Determination and detoxification of aflatoxin and ochratoxin in maize from different regions of Pakistan.

The contamination of food commodities with mycotoxins could be a serious health threat to humans and animals. Therefore, identification, quantification and reduction of mycotoxins in food commodities, particularly of aflatoxins (AFs) and ochratoxin A (OTA) in grain foods, is essentially required to guarantee safe food. This study determined the levels of AFs and OTA in 135 maize grains samples belonging to eight salient maize varieties cultivated in Pakistan, and evaluated the usefulness of radiations and adsorbents to reduce their levels. High performance liquid chromatography (HPLC)-based method was validated for the determination of AFs and OTA in maize grains. The results showed that 69 and 61% samples were positive for AFs and OTA, respectively and 54 and 22% of the respective samples had AFs and OTA above the permissible limits set by Pakistan Standards and Quality Control Authority. The concentration of AFs, AFB1and OTA in grains ranged from 14.5 to 92.4, 1.02 to 2.46 and 1.41 to 53.9 µg kg-1, respectively. Among the varieties, Pearl had the highest level of total AFs and OTA, whereas YH-5427 had the highest AFB1 level. The lowest concentration of AFs and OTA was found in Malaka and 30Y87, respectively. The use of 15 kGy gamma irradiation for 24 h, sunlight-drying for 20 h and UV irradiation for 12 h almost completely degraded the mycotoxins. The microwave heating for 120 s resulted in 9-33% degradation of mycotoxins. Moreover, the treatment of grains' extract with activated charcoal (5% w/w) removed > 96% of total AFs and AFB1, and up to 43% of OTA. The use of bentonite at the same rate removed OTA, total AFs and AFB1 by 93, 73 and 92%, respectively. Thus, it is concluded that contamination of maize grains with mycotoxins was fairly high in the collected maize grain samples in Pakistan, and treatment with radiations and adsorbents can effectively reduce mycotoxins contamination level in maize grains.

Do morbidity measures predict the decline of activities of daily living and instrumental activities of daily living amongst older inpatients? A systematic review.

OBJECTIVES: Older adults often suffer from multimorbidity, which results in hospitalisations. These are often associated with poor health outcomes such as functional dependence and mortality. The aim of this review was to summarise the current literature on the capacities of morbidity measures in predicting activities of daily living (ADL) and instrumental activities of daily living (IADL) amongst inpatients. METHODS: A systematic literature search was performed using four databases: Medline, Cochrane, Embase, and Cinahl Central from inception to 6th March 2019. Keywords included comorbidity, multimorbidity, ADL, and iADL, along with specific morbidity measures. Articles reporting on morbidity measures predicting ADL and IADL decline amongst inpatients aged 65 years or above were included. RESULTS: Out of 7334 unique articles, 12 articles were included reporting on 7826 inpatients (mean age 77.6 years, 52.7% females). Out of five morbidity measures, the Charlson Comorbidity Index was most often reported. Overall, morbidity measures were poorly associated with ADL and IADL decline amongst older inpatients. CONCLUSION: Morbidity measures are poor predictors for ADL or IADL decline amongst older inpatients and follow-up duration does not alter the performance of morbidity measures.

Implantable devices for heart failure monitoring and therapy.

Heart failure (HF), the cardiovascular epidemic of the twenty-first century, is associated with significant comorbidities and high mortality. The prevalence of HF is estimated around 6.5 million people and is expected to increase to 8 million by the year 2030. The associated costs to care for these patients continue to increase. Despite the advancement of pharmacologic therapy with significant improvement in morbidity and mortality, the 5-year survival for heart failure still stands at 61%. The challenges faced by HF patients include difficulty with lifestyle modifications, nonadherence to complex medical regimens, financial limitations, lack of access to medical care, and unfavorable side effects. The sickest HF patients, who are ACC/AHA stage D, have advanced therapeutic options such as left ventricular assist devices and orthotopic heart transplant; however, the majority of patients are ACC/AHA stage C and/or not candidates for such advanced care. With constraints placed on hospitals by Medicare on HF readmissions as well as the multiple comorbidities imposed by this disease, intense interest is focused on the development of implantable devices as add-on therapy. This review discusses the innovative devices under varying stages of investigation or approved for monitoring and treatment of HF.

A preliminary study on benthic nutrient exchange across sediment-water interfaces in a shallow marine protected area of the Northwestern Arabian Gulf.

Sedimentary processes are expected to play a crucial role in macronutrient cycling of the shallow Arabian Gulf. To investigate this aspect, sediment cores were collected from the shallow intertidal and subtidal expanses of the first Marine Protected Area (MPA) of Kuwait in the Northwestern Arabian Gulf (NAG). Porewater nutrient profiling and whole core incubation experiments were conducted to measure the nutrient fluxes, both with and without the addition of the nitrification inhibitor allylthiourea (ATU). The porewater data confirmed the potential of sediments to host multiple aerobic and anaerobic pathways of nutrient regeneration. The average (±SD) of net nutrient fluxes from several incubation experiments indicated that ammonium (NH4+) predominantly fluxed out of the sediment (3.81 ± 2.53 mmol m-2 d-1), followed by SiO44- (3.07 ± 1.21 mmol m-2 d-1). In contrast, the average PO43- flux was minimal, at only 0.06 ± 0.05 mmol m-2 d-1. Fluxes of NO3- (ranged from 0.07 ± 0.005 to 1.16 ± 0.35 mmol m-2 d-1) and NO2- (0.03 ± 0.003 to 0.71 ± 0.21 mmol m-2 d-1) were moderate, which either reduced or reversed in the presence of ATU (-0.001 ± 0.0001 to 0.01 ± 0.0001 mmol m-2 d-1 and -0.001 ± 0.0003 to 0.006 ± 0.001 mmol m-2 d-1 for NO3- and NO2- respectively). Thus, this study provides preliminary experimental evidence that nitrification can act as a source of NO3- and NO2- as well as contribute towards the relatively high concentrations of NO2- (>1 in the gulf waters.

Lead Toxicity-Mediated Growth and Metabolic Alterations at Early Seedling Stages of Maize (Zea mays L.).

To investigate the toxic effects of lead (Pb) on key metabolic activities essential for proper germination and seedling growth of maize seeds, experiments were carried out with different levels of Pb (0 to 120 mg of Pb L-1 as PbCl2) applied through growth medium to two maize hybrids H-3310S and H-6724. The research findings indicated that growth and metabolic activities were adversely affected by increased Pb contamination in growth medium; however, a slow increase in these parameters was recorded with increasing time from 0 to 120 h. Protease activity decreased with an increase in the level of Pb contamination but increased with time; consequently, a reduction in seed proteins and an increase in total free amino acids were observed with time. Similarly, α-amylase activity decreased with an increase in Pb concentration in growth medium while it increased with increasing time from 0 to 120 h; consequently, reducing and non-reducing sugars increased with time but decreased with exposure to lead. The roots of both maize hybrids had higher Pb contents than those of the shoot, which decreased the uptake of nitrogen, phosphorus, and potassium. All these nutrients are essential for optimal plant growth; therefore, the reduction in growth and biomass of maize seedlings could be due to Pb toxicity that altered metabolic processes, as sugar and amino acids are necessary for the synthesis of metabolic compounds, rapid cell division, and proper functioning of enzymes in the growing embryo, but all were dramatically reduced due to suppression of protease and α-amylase by toxicity of Pb. In general, hybrid H-3310S performed better in Pb-contaminated growth medium than H-6724.

Pancytopenia Resulting From Low-Dose Methotrexate Use: A Diagnostic Challenge.

Rheumatoid arthritis (RA) is a common autoimmune disease primarily affecting small joints which leads to crippling erosion of the articular cartilage and bone. It is associated with complications related to both its disease course and treatment. Methotrexate (MTX) is a folate antagonist responsible for modulating cell-specific signaling pathways and inhibiting the proinflammatory properties of major cell lineages involved in the pathogenesis of RA. It is considered to be the first-line agent in RA because of its disease-modifying ability and safety profile at low doses. This case report discusses how a middle-aged female presented with severe bone marrow suppression secondary to MTX toxicity, an unusual presentation at the usual low-dose regimen. Her presentation overlapped with several other conditions, especially with Felty's syndrome, a rare complication of RA, characterized by the triad of splenomegaly, neutropenia, and RA. Other differentials included hemophagocytic lymphohistiocytosis, hematologic neoplasms, drug reaction, and infection. Therefore, it was essential to exclude all possible differentials before initiating therapy. We found the corrected reticulocyte count coupled with a good response to leucovorin to be an effective way to differentiate MTX-induced pancytopenia from other possible hematologic diagnoses without the use of a bone marrow biopsy. Additionally, our case incidentally demonstrated a potential interaction between piperacillin/tazobactam and MTX.

Impact of physical processes on oxygen loss and production of hydrogen sulphide and methane in a tropical freshwater reservoir.

Carbon neutrality of tropical reservoirs is a big concern in recent years as some estimates project high methane emission from these reservoirs. While there are studies available on the impact of physical processes (stratification and mixing) on the biogeochemistry of tropical reservoirs, not much information is available on the inter-annual variability in the low-oxygen conditions and production/accumulation of hydrogen sulphide (H2S) and methane (CH4) during summer. This paper presents time series data based on monthly in situ observations from a tropical reservoir (Tillari, Maharashtra) situated in the Western Ghats in India. Sampling was carried out for temperature, dissolved oxygen (DO), H2S, and CH4 at a fixed location from March 2010 until June 2014. The reservoir experiences stable stratification during summer (March to June) with complete loss of oxygen and production of H2S (max. ~ 9 µM) and CH4 (max. ~ 185 µM) in the profundal zone. During the summer stratification, the hypolimnion acted as a pool of CH4 with integrated values ranging between 3502 and 41,632 mg m-2. However, the intensity and duration of anoxia varied during different years, influencing H2S and CH4 production. Mixing in the reservoir was observed between July and September in association with the monsoonal runoff, which increased the DO concentrations in the sub-surface layers. Besides, complete mixing was observed between December and February due to winter convection. This, however, was found to play an important role, as weaker mixing in the preceding year was associated with severe oxygen loss in the profundal zone during the following summer with a production of H2S and CH4. In contrast, more robust mixing during winter led to moderate low-oxygen conditions with less production of these gases in the subsequent summer. Based on our observations and considering a large number of reservoirs in the tropics, we hypothesise that with the present trends of global warming and less cold winters, low-oxygen conditions in the profundal zone may become more severe in the future with positive feedback on H2S and CH4 production during summer.

Morbidity Measures Predicting Mortality in Inpatients: A Systematic Review.

OBJECTIVES: Morbidity is an important risk factor for mortality and a variety of morbidity measures have been developed to predict patients' health outcomes. The objective of this systematic review was to compare the capacity of morbidity measures in predicting mortality among inpatients admitted to internal medicine, geriatric, or all hospital wards. DESIGN: A systematic literature search was conducted from inception to March 6, 2019 using 4 databases: Medline, Embase, Cochrane, and CINAHL. Articles were included if morbidity measures were used to predict mortality (registration CRD42019126674). SETTING AND PARTICIPANTS: Inpatients with a mean or median age ≥65 years. MEASUREMENTS: Morbidity measures predicting mortality. RESULTS: Of the 12,800 articles retrieved from the databases, a total of 34 articles were included reporting on inpatients admitted to internal medicine, geriatric, or all hospital wards. The Charlson Comorbidity Index (CCI) was reported most frequently and a higher CCI score was associated with greater mortality risk, primarily at longer follow-up periods. Articles comparing morbidity measures revealed that the Geriatric Index of Comorbidity was better predicting mortality risk than the CCI, Cumulative Illness Rating Scale, Index of Coexistent Disease, and disease count. CONCLUSIONS AND IMPLICATIONS: Higher morbidity measure scores are better in predicting mortality at longer follow-up period. The Geriatric Index of Comorbidity was best in predicting mortality and should be used more often in clinical practice to assist clinical decision making.

Are patients on oral anticoagulation therapy aware of its effects? A cross-sectional study from Karachi, Pakistan.

OBJECTIVE: Oral anticoagulants are one of the most frequently used medications. However, these drugs have a range of side effects including potential life-threatening complications. Little is known regarding the awareness of its side effect profile amongst the patients in Pakistan. Therefore, the aim of this study was to assess the knowledge of oral anticoagulant therapy and its side effects among its users. RESULTS: The mean age was 48.9 ± 15.2 years. Median scores of the participants for knowledge regarding oral anticoagulants and warfarin were 48.7 (8.3-91.7) and 10.3 (0.0-70.0) respectively. Of 207 patients, most notably, 65.7% did not know what side effects to be wary of or how to reduce their occurrence; and most patients were unaware of the interaction between oral anticoagulant drugs and over-the-counter substances such as aspirin, herbal medicines and alcohol. Knowledge of international normalised ratio (INR) was extremely poor with more than 75% of the population not being aware of the target INR range during warfarin therapy. Higher level of education was significantly associated with better knowledge scores. Overall, knowledge of oral anticoagulant therapy and INR monitoring is extremely poor among oral anticoagulant users.

Impact of insulin pump on quality of life of diabetic patients.

AIM: Diabetes is an emerging health problem, both in developing and developed countries and has an enormous economic and social impact. The objective of our study was to find the impact of insulin pump on the quality of life of patients with type 2 diabetes (T2D) and compare it to the quality of life of patients with T2D using an insulin pen. SUBJECTS AND METHODS: This is a case-control study which was conducted among patients with T2D presenting between November 2014 and November 2015. A total of 83 patients with T2D, using insulin pump were enrolled in the study as cases and 322 patients with T2D not using insulin pump but using insulin pens were enrolled as controls. Short form-36 quality of life questionnaire was used for data collection. RESULTS: Mean age of patients using insulin pump was 52.49 ± 9.28 while the mean age of patients not using insulin pump was 54.72 ± 16.87. Mean score of all domains in the questionnaire was found to be higher in patients using insulin pump as compared to patients not using insulin pumps (P < 0.05). In 81.1% of the patients, the insulin pump decreased the frequency of hypoglycemic episodes. CONCLUSION: Insulin pump has significantly improved the quality of life of patients in terms of better self-esteem, decreased stress, and better mood. It has resulted in improved physical health, meal time flexibility, and ease of travel. It allows patient to have more active participation in social and recreational activities improving their personal and family life.

Mechanical Pre-Conditioning With Acute Circulatory Support Before Reperfusion Limits Infarct Size in Acute Myocardial Infarction.

OBJECTIVES: This study tested the hypothesis that first reducing myocardial work by unloading the left ventricle (LV) with a novel intracorporeal axial flow catheter while delaying coronary reperfusion activates a myocardial protection program and reduces infarct size. BACKGROUND: Ischemic heart disease is a major cause of morbidity and mortality worldwide. Primary myocardial reperfusion remains the gold standard for the treatment of an acute myocardial infarction (AMI); however, ischemia-reperfusion injury contributes to residual myocardial damage and subsequent heart failure. Stromal cell-derived factor (SDF)-1α is a chemokine that activates cardioprotective signaling via Akt, extracellular regulated kinase, and glycogen synthase kinase-3ß. METHODS: AMI was induced by occlusion of the left anterior descending artery (LAD) via angioplasty for 90 min in 50-kg male Yorkshire swine (n = 5/group). In the primary reperfusion (1° Reperfusion) group, the LAD was reperfused for 120 min. In the primary unloading (1° Unloading) group, after 90 min of ischemia the axial flow pump was activated and the LAD left occluded for an additional 60 min, followed by 120 min of reperfusion. Myocardial infarct size and kinase activity were quantified. RESULTS: Compared with 1° Reperfusion, 1° Unloading reduced LV wall stress and increased myocardial levels of SDF-1α, CXCR4, and phosphorylated Akt, extracellular regulated kinase, and glycogen synthase kinase-3ß in the infarct zone. 1° Unloading increased antiapoptotic signaling and reduced myocardial infarct size by 43% compared with 1° Reperfusion (73 ± 13% vs. 42 ± 8%; p = 0.005). Myocardial levels of SDF-1 correlated inversely with infarct size (R = 0.89; p < 0.01). CONCLUSIONS: Compared with the contemporary strategy of primary reperfusion, mechanically conditioning the myocardium using a novel axial flow catheter while delaying coronary reperfusion decreases LV wall stress and activates a myocardial protection program that up-regulates SDF-1α/CXCR4 expression, increases cardioprotective signaling, reduces apoptosis, and limits myocardial damage in AMI.

Biogeochemistry and ecology of Pyrosoma spinosum from the Central Arabian Sea.

BACKGROUND: A swarm of pelagic tunicate (Pyrosoma spinosum) was found in the surface open waters of the Arabian Sea during late southwest monsoon (September 2007). The swarm site was characterized by moderate southwesterly wind (approximately 7 m s-1), relatively low sea-surface temperature (approximately 26°C), shallow mixed layer (approximately 50 m), and substantial macro-nutrient concentrations (surface values: 2.5 µM nitrate, 0.3 µM phosphate, 0.9 µM silicate, and 5.0 µM ammonium). Despite adequate macronutrient availability, the swarm site was characterized by low diversity of phytoplankton (>5 µm) and mesozooplankton in the upper 200 m. Low chlorophyll a concentration (27.3 mg/m2 in the upper 120 m) at the swarm site was dominated (90% to 95% in the upper 40 m) by the Synechococcus (20 × 106 /ml). RESULTS: Silicate deficiency in surface waters upwelled or entrained from the thermocline may be a key factor for the dominance of smaller autotrophs (flagellates and cyanobacteria) that seems to offer favorable conditions for episodic occurrence of swarms of these filter feeders. Low carbon content (37% of total dry weight) and the lower molar(carbon-to-nitrogen) ratio (5) in P.spinosum suggestgrowth of these organisms is carbon-limited. CONCLUSIONS: Wedescribe various physicochemical and biological conditions at the P.spinosum swarmlocation and at two other nearby sites not affected by it. The biological factors predominantly high densities of Synechococcus and flagellates were best suited conditions for the proliferation of pyrosome biomass in the central Arabian Sea.

Geographic disparities in arteriovenous fistula placement in patients approaching hemodialysis in the United States.

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD). Several factors associated with AVF placement have been identified (e.g., age, sex, race, comorbidities). We hypothesized that geographic location of patient residence might be associated with the probability of AVF placement as the initial access. We used the data from the United States Renal Data System (USRDS) database (2005-2008) linked to Medicare claims (2003-2008). Logistic regression was used to estimate specific characteristics of population associated with the AVF as first access placed or attempted for HD initiation. Our primary variable of interest was the geographic location, and the multivariate model was adjusted for age, sex, race, body mass index, primary cause of end-stage renal disease (ESRD), duration of pre-ESRD nephrology care, comorbidities, employment status, substance abuse, and income. Geographic location was determined using the data collected by the RUCA project and divided population into metropolitan, micropolitan, and rural categories. Patients (n = 111,953) identified from the USRDS database with linked Medicare claims were examined. Rates of fistula placement in the metropolitan, micropolitan, and rural population were 18.5%, 22.4%, and 21.6%, respectively. In comparison, patients who received catheter as the first access were 81.5%, 77.6% and 78.4%, respectively. The odds ratio of AVF placement as a first HD access in the rural and metropolitan population compared with the micropolitan population were 0.96 (0.90-1.03; P = 0.26) and 0.80 (0.76-0.84; P < 0.001), respectively. Our results indicate the presence of geographic disparities in AVF placement with decreased rates of AVF as the first access created in the metropolitan (but not rural) populations compared with the micropolitan communities.