Plasma GDNF levels in spinal dysraphism and its relation with neurological impairment in children: A point of care study

AIMS

GDNF plays a crucial role in the stimulation of recovery, neuroplasticity and synaptic reorganization after spinal cord injury providing neuroprotection and neuroregeneration. Plasma GDNF levels are upregulated in cases of spina bifida owing to the intrauterine damage of the exposed spinal cord. Our aim was to compare the plasma GDNF levels in patients of spina bifida with non-spina bifida cases and assess the correlation with neurological impairment at one year of follow up.

METHODS

Single centre prospective analysis of cases of spina bifida from 2020 to 2022 at presentation and after one year of follow up post-surgery. Cases with hernia and hydrocele without any other disorders were recruited into the control group. Plasma GDNF levels were assessed with immunoassay kits and compared with neurological involvement.

RESULTS

85 cases were included in the study. GDNF levels were elevated in cases compared to controls (mean 6.62 vs 1.76) with significant p value (<0.01). Same was observed for open and closed defects (mean 7.63 vs 4.86: p < 0.01). At follow up of 52 cases post-surgery cases with neurogenic bladder with abnormal urodynamic studies, sphincter involvement and motor impairment had significantly elevated baseline levels of GDNF compared with those who did not have this neurological impairment (p < 0.01).

DISCUSSION

The neurotrophic factor up-regulation can reflect an endogenous attempt at neuroprotection against the biochemical and molecular cascades triggered by the spinal cord damage. This upregulation can be represented as important biochemical markers of severe spinal cord damage and can be associated with severity of spine injury in MMC patients. Our results are in keeping with these findings, that, there were increased levels of plasma GDNF levels in cases of spinal dysraphism compared to control population. Also, the type of lesion reflecting the severity whether a closed or an open dysraphism, showed significant difference in levels between them suggesting, yet again, more damage in open defect as expected. The levels were higher with involvement of bladder, sphincter and lower limb power.

CONCLUSION

There is significant elevation of plasma GDNF levels in cases of spina bifida and this elevation is proportional to the degree of spinal damage and hence the neurological impairment. GDNF levels are a good predictor for assessing the severity of the lesion and thus the outcome in these cases. Additional prospective and long-term studies with a larger cohort are needed for a better understanding of neurotrophin pattern modulation in MMC.

Role of non-contrast CT component of prostate-specific membrane antigen PET/CT scan in the detection of peripheral zone prostate cancer

OBJECTIVE

The aim of this study was to look for feasibility of non-contrast CT (NCCT) in detecting peripheral zone prostate cancer (PCa).

METHODS

A retrospective analysis included 50 biopsy-proven PCa patients between April 2019 and March 2022 who underwent staging whole body prostate-specific membrane antigen (PSMA)/CT prior to treatment. The control subjects were 50 randomly selected adult male patients who underwent PET/CT for non-prostate malignancy during the same time period. Two readers independently calculated the Hounsfield unit (HU) of normal peripheral zone, central zone, and corresponding PSMA avid focus in cases.

RESULTS

No significant difference was seen in the mean HU value of normal peripheral zone between cases and controls. Significant difference in the mean HU was seen between the PSMA avid focus in cases (40.1 ± 6.2) and normal peripheral zone of cases (28.2 ± 7.0) and controls (27.7 ± 5.8). No significant difference was found between the mean HU values of high-grade PCa and non-high-grade PCa. Receiver operating characteristic (ROC) curve analysis revealed a mean HU cut-off of ≥35 for detecting PCa with a sensitivity and specificity of 86% and 90%, respectively, between cases and controls (AUC 0.88).

CONCLUSION

Detection of clinically significant PCa is possible on routinely performed NCCT scans. Radiologists should routinely look for and convey these findings to facilitate further work-up and early detection of PCa.

ADVANCES IN KNOWLEDGE

Our study adds to the knowledge that NCCT scans performed for unrelated indications can serve as a screening tool for clinically significant PCa.

Ammonia gas treatment in low cost biological reactor

Ammonia gas contributes to a number of environmental and human health concerns. The use of chalk, a cheap alkalinity source may reduce costs for biological systems. This research studies a closed liquid flow reactor to treat ammonia gas using chalk as biomass media and alkalinity source with high value calcium nitrate fertilizer production. The proposed reactor showed complete ammonia gas removal at high rate (500 mg N/L/day) and with low cost; where chalk dissolution and ammonia gas absorption contributed to alkalinity in the water for nitrification. High calcium ion concentration (up to 10,000 mg Ca2+ as CaCO3/L) showed only minor effects on ammonia absorption and nitrification rate.

Evaluation of Dual Dye Technique for Sentinel Lymph Node Biopsy in Breast Cancer: Two-Arm Open-Label Parallel Design Non-Inferiority Randomized Controlled Trial

INTRODUCTION

Radioisotope and blue dye are standard agents for performing sentinel lymph node (SLN) biopsy in breast cancer. The paucity of nuclear medicine facility poses logistic challenge. This study evaluated performance of radioisotope & methylene blue (MB) with indocyanine green (ICG) and MB for SLNB.

PATIENTS AND METHODS

This randomized controlled trial was conducted from December 2019 to July 2022 comparing SLN identification proportions of radioisotope-blue dye [Group A] with dual dye (MB + ICG; Group B]. Secondary objective included time required and cost effectiveness of performing SLNB. Sample size of 70 (35 in each arm) was calculated. Upfront operable node negative early breast cancer was included in the study. Clinico-demographic data, number & type of SLN, time taken were noted. Cost analysis was done including the equipment, manpower & consumables. Chi-square/Fisher exact test was used to compare proportion between two groups. p value of less than 0.05 was considered to represent statistical significance.

RESULTS

Seventy patients randomized to either group were similar in clinico-demographic and tumor characteristics. SLN identification rate (IR) was 91.43% in group A and 100% in group B. Overall IR of MB, radioisotope and ICG were 91.43%, 91.43% and 100%, respectively. Mean number of SLNs identified were 3 in group A and 4 in group B. Median time required for SLNB was 12 min and 14 min in either group, respectively. Cost of performing SLNB was higher in Group B.

CONCLUSION

SLNB using dual dye is non-inferior to radioisotope-blue dye in upfront operable early breast cancer. Trial registration number Clinical Trial registry India CTRI/2020/02/023503.

Urinary tract infection caused by Lactococcus garvieae in a premature neonate: A case report

Lactococcus garvieae is a gram-positive cocci that has primarily been described as a pathogen in various fish species, but has increasingly been reported to cause endocarditis and other infections in humans [1]. Neonatal infection caused by Lactococcus garvieae has not been previously reported. Here we describe a premature neonate who developed a urinary tract infection with this organism and was successfully treated with vancomycin therapy.

Microplastics assessment in Arabian Sea fishes: accumulation, characterization, and method development

Around the globe, plastic has been entering the aquatic system and is ingested by organisms. Identification, optimal digestion method, and characterization of the polymers to trace sources are of growing importance. Hence, the present work investigated microplastics accumulation, digestion protocol efficiency, and characterization of polymers with FTIR analysis in the guts of five fishes (Lethrinus nebulosus, Rastrelliger kanagurta, Acanthopagrus arabicus, Otolithes ruber, and Euryglossa orientalis) from the Karachi coastal area, Arabian Sea. A total of 1154 microplastics (MPs) were ingested by 29 out of 33 fish species (87%). The highest average MP/fish was recorded in Otolithes ruber (54) and the lowest in Rastrelliger kanagurta (19.42). Microfibers were the most abundant shape with the highest numbers (35.52%) as compared to the rest of the MPs identified. Transparent microfibers were recorded as the highest in numbers followed by red, black, blue, and green. In this study, KOH with different concentrations and exposure times along with oxidizing agent hydrogen peroxide was tested (Protocols 3 and 4). Results showed these bases were highly efficient in obtaining optimal digestion of the samples. FTIR analysis confirmed that the majority of the polymers found in the fish guts were polyethylene and polypropylene. This study validated for the first time the presence of these polymers of plastic in marine fish from Pakistan.

A commercial monovalent canine parvovirus vaccine performs better than a commercial combination vaccine in puppies

Thirty puppies were randomly divided in to 3 groups for comparative evaluation of two commercial CPV vaccines. Each group was further subdivided in to < 6 months and < 3 months -old puppies and either vaccinated with a monovalent vaccine: Primodog, a combination vaccine: Duramune or maintained as a non-vaccinated control. Humoral immune response was determined by Hemagglutination Inhibition (HAI) on 21 and 35 -days after vaccination. The geometric mean titer (GMT) induced by Duramune, 21 and 35 -days post-vaccination was GMT 73.3 and 137.2, respectively. Comparatively, Primodog demonstrated higher GMT on 21 and 35 -days after vaccination: 97.0 and 168.9, respectively. The older puppies (< 6 months old) demonstrated higher seroconversion to both vaccines.

HLA B27 in Ankylosing Spondylitis: Differences in Frequency and Relative Risk in American Blacks and Caucasians

Twenty-eight HLA alleles of the A and B loci were determined in 23 American Blacks and 50 Caucasians with primary ankylosing spondylitis (AS). The prevalence of HLA B27 was significantly increased in American Black patients (48 per cent) vs Black controls (two per cent), but was much less than the 94 per cent found in Caucasian patients (controls eight per cent). The lower prevalence of B27 in American Black patients vs Caucasian patients was significant (p < 0.001), and indicated that susceptibility to AS is not as closely associated with B27 in Blacks as in Caucasians. No other HLA antigen was significantly associated with AS in either racial group. Among B27 positive individuals, the relative risk of developing AS was significantly lower in American Blacks than in Caucasians. These data indicate that for diagnostic purposes, the absence of B27 is less important in ruling out AS in Blacks than in Caucasians.

[Medical rehabilitation of children with obstructive uropathy]

Obstructive uropathy in children is predominantly urinary system malformation and one of the leading causes of chronic renal failure. Antenatal ultrasound can detect obstructive uropathy in infants. It is important to conduct diagnostics not only to identify the obstruction level in urinary system, but to assess renal function, renal blood flow and urination. Children are given conservative and surgical treatment methods to restore urodynamics, prevent infectious complications, improve renal blood flow. Currently, there are no principles, approaches and technologies for medical rehabilitation of patients with obstructive uropathy, therefore, the use of selective chromotherapy, which has an activating effect on regional circulation, and sound stimulation improving muscles tone of pelvis and ureters, is pathogenetically reasonable and promising.

OBJECTIVE

To develop technologies of physiotherapy application (sound stimulation, selective chromotherapy) for inclusion in comprehensive medical rehabilitation of children with megaloureter.

MATERIAL AND METHODS

Clinical observations and special examinations have been performed in 90 children with megaloureter aged from 1 to 10 years. The patients were divided into 2 groups: 30 children (study group) received sound stimulation combined with selective chromotherapy; 30 children (the 1st comparison group) - sound stimulation; 30 children (the 2nd comparison group) - selective chromotherapy (blue spectrum). General clinical methods, ultrasound of kidneys and bladder with Doppler monitoring of intrarenal blood flow, functional methods of bladder examination were used.

RESULTS

The positive effects of separate and combined application of sound stimulation and selective chromotherapy on clinical and laboratory indicators, urodynamics of urinary tract and renal blood flow in children with megaloureter after surgery have been revealed. The efficacy of selective chromotherapy use in children with megaloureter and comorbid neurologic bladder dysfunction has been proven.

CONCLUSION

Modern technologies for the application of physiotherapy, namely selective chromotherapy and sound stimulation, to include them in the comprehensive medical rehabilitation of children with megaloureter, have been developed for the first time and their high efficacy has been proven.

[The high-intensity pulsed magnetic therapy in the medical rehabilitation of children. (Literature review)]

In recent decades, a promising area of physiotherapy has been intensively developed In Russia and abroad - magnetic therapy, based on the use of various types of magnetic fields for preventive, curative and rehabilitative purposes. The use of high-intensity pulsed magnetotherapy is promising. The effectiveness of the method in a number of diseases of childhood, which has an active stimulating effect on the state of the neuromuscular apparatus, has been proven.

Successful Pregnancy with SLE-associated Antiphospholipid Syndrome: A Case Report

Pregnancy in women with systemic lupus erythematosus (SLE) is associated with an increased risk of adverse maternal and fetal outcomes. Risk is significantly increased when SLE pregnancy is complicated by anti-phospholipid syndrome (APS). Here, we present a case of a 21 year-old multi-gravid lady with SLE- associated APS who was diagnosed as such when she presented with multisystem flare at her 16 weeks of gestation. At presentation she had fever, multiple joint pain in both upper and lower limbs, loss of hair, history of recurrent oral ulcer, skin rash over hand and feet. Physical examination and laboratory evaluation were consistent with an active SLE flare. A diagnosis of antiphospholipid syndrome (APS) was made based on her clinical presentation and laboratory findings. The reported patient had APS secondary to SLE. She had all the risk factors that would confer a remarkably high risk of pregnancy morbidity: positive anti-SSA(RO) antibody and lupus anticoagulant, history of one neonatal death due to congenital heart block and two consecutive first trimester pregnancy loss. Multidisciplinary management approach with appropriate intervention and close monitoring can bring a successful outcome.

Evaluation of HE4 as a prognostic biomarker in uterine cervical cancer. Cancer Treat Res Commun 2023;34:100672. [PMID: 36525756 DOI: 10.1016/j.ctarc.2022.100672]

INTRODUCTION

Uterine cervical cancer (UCC) is the fourth most common health problem worldwide among women. Currently available biomarkers CA125, CA199, and CEA for diagnosis or prognostic evaluation of UCC have not got widespread acceptance.

METHOD

Whole blood samples of 64 patients with UCC were collected along with 63 healthy females and tested for serum levels of HE4 (sHE4). A cut-off value for positive result 64.0 pmol/L was set. Statistical analysis of different clinical variables was done.

RESULT

Serum level of HE4 has a significant role in the diagnosis of uterine cervical cancer. Its level increases with age, higher parity (P < 0.05), stage (P < 0.16), tumor size, and parametrial invasion. Negative result was seen with vaginal invasion, lymph node involvement & cases which had recurrence. Various histological types showed variable results. So the serum level of HE4 (sHE) level may play a role in the diagnosis & therapeutic monitoring of UCC. But the prognostic evaluation needs further studies.

CONCLUSION

sHE4 is useful in the diagnosis of cervical cancer, but its prognostic significance is under the question marks. It may be associated with higher values in higher stages. Higher parity of the patient is associated with higher level of HE4 in UCC.

Molecular epidemiology and phylogenetic analysis of Tams I gene of Theileria annulata in Khyber Pakhtunkhwa, Pakistan

Theileriosis is a hemoparasitic disease that affects a wide range of different animal species and is caused by various species of Theileria. This study aimed to determine the molecular epidemiology of Theileria annulata through microscopy and PCR, in crossbred cattle in some districts of Khyber Pakhtunkhwa, Pakistan. For this study, a total of 384 blood samples were collected from cattle in the Peshawar (n=120), Charsadda (n=94), Nowshera (n=84), and Swabi (n=86) districts. Microscopy and PCR were used to determine the overall prevalence of theileriosis, which was found to be 15.8 and 22.6%, respectively. Theileria annulata was detected in blood samples through PCR in the study area, and the target gene i.e., Tams 1, of positive samples was sequenced. The sequences in the current study revealed high sequence homology (ranging from 96 to 100%) with Tams 1 sequences of neighboring countries present in the NCBI database. Season, breed, age, and sex were found to be important risk factors among the several risk factors examined, whereas, among different clinical manifestations, lymphadenopathy showed a strong association with theileriosis. According to Cohen's kappa and ROC analysis, microscopy was proven to be a fair diagnostic test for detecting theileriosis in cattle, and may be used in combination with molecular techniques for screening a large number of animals.

A secure healthcare 5.0 system based on blockchain technology entangled with federated learning technique

In recent years, the global Internet of Medical Things (IoMT) industry has evolved at a tremendous speed. Security and privacy are key concerns on the IoMT, owing to the huge scale and deployment of IoMT networks. Machine learning (ML) and blockchain (BC) technologies have significantly enhanced the capabilities and facilities of healthcare 5.0, spawning a new area known as "Smart Healthcare." By identifying concerns early, a smart healthcare system can help avoid long-term damage. This will enhance the quality of life for patients while reducing their stress and healthcare costs. The IoMT enables a range of functionalities in the field of information technology, one of which is smart and interactive health care. However, combining medical data into a single storage location to train a powerful machine learning model raises concerns about privacy, ownership, and compliance with greater concentration. Federated learning (FL) overcomes the preceding difficulties by utilizing a centralized aggregate server to disseminate a global learning model. Simultaneously, the local participant keeps control of patient information, assuring data confidentiality and security. This article conducts a comprehensive analysis of the findings on blockchain technology entangled with federated learning in healthcare. 5.0. The purpose of this study is to construct a secure health monitoring system in healthcare 5.0 by utilizing a blockchain technology and Intrusion Detection System (IDS) to detect any malicious activity in a healthcare network and enables physicians to monitor patients through medical sensors and take necessary measures periodically by predicting diseases. The proposed system demonstrates that the approach is optimized effectively for healthcare monitoring. In contrast, the proposed healthcare 5.0 system entangled with FL Approach achieves 93.22% accuracy for disease prediction, and the proposed RTS-DELM-based secure healthcare 5.0 system achieves 96.18% accuracy for the estimation of intrusion detection.

295 SPEP IT UP! DEVELOPING AN ALGORITHM FOR ABNORMAL SERUM PLASMA ELECTROPHORESIS RESULTS IN HIP FRACTURE PATIENTS

Background

Hip fracture is a common manifestation of osteoporosis. All patients who sustain a hip fracture should receive a specialist bone health assessment, including Serum Protein Electrophoresis (SPEP) because plasma cell disorders such as multiple myeloma are an important differential diagnosis. SPEP results can be challenging to interpret without training and expertise. We aimed to review the proportion of abnormal SPEP results in hip fracture patients and used a newly developed algorithm to assess urgency of referral to haematology.

Methods

The Orthogeriatrics and Haematology teams collaborated to develop an algorithm to help facilitate decision making in hip fracture patients with abnormal SPEP results. A retrospective study was then conducted using data from the local Hip Fracture Database from Quarters 1 and 3 in 2020, and the hospital electronic laboratory system. The algorithm was used to retrospectively determine which patients warranted haematology review. The electronic appointment system was then accessed to review whether those who warranted haematology referral had appointments on the system.

Results

Of 270 hip fracture presentations, 19 duplicate records were excluded. Five patients had no data and three patients had passed away. Of the remaining 243 patients, 193 (79.42%) had SPEP’s sent. Abnormalities were detected in 116 patients (47.74%). According to the SPEP referral pathway, two patients warranted routine referral and one patient required an urgent referral, none of whom appeared to have been referred to haematology. Two patients who did not warrant haematology referral were already under haematology for different conditions.

Conclusion

Not all patients who sustain acute osteoporotic fractures with an abnormal SPEP result require haematology referral. The need for an urgent or routine haematology can be guided by the SPEP result along with other clinical features. With the introduction of this pathway, it is proposed that all hip fracture patients will be triaged in a timely, appropriate, and consistent manner.

Community- vs. hospital-based management of multidrug-resistant TB in Pakistan

BACKGROUND Multidrug-resistant TB (MDR-TB) treatment takes 18-24 months and is complex, costly and isolating. We provide trial evidence on the WHO Pakistan recommendation for community-based care rather than hospital-based care.METHODS Two-arm, parallel-group, superiority trial was conducted in three programmatic management of drug-resistant TB hospitals in Punjab and Sindh Provinces, Pakistan. We enrolled 425 patients with MDR-TB aged >15 years through block randomisation in community-based care (1-week hospitalisation) or hospital-based care (2 months hospitalisation). Primary outcome was treatment success.RESULTS Among 425 patients with MDR-TB, 217 were allocated to community-based care and 208 to hospital-based care. Baseline characteristics were similar between the community and hospitalised arms, as well as in selected sites. Treatment success was 74.2% (161/217) under community-based care and 67.8% (141/208) under hospital-based care, giving a covariate-adjusted risk difference (community vs. hospital model) of 0.06 (95% CI -0.02 to 0.15; P = 0.144).CONCLUSIONS We found no clear evidence that community-based care was more or less effective than hospital-based care model. Given the other substantial advantages of community-based care over hospital based (e.g., more patient-friendly and accessible, with lower treatment costs), this supports the adoption of the community-based care model, as recommended by the WHO.

Corona Virus Disease 2019 (COVID-19) Diagnostic Tests: A Glimpse

Mass testing for COVID-19 infection is one of the core measures in tackling the global spread of the disease. Testing is vital to diagnose and estimate cases, attack rates and case fatality rates- critical data for policy-making. As COVID-19 continues to spread globally, the demand for more extensive laboratory testing and innovative technology increases. However, countries around the world have been struggling to keep up pace with the worldwide demand to expand testing strategy. The pandemic evolves, so does our knowledge and understanding of diagnostic tests of COVID-19. Here we aim to review major challenges related to COVID-19 diagnostic tests and future development. So, the ongoing urgency and demand for tests would certainly steer the rapid uptake of novel techniques, which in turn would boost our understanding of diagnostic tests for COVID-19.

Identification of SCAR markers for genetic authentication of Dendrobium nobile Lindl

Dendrobium nobile Lindl. is an orcid plant with important medicinal values. This is a colourful houseplant, and also a popular herb in traditional Chinese medicine (TCM). The variants of this plant from different geographic regions might be high, and in this study, we aimed to develop specific sequence characterized amplified region (SCAR) markers for the identification of specific variant of this plant. Different cultivars of D. nobile were collected from nine different places of China, and one cultivar from Myanmar. DNA materials were extracted from the plant samples, random amplified polymorphic DNA (RAPD) were developed, cloned and sequenced for the development of SCAR markers. We have developed four SCAR markers, which are specific to the cultivar from Luzhou China, and clearly distinguishable (genetically) from other cultivars. These SCAR markers are deposited in GenBank (accession number MZ417502, MZ484089, MZ417504 and MZ417505). Four SCAR markers for D. nobile are effective molecular technique to genetically identify the different cultivars or species, and this method is applicable for genetic characterization and identification of other plant species too.

Impact of COVID-19 pandemic on quality of partner relationship and sexual activity among COVID positive males: a cross sectional study

OBJECTIVE

Our aim was to assess sexual activity, partner relationships among males who had been infected with COVID-19, to study the impact of COVID-19 infection on partner relationship and to find out the association between partner and sexual relationship during lockdown.

MATERIALS AND METHODS

A cross sectional study was conducted in Saudi Arabia through social media platforms via online questionnaire between December 1, 2020 and January 31, 2021 among 871 participants after a pilot study among 20 participants of which 497 were included in the study. Statistical analysis was conducted using SPSS version 20.0 (IBM Inc., Armonk, NY, USA). Responses were presented as frequencies and percentages and the association was studied using Chi squared test/Fisher's exact test. The value of p ≤ .05 was considered significant.

RESULTS

Out of the total study participants, nearly 85% of them belonged to the age range of 18 to 39 years, more than half of the participants were married. In the six months prior to the study being conducted, 268 respondents (53.9%) did not have sexual relationships. Respondents with positive COVID-19 infection reported that their partner lived with them in the same house during home isolation and was also found to be significantly associated with having intact sexual relationships in the last six months of the lockdown period (p-value < .001). Moreover, respondents who reported having good relationships with their partners during the pandemic were found to be significantly associated with having intact sexual relationships during the pandemic lockdown (p-value < .001).

CONCLUSIONS

Among the COVID-19-positive respondents, sexual activity and partner relationships were largely found to be intact during the pandemic lockdown period.

Activity of Fosfomycin Against The Spectrum of Uropathogens Causing Cystitis

Background:

Urinary tract infections (UTIs) are the most frequent bacterial infections, commonly seen in females. High degree of antimicrobial resistance in uropathogens has challenged the use of therapeutic agents. Fosfomycin which is an old antibiotic with distinctive characteristics, seems to be a promising novel therapeutic agent with a good bactericidal activity towards multi-drug resistant (MDR) uropathogens.

Objective:

The main objective of the study is to evaluate the antibacterial activity of fosfomycin among uropathogens causing cystitis.

Methods:

The study was carried out between 2017-2018. A total of 2060 UTI suspects from outpatient department (OPDs) and inpatient department (IPDs) were screened. Out of 2060 screened patients 1658 were IPD patients and 402 were OPD patients. Patient’s midstream urine samples were collected aseptically and processed according to standard protocols. The frequency of extended-spectrum-beta lactamases (ESBLs) producer and carbapenem resistance were estimated respectively. Cultures with significant growth of uropathogens were identified and minimum inhibitory concentration (MIC) to fosfomycin was determined by agar dilution (AD) and by E-test methods.

Results:

184 out of 2060 (8.9%) urine samples showed significant growth of uropathogens. Uropathogenic Escherichia coli (UPEC) (64%,118/184) was found to be the mostly isolated uropathogen. Among these Gram-negative uropathogens, 80% were ESBLs producers, 43.2% were carbapenem-resistant and 78% isolates were found to be MDR. The fosfomycin susceptibility for UPEC was 95% by AD method.

Conclusions:

This study suggests that Fosfomycin is reasonably effective and can be used in the treatment of MDR uropathogens along with uncomplicated UTIs.

[Medical rehabilitation for children with scoliosis]

The article presents a literature review on the prevalence, relevance, social significance, and principles of medical rehabilitation of children with different types of scoliosis in scoliotic disease. The current classification, diagnostics features, and clinical course of the disease are addressed. Current approaches to the choice of medical rehabilitation methods for scoliotic disease in children are described: therapeutic exercise, hydrokinesiotherapy, massage, physiotherapeutic treatment, kinesiotaping, and corseting. Special consideration is given to postoperative management and stages of medical rehabilitation of children with scoliosis, including resort treatment.

Anti-hyperglycemic and anti-hyperlipidemic effects of a methanolic extract of Debregeasia salicifolia in Alloxan-induced diabetic albino mice

Diabetes mellitus (DM), an endocrine syndrome characterized by high blood glucose levels due to abrogated insulin activity. The existing treatments for DM have side effects and varying degrees of efficacy. Therefore, it is paramount that novel approaches be developed to enhance the management of DM. Therapeutic plants have been accredited as having comparatively high efficacy with fewer adverse effects. The current study aims to elucidate the phytochemical profile, anti-hyperlipidemic, and anti-diabetic effects of methanolic extract D. salicifolia (leaves) in Alloxan-induced diabetic mice. Alloxan was injected intraperitoneally (150 mg kg-1, b.w), to induced diabetes in mice. The mice were divided into three groups (n=10). Group 1 (normal control) received normal food and purified water, Group II (diabetic control) received regular feed and clean water and group III (diabetic treated) received a methanolic extract of the plant (300 mg kg-1) for 28 days with a typical diet and clean water throughout the experiment. Blood samples were collected to checked serum glucose and concentration of LDL, TC, TG. The extract demonstrated significant antihyperglycemic activity (P<0.05), whereas improvements in mice's body weight and lipid profiles were observed after treatment with the extract. This study establishes that the extract has high efficacy with comparatively less toxicity that can be used for DM management.

682 Pre-clinic mpMRI Prostate for Suspected Localised Significant Prostate Cancer – Incidental Findings and Outcomes

Aim

Two week wait pathways demand rapid investigation of patients with suspected prostate cancer. To facilitate this, mpMRI prostate imaging is now routinely organised for patients whom meet specific criteria, without prior physical review by an urologist. We sought to establish what incidental findings were amongst this patient group and whether management was affected.

Method

All patients referred between 1/4/2019 – 30/4/20 on a suspected prostate cancer pathway to the Leicester General Hospital were included with those coded to have had pre-clinic MRI selected.

Results

During this period 1487 patients were referred on the pathway of which 482 were coded as having has pre-clinic MRI. 8 patients were excluded due to incorrect coding leaving 474 to be analysed. 121 patients had incidental findings mentioned in the report, of these a higher proportion did not have prostate cancer (69%). There were just 11 (2%) significant findings that required further investigation or intervention. These included colorectal lesions, primary bone lesions, suspected bladder cancers and urinary tract calculi. Of this group 3 patients had prostate cancer. Of note 13% of these patients were noted to have diverticular disease and 6% had herniae noted although none required emergent treatment. In this series 32% of patients were confirmed to have prostate cancer with 67.1% of MRI scan reported as PIRADS 3-5.

Conclusions

Pre-clinic MRI prostate facilitates rapid investigation for suspected prostate cancer. There is a small chance of establishing a significant incidental finding which is slightly more common in the non-cancer group.

Review: Markers and proxies to monitor ruminal function and feed efficiency in young ruminants

Developing the rumen's capacity to utilise recalcitrant and low-value feed resources is important for ruminant production systems. Early-life nutrition and management practices have been shown to influence development of the rumen in young animals with long-term consequences on their performance. Therefore, there has been increasing interest to understand ruminal development and function in young ruminants to improve feed efficiency, health, welfare, and performance of both young and adult ruminants. However, due to the small size, rapid morphological changes and low initial microbial populations of the rumen, it is difficult to study ruminal function in young ruminants without major invasive approaches or slaughter studies. In this review, we discuss the usefulness of a range of proxies and markers to monitor ruminal function and nitrogen use efficiency (a major part of feed efficiency) in young ruminants. Breath sulphide and methane emissions showed the greatest potential as simple markers of a developing microbiota in young ruminants. However, there is only limited evidence for robust indicators of feed efficiency at this stage. The use of nitrogen isotopic discrimination based on plasma samples appeared to be the most promising proxy for feed efficiency in young ruminants. More research is needed to explore and refine potential proxies and markers to indicate ruminal function and feed efficiency in young ruminants, particularly for neonatal ruminants.

Hyperhomocysteinemia as an Independent Risk Factor for Coronary Heart Disease. Comparison with Conventional Risk Factors

The present study was designed to evaluate the strength of association of raised plasma homocysteine concentration as a risk factor for coronary heart disease independent of conventional risk factor. It was a case control study conducted at Punjab Institute of Cardiology Lahore. A total of 210 subjects aged 25 to 60 years comprising of 105 newly admitted patients of CHD as cases and 105 age and sex matched healthy individuals with no history of CHD as control were recruited for the study. Fasting blood samples were obtained from cases and controls. Plasma homocysteine was analyzed by fluorescence polarization immunoassay (FPIA) method on automated immunoassay analyzer (Abbott IMX). Total cholesterol, triglyceride and HDL cholesterol were analyzed using calorimetric kit methods. The concentration of LDL cholesterol was calculated using Friedewald formula. The patients were also assessed for traditional risk factors such as age, sex, family history of CVD, hypertension, smoking and physical activity, and were compared with control subjects. The collected data was entered in SPSS version 24 for analysis and interpretation.The mean age in controls and experimental groups were 43.00± 8.42 years and 44.72± 8.59 years with statistically same distribution (p- value= 0.144). The mean plasma homocysteine for cases was 22.33± 9.22 µmol/L where as it was 12.59±3.73 µmol/L in control group. Highly significant difference was seen between the mean plasma level of homocysteine in cases and controls (p˂0.001).Simple logistic regression indicates a strong association of coronary heart disease with hyperhomocysteinemia (OR 7.45), which remained significantly associated with coronary heart disease by multivariate logistic regression (OR 7.10, 95%C1 3.12-12.83, p=0.000). The present study concludes that elevated levels of Plasma homocysteine is an independent risk factor for coronary heart disease independent of conventional risk factors and can be used as an indicator for predicting the future possibility for the onset of CVD.

Habitat selection by Asiatic black bear (Ursus thibetanus) in Siran and Kaghan Valleys, Pakistan

Asiatic black bear is present in variety of habitats like broad-leaves and coniferous forests, extending form sea level to 4300m elevation and change their habitat for food purpose seasonally. The present study was conducted at Kaghan and Siran Valleys, District Mansehra, Khyber Pakhtunkhwa, Pakistan to assess habitat of black bear. Line transect method was used for observation of bear signs. Twelve meter circular radius plots were selected for the concern vegetation's i.e. (trees, shrubs and herbs) and three to six plots were placed in each transect. At the result of sign survey, thirteen different categories of bear signs were recorded and encounter rate was calculated for each sign. A total of 1858 signs were observed during field surveys. Total (81%) coniferous species were recoded among trees, with the highest appearance of Pinus wallichiana (34.22%) and Spruce spp (27.76%), similarly broad leaves trees (18.56%) were also recoded from habitat plots. Most of the signs were encountered in bushy areas, whereas high number of Viburnum Spp (60.29%) was present. It is indicated that black bear prefers blend of Coniferous Trees, Viburnum and Ferns Species; probably because these plants provide enough food, protection, and meticulous shelter because more than 80% of habitat composed of these three species. Currently habitat destruction and increase in human population are the up-growing issues for wild animals (especially Asiatic black bear), which is highly sensitive to such problems. High levels of conservation efforts are recommended for the protection of black bear habitat and to avoid human interference in their territory.

Effect of postpartum collection time and colostrum quality on passive transfer of immunity, performance, and small intestinal development in preweaning calves

This study evaluated the effects of postpartum collection time and quality of colostrum fed to calves on the failure of passive transfer, growth, and small intestine development in the first 5 wk of life. Newborn calves (Holstein-Friesian × Jersey) were identified at birth and collected either early (E; within 12 h postpartum; n = 20) or late (L; 18-24 h postpartum; n = 20) and fed either high-quality colostrum [HQC, first milking colostrum with Brix% = 23 ± standard deviation (SD) 2] or low-quality colostrum (LQC, mixed colostrum and transition milk with Brix% = 12 ± 1) to create 4 treatments: E-HQC, E-LQC, L-HQC, and L-LQC (n = 10/treatment). After collection, calves (body weight = 32.3 ± 4.6 kg/calf) were fed either HQC or LQC (7.5% of their arrival body weight per feed) for the first 3 (L calves) or 4 feedings (E calves). All calves were then managed and fed similarly using automatic feeders which recorded individual intake of milk replacer and calf starter. Blood samples were taken at d 1 (after collection from dams but before colostrum feeding), 4, 14, and 35 of age to analyze selected metabolites. All calves were killed at d 35 ± 2 of age and histomorphology of duodenum, jejunum, and ileum was evaluated. At collection, 75% of E calves and 58% of L calves had serum total protein ≤52 g/L. At d 4 of age, calves fed HQC had greater serum total protein than calves fed LQC; however, failure of passive transfer (serum total protein ≤52 g/L) incidence did not differ between HQC and LQC. Collection time did not affect the scouring duration, but the amount of electrolyte used to treat sick calves was lower in L versus E calves, whereas feeding HQC versus LQC lowered both the scouring duration and electrolyte use to treat sick calves. Calves fed HQC had a greater total surface area of the duodenum (+23%) and jejunum (+17%) compared with LQC calves. Duodenal crypts were deeper in E-LQC calves than E-HQC and L-HQC calves, whereas L-LQC calves were intermediate. Villus height to crypt depth ratio in duodenum, jejunum, and ileum was greater in HQC than LQC calves. A trend toward greater average daily gain was observed in HQC versus LQC calves (667 vs. 590 g/d) but the average daily gain was not influenced by collection time. Serum IGF-1 at d 4 was higher in HQC versus LQC calves and this might have contributed to greater average daily gain and small intestine development. Calves fed HQC had higher feed conversion ratios (FCR; total body weight gain/total dry matter intake) compared with LQC calves, and L calves had higher FCR compared with E calves. In conclusion, in comparison to feeding LQC, feeding HQC reduced the scouring duration, enhanced surface area of duodenum and jejunum, and improved FCR during the first 5 wk of calf age. Postpartum collection time of calves did not affect small intestine development, but L calves had higher FCR and required a lesser volume of electrolytes to treat scours compared with E calves during the first 35 d of life.

Phytochemicals induce apoptosis by modulation of nitric oxide signaling pathway in cervical cancer cells

OBJECTIVE

Nitric Oxide (NO) is produced by NO synthases (NOS) and is a key signaling molecule that regulates tumorigenesis, both aiding and alleviating it. Elevated NO levels are cytotoxic to cancer cells, making NOS an important target for cancer treatment. In the present study, the modulatory effects of the phytochemicals, quercetin, sulforaphane, genistein, and epigallocatechin-3-gallate on NO pathway and apoptosis were shown in HeLa cervical cancer cells.

MATERIALS AND METHODS

Fluorescent microscopy and flow cytometry were used to assess apoptosis. A Griess assay was used to quantitatively measure NO, quantitative PCR array was used to assess the expression levels of genes involved in the NO signaling pathway, and immunocytochemistry was used to determine NOS protein expression. The functional association among the modulated genes was evaluated using network biology analysis, gene set enrichment, and KEGG pathway analysis.

RESULTS

Treatment with the phytochemicals elevated NO levels in HeLa cells and modulated various genes involved in nitric oxide biosynthesis, superoxide metabolism, and oxidative stress, including NOS1, NOS2, NOS3, ALOX12, and SOD2, with a concomitant increase in NOS2 and NOS3 protein expression levels; also, the phytochemicals were found to induce apoptosis.

CONCLUSIONS

These results suggest that the phytochemical-induced cell death is partially attributed to the activation of the NO pathway and upregulation of pro-oxidant ROS generators. Further experimental studies are required to explore this mechanistic association of NO signaling pathway activation and induction of apoptosis in other types of cancer.

[Medical rehabilitation of children with bronchial asthma]

Medical rehabilitation of children suffering from bronchial asthma is based on the complex use of natural therapeutic factors, drug, non-drug therapy and other methods in order to achieve control over the disease and long-term remission. The use of non-drug technologies is necessary taking into account the pathogenesis of the bronchial asthma development and is aimed at relieving bronchospasm, reducing the activity of allergic inflammation in the bronchi, improving their drainage function, strengthening the respiratory muscles and increasing exercise tolerance. When carrying out rehabilitation measures it is important to observe the basic principles of medical rehabilitation. An individual medical rehabilitation program is drawn up taking into account the assessment of the child's clinical condition at each stage with the diagnosis of the initial rehabilitation status, the establishment of a rehabilitation diagnosis and an assessment of the rehabilitation potential. The article presents the data of the analysis of scientific publications and our own research allowing to draw up an algorithm for the formation of an individual program of medical rehabilitation for children with bronchial asthma.

Proportion of Low Back Pain among Physicians Working in a Tertiary Level Hospital of Bangladesh

Low back pain (LBP) is a common problem and is an important public health issue. A major proportion of LBP is concomitant with prolong and repetitive awkward postures, related with occupation like miners, health workers and professional drivers. Physicians are exposed to a wide range of occupational risk factors which results in LBP. A variety of occupational and personal factors are responsible for increased risk of low back pain among physicians. This cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to June 2018, to estimate the proportion of LBP among physicians. Data were collected from purposively selected 102 physicians of different levels by face to face interview using a case record form. Informed written consent of participants was taken prior to interview. Data were analyzed by using SPSS version 20.0. The study results revealed that majority (60.8%) of the physicians were in the age group of 31-50 years. Mean age of the physicians was 49.9 years with a standard deviation (SD) of 3.61 years. More than three fourth (79, 77.5%) of the physicians were male and 23(22.5%) were female. Out of 102 physicians more than two third (70, 68.6%) had LBP while 32(31.4%) did not have any LBP. Proportion of low back pain among physician was 68.6%. Low back pain was found in all age group. Among the physicians having low back pain, 55(78.6%) were male and 15(21.4%) were female. Among 102 physicians, 45(44.1%) had different types of comorbidities while 57(55.9%) did not have any comorbidities. Among the co-morbidities HTN, DM, Dyslipidemia, CHD and asthma were common. Results of the study concluded that 68.6% physicians had low back pain. Physicians of age group 31-60 years (88.5%) and male (78.6%) experienced LBP more. Further multi-centric large scale case control study is recommended to determine the risk factors of LBP among physicians of Bangladesh.

Hyponatraemia in Adult Patients with Pneumonia in a Medical College Hospital of Bangladesh

Pneumonia is an acute on chronic infection involving the pulmonary parenchyma. Most cases are caused by microbial pathogens usually bacteria or viruses and less often fungi or parasites. Hyponatraemia on admission is associated with greater risk of death and increased length of hospital stays. Hyponatraemia is usually related to severe disease and specially occur in old aged people. This study is designed to identify proportion of hyponatraemia in patients with pneumonia and to determine the association of hyponatraemia with the severity of pneumonia. The cross sectional descriptive study was carried out at Mymensingh Medical College Hospital during the period of January 2018 to December 2018. Data were collected from purposively selected 73 admitted patients with pneumonia by interview, clinical examination and laboratory investigations using a pre-tested case record form. Data were analyzed by using SPSS version 20.0. Quantitative variables were summarized by mean and standard deviation. On the other hand qualitative variables were summarized by percentage. Necessary bivariate analysis was done. Majority (68.5%) of the patients were in the age group of 21 years to 50 years. Mean age of the patients was 41.9 years with a SD of 17.4 years. More than three fourth (57, 78.1%) were male and 16(21.9%) were female. More than two third (51, 69.9%) of the patients were smoker and 45(61.6%) was abuse of chewable tobacco or ghul. All the patients had fever (73, 100.0%); 70(95.9%) had cough, 50(68.5%) had chest pain, 10(13.5%) had respiratory distress and 8(11.0%) had haemoptysis. Vomiting was present in 9(12.3%) patients and 3(4.1%) had impaired level of consciousness. About one third of patients (32, 43.8%) had comorbidities. On chest X-ray consolidation was found in 59(80.8%) of patients with pneumonia. In 35(47.9%) patients serum Na⁺ level was normal and 38(52.1%) had different level of hyponatraemia; 26(35.6%) patients had mild hyponatraemia, 7(9.6%) had moderate hyponatraemia and 5(6.8%) had severe hyponatraemia. Majority (58, 79.5%) had lobar pneumonia and 71(97.3%) had community acquired pneumonia. Severity of pneumonia was assessed according to CURB 65. Less than half (35, 47.9%) of the patients had mild (score 0-1) pneumonia; 33(45.2%) had moderate (score 2) pneumonia and 5(6.8%) patients had severe (score ≥3) pneumonia. Average duration of hospital stay was 6.5±3.2 days. Maximum (69, 94.5%) patients were cured after treatment. In case of 3(4.1%) patients pneumonia was unresolved. One (1.4%) patients died due to pneumonia. In this study hyponatraemia was not associated with the severity of pneumonia (p>0.05) and outcome on discharge from the hospital (p>0.05). Difference in mean duration of hospital stay between patients of pneumonia with or without hyponatraemia was not significant (>0.05). The study results revealed that 52.1% patients with pneumonia developed different level of hyponatraemia. Hyponatraemia was not associated with the severity of pneumonia, duration of hospital stay and outcome of pneumonia.

Indoor air quality and its relationship with cluster type in urban Pakistani households

OBJECTIVE: To assess the levels and predictors of formaldehyde, nitrogen dioxide (NO₂), carbon monoxide (CO) and fine particulate matter with diameter less than 2.5 μm (PM2.5) in Karachi, Pakistan.METHODS: A total of 1629 households were selected through multistage cluster sampling in a community-based cross-sectional survey. Formaldehyde, NO₂ and CO levels were measured using YesAir Indoor air monitor and for PM2.5, UCB-PATS (University of California Berkeley Particle and Temperature Sensor) was used. Clusters were classified either as planned (areas of planned housing) or unplanned (informal settlements).RESULTS: We found the median concentrations to be as follows: formaldehyde, 0.03 ppm (IQR 0.00-0.090); CO, 0.00 ppm (IQR 0.00-1.00); NO₂, 0 ppm (IQR 0.00-0.00) and PM2.5, 0.278 mg/m³ (IQR 0.162-0.526). We found a significant association of the upper quartiles of formaldehyde and PM2.5 levels with type of cluster. The risk of obtaining formaldehyde and PM2.5 levels in the upper quartile was higher in unplanned clusters than in planned clusters (adjusted odds ratio [aOR] 33.0, 95% CI 4.02-271.5 and aOR 0.10, 95% CI 0.001-0.16, respectively). No significant association was observed between levels of CO and cluster type (aOR 0.84, 95%CI 0.62-1.14).CONCLUSION: This study reports high levels of indoor air pollutants in Karachi, with considerable variation across planned vs. unplanned clusters.

Addition of straw to the early-lactation diet: Effects on feed intake, milk yield, and subclinical ketosis in Holstein cows

This study evaluated feed intake, milk yield, and subclinical ketosis in dairy cows in early lactation fed 2 different diets postpartum. Cows are typically offered a high-energy ration immediately after calving. We compared a conventional high-energy total mixed ration (TMR) with a transition ration that contained chopped straw. We predicted that adding chopped straw would increase dry matter intake, milk production, and indicators of energy metabolism during the first 3 wk of lactation compared to cows fed a conventional high-energy TMR. We also predicted that carryover effects would be likely for at least 2 wk after treatment ended. A total of 68 mixed-age Holstein cows were enrolled in the study 3 wk before their expected calving. All cows were managed on a single high-forage diet during the dry period. At calving, cows were allocated to 1 of the 2 diets: half to the conventional high-energy TMR (CTMR; n = 34; net energy for lactation = 1.61 Mcal/kg; neutral detergent fiber = 31.7%), and the other half to a high-forage TMR containing chopped wheat straw, equivalent to 4.27% dry matter (STMR; n = 34; net energy for lactation = 1.59 Mcal/kg; neutral detergent fiber = 33.7%) for 3 wk after calving. Cows on STMR were then shifted to CTMR for the next 2 wk to study short-term residual effects on the performance of cows. Treatments were balanced for parity, body condition score, and body weight. Feed intake was measured daily from 2 wk before to 5 wk after calving using automatic feed bins. Blood was sampled twice weekly from 2 wk before to 5 wk after calving, and β-hydroxybutyrate and glucose were measured in serum samples. Subclinical ketosis was identified using a threshold of β-hydroxybutyrate ≥1.0 mmol/L in wk 1 after calving and ≥1.2 mmol/L in wk 2 to 5 after calving. Cows were milked twice daily, and weekly samples (composite samples of morning and afternoon milkings) were analyzed to determine total solids, fat, protein, lactose, and somatic cell count. Data were analyzed in 2 separate periods: the treatment phase (wk +1, +2, and +3) and the post-treatment phase (wk +4 and +5). The addition of straw to the TMR negatively affected the dry matter intake of STMR cows during wk 2 and 3 of lactation. Daily milk yield during the first 5 wk of lactation was lower in STMR cows than in CTMR cows. Concentrations of β-hydroxybutyrate were higher in CTMR cows than in STMR cows during wk 1, but this effect was reversed during wk 2 and 3 of lactation. By 21 d in milk, STMR cows had a greater risk of developing subclinical ketosis than CTMR cows. Adding chopped wheat straw to the TMR during the first 21 d after calving lowered dry matter intake and provided no metabolic or production benefits to lactating dairy cattle.

The Interplay of Disease Modifying Anti Rheumatic Drugs and Tuberculin Skin Test

OBJECTIVE

The study was conducted to determine whether synthetic Disease-Modifying Anti Rheumatic Drugs (DMARDs) suppress the latency of Tuberculosis (TB) infection in Rheumatoid Arthritis (RA) patients along with other variables.

METHODS

This was done through Tuberculin Skin Test (TST) using purified protein derivative (PPD) in a cohort of RA patients. The TST was taken positive when induration post-PPD injection was ≥ 5mm and negative or anergic when it was < 5mm. We included 100 patients (N = 100).

RESULTS

The prevalence of positive TST was 36%, while 64% presented a negative result. Negative TST was significantly associated with steroid usage (39.4%, 95% CI: 28.4%-51.4%). Anergic (TST negative) and non-anergic (TST positive) patients were separated into groups, and a new analysis was conducted with elaboration on DMARDs used.

CONCLUSION

The use of steroids was associated with TST negativity, The same is not true with use of methotrexate or other DMARDs. Thus TST should be interpreted with caution, especially before starting biologicals.

[Modern non-drug technologies for medical rehabilitation of children with consequences of perinatal affection of the central nervous system]

The article is devoted to the issues of medical rehabilitation of children with consequences of perinatal affection of the central nervous system (CNS). An important and principal aspect of the medical rehabilitation of children with perinatal pathology is the minimization of drugs, in this regard, in children in the first year of life, the leading role is given to non-drug methods of exposure. Among the important challenges of the medical rehabilitation of children with perinatal pathology are: improvement of blood supply and metabolic processes in the brain tissue, normalization of the central and peripheral regulation of muscle tone, improvement of neuromuscular conduction, stimulation of psychomotor development. In this case, kinesitherapy technologies are of leading importance: massotherapy, therapeutic exercises, reflex kinesitherapy according to V. Vojta; fitball gymnastics, method of fine finger training, dry floatation, etc. Along with physical rehabilitation methods, physiotherapy methods are actively used, which makes it possible to increase the effectiveness of treatment. The analysis of the literature showed that the use of modern non-drug technologies in children with perinatal CNS pathology, and their introduction into practice can significantly increase the effectiveness of medical rehabilitation of such children.

The impact of COVID-19 on emergency general surgery admissions and operative volumes: A single centre experience

Introduction

The COVID-19 pandemic has placed a significant strain on healthcare resources and utilisation globally. The appearance of the disease in the Republic of Ireland resulted in a broad postponement of scheduled and routine surgical care. The influence of the novel coronavirus, and the associated imposition of public health measures such as school closures and social distancing, on the burden of emergency surgical disease is less clear.

Aim

The aim of this study was to examine the impact of COVID-19 on the number of patients presenting to our institution with emergent surgical illnesses or requiring emergency general surgical procedures.

Methods

All patients attending our service between March 1st 2020 and April 30th 2020 were identified retrospectively by examining electronic handover and electronic discharge summaries, and data were collected relating to demographics, presenting illness, critical care utilisation, length of stay, operative or endoscopic procedure performed, and in-hospital mortality. Similar data were collected March 1st to April 30th 2019, 2018, and 2017 respectively to allow direct comparison.

Results

151 patients were admitted during the study period, compared to a total of 788 during the proceeding three years (mean 2.49 admissions per night versus 4.35 per night, 42.8% reduction, p < 0.001). Median age of admitted patients was 51.8 years, compared to 50.3 years formerly (p = 0.35). 53 emergency procedures were performed, compared to a median of 70 over the same period in the previous years (mean 0.87 per day versus 1.16 per day, 25.4% reduction, p = 0.05).

Conclusion

A significant overall reduction in the number of patients being admitted to our unit and requiring emergency surgical procedures during March and April 2020 was seen, in line with patterns reported internationally.

[To the question of the possibility of using selective chromotherapy for allergic diseases in children]

Allergic diseases are a common pathology in childhood. In the comprehensive medical rehabilitation of children with allergic pathology, non-drug methods of treatment are widely used, which help to reduce the number of drugs used, achieve and prolong the remission of the disease, favorably affect the clinical and functional indicators.

THE PURPOSE OF THE STUDY

Is the scientific justification for the use of selective chromotherapy in children with bronchial asthma (BA) and atopic dermatitis (AD).

MATERIAL AND METHODS

The study included 120 children with allergic diseases (BA and AD). Among 100 patients with BA, the main group included 50 children, who received exposure to monochromatic polarized green light on biologically active zones for 10 days, 50 - a comparison group that did not receive physiotherapy. The main group of children with AD included 10 patients who received selective blue chromotherapy for foci of skin lesions; the comparison group included 10 children who used only moisturizers without physiotherapy methods. In order to assess the effectiveness of the impact of physical factors in all patients, clinical and functional studies were conducted in the dynamics before and after treatment.

RESULTS AND DISCUSSION

The results of clinical and functional examinations showed high therapeutic efficacy of the use of monochromatic polarized green light in children with BA (92.0%). The effectiveness of treating children with blood pressure AD using monochromatic polarized light (blue) was 80%. Indications for the use of selective chromotherapy in children with allergic diseases have been developed. For children with BA, selective chromotherapy of the green spectrum is indicated in the presence of a mild to moderate course of the disease, a period of incomplete remission, and an increased level of anxiety. It is advisable to prescribe selective chromotherapy of the blue spectrum to children with a moderate and mild course of AD.

CONCLUSION

The positive effect of selective chromotherapy of the green spectrum on the clinical course of BA in children, bronchial patency, the functional state of the central nervous system and its autonomic part, and the psychoemotional status of children have been identified. The use of selective blue spectrum chromotherapy in children with AD helps to decrease the severity of objective symptoms, reduce the intensity of itching and sleep disturbance, as well as a marked decrease in the area of skin lesion.

[Modern possibilities of cryotherapy for chronic functional constipation in children]

INTRODUCTION

Among the urgent problems of pediatrics, chronic constipation occupies one of the leading positions due to its high prevalence (20-40%) and the possibility of complications. Conductive cryotherapy, used separately and in combination with percutaneous electroneurostimulation, is a promising technology for the treatment of chronic constipation in children.

AIM OF STUDY

Scientific evidence of the use of conductive cryotherapy and its combined effect with percutaneous electroneurostimulation in children with chronic constipation.

MATERIALS AND METHODS

We examined 80 children aged 3-15 years (average age 8±2 years) suffering from chronic constipation: 35 (43.8%) boys, 45 (56.2%) girls. In 47 (58.8%) children, chronic constipation of the hypotonic type (HT) was detected, in 33 (41.2%) - chronic constipation of the spastic type (ST). Children were divided into 4 groups, comparable in number, age, gender and clinical manifestations. Patients of all groups received basic treatment: laxative diet, probiotics, choleretic drugs, enzymes. Patients of the main group used the combined effect of conduction cryotherapy and percutaneous electroneurostimulation - cryoelectroneurostimulation. Conduction cryotherapy was prescribed for children of the 1st comparison group, percutaneous electroneurostimulation was assigned to the 2nd comparison group. Patients in the control group received only basic therapy. In order to assess the effectiveness of impact of physical factors, clinical and functional examinations of children were carried out before treatment, immediately after the course of treatment, and also 3, 6 and 12 months later after treatment.

RESULTS AND DISCUSSION

The highest treatment efficacy was found in children of the main group with HT and ST (91.6 and 87.5%, respectively) after cryoelectronic neurostimulation. Conduction cryotherapy was most effective for the treatment of ST (77.7%). The results of the study made it possible to develop an algorithm for the prescription of percutaneous electroneurostimulation and conduction cryotherapy, depending on the type of dyskinetic disorders of the colon in children. All children, regardless of the type of chronic constipation, are prescribed to use the combined effects of physical factors (cryoelectroneurostimulation), percutaneous electroneurostimulation is recommended for HT, conductive cryotherapy - for ST.

CONCLUSION

The higher therapeutic effectiveness of the combined use of conduction cryotherapy and percutaneous electroneurostimulation in various types of dyskinetic disorders in children has been proved according to immediate and long-term results of treatment. An algorithm is proposed for differential use of conduction cryotherapy and percutaneous electroneurostimulation taking into account the type of dyskinetic disorders of the colon.

Effects of physical forms of starter and milk allowance on growth performance, ruminal fermentation, and blood metabolites of Holstein dairy calves

A 2 × 2 factorial study was conducted to evaluate the effects of milk allowance and physical forms of starter on growth performance, ruminal fermentation, and blood metabolites of Holstein dairy calves. A total of 48 calves [40.4 ± 1.55 kg of body weight (BW), n = 12 per treatment: 6 males and 6 females] were randomly assigned to 1 of the 4 treatments: (1) calves fed low milk allowance and finely ground (FG) starter feed [low-FG; 1.47 ± 2.12-mm geometric mean particle size (GMLP)], (2) calves fed low milk allowance and textured (TS) starter feed [low-TS, includes steam-flaked grains (corn and barley) with a pelleted supplement, GMLP 4.15 ± 1.77 mm], (3) calves fed high milk allowance and FG starter feed (high-FG); and (4) calves fed high milk allowance and TS starter feed (high-TS). The starter diets were blended with 7% of chopped alfalfa hay as a proportion of diet dry matter (DM). No milk refusal was observed in any treatments, and calves on both treatments were weaned from milk by wk 8 of the study using a gradual weaning procedure. We observed no interaction between milk allowance and physical forms of starter on feed intake, average daily gain, feed efficiency, BW, and structural growth. Calves fed high milk allowance had lower starter feed intake but greater feed efficiency and overall BW compared with those fed low allowance. Total DM intake and average daily gain were not different among treatments. Regardless of the physical form of starter feed, hip height, heart girth, the molar proportion of ruminal acetate, acetate to propionate ratio, plasma cholesterol, and high-density lipoprotein were greater, but ruminal total volatile fatty acids, the molar proportion of propionate, and plasma β-hydroxybutyrate were lower in calves fed high milk allowance compared with those fed low allowance. Regardless of the milk allowance, calves fed the FG starter feeds had greater blood urea nitrogen concentrations compared with calves fed the TS starter diets. In conclusion, both forms of the starter feeds can be used when calves are fed high milk allowance with no negative effect on their performance.

Assessment of Mental Health and Various Coping Strategies among general population living Under Imposed COVID-Lockdown Across world: A Cross-Sectional Study

The 2019 corona virus disease (COVID-19) which outbreak in December 2019, in the Chinese city of Wuhan has became a global threat and is currently the largest known outbreak of atypical pneumonia affecting every continent of the world with about 6,416,828 cases and 382,867 deaths. Disease enforced lockdowns are known to cause heightened levels of depression, anxiety, and stress. Our study aimed to investigate the immediate impact of the COVID-19 pandemic enforced lockdown on mental health and quality of life among general population aged 18 years and to identify various coping strategies used under lockdown. An online survey was conducted between 1st of April-10th of May, 2020; using a validated questionnaire based on DASS-42, employing a snowball sampling technique. A total of 418 responses from 16 different countries were received. The respondents had a high level of depression and anxiety scores, which were significantly different among genders. Also, participants from developing countries-India and Pakistan had severe depression while as participants from India, Pakistan and Kingdom of Saudi Arabia had severe anxiety. We also found that among the various coping strategies, (a) watching television for entertainment, (b) social networking, (c) listening to music, (d) sleeping, (e) doing mundane house chores like cleaning, washing, etc. (f) eating well, and (g) clearing/finishing thepiled-up work were ranked among the most utilized coping strategies by all participants. This study identifies the need to provide the free professional and psychological services to help cope with stress during the disease-enforced lockdown.

Effects of step-down weaning implementation time on growth performance and blood metabolites of dairy calves

The current study evaluated the effects of step-down weaning implementation time on starter feed intake, growth performance, blood metabolites, and ruminal pH in dairy calves. A total of 48 Holstein dairy calves (24 male and 24 female; 3 ± 1 d old; 41.2 ± 1.8 kg of body weight) were assigned (n = 12 per treatment; 6 male and 6 female) to 4 experimental treatments in a completely randomized block design. All calves were fed 6 L/d of milk from d 3 to 10 of age, and the treatments consisted of the following: calves were offered 8 L/d of milk from d 11 to 28 of age and then 4 L/d from d 29 to 63 (Step-28; total milk offered = 326 L); calves were offered 8 L/d of milk from d 11 to 42 of age and then 4 L/d from d 43 to 63 (Step-42; total milk offered = 382 L); calves were offered 8 L/d of milk from d 11 to 56 of age and 4 L/d from d 57 to 63 (Step-56; total milk intake = 438 L); and calves were fed 8 L/d of milk from d 11 to 63 of age and abruptly weaned (control; total milk offered = 466 L). All calves were housed individually in pens and had ad libitum access to water and solid feed throughout the experiment. All calves were completely milk weaned on d 64, and their performance was measured until d 80 of age. During the experiment, the starter intake (kg/d and % of body weight) was greater in calves in the Step-28 group compared with those in the other groups. However, the total metabolizable energy intake was greater in the Step-56 calves compared with the other calves. Overall, the average daily gain (ADG), feed efficiency (ADG/dry matter intake), and ADG/total metabolizable energy intake were similar across the treatments. Circulating glucose, β-hydroxybutyrate, blood urea nitrogen, albumin, total protein, alanine aminotransferase, and aspartate aminotransferase, as well as ruminal pH, were not affected by the treatments. The implementation of step-down weaning in early life (4-6 wk of age) could stimulate solid feed intake compared with weaning at a later age with no negative effect on performance.

Plant growth-promoting endophytic bacteria augment growth and salinity tolerance in rice plants

Salt stress negatively affects growth and development of plants. However, it is hypothesized that plant growth-promoting endophytic bacteria can greatly alleviate the adverse effects of salinity and can promote growth and development of plants. In the present research, we aimed to isolate endophytic bacteria from halotolerant plants and evaluate their capacity for promoting crop plant growth. The bacterial endophytes were isolated from selected plants inhabiting sand dunes at Pohang beach, screened for plant growth-promoting traits and applied to rice seedlings under salt stress (NaCl; 150 mm). Out of 59 endophytic bacterial isolates, only six isolates, i.e. Curtobacterium oceanosedimentum SAK1, Curtobacterium luteum SAK2, Enterobacter ludwigii SAK5, Bacillus cereus SA1, Micrococcus yunnanensis SA2, Enterobacter tabaci SA3, resulted in a significant increase in the growth of Waito-C rice. The cultural filtrates of bacterial endophytes were tested for phytohormones, including indole-3-acetic acid, gibberellins and organic acids. Inoculation of the selected strains considerably reduced the amount of endogenous ABA in rice plants under NaCl stress, however, they increased GSH and sugar content. Similarly, these strains augmented the expression of flavin monooxygenase (OsYUCCA1) and auxin efflux carrier (OsPIN1) genes under salt stress. In conclusion, the pragmatic application of the above selected bacterial strains alleviated the adverse effects of NaCl stress and enhanced rice growth attributes by producing various phytohormones.

Effects of conditioner retention time during pelleting of starter feed on nutrient digestibility, ruminal fermentation, blood metabolites, and performance of Holstein female dairy calves

This study evaluated the effects of conditioner retention time during the pelleting process of starter feed on intake, nutrient digestibility, ruminal fermentation, blood metabolites, and growth performance of dairy calves. A total of 30 Holstein female dairy calves [40 ± 1.93 kg of body weight (BW)] were randomly assigned to 1 of 3 treatments: (1) pelleted starter conditioned for 0 min (CON), (2) pelleted starter conditioned for 2 min, and (3) pelleted starter conditioned for 4 min. Three pelleted starter feeds had similar nutritional composition, and the starters were blended with 3% chopped wheat straw and fed to individually housed calves from d 3 to 70 of age. All calves were fed 4 L/d of pasteurized whole milk twice daily at 0800 and 1600 h from d 3 to 50 of calf age, followed by 2 L/d of morning feeding from 51 to 56 d of age. All calves were weaned on d 56 of age and remained in the study until d 70 of age. With the increase of conditioner retention time during pellet processing for 0, 2, and 4 min, the gelatinized starch content of pelleted starter feed linearly increased from 14, 30, and 45%, respectively. Additionally, the pellet durability and hardness also linearly increased with increasing conditioner retention time during pelleting. Feeding pelleted feed prepared using different conditioner retention time did not affect feed dry matter intake, metabolizable energy intake, weaning BW, final BW, or feed efficiency during the study. We observed no differences in the total-tract apparent digestibility of organic matter, neutral detergent fiber, and crude protein around weaning (d 49 to 56 of age) and after weaning (d 63 to 70 of calf cage); however, the digestibility of dry matter and starch after weaning was increased with increasing conditioner retention time during pelleting of starter feed. No difference was found in overall average daily gain (ADG) or growth rates of hip height, withers height, and heart girth. Ruminal volatile fatty acid profile was not affected by pelleting under different conditioner retention times. The ruminal ammonia concentration tended to be lower for calves fed the 4-min diet compared with those fed the CON diet during the postweaning period. The postweaning (d 57-70 of age) ADG was greater for calves fed the 4-min diet compared with those fed the CON diet. In conclusion, the conditioning time during the pelleting process of starter feed increased the gelatinization of starch, durability, and hardness of the pellets but did not influence feed intake, feed efficiency, and skeletal growth during the first 70 d of age. Increasing conditioning time during the pelleting process improved postweaning ADG; however, the final BW of calves was similar among treatments.

Comparison of statistical methods for recurrent event analysis using pediatrics asthma data

When the same type of event is experienced by a subject more than once it is called recurrent event, which possess two important characteristics, namely "within-subject correlation" and "time-varying covariate." As a result, the traditional statistical methods do not work well on recurrent event data. Over the past few decades, many alternatives methods have been proposed for the analysis of recurrent event data. In this article, the six most prominent methods for recurrent event analysis have been compared on pediatric asthma data. Three variance corrected models (viz "Anderson and Gill [AG] model," "Prentice, William, and Peterson-Counting Process [PWP-CP] model," and "Prentice, William, and Peterson-Gap Time [PWP-GT] model") and three corresponding frailty variants (AG-frailty, PWP-CP-frailty, and PWP-GT-frailty) were compared using three mathematical criterion (AIC, BIC, and log-likelihood) and one graphical criteria (Cox-Snell goodness of fit, visual test). All model comparison indices showed the PWP-GT model as the most appropriate model on asthma data over other models. By using PWP-GT model, seven predictors of asthma exacerbation (viz "abdominal pain at previous visit," "Z5 (%) at previous visit," "diagnosis of asthma at previous visit," "calendar month of exacerbation," "history of maternal asthma," "monthly per capita income," and "emotional stress") were identified. The PWP-GT model was identified as the most appropriate model over other models on pediatrics asthma data.

Effect of arginine or glutamine supplementation and milk feeding allowance on small intestine development in calves

The development of the small intestine (SI) is important for the health and growth of neonatal calves. This study evaluated the effect of arginine (Arg) and glutamine (Gln) supplementation and 2 levels of milk allowance on the histomorphological development of the SI in preweaning calves. Sixty mixed-sex Friesian × Jersey calves (3-5 d of age) were offered reconstituted whole milk (125 g/L, 26% fat, 26% protein) at either high (20% of arrival body weight/d; HM) or low (10% of arrival body weight/d; LM) milk allowance without (Ctrl) or with supplementary Arg or Gln (at 1% of milk dry matter) in a 2 × 3 factorial design (n = 10/treatment). After 35 d on the diets, all calves were slaughtered to collect tissues for examination of SI development. Calves in the HM group had higher milk intake, total weight gain, and average daily gain compared with LM calves, but no effect of AA supplementation nor an interaction between milk allowance and AA supplementation was observed. For the duodenum, we observed an AA by milk allowance interaction for villus height and width, and goblet cell number per villus (HM-Arg > HM-Gln > HM-Ctrl), and villus height to crypt depth ratio (HM-Arg > HM-Gln = HM-Ctrl), but no effect of AA supplementation in the LM group. Goblet cell numbers per 100 µm of SI were greater in Arg-supplemented calves than in unsupplemented controls, with Gln-supplemented calves intermediate to but not different from the other groups. Epithelium thickness was greater in LM than in HM calves. Villus density, crypt depth, and muscle thickness did not differ between groups. For the jejunum, there was an AA by milk allowance interaction for villus height, villus surface area, and villus height to crypt depth ratio (HM-Arg = HM-Gln > HM-Ctrl), with no effect of AA supplementation in the LM groups. Amino acid supplementation affected goblet cell number per villus (HM-Gln > HM-Ctrl calves, HM-Arg intermediate), and both LM-Arg and LM-Gln calves had greater numbers than LM-Ctrl calves. Villus width, crypt depth, and muscle thickness were greater in HM than LM calves but there was no effect of AA supplementation. Villus density, goblet cell number per 100 µm of SI, and epithelium thickness were unaffected by AA supplementation and milk allowance. Milk allowance and AA supplementation had no effect on SI morphology in the ileum. Increasing milk allowance improved villus height, width, and surface area but only in Arg- or Gln-supplemented calves, not in control calves. The observed changes in development may be important for intestinal functionality, integrity, and barrier function in preweaning calves, potentially through increased cell growth and proliferation or reduced levels of cellular atrophy.

[Medical Rehabilitation after Hydronephrosis Surgical Treatment in Children]

The article presents modern technologies of medical rehabilitation of children operated for hydronephrosis. The importance of medical rehabilitation of children with hydronephrosis is associated with high incidence, possibility of developing chronic kidney disease, and early disability of these patients. After surgery on the ureter it is important to use medical rehabilitation technologies aimed at preventing urodynamics disorders of upper and lower urinary tract, and at stimulation of regenerative processes. In recent years, particular attention has been paid to high-intensity pulsed electromagnetic field therapy, which has a more significant and long-term stimulating effect compared to various types of electrical stimulation. Clinical studies were conducted in 80 children operated for hydronephrosis, aged 3 to 15. The main group consisted of 40 children who received high-intensity pulsed magnetic therapy, and 40 children were included in the control group (without physiotherapy). Basic treatment included uroseptics and exercise therapy. Effectiveness of the method was assessed using clinical, laboratory and ultrasound data, and Doppler ultrasound of the renal blood flow. The results of the study demonstrated the rationale of including high-intensity pulsed electromagnetic field therapy in medical rehabilitation of children operated for hydronephrosis. The positive effect of high-intensity pulsed electromagnetic therapy on the urodynamics of the urinary tract (reduction in the size of renal pelvis and calyx) and renal blood flow (restoration of blood flow to the renal cortex) were revealed. This method helped to reduce inflammation in the renal parenchyma (reduction of proteinuria, leukocyturia) in children operated on for hydronephrosis. A significantly higher effectiveness of medical rehabilitation with the use of high-intensity pulsed magnetic therapy was proved (87.5%).