Aiding the well celebrated Kuk's randomized response technique through auxiliary and prior information

Asking direct questions in face to face surveys about sensitive traits is an intricate issue. One of the solutions to this issue is the randomized response technique (RRT). Being the most widely used indirect questioning technique to obtain truthful data on sensitive traits in survey sampling RRT has been applied in a variety of fields including behavioral science, socio-economic, psychological, epidemiology, biomedical, criminology, data masking, public health engineering, conservation studies, ecological studies and many others. This paper aims at exploring the methods to subsidize the randomized response technique through additional information relevant to the parameter of interest. Specifically, we plan to contribute by proposing more efficient hybrid estimators compared to existing estimator based on (Kuk, 1990) [31] family of randomized response models. The proposed estimators are based on the methodology of incorporating the pertinent information, available on the basis of either historical records or expert opinion. Specifically, in case of availability of auxiliary information, the regression-cum-ratio estimator is found to be the best to further enhance the estimation through (Kuk, 1990) [31] model while the (Thompson, 1968) [49] shrinkage estimation is observed to be yielding more precise and accurate estimator of sensitive proportion. The findings in this study signify the importance of the proposed methodology. Additionally, to support the mathematical findings, a detailed numerical investigation to evaluate the comparative performances is also conducted. Based on performance analysis, overwhelming evidences are witnessed in the favor of proposed strategies.

Antibiotic resistance pattern and pathological features of avian pathogenic Escherichia coli O78:K80 in chickens

Abstract Avian pathogenic Escherichia coli (APEC) induces colibacillosis, an acute and systemic disease, resulting in substantial economic losses in the poultry sector. This study aimed to investigate the antibiotic resistance pattern associated with frequent virulence gene distribution in APEC O78:K80 that may cause pathological alterations in chickens. The antibiogram profile showed high resistance to erythromycin, chloramphenicol, tetracycline, ampicillin, and co-trimoxazole, followed by intermediate resistance to ciprofloxacin, levofloxacin, enrofloxacin, norfloxacin, nitrofurantoin, and doxycycline hydrochloride, and sensitive to amikacin, streptomycin, gentamicin, and colistin. Virulence gene distribution identifies eight (irp-2, iutA, ompT, iss, iucD, astA, hlyF, iroN) genes through a conventional polymerase chain reaction. APEC O78:K80 caused significantly high liver enzyme concentrations, serum interleukin-6 and tumor necrosis factor-alpha levels in experimental birds. Also, infected birds have hypoproteinemia, hypoalbuminemia, and hyperglobulinemia. Necropsy examination revealed fibrinous perihepatitis and pericarditis, congested lungs, intestinal ecchymotic hemorrhages and necrotizing granulomatosis of the spleen. Histopathological examination depicted hepatocellular degeneration, myocardial necrosis, interstitial nephritis, intestinal hemorrhages and lymphopenia in the spleen. This study is the first evidence to assess the antibiotic resistance profile linked with virulence genes and clinicopathological potential of APEC O78:K80 in chickens in Pakistan, which could be a useful and rapid approach to prevent and control the disease by developing the control strategies.

Estimation of genetic components, heterosis and combining ability of elite Pakistani wheat varieties for yield attributing traits and stripe rust response

Wheat (Triticum aestivum L.) is a staple food and major source of dietary calories in Pakistan. Improving wheat varieties with higher grain yield and disease resistance is a prime objective. The knowledge of genetic behaviour of germplasm is key. To achieve this objective, elite wheat varieties were crossed in 4 by 3, line × tester design, and tested in 2019 in a triplicate yield trial to estimate genetic variance, general and specific combining ability, mid-parent heterosis and stripe rust (Puccinia striiformis L.). High grain 3358 kg·ha-1 was recorded in F1 hybrid (ZRG-79 × PAK-13). Analysis of variance (ANOVA) revealed significant genotypic variance in grain yield. Broad sense heritability (H2) was recorded in the range of 28 to 100 %. General combining ability (GCA) significant for grain yield in parents except FSD-08 and PS-05 was recorded, while specific combining ability (SCA) was recorded to be highly significant for grain yield only in two crosses (ZRG-79 × NR-09 and ZRG-79 × PAK-13). Mid-parent heterosis was estimated in the range of -28 to 62.6 %. Cross combinations ZRG-79 × PAK-13 depicted highly significant mid-parent heterosis (62.6 %). Highly significant correlation was observed among spike length, spikelets per spike, plant height and 1000-grain weight. Rust resistance index was recorded in the range of 0 to 8.5. These findings suggest exploitation of GCA for higher grain yield is important due to the presence of additive gene action and selection in the filial generations will be effective with improved rust resistance, while cross combinations ZRG-79 × PAK-13 high GCA are best suited for hybrid development.

Phyto-fabrication of ultrafine nanoscale holmium oxide HT-Ho2O3 NPs and their biomedical potential

In this study holmium oxide nanoparticles (Ho2O3 NPs) are fabricated using Hyphaene thebaica extracts as a bioreductant. The XRD pattern of HT-Ho2O3 NPs (product from phyto-reduction) suggested that the nanoparticles are crystalline with no impurities. Scherrer approximation revealed grain sizes of ∼10 nm. The HR-TEM revealed HT-Ho2O3 NPs possessed a quasi-spherical morphology complemented by SEM and the particle sizes were in the range of 6-12 nm. The infrared spectra revealed characteristic Ho-O bonding at ∼603 cm-1. Raman spectra indicated five main peaks positioned at 156 cm-1, 214 cm-1, 328 cm-1, 379 cm-1 and 607 cm-1. Eg (optical bandgap) was found to be 5.1 eV. PL spectra indicated two major peaks at 415 nm and 607 nm. EDS spectra confirmed the elemental presence of holmium (Ho). Spotty rings were obtained during the SAED measurement which indicated crystallinity of HT-Ho2O3 NPs. The HT-Ho2O3 NPs were further analyzed for their antioxidant, anti-angiogenic and cytotoxic properties. The antioxidant potential was moderate i.e., 43.40 ± 0.96% at 1000 μg mL-1 which decreased in a dose dependent manner. Brine shrimp lethality was highest at 1000 μg mL-1 with the LC50 320.4 μg mL-1. Moderate anti-angiogenic potential was observed using in ova CAM assay. MTT bioassay revealed that the HT-Ho2O3 NPs inhibited the 3T3 cells (IC50 67.9 μg mL-1), however, no significant inhibition was observed against MCF-7 cells. α-Amylase and β-glucosidase inhibition revealed that the HT-Ho2O3 NPs can be of use in controlling blood glucose levels. Overall, it can be concluded that biosynthesis using aqueous extracts can be a suitable alternative in finding ecofriendly paradigms for the synthesis of nanoparticles. We suggest extended research into the bioreduced Ho2O3 NPs for establishing their biomedical potential and toxicity.

Evidence of novel Treponema phylotypes implicated in contagious ovine digital dermatitis and association of treponemes with major lameness causing foot pathogens

In this study 269 swabs collected from 254 ovine foot lesions and 15 apparently healthy ovine feet were screened by PCR for the presence of major lameness causing foot pathogens viz. Treponema species, D. nodosus, F. necrophorum and T. pyogenes with the presumption that ovine foot lesion positive for Treponema species alone or in association with other three pathogens were categorized as contagious ovine digital dermatitis (CODD). While samples positive for D. nodosus alone or its combination with F. necrophorum and T. pyogenes were considered as footrot (FR) and samples in which F. necrophorum or T. pyogenes was found either alone or in combination were considered as interdigital dermatitis (ID). The overall occurrence of Treponema sp. in ovine foot lesions was 48.0%, and ranged from 33 to 58%. In Treponema positive samples D. nodosus, F. necrophorum and T. pyogenes were present in 34 (27.4%), 66 (54.4%) and 84 (68.5%) in contrast to Treponema negative samples in which these were present in 15 (11.1%), 20 (14.12%) and 17 (12.6%) samples, respectively. The data signifies that Treponema sp. are significantly associated with these foot pathogens and their different combinations with Treponema sp. influence the severity of CODD lesion. The identification of Treponema phylotypes was done by sequencing the 16S rRNA gene fragment of ten representative samples. Out of ten sequences, four (Trep-2, Trep-4, Trep-7 and Trep-10) were identical to Treponema sp. phylotype 1 (PT1) that belongs to phylogroup T. refringens-like, one sequence (Trep-1) was genetically close (90% sequence homology) to Treponema brennaborense while five sequences (Trep-3, Trep-5, Trep-6, Trep-8 and Trep-9) matched with uncultured bacterium clones of treponemes forming separate monophyletic group in phylogenetic tree and could represent new digital dermatitis phylogroup presently containing five ovine specific phylotypes. This is the first report on the presence of Treponema phylotypes other than three digital dermatitis (DD) Treponema phylogroups viz. T. phagedenis-like, T. medium/T. vincentii-like, and T. pedis-like that are frequently detected in CODD lesions. Metagenomic analysis of two representative samples revealed the abundance of genus Treponema in CODD lesion while this genus was absent in swab collected from clinically healthy foot suggesting that it might play primary role in producing CODD. These findings may further aid in understanding the etiopathogenesis of CODD and could help to develop appropriate treatment and mitigation strategies to combat the disease.

Potential anticancer and antioxidant lauric acid-based hydrazone synthesis and computational study toward the electronic properties

The modification of natural products is one of the key areas of synthetic organic chemistry for obtaining valuable chemical building blocks that have medicinal significance. In this study, lauric acid-based hydrazones, namely (E)-N'-(2-nitrobenzylidene)dodecanehydrazide (NBDH), (E)-N'-(naphthalen-1-ylmethylene)dodecanehydrazide (NMDH), and (E)-N'-(4-fluorobenzylidene)dodecanehydrazide (FBDH), were synthesized and characterized using spectroscopic techniques. The newly synthesized lauric acid-based hydrazones were screened for their anticancer and antioxidant potential. The antioxidants showed their activity by inhibiting the oxidative chain reactions that produce reactive oxygen species. The antioxidant activity showed that NBDH exhibited the maximum DPPH inhibitory activity when compared with that of NMDH and FBDH, whereas the anticancer activity showed that FBDH exhibited maximum percent viability when compared to that of NBDH and NMDH. The reactivity and biological needs of the synthesized compounds NBDH, NMDH, and FBDH were met by performing geometrical, FT-IR vibrational, UV-visible, global reactivity parameters (GRP), MEP, FMO, NBO, ELF, LOL, and nonlinear optical (NLO) analysis at the DFT/B3LYP/6-311+G(d,p) level. NBO analysis confirmed the existence of extended conjugation and intramolecular charge transfer among NBDH, NMDH, and FBDH, which have the lowest gap in π → π*, which are in line with the FMO results where successful charge transfer occurred from the highest occupied molecular orbital (HOMO) to the lowest unoccupied molecular orbital (LUMO). GRP analysis confirmed the potential of NBDH, NMDH, and FBDH for biological, electronic, and NLO applications. It is clear from the comparative analysis of the urea molecule that NBDH, NMDH, and FBDH all comprise fine NLO properties.

Extra-modification of zirconium dioxide for potential photocatalytic applications towards environmental remediation: A critical review

Photocatalytic degradation is a valuable direction for eliminating organic pollutants in the environment because of its exceptional catalytic activity and low energy requirements. As one of the prospective photocatalysts, zirconium dioxide (ZrO₂) is a promising candidate for photoactivity due to its favorable redox potential and higher chemical stability. ZrO₂ has a high rate of electron-hole recombination and poor light-harvesting capabilities. Still, modification has demonstrated enhancements, especially extra-modification, and is therefore worthy of investigation. This present review provides a comprehensive overview of the extra-modifications of ZrO₂ for enhanced photocatalytic performance, including coupling with other semiconductors, doping with metal, non-metal, and co-doping with metal and non-metal. The extra-modified ZrO₂ showed superior performance in degrading the organic pollutant, particularly dyes and phenolic compounds. Interestingly, this review also briefly highlighted the probable mechanisms of the extra-modification of ZrO₂ such as p-n heterojunction, type II heterojunction, and Z-scheme heterojunction. The latter heterojunction with excellent electron-hole space separation improved the photoactivity. Extensive research on ZrO₂'s photocatalytic potential is presented, including the removal of heavy metals, the redox of heavy metals and organic pollutants, and the evolution of hydrogen. Modified ZrO₂'s photocatalytic effectiveness depends on its band position, oxygen vacancy concentration, and metal defect sites. The opportunities and future problems of the extra-modified ZrO₂ photocatalyst are also discussed. This review aims to share knowledge regarding extra-modified ZrO₂ photocatalysts and inspire new environmental remediation applications.

Can Honey Improve the Quality of Cryopreserved Cross Bred Ram Semen Added to Tris Egg Yolk Extender?

BACKGROUND: Honey can improve the quality of cryopreserved ram semen because of its multinutrient and cryoprotective nature added to standard tris egg yolk extender. OBJECTIVE: Different concentrations of honey were added to the standard tris egg yolk extender to improve the post-thaw quality of crossbred ram semen. METHOD: Thirty six (36) ejaculates from eight healthy cross bred rams were pooled and divided into four aliquots. Standard tris egg yolk extender without any alteration acted as Control (C) and was supplemented with different concentrations of honey, viz. T1 (honey 1.5%), T2 (2.5%), and T3 (3.5%). RESULTS: The percent (mean ± S. E. M) sperm motility at pre-freeze was significantly (P<;0.05) higher in Group T2 and at post-thaw in Group T3 in comparison to T1 and C treatment groups. The percent (mean ± S. E. M) HOST reacted spermatozoa at post-thaw was significantly (P< 0.05) higher in Group C and at pre-freeze the value was significantly (P< 0.05) higher in the same treatment group than Group T1. The mean MDA level (mean ± S. E. M) at post thaw was significantly (P<0.05) low er in Group T3 than the treatment groups C and Group T1. CONCLUSION: From this study it is concluded that the addition of 3.5% honey to the standard tris egg yolk extender provides better protection to ram semen than the addition of 1.5% honey (i. e., Control).

Can honey improve the quality of cryopreserved cross bred ram semen added to tris egg yolk extender?

BACKGROUND

Honey can improve the quality of cryopreserved ram semen because of its multinutrient and cryoprotective nature added to standard tris egg yolk extender.

OBJECTIVE

Different concentrations of honey were added to the standard tris egg yolk extender to improve the post-thaw quality of crossbred ram semen.

METHOD

Thirty six (36) ejaculates from eight healthy cross bred rams were pooled and divided into four aliquots. Standard tris egg yolk extender without any alteration acted as Control (C) and was supplemented with different concentrations of honey, viz. T1 (honey 1.5%), T2 (2.5%), and T3 (3.5%).

RESULTS

The percent (mean ± S.E.M) sperm motility at pre-freeze was significantly (P < 0.05) higher in Group T2 and at post-thaw in Group T3 in comparison to T1 and C treatment groups. The percent (mean ± S.E.M) HOST reacted spermatozoa at post-thaw was significantly (P < 0.05) higher in Group C and at pre-freeze the value was significantly (P < 0.05) higher in the same treatment group than Group T1. The mean MDA level (mean ± S.E.M) at post thaw was significantly (P < 0.05) lower in Group T3 than the treatment groups C and Group T1.

CONCLUSION

From this study it is concluded that the addition of 3.5% honey to the standard tris egg yolk extender provides better protection to ram semen than the addition of 1.5% honey (i.e., Control). doi.org/10.54680/fr22610110212.

A state of the art review on electrochemical technique for the remediation of pharmaceuticals containing wastewater

Pharmaceutical wastewater is a frequent kind of wastewater with high quantities of organic pollutants, although little research has been done in the area. Pharmaceutical wastewaters containing antibiotics and high salinity may impair traditional biological treatment, resulting in the propagation of antibiotic resistance genes. The potential for advanced oxidation processes (AOPs) to break down hazardous substances instead of present techniques that essentially transfer contaminants from wastewater to sludge, a membrane filter, or an adsorbent has attracted interest. Among a variety of AOPs, electrochemical systems are a feasible choice for treating pharmaceutical wastewater. Many electrochemical approaches exist now to remediate rivers polluted by refractory organic contaminants, like pharmaceutical micro-pollutants, which have become a severe environmental problem. The first part of this investigation provides the bibliometric analysis of the title search from 1970 to 2021 for keywords such as wastewater and electrochemical. We have provided information on relations between keywords, countries, and journals based on three fields plot, inter-country co-authorship network analysis, and co-occurrence network visualization. The second part introduces electrochemical water treatment approaches customized to these very distinct discarded flows, containing how processes, electrode materials, and operating conditions influence the results (with selective highlighting cathode reduction and anodic oxidation). This section looks at how electrochemistry may be utilized with typical treatment approaches to improve the integrated system's overall efficiency. We discuss how electrochemical cells might be beneficial and what compromises to consider when putting them into practice. We wrap up our analysis with a discussion of known technical obstacles and suggestions for further research.

Hydrogen sulphide alleviates cadmium stress in Trigonella foenum-graecum by modulating antioxidant enzymes and polyamine content

Cadmium (Cd) toxicity reduces growth and yield of crops grown in metal-polluted sites. Research was conducted to estimate the potential of hydrogen sulphide (H₂ S) to mitigate toxicity caused by Cd in fenugreek seedlings (Trigonella foenum-graecum L.). Different concentrations of CdCl₂ (Cd1-1 mM, Cd2-1.5 mM, Cd3-2mM) and H₂ S (HS1-100 µM, HS2-150 µM, HS3-200 µM) were assessed. Seeds of fenugreek were primed with sodium hydrosulphide (NaHS), as H₂ S donor. Seedlings growing in Cd-spiked media treated with H₂ S were harvested after 2 weeks. Cd stress affected growth of fenugreek seedlings. Cd toxicity decreased leaf relative water content (LRWC), intercellular CO₂ concentration, net photosynthesis, stomatal conductance and transpiration. However, application of H₂ S significantly improved seedling morphological attributes by increasing the activity of antioxidant enzymes, i.e. APX, CAT and SOD, in Cd-contaminated soil. H₂ S treatment also regulated phenolic and flavonoid content. H₂ S-induced biosynthesis of spermidine (Spd) and putrescine (Put) could account for the enhancement of growth and physiological performance of fenugreek seedlings under Cd stress. H₂ S treatment also reduced H₂ O₂ production (38%) and electrolyte leakage (EL, 51%) in seedlings grown in different concentrations of Cd. It is recommended to evaluate the efficacy of H₂ S in alleviating Cd toxicity in other crop plants.

A cooperative approach for treatment of Zenker's diverticulum

BACKGROUND

Symptomatic Zenker's diverticulum management has evolved from an open intervention to an endoscopic management. At our center, both an otolaryngologist and a gastroenterologist are present in the operating room when treating these lesions. An intra-procedural consensus is reached to undergo either rigid endoscopy or flexible endoscopic diverticulotomy with ENT guidance. We evaluated the real-world efficacy with a cooperative gastroenterology-otolaryngology approach.

METHODS

Single-center retrospective study of patients who underwent a cooperative endoscopic diverticulotomy by a gastroenterologist and otolaryngologist at Cleveland Clinic Florida between 2012 and 2019. Demographic and clinical data, intra-procedural findings/complications, post-procedural symptoms, recurrence rate, and reintervention variables were extracted. Patients included in the study were > 17 years old, with symptomatic confirmed typical single Zenker's diverticulum.

RESULTS

63 subjects were identified. Patients were predominantly males (63.5%) and white (84.1%), with mean age 73.5 years (53-95). Most subjects presented dysphagia (98.4%), mostly to solids (79.4%). Other demographic and clinical data are described in Table 1. The diverticula had a mean size of 36.3 mm. In 30.1% of the cases food debris was found during the procedure. The mean procedure length was 38.4 minutes. All cases were performed as outpatient. Technical success was achieved in all cases. Patients were followed for a mean of 3.24 months post-procedure. Clinical success was achieved in 92% subjects. One intra-procedural perforation was treated with endoclip. Table 1 Pre-procedural demographic and clinical variables in patients undergoing Zenker's diverticulum cooperative approach Variable Value (n = 63) Sex, n (%)  Male  Female 40 (63.5) 23 (36.5) Ethnicity/Race, n (%)  Non-Hispanic White  Hispanic  Black 53 (84.1) 7 (11.1) 3 (4.8) Smoking status, n (%)  Never  Former  Active 29 (46.0) 26 (41.3) 8 (10.7) Previous intervention for Zenker's diverticulum, n (%) 12 (19.1) Dysphagia, n (%)  Only to solids  Only to liquids  Both solids and liquids 50 (79.4) 0 (0) 12 (19.0) Regurgitation of food, n (%)  Chronic cough, n (%) 13 (20.6)  Halitosis, n (%) 9 (14.3) CONCLUSION: A cooperative endoscopic approach by gastroenterology and otolaryngology for symptomatic Zenker's diverticulum management offered excellent technical and clinical success. This approach proved to be safe and effective.

Hydrogen sulphide and nitric oxide mitigate the negative impacts of waterlogging stress on wheat (Triticum aestivum L.)

Nitric oxide (NO) and hydrogen sulphide (H₂ S) are important gaseous signalling molecules that regulate key physiochemical mechanisms of plants under environmental stresses. A number of attempts have been made to improve waterlogging tolerance in plants, but with limited success. Having said that, NO and H₂ S are vital signalling molecules, but their role in mitigating waterlogging effects on crop plants is not well established. We investigated the efficacy of exogenous NO and H₂ S to alleviate waterlogging effects in two wheat cultivars (Galaxy-2013 and FSD-2008). Waterlogging produced a noticeable reduction in plant growth, yield, chlorophyll, soluble sugars and free amino acids. Besides, waterlogging induced severe oxidative damage seen as higher cellular TBARS and H₂ O₂ content. Antioxidant enzyme activity increased together with a notable rise in Fe²⁺ and Mn²⁺ content. Proline content was higher in waterlogged plants compared with non-waterlogged plants. In contrast, waterlogging caused a substantial decline in endogenous levels of essential nutrients (K⁺ , Ca²⁺ and Mg²⁺ ). Waterlogged conditions led to Fe²⁺ and Mn²⁺ toxicity due to rapid reduction of Fe³⁺ and Mn³⁺ in the soil. Exogenous NO and H₂ S significantly protected plants from waterlogging effects by enhancing the oxidative defence and regulating nutritional status. Besides, the protective effects of exogenous NO were more prominent as compared with effects of H₂ S. Further, we did not study the effect of H₂ S and NO on photosynthetic attributes and expression of stress-related genes. Therefore, future studies should examine the effects of H₂ S and NO on wheat physiology and gene expression under waterlogging.

Endoscopic ultrasound with combined fine needle aspiration plus biopsy improves diagnostic yield in solid pancreatic masses

GOALS

Our aim was to compare the diagnostic yield of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) versus combined fine needle aspiration and fine needle biopsy (EUS-FNA + FNB) in the evaluation of solid pancreatic masses (SPMs).

BACKGROUND

EUS-FNA and EUS-FNB are established methods to diagnose SPMs. No studies have evaluated the efficacy of combination of both (EUS-FNA + FNB). Our senior author (MRS) hypothesized that combining the two techniques by using a single FNB needle improves diagnostic yield and started combination technique in October 2016.

STUDY

Patients who underwent EUS for SPMs by MRS during January 2014-September 2019 were included. They were divided into the EUS-FNA group and EUS-FNA + FNB group. EUS-FNA was performed using a 22 or 25 gauge Expect Slimline needle (Boston Scientific, Marlborough, MA) and EUS-FNA + FNB was performed using a single 22 or 25 gauge Shark-core needle (Medtronics, Minneapolis, MN, USA). Our primary outcome was to compare the diagnostic yield in the two groups.

RESULTS

Among 105 patients included, 58 were in the EUS-FNA group and 47 were in the EUS-FNA + FNB group. EUS-FNA + FNB group had significantly higher diagnostic yield and required fewer needle passes compared to EUS-FNA group, 95.7% vs. 77.6%, p = .01: and 4 vs. 5, p = .002; respectively. Procedural duration was similar in both groups but the combined technique required less number of needles per procedure. There was no difference in adverse events in the two groups.

CONCLUSION

Our study showed that combined EUS-FNA + FNB had higher diagnostic yield compared to EUS-FNA in SPMs along with less number of needle passes and needles required. Further prospective studies are needed to validate these findings and cost-effectiveness of this strategy.

The Effect of Moringa oleifera Lam. Leaf Aqueous Extract on Seed Yield and Fibre Quality of Linseed under Water Deficit Stress

Moringa oleifera leaf extract contains active ingredients with stimulatory effects on natural processes of plants like uptake of nutrients, photosynthesis, biomass production and flowering. Therefore, we conducted field experiments to determine the effects of M. oleifera leaf aqueous extract (MLAE) on growth and fibre quality of three linseed varieties viz. Roshni, BL1 and Chandni under water deficit stress for two years. Water deficit stress was imposed during tillering growth phase (60 days after sowing) by skipping four irrigations, keeping 40% soil field capacity. The MLAE (5%) was applied to leaves once before the start of water deficit stress period and next 15 days after imposition of water deficit stress. Analysis of MLAE showed the presence of natural phenolics (150 mg gallic acid equivalents (GAE)/mL extract) and essential nutrients like Ca, Mg, K, Zn, Mn, and Fe. Positive impact of the MLAE was observed on plant height, tillers production, leaf chlorophyll pigments, phenolics content, sugars content, seed yield and fibre quality of linseed both under non-stress and water deficit stress. Our studies concluded that MLAE can be a probable approach for maintaining normal growth and fibre quality of linseed plants under short supply of water.

Variability in indigenous Pakistani tomato lines and worldwide reference collection for Tomato Mosaic Virus (ToMV) and Tomato Yellow Leaf Curl Virus (TYLCV) infection

Local and exotic germplasm of tomato remains a major source for genetic improvement. Assessment of such lines for biotic stresses particularly viral diseases are the most important criteria for selection in Pakistan, where Tomato Yellow Leaf Curl Virus (TYLCV) and Tomato Mosaic Virus (ToMV) are the major diseases/viruses. A set of 40 accessions (including indigenous Pakistani lines and exotic germplasm from Europe, the United States, and Asia) were evaluated for their resistance/infection response to ToMV with artificial inoculation under greenhouse conditions. Infection response was quantified through disease scoring and DAS-ELISA test (for ToMV). A subset of 24 lines, was further screened for TYLCV using disease scoring and TAS-ELISA. The tested lines showed significant variability for resistance to ToMV. Only one accession (Acc-17878) was resistant to the ToMV whereas seven accessions i.e. Acc-17890, AVR-261, CLN-312, AVR-321, EUR-333, CLN-352, and CLN-362 expressed resistance to TYLCV. Correlation between phenotypic evaluation was confirmed by the ELISA results in both diseases, although both tools complemented to assess the viral infection status. In future, tomato breeding programs must consider breeding for ToMV and TYLCV resistance (using identified germplasm in our study) so as to deliver virus resistant tomato varieties.

Sublethal toxicity of carbofuran in cattle egret (Bubulcus ibis coromandus): hematological, biochemical, and histopathological alterations

This study was aimed to investigate Carbofuran (CF)-induced pathological changes in cattle egret. Two hundred cattle egrets were reared and equally divided into four groups and given different CF concentrations (0.03 mg/L, 0.02 mg/L, 0.01 mg/L and 0 mg/L (control group)). Hematology, serum biochemistry, histopathology, and immunological markers were studied. Our results confirm that CF induces anemic conditions, leukocytosis, elevated liver enzymatic activity, and alterations in renal biomarkers. Moreover, specific microscopic lesions such as multifocal necrosis, pyknotic nuclei, hemorrhages, congestion, and inflammatory cell proliferation were observed in the liver, kidney, spleen, and thymus. These findings suggest that CF can induce harmful effects, so the application of this pesticide in the field must be strictly monitored to mitigate the possibility of exposure to non-target species.

Evaluation of the Diagnostic Potential of Liver Aminotransferases and Alkaline Phosphatase in Patients with Cardiovascular Diseases

Background Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality, particularly in developing countries. Early diagnosis with the best diagnostic marker is highly desired for the prevention and timely treatment of CVDs. However, there is still a dearth of an ideal marker for the detection of CVDs. Objective To explore the diagnostic potential of liver aminotransferases (AST and ALT), and alkaline phosphatase for the diagnosis of CVDs without liver involvement. Method This was a cross-sectional study conducted among 200 adult patients with CVDs, who visited the cardiology and emergency units of Manipal Teaching Hospital, Pokhara, Nepal. The study was conducted from January 2018 to December 2020. The baseline data on family history, anthropometry, baseline biochemical parameters, liver enzymes, and cardiac biomarkers were collected using standard and validated methods. The data were analyzed using SPSS version 21 and MedCalc software 2021. Result The diagnostic sensitivity of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were 53.7%, 52.6%, and 33.7% and specificity were 99%, 90%, and 90% respectively. The area under the curve (AUC) of AST, ALT, and ALP were 0.78, 0.73, and 0.52 respectively. ROC curve indicated that serum AST and ALT activity was a better reliable marker than the serum ALP activities. Conclusion Our study suggests that serum aspartate aminotransferase and alanine aminotransferase but not alkaline phosphatase could have some diagnostic potential to diagnose the risk of CVDs. However, they could not replace the currently adopted cardiac biomarkers such as cTnI and CK-MB.

A critical review on relationship of CeO2-based photocatalyst towards mechanistic degradation of organic pollutant

Nanostructured photocatalysts commonly offered opportunities to solve issues scrutinized with the environmental challenges caused by steep population growth and rapid urbanization. This photocatalyst is a controllable characteristic, which can provide humans with a clean and sustainable ecosystem. Over the last decades, one of the current thriving research focuses on visible-light-driven CeO₂-based photocatalysts due to their superior characteristics, including unique fluorite-type structure, rigid framework, and facile reducing oxidizing properties of cerium's tetravalent (Ce⁴⁺) and trivalent (Ce³⁺) valence states. Notwithstanding, owing to its inherent wide energy gap, the solar energy utilization efficiency is low, which limits its application in wastewater treatment. Numerous modifications of CeO₂ have been employed to enhance photodegradation performances, such as metals and non-metals doping, adding support materials, and coupling with another semiconductor. Besides, all these doping will form a different heterojunction and show a different way of electron-hole migration. Compared to conventional heterojunction, advanced heterojunction types such as p-n heterojunction, Z-scheme, Schottky junction, and surface plasmon resonance effect exhibit superior performance for degradation owing to their excellent charge carrier separation, and the reaction occurs at a relatively higher redox potential. This review attends to providing deep insights on heterojunction mechanisms and the latest progress on photodegradation of various contaminants in wastewater using CeO₂-based photocatalysts. Hence, making the CeO₂ photocatalyst more foresee and promising to further development and research.

Deciphering Chemical Profiling, Pharmacological Responses and Potential Bioactive Constituents of Saussurea lappa Decne. extracts through In Vitro Approaches

Despite advancement in modern medicines, plant derived medicines have still wide range utilities as they have less side effects and are cheap and biocompitable. Sassurea lappa is an extensively used plant in traditional medicinal formulations. Plant roots are used to cure various diseases including cancer, rheumatic pain, abdominal and nervous disorders. The present study was aimed for the evalution of biological potentials of methanolic and chloroform extracts of Saussurea lappa root, leaf, seed and flower. The methanolic and chloroform extracts were subjected to qualitative and quantitative phytochemical analyses. Identification of functional groups was performed using Fourier Transform infrared (FT-IR) spectroscopy. Antioxidant potential was determined via diphenyl-1-picrylhydrazyl (DPPH), total reducing power (TRP) and total antioxidant capacity (TAC) method, anti-hemolytic potential was conducted on human RBCs, antibacterial activity was evaluated against six American type culture collection (ATCC) and three multi drug resistance (MDR) strains, cytotoxic and phytotoxic potentials were evaluated through brine shrimp lethality assay and raddish seed assay respectively. Experiments were performed in triplicates and analysis of variance (ANOVA) was applied using statistics version-8.1. Phytochemical analysis revealed the presence of sixteen secondary metabolites. Fourteen functional groups were identified through FTIR. S. lappa root methanolic (SLRM) showed maximum antioxidant activity index (AAI-79.42%) whereas chloroform extract of leaves (SLLC) gave highest antibacterial activity with maximum zone of inhibition (ZOI) against Pseudomonas aeruginosa (21.4 mm). Maximum cytotoxicity was observed for SLRM with lethal dose concentration (LC₅₀) of 58.8 µg/mL. However, root extracts showed significant phytotoxicity (15% germination). The current study investigated that bioactive compounds present in S. lappa leaves, seed, flower and roots were responsible for enhanced biological potentials. Further studies on isolation and characterization of these bioactive compounds may help in drug development. In future, we recommend different in-vitro and in-vivo studies to further confirm it biopharmacological potencies.

Prevalence of parasites in selected captive bird species

Blood and fecal samples of chukar partridge (Alectoris chukar), albino pheasant (Phasianus colchicus), silver pheasant (Lophura nycthemera), rose-ringed parakeet (Psittacula krameri) and turkeys (Meleagris gallopavo) were analyzed to check parasitic prevalence. To record parasites these five avian species were placed kept in separate cages at Avian Conservation and Research Center, Department of Wildlife an Ecology, University of Veterinary and Animal Sciences, Lahore, Pakistan. 100 fecal and 100 blood samples for each bird species were inspected to analyze internal parasites. During present study, 17 species of endoparasites 14 from fecal samples and three from blood were examined. Two species of ectoparasites i.e. mite Dermanyssus gallinae 42% and fowl ticks Args persicus 41%were studied. Blood parasites included Plasmodium juxtanucleare 50%, Leucoctoyzoon simond having parasitic prevalence 40%, and Aegyptinella pullorum having parasitic prevalence of 40%. Parasitic species recorded from fecal samples included 6 species of nematodes viz. Allodpa suctoria 2%. Syngamus trachea with parasitic prevalence of 60%, Capillaria annulata 37.5%, Ascardia galli 24%, Capillaria anatis 40% and Heterakis gallinarum 28.3%. Similarly, two species of trematodes viz. Prosthogonimus ovatus having parasitic prevalence of 50% and Prosthogonimus macrorchis 21% were also documented from fecal avian samples . Single cestode species Raillietina echinobothrida having parasitic prevalence of 72% and 3 protozoan species i.e. Eimeria maxima having parasitic prevalence of 21%, Giardia lamblia 41% and Histomonas meleagridis 18% were documented during corpological analysis. In our recommendation, proper sanitation, medication and vaccination of bird's enclousres are suggested to avoid parasites.

Safety of anti-TNF agents in patients with compensated cirrhosis: a case-control study

BACKGROUND

There is limited data on the use of anti-TNF agents in patients with concomitant cirrhosis. The aim of this study is to assess the safety of anti-TNF agents in patients with compensated cirrhosis who used these medications for the treatment of an underlying rheumatologic condition or IBD.

METHODS

Multicenter, retrospective, matched, case-control study. A one to three case-control match was performed. Adults who received anti-TNF therapy were matched to three adults with cirrhosis who did not receive anti-TNF therapy. Patients were matched for etiology of cirrhosis, MELD-Na and age. Primary outcome was the development of hepatic decompensation. Secondary outcomes included development of infectious complications, hepatocellular carcinoma (HCC), extra-hepatic malignancy, and mortality.

RESULTS

Eighty patients with cirrhosis who received anti-TNF agents were matched with 240 controls. Median age was 57.2 years. Median MELD-Na for the anti-TNF cohort was seven and median MELD-Na for the controls was eight. The most common etiology of cirrhosis was NAFLD. Anti-TNF therapy did not increase risk of decompensation (HR: 0.91, 95% CI: 0.64-1.30, p = 0.61) nor influence the time to development of a decompensating event. Anti-TNF therapy did not increase the risk of hepatic mortality or need for liver transplantation (HR: 1.18, 95% CI: 0.55-2.53, p = 0.67). Anti-TNF therapy was not associated with an increased risk of serious infection (HR: 1.21, 95% CI: 0.68-2.17, p = 0.52), HCC (OR: 0.45, 95% CI: 0.13-1.57, p = 0.21), or extra-hepatic malignancy (OR: 0.82, 95% CI: 0.29-2.30, p = 0.71).

CONCLUSIONS

Anti-TNF agents in patients with compensated cirrhosis does not influence the risk of decompensation, serious infections, transplant free survival, or malignancy.

The family planning "know-do" gap among married women of reproductive age in urban Pakistan

OBJECTIVE

To examine the prevalence and predictors of family planning (FP) know-do gaps among married women of reproductive age (MWRA) in low socio-economic urban areas of Karachi, Pakistan.

DESIGN

This was a cross-sectional survey of randomly selected 7288 MWRA (16-49 years) to identify predictors of the know-do gap in FP using a logistic regression model.

RESULTS

More than one third (35.5%) of MWRA had FP know-do gap, i.e., despite having a knowledge of contraceptives and desire to limit or delay childbearing, they were not using contraceptives. Women were less likely to use FP if they were getting older (25-35 years: OR 1.45, 95% CI 1.09-1.94; >35 years: OR 3.02, 95% CI 1.90-4.80), from certain ethnicities (Sindhi: OR 1.64, 95% CI 1.11-2.42; Saraiki: OR 1.66, 95% CI 1.01-2.71; other minorities: OR 2.37, 95% CI 1.63-3.44); did not receive FP counselling: OR 1.43, 95% CI 1.13-1.80; and had not made a joint decision on FP: OR 1.44, 95% CI 1.06-1.98). Conversely, women were more likely to use contraceptives if they had >10 years of schooling (OR 0.66, 95% CI 0.46-0.94), with each increasing number of a living child (OR 0.68, 95% CI 0.62-0.75) and each increasing number of contraceptive method known (OR 0.93, 95% CI 0.88-0.98).

CONCLUSION

The predictors associated with the FP know-do gap among MWRA should be considered when planning future strategies to improve the contraceptive prevalence rate in Pakistan.

Recent advances in catalytic systems in the prism of physicochemical properties to remediate toxic CO pollutants: A state-of-the-art review

Carbon monoxide (CO) is the most harmful pollutant in the air, causing environmental issues and adversely affecting humans and the vegetation and then raises global warming indirectly. CO oxidation is one of the most effective methods of reducing CO by converting it into carbon dioxide (CO₂) using a suitable catalytic system, due to its simplicity and great value for pollution control. The CO oxidation reaction has been widely studied in various applications, including proton-exchange membrane fuel cell technology and catalytic converters. CO oxidation has also been of great academic interest over the last few decades as a model reaction. Many review studies have been produced on catalysts development for CO oxidation, emphasizing noble metal catalysts, the configuration of catalysts, process parameter influence, and the deactivation of catalysts. Nevertheless, there is still some gap in a state of the art knowledge devoted exclusively to synergistic interactions between catalytic activity and physicochemical properties. In an effort to fill this gap, this analysis updates and clarifies innovations for various latest developed catalytic CO oxidation systems with contemporary evaluation and the synergistic relationship between oxygen vacancies, strong metal-support interaction, particle size, metal dispersion, chemical composition acidity/basicity, reducibility, porosity, and surface area. This review study is useful for environmentalists, scientists, and experts working on mitigating the harmful effects of CO on both academic and commercial levels in the research and development sectors.

Leadership empowering behaviour as a predictor of employees' psychological well-being: Evidence from a cross-sectional study among secondary school teachers in Kohat Division, Pakistan

In this technologically developed scenario, many organizations in developing countries including Pakistan have expanded the enthusiasm for understanding and creating an encouraging administrative and managerial environment. Numerous organizations are struggling for structural changes by deserting the old-fashioned organizational management style and implementing an empowering leadership where leaders give more authority to subordinates in decision making and responsibilities with the aim to increase organizational productivity. Therefore, the study examined the leadership empowering behaviour as a predictor of employees’ psychological well-being of the educational institutions at secondary level in Kohat Division, Pakistan. A total sample of 564 secondary school teachers (male n = 379; female n = 185) was carefully chosen through a stratified random sampling technique. In this study, a non-experimental predictive correlational design was adopted. In order to collect data from the participants, two different standardized research tools i.e., the Leader Empowering Behaviour Questionnaire and Ryff’s Psychological Well-being Scale were used. After the collection of data, it was analyzed on the basis of mean, standard deviation, Pearson’s product-moment correlation, and multiple linear regression model. In conclusion, the study confirmed a significant positive correlation between leadership empowering behaviour and employees’ psychological well-being. Leadership empowering behaviours predict employees’ psychological well-being positively. Therefore, it was recommended that empowering behaviour might be adopted by the school leaders to improve the employees’ psychological well-being for better organizational productivity.

Green carbonaceous material‒fibrous silica-titania composite photocatalysts for enhanced degradation of toxic 2-chlorophenol

In this work, fibrous silica-titania (FST) was successfully prepared by the microemulsion method prior to the addition of three types of carbonaceous materials: graphitic-carbon nitride, g-C3N4 (CN), graphene nanoplatelets (GN), and multi-wall carbon nanotubes, MWCNT (CNT), via a solid-state microwave irradiation technique. The catalysts were characterized using XRD, FESEM, TEM, FTIR, UV-Vis DRS, N2 adsorption-desorption, XPS and ESR, while their photoactivity was examined on the degradation of toxic 2-chlorophenol (2-CP). The result demonstrated that the initial reaction rate was in the following order: CNFST (5.1 × 10^-3 mM min^-1) > GNFST (2.5 × 10^-3 mM min^-1) > CNTFST (2.3 × 10^-3 mM min^-1). The best performance was due to the polymeric structure of g-C3N4 with a good dispersion of C and N on the surface FST. This dispersion contributed towards an appropriate quantity of defect sites, as a consequence of the greater interaction between g-C3N4 and the FST support, that led to narrowed of band gap energy (2.98 eV to 2.10 eV). The effect of scavenger and ESR studies confirmed that the photodegradation over CNFST occurred via a Z-scheme mechanism. It is noteworthy that the addition of green carbonaceous materials on the FST markedly enhanced the photodegradation of toxic 2-CP.

Development of a rapid loop-mediated isothermal amplification (LAMP) assay for visual detection of porcine parvovirus (PPV) and its application

Porcine parvovirus (PPV) infection is one of the most important causes of reproductive failure in pigs impacting the piggery industry globally with huge economic losses. A cost-effective, simple, rapid, specific, and sensitive method is critical for monitoring PPV infection on pig farms. The main aim of the present study was to develop and evaluate a loop-mediated isothermal amplification (LAMP) assay for rapid visual detection of porcine parvovirus (PPV) in pigs. A set of six LAMP primers including two outer primers, two inner primers, and two loop primers were designed utilizing the conserved region of capsid protein VP2 gene sequences of PPV and was applied for detection of PPV from porcine samples. Time and temperature conditions for amplification of PPV genes were optimized to be 30 min at 63 °C. The developed assay was ten-fold more sensitive than conventional PCR with analytical sensitivity of 20 pg and 200 pg, respectively. This is the first report of detection of PPV by LAMP assay from India. The assay did not cross-react with porcine circovirus type 2 (PCV2), porcine reproductive and respiratory syndrome virus (PRRSV), or classical swine fever virus (CSFV). The LAMP assay was assembled into a LAMP assay kit of 20 reactions and was validated in different laboratories in India. The newly developed LAMP assay was proved to be a specific, sensitive, rapid, and simple method for visual detection of PPV which does not require even costly equipments for performing the test. It complements and extends previous methods for PPV detection and provides an alternative approach for detection of PPV.

Biodiversity of orb-web spiders (family: araneidae) of buner valley, Pakistan

The present research was carried out to explore the spider fauna of Buner valley with taxonomic study from February 2018 to January 2019. For this purpose samples were collected, four times at each month from 4 tehsils: Daggar, Gagra, Mandan and Totalai. Two methods were used, hand picking and sweep net for collection of samples. During day and night, three habitats, arid area, agriculture land and building area were search for collection. A total of 534 samples of spider were collected from four sampling sites, in which 379 were belonging to family Araniedae. After confirmation, the identified species were belonging to 8 genera (Neoscona, Argiope, Cyclosa, Araneus, Cyrtophora, Larinia, Erivoxia and Poltys) and 19 species. 18 of them were identified to specie level while a single specie to its generic level. The genus Neoscona was the dominant genus 26.31% having 5 species while the genus Argiope 21.05% is the second dominant having 4 species followed by Cyclosa 15.78% having 3 species followed by Cyrtophora and Araneus 10.52% having two species both. The Poltys and Larinia 5.26% are the rarest genera represent single-single specie both. Statistical analysis show that specie richness (D) = 5.77, Simpson index (1-D) = 0.87, Shannon index (H) = 2.33. Diversity of spiders was evenly distributed and calculated Evenness value was H/InS = 0.5408. There is also few atypical species and Fisher alpha estimate high value (Fisher α) = 4.42. Chao-1 estimated we have reported 22 species.

Association of Complicated Diverticulitis With Development of De Novo Inflammatory Bowel Disease

BACKGROUND

There has been a historic similarity in the epidemiology and pathophysiology of diverticular disease and inflammatory bowel disease (IBD). Because there are limited to no data on the role of diverticulitis as a potential risk factor for de novo IBD, we aimed to evaluate the role of diverticulitis and complicated diverticulitis as a potential predictor of IBD.

METHODS

We performed a retrospective, single-center study including patients older than age 18 years who were diagnosed with diverticulitis from January 2012 until December 2018 without a prior diagnosis of IBD. These patients were then evaluated for development of IBD. Univariate and multivariate analyses were conducted to compare the characteristics and outcomes between patients who did or did not develop IBD.

RESULTS

A total of 2770 patients were diagnosed with diverticulitis from 2012 until 2018. Of these patients, 17 were diagnosed with IBD, resulting in an incidence rate of 0.23% per patient-year. The incidence rate among patients who required surgery for diverticulitis was 0.44% per patient-year, and patients with complicated diverticulitis had an incidence rate of 0.91% per patient-year. Univariate analysis showed that the need for surgery related to diverticulitis (hazard ratio [HR], 6.27; P = 0.003) and complicated diverticulitis was associated with the development of IBD (HR, 14.71; P < 0.001). Multivariate analysis showed that complicated diverticulitis was the sole factor associated with IBD (HR, 10.34; P < 0.001).

CONCLUSIONS

Patients with diverticulitis are at a higher risk of developing de novo IBD. This risk is highest in patients with complicated diverticulitis.

Distribution of commensal rodents in some shops of three districts in Malakand region, Pakistan

Using wire mesh live traps distribution pattern of the Rattus rattus and Mus musculus in different shops of three districts of Malakand region, Pakistan were recorded from September 2014 to October 2015. Over all 103 rodents (Rattus rattus 86 and Mus musculus 17) were caught during in 0.04 trap success (2448 trap nights). Regression of daily captures on cumulative captures revealed an estimate of 103 rodents from all the sampled structures with an average of 3.55 rodents per shop. R. rattus; 83.4% of captures were numerically dominant in almost all types of shops sampled, and were significantly different than Mus musculus; 16.5% of captures. Both species were found together in some shops while they were mostly trapped from the separate shops. Male rodents outnumbered the females.

Systematic analysis of leisler's bat Nyctalus leisleri (Kuhl, 1817) captured from FATA region, Pakistan

Extensive field surveys were carried out to explore the distribution of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) in selected area of FATA regions, Pakistan. Specimens of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) (n5) were collected from Kurram Agency (Shublan) (N33.8229788 E70.1634414) at elevation 1427m and Khyber Agency (Landi Kotel) (N34.0909899 E71.1457517) at elevation 1091m for two years survey extending from May 2013 through August 2015. The mean head and body length, hind foot length, ear length and tail length the Nyctalus leisleri specimens captured from the study area was 65.08 ± 1.58 mm, 44.06 ± 0.52 mm, 8.38 ± 0.60 mm, 13.20 ± 0.99 mm and 39.46 ± 1.46 mm, respectively. For molecular analysis the sequences of COI gene were obtained and analyzed. The mean intraspecific divergences of Nyctalus leisleri was 0.04%. The mean interspecific divergences of Nyctalus noctula and Nyctalus leisleri was 0.2%. The mean concentration of each nucleotides was A = (26.3%), T = (32.8%), G = (15.9%) and C = (25.0%). The mean A+T contents were 59.2%and C+G were 40.9%. In the phylogenetic tree Nyctalus leisleri and Nyctalus noctula clustered with significant bootstrap support value.

690 Intracranial Hypotension Due to CSF Leak Secondary to Ventral Thoracic Osteophyte Complex: Resolution After Transdural Thoracic Discectomy and Dural Repair

The hallmark symptom of spontaneous intracranial hypotension (SIH) is orthostatic headaches which manifests secondary to cerebrospinal fluid (CSF) hypovolaemia. Well-recognised aetiologies include trauma which includes procedures such as lumbar punctures and spinal surgery. More recently, structural defects such as bony osteophytes and calcified or herniated discs have been attributed to mechanically compromising dural integrity consequently resulting in CSF leak and symptom manifestation. A thorough literature review noted only a handful of such cases.

We report the case of a thirty-two-year-old Asian female who presented with a one-month history of new-onset progressively worsening orthostatic headaches. Workup included MRI of the thoracic spine which revealed an epidural collection of CSF consequently prompting a dynamic CT-myelogram of the spine which not only helped to confirm severe cerebral hypotension but also suggested the underlying cause as being a dorsally projecting osteophyte-complex at level T2-3. Conservative and medical management including bed rest, analgesia, mechanical compression, and epidural blood patches failed to alleviate symptoms and a permanent surgical cure was eventually sought. The surgery involved T2-T3 laminectomy and osteophytectomy and at a 3-month follow-up, complete resolution of symptoms was noted.

Clinical and Endoscopic Predictors of Hydrostatic Balloon Dilation Failure for Post-Bariatric Anastomotic Stricture Treatment

BACKGROUND

Roux-en-Y gastric bypass (RYGB) patients can develop anastomotic strictures. The initial management relies on endoscopic hydrostatic balloon dilation, but in a subset of patients, it may be unsuccessful despite several dilations, requiring a different treatment modality. We evaluated the factors associated with balloon dilation failure and need for revision surgery.

METHODS

Retrospective analysis from patients presenting with a post-RYGB anastomotic stricture who underwent balloon dilation from 2005 to 2018 at Cleveland Clinic Florida and Cleveland Clinic Main Campus. Demographic, clinical, surgical, endoscopic, and post-procedural variables were collected. Univariate and multivariate analysis with odds ratio (OR) and 95% confidence interval (95% CI) calculation for factors associated to dilation failure was performed.

RESULTS

Eighty-nine patients were included in the analysis. Population was predominantly white (85.4%) and female (87.6%), with mean age 46.4 years and followed for a mean of 97.4 months. All patients presented dysphagia, with mean stricture diameter of 7.7 mm and associated marginal ulcer in 69%. Successful dilation was achieved in 65 patients, while 24 patients had dilation failure and underwent revisional surgery. Multivariate analysis showed a higher risk of dilation failure if time from RYGB to first dilation was >3 months (OR 4.95, 1.29-19.04; p = 0.02), and if nausea/vomiting were present before first dilation (OR 4.37, 1.11-17.16; p = 0.03). One patient had a perforation after dilation and was treated surgically.

CONCLUSIONS

Post-RYGB anastomotic strictures can be successfully treated with hydrostatic balloon dilation. However, patients with dilations performed > 3 months after initial RYGB and nausea/vomiting have an increased risk of dilation failure and need for further interventions.