Design and performance of a double-solenoid magnetic bottle photoelectron spectrometer for attosecond metrology

The design and performance of an in-house developed double-solenoid magnetic bottle (MB) time-of-flight photoelectron spectrograph are presented. A combination of a strong permanent magnet (Sm₂Co₁₇) with a soft iron cone and a double-solenoid geometry is used to generate MB configuration. The first solenoid (length ∼150 mm) is placed inside the vacuum, and the second solenoid (length ∼1 m) is placed outside the vacuum. The double-solenoid geometry improves the effective conductance and reduces overall material outgassing. Due to this, an ultra-high vacuum (∼5 × 10^-8 mbar) desirable for the working of the spectrograph was achieved using a small capacity (300 lps) turbo-molecular pump. An optimization of solenoid current generates a smooth magnetic field variation in MB, which keeps the adiabaticity parameter ∼0.6 at ∼25 eV photoelectron energy. The double-solenoid geometry also provides high collection efficiency as well as high energy resolution of the spectrograph. The experimentally measured energy resolution (ΔE) of the spectrograph is better than ∼60 meV at ∼15 eV photoelectron energy. The collection efficiency is estimated to be ∼25% under optimum conditions as compared with ∼10^-4 in field-free configuration. The calibrated MB spectrograph is used for the characterization of the attosecond pulse train using a cross-correlation "RABBITT" technique. The attosecond pulse train is generated from 15th to 25th odd high-harmonic orders, in argon filled cell. Attosecond pulses of average duration ∼260 as (FWHM) have been measured. The proposed MB electron spectrograph design provides a compact experimental setup for attosecond metrology and pump-probe studies with a relaxed requirement on vacuum pump capacity.

Frequency of Low Cardiac Output Syndrome Following on Pump Coronary Artery Bypass Grafting Surgery and it's Association with Degree of Pre-operative Left Ventricular Dysfunction

Background Low cardiac output syndrome (LCOS) is a serious complication after coronary artery bypass grafting (CABG) surgery. It is associated with 10 times to 17 times increase in mortality and markedly increase morbidity. Objective To find out the frequency of Low cardiac output syndrome following on pump coronary artery bypass grafting surgery, to determine the association of Low cardiac output syndrome with degree of pre-operative left ventricular dysfunction and to compare in hospital outcomes of coronary bypass surgery with and without low cardiac output syndrome. Method This prospective, descriptive study enrolled 200 patients who underwent on pump coronary artery bypass grafting surgery using antegrade St Thomas blood cardioplegia. Pre-operatively grouped into two groups consisting Group A of 100 patients with pre-operative left ventricular ejection fraction (LVEF) ≥ 40% and group B of 100 patients with pre-operative left ventricular ejection fraction (LVEF) < 40%. Post-operatively frequency of low cardiac output syndrome was compared between the groups and in-hospital outcomes were studied. Result The mean age of the patients in the study was 53.50±7.57 years. Male to female ratio was 1.8:1. Results showed overall frequency of low cardiac output syndrome was 21.5%. The frequency of LCOS was 15 vs 28% (p - 0.038) in patients with preoperative LV EF ≥ 40% and < 40% respectively. The outcomes of coronary artery bypass grafting surgery were stroke (3.82 vs. 30.23%, p - 0.001), acute kidney injury (5.09 vs. 23.25%, p - 0.001), respiratory failure (6.36 vs. 34.88%, p - 0.001), ICU stay days (4.75 ± 1.28 vs. 7.44 ± 4.66, p - 0.018), hospital stay days (9.56 ± 2.40 vs. 15.22 ± 3.89, p - 0.001) and mortality (4.45 vs. 32.55%, p - 0.001) in patients without and with low cardiac output syndrome respectively. Conclusion The frequency of low cardiac output syndrome following coronary artery bypass surgery is 21.5%. Left ventricular dysfunction pre-operatively is associated with high frequency of low cardiac output syndrome following surgery. There is significantly poor outcome of coronary artery bypass surgery with low cardiac output syndrome in terms of stroke, respiratory failure, acute kidney injury, mortality and significant ICU stay, hospital stay in compare to patients without low cardiac output syndrome.

Clinical Course of SARS CoV-2 Infection in Hospitalized Pregnant Patients

Objective: To determine the clinical course and outcome of hospitalized pregnant patients with laboratory confirmed SARS CoV-2 (COVID-19) infection Study Design: Prospective longitudinal study Place and Duration of Study: Obstetrics Units of Pak Emirates Military Hospital and Combined Military Hospital, Rawalpindi Pakistan, from May to Jun 2020. Methodology: All patients reporting for childbirth were tested for SARS-CoV-2, and those testing positive were included. The primary outcome was virus clearance time and categorization according to the severity of the disease into asymptomatic,mild, moderate, severe and critical. Furthermore, a comparison was made between the presence of comorbid conditions and symptoms in the category of COVID-19. In addition, neonatal sample evaluation for SARS-CoV-2 was done. Results: Out of the 881 women giving birth, 41(4.6%) tested positive for SARS Cov-2. Majority were asymptomatic 28(68.3%)followed by mild 8(19.5%), moderate 4(9.8%) and severe 1(2.4%) category. There was a significant association of the COVID categories with symptoms (p-value<0.005) and comorbid condition (p-value<0.001). The mean virus clearance time was 8.20±1.66 days. During hospital stay 34(82.9%) delivered. All 34(100%) delivered babies had no evidence of vertical transmission. Conclusion: Pregnant women with COVID-19 infection have a nearly similar clinical course to non-COVID women in this study. There is also no evidence of vertical transmission to the neonate.

Spectrum of Grown up Congenital Heart (GUCH) at Armed Forces Institute of Cardiology/ National Institute of Heart Diease: 10 years Experience

Objective: To determine the spectrum of Grown up Congenital Heart (GUCH) at Armed Forces Institute of Cardiology/National Institute of Heart Dieases. Study Design: Descriptive cross sectional study. Place and Duration of Study: Paediatric Cardiac Surgery and Obstetric department of Armed Force Institute of Cardiology/National Institute of Heart Diease, Rawalpindi Pakistan, from 2011 to 2021. Methodology: It was a descriptive cross sectional study conducted at Paediatric Cardiology, Paediatric Cardiac Surgery and Obstetric department of AFIC/NIHD. After taking informed consent, a total of 1344 patients fulfilling inclusion and exclusion criteria with non probability consecutive sampling were enrolled in study from 2011 to 2021. Diagnosis, transthoracic echocardiography findings, procedural details (cardiac catheterization/cardiac surgery/obstetrical intervention) and outcome of all patients were noted. Results: Out of 1344 patients, 700 patients had cardiac catheterization. Among patients who underwent cardiac cath, 304(43%)were males and 396(56.6%) were females. 279(39%) diagnostic and 421(61%) cardiac interventional procedures were done.Most common procedure done was ASD device closure in 227(32%) patients. Complications were seen in 29(4%) patients and mortality in 3(0.4%) patients. There were a total of 188 patients who underwent congenital cardiac surgery. Out of patients who underwent congenital cardiac surgery procedures, 96(51%) were male and 92(49%) were female patients. Major complications were observed in 51(25%) patients and the mortality was 11(5%).There were total of 456 patients in obstetrics department. Out of 456 patients, 54(11%) were with congenital cardiac lesions .The most common defect was VSD 27(6%)patients and dilated cardiomyopathy (DCM) 27(6%) patients followed by ASD and TOF. The maternal and fetal mortality was12(2.7%) and 22(5.5%) respectively. Conclusion:With immense advancement in diagnosis and management of congenital cardiac diseases, a significant number of patients remain undiagnosed and untreated till the time they present as GUCH. Most common presentation is ASD which is mostly manageable by transcatheter intervention, however late presentation carries a risk of complications like pulmonary hypertension.

843 Improving Antibiotic Prophylaxis Prescribing in Arthroplasty Surgery Following Neck of Femur Fracture (NOF#): A Clinical Audit Revealing Multi-Factorial Influences on Prescribing Accuracy

Introduction

Post-op infection is a serious complication in surgery, particularly in arthroplasty. NICE guidelines advise antibiotic prophylaxis for all arthroplasty procedures to avoid this. This audit aimed to assess our concordance with our local guidelines and achieve improvements where we were deficient.

Method

Electronic prescribing records were analysed for 60 patients who underwent arthroplasty following NOF# across St. Richard's and Worthing Hospitals between 4/3/19 – 17/6/19. We presented these initial findings at our local orthopaedic clinical governance meeting to educate team members. We then collected a second cycle of data between 1/11/20 – 16/12/20.

Results

Patients receiving some form of antibiotic prophylaxis improved from 90% to 100%. Patients receiving the appropriate prophylaxis as per local guidelines increased from 78% to 83%. However, more patients were given incomplete prophylaxis in the second cycle: 5% of patients were on concurrent antibiotics for chest infection and were not given full prophylaxis, 5% of patients were under-dosed on gentamicin and 3% of patients were not given the full 24 hours’ worth of flucloxacillin. No patients developed joint infections post-op after following up for 6 months.

Conclusions

Although all patients were given prophylaxis in the second cycle, patients not receiving the full recommended course of antibiotics represents an avoidable risk in developing post-op infection. We identified that communication between orthopaedic surgeons, anaesthetists and orthogeriatric ward team members and awareness of prescribing responsibility were implicated in accurate prescribing of prophylactic antibiotics. We aim to address these with further education and amendments to performas and then re-audit to look for further improvements.

Insights of OPs and PYR cytotoxic potential Invitro and genotoxic impact on PON1 genetic variant among exposed workers in Pakistan

Different pesticide chemicals are used to enhance crop yield by protecting from pests. Organophosphate (OPs) and Pyrethroid (PYR) are used in fields of Sanghar, Sindh Pakistan. PON1 an antioxidant enzyme implicated in OPs detoxification may predispose by OPs chronic exposure. This study was conducted to evaluate the toxic potential of active pesticide chemicals at cellular and genetic levels. To examine toxic potential, locally consumed pesticide n = 2 and reference pesticide compounds organophosphate (OPs): Chloropyrifos, Malathion and Pyrethroid (PYR): Cyprmethrin, Cyhalothrin n = 4 were tested against NIH 3T3 cells using MTS assay. Local consumer pesticides demonstrated relevance for half-maximum inhibitory concentration (IC50) 0.00035 mg/mL with selected compound. Malathion IC50 exhibited the highest cytotoxicity among four compounds at 0.0005 mg/mL. On genotoxicity analysis in exposed subjects n = 100 genotypes and alleles n = 200 exhibited significant differences in genotypic and allelic frequencies of pesticide exposed subjects and controls n = 150 (X² = 22.9, p = 0.001). Screening of genotypes were performed by PCR- RFLP. Statistical assessment carried out using online software and tools. Results suggested that higher heterozygous genotype A/G (74%) may confer low PON1 metabolic activity towards pesticides in exposed subjects. Findings could be helpful to establish health plans by avoiding toxic chemicals that harming exposed population.

Impact of Obstetric Cholestasis on Fetomaternal Outcome

Objective: To evaluate the impact of obstetric cholestasis on maternal and fetal outcomes. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital Karachi Pakistan, from Jan to Dec 2019. Methodology: All pregnant women with no comorbid and ladies with symptoms and signs of obstetric cholestasis were included during the study period. Antenatal complications and perinatal outcomes of women having obstetric cholestasis were compared with those of pregnant ladies having no comorbid. Results: Out of 6932 obstetric patients, 90 (1.29%) had obstetric cholestasis. The cholestatic group had significantly high levels of aminotransferases and alkaline phosphatase. There was higher occurrence of preterm prelabour rupture of membrane (11.11% vs 3.33%, p=0.044), preterm delivery (26.66% vs 4.44%, p<0.001), prelabor rupture of membrane (31.11% vs 13.33%, p=0.004) and emergency cesarean section (16.66% vs 4.44%, p=0.008) in obstetric cholestatic group as compared to control. No difference in the occurrence of postpartum haemorrhage was observed in both groups. Meconium stained amniotic fluid (42.22% vs 8.88%, p<0.001) and neonatal intensive care unit admission (23.33% vs 7.77%, p=0.004) were significantly high in the study group as compared to the control. Whereas occurrences of abnormal cardiotocography, APGAR score at 5 minutes, and intrauterine growth restriction in both groups had no significant difference. Conclusion: Women with obstetric cholestasis are at increased risk of preterm labour, PPROM, emergency LSCS, and poor neonatal outcome (low APGAR, macrosomia, NICU admission), burdening the health care system; hence early diagnosis with careful clinical examination...

An Association of Fear of Childbirth with the Preference for Cesarean Section; A Cross Sectional Study

Objective: To determine the fear of childbirth (FOC) amongst pregnant women and its association with preference for cesarean section. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynecology Pak Emirates Military Hospital, Rawalpindi from Jan 2018 to Jun 2018. Methodology: Demographic and reproductive data of the patients including mode of delivery, was noted. The intensity of fear of childbirth was measured by Wijma delivery expectancy/experience questionnaire (W-DEQ), and a score was allotted. The total sum of scoring ranged from 0 to 165. A score of >85-99 indicated an intense fear of childbirth, and ≥100 indicated very intense fear. The frequency of requests for cesarean section in women suffering from fear of childbirth was calculated. Results: A total of 335 patients were included. The mean age was 28.74 ± 3.58 years, and the mean gestational age was 39.50 ± 1.43 weeks. The mean W-DEQ score was 94.59 ± 9.86. The fear of childbirth calculated by W-DEQ in the third trimester of pregnancy showed no fear in 233 (69.55%) participants, intense fear in 42 (12.54%) and very intense fear in 60 (17.91%) women. The requests for cesarean section in women suffering from intense fear were made by 5 (11.90%) women and in women suffering from very intense fear of childbirth was 19 (31.67%) (p-value <0.001). Conclusion: This study concluded that the intensity of fear of childbirth calculated by W-DEQ amongst pregnant women in the third trimester of pregnancy was relatively high, with a much higher rate ...

Video based learning vs instructor led training for optimizing personal protective equipment use to prevent Covid-19 infection - a comparative study

Objectives

To evaluate two different types of education and training aids to improve compliance with guidelines related to personal protective equipment in healthcare workers.

METHODS

The quasi-experimental study was conducted at the Department of Gynaecology and Obstetrics, Combined Military Hospital, Rawalpindi, from July 1 to December 31, 2020, and comprised healthcare personnel who were divided into two equal groups. Group A received weekly instructor-led training session of donning and doffing for two hours. Group B was assigned to watch 30-min training videos weekly. After one month, an independent instructor evaluated both the groups using validated checklists, with maximum score 8 for donning and 14 for doffing. Data was analysed using SPSS 22.

RESULTS

Of the 60 subjects, 34(56.6%) were females and 26(43.3%) were males. There were 30(50%) subjects in group A with a mean age of 35.35±5.67years, and the remaining 30(50%) were n group B with a mean age of 33.12±4.13 years. There was no significant difference in donning and doffing scores between the groups (p>0.05).

CONCLUSIONS

Both types of education and training aids could be used to improve compliance with guidelines related to personal protective equipment in healthcare workers.

Using World Health Organisation near miss approach to assess preventable maternal morbidity and mortality at a tertiary care hospital

OBJECTIVE

To determine frequency of severe maternal complications, maternal near-miss cases and maternal deaths in obstetric patients in a tertiary care setting.

METHODS

The prospective cross-sectional analytical study was conducted at the Obstetrics Unit of Combined Military Hospital, Kharian, Pakistan, from January to June 2019, and comprised cases of severe maternal complications, critical interventions and life-threatening situations. A conditions as defined by the World Health Organisation guidelines. Severe maternal outcome ratio, maternal near-miss, maternal mortality ratio, near-miss-to-mortality ratio and the mortality index were calculated. Data was analysed using SPSS 20.

RESULTS

Of the 1054 live births during the study period, there were 42(3.9%) near-miss cases and 4(0.3%) maternal deaths. Management-based criteria identified 34(80%) cases, followed by clinical 14(33%) and laboratory criteria 2(4.7%). Maternal mortality ratio was 379/100,000 and near-miss-to-mortality ratio was 39/1000 live births. Severe maternal outcome ratio was 4.36 (42+4/1054). For near-miss cases, the mortality index was 8.6, and the maternal near-miss-to-maternal death ratio was 10.5:1.

CONCLUSION

The use of a standardised near-miss criterion makes audit and comparison of results between hospitals and even countries having the same resources possible and reproducible.

Production of multienzyme by Bacillus aestuarii UE25 using ionic liquid pretreated sugarcane bagasse

The utilization of sugarcane bagasse (SB) in fermentation requires pretreatment processes to render fermentable components available to microorganisms. Pretreatment by using ionic liquids (ILs) is considered promising but the high cost is an impediment in its adoption, therefore, a mixture of IL pretreated and untreated SB was utilized to obtain bacterial multienzyme under solid-state fermentation (SSF). Bacillus aestuarii UE25, a thermophilic strain was utilized for that purpose. Fermentation conditions were optimized by adopting a central composite design. The model showed a good correlation between the predicted and the experimental values for amylase, xylanase, endoglucanase, and β-glucosidase. Volumetric and specific productivity of xylanase (4580 IU ml^-1  h^-1 , 244.25 IU mg^-1 substrate, and 50 IU mg^-1 protein) were higher than the other enzymes. Changes in lignin content and reduced cellulose crystallinity due to IL pretreatment, followed by fermentation, were visualized by scanning electron microscopy, Fourier transform infrared spectroscopy, and Nuclear magnetic resonance. The strategy adopted by utilizing a mixture of IL pretreated and untreated SB under SSF proved promising to obtain high titers of different enzymes simultaneously. Since the bacterial strain used is thermophilic, therefore, the multienzyme can find its application in commercial processes which are carried out at high temperatures.

FETAL ECHOCARDIOGRAPHY: 12 YEARS EXPERIENCE AT AFIC /NIHD

Objective: To determine the frequency of congenital cardiac lesions in pregnant women reporting for fetal echocardiogram and correlate with obstetrical risk factors. Study Design: Descriptive cross-sectional study. Place and Duration of Study: To be conducted at pediatric cardiology and obstetrical unit of AFIC/NIHD and CMH Rawalpindi, from Jan 2009 to Jan 2020. Methodology: Pregnant women referred for fetal echocardiogram from 19-49 years of age were enrolled. Echo was done between 20 to 36 weeks gestation. Primary outcome was the nature of cardiac lesion and gestation at diagnosis. Neonatal scan was done at follow up to confirm cardiac diagnosis. Secondary outcome was obstetrical risk factors which were the reason for referral. This included age consanguinity, family history, previous history of intrauterine death or early neonatal death, maternal and paternal diseases. Data was collected and analyzed n frequencies and percentage. Chi-square was applied for association between variable and p-valve 0.05 was considered significant. Results: A total of n=967 pregnant women referred to outpatient department for fetal echocardiogram. Congenital cardiac lesion were detected in n=83 patients. Majority of patients had CAVSD (1.2%) CCAVB (1.2%) followed by ASD (1.1%) VSD (0.9%) Abnormal heart rate (0.8%) Single ventricle (0.3%). Most significant maternal age group was between 21 to 30 and 30-40 years (43.7 and 46.2%). Only 3% below 20 years and 6.7% above40 years of age. Most important maternal risk factor was previous off spring 0.5% past family history 0.3% and abnormal obstetrical ultrasound 0.3% Followed by maternal diabetes 0.1% and maternal hypertension 0.1%. The yield of detection of congenital cardiac lesions was 8.3%. Conclusions: Congenital cardiac diseases are the second most common congenital anomaly and huge burden n pediatric population. Timely diagnosis and referral can be lifesaving.

ROLE OF OBSTETRIC TRIAGE IN IMPROVING PATIENT HEALTH CARE AT CMH KHARIAN-A COMPARITIVE STUDY

Objective: To evaluate the up gradation of obstetric patient care by using obstetrics-specific triage acuity tool. Study design: Comparative prospective study Place and duration of study: This study was conducted at obstetrics unit of combined military hospital Kharian from June 2018 to Dec 2018. Methodology: Pregnant patients were triaged and prioritized according to Maternal fetal triage index (MFTI) into five levels. Primary outcome was time to triage and management plan documentation. Patient and health care provider satisfaction was evaluated using Likert’s scale before and after implementation of MFTI. Data was collected and expressed in frequencies and percentage. Chi square test was applied for association between before and after triage intervention variables, and a P value of 0.05 was considered significant. Results: A total of 1000 pregnant patients referred to OPD were enrolled, 500 patients before and 500 after implementation of MFTI. Patients were prioritized using MFTI system,10(2%) patients category 1 while category 2,3,4,and 5 were 28(5.6%),68(13.6%),150(30%) and 244(48.8%) respectively. There was significant reduction in waiting time from 35.4±8.2 minutes to18.2±6.5 p=<0.002. Hospital complaints reduced significantly from 25(5%) in before group to 4(0.8%) P=<0.001 after application of obstetric triage. Conclusion: Obstetric triage by MFTI focuses on the urgency and symptoms at presentation to decide further disposal. The usage of a systematic and properly developed triage system produces improvement in patient care. The results of study not only highlight the importance of usage of a triage system but also explore its usefulness and improvement in outcomes in a developing country like Pakistan.

Inhibitory mechanism of BAC-IB17 against β-lactamase mediated resistance in methicillin-resistant Staphylococcus aureus and application as an oncolytic agent

Cancer remains a foremost cause of deaths worldwide, despite several advances in the medical science. The conventional chemotherapeutic methods are not only harmful for normal body cells but also become inactive due to the development of resistance by cancer cells. Therefore, the demand of safe anticancer agents is increasing and enforced the bottomless research on the bacteriocins. Several studies have reported the selective anticancer property of bacteriocins. Current research is the contribution to explore the exact mechanism of action and in vitro application of bacteriocin (BAC-IB17) as an oncolytic agent. In this study, β-lactamase mediated resistance of methicillin resistant Staphylococcus aureus (MRSA) was studied and inhibitory mechanism of MRSA by BAC-IB17 was investigated. Cytotoxic studies were conducted to analyze the anticancerous potential of BAC-IB17. Results revealed that BAC-IB17 inhibited the β-lactamase and produced profound effect on the membrane integrity of MRSA confirmed by scanning electron microscope (SEM). FTIR spectroscopic analysis revealed the changes in the functional groups of bacterial cells before and after treatment with BAC-IB17. BAC-IB17 also found anticancer in nature as it kills HeLa cell lines with the IC₅₀ value of 12.5 μg mL^-1 with no cytotoxic effect on normal cells at this concentration. This specific anticancer property of BAC-IB17 will make it a promising candidate for the treatment of cancer after further clinical trials. Moreover, BAC-IB17 may control MDR bacteria responsible for the secondary complications in cancer patients.

Production of commercially important enzymes from Bacillus licheniformis KIBGE-IB3 using date fruit wastes as substrate

BACKGROUND

Pakistan is one of the top five date fruit-producing countries and produced more than 30% wastes in picking, packing, storage, and commercialization stages. The date fruit wastes are usually considered inedible for humans and only used for livestock feed. In current research, Bacillus licheniformis KIBGE-IB3 was screened for pectinase, xylanase, cellulase, and amylase production using date fruit wastes as substrate through solid state fermentation.

RESULTS

The B. licheniformis KIBGE-IB3 produced higher concentration of pectinase using date fruit wastes as substrate as compared to amylase, cellulase, and xylanase. B. licheniformis KIBGE-IB3 produced maximum pectinase using 5.0 g/dl date fruit wastes and 0.5 g/dl yeast extract. B. licheniformis KIBGE-IB3 required pH 7.0, 37 °C incubation temperature, and 72 h incubation period for maximum production of pectinase.

CONCLUSION

It has been concluded that date fruit waste is a good source of biomass and can be utilized for the commercial production of pectinase.

Estimation of External Contamination and Exposure Rates Due to Fission Product Release

In the event of a radiological incident, the release of fission products into the surrounding environment and the ensuing external contamination present a challenge for triage assessment by emergency response personnel. Reference exposure rate and skin dose rate calibration data for emergency response personnel are currently lacking for cases where receptors are externally contaminated with fission products. Simulations were conducted to compute reference exposure rate coefficients and skin dose rate coefficients from photon-emitting fission products of radiological concern. To accomplish this task, simplified mathematical skin phantoms were created using surface area and height specifications from International Commission on Radiological Protection Publication 89. Simulations were conducted using Monte Carlo radiation transport code using newborn, 1-y-old, 5-y-old, 10-y-old, 15-y-old, and adult phantoms for 22 photon-emitting radionuclides. Exposure rate coefficient data were employed in a case study simulating the radionuclide inventory for a 17 × 17 Westinghouse pressurized water reactor, following three burn-up cycles at 14,600 MWd per metric ton of uranium. The decay times following the final cycle represent the relative activity fractions over a period of 0.5-30 d. The resulting data can be used as calibration standards for triage efforts in emergency response protocols.

Expectations, Fears and Perceptions of doctors during Covid-19 Pandemic

OBJECTIVES

The aim of this study was to explore the expectations and fears faced by doctors during Covid-19 Pandemic.

METHODS

This is a mixed method exploratory survey. A questionnaire exploring expectations of doctors from administration and seniors as well as their fears while working during pandemic, was developed on Google survey Forms. It included eight closed ended questions and four open ended questions. Data was collected through online Google survey Forms during month of March and April 2020. Doctors were approached through email and WhatsApp group.

RESULTS

The mean age of participants was 33.58±4.21 years. Female 150(67.5%) and Male 72(32.4%) participated. 29(13.1%) Associate Professor, 34(15.3%) Assistant Professor, 56(25.2%) Senior Residents and 103(46.3%) residents, medical officers and house officers responded to the survey. 134(60.3%) doctors were working in hospitals which were not dealing with Covid-19. Fear included, infecting family members 177(79.7%), rapid spread of disease 140(63%), complications of disease 134(60.3%), becoming a carrier in 64(28.8%) and 62(27.9%) feared missing the diagnosis. More than 80% expected from seniors and administration, of providing PPE, facilitation, continue chain of supply of essential items, ensuring doctor safety, avoiding exposure of all doctors and keeping reserve workforce, limiting routine checkups, avoid panic and 20% had no expectations.

CONCLUSION

It was concluded that doctors had their fears and perceptions regarding pandemic which need to be addressed while policy making. They fear wellbeing of their families and contacting Covid-19, if not provided proper PPE. Our study provides insight of expectations, fears and perceptions of our frontline which invariably gives insight of the views of healthcare workers.

Study of causes behind abnormal uterine bleeding according to PALM- COEIN classification at a tertiary care hospital

This descriptive observational study was carried out to determine the frequency of causes behind Abnormal Uterine Bleeding (AUB) amongst patients of reproductive age presenting to gynaecology OPD from January to June 2018 at the Combined Military Hospital Kharian, a tertiary care hospital. All women presenting with complaints of AUB were enrolled for the study, except for those who were pregnant, adolescent and postmenopausal. Detailed history, physical examination and relevant investigations were done and patients were categorised according to FIGO PALM-COEIN classification system and placed in nine main categories. A total of 238 patients were enrolled and the incidence of AUB among them was found to be 11% according to PALM-COEIN classification system. The frequency and percentage of all etiologies was calculated. Frequency of structural causes was Polyp 10 (6.7%), Adenomyosis 35 (23.5%), Leiomyomata 80 (53.7) and Malignancy 24 (16.1%). Nonstructural causes were Coagulation Disorders 5 (5.6%), Ovulatory 56 (37.6%), Endometrial Dysfunction 3 (3.4%), Iatrogenic 14 (15.7%) and Not-yet-classified 11 (12.4%). Development of a universally accepted classification system is a step towards facilitating clinicians, patients and researchers to communicate with each other and make objective management plans.

A comparative study on degradation of complex malathion organophosphate using of Escherichia coli IES-02 and a novel carboxylesterase

Malathion organophosphates considered as the major constituent of herbicides, pesticides and insecticides. Extensively used in agricultural, horticultures and for numerous household applications contributes to precedence organic pollutants leading antagonistic effects on human health and environment. Therefore detoxification of malathion from contaminated site is of general interest. Simultaneously it is very emerging to isolated novel indigenous microbial strains from contaminated site with a record of pesticide application. In this study Escherichia coli IES-02 isolated from malathion contaminant effluent and the strain showed maximum efficiency in malathion degradation that utilized it as the sole source of carbon. Carboxylesterase (33.0, 30.0, 28.0 kDa) were purified (1685.71 U/mg) from Escherichia coli IES-02 showed significant results in malathion degradation approximately 81% within 20 min as compared with Escherichia coli IES-02 cells within 4 h (99.0 to 95.0%) into monocarboxylic acid and diacid derivatives. The generation time of Escherichia coli was also observed at 60 min with 0.1 ppm, 68 min with 0.5 ppm, 74.5 min with 2.0 ppm and 91.37 min with 50 ppm of malathion. The degradation rate and transformation metabolites were estimated by Gas Chromatography-Mass Spectrometry respectively. Malathion metabolites pathway proposed in this study which revealed the potential application against lethal environmental pollution.

An Audit of Caesarean Section Rate Using Modified Robson Criteria at a Tertiary Care Hospital

OBJECTIVE

To evaluate the rising rate of caesarean section (CS) and its contributing factors at a tertiary care hospital.

STUDY DESIGN

Clinical audit.

PLACE AND DURATION OF STUDY

Obstetrics and Gynecology Department, Pak Emirates Military Hospital (PEMH), Rawalpindi, from January to December 2017.

METHODOLOGY

All caesarean sections were classified according to modified Robson criteria into twelve groups, after modification. The size of each group, rate of caesarean section and contribution of each group was calculated. A re-audit was carried out after 6 months under the same protocol thus completing the audit cycle.

RESULTS

CS rate was 54% (n=3878). The maximum contribution 27.42% (n=1976) to total CS rate was made by Group 5, 12.07% (n=870) by group 12 and 7.34% (n=531) by group 2. Re-audit showed a reduced CS rate of 38.2% (n=1342) with contribution by Group 5 reduced to 16.05% (n=563), Group 12 to 7.47% (n=262) and Group 2 reduced to 5.7% (n=202), respectively.

CONCLUSION

Modified Robson Criteria is an effective auditing tool which identifies the exact areas where efforts and strategies are required to reduce the overall CS rate.

Extensive Spinal Epidural Abscess Associated with an Unremarkable Recovery

Spinal epidural abscess is a rare complication of epidural catheter insertion, with an incidence reported to be as low as 0.02%, but with a high morbidity and mortality. This reflects the difficulty in diagnosis of the condition, as early symptoms and signs are usually non-specific with late neurological manifestations. We report a case of spinal epidural abscess in a diabetic patient who underwent splenectomy and distal pancreatectomy. Early investigation with magnetic resonance imaging was effective in demonstrating an extensive epidural abscess involving the thoracic spine, with extension to the base of the skull and associated cord compression. Extensive multilevel laminectomies with thorough irrigation and washout of the epidural space were successful in treating this patient and preventing the development of permanent neurological sequelae.

Screening, purification and characterization of thermostable, protease resistant Bacteriocin active against methicillin resistant Staphylococcus aureus (MRSA)

BACKGROUND

The emergence of serious issues of multidrug resistance in the past few years have enforced the use of bacteriocins for combating infections. Threat posed to public health by various multidrug resistant (MDR) organisms can be resolved by discovering new antimicrobial proteins with broad spectrum of inhibition.

RESULTS

In the current study, Bacteriocin (BAC-IB17) produced by Bacillus subtilis KIBGE-IB17 is found to be effective against different strains of methicillin resistant Staphylococcus aureus (MRSA). The approximate molecular mass of BAC-IB17 is 10.7 kDa. This unique bacteriocin is found to be highly thermostable and pH stable in nature. It also showed its stability against various heavy metals, organic solvents, surfactants and proteolytic enzymes. Amino acid profile of BAC-IB17 clearly showed that this protein mainly consists of non-polar and basic amino acids whereas; some acidic amino acids were also detected. Sequence of first 15 amino acid residues obtained from N-terminal sequencing of BAC-IB17 were NKPEALVDYTGVXNS.

CONCLUSIONS

The anti-MRSA property of purified bacteriocin may be used to prevent the spread of MRSA infections. Remarkable features of BAC-IB17 suggests its applications in various pharmaceutical and food industries as it can function under a variety of harsh environmental conditions.

Characterization and interplay of bacteriocin and exopolysaccharide-mediated silver nanoparticles as an antibacterial agent

Metallic nanoparticles have a substantial scientific interest because of their distinctive physicochemical and antimicrobial properties and the emergence of multidrug resistant pathogens could unlock the potential of nanoparticles to combat infectious diseases. The aim of the current study is to enhance the antibacterial potential of purified bacteriocin by combining bacteriocin and antibacterial silver nanoparticles (AgNPs). Hence, the interaction of natural antimicrobial compounds and antibacterial nanoparticles can be used as a potential tool for combating infectious diseases. In this study, a green, simple and effective approach is used to synthesize antibacterial AgNPs using fungal exopolysaccharide as both a reducing and stabilizing agent. The AgNPs were characterized by spectroscopic analysis, Scanning Electron Microscopy (SEM), Energy Dispersive X-ray spectroscopy (EDX) and Dynamic Light Scattering (DLS). Furthermore, the synergistic effect of bacteriocin-AgNPs was determined against pathogenic strains. The histogram of AgNPs indicated well-dispersed, stabilized and negatively charged particles with variable size distribution. The combination of bacteriocin with nanoparticles found to be more effective due to broad antibacterial potential with possibly lower doses. The current study is imperative to provide an alternative for the chemical synthesis of silver nanoparticles. It showed environmental friendly and cost effective green synthesis of antibacterial nanoparticles.

Cardiac Pathology in Patients with End-Stage Renal Disease Maintained on Hemodialysis

We report the spectrum of cardiovascular pathology found on autopsy examination in 106 consecutive patients with end-stage renal disease. Cardiovascular pathology was present in nearly all patients, and was the most frequent cause of death (36%), with acute myocardial infarction accounting for 15%. Particularly frequent pathologic findings were left ventricular hypertrophy, coronary and aortic atherosclerosis, pericarditis with effusion, myocardial fibrosis, and valvular dilatation. Cardiovascular death rate was higher during the first year than after the fifth year of dialysis. Nearly all patients had a history of hypertension. The nature of the underlying cause of renal failure and pre-existing cardiovascular disease, specifically diabetes mellitus and hypertension, were the principal predictors of cardiovascular mortality rather than maintenance hemodialysis therapy per se.

Novel use of bioelectric impedence technique to detect alterations in body composition in advanced small cell lung cancer

BACKGROUND

Malnutrition is frequent in lung cancer and is measured using various tools, including the novel bioelectric impedance technique for measuring body composition. However, the validation of this technique for assessing body composition in advanced small cell lung cancer (SCLC) is untested.

METHODS

Forty-one treatment naïve patients (all males) and an equal number of age- and sex-matched controls were evaluated by anthropometric measurements of skinfold thicknesses and body composition parameters such as body fat%, fat mass, fat-free mass (FFM), and total body water (TBW).

RESULTS

The mean (SD) age of the patient group was 55.7 (7.5) years, median pack-years was 20 (range, 0-80), and mean (SD) duration of symptoms was 152.6 (153.7) days. Median Karnofsky Performance Scale was 70 (range, 50-90). Majority of our patients (68.3%) were Stage IV followed by Stage III (31.7%). The percentage of patients with low, normal, and high body mass index (BMI) was 31.7%, 61%, and 7.3%, respectively. All components of body composition, i.e., body fat%, FFM, and TBW were significantly lower in patients compared to controls. However, the body composition in patients and controls with normal BMI was similar. The phenomenon of sarcopenia as a cause of cancer cachexia may explain these findings, whereas the combination of loss of body fat and lean body mass may lead to weight loss and reduced BMI.

CONCLUSION

Our results indicate that body composition is markedly altered in Indian patients with advanced SCLC. The impact of these parameters on clinically relevant outcomes needs further evaluation.

Manual Vacuum Aspiration (MVA) - A safe option for evacuation of first trimester miscarriage in cardiac patients

This case series was done at Armed Forces Institute of Cardiology, National Institute of Heart Disease, Rawalpindi, to observe safety and efficacy of manual vacuum aspiration and frequency of complications in cardiac patients with missed abortion. All cardiac patients presenting in first trimester with diagnosed early foetal demise (missed miscarriage) or incomplete miscarriage were included. Manual vacuum aspiration was done as an outpatient procedure. Cardiac and procedure related complications including arrhythmias, thromboembolism, heart failure and ischaemia were noted. A total of 34 patients were enrolled. Mean age and parity was 25.9±2.25 years and 1.18±1.02. Mitral valve was the dominant valve involved in 20(58.8%) followed by double valve replacement in 5(14.7%), dilated cardiomyopathy 4(11.76%), aortic valve involvement in 3(8.8%) and supra ventricular tachycardia in 2(5.9%) patients. Complete evacuation was achieved in 100% patients and there were no major cardiac or gynaecological complications except arrhythmia in 1(2.9%) patient. MVA seems to be a safe and cost effective intervention compared to other modalities of miscarriage management even in high risk cardiac patients.

Abstract P5-03-03: Designing a novel platinum chemotherapeutic (IO-125) for treatment of breast cancer

Triple-negative breast cancer (TNBC) is an aggressive form of cancer occurring in 15-20% of breast cancer patients, with most patients relapsing on currently approved therapy. Recent studies have shown activity of platinum chemotherapy in this class of patients. IO-125 is a novel platinum (II) chemotherapeutic agent with an unique coordination environment. In this study, we investigated the anti-tumor activity of IO-125 in pre-clinical models of TNBC.

The coordination environment in IO-125 facilitates supramolecular assembly and releases diaminocyclohexane (DACH)-platinum in a sustained pH-dependent manner. In vitro cell viability studies using an array of breast cancer cell lines shows IO-125 exerts increased potency compared to carboplatin or oxaliplatin. The maximum tolerated (platinum-equivalent) dose (MTD) of IO-125 in mice was 8-fold higher than the MTD (platinum-equivalent) dose of oxaliplatin. The biodistribution and pharmacokinetic profile of IO-125 in plasma and tumor revealed preferential tumor accumulation, significantly increased area-under-the-curve (AUC), a reduction in clearance (CL) and a longer terminal half-life (42 hours) in comparison to oxaliplatin (18 hours). In addition, DNA-Pt adduct formation in tumors was significantly higher for IO-125. When administered at their respective MTDs, IO-125 led to sustained regression of the tumor in a 4T1 syngeneic breast cancer model. Based on these observations, we conclude that IO-125 may emerge as a novel therapeutic against triple negative breast cancer.

Citation Format: Sengupta A, Roy M, Sarkar A, Mylavarapu S, Modi S, Gupta N, B H, Hossain S, Ansari A, Pandey M, Yadav Y, Sengupta S. Designing a novel platinum chemotherapeutic (IO-125) for treatment of breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-03-03.

Frequency of intrahepatic cholestasis of pregnancy in Punjab Pakistan: A single centre study

OBJECTIVE

To find out the frequency of intrahepatic cholestasis of pregnancy and its identification parameters.

METHODS

The cross-sectional observational study was conducted in the Department of Medicine and the Department of Obstetrics, Combined Military Hospital, Kharian, from October 2013 to March 2014, and comprised all pregnant patients having symptoms suggestive of intrahepatic cholestasis which was confirmed after systemic inquiry, examination and biochemical analysis. Patients with cholestasis due to another reason, coagulopathies, thrombocytopenia and tumours were excluded. The patients were followed up till delivery to see the effects of cholestasis on mother and child.

RESULTS

Out of 1001 obstetric patients, 31(3.1%) had intrahepatic cholestasis of pregnancy. Pruritus was the main symptom in 25 (85%) patients followed by rash in 20 (65%). In 20 (64%) patients, labour was induced. Mode of delivery was Caesarean Section in 18 (58%) patients and 9 (29%) had postpartum haemorrhage. Regarding neonatal complications, 22 (70%) required admission to neonatal intensive care and 15 (48%) had meconium aspiration.

CONCLUSIONS

A high frequency of intrahepatic cholestasis of pregnancy was observed. It had significant impact on maternal and foetal health.

Role of nutrients and environmental conditions for the production of dextransucrase from L. mesenteroides KIBGE-IB26

The bacterial strains capable of producing dextransucrase enzyme were isolated from different fruits and vegetables sources. In primary screening, five strains were selected on the basis dextransucrase production and among them L. mesenteroides KIBGE- IB26 isolated from bottle gourd (Lagenaria Vulgaris) was selected for further studies. For the enhancement of enzyme production, different physicochemical parameters were optimized. Maximum production of dextransucrase was achieved after 06 hrs using sucrose (20.0 g/l) as a substrate at 25°C. Maximum dextransucrase production was achieved when medium pH was kept 7.5 before sterilization. In addition, medium was also supplemented with CaCl2 and K2HPO4 and maximum enzyme production was achieved at 0.0025 g/dl calcium chloride and 2.0 g/dl K₂HPO₄with enzyme activity of 87 DSU/ml/hr. Production of dextransucrase in shorter period of time makes this strain an attractive candidate for commercial production of dextransucrase.

Strategic aspects of higher education reform to cultivate specialists in diagnostic and biopharma industry as applicable to Predictive, Preventive and Personalized Medicine as the Medicine of the Future

Predictive, Preventive and Personalized Medicine as the Medicine of the Future represents an innovative model for advanced healthcare and robust platform for relevant industrial branches for diagnostics and pharmaceutics. However, rapid market penetration of new medicines and technologies demands the implementation of reforms not only in the spheres of biopharmaceutical industries and healthcare, but also in education. Therefore, the problem of the fundamental, modern preparation of specialists in bioengineering and affiliated fields is becoming particularly urgent, and it requires significant revision of training programs of higher education practice into current medical universities. Modernization and integration of widely accepted medical and teaching standards require consolidation of both the natural sciences and medical sciences that may become the conceptual basis for a university medical education. The main goal of this training is not simply to achieve advanced training and expansion of technological skills, but to provide development of novel multifaceted approaches to build academic schools for future generations.

Plasmid borne BAC-IB17: Localization of a potential antibacterial positive marker (Bac+) encoded broad inhibitory spectrum bacteriocin

Production of antimicrobial compounds is considered as ubiquitous anti-competitor strategy in bacterial ecosystem. Bacteriocins are heterogeneous; highly specific and efficient anti-competitor agents and the gene responsible for the production of bacteriocins mostly exist in an autosomal state and associated with plasmids. BAC-IB17 is a broad spectrum bacteriocin and its production was observed at different stages of the growth cycle from Bacillus subtilis KIBGE-IB17. Growth kinetics of B. subtilis KIBGE-IB17 along with the production of BAC-IB17 showed that it exhibited secondary metabolite kinetics. Plasmid curing technique revealed that the gene responsible for the bacteriocinogenecity in B. subtilis KIBGE-IB17 was located on the plasmid of the bacterium. Overlay method also demonstrated the plasmid-mediated bacteriocinogenesis of the isolated colonies. With the advancement in genomics and proteomics, the plasmid borne BAC-IB17 can play a significant role in the transfer of bacteriocinogenic factor to other incompetent cells and also in the maintenance of plasmid in bacterial population.

Purification, characterization and end product analysis of dextran degrading endodextranase from Bacillus licheniformis KIBGE-IB25

Degradation of high molecular weight dextran for obtaining low molecular weight dextran is based on the hydrolysis using chemical and enzymatic methods. Current research study focused on production, purification and characterization of dextranase from a newly isolated strain of Bacillus licheniformis KIBGE-IB25. Dextranase was purified up to 36 folds with specific activity of 1405 U/mg and molecular weight of 158 kDa. It was found that enzyme performs optimum cleavage of dextran (5000 Da, 0.5%) at 35 °C in 15 min at pH 4.5 with a Km and Vmax of 0.374 mg/ml and 182 μmol/min, respectively. Relative amino acid composition analysis of purified enzyme suggested the presence of higher number of hydrophobic, acidic and glycosylation promoting amino acids. The N-terminal sequence of dextranase KIBGE-IB25 was AYTVTLYLQG. It exhibited distinct amino acid sequence yet shared some inherent characteristics with glycosyl hydrolases (GH) family 49 and also testified the presence of O-glycosylation at N-terminal end.

A hybrid artificial neural network and particle swarm optimization for prediction of removal of hazardous dye brilliant green from aqueous solution using zinc sulfide nanoparticle loaded on activated carbon

In the present study, zinc sulfide nanoparticle loaded on activated carbon (ZnS-NP-AC) simply was synthesized in the presence of ultrasound and characterized using different techniques such as SEM and BET analysis. Then, this material was used for brilliant green (BG) removal. To dependency of BG removal percentage toward various parameters including pH, adsorbent dosage, initial dye concentration and contact time were examined and optimized. The mechanism and rate of adsorption was ascertained by analyzing experimental data at various time to conventional kinetic models such as pseudo-first-order and second order, Elovich and intra-particle diffusion models. Comparison according to general criterion such as relative error in adsorption capacity and correlation coefficient confirm the usability of pseudo-second-order kinetic model for explanation of data. The Langmuir models is efficiently can explained the behavior of adsorption system to give full information about interaction of BG with ZnS-NP-AC. A multiple linear regression (MLR) and a hybrid of artificial neural network and partial swarm optimization (ANN-PSO) model were used for prediction of brilliant green adsorption onto ZnS-NP-AC. Comparison of the results obtained using offered models confirm higher ability of ANN model compare to the MLR model for prediction of BG adsorption onto ZnS-NP-AC. Using the optimal ANN-PSO model the coefficient of determination (R(2)) were 0.9610 and 0.9506; mean squared error (MSE) values were 0.0020 and 0.0022 for the training and testing data set, respectively.