Management of acute colonic pseudo-obstruction: opportunities to improve care?

BACKGROUND: Acute colonic pseudo-obstruction (ACPO) is a functional bowel obstruction characterised by colonic dilatation in the absence of mechanical obstruction on imaging. Complications include bowel ischaemia, perforation and death. The aim of this study was to explore outcomes for patients treated for ACPO and to assess adherence to current ACPO treatment guidelines. METHODS: This is a retrospective service evaluation and included patients with a diagnosis of ACPO between 1 March 2018 and 31 March 2023. Process measures were identified following discussion with the clinical team from published guidance. Patients were identified using clinical coding and radiological text reports. Cases were eligible for inclusion if they had radiologically confirmed ACPO. Data were collected following review of patient notes into Microsoft Excel. Descriptive analysis was performed with no formal statistical assessment. RESULTS: A total of 45 patients were identified, of whom 13 were admitted under general surgery. All patients received admission bloods (n=45). Nearly all patients had computed tomography imaging (43/45, 96%). Only 3/45 (6.7%) of the patients received optimal conservative management (intravenous infusion, nil by mouth, flatus tube, treatment of reversible causes). In all, 11/45 (24%) required further treatment, of whom 7 received this within 72 h. The leading (11/45) complication following diagnosis of ACPO was hospital-acquired pneumonia. Mortality was seen in 9/45. CONCLUSIONS: ACPO is often managed remotely by general surgeons. This may impact on the quality of conservative management, and timeliness of endoscopic or pharmacological intervention. Further work is needed to optimise management.

A comprehensive review on the documented characteristics of four Reticulitermes termites (Rhinotermitidae, Blattodea) of China / Uma revisão abrangente sobre as características documentadas de quatro cupins Reticulitermes da China

Termites are known as social insects worldwide. Presently in China 473 species, 44 genera and 4 families of termites have been reported. Of them, 111 Reticulitermes species are widely spread in different zones of China. The dispersion flight season of these Chinese Reticulitermes species are usually started from February to June, but in some regions different species are distributed, sharing their boundaries and having overlapping flight seasons. These reasons become important sources of hybridization between two different heterospecific populations of termites. It was confirmed that the fertilized eggs and unfertilized eggs of some Reticulitermes termites have the capacity of cleavage. While the unfertilized eggs of R. aculabialis, R. chinensis and R. labralis cleaved normally and the only R. aculabialis unfertilized eggs develop in embryos. While, the R. flaviceps and R. chinensis were observed with their abnormal embryonic development, and not hatching of eggs parthenogenetically. They were reported more threatening to Chinese resources as they propagate with parthenogenesis, hybridization and sexual reproduction. Eggshell and macrophiles of eggs play important roles in species identification and control. Although, they are severe pests and cause a wide range of damages to wooden structures and products in homes, buildings, building materials, trees, crops, and forests in China's Mainland.

Os cupins são conhecidos como insetos sociais em todo o mundo. Atualmente na China foram relatadas 473 espécies, 44 gêneros e 4 famílias de cupins. Destas, 111 espécies de Reticulitermes estão amplamente distribuídas em diferentes zonas da China. A temporada de voo de dispersão dessas espécies chinesas de Reticulitermes geralmente começa de fevereiro a junho, mas em algumas regiões diferentes espécies são distribuídas, compartilhando seus limites e tendo temporadas de voo sobrepostas. Essas razões tornam-se importantes fontes de hibridização entre duas populações heteroespecíficas de cupins. Foi confirmado que os ovos fertilizados e não fertilizados de alguns cupins Reticulitermes possuem capacidade de clivagem. Já os ovos não fertilizados de R. aculabialis, R. chinensis e R. labralis clivaram normalmente, e os únicos ovos não fertilizados de R. aculabialis se desenvolvem em embriões. R. flaviceps e R. chinensis foram observados com desenvolvimento embrionário anormal, e não eclosão de ovos por partenogênese. Eles foram relatados como mais ameaçadores para os recursos chineses à medida que se propagam com partenogênese, hibridização e reprodução sexual. Casca de ovo e macrófilos de ovos desempenham papéis importantes na identificação e controle de espécies, embora sejam pragas graves e causem uma ampla gama de danos a estruturas e produtos de madeira em residências, edifícios, materiais de construção, árvores, plantações e florestas na China continental.

ADVANCEMENTS IN MINIMALLY INVASIVE SURGERY: A COMPREHENSIVE ANALYSIS OF ROBOTIC SURGERY, ENDOSCOPIC TECHNIQUES, AND NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY.

The term "Natural Orifice Transluminal Endoscopic Surgery" (NOTES) defines a surgical approach that leverages the body's natural orifices to access the abdominal cavity, presenting a patient-centric perspective by highlighting its potential to eliminate abdominal wall aggression, mitigate postoperative discomfort, and offer benefits comparable to laparoscopic surgery. This comprehensive paper aims to not only review the existing landscape of NOTES techniques but also to propose advancements in flexible tools augmenting established endoscopic platforms, while also exploring the revolutionary concept of robotic structures grounded in micromechatronics and communication technologies. The thorough analysis encompasses the assessment of advantages and limitations associated with flexible devices and robotic platforms, coupled with an in-depth evaluation of the current array of devices used in NOTES, informed by pertinent literature. The authors' comprehensive approach entails scrutinizing technological breakthroughs and offering viable solutions, fostering a comprehensive understanding. Furthermore, the study encompasses an exhaustive evaluation and juxtaposition of state-of-the-art NOTES devices, supplemented by a nuanced discourse on the merits and demerits of flexible devices and robotic platforms, with a focused emphasis on their inherent strengths and weaknesses. Within this context, the discourse extends to strategic suggestions aimed at refining extant designs and cultivating robust, dependable autonomous robotic platforms purpose-built for NOTES. This narrative encapsulates the multifaceted exploration of benefits, challenges, and potential remedies directed towards enhancing prevailing designs and forging a dependable foundation for the future of NOTES.

Evaluation of 3 northwest European seaweed species on enteric methane production and lactational performance of Holstein-Friesian dairy cows.

Seaweeds have been studied for their ability to reduce enteric methane emissions of ruminants when fed as a feed supplement. In vivo research with dairy cattle is mainly limited to the seaweed species Ascophyllum nodosum and Asparagopsis taxiformis, whereas in vitro gas production research covers a broader range of brown, red, and green seaweed species from different regions. The objective of the present study was to determine the effect of Chondrus crispus (Rhodophyta), Saccharina latissima (Phaeophyta), and Fucus serratus (Phaeophyta), 3 common northwest European seaweeds, on enteric methane production and lactational performance of dairy cattle. Sixty-four Holstein-Friesian dairy cattle (16 primiparous, 48 multiparous) averaging (mean ± standard deviation) 91 ± 22.6 d in milk and 35.4 ± 8.13 kg/d fat- and protein-corrected milk yield (FPCM) were randomly assigned to 1 of 4 treatments in a randomized complete block design. Cows were fed a partial mixed ration [54.2% grass silage, 20.8% corn silage, and 25.0% concentrate; dry matter (DM) basis] with additional concentrate bait in the milking parlor and the GreenFeed system (C-Lock Inc.). The 4 treatments consisted of a control diet without seaweed supplement (CON), or CON supplemented with 150 g/d (fresh weight of dried seaweed) of either C. crispus (CC), S. latissima (SL), or a 50/50 mix (DM basis) of F. serratus and S. latissima. Milk yield (28.7 vs. 27.5 kg/d, respectively), fat- and protein-corrected milk (FPCM) yield (31.4 vs. 30.2 kg/d, respectively), milk lactose content (4.57 vs. 4.52%, respectively), and lactose yield (1,308 vs. 1,246 g/d, respectively) increased for SL compared with CON. Milk protein content was lower for SL compared with the other treatments. Milk fat and protein contents; yields of fat, protein, lactose, and FPCM; feed efficiency; milk nitrogen efficiency; and somatic cell count did not differ between CON and the other treatments. Depending on week of experiment, milk urea content was higher for SL compared with CON and CC. No effects were observed of the treatments compared with CON for DM intake, number of visits to the GreenFeed, or gas emission (production, yield, or intensity) of CO2, CH4, and H2. In conclusion, the seaweeds evaluated did not decrease enteric CH4 emissions and did not negatively affect feed intake and lactational performance of dairy cattle. Milk yield, FPCM yield, milk lactose content, and lactose yield increased, and milk protein content decreased, with S. latissima.

Comparative analysis of dural substitute autologous vs. semisynthetic collagen-based dura graft.

OBJECTIVE: The aim of the present study is to evaluate the success rate and safety of both auto-grafts and collagen-based semi-synthetic grafts in patients with dura defects. PATIENTS AND METHODS: A prospective comparative study was conducted at the neurosurgery departments of different hospitals in Peshawar and Faisalabad. Patients were divided into two groups: A (autologous graft) and B (semi-synthetic graft). Dura graft autologous was applied in one group of patients with supratentorial brain surgery. Fascia lata was used, harvested from the lateral thigh, 3 to 5 cm long incision at the junction of the upper and middle one-third of the upper leg. A bone flap was implanted in the subcutaneous region in the abdominal part. Perioperative antibiotics were given to all the patients, and surgical drains placed intraoperatively were removed after 24 hours of surgery. In the second group, semi-synthetic dura grafts of 2.5x2.5 cm and 5x5 cm 7.5x7.5 cm sizes were used. Statistical analysis was performed using SPSS version v.20. Student's t-test was performed for the two groups to compare categorical variables, and the data were considered statistically significant at p > 0.05. RESULTS: In this study, 72 patients of both genders were recruited. We observed that the Semi-synthetic collagen matrix had less surgical time. The mean difference in surgical duration was observed as 40 minutes. However, both groups reported statistically significant differences in terms of surgical duration (< 0.001). No case of infection was reported in both groups. The overall mortality ratio was 12%. Two male deaths were recorded due to cardiovascular disorders, while one death of a 42-year male was also recorded. CONCLUSIONS: Based on the above findings, it may be concluded that using a semi-synthetic collagen substitute for dura repair is a simple, safe, and effective alternative to the autologous graft for dura repair in dura defects.

Cobalt availability in the soil plant and animal food chain: a study under a peri-urban environment.

Cobalt metal is considered as an essential trace element for the animals. Present investigation was undertaken in the peri-urban area to analyze the cobalt availability in animal food chain by using different indices. Cow, buffalo and sheep samples along with forage and soil samples were collected from the three different sites of District Jhang and analyzed through atomic absorption spectrophotometer. Cobalt values differed in soil samples as 0.315-0.535 mg/kg, forages as 0.127-0.333 mg/kg and animal samples as 0.364-0.504 mg/kg. Analyzed cobalt concentration in soil, forage and animal samples was found to be deficient in concentration with respect to standard limits. Soil showed the minimum cobalt level in Z. mays while maximum concentration was examined in the forage C. decidua samples. All indices examined in this study has values lesser than 1, representing the safer limits of the cobalt concentration in these samples. Enrichment factor (0.071-0.161 mg/kg) showed the highly deficient amount of cobalt enrichment in this area. Bio-concentration factor (0.392-0.883) and pollution load index (0.035-0.059 mg/kg) values were also lesser than 1 explains that plant and soil samples are not contaminated with cobalt metal. The daily intake and health risk index ranged from 0.00019-0.00064 mg/kg/day and 0.0044-0.0150 mg/kg/day respectively. Among the animals, cobalt availability was maximum (0.0150 mg/kg/day) in the buffaloes that grazed on the C. decidua fodder. Results of this study concluded that cobalt containing fertilizers must be applied on the soil and forages. Animal feed derived from the cobalt containing supplements are supplied to the animals, to fulfill the nutritional requirements of livestock.

Evaluation of potential ecological risk assessment of toxic metal (lead) in contaminated meadows in the vicinity of suburban city: soil vs forages vs livestock.

Heavy metal toxicity is becoming an increasing concern for environmental, human and animal health. The current research analyzed the lead (Pb) contamination in the food chain under three different irrigation sources (ground, canal, and wastewater). Soil, plant and animal samples were collected from the Jhang district of Pakistan and processed with an atomic absorption spectrophotometer. Lead concentration varied in the samples as: 5.22-10.73 mg/kg in soil, 2.46-10.34 mg/kg in forages and 0.736-2.45 mg/kg in animal samples. The observed lead concentration in forage and animal blood samples was higher than the standard limits. The pollution load index (0.640-1.32) in soil showed that lead contamination mainly took place at the wastewater irrigating sites. Bio-concentration factor values (0.313-1.15) were lower than one in all samples except Zea mays, showing that lead metal was actively taken up by Zea mays tissues from the soil. Enrichment factor values ranged from 0.849-3.12, showing a moderate level of lead enrichment. Daily intake and health risk index varied between 0.004-0.020 mg/kg/day and 0.906-4.99, respectively. All the samples showed maximum lead concentration at the wastewater irrigating site compared to the ground or canal water application sites. These results recommended that consistent application of wastewater for forage irrigation must be avoided to prevent health hazards associated with lead in the animal and human food chain. Government must implement adequate strategies to protect the animal and human health from the harms of toxic heavy metals.

Role of Intraoperative Coeliac Plexus Neurolysis on Postoperative Pain Management for Chronic Pancreatitis.

Control of pain in patients with chronic pancreatitis is difficult because 30.0% to 50.0% of patients still experience persistence or recurrence of pain even after surgery. So a combined approach of surgery and coeliac plexus neurolysis was carried out in this study to see the relief of pain and reduce the requirement of analgesics in these patients. This prospective observational comparative study was carried out in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from November 2017 to October 2018. Forty one (41) study participants with the diagnosis of chronic pancreatitis were included consecutively in this study. The participants were divided into two groups. Group I (n=18) underwent pancreatic surgery with coeliac plexus neurolysis by infiltration of 20ml of 100% alcohol in the loose areolar tissue 10ml each into right and left para-aortic space at the level of coeliac trunk and Group II (n=23) underwent pancreatic surgery only. Participants' preoperative data were collected from patient record file. Number, frequency and intensity of pain and requirement of amount of analgesics for the last 3 months were recorded from patients' history. The intensity of pain was categorized by visual analog scale (VAS) preoperatively. The participants of both groups were followed up at 1, 2 and 3 months interval and asked for disappearance or reduction of pain, frequency of attack and requirement of analgesics. Again visual analog scale was used for categorization of pain. Pain free period was recorded after the end of follow up period. Pain reduction occurred after surgery in both groups. But when pain relief was compared on the basis of VAS (Visual Analogue Scale), it was significantly better in Group I after 1 month of surgery than Group II (p=0.05). But 2 and 3 months after surgery this difference became insignificant (p=0.246 and 0.264). No statistical difference was found in terms of analgesic usage, severe acute attack or hospital admission (p=0.511, 0.439 and 0.495) at the end of 3 months follow up. Participants in Group I had significantly longer pain free period than Group II (p=0.025). Regarding complications, postural hypotension developed in 5.6% (1) patients. Diarrhea developed in 11.1% (2) patients in Group I and wound infection developed in 2 patients in each groups respectively. No patients developed any major complications like anastomotic leakage, deep or organ or space infection. Intraoperative coeliac plexus neurolysis reduces pain immediately after surgery and provides longer pain free period in patients with chronic pancreatitis after surgery.

Genetic diversity and molecular characterization of Cucumber mosaic cucumovirus (CMV) subgroup II infecting Spinach (Spinacia oleracea) and Pea (Pisum sativum) in Pothwar region of Pakistan / Diversidade genética e caracterização molecular do Cucumber mosaic cucumovirus (CMV) subgrupo II infectando espinafre (Spinacia oleracea) e ervilha (Pisum sativum) na região de Pothwar, Paquistão

Abstract Cucumber mosaic virus (CMV) is a tremendous threat to vegetables across the globe, including in Pakistan. The present work was conducted to investigate the genetic variability of CMV isolates infecting pea and spinach vegetables in the Pothwar region of Pakistan. Serological-based surveys during 2016-2017 revealed 31.70% overall CMV disease incidence from pea and spinach crops. Triple-antibody sandwich enzyme-linked immunosorbent assay (TAS-ELISA) revealed that all the positive isolates belong to CMV subgroup II. Two selected cDNA from ELISA-positive samples representing each pea and spinach crops were PCR-amplified (ca.1100 bp) and sequenced corresponding to the CMV CP gene which shared 93.7% nucleotide identity with each other. Both the sequences of CMV pea (AAHAP) and spinach (AARS) isolates from Pakistan were submitted to GenBank as accession nos. MH119071 and MH119073, respectively. BLAST analysis revealed 93.4% sequence identity of AAHAP isolate with SpK (KC763473) from Iran while AARS isolate shared maximum identity (94.5%) with the strain 241 (AJ585519) from Australia and clustered with some reference isolates of CMV subgroup II from UK (Z12818) and USA (AF127976) in a Neighbour-joining phylogenetic reconstruction. A total of 59 polymorphic (segregating) sites (S) with nucleotide diversity (π) of 0.06218 was evident while no INDEL event was observed in Pakistani isolates. The evolutionary distance of Pakistani CMV isolates was recorded as 0.0657 with each other and 0.0574-0.2964 with other CMV isolates reported elsewhere in the world. A frequent gene flow (Fst = 0.30478 <0.33) was observed between Pakistani and earlier reported CMV isolates. In genetic differentiation analysis, the value of three permutation-based statistical tests viz; Z (84.3011), Snn (0.82456), and Ks* (4.04042) were non-significant. The statistical analysis revealed the values 2.02535, 0.01468, and 0.71862 of Tajima's D, Fu, & Li's F* and D* respectively, demonstrating that the CMV population is under balancing selection.

Resumo Cucumber mosaic cucumovirus (CMV) é uma tremenda ameaça aos vegetais em todo o mundo, inclusive no Paquistão. O presente trabalho foi conduzido para investigar a variabilidade genética de isolados de CMV infectando vegetais de ervilha e espinafre na região de Pothwar, Paquistão. Pesquisas com base em sorologia durante 2016-2017 revelaram 31,70% da incidência geral da doença por CMV em safras de ervilha e espinafre. O ensaio de imunoabsorção enzimática em sanduíche de anticorpo triplo (TAS-ELISA) revelou que todos os isolados positivos pertencem ao subgrupo II do CMV. Dois cDNA selecionados de amostras positivas para ELISA representando cada safra de ervilha e espinafre foram amplificados por PCR (ca.1100 pb) e sequenciados correspondendo ao gene CMV CP que compartilhou 93,7% de identidade de nucleotídeo um com o outro. Ambas as sequências de isolados de ervilha CMV (AAHAP) e espinafre (AARS) do Paquistão foram submetidas ao GenBank como nos de acesso. MH119071 e MH119073, respectivamente. A análise BLAST revelou 93,4% de identidade de sequência do isolado AAHAP com SpK (KC763473) do Irã, enquanto o isolado AARS compartilhou a identidade máxima (94,5%) com a cepa 241 (AJ585519) da Austrália e agrupada com alguns isolados de referência do subgrupo II de CMV do Reino Unido (Z12818) e EUA (AF127976) em uma reconstrução filogenética vizinha. Um total de 59 sítios polimórficos (segregantes) (S) com diversidade de nucleotídeos (π) de 0,06218 foi evidente, enquanto nenhum evento INDEL foi observado em isolados do Paquistão. A distância evolutiva de isolados de CMV do Paquistão foi registrada como 0,0657 entre si e 0,0574-0,2964 com outros isolados de CMV relatados em outras partes do mundo. Um fluxo gênico frequente (Fst = 0,30478 < 0,33) foi observado entre os isolados de CMV do Paquistão e relatados anteriormente. Na análise de diferenciação genética, os valores de três testes estatísticos baseados em permutação viz, Z (84,3011), Snn (0,82456) e Ks * (4,04042) não foram significativos. A análise estatística revelou os valores 2,02535, 0,01468 e 0,71862 de Tajima's D, Fu, & Li's F * e D * respectivamente, demonstrando que a população de CMV está sob seleção de balanceamento.

Genetic diversity and molecular characterization of Cucumber mosaic cucumovirus (CMV) subgroup II infecting Spinach (Spinacia oleracea) and Pea (Pisum sativum) in Pothwar region of Pakistan / Diversidade genética e caracterização molecular do Cucumber mosaic cucumovirus (CMV) subgrupo II infectando espinafre (Spinacia oleracea) e ervilha (Pisum sativum) na região de Pothwar, Paquistão

Cucumber mosaic virus (CMV) is a tremendous threat to vegetables across the globe, including in Pakistan. The present work was conducted to investigate the genetic variability of CMV isolates infecting pea and spinach vegetables in the Pothwar region of Pakistan. Serological-based surveys during 2016-2017 revealed 31.70% overall CMV disease incidence from pea and spinach crops. Triple-antibody sandwich enzyme-linked immunosorbent assay (TAS-ELISA) revealed that all the positive isolates belong to CMV subgroup II. Two selected cDNA from ELISA-positive samples representing each pea and spinach crops were PCR-amplified (ca.1100 bp) and sequenced corresponding to the CMV CP gene which shared 93.7% nucleotide identity with each other. Both the sequences of CMV pea (AAHAP) and spinach (AARS) isolates from Pakistan were submitted to GenBank as accession nos. MH119071 and MH119073, respectively. BLAST analysis revealed 93.4% sequence identity of AAHAP isolate with SpK (KC763473) from Iran while AARS isolate shared maximum identity (94.5%) with the strain 241 (AJ585519) from Australia and clustered with some reference isolates of CMV subgroup II from UK (Z12818) and USA (AF127976) in a Neighbour joining phylogenetic reconstruction. A total of 59 polymorphic (segregating) sites (S) with nucleotide diversity (π) of 0.06218 was evident while no INDEL event was observed in Pakistani isolates. The evolutionary distance of Pakistani CMV isolates was recorded as 0.0657 with each other and 0.0574-0.2964 with other CMV isolates reported elsewhere in the world. A frequent gene flow (Fst = 0.30478 <0.33) was observed between Pakistani and earlier reported CMV isolates. In genetic differentiation analysis, the value of three permutation-based statistical tests viz; Z (84.3011), Snn (0.82456), and Ks* (4.04042) were non-significant. The statistical analysis revealed the [...].

Cucumber mosaic cucumovirus (CMV) é uma tremenda ameaça aos vegetais em todo o mundo, inclusive no Paquistão. O presente trabalho foi conduzido para investigar a variabilidade genética de isolados de CMV infectando vegetais de ervilha e espinafre na região de Pothwar, Paquistão. Pesquisas com base em sorologia durante 2016-2017 revelaram 31,70% da incidência geral da doença por CMV em safras de ervilha e espinafre. O ensaio de imunoabsorção enzimática em sanduíche de anticorpo triplo (TAS-ELISA) revelou que todos os isolados positivos pertencem ao subgrupo II do CMV. Dois cDNA selecionados de amostras positivas para ELISA representando cada safra de ervilha e espinafre foram amplificados por PCR (ca.1100 pb) e sequenciados correspondendo ao gene CMV CP que compartilhou 93,7% de identidade de nucleotídeo um com o outro. Ambas as sequências de isolados de ervilha CMV (AAHAP) e espinafre (AARS) do Paquistão foram submetidas ao GenBank como nos de acesso. MH119071 e MH119073, respectivamente. A análise BLAST revelou 93,4% de identidade de sequência do isolado AAHAP com SpK (KC763473) do Irã, enquanto o isolado AARS compartilhou a identidade máxima (94,5%) com a cepa 241 (AJ585519) da Austrália e agrupada com alguns isolados de referência do subgrupo II de CMV do Reino Unido (Z12818) e EUA (AF127976) em uma reconstrução filogenética vizinha. Um total de 59 sítios polimórficos (segregantes) (S) com diversidade de nucleotídeos (π) de 0,06218 foi evidente, enquanto nenhum evento INDEL foi observado em isolados do Paquistão. A distância evolutiva de isolados de CMV do Paquistão foi registrada como 0,0657 entre si e 0,0574-0,2964 com outros isolados de CMV relatados em outras partes do mundo. Um fluxo gênico frequente (Fst = 0,30478 < 0,33) foi observado entre os isolados de CMV do Paquistão e relatados anteriormente. Na análise de diferenciação genética, os valores de três testes estatísticos baseados em [...].

Genetic diversity and molecular characterization of Cucumber mosaic cucumovirus (CMV) subgroup II infecting Spinach (Spinacia oleracea) and Pea (Pisum sativum) in Pothwar region of Pakistan

Abstract Cucumber mosaic virus (CMV) is a tremendous threat to vegetables across the globe, including in Pakistan. The present work was conducted to investigate the genetic variability of CMV isolates infecting pea and spinach vegetables in the Pothwar region of Pakistan. Serological-based surveys during 2016-2017 revealed 31.70% overall CMV disease incidence from pea and spinach crops. Triple-antibody sandwich enzyme-linked immunosorbent assay (TAS-ELISA) revealed that all the positive isolates belong to CMV subgroup II. Two selected cDNA from ELISA-positive samples representing each pea and spinach crops were PCR-amplified (ca.1100 bp) and sequenced corresponding to the CMV CP gene which shared 93.7% nucleotide identity with each other. Both the sequences of CMV pea (AAHAP) and spinach (AARS) isolates from Pakistan were submitted to GenBank as accession nos. MH119071 and MH119073, respectively. BLAST analysis revealed 93.4% sequence identity of AAHAP isolate with SpK (KC763473) from Iran while AARS isolate shared maximum identity (94.5%) with the strain 241 (AJ585519) from Australia and clustered with some reference isolates of CMV subgroup II from UK (Z12818) and USA (AF127976) in a Neighbour-joining phylogenetic reconstruction. A total of 59 polymorphic (segregating) sites (S) with nucleotide diversity () of 0.06218 was evident while no INDEL event was observed in Pakistani isolates. The evolutionary distance of Pakistani CMV isolates was recorded as 0.0657 with each other and 0.0574-0.2964 with other CMV isolates reported elsewhere in the world. A frequent gene flow (Fst = 0.30478 0.33) was observed between Pakistani and earlier reported CMV isolates. In genetic differentiation analysis, the value of three permutation-based statistical tests viz; Z (84.3011), Snn (0.82456), and Ks* (4.04042) were non-significant. The statistical analysis revealed the values 2.02535, 0.01468, and 0.71862 of Tajima's D, Fu, & Lis F* and D* respectively, demonstrating that the CMV population is under balancing selection.

Resumo Cucumber mosaic cucumovirus (CMV) é uma tremenda ameaça aos vegetais em todo o mundo, inclusive no Paquistão. O presente trabalho foi conduzido para investigar a variabilidade genética de isolados de CMV infectando vegetais de ervilha e espinafre na região de Pothwar, Paquistão. Pesquisas com base em sorologia durante 2016-2017 revelaram 31,70% da incidência geral da doença por CMV em safras de ervilha e espinafre. O ensaio de imunoabsorção enzimática em sanduíche de anticorpo triplo (TAS-ELISA) revelou que todos os isolados positivos pertencem ao subgrupo II do CMV. Dois cDNA selecionados de amostras positivas para ELISA representando cada safra de ervilha e espinafre foram amplificados por PCR (ca.1100 pb) e sequenciados correspondendo ao gene CMV CP que compartilhou 93,7% de identidade de nucleotídeo um com o outro. Ambas as sequências de isolados de ervilha CMV (AAHAP) e espinafre (AARS) do Paquistão foram submetidas ao GenBank como nos de acesso. MH119071 e MH119073, respectivamente. A análise BLAST revelou 93,4% de identidade de sequência do isolado AAHAP com SpK (KC763473) do Irã, enquanto o isolado AARS compartilhou a identidade máxima (94,5%) com a cepa 241 (AJ585519) da Austrália e agrupada com alguns isolados de referência do subgrupo II de CMV do Reino Unido (Z12818) e EUA (AF127976) em uma reconstrução filogenética vizinha. Um total de 59 sítios polimórficos (segregantes) (S) com diversidade de nucleotídeos () de 0,06218 foi evidente, enquanto nenhum evento INDEL foi observado em isolados do Paquistão. A distância evolutiva de isolados de CMV do Paquistão foi registrada como 0,0657 entre si e 0,0574-0,2964 com outros isolados de CMV relatados em outras partes do mundo. Um fluxo gênico frequente (Fst = 0,30478 0,33) foi observado entre os isolados de CMV do Paquistão e relatados anteriormente. Na análise de diferenciação genética, os valores de três testes estatísticos baseados em permutação viz, Z (84,3011), Snn (0,82456) e Ks * (4,04042) não foram significativos. A análise estatística revelou os valores 2,02535, 0,01468 e 0,71862 de Tajimas D, Fu, & Lis F * e D * respectivamente, demonstrando que a população de CMV está sob seleção de balanceamento.

Triple Assessment of a Palpable Parotid Lump in "One-Stop" Clinics.

Introduction: The National Institute of Clinical Excellence in the UK (NICE) recommended the use of "one-stop" clinics for the assessment and management of head and neck lumps like those established for breast lumps. "One-stop" clinics should follow a triple assessment protocol involving physical examination, radiological imaging and fine-needle aspiration cytology (FNAC). Methods: A retrospective analysis of 144 patients with suspected parotid tumours from 2005 to 2011 was done. Patients were assessed for individual modalities and compared against the final histological diagnosis. Statistical analysis was used for sensitivity and specificity, as well as positive and negative predictive values. All calculations were performed using SPSS version 16 (Statistical Packages for the Social Sciences, Chicago, IL). A p value of < 0.05 was considered to indicate statistical significance. Results: A total of 105 patients underwent all the three modalities. Out of them, 93 had imaging that was considered radiologically benign and 12 were reported to have a malignant lesion. Cytologically, 75 were found to have a benign tumour, 13 were malignant, and 17 were considered to be indeterminate. The most common benign neoplasm was pleomorphic adenoma followed by Warthin's tumour. The sensitivity and specificity of triple assessment were 96% (p value 0.878-0.984) and 73% (p value 0.42-0.904), respectively. The positive predictive value was 96% (p value 0.878-0.984) and negative predictive value came out to be 93% (p value 0.42-0.904). Conclusions: The overall accuracy of triple assessment was found to be 92%. This study concludes that triple assessment is a useful assessment tool to evaluate a patient with parotid lump. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-021-01590-5.

Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft with Fixation Using Endobutton at Femoral End and Bioabsorbable Screw at Tibial End.

Anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. It can be repaired and reconstructed by open and endoscopic method, the gold standard is, however, endoscopic reconstruction. It is usually reconstructed using bone patellar tendon bone (BPTB) or Hamstring autograft. The graft is supported using endobutton at the femoral end while bioabsorbable interference screw at the tibial end. This study aimed to determine how a certain fixation procedure for quadrupled hamstring autografts worked out. This prospective observational study duration period was 1 year in which 40 patients with ACL injury were treated with arthroscopic reconstruction using hamstring autograft from January 2020 to December 2020 with 6 months follow up after surgery. On the femoral side, an endobutton was used to secure the graft, while the tibial end was secured using a bioabsorbable screw. The International Knee Documentation Committee (IKDC) scoring system was used for prospective evaluation. According to subjective IKDC scoring, 20(50.0%) results were very good, 14(35.0%) were good, 4(10.0%) were satisfactory and 2(5.0%) were bad. In 95.0% patients the state of knee joint is very good compared to preoperative state. Of all the 40 patients underwent ACL reconstruction, 38(95.0%) patients are satisfied with the results of the operation.

Prevalence of insect pests on maize crop in District Mansehra, Khyber Pakhtunkhwa, Pakistan.

The maize crop is used as food for humans, livestock and poultries forms, it is also used in bread making, corn flakes, corn syrup, corn starch and corn oils. The field study consisted of one experimental trial, about the incidence of that insect pest complex on maize cultivar Azam during the Kharif season 2020 at the Agricultural, Research Station, Baffa, Mansehra. The trial was laid out in the Randomized Complete Block Design (RCBD), and then it was divided into three replications. The result obtained from the trial showed that a number of the pest species were recorded during the experimental period; however, the population was noticed at a low level. The obtained insect species were corn leaf aphid (6.90 ± 5.5) per square inch, corn leafhopper (1.32 ± 0.63), maize stem borer (0.63 ± 0.29), corn flea beetle (0.43 ± 0.28), Thrips (0.38 ± 0.22), Hairy caterpillar (0.21 ± 0.22), Grasshopper (0.17 ± 0.11) and shoot fly (0.11 ± 0.08) throughout the season.

Effects of public policies in the prevention of cardiovascular diseases: a systematic review of global literature.

OBJECTIVES: Given the growing interest worldwide in applying public policies to improve human health, we undertook a systematic review of studies investigating whether public policies targeting unhealthy products could reduce cardiovascular diseases. STUDY DESIGN: This study was a systematic review of the literature. METHODS: We searched research studies published in 2000-2020 from major databases, including MEDLINE and Embase. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and narratively synthesized the studies based on vote counting and direction of the intervention effect. RESULTS: Ninety-eight studies, mostly from high-income countries, met the inclusion criteria. Most studies were on public policies targeting sugar-sweetened beverages and tobacco, followed by alcohol, sugar, salt, and junk foods. Overall, many reported that several fiscal, regulatory, and educational policies generated beneficial effects of reducing the diseases. Those studies that reported no or limited effects highlighted several sociodemographic and health risk characteristics and design and implementation aspects of the policy interventions as factors limiting the policy effects; most of these are modifiable with appropriate policy interventions. For instance, low magnitude of tax, substitution with other unhealthy products, firms' competitive response strategies, pre-existence of smoking bans, incremental enactment of smoking regulations, degree of enforcement, and various sociocultural factors minimized the effects of the policies. CONCLUSION: The literature supports a growing consensus on the beneficial effects of public policy for improving human health. The design and implementation of public policies must address various impeding factors and incorporate appropriate remedial measures. Further research is needed from low- and middle-income countries and on whether and how multiple policy instruments work in tandem.

Scoping Review of Existing Evaluations of Smokeless Tobacco Control Policies: What Is Known About Countries Covered, Level of Jurisdictions, Target Groups Studied, and Instruments Evaluated?

OBJECTIVE: The implementation of smokeless tobacco control policies lags behind those for smoking. This scoping review summarizes the studies that evaluated public policies on smokeless tobacco regulation (SLT) and provides an overview of the jurisdictional level, target groups, and policy instruments. METHODS: Seven databases were systematically searched for studies reporting on public policies regulating SLT. Two reviewers independently screened all studies. Data extraction was performed using a predefined extraction form. Extraction was replicated for 10% of the identified studies for quality assurance. A narrative synthesis of the included studies was used to analyze and interpret the data. The protocol was published beforehand with the Open Science Foundation (OSF). RESULTS: Fourty articles comprising 41 studies were included. Most of the studies reported in the articles were conducted in the United States (n = 17) or India (n = 14). Most studies reported outcomes for students (n = 8), retailers/sellers (n = 8), and users/former users (n = 5). The impact of public policies on smokeless tobacco use, in general, was most frequently assessed (n = 9), followed by the impact of taxes (n = 7), product bans (n = 6), sales/advertising bans near educational institutions (n = 4), and health warnings (n = 3) on consumer behavior. CONCLUSIONS: There are significant gaps in the evaluation of smokeless tobacco regulation studies that need to be filled by further research to understand the observed outcomes. WHO reporting on Framework Convention on Tobacco Control (FCTC) implementation should be linked to studies evaluating smokeless tobacco control measures at all levels of jurisdictions and in countries not members of the WHO FCTC or do not provide data. IMPLICATION: Large gaps in the evaluation of SLT control policies exist. For some countries, WHO FCTC evaluations are available for different levels of jurisdictions. In countries with a strong federal structure, there is a lack of data beyond the national level to provide a more detailed look at compliance, indirect effects, or implementation gaps. More research is needed at all levels of jurisdictions, which add to the work of the WHO to understand what works for which target group, how the different levels of jurisdiction interact, how the real-world context can be incorporated, and what indirect effects may occur.

Management of Choledocholithiasis: Should We Remove the Bile Duct?

Retrieval of stone by endoscopic papillotomy, laparoscopic choledochotomy or open choledochotomy is the treatment of choice for choledocholithiasis. Published literature shows that the recurrence rate is 4% to 24% with existing method of treatment. We have treated 8 patients who admitted with recurrent choledocholithiasis in the department of Hepato-Biliary-Pancreatic and Liver Transplant Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh in the period of January 2016 to December 2019. None had intrahepatic duct abnormality or stones. All patients underwent either ERCP stenting, open choledocholithotomy or both 16 to 84 months back. Management policy is designed and outcome is observed on these patients. There were 3 males and 5 females; age ranges 18 to 60 years. The common bile duct (CBD) diameter of all patient ranges from 15 to 24mm. The shape of CBD is different from normal variant; S shaped, saculated, grossly dilated with terminal narrowing. Considering the anatomical abnormality and recurrence of disease we have removed the abnormal part of common bile duct along with stones and the operation was completed by Roux-en-Y hepaticojejunostomy. All patients were completely symptom free for 6 to 48 months after surgery. Removal of abnormal part of common bile duct with reconstruction in the form of Roux-en-Y hepatico-jejunostomy may be considered for treating choledocholithiasis with abnormal CBD (abnormally dilated, abnormally shaped, angulated or sacculated) however, long-term follow up is required for final comment.

A comprehensive review on the documented characteristics of four Reticulitermes termites (Rhinotermitidae, Blattodea) of China.

Termites are known as social insects worldwide. Presently in China 473 species, 44 genera and 4 families of termites have been reported. Of them, 111 Reticulitermes species are widely spread in different zones of China. The dispersion flight season of these Chinese Reticulitermes species are usually started from February to June, but in some regions different species are distributed, sharing their boundaries and having overlapping flight seasons. These reasons become important sources of hybridization between two different heterospecific populations of termites. It was confirmed that the fertilized eggs and unfertilized eggs of some Reticulitermes termites have the capacity of cleavage. While the unfertilized eggs of R. aculabialis, R. chinensis and R. labralis cleaved normally and the only R. aculabialis unfertilized eggs develop in embryos. While, the R. flaviceps and R. chinensis were observed with their abnormal embryonic development, and not hatching of eggs parthenogenetically. They were reported more threatening to Chinese resources as they propagate with parthenogenesis, hybridization and sexual reproduction. Eggshell and macrophiles of eggs play important roles in species identification and control. Although, they are severe pests and cause a wide range of damages to wooden structures and products in homes, buildings, building materials, trees, crops, and forests in China's Mainland.