Treatment of marble industry wastewater by Brassica napus (L.) under oxalic acid amendment: efficacy as fodder and carcinogenic risk assessment.

In the present study, Brassica napus, a food plant, was grown for phytoextraction of selected heavy metals (HMs) from marble industry wastewater (WW) under oxalic acid (OA) amendment. The hydroponic experiment was performed under different combination of WW with OA in complete randomized design. Photosynthetic pigments and growth reduction were observed in plants treated with WW alone amendments. The combination of OA in combination with WW significantly enhanced the growth of plants along with antioxidant enzyme activities compared with WW-treated-only plants. HM stress alone enhanced the hydrogen peroxide, electrolyte leakage, and malondialdehyde contents in plants. OA-treated plants were observed with enhanced accumulation of cadmium (Cd), copper (Cu), and lead (Pb) concentrations in the roots and shoots of B. napus. The maximum concentration and accumulation of Cd in root, stem, and leaves was increased by 25%, 30%, and 30%; Cu by 42%, 24%, and 17%; and Pb by 45%, 24%, and 43%, respectively, under OA amendment. Average daily intake and hazard quotient (HQ) were calculated for males, females, and children in two phases of treatments in phytoremediation of metals before and after accumulation into B. napus leaves and stems. HQ of metals in the leaves and stem was < 1 before metal accumulation, whereas > 1 was observed after HM accumulation for all males, females, and children. Similarly, the hazard index of the three study types was found > 1. It was observed that the estimated excess lifetime cancer risk was of grade VII (very high risk), not within the accepted range of 1 × 10-4 to 1 × 10-6. Based on the present study, the increased levels of HMs up to carcinogenicity was observed in the B. napus which is not safe to be consumed later as food.

Analytical assessment of modulated electric flux triggered degradation of chlorfenapyr and deltamethrin pesticides in guava fruits.

The purpose of this study was to explore the new effective method and investigate the dissipation of chlorfenapyr and deltamethrin (DM) pesticides used in the treatment of guava fruit from tropical and sub-tropical areas of Pakistan. Five different solutions of varying concentrations of pesticides were prepared. This study involved the in-vitro and in-vivo analysis of modulated electric flux-triggered degradation as an efficient method for the safer degradation of selected pesticides. The Taser gun was used as a tool for providing different numbers of electrical shocks of million voltages to the pesticides present in guava fruit at different temperatures. The degraded pesticides were extracted and analyzed by High-performance liquid chromatography (HPLC). The HPLC chromatograms verified that significant dissipation of pesticides took place when these were exposed to 9 shocks at 37 °C, which proved the efficiency of this degradation method. More than 50% of the total spray of both pesticides was dissipated. Thus, modulated electrical flux-triggered degradation is one of the effective methods for pesticide degradation.

Assessment of potentially toxic metal(loid)s contamination in soil near the industrial landfill and impact on human health: an evaluation of risk.

The generation of solid waste is increasing with each passing day due to rapid urbanization and industrialization and has become a matter of concern for the international community. Leachate leakages from landfills pollute the soil and can potentially harm the human health. In this paper, inductively coupled plasma-optical emission spectrometric studies were employed to assess and analyze the composition of metals (Ba, Cd, Pb, Hg, Cu, Cr and Mn) and metalloid (As) in soil samples. Results of Cr, Mn, Cu, As, Ba, Cd, Pb and Hg from CRM (certified reference material, SRM 2709a) of San Joaquin soil were evaluated and reported in terms of percent recoveries which were in the range of 97.6-102.9% and show outstanding extraction efficiency. Other than copper, where the permitted limit set by the EU is specified as 50-140 mg/kg in soil, the average amount of all the metals in soil was found within the permissible limits provided by WHO, the European Community (EU) and US EPA. Soil contaminated with Hg (PERI = 100) and Cd (PERI = 145.50) posed an ecological risk significantly. Pollution load index (PLI) value is greater than 1, while degree of contamination (Cdeg) value is less than 32 which indicated that the soil is polluted and considerably contaminated with metals and metalloid, respectively. In terms of the average daily dosage (ADD) of soil, children received the highest doses of all metals (ADDing = 1.315 × 10-7 - 2.470 × 10-3 and ADDderm = 9.939 × 10-7 - 5.292 × 10-11), whereas ADDing (1.409 × 10-8 - 2.646 × 10-4) was found greater in adults. For all metals except for Ba, the hazard quotient (HQ) trend in both children and adults was observed to be HQing > HQderm > HQinh of soil. Children who are at the lower edge of cancer risk had a lifetime cancer risk (LCR) of 2.039 × 10-4 for Cr from various paths of soil exposure.

Cost-Sensitive Learning for Anomaly Detection in Imbalanced ECG Data Using Convolutional Neural Networks.

Arrhythmia detection algorithms based on deep learning are attracting considerable interest due to their vital role in the diagnosis of cardiac abnormalities. Despite this interest, deep feature representation for ECG is still challenging and intriguing due to the inter-patient variability of the ECG's morphological characteristics. The aim of this study was to learn a balanced deep feature representation that incorporates both the short-term and long-term morphological characteristics of ECG beats. For efficient feature extraction, we designed a temporal transition module that uses convolutional layers with different kernel sizes to capture a wide range of morphological patterns. Imbalanced data are a key issue in developing an efficient and generalized model for arrhythmia detection as they cause over-fitting to minority class samples (abnormal beats) of primary interest. To mitigate the imbalanced data issue, we proposed a novel, cost-sensitive loss function that ensures a balanced deep representation of class samples by assigning effective weights to each class. The cost-sensitive loss function dynamically alters class weights for every batch based on class distribution and model performance. The proposed method acquired an overall accuracy of 99.81% for intra-patient classification and 96.36% for the inter-patient classification of heartbeats. The experimental results reveal that the proposed approach learned a balanced representation of ECG beats by mitigating the issue of imbalanced data and achieved an improved classification performance as compared to other studies.

Toxic and heavy metals contamination assessment in soil and water to evaluate human health risk.

Due to urbanization and industrialization, there has been an increase in solid waste generation and has become a global concern and leakage of leachate from landfills contaminate the soil and groundwater and hence can have a severe impact on human health. The present study aimed to determine the composition of toxic metals (Cr, Mn, Cu, As) and heavy metals (Cd, Ba, Hg, Pb) in soil and water by an inductively coupled plasma optical emission spectrometer (ICP-OES). To ensure accuracy during the analysis of Cr, Mn, Cu, As, Cd, Ba, Hg, and Pb in real samples, certified reference material (CRM, SRM 2709a) of San Joaquin soil and water (SRM 1640a) were analyzed and results were presented in terms of % recovery studies. The mean concentration of all the metals in soil and water did not exceed the limit set by the European Community (EU), WHO, and US EPA except Cu where the permissible limit defined by the EU is 50-140 mg/kg in soil. The soil is uncontaminated to moderately contaminated with respect to all metals except the Cu and Pb. Among the average daily dose (ADD) of soil, ADDing and ADDinh for children had the maximum dose for all metals than adults while ADDderm was higher in adults. Hazard quotient (HQ) trend in both adults and children was found in order HQing > HQderm > HQinh of soil for all metals except Ba which followed HQing > HQinh > HQderm. Hazard index (HI) values of soil for Cr and Pb in children were 7 and 7.5 times higher than adults respectively. Lifetime cancer risk (LCR) value for Cr by different exposure pathways of soil was 5.361 × 10-4 for children which are at the lower borderline of risk for cancer.

Zwolle Risk Score for Safety Assessment of Same-day Discharge after Primary Percutaneous Coronary Intervention.

OBJECTIVES: The Zwolle risk score (ZRS) has been considered to be a useful tool for the systematic evaluation of patients for early discharge after primary percutaneous coronary intervention (PCI). Therefore, aim of this study was to evaluate the clinical utility of ZRS for the same-day discharge strategy after primary PCI at a tertiary care cardiac center of Karachi, Pakistan. METHODS: This study was conducted at a tertiary care cardiac center between August 2019 and July 2020. Patients discharged within 24 h (same-day) of the primary PCI procedure were included. Patients were stratified as high- and low-risk based on ZRS score; low-risk (≤3) and high-risk (≥4). All patients were followed during 30-days post-procedure period for major adverse cardiac events (MACE). RESULTS: Out of 487 patients, 83.2% (405) were male and mean age was 54.6 ± 10.87 years. Mean ZRS was 2.34 ± 1.64 with 16.0% (78) patients in high-risk (≥4) group. 30-days MACE rate was observed to be 5.3% (26) with significantly higher rate among high-risk patients as compared to low-risk patients 12.8% (10) vs. 3.9% (16); p = 0.004 respectively with OR of 3.61 [1.57-8.29]. The area under the curve (AUC) of ZRS for prediction of 30-day MACE was 0.67 [95% CI: 0.58-0.77], ZRS ≥4 had sensitivity of 38.5% and specificity of 85.2% with AUC of 0.62 [95% CI: 0.50-0.74] for prediction of 30-day MACE. CONCLUSION: ZRS showed moderate discriminating potential in identifying patients with high-risk of MACE at 30-day after same-day discharge after primary PCI.

Occurrence, spatial variation and risk assessment of pharmaceuticals and personal care products in urban wastewater, canal surface water, and their sediments: A case study of Lahore, Pakistan.

Due to the lack of wastewater treatment facility in Pakistan, the wastewater is directly discharged via urban drains, which might cause a high load of contaminants of emerging concerns and potential environmental risks. The present study focused on the occurrence and risk assessment of 52 pharmaceuticals and personal care products (PPCPs) of diversified classes in the water and sediment samples of urban drains and canal of Lahore, Pakistan. Non-steroidal anti-inflammatory drugs were the predominant PPCPs detected in the wastewater of urban drains and surface water of canal. The highest concentration was observed for acetaminophen, with median concentration of 13,880 ng/L followed by caffeine with median concentration of 6200 ng/L. Antibiotics were the predominant PPCPs in the sediment samples with highest concentration of ofloxacin (median value of 1980 µg/kg) followed by ciprofloxacin and oxytetracycline. Spatial variation showed that the population density has significant correlation with the level of many PPCPs in surface water while one of the drainage systems is affected by the direct wastewater discharge from the nearby industrial area. Ecological risk assessment in terms of risk quotient revealed that most of the PPCPs may cause high risk to the aquatic community. This high risk may lead to further contamination of food and crops, therefore enforcement of environmental legislations for treatment of wastewater is recommended.

Comparison of pulmonary lobectomies using robotic and video-assisted thoracoscopic approaches: results from 2010-2013 National Inpatient Sample.

BACKGROUND: Robotic lobectomies for pulmonary pathologies, such as lung cancer, have seen increased usage over the past 10 years. Previous studies have shown that robotic lung surgery is safe and can lead to improved outcomes for patients. The purpose of this study was to compare postoperative complications associated with robotic lobectomy and video-assisted thoracoscopic surgery (VATS) lobectomy using the National Inpatient Sample (NIS) database in the USA. The use of this large, nationwide database may help clarify differences in outcomes of these two operative approaches. METHODS: Patients who underwent VATS and robotic lobectomy from 2010-2013 were identified using the NIS database. A propensity score matched analysis was applied in a 1:1 ratio to minimize imbalance between preoperative comorbidities. RESULTS: Final analysis included a total of 2868 patients: 1434 were VATS and 1434 were robotic cases. Postoperatively, the rate of overall morbidity was not statistically different in the VATS versus the robotic group (39.9% vs. 43.0%, P=0.084). Specific complications that were higher in the robotic group included: rates of accidental puncture or laceration (1.8% vs. 0.8%, P=0.016), pneumonia (5.7% vs. 4.1%, P=0.048), and bleeding complications (2.4% vs. 1.1%, P=0.012). Total costs were lower for the VATS group than the robotic group ($77,940.54 vs. $102,057.07, P<0.001). CONCLUSIONS: Overall morbidity between the two groups was not statistically different. Patients that underwent robotic versus VATS lobectomy were significantly more likely to experience accidental puncture or laceration, pneumonia, and bleeding complications. Robotic surgery also incurred more cost.

Feasibility of robotic surgery in a developing country, a public sector Perspective.

OBJECTIVE: To assess the clinical feasibility of robotic platform and to calculate cost for sustaining it.. METHODS: The study was conducted at Sindh Government Qatar Hospital and Civil Hospital Karachi from October 11, 2011, to August 30, 2017. Feasibility was assessed in terms of clinical outcome i.e. surgical complications, duration of stay and readmissions. The cost of doing an individual procedure was calculated along with the projected cost for 150, 200 and 250 cases per year. SPSS 23 was used for data analysis.. RESULTS: Of the 119 patients, 45(37.8%) were males and 74(62.2%) were females. Overall mean age was 42.10}13.40 years (range: 21-80 years. Mean hospital stay was 3.59}3 (range: 1-19 days). Complications occurred in 17(14.3%) patients ranging from wound infection 7(5.9%), bleeding 5(4.2%), intra-abdominal abscess 3(2.5%) and recurrence 2(1.7%). The total cost of robotic platform was Rs320 million with an annual maintenance contract of 10% of the total cost. The mean cost of performing a robotic procedure was Rs.389,263.05}39,249.63 (range: Rs252,823.09- Rs456,842.79).. CONCLUSIONS: Robotic surgery was found to be a feasible and viable option. The major hindrance was the cost involved in setting up the system and recurring costs in terms of disposables.

Risk assessment, cross-resistance potential, and biochemical mechanism of resistance to emamectin benzoate in a field strain of house fly (Musca domestica Linnaeus).

Reduced sensitivity to insecticides in insect pests often results in control failures and increases in the dose and frequency of applications, ultimately polluting the environment. Reduced sensitivity to emamectin benzoate, a broad-spectrum agrochemical belonging to the avermectin group of pesticides, was reported in house flies (Musca domestica L.) collected from Punjab, Pakistan, in 2013. The aim of the present study was to investigate the risk for resistance development, biochemical mechanism, and cross-resistance potential to other insecticides in an emamectin benzoate selected (EB-SEL) strain of house flies. A field-collected strain showing reduced sensitivity to emamectin was re-selected in the laboratory for five consecutive generations and compared with a laboratory susceptible (Lab-Susceptible) reference strain, using bioassays. The field strain showed rapid development of resistance to emamectin (resistance ratio (RR) increased from 35.15 to 149.26-fold) as a result of selection experiments; however, resistance declined when the selection pressure uplifted. The EB-SEL strain showed reduction in resistance to abamectin, indoxacarb, and thiamethoxam. The results of synergism experiments using piperonyl butoxide (PBO) and S,S,S-tributylphosphorotrithioate (DEF) enzyme inhibitors and biochemical analyses revealed that the metabolic resistance mechanism was not responsible in developing emamectin resistance in the EB-SEL strain. In conclusion, the risk for the rapid development of emamectin resistance under continuous selection pressure suggests using a multifaceted integrated pest management approach for house flies. Moreover, the instable nature of emamectin resistance in the EB-SEL strain and lack of cross-resistance to other insecticides provide windows for the rotational use of insecticides with different modes of action. This will ultimately reduce emamectin selection pressure and help improving management programs for house flies without polluting the environment.

Abdominal tuberculosis: epidemiologic profile and management experience of 233 cases.

OBJECTIVE: To document the epidemiologic profile and management outcome of patients with abdominal tuberculosis in a tertiary care setup. METHODS: This descriptive case series was conducted at the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, between January 2003 and December 2008. All adult patients of either gender who presented with abdominal tuberculosis and were managed at our hospital during the study period were included in the study on the basis of convenience sampling. Numerical data were expressed as mean +/- standard deviation, while categorical data were analysed using SPSS version 10. Chi square test was conducted to compare categorical variables. RESULTS: Of the 233 adult patients with abdominal tuberculosis who were part of the study, 110 (47.21%) were males and 123 (52.78%) females. The mean age was 28.21 +/- 5.75 years. Majority of our patients (80.68%) belonged to poor families. History of concomitant pulmonary tuberculosis was found in 23 (9.87%) patients. Family history of tuberculosis was found in 13 (5.57%) patients. Of the patients 157 (67.38%) presented with acute abdomen; strictures were the most common operative finding (n = 161; 69%); the patients needing hospitalisation were 204 (87.55%), with the mean hospital stay being 19.55 +/- 4.51 days. The in-hospital mortality was 5 (2.14%). CONCLUSION: Abdominal tuberculosis was found prevalent in the population and predominantly affected the younger lot belonging to the poor socioeconomic strata. Majority of the cases were of primary intestinal variety, and in a small proportion it was secondary to pulmonary tuberculosis. Majority of the patients presented with complications such as acute intestinal obstruction, intestinal perforation and peritonitis, necessitating emergency laparotomy.

Does the added benefit of ondansetron over dexamethasone, to control post-operative nausea and vomiting, justify the added cost in patients undergoing tonsillectomy and adenotonsillectomy?

OBJECTIVE: To investigate comparative effectiveness of ondansteron and dexamethasone in prophylaxis of PONV in tonsillectomy and adenotonsillectomy patients. METHODS: The study was conducted at Shifa International Hospital Islamabad from 1st January to 30th June 2009, on 60 patients undergoing tonsillectomy or adenotonsillectomy, with their consent. After consecutive alternate sampling, patients were divided into two groups containing 30 patients each. Ondansteron was given in one group, and Dexamethasone in the other group, as anti emetic, at the time of induction. Episodes of PONV were recorded at three specified intervals, i.e., immediate postoperative, 6 hours after surgery and 12 hours after surgery. Data was entered on a pre-designed performa. The data was analyzed in SPSS Version 13.0. RESULTS: Ondansteron Group had a mean age of 12.7 +/- 9.54 years (5-36 years). There were 22 (73.3%) males and 8 (26.7%) females. Dexamethasone Group had a mean age of 14.8 +/- 8.4 years (5-35 years) of whom 18 (60.0%) were males and 12 (40.0%) were females. Overall 6 patients who received ondansetron had PONV compared to 7 patients in the dexamethasone group. This difference was statistically insignificant (p > 0.05). CONCLUSION: Dexamethasone was equally effective in controlling PONV in tonsillectomy and adenotonsillectomy patients. The improved benefit of using ondansetron over dexamethasone, on a regular basis, does not justify the added cost.

Microbial transformation of sesquiterpenoids.

Biotransformations are useful methods for producing medicinal and agricultural chemicals from both active and inactive natural products with the introduction of chemical functions into remote sites of the molecules. Research on microbial biotransformations of commonly available sesquiterpenoids into more valuable derivatives has always been of interest because of their economical potential to the perfume, food, chemical and pharmaceutical industries. Fungal transformations of sesquiterpenoids have been less frequently studied compared with many other natural products. In recent years, however, much attention has been given to the exploitation of new products with enhanced biological activity using microorganisms. This review, covering the period from 1990 to 2006, summarizes our knowledge of the biotransformations of sesquiterpenoids by various fungi. Such transformations could lead to the discovery of new reaction pathways that might be useful in the design of new value-added products.