Nivolumab in sorafenib-naive and sorafenib-experienced patients with advanced hepatocellular carcinoma: 5-year follow-up from CheckMate 040.

BACKGROUND: Patients with advanced hepatocellular carcinoma (aHCC) have a poor prognosis and high mortality. Nivolumab monotherapy demonstrated clinical benefit with an acceptable safety profile in patients with aHCC in the CheckMate 040 study. Five-year follow-up of the sorafenib-naive and sorafenib-experienced groups of CheckMate 040 is presented here. PATIENTS AND METHODS: Patients received nivolumab monotherapy at dose levels of 0.1-10.0 mg/kg (dose-escalation phase) or 3 mg/kg (dose-expansion phase) every 2 weeks until disease progression or unacceptable toxicity. Primary endpoints were safety and tolerability (dose escalation), and objective response rate (ORR) by blinded independent central review (BICR) and by investigator as per RECIST version 1.1 (dose expansion). RESULTS: Eighty sorafenib-naive and 154 sorafenib-experienced patients were treated. Minimum follow-up in both groups was 60 months. ORR as per BICR was 20% [95% confidence interval (CI) 12% to 30%] and 14% (95% CI 9% to 21%) in the sorafenib-naive and sorafenib-experienced groups, respectively. Responses occurred regardless of HCC etiology or baseline tumor cell programmed death-ligand 1 (PD-L1) expression levels. Median overall survival (OS) was 26.6 months (95% CI 16.6-30.6 months) and 15.1 months (95% CI 13.0-18.2 months) in sorafenib-naive and sorafenib-experienced patients, respectively. The 3-year OS rates were 28% in the sorafenib-naive and 20% in the sorafenib-experienced groups; 5-year OS rates were 14% and 12%, respectively. No new safety signals were identified; grade 3/4 treatment-related adverse events were observed in 33% and 21% of patients in the sorafenib-naive and sorafenib-experienced groups, respectively. Biomarker analyses showed that baseline PD-L1 expression ≥1% was associated with higher ORR and longer OS compared with PD-L1 <1%. In the sorafenib-naive group, patients with OS ≥3 years exhibited higher baseline CD8 T-cell density compared with those with OS <1 year. CONCLUSION: With 5 years of follow-up, nivolumab monotherapy continued to provide durable clinical benefit with manageable safety in sorafenib-naive and sorafenib-experienced patients with aHCC.

Epidemiology of antimicrobial resistance in commensal E. coli from healthy dairy cattle on a Mediterranean pasture-based system of Australia: A cross-sectional study.

This study aimed to determine the prevalence of antimicrobial resistance (AMR) in commensal E. coli from healthy lactating cows and calves in the Mediterranean pasture-based feeding dairy system of Western Australia (WA). Fecal samples were collected from healthy adult lactating cows and healthy calves from dairy farms in WA. Presumptive commensal E. coli was isolated from these samples and confirmed using matrix-assisted laser-desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Broth microdilution was used to assess the prevalence and the phenotypic AMR profiles of the E. coli isolates to 8 antimicrobial agents of dairy industry and human importance. The minimum inhibitory concentration (MIC) for each isolate was interpreted using the Epidemiologic Cutoff (ECOFF) and Clinical and Laboratory Standards Institute (CLSI) breakpoints. Genomic characterization provided multi-locus sequence types and AMR genes for a selection of isolates categorised as non-wild type (NWT) by ECOFF values for the combination of ampicillin, trimethoprim-sulfamethoxazole, and tetracycline. From a total of 1,117 fecal samples (633 adult, 484 calf) collected across 26 randomly selected farms, 891 commensal E. coli isolates were recovered (541 adult, 350 calf). Commensal E. coli classified as NWT was highest for ampicillin for both adult (68.8%; 95% CI = 64.7 - 72.7) and calf feces (67.1%; 95% CI = 62.0 - 72.0). A large proportion of tetracycline NWT and trimethoprim-sulfamethoxazole NWT organisms were also identified from calf feces, being 44.0% (95% CI = 38.7 - 49.4) and 24.6% (95% CI = 20.2 - 29.4) respectively. Clinical resistance prevalence was low, being higher for calves than for adult feces (ampicillin (adult: 7.8% (95% CI = 5.7 - 10.3); calf: 30.0% (95% CI = 25.2 - 35.1), tetracycline (adult: 6.3% (95% CI = 4.4 - 8.7); calf: 40.3% (95% CI = 35.1 - 45.6), and trimethoprim-sulfamethoxazole (adult: 2.6% (95% CI = 1.4 - 4.3); calf: 22.0% (95% CI = 17.7 - 26.7)). Commensal E. coli originating from calf feces was significantly higher in NWT prevalence compared with adult feces for ciprofloxacin (P = 0.023), gentamicin (P = 0.02), tetracycline (P < 0.001), and trimethoprim-sulfamethoxazole (P < 0.001). The overall number of antimicrobials an isolate was classified as NWT toward varied among farms and was significantly higher for isolates originating from calf than adult feces (P < 0.001). The strain type and sampling source of the commensal E. coli investigated were both associated with the commonality of the resultant resistance genome. Clinical resistance and NWT classification were highest for ampicillin, tetracycline, and trimethoprim-sulfamethoxazole, all antimicrobials commonly used in the treatment of dairy cattle in Australia. Though highly variable across farms, commensal E. coli isolated from healthy dairy calf feces had significantly higher NWT and multidrug resistance (MDR) prevalence compared with feces from healthy adult lactating dairy cows. The resistant genome identified in MDR isolates, though not always consistent with the phenotype, included QnrS1 and genes encoding AmpC ß-lactamase and aminoglycoside phosphotransferase.

Burden of osteoarthritis in India and its states, 1990-2019: findings from the Global Burden of disease study 2019.

OBJECTIVE: To describe the burden of osteoarthritis (OA) in India from 1990 to 2019. DESIGN: Data from Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used. The burden of OA -knee OA, hip OA, hand OA, and other OA- was estimated for India and its states from 1990 to 2019 through a systematic analysis of prevalence, incidence, years lived with disability (YLD), and disability-adjusted life years (DALY) using methods reported in GBD 2019 study. RESULT: Around 23.46 million individuals in India had OA in 1990; this increased to 62.35 million in 2019. The age-standardised prevalence of OA increased from 4,895 (95% uncertainty interval (UI):4,420-5,447) in 1990-5313 (95%UI:4,799-5,898) in 2019, per 100,000 persons. Similarly, DALYs due to OA increased from 0.79 million (95%UI:0.40-1.55) to 2.12 million (95%UI:1.07-4.23); while age-standardised DALYs increased from 164 (95%UI:83-325) to 180 (95%UI:91-361) per 100,000 persons from 1990 to 2019. OA was the 20th most common cause of YLDs in India in 2019, accounting for 1.48% (95%UI:0.88-2.78) of all YLDs; increasing from 23rd most common cause in 1990 (1.25%(95%UI:0.74-2.34)). Knee OA was the most common form of OA, followed by hand OA. The prevalence, incidence, and DALYs for OA and knee OA were consistently higher in females than males. CONCLUSION: The burden and impact of OA in India are substantial and is increasing. Adopting suitable control and preventive community measures to reduce modifiable risk factors (obesity, injuries, occupational stress) are needed to reduce the current and future burden of OA in India.

Parathyroid Adenoma within the Carotid Sheath.

OBJECTIVE: Ectopic parathyroid adenoma is an uncommon cause of primary hyperparathyroidism. Apart from the usually described sites of ectopic parathyroid adenoma, anecdotal case reports of undescended parathyroid adenoma along the carotid artery have been described. METHODS: We report a rare case of a 4 cm large parathyroid adenoma within the carotid sheath. RESULTS: A 27-year-old lady presented with severe bony pains, history of height loss, fracture of left shaft femur following trivial trauma and renal calculi. On evaluation she had hypercalcemia with elevated iPTH suggestive of primary hyperparathyroidism. Ultrasound of neck and 99mTc sestamibi SPECT/CT incorrectly localised the lesion as right inferior parathyroid adenoma leading to a failed initial surgery. Later CECT of the neck identified adenoma posterior to right common carotid artery which was confirmed on repeat surgery and the patient was cured. CONCLUSION: Ectopic parathyroid adenomas are both difficult to localise and are a common cause of failed initial parathyroid surgery. Surgeons should exercise caution while removing a visually normal parathyroid gland. In case of any discordance with the pre-operative localization, a meticulous systematic dissection using the conventional approach should be performed and the possibility of an undescended gland in the carotid sheath should be considered.

THYROIDITIS DEVELOPING POST INITIATION OF OCTREOTIDE IN A CASE OF TSH SECRETING TUMOR.

Thyroiditis developing post pituitary surgery in a case of TSH secreting tumor has been reported, albeit rarely. A 46 year old female was treated as a case of hypothyroidism for almost five years, however, TSH levels remained unsuppressed in spite of increasing thyroxine doses. A cyclic pattern of TSH with T3 secretion was observed after stopping thyroxine, though T4 levels were normal. T3 suppression test revealed a non suppressed TSH and MRI sella revealed a pituitary mass with Grade 1 cavernous sinus invasion. With a diagnosis of TSH secreting tumor, the patient was initiated on octreotide therapy. TFT normalized within 4 days of initiation of octreotide, tumor size reduced by about 30% within 2 months of therapy and goiter size reduced to almost half with octreotide therapy. Anti TPO levels which were initially negative became positive within a month of octreotide therapy and FNAC thyroid revealed thyroiditis. To the best of our knowledge, this is the second case report of development of thyroiditis after octreotide therapy. The immunomodulatory role of TSH and somatostatin may have a role in the development of thyroiditis in this case.

Comparative reliability and diagnostic performance of conventional 3T magnetic resonance imaging and 1.5T magnetic resonance arthrography for the evaluation of internal derangement of the hip.

OBJECTIVE: To compare the diagnostic accuracy of conventional 3T MRI against 1.5T MR arthrography (MRA) in patients with clinical femoroacetabular impingement (FAI). METHODS: Sixty-eight consecutive patients with clinical FAI underwent both 1.5T MRA and 3T MRI. Imaging was prospectively analysed by two musculoskeletal radiologists, blinded to patient outcomes and scored for internal derangement including labral and cartilage abnormality. Interobserver variation was assessed by kappa analysis. Thirty-nine patients subsequently underwent hip arthroscopy and surgical results and radiology findings were analysed. RESULTS: Both readers had higher sensitivities for detecting labral tears with 3T MRI compared to 1.5T MRA (not statistically significant p=0.07). For acetabular cartilage defect both readers had higher statistically significant sensitivities using 3T MRI compared to 1.5T MRA (p=0.02). Both readers had a slightly higher sensitivity for detecting delamination with 1.5T MRA compared to 3T MRI, but these differences were not statistically significant (p=0.66). Interobserver agreement was substantial to perfect agreement for all parameters except the identification of delamination (3T MRI showed moderate agreement and 1.5T MRA substantial agreement). CONCLUSION: Conventional 3T MRI may be at least equivalent to 1.5T MRA in detecting acetabular labrum and possibly superior to 1.5T MRA in detecting cartilage defects in patients with suspected FAI. KEY POINTS: • Conventional 3T MRI is equivalent to 1.5T MRA for diagnosing labral tears. • Conventional 3T MRI is superior to 1.5T MRA for diagnosing acetabular cartilage defect. • Conventional 3T MRI is equivalent to 1.5T MRA for diagnosing cartilage delamination. • Symptom severity score was significantly higher (p<0.05) in group proceeding to surgery.

Assessment of plant growth attributes, bioaccumulation, enrichment, and translocation of heavy metals in water lettuce (Pistia stratiotes L.) grown in sugar mill effluent.

This study was conducted to assess the pollutant uptake capability of water lettuce (Pistia stratiotes L.) in terms of bioaccumulation, enrichment, and translocation of heavy metals grown in sugar mill effluent. Results showed that the maximum fresh weight (328.48 ± 2.04 gm kg-1), total chlorophyll content (2.13 ± 2.03 mg g-1 fwt), and relative growth rate, RGR (11.89 gg-1 d-1) of P. stratiotes were observed at 75% concentration of the sugar mill effluent after 60 days of phytoremediation experiment. The bioaccumulation factor (BF) of different heavy metals was greater than 1 with 50% and 75% concentrations of sugar mill effluent and this indicated that P. stratiotes was hyperaccumulator or phytoremediator of these metals. The enrichment factor (EF < 2 for Cu, Fe, Cr, Pb, Zn, and Mn) and (EF > 2 for Cd) indicated that P. stratiotes mineral enrichment deficient and it moderately enriched the different heavy metals. Moreover, translocation factor (TF) was less than 1 which indicated the low mobility of metals in different parts (root and leaves) of P. stratiotes after phytoremediation. Therefore, P. stratiotes can be used for phytotreatment of sugar mill effluent up to 50% to 75% concentrations and considered as hyperaccumulator aquatic plant for different heavy metals and other pollutants from the contaminated effluents.

Search for Neutrinoless Quadruple-ß Decay of

We report the results of a first experimental search for lepton number violation by four units in the neutrinoless quadruple-ß decay of ^{150}Nd using a total exposure of 0.19 kg yr recorded with the NEMO-3 detector at the Modane Underground Laboratory. We find no evidence of this decay and set lower limits on the half-life in the range T_{1/2}>(1.1-3.2)×10^{21} yr at the 90% C.L., depending on the model used for the kinematic distributions of the emitted electrons.

Irrigating okra with secondary treated municipal wastewater: Observations regarding plant growth and soil characteristics.

The present study was carried out to probe the agronomic response of hybrid cultivar of okra (Hibiscus esculentus L. var. JK 7315) grown in secondary treated municipal wastewater irrigated soil with field investigations. The concentrations of the municipal wastewater viz., 10%, 20%, 40%, 60%, 80%, and 100% along with the control (groundwater) were used for the irrigation of the H. esculentus. The study revealed that the concentrations of the municipal wastewater showed significant (p < 0.05/p < 0.01) effect on the soil parameters after wastewater fertigation in comparison to groundwater in both the seasons. The maximum agronomic performance of the H. esculentus was recorded with 60% concentration of the municipal wastewater in both the seasons. The contamination factor of heavy metals varied in the H. esculentus plants and soils. In the H. esculentus plants, following fertigation with municipal wastewater, the contamination factor of manganese was the highest, while that of chromium was the lowest. Intermediate contamination factor were observed for zinc, copper, and cadmium. Therefore, secondary treated municipal wastewater can be used as an agro-fertigant after appropriate dilution (up to 60%) to achieve the maximum yield of the H. esculentus.

Clinical importance of median mandibular flexure in oral rehabilitation: a review.

The mandible has a property to flex inwards around the mandibular symphysis with change in shape and decrease in mandibular arch width during opening and protrusion of the mandible. The mandibular deformation may range from a few micrometres to more than 1 mm. The movement occurs because of the contraction of lateral pterygoid muscles that pulls mandibular condyles medially and causes a sagittal movement of the posterior segments. This movement of mandible can have a profound influence on prognosis and treatment outcome for various restorative, endodontics, fixed, removable and implant-related prosthesis. The review unfolds the causes, importance and clinical implications of median mandibular flexure in oral rehabilitation. This review also highlights the appropriate preventive measures and techniques that should be adopted by clinicians to minimise the effect of flexural movement of the jaw during oral rehabilitation. This would not only help clinicians to achieve a good prosthesis with accurate fit and longevity but also maintain the health of the surrounding periodontal or periimplant gingival tissues and bone.

Comparison of clinically suspected injuries with injuries detected at whole-body CT in suspected multi-trauma victims.

AIM: To assess the accuracy of the trauma team leader's clinical suspicion of injury in patients who have undergone whole-body computed tomography (WBCT) for suspected polytrauma, and to assess the frequency of unsuspected injuries and specific patterns of injury at WBCT. MATERIALS AND METHODS: Requests for patients who underwent WBCT for suspected polytrauma from April 2011 to March 2014 were reviewed and each body area that was clinically suspected to be injured was recorded. Body areas were divided into the following groups based on anatomical regions covered in each segment of the WBCT examination: head (including facial bones); neck (including cervical spine); chest (including thoracic spine); and abdomen/pelvis (including lumbar spine). The formal radiology report for each study was reviewed and injuries found at CT were grouped into the same body areas. For each patient, the number of clinically suspected injured areas was compared to the number of confirmed injured areas at WBCT. RESULTS: Five hundred and eighty-eight patients were included in the study. Thirty-two percent (186/588) had a normal scan. Ninety-three percent (546/588) had fewer injured body areas at WBCT than suspected. Four percent (27/588) had the equivalent number of injured areas at WBCT as suspected. Three percent (15/588) had more injured areas at WBCT than suspected. Fifty percent (263/527) with clinically suspected chest injuries were confirmed to have chest injuries at WBCT. This was lower for other areas: abdomen/pelvis 31% (165/535); head 29% (155/533); neck 13% (66/513). Four percent of (24/588) patients had unsuspected injuries found at WBCT. Seventy-five percent (18/24) of unsuspected injuries were considered as serious, where failure to treat would have the potential for significant morbidity. Most of these patients had severe injuries to other body areas that were correctly suspected. Of the 165 with abdominal/pelvic region injuries, there were associated injuries in the thoracic region in 62% (103/165) cases. Of the 278 thoracic injuries, there were abdominal/pelvic region injuries in 37% (103/278) and injuries to the neck in 19% (52/278) cases. Of the 158 head injuries, there were neck injuries in 22% (34/158) cases. CONCLUSION: Clinical suspicion of injury correlates poorly with findings at WBCT, with a high proportion of uninjured body areas. The number of unsuspected injuries found at WBCT was low, but the majority of these were serious injuries, possibly masked by distracting injury to other body areas. The use of a WBCT protocol is recommended for suspected polytrauma, but regular monitoring of WBCT findings and regular feedback of the results to emergency physicians is suggested to help inform their selection of patients for trauma WBCT.

Experimental and kinetic studies for phycoremediation and dye removal by Chlorella pyrenoidosa from textile wastewater.

Potential of Chlorella pyrenoidosa was experimentally investigated for phycoremediation and dye removal from textile wastewater (TWW) in batch cultures. Growth of alga was observed at various concentration of textile wastewater (25%, 50%, 75% and 100%) and was found in a range of 8.1-14 µg ml(-1) day(-1). Growth study revealed that alga potentially grows up to 75% concentrated textile wastewater and reduces phosphate, nitrate and BOD by 87%, 82% and 63% respectively. Methylene blue dye (MB) removal was also observed by using dry and wet algal biomass harvested after phycoremediation. Adsorption isotherms (Langmuir and Freundlich) and kinetic models (pseudo first and second order) were applied on adsorption process. Dry algal biomass (DAB) was found more efficient biosorbent with large surface area and showed high binding affinity for MB dye in compare to wet algal biomass (WAB). The RL value for both biosorbent showed feasible adsorption process as the obtained value was between 0 and 1. Pseudo second order kinetic model with high degree of correlation coefficient and low sum of error squares (SSE %) value was found more suitable for representation of adsorption process in case of both biosorbents, however pseudo first order also showed high degree of correlation for both biosorbents.

Accumulation of heavy metals in the vegetables grown in wastewater irrigated areas of Dehradun, India with reference to human health risk.

The present study on accumulation of heavy metals in the vegetables viz. Beta vulgaris, Phaseolus vulgaris, Spinacea oleracea, and Brassica oleracea var. botrytis grown in the wastewater-irrigated soil near the Bindal river, Dehradun, has shown the maximum accumulation of metals for Pb (196.91 ± 8.13 mg/kg), Cu (36.75 ± 6.19 mg/kg), Zn (305.54 ± 14.30 mg/kg), Ni (125.48 ± 5.97 mg/kg), Cd (29.58 ± 4.26 mg/kg), and Cr (93.06 ± 3.25 mg/kg) in agricultural soil irrigated with wastewater. The enrichment factor of soil was maximum for Cr (8.74) and minimum for Cu (0.88). In case of vegetables, the concentrations of heavy metals were maximum for Pb (86.69 ± 6.69) in the flower of B. oleracea var. botrytis, Cu (33.49 ± 2.09) and Zn (161.86 ± 17.79) in the leaves of S. oleracea, Ni (80.72 ± 8.40) and Cd (23.19 ± 2.76), and Cr (57.18 ± 8.16) in the root of B. vulgaris grown in wastewater (WW)-irrigated soil. The bioaccumulation factor (BAF) for Cu (0.911) was maximum in S. oleracea and minimum for Pb (0.440) in B. vulgaris. The maximum daily intake of metals was found for Zn (0.059) in S. oleracea and minimum for Cd (0.008) in B. vulgaris. The human health risk index was found to be more than 1 for Pb and Cd. The long-term wastewater irrigation resulted in accumulation of heavy metals in vegetables which may cause potential health risks to consumers as these vegetables are sold in local markets of Dehradun city.

Phenotypic Characterization and Multivariate Analysis to Explain Body Conformation in Lesser Known Buffalo (Bubalus bubalis) from North India.

Phenotypic characterization and body biometric in 13 traits (height at withers, body length, chest girth, paunch girth, ear length, tail length, length of tail up to switch, face length, face width, horn length, circumference of horn at base, distances between pin bone and hip bone) were recorded in 233 adult Gojri buffaloes from Punjab and Himachal Pradesh states of India. Traits were analysed by using varimax rotated principal component analysis (PCA) with Kaiser Normalization to explain body conformation. PCA revealed four components which explained about 70.9% of the total variation. First component described the general body conformation and explained 31.5% of total variation. It was represented by significant positive high loading of height at wither, body length, heart girth, face length and face width. The communality ranged from 0.83 (hip bone distance) to 0.45 (horn length) and unique factors ranged from 0.16 to 0.55 for all these 13 different biometric traits. Present study suggests that first principal component can be used in the evaluation and comparison of body conformation in buffaloes and thus provides an opportunity to distinguish between early and late maturing to adult, based on a small group of biometric traits to explain body conformation in adult buffaloes.

Lactoferrin gene promoter variants and their association with clinical and subclinical mastitis in indigenous and crossbred cattle.

Lactoferrin (Lf) gene promoter was screened for the presence of single nucleotide polymphism in indigenous and crossbred cattle from North India and to evaluate its association with Mastitis. Study revealed the presence of genetic variation in regulatory region of bovine Lactoferrin gene using PCR-RFLP technique. Three genotypes namely GG, GH and HH were identified. A single nucleotide change, from guanine to adenine at 25th position was found to be significantly associated (p<0.05) with clinical mastitis in indigenous Sahiwal and crossbred Karan Fries cattle maintained at organised herd of National Dairy Research Institute, Karnal. A non-significant association was observed between subclinical mastitis, somatic cell score (SCS), and GG genotype in Karan Fries cattle, however, a lower SCS was observed in animals having GG genotype. Overall a lower incidence of clinical mastitis was recorded in those animals having GG genotype of Lf in Sahiwal and Karan Fries (KF) cattle. The SNP identified in the promoter region may effect expression lactoferrin protein, which may lead to different levels of antibacterial and anti-inflammatory activity of Lf gene. Results from this study indicated the probable role played by Lactoferrin promoter to serve as candidate gene for mastitis susceptibility among indigenous and crossbred milch cattle.

Phycoremediation of textile wastewater by unicellular microalga Chlorella pyrenoidosa.

The potential application of microalga Chlorella pyrenoidosa was investigated for phycoremediation of textile wastewater. Two 15 days batch experiment containing autoclaved and unautoclaved textile wastewater were performed to measure the efficiency of alga to remediate the wastewater. Experiments were set at equivalent external conditions and pollutant load was measured on alternate of 5 days to determine the pollutant removal efficiency of alga. Alga was found to be more efficient in removal of pollutants load in autoclaved wastewater; agents of eutrophication such as nitrate and phosphate are reduced by 62% ±0.5 and 87% ±0.7 respectively while organic load in terms of BOD is reduced by 81% ±0.2 whereas, In unautoclaved wastewater in presence of algal-bacterial consortium, nitrate and phosphate were removed by 81% ±1 and 36% ±2.2 while BOD is reduced by 73% ±1.6 only. Another time dependent experiment of dye removal was also performed to measure the adsorption potential of selected dried algal biomass. An equal amount of dried algal biomass was introduced to various range of textile wastewater simulated with methylene blue (MB) dye. The maximum colour removal was observed afterduration of 30 minutes by dry algal biomass.

Results from the first year as a major trauma radiology unit in the UK.

AIM: To record and analyse data from all facets of practice in the first year as a newly set-up major trauma centre radiology department. MATERIALS & METHODS: Retrospective analysis of all patients who underwent whole-body computed tomography (WBCT) for suspected polytrauma over a 1 year period was performed. The mechanism, the time of day, the number of body parts injured, the type of injuries, and resulting surgical or radiological interventions were recorded. Also recorded was the time from the CT examination to the formal report. Where applicable, the consultant-verified reports were cross-referenced with the out-of-hours registrar reports to assess for discrepancies. RESULTS: Two hundred and one patients underwent WBCT for suspected polytrauma. Sixty-four percent (128/201) of WBCT examinations were performed "out-of-hours". Fifty-seven percent (115/201) were road traffic accidents (RTAs), 33% (66/201) were falls, and 6% (12/201) were assaults. At WBCT, 31% (63/201) had no injuries; 27% (54/201) had injury to one body area; 21% (43/201) had injury to two areas; and 20% (41/201) had injury to three or more areas. Nineteen percent (39/201) required urgent radiological or surgical intervention. The mean time from end-of-CT to a formal report was 27 min. There were discrepancies between consultant reports and registrar reports in 22% (31/142) of cases; 1% (2/142) led to a change in acute management. CONCLUSION: Based on our early experiences, nearly one-third of patients who undergo a WBCT scan for suspected polytrauma, will have no acute injury at WBCT. One-fifth of patients in our study required emergency surgical or radiological intervention for acute injuries found on WBCT. A low discrepancy rate was found between on-call registrar reports and the consultant-verified reports.

Irrigational impact of distillery effluent on Abelmoschus esculentus L. Okra with special reference to heavy metals.

The present study was performed under natural environment to assess levels of different heavy metals in soil and Abelmoschus esculentus plants along with soil microbial population irrigated with five rates of distillery effluent (DE) viz. 10, 25, 50, 75 and 100 % concentration in comparison with control (Bore well water). Results revealed that among various concentrations of DE, irrigation with 100 % DE significantly (P < 0.001) increased Zn (+63.46 %), Cu (+292.37 %), Zn (+3763.63 %), Cd (+264.29 %), Ni (+48.39 %) and Cr (+815.74 %), while decreased total bacteria (-45.23 %), fungi (-17.77 %) and actinomycetes (-42.57 %) in the soil. Enrichment factor of various heavy metals for soil was in the order Ni > Cr > Cd > Zn > Cu, and for A. esculentus plants, it was in the order Ni > Cr > Cu > Cd > Zn after irrigation with distillery effluent. The enrichment factor value was found maximum for Ni in comparison to other metals at 100 % DE concentration as compared with BWW. However, the values of these metals were below the recommended permissible limit.

Ferti-irrigational impact of sugar mill effluent on agronomical characteristics of Phaseolus vulgaris (L.) in two seasons.

Ferti-irrigation response of 5, 10, 25, 50, 75, and 100 % concentrations of the sugar mill effluent (SME) on French bean (Phaseolus vulgaris L., cv. Annapurna) in the rainy and summer seasons was investigated. The fertigant concentrations produced significant (P < 0.01) changes in the soil parameters, viz., electrical conductivity (EC), pH, organic carbon (OC), sodium (Na(+)), potassium (K(+)), calcium (Ca(2+)), magnesium (Mg(2+)), total Kjeldahl nitrogen (TKN), phosphate (PO4 (3-)), sulfate (SO4 (2-)), ferrous (Fe(2+)), cadmium (Cd), chromium (Cr), copper (Cu), manganese (Mn), and zinc (Zn), in both seasons. The contents of Cr, Cu, Mn, and Zn except Cd were found to be below the maximum levels permitted for soils in India. The agronomic performance of P. vulgaris was gradually increased at lower concentrations, i.e., from 5 to 25 %, and decreased at higher concentrations, i.e., from 50 to 100 %, of the SME in both seasons when compared to controls. The accumulations of heavy metals were increased in the soil and P. vulgaris from 5 to 100 % concentrations of the SME in both seasons. The contents of Cu, Mn, and Zn except Cd and Cr were noted under the permissible limit of Food and Agriculture Organization (FAO)/World Health Organization (WHO) standards. Most contents of biochemical components like crude proteins, crude fiber, and total carbohydrates were found with 25 % concentration of the SME in both seasons. The contamination factor (Cf) of various metals was in the order of Cd > Cr > Zn > Mn > Cu for soil and Mn > Zn > Cu > Cr > Cd for P. vulgaris in both seasons after fertigation with SME. Therefore, the SME can be used to improve the soil fertility and yield of P. vulgaris after appropriate dilution.

Accumulation and translocation of metals in soil and different parts of French bean (Phaseolus vulgaris L.) amended with sewage sludge.

A pot experiment was conducted to study the accumulation and translocation of metals in French bean (Phaseolus vulgaris L.). Plants were grown in soil amended with up to 100 % sewage sludge. Significant (p < 0.01) changes to soil characteristics were observed. The maximum growth of P. vulgaris was noted in the treatment with 40 % of sewage sludge. Metal concentrations were significantly (p < 0.05) higher in P. vulgaris after sewage sludge amendment where Fe > Zn > Cd > Cu > Cr > Pb. The translocation for Fe and Zn was in the order of leaves > shoot > root > fruits, for Cd, shoot > root > leaves > fruits, for Cu and Pb shoot > leaves > root > fruits and for Cr root > shoot > leaves > fruits of P. vulgaris. All accumulated metal concentrations except Cd in the fruit were below the FAO/WHO standard limits. Thus, the amendment of agricultural soil by sewage sludge might be feasible. However, a regular monitoring of metal levels in agricultural products is recommended to prevent their accumulation in the food chain.