Normal Levels of Ionized Calcium Despite Persistent Increase in Total Calcium in a Patient With IgA Paraproteinemia.

Approximately half of the calcium in the blood circulates in the ionized, free form; which is critical for cellular function. As a result, its levels are tightly regulated by homeostatic mechanisms dependent on hormones such as PTH, vitamin D, and fibroblast growth factor-23. The other half of the total calcium is in a complex with anions, predominantly albumin. Clinically, the levels of albumin are known to influence the relationship of total calcium to free calcium. However, the relevance of changes in other serum proteins on calcium homeostasis is less appreciated. We present the case of a 70-year-old woman who was followed over 5 years with persistently elevated total calcium levels but with normal ionized calcium levels. Her evaluation was notable for IgA paraprotein, which paralleled her history of elevated total serum calcium. Extensive clinical investigations did not reveal hyperparathyroidism or cancer-mediated hypercalcemia. Additional in vitro analyses comparing the plasma containing the IgA paraprotein against a healthy control revealed that a high-molecular-weight IgA paraprotein in the patient has increased capacity to reduce the amount of free calcium in solution, thus providing a direct mechanistic explanation for the clinical findings.

Red light enhances the antibacterial properties, biofabrication, and stability of Fagonia indica callus-based silver nanoparticles.

Plant-based nanoparticles can be tuned through the frequency of light for efficient synthesis, structural properties, and antibacterial applications. This research assessed the effect of material type (callus and whole-plant extract) and the interaction with a specific range of light wavelength on AgNP synthesis. All types of AgNPs were characterized by their size, shape, associated functional groups, and surface charge. Interestingly, the size of red light and callus-based AgNPs (RC-AgNPs) was smaller (6.32 nm) compared to 14.59 nm for Ultraviolet light and callus-based AgNPs (UV-C-AgNPs). Zeta potential analysis showed that RC-AgNPs had higher stability (-29.2 mV) compared to UV-C-AgNPs (-16.7 mV). Similarly, red light-based AgNPs had higher Oxidation reduction potential in both whole-plant-based and callus-based AgNPs, indicating a more oxidizing nature compared to those synthesized under UV light. This was confirmed by the lower total phenolic and flavonoid content associated with them and their lower antioxidant activity. The higher antibacterial activities and lower minimum inhibitory concentrations of red light-based AgNPs against highly resistant pathogenic bacteria demonstrated the role of red light in enhancing antibacterial activity. These results indicate that AgNPs synthesized in red light and callus extract are more active compared to those synthesized under other wavelengths and/or in whole-plant extracts.

Zinc Foliar Application Mitigates Cadmium-Induced Growth Inhibition and Enhances Wheat Growth, Chlorophyll Contents, and Yield.

Cadmium (Cd) is a toxic heavy metal that significantly threatens plants and the environment. Its toxicity in plants can result in various adverse effects, including reduced growth, altered metabolism, and cell damage. Cadmium can also interfere with nutrient uptake, particularly zinc (Zn), leading to Zn deficiency and further exacerbating Cd toxicity. On the other hand, foliar application of zinc might be a useful strategy to mitigate cadmium (Cd) toxicity in plants. Hence, a pot experiment was conducted with three replications. The wheat plants were treated with various concentrations of Zn as a foliar spray (control, 0.1, 0.2, 0.4, and 0.5%) in Cd-spiked soil in pots. The results showed that foliar use of Zn at 0.4 or 0.5% resulted in higher plant height, grain yield, and dry matter yield than the control group. Using Zn as foliar spray enriched shoot and grain Zn content while reducing Cd content in the shoot and grain. The leaf's electrolyte leakage (EL) decreased by 15.4, 29.8, 40.7, and 45.9% in the Zn 0.1%, Zn 0.2%, Zn 0.4%, and Zn 0.5% treatments, respectively, compared to the control treatment. Regarding superoxide dismutase (SOD) activity, Zn 0.5% treatment showed a decrease of 42.9% over control. Specifically, the Zn 0.1% showed a 27.2%, Zn 0.2% showed a 56.8%, Zn 0.4% showed a 91.1%, and Zn 0.5% showed a 133.7% increase in total chlorophyll content than control. Based on the results, it is recommended that 0.4% Zn solution may be used for foliar application for enhancing crop productivity and Zn concentration in plants under high Cd stress. Additionally, continued research on the mechanisms of cadmium uptake, transport, and detoxification in plants may lead to the identification of new targets for intervention.

Evaluating the Efficacy of Activated Carbon in Minimizing the Risk of Heavy Metals Contamination in Spinach for Safe Consumption.

Toxicity induced by heavy metals is a major concern in agriculture as it decreases crops' growth and yield and leads to the deterioration of food quality. Recently, activated carbon has been identified as a possible solution. It can potentially improve crop nutrition and immobilize heavy metals in soil. That is why a glasshouse trial was conducted to investigate the effects of sugarcane bagasse-derived biochar on spinach growth and the availability of cadmium (Cd) and chromium (Cr) in artificially contaminated soil. The soil was placed in pots and contaminated with Cd and Cr at a rate of 10 mg kg-1. Biochar was added to the soil at concentrations of 0 (control), 0 (contaminated control), 100, 150, and 200 g, and 10-day-old nursery spinach plants were transplanted to the pots. The results showed that applying 200 g of biochar significantly increased shoot weight (235 g), soil pH, electrical conductivity, and organic matter. The highest levels of Cd (27.71 mg kg-1) and Cr (20.44 mg kg-1) were observed in the contaminated control pots, while the lowest levels of Cd (16.80 mg kg-1) and Cr (9.80 mg kg-1) were found in pots treated with 200 g of biochar (2%). Similarly, the highest levels of Cd (35.80 mg kg-1) and Cr (40.24 mg kg-1) in the roots were found in the contaminated control pots, while the lowest levels of Cd (19.26 mg kg-1) and Cr (21.34 mg kg-1) were observed in pots treated with 200 g of biochar. Biochar application at a rate of 2% can immobilize Cd and Cr in the soil and improve chlorophyll contents, carotenoids, photosynthetic rate, transpiration rate, and stomatal conductance in spinach in Cd- and Cr-contaminated soils. Further long-term field studies will be necessary to determine the feasibility of applying biochar as an organic amendment for enhancing spinach growth and reducing Cd and Cr bioavailability in contaminated soil.

High Genetic Diversity in the Himalayan Common Bean (Phaseolus vulgaris) Germplasm with Divergence from Its Center of Origin in the Mesoamerica and Andes.

The common bean is found in the Himalayan region of Pakistan with substantial morphological variability. Genetic diversity within any crop species is a precursor for genetic improvement; however, little is known about common bean genetic diversity in this region. We explored the genetic diversity in the common bean from the Himalayan region (Khyber Pakhtunkhwa, Gilgit-Baltistan, Kashmir) of Pakistan. Microsatellite genotyping was carried out for 147 samples with 40 simple sequence repeat (SSR) markers. The results revealed a clear divergence of the Pakistani population from the primary gene pool (with FST values of 0.2 with Andes and 0.27 with Mesoamerica). However, within the Himalayan germplasm, no clear evidence of spatial structure was observed (with the maximum FST values of only 0.025), probably due to the dispersal of seeds by human activity within the region. This was further elucidated by the discriminant analyses of principal components. Considering the diversity parameters, high genotypic diversity was observed for the indigenous lines (0.990), comparable to the primary gene pool (0.976 for Mesoamerica and 0.976 for Andes populations). A high genotypic diversity was observed within the Himalayan population (ranging from 0.500 for Upper Dir to 0.952 for Mansehra). Gene diversity across loci varied between 0.28 for Chitral to 0.38 for Kurram. Our results suggested a divergent and independent evolution of the Himalayan population, which might have led to the diversification of the common bean germplasm in the region postintroduction into the region. The diversity observed could also be exploited in future breeding programs for the development and introduction of climate-resilient varieties.

Transforming traditional CRM into social CRM: An empirical investigation in Iraqi healthcare industry.

The unprecedented growth of social media usage questions the conventional customer relationship management (CRM). Social CRM strategy is a novel version of CRM empowered by social media technology that offers a new way of managing relationships with customers effectively. The aims of this study are two-fold, examining the important determinants of the successful adoption of the social CRM; and to validate the outcomes on this novel social CRM adoption in the healthcare industry. The proposed adoption model of this study derived with theoretical support from TOE, DOI and ISS theories in IS/IT, social media, and CRM literatures. This undertaking focuses on the use of structural equations modelling, to examine a theoretical social CRM (Social Customer Relationship Management) model involving 17 Iraqi hospitals, and a sample total of 428. The model's principal independent constructs are associated to the viewpoint of top management, IT staff and operational staff, regarding the grounds for social CRM adoption, the operations performed on social CRM, and the themes employed. PLS-SEM was applied for statistical analysis, to evaluate the hypnotized linkages between the variables. The results show that, social CRM adoption has a tremendous impact on healthcare organizations with its perceived benefits. According to the results attained, all constructs have significant impact on social CRM adoption except for leadership knowledge. Consequently, adoption results in remarkable outcomes that gives credence to the intervening performance of social CRM. Following an examination of the model, which included a scrutiny of its pathways, we are of the view that the concerns, past history, and potential let-downs with regards to social CRM adoption, need to be thoroughly investigated. This study is one of the few researches that provide the in-depth knowledge about the constructs impacting CRM transformation and the benefits attained. The results can guide healthcare providers during their efforts to develop effective marketing techniques, and advance the perceived benefits, particularly in the healthcare profession. Moreover, this study contributes to the IS literature by suggesting the empirically extended TOE model which advances the conventional TOE model.

Prevalence and associated risk factors of Shigella flexneri isolated from drinking water and retail raw foods in Peshawar, Pakistan.

This study was designed to investigate the prevalence and associated risk factors of Shigella flexneri isolated from drinking water and retail raw food samples in Peshawar, Pakistan. A total of 1,020 different samples were collected from various areas of Peshawar between January 2016 and May 2017, followed by identification of S. flexneri through biochemical, serological, and 16S rRNA gene sequencing. Potential risk factors associated with the development and spreading of S. flexneri infection were also investigated. Overall, 45 (4.41%) samples were positive for Shigella species. Among these samples, the predominant species was S. flexneri (n = 44) followed by S. boydii (n = 1). Interestingly, S. sonnei and S. dysenteriae isolates were not found in any sample. The isolation rate of S. flexneri in drinking water samples, market raw milk, and fruits/vegetables from Peshawar were 6.47%, 3.5%, and 2.9%, respectively. The phylogenetic reconstruction showed genetic diversity among three clades, as clades I and II have isolates of S. flexneri that were circulating within the drinking water, milk, fruits/vegetables, while clade III isolates were recovered from milk samples. Most of S. flexneri were detected in June to September. Potential risk factors of S. flexneri were water sources contaminated by toilet wastes (p = 0.04), surface water drainage (p = 0.0002), hospital wastes (p = 0.01), unhygienic handling (p < 0.05), and transportation of raw food (p = 0.04). In conclusion, S. flexneri isolates of closely related lineage originating from non-clinical samples might be associated with an increased human risk to shigellosis in Pakistan, as significant numbers of S. flexneri were observed in the drinking water and retail raw food samples. PRACTICAL APPLICATION: This study demonstrated the presence of S. flexneri in drinking water and retail raw food samples which seem to possess a serious threat to public health. Potential sources of food and water contamination should properly be monitored by public health authorities to reduce cases of shigellosis.

Association of Serotype With Antimicrobial Resistance Patterns Among Shigella flexneri Isolates From Pakistan: The Importance of Serotype 2b.

BACKGROUND: Shigella flexneri is an emerging threat in low socioeconomic countries including Pakistan. No previous data is available on the association between S. flexneri serotypes and antimicrobial resistance in Pakistan. OBJECTIVES: The objective of the present study was to assess the association between serotypes and antimicrobial resistance patterns among S. flexneri isolated from clinical and nonclinical samples. METHODS: A total of 199 S. flexneri isolates were subjected to molecular serotyping and antibiotic resistance. RESULTS: The most prevalent S. flexneri serotype was 2b (38%) followed by 1b (24%), 7a (20%), 2a (11%), 1d (5%) and Y (2%). The phylogenetic reconstruction showed 12 clades among which the clades II, III, V, VIII, IX and XI have consisted of serotypes that were found both in human population and environment samples. A high level of multidrug resistance (MDR) was observed in serotype 2b (37.68%) followed by 1b (19.5%) and 7a (19.5%), 2a (11.5%), 1d (5%) and Y (2%). All isolates of serotype 2b showed high level of resistance to amoxicillin/clavulanic acid (100%) followed by quinolone (74.6%) and trimethoprim-sulfamethoxazole (54.6%). Interestingly, none of the serotype was resistant to piperacillin-tazobactam, imipenem and amikacin. The most frequently detected resistance genes among serotype 2b were blaOXA (100%) followed by qnrS (88%), cat (81%) and sul2 (63%). CONCLUSION: The most frequent S. flexneri serotype was 2b while 1d and Y was first time reported in Pakistan. High frequency of MDR serotypes of S. flexneri is a serious threat in diarrhea endemic regions and thus require urgent strategies for its continuous monitoring and prevention.

Linkage analysis of hearing impairment in families of Bannu Distric.

OBJECTIVE: To link congenital hearing loss with known loci to establish a platform for future research. METHODS: The cross-sectional study was conducted from February 2016 to March 2017 in Bannu, Khyber Pakhtunkhwa, Pakistan, and comprised families with Pashtun ethnicity having at least 2 individuals suffering from congenital hearing loss. Deoxyribonucleic acid from whole blood samples was extracted by salting-out method. Amplification was done through touchdown polymerase chain reaction to see any possible linkage to already reported deafness loci. Linkage analysis was carried out using microsatellite markers for each locus. Genotyping of the samples was done and haplotypes were accordingly generated to either include or exclude the linked / unlinked regions. RESULTS: Of the 4 families, family PKDF 1620 showed linkage with DFNB12/CDH23 (D10S1432, D10S606, and D10S1694) and family PKDF 1625 had linkage with DFNB3/MYO15A (D17S2196, D17S2207 and D17S2206). Families PKDF1623 and PKDF1624 showed no linkage with any of the prevalent reported loci in Pakistan . CONCLUSIONS: Linkage to DFNB12 and MYO 15 showed heterogeneity of congenital deafness.

Prevention of Postoperative Pneumonia in Noncardiac Surgical Patients: A Prospective Study Using the National Surgical Quality Improvement Program Database.

Postoperative pneumonia increases morbidity, length of stay, and hospital readmission rates. Current data support the use of perioperative chlorhexidine gluconate in elective cardiac surgery patients to prevent postoperative pneumonia. The objectives of this study were to implement a resident-driven quality improvement project and determine the efficacy of an oral care bundle in preventing postoperative pneumonia among noncardiac surgical patients. A retrospective review of postoperative pneumonia occurrences at our hospital captured by the NSQIP database from 2014 to 2016 was conducted. A pre- and postoperative pulmonary care bundle was implemented in all surgical patients undergoing general anesthesia and outcomes were tracked by NSQIP for up to 90 days postoperatively for calendar year 2017. The NSQIP-reported incidence of postoperative pneumonia at our hospital was reduced from 0.8 to 0 per cent (P = 0). The risk-adjusted smoothed rate fell from 1.17 (95% confidence interval 0.77-1.66) in 2014 to 0.33 (95% confidence interval 0.03-0.98) in 2017. We encountered multiple systematic issues while conducting this study, which led to an imbalanced compliance to the preoperative (90%) and postoperative (31%) bundle; however, there was no significant difference between these two groups. Successful implementation of a resident-driven quality project resulted in a decreased rate of postoperative pneumonia.

Low-cost low-tech obstacle pushing/gliding wheelchair accessory.

Purpose: Some wheelchair users continue to struggle in maneuvering a wheelchair and navigating through manual doors. Several smart wheelchairs and robotic manipulators were developed to minimize such challenges facing disabled people. Disappointingly, a majority of these high-tech solutions are restricted to laboratories and are not extensively available as commercial products. Previously, a low-tech wheelchair accessory (arc-shaped with many wheels) for pushing doors was modelled and simulated. This work demonstrates the fabrication and testing of the first-generation prototype of the accessory.Materials and methods: The accessory has side portions with a straight arrangement of wheels and a front portion with a straight-arc-straight arrangement of wheels. The accessory was fabricated using conventional manufacturing, off-the-shelf components, and 3D printed ABS fasteners. Stress analysis simulations were done for the fasteners that attach the front accessory to the wheelchair frame. The proof-of-concept of the prototype installed onto a powered wheelchair was tested with a door and an obstacle, each with ∼50 N resistance force.Results: Prototype tests demonstrate the ability of the accessory along with the mechanical robustness of the 3D printed fasteners to push open doors allowing easy navigation through doors and to push/glide against obstacles. The accessory is foldable and detachable.Conclusion: The low-cost of the accessory makes it affordable to many users intending to improve their quality of life. The current study provides an engineering perspective of the accessory, and a clinical perspective is crucial. Other potential applications of the wheelchair accessory include use with scooters, walkers and stretchers.Implications for rehabilitationLow-cost, low-tech accessory is foldable and detachable.Accessory is effective for pushing doors and pushing/gliding against obstacles.Protective nature of the front accessory could prove highly beneficial to some wheelchair users.

Punica granatum peel extracts: HPLC fractionation and LC MS analysis to quest compounds having activity against multidrug resistant bacteria.

BACKGROUND: Medicinal plants are rich source of traditional herbal medicine around the globe. Most of the plant's therapeutic properties are due to the presence of secondary bioactive compounds. METHODS: The present study analyzed the High Pressure Liquid Chromatography (HPLC) fractions of Puncia granatum (peel) extracts (aqueous, chloroform, ethanol and hexane) against multidrug resistant bacterial pathogens (Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus). All the fractions having antibacterial activity was processed for bioactive compounds identification using LC MS/MS analysis. RESULTS: Among total HPLC fractions (n = 30), 4 HPLC fractions of P. granatum (peel) showed potential activity against MDR pathogens. Fraction 1 (F1) and fraction 4 (F4) collected from aqueous extract showed maximum activity against P. aeruginosa. Fraction 2 (F2) of hexane showed antibacterial activity against three pathogens, while ethanol F4 exhibited antibacterial activity against A. baumannii. The active fractions were processed for LC MS/MS analysis to identify bioactive compounds. Valoneic acid dilactone (aqueous F1 and F4), Hexoside (ethanol F4) and Coumaric acid (hexane F2) were identified as bioactive compounds in HPLC fractions. CONCLUSION: Puncia granatum peel extracts HPLC fractions exhibited potential inhibitory activity against MDR bacterial human pathogens. Several bioactive compounds were identified from the HPLC fractions. Further characterization of these compounds may be helpful to conclude it as therapeutic lead molecules against MDR pathogens.

A small multifunctional pentatricopeptide repeat protein in the chloroplast of Chlamydomonas reinhardtii.

Organellar biogenesis is mainly regulated by nucleus-encoded factors, which act on various steps of gene expression including RNA editing, processing, splicing, stabilization, and translation initiation. Among these regulatory factors, pentatricopeptide repeat (PPR) proteins form the largest family of RNA binding proteins, with hundreds of members in flowering plants. In striking contrast, the genome of the unicellular green alga Chlamydomonas reinhardtii encodes only 14 such proteins. In this study, we analyzed PPR7, the smallest and most highly expressed PPR protein in C. reinhardtii. Green fluorescent protein-based localization and gel-filtration analysis revealed that PPR7 forms a part of a high-molecular-weight ribonucleoprotein complex in the chloroplast stroma. RIP-chip analysis of PPR7-bound RNAs demonstrated that the protein associates with a diverse set of chloroplast transcripts in vivo, i.e. rrnS, psbH, rpoC2, rbcL, atpA, cemA-atpH, tscA, and atpI-psaJ. Furthermore, the investigation of PPR7 RNAi strains revealed that depletion of PPR7 results in a light-sensitive phenotype, accompanied by altered levels of its target RNAs that are compatible with the defects in their maturation or stabilization. PPR7 is thus an unusual type of small multifunctional PPR protein, which interacts, probably in conjunction with other RNA binding proteins, with numerous target RNAs to promote a variety of post-transcriptional events.