A postoperative complication of lumbar discectomy: A discal/annular cyst.

Background: A postoperative discal/annular cyst following lumbar discectomy may reproduce the symptoms/signs of a recurrent lumbar disc herniation (i.e., back pain and radiculopathy). Case Description: A 21-year-old rugby player developed leg pain after an uncomplicated lumbar microdiscectomy. The repeat lumbar magnetic resonance imaging confirmed a postoperative lumbar annular/ discal cyst, for which he underwent repeat surgery. The diagnosis was further confirmed histopathologically at surgery. Conclusion: Although rare, postoperative discal/annular cysts may be potential causes of recurrent postoperative pain and lumbar radiculopathy mimicking recurrent disc herniations.

Rapid Arterial Occlusion Evaluation Scale Agreement between Emergency Medical Services Technicians and Neurologists.

BACKGROUND: Rapid arterial occlusion evaluation (RACE) scale is a valid prehospital tool used to predict large vessel occlusion of major cerebral arteries in patients with suspected acute stroke. RACE scale administered by Emergency medicine services (EMS) technicians in the prehospital setting correlates well with NIH Stroke Scale score after patient arrival at a hospital. Despite this, the RACE scale is often characterized as too difficult for EMS technicians to accurately utilize. There are no data examining RACE scale accuracy in the prehospital setting comparing EMS technicians with neurologists. We sought to examine agreement between RACE scores calculated by EMS technicians and stroke neurologists in the prehospital setting during telestroke consultation. METHODS: Data for this observational cohort study were prospectively collected and retrospectively analyzed. EMS technicians in person and stroke specialized neurologists via televideo connection independently assessed suspected stroke patients and calculated RACE scores in the prehospital setting. We used a linearly weighted Cohen's kappa (kw) to estimate the extent of agreement for RACE score between EMS technicians and stroke neurologists. RESULTS: Thirty-one patients with stroke symptoms were independently examined and assessed with the RACE scale by EMS technicians and stroke neurologists in the prehospital setting. Exact agreement on the RACE score was found in 24 of 31 (77%) patients. We found very good agreement between EMS technicians and stroke neurologists, kw = .818 (95% CI, .677-.960), P< .001. CONCLUSIONS: EMS technicians provide reliable RACE assessments in patients with suspected stroke, with agreement similar to stroke specialized neurologists in the prehospital setting.

Toxicopathological effects of feeding aflatoxins B1 in broilers and its ameliosration with indigenous mycotoxin binder.

Mycotoxicosis is the second most important problem faced by the Pakistan poultry industry, after high feed prices. The present experimental study was designed to investigate the toxicopathological effects of aflatoxin B1 (AFB1) in commercial broiler chicks and its amelioration with locally produced mycotoxin binder. Total of 125 broiler chicks was divided into five equal groups (A-E). Group A served as negative control, group B (300 µg AFB1/kg feed) as positive control, group C (300 µg AFB1/kg + Local Mycotoxin Binder (LMB), 1 g/kg feed), group D (300 µg AFB1/kg + 2 g LMB/kg feed), and group E (300 µg AFB1/kg + Commercial Mycotoxin Binder (CMB), 2 g/kg of feed). Parameters studied included mortality, feed intake, bodyweights, absolute and relative organ weights, and gross and microscopic lesions in visceral organs. Clinical signs including alertness, fecal consistency, and feather shine were significantly lower in group B compared with control group A. The feed intake of 2 g/kg LMB treated group was significantly higher than that of the positive control group B. Also mean bodyweights of group D birds was higher than that of group B birds indicating an ameliorative effect of LMB. Histopathological results showed that moldy feed produced necrotic changes in the liver and kidneys in group B birds. However, in group D and E birds, the hepatic and renal parenchyma was normal, showing a protective effect of LMB. In the present study, a higher dose of LMB (2 g/kg) in group D showed higher bodyweights and feed intake. In group D, birds hepatic and renal parenchyma was also normal. The results suggested that local mycotoxin binder ameliorated the toxicopathological effects of AFB1 in mortality, feed intake, bodyweights, organ weights and, gross and microscopic lesions in visceral organs. These ameliorative effects of LMB were dose-dependent. The results of the present study concluded that AFB1 intoxication leads to decrease in bodyweights, feed intake in dose-related manner. The mortality was also dose-dependent. Gross and microscopic changes in the aflatoxin groups were more pronounced, however, all these deleterious effects were ameliorated in higher dose of LMB (group D) and CMB (group E). In group C, these deleterious effects were partially ameliorated. Local mycotoxin binder is an economical solution for aflatoxicosis problem, making poultry production more cost-effective.

Detection and characterization of multidrug-resistant Salmonella enterica serovar Infantis as an emerging threat in poultry farms of Faisalabad, Pakistan.

AIMS: The aim of this study was the molecular identification of Salmonella enterica serovar Infantis (S. Infantis) isolated from poultry samples and their antimicrobial resistance and virulence profiling. METHODS AND RESULTS: A total of 149 isolates, belonging to genus Salmonella, originally isolated from 340 suspected poultry post mortem specimens reported by us earlier were preliminary identified as Salmonella by biochemical methods and confirmed by polymerase chain reaction targeting genus-specific gene invA. Targeting serovar-specific gene fragment (fljB) resulted in confirmation of 54 isolates as S. Infantis which were further confirmed by sequencing of 16S RNA and fljB genes. Swimming and swarming motilities were detected in 98·1 and 11·1% isolates respectively. Phenotypic disc diffusion assay against 23 antimicrobial agents showed the highest resistance against pefloxacin (PEF) (94·4%), chloramphenicol (83·3%) and imipenem (77·7%) while 5·3% isolates showed extended-spectrum ß-lactamase production. Fifty-nine genes reported for antimicrobial resistance and 12 for conferring virulence were targeted. The most prevalent resistance gene for aminoglycosides was aadA (42·3%), for quinolone resistance determining region parE (62·5%), for penicillin's Int1 (62·9%), for chloramphenicol cat3 (66·1%) and for beta-lactams blaTEM -1 (44·4%). Among efflux pump coding genes, armA showed highest (74·2%) prevalence and for virulence, a high prevalence of SopE (89·2%) showed the zoonotic potential of the isolates. The activity of efflux pumps was detected through Ethidium Bromide-agar method. CONCLUSIONS: Poultry could act as reservoirs of multidrug resistance Salmonella. SIGNIFICANCE AND IMPACT OF THE STUDY: We firstly report the prevalence and molecular characterization of virulence/drug resistance in S. Infantis from this region and the results may contribute to designing precisely targeted therapy. This study has also highlighted the possible emergence of S. Infantis with zoonotic potential.

Pathophysiology of peste des petits ruminants in sheep (Dorper & Kajli) and goats (Boer & Beetal).

Peste des petits ruminants (PPR), an economically important viral transboundary disease of small ruminants is not only prevalent in Pakistan but also in other countries where people rely on agriculture and animal products. The present study was aimed at describing the pathology and antigen localization in natural PPR infections in local (Kajli sheep; Beetal goats) as well as imported small ruminant breeds (Dorper sheep; Australian Boer goat). Morbidity and mortality rates were significantly (P < 0.001) higher in indigenous Kajli sheep (75.37 and 32.80%) and Beetal goats (81.10 and 37.24%) as compared to Dorper sheep (6.99 and 1.48%) and Australian Boer goat (5.01 and 2.23%). Affected animals exhibited high fever, severe diarrhea, abdominal pain, respiratory distress and nodular lesions on lips and nostrils. Thick mucous discharge was oozing out from nostrils. On necropsy, lungs were congested and pneumonic, with nodular and cystic appearance. Intestines were hemorrhagic with zebra stripping. Characteristic histopathological lesions of PPR were noted in intestines, lymphoid organs and lungs. In GI tract, stunting and blunting of villi, necrotic enteritis, and infiltration of mononuclear cells in duodenum, jejunum and ileum. Small intestines exhibited diffuse edema of the submucosa along with proliferation of fibrocytes leading to thickened submucosa which has not been reported previously. Lymphoid organs showed partial to complete destruction of lymphoid follicles. Lesions of the respiratory tract included depictive of bronchopneumonia, severe congestion of trachea and apical lobe of lungs with deposition of fibrinous materials. Histopathological lesions of respiratory tract were severe and characteristic of broncho-interstitial pneumonia, bronchopneumonia, interstitial pneumonia and fibrinous pneumonia. The alveoli were filled with edematous fluid mixed with fibrinous exudate, numerous alveolar macrophages, mononuclear cells along with thickened interalveolar septa and presence of intranuclear eosinophilic inclusion bodies. One-Step RT-PCR using NP3 and NP4 primers confirmed a PPR virus of 352 bp size in spleen, lungs and mesenteric and brachial lymph node samples. It was concluded that morbidity and mortality due to PPR were significantly higher in indigenous breeds of sheep and goat as compared to imported sheep and goat breeds. PPR has rendered various lesions in GI and respiratory tract which are characteristic in nature for the diagnosis of the disease under field condition.

Estimation of ochratoxin A in poultry feed and its ingredients with special reference to temperature conditions.

1. The present study was designed to analyse ochratoxin A (OTA) in poultry feed samples (mixed types) along with different poultry feed ingredients collected from different farms and market of Lahore, Pakistan. 2. The whole year (2012-2013) was divided into three sub-periods depending upon environmental conditions, that is, July-October (hot and humid), November-February (winter) and March-June (moderate). During each sub-period 120 samples were collected for each feed and each ingredient constituting a total of 840 samples (120x7 of feed and feed ingredients in each sub-period). 3. The results of this study indicated that the incidence of OTA-positive samples was highest in July-October followed by that during March-June while the incidence was minimum during November-February. Similarly, the largest number of samples was below the maximum tolerable level (MTL) during November-February followed by March-June while the least number of samples was below MTL during hot weather (July-October). 4. This is the first elaborative study regarding the levels of OTA in poultry feed and its ingredients collected from Lahore, Pakistan.

Protective effects of vitamin E on sodium arsenite-induced toxicity, testicular measurements and histopathological studies of testes in Teddy goat bucks.

The objective of this study was to investigate the toxic effects of arsenic on testicular measurements and histology of adult Teddy goats bucks and to examine whether these toxic effects are scavenged by vitamin E. Twelve adult Teddy goat bucks were divided randomly into three groups, A, B and C. Group A was kept as control, the B was given sodium arsenite 5 mg/kg BW per day, and group C was fed with vitamin E 200 mg/kg BW per day + arsenic 5 mg/kg BW per day. This treatment was continued for 84 days. Analysis of data revealed that the testicular measurements (scrotal circumference, width, length and weight) were significantly reduced in arsenic-treated animals, whereas there were ameliorating effects of vitamin E on these parameters. The major histopathological changes were present in the form of loss of germinal epithelium, atrophy of Leydig cells and vacuolations. Vitamin E in combination with sodium arsenite increased the active spermatogenesis as well as restoration of germinal epithelium. It can be concluded from the present findings that sodium arsenite causes toxicity in the male reproductive system of Teddy goat bucks with major changes in parenchyma of testes. Supplementation of vitamin E has protective effects on the toxicity of sodium arsenite on the reproductive system of male Teddy goat bucks.

ZnO-PLLA nanofiber nanocomposite for continuous flow mode purification of water from Cr(VI).

Nanomaterials of ZnO-PLLA nanofibers have been used for the adsorption of Cr(VI) as a prime step for the purification of water. The fabrication and application of the flexible ZnO-PLLA nanofiber nanocomposite as functional materials in this well-developed architecture have been achieved by growing ZnO nanorod arrays by chemical bath deposition on synthesized electrospun poly-L-lactide nanofibers. The nanocomposite material has been tested for the removal and regeneration of Cr(IV) in aqueous solution under a "continuous flow mode" by studying the effects of pH, contact time, and desorption steps. The adsorption of Cr(VI) species in solution was greatly dependent upon pH. SEM micrographs confirmed the successful fabrication of the ZnO-PLLA nanofiber nanocomposite. The adsorption and desorption of Cr(VI) species were more likely due to the electrostatic interaction between ZnO and Cr(VI) ions as a function of pH. The adsorption and desorption experiments utilizing the ZnO-PLLA nanofiber nanocomposite have appeared to be an effective nanocomposite in the removal and regeneration of Cr(VI) species.

Immuno-pathologic effects of oral administration of chlorpyrifos in broiler chicks.

This study sought to assess if chlorpyrifos (CPF) induced immunotoxic effects in orally-treated day-old broiler chicks. Groups of chicks received per os CPF diluted in xylene at 5, 10, and 20 mg/kg body weight (CPF-5, CPF-10, and CPF-20) orally daily for 15 days. Xylene and control groups received xylene alone (1 ml/kg BW) and physiological saline, respectively. At various times during/after the exposure regimens, different immune end-points were analyzed in the birds. Humoral immunity was examined by assessing antibody responses to sheep red blood cells. Cell-mediated immunity was measured via lymphoproliferative responses to avian tuberculin. Leukocyte phagocytic ability was measured using a carbon clearance assay. Results showed that CPF administered to broiler chicks caused a dose-dependent decrease in humoral immunity, cell-mediated immunity, and phagocytic activity. Dose- and time-related pathological changes were observed in bursa of Fabricius, spleen, and thymus in treated birds. These changes were mild, moderate, and severe, respectively, in the 5, 10, and 20 mg/kg CPF groups. The Bursa of Fabricius in treated birds showed increased inter-follicular connective tissue proliferation, severe moderate cytoplasmic vacuolation, edema, and degenerative changes such as pyknosis and fragmentation of nuclei that depleted the follicles of lymphoid cells. In the spleen, disorganization of follicular patterns, severe congestion, cytoplasmic vacuolation, degenerative changes, and hyperplasia of reticular cells were noted. The thymus in treated birds exhibited congestion, hyper-cellularity, and a presence of immature monocytes in the medullary region, as well as myoid cell necrosis. Taken together, these studies clearly demonstrated that chlorpyrifos could induce immunotoxicities in broiler birds.

Ameliorative effects of L-carnitine and vitamin E (α-tocopherol) on haematological and serum biochemical parameters in White Leghorn cockerels given ochratoxin A contaminated feed.

1. L-carnitine is a quaternary ammonium compound biologically synthesised from the amino acids methionine and lysine while vitamin E (α-tocopherol) is an important antioxidant. The objective of the present study was to evaluate the ameliorative effects of L-carnitine and vitamin E upon haematological and serum biochemical parameters in ochratoxin A intoxicated birds. 2. Day-old White Leghorn cockerels were acclimatised for 2 d, divided in 12 groups with 20 birds in each group. From d 3 of age, they were given different combinations of ochratoxin A (1.0 and 2.0 mg/kg), L-carnitine (1 g/kg) and vitamin E (200 mg/kg) in feed. Haematological (erythrocyte count, leucocyte count, haemoglobin concentration and haematocrit percentage) and serum biochemical parameters (serum urea, creatinine, albumin, total proteins and alanine aminotransferase) were evaluated. 3. Results confirmed that L-carnitine and vitamin E given alone or combined with 1.0 mg/kg ochratoxin A ameliorated toxin induced alterations in haematological and serum biochemical parameters. This amelioration, however, did not occur when ochratoxin of 2.0 mg/kg was given. 4. L-carnitine and vitamin E in combination have the ability to ameliorate ochratoxin altered haematological and serum biochemical parameters. However, the optimum ratio of L-carnitine + vitamin E, to be used to assure such mitigation of ochratoxin A altered changes in haematological and serum biochemical parameters in cockerels, has yet to be determined. The combination used in this study was indeed sufficient to ameliorate the alterations induced by ochratoxin A up to 1.0 mg/kg feed.

Bronchopleural fistula in a newborn undergoing ECMO-transbronchial closure.

Refractory pneumothoraces with bronchopleural fistula (BPF) pose a significant challenge in managing critically sick and ventilated neonates. We report a case of the term female neonate being treated with extracorporeal membrane oxygenation (ECMO) support for meconium aspiration and presumed sepsis, with a significant air leak refractory to pleural drainage that was managed using endobronchial application of cyanoacrylate (enbucrilate) glue to seal the leak.

Myocardial assessment using tissue doppler imaging in preterm very low-birth weight infants before and after red blood cell transfusion.

OBJECTIVE: To investigate myocardial velocities in anemic very low-birth weight (VLBW) preterm infants, pre and post red blood cells transfusion using tissue Doppler imaging echocardiography. STUDY DESIGN: Forty-eight VLBW preterm infants34 weeks and>2 weeks old were prospectively divided: Transfused symptomatic infants (Hematocrit (Hct)<0.30 (n=32)) and non transfused asymptomatic controls (control 1, Hct >0.30 (n=9) and control 2, Hct <0.30 (n=7)). Echocardiography was performed before and 3-5 days after transfusion in the transfused, and the controls were studied at similar intervals. Non parametric tests were used for statistical analysis. RESULT: Left ventricular (LV) systolic velocity increased (transfused (4.6±0.70 vs 6.0±0.65, P<0.01)) as did LV diastolic velocities (P<0.01) without significant difference over time in each control. The percentage change in LV velocity following transfusion correlated negatively (ρ=0.36) with pre transfusion Hct. CONCLUSION: There is a significant increase in myocardial performance following transfusion, which is related to the severity of the anemia.

Toxicological effects of diclofenac in four avian species.

The objective of the present study was to investigate the toxico-pathological effects of diclofenac in different avian species including broiler chicks (Gallus gallus, 15 days old), pigeons (Columba livia, 3 months old), Japanese quail (Coturnix japonica, 4 weeks old) and mynah (Acridotheres tristis, independent young). For each species, five groups each containing 10 birds were maintained and administered diclofenac sodium orally at dose rates of 0, 0.25, 2.5, 10 and 20 mg/kg body weight, respectively, for seven consecutive days. Clinical signs in all species included depression, somnolence, decreased body weight and mortality. Severity of clinical disease increased in a dose-related manner and was most severe in broiler chicks, followed by pigeons, Japanese quail, and was least severe in mynah. Serum creatinine levels were elevated in all species. Serum urea levels varied non-significantly in broiler birds, significantly decreased in pigeons and significantly elevated in Japanese quail and mynah. Broiler chicks and pigeons administered 10 and 20 mg diclofenac/kg had visceral gout; however, this was not observed in Japanese quail and mynah. The kidneys and liver were enlarged in all species. Histologically, the kidneys of all species showed acute renal necrosis and the livers had fatty change and necrosis of hepatocytes. The kidneys and liver of broiler chicks and pigeons given 10 and 20 mg/kg diclofenac also exhibited uric acid crystal aggregates (tophi) and associated lesions in the parenchyma.

Estimation of spilled hydrocarbon volume--the state-of-the-art.

With the increase in the environmental awareness and reorganization of the need for its protection, the study of soil and groundwater contamination and its remediation have become the focus of numerous researchers. Intentional and unintentional release of hydrocarbon into soil and subsurface pose a great threat to the biosphere environment. The quantification of spilled volume has primary importance for carrying out the remediation work and is considered a first step in the remediation hierarchy. Different investigators approached the problem from many viewpoints, and the resulting achievements are so extensive and scattered that it seems essential to inventory the completed works. This paper presents a systematic study of the available experimental and theoretical works. A complete picture of the present status of the problem is also provided. Issues that remain unresolved and obscure by the current day investigators are pointed out to facilitate future research directions and more comprehensive analyses of the quantification of spilled hydrocarbon volumes.

Feeding patterns, diarrhoeal illness and linear growth in 0-24-month-old children.

The aim was to study the impact of simple healthcare interventions in 0-24-month-old children living in rural communities outside Lahore, Pakistan. Newborns belonging to four birth cohorts were followed monthly from 0-24 months of age living in rural communities. Three cohorts were from the same village: Cohort A (1984-1987), n = 485; Cohort B (1990-1992), n = 544; and Cohort C (1995-1997), n = 518. A fourth, Cohort D, was from neighbouring villages (1995-1997), n = 444. Findings from Cohort A formed the basis of a healthcare programme, including promotion of optimal breastfeeding practices, advice on oral rehydration therapy, and continued feeding during diarrhoea. The outcome measures studied were time of initiation of breastfeeding, feeding of prelacteals, exclusive breastfeeding, diarrhoeal illnesses, and postnatal linear growth. The median time of initiation of breastfeeding decreased from 47 to 3 h and exclusive breastfeeding increased from 5 per cent in Cohort A to more than 80 per cent in the subsequent cohorts, at 1 month of age. No prelacteals were given to 34 per cent of newborns in later cohorts compared with 100 per cent in Cohort A. Diarrhoeal illnesses during the first 6 months had reduced significantly. Postnatal linear growth improved by about 3 cm in the later cohorts. Appropriate changes in breastfeeding practices through integrated and focused healthcare, especially antenatally, can reduce diarrhoeal illnesses, and sustain and improve linear growth in young children.

Determinants of stunting at 6, 12, 24 and 60 months and postnatal linear growth in Pakistani children.

UNLABELLED: A "nested" case-control design was used to identify cases from a longitudinally followed cohort of 1236 newborns registered during 1984-1987, living in three socioeconomically different areas. The children had a length <-2SDS (standard deviation scores) at 6, 12, 24 and 60 mo of age using the NCHS reference. The controls were matched for gender, area and month of birth. A logistic regression analysis was used for determining the risk factors for stunting at each age. Postnatal linear growth was also examined in these two groups of children and body size was compared with the NCHS reference and that of upper-middle-class children (n = 240). At 6 mo of age, prematurity and duration of breastfeeding showed a significant association with stunting. At 12 mo, maternal height, birthweight and stunting at 6 mo, while at 24 mo, stunting at 6, 12 and 18 mo were identified as important factors. At 60 mo, no other factors besides previous stunting could be identified. The mean height reached at 60 mo showed a deficit of 6 and 13 cm for the controls and the cases, respectively, compared to the NCHS reference. Twenty-eight percent of the children from the two poor areas who were stunted at 6 mo had improved by 60 mo of age. CONCLUSION: The risk factors for stunting varied at different ages, relating more to feeding at early ages and to previous stunting, predominantly at higher ages. The linear growth showed that faltering increased with age when cases and controls were treated separately. Recovery from stunting could also be demonstrated.

Clostridium difficile toxic megacolon following splenectomy.

A case of toxic megacolon following splenectomy for lymphoma is presented. The aetiology of Clostridial difficile infection is reviewed and the hazards of perioperative prohylactic antibiotics are discussed.

Dental development, dental age and tooth counts. A prospective longitudinal study of Pakistani children.

A sample of 443 Pakistani infants from four different socioeconomic areas was followed longitudinally study the emergence of the primary teeth. The mean ages of emergence of the primary teeth, without regard what kind of tooth and dental ages of the primary teeth were calculated. The subjects showed no sexual dimorphism in the emergence times of the primary teeth. The children from poor areas. were ahead by statistically significant differences from upper middle class, for emergence of the primary teeth 17-20. On comparison with Swedish standards (Hägg & Taranger, 1985) Pakistani children are delayed, by a statistically significant difference, in the emergence of primary teeth 1-16, however, they were at par in the emergence of 17-20 primary teeth.