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Background: Methylene blue staining of the resected specimen has been described as an alternative to the conventional palpation and visual inspection method to improve lymph node harvest. This meta-analysis evaluates the usefulness of this technique in surgery for rectal cancer, particularly after neoadjuvant therapy. Methods: Randomized controlled trials (RCTs) comparing lymph node harvest in methylene blue-stained rectal specimens to those of unstained specimens were identified from the Medline, Embase, and Cochrane databases. Non-randomized studies and those with only colonic resections were excluded. The quality of RCTs was assessed using Cochrane's risk of bias tool. A weighted mean difference (WMD) was calculated for overall harvest, harvest after neoadjuvant therapy, and metastatic nodal yield. In contrast, the risk difference (RD) was calculated to compare yields of less than 12 lymph nodes between the stained and unstained specimens. Results: Study selection comprised seven RCTs with 343 patients in the unstained group and 337 in the stained group. Overall lymph node harvest and harvest after neoadjuvant therapy were significantly higher in stained specimens with a WMD of 13.4 and 10.6 and a 95% confidence interval (CI) of 9.5–17.2 and 4.8–16.3, respectively. Harvest of metastatic lymph nodes was significantly higher in the stained group (WMD 1.0, 95% CI 0.6–1.4). The yield of less than 12 lymph nodes was significantly higher in the unstained group with RD of 0.292 and 95% CI of 0.182–0.403. Conclusion: Despite a small number of patients, this meta-analysis confirms improved lymph node harvest in surgical specimens stained with methylene blue compared with unstained specimens. [ABSTRACT FROM AUTHOR]

Background: Non-restorative surgery for rectal cancer is indicated in patients with comorbidities, advanced disease and poor continence. The aim of this meta-analysis was to compare the postoperative morbidity of Hartmann's procedure (HP) with that of extrasphincteric and intersphincteric abdominoperineal resection (APR) in the treatment of rectal cancer. Methods: The Medline, Embase and Cochrane databases were searched for publications comparing postoperative morbidity of HP and APR. The incidence of overall surgical complications, pelvic-perineal complications and pelvic abscess was analysed as primary endpoints. Readmissions requiring reintervention and postoperative mortality were also compared. Results: A cumulative analysis showed a significantly higher rate of overall complications (odds ratio (OR) 0.553, 95% confidence interval (CI) 0.320 to 0.953 and P value 0.033) and pelvic-perineal complications (OR 0.464, 95% CI 0.250 to 0.861 and P value 0.015) after APR. The incidence of isolated pelvic abscess formation was significantly higher after HP (OR 2.523, 95% CI 1.383 to 4.602 and P value 0.003). A subgroup analysis of intersphincteric APR compared with HP did not show any significant difference in the incidence of overall complications, pelvic-perineal complications or pelvic abscess formation (P values of 0.452, 0.258 and 0.100, respectively). There was no significant difference in readmissions, reinterventions and mortality after HP and APR (P 0.992, 0.198 and 0.151). Conclusion: An extrasphincteric APR is associated with higher overall and pelvic-perineal complications and may be reserved for tumours invading the anal sphincter complex. In the absence of sphincter involvement, both HP and intersphincteric APR are better alternatives with comparable morbidity. [ABSTRACT FROM AUTHOR]

Purpose: Anastomotic leak is a feared complication of rectal cancer surgery. A diverting stoma is believed to act as a safety mechanism against this undesirable outcome. This meta-analysis aimed to examine the role of loop ileostomy in the prevention of this complication. Methods: The Medline, Embase and Cochrane databases were searched for randomized controlled trials (RCTs) comparing anastomotic complications after rectal cancer surgery in the presence or absence of diverting ileostomy. The need for reoperation and postoperative complications were also analysed. The length of hospital stay, intraoperative blood loss and operating time were analysed as secondary endpoints. Results: A significantly higher number of anastomotic leaks was detected in patients with no diverting ileostomies than in those with diversion (odds ratio (OR) 0.292 and 95% confidence interval (CI) 0.177–0.481), and more patients required reoperations in this group (OR 0.219 and 95% CI 0.114–0.422). The rate of complications other than anastomotic leak was significantly higher in patients with diverting ileostomies than in those without (OR 3.337 and 95% CI of 1.570–7.093). The operating time was longer in the ileostomy group than in the no ileostomy group (P 0.001), but no significant differences in the intraoperative blood loss or postoperative hospital stay length were observed between the two groups(P 0.199 and 0.191 respectively). Conclusion: A lower leak rate in the presence of diverting ileostomy is supported by relatively weak evidence. While mitigating the consequences of leakage, diverting ileostomies lead to numerous other complications. High-quality RCTs are needed before routine ileostomy diversions can be recommended after rectal cancer surgery. [ABSTRACT FROM AUTHOR]

Exposure to airborne biological hazards in an ever expanding urban transport infrastructure and highly diverse mobile population is of growing concern, in terms of both public health and biosecurity. The existing policies and practices on design, construction and operation of these infrastructures may have severe implications for airborne disease transmission, particularly, in the event of a pandemic or intentional release of biological of agents. This paper reviews existing knowledge on airborne disease transmission in different modes of transport, highlights the factors enhancing the vulnerability of transport infrastructures to airborne disease transmission, discusses the potential protection measures and identifies the research gaps in order to build a bioresilient transport infrastructure. The unification of security and public health research, inclusion of public health security concepts at the design and planning phase, and a holistic system approach involving all the stakeholders over the life cycle of transport infrastructure hold the key to mitigate the challenges posed by biological hazards in the twenty-first century transport infrastructure. [ABSTRACT FROM AUTHOR]

The total concentration and size distribution of bioaerosols in three different types of housing (single room in shared accommodation [type I], single bedroom flat in three-storey building [type II] and two- or three-bedroom detached houses [type III]) was assessed during the winter. This research was an extension of a previous study carried out in the summer. The measurement campaign was undertaken in winter 2008 and 30 houses were sampled. Samples were taken from kitchens, living rooms, corridors (only in housing type I) and outdoors with an Anderson 6 stage viable impactor. In housing type I, the total geometric mean concentration was highest in the corridor for both bacteria and fungi (3,171 and 1,281 CFU/m, respectively). In type II residences, both culturable bacteria and fungi were greatest in the living rooms (3,487 and 833 CFU/m, respectively). The living rooms in type III residences had largest number of culturable bacteria (1,361 CFU/m) while fungi were highest in kitchens (280 CFU/m). The concentrations of culturable bacteria and fungi were greater in mouldy houses than non-mouldy houses. A considerable variation was seen in the size distribution of culturable bacteria in type I residences compared to types II and III. For all housing types more than half of culturable bacterial and fungal aerosol were respirable (<4.7 μm) and so have the potential to penetrate into lower respiratory system. Considerable variation in concentration and size distribution within different housing types in the same geographical region highlights the impact of differences in design, construction, use and management of residential built environment on bioaerosols levels and consequent varied risk of population exposure to airborne biological agents. [ABSTRACT FROM AUTHOR]

The concentration and size distribution of bacterial and fungal aerosol was studied in 15 houses. The houses were categorized into three types, based on occupant density and number of rooms: single room in shared accommodation (type I), single bedroom flat in three storey buildings (type II) and two or three bedroomed houses (type III). Sampling was undertaken with an Anderson six-stage impactor during the summer of 2007 in the living rooms of all the residential settings. The maximum mean geometric concentration of bacterial (5,036 CFU/m, ± 2.5, n = 5) and fungal (2,124 CFU/m, ± 1.38, n = 5) aerosol were in housing type III. The minimum levels of indoor culturable bacteria (1,557 CFU/m, ±1.5, n = 5) and fungal (925 CFU/m, ±2.9, n = 5) spores were observed in housing type I. The differences in terms of total bacterial and fungal concentration were less obvious between housing types I and II as compared to type III. With reference to size distribution, the dominant stages for culturable bacteria in housing types I, II and III were stage 3 (3.3–4.7 μm), stage 1 (7 μm and above) and stage 5 (1.1–2.1 μm), respectively. Whereas the maximum numbers of culturable fungal spores were recovered from stage 2 (4.7–7 µm), in housing type I, and from stage 4 (2.1–3.3 μm) in both type II and III houses. The average geometric mean diameter of bacterial aerosol was largest in type I (4.7 μm), followed by type II (3.89 μm) and III (1.96 μm). Similarly, for fungal spores, type I houses had the highest average mean geometric diameter (4.5 μm), while in types II and III the mean geometric diameter was 3.57 and 3.92 μm, respectively. The results indicate a wide variation in total concentration and size of bioaerosols among different residential settings. The observed differences in the size distributions and concentrations reflect their variable airborne behaviour and, as a result, different risks of respiratory exposure of the occupants to bioaerosols in various residential settings. [ABSTRACT FROM AUTHOR]

In Pakistan, almost 70% of the population lives in rural areas. Ninety-four percent of households in rural areas and 58% in urban areas depend on biomass fuels (wood, dung, and agricultural waste). These solid fuels have poor combustion efficiency. Due to incomplete combustion of the biomass fuels, the resulting smoke contains a range of health-deteriorating substances that, at varying concentrations, can pose a serious threat to human health. Indoor air pollution accounts for 28,000 deaths a year and 40 million cases of acute respiratory illness. It places a significant economic burden on Pakistan with an annual cost of 1% of GDP. Despite the mounting evidence of an association between indoor air pollution and ill health, policy makers have paid little attention to it. This review analyzes the existing information on levels of indoor air pollution in Pakistan and suggests suitable intervention methods. This review is focused on studies of indoor air pollution, due to biomass fuels, in Pakistan published in both scientific journals and by the Government and international organizations. In addition, the importance of environmental tobacco smoke as an indoor pollutant is highlighted. Unlike many other developing countries, there are no long-term studies on the levels of indoor air pollution. The limited studies that have been undertaken indicate that indoor air pollution should be a public health concern. High levels of particulate matter and carbon monoxide have been reported, and generally, women and children are subject to the maximum exposure. There have been a few interventions, with improved stoves, in some areas since 1990. However, the effectiveness of these interventions has not been fully evaluated. Indoor air pollution has a significant impact on the health of the population in Pakistan. The use of biomass fuel as an energy source is the biggest contributor to poor indoor air quality followed by smoking. In order to arrest the increasing levels of indoor pollution, there is a dire need to recognize it as a major health hazard and formulate a national policy to combat it. An integrated effort, with involvement of all stakeholders, could yield promising results. A countrywide public awareness campaign, on the association of indoor air pollution with ill health, followed by practical intervention would be an appropriate approach. Due to the current socioeconomic conditions in the country, development and adoption of improved cooking stoves for the population at large would be the most suitable choice. However, the potential of biogas as a fuel should be explored further, and modern fuels (natural gas and LPG) need to be accessible and economical. Smoking in closed public spaces should be banned, and knowledge of the effect of smoking on indoor air quality needs to be quantified. [ABSTRACT FROM AUTHOR]

The article presents a review on the ambient air quality in Pakistan. Study finds particulate matter (PM) as the most serious air pollutant in the country. It notes that the levels of carbon monoxide (CO), PM, and nitrogen monoxide (NO) were many times higher than the World Health Organization air quality guidelines. It suggests that air quality flow calls for action to discuss poor air quality through an extension of monitoring sites and creation of ambient air quality standards.

In the developing world, the vast majority of people rely on solid biomass fuels for cooking and heating which results in poor indoor air quality. The present study determined indoor air quality in some rural and urban areas of Pakistan. Measurements were made of particulate mass (PM10, PM2.5 and PM1), number concentration and bioaerosols in different micro environments. PM10 concentrations of up to 8,555 μg/m3 were observed inside the kitchens where biofuels were used as energy source. Cleaning and smoking was identified as a major source of indoor particulate pollution and concentrations of more than more than 2,000 μg/m3 were recorded in the living room during these activities. Indoor number concentrations in Lahore were typically greater than those observed outdoors in European cites. At a rural site the highest Colony Forming Units (CFUs) were in the 0.5 μm–2 μm size fraction, while at the urban location CFUs were dominant for 2 μm–16 μm. It was observed that CFUs(Colony Forming Units) counts were higher inside living rooms than kitchens. It is important to note that women and children were exposed to extremely high levels of particulates during cooking. Overall, indoor air quality in Pakistan was poor and there is a dire need to take a serious step to combat with it. [ABSTRACT FROM AUTHOR]

Particulate and gaseous emissions from intensive poultry facilities are major public and environmental health concern. The present study was aimed at exploratively monitoring particulate matter (PM) and gaseous concentrations in controlled-environment facilities using low-cost sensors in Lahore, Pakistan. The indoors and outdoors of 18 broiler houses, grouped into three categories based on the age of birds: group I (1–20 days), group II (21–30 days) and group III (31–40 days), were examined. Low-cost sensors Dylos 1700 and Aeroqual 500 series with different gas sensor heads were used to monitor PM and different gases such as nitrogen dioxide (NO2), hydrogen sulphide (H2S), carbon dioxide (CO2) and methane (CH4), respectively. Overall, the mean PM and gaseous concentrations increased with the age and activity of birds as compared with the non-activity time of birds. Statistically significant differences were observed in all measured parameters among the groups. The negative correlation between indoor and outdoor environments for PM and gas concentrations at some broiler houses demonstrates the contribution of additional sources to emissions in outdoor environments. The findings contribute to our knowledge of temporal characteristics of particulate and gaseous concentrations from poultry facilities particularly in Pakistan and generally to the capability of using low-cost sensors to evaluate emissions from such facilities. [ABSTRACT FROM AUTHOR]