Strength and leaching behavior of tailing-based paste backfill at high water content amended with lime activated ground granulated blast furnace slag and flocculant.

Flocculent is commonly used in mining activities to improve the concentration of tailing slurry by enhancing the sedimentation process of small tailings particles. The presence of flocculent in thickened tailings is unavoidable, and it affects the heavy metal leaching performances and mechanical and rheological characteristics of tailing-based cemented paste backfill (CPB). This study is carried out to investigate the physicochemical and leachability of CPB amended with flocculants and lime-activated ground granulated blast-furnace slag (GGBS). The stabilized samples were subjected to a series of model tests, including toxicity characteristics leaching procedure (TCLP) and pH, unconfined compressive strength (UCS), scanning electron microscopy (SEM), and X-ray diffraction. Moreover, the CPB amended with anionic polyacrylamide (APAM) demonstrated better performance in terms of a decrease in heavy metal leachability besides higher mechanical strength than poly aluminum chloride (PAC) and poly ferric chloride (PFC) samples. Furthermore, the UCS results showed that increasing binder content up to 15% negatively influences strength improvement of all stabilized samples because of weak connections between soil particles and cementitious material, resulting in high leachability of heavy metals. The analysis of XRD and SEM showed that anionic polyacrylamide (APAM) cases exhibited more voluminous hydration products, resulting in a compact stabilized matrix and substantially reduced heavy metal leachability.

Genetic and transcriptome analysis of a cotton leaf variegation mutant.

In eukaryotic photosynthetic organisms, chloroplast is not only a site for photosynthesis, but it also have a vital role in signal transduction mechanisms. Plants exhibit various colors in nature with various mutants induced by EMS, whose traits are regulated by developmental and environmental factors, making them ideal for studying the regulation of chloroplast development. In this study, the cotton leaf variegated mutant (VAR) induced by EMS was used for this experiment. Genetic analysis revealed that VAR phenotype was a dominant mutation and by performing freehand section inspection, it was noticed that the vascular bundles of VAR were smaller. Chloroplast ultrastructure showed that the stacking of grana thylakoid was thinner and the starch granules were increased significantly in VAR comparedto wild type (WT). Transcriptome analysis found that the KEGG was enriched in photosynthesis pathway, and GO was abundant in zinc ion transmembrane transport, electron transporter and cation binding terms. In addition, GhFTSH5 expression in VAR was significantly higher than WT and the promoter sequence of GhFTSH5 had differences. The results showed that the VAR plant had altered GhFTSH5 expression and disrupted chloroplast structure, which in turn affects plant photosynthesis. More importantly, this study lays a foundation for further analyzing molecular mechanism of cotton variegated phenotypes.

Treatment outcomes and adverse drug reactions among patients with drug-resistant tuberculosis receiving all-oral, long-term regimens: First record viewing report from Pakistan

Objective: To assess the effectiveness and adverse drug reactions of all-oral regimens for patients with multidrug-resistant tuberculosis. Methods: This retrospective study was conducted at 10 Programmatic Management of Drug Resistant Tuberculosis sites in Punjab province of Pakistan. Patients receiving treatment for drug resistant tuberculosis from July 2019 to December 2020 with at least interim result i.e. 6th month culture conversion or final outcomes (cured, complete, lost to follow-up, failure, death) available, were included in the study. Data was extracted from electronic data management system. For the reporting and management of adverse drug events, active tuberculosis drug safety monitoring and management was implemented across all sites. All the data was analyzed using SPSS version 22. Results: Out of 947 drug resistant tuberculosis patients included in this study, 579 (68%) of the patients had final outcomes available. Of these, 384 (67.9%) successfully completed their treatment. Out of 368 (32%) patients who had their interim results available, all had their 6th month culture negative. Combining new medications was thought to result in serious adverse outcomes such as QT prolongation. However, this study did not record any severe adverse events among patients. Conclusions: All-oral regimens formulation guided by overall treatment effectiveness resulted in treatment outcomes comparable to those obtained with traditional injectable treatment.

Preliminary investigation of high-water content dredged sediment treated with chemical-physical combined method at low cement content.

Land reclamation projects are increasingly incorporating dredged sediment from waterways. The high water content of dredged sediment is a major issue, making the dewatering process difficult and time-consuming. The chemical-physical combined method (CP) is therefore used in this study, which simultaneously uses vacuum dewatering by utilising vacuum pressure (VP) in conjunction with prefabricated horizontal drain (PHD) and Portland cement (PC)-based solidification/stabilisation (SS), thereby significantly reducing the duration of treatment of DS with high water content. The effectiveness and feasibility of the chemical-physical combined method with Portland cement (PC) as a binder are evaluated and compared with the traditional PC-based solidification/stabilisation (SS) method. A number of experimental tests were performed to accomplish the objectives of the study, such as unconfined compressive strength (USS), X-ray diffraction (XRD), and scanning electron microscopy (SEM). The experimental results indicated that the CP method showed better performance compared to the traditional SS method in treating high water content DS at low cement content. The water content of DS treated with the chemical-physical combined method was reduced by half in just about 3 days, and the final rate of settlement was 2.9 times higher than with SS-treated DS. The USC results showed that the strength of CP cases was 4.8 times higher than SS-treated DS after 56 days of curing age. The microstructural tests revealed the development of CSH and CASH as major hydration products of both CP and SS cases. Moreover, CP cases exhibited a densely stabilised matrix compared to SS cases.

A sketch of microbiological remediation of explosives-contaminated soil focused on state of art and the impact of technological advancement on hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) degradation.

When high-energy explosives such as hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX), Octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX), 2,4,6-trinitrotoluene (TNT) are discharged into the surrounding soil and water during production, testing, open dumping, military, or civil activities, they leave a toxic footprint. The US Environmental Protection Agency has labeled RDX as a potential human carcinogen that must be degraded from contaminated sites quickly. Bioremediation of RDX is an exciting prospect that has received much attention in recent years. However, a lack of understanding of RDX biodegradation and the limitations of current approaches have hampered the widespread use of biodegradation-based strategies for RDX remediation at contamination sites. Consequently, new bioremediation technologies are required to enhance performance. In this review, we explore the requirements for in-silico analysis for producing biological models of microbial remediation of RDX in soil. On the other hand, potential gene editing methods for getting the host with target gene sequences responsible for the breakdown of RDX are also reported. Microbial formulations and biosensors for detection and bioremediation are also briefly described. The biodegradation of RDX offers an alternative remediation method that is both cost-effective and ecologically acceptable. It has the potential to be used in conjunction with other cutting-edge technologies to further increase the efficiency of RDX degradation.

Environmental assessment and mechanical properties of Polypropylene fibres reinforced ternary binder foamed concrete.

Rapid urbanization and 'concretization' have increased the use of concrete as the preferred building material. However, the production of cement and other concrete-related activities, contribute significantly to both the carbon dioxide emissions and climate change. Agro-industrial wastes such as Palm Oil Fuel Ash (POFA) and Eggshell Powder (ESP) have been utilized in concrete as supplementary cementitious materials, to reduce the cement content, in order to minimize the carbon footprint and the environmental pollution associated with the dumping of waste. Both POFA and ESP have been utilized in ternary binder foamed concrete; however, higher content of cement replacement tends to reduce the concrete's strength significantly. Therefore, this research was conducted to study the influence of ternary binder foamed concrete, incorporating 30% POFA and 5-15% ESP by weight of the total binder, when reinforced with polypropylene (PP) fibres. Based on the results, the ternary binder foamed concrete showed better strength than the control foamed concrete due to the pozzolanic reaction and the addition of PP fibres slightly improved the strength. Furthermore, ternary binder foamed concrete can reduce up to 33.79% of the total CO2 emissions. In terms of cost, all ternary binder foamed concrete mixes reduced the overall cost of the mix. The lowest cost per 1 MPa was achieved by ternary binder foamed concrete mix which incorporated 30% POFA, 5% ESP and 0.20% PP fibres. However, the optimum S5 ternary binder foamed concrete mix, which incorporated 30% POFA, 10% ESP and 0.20% PP fibres, exhibited a cost of $3.74 per 1 MPa strength, which was $1.1 lower than the control foamed concrete. PP reinforced ternary binder foamed concrete is an eco-efficient and cost-effective concrete that can be used in numerous civil engineering applications, mitigating the environmental and the emissions generated by agro-industrial waste.

Assessing long-term performance of stabilized Zn-contaminated dredged sediment slurry treated with the PHDVPSS method.

Solidification/stabilization (S/S) has been widely used for effective treatment of dredged sediment (DS) for many years, with the objective of improving the mechanical properties of DS through the addition of inorganic cementitious materials. Most previous studies have reported the short-term performance of S/S. However, long-term effectiveness is critical, as contaminants remain underground and are subjected to a variety of environmental stresses that can degrade S/S materials. In this regard, this experimental work investigated the long-term efficacy of solidification/stabilization of dredged contaminated sediments (DCS) treated with a new integrated method, namely PHDVPSS, which uses a prefabricated horizontal drain (PHD) assisted by vacuum pressure (VP) as well as solidification/stabilization. The DCS were treated with Portland cement (PC) as binder in the PHDVPSS method (abbreviated as VP-PC) at different zinc (Zn) concentration levels and compared with the traditional cement-based solidification/stabilization method (abbreviated as SS-PC). A series of experimental tests such as unconfined compressive strength (UCS), toxicity characteristics leaching procedure (TCLP), X-ray diffraction (XRD) and scanning electron microscopy in conjunction with energy-dispersive spectroscopy (SEM-EDS) were performed to assess the long-term strength, leaching and microstructural characteristics of high-water-content DCS, respectively. The UCS test results indicated that the strength of VP-PC mixes increased significantly with curing time compared to the limited strength development of SS-PC mixes. After 180-day curing, VP-PC mixes exhibited 3.5-5.5 times higher UCS values than the SS-PC mixes. Furthermore, when compared to the SS-PC mixes, the VP-PC mixes had 14.7-36.4% lower leached Zn concentrations at different Zn levels. This is attributed to an increase in the least reactive F4 (residual) fraction and a decrease in the most mobile F1 (acid-soluble) fraction as confirmed by the BCR method. Microstructural tests including XRD and SEM-EDS revealed that calcium silicate hydrate-like compounds were identified as the main hydration products of both the VP-PC and SS-PC mixes. However, portlandite, a major hydration product of PC, was not detected in either case, which is attributed to the retardant effect of Zn on cement hydration. Overall, the experimental results showed that the PHDVPSS method, when compared to the conventional solidification/stabilization method, is a viable choice for treating high-water-content DCS at different Zn concentration levels with low cement content.

Effects of high-intensity interval training and strength training on levels of testosterone and physical activity among women with polycystic ovary syndrome

Objective@#Polycystic ovary syndrome is a diverse endocrine disorder characterized by hyperandrogenism and ovulatory dysfunction. Hyperandrogenism affects body morphology, resulting in excess weight (overweight or obesity). This study aimed to evaluate the efficacy of high-intensity interval training on serum testosterone levels, body fat percentage, and level of physical activity among women with polycystic ovary syndrome. @*Methods@#Fifty participants were enrolled in the study and randomly allocated into two groups. Group A performed highintensity interval training on alternate days per week (total of 12 weeks) and group B performed strength training on alternate days per week (total of 12 weeks). Baseline and 12th-week assessments included serum testosterone levels, body fat percentage using the skinfold method, and level of physical activity assessed using the International Physical Activity Questionnaire. @*Results@#After 12 weeks of intervention, both groups showed significant improvements in all the outcomes. However, group A (high intensity interval training) showed statistically significant results compared to group B (strength training) in lowering serum testosterone levels (P=0.049) and body fat percentage (P=0.001) and increasing physical activity levels (P=0.006). @*Conclusion@#After 12 weeks of exercise, both exercises benefited the participants; however, high-intensity interval training specifically was found to be a more effective exercise regimen than strength training in reducing serum testosterone levels and body fat percentage and enhancing levels of physical activity in women with polycystic ovary syndrome.

Strength and Leaching Behavior of Contaminated Mining Sludge at High Water Content Stabilized with Lime Activated GGBS.

Sludge management is one of the major challenges in mining activities. The direct disposal of contaminated mining sludge can bring severe damages to the environment and community. Solidification/stabilization (S/S) is a very efficient technology for the treatment of contaminated mining sludge because it improves the stability of sludge dumping sites and reduces the leachability of contaminants. Very few studies investigate the S/S of mining sludge, especially with high water content. This paper investigated the effectiveness of S/S for the treatment of mining sludge at high water content by using quick lime (CaO) activated ground granulated blast furnace slag (GGBS) in comparison to ordinary Portland cement (OPC). To evaluate the mechanical, leaching, and microstructural behavior of CMS at high water content stabilized by lime-activated GGBS and OPC, a series of laboratory experimental tests were performed. Experimental results indicated that increasing the dosage of binder led to increased strength and decreased leachability of the heavy metal. In contrast, an increase in the water content of the mixture resulted in a decrease in compressive strength and an increase in the leachability of heavy metals. On the other hand, lime-activated GGBS mixes had substantially better performance than OPC mixes in the aspect of strength development of treated mining sludge and showed comparable capability of heavy metal stabilization compared to OPC. The microstructural tests revealed the formation of different hydration products such as calcium silicate hydrate, calcium aluminum silicate hydrate, ettringite, hydrotalcite, and heavy metal complexes in CG and OPC mixes.

Searching appropriate system boundary for accounting India's emission inventory for the responsibility to reduce carbon emissions.

This paper explores the features of accounting for the national carbon emission inventory under four different system boundaries, including the presently operational territorial production-based accounting (PBA) practised by the UNFCCC. Using a recently published input-output table with the base year for 2013-2014, the study calculates India's 'Nationally Determined Contribution (NDC)' to the mitigation of carbon emissions using production-based, consumption-based, sharing-based and equity-based accounting. The study finds India as a net importer of carbon emissions, especially for its high emission-intensive capital and energy goods import such that the country is bearing the minimum burden of emission reduction responsibility. However, the study intends to analyse this burden of responsibility in terms of the criteria of justice and effectiveness and addresses the future policy priorities for India to become a net exporter of industrial goods. We recommend India for supporting and implementing an alternative system boundary of emission inventory accounting which would be more consistent with the provisions of 'equity' subscribed under the UNFCCC while at the same time, helpful for achieving the climate goals by appropriately trace and track the sources of 'carbon leakage'.

Physico-mechanical and microstructural behaviour of high-water content zinc-contaminated dredged sediment treated with integrated approach PHDVPSS.

This paper uses a new integrated method, namely PHDVPSS, which utilizes vacuum pressure (VP) coupled with prefabricated horizontal drain along with solidification/stabilization (SS) for the effective treatment of high-water content dredged contaminated sediment (DCS). This study sought to evaluate the physico-mechanical and microstructural behaviour of high-water content DCS treated with MgO-GGBS (MG) and Portland cement (PC) as PHDVPSS binders and compared to the traditional Portland cement solidification/stabilization (SS-PC) method. Physico-mechanical and microstructural characteristics of the DCS treated with the PHDVPSS method were evaluated by performing a number of tests such as unconfined compressive strength (UCS), toxicity characteristics of the leaching process (TCLP), pH, X-ray diffraction (XRD) and scanning electron microscopy (SEM) combined with energy-dispersive X-ray spectroscopy (EDS). Treatment results showed that the DCS treated with the MG binder in the PHDVPSS method showed superior performance in terms of a significant reduction in the water content and leachability of zinc (Zn) along with higher mechanical strength and dry density of the samples compared to the traditional SS-PC method. After 56-day curing time, VP-MG cases showed 17.6 % and 50 % higher dry density values, resulting in 2.5 and 17.3 times higher UCS values than VP-PC and SS-PC cases, respectively. In contrast, VP-MG cases showed lower pH values than those of VP-PC and SS-PC cases. Moreover, VP-MG cases exhibited 37.5 % and 44.3 % lower leached Zn concentration during a TCLP test than VP-PC cases and SS-PC cases, respectively. XRD and SEM-EDS tests showed that more voluminous hydration products were produced in the VP-MG cases, which in turn produced a dense stabilized matrix and significantly reduced the leachability of zinc.

Thermo-mechanical properties and sustainability analysis of newly developed eco-friendly structural foamed concrete by reusing palm oil fuel ash and eggshell powder as supplementary cementitious materials.

The production of cement contributes to 10% of global carbon dioxide (CO2) pollution and 74 to 81% towards the total CO2 pollution by concrete. In addition to that, its low strength-to-weight ratio, high density and thermal conductivity are among the few limitations of heavy weight concrete. Therefore, this study was carried out to provide a solution to these limitations by developing innovative eco-friendly lightweight foamed concrete (LFC) of 1800 kg/m3 density incorporating 20-25% palm oil fuel ash (POFA) and 5-15% eggshell powder (ESP) by weight of total binder as supplementary cementitious material (SCM). The influence of combined utilization of POFA and ESP on the fresh state properties of eco-friendly LFC was determined using the J-ring test. To determine the mechanical properties, a total of 48 cubes and 24 cylinders were prepared for compressive strength, splitting tensile strength and modulus of elasticity each. A total of 24 panels were prepared to determine the thermal properties in terms of surface temperature and thermal conductivity. Furthermore, to assess the environmental impact and eco-friendliness of the developed LFC, the embodied carbon and eco-strength efficiency was calculated. It was determined that the utilization of POFA and ESP reduced the workability slightly but enhanced the mechanical properties of LFC (17.05 to 22.60 MPa compressive strength and 1.43 to 2.61 MPa tensile strength), thus satisfies the ACI213R requirements for structural lightweight concrete and that it can be used for structural applications. Additionally, the thermal conductivity reduced ranging from 0.55 to 0.63 W/mK compared to 0.82 W/mK achieved by control sample. Furthermore, the developed LFC showed a 16.96 to 33.55% reduction in embodied carbon and exhibited higher eco-strength efficiency between 47.82 and 76.97%. Overall, the combined utilization of POFA and ESP as SCMs not only enhanced the thermo-mechanical performance, makes the sustainable LFC as structural lightweight concrete, but also has reduced the environmental impacts caused by the disposal of POFA and ESP in landfills as well as reducing the total CO2 emissions during the production of eco-friendly LFC.

Interactive Partitioning of 3D Models into Printable Parts.

In this paper, we present an easy, flexible and interactive tool for partitioning a 3D model, which is larger than 3D-printers working volume, into printable parts in an intuitive way. Our presented tool is based on the elegant partitioning optimization framework Chopper. Our tool aims at improving Chopper by providing users three easy-to-use interactive operations: no-go region painting, cutting plane specification and components re-union. With these operations, we show that (1) exhaustive search in the BSP tree --- the most time-consuming step in Chopper --- can be avoided, (2) more flexible geometric configurations can be provided, (3) users design intention is considered naturally and efficiently, and customized 3D partitioning results can be obtained. We test our tool on a wide range of 3D models and observe promising results. A preliminary user study also demonstrates its effectiveness and efficiency.

Factors Determining Pakistani Medical Students' Career Preference for General Practice Residency Training.

Background Few studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students' general practice career aspirations in Karachi, Pakistan. Methods From January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. Results A total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The "intent to inherit existing practice" and "other academic or professional experiences prior to medical school" had a positive association with choosing general practice while "having a physician parent'' had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked "clinical diagnostic reasoning", "community-oriented practice", "involvement in preventive medicine", and "frequent patient communication" as highly important were more likely to choose general practice, whereas, "access to advanced medical fields", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration. Conclusion The study's results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine.

Interactive Partitioning of 3D Models into Printable Parts.

This article presents an easy, flexible and interactive tool for partitioning a 3D model, which is larger than a 3D printers working volume, into printable parts in an intuitive way. Our tool is based on the elegant partitioning optimization framework Chopper. Our tool aims at improving Chopper by providing users three easy-to-use interactive operations: no-go region painting, cutting plane specification and components reunion. With these operations, we show that (1) exhaustive search in the BSP tree-the most time-consuming step in Chopper-can be avoided, (2) more flexible geometric configurations can be provided, (3) users design intention is considered naturally and efficiently, and customized 3D partitioning results can be obtained. We test our tool on a wide range of 3D models and observe promising results. A preliminary user study also demonstrates its effectiveness and efficiency.

A Combined Comparative Transcriptomic, Metabolomic, and Anatomical Analyses of Two Key Domestication Traits: Pod Dehiscence and Seed Dormancy in Pea (Pisum sp.).

The origin of the agriculture was one of the turning points in human history, and a central part of this was the evolution of new plant forms, domesticated crops. Seed dispersal and germination are two key traits which have been selected to facilitate cultivation and harvesting of crops. The objective of this study was to analyze anatomical structure of seed coat and pod, identify metabolic compounds associated with water-impermeable seed coat and differentially expressed genes involved in pea seed dormancy and pod dehiscence. Comparative anatomical, metabolomics, and transcriptomic analyses were carried out on wild dormant, dehiscent Pisum elatius (JI64, VIR320) and cultivated, indehiscent Pisum sativum non-dormant (JI92, Cameor) and recombinant inbred lines (RILs). Considerable differences were found in texture of testa surface, length of macrosclereids, and seed coat thickness. Histochemical and biochemical analyses indicated genotype related variation in composition and heterogeneity of seed coat cell walls within macrosclereids. Liquid chromatography-electrospray ionization/mass spectrometry and Laser desorption/ionization-mass spectrometry of separated seed coats revealed significantly higher contents of proanthocyanidins (dimer and trimer of gallocatechin), quercetin, and myricetin rhamnosides and hydroxylated fatty acids in dormant compared to non-dormant genotypes. Bulk Segregant Analysis coupled to high throughput RNA sequencing resulted in identification of 770 and 148 differentially expressed genes between dormant and non-dormant seeds or dehiscent and indehiscent pods, respectively. The expression of 14 selected dormancy-related genes was studied by qRT-PCR. Of these, expression pattern of four genes: porin (MACE-S082), peroxisomal membrane PEX14-like protein (MACE-S108), 4-coumarate CoA ligase (MACE-S131), and UDP-glucosyl transferase (MACE-S139) was in agreement in all four genotypes with Massive analysis of cDNA Ends (MACE) data. In case of pod dehiscence, the analysis of two candidate genes (SHATTERING and SHATTERPROOF) and three out of 20 MACE identified genes (MACE-P004, MACE-P013, MACE-P015) showed down-expression in dorsal and ventral pod suture of indehiscent genotypes. Moreover, MACE-P015, the homolog of peptidoglycan-binding domain or proline-rich extensin-like protein mapped correctly to predicted Dpo1 locus on PsLGIII. This integrated analysis of the seed coat in wild and cultivated pea provides new insight as well as raises new questions associated with domestication and seed dormancy and pod dehiscence.

Effect of band ligation on portal hypertensive gastropathy and development of fundal varices.

BACKGROUND: Use of endoscopic therapies for esophageal varices has resulted in increased prevalence of fundal varices and severe portal hypertensive gastropathy. This study was meant to compare the effect of band ligation and sclerotherapy on development of fundal varices and portal hypertensive gastropathy. METHODS: Patients with esophageal varices presenting in the endoscopy unit of Shiakh Zayed Hospital, with at least one previous endoscopy were included. Patient's past record was reviewed for findings and type of treatment given for varices during first endoscopy, number of endoscopies till date, number of esophageal varices band ligation (EVBL) or sclerotherapy sessions. All patients underwent upper GI endoscopy and findings were recorded. Type of treatment patient rendered during first endoscopy either EVBL or sclerotherapy was correlated to the presence of fundal varices and severity of portal hypertensive gastropathy observed on present endoscopy, using Chi square test (chi2). RESULTS: Eighty one patients were included. Mean age of patients was 48.70 +/- 12.63. Esophageal varices band ligation was carried out during first endoscopy in 49 (60.5%) patients and sclerotherapy in 31 (38.2%) patients. On fresh endoscopy, fundal varices were seen in 25 (30.8%) patients. Severe portal hypertensive gastropathy was found in 26 (32.1%) and mild in 54 (66.7%) patients. Severity of portal hypertensive gastropathy and presence of fundal varices in recent endoscopy was significantly more in patients with EVBL in first endoscopy. CONCLUSION: Band ligation of esophageal varices is associated with more frequent development of fundal varices and worsening of portal hypertensive gastropathy compared to sclerotherapy.

Predictors of fatal outcome in fulminant hepatic failure.

OBJECTIVE: To determine prognostic indicators for morbidity and mortality in patients with fulminant hepatic failure. DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Gastroenterology and Hepatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, from April 2003 to June 2005. PATIENTS AND METHODS: Forty five patients with confirmed diagnosis of fulminant hepatic failure were included in this study. They were investigated for acute viral serology, complete blood count, liver function tests, renal function tests, serum electrolytes, arterial blood gases, initially daily and then on alternate days. Patients were followed in high dependency/ICU at the Shaikh Zayed Postgraduate Medical Institute. Data were analyzed by logistic regression analysis to identify predictors of mortality and morbidity. RESULTS: Of the 45 subjects, 31 were males and 14 females. Twenty four patients were positive for acute hepatitis E. Twenty patients recovered fully, whereas 25 died with mortality rate of 55.6 %. Variables i.e. presence of non-A non-B viral hepatitis, serum creatinine > 2.0 mg/dl, serum phosphate > 3.5 mg/dl and sepsis were found to have significant association with mortality on linear correlation. Only serum creatinine more than 2.0 mg/dl, serum phosphate > 3.5 mg/dl and development of sepsis were found to predict the outcome after multivariate analysis. CONCLUSION: Patients with serum creatinine > 2.0 mg/dl, serum phosphate > 3.5 mg/dl and sepsis showed adverse prognosis for survival.

Bedside diagnosis of spontaneous bacterial peritonitis using reagent strips.

OBJECTIVE: To determine the efficacy of reagent strip for bedside diagnosis of spontaneous bacterial peritonitis (SBP). DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Shaikh Zayed Postgraduate Medical Institute from November 2003 to August 2004. PATIENTS AND METHODS: Patients with cirrhosis and ascites underwent diagnostic paracentesis. Fluid was checked for leukocyte esterase released by PMN by using Combur 10 urine strip and graded for color change from 0-3. Fluid was also analyzed by cytology for PMN count. Results of both methods were compared to determine sensitivity, specificity and accuracy of strip for diagnosis of SBP. RESULTS: Of 214 paracentesis performed, SBP was diagnosed in 38 patients whereas 176 were negative for infection. Strip test was 97.7% sensitive and 89.4% specific with positive predictive value of 90%, negative predictive value of 97.7% and accuracy of 96.2%, when reagent strip grade 3 was considered as positive for diagnosis. CONCLUSION: Reagent strip is a quick bedside test, highly sensitive and specific for the diagnosis of SBP, based on polymorphonuclear count in ascitic fluid, to initiate early treatment, thus improving patient's outcome.