Assessment of heavy metals in cyprinid fishes: Rivers of district Khuzdar Balochistan Pakistan.

The present study was conducted to measured heavy metals in cyprinid fishes in rivers of District Khuzdar Balochistan, Pakistan. In the present study, 25 fish samples were collected that belonged to 8 order of 13 families, The Cyprinidae family had the largest number of eight fish species. Present study is focused on Heavy metals in cyprinid fishes. Heavy metals accumulation like Zinc, Manganese, Copper, and Nickel was evaluated in water and various organs of fishes. Atomic Absorption Spectroscopy was used for the identification of these heavy metals in fish species and water bodies. The average concentration (mg/L) of Zn 0.26-0.41, Mn 0.030- 0.073, Cu 0.017-0.080 and NI 0.14-0.79 were observed in water. The Concentration (mg/L), of Zn Conc 0.383-.028 Mn Conc .073- .030 Cu Conc 080-.017 NI Conc .79-.14. The concentration of heavy metals was found both similar and varied simultaneously across the whole research area. Zinc concentration was reported highest, whereas Copper was at the lowest concentration in all fish species .The concentration of heavy metals, in all the fish species under this study, was above the threshold of WHO limits.

Literature review of baseline study for risk analysis - the landfill leachate case.

There is growing awareness and public concern about environmental impacts of waste management and disposal. Environmental policy instruments have been strengthened and associated governmental programmes have increased in recent years, resulting in high level strategies for waste management. Risk assessment is now an essential tool in the prioritisation of environmental and human health protection. However, regulators need to compare the full range of risks on a sound and consistent basis. Comparing risks from such diverse sources poses a significant challenge, and traditional hazard and risk assessments are no longer sufficient. Consideration now needs to be given to a much wider range of factors if risk assessment is to be used as an aid to more integrated decision-making process. For this purpose, baseline study - the foundation of risk assessment - can play a crucial role. To date limited research has been conducted on the need, parameters, requirements, and constituents of baseline study particularly in the context of how, why, and what information is to be collated in order to render risk assessments more appropriately integrated and complete. To establish the 'state-of-the-art' of baseline study, this paper comprehensively reviews the literature regarding environmental risk assessment in general terms, and then proceeds to review work that is specifically related to landfills and landfill leachate, thereby identifying knowledge gaps and shortfall areas. This review concludes that a holistic baseline study procedure for waste disposal sites, which risk assessors could use for carrying out risk analyses specifically for landfill leachate, does not as yet exist.

Arterio venous fistula experience at a tertiary care hospital in Pakistan.

OBJECTIVE: To evaluate the two year patency rate of functioning arteriovenous fistula. METHODOLOGY: This prospective case series study was conducted at Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from 1(st) January 2009 to 31(st) December, 2010. Patients were chosen for CBRC arteriovenous fistula at wrist and patients undergoing other types of vascular access or secondary fistula formation were excluded. RESULTS: One hundred and eighty two patients underwent arteriovenous fistula formation. The mean ± SD age was 63 ± 13 years and there were 102 (56%) males and 80 (44%) females. 12.6% fistulae failed within first month without dialysis. The primary patency rate was 66.5% at three months and 57.7% at six months. Failing arteriovenous fistula was managed by new arteriovenous fistula in our series. 28.6% patients had redo arteriovenous fistula. This study demonstrated a poor outcome for fistulas in diabetic patients. Fifteen out of 23 (65.2%) who failed primarily were diabetics and out of these diabetics 13 (86.7%) failed in first three months. Infection and burst fistulae were found in nine (4.9%), pseudo aneurysm in 3.2%, fever 4.9%, peri-operative failure 0.55% and burst fistulae 3.2%. CONCLUSIONS: One-third of radiocephalic fistulas fail within two years. The outcome is worse for women and diabetic patients. This information may be useful in assessing and counseling patients with end-stage renal failure. Arteriovenous fistula is the better and ideal choice for haemodialysis. A Radiocephalic fistula in forearm seems to have better results as comparison to cubital fossa arteriovenous fistula. End to side anastomosis results are better than side to side anastomosis.

A systems analysis of irrigation water quality in environmental assessments related to foodborne outbreaks.

Irrigation water quality can affect food safety and health and has been identified as a possible source of pathogens in produce linked to disease outbreaks. Many irrigation water sources are subject to contamination from various sources in surrounding watersheds. A systems-based, watershed scale analysis is therefore necessary to comprehensively identify both sources of contamination and the conditions in the environment that facilitated or created that contamination, termed here 'environmental antecedents'. Three nationwide disease outbreaks linked to produce in the United States (US) are used to illustrate this concept of a watershed scale assessment to investigate potential impacts of irrigation water quality on food safety.

Determination of trace metals abnormalities in patients with vivax malaria.

BACKGROUND: In the present study, blood serum level of metals were determined in malarial patients and compared with those in the normal subjects without complication using Atomic Absorption Spectrometer. METHODS: For the determination of these metals twelve intravenous blood samples each from referred malarial patients and a group of normal subjects were collected and immediately centrifuged to obtain the supernatant liquid, serum of both the groups for analysis. RESULTS: The blood serum levels of copper in malarial patients determined to be 2.6917 ppm, which is higher as compared to that found 2.045 in normal subjects. Whereas the blood serum levels of iron, magnesium, and zinc found 2.0708 ppm, 12.2467 ppm and 4.9017 ppm respectively in malarial patients, who are lower than those, are determined in the blood serum of normal subjects. Blood serum levels of iron, magnesium, and zinc in normal subjects found 3.950 ppm, 19.4892 ppm, and 5.242 ppm respectively. CONCLUSION: In this study the metal content of copper, iron, magnesium and zinc in vary in malarial patients as compared those in the normal subjects. It may suggest that the decreased levels of iron, magnesium, and zinc can be maintained by giving as supplement of these metals in therapy.

Anaesthetic management of two different modes of delivery in patients with dystrophic epidermolysis bullosa.

Dystrophic epidermolysis bullosa is an inherited severe bullous condition characterised by extreme skin fragility and blistering in response to minor trauma. We present two obstetric cases with recessive dystrophic epidermolysis bullosa, one who underwent elective caesarean section, the other who delivered vaginally. The key points in the anaesthetic management of the obstetric patient with dystrophic epidermolysis bullosa include multidisciplinary preassessment, airway management strategies and the role of regional anaesthesia.

Structural analysis of anaerobic granules in a phase separated reactor by electron microscopy.

This paper discusses the microbial community structure of anaerobic granules and the effect of phase separation in anaerobic reactor on the characteristics of granules. Electron micrographs revealed that the core of anaerobic granular sludge consists predominantly of Methanosaeta-like cells, a key microorganism in granulation process. Granules in the methanogenic dominant zone of the reactor were stable and densely packed with smooth regular surface. On the other hand, granules subjected to acidogenic activities were less stable structures with broken parts and an irregular fissured surface. Anaerobic granules consisted of a vast diversity of species from the outer surface to the core of the granule and possessed a multi-layered structure. Viruses in the granules suggests the presence of bacteriophage in the granular biomass. These could be responsible for destroying cells and weakening the internal structure of granules, and thus possibly causing the breaking of granules. The observation of protozoa-like microorganism on the exterior zone of granular structure is believed to play an important role as bacterial predator and control the growth of bacterial cells. The images observed in this study shows that anaerobic granule harbour diverse number of microbial species, and act differently in acidogenic and methanogenic microbial zones.

Surgical management of hyperparathyroidism.

OBJECTIVE: To determine the efficacy of focused parathyroidectomy for adenoma and total parathyroidectomy with forearm autotransplantation for hyperplasia in maintaining serum calcium levels. STUDY DESIGN: Observational case series. PLACE AND DURATION OF STUDY: Department of General Surgery (Ward-2), Jinnah Postgraduate Medical Centre, Karachi, from January, 2002 to December, 2004. PATIENTS AND METHODS: Sixteen patients were admitted in this time period. Eleven of these patients had primary hyperparathyroidism and 4 had secondary hyperparathyroidism due to chronic renal failure. Pre-operative localization was done with Sestamibi scan and ultrasound of neck while methylene blue was used for intra-operative localization. All patients with primary hyperparathyroidism had single gland disease and were treated with focused parathyroidectomy. In 4 patients with parathyroid hyperplasia, total parathyroidectomy with forearm autotransplantation was done. RESULTS: In the postoperative period, 3 patients developed hypocalcemia but they were managed on oral calcium and vitamin-D supplements. All of the remaining patients became normocalcaemic and there were no major complications. Mean hospital stay was 7-days. CONCLUSION: Focused parathyroidectomy for single gland disease and total parathyroidectomy with forearm auto-transplantation for hyperplasia was a satisfactory treatment for patients in this series.

Applicability of modelling tools in watershed management for controlling diffuse pollution.

Diffuse pollution is hard to analyze, control and manage by its nature. Watershed models and Geographical Information Systems (GIS) are recently developed tools that aid analysis of diffuse sources of pollution. However, their applications are not always easy and straightforward. Turkey is a typical example of a mountainous country rich in rivers and streams. Due to the complex geomorphology, land-use and agricultural practices in most of the watersheds in Turkey, modelling, analyzing and managing diffuse pollution has been a challenge. The complex watershed structure forces the modellers to work with spatially high resolution data. Apart from the data, the models themselves may also cause operational problems. These issues and their probable solutions form the basis of the discussions in this paper. It acts as a guideline for modelling and analyzing diffuse pollution by emphasizing the referred problems and difficulties. Design of an Information Technology-based system tool for watershed and/or water quality modelling, which would be suitable for countries having watersheds with similar structure and problems to those of Turkey, is also outlined.

Analysis and modelling of land-based nutrient pollution by watershed models coupled with GIS: a case study from Turkey.

Diffuse pollution is usually temporally and spatially uncertain, and thus hard to analyze. In many cases, discretizing a diffuse source of pollution into individual point sources can ease diffuse pollution modelling and analysis, and therefore reduce high uncertainty especially in the spatial distribution of pollution loads. This is however a difficult task, since quite a number of sub-drainage areas, with complex structures and land-use properties, has to be delineated. Watershed models can be used to delineate the sub-drainage areas in a watershed with high accuracy and locate the related outlets which connect the sub-drainage areas to the main waterbody in a watershed. In this study, such an approach has been used on a case study to model the diffuse nutrient loads carried to streams that reach to a medium-sized lake in Turkey. The annual nutrient loads, which were calculated by using mathematical models, were then converted to a load-map with the help of a geographical information system.

Ileosigmoid knotting.

Ileosigmoid knotting or compound volvulus is a very uncommon cause of intestinal obstruction, which is associated with significant morbidity and mortality. A case of compound volvulus is reported in a 24 years old male patient who presented with diagnostic dilemma.

The performance of a phase separated granular bed bioreactor treating brewery wastewater.

This study presents the performance characteristics of a plug flow phase separated anaerobic granular bed baffled reactor (GRABBR) fed with brewery wastewater at various operating conditions. The reactor achieved chemical oxygen demand (COD) removal of 93-96% with high methane production when operated at organic loading rates (OLRs) of 2.16-13.38kg COD m(-3)d(-1). The reactor configuration and microbial environment encouraged the acidogenic dominant zone to produce intermediate products suitable for degradation in the predominantly methanogenic zone. Noticeable phase separation between acidogenesis and methanogenesis mainly occurred at high OLR, involving a greater number of compartments to contribute to wastewater treatment. The highly active nature and good settling characteristics of methanogenic granular sludge offered high biomass retention and enhanced methanogenic activities within the system. The granular structure in the acidogenic dominant zone of the GRABBR was susceptible to disintegration and flotation. Methanogenic granular sludge was a multi-layered structure with Methanosaeta-like organisms dominant in the core.

Assessment of morphology for anaerobic-granular particles.

This study shows that a proper assessment of granule morphology is fundamental before applying any mathematical derivation or empirical formula based on the shape factor of anaerobic-granular particles to determine granular characteristics. The granular images and size distribution of samples observed in this study revealed two different dimensions along two axes, which characterize these particles as ellipsoids. In the literature, theoretical-settling velocities and particle-size distribution of anaerobic granules have been calculated by assuming granules as spherical-shaped and using the numerical correlation between the size and settling velocity. This resulted in large deviations in results reported for settling velocities and size distribution calculated by using empirical equations when compared with experimentally measured values. It is believed that, because of the nonspherical nature of these particles, errors have been made in the earlier studies (which considered these particles as spherical), while evaluating granular-physical properties.

Carbon and nitrogen removal in a granular bed baffled reactor.

The application of an anaerobic five compartment granular bed baffled reactor (GRABBR) was investigated with brewery wastewater for combined carbon and nitrate removal, with a separate downstream nitrification unit for converting ammonia to nitrate. The GRABBR was operated at an organic loading rate of 3.57 kg chemical oxygen demand (COD) m(-3) d(-1) and ammoniacal nitrogen (NH4-N) loading rate of 0.13 kg NH4-N m(-3) d(-1) when nitrified effluent from a downstream nitrification unit was recycled to the feed point of the GRABBR. Carbonaceous matter and nitrate were removed simultaneously in the GRABBR at different recycle to influent ratios (from 1 to 2), with nitrogen oxide (nitrate and nitrite nitrogen, NOx-N) loading rates varying from 0.04 to 0.05 kg NOx-N m(-3) d(-1). At all recycle to influent ratios, COD removal efficiency of 97% to 98% were observed in the GRABBR, and over 99% by the two-stage treatment configuration (i.e. GRABBR and nitrification unit). All the nitrates added to the GRABBR were denitrified in the first three compartments of the system. For all the recycle to influent ratios studied, almost all ammonia was converted to nitrate nitrogen with only small traces of nitrite nitrogen in the nitrification unit. Methane production was observed throughout the experimental period with its composition varying from 25% to 50%, showing that simultaneous methanogenesis and denitrification occurred. This study shows that a GRABBR could bring about a high degree of carbon and nitrate removal, with simultaneous methanogenesis and denitrification, due to plug flow granular bed multi-stage characteristics of the bioreactor.

Reducing cardiovascular responses to laryngoscopy and tracheal intubation: a comparison of equipotent doses of tramadol, nalbuphine and pethidine, with placebo.

The stress response to tracheal intubation may be obtunded by opioids given with induction of anesthesia. Tramadol is an opioid acting on mu-receptors and the monoaminergic pain modulating systems. This study examined vasomotor responses to tracheal intubation after equipotent doses of tramadol, nalbuphine and pethidine (3.0, 0.3 mg/kg(-1), and 1.5 mg/kg(-1), respectively), and placebo, given prior to induction of anesthesia in 118 healthy patients. Premedication and induction of anesthesia were standardized. Recordings of HR and SAP were made prior and subsequent to induction of anesthesia, and at 1, 3, 5 and 7 minutes after tracheal intubation. Prior to laryngoscopy and intubation, HR increased in all groups (p < or = 01, all comparisons), but least so after nalbuphine, whilst SAP remained unchanged after placebo, tramadol and pethidine, but fell after nalbuphine (p < 0.025). Maximum increases in HR (p < or = 0.005, all comparisons) and SAP (p < or = 0.02, all comparisons) occurred one minute after intubation. Maximum HR after placebo (108 SD 15 bpm), tramadol (107 SD 20 bpm), pethidine (113 SD 16 bpm) and nalbuphine (110 SD 26 bpm) was similar; with placebo HR remained faster than baseline until the seventh minute but had returned to baseline by the fifth minute with the opioids. Maximum SAP with tramadol (151 SD 26 mmHg) was similar to that with placebo (157 SD 20 mmHg), but was greater than after pethidine (136 SD 27 mmHg; p < 0.05) and nalbuphine (135 SD 19 mmHg; p < 0.02). With each test drug SAP returned to baseline by the third minute. It is concluded that, in these doses, 1) tramadol does not attenuate the chronotropic nor the inotropic response to tracheal intubation, and 2) pethidine and nalbuphine reduce only the inotropic response to airway instrumentation.

Effect of rapid hydraulic shock loads on the performance of granular bed baffled reactor.

This paper describes the performance of a granular bed baffled reactor when receiving unpredictable hydraulic shock loads, which is a frequent occurrence in industrial wastewater treatment plants. Shock loads were created by rapidly increasing volumetric organic loading rates from 2.5 to 20 kg COD m(-3) d(-1), by decreasing (in a stepwise fashion) hydraulic retention time from 48 hrs to 6 hrs. Synthetic wastewater containing glucose as the main organic compound was used in this study. High effluent quality was observed, with soluble COD removal efficiencies of 94% to 97%, during all shock loading conditions at steady state. The reactor appeared to possess high tolerance to rapid hydraulic changes with fast recovery time. Marked phase separation between different microorganisms occurred at high organic loading rate, with acidogenesis and methanogenesis being the respective dominant activities in the upstream and downstream compartments of the reactor. The compartmentalised nature of the reactor and the granular bed structure were believed to be responsible for high reactor stability during overloading conditions. Microbial ecology in the system appeared to favour acetate and butyrate production at high organic loading rate. Granular biomass possessed good settling characteristics, hence encouraging high biomass retention within the system. The dense granular bed in the methanogenic zone acted as a filtration bed for lighter floating non-granular biomass, thus further reducing overall effluent solids concentration. This study demonstrated that the granular bed baffled reactor is a suitable system for treating industrial wastewaters with highly varying rates.

Analgesia for adenotonsillectomy in children and young adults: a comparison of tramadol, pethidine and nalbuphine.

A prospective, double-blind, randomized, controlled study was undertaken to compare the perioperative analgesic and recovery characteristics of equipotent doses of tramadol, pethidine and nalbuphine (3.0 mg kg-1, 1.5 mg kg-1 and 0.3 mg kg-1 respectively) with placebo (saline 0.02 ml kg-1) given at induction of anaesthesia in 152 ASA 1 children and young adults undergoing tonsillo-adenoidectomy. Premedication (temazepam and diclofenac), induction and maintenance of anaesthesia (thiopentone, atracurium, nitrous oxide and isoflurane), with controlled ventilation, were standardized. Variables monitored were heart rate (HR) and systolic arterial pressure (SAP) during surgery, time to recovery of spontaneous respiration at the termination of anaesthesia and restlessness, time to awakening, sedation and emesis in the recovery unit. Increases in HR or SAP > 33% of baseline during surgery were treated with esmolol 2.0 mg kg-1 intravenously (i.v.) and restlessness during recovery was treated with the same opioid i.v. given with an aesthesia, or pethidine i.v. in the placebo group. With placebo, there was a high requirement for esmolol during surgery and for pethidine in the recovery ward. Tramadol did not reduce the rate of intra-operative treatment with esmolol, but reduced the tramadol requirement during recovery (P < 0.05). Pethidine and nalbuphine reduced the intra-operative esmolol requirement more significantly (P < 0.025 and P < 0.005 respectively) and the need for treatment during recovery with opioids (P < 0.005 each). The time to recovery of spontaneous respiration at the end of anaesthesia was only delayed by pethidine. Other recovery variables were similar, except that restlessness-pain scores were reduced by tramadol (P < 0.02), pethidine (P < 0.005) and nalbuphine (P < 0.005). These results suggest that pethidine 1.5 mg kg-1 and nalbuphine 0.3 mg kg-1 given with induction of anaesthesia provide better analgesia during and after tonsillo-adenoidectomy than does tramadol 3.0 mg kg-1. The delay to recovery of spontaneous respiration with pethidine suggests a greater safety profile of nalbuphine and tramadol.

The effects of tramadol on postoperative nausea, vomiting and headache after ENT surgery. A placebo-controlled comparison with equipotent doses of nalbuphine and pethidine.

BACKGROUND: Opioids given as adjuncts to balanced inhalational anaesthesia augment postoperative nausea and vomiting (PONV). Tramadol, equipotent to pethidine, does not depress respiration, but can cause an increase in blood pressure and headache via its monoaminergic actions. Nalbuphine, ten times as potent as pethidine, has a ceiling respiratory depressant and ceiling analgesic effect at > 0.3 mg.kg-1. We compared the effects of equipotent doses of tramadol and nalbuphine (3.0 and 0.3 mg.kg-1, respectively) given as analgesic with induction of anaesthesia on emesis during recovery from anaesthesia and on PONV and headache until 24 h after ENT surgery, using saline (0.2 ml.kg-1) and an equipotent dose of pethidine (1.5 mg.kg-1) as controls. METHOD: The study population (N = 281) comprised 4 comparable subgroups (N = 69 to 71 each). Anaesthetic medications were standardised. Emesis during recovery from anaesthesia and nausea, vomiting, retching, headache and administrations of antiemetic and analgesics until 24 h after surgery were recorded. RESULTS: Emesis and antiemetic requirements during recovery from anaesthesia were similar and infrequent in each group, as were the incidences of nausea alone (3 to 5%), vomiting alone (17 to 31%), and nausea with vomiting (10 to 22%) during the first 24 h after surgery. However, any complaint of PONV was least frequent in the saline and pethidine groups (32% and 37%, respectively) and most frequent in the tramadol and nalbuphine groups (49% and 52%, respectively; P < 0.05 versus saline, both comparisons; P = NS versus pethidine, both comparisons). The times to onset and severity of PONV were similar in each group, but patients given nalbuphine most frequently (P < 0.025) needed rescue antiemetic to treat PONV. Headache occurred with similar frequency in each group. CONCLUSION: It is concluded that tramadol, nalbuphine and pethidine have similar emetic effect in the doses and manner used, and that tramadol does not increase the incidence of post-operative headache when used as peroperative analgesic.

Evidence that Ca2+-activated K+ channels play a major role in mediating the vascular effects of iloprost and cicaprost.

The role of K+ channels in mediating vasorelaxation induced by two prostacyclin analogues was investigated in guinea-pig aorta. Iloprost caused substantial relaxation of tissues contracted with phenylephrine or 25 mM K+ but not 60 mM K+. In endothelial-denuded tissues, maximal relaxations to iloprost, cicaprost or isoprenaline were inhibited by approximately 40-50% with tetraethylammonium or iberiotoxin, both blockers of large conductance Ca2+-activated K+ (BKCa) channels. In contrast, the response to forskolin, an activator of adenylate cyclase was marginally inhibited by tetraethylammonium. The K(ATP) channel blocker, glibenclamide significantly augmented the response to iloprost but not cicaprost. These effects were largely inhibited by the EP1 receptor antagonist, 8-chlorodibenz[b,f][1,4]oxazepine-10(11H)-carboxylic acid 2-[1-oxo-3(4-pyridinyl)propyl]hydrazide, monohydrochloride (SC-51089) and partially by indomethacin, suggesting that iloprost relaxation is counterbalanced by activation of EP1 receptors, in part through a constrictor prostaglandin. We conclude that BKCa channels play an important role in mediating the effects of iloprost and cicaprost and raises the possibility that cyclic AMP-independent pathways might be involved.