Impact of drug-eluting stent-associated coronary artery spasm on 3-year clinical outcomes: A propensity score matching analysis.

BACKGROUND: It has been reported that significant endothelial dysfunction or clinically evident vasospasm can be associated with drug-eluting stents (DESs). However, the impact of DES associated coronary artery spasm (CAS) on long-term clinical outcomes has not been fully elucidated as compared with those of patients with vasospastic angina. METHODS: A total of 2797 consecutive patients without significant coronary artery lesion (<70%), who underwent the Acetylcholine (Ach) provocation test, were enrolled between Nov 2004 and Oct 2010. DES-associated spasm was defined as significant CAS in proximal or distal to previously implanted DES site at follow-up angiography with Ach test. Patients were divided into two groups (DES-CAS; n = 108, CAS; n = 1878). For adjustment, propensity score matching (PSM) was done (C-statistics = 0.766, DES-CAS; n = 102, CAS; n = 102). SPSS 20 (Inc., Chicago, Illinois) was used to analyze this data. RESULTS: Baseline characteristics were worse in the DES-CAS group. After PSM, both baseline characteristics and the Ach test results were balanced except higher incidence of diffuse CAS and ECG change in the DES-CAS group. During Ach test, the incidence of diffuse spasm (93.1% vs. 81.3%, p = 0.012) and ST-T change (10.7% vs. 1.9%, p = 0.010) were higher in the DES-CAS group. At 3-year, before and after adjustment, the DES-CAS group showed a higher incidence of coronary revascularization (9.8% vs. 0.0%, p = 0.001), recurrent chest pain requiring follow up coronary angiography (CAG, 24.5% vs. 7.8%, p = 0.001) and major adverse cardiac events (MACEs, 9.8% vs. 0.9%, p < 0.005). CONCLUSION: In this study, DES associated CAS was associated with higher incidence of diffuse spasm, ST-T change and adverse 3-year clinical outcomes. Special caution should be exercised in this particular subset of patients.

EVALUATION OF INDOOR/OUTDOOR GAMMA EXPOSURE RATES AND EXCESS LIFE TIME CANCER RISK IN DIFFERENT CITIES OF PAKISTAN.

This study presents a detailed measurement of indoor and outdoor terrestrial gamma radiation levels in different cities of Pakistan. The measurements covered dwellings in 27 cities, covering all provinces and region of Azad Kashmir. Most of the houses were of attached type, made of brick walls and concrete roofs. The measurements were made by a handheld radiation survey meter containing Geiger-Muller tube. The average absorbed dose rate in air was 100 ± 32 nGy h-1 for indoor and 74 ± 30 nGy h-1 for outdoor. The population-weighted mean terrestrial dose rates were 90 nGy h-1 for indoor and 78 nGyh-1 for outdoor. The ratio of indoor to outdoor absorbed dose rate was 1.5 as compared to 1.3 for the world average. The estimated average annual effective dose rate was 0.58 ± 0.18 mSv a-1 and the mean excess life time cancer risk was 2.0 × 10-3.

CHARACTERIZATION OF SAND SAMPLES FROM KARACHI BEACHES USING GAMMA SPECTROMETRY AND XRD.

Chemical phase and distribution of natural radionuclides (226Ra, 232Th and 40K) were determined for sand samples collected from ten different beaches of Karachi. All samples, except one, were identified with major and minor phases as SiO2 and CaCO3, respectively. The average activity concentrations were 24.9, 25.0 and 239 Bq kg-1 for 226Ra, 232Th and 40K, respectively. Including all samples, the average radium equivalent activity was 79.1 Bq kg-1. The external and internal radiation hazard indices and representative level index were all found below unity. The average air absorbed dose rate at 1 m above the sand due to the natural radionuclides was 18.3 nGy h-1, which was less than the world average for soil. The corresponding annual effective dose rate was 22.4 µSv y-1. It was found that Raeq had positive significant correlation with the amount of quartz present at the beaches.

Elective Cesarean Section in Obstetric COVID-19 Patients under Spinal Anesthesia: A Prospective Study.

BACKGROUND: Managing obstetric emergencies in COVID-19 pandemic is a real challenge as these patients need timely intervention to save the life of the mother and the baby. Hence, to avoid life-threatening challenges, all pregnant patients were electively admitted and tested for COVID-19 near term to anticipate the difficulties and prevent complications. AIM: Our aim was to assess the impact of COVID-19 infection on maternal morbidity and mortality as well as the effect on the neonate under spinal anesthesia. SETTINGS AND DESIGN: This was a prospective observational study. MATERIALS AND METHODS: One hundred and fifteen COVID-19-positive pregnant patients in the age group of 20-40 years from July 2020 to December 2020 were electively taken for cesarean section under spinal anesthesia. Patients who needed emergency cesarean delivery were excluded from the study. Emergency cesarean delivery was avoided to reduce the risk of aerosol generation under general anesthesia as endotracheal intubation of COVID-19 patients poses a significant risk of viral exposure to doctors and staff. Written informed consent was obtained from all patients. Spinal anesthesia was given at L4-L5 intervertebral space. Demographic parameters, anesthetic and surgical parameters, and neonatal parameters were observed. Any inadvertent event was noted. STATISTICAL ANALYSIS: Data were expressed as mean, median, percentage, or number. RESULTS: All pregnancies were singleton. None of the patients was converted to general anesthesia. One hundred and ten were either mildly symptomatic or asymptomatic. Five of our patients had severe symptoms and needed intensive care unit care preoperatively and postoperatively. Seven patients developed spinal hypotension and were managed by vasopressors. No significant thrombocytopenia was noted in any of our patients. None of our patients developed symptomatic thromboembolism. Vertical transmission was not reported in any of the cases. All babies were born with weight >2500 g and good APGAR score. CONCLUSION: Spinal anesthesia for LSCS is safe and effective for obstetric anesthesia in COVID-19 both for the parturient and the newborn.

Community-acquired urinary tract infections due to extended-spectrum ß -lactamase-producing organisms in United Arab Emirates.

BACKGROUND: The epidemiology of extended-spectrum ß-lactamase (ESBL)-producing bacteria is fast evolving with increasing global trend towards community-acquired infections. Limited information available about ESBLs therapy outcomes and control strategies, especially in the Middle Eastern countries. METHODS: We studied 399 ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates from urinary tract infections (UTIs) occurred between 2014 and 2016 in University Hospital Sharjah. We included 124 ESBL-negative E. coli and K. pneumoniae isolates from UTIs as controls. Pearson Chi squares test and independent t-test were used to compare difference between ESBL positives and negatives. Multivariate logistic regression analysis was also performed. RESULTS: Approximately 75% of the E. coli and K. pneumoniae isolates causing UTIs were community-acquired. We found that recurrent UTIs, old age, and catheterization among other risk factors for community-acquired ESBL-positive UTIs. Majority of these ESBL-positive isolates were resistant to antibiotics such as ciprofloxacin (74%) and trimethoprim-sulphamethoxazole (73%) that are commonly used for treatment of community-acquired urinary tract infections. CONCLUSIONS: ESBL-producing E. coli and K. pneumoniae have become major etiological pathogens of community-acquired UTIs in the United Arab Emirates. Healthcare providers should implement better infection control strategies and careful use of antimicrobials especially in out-patient and community settings.

Postoperative Analgesic Efficacy of Bilateral Transversus Abdominis Plane Block in Patients Undergoing Midline Colorectal Surgeries Using Ropivacaine: A Randomized, Double-blind, Placebo-controlled Trial.

BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) block is done as a part of multimodal analgesia for pain relief after abdominal surgeries. This prospective randomized, double-blind, placebo-controlled trial was conducted to evaluate the postoperative analgesic efficacy of bilateral TAP block in patients undergoing midline colorectal surgeries using ropivacaine. MATERIALS AND METHODS: Eighty patients scheduled for elective colorectal surgeries involving midline abdominal wall incision under general anesthesia were enrolled in this prospective randomized controlled trial. Group A received TAP block with 20 ml of 0.2% ropivacaine on either side of the abdominal wall, and Group B received 20 ml of normal saline. The time to request for rescue analgesia, total analgesic consumption in 24 h, and satisfaction with the anesthetic technique were assessed. RESULTS: The mean visual analog scale scores at rest and on coughing were higher in control group (P > 0.05). Time (min) to request for the first rescue analgesia was prolonged in study group compared to control group (P < 0.001). The total tramadol consumption in 24 h postoperatively was significantly high in control group (P < 0.001). Nausea/vomiting was more common in control group (P > 0.05). The level of satisfaction concerning postoperative pain control/anesthetic technique was higher in study group (P < 0.001). CONCLUSION: TAP block produces effective and prolonged postoperative analgesia in patients undergoing midline colorectal surgery. It is a technically simple block to perform with a high margin of safety. It produces a considerable reduction in mean intravenous postoperative tramadol requirements, reduction in postoperative pain scores, and increased time to first request for further analgesia, both at rest and on movement.

Efficacy and Safety of Mycobacterium indicus pranii as an adjunct therapy in Category II pulmonary tuberculosis in a randomized trial.

Prolonged treatment of tuberculosis (TB) often leads to poor compliance, default and relapse, converting primary TB patients into category II TB (Cat IITB) cases, many of whom may convert to multi-drug resistant TB (MDR-TB). We have evaluated the immunotherapeutic potential of Mycobacterium indicus pranii (MIP) as an adjunct to Anti-Tubercular Treatment (ATT) in Cat II pulmonary TB (PTB) patients in a prospective, randomized, double blind, placebo controlled, multicentric clinical trial. 890 sputum smear positive Cat II PTB patients were randomized to receive either six intra-dermal injections (2 + 4) of heat-killed MIP at a dose of 5 × 108 bacilli or placebo once in 2 weeks for 2 months. Sputum smear and culture examinations were performed at different time points. MIP was safe with no adverse effects. While sputum smear conversion did not show any statistically significant difference, significantly higher number of patients (67.1%) in the MIP group achieved sputum culture conversion at fourth week compared to the placebo (57%) group (p = 0.0002), suggesting a role of MIP in clearance of the bacilli. Since live bacteria are the major contributors for sustained incidence of TB, the potential of MIP in clearance of the bacilli has far reaching implications in controlling the spread of the disease.

Seropositivity and coinfection of hepatitis B and C among patients seeking hospital care in Islamabad, Pakistan.

The undertaken study was conducted to find out the seroprevalence and coinfection of HBV and HCV infection among patients seeking hospital care. A total of 845 samples were received at tertiary care hospital of Islamabad and were screened for hepatitis B and C. The ELISA was used to detect antigen for HBV and antibodies for HCV in patient serum. Among 845 collected samples, 255 (30.1%) were seropositive for HBV and HCV. Out of 255 seropositive samples, 45 (5.3%) were positive for HBsAg while 199 (23.5%) were positive for anti-HCV. Among 255, 11 (1.3%) were seropositive for both HBsAg and anti-HCV (coinfection). Among the seropositive male, HBV was more prevalent (23.8%) while female patients had a high incidence of HCV (52.2%). Among the age group variable, HBV, HCV, and coinfection were found to be more common in the age groups of 21-30 (29%) and 30-40 (24%) years. The seropositivity for HBsAg was higher in unmarried individuals (31.2%) while anti-HCV was more prevalent in married individuals (84%). The present study provides the preliminary information about high HCV and HBV prevalence. Findings from the current study will be helpful for the better management and control of viral hepatitis among patients seeking hospital care.

Determination of the risk associated with the natural and anthropogenic radionuclides from the soil of Skardu in Central Karakoram.

The radioactivity levels were determined in 39 soil samples from six towns of Skardu using gamma-ray spectrometry. The samples were collected at an average altitude of 2293 m above sea level in Central Karakoram. The activity concentration data were analysed by principal component analysis for outlier detection and data structure elucidation and for frequency distributions. The median activity concentrations of (226)Ra, (232)Th, (40)K and (137)Cs were found to be 49.8 ± 12.6, 80.9 ± 18.7, 977 ± 91 and 4.37 ± 4.08 Bq kg(-1), respectively. An uncertainty analysis showed that the main contribution to uncertainty budget was from the counting statistics and uncertainty in the reference activity of standard. The activity concentration data showed a positive significant correlation between (226)Ra and (232)Th. Three hazard indices named the radium equivalent activity, external hazard index and internal hazard index were calculated. In the total activity concentration, (40)K accounted for the most (87.5 %), whilst in the radium equivalent activity, (232)Th contributed the most (48.5 %). In the Skardu samples, the air-absorbed dose rate was found to be 112 ± 17 nGy h(-1), annual effective dose rate from terrestrial to be 243 ± 38 µSv y(-1), effective dose rate due to the deposition of (137)Cs on soil to be 1.1 ± 2.4 µSv y(-1) and dose rate from the cosmic radiations to be 1371 ± 107 µSv y(-1). The ratio of mass fractions of Th/U was 4.8 ± 0.6.The results were compared with the similar measurements made in other parts of the world. A comparison with the other cities of Pakistan revealed that the soil in Skardu presented the highest external exposure rate.

Soil radioactivity levels and radiological risk assessment in the highlands of Hunza, Pakistan.

This paper deals with the determination of (226)Ra, (232)Th, (40)K and (137)Cs in 42 soil samples collected from eight towns of Hunza district, at an average altitude of 2267 m, using gamma-ray spectrometry. The activity concentration data were analysed for frequency distribution and other descriptive measures. Risk assessment was done by calculating the hazard indices, air absorbed dose rate and external annual effective dose rate due to cosmic radiations, terrestrial radionuclides and (137)Cs deposited on the surface of the earth. Both indoor and outdoor occupancy factors were taken into account. The average dose rate due to cosmic radiation was estimated as 828 ± 87 µSv y(-1), from external terrestrial radiation as 97 ± 20 µSv y(-1) and from (137)Cs as 1.05 µSv y(-1) for a total annual effective dose rate of 926 ± 92 µSv. The results of the present study were discussed and compared with other similar studies performed in East Asia. The present study indicates that Hunza can be ranked among those areas having a high level of dose rate not only from cosmic rays but also from terrestrial radionuclides. This paper also proposes another measure of radiation hazard called 'radium equivalent for internal exposure'.

Elemental contamination in urban parks of Rawalpindi/Islamabad--a source identification and pollution level assessment study.

The soil quality of urban parks is of vital importance as the children playing in the parks get themselves easily contaminated. A study was conducted to assess the level of elemental pollution caused by constant urbanization and industrialization, in various parks of Islamabad and Rawalpindi. The soil samples, collected from 14 urban parks of Islamabad and Rawalpindi areas, were analysed for their elemental concentrations. In each sample, 32 elements were quantified using semi-absolute k (0)-instrumental neutron activation analysis and flame atomic absorption spectrophotometry. The quality of analysis was assured by analysing the International Atomic Energy Agency (IAEA) reference material IAEA-S7 (soil). The pollution level was assessed by enrichment factor, pollution load index and our suggested indicator called "average toxic element concentration". The elemental concentrations measured in the parks of two cities were compared by t test. Four sources of different elements in the soils were identified by employing principal component analysis and cluster analysis. The results of multivariate techniques grouped all parks into four classes. The use of enrichment factor indicated the presence of Ni at slightly higher level in all parks while the pollution load index revealed that the parks of Rawalpindi were relatively more polluted as compared to that of Islamabad. The hot spot areas of elemental concentration were closely related to high traffic conditions.

Determination of the natural and anthropogenic radioactivity in the soil of Gilgit--a town in the foothills of Hindukush range.

The activity concentration of terrestrial (226Ra, 232Th, and 40K) and anthropogenic gamma-emitting radionuclide (137Cs) have been analyzed in 48 soil samples collected from Gilgit, a famous city for mountaineers and tourists in northern Pakistan, at an average altitude of 1,550 m, using gamma-ray spectrometry. The data analysis includes descriptive statistics, radium equivalent activity and its principal component analysis, air absorbed dose rate, annual effective dose rate, and collective effective dose equivalent. It is found that the level of cosmic exposure is high in Gilgit relative to the world average values, but the average outdoor annual effective dose rate from terrestrial radionuclides is lower as compared to its value in the soil of Punjab, Pakistan, and the world average values found in United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) for the general public. The median annual effective dose rate produced by 137Cs was 0.11 microSv y-1.

Pattern recognition of inductively coupled plasma atomic emission spectroscopy of human scalp hair for discriminating between healthy and hepatitis C patients.

Inductively Coupled Plasma Atomic Emission Spectroscopy measurements of six trace elements were performed on the scalp hair of 155 donors, 73 of which have been diagnosed with Hepatitis C and 82 Controls. Principal Components Analysis (PCA) was employed to visualise the separation between groups and show the relationship between the elements and the diseased state. Pattern recognition methods for classification involving Quadratic Discriminant Analysis and Partial Least Squares Discriminant Analysis (PLS-DA) were applied to the data. The number of significant components for both PCA and PLS were determined using the bootstrap. The stability of training set models were determined by repeatedly splitting the data into training and test sets and employing visualisation for two components models: the percent classification ability (CC), predictive ability (PA) and model stability (MS) were computed for test and training sets.

Hard modeling methods for the curve resolution of data from liquid chromatography with a diode array detector and on-flow liquid chromatography with nuclear magnetic resonance spectroscopy.

Hard modeling methods have been performed on data from high-performance liquid chromatography with a diode array detector (LC-DAD) and on-flow liquid chromatography with 1H nuclear magnetic spectroscopy (LC-NMR). Four methods have been used to optimize parameters to model concentration profiles, three of which belong to classical optimization methods (the simplex method of Nelder-Mead, sequential quadratic programming approach, and Levenberg-Marquardt method), and the fourth is the application of genetic algorithms using real-value encoding. Only classical methods worked well for LC-DAD data, while all of the methods produced good results when LC-NMR data were divided into small spectral windows of peak clusters and parameters were optimized over each window.

Application of multivariate curve resolution methods to on-flow LC-NMR.

The application of evolving window factor analysis (EFA), subwindow factor analysis (SFA), iterative target transformation factor analysis (ITTFA), alternating least squares (ALS), Gentle, automatic window factor analysis (AUTOWFA) and constrained key variable regression (CKVR) to resolve on-flow LC-NMR data of eight compounds into individual concentration and spectral profiles is described. CKVR has been reviewed critically and modifications are suggested to obtain improved results. A comparison is made between three single variable selection methods namely, orthogonal projection approach (OPA), simple-to-use interactive self-modelling mixture analysis approach (SIMPLISMA) and simplified Borgen method (SBM). It is demonstrated that LC-NMR data can be resolved if NMR peak cluster information is utilised.