Performance evaluation and microbial profiling of integrated vertical flow constructed wetland (IVFCW) for simultaneous treatment of domestic and pulp and paper industry waste water.

The present study demonstrates the potential of an integrated vertical flow-constructed wetland (IVFCW) for simultaneously treating black liquor and domestic wastewater. IVFCW was operated and monitored for 12 samples with the frequency of one sample per week with the following specifications viz,4 L of wastewater, a blend of 1:1 of pulp and paper industry effluent (black liquor BL), and domestic wastewater, was fed daily in a continuous mode with organic loading rate (OLR) of 1230 mg COD/L-Day, at a temperature range of 40-45℃ (natural temperature of the workstation). Valves controlled each chamber's hydraulic retention time (HRT) of 3 days and flow rate of 10 mL/minute. The IVFCW showed remarkable efficiency in removing various pollutants, including total suspended solids (TSS) and total dissolved solids (TDS), by 100 % and 83 %, respectively, and organic contaminants such as chemical oxygen demand (COD) and biological oxygen demand (BOD) by 80 % and 81 %, respectively. Moreover, the IVFCW efficiently reduced nutrients such as sulfates (SO4-2), phosphates (PO4-3), and total nitrogen by about 81 %, 63 %, and 61 %, respectively. The treatment also led to the reduction of lignin content by 83 %. Microbiological analysis revealed a significant reduction in fecal coliforms, and microbial profiling of Typha latifolia roots confirmed the presence of bacteria involved in lignin degradation. Seed germination and seedling survival were found to be negativelyaffected by untreated wastewater in a phytotoxicity study, suggesting that the wastewater's toxic chemicals could be harmful to plant life.This study highlights the effectiveness of IVFCW as a sustainable, economically viable, and resilient wastewater treatment system for mitigating environmental concerns related to the release of untreated wastewater.

Accompanying effects of sewage sludge and pine needle biochar with selected organic additives on the soil and plant variables.

The effects of synthetic fertilizer and nutrient leaching are causing serious problems impacting soil function and its fertility. Mitigation of nutrient leaching and use of chemical fertilizer is crucial as fertile land adds up sustainability to climate changes. Biochar produced from agricultural bio-waste and municipal solid waste has been used for crop production and when applied in combination with organic nutrients may support mitigation of nutrient loss and adverse effects of chemical fertilizers. Different types of biochar and their application for soil enhancement have been observed, pine needle and sewage sludge derived low-temperature biochar along with compost, organic fertilizer in the form of manure and microalgal biomass may interact with soil chemistry and plant growth to impact nutrient loss and compensate the hazardous effect of chemical fertilizer, but it has not been investigated yet. This present study elaborates application of sewage sludge and pine needle biochar produced at 400 °C in an application rate of 5 % w/w and 10 t h-1 in combination with compost, manure and microalgal biomasses of Closteriopsis acicularis (BM1) and Tetradesmus nygaardi (BM2) on the growth of Chickpea (Cicer arietinum) and Fenugreek (Trigonella foenum-graecum) crop assessed in a pot experiment over a two crop (Chickpea - Fenugreek) cycle in Pakistan. Results depict that the pine needle biochar with additives has increased plant height by 104.1 ± 2.76 cm and fresh biomass by 49.9 ± 1.02 g, buffered the soil pH to 6.5 for optimum growth of crops and enhance carbon retention by 36 %. This study highlights the valorization of sewage sludge and pine needle into biochar and the effect of biochar augmentation, its impact on soil nutrients and plant biomass enhancement. The greener approach also mitigates and helps in the sustainable management of solid wastes.

Dosimetric Comparison of Whole Breast Radiotherapy Using Field-in-Field and Volumetric Modulated Arc Therapy Techniques in Left-Sided Breast Cancer Patients.

Introduction The radiotherapy of left-sided breast cancers is challenging because of neighboring critical organs, posing an increased risk of complications. Various radiation delivery techniques have been used to deliver the desired dose of radiation to the target area while keeping the doses to nearby structures within constraints. The main aim of this study is to quantify doses delivered to the organs at risk (OARs) including heart, left lung, spinal cord, and contralateral breast, and to the planning target volume (PTV) using Field-in-Field (FIF) and Volumetric Modulated Arc Therapy (VMAT). Patients and methods A retrospective review of 15 left-sided breast cancer patients was done. All the patients underwent breast-conserving surgery and adjuvant radiation. For every patient, two different radiation treatment plans were formulated and compared for the PTV coverage and doses to OARs, including heart, ipsilateral lung, spinal cord, and contralateral breast. The radiation treatment techniques utilized for this purpose were FIF and VMAT. The homogeneity index (HI), and conformity index (CI) required for the treatment planning were also calculated. Data was analyzed using Statistical Package for the Social Sciences (IBM Corp., Armonk, USA). An Independent T-test was used for statistical analysis. Results The mean age was 41 years and the majority of them were stage II. Total nine patients were given 4005centi Gray (cGy) in 15 fractions (fr) followed by 10Gy boost, hence receiving a total dose of 5005cGy in 20fr. While remaining six patients were given a total dose 4005cGy in 15fr without any boost. All patients were hypofractionated and the dose was delivered at a rate of 267cGy per fr. The FIF technique utilized in breast cancer radiation significantly reduced the mean doses to OARs: mean heart dose (3.81cGy), ipsilateral lung dose (V16- 15cGy), mean contralateral breast dose (0.03cGy), and maximum spinal cord dose (0.18cGy); as compared to VMAT technique which delivered comparatively higher doses: mean heart dose (8.85cGy), ipsilateral lung dose (V16- 19.82cGy), mean contralateral breast dose (4.59cGy), and maximum spinal cord dose (7.14cGy). There was a significant mean difference between doses of OARs and all p-values were statistically significant (p<0.005). Moreover, the FIF technique also improves the dose distribution of PTV in terms of dose homogeneity. However, the conformity index is more enhanced with VMAT as opposed to FIF. Conclusion The FIF technique is more advantageous than the VMAT planning technique because it provides better dose distribution in terms of PTV coverage and significantly lower doses to OARs in radiotherapy to left-sided breast cancer.

Students' perspective of bedside teaching: A qualitative study.

OBJECTIVES: To determine students' perception of bedside teaching, to find out barriers in its effective implementation and to suggest strategies to make it an effective learning tool. METHODS: This study was conducted in Faculty of Medicine, Northern Border University Arar, Kingdom of Saudi Arabia between November 2013 and January 2014. The study design was qualitative inductive thematic analysis using transcripts from audio-recorded focus group discussions. Four focused group discussions with medical students of 4(th) and 5(th) year MBBS were conducted. Each 40 to 50 minutes discussion session was audio taped and transcribed verbatim. Thematic analysis extracted key themes pertaining to objectives of the study. RESULTS: A total 75 students of 4(th) and 5(th) year MBBS took part in the study, 48 were female and 27 of them were male. Students believed that bedside teaching is valuable for learning essential clinical skills. They described many barriers in its effective implementation: uncooperative and less number of patients and faculty attitude. Our students suggested various strategies to address these barriers: promotion of awareness among general public about students' learning and its benefits, free medical treatment for expatriates and building of university hospital. CONCLUSION: Bedside teaching is an important learning tool. Its utility can be enhanced by orienting local patients' attitude towards importance of students' learning, by providing free medical treatment to expatriates and by including bedside teaching in faculty development programs.

Perceptions of faculty and students regarding Problem Based Learning: A mixed methods study.

OBJECTIVE: To determine perception of faculty and students regarding problem-based learning. METHODS: The study was conducted at Northern Border University, Arar, Kingdom of Saudi Arabia, from May 21to November 21, 2014. Data was collected on a structured close-ended questionnaire from faculty members. Application of problem-based learning by the faculty was assessed through observations of first such session of medical students. Observations were recorded on a structured checklist. Perceptions of students about learning methodology were determined through focused group discussion which was audio-taped and transcribed. Qualitative data was analysed through content analysis and quantitative data through SPSS 16. RESULTS: Of the 60 faculty members, 44(73%) took part in the study. Of them, 35(79.5%) were males and 9(20.5) were females. There were 23(52%) assistant professors and 31(70.45%) were trained in problem-based learning. Overall, 22(50%) faculty members thought that it was better than lecture-based learning; and 32(72.7%) stated that they conducted problem-based learning in classic seven jumps. In focus group discussions, students appreciated learning subject content but could not identify other benefits of problem-based learning. CONCLUSIONS: Faculty still had to come to terms with application of problem-based learning methodology.

LEARNING STYLE OF MEDICAL STUDENTS AND ITS CORRELATION WITH PREFERRED TEACHING METHODOLOGIES AND ACADEMIC ACHIEVEMENT.

BACKGROUND: Researchers have categorized the learning styles in many ways. Kolb proposed a classification of learner's styles as convergers, divergers, assimilators and accommodators. Honey and Mumford simplified learning styles as activists, reflectors, theorists and pragmatists. Neil Fleming's VARK model (Visual, Auditory, Read/write and Kinesthetic) is also popular. This study was carried out to determine the frequency of learning styles (Honey and Mumford) of medical students and its correlation with preferred teaching methodologies and academic achievements. METHODS: A total of 77 medical students of 4th year MBBS were selected through non-probability convenient sampling for this study. Honey and Mumford's learning style questionnaire, and a 2nd questionnaire to know their preference for different teaching methodologies were distributed to the students. Learning styles were identified and correlated with preferred teaching methodologies and academic achievements by Chi-square test. RESULTS: Mean age of the medical students was 22.75 ± 1.05 years. Twenty one (27.3%) participants were males and 56 (72.7%) females. By learning styles, 7 (9.1%) medical students were activists, 36 (46.8%) reflectors, 13 (16.9%) theorists and 21 (27.3%) were pragmatists. Out of 77 students, 22 preferred interactive lectures; 16, small group discussion; 20 problem based learning, 10 preferred demonstration on models. Only 01 students preferred one-way lecture as the best teaching methodology. No significant correlation was found between learning styles and preferred teaching methodologies and learning styles and academic scores. CONCLUSION: Most of the medical students had reflector (46.8%) and pragmatist (27.3%) learning styles. Majority preferred interactive lectures (28.57%) and problem based learning (25.98%) as teaching methodologies. Aligning our instructional strategies with learning styles of the medical students will improve learning and academic performance.

Bedside teaching-making it an effective instructional tool.

BACKGROUND: Bedside teaching is defined as any teaching in the presence of patient and is the core teaching strategy during the clinical years of a medical student. Although it is considered the most effective method to teach clinical and communication skills but its quality is deteriorating with the passage of time. The objective of this study is to explore faculty's perceptions about bedside teaching. METHODS: This study was conducted in clinical disciplines of Ayub Medical College and hospital Abbottabad, Pakistan from January 2012 to July 2012. Pragmatic paradigm was selected to gather both quantitative and qualitative information. Data was collected sequentially to validate findings. Perceptions of all professors of clinical subjects about bed side teaching were recorded on a close-ended structured questionnaire. Then in-depth interviews were taken from 5 professors using an open ended questionnaire. Quantitative data was analysed using, SPSS-16. Qualitative research data was analysed through content analysis. RESULTS: Out of 20 professors of clinical departments 18 agreed to respond to the questionnaire assessing their perceptions about bed side teaching. Non-existence of bedside teaching curriculum, lack of discipline in students and faculty, lack of accountability, poor job satisfaction and low salary were identified as major factors responsible for decline in quality of bedside teaching. Most of them advocated that curriculum development, planning bedside teaching, implementation of discipline and accountability, improved job satisfaction and performance based promotions will improve quality of clinical teaching. CONCLUSIONS: Curriculum development for bedside teaching, institutional discipline, application of best planning strategies, performance based appraisal of faculty and good job satisfaction can make bedside teaching an effective instructional tool.

Production and characterization of esterase in Lantinus tigrinus for degradation of polystyrene.

Polystyrene is considered stable to biological degradation. Lantinus tigrinus isolated from wood sample produced esterase in growth medium under normal conditions. However, acidic medium, 37 degrees C temperature, presence of tween 80; and urea and yeast extract in mineral salt medium enhance the production of esterase and specific activity. Purified esterase was active at broad pH range and 45 degrees C. FTIR analysis confirmed that esterase produced by Lantinus tigrinus effectively degraded polystyrene film and broke macromolecules down to non-toxic molecules. This study concludes that the presence of Lantinus tigrinus at dumping sites can be exploited for waste management containing high molecular weight synthetic polymers.

Risk factors for diabetic foot ulcer.

BACKGROUND: Diabetic foot is one of the common complications of diabetes mellitus. Many risk factors are involved in its causation. This study was conducted to determine risk factors responsible for foot ulcer in diabetic patients. METHODS: A total of 196 consecutive patients with diabetic foot were included in the study. Detailed history, clinical findings and investigations were recorded. Lesions were graded according to Wagner's classification, and appropriate medical and/or surgical treatment was carried out. Patients who did not consent to participate in the study had established gangrene of the foot, or had any medical co-morbidity especially chronic heart failure and chronic renal failure which could influence these risk factors were excluded from the study. Data were collected on a special proforma for analysis. RESULTS: Out of 196 patients 80.1% were male. One hundred and forty-six (74.48%) patients were in the range of 40-70) years. Right foot was more commonly involved (65.3%). 91.3% patients had diabetes of more than 5 years duration. No treatment had been received by 47.4% patients while 41.3% were on oral anti-diabetics; 11.2% patients were on insulin. All patients had type 2 diabetes mellitus. Neuropathy was present in 51% patients, 62.8% had absent or diminished peripheral pulses, 43.4% had poorly controlled diabetes. According to the Wagner classification 30.6% patients had grade 1, 26.5% had grade 2, and 42.9% had grade 3 diabetic foot. Evidence of infection was seen in 85.7% patients: staphylococcus aureus was isolated in 43.4% patients. Osteomyelitis was present in 42.9% patients. Surgical intervention was performed in 85.7% patients. Direct relation was found between the duration of diabetes, sugar control, peripheral neuropathy, peripheral arterial disease. grade of diabetic foot, evidence of osteomyelitis, intervention and the outcome of the disease. CONCLUSION: Neuropathy, peripheral arterial disease, duration of diseases and undlerlying osteomylitis are the major risk factors and need to addressed while educating patients.

Aetiological factors in mechanical intestinal obstruction.

BACKGROUND: Intestinal obstruction occurs when the normal flow of intestinal contents is interrupted. The most frequent causes of intestinal obstruction are postoperative adhesions and hernias, which cause extrinsic compression of the intestine. Less frequently, tumours or strictures of the bowel can cause intrinsic blockage. Objective of the study was to find out the various aetiological factors of mechanical intestinal obstruction and to evaluate the morbidity and mortality in adult patients presenting to Surgical 'A' unit of Ayub teaching hospital with mechanical intestinal obstruction. METHODS: This cross-sectional study was conducted from March 2009 to September, 2009. All patients presenting with intestinal obstruction and were above the age of 12 years were included in the study. Patients with non-mechanical obstruction were excluded from the study and those who responded to conservative measures were also excluded. RESULTS: A total of 36 patients with age ranging from 12 to 80 years (Mean age 37.72 +/- 19.74 years) and male to female ratio of 1.77:1, were treated for mechanical intestinal obstruction. The most common cause for mechanical intestinal obstruction was adhesions (36.1%). Intestinal tuberculosis was the second most common cause (19.4%), while hernias and sigmoid volvulus affected 13.9% patients each. Malignancies were found in 5.6% cases. CONCLUSION: Adhesions and Tuberculosis are the leading causes of mechanical intestinal obstruction in Pakistan. Although some patients can be treated conservatively, a substantial portion requires immediate surgical intervention.

Empyema thoracis: management outcome.

BACKGROUND: Empyema thoracis results from postpneumonic effusion of bacterial origin or trauma. If untreated it may convert to fibro-purulent or an organising stage. METHODS: This study was conducted at cardiothoracic unit of Ayub Teaching Hospital Abbottabad from Jan 2008 to Aug 2009. Patients with diagnosis of empyema thoracic were studied. Their clinical features and investigations were recorded on a proforma. Antibiotics alone, aspiration, chest intubation, rib resection or decortication were performed where required. RESULTS: Out of 71 patients, males were 58 (81.69%) and females were 13 (18.3%). Majority of the patients (24, 33.8%), were below 20 years of age. Most of the patients (59, 83.09%), were from the poor socioeconomic class. Forty-one (57.76%) patients were smokers, 12 (16.9%) were diabetic, and 39 (54.92%) were hypertensive. Cough was the most common complain (62, 87.32%). Forty (56.33%) had more than 50% involvement of hemi thorax. In 44 (61.97%) cases, cause was tuberculosis. Fifty-one (71.83%) patients were treated with tube thoracostomy and 13 (18.3%) required decortication. CONCLUSION: Empyema thoracis commonly affects males. Apart from clinical assessment, x-ray chest is an important and simple investigation to detect empyema thoracic. Mostly tube drainage cures the diseases but in case of failure other options are also available.

Management of thoracic trauma: experience at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: The incidence of thoracic trauma has rapidly increased in this century of high speed vehicles, violence and various other disasters. It has been observed that chest intubation was required in more than 75% of patients. METHODS: This prospective study was performed in cardiothoracic surgery unit of Ayub Teaching Hospital Abbottabad from Jun 2007 to Dec 2007. A total of 114 consecutive patients with chest trauma were included in the study, their patterns of injuries classified, treatment strategies and outcome were recorded on a proforma. RESULTS: Out of 114 patients with chest trauma, 76 (66.65%) were having penetrating and 38 (33.33%) had blunt trauma. Haemothorax was detected in 67 (58.77%), Pneumothorax in 23 (20.17%), rib fracture in 11 (15.02%) and diaphragmatic injuries in 4 (3.5%) cases. Overall complication rate was 14%. Wound infection was present in 8 (7.01%) and empyema in 4 (3.5%). Mortality was 2.6%. CONCLUSION: Penetrating chest injuries were more common than blunt injuries and chest intubation with resuscitation was adequate in most of the patients.

Comparison of closed and open methods of pneumoperitonium in laparoscopic cholecystectomy.

BACKGROUND: Pneumoperitonium is the first step in laparoscopic surgery including cholecystectomy. Two commonly used methods to create pneumoperitonium are closed and open technique. Both have advantages and disadvantages. The current study was designed to compare these two techniques in terms of safety and time required to complete the procedure. METHODS: This was a randomized controlled prospective study conducted at Department of Surgery, Ayub Hospital Complex Abbottabad, from 1st June 2007 to 31st May 2008. Randomization was done into two groups randomly using sealed envelopes containing the questionnaire. Seventy envelopes were kept in the cupboard, containing 35 proformas for group A and 35 for group B. An envelope was randomly fetched and opened upon selection of the patient after taking the informed consent. Pneumoperitonium was created by closed technique in group A, and by open technique in group B. Time required for successful pneumoperitonium was calculated in each group. Failure to induce pneumoperitonium was determined for each technique. Time required to close the wounds at completion, total operating time and injuries sustained during induction of pneumoperitonium were compared in both techniques. RESULT: Out of the total 70 patients included in study, 35 were in group A and 35 in group B. Mean time required for successful pneumoperitonium was 9.17 minutes in group A and 8.11 minutes in group B. Total operating time ranged from 55 minutes to 130 minutes in group A and from 45 minutes to 110 minutes in group B. Mean of total operating time was 78.34 and 67 minutes in group A and B respectively. Mean time needed to close the wound was 9.88 minutes in group A and 4.97 minutes in group B. Failure of technique was noted in three patients in group A while no failure was experienced in group B. In two cases in group A minor complications during creation of pneumoperitonium were observed while in group B no complication occurred. No patient died in the study. CONCLUSIONS: We concluded from this study that open technique of pneumoperitonium was, less time consuming and safer than the closed technique.

Carcinoma of prostate in clinically benign enlarged gland.

BACKGROUND: Carcinoma of the prostate is one of the common tumours of old age in men. This cross sectional study was conducted to detect carcinoma of prostate in clinically benign enlarged gland and to evaluate the efficacy of Digital rectal Examination in detection of prostatic cancer in patients presented at Khyber Teaching Hospital, Peshawar from July 1998 to July 1999. METHODS: Patients presenting with lower urinary tract symptoms over the age of 50 years were evaluated on English version of International Prostate Symptoms Score (IPSS), clinically examined and post-voiding residual urine determined on abdominal sonography. The selection criteria were; Severe IPSS, absence of signs of malignancy on Digital Rectal Examination (DRE) and post-voiding residual urine more than 100 ml. Thus a total 100 patients were selected for further study. Four ml blood was taken to assess Prostate Specific Antigen (PSA) level pre-operatively. All these patients underwent either transvesical prostatectomy or transurethral resection of prostate (TURP) and enucleated prostatic tissues were sent to histopathology. RESULTS: Eighty-five percent patients had PSA level up to 10 etag/ml. PSA level of 15 (15%) patients were above 10n gm/ml out of which 13 (13%) patients were having PSA in range of 11-12 etag/ml and two (2%) had PSA level between 20-25 etag/ml. Histopathology report of 2% patients turned out as adenocarcinoma of the prostate. CONCLUSION: Out of 100 patients who were having clinically benign DRE findings, 2 turned out as Carcinoma of the prostate histologically.

Abdominal tuberculosis an experience at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Abdominal tuberculosis is one of the common diseases in our country. This study was performed at Surgical A Unit Ayub Teaching Hospital Abbottabad from August 2006 to December 2007 to asses the clinical presentation of abdominal tuberculosis and its management. METHODS: All patients presenting to outpatient department with clinical feature suggestive of abdominal tuberculosis were included in the study. They were investigated. On the basis of clinical presentation, patients were divided in two groups. Patients with acute abdomen (peritonitis, intestinal obstruction) were prepared for laparotomy and operated upon. Required surgical procedure performed and tissue diagnosis was obtained. Patients with sub-acute obstruction, chronic pain abdomen and mass abdomen with out peritonism were managed conservatively. These patients were started on anti TB drugs on the basis of clinical and laboratory assessment. Empiric therapeutic trial was conducted for at least for 3 months with standard four drugs regimen. They were sent home on 9 month course of Anti TB drugs and were advised to come for follow up twice a month. On reassessment good clinical response was considered abdominal tuberculosis and anti TB continued with monthly follow up. In case of no response patients were operated. Required surgical intervention performed and tissue was taken to establish diagnosis. Detailed history, family history, examination findings, results of investigations, operative findings of the histologically proven cases of abdominal tuberculosis were recorded on a separate proforma and analyzed. RESULTS: Amongst 76 patients majority were females 52 (68.40%). Most of the patients were young with mean age of 34 years. Abdominal pain was the most common presentation 73 (96%) followed by fever and anorexia. Tender lower abdomen as found in 53 (70%) patients and mass abdomen was found in 35 (46%). Family history of TB was present in 20 (26%). Fifty three (70%) patients underwent laparotomy. Bands and adhesion was the most frequent finding on laparotomy. CONCLUSION: Abdominal TB is more common in female and abdominal pain fever and nausea are the most common presentations.

Re-do orchidopexy in a general surgical unit-reliability of clinical diagnosis and the outcome of surgery.

BACKGROUND: Re-do Orchidopexy is not very common, expertise is limited and the results of clinical examination and ultrasonography are not always reliable. METHODS: This cross-sectional study was based on medical records of patients under-going re-exploration of inguinal region for a missing testicle after previous groin surgery, and no mention of orchidectomy. All patients were thoroughly examined, investigated with ultrasonography and offered re-exploration. Results were graded as Good, Fair and Poor. RESULTS: Out of 11 boys included in the study, 7 (63.63%) had failed orchidopexy. Another 3 (27.27%) were opened for 2nd stage orchidopexy and 1 (9.09%) had iatrogenic ascent of testis after herniotomy. On clinical examination 4 (36.36%) had a palpable testicle at the superficial ring, 2 (18.18%) were in inguinal canal (1 doubtful!), and no testicle could be palpated in 5 (45.45%). Ultrasonography picked up 2 testicles (18.18%) at the superficial Inguinal ring, 1 (9.09%) in Inguinal canal and 1 (9.09%) testicle in the abdominal cavity. On reexploration, 10 (90.9%) testicles were found and brought down, 7 (63.63%) being considered of reasonable consistency and size. Another 3 (27.27%) were considered soft or small in size, and in 1 (9.09%)), no testicle was found. In 5 patients (45.45%), the testicle was at superficial ring, in 3 (27.27%) in the inguinal canal, and in 2 (18.18%) in the abdominal cavity. Results were considered good in 6 (54.54%), fair in 3 (27.27%)) and poor in 2 (18.18%). CONCLUSION: Groin examination after previous inguinal surgery is tricky. Ultrasonography is also not very reliable. Re-exploration via the inguinal approach is adequate and recommended. Thorough exploration is essential before declaring the testicle absent