Unveiling Disparities: Exploring Differential Attainment in Postgraduate Training Within Clinical Oncology

AIMS

Differential attainment (DA) in post graduate medical training is a recognised challenge and refers to unexplained variation across groups when split by several protected characteristics. The Royal College of Radiology is committed to fostering diversity, inclusivity, and equality with the goal of narrowing existing gaps and improving training outcomes.

MATERIALS AND METHODS

This was a mixed methods study aiming to understand the causes of DA with view to helping the RCR develop strategies to address this. A cross-sectional survey was completed by 140 clinical oncology trainees in September 2022. Trainees and trainers (17 and 6 respectively) from across England, Scotland, Wales and Northern Ireland, took part in focus group and interviews from August to December 2022. Quantitative and qualitative data merged and interpreted.

RESULT

Results showed international medical graduates and trainees from ethnic minority backgrounds were more likely to encounter challenges. The qualitative findings were used to identify three themes through which these problems could be framed. The trainee as a "space invader," the hidden curriculum of clinical oncology training and the process of navigating and tacking the training journey.

CONCLUSION

Differential attainment is the product of a complex interplay between the trainee, trainer, and the training environment. Therefore, interventions must be tailored to different people and contexts. At a national level, the RCR can adopt general policies to promote this such as mentorship programmes, protected time for supervision and cultural competency training. Efficacy of proposed interventions for trial and their impact on DA should be evaluated to drive evidence-based changes.

Fate and potential risks of microplastic fibers and fragments in water and wastewater treatment processes

Water and wastewater treatment plants (WWTPs) receive various types of microplastics (MPs), with fibers and fragments being dominant shapes. Here we investigated the removal behavior and transformation of MPs (polypropylene and polyethylene terephthalate fibers and fragments) in simulated water and wastewater treatment units, including activated sludge process, coagulation, sand filtration, and advanced oxidation/disinfection. Sand filtration demonstrated the highest average efficiency in removing MPs (98 %), followed by activated sludge process (61 %) and coagulation (55 %), which was associated with their physicochemical properties (shape, size, density, surface functional groups, etc). In activated sludge process and coagulation, the polymer type had a greater impact on the removal of MPs than the particle shape, while in sand filtration, the particle shape played a more important role. When subjected to the long-term operation and backwashing of sand filters, approximately 15 % of the initially filtered fragments broke through the sand media, with nearly no fibers escaping. UV-based advanced oxidation and chlorination induced the leaching of dissolved organic matters with different molecular characteristics from fragment MPs, resulting in varying levels of cytotoxicity and bacterial toxicity. Our study provides important information for predicting the fate of MPs and mitigating their impacts in WWTPs.

Acyclovir-Induced Nephrotoxicity in Adults with Viral Encephalitis

OBJECTIVE

To determine the frequency of parenteral Acyclovir-induced Acute Kidney Injury (AKI) in patients with viral encephalitis.

STUDY DESIGN

Descriptive study. Place and Duration of the Study: Department of Neurology, Liaquat National Hospital, Karachi, from January to December 2021.

METHODOLOGY

A total of 89 suspected and proven cases of encephalitis receiving IV Acyclovir were collated. All had extensive medical histories and underwent CSF studies with +/- brain imaging. CSF routine and viral PCR were done. Acyclovir-induced AKI was defined as a rise in serum creatinine of >0.3 mg/dl in 48 h or by ≥1.5 times the baseline value, and its severity was staged into 1 (risk), 2 (injury), and 3 (failure) according to the KDIGO guidelines (Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group, 2012). Patients' variables, including age, gender, presenting features, comorbid conditions, and CSF findings, were divided into two groups, i.e. with and without AKI.

RESULTS

This research included 89 patients with a mean age of 48 years. AKI occurred in 34 patients (38.2%). The frequency of AKI with Stage 1 was 24%, Stage 2 was 44%, and Stage 3 was 32%; approximately two-thirds of cases were in Stage 2 and 3 (p >0.05). Five patients (5.6%) from Stage 3, required dialysis.

CONCLUSION

AKI is an important adverse effect of parenteral acyclovir, which necessitates its early identification and timely management. Renal function monitoring is essential for patients on Acyclovir treatment as they are at risk for AKI.

KEY WORDS

Acyclovir, Acute kidney injury, Viral encephalitis, Creatinine, Kidney Disease Improving Global Outcomes.

Chromate Removal by Enterobacter cloacae Strain UT25 from Tannery Effluent and Its Potential Role in Cr (VI) Remediation

An indigenous chromate-resistant bacterial strain isolated from tannery effluent was identified based on morphological, biochemical, and 16S rRNA gene sequencing, as Enterobacter cloacae UT25. It was found to resist heavy metal ions such as Cr (VI), Pb (II), Cu (II), Co (II), Ni (II), Hg (II), and Zn (II) and antibiotics. The strain was able to remove 89 and 86% chromate, after 24 h of incubation in a Luria-Bertani (LB) medium at an initial Cr (VI) concentration of 1000 and 1500 µg/ml, respectively. Minimum inhibitory concentration (MIC) was observed for chromate to be 80,000 and 1850 µg/ml, after 48 h of incubation in LB and acetate minimal media (AMM), respectively. Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM) analysis showed discrete cells with intact and smooth cell walls and homogenous cytoplasm in the absence of metal stress, whereas chromate stress caused cell lysis and reduction in size, which was a characteristic response to Cr (VI) toxicity. Energy Dispersive X-Ray Spectroscopy (EDX) confirmed the adsorption of oxyanions to the cell wall which was one of the Cr (VI) removal mechanisms by the bacterium. Atomic Force Microscopy (AFM) micrographs of chromate-untreated and treated cells revealed Root Mean Square roughness (Rq) values of 16.25 and 11.26 nm, respectively, indicating less roughness in the presence of stress. The partial gene sequence of class 1 integrons (intI1) of strain UT25 showed 94% homology with intI1 gene of strain Enterobacter hormaechei strain ECC59 plasmid pECC59-1. The present analysis highlighted the potential of E. cloacae UT25 as a promissory bacterium that could be applied in removing chromate from polluted environments.

Seasonal variation and spatial distribution of microplastics in tertiary wastewater treatment plant in South Korea

Wastewater treatment plant (WWTP) is proposed to be a point source of microplastics (MPs) that enter aquatic environments. Here, we quantified and characterized MPs down to 20 µm at a tertiary WWTP in Korea over a 1-year period. All wastewater contained MPs during the monitoring period, with concentrations ranging from 114 ± 17-216 ± 65 particles/L for influent and from 0.26 ± 0.29-0.48 ± 0.11 particles/L for effluent. MP abundance in the influents showed significant seasonal differences whereas a seasonal trend was not observed for the effluents, indicating a stable treatment performance (approx. 99.8%) of the WWTP. Spatial surveys of MP distribution in the WWTP showed that most MPs were removed by coagulation-sedimentation and rapid sand filtration, but some MPs still remained in the final effluent to generate the potential annual load of 2.9 × 10⁹ particles and 0.54 kg into the rivers. These findings highlight the importance of long-term monitoring and MP mass quantification that would promote more accurate estimation of the MP load from WWTPs.

Evaluating the Role of Wastewaters as Reservoirs of Antibiotic-Resistant ESKAPEE Bacteria Using Phenotypic and Molecular Methods

Introduction

Methodology

Results

Conclusion

A study on the utilization of rice husk as a biosorbent material for Cr (VI) removal from industrial effluent

Purpose: To study Cr (VI) removal from waste water using chromium-resistant bacterial strains in combination with rice husk. Methods: Two strains of Exiguobacterium sp. resistant to chromium (VI) were applied in the present work. Rice husk (RH) was used as an agricultural waste for Cr (VI) removal. The elimination of Cr from the husk was chemically facilitated using hydrochloric, sulphuric and citric acids, as well as formaldehyde and potassium dihydrogen phosphate Investigation of optimum physical factors such as pH, temperature, shaking speed and biomass concentration on Cr (VI) removal was carried out using citric acid-processed rice husk alone, and in combination of bacterial strains. Fourier transform infra-red (FTIR) spectroscopy was performed to determine the contributions of different functional groups involved in Cr (VI) binding. Scanning electron microscopy (SEM) of treated and untreated RH was also performed. Results: Citric acid-processed RH was most effective in the removal of chromate (97.3 %). The two bacterial strains combined with rice husk proved highly efficient in Cr (VI) removal from sterile and non-sterile industrial effluents. FTIR spectra showed the involvement of esters, amines and aliphatic functional groups in Cr (VI) binding, while SEM displayed the damaging effects of Cr (VI) on the surface of RH; however, bacterial inoculation minimized the damage. Conclusion: Exopolysaccharides from Exiguobacterium strains and citric acid-processed rice husk demonstrated high efficiency for Cr (VI) removal. Hence, RH with these bacterial strains are potential biosorbents for control of heavy metal contamination arising from industrial effluents.

COVID-19 severity: Studying the clinical and demographic risk factors for adverse outcomes

BACKGROUND

The primary goal of the presented cross-sectional observational study was to determine the clinical and demographic risk factors for adverse coronavirus disease 2019 (COVID-19) outcomes in the Pakistani population.

METHODS

We examined the individuals (n = 6331) that consulted two private diagnostic centers in Lahore, Pakistan, for COVID-19 testing between May 1, 2020, and November 30, 2020. The attending nurse collected clinical and demographic information. A confirmed case of COVID-19 was defined as having a positive result through real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay of nasopharyngeal swab specimens.

RESULTS

RT-PCR testing was positive in 1094 cases. Out of which, 5.2% had severe, and 20.8% had mild symptoms. We observed a strong association of COVID-19 severity with the number and type of comorbidities. The severity of the disease intensified as the number of comorbidities increased. The most vulnerable groups for the poor outcome are patients with diabetes and hypertension. Increasing age was also associated with PCR positivity and the severity of the disease.

CONCLUSIONS

Most cases of COVID-19 included in this study developed mild symptoms or were asymptomatic. Risk factors for adverse outcomes included older age and the simultaneous presence of comorbidities.

Bursting the Virulence Traits of MDR Strain of Candida albicans Using Sodium Alginate-based Microspheres Containing Nystatin-loaded MgO/CuO Nanocomposites

INTRODUCTION

Candida albicans is a major opportunistic pathogen that causes a wide range of human infections. Currently available therapeutic agents are limited for treating these fungal infections due to multidrug resistance as well as their nonbiodegradability, poor biocompatibility and toxicity. In order to battle these limitations, we have synthesized a polymeric system as microcarriers to deliver the antifungal drug. The objective of the present study was to immobilize MgO/CuO nanocomposite and nystatin-loaded MgO/CuO nanocomposites in nontoxic, nonimmunogenic, biodegradable and biocompatible sodium alginate microspheres for the first time.

MATERIALS AND METHODS

Nanoparticle-loaded sodium alginate microspheres were prepared by ionotropic gelation technique using calcium chloride as a cross-linker. Synthesized microspheres were characterized using standard characterization techniques and were evaluated for biological activity against MDR strain of C. albicans.

RESULTS

Characterization of microspheres by Fourier-transform infrared spectroscopy confirmed loading of Nys-MgO/CuO NPs, scanning electron microscopy (SEM) revealed rough spherical beads with a highly porous surface having an average size in the range of 8-10 µm. X-ray diffraction (XRD) analyzed its semicrystalline structure. Entrapment efficiency of Nys-MgO/CuO NPs was 80% and release kinetic study revealed sustained and prolonged release of drug in pH 5.5. Flow cytometry analysis showed yeast cell death caused by Nys-MgO/CuO MS exhibits late apoptotic features. In cytotoxicity assay 5-14 mg of microspheres did not cause hemolysis. Microspheres reduced virulence traits of C. albicans such as germ tube and biofilm formation were compromised at concentration of 5 mg/mL. Antimicrobial assessment results revealed a pronounced inhibitory effect against C. albicans.

CONCLUSION

The in vitro experiments have shown promising results based on good stability, Nys-MgO/CuO NP-encapsulated microspheres can be used as a prolonged controlled release system against MDR pathogenic C. albicans.

Novel N-p-carboxy benzyl chitosan/poly (vinyl alcohol/functionalized zeolite mixed matrix membranes for DMFC applications

The novel N-p-carboxy benzyl chitosan (CBC)/ poly (vinyl alcohol) (PVA) based mixed matrix membranes (MMMs) filled with surface-modified zeolite have been prepared using the dissolution casting technique. The applicability of prepared MMMs for direct methanol fuel cell (DMFC) was investigated in terms of water uptake, methanol permeation, and proton conductivity by changing filler content (10-50 wt. %). The zeolite was modified by silane coupling agent, 3-mercaptopropyltrimethoxysilane (MPTMS). The resultant modified zeolite (MZ) was incorporated into CBC/PVA blend to obtain mixed matrix PEMs. The functional group, structural properties, morphological and topographical investigation of MMMs were examined using Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and Scanning electron microscopy (SEM) respectively. The prepared MMMs exhibited a remarkable decrease in methanol permeability of 2.3 × 10^-7  cm²/s with C-CPMZ50. The maximum value of proton conductivity of 0.0527 Scm^-1, was shown by C-CMPZ10. The prepared PEMs also displayed good stability during long term operating time.

Phytochemical screening and antibacterial potential of Artemisia absinthium L., Swertia chirayita and Sphaeranthus indicus

Utilization of herbs for medicinal purpose started in the early history of mankind several thousand years ago. In this study, some plants that are used for lowering cholesterol level in local areas of Pakistan, such as Artemisia absinthium L., Swertia chirayita and Sphaeranthus indicus were screened for their phytochemical and antibacterial properties. For this purpose, these plants were extracted in different solvents i.e. ethanol, hexane and ethyl acetate. Phytochemcial analysis unveiled the existence of different bioactive compounds in these extracts. Presence of sugars was further confirmed by performing TLC. Antibacterial activity was determined against indicated bacterial strains, among all extracts Gul-e-mundi had maximum inhibition zone (23mm). DPPH free radical assay revealed the significant antioxidative potential of all the extracts where Gul-e-mundi showed maximum potential i.e., 83%. Plant extracts were also showing anti-proliferative activity on root tips of Allium cepa and Gul-e-mundi was observed to have maximum antimitotic activity i.e. 5%. GC-MS analysis revealed that oleic acid and linoleic acid were the compounds responsible for imparting antibacterial potential to Gul-e-mundi. In conclusion, among all the tested extracts Gul-e-mundi had maximum antibacterial, antioxidative and antimitotic potential. For future studies, phytochemcials responsible for these activities can be isolated and modified for pharmacological purpose.

Antilisterial Effect of Rosa damascena and Nymphaea alba in Mus musculus

The present study was proposed to investigate the toxicological and prophylactic potential of ethanolic extracts of Rosa damascena and Nymphaea alba and their mixture in albino mice. For toxicity study, three different doses of plant extracts were orally administrated to three groups of mice for 14 successive days. Blood biochemistry and histological examinations of liver and kidney revealed that these extracts had no harmful effects up to 1000 mg/kg. To determine the prophylactic effects of Rosa damascena, Nymphaea alba, and their mixture, an infection model of Listeria monocytogenes was established in a pilot study. Establishment of infection was confirmed by changes in haematological parameters and reisolation of Listeria monocytogenes from different tissues. Results showed that these extracts alone or in combination could restrict the growth of Listeria monocytogenes in different organs. Neutrophils were high in positive control group but remained in normal range in all treated groups. Listeria monocytogenes was recovered in low numbers from animals treated with extract of single plant but was negligible in group treated with mixture of extract of plants. Platelets count was increased in treated groups as compared to control. Results confirmed that these extracts are potent source of antimicrobial compounds and that they have synergistic effect in combined form.

Study of anticancer and antibacterial activities of Foeniculum vulgare, Justicia adhatoda and Urtica dioica as natural curatives

High-throughput technologies, such as synthetic biology and genomics have paved new paths for discovery and utility of medicinally beneficial plants. Bioactive molecules isolated from different plants have significantly higher biological activities. The present study was done to analyze antibacterial potential of some medicinal plants against multi drug resistant (MDR) pathogens and anticancer effect against MCF-7 cell line. Methanolic and ethanolic extracts were tested for their antibacterial activity by disc diffusion method against six MDR bacterial strains and for cytotoxicity evaluation by MTT assay. Ethanolic extracts of the three tested plants exhibited growth inhibitory effect against Klebsiella pneumonia, Serratia marcescens and Methicillin-resistant S. aureus. Pseudomonas aeruginosa was more resistant to all extracts as its growth was least inhibited by the extracts of all tested plants. Ethanol extract of Foeniculum vulgare exhibited significant inhibition of cancer cells proliferation. Methanol extract of Justicia adhatoda also showed considerable inhibition of cancer cells. Future studies must converge on detailed investigation of modes of action of extracts of tested plants.

Anticancer activity of Cynodon dactylon and Oxalis corniculata on Hep2 cell line

Bioactive chemicals isolated from plants have attracted considerable attention over the years and overwhelmingly increasing laboratory findings are emphasizing on tumor suppressing properties of these natural agents in genetically and chemically induced animal carcinogenesis models. We studied in vitro anticancer activity of organic extracts of Cynodon dactylon and Oxalis corniculata on Hep2 cell line and it was compared with normal human corneal epithelial cells (HCEC) by using MTT assay. Real Time PCR was conducted for p53 and PTEN genes in treated cancer cell line. DNA fragmentation assay was also carried out to note DNA damaging effects of the extracts. The minimally effective concentration of ethanolic extract of Cynodon dactylon and methanolic extract of Oxalis corniculata that was nontoxic to HCEC but toxic to Hep2 was recorded (IC50) at a concentration of 0.042mg/ml (49.48 % cell death) and 0.048mg/ml (47.93% cell death) respectively, which was comparable to the positive control. Our results indicated dose dependent increase in cell death. P53 and PTEN did not show significant increase in treated cell line. Moreover, DNA damaging effects were also not detected in treated cancer cell line. Anticancer activity of these plants on the cancer cell line showed the presence of anticancer components which should be characterized to be used as anticancer therapy.

Impact of environmental stress on biochemical parameters of bacteria reducing chromium

Chromium pollution is produced in connection with industrial processes like in tanneries. It has been suggested that bioremediation could be a good option for clean up. The stress effect of variable chromate levels, pHs and growth temperatures on biochemical parameters of two Cr(VI) reducing bacterial strains Pseudomonas aeruginosa Rb-1 and Ochrobactrum intermedium Rb-2 was investigated. Transmission electrone microscopy (TEM) was performed to study the intracellular distribution of Cr(VI). It was observed that initial stress of 1000 μgmL(-1) caused significant enhancement of all studied biochemical parameters at pH 7.0 and growth temperature of 37 °C showing great bioremediation potential of the strains. Transmission electron microscopy revealed that the distribution of chromium precipitates was not uniform as they were distributed in the cytoplasm as well as found associated with the periplasm and outer membrane. Fourier transform infrared spectroscopy showed the possible involvement of carboxyl, amino, sulpohonate and hydroxyl groups present on the bacterial cell surface for the binding of Cr(VI) ions. Cr(VI) stress brought about changes in the distridution of these functional groups. It can be concluded that the investigated bacterial strains adjust well to Cr(VI) stress in terms of biochemical parameters and along that exhibited alteration in morphology.