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

Medico-Legal Cases (MLC) Presented at a Tertiary Care Center and Acute Symptoms of Post-Traumatic Stress Disorder among the Survivors

Objectives:  An observational, prospective study was conducted to determine the incidence and risk factors associated with victims of physical assault and symptoms of post-traumatic stress disorder (PTSD). Material & Methods:  All the registered medico-legal cases reported to the emergency department of Gambat hospital were included in the study. The data was collected on a predefined questionnaire including age, gender, mode of injury, weapon of the injury, type of assault (blunt or penetrating), firearm injuries, and road traffic accidents from medico-legal registers. Impact of Event Scale (IES) was used to assess Post-traumatic stress disorder. Results:  The mean age (SD) of victims was 29.3 (10.25) years. Blunt injuries were experienced by 47 (31.33%) victims. The majority of the victims suffered road traffic collision injuries, 59 (39.33%). Forty-eight (32%) victims had substantially higher IES scores (above 37) that confirmed severe PTSD that may contribute to the suppression of the immune system’s functioning among survivors. The majority of the victims were between 18 and 40 years. Conclusion:  The most common cases were related to road traffic collisions followed by blunt injuries. The incidence rate of PTSD was also prevalent in these individuals. Thus, strategies should be developed to prevent such incidents and those who suffer from such traumatic events must be offered psychiatric consultation

The Role of Radiology (X-Ray versus Computed Tomography) in Medicolegal Cases Presented at a Tertiary Care Hospital in Pakistan

Objectives:  A prospective observational study was aimed to assess the role of plain radiographs and computed tomography in detecting head injuries presented at the medicolegal office at the Forensics and Radiology Departments, Gambat Medical Hospital, Sindh. Material and Methods:  All cases referred from the Medicolegal Office (MLO) with head injury were included. All victims underwent X-ray head and computed tomography skull was done with 1 or 1.5 cm thick axial sections without administration of intravenous contrast. The radiological reports of X-ray head and CT scans were documented and comparatively evaluated. Results:  Mean age was 38.63 ± 3.91 years. In 51 (45.13%) cases, X-ray was able to detect skull fracture, while CT scan detected 64(56.64%) skull fractures. There were 54 (84.3%) true positives, 3 (2.6%) false positives, 10(8.8%) false negatives, and 40 (40.7%) true negatives. The accuracy of X-ray to detect skull fracture was 88.50%. Conclusion:  X-ray had a sensitivity and specificity of 84.38% and 93.88%, respectively. It is a reliable tool to detect skull fractures in victims of assault in comparison with CT scans. X-ray is also associated with low dose radiation exposure as compared with CT scan which delivers 70 times more exposure than the former

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

Genetic Variability through Induced Mutation

The success of plant breeding is based on the accessibility of genetic variation, information about desired traits with well-organized approach that make it likely to develop existing genetic resources. Food security demands to break the yield barrier through increasing new cultivars which can adapt to wide range of environment. It is especially important to observe the character association for yield along with its components before recognizing novel technique to break the yield barrier. There are numerous methods for improved exploiting of the inherent genetic makeup of crops with heritable variations. It is recommended that recognized parental resources can also be induced to mutate for unmasking novel alleles of genes that organize the traits suitable for the crop varieties of the 21st century world. Chemical mutagens have extensively been applied to make genetic changes in crop plants for breeding investigation as well as genetic studies. Ethyl methane sulphonate (EMS) is the most frequently applied as chemical agents in plants. EMS normally induces GC → AT transitions in the genome causing mutated protein that performed different functions rather than normal. It is exposed that the utilization of EMS is an efficient approach for developing novel gene pool

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care