In silico design of a novel multi-epitope vaccine against HCV infection through immunoinformatics approaches

Infection with the hepatitis C virus (HCV) is one of the causes of liver cancer, which is the world's sixth most prevalent and third most lethal cancer. The current treatments do not prevent reinfection; because they are expensive, their usage is limited to developed nations. Therefore, a prophylactic vaccine is essential to control this virus. Hence, in this study, an immunoinformatics method was applied to design a multi-epitope vaccine against HCV. The best B- and T-cell epitopes from conserved regions of the E2 protein of seven HCV genotypes were joined with the appropriate linkers to design a multi-epitope vaccine. In addition, cholera enterotoxin subunit B (CtxB) was included as an adjuvant in the vaccine construct. This study is the first to present this epitopes-adjuvant combination. The vaccine had acceptable physicochemical characteristics. The vaccine's 3D structure was predicted and validated. The vaccine's binding stability with Toll-like receptor 2 (TLR2) and TLR4 was confirmed using molecular docking and molecular dynamics (MD) simulation. The immune simulation revealed the vaccine's efficacy by increasing the population of B and T cells in response to vaccination. In silico expression in Escherichia coli (E. coli) was also successful.

Clinicopathological Features and Treatment Outcomes of Male Breast Cancer in Pakistani Population: A 10-Year Retrospective Cross-Sectional Study

Background

Male breast cancer (MBC) accounts for 1% of global breast cancer cases. On account of its rarity, very few prospective clinical trials have been carried out on MBC. Pakistan has the highest incidence of breast cancer in Asia, but very limited data are available on MBC.

Objectives

The objective is to determine the clinicopathological characteristics and treatment patterns of MBC in Pakistani population.

Design

This is a retrospective cross-sectional study.

Methods

A retrospective cross-sectional study carried out using the cancer database of Shaukat Khanum Memorial Cancer Hospital & Research Center. Men with a histologically proven breast cancer, stage 0 to III disease and requiring surgical intervention were included. The Kaplan-Meier curve and log-rank test were used for survival analysis.

Results

Sixty-eight patients with MBC were included with a median age at diagnosis of 55 years. Most patients were stage II (47.1%). Invasive ductal carcinoma (IDC) was the commonest type (89.7%). Estrogen receptor (ER), progesterone receptor (PR), and Her-2 receptor positivity were 92.6%, 86.8%, and 32.4%, respectively. Mastectomy was performed in 95.6% of the cases. Neoadjuvant and adjuvant chemotherapy was administered in 25 (36.8%) and 26 (38.2%) patients, respectively. Fifty-five (80.9%) patients received adjuvant radiotherapy. Most of the patients (89.7%) received tamoxifen. The 5-year overall and disease-free survival was 88.2% and 80.9%, respectively. Patients receiving neoadjuvant chemotherapy had a better overall and disease-free survival (P = .025).

Conclusions

Male breast cancer occurs at a relatively earlier age in Pakistani population as compared with Western men. Mastectomy is the preferred surgical option for MBC on account of the advanced disease and delayed presentation. Neoadjuvant chemotherapy has a statistically significant effect on overall and disease-free survival, but in spite of these benefits, it remains underutilized.

Impact of SSO-ASTRO Margin Guidelines on Re-excision Rate in Breast-conserving Surgery: A Single-center Experience

Introduction

Breast-conserving surgery (BCS) has been historically linked with a high rate of re-excision. To address this issue, the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) developed consensus guidelines in 2014 to standardize practices and improve clinical outcomes for BCS patients. In our tertiary cancer care hospital, we assessed the impact of these guidelines on the re-excision rate following BCS.

Materials and Methods

We conducted a retrospective study on breast cancer patients who underwent BCS at the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan. The study compared the re-excision rate before the implementation of the SSO-ASTRO consensus guidelines (November 2015-July 2017) and after the implementation (January 2018-August 2019). Margins were considered positive if "ink on tumor" was present and negative if "no ink on tumor" was present. Fisher's exact test or Chi-square test was used to compare the re-excision rates between the pre- and post-guideline periods.

Results

A total of 919 patients were identified, with 533 from the pre-guideline period and 386 from the post-guideline period. Of the 919 patients, 31 with ductal carcinoma in situ (DCIS) were excluded from the re-excision analysis because the guidelines were not implemented on the DCIS. Furthermore, the overall rate of re-excision in our data was 4.3%. The re-excision rate decreased from 71.1% to 28.9% (P ≤ 0.05) following the adoption of the guidelines. We observed a statistically significant decrease in the re-excision rate after implementing the SSO-ASTRO guidelines.

Conclusion

Implementation of the SSO-ASTRO margin guidelines led to a notable decrease in the overall re-excision rate in our data set. These findings suggest that continued adherence to the guidelines may lead to a further reduction in the re-excision rate in the future.

A novel therapeutic approach to prevent Helicobacter pylori induced gastric cancer using networking biology, molecular docking, and simulation approaches

Helicobacter pylori infects 50% of the world population and in 80% of cases, the infection progresses to the point where an ulcer develops leading to gastric cancer (GC). This study aimed to prevent GC by predicting Hub genes that are inducing GC. Furthermore, the study objective was to screen inhibitory molecules that block the function of predicted genes through several biophysical approaches. These proteins, such as Mucin 4 (MUC4) and Baculoviral IAP repeat containing 3 (BIRC3), had LogFC values of 2.28 and 3.39, respectively, and were found to be substantially expressed in those who had H. pylori infection. The MUC4 and BIRC3 inhibit apoptosis of infected cells and promote cancerous cell survival. The proteins were examined for their Physico-chemical characteristics, 3D structure and secondary structure analysis, solvent assessable surface area (SASA), active site identification, and network analysis. The MUC4 and BIRC3 expression was inhibited by docking eighty different compounds collected from the ZINC database. Fifty-seven compounds were successfully docked into the active site resulting in the lowest binding energy scores. The ZINC585267910 and ZINC585268691 compounds showed the lowest binding energy of -8.5 kcal/mol for MUC4 and -7.1 kcal/mol for BIRC3, respectively, and were considered best-docked solutions for molecular dynamics simulations. The mean root mean square deviation (RMSD) value for the ZINC585267910-MUC4 complex was 0.86 Å and the ZINC585268691-BIRC3 complex was 1.01 Å. The net MM/GBSA energy value of the ZINC585267910-MUC4 complex estimated was -46.84 kcal/mol and that of the ZINC585268691-BIRC3 complex was -44.84 kcal/mol. In a nutshell, the compounds might be investigated further as an inhibitor of the said proteins to stop the progress of GC induced by H. pylori.Communicated by Ramaswamy H. Sarma.

An In Silico Multi-epitopes Vaccine Ensemble and Characterization Against Nosocomial Proteus penneri

Proteus penneri (P. penneri) is a bacillus-shaped, gram-negative, facultative anaerobe bacterium that is primarily an invasive pathogen and the etiological agent of several hospital-associated infections. P. penneri strains are naturally resistant to macrolides, amoxicillin, oxacillin, penicillin G, and cephalosporins; in addition, no vaccines are available against these strains. This warrants efforts to propose a theoretical based multi-epitope vaccine construct to prevent pathogen infections. In this research, reverse vaccinology bioinformatics and immunoinformatics approaches were adopted for vaccine target identification and construction of a multi-epitope vaccine. In the first phase, a core proteome dataset of the targeted pathogen was obtained using the NCBI database and subjected to bacterial pan-genome analysis using bacterial pan-genome analysis (BPGA) to predict core protein sequences which were then used to find good vaccine target candidates. This identified two proteins, Hcp family type VI secretion system effector and superoxide dismutase family protein, as promising vaccine targets. Afterward using the IEDB database, different B-cell and T-cell epitopes were predicted. A set of four epitopes "KGSVNVQDRE, NTGKLTGTR, IIHSDSWNER, and KDGKPVPALK" were chosen for the development of a multi-epitope vaccine construct. A 183 amino acid long vaccine design was built along with "EAAAK" and "GPGPG" linkers and a cholera toxin B-subunit adjuvant. The designed vaccine model comprised immunodominant, non-toxic, non-allergenic, and physicochemical stable epitopes. The model vaccine was docked with MHC-I, MHC-II, and TLR-4 immune cell receptors using the Cluspro2.0 web server. The binding energy score of the vaccine was - 654.7 kcal/mol for MHC-I, - 738.4 kcal/mol for MHC-II, and - 695.0 kcal/mol for TLR-4. A molecular dynamic simulation was done using AMBER v20 package for dynamic behavior in nanoseconds. Additionally, MM-PBSA binding free energy analysis was done to test intermolecular binding interactions between docked molecules. The MM-GBSA net binding energy score was - 148.00 kcal/mol, - 118.00 kcal/mol, and - 127.00 kcal/mol for vaccine with TLR-4, MHC-I, and MHC-II, respectively. Overall, these in silico-based predictions indicated that the vaccine is highly promising in terms of developing protective immunity against P. penneri. However, additional experimental validation is required to unveil the real immune response to the designed vaccine.

Ab initio insight into the physical properties of MgXH3 (X = Co, Cu, Ni) lead-free perovskite for hydrogen storage application

Renewable energy systems are vital for a sustainable future, where solid-state hydrogen storage can play a crucial role. Perovskite hydride materials have attracted the scientific community for hydrogen storage applications. The current work focuses on the theoretical study using density functional theory (DFT) to evaluate the characteristics of MgXH3 (X = Co, Cu, Ni) hydrides. The structural, vibrational, electronic, mechanical, thermodynamic, and hydrogen storage properties of these hydrides were investigated. The equilibrium lattice parameters were calculated using the Birch-Murnaghan equation of state-to-energy volume curves. The elastic constants (Cij) and relevant parameters, such as Born criteria, were calculated to confirm the mechanical stability of the hydrides. The Cauchy pressure (Cp) revealed brittle or ductile behavior. The outcomes of the Pugh ratio, Poisson ratio, and anisotropy were also calculated and discussed. The absence of negative lattice vibrational frequencies in phonon dispersion confirmed the lattice's dynamic stability. The heat capacity curves of thermodynamic properties revealed that hydrides can conduct thermal energy. The metallic character and ample interatomic distances of hydrides were confirmed by the band structure and population analysis, which confirmed that hydrides can conduct electrical energy and adsorb hydrogen. The density of state (DOS) and partial DOS unveiled the role of specific atoms in the DOS of the crystal. The calculated gravimetric hydrogen storage capacity of MgCoH3, MgCuH3, and MgNiH3 hydrides was 3.64, 3.32, and 3.49wt%, respectively. Our results provide a deeper understanding of its potential for hydrogen storage applications through a detailed analysis of MgXH3 (X = Co, Cu, Ni) perovskite hydride material.

Is complete pathological response truly a complete response in breast cancer?

OBJECTIVE

To check if complete pathological response in breast cancer is a good prognostic factor.

METHODS

The retrospective study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 2012 to December 2015 of all patients who received neo-adjuvant chemotherapy and had no distant metastasis at diagnosis. Mastectomy patients were excluded. Complete pathological response was defined as no detectable tumour cell in breast and axilla on pathological examination of the resected specimen. Tumour characteristics and 5-year disease free survival and overall survival were recorded. Data was analysed using SPSS 20.

RESULTS

Of the 353 patients whose data was evaluated, 91(25.8%) had complete pathological response. Mean age at diagnosis was 43±10 years. Among them, 62(68%) patients had grade III tumour, 39(42.9%) were negative for oestrogen receptor, 58(63.7%) were negative for progesterone receptor, 25(27.5%) were positive for human epidermal growth factor receptor 2, and 26(28.6%) patients were triple negative. Overall, 28((30.7%) patients had recurrence; 20(71.4%) had distant metastasis, 6(21.4%) had local recurrence, and 2(7.14%) had contralateral cancer. The 5-year disease-free survival and overall survival rates (Kaplan-Meier Survial curve) were 70% (28 patients-recurrence) and 87% (15 patients-deaths), respectively.

Conclusion

Despite complete disappearance of tumour, a significant number of patients developed recurrences.

MRI Features of Synchronous Masses in Known Breast Cancer Patients in Predicting Benign Versus Malignant Lesions: A Case Based Review at Tertiary Care Cancer Hospital

Sara RehmanObjectives  The purpose of this study was to determine the diagnostic accuracy of breast magnetic resonance imaging (MRI) in classifying incidental satellite masses in biopsy-proven breast cancer patients as benign or malignant masses and assessing its impact on surgical management of these patients. We also analyzed the incidence of MRI-detected lesions, which were thereafter assessed with second look ultrasound (US). Materials and Methods  A retrospective study was performed on breast cancer patients presenting from August 01, 2016 to July 31, 2019, with satellite masses seen on base line MRI. Satellite masses were classified as benign and malignant based on MRI features of shape, margin, T2-weighted imaging signals, internal enhancement pattern, enhancement kinetic curves, and diffusion restriction. This was compared with results of histopathological examination. The number of MRI-detected lesions, location of the satellite mass, and type of surgery were also documented. Results  Out of 400 breast cancer patients undergoing MRI breast, 115 patients had multiple masses. Histopathological diagnosis was available for 73 patients; and a total of 93 satellite masses were evaluated. There was evidence of additional masses on second look ultrasound in 21 patients. Of 72 masses classified as malignant on MRI, 58 showed malignant pathological outcome; while out of 21 masses characterized as benign on MRI, 18 turned out to be benign on histopathology. A statistically significant association was found between MRI features and pathological outcome of satellite masses ( p  = 0.001). The sensitivity, specificity, positive and negative predictive values, and accuracy were 95%, 56%, 80.56%, 85.7% and 81.7%, respectively. Based on these findings, modified radical mastectomy (MRM)/mastectomy was done for 42 patients, 5 patients underwent lumpectomy limited to a single tumor, extended resection done for 14 patients, 5 underwent bilateral breast conservation surgery (BCS), BCS for contralateral breast done for 4 patients undergoing ipsilateral MRM/mastectomy, and bilateral MRM/mastectomies were performed for 2 patients. One patient was lost to follow up. Conclusion  Breast MRI is the most sensitive modality for the assessment of breast cancer and plays an essential role in the detection of additional tumor foci. These findings can modify the surgical approach in these patients. However, considering the low specificity, biopsy of satellite masses is imperative to determine the most appropriate surgical plan.

ACC deaminase-producing endophytic fungal consortia promotes drought stress tolerance in M.oleifera by mitigating ethylene and H2O2

INTRODUCTION

Drought has become more prevalent due to dramatic climate change worldwide. Consequently, the most compatible fungal communities collaborate to boost plant development and ecophysiological responses under environmental constraints. However, little is known about the specific interactions between non-host plants and endophytic fungal symbionts that produce growth-promoting and stress-alleviating hormones during water deficits.

METHODS

The current research was rationalized and aimed at exploring the influence of the newly isolated, drought-resistant, ACC deaminase enzyme-producing endophytic fungi Trichoderma gamsii (TP), Fusarium proliferatum (TR), and its consortium (TP+TR) from a xerophytic plant Carthamus oxycantha L. on Moringa oleifera L. grown under water deficit induced by PEG-8000 (8% osmoticum solution).

RESULTS

The current findings revealed that the co-inoculation promoted a significant enhancement in growth traits such as dry weight (217%), fresh weight (123%), root length (65%), shoot length (53%), carotenoids (87%), and chlorophyll content (76%) in comparison to control plants under water deficit. Total soluble sugars (0.56%), proteins (132%), lipids (43%), flavonoids (52%), phenols (34%), proline (55%), GA₃ (86%), IAA (35%), AsA (170%), SA (87%), were also induced, while H₂O₂ (-45%), ABA (-60%) and ACC level (-77%) was decreased by co-inoculation of TP and TR in M. oleifera plants, compared with the non-inoculated plants under water deficit. The co-inoculum (TP+TR) also induced the antioxidant potential and enzyme activities POX (325%), CAT activity (166%), and AsA (21%), along with a lesser decrease (-2%) in water potential in M. oleifera plants with co-inoculation under water deficit compared with non-inoculated control. The molecular analysis for gene expression unraveled the reduced expression of ethylene biosynthesis and signaling-related genes up to an optimal level, with an induction of antioxidant enzymatic genes by endophytic co-inoculation in M. oleifera plants under water deficit, suggesting their role in drought stress tolerance as an essential regulatory function.

CONCLUSION

The finding may alert scientists to consider the impacts of optimal reduction of ethylene and induction of antioxidant potential on drought stress tolerance in M. oleifera. Hence, the present study supports the use of compatible endophytic fungi to build a bipartite mutualistic symbiosis in M. oleifera non-host plants to mitigate the negative impacts of water scarcity in arid regions throughout the world.

Association of Nrf2 gene polymorphism (rs6721961) with semen parameters in primary male infertility cases in Pakistani population

Objective: To determine an association of single nucleotide polymorphism of the NRF2 gene (RS6721961) with semen parameters of primary male infertility patients in the Pakistani population. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Biochemistry, Islamic International Medical College, Rawalpindi, in collaboration with two private infertility clinics (American Infertility Center, Rawalpindi and Mother and Child International Hospital and Research Institute, Mirpur, AJK) from Oct 2020 to Sep 2021. Methodology: A total of 288 participants were included in this study. There were 144 diagnosed cases of primary male infertility and 144 healthy fertile males, age and ethnicity matched controls. Blood samples were collected from participants after obtaining written informed consent. DNA was extracted by the Chelex TM Methodoogy. Multiplex PCR was done to determine the respective allelic frequencies of NRF2 (RS6721961) genotypes using specific primers. Results: There was no significant association between NRF2 genotypes and semen volume and semn colour in infertile males (p-value 0.32 and 0.84, respectively). Out of 144 cases, 111 (77%) had normal sperm count, 29 (20.1%) had oligospermia, while 4 (2.7%) patients had azoospermia. A significant association was observed between NRF2 genotypes and sperm concentration of infertile males (p-value <0.001). Out of 144 cases, 80 (55.5%) had normal motility, 57 (39.5%) had asthenospermia while 7 (8.4%) patients had necrospermia. A strong association was observed between NRF2 genotypes and sperm motility in infertile males (p-value <0.001). Conclusion: Single nucleotide polymorphism (RS6721961) of the NRF2 gene is significantly associated with sperm concentration and......

Breast conservation surgery (BCS) for breast cancer in a resource limited country- Are we upto the challenge!

Objective: To analyse outcomes of breast conservation surgery and to identify the factors that could have affected the outcomes. Method: The retrospectively study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data of breast conservation surgery cases done between January 2011 and October 2014 in order to cover up for the 5-year follow-up of the last enrolled patient. Data, obtained through the institutional information and database system, included disease-recurrence, 5-year disease-free survival and overall survival. Data was statistically analysed using SPSS 20. Results: Of the 553 cases, 417(75%) had no loco-regional recurrence or distant metastasis, while 136(25%) had some form of loco-regional, distant or contralateral metastasis at 5-year follow-up. In patients who had recurrence or metastasis, only progesterone receptor status, nodal status and mode of treatment showed significant association (p<0.05). Mortality at 5-year follow-up was 77(14%). Amongst the patients who died, only progesterone receptor status and nodal status had significant association (p<0.05). Five-year overall survival for the cohort was 476(86%), whereas 5-year disease-free survival was 409(74%). Conclusion: Breast conservation surgery was found to have favourable outcomes, while progesterone status, nodal involvement and mode of treatment significantly affected the outcome. Key Words:  Breast cancer, Breast conserving surgery, 5-year disease free survival, 5-year overall survival Continuous...

Helping babies breathe: assessing the effectiveness of simulation-based high-frequency recurring training in a community-based setting of Pakistan

Background

Birth asphyxia is one of the significant causes of neonatal deaths in Pakistan. Poor newborn resuscitation skills of birth attendants are a major cause of neonatal mortality in low resource settings across the globe. This study aimed to evaluate the effectiveness of the Simulation-Based High-Frequency training of the Helping Babies Breathe for Community Midwives (CMW), in district Gujrat, Pakistan.

Method

A pre-post-test interventional study design was used. The universal sampling technique was employed to recruit 50 deployed CMWs in the entire district of Gujrat. The pre-tested module and tools of Helping Babies Breathe (2nd edition) were used in the intervention. Using the High Frequency training approach, three one-day training sessions were conducted for CMWs at an interval of 2 months. During the 2 months interval, participants were monitored and supported to practice their skills at their birthing centers. Knowledge and skills were assessed before and after each session. The McNemar and Cochran’s Q tests were applied for data analysis. Participants’ feedback was also obtained at the end of each training, which was analyzed through descriptive statistics.

Results

Data from 34 CMWs were analyzed as they completed all three training sessions and assessments. The results were statistically different after each training session for OSCE B (p-value < 0.05). However, for knowledge and OSCE A, significant improvement was observed after training sessions 1 and 2 only. Pairwise comparison showed that pre-assessment at training 1 was significantly different from most of the repeated measures of knowledge, OSCE A, and OSCE B. Moreover, the learners appreciated the overall training in terms of organization, content, material, assessment, and overall competency. Additionally, due to a small sample size of the CMWs, and a short time of the intervention, significant differences in morbidity and mortality outcomes could not be detected.

Conclusion

The study concluded that a series of training and continuous supportive supervision and facilitation enhances Helping Babies Breathe (HBB) knowledge retention and skills. The study recommends, periodic, structured and precise HBB trainings, with ongoing quality monitoring activities through blended learning modalities would help sustain and scale-up the intervention.

Dysbiosis in salivary bacterial diversity of postpartum females and its association with oral health problems and APOs

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In present study, salivary microbial diversity of postpartum females was compared with nonpregnant females.

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Microbial colonization was raised in postpartum females especially those having oral health issues.

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Isolated bacterial species showed enhanced biofilm forming and multi drug resistance.

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Alpha diversity was decrease in postpartum female having oral health issues with PLWB.

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Bray-Curtis dissimilarity was highest between females with dental issues and different pregnancy outcomes.

The present study investigates the dysbiosis in salivary bacterial diversity by culture-dependent and independent methods. Culturable aerobic and facultative anaerobic bacterial diversity was studied in saliva collected from 267 postpartum and 54 nonpregnant females by using standard microbiological methods. For unculturable bacterial diversity, DNA from saliva samples of four selected females was sequenced by targeting V4 region of 16S rRNA. In postpartum females, S. mutans was significantly more prevalent. Its colonization was also seen significant among females having gingivitis (P < 0.01), dental caries (P < 0.01), and in those giving birth to low weight baby. In postpartum group, 65.16% females were culture positive for Staphylococcus, 12.73% Gram positive rods, 10.48% N. meningitides, 6.36% K. pneumoniae, 5.61% Enterobacter species and 2.62% E. coli. Isolates showed high biofilm forming ability and antibiotic resistance. Upon analysis of unculturable bacterial diversity, a total of 16 phyla and 156 genera were observed. Alpha diversity was decrease in postpartum female having oral health issues with pre-term low weight birth, compared to females with full term birth. Bray-Curtis dissimilarity was highest between female with dental issues and different pregnancy outcomes. Bacterial diversity and abundance altered among females with different oral health conditions and pregnancy outcomes, and also have pathogenic potential.

Sonographic Evaluation of Incidental Synchronous Masses in Patients with Breast Cancer: Clinical Significance and Diagnostic Workup

Objective

This study aimed to evaluate the diagnostic accuracy of breast ultrasonography in classifying incidental satellite masses as benign or malignant in patients with breast cancer and to assess its effect on their surgical management.

Materials and Methods

Ultrasound-guided fine needle aspiration/biopsy was performed in 288 satellite masses of 225 patients with breast cancer. Two radiologists retrospectively reviewed the sonograms of these masses and classified them as benign or malignant and compared this feature with the results of the histopathological examination. The location of the satellite mass and type of surgery were also documented.

Results

Of the 288 satellite masses, 139 were located in the same quadrant, 95 in different quadrants, while 54 were in the contralateral breast. Of the 123 sonographically benign masses, 106 showed benign pathological outcome, and from 165 sonographically malignant masses, 127 were found malignant on histopathology/cytology. McNemar's chi-square was 7.27 (p-value=0.007), showing statistically significant association between sonographic features and pathological outcome of satellite masses. The sensitivity, specificity, positive and negative predictive values, and accuracy were 88.2%, 73.6%, 77%, 86.1%, and 80.9% respectively. Based on these findings, 61 patients underwent lumpectomy limited to a single tumor, 52 underwent extended resection, 78 underwent mastectomy, four underwent lumpectomy for the contralateral breast, and bilateral mastectomies were performed in another four patients. Surgery was not performed in 26 patients.

Conclusion

Although ultrasound is an effective tool for the detection and characterization of incidental satellite masses in patients with breast cancer, biopsy is imperative to ascertain the pathological diagnosis and, therefore, select the most appropriate surgical plan.

Taking stock: UK national antidote availability increasing, but further improvements are required

Background

A 2010/2011 audit of the Royal College of Emergency Medicine (RCEM) National Poisons Information Service (NPIS) UK guidelines on antidote availability demonstrated variable stocking of antidotes for the management of poisoned patients; the guidelines were updated and republished in 2013.

Aim

To assess if antidote stocking has improved since the 2010/2011 audit and introduction of the 2013 guidelines.

Methods

Questionnaires were sent to Chief Pharmacists at all 215 acute hospitals in England, Wales and Northern Ireland in October 2014. Data were collected on the timing of availability (category A antidotes should be available immediately, category B within 1 h and category C can be held supraregionally) and stock levels.

Results

169 (78.6%) responses were received. Atropine, calcium gluconate and flumazenil (category A) were the only antidotes available in all hospitals within the recommended time and stock levels. Forty-one (24.3%) hospitals held every category A antidote; this increased to 81 (47.9%) for those holding at least one cyanide antidote and all other category A antidotes. The proportion of hospitals stocking category A/B antidotes within the recommended time increased for 20 (90.9%) category A/B antidotes. Fomepizole (category B) availability increased to 62.1% of hospitals from 11.4% in 2010/2011. Other than penicillamine (63.3% hospitals), there was poor availability (2.4%-36.1%) of category C antidotes.

Conclusions

Availability of category A and B antidotes has improved since the 2010/2011 audit and 2013 guidelines. However, there remains significant variability particularly for category C antidotes. More work is required to ensure that those treating poisoned patients have timely access to antidotes focusing particularly on category C antidotes.

The CTSA Consortium's Catalog of Assets for Translational and Clinical Health Research (CATCHR)

The 61 CTSA Consortium sites are home to valuable programs and infrastructure supporting translational science and all are charged with ensuring that such investments translate quickly to improved clinical care. Catalog of Assets for Translational and Clinical Health Research (CATCHR) is the Consortium's effort to collect and make available information on programs and resources to maximize efficiency and facilitate collaborations. By capturing information on a broad range of assets supporting the entire clinical and translational research spectrum, CATCHR aims to provide the necessary infrastructure and processes to establish and maintain an open-access, searchable database of consortium resources to support multisite clinical and translational research studies. Data are collected using rigorous, defined methods, with the resulting information made visible through an integrated, searchable Web-based tool. Additional easy-to-use Web tools assist resource owners in validating and updating resource information over time. In this paper, we discuss the design and scope of the project, data collection methods, current results, and future plans for development and sustainability. With increasing pressure on research programs to avoid redundancy, CATCHR aims to make available information on programs and core facilities to maximize efficient use of resources.

Antibacterial activity of some medicinal plants against selected human pathogenic bacteria

Medicinal plants are traditionally used for the treatment of human infections. The present study was undertaken to investigate Bergenia ciliata, Jasminum officinale, and Santalum album for their potential activity against human bacterial pathogens. B. ciliata, J. officinale, and S. album extracts were prepared in cold and hot water. The activity of plant extracts and selected antibiotics was evaluated against five bacterial pathogens including Staphylococcus aureus, Bacillus subtilis, Proteus vulgaris, Pseudomonas aeruginosa, and Escherichia coli using agar well diffusion method. Among the three medicinal plants, B. ciliata extracts displayed potential activity against bacterial pathogens. Cold water extract of Bergenia ciliate showed the highest activity against B. subtilis, which is comparable with a zone of inhibition exhibited by ceftriaxone and erythromycin. J. officinale and S. album extracts demonstrated variable antibacterial activity. Further studies are needed to explore the novel antibacterial bioactive molecules.

Posterior reversible encephalopathy syndrome (PRES)

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity. Neurotoxicity with characteristic watershed CT/MR imaging features characterize this condition. This case report describes PRES syndrome in a 35-year-old patient admitted with eclampsia. On the first postpartum day; she developed severe headache, generalized tonic-clonic seizures and visual symptoms including transient visual loss. MRI scan of the brain showed symmetric areas of hyperintense signal on T2-weighted images in the occipital lobes bilaterally. Patient improved symptomatically. Repeat MRI of the brain 4 months after initial admission showed resolution of the previous abnormalities.

Assessment of carotid artery intima media thickness in hypertensive patients compared with normotensives by B-mode ultrasonography

BACKGROUND

Cardiovascular disease is the leading cause of mortality and morbidity worldwide. Common carotid artery intima media thickness has recently generated considerable interest as a marker of atherosclerosis and in the prediction of clinical coronary events and coronary artery disease. Ultrasonography is a non-invasive technique of measuring carotid artery intima media thickness. This study was carried out at Military Hospital Rawalpindi during 6 months from 24th May to 24th Nov 2007 to compare the common carotid artery intima media thickness in hypertensive patients with normotensives.

METHODS

Two hundred willing cases fulfilling inclusion criteria were included in the study and 200 controls were selected reporting to radiology department. Blood pressure was measured from brachial artery with mercury sphygmomanometer taking first and fifth Korotkoff sounds to identify systolic and diastolic values respectively. Intima media thickness was assessed in the distal part, 0.5-1.0 Cm proximal to carotid bulb of common carotid artery.

RESULTS

The age range of control group was 42-85 years and of hypertensive was 41-90 years. Mean age of control group was 55.03 +/- 8.57 years, and of hypertensive group was 58.02 +/- 9.74 years. The Mean of IMT right CCA of control group was 0.515 +/- 0.148 mm and of hypertensive group it was 1.06 +/- 0.23 mm (p < 0.001). The Mean of IMT of left CCA control group was 0.508 +/- 0.150 mm and of hypertensive group was 1.06 +/- 0.223 mm (p < 0.01).

CONCLUSION

Intima media thickness was significantly increased among hypertensive patients as compared to normotensives.

Peritoneal encapsulation presenting as small bowel obstruction in a 16 year old girl

Peritoneal encapsulation is a rare congenital anomaly characterized by a thin membrane of peritoneum encasing the small bowel to form an accessory peritoneal sac. Cases usually present with small bowel obstruction or can be an incidental finding during laparotomy. We report a case of peritoneal encapsulation presenting as a small bowel obstruction in a 16 year old girl. The sac was easily excised and surgery was otherwise uneventful. A discussion of the case and review of literature is presented.

Bronchial atresia with partial anomalous pulmonary venous return

Bronchial atresia and anomalous superior pulmonary venous return into the left brachiocephalic vein are unusual anomalies. We present a young asymptomatic man in whom these two distinct anomalies were co-existingly found on routine medical examination. Patient was diagnosed as a case of congenital bronchial atresia with partial anomalous pulmonary venous return based on the evidence of special features on X-ray chest film, characteristic contrast enhanced 16-slice CT chest findings, lack of symptoms and no change on fallow-up X-ray chest films.

Mucocele of the appendix: an unusual cause of disturbed bowel habits

There are many causes of disturbed bowel habits. In this rare case of mucocele of appendix, patient presented with disturbed bowel habits of increased frequency, urgency and semisolid stool. Ultrasound of abdomen revealed fusiform cyst just below umbilicus. Differential diagnoses included mesenteric cyst, duplication cyst and mucocele of appendix. Coronal and saggital reformats of CT abdomen confirmed its origin from ceacum. Its tip was in contact with sigmoid colon. Surgical resection was carried out and histopathology revealed mucinous cyst adenoma.

Accuracy of multiphase helical tomography in detection and characterisation of suspected renal masses using histopathological findings as gold standard

BACKGROUND

The introduction of multiphase helical computed tomography has created many important advances in the detection and characterisation of renal masses. Renal cell carcinoma (RCC) is the seventh most common cancer and makes up 80-85% of all primary renal cancer in adults. If it is found and treated early, the chances of survival from kidney cancer are high. This cross-sectional comparative was carried out at department of CMH/MH Rawalpindi from 1st February 2007 to 25 March 2008 to evaluate accuracy of multiphase helical tomography in detection and characterisation of suspected renal masses using histopathological findings as gold standard.

METHODS

Thirty patients with suspicion of having renal masses were scanned with multiphase CT scanning and 5 mm thick contiguous section were obtained from kidneys before and after injection of intravenous contrast material. The corticomedullary phase images were obtained after a delay of 25 seconds and nephrographic phase images, after a delay of 120 seconds after initiation of contrast medium injection. The numbers of lesions detected in all three phases were determined. The mass was then characterised by evaluation of its features and by its degree of contrast enhancement. Results of CT scan were compared with histopathology.

RESULTS

At review of unenhanced, corticomedullary and nephrographic phase images, 26, 29 and 30 lesions, respectively, were identified. One malignant lesion was not identified and 3 malignant lesions falsely appeared benign in the corticomedullary phase. All lesions were detected in the nephrographic phase and only 1 malignant lesion falsely appeared benign. The corticomedullary phase had a sensitivity of 86.2% and nephrographic phase 96.6% in malignant lesion detection.

CONCLUSION

Enhancement of renal neoplasm is time dependent and is better in nephrographic phase. Small, hypovascular tumours and those placed in medulla may be missed or inadequately characterised if nephrographic phase scanning is not done.

The genome sequence of the filamentous fungus Neurospora crassa

Neurospora crassa is a central organism in the history of twentieth-century genetics, biochemistry and molecular biology. Here, we report a high-quality draft sequence of the N. crassa genome. The approximately 40-megabase genome encodes about 10,000 protein-coding genes--more than twice as many as in the fission yeast Schizosaccharomyces pombe and only about 25% fewer than in the fruitfly Drosophila melanogaster. Analysis of the gene set yields insights into unexpected aspects of Neurospora biology including the identification of genes potentially associated with red light photobiology, genes implicated in secondary metabolism, and important differences in Ca2+ signalling as compared with plants and animals. Neurospora possesses the widest array of genome defence mechanisms known for any eukaryotic organism, including a process unique to fungi called repeat-induced point mutation (RIP). Genome analysis suggests that RIP has had a profound impact on genome evolution, greatly slowing the creation of new genes through genomic duplication and resulting in a genome with an unusually low proportion of closely related genes.

Resectable colonic carcinoma--a five year experience

Clinical characteristics, mode of presentation and pathological features of resectable carcinoma of the colon have been studied in 224 cases presenting between January 1971 and December 1975. Minimum length of follow-up is five years and is complete. Forty-three per cent of patients survived five years or more, only 23 per cent of tumours being early in histological terms. The conventional high risk groups contributed little to the total and their active surveillance will not significantly improve the overall statistics.