Comparison of real time PCR with phenotypic methods in bronchoalveolar lavage in diagnosis of sputum smear negative pulmonary tuberculosis patients

Background: Early diagnosis of pulmonary tuberculosis is of utmost importance for proper control of the disease in the patient. Diagnosis of pulmonary tuberculosis is usually by acid fast bacilli (AFB) smear examination and culture Mycobacterium tuberculosis (MTB). In this study, we have employed polymerase chain reaction (PCR) for MTB in bronchoalveolar lavage (BAL) along with AFB smear and culture MTB for early diagnosis of pulmonary tuberculosis.Methods: A prospective observational study was conducted in the Department of Pulmonary Medicine, Era’s Lucknow medical college and Hospital, Lucknow over a period of two years. A total of 123 previously treated cases of pulmonary tuberculosis were enrolled for the study whose two sputum smear samples were negative for AFB. These patients underwent fibreoptic bronchoscopy and BAL was obtained which was sent for AFB smear, culture MTB and PCR for MTB.Results: The examination of BAL revealed the highest sensitivity for culture MTB at 87.4% followed by PCR for MTB at 73.8% and then AFB smear at 61.2%. PCR for MTB helped in diagnosing an additional 12% patients of pulmonary tuberculosis which were negative on AFB smear and an additional 6.8% patients which were negative on culture MTB.Conclusions: PCR for MTB is useful in making an early diagnosis of pulmonary tuberculosis especially in paucibacillary cases negative on AFB smear and also in some culture MTB negative patients

Biofloc System with Different Carbon Sources Improved Growth, Haematology, Nonspecific Immunity, and Resistivity against the Aeromonas hydrophila in Common Carp, Cyprinus carpio

Biofloc technology (BFT) is one of the most sustainable aquaculture system, which is based on the principle of nutrient recycling and addition of carbon to enable heterotrophic microorganisms to the system. To evaluate the performance of the biofloc culture system for Cyprinus carpio fingerlings, a 60-day growth trial was conducted. The fingerlings (n=600) of average body weight (4.92 g0.14) were stocked in 12 circular fiberglass tanks (300 L, volume 10.59 cft) to form three biofloc treatments (T1, T2, and T3) along with one control group. The carbon sources for treatments were sugarcane molasses, tapioca, and wheat. The C/N ratio of 15 was maintained for all treatments. After 60 days of rearing, the fish were challenged with Aeromonas hydrophila, and the relative percentage survival (RPS) was observed over 14 days. A haematological, nonspecific immune, and stress parameters were analyzed using blood and serum samples collected at intervals of 20, 40, and 60 days. According to the results, the carbon sources affected the water quality parameters but were still adequate for fish welfare. An increased biofloc volume was observed with tapioca. Growth performance and better feed conversion ratio were recorded in biofloc with the tapioca group. The hematological parameters, including haemoglobin (Hb), hematocrit (HCT), white blood cells and lymphocytes were significantly (P <0:05) higher in biofloc based tapioca group than in other treatments and control. Further, the serum protein, globulin, albumin, total immunoglobulin, and respiratory burst activity were also found significantly (P <0:05) higher in biofloc with tapioca as carbon source. However, the lysozyme activity was higher in biofloc with the wheat group. The RPS in tapioca was significantly higher, followed by biofloc with wheat. In conclusion, the tapioca-based biofloc can improve C. carpio growth, haematology, and nonspecific immune response under zero water exchange

Presence of BlaPER-1 and BlaVEB-1 Beta-Lactamase Genes among Isolates of Pseudomonas Aeruginosa from Burn and Trauma Hospital Peshawar, Pakistan

Pseudomonas aeruginosa spp are the most prevalent bacteria that cause nosocomial infections in hospitals. Most antibiotics, including novel new β-lactams, are already resistant to them, and they can become resistant during treatment, which can make the treatment fail. P. aeruginosa isolates from ICU patients who had Per-1 and VEB-1 were the main focus of this study. These two ESBLs are the two most common in ICU patients who had them. 50 isolates were gathered from Peshawar\u27s LRH ICU facilities in the year 2021. The antibiotic susceptibility test was conducted in accordance with the Clinical and Laboratory Standards Institute\u27s standards (CLSI). The combination disc test used to identify isolates that produce ESBLs. Ceftazidime MIC was determined using the agar dilution method using particular primers, the PER-1 and VEB-1 genes were detected using polymerase chain reaction (PCR). Fifty-six percent patients (n=40) male, whereas forty percent (n=25) were female. Augmentin (96.6%, n=61) and cefpodoxim (86.7%, n=55) resistance was found in the majority of ICU isolates. Fifty isolates (77%) tested positive for ESBL, with 94 percent (n=47) carrying the PER-1 gene and VEB-1 gene 52 percent (n=26). Ten isolates had blaPER1 and blaVEB1 present at the same time, and seven of them amplified all three genes. ESBL producers were found in a large number of ICU P. aeruginosa isolates. Although blaVEB1 and blaPER1 were found in a small number of isolates, their frequency was very high. Furthermore, carbapenem resistance was negligible. Because of drug-resistant P. aeruginosa isolates, it is vital to monitor ICU centers

Assessing emergency medical care in low income countries: A pilot study from Pakistan

Background: Emergency Medical Care is an important component of health care system. Unfortunately it is however, ignored in many low income countries. We assessed the availability and quality of facility-based emergency medical care in the government health care system at district level in a low income country - Pakistan. Methods: We did a quantitative pilot study of a convenience sample of 22 rural and 20 urban health facilities in 2 districts - Faisalabad and Peshawar - in Pakistan. The study consisted of three separate cross-sectional assessments of selected community leaders, health care providers, and health care facilities. Three data collection instruments were created with input from existing models for facility assessment such as those used by the Joint Commission of Accreditation of Hospitals and the National Center for Health Statistics in USA and the Medical Research Council in Pakistan. Results: The majority of respondents 43/44(98%), in community survey were not satisfied with the emergency care provided. Most participants 36/44(82%) mentioned that they will not call an ambulance in health related emergency because it does not function properly in the government system. The expenses on emergency care for the last experience were reported to be less than 5,000 Pakistani Rupees (equivalent to US$ 83) for 19/29(66%) respondents. Most health care providers 43/44(98%) were of the opinion that their facilities were inadequately equipped to treat emergencies. The majority of facilities 31/42(74%) had no budget allocated for emergency care. A review of medications and equipment available showed that many critical supplies needed in an emergency were not found in these facilities. Conclusion: Assessment of emergency care should be part of health systems analysis in Pakistan. Multiple deficiencies in emergency care at the district level in Pakistan were noted in our study. Priority should be given to make emergency care responsive to needs in Pakistan. Specific efforts should be directed to equip emergency care at district facilities and to organize an ambulance network

Regional and scale-specific effects of land use on amphibian diversity [poster]

Background/Question/Methods Habitat loss and degradation influence amphibian distributions and are important drivers of population declines. Our previous research demonstrated that road disturbance, development and wetland area consistently influence amphibian richness across regions of the U.S. Here, we examined the relative importance of these factors in different regions and at multiple spatial scales. Understanding the scales at which habitat disturbance may be affecting amphibian distributions is important for conservation planning. Specifically, we asked: 1) Over what spatial scales do distinct landscape features affect amphibian richness? and 2) Do road types (non-rural and rural) have similar effects on amphibian richness? This is the second year of a collaborative, nationwide project involving 11 U.S. colleges integrated within undergraduate biology curricula. We summarized North American Amphibian Monitoring Program data in 13 Eastern and Central U.S states and used geographic information systems to extract landscape data for 471 survey locations. We developed models to quantify the influence of landscape variables on amphibian species richness and site occupancy across five concentric buffers ranging from 300m to 10,000m. Results/Conclusions Across spatial scales, development, road density and agriculture were the best predictors of amphibian richness and site occupancy by individual species. Across regions, we found that scale did not exert a large influence on how landscape features influenced amphibian richness as effects were largely comparable across buffers. However, development and percent impervious surface had stronger influence on richness at smaller spatial scales. Richness was lower at survey locations with higher densities of non-rural and rural roads, and non-rural road density had a larger negative effect at smaller scales. Within regions, landscape features driving patterns of species richness varied. The scales at which these factors were associated with richness were highly variable within regions, suggesting the scale effects may be region specific. Our project demonstrates that networks of undergraduate students can collaborate to compile and analyze large ecological data sets, while engaging students in authentic and inquiry-based learning in landscape-scale ecology

Developing Consensus-Based Priority Outcome Domains for Trials in Kidney Transplantation:A Multinational Delphi Survey With Patients, Caregivers, and Health Professionals

Background: Inconsistencies in outcome reporting and frequent omission of patient-centered outcomes can diminish the value of trials in treatment decision-making. We identified critically important outcome domains in kidney transplantation based on the shared priorities of patients/caregivers and health professionals. Methods: In a 3-round Delphi survey, patients/caregivers and health professionals rated the importance of outcome domains for trials in kidney transplantation on a 9-point Likert scale and provided comments. During Round 2 and 3, participants re-rated the outcomes after reviewing their own score, the distribution of the respondents’ scores, and comments. We calculated the median, mean, and proportion rating 7-9 (critically important), and analyzed comments thematically. Results: 1018 participants (461 [45%] patients/caregivers and 557 [55%] health professionals) from 79 countries completed Round 1, and 779 (77%) completed Round 3. The top eight outcomes that met the consensus criteria in Round 3 (mean ≥7.5, median ≥8 and proportion >85%) in both groups were graft loss, graft function, chronic rejection, acute rejection, mortality, infection, cancer (excluding skin) and cardiovascular disease. Compared with health professionals, patients/caregivers gave higher priority to six outcomes (mean difference of 0.5 or more): skin cancer, surgical complications, cognition, blood pressure, depression, and ability to work. We identified five themes: capacity to control and inevitability, personal relevance, debilitating repercussions, gaining awareness of risks, and addressing knowledge gaps. Conclusions: Graft complications and severe comorbidities were critically important for both stakeholder groups. These stakeholder-prioritized outcomes will inform the core outcome set to improve the consistency and relevance of trials in kidney transplantation

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions