BACKGROUND: The purpose of the study was to explore the association between post-traumatic stress disorder (PTSD) and work performance of emergency medical services personnel in Karachi, Pakistan. METHODS: Emergency medical service personnel were screened for potential PTSD using Impact of Event Scale-Revised (IES-R). Work performance was assessed on the basis of five variables:number of late arrivals to work, number of days absent, number of days sick, adherence to protocol, and patient satisfaction over a period of 3 months. In order to model outcomes like the number of late arrivals to work, days absent and days late, negative binomial regression was applied, whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores. RESULTS: Mean scores of PTSD were 24.0±12.2. No association was found between PTSD and work performance measures: number of late arrivals to work (RRadj 0.99; 0.98–1.00), days absent (RRadj 0.98; 0.96–0.99), days sick (RRadj 0.99; 0.98–1.00), adherence to protocol (ORadj 1.01; 0.99–1.04) and patient satisfaction (β 0.001％–0.03％) after adjusting for years of formal schooling, living status, coping mechanism, social support, working hours, years of experience and anxiety or depression. CONCLUSION: No statistically significant association was found between PTSD and work performance amongst EMS personnel in Karachi, Pakistan.

STUDY DESIGN: Cross sectional study. PURPOSE: The purpose of this study was to determine the incidence and the associated risk factors of pinhole type of durotomy and cerebrospinal fluid (CSF) leakage following a simple laminectomy for spinal stenosis. OVERVIEW OF LITERATURE: The incidence of spinal stenosis is expected to rise with increasing life expectancy. Moreover, lumbar spinal stenosis is the most common indication for spinal injury in the geriatric population. It is therefore important to identify and prevent the risks associated with laminectomy, the most widely used surgical procedure for spinal stenosis. The serious complication of incidental dural tear or durotomy and subsequent CSF leakage has not been studied in the region of Southeast Asia. METHODS: In this cross sectional study, we included 138 adult patients (age>18 years), who underwent a simple laminectomy for lumbar stenosis between 2011 and 2012. CSF leakage was the main outcome variable. Patients' wounds were examined for CSF leakage up to 1 week postoperatively. RESULTS: The incidence of pinhole type durotomy and subsequent CSF leakage in our region was 8.7%. Univariate analysis showed that hypertension, diabetes and smoking were significantly associated with durotomy and increased CSF leakage by 16.72, 44.25, and 33.71 times, respectively. Multivariate analysis showed that only smoking and diabetes significantly increased the chances of leakage. CONCLUSIONS: Glycemic control and cessation of smoking prior to a simple laminectomy procedure reduced the incidence of a dural tear. Larger clinical studies on this lethal complication are required.
Adult ; Asia, Southeastern ; Cerebrospinal Fluid* ; Constriction, Pathologic ; Dura Mater ; Humans ; Hypertension ; Incidence* ; Laminectomy* ; Life Expectancy ; Multivariate Analysis ; Risk Factors ; Smoke ; Smoking ; Spinal Injuries ; Spinal Stenosis ; Wounds and Injuries

Background: Various parts of Pandanus foetidus Roxb. are used as traditional medicines. However, scientific reports concerning the effect of this plant on central nervous system (CNS) depression and analgesia are unavailable. This study investigated the CNS depressant and antinociceptive effects of Pandanus foetidus leaf extracts in a rodent model. Methods: The sedative and anxiolytic activities of Pandanus foetidus extract (500 g) were tested using behavioural models of Swiss albino mice, and the analgesic activity was assessed by formalin-induced pain and tail immersion tests at 200 mg/kg body weight of the mice. The data were analysed by a one-way ANOVA, a repeated measure of ANOVA and a non-parametric test (Kruskal-Wallis test) using the SPSS software. Acute toxicity was tested using an established method. Results: Compared with the aqueous fraction, the methanol, petroleum ether and chloroform fractions of the extract exhibited a more significant (P < 0.001) reduction of locomotor activity in the mice in the open field, hole-cross, and elevated plus maze (EPM). The methanol fraction maximized the duration of sleeping time caused by the thiopental sodium induction. The extract produced a significant step-down in pain, as shown by the paw licking time in the early and late phases of the formalin test. In the tail immersion test, the chloroform fraction maximally reduced the heat-induced analgesia. The extract was found to be non toxic. Conclusion: The methanol, petroleum ether, and chloroform fractions of P. foetidus have strong CNS depressant and antinociceptive effects and thus merit further pharmaceutical studies.

Objective: To investigate the comparative effects of Diospyros blancoi (Ebenaceae) leaves (DBL), root bark (DBRB) and stem bark (DBSB) on free radicals and cancer. Methods: The polyphenol contents, antioxidant and free radical scavenging properties were determined using standard spectrophotometric methods. Cytotoxicity and anticancer activ-ities were performed on brine shrimp nauplii and Ehrlich ascite carcinoma cells, respectively. Results: Among the extracts, DBSB showed the highest total antioxidant capacity and reducing capacity on ferrous ion. Based on 1,1-diphenyl-2-picrylhydrazyl and hydroxyl radical scavenging activities, DBSB showed (95.760 ± 0.343)%and (67.460 ± 2.641)%scavenging with IC50 of (3.10 ± 0.17) and (50.00 ± 3.11) mg/mL, respectively. The IC50 values of standard butylated hydroxytoluene and catechin (CA) for 1,1-diphenyl-2-picrylhydrazyl and hydroxyl radicals were (8.50 ± 0.25) and (75.00 ± 0.14) mg/mL, respectively suggesting that DBSB had a significant (P < 0.05) radical scavenging ac-tivity than standards. In lipid peroxidation inhibition assay, the inhibitory activity of the extracts and the standard was in the following order: DBSB > DBRB > CA > DBL. Also, the phenolic [(139.91 ± 3.924) mg gallic acid equivalent/g] and flavonoid contents [(412.00 ± 16.70) mg catechin equivalent/g)] of DBSB were higher than that of other extracts. In addition, the DBSB showed the moderate cytotoxic and anticancer properties. Conclusions: Our results indicate that Diospyros blancoi stem bark had the significant highest antioxidant and free radical scavenging properties as well as moderate anticancer activity. Hence, we assume that the anticancer activity of this plant can be, at least in part, attributed to its content in phenolic compounds as well as its significant free radical scavenging properties.

Purpose: This study was aimed to assess the feasibility of laparoscopic rectal surgery, comparing quality of surgical specimen, morbidity, and mortality. Methods: Prospectively acquired data from consecutive patients undergoing laparoscopic surgery for rectal cancer, at 2 minimally invasive colorectal units, operated by the same team was included. Locally advanced rectal tumors were identified as T3B or T4 with preoperative magnetic resonance imaging scans. All the patients were operated on by the same team. The 1:1 propensity score matching was performed to create a perfect match in terms of tumor height. Results: Total of 418 laparoscopic resections were performed, out of which 109 patients had locally advanced rectal cancer (LARC) and were propensity score matched with non-LARC (NLARC) patients. Median operation time was higher for the LARC group (270 minutes vs. 250 minutes, P=0.011). However, conversion to open surgery was done in 5 vs. 2 patients (P=0.445), reoperation in 8 vs. 7 (P=0.789), clinical anastomotic leak was found in 3 vs. 2 (P=0.670), and 30-day mortality rates was 2 vs. 1 (P>0.999) between LARC and NLARC, respectively. Readmission rate was higher in the NLARC group (33 patients vs. 19 patients, P=0.026), due to stoma-related issues. There was no statistically significant difference in the R0 resection between the 2 groups (99 patients in LARC vs. 104 patients in NLARC, P=0.284). Conclusion This study demonstrates that standardized approach to laparoscopy is safe and feasible in LARC. Comparable postoperative short-term clinical and pathological outcomes were seen between LARC and NLARC groups.

BACKGROUND/AIMS: Genes associated with the Helicobacter pylori (H. pylori) plasticity region may play a role in the pathogenesis of H. pylori. We compared the genes jhp0940, jhp0947, and jhp0986 in H. pylori isolates from patients with different gastroduodenal diseases and in different age groups. METHODS: The H. pylori hyperplasticity region genes jhp0940, jhp0947, and jhp0986 were studied by PCR. We also evaluated whether these genes were related to the cytotoxin-associated gene (cagA) and histology findings. RESULTS: Of the patient cohort, 71 (62%) were positive for jhp0940, 67 (59%) for jhp0947, 12 (10%) for jhp0986, and 69 (60%) for cagA. jhp0940 (n=18, 67%) and jhp0947 (n=23, 85%) were found more frequently in duodenal ulcer (DU) patients than in gastritis patients (n=14, 39%; p=0.029 and p<0.001, respectively). Gastric ulcer (GU) was more frequently associated with jhp0940 (17 patients, 77%; p=0.003) than with gastritis (14 patients, 39%). Gastric carcinoma (GC) was more strongly associated with both jhp0940 (22 patients, 76%; p=0.003) and jhp0947 (22 patients, 76%; p=0.003) than was gastritis (14 patients, 39%). jhp0947 was more frequently associated with chronic active inflammation (58 patients, 87%; p=0.009) than with chronic inflammation (9 patients, 13%). Multivariate analysis demonstrated that jhp0947 was associated with DU (odds ratio, 6.1; 95% confidence interval, 1.87-20). CONCLUSIONS: The genes jhp0947 and jhp0940 were identified in H. pylori isolates from patients with GC and DU, while jhp0940 was also isolated from patients with GU. jhp0947 was independently associated with DU.
Cohort Studies ; Duodenal Ulcer ; Gastritis ; Helicobacter ; Helicobacter pylori ; Humans ; Inflammation ; Multivariate Analysis ; Plastics ; Polymerase Chain Reaction ; Stomach Ulcer

Vibrio harveyi belongs to the Vibrio genus that causes vibriosis in marine and aquatic fish species through double-stranded DNA virus replication. In humans, around 12 Vibrio species can cause gastroenteritis (gastrointestinal illness). A large amount of virus particles can be found in the cytoplasm of infected cells, which may cause death. Despite these devastating complications, there is still no cure or vaccine for the virus. As a result, we used an immunoinformatics approach to develop a multi-epitope vaccine against most pathogenic hemolysin gene of V. harveyi. The immunodominant T- and B-cell epitopes were identified using the hemolysin protein. We developed a vaccine employing three possible epitopes: cytotoxic T-lymphocytes, helper T-lymphocytes, and linear B-lymphocyte epitopes, after thorough testing. The vaccine was developed to be antigenic, immunogenic, and non-allergenic, as well as having a better solubility. Molecular dynamics simulation revealed significant structural stiffness and binding stability. In addition, the immunological simulation generated by computer revealed that the vaccination might elicit immune reactions in the actual life after injection. Finally, using Escherichia coli K12 as a model, codon optimization yielded ideal GC content and a higher codon adaptation index value, which was then included in the cloning vector pET2+ (a). Altogether, our experiment implies that the proposed peptide vaccine might be a good option for vibriosis prophylaxis.

OBJECTIVEDuring present investigation the data of a laboratory-scale anoxic sulfide oxidizing (ASO) reactor were used in a neural network system to predict its performance.

METHODSFive uncorrelated components of the influent wastewater were used as the artificial neural network model input to predict the output of the effluent using back-propagation and general regression algorithms. The best prediction performance is achieved when the data are preprocessed using principal components analysis (PCA) before they are fed to a back propagated neural network.

RESULTSWithin the range of experimental conditions tested, it was concluded that the ANN model gave predictable results for nitrite removal from wastewater through ASO process. The model did not predict the formation of sulfate to an acceptable manner.

CONCLUSIONApart from experimentation, ANN model can help to simulate the results of such experiments in finding the best optimal choice for ASObased denitrification. Together with wastewater collection and the use of improved treatment systems and new technologies, better control of wastewater treatment plant (WTP) can lead to more effective maneuvers by its operators and, as a consequence, better effluent quality.

Bioreactors ; Neural Networks (Computer) ; Oxidation-Reduction ; Sulfates ; chemistry ; Sulfides ; chemistry ; Time Factors ; Waste Disposal, Fluid ; methods

Aims: The aim of this study was to identify an isolate B, an exopolysaccharide (EPS)-producing lactic acid bacteria and determine the fermentation time effect on EPS production. Methodology and results: Isolate B, an EPS producer, was isolated from peanut milk containing commercial sugar, which was fermented spontaneously for 24 h. Isolate B was identified biochemically using API 50 CH and molecularly based on 16S rDNA. The effect of fermentation time on EPS production by isolate B with variations of the fermentation time were 12, 24, 36, 48 and 60 h. Isolate B was able to produce EPS qualitatively by producing mucoid colonies on solid media containing sucrose. The identification revealed that this isolate was Weissella confusa both biochemically using API 50 CH and molecularly based on 16S rDNA sequence homology-based method. The fermentation time significantly affected EPS production (P<0.05). Isolate B (W. confusa) produced the highest EPS (10.41 g/L) at 36 h with a cell viability of 6.5 × 108 CFU/mL. Furthermore, the FTIR results of EPS showed absorption bands characteristic of carbohydrates, including O-H, C-H, C=O, C-O-C and α-1,6 glycosidic groups. The EPS in this study was most likely a dextran type. Conclusion, significance and impact of study The yield of EPS production was influenced by fermentation time. Results suggest that W. confusa isolated from peanut milk had a good ability for EPS production. Therefore, it can be considered further to apply this strain for the production of EPS. However, further research is required.