Xylem hydraulics strongly influence the niche differentiation of tree species along the slope of a river valley in a water-limited area.

Xylem hydraulic characteristics govern plant water transport, affecting both drought resistance and photosynthetic gas exchange. Therefore, they play critical roles in determining the adaptation of different species to environments with various water regimes. Here, we tested the hypothesis that variation in xylem traits associated with a trade-off between hydraulic efficiency and safety against drought-induced embolism contributes to niche differentiation of tree species along a sharp water availability gradient on the slope of a unique river valley located in a semi-humid area. We found that tree species showed clear niche differentiation with decreasing water availability from the bottom towards the top of the valley. Tree species occupying different positions, in terms of vertical distribution distance from the bottom of the valley, showed a strong trade-off between xylem water transport efficiency and safety, as evidenced by variations in xylem structural traits at both the tissue and pit levels. This optimized their xylem hydraulics in their respective water regimes. Thus, the trade-off between hydraulic efficiency and safety contributes to clear niche differentiation and, thereby, to the coexistence of tree species in the valley with heterogeneous water availability.

Comparison of 3 Days Amoxicillin Versus 5 Days Co-Trimoxazole for Treatment of Fast-breathing Pneumonia by Community Health Workers in Children Aged 2-59 Months in Pakistan: A Cluster-randomized Trial.

BACKGROUND: Globally, most deaths due to childhood pneumonia occur at the community level. Some countries are still using oral co-trimoxazole, despite a World Health Organization recommendation of oral amoxicillin for the treatment of fast-breathing pneumonia in children at the community level. METHODS: We conducted an unblinded, cluster-randomized, controlled-equivalency trial in Haripur District, Pakistan. Children 2-59 months of age with fast-breathing pneumonia were treated with oral amoxicillin suspension (50 mg/kg/day) for 3 days in 14 intervention clusters and oral co-trimoxazole suspension (8 mg trimethoprim/kg and 40 mg sulfamethoxazole/kg/day) for 5 days in 14 control clusters by lady health workers (LHW). The primary outcome was treatment failure by day 4 for intervention clusters and by day 6 for control clusters. The analysis was per protocol. RESULTS: Out of the 15 749 cases enrolled in the study, 9153 cases in intervention and 6509 cases in control clusters were included in the analysis. Treatment failure rates were 3.6% (326) in intervention clusters and 9.1% (592) in control clusters. After adjusting for clustering, the risk of treatment failure was lower in intervention clusters (risk difference [RD] -5.5%, 95% confidence interval [CI] -7.4--3.7%) than in control clusters. Children with incomplete adherence had a small increase in treatment failure versus those with complete adherence (RD 2.9%, 95% CI 1.6-4.1%). No deaths or serious adverse events occurred. CONCLUSIONS: A 3-day course of oral amoxicillin, administered by LHWs, is an effective and safe treatment for fast-breathing pneumonia in children 2-59 months of age. A shorter course of amoxicillin improves adherence to therapy, is low in cost, and puts less pressure on antimicrobial resistance. CLINICAL TRIALS REGISTRATION: ISRCTN10618300.

Evaluation of postoperative antibiotics after non-perforated appendectomy.

OBJECTIVE: To evaluate the role of postoperative antibiotics in reducing surgical site infections after appendectomy for non-perforated appendicitis. METHODS: The randomised controlled trial was conducted at Khyber Teaching Hospital, Peshawar, Pakistan, from November 11, 2012, to May 30, 2014, and comprised patients of emergency appendectomy for non-perforated appendicitis who were divided into groups A and B. Group A received a single dose of cefuroxime sodium and metronidazole half-an-hour before induction, while Group B received one more dose of the same antibiotics postoperatively. Both groups were followed for 6 weeks. SPSS 20 was used for statistical analysis. RESULTS: Of the 390 patients in the study, 192(49.2%) were in Group A and 198(50.7%) in Group B. Number of surgical site infections was 15(7.8%) in Group A and 18(9.1%) in Group B (p=0.65). Mean hospital stay of 3.32±0.4 days and 3.59±0.46 days was observed for Group A and B, respectively, (p<0.001). CONCLUSIONS: A single pre-operative dose of cefuroxime and metronidazole had the same efficacy in preventing surgical site infections in cases of non-perforated appendicitis as when the same regimen was repeated post-operatively.

FREQUENCY OF ABDOMINAL OBESITY AND ITS ASSOCIATION WITH DIABETES MELLITUS AMONG PEOPLE OF PESHAWAR.

BACKGROUND: Increased body weight is a major risk factor for the metabolic syndrome which is a cluster of coronary heart disease risk factors, like: hypertension, diabetes mellitus and dyslipidaemia. This study was conducted to determine the frequency of abdominal obesity and diabetes mellitus in the population of Peshawar and association between them. METHODS: This was a cross sectional study, performed by the Cardiology Department, Lady Reading Hospital Peshawar, in the population of Peshawar. All participants were interviewed in detail regarding known risk factors for coronary artery disease. Waist circumference (≥102 cm in male and ≥88 cm in females) was used as the surrogate marker for abdominal obesity in already diagnosed patients of type-2 diabetes mellitus. RESULTS: A total of 2548 individuals were included, 71.1% were male. Mean age was 37.94±12.59 years. Mean waist circumference was 90.25±13.45cm in males and 90.52±12.52cm in females. Diabetes was present in 4.4% of the participants and abdominal obesity in 56.6% Among the male, abdominal obesity was present in 39.4% and diabetes in 2.9%. Out of 39.4% males with abdominal obesity, 2% were diabetic. Out of 38.6% males with no abdominal obesity, 0.9% was diabetic. Amongst the total 559 (21.1%) female subjects, 17.2% were having abdominal obesity and 1.4% was diabetics. Among 123 (4.8%) females with no abdominal obesity, 0.1% was diabetic. A positive association was established between abdominal obesity and diabetes mellitus with a significant p-valve (<0.05). CONCLUSION: Abdominal obesity is more common in the local population of Peshawar and associated with type-2 diabetes mellitus.

Community case management of severe pneumonia with oral amoxicillin in children aged 2-59 months in Haripur district, Pakistan: a cluster randomised trial.

BACKGROUND: First dose oral co-trimoxazole and referral are recommended for WHO-defined severe pneumonia. Difficulties with referral compliance are reported in many low-resource settings, resulting in low access to appropriate treatment. The objective in this study was to assess whether community case management by lady health workers (LHWs) with oral amoxicillin in children with severe pneumonia was equivalent to current standard of care. METHODS: In Haripur district, Pakistan, 28 clusters were randomly assigned with stratification in a 1:1 ratio to intervention and control clusters by use of a computer-generated randomisation sequence. Children were included in the study if they were aged 2-59 months with WHO-defined severe pneumonia and living in the study area. In the intervention clusters, community-based LHWs provided mothers with oral amoxicillin (80-90 mg/kg per day or 375 mg twice a day for infants aged 2-11 months and 625 mg twice a day for those aged 12-59 months) with specific guidance on its use. In control clusters, LHWs gave the first dose of oral co-trimoxazole (age 2-11 months, sulfamethoxazole 200 mg plus trimethoprim 40 mg; age 12 months to 5 years, sulfamethoxazole 300 mg plus trimethoprim 60 mg) and referred the children to a health facility for standard of care. Participants, carers, and assessors were not masked to treatment assignment. The primary outcome was treatment failure by day 6. Analysis was per protocol with adjustment for clustering within groups by use of generalised estimating equations. This study is registered, number ISRCTN10618300. FINDINGS: We assigned 1995 children to treatment in 14 intervention clusters and 1477 in 14 control clusters, and we analysed 1857 and 1354 children, respectively. Cluster-adjusted treatment failure rates by day 6 were significantly reduced in the intervention clusters (165 [9%] vs 241 [18%], risk difference -8·9%, 95% CI -12·4 to -5·4). Further adjustment for baseline covariates made little difference (-7·3%, -10·1 to -4·5). Two deaths were reported in the control clusters and one in the intervention cluster. Most of the risk reduction was in the occurrence of fever and lower chest indrawing on day 3 (-6·7%, -10·0 to -3·3). Adverse events were diarrhoea (n=4) and skin rash (n=1) in the intervention clusters and diarrhoea (n=3) in the control clusters. INTERPRETATION: Community case management could result in a standardised treatment for children with severe pneumonia, reduce delay in treatment initiation, and reduce the costs for families and health-care systems. FUNDING: United States Agency for International Development (USAID).

Limited Acclimation in Leaf Morphology and Anatomy to Experimental Drought in Temperate Forest Species.

Drought is a critical and increasingly common abiotic factor that has impacts on plant structures and functioning and is a challenge for the successful management of forest ecosystems. Here, we test the shifts in leaf morpho-anatomical or hydraulic traits and plant growth above ground caused by drought. A factorial experiment was conducted with two gymnosperms (Larix gmelinii and Pinus koraiensis) and two angiosperms (Fraxinus mandshurica and Tilia amurensis), tree species grown under three varying drought intensities in NE China. Considering all the species studied, the plant height (PH), root collar diameter (RCD), and plant biomass (PB) were significantly decreased by drought. The leaf thickness (LT) increased, while the leaf area (LA) decreased with drought intensity. In the gymnosperms, the mesophyll thickness (MT) increased, and the resin duct decreased, while in the angiosperms the palisade mesophyll thickness (PMT), the spongy mesophyll thickness (SMT), and the abaxial (ABE) and adaxial epidermis (ADE) thickness were increased by drought. The correlation analysis revealed that P. koraiensis and F. mandshurica had the higher RMF and total plant biomass, but the least LMF, suggesting drought tolerance. In contrast, the L. gmelinii had the least RMF and higher LMF, suggesting vulnerability to drought. Similarly, T. amurensis had the higher leaf size, which increased the evaporative demand and depleted the soil water quickly relative to the other species. The interrelation among the morpho-anatomical leaf traits was equally affected by drought across all the studied species, suggesting that there is no clear evidence to differentiate the taxa based on drought resistance vs. drought tolerance. Thus, we have identified some easily measurable traits (i.e., LMF, RMF, and PB) which evidenced the seedling's ability to cope with drought and which therefore could be used as proxies in the selection of drought tolerant species for reforestation in the temperate forest.

The Impact of Swine Manure Biochar on the Physical Properties and Microbial Activity of Loamy Soils.

Biochar has been proven to influence soil hydro-physical properties, as well as the abundance and diversity of microbial communities. However, the relationship between the hydro-physical properties of soils and the diversity of microbial communities is not well studied in the context of biochar application. The soil analyzed in this study was collected from an ongoing field experiment (2019-2024) with six treatments and three replications each of biochar (B1 = 25 t·ha-1 and B0 = no biochar) and nitrogen fertilizer (N1 = 160, N2 = 120 kg·ha-1, and N0 = no fertilizer). The results show that biochar treatments (B1N0, B1N1, and B1N2) significantly improved the soil bulk density and total soil porosity at different depths. The B1N1 treatment substantially enhanced the volumetric water content (VMC) by 5-7% at -4 to -100 hPa suction at 5-10 cm depth. All three biochar treatments strengthened macropores by 33%, 37%, and 41%, respectively, at 5-10 cm depth and by 40%, 45%, and 54%, respectively, at 15-20 cm depth. However, biochar application significantly lowered hydraulic conductivity (HC) and enhanced carbon source utilization and soil indices at different hours. Additionally, a positive correlation was recorded among carbon sources, indices, and soil hydro-physical properties under biochar applications. We can summarize that biochar has the potential to improve soil hydro-physical properties and soil carbon source utilization; these changes tend to elevate fertility and the sustainability of Cambisol.

Effects of Increased N Deposition on Leaf Functional Traits of Four Contrasting Tree Species in Northeast China.

Northeast China is persistently affected by heavy nitrogen (N) deposition. Studying the induced variation in leaf traits is pivotal to develop an understanding of the adaptive plasticity of affected species. This study thus assesses effects of increased N deposition on leaf morphological and anatomical traits and their correlation among and with biomass allocation patterns. A factorial experiment was conducted utilizing seedlings of two gymnosperms (Larix gmelinii, Pinus koraiensis) and two angiosperms (Fraxinus mandshurica, Tilia amurensis). Leaf mass per area and leaf density decreased and leaf thickness increased under high N deposition but trait interrelations remained stable. In gymnosperms, leaf mass per area was correlated to both leaf thickness and area, while being correlated to leaf density only in angiosperms. Epidermis, mesophyll thickness, conduit and vascular bundle diameter increased. Despite the differences in taxonomic groups and leaf habits, the common patterns of variation suggest that a certain degree of convergence exists between the species' reaction towards N deposition. However, stomata pore length increased in angiosperms, and decreased in gymnosperms under N deposition. Furthermore, biomass and leaf mass fraction were correlated to leaf traits in gymnosperms only, suggesting a differential coordination of leaf traits and biomass allocation patterns under high N deposition per taxonomic group.

Hirschsprung's Disease: A Rare Entity in Adults.

Hirschsprung's disease (HD), a classic disease of childhood, may rarely escape diagnosis and lead to unique presentations in adults. By definition, the disease involves the rectosigmoid colon and is the result of a birth defect characterised by the absence of nerve cells responsible for the movement of the colon; thereby leading to functional obstruction. We present here a case of an 18-year girl who visited multiple doctors for the complaints of chronic constipation, abdominal distension, and failure to thrive since infancy. Based on a full-thickness rectal biopsy, she was ultimately diagnosed as a case of HD in our Unit. A defunctioning loop ileostomy for colonic decompression, followed by a Swenson Abdominoperineal Pull- Through at a six weeks interval was done, which proved curative.

Salmonella Osteomyelitis Of Ribs.

A 45-year-old diabetic male who was a farmer by profession, presented to Khyber Teaching Hospital with swelling and redness on the right side of the chest at the level of 8th rib for the past 5 months which was accompanied by fever and pain. He went to a local hospital where he was given broad spectrum antibiotics. He presented again with yellowish discharge from the wound. Dressing of the wound was done and he was referred to Khyber Teaching Hospital. On presentation, there was an open wound of about 4 cm on the right side of the chest wall at the level of 8th rib near the midclavicular line. X-ray revealed a lytic bone lesion near the costo-chondral junction of the 8th rib. CT scan also showed erosive changes at the above mention site. His fasting blood sugar was well above the normal range and his Alkaline Phosphatase was slightly raised. He was started on Insulin. Debridement and dressing were done and samples were taken for investigations. Bone tissue biopsy revealed inflammatory non-caseating tissue. Culture report was positive for Salmonella Typhi which was resistant to Ciprofloxacin. The patient was given antibiotic (co-amoxiclave) treatment to which he responded leading to a satisfactory recovery.

Receiver operator characteristic curve analysis of the Lintula score for reduction of negative appendectomies in adults.

OBJECTIVE: To evaluate the Lintula score in reducing negative appendectomies in the adult population. STUDY DESIGN: Descriptive analytical study. PLACE AND DURATION OF STUDY: Surgical Department, Khyber Teaching Hospital, Peshawar, Pakistan, from August 2012 to April 2014. METHODOLOGY: A total of 408 emergency patients with a clinical diagnosis of acute appendicitis were included in the study. True or negative appendectomy status was determined per-operatively. Lintula score was calculated afterwards and evaluated for various cut-off points. RESULTS: Among the study population, 72 (17.6%) had a normal appendix by operative assessment and 336 (82.4%) had an acutely inflammed appendix. The receiver operating characteristic curve showed that the optimal cut-off point was ≤ 21 with 100% sensitivity, 88.4% specificity and positive and negative predictive values of 97.3% and 100%, respectively. Area under the curve was 0.963 with 90.4% overall accuracy. CONCLUSION: Utilizing the Lintula cut-off point of ≤ 21, negative appendectomies, unnecessary admissions and healthcare cost can all be reduced.

Effect of community mobilization on appropriate care seeking for pneumonia in Haripur, Pakistan.

BACKGROUND: Appropriate and timely care seeking reduces mortality for childhood illnesses including pneumonia. Despite over 90 000 Lady Health Workers (LHWs) deployed in Pakistan, whose tasks included management of pneumonia, only 16% of care takers sought care from them for respiratory infections. As part of a community case management trial for childhood pneumonia, community mobilization interventions were implemented to improve care seeking from LHWs in Haripur district, Pakistan. The objective of the study was to increase the number of children receiving treatment for pneumonia and severe pneumonia by Lady Health Workers (LHWs) through community mobilization approaches for prompt recognition and care seeking in 2 to 59 month-old children. METHODS: To assess pneumonia care seeking practices, pre and post-intervention household surveys were conducted in 28 target Union Councils. Formative research to improve existing LHW training materials, job aids and other materials was carried out. Advocacy events were organized, LHWs and male health promoters were trained in community mobilization, non-functional women and male health committees were revitalized and LHWs and male health promoters conducted community awareness sessions. RESULTS: The community mobilization interventions were implemented from April 2008 - December 2009. Project and LHW program staff organized 113 sensitization meetings for opinion leaders, which were attended by 2262 males and 3288 females. The 511 trained LHWs organized 6132 community awareness sessions attended by 50 056 women and 511 male promoters conducted 523 sessions attended by 7845 males. In one year period, the number of LHWs treating pneumonia increased from 11 in April 2008 to 505 in March 2009. The care seeking from LHWs for suspected pneumonia increased from 0.7% in pre-intervention survey to 49.2% in post-intervention survey. CONCLUSION: The increase in care seeking from LHWs benefited the community through bringing inexpensive appropriate care closer to home and reducing burden on overstretched health facilities. The community mobilization interventions led to improvements in appropriate care seeking that would not have been achievable just by strengthening pneumonia case management skills of LHWs. In addition to strengthening skills, community mobilization and behavior change activities should also be included in community case management programmes.

Household costs for treatment of severe pneumonia in Pakistan.

Current World Health Organization (WHO) guidelines for severe pneumonia treatment of under-5 children recommend hospital referral. However, high treatment cost is a major barrier for communities. We compared household costs for referred cases with management by lady health workers (LHWs) using oral antibiotics. This study was nested within a cluster randomized trial in Haripur, Pakistan. Data on direct and indirect costs were collected through interviews and record reviews in the 14 intervention and 14 control clusters. The average household cost/case for a LHW managed case was $1.46 compared with $7.60 for referred cases. When the cost of antibiotics provided by the LHW program was excluded from the estimates, the cost/case came to $0.25 and $7.51 for the community managed and referred cases, respectively, a 30-fold difference. Expanding severe pneumonia treatment with oral amoxicillin to community level could significantly reduce household costs and improve access to the underprivileged population, preventing many child deaths.