The prognostic value of blood cellular indices in pulmonary embolism.

Prognostication in acute pulmonary embolism (PE) requires reliable markers. While cellular indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) appear promising, their utility in PE prognostication needs further exploration. We utilized data from the RIETE registry and the Loyola University Medical Center (LUMC) to assess the prognostic value of NLR, PLR, and SII in acute PE, using logistic regression models. The primary outcome was 30-day all-cause mortality. We compared their prognostic value versus the simplified Pulmonary Embolism Severity Index (sPESI) alone. We included 10 085 patients from RIETE and 700 from the LUMC. Thirty-day mortality rates were 4.6% and 8.3%, respectively. On multivariable analysis, an elevated NLR (>7.0) was associated with increased mortality (adjusted odds ratio [aOR]: 3.46; 95% CI: 2.60-4.60), outperforming the PLR > 220 (aOR: 2.36; 95% CI: 1.77-3.13), and SII > 1600 (aOR: 2.52; 95% CI: 1.90-3.33). The c-statistic for NLR in patients with low-risk PE was 0.78 (95% CI: 0.69-0.86). Respective numbers were 0.66 (95% CI: 0.63-0.69) and 0.68 (95% CI: 0.59-0.76) for intermediate-risk and high-risk patients. These findings were mirrored in the LUMC cohort. Among 9810 normotensive patients in RIETE, those scoring 0 points in sPESI and with an NLR ≤ 7.0 (35% of the population) displayed superior sensitivity (97.1%; 95% CI: 95.5-98.7) and negative predictive value (99.7%; 95% CI: 99.5-99.8) than sPESI alone (87.1%; 95% CI: 83.9-90.3, and 98.7%; 95% CI: 98.4-99.1, respectively) for 30-day mortality. The NLR is a significant prognostic marker for 30-day mortality in PE patients, especially useful to identify patients with very low-risk PE.

Machine learning based efficient prediction of positive cases of waterborne diseases.

BACKGROUND: Water quality has been compromised and endangered by different contaminants due to Pakistan's rapid population development, which has resulted in a dramatic rise in waterborne infections and afflicted many regions of Pakistan. Because of this, modeling and predicting waterborne diseases has become a hot topic for researchers and is very important for controlling waterborne disease pollution. METHODS: In our study, first, we collected typhoid and malaria patient data for the years 2017-2020 from Ayub Medical Hospital. The collected data set has seven important input features. In the current study, different ML models were first trained and tested on the current study dataset using the tenfold cross-validation method. Second, we investigated the importance of input features in waterborne disease-positive case detection. The experiment results showed that Random Forest correctly predicted malaria-positive cases 60% of the time and typhoid-positive cases 77% of the time, which is better than other machine-learning models. In this research, we have also investigated the input features that are more important in the prediction and will help analyze positive cases of waterborne disease. The random forest feature selection technique has been used, and experimental results have shown that age, history, and test results play an important role in predicting waterborne disease-positive cases. In the end, we concluded that this interesting study could help health departments in different areas reduce the number of people who get sick from the water.

Investigating In Situ Expression of c-MYC and Candidate Ubiquitin-Specific Proteases in DLBCL and Assessment for Peptidyl Disruptor Molecule against c-MYC-USP37 Complex.

Diffuse Large B-Cell Lymphoma (DLBCL) is the most common form of non-Hodgkin's lymphoma (NHL). Elevated expression of c-MYC in DLBCL is associated with poor prognosis of the disease. In different cancers, c-MYC has been found regulated by different ubiquitin-specific proteases (USPs), but to date, the role of USPs in c-MYC regulation has not been investigated in DLBCL. In this study, in situ co expression of c-MYC and three candidates USPs, USP28, USP36 and USP37, have been investigated in both the ABC and GCB subtypes of DLBCL. This shows that USP37 expression is positively correlated with the c-MYC expression in the ABC subtype of DLBCL. Structurally, both c-MYC and USP37 has shown large proportion of intrinsically disordered regions, minimizing their chances for full structure crystallization. Peptide array and docking simulations has shown that N-terminal region of c-MYC interacts directly with residues within and in proximity of catalytically active C19 domain of the USP37. Given the structural properties of the interaction sites in the c-MYC-USP37 complex, a peptidyl inhibitor has been designed. Molecular docking has shown that the peptide fits well in the targeted site of c-MYC, masking most of its residues involved in the binding with USP37. The findings could further be exploited to develop therapeutic interventions against the ABC subtype of DLBCL.

Enhancing Cu2+ Ion Removal: An Innovative Approach Utilizing Modified Frankincense Gum Combined with Multiwalled Carbon Tubes and Iron Oxide Nanoparticles as Adsorbent.

Aquatic pollution, which includes organic debris and heavy metals, is a severe issue for living things. Copper pollution is hazardous to people, and there is a need to develop effective methods for eliminating it from the environment. To address this issue, a novel adsorbent composed of frankincense-modified multi-walled carbon nanotubes (Fr-MMWCNTs) and Fe3O4 [Fr-MWCNT-Fe3O4] was created and subjected to characterization. Batch adsorption tests showed that Fr-MWCNT-Fe3O4 had a maximum adsorption capacity of 250 mg/g at 308 K and could efficiently remove Cu2+ ions over a pH range of 6 to 8. The adsorption process followed the pseudo-second-order and Langmuir models, and its thermodynamics were identified as endothermic. Functional groups on the surface of modified MWCNTs improved their adsorption capacity, and a rise in temperature increased the adsorption efficiency. These results highlight the Fr-MWCNT-Fe3O4 composites' potential as an efficient adsorbent for removing Cu2+ ions from untreated natural water sources.

Mixed epithelial and stromal tumour of the kidney masquerading as hydatid cyst: a rare case report from the developing world.

Mixed epithelial and stromal tumour (MEST) is a rare entity with an incidence of 0.2% among renal cancers. It has strong predilection towards females with a 1:6 male to female ratio, the tumour is cystic with some solid component with biphasic proliferation of stromal and epithelial cells. The case of a 37-years-old female is presented with right lumbar pain since 3 months. The family history was unremarkable. The routine workup revealed mild neutrophilia and borderline Echinococcus antibody titres. Ultrasound revealed a complex cystic lesion with a solid component in the right kidney. CT scan with contrast confirmed a multiloculated mixed density lesion with daughter cysts arising from the middle lobe of the right kidney. Initial diagnosis of renal hydatid cyst was established and she underwent partial nephrectomy with excision of the cystic mass. Surprisingly the histopathology revealed mixed epithelial and stromal tumour.

Immunoinformatic analysis of structural and epitope variations in the spike and Orf8 proteins of SARS-CoV-2/B.1.1.7.

A newly emerged strain of SARS-CoV-2 of B.1.1.7 lineage has caused a significant surge in the SARS-CoV-2 infections in the UK. In this study, changes in the epitopes of spike and orf8 proteins in SARS-CoV-2 of B.1.1.7 lineage were investigated. Genomic alignment of the SARS-CoV-2/B.1.1.7 with SARS-CoV-2/Wuhan showed the presence of several mutations in orf1a/b, spike, orf8, and N proteins of SARS-CoV-2/B.1.1.7. Molecular models of spike and orf8 proteins were constructed by homology modeling. Superimposition between the spike proteins of SARS-CoV-2/Wuhan and SARS-CoV-2/B.1.1.7 showed noticeable variations in the spatial orientation in Val70-Asn74 and Thr250-Ser255 regions. This may have also resulted in the extension of the epitopic region at Ser244-Gly249 in the SARS-CoV-2/B.1.1.7 spike protein. Superimposition of the SARS-CoV-2/B.1.1.7 spike protein over Fab-spike protein complexes of SARS-CoV-2/Wuhan also showed subtle variations in the antibody binding affinity targeting the N-terminal domain of the spike protein. Epitopic variations were also observed between the corresponding orf8 regions of SARS-CoV-2/Wuhan and SARS-CoV-2/B.1.1.7. Moreover, the presence of a stop codon at position 27 in orf8 connotes the emergence of two frames (orf8a and orf8b) in SARS-CoV-2, which further hampers its extracellular secretion, and in turn, immunogenicity. The findings of the present study could further be used to develop targeted immunotherapeutics.

Structural variations in human ACE2 may influence its binding with SARS-CoV-2 spike protein.

The recent pandemic of COVID-19, caused by SARS-CoV-2, is unarguably the most fearsome compared with the earlier outbreaks caused by other coronaviruses, SARS-CoV and MERS-CoV. Human ACE2 is now established as a receptor for the SARS-CoV-2 spike protein. Where variations in the viral spike protein, in turn, lead to the cross-species transmission of the virus, genetic variations in the host receptor ACE2 may also contribute to the susceptibility and/or resistance against the viral infection. This study aims to explore the binding of the proteins encoded by different human ACE2 allelic variants with SARS-CoV-2 spike protein. Briefly, coding variants of ACE2 corresponding to the reported binding sites for its attachment with coronavirus spike protein were selected and molecular models of these variants were constructed by homology modeling. The models were then superimposed over the native ACE2 and ACE2-spike protein complex, to observe structural changes in the ACE2 variants and their intermolecular interactions with SARS-CoV-2 spike protein, respectively. Despite strong overall structural similarities, the spatial orientation of the key interacting residues varies in the ACE2 variants compared with the wild-type molecule. Most ACE2 variants showed a similar binding affinity for SARS-CoV-2 spike protein as observed in the complex structure of wild-type ACE2 and SARS-CoV-2 spike protein. However, ACE2 alleles, rs73635825 (S19P) and rs143936283 (E329G) showed noticeable variations in their intermolecular interactions with the viral spike protein. In summary, our data provide a structural basis of potential resistance against SARS-CoV-2 infection driven by ACE2 allelic variants.

Antimicrobial and synergistic activity of thiazoline derivatives in combination with conventional antibiotics against multidrug resistant Staphylococcus aureus isolated from abscess drainage samples.

Emergence and spread of multidrug resistant (MDR) Staphylococcus aureus strains is becoming major challenge in treatment of soft tissue infections. This study aimed to explore antimicrobial and synergistic antimicrobial potential of three commercially available thiazoline derivatives (2-amino-2-thiazoline, 2-thiazoline-2-thiol and 2-acetyl-2-thiazoline) against MDR Staphylococcus aureus strains isolated from abscess drainage samples (n=20). MDR Staphylococcus aureus isolates were identified by Kirby-Bauer disk diffusion assay and were further subjected to molecular identification by 16srRNA amplification and DNA sequencing. Minimum Inhibitory Concentration (MIC) values of test compounds and antibiotics (0.25-512µg/mL) were measured and subsequently, synergism assay was performed to calculate Fractional Inhibitory Concentration (FIC) index. Out of twenty Staphylococcus aureus isolates, sixteen (80%) were found to be MDR whereas four (20%) were Non-MDR. Moxifloxacin and vancomycine were found most effective antibiotics, inhibiting 100% (n=20) and 95% (n=19) strains respectively. Antimicrobial activity of 2-amino-2-thiazoline (MIC: 32µg/mL), 2-thiazoline-2-thiol (MIC: 64µg/mL) and 2-acetyl-2-thiazoline (MIC: 32µg/mL) was found significant against all ten tested MDR strains. Synergistic combinations of thiazoline derivatives with test antibiotics reduced MIC values significantly. Therefore, combination of tested thiazoline derivatives with antibiotics could be used as alternative therapeutic approach to treat soft tissue infections caused by MDR Staphylococcus aureus after further pre-clinical and clinical studies.

Production and antimicrobial activity of silver nanoparticles synthesized from indigenously isolated Pseudomonas aeruginosa from Rhizosphere.

Nanoparticles hold profound biological, pharmaceutical and industrial applications. Green synthesis of nanoparticles is considered amongst the environmentally safe and cost effective method of nanoparticle synthesis. Briefly, Pseudomonas strains were isolated from rhizosphere soil samples. Cell free supernatants of 36% of the isolates showed production of silver nanoparticles. Of these, three isolates, SMS13, SMS100 and SMS124 were selected as the potentially best nanoparticle producers. Amplification and DNA sequencing of 16srRNA gene identified all three strains as Pseudomonas aeruginosa. Scanning electron microscopy showed existence of particles between the ranges of 60nm to 70nm in the diameter with elemental composition of silver varies from 0.48% to 1.61%. Consistently, surface plasmon resonance showed maximum absorbance of nanoparticles between 352nm to 406nm. Finally, antibacterial activity of the synthesized nanoparticles was assessed by spot assay whereas Cell Free Supernatants (CFS) of respective isolates were taken as control against clinical isolates of Salmonella typhi, Shigella dysentriae, Klebsiella pneumoniae, P. aeruginosa, Proteus mirabilis and Streptococcus epidermidis. Nanoparticles suspension from all isolates exhibited antibacterial activity against all the screened isolates, whereas no biological activity was observed in the CFS of corresponding strains.

Pharmacogenetics of sulfonylurea: Presence of CYP2C9*2, CYP2C9*3 and a novel allele, CYP2C9*61, in Type 2 diabetes patients under sulfonylurea therapy.

CYP2C9 is an important member of the cytochrome P450 gene family involved in the metabolism of 15% of the drugs including an oral antidiabetic agent sulfonylurea. This study aims to investigate the frequency of CYP2C9*2 and CYP2C9*3 alleles of the gene in the sulfonylurea treated diabetic subjects in Pakistan. Briefly, total 105 patients were included in the study and segregated as control (24) and test (81) based on the clinical manifestations after taking sulfonylurea. Genomic DNA was extracted from blood of the subjects and amplified using CYP2C9 specific primers for exon 3 and exon 7 and then subjected to DNA sequencing. Alignment of the sequences with the reference sequence shows presence of CYP2C9*3/*3, CYP2C9*1/*3 and CYP2C9*1/*2 genotypes in the test cases but only the latter two were found in the control cases. In addition a novel allele, CYP2C9*61 in the heterozygous state, was also identified frequently in the test cases. Molecular structure comparison also showed variations in the structural features of protein encoded by the allelic variants. To the best of our knowledge, the present data is the first report for CYP2C9 allelic variations in the indigenous diabetic subjects and also report the existence of novel allelic variant of CYP2C9, CYP2C9*61.

Modelling the structure of full-length Epstein-Barr virus nuclear antigen 1.

Epstein-Barr virus is a clinically important human virus associated with several cancers and is the etiologic agent of infectious mononucleosis. The viral nuclear antigen-1 (EBNA1) is central to the replication and propagation of the viral genome and likely contributes to tumourigenesis. We have compared EBNA1 homologues from other primate lymphocryptoviruses and found that the central glycine/alanine repeat (GAr) domain as well as predicted cellular protein (USP7 and CK2) binding sites are present in homologues in the Old World primates, but not the marmoset, suggesting that these motifs may have co-evolved. Using the resolved structure of the C-terminal one-third of EBNA1 (homodimerization and DNA binding domain), we have gone on to develop monomeric and dimeric models in silico of the full-length protein. The C-terminal domain is predicted to be structurally highly similar between homologues, indicating conserved function. Zinc could be stably incorporated into the model, bonding with two N-terminal cysteines predicted to facilitate multimerisation. The GAr contains secondary structural elements in the models, while the protein binding regions are unstructured, irrespective of the prediction approach used and sequence origin. These intrinsically disordered regions may facilitate the diversity observed in partner interactions. We hypothesize that the structured GAr could mask the disordered regions, thereby protecting the protein from default degradation. In the dimer conformation, the C-terminal tails of each monomer wrap around a proline-rich protruding loop of the partner monomer, providing dimer stability, a feature which could be exploited in therapeutic design.

Da Vinci Robotic Surgical System: Early Experience from Pakistan.

OBJECTIVE: To determine the outcomes of robotic surgeries using the Da Vinci robotic surgical system (DVSS) at Pakistan's largest urological tertiary healthcare system. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Minimally Invasive and Robotic Surgery, Division of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from March 2017 to December 2021. METHODOLOGY: Hospital records of patients who underwent robotic urological surgeries were assessed for their outcomes in terms of blood loss, mortality, system malfunction, and conversion to open surgery. Descriptive statistics were determined. RESULTS: A total of 550 procedures were performed. The mean age recorded was 39.58±16.83 years. The mean blood loss recorded was 255.611±353.57 ml; there were 3 cases of malfunction. Forty cases were converted to open surgery, and the mortality rate was 1.1%. CONCLUSION: Minimally invasive surgical techniques have high precision, fewer complications, and lower morbidity rates. Using DVSS for surgical interventions is both effective and safe. KEY WORDS: Minimally invasive surgery, Da Vinci robotic surgical system, Robotic surgery.

Microwave-assisted synthesis of Limonia acidissima Groff gum stabilized palladium nanoparticles for colorimetric glucose sensing.

Herein, we present a novel microwave-assisted method for the synthesis of palladium nanoparticles (PdNPs) supported by Limonia acidissima Groff tree extract gum. The synthesized PdNPs were characterized using various analytical techniques, including FTIR, SEM, TEM, UV-visible, and powder XRD analyses. TEM and XRD analysis confirmed that the synthesized LAG-PdNPs are highly crystalline nature spherical shapes with an average size diameter of 7-9 nm. We employed these gum-capped PdNPs to investigate their peroxidase-like activity for colorimetric detection of hydrogen peroxide (H2O2) and glucose. The oxidation of 3,3',5,5'-tetramethylbenzidine (TMB) by H2O2, catalyzed by PdNPs, produces oxidation products quantified at 652 nm using spectrophotometry. The catalytic activity of PdNPs was optimized with respect to temperature and pH. The developed method exhibited a linear range of detection from 1 to 50 µm, with detection limits of 0.35 µm for H2O2 and 0.60 µm for glucose.

Frankincense-Based Functionalized Multiwalled Carbon Nanotubes with Iron Oxide Composites for Efficient Removal of Crystal Violet: Kinetic and Equilibrium Analysis.

In this study, novel adsorbents were developed by functionalizing multiwalled carbon nanotubes with frankincense (Fr-fMWCNT) and adding iron oxide (Fe3O4) to the adsorbent (Fr-fMWCNT-Fe3O4). The morphology, surface characteristics, and chemical nature of the synthesized samples were analyzed by using various characterization techniques. The prepared adsorbents were then applied for the elimination of the toxic dye, crystal violet (CV), from water-based solutions by employing a batch adsorption method. The effectiveness of materials for the adsorption of CV was investigated by tuning various effective experimental parameters (adsorbent dosage, dye quantity, pH, and contact time). In order to derive adsorption isotherms, the Langmuir and Freundlich adsorption models were investigated and compared. The Fr-fMWCNT and Fr-fMWCNT-Fe3O4 were found to remove 85 and 95% of the CV dye within 30 min of the adsorption experiment at pH 6, respectively. It was found that a pseudo-second-order reaction rate was consistent with the experimental adsorption kinetics. The equilibrium data demonstrated that the Langmuir model adequately explained the adsorption behavior of the CV dye on the Fr-fMWCNT and Fr-fMWCNT-Fe3O4 surfaces, respectively. According to the Langmuir study, the highest adsorption capacities of the dye are 434 mg/g for Fr-fMWCNT and 500 mg/g for Fr-fMWCNT-Fe3O4. Remediation of the CV dye using our novel composite materials has not been reported previously in the literature. The synthesized Fr-fMWCNT and Fr-fMWCNT-Fe3O4 adsorbents can be economical and green materials for the adsorptive elimination of CV dye from wastewater.

New paralogues and revised time line in the expansion of the vertebrate GH18 family.

Chitinase enzymes hydrolyse the polysaccharide chitin, an abundant architectural component in invertebrates and fungi. Most mammals encode at least two endochitinases (CHIT1 and CHIA/AMCase), as well as several homologues encoding catalytically inactive chitinase-like proteins or chilectins (all GH18 family proteins). It is becoming increasingly apparent that chitinases and chilectins play an important role in inflammation and their over-expression is correlated with numerous pathological conditions. We have conducted a detailed phylogenomic study of this gene family in order to understand its evolutionary history and the selection forces at work. The family has undergone extensive expansion, initiating with a duplication event at the root of the vertebrate tree generating the ancestors of CHIT1 and CHIA. Our analyses indicate that two further duplications of ancestral CHIA predate the divergence of bony fishes, one leading to a newly identified paralogous group (we have termed CHIO). In fish these sequences fall into two clades bearing the hallmarks of the teleost-specific genome duplication (referred to as 3R). In tetrapods, additional duplications predate and postdate the amphibian/mammalian split and relics of some exist as pseudogenes in the human genome. Expansion and selection of chilectins is pronounced in mammals and CHI3L1 (with a proposed function in immunity) is found in most mammals but not other vertebrates, while CHI3L2 is also evident in reptiles. Notably oviductin (OVGP1) became basic and gained a glycosylated tail with its evolving role in the mammalian reproductive system. In each case, retention of the sugar-binding barrel structure has constrained positive selection to limited sites.

Selenium: a brief review and a case report of selenium responsive cardiomyopathy.

BACKGROUND: The authors review the role of selenium and highlight possible low selenium levels in soil that may result in deficient states in Saudi Arabia. CASE PRESENTATION: The authors report a case of selenium-responsive cardiomyopathy in a 15-month old Saudi Arabian boy. This case of selenium deficiency causing dilated cardiomyopathy is presented with failure to thrive, prolonged fever and respiratory distress. The investigations revealed selenium deficiency. Selenium supplementation along with anti-failure therapy [Furosimide, Captopril] was administered for 6 months. Following therapy the cardiac function, hair, skin and the general health of the patient improved significantly. CONCLUSION: The patient with dilated cardiomyopathy of unknown etiology, not responding to usual medication may be deficient in selenium. Serum selenium measurements should be included in the diagnostic work-up to ensure early detection and treatment of the disease. The selenium level in the Saudi population needs be determined. Vulnerable populations have to undergo regular selenium measurements and supplementation if indicated. Dependence on processed foods suggests that the Saudi population fortify themselves with nutrient and micronutrient supplements in accordance to the RDA.

RAS gene mutations and histomorphometric measurements in oral squamous cell carcinoma.

Members of the RAS gene family frequently are mutated in cancers including oral squamous cell carcinoma (OSCC). We investigated the correlation of histological characteristics of OSCC with RAS gene mutations. We graded tumors and extracted genomic DNA from OSCC. The first two exons of KRAS, HRAS and NRAS genes were subjected to PCR amplification and DNA sequencing followed by bioinformatic analysis to explore the structural and functional impact of the mutations on encoding of proteins. Cellular and nuclear diameters in histological sections were varied in all grades of cancer. Using sequence analysis, we identified nonsynonymous mutations in both HRAS (G12S, G15C, D54H, Q61H, Q61L, E62D, E63D, Q70E, Q70V) and NRAS (Q22P, K88R). Stop codon mutations, however, were observed in KRAS. Spatial orientation of substituted amino acids was observed despite conservation of overall structure of variant proteins. Our findings suggest that KRAS may be mutated more frequently in OSCC compared to HRAS and NRAS. Also, the histological features of nuclear and cellular diameter differed significantly between the KRAS mutated and unmutated cases.

Inbreeding-Driven Innate Behavioral Changes in Drosophila melanogaster.

Drosophila melanogaster has long been used to demonstrate the effect of inbreeding, particularly in relation to reproductive fitness and stress tolerance. In comparison, less attention has been given to exploring the influence of inbreeding on the innate behavior of D. melanogaster. In this study, multiple replicates of six different types of crosses were set in pair conformation of the laboratory-maintained wild-type D. melanogaster. This resulted in progeny with six different levels of inbreeding coefficients. Larvae and adult flies of varied inbreeding coefficients were subjected to different behavioral assays. In addition to the expected inbreeding depression in the-egg to-adult viability, noticeable aberrations were observed in the crawling and phototaxis behaviors of larvae. Negative geotactic behavior as well as positive phototactic behavior of the flies were also found to be adversely affected with increasing levels of inbreeding. Interestingly, positively phototactic inbred flies demonstrated improved learning compared to outbred flies, potentially the consequence of purging. Flies with higher levels of inbreeding exhibited a delay in the manifestation of aggression and courtship. In summary, our findings demonstrate that inbreeding influences the innate behaviors in D. melanogaster, which in turn may affect the overall biological fitness of the flies.

The quality of published paediatric audits and their standards.

OBJECTIVE: Audit is a recognised tool for evaluating the performance and improving the quality of health services. In Ireland and the UK, clear resources are available outlining audit elements. This study was undertaken to evaluate paediatric audits published from 2007 to 2020 to determine the adherence level to the definition of audit and to assess the quality of audit standards. DESIGN: PUBMED, MEDLINE and CINAHL databases were searched to identify relevant articles published in the English language. Each was reviewed to assess whether the following criteria were met: (1) a paediatric healthcare topic was described, (2) practice was reviewed, (3) the standard was specified, (4) an intervention was made and data collection was repeated to assess improvement. The quality of the standard for each true audit was graded utilising the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS: Of 1230 published paediatric healthcare articles reviewed, 144 (11.4%) fulfilled the full criteria of an audit. Sixty-three (43.8%) true audits used the highest quality of evidence (level 1a and 1b), predominantly international or national guidelines. Fifty-six (38.9%) audits used the lowest quality of evidence (level 5), predominantly expert opinion. CONCLUSIONS: There is a mismatch between the common usage of the term audit, and the definition, despite its incorporation into training curricula and institutional support. Many articles published as audits do not adhere to the definition of audit. There are variable levels of evidence supporting the standards utilised in published true audits.