Ameliorative effects of Lactobacillus against Aflatoxin B1

Lactobacilli are probiotics with Aflatoxin (AF) detoxification ability, found in fermented products, GIT of animals and environment. Purpose of this study was to investigate the ability of broiler isolates of Lactobacillus against Aflatoxin B1 (AFB1). For this purpose, 5 isolates of Lactobacillus from broiler gut were incubated with 100 ppb AFB1 in aqueous environment and effect of different parameters (cell fractions, time, temperature, pH) on detoxification was determined by HPLC. The ameliorative effect of Lactobacillus salivarius (LS) against AFB1 was studied in broiler. The results revealed that LS (CR. 4) showed the best results (in vitro) as compared to other isolates (L. salivarius (CR. 3, CR, 4), L. agilis (CE. 2.1, CE. 3.1) and L. crispatus (CE. 28). Cell debris of CR. 4 showed significantly higher detoxification (P<0.05). Maximum amount of AFB1 was detoxified at 30°C (97%), pH 4.0 (99%) and 6 h (99.97%). In vivo study showed that AFB1 decreased weight gain (1,269 ± 0.04 gm/ bird), feed consumed (2,161 ± 0.08 gm/ bird), serum total protein (2.42 ± 0.34 gm/ dl), serum albumin (0.5 ± 0.2 2 gm/dl) and antibody titer (4.2 ± 0.83). Liver function enzymes were found (alanine transaminase (ALT): 32 ± 10.7 U/L) and aspartate transaminase (AST): 314.8 ± 27 U/L) elevated in AFB1 fed broilers. Treatment with 1% LS not only decreased the toxic effects of AFB1 (group D) but also improved the overall health of broilers due to its probiotic effects (p<0.05) as compared to control negative (group A). The detoxification ability of LS was better than commercial binder (CB) (0.2% Protmyc). It was concluded that detoxification of AFB1 by Lactobacillus was strain, temperature, pH and time dependent. LS has detoxification ability against AFB1 in vivo.

Molecular identification of genus Pipistrellus (Mammalia: Chiroptera) from Fata region, Pakistan

A total of 10 specimens were captured from selected sites of Bajaur Agency FATA, Pakistan using mist nets. The captured specimens were morphologically identified and various morphometric measurements were taken. The head and Body length (HB) of Pipistrellus coromondra and Pipistrellus kuhlii lepidus (n=10) was 43±0.11 mm and 45±1.1 respectively. Morphologically identified Pipistrellus kuhlii confirmed as Pipistrellus kuhlii lepidus based on 16S rRNA sequences. The DNA sequences were submitted to GenBank and accession numbers were obtained (MN 719478 and MT430902). The available 16S rRNA gene sequences of Pipistrellus coromondra and Pipistrellus kuhlii lepidus were retrieved from NCBI and incorporated in N-J tree analysis. Overall, the interspecific genetic variations among Pipistrellus coromondra and Pipistrellus kuhlii lepidus were 8% and 1% respectively. In our recommendation, a comprehensive molecular identification of bats is need of hour to report more cryptic and new species from Pakistan.

Serum Immunogllobulin G Levels in Graves’ disease Patients at Various Stages of Antithyroid Therapy

Thirty six patients with Graves’ disease (GD), diagnosed on the basis of clinical examination and appropriate laboratory tests were classified into three groups (A-C): Group A: twelve newly diagnosed Graves’ disease patients; Group B: twelve hyperthyroid Graves’ disease patients on Antithyroid drug therapy and Group C: twelve Graves’ disease patients who had been rendered cuthyroid with Antithyroid drug (ATD) therapy, Serum lgG was determined  by radial immunodiffusion method using commercially available kits (The Binding Site UK). The mean lgG in newly diagnosed patients with GD (Group A) was 18.78±1.81. It was 22.75 ± 1.89 in hyperthyroid GD patients on drug therapy (Group B), 14.3±0.8 in GD patients who were rendered euthyroid with drug therapy (Group C) and 11.85±0.72 in normal controls. The lgG level of group A patients were not significantly different from those of Group B. However, the levels of lgG and lgA were significantly low in group C Graves’ disease patients as compared to group A patients. A significant reduction in lgG LEVEL IN Graves’ disease patients who were rendered cuthyroid after Antithyroid drug therapy as compared to newly diagnosed Graves’ disease patients indicate the immunosuppressive effect of Antithyroid drug therapy.

Micrometer-sized negative-ion accelerator based on ultrashort laser pulse interaction with transparent solids

We report here energetic (>100 keV) negative hydrogen ions (H(-)) generated in the interaction of moderately intense (10(18) W cm(-2)) ultrashort laser pulses (45 fs) with transparent hydrogen containing solid targets. An unambiguous and consistent detection of negative hydrogen ions, with a flux of 8×10(11)H(-) ions/sr, has been observed in every single laser shot, using a Thomson parabola ion spectrograph. Simple estimates based on charge transfer cross sections match well with experimental observations. Our method offers the implementation of an intense, ultrashort laser based negative-ion source at a higher repetition rate, which can be important for various applications.

Role of target material in proton acceleration from thin foils irradiated by ultrashort laser pulses

We report on the proton acceleration studies from thin metallic foils of varying atomic number (Z) and thicknesses, investigated using a 45 fs, 10 TW Ti:sapphire laser system. An optimum foil thickness was observed for efficient proton acceleration for our laser conditions, dictated by the laser ASE prepulse and hot electron propagation behavior inside the material. The hydrodynamic simulations for ASE prepulse support the experimental observation. The observed maximum proton energy at different thicknesses for a given element is in good agreement with the reported scaling laws. The results with foils of different atomic number Z suggest that a judicious choice of the foil material can enhance the proton acceleration efficiency, resulting into higher proton energy.

Identification of a novel mutation (p.Ile198Thr) in gene TYR in a Pakistani family with nonsyndromic oculocutaneous albinism

The TYR gene (MIM #6069333) is located at position 11q14.3 on the human chromosome, and encodes tyrosinase, which is expressed in melanocytes and controls the biosynthesis of melanin. Most TYR mutations eliminate the activity of tyrosinase, preventing melanocytes from producing any melanin throughout life. People with this form of albinism have white hair, light-coloured eyes and very pale skin. Some mutations in TYR reduce but do not completely eliminate tyrosinase activity, and allow some melanin to be produced. We report a Pakistani family with four members affected by oculocutaneous albinism (OCA). Blood samples were collected from all affected individuals, normal siblings and their parents. Genomic DNA was extracted, and sequence analysis of all the coding exons and adjacent intronic sequences of TYR was performed, which identified a novel missense substitution (p.Ile198Thr). Sequencing of TYR in 90 unrelated healthy individuals showed no sequence variant at this location. Our study expands the mutational spectrum of OCA1.

Injectable anal bulking agent for the management of faecal incontinence

This study was conducted to determine the safety and efficacy of injectable bulking agents. A total of 13 procedures were performed on 11 patients with faecal incontinence during 2002 to 2007. Patients with internal anal sphincter defect and low incontinence score (Cleveland score < 10) revealed improvement. Patients with higher incontinence score and external sphincter defect secondary to obstetric damage required further intervention. At a median follow-up of 43 months, 7 (63%) patients showed improvement in incontinence score and 4 (32%) showed marked improvement in their symptoms. Fifty six percent of the patients described this as an effective procedure, though the level of effectiveness varied from person to person. Anal injectable collagen was found safe and effective in the management of faecal incontinence. Long-term follow-ups are required to re assess and consider definitive procedure in failed cases.

Sacral neuromodulation for the treatment of faecal incontinence in a patient with organophosphate poisoning

Faecal incontinence is a debilitating condition. Sacral neuromodulation may have a role in the treatment of faecal incontinence. We report a case of faecal incontinence secondary to chronic organophosphate poisoning, which was successfully treated with sacral neuromodulation. The patient's faecal incontinence and quality of life improved significantly.

Risk to household contacts of tuberculous patients based on Mantoux test and antibody titre

BACKGROUND

Tuberculosis, being an infectious disease, carries a risk of infection to contacts attending tuberculous patients. This study was conducted to evaluate the risk for household contacts of tuberculous patients as compared to non-contacts. The study was conducted at PGMI, Gulab Devi Hospital and Defence Housing Authority Lahore. The study included 120 household contacts and 80 non-contacts.

METHODS

A Cross sectional study for evaluation of antituberculous antibodies levels by ELISA method in two groups; Mantoux positive household contacts 49, Mantoux negative household contacts 71 and normal healthy persons 'non contacts' 80. Routine Haematological investigations like HB, TLC and ESR were done by conventional methods and all the sera of 200 subjects included in the study were tested for IgM, IgG and IgA anti tuberculous antibodies by enzyme linked immunosorbant assay (ELISA). Purified protein derivative 0.1 ml containing 5 TU was injected intradermally. The test was read after 72 hours by measuring the induration around injection site of forearm.

RESULTS

There was no difference in the average age of the household contacts and non-contacts. The complaints of pyrexia, night sweats and weight loss were more in house hold contacts as compared to non-contacts. The awareness about BCG vaccination was equal in both. There were 49 contacts with positive Mantoux test while negative Mantoux test was found in 71 contacts. There were only three Mantoux positive among eighty non-contacts. There was no significant difference in the presence of IgM among household contacts as compared to non-contacts. However both IgG and IgA were present in significantly higher number of household contacts compared to non-contacts.

CONCLUSION

Household contacts of patients suffering from active pulmonary tuberculosis have more chances of being infected with Mycobacterium tuberculosis as compared to the healthy non-contact, as shown by the higher levels of antituberculous antibodies & positivity of Mantoux test.

Percutaneous endoscopic, radiological and surgical gastrostomy tubes: a comparison study in head and neck cancer patients

A gastrostomy feeding tube has become the most acceptable method for long-term feeding support in patients with head and neck cancer. The aim of this study was to compare the complications of percutaneous endoscopically inserted gastrostomy (PEG) tubes, radiologically inserted gastrostomy (RIG) tubes and surgically inserted gastrostomy (open/laparoscopic) (SUR) tubes in head and neck cancer patients and also to compare the mortality rates of these patients. Seventy-eight head and neck cancer patients underwent gastrostomy tube insertion (40 PEG, 28 RIG and 10 SUR) during the period February 2002 to February 2005. There were no significant demographic differences between the three groups. Thirty-six patients (46 per cent) developed complications, 32 minor and four major. All three groups were similar in their rate of minor complications, with the dislodgement and blockage rate being lowest in the PEG group (p > 0.05). The mortality rate was 4 per cent within 30 days of gastrostomy tube insertion. There were no deaths in the PEG group, two deaths in the RIG group and one in the SUR group. The PEG tube was considered superior to the RIG and SUR gastrostomy tubes, had fewer complications and was safer. Thus, PEG tube insertion is our first choice for head and neck cancer patients.

FIGO save the Mothers Initiative: the Pakistan-UK collaboration

The pilot study in Punjab, Pakistan was one of the five paired demonstration projects sponsored by FIGO in the "Save the Mothers" maternal mortality project. The goal of the project was to bring basic and comprehensive emergency obstetric care (EmOC) to a semiurban and rural area some 30 km from Lahore, where effectively there was none. The aim was to achieve this by using the existing facilities within the rural health system without the deployment of extra specialist staff other than as initial facilitators. This report shows trebling of some performance indicators and an improvement in met need. There is coincidentally a similar increase in the uptake of general medical services. Reducing maternal mortality requires building local capacity for EmOC; the essential components being the premises, trained personnel, equipment, and availability of drugs and blood. Availability and provision of EmOC coupled with changes in the attitude of the population resulted in marked improvement of process indicators.

Serum and CSF immunoglobulins G, A and M in 37 intracranial tumors

OBJECTIVE

To estimate different proteins and immunoglobulins as humoral immune response in patients with intracranial tumours.

METHODS

Cellulose acetate membrane electrophoresis for estimation of different proteins and radialimmunodiffusion (RID) for measurement of serum and CSF immunoglobulins were used.

RESULTS

Thirty seven patients with different types of tumours showed increase in serum alpha II globulin, significant decrease of IgG, in patients when compared with controls, significant decrease of IgG in malignant tumours compared with benign tumours. CSF albumin, gamma globulin, immunoglobulins G,A,and M were increased.

CONCLUSION

Alpha II globulin, steroid therapy and active neoplasia may be responsible for decreased serum immunoglobulins, while raised gamma globulin and immunoglobulins with intact BBB indicates capability of CNS to produce immunoglobulins.

Significance of thyrotrophin and thyroxine estimations in type 1 diabetes

OBJECTIVE

To investigate whether estimation of thyrotrophin (TSH) and thyroxine (T4) is significant to assess the thyroid status of diabetic patients.

MATERIALS AND METHODS

Fifty patients with type 1 diabetes (25 male and 25 female) aged 9-50 years were included. The mean duration of diabetes was 6.7 +/- 4.3 years. Clinically they were not suffering from any systemic disease or endocrine ailment. Twenty-six, age and sex matched, normal controls were also included. The TSH and and T4 were estimated in the sera of all the subjects using the commercially available ELISA kits.

RESULTS

The mean +/- SD concentration of TSH was raised significantly (p < 0.001) in the patients as compared to the controls, whereas the T4 concentration was comparable. Furthermore, 30% diabetics showed significantly elevated TSH concentration than the controls.

CONCLUSION

It is proposed that the estimation of TSH in the patients with type 1 diabetes may be useful in the early identification of thyroid dysfunction.

Prevalence of thyroid microsomal and thyroglobulin autoantibodies in goitrous lesions

BACKGROUND

This prospective study was done to evaluate the serum levels of Microsomal and Thyroglobulin autoantibodies in patients with toxic diffuse goiter and nodular goitre (non-toxic) undergoing radio-iodine therapy and thyroidectomy respectively.

METHODS

Forty eight patients suffering from thyroid disorders, 29 with nodular goiter and 19 with toxic diffuse goitre (TDG) and 15 age & sex-matched normal controls were studied. Thyroid microsomal (MSAb) and thyroglobulin autoantibodies (TGAb) were estimated in the sera of all the subjects using the commercially available kits based on tanned red cell haemaglutination technique.

RESULTS

MSAb seropositivity in TDG and nodular goitre was found to be 78.9% and 51.7% respectively. On the other hand, TGAb seropositivity was 57.9% and 27.6% in cases of TDG and nodular goitre. 13.3% and 6.7% of the normal controls were positive for MSAb and TGAb respectively.

CONCLUSION

These findings indicate that autoimmunity is implicated in the genesis of commonly occurring thyroid disorders.

Detection of beta-thalassaemia trait: a study of fifty families

BACKGROUND

This study was carried out to detect beta-thalassaemia trait in the siblings of beta thalassaemia major children by Hemoglobin (Hb) electrophoresis.

METHODS

Subjects were divided into two groups. Group 1 was the patients group comprising 100-subjects siblings of beta-thalassaemia major children and Group 2 was the control group with 25-subjects.

RESULTS

It was observed that 58% of the siblings of beta-thalassaemia major children had beta-thalassaemia trait. Even in the control group 2 subjects had beta thalassaemia trait, which shows that thalassaemia gene is very common in Hazara division of Pakistan.

Significance of serum inhibin in female infertility

BACKGROUND

Serum inhibin, a glycoprotein hormone is secreted from granulosa cells in females and has been shown to suppress secretions of FSH from pituitary.

METHODS

A total of 45 women, 30 infertile subjects and 15 age matched fertile controls were included in this study. Blood samples from each subject were collected during follicular and luteal phases separately and were tested for serum inhibin levels using an enzyme linked immunosorbent assay (ELISA).

RESULTS

Serum inhibin concentration of infertile subjects during follicular phase was 35.5 +/- 22.94 pg/ml and luteal phase was 32.4 +/- 24.2 pg/ml. Whereas serum inhibin level in follicular phase was 10.39 +/- 2.03 pg/ml and luteal phase was 12.78 +/- 6.86 pg/ml of the fertile subjects. Serum inhibin was significantly raised in the infertile subjects as compared to the fertile subjects (P < 0.05). However serum inhibin concentration during the follicular and luteal phases of the infertile subjects was not significantly different (P > 0.05).

CONCLUSION

It is thus concluded that increased serum inhibin level may be treated as sensitive and early index of declining ovarian function.

Diagnosis of Clostridium difficile antibiotic associated diarrhoea culture versus toxin assay

OBJECTIVE

To compare the results of Clostridium Difficile (CD) on culture with detection of C. difficile toxin by Enzyme Immunoassay (EIA) in the stool specimens of hospitalized patients with antibiotic associated diarrhoea (AAD).

PATIENTS AND METHODS

The study included 80 adult patients with AAD and 20 adult patients with non-AAD. Stool specimens of all these subjects were inoculated on cycloserine cefoxitin fructose agar and incubated anaerobically to isolate C. difficile. At the same time, all the stool specimens were tested for C. difficile toxin by EIA technique using cytoclone A and B kit manufactured by Cambridge Biotech Corporation, Worcester, Massachusette.

RESULTS

Out of 80 adult patients with AAD, thirty were females and fifty males. C. difficile was isolated on culture from stool specimen of 16 patients, while twenty-three stool specimens were positive for C. difficile toxin. From 20 control subjects, C. difficile was isolated from stool specimen of only one subject. No stool specimen from the controls was positive for toxin.

CONCLUSION

Diagnosis of CDAAD by culture is difficult and time consuming because of strict anaerobic nature of organism. Moreover, mere isolation of C. difficile on culture is not sufficient to establish the pathogenic role of these isolates. C. difficile toxin detection by EIA technique is a highly sensitive and specific method for diagnosis of CDAAD. Using this method, results are available in three hours time. Therefore, EIA is recommended for rapid diagnosis of CDAAD.

Bacteriological quality of drinking water in Punjab: evaluation of H2S strip test

OBJECTIVE

To assess bacteriological quality of drinking water in Punjab and to evaluate usefulness of H2S strip test in comparison with multiple tube test.

METHOD

Samples of water were tested using H2S strips and multiple tube test.

RESULTS

Maximum bacterial contamination was observed in water from domestic pumps (95.83%). Followed by tap water in rural areas of Punjab (91.30%) and tap water in Lahore (42.85%). Bacterial contamination was significantly higher (p < 0.001) in rural areas as compared to urban areas. Comparison of results of testing water samples by H2S strip test and multiple tube test revealed that H2S strip is 87.24% sensitive and 100% specific for detection of bacterial contamination with a positive predictive value of 100%. It was also observed that 100% water samples negative for total coliforms were also negative by H2S strip method. Moreover, with increase in number of total coliforms in the water samples, positivity by H2S strip method also increased (samples with more than 10 total coliforms/100 ml were 100% positive by H2S strip method). Therefore, H2S strip test can be used as alternative to multiple tube test for detection of bacterial contamination of water supplies.

CONCLUSION

It is concluded that bacterial contamination of water is a significant problem in Punjab. It can be improved by regular monitoring of water supplies. For this purpose use of H2S strip test is advocated at house hold level.

Evaluation of dipstrips, direct gram stain and pyuria as screening tests for the detection of bacteriuria

Two hundred and fifty cases of clinically suspected urinary tract infection were analysed for the detection of bacteriuria. Parameters studied included direct Gram staining, pyuria on microscopic examination of uncentrifuged urine and dip strip method for the detection of blood, protein, nitrite and leucocyte esterase. Significant bacteriuria (colony count 10(5) per ml) was found in 112 cases with a positivity ranging from 65 to 83% for the presence of blood, protein, nitrite and leucocyte esterase. Highest positive predictive values were obtained with the presence of nitrite and leucocyte esterase (98%), blood, protein and nitrite (94%) as well as with blood, protein, nitrite and leucocyte esterase (98%). Both pyuria and direct Gram staining were positive in 85% cases. The combined presence of both these parameters gave 100% positive predictive value. Gram staining combined with pyuria was more effective and economical as compared to the dipstrips for the detection of bacteriuria.

Acute nonlymphoblastic leukaemia in adults

Fifty-four cases of adult acute nonlymphoblastic leukaemia (ANLL) were studied. Their main symptoms were weakness and easy fatiguability (80%), fever (78%) and bleeding manifestation (48.38%). Our patients were younger (median age 34 years) and the disease was more advanced at the time of presentation than that seen in the West. FAB morphological classification of adult ANLL cases showed M2 (44.44%) the most predominant type followed by M4 (24%), M5 and M6 were less common (3.7%). Majority of ANLL cases (68.51%) occurred up to the age of 40 years. Our results are comparable to European and consistent with Pakistani and Libyan studies.

Significance of thyroid microsomal antibody in Graves' disease

Thyroid microsomal antibody (MsAb) was estimated in 48 patients with Graves' disease (15 newly diagnosed, 15 on drugs for about 4 weeks and 18 euthyroid with drug treatment) and twenty age and sex matched controls. The diagnosis of Graves' disease (GD) was based on clinical history, physical examination and thyroid function tests, viz. 131I uptake, thyroid scintigram and serum T3, T4 and TSH levels. MSAb was positive in 93.3% of newly diagnosed as well as hyperthyroid GD patients on drugs. Eighty-three percent euthyroid GD patients and 20% normal controls also showed MSAb positivity. The titres of newly diagnosed patients were significantly raised (P < 0.05) than those of euthyroid patients and controls indicating the diagnostic as well as prognostic significance of MSAb in Graves' disease.

Immunoglobulin classes G,A,M in brain tumours

Serum of 37 brain tumour patients was studied for, Total protein, Protein electrophoresis, IgG, IgA, and IgM in an attempt to ascertain humoral immune response. Findings were compared with 20 healthy subjects, matched for age, sex and socioeconomic status. There was significant rise in alpha-II globulin, while IgG was suppressed in tumour patients. Decrease of IgG was more marked in patients with malignant tumours. Immunoglobulin A was low in children when compared with adults. Immunoglobulin M remained unchanged (JPMA 42: 157, 1992).

Ventricular CSF immunoglobulins in brain tumours

Ventricular CSF glucose, total protein, protein electrophoresis, IgG, IgA, IgM and CSF cytology were determined in thirty seven patients with brain tumours. CSF glucose was unchanged and total protein was significantly high. Protein electrophoresis showed higher albumin and gamma globulin fractions. Mean IgG and IgA were significantly higher (P less than 0.001) in malignant tumours than in benign ones. IgM was detectable in 7 of 37 cases. The higher concentration of total protein, albumin and gamma globulin shows some degree of impairment of blood brain barrier. Increased concentration of IgG, IgA and IgM indicates humoral immune response of the brain against the tumours.

Evaluation of bronchodilator responsiveness in mechanically ventilated patients

Airway pressure, flow, and volume were measured before and after administration of aerosolized metaproterenol during controlled mechanical inflation and stepwise deflation of the relaxed respiratory system in 13 mechanically ventilated patients. An increase in passive expiratory flow at constant respiratory system recoil pressure was considered evidence of bronchodilatation. In 10 patients, at a respiratory system recoil pressure of 6 cm H2O (VP6), expiratory flow increased 21 to 500% above prebronchodilator level. In these 10 dynamically hyperinflated patients, an increase in VP6 was associated with a decrease in peak inspiratory pressure (Ppeak) (mean delta = -4.7 cm H2O) and a decrease in intrinsic positive end-expiratory pressure (Peepi) (mean delta = -2.4 cm H2O). The elastance of the respiratory system was not affected by metaproterenol, and the delta Peepi corresponded to a mean decrease in end-expiratory lung volume of 0.20 L. The results are consistent with predictions based on a single-compartment model. When mean expiratory flow is determined only by the tidal volume and expiratory time, a decrease in airway resistance results in a decrease in lung volume at which patients are ventilated. Therefore, the decrease in Ppeak is caused not only by a decrease in the resistive pressure cost but also by a decrease in the elastic pressure cost of inflating the respiratory system. It is emphasized that Ppeak and Peepi provide valuable information about bronchodilator-induced changes in lung function during controlled mechanical ventilation.

Respiratory system mechanics in ventilated patients: techniques and indications

For the past 50 years, basic research has provided valuable insights into the concepts of respiratory system mechanics, but clinical application in the critical-care arena remains in its infancy. On the basis of the limited information that is available on critically ill patients, we believe that physicians who are responsible for the care of mechanically ventilated patients must understand the mechanical interactions between humans and machines. With measurements of flow, volume, and pressure, a more precise quantitative evaluation of the respiratory system can be obtained than with clinical assessment alone. In this article, we discuss the principles, techniques, and clinical applications of measurements of respiratory system mechanics in ventilated patients and suggest directions for further research that may prove to be clinically relevant.