Comparison of quantitative bronchoscopic lavage cultures [B-BAL] with blind NG Tube lavage [N-BAL] cultures in the diagnosis of ventilator associated pneumonia [VAP]

To compare quantitative Bronchoscopic Bronchoalveolar Lavage [B-BAL] cultures with blind nasogastric tube bronchoalveolar lavage [N-BAL] cultures in the diagnosis of Ventilator Associated Pneumonia [VAP]. Cross-sectional comparative study. The study was conducted in Medical ICU and Chest ICU at Liaquat National Hospital [LNH], Karachi, from January till August, 2007. Patients admitted in ICU with clinical suspicion of VAP, fulfilling inclusion criteria viz. fever, leukocytosis, new or worsening infiltrate in chest radiograph or purulent secretions were included. Exclusion criteria were deranged coagulopathy, extreme ventilatory and oxygenation demands and tracheal obstruction. All patients had N-BAL using 16 fr Nasogastric tube [NG] without lubrication followed by B-BAL. Samples collected were submitted to the laboratory for quantitative cultures and sensitivities. Results were documented on predesigned proforma. Fifty four patients underwent paired B-BAL and N-BAL sampling. The N-BAL sensitivity and specificity for N-BAL were 87.87% and 85.71% respectively and p-value was <0.001. N-BAL showed sensitivity of 87.87%, specificity of 75.71%, positive predictive value of 89.65%, negative predictive value of 77.77% and p <0.001, which was statistically significant. Significant differences in time required for sample collection and cost of both procedures were also observed. The results favour the use of blind NG tube bronchoalveolar lavage quantitative cultures as it is simple, safe, cost-effective and minimally invasive method of diagnosing VAP

Mycorrhizoremediation--an enhanced form of phytoremediation / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Study of plant roots and the diversity of soil micro biota, such as bacteria, fungi and microfauna associated with them, is important for understanding the ecological complexities between diverse plants, microbes, soil and climates and their role in phytoremediation of contaminated soils. The arbuscular mycorrhizal fungi (AMF) are universal and ubiquitous rhizosphere microflora forming symbiosis with plant roots and acting as biofertilizers, bioprotactants, and biodegraders. In addition to AMF, soils also contain various antagonistic and beneficial bacteria such as root pathogens, plant growth promoting rhizobacteria including free-living and symbiotic N-fixers, and mycorrhiza helping bacteria. Their potential role in phytoremediation of heavy metal (HM) contaminated soils and water is becoming evident although there is need to completely understand the ecological complexities of the plant-microbe-soil interactions and their better exploitation as consortia in remediation strategies employed for contaminated soils. These multitrophic root microbial associations deserve multi-disciplinary investigations using molecular, biochemical, and physiological techniques. Ecosystem restoration of heavy metal contaminated soils practices need to incorporate microbial biotechnology research and development. This review highlights the ecological complexity and diversity of plant-microbe-soil combinations, particularly AM and provides an overview on the recent developments in this area. It also discusses the role AMF play in phytorestoration of HM contaminated soils, i.e. mycorrhizoremediation.

Bidirectional cavopulomanry shunt for cyanotic heart disease: Surgical experience from a developing country

The importance of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic congenital heart disease is widely recognized. This study was conducted to highlight our surgical experience with this procedure in a developing country. A retrospective study was conducted using medical records at the Aga Khan University Hospital, Karachi, Pakistan. Clinical findings at presentation, anatomical defects seen on transthoracic echocardiography, pre-operative McGoon index, cardiopulmonary bypass time, use of cardioplegia, post-procedure oxygen saturations and complications were evaluated. A total of 8 patients underwent bidirectional cavopulmonary anastomosis. There were 6 males [75%] and 2 females [25%]. Ages and weights at operation averaged 5.7 +/- 3.7 years [range 2-14 years] and 18.6 +/- 10.4 kg [range 8.5-35.5 kg] respectively. The most common symptoms were the presence of cyanosis in all [100%] patients followed by recurrent respiratory tract infections in 3 [37.5%] patients. Transthoracic echocardiography revealed 6 [75%] patients with atrial septal defects, 5 [62.5%] with tricuspid atresia, 3 [37.5%] with ventricular septal defects, 3 [37.5%] with malposition of great vessels, 2 [25%] with pulmonary stenosis and 2 [25%] with double inlet left ventricles. The mean pre-procedure McGoon index was 2.1 +/- 0.5 [range 1.37-2.80]. All patients received cardioplegia. Cardiopulmonary bypass was used in all patients for a mean time of 154.1 +/- 83.6 minutes [range 60-298 minutes]. All patients were ventilated for a mean period of 1.5 +/- 0.7 days [range 1-3 days]. The ICU stay was 3.0 +/- 0.6 days [range 2-5 days] with a total hospital stay of 9.8 +/- 3.8 days [range 7-18 days]. The mean post-procedure oxygen saturation was 82.6 +/- 3.5% [range 76-86%]. The most common post-operative complication was supraventricular arrhythmia in 2 [25.0%] patients. There were no intra-operative or early [within 7 days of procedure] deaths. One patient developed pulmonary artery hypertension and died 23 months later due to cardiac arrest. Patients tolerated the procedure well. After a mean follow-up of 10 months, 6 patients were assessed to be in New York Heart Association [NYHA] functional class I and one patient in NYHA class II. Clinical and post-procedural data gathered from our experience confirms the safety of bidirectional cavopulmonary anastomosis

Serum levels of unconjugated estriol during normal pregnancy in Pakistani women

Using a specific radiofmrnunoassay, serum levels of unconjugated oestriol were measured in 27 normal women during the 16th to the 36th week of pregnancy. The data obtained show a rise In the mean oestriol level which increased from 1.15 +/- 0.23 ng/ ml In the 16-week to 16,36 +/- 3.6 ng ml in the 36-week. During 16-24 weeks of pregnancy, mean serum oestriol levels ranged between 1.15 and 2.08 ng ml. A marked rase In oestriol concentrations [7.1 +/- 1,5 ng/ml] was observed at 28 weeks. In subsequent months the serum oestriol concentration increased steadily reaching the mean value of 16.36 +/- 3.6 ng ml, near term, In one patient, receiving antibiotic treatment, the levels remained low until the 32nd week of pregnancy. In five subjects including a Rh negative individual, the serum oestrici levels were within the normal range until 28 weeks of pregnancy but there was a marked fall in the levels during the 32nd week. In these subjects, however, the foetal outcome was normal In one case a neonatal death occurred following delivery in which the serum oestnoi concentration was normal. Except for an earlier rise in the serum oestriol concentration, the profile of oestriol levels during pregnancy in this restricted sample of Pakistan women, indicated no major divergence from the already reported data