Emerging Risk Factors for Impaired Lung Function in Chemical Industry Workers of Faisalabad

Objective: To determine the impact, obesity and age on the lung functions determined by PEFR of healthy workers of chemical industries. Methodology:  This was a cross sectional study performed at private medical college of Faisalabad. Three days medical camp was arranged during 2nd to 4th  September 2020 after taking approval from institutional ethical committee. All relevant information including age, residence and history about chemical exposure were recorded in a structured proforma. Obesity was determined on basis of BMI grading. BMI was calculated from estimated Height and weight   PEFR of each participant was determined using Wright’s Peak flow meter.  Data was analyzed by SPSS21. Results: Mean± SD age, height and weight of the studied population was 38.85 ± 12.1, 170.07  ±12.0   and 78.12 ±12.7. lowest PEFR value was found in subjects with age range 61 to 70 years as compred to youger subjects . The mean PEFR value were significantly different  with respect to various age catagoeies with  p value= 0.000 Highest mean PEFR values were found in  taller subjects having height ≥ 180 cm and lowest values were found in subjects with height 150-159 cm,  the difference in means was statisticaly significant with p value= 0.05. Morbid  obese subjects showing comparatively  lower PEFR values in morbid obese  with significant p value =0.002. . PEFR was found to be negatively associated with age ( p- value= 0.000*)  and BMI( p value =0.001*). Our results also showed weak positive association of PEFR with height, however this relation was not found to be statistically significant (p value= 0.081). Conclusion: Peak expiratory flow rate is negatively associated with increasing BMI and age, reflecting that elderly and obese subjects are more prone to have affected lung function due to exposure to chemical

Emerging Risk Factors for Impaired Lung Function in Chemical Industry Workers of Faisalabad

Objective: To determine the impact, obesity and age on the lung functions determined by PEFR of healthy workers of chemical industries. Methodology:  This was a cross sectional study performed at private medical college of Faisalabad. Three days medical camp was arranged during 2nd to 4th  September 2020 after taking approval from institutional ethical committee. All relevant information including age, residence and history about chemical exposure were recorded in a structured proforma. Obesity was determined on basis of BMI grading. BMI was calculated from estimated Height and weight   PEFR of each participant was determined using Wright’s Peak flow meter.  Data was analyzed by SPSS21. Results: Mean± SD age, height and weight of the studied population was 38.85 ± 12.1, 170.07  ±12.0   and 78.12 ±12.7. lowest PEFR value was found in subjects with age range 61 to 70 years as compred to youger subjects . The mean PEFR value were significantly different  with respect to various age catagoeies with  p value= 0.000 Highest mean PEFR values were found in  taller subjects having height ≥ 180 cm and lowest values were found in subjects with height 150-159 cm,  the difference in means was statisticaly significant with p value= 0.05. Morbid  obese subjects showing comparatively  lower PEFR values in morbid obese  with significant p value =0.002. . PEFR was found to be negatively associated with age ( p- value= 0.000*)  and BMI( p value =0.001*). Our results also showed weak positive association of PEFR with height, however this relation was not found to be statistically significant (p value= 0.081). Conclusion: Peak expiratory flow rate is negatively associated with increasing BMI and age, reflecting that elderly and obese subjects are more prone to have affected lung function due to exposure to chemical

Polymorphism of HLA-DR and HLA-DQ in rheumatoid arthritis patients and clinical response to methotrexate--a hospital-based study

Objective: To investigate the frequency and distribution of DRB1 and DQB1 alleles in Patients with rheumatoid arthritis (RA) and analyze the relationship between clinical response to methotrexate (MTX) and the HLA-DR and HLA-DQ genotypes in these patients.Methods: In this case-control study, the HLA-DRB1 and HLA-DQB1 polymorphism in 91 RA patients and 91 healthy controls was done using polymerase chain reaction and sequence specific primers.Results: There was no statistical difference in frequencies of HLA-DRB1*03, DRB1*04, DRB1*07, DRB1*10, DRB1*11, DRB1*12, DRB1*13, DRB1*14, DRB1*15 and DRB1*16 genotypes between patients and controls. However, DRB1*01 was found to be significantly more common (p=0.015) in RA patients compared to controls. HLA-DRB1*15 was more common in patients (43.5%) compared to controls (30.8%) but results were not significant. HLA-DRB1*08 and DRB1*09 were present in negligible number in patients as well as controls while HLA-DRB1*12 was conspicuously absent in controls. Similarly, DQB1*06 was also significantly more common (p = 0.01) among the patients compared to healthy control subjects, while there was no statistical difference in the frequencies of DQB1*02, DQB1*03, DQB1*04 and DQB1*05 among the cases and the controls. RA susceptibility in most patients appeared to be associated with the HLA-DRB1*01/DQB1 *06 genotype. Regarding association between HLA-DR or HLA-DQ genotype and clinical response to methotrexate (MTX), the data showed that with the exception of HLA-DRB1*03, there appears to be no association between the particular subtypes of HLA-DR and HLA-DQ. HLA-DRB1*03 was significantly-more common among non-responders to MTX alluding to the possibility that another genes responsible for MTX metabolism, might be in linkage disequilibrium with HLA-DRB1*03 in the Pakistani population, thereby making such individuals non-responsive to MTX-therapy.Conclusion: RA susceptibility in most Pakistani patients is associated with the HLA-DRB1*01/DQB1*06 genotype. HLA-DRB1*03 was found to be significantly more common among non-responders to MTX treatment suggesting that Pakistani patients with this genotype are less likely to benefit from MTX

Impact of Exposure of Chemical Fumes on Blood Pressure and Peak Expiratory Flow Rate in Industrial Workers of Faisalabad

Objectives: 1. To determine the impact of duration of exposure to industrial chemical fumes on Peak Expiratory Flow Rate (PEFR) and blood pressure of the industrial workers. 2. To find out the association between changes in blood pressure and PEFR due to exposure to industrial chemical fumes in these subjects. Methods: This cross-sectional study was performed at Aziz Fatimah Medical and Dental College, Faisalabad. The study participants were 151 males working in the chemical industries. The study was approved by institutional ethical committee and informed consent was taken from the participants. Free camp was arranged for three days in September 2020 in the industrial area of Faisalabad. Thorough history of exposure to chemicals was taken using structured proforma. PEFR values were recorded using Wrights handheld peak flow meter. Blood pressure was taken by auscultatory method using mercury sphygmomanometer. Data was analyzed using SPSS version 22. Results: Systolic and diastolic blood pressures were significantly raised with increase in duration of exposure.  PEFR levels were significantly declined with increase in duration of exposure to chemicals. Significant negative association was noted between diastolic blood pressure and PEFR (p value = 0.003). Negative correlation was observed between PEFR and systolic Blood pressure, however it was not statistically significant (p value = 0.92). Conclusions: PEFR decreased while Systolic and diastolic blood pressures increased significantly with increase in the duration of exposure to chemicals. There was a significant negative correlation between PEFR and diastolic blood pressure while there was no association between PEFR and systolic blood pressure

Pulmonary metastasectomy versus continued active monitoring in colorectal cancer (PulMiCC): a multicentre randomised clinical trial

BACKGROUND: Lung metastasectomy in the treatment of advanced colorectal cancer has been widely adopted without good evidence of survival or palliative benefit. We aimed to test its effectiveness in a randomised controlled trial (RCT). METHODS: Multidisciplinary teams in 13 hospitals recruited participants with potentially resectable lung metastases to a multicentre, two-arm RCT comparing active monitoring with or without metastasectomy. Other local or systemic treatments were decided by the local team. Randomisation was remote and stratified by site with minimisation for age, sex, primary cancer stage, interval since primary resection, prior liver involvement, the number of metastases, and carcinoembryonic antigen level. The central Trial Management Group were blind to patient allocation until completion of the analysis. Analysis was on intention to treat with a margin for non-inferiority of 10%. RESULTS: Between December 2010 and December 2016, 65 participants were randomised. Characteristics were well-matched in the two arms and similar to those in reported studies: age 35 to 86 years (interquartile range (IQR) 60 to 74); primary resection IQR 16 to 35 months previously; stage at resection T1, 2 or 3 in 3, 8 and 46; N1 or N2 in 31 and 26; unknown in 8. Lung metastases 1 to 5 (median 2); 16/65 had previous liver metastases; carcinoembryonic antigen normal in 55/65. There were no other interventions in the first 6 months, no crossovers from control to treatment, and no treatment-related deaths or major adverse events. The Hazard ratio for death within 5 years, comparing metastasectomy with control, was 0.82 (95%CI 0.43, 1.56). CONCLUSIONS: Because of poor and worsening recruitment, the study was stopped. The small number of participants in the trial (N = 65) precludes a conclusive answer to the research question given the large overlap in the confidence intervals in the proportions still alive at all time points. A widely held belief is that the 5-year absolute survival benefit with metastasectomy is about 35%: 40% after metastasectomy compared to < 5% in controls. The estimated survival in this study was 38% (23-62%) for metastasectomy patients and 29% (16-52%) in the well-matched controls. That is the new and important finding of this RCT. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT01106261. Registered on 19 April 2010

A New Approach for Heparin Standardization: Combination of Scanning UV Spectroscopy, Nuclear Magnetic Resonance and Principal Component Analysis

The year 2007 was marked by widespread adverse clinical responses to heparin use, leading to a global recall of potentially affected heparin batches in 2008. Several analytical methods have since been developed to detect impurities in heparin preparations; however, many are costly and dependent on instrumentation with only limited accessibility. A method based on a simple UV-scanning assay, combined with principal component analysis (PCA), was developed to detect impurities, such as glycosaminoglycans, other complex polysaccharides and aromatic compounds, in heparin preparations. Results were confirmed by NMR spectroscopy. This approach provides an additional, sensitive tool to determine heparin purity and safety, even when NMR spectroscopy failed, requiring only standard laboratory equipment and computing facilities

Lessons and implications from a mass immunization campaign in squatter settlements of Karachi, Pakistan: an experience from a cluster-randomized double-blinded vaccine trial [NCT00125047]

OBJECTIVE: To determine the safety and logistic feasibility of a mass immunization strategy outside the local immunization program in the pediatric population of urban squatter settlements in Karachi, Pakistan. METHODS: A cluster-randomized double blind preventive trial was launched in August 2003 in 60 geographic clusters covering 21,059 children ages 2 to 16 years. After consent was obtained from parents or guardians, eligible children were immunized parenterally at vaccination posts in each cluster with Vi polysaccharide or hepatitis A vaccine. Safety, logistics, and standards were monitored and documented. RESULTS: The vaccine coverage of the population was 74% and was higher in those under age 10 years. No life-threatening serious adverse events were reported. Adverse events occurred in less than 1% of all vaccine recipients and the main reactions reported were fever and local pain. The proportion of adverse events in Vi polysaccharide and hepatitis A recipients will not be known until the end of the trial when the code is broken. Throughout the vaccination campaign safe injection practices were maintained and the cold chain was not interrupted. Mass vaccination in slums had good acceptance. Because populations in such areas are highly mobile, settlement conditions could affect coverage. Systemic reactions were uncommon and local reactions were mild and transient. Close community involvement was pivotal for information dissemination and immunization coverage. CONCLUSION: This vaccine strategy described together with other information that will soon be available in the area (cost/effectiveness, vaccine delivery costs, etc) will make typhoid fever control become a reality in the near future