Role of trans-radial band protocols in radial artery occlusion: Randomized trial.

BACKGROUND: Radial artery occlusion is a common complication of coronary angiography via radial artery, attributed to the prolonged use of trans-radial band post procedure. Literature suggests there is no standard protocol for radial band deflation, and it varies across institutions. However, the protocol suggested by Cohen and Alfonso is widely used globally. This study aims to test whether our hospital's radial band deflation protocol is non-inferior to the protocol of Cohen and Alfonso, which affirms lesser complications. METHODS: This is an outcome assessor blinded, non-inferiority trial conducted at a tertiary care hospital in Karachi. We enrolled 100 patients who underwent coronary angiography from radial access and gave written informed consent. The intervention group received protocol A, that is in practice at the institution, while the control group received protocol B, developed by Cohen and Alfonso. The primary outcome was occurrence of radial artery occlusion at 24 h. The secondary outcomes included hematoma and bleeding after radial band removal. RESULTS: The mean age of the participants in the trial was 58.3 ± 11.5 years, while 63% of them were men. Participants in both the groups had similar baseline characteristics. Radial artery occlusion was not significantly different between protocol A and protocol B (10% vs. 14%, p = 0.49, respectively). Similarly, hematoma and bleeding after trans-radial band removal showed no statistical difference between the groups. CONCLUSION: Trans-radial band deflation practice at our institution was non-inferior to Cohen and Alfonso's protocol in the incidence of radial artery occlusion after coronary angiography. TRIAL REGISTRATION NUMBER: This trial is registered at clinicaltrials.gov (https://clinicaltrials.gov) with registration number NCT03298126.

Environmental and human iodine and selenium status: lessons from Gilgit-Baltistan, North-East Pakistan.

Iodine and selenium deficiencies are common worldwide. We assessed the iodine and selenium status of Gilgit-Baltistan, Pakistan. We determined the elemental composition (ICP-MS) of locally grown crops (n = 281), drinking water (n = 82), urine (n = 451) and salt (n = 76), correcting urinary analytes for hydration (creatinine, specific gravity). We estimated dietary iodine, selenium and salt intake. Median iodine and selenium concentrations were 11.5 (IQR 6.01, 23.2) and 8.81 (IQR 4.03, 27.6) µg/kg in crops and 0.24 (IQR 0.12, 0.72) and 0.27 (IQR 0.11, 0.46) µg/L in water, respectively. Median iodised salt iodine was 4.16 (IQR 2.99, 10.8) mg/kg. Population mean salt intake was 13.0 g/day. Population median urinary iodine (uncorrected 78 µg/L, specific gravity-corrected 83 µg/L) was below WHO guidelines; creatinine-corrected median was 114 µg/L but was unreliable. Daily selenium intake (from urinary selenium concentration) was below the EAR in the majority (46-90%) of individuals. Iodine and selenium concentrations in all crops were low, but no health-related environmental standards exist. Iodine concentration in iodised salt was below WHO-recommended minimum. Estimated population average salt intake was above WHO-recommended daily intake. Locally available food and drinking water together provide an estimated 49% and 72% of EAR for iodine (95 µg/day) and selenium (45 µg/day), respectively. Low environmental and dietary iodine and selenium place Gilgit-Baltistan residents at risk of iodine deficiency disorders despite using iodised salt. Specific gravity correction of urine analysis for hydration is more consistent than using creatinine. Health-relevant environmental standards for iodine and selenium are needed.

Multiple geochemical factors may cause iodine and selenium deficiency in Gilgit-Baltistan, Pakistan.

Deficiencies of the micronutrients iodine and selenium are particularly prevalent where populations consume local agricultural produce grown on soils with low iodine and selenium availability. This study focussed on such an area, Gilgit-Baltistan in Pakistan, through a geochemical survey of iodine and selenium fractionation and speciation in irrigation water and arable soil. Iodine and selenium concentrations in water ranged from 0.01-1.79 µg L-1 to 0.016-2.09 µg L-1, respectively, which are smaller than levels reported in similar mountainous areas in other parts of the world. Iodate and selenate were the dominant inorganic species in all water samples. Average concentrations of iodine and selenium in soil were 685 µg kg-1 and 209 µg kg-1, respectively, much lower than global averages of 2600 and 400 µg kg-1, respectively. The 'reactive' fractions ('soluble' and 'adsorbed') of iodine and selenium accounted for < 7% and < 5% of their total concentrations in soil. More than 90% of reactive iodine was organic; iodide was the main inorganic species. By contrast, 66.9 and 39.7% of 'soluble' and 'adsorbed' selenium, respectively, were present as organic species; inorganic selenium was mainly selenite. Very low distribution coefficients (kd = adsorbed/soluble; L kg-1) for iodine (1.07) and selenium (1.27) suggested minimal buffering of available iodine and selenium against leaching losses and plant uptake. These geochemical characteristics suggest low availability of iodine and selenium in Gilgit-Baltistan, which may be reflected in locally grown crops. However, further investigation is required to ascertain the status of iodine and selenium in the Gilgit-Baltistan food supply and population.

Investigation on Parasites and Some Causes of Mortality in Captive Punjab urial (Ovis vignei punjabiensis), Pakistan.

BACKGROUND: The present study was conducted in Jul 2019 and Jan 2020 in two wildlife parks of the Nowshera district, Khyber Pakhtunkhwa, Pakistan, where the endangered Punjab urial (Ovis vignei punjabiensis) is successfully bred in captivity. We determined diversity of internal and external parasites that take advantage of the situation of congestion, resulting in massive mortalities of wild animals in captivity. METHODS: Internal parasites of living urial were determined by direct wet smear and flotation methods, while dead urial was necropsied for any pertaining observation. RESULTS: All examined fecal samples were found infected with gastrointestinal parasites, which had significant difference in the total abundance in winter and summer. S. papillosus and H.contortus, and a single protozoan, Eimeria spp. were the dominant parasites in fecal samples. Ticks collected from urial enclosures and dead animals were of single species H. anatolicum. Theileria spp. was observed in blood, while hydatid cysts were found in lungs and liver of necropsied urial. CONCLUSION: The study indicates that internal parasites such as Haemonchus contortus and Strongyloides papillosus, while external parasites as Hyalomma anatolicum ticks played major role in the population decline. Strict veterinary control of infectious diseases, provision of hygienic and supplementary diet, and proper maintenance of urial population are necessary measures for the control of mortalities.

Fate of selenium in biofortification of wheat on calcareous soil: an isotopic study.

Selenium (Se) biofortification of staple cereal crops can improve the Se nutritional status of populations. A field trial employing an enriched stable isotope of Se (77Se) was undertaken over three consecutive cropping seasons in a coarse-textured, calcareous soil in Gilgit-Baltistan, Pakistan. The objectives were to (1) assess the feasibility and efficiency of Se biofortification, (2) determine the fate of residual Se, and (3) assess the consequences for dietary Se intake. Isotopically enriched 77Se (77SeFert) was applied, either as selenate or as selenite, at three levels (0, 10, and 20 g ha-1) to a wheat crop. Residual 77SeFert availability was assessed in subsequent crops of maize and wheat without further 77SeFert addition. Loss of 77SeFert was c.35% by the first (wheat) harvest, for both selenium species, attributable to the practice of flood irrigation and low adsorption capacity of the soil. No 77SeFert was detectable in subsequent maize or wheat crops. The remaining 77SeFert in soil was almost entirely organically bound and diminished with time following a reversible (pseudo-)first-order trend. Thus, repeat applications of Se would be required to adequately biofortify grain each year. In contrast to native soil Se, there was no transfer of 77SeFert to a recalcitrant form. Grain from control plots would provide only 0.5 µg person-1 day-1 of Se. By contrast, a single application of 20 g ha-1 SeVI could provide c. 47 µg person-1 day-1 Se in wheat, sufficient to avoid deficiency when combined with dietary Se intake from other sources (c. 25 µg day-1).

Parasites of markhor, urial and Chiltan wild goat in Pakistan

Parasites are transferred between domestic and wild animals, when host animals come in contact with each other, particularly while grazing the same pastures, or when using same water bodies for drinking. Chances of parasite transmission and adaptation are high when hosts are genetically related. Afghan urial (Ovis vignei blanfordi), Suleiman markhor (Capra falconeri jerdoni) and Chiltan wild goat (C. aegagrus chialtanensis) are wild kin of domestic sheep and goats, sharing numerous parasitic diseases with each other. The present study was conducted in 2014­2015, to determine parasitic infections of Suleiman markhor and Afghan urial of Torghar Game Reserve, and the endemic wild goat of Chiltan National Park. For comparison, parasites of domestic small ruminants of these areas were also studied. A total of 11 species of helminth and 20 species of protozoa were recorded. Highly prevalent helminth among wild ruminants were Trichuris spp., Nematodirus spp., Protostrongylus rufescens and Moniezia benedeni, while highly prevalent Eimeria were E. arloingi and E. ninakohlyakimovae in caprines and E. ovinoidalis in urial. Chiltan wild goats were also found infected with Entamoeba spp. A short tabulated review of the helminth and protozoan parasites of wild sheep and goats of Pakistan, India, Iran and Turkey has been presented.

Ultrathin Ceramic Membranes as Scaffolds for Functional Cell Coculture Models on a Biomimetic Scale.

Epithelial tissue serves as an interface between biological compartments. Many in vitro epithelial cell models have been developed as an alternative to animal experiments to answer a range of research questions. These in vitro models are grown on permeable two-chamber systems; however, commercially available, polymer-based cell culture inserts are around 10 µm thick. Since the basement membrane found in biological systems is usually less than 1 µm thick, the 10-fold thickness of cell culture inserts is a major limitation in the establishment of realistic models. In this work, an alternative insert, accommodating an ultrathin ceramic membrane with a thickness of only 500 nm (i.e., the Silicon nitride Microporous Permeable Insert [SIMPLI]-well), was produced and used to refine an established human alveolar barrier coculture model by both replacing the conventional inserts with the SIMPLI-well and completing it with endothelial cells. The structural-functional relationship of the model was evaluated, including the translocation of gold nanoparticles across the barrier, revealing a higher translocation if compared to corresponding polyethylene terephthalate (PET) membranes. This study demonstrates the power of the SIMPLI-well system as a scaffold for epithelial tissue cell models on a truly biomimetic scale, allowing construction of more functionally accurate models of human biological barriers.

Retrocaval ureter.

Two cases of retrocaval ureter are reported. A 22 years old male patient presented to us with the complaints of right flank pain and hematuria and a child of 2 years referred to us for evaluation of right side moderate hydronephrosis detected on ultrasound. The diagnosis was confirmed on intravenous urography and retrograde pyelography. Both the ends were transected and anastomosed above a JJ stent in front of the inferior vena cava. Postoperatively the patients remained asymptomatic and the hydronephrosis improved.

Evaluation of low ligation and high ligation procedures of varicocele.

OBJECTIVE: To describe the mode of presentation of varicocele and to compare the low ligation (Inguinal approach/Ivanissevich's procedure) and high ligation (Retroperitoneal approach/modified Palomo's procedure) of varicocele repair regarding efficacy and postoperative complications. DESIGN: Institutional-based randomized comparative clinical trial. PLACE AND DURATION OF STUDY: This study was conducted at the Urology Department, Bolan Medical College and Sandeman Provincial Teaching Hospital, Quetta from December 1996 to November 2001 (5 years). SUBJECTS AND METHODS: A total of 213 patients of varicocele who underwent treatment in the department and completed 6 months follow-up were included in the study. The mode of presentation of varicocele was recorded for all patients. For treatment purpose patients were randomly divided into two groups: in group I (n: 115) varicocele was ligated by inguinal approach (Ivanissevich's procedure) while in group II (n: 98) by retroperitoneal approach (modified Palomo's procedure). The efficacy and postoperative complications of the two procedures were carefully recorded and compared between the two groups. RESULTS: The mean age of the patients of group-I and group-II was 27.2 and 27.5 years respectively. More than 50% patients of both groups presented with feeling of heaviness/dragging sensation on ipsilateral side. Presentation with infertility/sub fertility in group-I and group-II was 16.5% and 15.3% respectively. Majority of patients of both groups had grade III varicocele with visible deformity. The rate of postoperative complications was very low in both groups of patients. Recurrence of varicocele and postoperative hydrocele formation were slightly more common in group-II as compared to group-I but the difference was statistically not significant (p>0.05). An extremely significant improvement occurred postoperatively in both sperms density and motility in infertile/sub fertile patients of both groups. CONCLUSION: Both procedures of varicocele repair are equally effective and have a low rate of complications. There is no significant difference in postoperative complications. An extremely significant improvement occurs in semen parameters of infertile/sub fertile patients postoperatively, irrespective of method/technique of varicocelectomy