Oncolytic E1B 55KDa-deleted adenovirus replication is independent of p53 levels in cancer cells.

Oncolytic adenoviruses represent a new approach for cancer therapy due to its tumor specificity. E1B 55kDa-deleted adenovirus type 5 (Ad5dlE1B 55kDa) is a promising therapeutic agent that can selectively replicate in and lyse p53 defective cancer cells. However, the overall efficacy has shown varying degrees of success with raised doubts about the correlation between p53 status and E1B-deleted adenovirus replication ability. In this study, we investigated the relationship between the efficiency of Ad5dlE1B 55kDa replication and p53 levels in cancer cells. Five transient p53 expression vectors were engineered to expresses different p53 levels in transfected cells. Then, the effect of the variable p53 levels and cellular backgrounds on the replication efficiency of oncolytic Ad5dlE1B 55kDa was evaluated in H1299 and HeLa cell lines. We found that the replication efficiency of these oncolytic viruses is dependent on the status, but not the expression levels, of p53. Ad5dlE1B 55kDa was shown to have selective replication activity in H1299 cells (p53-null) and decreased viral replication in HeLa cells (p53-positive), relative to the wild-type adenovirus in both cell lines. Our findings suggest that there is a relation between the E1B-deleted adenovirus replication and the presence as well as the activity of p53, independent of its quantity.

Malaria risk in Nigeria: Bayesian geostatistical modelling of 2010 malaria indicator survey data.

BACKGROUND: In 2010, the National Malaria Control Programme with the support of Roll Back Malaria partners implemented a nationally representative Malaria Indicator Survey (MIS), which assembled malaria burden and control intervention related data. The MIS data were analysed to produce a contemporary smooth map of malaria risk and evaluate the control interventions effects on parasitaemia risk after controlling for environmental/climatic, demographic and socioeconomic characteristics. METHODS: A Bayesian geostatistical logistic regression model was fitted on the observed parasitological prevalence data. Important environmental/climatic risk factors of parasitaemia were identified by applying Bayesian variable selection within geostatistical model. The best model was employed to predict the disease risk over a grid of 4 km(2) resolution. Validation was carried out to assess model predictive performance. Various measures of control intervention coverage were derived to estimate the effects of interventions on parasitaemia risk after adjusting for environmental, socioeconomic and demographic factors. RESULTS: Normalized difference vegetation index and rainfall were identified as important environmental/climatic predictors of malaria risk. The population adjusted risk estimates ranges from 6.46% in Lagos state to 43.33% in Borno. Interventions appear to not have important effect on malaria risk. The odds of parasitaemia appears to be on downward trend with improved socioeconomic status and living in rural areas increases the odds of testing positive to malaria parasites. Older children also have elevated risk of malaria infection. CONCLUSIONS: The produced maps and estimates of parasitaemic children give an important synoptic view of current parasite prevalence in the country. Control activities will find it a useful tool in identifying priority areas for intervention.

Effect and behaviour of different substrates in relation to the formation of aerobic granular sludge.

When aerobic granular sludge is applied for industrial wastewater treatment, different soluble substrates can be present. For stable granular sludge formation on volatile fatty acids (e.g. acetate), production of storage polymers under anaerobic feeding conditions has been shown to be important. This prevents direct aerobic growth on readily available chemical oxygen demand (COD), which is thought to result in unstable granule formation. Here, we investigate the impact of acetate, methanol, butanol, propanol, propionaldehyde, and valeraldehyde on granular sludge formation at 35 °C. Methanogenic archaea, growing on methanol, were present in the aerobic granular sludge system. Methanol was completely converted to methane and carbon dioxide by the methanogenic archaeum Methanomethylovorans uponensis during the 1-h anaerobic feeding period, despite the relative high dissolved oxygen concentration (3.5 mg O2 L(-1)) during the subsequent 2-h aeration period. Propionaldehyde and valeraldehyde were fully disproportionated anaerobically into their corresponding carboxylic acids and alcohols. The organic acids produced were converted to storage polymers, while the alcohols (produced and from influent) were absorbed onto the granular sludge matrix and converted aerobically. Our observations show that easy biodegradable substrates not converted anaerobically into storage polymers could lead to unstable granular sludge formation. However, when the easy biodegradable COD is absorbed in the granules and/or when the substrate is converted by relatively slow growing bacteria in the aerobic period, stable granulation can occur.

Animal health constraints to livestock exports from the Horn of Africa.

The Horn of Africa (Djibouti, Ethiopia, Somalia, Eritrea) is home to the largest population of livestock in Africa and is the historic centre of the livestock trade to the Middle East and northern Africa. The recent resumption of livestock exports from the region has resulted in the handling of over one million head of cattle, sheep, goats and camels at one quarantine facility during a single year. Several of the importing countries for which the facility operates have differing hygiene requirements for the same diseases. Most of the animals handled in the facility come from pastoralist areas, which lack state Veterinary Services. The pathological conditions encountered during one year of monitoring were recorded and the impacts of some of the endemic diseases are discussed, together with particular import-limiting hygiene requirements on this trade.

Discharging patients home from the intensive care unit: A new trend.

Discharging patients directly to home from the intensive care unit (ICU) is becoming a new trend. This review examines the feasibility, benefits, challenges, and considerations of directly discharging ICU patients. By analyzing available evidence and healthcare professionals' experiences, the review explores the potential impacts on patient outcomes and healthcare systems. The practice of direct discharge from the ICU presents both opportunities and complexities. While it can potentially reduce costs, enhance patient comfort, and mitigate complications linked to extended hospitalization, it necessitates meticulous patient selection and robust post-discharge support mechanisms. Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition. Through critical evaluation of existing literature, this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery. The insights provided contribute evidence-based recommendations for refining the direct discharge approach, fostering improved patient outcomes, heightened satisfaction, and streamlined healthcare processes. Ultimately, the review seeks to balance patient-centered care and effective resource utilization within ICU discharge strategies.

Microbial diversity differences within aerobic granular sludge and activated sludge flocs.

In this study, we investigated during 400 days the microbial community variations as observed from 16S DNA gene DGGE banding patterns from an aerobic granular sludge pilot plant as well as the from a full-scale activated sludge treatment plant in Epe, the Netherlands. Both plants obtained the same wastewater and had the same relative hydraulic variations and run stable over time. For the total bacterial population, a similarity analysis was conducted showing that the community composition of both sludge types was very dissimilar. Despite this difference, general bacterial population of both systems had on average comparable species richness, entropy, and evenness, suggesting that different bacteria were sharing the same functionality. Moreover, multi-dimensional scaling analysis revealed that the microbial populations of the flocculent sludge system moved closely around the initial population, whereas the bacterial population in the aerobic granular sludge moved away from its initial population representing a permanent change. In addition, the ammonium-oxidizing community of both sludge systems was studied in detail showing more unevenness than the general bacterial community. Nitrosomonas was the dominant AOB in flocculent sludge, whereas in granular sludge, Nitrosomonas and Nitrosospira were present in equal amounts. A correlation analysis of process data and microbial data from DGGE gels showed that the microbial diversity shift in ammonium-oxidizing bacteria clearly correlated with fluctuations in temperature.

The Role of Computed Tomography in the Management of Hospitalized Patients With COVID-19.

The emergence of SARS-CoV-2 at the end of 2019 sparked the beginning of the COVID-19 pandemic. Even though it was a novel virus, the workup of suspected COVID-19 included standard protocols used for the investigation of similar respiratory infections and pneumonia. One of the most important diagnostic tests in this regard is computed tomography (CT). CT scans have a high sensitivity in diagnosing COVID-19, and many of the characteristic imaging findings of COVID-19 are used in its diagnosis. The role of CT in COVID-19 management is expanding as more and more hospital practices adopt regular CT use in both the initial workup and continued care of COVID-19 patients. CT has helped hospitalists diagnose complications such as pulmonary embolism, subcutaneous emphysema, pneumomediastinum, pneumothoraces, and nosocomial pneumonia. Although mainly used as a diagnostic tool, the prognostic role of CT in COVID-19 patients is developing. In this review, we explore the role of CT in the management of hospitalized patients with COVID-19, specifically elucidating its use as a diagnostic and prognostic modality, as well as its ability to guide hospital decision-making regarding complex cases. We will highlight important time points when CT scans are used: the initial encounter, the time at admission, and during hospitalization.

An Unusual Case of Escherichia Coli Meningitis in an Immunocompetent Adult.

Spontaneous meningitis caused by Gram-negative bacilli is rare in adults. It typically occurs after a neurosurgical procedure or head injury but may also be related to the presence of a neurosurgical device, cerebrospinal fluid (CSF) leak syndrome, or seen in immunosuppressed patients. Escherichia coli (E. coli) is the leading cause of Gram-negative bacilli meningitis. We describe the case of a 47-year-old man who was hospitalized for spontaneous, community-acquired E. coli meningitis, which is unusual to see in an immunocompetent adult. CSF analysis was consistent with bacterial meningitis; his blood culture was positive for E. coli. Within 24 hours of initiation of antibiotics, his status improved.

Quality Improvement Initiative in a Community Hospital to Reduce Central Line Device Utilization Rate.

Background The intensive care unit (ICU) in a community hospital in southwest Minnesota saw a steady increase in central line-associated bloodstream infections (CLABSI) and an increase in the utilization of central lines. The baseline CLABSI rate was 11.36 at the start of the project, which was the highest in the last five years. The corresponding device utilization rate (DUR) was 64%, which increased from a pre-COVID pandemic rate of 45%. Aim The aim of this project was to decrease the ICU DUR by 37.5% from a baseline of 64% to 40% within six months without adversely impacting staff satisfaction. Methods A multidisciplinary team using the define, measure, analyze, improve, and control (DMAIC) methodology reviewed the potential causes of the increased use of central lines in the ICU. The team identified the following major causal themes: process, communication, education, and closed-loop feedback. Once the root causes were determined, suitable countermeasures were identified and implemented to address these barriers. These included reviewing current guidelines, enhanced care team rounding, staff education, and the creation of a vascular access indication algorithm. The team met biweekly to study the current state, determine the future state, evaluate feedback, and guide implementation. Results The pandemic saw a surge in the number of severely ill patients in the ICU, which may have caused an increase in the DUR. The project heightened the awareness of the increased DUR and its impact on the CLABSI rate. The initiation of discussion around this project led to an immediate decline in DUR via increased awareness and focus. As interventions were introduced and implemented, the DUR continued to decrease at a steady rate. Post implementation, the DUR met the project goal of less than 40%. The team continued to track progress and monitor feedback. The DUR continued to meet the goal for three months post implementation. Since the start of the project, there have been no CLABSI events reported. This effort has positively impacted safety and patient outcomes. Conclusions Through a defined process, the central line utilization rate in our ICU was decreased to 37.5% to meet the target goal and has been sustained.

Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic: A systematic review and meta-analysis.

BACKGROUND: ST-elevation myocardial infarction (STEMI) is the result of transmural ischemia of the myocardium and is associated with a high mortality rate. Primary percutaneous coronary intervention (PPCI) is the recommended first-line treatment strategy for patients with STEMI. The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019 (COVID-19) pandemic, leading to a projected steep rise in mortality. These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion. It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints. AIM: To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes. METHODS: PubMed, Google Scholar, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic. Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality. Data were meta-analyzed using the random effects model to derive odds ratios (OR) and 95% confidence intervals. Quality assessment was carried out using the Newcastle-Ottawa scale. RESULTS: Fourteen studies including 50136 STEMI patients (n = 15142 in the pandemic arm; n = 34994 in the pre-pandemic arm) were included. The mean age was 61 years; 79% were male, 27% had type 2 diabetes, and 47% were smokers. Compared with the pre-pandemic period, there was a significantly increased overall incidence of fibrinolysis during the pandemic period [OR: 1.80 (1.18 to 2.75); I2= 78%; P = 0.00; GRADE: Very low]. The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting. The countries with a low-and middle-income status reported a higher incidence of fibrinolysis [OR: 5.16 (2.18 to 12.22); I2 = 81%; P = 0.00; GRADE: Very low] and an increased risk of all-cause mortality in STEMI patients [OR: 1.16 (1.03 to 1.30); I2 = 0%; P = 0.01; GRADE: Very low]. Meta-regression analysis showed a positive correlation of hyperlipidemia (P = 0.001) and hypertension (P < 0.001) with all-cause mortality. CONCLUSION: There is an increased incidence of fibrinolysis during the pandemic period, but it has no effect on the risk of all-cause mortality. The low- and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.

Case Report of Acute Q Fever with Hepatitis Progressing to Chronic Q Fever with Endocarditis.

A 35-year-old male greenhouse worker presented with myalgia, fatigue, and fever. Initially, he was thought to have an unspecified viral infection and was treated with conservative therapy. However, the patient's symptoms persisted, and he reported additional symptoms of mild abdominal pain and headaches. Laboratory evaluation was significant for elevated liver enzymes. Due to concern for acute hepatitis and persistent fever the patient was hospitalized. During his hospital course, no infectious etiology was found to explain his symptoms. After discharge from the hospital, additional testing showed positive serology for Q fever IgG phase II antibody (1:8192) and phase II antibody IgM (>1:2048). He was treated with doxycycline and had a good clinical response. Upon follow-up, he had worsening Phase I IgG serologies. Transesophageal echo demonstrated vegetations consistent with endocarditis.

Coronary Artery Dissection and Myocarditis Caused by Eosinophilic Granulomatosis with Polyangiitis (EGPA): A Case Report.

Eosinophilic granulomatosis with polyangiitis (EGPA) also referred to as Churg-Strauss syndrome is a rare vasculitis of the small to medium vessels. We present a rare case of acute coronary artery dissection brought on by EGPA, which generally has a poor prognosis. A 41-year-old male with history of bronchial asthma presented to the emergency room with a 2-week history of dyspnea, cough with clear phlegm, and fever. For the past eight months he had experienced episodes with similar symptoms relieved by steroids. CT chest showed bilateral upper lobe patchy opacities with extensive workup for infectious etiology being negative. He had peripheral eosinophilia with sinusitis. He had acute coronary syndrome and Coronary angiogram showed Right coronary artery dissection. After making a diagnosis of EGPA based on American college of Rheumatology criteria, he was successfully treated with high dose immunosuppression. Coronary artery dissection is a fatal and uncommon complication of EGPA which is usually diagnosed postmortem. Early recognition of this condition ante mortem and aggressive treatment can be lifesaving as demonstrated in our case.

Gallionella spp. in trickling filtration of subsurface aerated and natural groundwater.

The growth of iron-oxidizing bacteria, generally regarded as obligate microaerophilic at neutral pH conditions, has been reported in a wide range of environments, including engineered systems for drinking water production. This research focused on intensively aerated trickling filters treating deep anaerobic and subsurface aerated groundwater. The two systems, each comprising groundwater abstraction and trickling filtration, were monitored over a period of 9 months. Gallionella spp. were quantified by qPCR with specifically designed 16S rRNA primers and identified directly in the environmental samples using clone libraries with the same primers. In addition, enrichments in gradient tubes were evaluated after DGGE separation with general bacterial primers. No other iron-oxidizing bacteria than Gallionella spp. were found in the gradient tubes. qPCR provided an effective method to evaluate the growth of Gallionella spp. in these filter systems. The growth of Gallionella spp. was stimulated by subsurface aeration, but these bacteria hardly grew in the trickling filter. In the uninfluenced, natural anaerobic groundwater, Gallionella spp. were only present in low numbers, but they grew extensively in the trickling filter. Identification revealed that Gallionella spp., growing in the trickling filter were phylogenetically distinct from the species found growing during subsurface aeration, indicating that the different conditions in both systems selected for niche organisms, while inhibiting other groups. The results suggest a minor direct significance for inoculation of Gallionella spp. during filtration of subsurface aerated groundwater.

Desulfonatronovibrio halophilus sp. nov., a novel moderately halophilic sulfate-reducing bacterium from hypersaline chloride-sulfate lakes in Central Asia.

Four strains of lithotrophic sulfate-reducing bacteria (SRB) have been enriched and isolated from anoxic sediments of hypersaline chloride-sulfate lakes in the Kulunda Steppe (Altai, Russia) at 2 M NaCl and pH 7.5. According to the 16S rRNA gene sequence analysis, the isolates were closely related to each other and belonged to the genus Desulfonatronovibrio, which, so far, included only obligately alkaliphilic members found exclusively in soda lakes. The isolates utilized formate, H(2) and pyruvate as electron donors and sulfate, sulfite and thiosulfate as electron acceptors. In contrast to the described species of the genus Desulfonatronovibrio, the salt lake isolates could only tolerate high pH (up to pH 9.4), while they grow optimally at a neutral pH. They belonged to the moderate halophiles growing between 0.2 and 2 M NaCl with an optimum at 0.5 M. On the basis of their distinct phenotype and phylogeny, the described halophilic SRB are proposed to form a novel species within the genus Desulfonatronovibrio, D. halophilus (type strain HTR1(T) = DSM24312(T) = UNIQEM U802(T)).

Molecular Detection and Phylogenetic Analysis of Pseudomonas aeruginosa Isolated from Some Infected and Healthy Ruminants in Basrah, Iraq.

Although P. aeruginosa is an environmental organism, it is infrequently found on the skin, mucous membranes, and in the feces of some healthy animals (wild, companion, or farm animals). P. aeruginosa produces a variety of toxins and enzymes which promote tissue invasion and damage. P. aeruginosa demonstrated resistance to several antimicrobial agents. It is of significant importance in both animal and human medicine. The present study aimed to isolate and diagnose P. aeruginosa isolates from some ruminants, cow and sheep, from different regions of Basrah, Iraq. A total of 200 samples were taken from infected and healthy ruminants, as well as the environment surrounding the animal in Basrah, Iraq. The identification of Pseudomonas aeruginosa was performed by conventional and molecular methods using the 16S rRNA gene and aroE gene by polymerase chain reaction (PCR). The recorded data pointed out that P. aeruginosa was successfully isolated from infected animals (cows and sheep) with total percentages of 46% and 22%, respectively. These percentages were obtained at 8% and 4% from healthy cows and sheep, respectively. The percentages of isolation of the environment surrounding cows and sheep were 40% and 32%, respectively. A higher percentage of infection was observed in the eye, skin, and wound swabs of cows. Healthy cows and sheep gave only three isolates of P. aeruginosa, while the environmental swabs recorded 18 isolates. Bacterial isolates were identified by culture methods and Vitek- 2. To confirm the diagnosis more accurately at the level of the species, the molecular confirmation was performed by PCR amplification of genus and species with 16S rRNA gene sequences. The results pointed out that all 10 selected isolates gave positive results, and the gene size was ≈ 1500 bp. New strains were recorded in GenBank/NCBI, and the phylogenetic tree was constructed. The isolates fall in three clads. Molecular confirmation of other isolates in this study (42 isolates) was carried out by PCR amplification of aroE gene. All PCR products of these isolates were amplified≈ 495 pb on agarose gel electrophoresis.

Effect of Eggshell Nanoparticles on Healing Bone Fracture.

Eggshell waste is considered the most abundant waste material from food processing technologies. Despite the freakish features that its components possess, it is very often discarded without further application. Nowadays, most researchers are focusing their research on pollution-free environment, biodegradable character, and balanced ecological aspects while fabricating the composite materials rather than mechanical strengths, costs, and processing methodologies. This study aimed to investigate the impact of the eggshell nanoparticles on the enhanced treatment of a bone fracture. The samples included 10 healthy female New Zealand white rabbits with an average body weight of 3 kg and age of 4 months years old. The animals were kept in an open place. All these ten rabbits had a fracture by making a surgical operation conducted by opening and excluding the muscle and anther tissue, followed by cutting the bone using a special small saw. After the operational step, the animals were divided into two groups (n=5). The fractures were checked by X-ray. The negative control group was left without treatment, however, was given 0.2 mL intraperitoneal saline injection weekly. The experimental group underwent treatment with 200 mg/kg of calcium carbonate nanoparticles (CaCO3-NPs) for 4 weeks. The animals were sacrificed at the end of the study period to collect organs for histological studies. Considering the results of the radiographic examination before and after treatment with CaCO3-NPs, the recorded data showed the speed of healing in the experimental group, compared to the control group. Regarding the histological study that was carried out on the vital organs, such as the liver, kidneys, heart, and lung, no side effects appeared when comparing the treatment group with the control group, except for some slight changes. In conclusion, the recorded data in the current study demonstrated that CaCO3-NPs had a beneficial effect on the pace of fracture recovery.

Effect of Long-Term Treatment with Dexamethasone on the Liver and Kidney Histopathology, as well as Blood Biochemistry in Male Rabbits (Lepus Cuniculus).

Glucocorticoids have a wide range of pharmacological activities. Generally speaking, the steroid drugs, such as dexamethasone (DEX) can have severe side effects on the histology of different organs. In fact, glucocorticoids have been known as powerful medicines which can cure inflammation and work with the immune system to treat a wide range of health problems. Therefore, this study aimed to investigate the effects of DEX on the histological changes of the liver and kidney, as well as blood biochemical parameters. In total, 13 specific pathogen-free male Lepus Cuniculus rabbits aged 8-10 months old, with a mean weight of 1.12±0.13 kg were randomly divided into three groups. Group I (n=3) did not receive DEX, and they only received saline solution as a placebo (control). In Group II (n=5), the animals received 0.25 mg DEX/kg body weight/day for a period of 56 days, and the animals in Group III (n=5) received 0.5 mg DEX/kg body weight/day for 56 days. Blood was aspirated from the rabbit's marginal ear vein. All blood samples were centrifuged at 3000×g for 10 min to separate serum samples. Blood lipids and trace elements (zinc, copper, calcium, and iron) were measured. The microscopical analyses of the liver and kidney tissues were performed through the observation of the histological changes in the tissues. The results showed a significant (P≤0.05) decrease in the body and organ weight, as well as serum concentrations for the trace elements. On the other hand, lipid profile showed a significant increase (P≤0.05) in cholesterol, triglycerides, and low-density lipoprotein. However, a significant decrease was recorded in high-density lipoprotein in both treated groups with DEX, compared to the control group. The results of the histological evaluation showed some degrees of degeneration, necrosis, cell vacuolation, and lymphocyte infiltration in the kidney and liver tissues in the treatment groups.

Is There a Bias Toward Unvaccinated COVID-19 Patients?

Description With more than 22% of the United States still not vaccinated for COVID-19, we are trying to shed some light on whether there is any bias when treating unvaccinated COVID-19 patients. We highlight several reports where some individuals or organizations displayed possible bias, whether implicit or explicit. We examine the legal and ethical implications of these biases and offer a general overview of how to tackle them.

Morphometric and gut microbial evaluation of Tilapia (Oreochromis niloticus) fed on different levels of Moringa oleifera.

In current study, different feeding levels of Moringa oleifera formulated diet was compared to analyze the growth performance, feed conversion ratio, feed conversion efficiency and gut microbiology of Oreochromis niloticus. The study was comprised of four treatment groups including 4%, 8% and 12% Moringa oleifera and one control group which was devoid of Moringa leaves. The experimental trial was conducted at the Zoology laboratory of Pakistan Institute of Applied and Social Sciences, (PIASS) Kasur. The physicochemical parameters of water such as temperature, dissolve oxygen, pH, total dissolved solids and salinity in all aquaria were found non-significantly different from each other. In control condition T1, the average weight gain was 14.89±16.90a grams, while average length gain was 11.52±7.444a cm. However, the total viable count on Eosin methylene blue was 7.4×107, 5.8×107 on Tryptic soy agar and 5.8×107on Nutrient agar. In T2, the average weight gain was 16.22±16.09b grams and average length gain was 12.97±7.79b cm. The total viable count on Eosin methylene blue was 7×107, 5.5×107 on Tryptic soy agar and 5.8×107on Nutrient agar. In T3, the average weight gain was 37.88±27.43c grams, while the average length gain was recorded as 16.48±12.56c cm. However, the total viable count for treatment 3 was 6.4×10 on Eosin methylene blue, 4.8×107 on Tryptic soy agar and 5.2×107on Nutrient agar. In T4, the average weight gain was 44.22±31.67d grams, while the average length gain was 15.25±10.49d cm. The total viable count was 4.3×107on Eosin methylene blue, 3.1×107 on Tryptic soy agar and 3.8×107 on Nutrient agar. The effect of Moringa oleifera on the growth of Oreochromis niloticus was found to be significant and 12% Moringa extract showed maximum length and weight gain and minimum feed conversion ratio with the least microbial count in fish intestine.

Management of Vasopressor-Induced Acute Limb Ischemia (VIALI) in Septic Shock.

Vasopressors used in critically ill patients with refractory shock poses a serious risk of non-occlusive peripheral limb ischemia leading to tissue necrosis and amputation. Acute limb ischemia is associated with high morbidity and mortality. Evidence-based medical literature is scarce on the prevention and management of vasopressor-induced acute limb ischemia (VIALI). Despite being a well-known and frequent complication of vasopressors, there is no standardized guideline for the prevention and management of vasopressor-induced limb ischemia. Vasopressors are required for the management of refractory shock which is defined as hypotension not responsive to intravenous fluid resuscitation alone. Distributive shock, which includes septic shock, causes inadequate tissue perfusion in adjunct with vasopressor use and is the most common cause of non-occlusive peripheral limb ischemia. This case study will focus on how early recognition and prompt treatment of VIALI are crucial in minimizing tissue necrosis and preventing amputations. We present a case of a middle-aged woman who developed distributive shock from sepsis of a urinary source secondary to obstructive uropathy (ureteral calculi). She presented with refractory shock and continued to remain in shock while undergoing emergent rigid cystoscopy with the placement of a ureteral stent. Despite adequate volume resuscitation, she required high doses of vasopressors resulting in peripheral extremity ischemia and necrosis of all her fingers and toes. By promptly initiating mitigation and preventive management strategies, we succeeded in minimizing tissue ischemia and reducing morbidity resulting from iatrogenic vasopressor-induced peripheral non-occlusive ischemia. These strategies include but are not limited to external warming of bilateral lower extremities, nitroglycerin paste application over the entire extremity, arterial assist pump, and low-dose therapeutic anticoagulation. The novel use of the arterial pump in acutely ischemic lower extremities likely helped salvage the toes which appeared to be at high risk of amputation.