Level of polychlorinated biphenyls in tumor and blood serum of breast cancer patients and control subjects from Punjab, Pakistan

The current study examined the level of Polychlorinated biphenyls (PCBs) in tumor and blood serum of female breast cancer patients and control individuals recruited from Punjab, Pakistan. Breast tumor and blood serum from 40 patients and only blood serum from ten control subjects were obtained and concentration of 32 PCB congeners was analyzed through Gas chromatography coupled with Mass spectrophotometry. Sociodemographic variables of the patients along with essential clinical and haematological parameters were taken as covariates. Tumor reflects the highest median (min-max) concentration (ng g-1 lw) of ƩPCBs at 115.94 (0.05-17.75) followed by 16.53 (0.09-2.94) and 5.24 (0.01-0.59) in blood serum of cancer patients and control group respectively. Median concentrations (ng g-1 lw) of non-dioxine like ƩPCBs were considerably higher at 83.04, 32.89 and 4.27 compared to 13.03 and 3.50 and 0.97 for dioxin like ƩPCBs in tumor, serum of breast cancer patients and control subjects respectively. PCB-87 was most dominant congeners in tumor followed by PCB-170 and -82 whereas PCB-28 and -52 reflected greatest contribution in serum of breast cancer patients. Blood haemoglobin, potassium and chloride ions showed significant positive whereas body mass index reflect inverse relationship when regressed with ƩPCBs in tumor. This pioneer study depicts elevated concentrations of PCBs in patients compared to control, reflecting potential positive association of PCBs with breast cancer which need further confirmation. We concluded that chronic exposure to PCBs might be associated with an increasing number of breast cancer incidences in developing countries like Pakistan, which should be further elucidated through detail in vitro and in vivo studies.

Spatial analysis of factors influencing bacterial leaf blight in rice production

Xanthomonas oryzae pv. oryzae (Xoo) causes bacterial leaf blight that is a major threat to rice production. Crop losses in extreme situations can reach up to75%, and millions of hectares of rice are affected each year. Management of the disease required information about the spatial distribution of BLB incidence, severity, and prevalence. In this study, major rice-growing areas of Pakistan were surveyed during 2018-2019 for disease occurrence, and thematic maps were developed using geographic information system (GIS). Results showed that Narowal district had highest percentage of disease incidence (54-69%), severity (42-44%), and prevalence (72-90%) meanwhile Jhung district had the lowest incidence (21-23%), severity (18-22%), and prevalence (45-54%). To understand the environmental factors contributing to this major rice disease, the research analyze, the spatial relationships between BLB prevalence and environmental variables. Those variables include relative humidity (RH), atmospheric pressure (A.P), minimum temperature, soil organic carbon, soil pH, and elevation, which were evaluated by using GIS-based Ordinary Least Square (OLS) spatial model. The fitted model had a coefficient of determination (R2) of 65 percent explanatory power of disease development. All environmental variables showed a general trend of positive correlation between BLB prevalence and environmental variables. The results show the potential for disease management and prediction using environmental variable and assessment.

Outcomes of cardiac CT investigations in patients from the Rapid Access Chest Pain clinic with consideration to additional CT modalities and individual risk factors

Funding Acknowledgements

Type of funding sources: None.

Coronary CT is a first line investigation according to NICE guidelines, yet there are still uncertainties in its ability to decrease adverse event rates. The high sensitivity and high negative predictive value of coronary CT only validates low to moderate pre-test probability of attaining significant CAD due to its low positive predictive value. Improving outcomes in coronary CT could avoid events and limit the use of invasive modalities such as invasive coronary angiography. Increased probability of MACE with presence of risk factors could also raise the merit of risk stratification utilization for better classification.

This study provides insight into the effectiveness of CT as a first-line investigation for new onset angina referred to RACPC regardless of CAD probability and any further testing. Data differences on outcome probabilities in risk stratification utilization and different CT modalities, both coronary calcium scoring and coronary angiography, raised notion that the incremental value of these tools should not be overlooked. End-outcomes would compromise of MACE composites after a 6-month follow-up. We hypothesize that patients investigated with coronary CT as opposed to without, with presence or absence of functional testing, would grant better clinical outcomes.

Data on 155 patients who registered in RACPC were identified and collected from Brunei Health Information Management Systems for a one-year period (August 2018- August 2019). Information on sociodemographic, risk factors, further diagnostic testing, CT reports and event follow-up at 6 months were extracted, subject to availability. Probability of CAD in patients were classified according to CCS and CTCA results.

CAD was detected in 62 (40.0%) patients with non-obstructive or obstructive CAD in addition to low to high calcium scores. Over the 6-month follow-up period, MACE occurred in 8 patients in the CT group (6.3%) and 4 (13.8%) without CT. 126 (81.3%) patients with CT did not attain MACE (p = 0.19) and chances of getting CABG after adjustments with co- founding factors were significantly lower than without CT [HR = 2.654e-06; 95% CI = 2.204e-07-3.195e-05; p= <0.001]. A higher event probability was associated with a high CCS (41.1%) (p= <0.001) than abnormal CTCA (11.4%) (p = 0.018). MACE was also associated with multiple risk factors such as age (p= <0.001), hypertension (p = 0.001), diabetes (p= <0.001), high cholesterol(p = 0.027), and abnormal total cholesterol (0.010) and creatinine levels [serum creatinine, p= 0.017; creatinine clearance, p = 0.006].

Outcomes measured were not significantly better in those with cardiac CT however risk of coronary artery bypass graft was significantly lower. CCS is better than CTCA in event prospects but both possess promising prognostic values in healthy arteries. Multiple CAD risk factors associated with MACE were likely as a result of intense atherosclerosis, marking appeal for risk stratifications and preventive measures. Abstract Figure. Kaplan-Meier curves for MACE  Abstract Figure. Multiple cox regression models

Effect of different dietary fiber-rich extenders on the quality attributes of functional restructured buffalo meat fillets

Background

The ever-increasing market of functional meat products demanded especially by modern health conscious consumers has prompted researchers to develop healthier meat products.

Aims

This experiment was conducted to improve the dietary fiber-deficient buffalo meat with natural functional fiber-rich extenders.

Methods

Meat obtained from the carcass of adult female buffalo (>10 years of age) was procured from the local market within 5-6 h of slaughter, conditioned for 24 h, and then processed by incorporating the dietary fiber-rich extenders at their optimum levels viz. 12% barley flour, 12% maize flour, 10% pea hull powder, and 8% wheat bran (hydrated as 1:1, w/w) for the development of functional restructured buffalo meat fillets (FRBMF).

Results

Results revealed higher cooking yield, pH, moisture content, lower protein, and fat percentage for most of the treated samples compared with the control group. The ash percentage of FRBMF prepared with the optimum level of pea hull powder and wheat bran was significantly higher (P<0.05) than in control and other treatments. Shear force values for FRBMF were lower than the control. Total dietary fiber (TDF) percentage of all the treatment products was significantly higher (P<0.05) than the control. Texture profile analysis revealed no significant differences (P>0.05) between FRBMF and the control. The sensory scores for most of the attributes of FRBMF incorporated with the optimum level of extenders were lower but comparable to the control.

Conclusion

It was concluded that the functionality of the product had improved, especially in terms of total dietary fiber, as compared to the control. Pea hull powder and wheat bran proved to be excellent sources of dietary fibers, followed by barley and maize flours, respectively.

Are You Really the Doctor? Physician Experiences with Gendered Microaggressions from Patients

Background: In contrast to physician implicit bias toward patients, bias and microaggressions from patients toward physicians have received comparatively less attention. Materials and Methods: We captured physician experiences of gendered microaggressions from patients by conducting a mixed-methods survey-based study of physicians at a single academic health care institution in May 2019. A quantitative portion assessed the frequency of gendered microaggressions (microaggression experiences [ME] score) and the association with measures of perceived impacts (job satisfaction, burnout, perceived career impacts, behavioral modifications). A one-tailed Wilcoxon rank sum test compared distributional frequencies of microaggressions by gender, and by gender and race. Chi-square tests measured the associations between gendered microaggressions and perceived impacts. Welch two-sample t-tests assessed differences in ME scores by rank and specialty. Linear regression assessed the association of ME scores and job satisfaction/burnout. A qualitative portion solicited anecdotal experiences, analyzed by inductive thematic analysis. Results: There were 297 completed surveys (response rate 27%). Female physicians experienced a significantly higher frequency of gendered microaggressions (p < 0.001) compared with male physicians. Microaggressions were significantly associated with job satisfaction (chi-square 6.83, p = 0.009), burnout (chi-square 8.76, p = 0.003), perceived career impacts (chi-square 18.67, p < 0.001), and behavioral modifications (chi-square 19.96, p < 0.001). Trainees experienced more microaggressions (p = 0.009) and burnout (p = 0.009) than faculty. Higher ME scores predicted statistically significant increases in burnout (p < 0.0001) and reduced job satisfaction (p = 0.02). Twelve microaggressions themes emerged from the qualitative responses, including role questioning and assumption of inexperience. The frequency of microaggressions did not vary significantly by race; however, qualitative responses described race as a factor. Conclusions: Physicians experience gendered microaggressions from patients, which may influence job satisfaction, burnout, career perceptions, and behavior. Future research may explore the multidirectionality of microaggressions and tools for responding at the individual and institutional level.

Evaluation of Sexual Harassment Policies at Medical Institutions to Understand Attention to Harassment of Physicians by Patients

This quality improvement study assesses the policies of top US medical centers for addressing sexual harassment of physicians by patients.

Molecular classification and comparative phylogeographic study of insectivorous bat species (Pipisitrellus coromandra) from Punjab, Pakistan

Molecular based identification of bat fauna in Pakistan has been relatively less explored. The current study was therefore planned to report for the first time the molecular classification of insectivorous bats (Pipistrellus coromandra) based on mitochondrion gene (COI) from Punjab, Pakistan. Specimens were collected from five different locations followed by DNA extraction with subsequent gene amplification and sequencing. All samples in the study had shown close identity matches with species (Pipistrellus coromandra) from India and (Pipistrellus tenuis) from Vietnam with percentage identity score of 96.11 and 95.58 respectively except one sequence which only revealed 86.78% identity match on Basic Local Alignment Search Tool (BLAST) and could only be assigned to genus level Pipistrellus sp. The results indicated negligible intra-population genetic distance among collected samples whereas the comparison with species from other countries had shown high intraspecific (P. coromandra) and interspecific (P. tenuis) mean genetic distances. The current study hence successfully proved the efficiency of COI gene as a molecular marker for species identification and in analyzing the patterns of genetic variation with species from other countries.

Identification of potential lockdown areas during COVID-19 transmission in Punjab, Pakistan

OBJECTIVES

Real-time COVID-19 spread mapping and monitoring to identify lockdown and semi-lockdown areas using hotspot analysis and geographic information systems and also near future prediction modeling for risk of COVID-19 in Punjab, Pakistan.

STUDY DESIGN

Data for all COVID-19 cases were collected until 20 October 2020 in Punjab Province.

METHODS

The methodology included geotagging COVID-19 cases to understand the trans-mobility areas for COVID-19 and characterize risk. The hotspot analysis technique was used to identify the number of areas in danger zones and the number of people affected by COVID-19. The complete lockdown areas were marked down geographically to be selected by the government of Pakistan based on increased numbers of cases.

RESULTS

As per predictive model estimates, almost 9.2 million people are COVID-19 infected by 20 October 2020 in Punjab Province. The compound growth rate of COVID-19 decreased to 0.012% per day and doubling rate increased to 364.5 days in Punjab Province. Based on Pueyo model predictions from past temporal data, it is more likely that Punjab and Pakistan entered into peak around the first week of July 2020, and the decline of growth rate (and doubling rate) of reported cases started afterward. Hospital load was also measured through the Pueyo model, and mostly, people in the 60+ years age group are expected to dominate the hospitalized population.

CONCLUSIONS

Pakistan is experiencing a high number of COVID-19 cases, with the maximum share from Punjab, Pakistan. Statistical modeling and compound growth estimation formulation were done through the Pueyo model, which was applied in Pakistan to identify the compound growth of COVID-19 patients and predicting numbers of patients shortly by slightly modifying it as per the local context.

Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension

Advances in ophthalmic diagnostics and results of interventional clinical trials are shifting diagnosis and management of idiopathic intracranial hypertension (IIH) to be more technology- and evidence-based. In this article, the evidence supporting current diagnostic criteria, evaluation, and medical and surgical management of IIH are reviewed.

Cancer of the ampulla of vater: current evaluation and therapy

Ampullary cancer is a relatively rare cancer of the digestive tract. In contrast to pancreatic cancer, ampullary cancer is often curable if detected at an early stage. The evaluation and management of ampullary cancer is similar to, but distinct from, that of other pancreaticobiliary tumors. This manuscript will review the current evaluation, diagnosis, and therapy of patients with ampullary cancer. The diagnosis of ampullary cancer is complicated by its similar clinical presentation to pancreatic cancer as well as its nonspecific laboratory findings. Diagnostic modalities such as ERCP, EUS, and biopsy are necessary for differentiating the 2 cancers, and noninvasive imaging techniques such as MRI and CT may be used for tumor staging. Although pancreaticoduodenectomy is considered the primary curative surgical option, consensus guidelines regarding adjuvant and neoadjuvant chemoradiation therapies are lacking.

γ-Radiation Induced Changes in the Physical and Chemical Properties of Lignocellulose

gamma-radiation induced effects on the physical and chemical properties of natural lignocellulose (jute) polymer were investigated. Samples were irradiated to required total doses at a particular dose rate. The changes in the parameters such as the tensile strength, elongation at break, and work done at rupture for the lignocellulose samples on irradiation with the gamma-rays from a cobalt-60 source were measured. The mechanical properties were found to have nonlinear relations with the radiation doses. The chemical stability of irradiated fibers was found to degrade progressively with the increase of radiation dose. Additionally, other chemical changes of the samples due to exposure to high-energy radiation were also investigated using fluorescence and infrared spectroscopic analysis. Differential scanning calorimetry and thermogravimetric studies showed a significant reduction in thermal stability. The wide-angle X-ray diffraction study showed that structural changes of cellulose appeared due to the radiation-induced chemical reaction of lignocellulose.

An optical technique for in situ monitoring of trace metals in effluent

An optical technique for real time elemental analysis in water environment is evaluated. This is based on laser-induced breakdown in water and the subsequent monitoring of atomic emission lines from the elemental species. Metals, such as copper, lead, iron, sodium etc, in water samples were detected and quantified from their relevant strong atomic emission lines. Experimental results show that metal concentrations in water at a level of a few mg l(-1) are detectable in a non-optimized but versatile experimental system. Elemental constituents in a sample of water effluent from a metal polishing factory for discharge in to streams was analysed and presented. A prototype of a portable system based on original equipment manufacturer's components has been constructed and its potential as a cost-effective effluent discharge monitor for selected elements is evaluated.

A new technology for automatic identification and sorting of plastics for recycling

A new technology for automatic sorting of plastics, based upon optical identification of fluorescence signatures of dyes, incorporated in such materials in trace concentrations prior to product manufacturing, is described. Three commercial tracers were selected primarily on the basis of their good absorbency in the 310-370 nm spectral band and their identifiable narrow-band fluorescence signatures in the visible band of the spectrum when present in binary combinations. This absorption band was selected because of the availability of strong emission lines in this band from a commercial Hg-arc lamp and high fluorescence quantum yields of the tracers at this excitation wavelength band. The plastics chosen for tracing and identification are HDPE, LDPE, PP, EVA, PVC and PET and the tracers were compatible and chemically non-reactive with the host matrices and did not affect the transparency of the plastics. The design of a monochromatic and collimated excitation source, the sensor system are described and their performances in identifying and sorting plastics doped with tracers at a few parts per million concentration levels are evaluated. In an industrial sorting system, the sensor was able to sort 300 mm long plastic bottles at a conveyor belt speed of 3.5 m.sec(-1) with a sorting purity of -95%. The limitation was imposed due to mechanical singulation irregularities at high speed and the limited processing speed of the computer used.

Quality of adverse drug experience reports submitted by pharmacists and physicians to the FDA

The US Food and Drug Administration (FDA)'s Spontaneous Adverse Experience Reporting System is a computerized database with over one million adverse drug experience (ADE) reports. In 1992, the FDA received over 100,000 ADE reports and pharmacists were major contributors to these reports. In 1993, the FDA launched MEDWatch, a new initiative to enhance direct reporting of adverse events by health professionals. thus far, majority of reports to MEDWatch are from pharmacists. Drug regulatory agencies of some countries do not accept reports submitted by pharmacists. We performed a study to assess the quality of information in ADE reports submitted directly to the FDA by pharmacists and physicians and compared that with manufacturer-channelled 15-day reports. We evaluated 589 ADE reports with serious outcomes associated with nine new molecular entities. Data were analysed using Epi Info. Our results showed no substantial difference in a subjective assessment of the quality of information in the reports submitted by pharmacists or physicians, irrespective of whether these reports were submitted directly or via manufacturers. This study suggests that reports from hospital pharmacists are valuable and of comparable quality. We believe that all health professionals contribute to the success of FDA's MEDWatch programme and thereby play an important part in protecting public health by promptly reporting serious adverse events.

Congestive heart failure associated with itraconazole

Itraconazole is a synthetic antifungal agent approved in the USA for the treatment of onychomycosis and serious systemic fungal infections. Animal and clinical pharmacology studies suggest negative inotropic effects with itraconazole. Data from the US Food and Drug Administration's Adverse Event Reporting System suggest that use of itraconazole is associated with congestive heart failure. We summarise the details of 58 cases suggestive of congestive heart failure in association with the use of itraconazole. Labelling of itraconazole has been changed to alert physicians to this new finding.

A survey of paediatric prescribing and dispensing in Karachi

In an effort to understand the paediatric prescribing practices of family physicians and dispensing of medicines from pharmacies, a survey was conducted in Karachi. Another objective was to understand the factors influencing such practices. Hundred family physicians and 55 pharmacists were surveyed. Four groups of drugs namely antidiarrhoeals, appetite stimulants, multivitamins and brain tonics were identified for assessment, these being drugs widely promoted by the pharmaceutical industry. Some of these drugs are known to have deleterious effects and therapeutic benefit of most of them is dubious. It was observed that roughly 55% of all drugs prescribed by the physicians fell into the aforementioned drug categories. These drugs also constituted nearly 60% of all sales of the pharmacies surveyed. The survey indicates that the antidiarrhoeal drugs Imodium (Ioperamide) and Lomotil (diphenoxylate) are being commonly prescribed though they have hazardous side effects and are unsuitable for use in children. Thirteen percent of physicians are still prescribing the anabolic steroid Durabolin (nandrolone phenylpropionate) as an appetite stimulant long after promotion for this purpose has been dropped. The survey indicates that 95% of the physicians relied upon industry promotional material as their main source of information about drugs. The survey highlights the need to introduce the concept of rational drug use in the undergraduate and postgraduate education.