other 180 had no such history (control group). Blood serum samples were tested for toxoplasma IgM antibodies by Enzyme Linked Immunosorbent Assay and for toxoplasma IgG antibodies using an Immunochromatographic technique.

RESULTS

The overall seroprevalence of toxoplasma infection in study group females was 40.6% and in control group females it was 7.2%. Specifically, IgM prevalence was 12.8% in the study group and 1.1% in the control group. IgG prevalence was 23.9% in the study group and 6.1% in the control group. IgM and IgG combined prevalence was 3.9% in the study group cases. There is a statistically significant association between BOH and seropositivity for T. gondii (p < 0.0001, Chi square test). Various risk factors associated with T. gondii seroprevalence in study and control groups were analyzed.

CONCLUSION

The seroprevalence of toxoplasmosis was significantly higher in women with a bad obstetric history compared to those with no such history. Associated risk factors had no significant effects on the results.

The effectiveness of Sufi music for mental health outcomes. A systematic review and meta-analysis of 21 randomised trials

BACKGROUND

There is some evidence that Sufi music therapy might improve physical and mental well-being; however, no systematic review or meta-analysis has pooled and critiqued the evidence. The aim of this systematic review was to evaluate the effects of Sufi music therapy on mental health outcomes.

METHODS

We searched Medline, PsycINFO, the Web of Science, Science Direct, PsycARTICLES, Cochrane Library, SCOPUS, CINAHL Plus, AMED, and ULAKBIM databases, and the reference lists of the studies found. Papers published in academic peer-reviewed journals were included, as well as from other sources such as chapters in edited books, the grey literature, or conference presentations. Articles published up to March 2020 in Turkish and English were included. Our primary outcome of interest was anxiety and secondary outcomes of interest were other mental health outcomes such as depression. To assess the methodological quality of the articles, the Cochrane Risk of Bias Tool was used. The quality of evidence was assessed using the GRADEpro GDT system.

RESULTS

This search yielded 21 clinical trials that were eligible for inclusion. A meta-analysis, using a random effects model, of 18 randomised controlled trials involving 1454 participants showed that Sufi music therapy with makams, compared with treatment as usual (TAU) or a no-music control group, reduced symptoms of anxiety in the short term in patients undergoing an operation or treatments such as chemotherapy or haemodialysis (standardised mean difference SMD= -1.15, 95 % CI, -1.64 to -0.65; very low-quality evidence). The evidence of Sufi music with makam's effect on anxiety is rated as very low. Qualitative synthesis of secondary outcomes revealed significant effects for depression, positive symptoms in schizophrenia, stress, which however were based on fewer studies. Trials were of moderate methodological quality, and there was significant heterogeneity across the studies.

CONCLUSION

Sufi music may reduce anxiety of patients undergoing medical procedures like haemodialysis, coronary artery surgery, angiography, colonoscopy, bone marrow aspiration and biopsy procedures. Evidence from single studies suggests effects on depression and stress as well. However, due to methodological limitations of the studies, further, higher quality studies are required in other cultures.