Assessment of essential minerals and physico-chemical analysis of floral origins fresh honey produced by Apis mellifera.

Honey is one of the best nutritious substances in the world, having different services in the body functions regulation. Ten elements (K, Na, Ca, Co, Cr, Mn, Mo, Ni, Pb, Se) from honey samples were analyzed from 80 different locations of Punjab and ten floras. The aim of the present study was to determine the quality and quantity of minerals and Physico-chemical analysis in honey. A flame photometer was used to measure the concentration of major minerals (K, Ca and Na). The concentration of micro minerals (Co, Cr, Mn, Mo, Ni, Pb and Se) was analyzed using Atomic Absorption Spectrometer. The concentration of macro-elements obtained was as follow (in ppm): K (166-1732), Na (107-418) and Ca (07-99), while the concentration of microelements (in ppm) Co (1-2), Cr (>1), Mn (<1), Mo (1.818), Ni (1.911), Pb (<1) and Se (1.968). The most abundant minerals were potassium, calcium and sodium, ranging between 396-810.5, 17.5-640.63 and 169.88-238.62 ppm, respectively. However, the trace mineral elements of honey were obtained in the order of decreasing Se > Co > Ni > Pb > Cr > Mo > Mn. The findings showed that all the heavy metals like Co, Cr, Ni and Pb were present in trace amounts and close to International Honey Quality Standard. The result of given honey samples represented highest value of moisture (31.23%), color (80 mm pfund), pH (8.23), acidity (72.02 meq/kg), electrical conductivity (0.85 ms/cm) and ash contents (0.83%).

A Low-cost Easy-to-Fabricate Sandwich-Structured Microdevice for Controllable Removal of Extracellular Cryoprotective Agents with High Efficiency.

　　BACKGROUND: Osmotic shock upon the addition and removal of cryoprotectant agent (CPA) is a major source of cell damage during cryopreservation. OBJECTIVE: Microfluidic device offers a new platform for CPA loading and unloading. The micro scale dimension makes possible to perform a detailed analysis and controllable removal of CPA with many advantages. MATERIALS AND METHODS: A microfluidic device was developed for extracting dimethyl sulfoxide (DMSO) from the sample streamline. The device has two parallel channels separated by a polytetrafluoroethylene (PTFE) membrane and serves as the stable environment for CPA removal. A diffusion-based simulation model was used to characterize the CPA extraction. To support the experimental design and device optimization we developed analogous scheme to simulate by COMSOL Multiphysics. RESULTS AND CONCUSION: The device can extract cryoprotectant in a mesoscale volume from cells and simplify the post-thaw sample handling. It has sufficient control on loading/unloading of CPAs by controlling the flow rate of cell stream/wash stream solutions via syringe pumps. Compared to other customary devices, this device is easy to fabricate and assemble, with features of high precision, reusability and low cost.

Water-transport and Intracellular Ice Formation of Porcine Adipose-derived Stem Cells during Freezing.

BACKGROUND: Water transport and intracellular ice formation are important processes that relate to cryoinjury of cells upon freezing. To date, no study is reported on the characteristics of water transport and intracellular ice formation in porcine adipose-derived stem cells (pADSC). OBJECTIVE: To study water transport and intracellular ice formation upon freezing of pADSCs at different cooling rates. MATERIALS AND METHODS: The pADSCs were isolated using collagenase digestion from a subcutaneous adipose tissue of a 28-day-old Landrace pig. Freeze experiments were performed in a gas tight chamber of cryomicroscopy stage at different cooling rates between 40°C and -150°C. RESULTS: Water permeability coefficient Lpg and the activation energy ELP decrease with increasing cooling rates for pADSCs. The probability of intracellular ice formation increases with increasing cooling rates, being 0.35, 0.4 and 0.5 for cooling rates at 20, 30 and 60 °C/min respectively. CONCLUSION: Based on the characteristics of water transport and intracellular ice formation in pADSCs, slow freezing is perhaps more suitable for pADSC cryopreservation.

Routine on-table cholangiography during cholecystectomy: a systematic review.

INTRODUCTION: The aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography (R-OTC) versus no on-table cholangiography (N-OTC) in patients undergoing cholecystectomy. METHODS: Randomised trials evaluating R-OTC versus N-OTC in patients undergoing cholecystectomy were selected and analysed. RESULTS: Four trials (1 randomised controlled trial on open cholecystectomy and 3 on laparoscopic cholecystectomy) encompassing 860 patients undergoing cholecystectomy with and without R-OTC were retrieved. There were 427 patients in the R-OTC group and 433 patients in the N-OTC group. There was no significant heterogeneity among trials. Therefore, in the fixed effects model, N-OTC did not increase the risk (p=0.53) of common bile duct (CBD) injury, and it was associated with shorter operative time (p<0.00001) and fewer peri-operative complications (p<0.04). R-OTC was superior in terms of peri-operative CBD stone detection (p<0.006) and it reduced readmission (p<0.03) for retained CBD stones. CONCLUSIONS: N-OTC is associated with shorter operative time and fewer peri-operative complications, and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy. R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones. The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical, biochemical or radiological features suggestive of CBD stones. However, a major multicentre randomised controlled trial is required to validate this conclusion.

Prediction of ectopic pregnancy in women with a pregnancy of unknown location.

OBJECTIVE: We have previously published on the use of mathematical Model M1 to predict ectopic pregnancy in women with no signs of intra- or extrauterine pregnancy. The aim of this study was to improve on the performance of this model for the detection of developing ectopic pregnancies in women with pregnancies of unknown location (PULs). We therefore generated and evaluated a new logistic regression model from simple hormonal data and compared it with Model M1. METHODS: Data were collected prospectively from women classified as having a PUL. These women were followed until the diagnosis was established as: a failing PUL, an intrauterine pregnancy (IUP) or an ectopic pregnancy. A multinomial logistic regression model, Model M4, was developed on 201 training cases and it was tested prospectively on another 175 women with a PUL. M4 performance was evaluated using receiver-operating characteristics (ROC) curves and compared with Model M1 based on the human chorionic gonadotropin (hCG) ratio alone. RESULTS: A total of 376 women with a PUL were recruited into this study: 201 in the training set (109 (54.2%) with a failing PUL, 76 (37.8%) with an IUP and 12 (6.0%) with an ectopic pregnancy; four with a persisting PUL were excluded from analysis) and 175 in the test set (94 (53.7%) with a failing PUL, 64 (36.6%) with an IUP and 15 (8.6%) with an ectopic pregnancy; two with a persisting PUL were excluded from analysis). The log serum hCG average ((hCG 0 h + hCG 48 h)/2) and the hCG ratio (hCG 48 h/hCG 0 h) were encoded as variables following multivariate analysis of the basic data. The new Model M4 contained the log of the hCG average, the hCG ratio and its quadratic effect. In the prediction of ectopic pregnancy, M4 gave an area under the ROC curve (AUC) of 0.900 and M1 gave an AUC of 0.842 (P = 0.0303). CONCLUSIONS: Although Model M4 is superior to Model M1 when comparing the AUCs for prediction of developing ectopic pregnancies in a PUL population, in real terms this model did not result in substantially more pregnancies being classified correctly as developing ectopic pregnancies. Prospective multicenter studies are needed to assess the diagnostic performance of such models in different populations.

A validation of the most commonly used protocol to predict the success of single-dose methotrexate in the treatment of ectopic pregnancy.

BACKGROUND: Currently, the likely success of single-dose methotrexate (MTX) (50 mg/m(2)) for the treatment of ectopic pregnancy is indicated by a >15% decrease in hCG from days 4-7 after administration. The aim of this study was to assess this protocol and to develop new rules that could be used to predict the outcome at an earlier stage. METHODS: Data were collected prospectively. Women receiving MTX for an ectopic pregnancy had serum hCG and progesterone levels checked on days 1, 3, 4, 5 and 7. Other factors including age, gestational age, previous obstetric history and ultrasound findings were recorded. The women were followed up until the outcome of medical management was known. Univariate analysis was performed to determine the benefit of the '15% day 4-7 rule', as well as to develop new rules, which potentially could be used to predict the likelihood of success before 7 days. Historical and ultrasound variables were also analysed to identify the significant variables associated with successful conservative management. RESULTS: The success rate of single-dose MTX was 68.1% (47/69). A second dose was required in 18.8% (13/69) of cases, and it was successful in 84.6% (11/13). The 15% day 4-7 rule correctly predicted the outcome in 90.3% of cases [sensitivity 93.0%, specificity 84.2%, positive predictive value (PPV) 93.0% and negative predictive value (NPV) 84.2%, Fisher exact test P-value < 0.0001]. New rules were developed based on the percentage change day 4-5 and logistic regression models incorporating day 5 hCG levels and ultrasound findings. These new rules did not outperform the current 15% day 4-7 rule. CONCLUSIONS: We have confirmed that a 15% decrease in serum hCG between day 4 and day 7 is a very good indicator of the likely success of MTX. The development of new rules did not significantly improve our ability to predict a successful outcome at an earlier stage.

Impact of the availability of sonography in the acute gynecology unit.

OBJECTIVE: The initial assessment of acute gynecology patients is usually based on history and clinical examination and does not involve ultrasound. The aim of this study was to investigate the impact of the availability of transvaginal sonography at the time of initial assessment of the emergency gynecology patient. METHODS: This was a prospective observational study carried out over a 5-month period in the acute gynecology unit of an inner London teaching hospital. Women were assessed in the routine manner by history-taking and clinical examination and questionnaires were completed by the doctors, including details of the intention to treat. Transvaginal ultrasound examinations were then performed and a second diagnosis and management plan were made utilizing the extra information from the scan. The plans for clinical management before and after the ultrasound examination were compared. RESULTS: We originally recruited 1000 consecutive women to the study. The mean age was 31.1 (SD, 9.81) years. Complete data were available for 920 (92%). 84 (9.1%) women did not require a scan. Of the 521 women with a positive pregnancy test, 75.6% were reassured immediately that their pregnancy was intrauterine. 143 women (27.4%) were given the diagnosis of a suspected ectopic pregnancy before sonography, compared with 29 (5.6%) after. Following the ultrasound examination there was a change in clinical management in 54.1% of the women with a positive pregnancy test and a reduction in admissions (including inpatient theater admissions) (from 40.3% to 17.1%) and outpatient follow-up examinations (from 41.1% to 35.5%). In 90 (23.8%) non-pregnant women a significant ovarian cyst (> 5 cm) was suspected clinically; 28/90 (31.1%) were confirmed on sonography. Following the ultrasound examination there was a change in clinical management for 38.1% of non-pregnant women and a reduction in admissions (from 37.1% to 19.4%) and outpatient follow-up examinations (from 25.7% to 18.1%). CONCLUSION: It appears that the availability of transvaginal sonography at the time of initial assessment of emergency gynecology patients improves diagnostic accuracy and reduces unnecessary admissions and follow-up examinations.

The conservative management of cervical ectopic pregnancies.

OBJECTIVE: To evaluate the role of conservative management in the treatment of cervical ectopic pregnancies. METHODS: This was a retrospective analysis of all cervical ectopic pregnancies diagnosed in women attending our early pregnancy unit between April 1997 and September 2004 inclusive. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound. Clinical and demographic data were recorded in all cases. Serum human chorionic gonadotropin levels were measured at presentation and monitored subsequently to determine the rate of successful resolution. Conservative management was in the form of medical or expectant management. Medical management involved administration of systemic or intra-amniotic methotrexate, with or without intra-amniotic potassium chloride. Systemic methotrexate was either a single dose of 50 mg/m2 or an alternate-day regimen of methotrexate at 1 mg/kg (days 1,3,5) with folinic acid rescue (days 2,4,6). If intra-amniotic treatment was required, this was either 50 mg methotrexate or 5 mmol/L potassium chloride. RESULTS: Seven cervical ectopic pregnancies were diagnosed during the study period. Three cases were managed successfully with a single dose of methotrexate. One case was managed successfully using a multiple-dose methotrexate regimen. Another case failed medical management with both the single- and multiple-dose regimens but was successfully treated after potassium chloride was given intra-amniotically under ultrasound guidance. One case was successfully treated with intra-amniotic methotrexate and another was managed expectantly. There was no associated morbidity or mortality during the study period. We also performed a review of the current literature. CONCLUSION: The conservative management of cervical ectopic pregnancy is effective and safe.

The practical application of a mathematical model to predict the outcome of pregnancies of unknown location.

OBJECTIVE: A logistic regression model has been developed previously to predict which pregnancies of unknown location (PULs) become ectopics. This model was based on the human chorionic gonadotropin (hCG) ratio (hCG 48 h/hCG 0 h). The aim of this study was to evaluate the model in an early pregnancy clinical setting. METHODS: This was a prospective non-interventional observational study. Women classified as having a PUL had serum hCG and progesterone levels taken at presentation and 48 h later. At 48 h, nurse practitioners in the early pregnancy unit gave their subjective assessment of the likely pregnancy outcome based upon existing strategies to predict the outcome of PULs and their own previous experience. This was used as the basis for the clinical management of the women. The hormonal data were then entered into the model, which was available on the clinic computer in the form of a Microsoft Excel package, and the predicted outcome according to this model was recorded for each case. The model was weighted in favor of detecting an ectopic pregnancy at the expense of failing PULs and intrauterine pregnancies. All women were followed up until the final true diagnosis was established: a failing PUL, an intrauterine pregnancy or an ectopic pregnancy. The predicted outcome according to the model was compared with that of the subjective assessment of the expert operator and the true outcome after follow-up. RESULTS: Data were obtained from 357 women classified as having PULs. The final clinical outcomes were: 162 (45.4%) failing PULs, 166 (46.5%) intrauterine pregnancies and 29 (8.1%) ectopic pregnancies. Subjective assessment utilizing current strategies gave sensitivities of 79.3%, 92.8% and 87.0% for the detection of ectopic pregnancy, intrauterine pregnancy and failing PUL, respectively. The model detected ectopic pregnancy, intrauterine pregnancy and failing PUL with sensitivities of 82.8%, 86.8% and 73.5%, respectively. There were no adverse outcomes. CONCLUSION: This logistic regression model, based on the hCG ratio, can be used to predict the outcome of PULs, especially the ectopic pregnancies, with a high degree of certainty. It compares favorably with subjective assessment by experienced operators using current strategies to predict the outcome of PULs. The model can be used by those with limited knowledge or understanding of the behavior of serum biochemistry in the first trimester and in turn aid in the classification of PULs into those at low and those at high risk of ectopic pregnancy at 48 h.

Transjugular intrahepatic cavoportal shunt for Budd-Chiari syndrome.

Budd-Chiari syndrome (BCS) is characterized by obstruction of the hepatic venous outflow tract. Therapeutic options for BCS are limited. We report a case of a 21-year-old woman with protein S and C deficiency with gross ascites. Treatment with transjugular intrahepatic portosystemic shunt (TIPS) was attempted, which revealed occluded hepatic veins, so transcaval TIPS was performed. No serious procedure-related complication occurred. After successful shunt creation, the patient's symptoms subsided and she was discharged and followed up for 6 months.

Patterns of pancytopenia patients in a general medical ward and a proposed diagnostic approach.

BACKGROUND: There has been little systematic study on the clinical spectrum of pancytopenia. This study was done to describe the etiology, presentation and outcome of patients with pancytopenia presenting in a general medical ward. METHODS: Hundred patients with pancytopenia were included in the study from October 2001 to October 2002. Patients on cancer chemotherapy were excluded. Blood counts, bone marrow examinations and trephine biopsies were performed according to standard methods. RESULTS: In all cases, megaloblastic anemia constituted the largest group (n = 39), and also seen in conjunction with hemolytic anemia and septicemia. Hypersplenism secondary to portal hypertension (cirrhosis) was the second most common diagnosis (n = 19). Aplastic anemia, septicemia and myelodysplasia were other common causes. Two patients were the suspected cases of viral hemorrhagic fever. Thirteen (13%) patients expired. Absolute neutrophil count (ANC) less than 500/microliter was seen in 14 (14%) patients, among which 6 (15.3%) had megaloblastic anemia, 3 (37.5%) had aplastic anemia, and 2 (40%) had myelodysplasia. Eleven patients with platelet counts < or = 10 x 10(9)/L, 6 (54.5%) presented with bleeding; and 2 of these 8 had aplastic anemia and 1 patient with megaloblastic anemia. MCV values > 100 fL and > 110 fL were more frequent in patients with megaloblastic anemia with most prominent anisopoikilocytosis, microcytosis and fragmented RBCs. Macrocytosis was noted in 35 (89.7%) patients with megaloblastic anemia and 12 (63.1%) with hypersplenism, 4 (50%) with aplastic anemia. Hypersegmented neutrophils were noted in the blood films of 36 (92.3%) patients with megaloblastic anemia. CONCLUSION: Megaloblastic anemia, hypersplenism and aplastic anemia are the common causes of pancytopenia in our study.

Yield of dual endoscopy for positive fecal occult blood test.

OBJECTIVES: Dual endoscopy is frequently performed on the same day in patients whose stools are found to be positive on fecal occult blood testing (FOBT). This is often done to localize the potential sources of GI bleed. The diagnostic yield of same day dual upper endoscopy (EGD) and lower endoscopy (colonoscopy) for the detection of positive FOBT is uncertain. In the era of cost-efficient medical practice, we investigated whether a more evidence-based and structured approach could be used to guide physicians to the workup of patients who present with positive FOBT. METHODS: We performed a retrospective analysis of 309 patients, and 260 patients from this population met our inclusion criteria. Inclusion criteria included FOBT without acute GI hemorrhage, hematochezia, or melena. Patients were required to have had EGD and colonoscopy within the same day (<24 h). RESULTS: Of 260 patients, a total of 135 (52%) patients had positive findings on colonoscopy and a total of 42 (16.1%) patients had positive findings on EGD. Sixteen (6.1%) had positive EGD and negative colonoscopy; 109 (42%) had positive colonoscopy and negative EGD; and 26 (10%) had positive findings on both EGD and colonoscopy. CONCLUSIONS: Colonoscopy should be chosen as the initial procedure of choice in the evaluation of patients who present with positive FOBT. Same day dual endoscopy does not seem to be cost-effective.

Predictors of gastrointestinal complications after conventional and beating heart coronary surgery.

BACKGROUND: Gastrointestinal complications after cardiac surgery remain a significant problem despite improvements in pre-operative, operative and post-operative care. The pathophysiology is uncertain, and their prevention remains suboptimal. This prospective, randomised study was designed to define the role of cardiopulmonary bypass (CPB) and cardioplegic arrest in the pathogenesis of gastrointestinal complications following coronary artery surgery. METHODS AND RESULTS: Three hundred patients were prospectively randomised to (1) on-pump conventional coronary artery surgery [150 patients, 114 men, mean age 64 (45-75 years)] with mild hypothermic (32c) CPB and cardioplegic arrest of the heart or (2) off-pump surgery [150 patients, 113 men, mean age 64 (38-66) years] on the beating heart. The association of perioperative factors with gastrointestinal complications was investigated by univariate analysis. Significant variables were then included into a stepwise logistic regression model to ascertain their independent influence on the occurrence of gastrointestinal complications. There were no significant baseline differences between the groups. Eleven patients in the on-pump group and one patient in the off-pump group had post-operative gastrointestinal complications. Univariate analysis showed that CPB inclusive of cardioplegic arrest, left ventricular ejection fraction <50%, emergency surgery, prolonged aortic cross clamp and CPB time, post-operative low cardiac output syndrome, post-operative inotropic requirement, new onset atrial fibrillation (AF), excessive post-operative blood loss and redo thoracotomy <24 hours were predictors of gastrointestinal complications after coronary artery surgery (all p<0.05). However, stepwise multivariate regression analysis identified CPB inclusive of cardioplegic arrest as the only predictor of post-operative gastrointestinal complications (OR7.4; CI 3.4-17.9). CONCLUSIONS: Cardiopulmonary bypass, inclusive of cardioplegic arrest, is the main independent predictor of post-operative gastrointestinal complications in patients undergoing coronary revascularisation.

Rational prescription of medicines--a study of indoor patients at a tertiary care hospital.

BACKGROUND: A study was conducted at Ayub Teaching Hospital, Abbottabad, a tertiary hospital, to know whether drugs are prescribed rationally keeping in mind indications, interactions, contraindications, proper dosage and economy of the patient. METHODS: The study was a descriptive case study. Records of 200 patients admitted in various units of the hospital were analysed by a panel of pharmacologists and conclusions drawn. RESULTS: It was found that only 52% of patients receive prescriptions that were rationale in all aspects. Where as in rest of the patients the rationale could be challenged. CONCLUSION: This study stresses the need for more concentrated and dedicated effort towards prescription of medicines.

The role of scintigraphy with technetium-99m nanocolloid in patients with peripheral joint pain.

We studied 51 patients with peripheral joint pain to assess the ability of technetium-99m-nanocolloid (99mTc NC) scintigraphy to distinguish patients with active joint disease from those without, irrespective of their underlying aetiology. Patients with peripheral joint pain due to various causes were clinically categorised as either having objective signs of active joint disease or not. Their clinical diagnoses were not made known to the nuclear physician until after scanning. Each patient was given an intravenous injection of 555 MBq of 99mTc NC 1 h prior to taking spot views of the peripheral joints. Seventeen patients with low backache but without peripheral joint pain were imaged in an identical manner to exclude peripheral joint involvement. The latter formed a control group. 99mTc NC scintigraphy demonstrated a sensitivity of 89% for identifying at least one affected joint per patient, a specificity of 87.5%, a negative predictive value (npv) of 87.5%, a positive predictive value (ppv) of 89%, and overall accuracy of 88%. There were three false negative and three false positive cases. The scan was negative in all control subjects. 99mTc NC scintigraphy proved to be sensitive in patients with active joint disease and demonstrated a good correlation with clinical assessment. The value of the high specificity, npv and negative controls together made the test highly discriminatory in excluding patients without active peripheral joint disease.

99Tc(m) nanocolloid scintigraphy: a reliable way to detect active joint disease in patients with peripheral joint pain.

We evaluated 99Tc(m) nanocolloid (NC) scintigraphy as a method for identifying patients with active joint disease in a group with peripheral joint pain of varying aetiology. Fifty-nine patients with peripheral joint pain were divided into two groups: those with clinical signs of active joint inflammation and those without objective signs. Thirty-four patients clinically diagnosed as having active joint disease had a total of 117 joints (95 large and 22 small) involved. 99Tc(m) NC identified 96 (79 large and 17 small) of these joints. Twenty-five patients were negative clinically. Twenty-two of these were scan negative. The other three had a total of 11 scan positive joints. The correlation coefficient between clinical and scan findings was 0.79. There was no significant difference shown between clinical evaluation and scintigraphy (z=-1.64, P = 0.1004). 99Tc(m) NC proved to be an effective method for identifying patients with active peripheral joint disease from among a group with arthralgia.

Tc-99m erythrocyte localization of an intramuscular hemangioma of the arm.

An unusual case of intramuscular hemangioma of the left triceps muscle is presented. This tumor may infiltrate the muscle and be misdiagnosed as a malignant neoplasm.