Environmental pollutants PM2.5, PM10, carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) impair human cognitive functions

OBJECTIVE

Environmental pollution is an emerging global public health problem across the world and causes serious threats to ecosystems, human health, and the planet. This study is designed to explore the impact of environmental pollution particulate matter PM2.5, PM10, carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) on cognitive functions in students from schools located in or away from air-polluted areas.

SUBJECTS AND METHODS

In this study, two schools were selected: one was located near a traffic-polluted area (school #1), and the second was in an area away from the traffic-polluted area (school #2). In this study, a total of 300 students were recruited: 150 (75 male and 75 female) students from school #1 located in a traffic-polluted area, and 150 students (75 male and 75 female) from school #2 located away from a traffic polluted area. The overall average age of students was 13.53±1.20 years. The students were selected based on age, gender, health status, height, weight, BMI, ethnicity, and homogenous socio-economic and educational status. The pollutants PM2.5, PM10, CO, NO2, O3, and SO2 were recorded in the surrounding environment. The overall mean concentration of environmental pollutants in school #1 was 35.00±0.65 and in school #2 was 29.95±0.32. The levels of airborne particles were measured, and the cognitive functions were recorded using the Cambridge Neuropsychological Test Automated Battery (CANTAB). The students performed the cognitive functions tasks, including the attention switching task (AST), choice reaction time (CRT), and motor screening task (MOT).

RESULTS

The results revealed that the AST-Mean 928.34±182.23 vs. 483.79±146.73 (p=0.001), AST-mean congruent 889.12±197.12 vs. 473.30±120.11 (p=0.001), AST-mean in-congruent 988.98±201.27  vs. 483.87±144.57 (p=0.001), CRT-Mean 721.36±251.72  vs. 418.17±89.71 (p=0.001), and MOT-Mean 995.07±394.37 vs. 526.03±57.83 (p=0.001) were significantly delayed among the students who studied in school located in the traffic polluted area compared to students who studied in school which was located away from the traffic-polluted area.

CONCLUSIONS

Environmental pollution was significantly higher in motor vehicle-congested areas. Cognitive functions were impaired among the students who were studying in a school located in a polluted area. The results further revealed that the students studying in schools located in environmentally polluted areas have attention, thinking, and decision-making abilities related to cognitive function impairment.

Effect of Raphanus raphanistrum on chronic kidney disease induced by ethanol in animal model rats

Abstract The aim of this study is to investigate the effect of Raphanus raphanistrum (radish) on chronic kidney disease damage by reactive oxygen species or free radicals in animal model rats. Total of 18 rats were used in this study, divided into 3 groups and each group consist of 6 rats. Group 1 control (C), group 2 model (M) and group 3 test (T). Model and test group were treated with alcohol to produce chronic kidney disease by reactive oxygen spices for 9 weeks a dose of 1 ml. After that test group was treated with Raphanus raphanistrum juice for 4 weeks 80mg/kg body weight to determine it effect. Raphanus raphanistrum juice effect on behavior of rats through increases the locomotor activity and anxiety. The serum creatinine and uric acid level were significantly improved in T group. The reactive oxygen enzyme test shows that Super Oxide Dismutase (SOD) and Glutathione Peroxidase (GPx) was increase in T group. The Glutathione S-Transferases (GST) and Catalase (CAT) enzyme level was nearly same in C and T groups. This study concludes that compound 1,1-diphenyl-2-picrylhydrazyl found in Raphanus raphanistrum juice and possess strong antioxidant activity on Chronic kidney disease induce by ethanol through reactive oxygen species. There is need of more researches to determine the use of natural compound to treat different disease.

Antioxidant associated chemoprophylaxis effect of natural spice and green vegetable on hepatotoxicity

This is a case control and cohort study, conducted at Department of Biochemistry in FUAST, compressing 24 number of albino Wistar rats. Illicium verum (star anise) natural spice and green vegetable broccoli are used for chemo-preventive herbal treatment in relation with vitamin C antioxidant activity. Hepatotoxicity was induced in liver of model rats by giving interperitoneally single injection of 200 mg/kg bod weight (B.W) of N-nitrosodiethylamine and orally giving 1 mg/kg BW phenobarbital for 14 days during disease prorogation period. The vitamin C analysis from Illicium verum (star anise), green broccoli, orange juice, orange peel and orange pulp was done by iodometric quantitative and qualitative titration method. Rats were given compound according to their bodyweight as 1 mg/kg B.W. After 14 days (Disease Promotion and Propagation Period) and 28 days (Disease cure period) of treatment behavioral activity was monitored by locomotors activity in open field experiment, stimulatory activity in home cage and anxiolytic effects observed in light and dark apparatus and also in T maze. Behavioral activity were significantly increased in Illicium verum and green broccoli treated rats. Hematological study including hemoglobin (Hb), white blood cells (WBC), red blood cells (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW) and Platelets was done by abbot laboratory analyzer cell. The value of Hb and RBC was also significantly increased in star anise and broccoli treated rats, showed proper function of RBC in microcirculation. WBC was also in normal range revealed that no disease regards to bone marrow and leukemia's. The biochemical activity of rats including urea, creatinine, total protein, albumin, globulin, A/G ratio, amylase and calcium in blood serum were analyzed while, liver health or performance was also determined by LFT (liver function test). Behavioral and laboratorial variables were analyzed by using SPSS v. 20 and p-value < 0.05 was considered statistically significant. The study report noticeable significant effect of Illicium verum and broccoli on hepatotoxicity of experimental model. Recent experimental study statistical outcomes show reciprocal relationship between the consumption of vegetable diet and natural spice with the risk of Hepatotoxicity. Thus, the aim of the study is to enhance the function of star anise or illicium verum natural spice and green vegetable broccoli as an anticancer or chemoprophylaxis agent.

A Suspected Case of COVID-19 with High Altitude-associated Massive Pulmonary Embolism and Right Ventricular Clots

Pulmonary Embolism (PE) is an elusive entity that has long baffled physicians. At times, it can present as a diagnostic and therapeutic challenge. The aim of this report is to emphasise that high altitude is one of the risk factors for PE. Physicians must keep a high index of suspicion for PE, especially in patients being evacuated from high altitudes with respiratory symptoms. A case of massive PE with right ventricular clots initially suspected to be high altitude-associated pulmonary edema (HAPE) and then novel coronavirus disease 2019 (COVID-19) pneumonia was managed. Computed tomography (CT) pulmonary angiography could not be done initially. The case was managed in intensive care settings. The patient had to be treated with thrombolytic therapy owing to hemodynamic compromise. Significant clinical improvement was noted after thrombolysis. A high index of suspicion is required for the diagnosis and management of PE. If standard imaging techniques cannot be used due to clinical constraints, ancillary techniques must be effectively employed during management. Key Words: Pulmonary embolism, Thrombolysis, High altitude, COVID-19.

P-137 ICM and TE quality significantly impact the live birth in euploid frozen blastocyst transfer cycles

Study question

Is the live birth rate (LBR) in euploid frozen blastocyst transfer (FET) affected by the quality of ICM (Inner cell mass) and TE (Trophectoderm)?

Summary answer

ICM and TE significantly impacts the LBR with a decline of LB from 57.3% (ICM-A) to 48.5% (ICM-B) to 22.1% (ICM-C) (p &lt; 0.001)

What is known already

The morphological blastocyst grading system proposed by Gardner-Schoolcraft remains the most accepted system to identify blastocysts with higher implantation potential. It relies on morphological features within the blastocyst, including ICM and TE. Several studies tried to identify the individual contribution of each. However, the conclusions remain contradictory and no clear consensus has yet been achieved. Due to heterogeneity of parameters evaluated between different publications, where embryos with unknown ploidy status were transferred in conjunction with a variability of stimulation protocols and in the number of transferred embryos, the real effect of the ICM and TE is difficult to infer.

Study design, size, duration

This two-center retrospective observational study includes a total of 977 euploid single FET cycles between March 2017 and March 2020 at ART Fertility Clinics Muscat, Oman and Abu Dhabi, UAE.

Participants/materials, setting, methods

Trophectoderm biopsies were analyzed with Next Generation Sequencing (NGS). All blastocysts available on D5 or D6 with a quality ≥ BL3CC were subjected to TE biopsy for PGT-A analysis and LBR was recorded. Vitrification/warming of blastocysts was performed using Cryotop method (Kitazato). Bivariate and multivariate analysis were performed between LB outcomes and ICM and TE grade while controlling for confounding factors.

Main results and the role of chance

A total of 977 single FET cycles were analyzed: 651 in hormone replacement therapy (HRT) and 326 in natural cycle regimen (NC) resulting in a 46.88% LBR. The mean patients’ age was 33.80 years with a mean Body Mass Index (BMI) of 26.80 kg/m2. Though all qualities of ICM and TE were associated with LB, blastocyst ICM-A LBR was statistically significantly higher (57.3%) than ICM-B (48.4%) and ICM-C (22.1%) (p &lt; 0.001). Similarly, blastocyst TE-A LBR was statistically significantly higher (59.2%) than TE- B (48.6%) and TE- C (30.3%) (p &lt; 0.001). Miscarriage rate was similar in all groups.

The grade of ICM and TE were significantly associated with Anti-Mullerian-Hormone (AMH) and day of blastocyst biopsy. Mean AMH (ng/ml) was higher in ICM groups (A: 3.78, B: 3.24, p &lt; 0.001) and TE group (A: 3.63, B: 3.38, p &lt; 0.05) compared to lower grade (ICM-C: 2.86, TE-C: 2.82).

In multivariate analysis, endometrial preparation for FET, BMI and AMH were the parameters influencing LBR: OR:1.45, [CI:1.07-1.96], p &lt; 0.015) for NC; OR 0.96 [CI:0.93-0.99], p = 0.004 for BMI; OR 0.95 [CI:0.90-1.00], p = 0.033 for AMH; Both, ICM-C and TE-C, resulted in a significantly lower chance of LB [ICM: OR 0.32, CI:0.17-0.61, p &lt; 0.001; TE: OR 0.44, CI:0.27-0.73, p = 0.002), compared to grade A.

Limitations, reasons for caution

The retrospective nature of the study and inter-observer variability in blastocyst scoring is a limitation. The physician/embryologist performing the embryo transfer could not been standardized due to the multicenter design. Randomized controlled studies are needed to determine whether ICM or TE should be prioritized in the selection of the blastocyst.

Wider implications of the findings

The ICM and TE scoring in FET may influence the LBR and should be considered as an important factor for the success of embryo transfer cycles. Whether these results can be extrapolated to fresh embryo transfer and to blastocysts with unknown ploidy status, needs further investigation.

Trial registration number

not applicable

Thyroid Dysfunction During Combined Pegylated Interferon Alpha and Ribavirin Therapy in Patients of Chronic Hepatitis C-Virus Infection

Objective: To determine frequency of thyroid dysfunction among patients of chronic hepatitis C receiving combined pegylated interferon alpha and ribavirin therapy. Study Design: Cross sectional study. Place and Duration of Study: Department of Medicine, Military Hospital Rawalpindi, from Jan to Jul 2017. Methodology: One hundred and twenty patients, aged 18–60 years from both genders, with established hepatitis C were included; while the patients with decompensated liver disease, previous antiviral treatment, pre-existing thyroid, autoimmune or severe cardiopulmonary disease and on immuno-suppressants or steroids were excluded. After formal informed consent, they were prescribed 24 weeks pegylated interferon alpha-2 (3 million units subcutaneously thrice weekly) and oral ribavirin (1000–1200 mg daily) therapy. After 12 weeks, serum thyroid stimulating hormone, free thyroxine and triiodothyronine levels were determined by chemiluminescence technique. Results: Out of 120 patients, 100 (83.33%) were males and 20 (16.67%) were females with male to female ratio of 5:1. Mean thyroid stimulating hormone levels at baseline and 12 weeks were 2.86 ± 1.03uiu/ml and 2.16 ± 0.79 uiu/ml respectively. Mean triiodothyronine levels at baseline and 12 weeks were 3.27 ± 1.31pg/ml and 2.69 ± 1.01 pg/ml respectively. Mean thyroxine levels at baseline and 12 weeks were 1.26 ± 0.38 pg/ml and 1.07 ± 0.53 pg/ml respectively. Frequency of thyroid dysfunction was found in 40 (33.33%) patients. Conclusion: Frequency of thyroid dysfunction among hepatitis C patients receiving combined pegylated interferon alpha and ribavirin therapy is quite high.

Can Thrombocytopenia be Used to Make a Presumptive Diagnosis of Malaria in Patients with Acute Febrile Illness

Objective: To ascertain the diagnostic accuracy of thrombocytopenia in making a presumptive diagnosis of malaria in patients with acute febrile illness, keeping thick and thin films as the gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi Pakistan, from May to Oct 2017. Methodology: A total of 145 patients meeting the inclusion criteria i.e., patients with fever of 10 or less days, age of ≥12 and ≤65 years of either sex were included in the study. Sample for a complete blood picture was taken in Ethylenediaminetetraacetic acid (EDTA) vacutainer. Simultaneously, two slides each with a thick and thin blood smears were made to ascertain absence or presence of plasmodium vivax species (smear positive and smear negative). The diagnostic accuracy was measured using two by two table and applying formulae for specificity, sensitivity, negative and positive predictive value. Likelihood ratio and ROC (Receiver operator curve) was also calculated. Results: Out of 145 subjects, ninety-four patients (64.8%) were males and 51 were (35.2%) females with mean age of 36.76 ± 14.749 years. The specificity, sensitivity, negative and positive predictive value and diagnostic accuracy of thrombocytopenia in making a presumptive diagnosis of malaria in patients having short history of fever, keeping thick and thin films as the gold standard was 68.8%, 81.4%, 64.7%, 84.0% and 77.2% respectively. Conclusion: Hematological abnormalities are encountered in malaria. Thrombocytopenia has a very good sensitivity and good specificity for malaria.

Association of blood groups/Rh and diabetes mellitus in Karachi city, Pakistan

Abstract The main purpose of this study was to find out a possible association between ABO blood groups or Rh and diabetes mellitus (DM) in the local population of eight (8) different towns of Karachi, Pakistan. For this purpose a survey was carried out in Karachi to have a practical observation of these towns during the period of 9 months from June 2019 to Feb. 2020. Out of eighteen (18) towns of Karachi, samples (N= 584) were collected from only eight (8) Towns of Karachi and gave a code-number to each town. Diabetic group sample was (n1=432) & pre-diabetes sample was (n2 =152). A standard Abbot Company Glucometer for Random Blood Sugar (RBS) and Fasting Blood Sugar (FBS) tests, standard blood anti sera were used for ABO/Rh blood type. Health assessment techniques were performed ethically by taking informed consent from all registered subjects. Finally data was analyzed by SPSS version 20.0. In our current study, the comparison of ABO blood groups frequencies between diabetic and pre-diabetic individuals were carried out. The percentage values of blood Group-B as given as: (32% in DM vs. 31% in pre-diabetics), followed by blood Group-O as: (18% in DM vs. 11% in pre-diabetics). Contrary to Group-“B” & “O”, blood Group-A and Group-AB were distribution percentage higher pre-diabetic as compared to DM patients, as given as: Group-A (32% in pre-diabetics vs. 26% in DM) & Group-AB (26% in pre-diabetics vs. 24% in diabetic’s patients). In addition, percentage distribution of Rh system was also calculated, in which Rh+ve Group was high and more common in DM patients as compared to pre-diabetics; numerically given as: Rh+ve Group (80% in DM vs. 72% in pre-diabetics). Different views and dimensions of the research topic were studied through literature support, some have found no any association and some established a positive association still some were not clear in making a solid conclusion. It is concluded that DM has a positive correlation with ABO blood groups, and people with Group-B have increased susceptibility to DM disease.

Persistent organic pollutants distribution in plasma lipoprotein fractions

This study determines the associations among serum lipid profiles, risk of cardiovascular disease, and persistent organic pollutants. Using Gas chromatography technique, the intensity of toxic pollutant residues in serum samples of Hypertensive patients were measured. Based on statistical analysis, the effects of different covariates namely pesticides, age, systolic blood pressure, diastolic blood pressure, and lipid profile duration was checked using the logistic regression model. Statistical computation was performed on SPSS 22.0. The P-values of F-Statistic for each lipid profile class are greater than 0.01 (1%), therefore we cannot reject the null hypothesis for all cases. The estimated coefficients, their standard errors, Wald Statistic, and odds ratio of the binary logistic regression model for different lipid profile parameters indicate if pesticides increase then the logit value of different lipid profile parameters changes from -0.46 to -0.246 except LDL which increases by 0.135. The study reports a significantly increased threat of cardiovascular disease with increased concentrations of toxic pollutants.

Comparison of Turbidimetric Inhibition Immunoassay, High-Performance Liquid Chromatography, and Capillary Electrophoresis Methods for Glycated Hemoglobin Determination

OBJECTIVE

The purpose of this study was to compare the performances of and evaluate the agreement among glycated hemoglobin values analyzed by using National Glycohemoglobin Standardization Program-certified and International Federation of Clinical Chemistry-standardized analyzers.

THIS CROSS-SECTIONAL STUDY WAS CONDUCTED AT THE

Armed Forces Institute of Pathology, Department of Chemical Pathology from March 2019 to May 2019.

METHODS

Glycated hemoglobin (HbA1c) was measured in the blood specimens from 100 patients on an ADVIA 1800 by a turbidimetric inhibitory immunoassay (TINIA), Sebia instrument by electrophoresis, and Bio-Rad Variant II Turbo system by high-performance liquid chromatography (HPLC). Quantitative variables were calculated as the mean ± standard deviation (SD). Precision and method comparisons were carried out according to Clinical and Laboratory Standards Institute recommendations. The results obtained from each analyzer were compared by correlation analysis. Method comparison was done by linear regression and Bland-Altman plots using the SPSS software version 24.

RESULTS

The mean ± SD HbA1c values from TINIA, electrophoresis, and HPLC were 7.188% ± 1.89%, 7.164% ± 1.866%, and 7.160% ± 1.85%, respectively. The between-run coefficients of variation for TINIA, electrophoresis, and HPLC were 0.64%, 0.61%, and 0.60%, respectively. All 3 showed good correlation (TINIA, R2 = .994, P = .00; electrophoresis, R2 = .992, P = 0.00; and HPLC, R2 = .994, P = 0.00).

CONCLUSION

The good clinical agreements of HbA1c and strong correlations between analyzers indicate that these analyzers can be used interchangeably.

Detection of Hepatitis B Virus DNA among Chronic and potential Occult HBV patients in resource-limited settings by Loop-Mediated Isothermal Amplification assay

Transmission of Hepatitis B Virus (HBV) usually occurs due to the transfusion of blood or blood products from chronic HBV (CHB) or occult HBV-infected (OBI) patients. Besides serological tests, e.g. HBsAg and anti- HBc (total), detection of HBVDNA is necessary for the diagnosis of OBI patients. Different nucleic acid tests (NATs) including real- time-Polymerase Chain Reaction (qPCR) are used to detect HBV- DNA. The NATs are expensive and require technical expertise which are barriers to introduce them in resource-limited settings. This study was undertaken to evaluate the use of Loop-Mediated Isothermal Amplification (LAMP) assay as an alternative to qPCR for the detection of HBV-DNA in CHB and potential OBI patients in resource-limited settings. Following the published protocols with some modifications, a LAMP assay was developed for detection of HBV-DNA by either using a heat block followed by detection in an agarose gel or using a qPCR thermocycler. The LAMP assay was applied to supernatant prepared from heat-treated serum collected from CHB and potential OBI patients. HBV viral load in serum was measured by qPCR using a single-step HBV-DNA quantification kit. Among 200 samples tested, qPCR was capable to detect HBV-DNA in 25.5% of cases, whereas LAMP assay detected HBV-DNA in 43.5% cases. The qPCR was able to detect 11 (9.16%) potential OBI cases, whereas LAMP assay identified HBV-DNA in 43 (35.83%) cases. In addition to tests for HBsAg and/or anti-HBc (total), detection of HBV-DNA by LAMP assay may aid in preventing post-transfusion HBV infection in resource-limited settings.

Determination of reference intervals of thyroid markers during pregnancy in Urban area of District Rawalpindi Pakistan

OBJECTIVE

To determine the reference values for thyroid stimulating hormone, free tetra-iodothyronine and total tri-iodothyronine for healthy pregnant women.

METHODS

This cross sectional study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January 2016 to June 2017. Pregnant women with normal, single intrauterine, uncomplicated pregnancy were recruited from the local population. Blood sample was taken to analyse thyroid stimulating hormone, free tetra-iodothyronine and total tri-iodothyronine using chemiluminescence immunoassay. For thyroid hormone levels during each trimester 5th and 95th percentiles were calculated as reference intervals. Data was analysed using SPSS 24.

RESULTS

Out of 384 subjects, 188(48.95%) were in their first trimester and 196(51.04 %) females were in their second trimester. There were 109(57.97%) primigravida in the first trimester and 137(69.9%) in the second trimester. Mean age of subjects presenting in the first and second trimester was 25.37±3.78 years and 26.54±4.65 years respectively. Reference intervals for those in the first trimester for thyroid stimulating hormone was 0.05-2.8uIU/ml, for free tetra-iodothyronine14.4-22.7pmol/l and total tri-iodothyronine1.5-3.3nmol/l. For those in second trimester the corresponding values were 0.16-3.3 uIU/ml, 14.2-24.6.0 pmol/l and 1.6-3.1nmol/l.

CONCLUSIONS

Laboratories should adopt trimester-specific reference intervals for thyroid function tests in pregnancy..

Spectrum of renin angiotensin aldosterone system disorders in young hypertensives

OBJECTIVE

To analyse the spectrum of renin angiotensin aldosterone system disorders in young hypertensive patients in hospital settings.

METHODS

This cross-sectional study was conducted at the Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January to December, 2016. It comprised hypertensive subjects aged 17-40 years of either gender presenting in the outpatient department. All subjects were having blood pressure more than 140/90mmHg and were not on any anti-hypertensive medicine. Blood sample was taken from each patient to analyse arterial blood gases, plasma renin, serum aldosterone and electrolytes. Association of qualitative variables like age, systolic and diastolic blood pressure with essential hypertension and primary hyperaldosteronism was explored.

RESULTS

Of the 80 patients, 72(90%) were diagnosed with essential hypertension and 8(10%) with primary hyperaldosteronism. None of the patients had Liddle syndrome, apparent mineralocorticoid excess or Gordon syndrome. Mean age of patients having essential hypertension was 30.97±7.1 years, whereas, for those with primary hyperaldosteronism it was 29.25±7.1 years. Systolic blood pressure was significantly higher (p = 0.000) among all patients. No statistically significant association was found between age, systolic and diastolic blood pressure (p<0.05).

CONCLUSIONS

Primary hyperaldosteronism as compared to other renin angiotensin aldosterone system disorders was found to be the leading cause of hypertension in young population.

How Are We Doing?-The Experience of the Merton Home Treatment Team in Gathering Real-Time Feedback and the Impact Upon Service Provision

Aims and Method:

To discuss the methods involved in gathering real-time feedback (RTF) by a London Home Treatment Team. We hypothesized that RTF would lead to changes in service provision and improvements in patient and carer feedback. Patients were invited to provide RTF on discharge. Quantitative and qualitative data were collected and analyzed centrally by the Trust before being disseminated to the team and changes made based upon the results. Quantitative feedback on the team’s performance in the first 6 months of RTF use was compared against data from the 6 months prior to March 2015 using 2-tailed Z tests.

Results:

There were significant improvements in feedback around the team visiting at the agreed times (P = .0069) and patients feeling that they had been involved in treatment decisions (P = .0371).

Clinical Implications:

Real-time feedback is a potentially valuable method for obtaining patient feedback and can result in service improvements if used appropriately.

Utility of 16S rRNA PCR performed on clinical specimens in patient management

BACKGROUND

Broad-range 16S rRNA PCR can be used for the detection and identification of bacteria from clinical specimens in patients for whom there is a high suspicion of infection and cultures are negative. The aims of this study were (1) to compare 16S rRNA PCR results with microbiological culture results, (2) to assess the utility of 16S rRNA PCR with regard to antimicrobial therapy, and (3) to compare the yield of 16S rRNA PCR for different types of clinical specimen and to perform a cost analysis of the test.

METHODS

A retrospective study was performed on different clinical specimens which had 16S performed over 3 years (2012-2015). Standard microbiological cultures were performed on appropriate media, as per the laboratory protocol. Patient clinical and microbiological data were obtained from the electronic medical records and laboratory information system, respectively. 16S rRNA PCR was performed in a reference laboratory using a validated method for amplification and sequencing. The outcomes assessed were the performance of 16S rRNA PCR, change of antimicrobials (rationalization, cessation, or addition), and duration of therapy. Concordance of 16S rRNA PCR with bacterial cultures was also determined for tissue specimens.

RESULTS

Thirty-two patients were included in the study, for whom an equal number of specimens (n=32) were sent for 16S rRNA PCR. 16S rRNA PCR could identify an organism in 10 of 32 cases (31.2%), of which seven were culture-positive and three were culture-negative. The sensitivity was 58% (confidence interval (CI) 28.59-83.5%) and specificity was 85% (CI 61.13-96%), with a positive predictive value of 70% (CI 35.3-91.9%) and negative predictive value of 77.2% (CI 54.17-91.3%). Antimicrobial therapy was rationalized after 16S rRNA PCR results in five patients (15.6%) and was ceased in four based on negative results (12.5%). Overall the 16S rRNA PCR result had an impact on antimicrobial therapy in 28% of patients (9/32). The highest concordance of 16S rRNA PCR with bacterial culture was found for heart valve tissue (80%), followed by joint fluid/tissue (50%).

CONCLUSIONS

Despite the low diagnostic yield, results of 16S rRNA PCR can still have a significant impact on patient management due to rationalization or cessation of the antimicrobial therapy. The yield of 16S rRNA PCR was highest for heart valves.

Inventory of medicinal flora from Thal Desert, Punjab, Pakistan

BACKGROUND

This article reports the preliminary findings of an ethno-botanical survey that was carried out in the Thal Desert, Punjab, Pakistan during 2010 to 2013. The aim of this study was to document the traditional use of medicinal plants from the study area.

MATERIALS AND METHODS

The whole area was surveyed for inventorying medicinal flora by using a semi-structured questionnaire.

RESULTS

The people of the study area are extremely knowledgeable, hence reported 120 plants which are being used in treating various human diseases. The detailed inventory including botanical name, parts used, method of preparation and diseases treated is provided in this paper.

CONCLUSION

This study revealed that the inhabitants possessed empirical knowledge of medicinal plants which would be useful in developing health care products and preserving traditional cultures as well as phyto-diversity.

PathGrid: a service-orientated architecture for microscopy image analysis

This paper describes 'PathGrid'--an analysis and data integration system, developed initially to meet the demands in the analysis of medical microscopy imaging data. An overview of the current system is given, describing the techniques used in developing the data handling infrastructure and the analysis algorithm development. The use of software created in the context of systems designed for the astronomy domain is noted, specifically infrastructure from the astronomy virtual observatory movement for data discovery, access and workflow management, and astronomical image analysis software adapted for the analysis of high-throughput astronomy imaging surveys. This paper notes the applicability of the techniques from the astronomy domain. The testbed infrastructure deployment is described, emphasizing its speed and ease of use and support. The validity of the analysis techniques is confirmed through the pilot study described here--with the application to a large sample of immunohistochemistry microscopy data obtained in part for assessing the oestrogen receptor status of breast cancers. The analysis showed that the specificity and sensitivity values for the automatic scoring using PathGrid were within the errors of those obtained via a 'gold standard' manual pathologist scoring.

Biomass acclimatisation and adaptation during start-up of a submerged anaerobic membrane bioreactor (SAMBR)

The effects of biomass acclimatisation and adaptation during the start-up of three 3-litre submerged anaerobic membrane bioreactors (SAMBRs) were studied for the treatment of a sucrose-meat extract based medium strength wastewater (4 gCOD l(-1)). At 30 hours hydraulic retention time, the SAMBRs achieved more than 90% chemical oxygen demand (COD) removal with two different types of initial sludge--one previously adapted in a SAMBR for low strength treatment (SAMBR A), while the other was acclimatised in low shear continuous stirred tank reactors (CSTRs; mixture of biomass from two CSTR reactors fed on sucrose and/or acetate and propionate: SAMBR B--gassed at 5 litres per minute, SAMBR C at 2 litres per minute = 1.2 m3 m(-2) h(-1)). Although acclimatisation (enrichment of sludge adapted in a SAMBR for sewage treatment) took longer (100 days) than adaptation (enrichment and adaptation of sludge to SAMBR conditions) (39 days), the methane potential of the biomass improved substantially from its initial values. For successful start-up of SAMBRs a low initial loading rate, low biogas sparging rate and long acclimatisation and adaptation times were necessary to develop strong bacterial associations for interspecies electron transfer (SAMBRs A and C). The shorter adaptation time in SAMBR B resulted in permanent deterioration of performance, probably because of an insufficient population of methanogens and acetogens, and a reduction in floc size during overloaded conditions. The low value of flux (2 litres per square metre per hour) during high strength treatment was attributed to fine colloids, higher amounts of SMP and a high biomass concentration inside the reactor.