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Background: The COVID-19 comorbid population is at higher risk of developing severe health issues like acute respiratory distress syndrome, coagulation syndrome, metabolic acidosis, and septic shock, potentially leading to patient death. Patients' knowledge, attitudes, and practices (KAP) significantly influence their response to the pandemic and aid in enhancing health policy implementation., Objective: To identify and evaluate the pattern and associated factors to COVID-19 knowledge, attitude, and practice among individuals with comorbidities., Methodology: The systematic review followed the PRISMA guidelines. Relevant studies assessing the KAP of comorbid patients were retrieved by carefully searching the PubMed and Google Scholar databases. The appraisal tool for cross-sectional studies was used to determine the quality of the included studies and the risk of biases., Results: Eighteen studies met the inclusion criteria and were included in the review. The pooled sample size of the included studies was 9,104. Different comorbidities reported in the studies include hypertension, diabetes, psychological disorders, and cancer. Pooled analysis showed that 65% of patients showed good knowledge, 57% of patients showed a positive attitude and 51% of patients followed good practices to manage the COVID-19 in presence of their comorbid condition. Significant factors impacting knowledge, attitude and practice in COVID-19 comorbid patients were ethnicity OR 1.78 [95% CI 1.35-2.32]; educational status 3.2 [2.79-3.58]; urban residence 2.43 [1.65-3.02]; employment Status 1.67[1.34-2.12]; financial Status 4.02[3.66-4.38]; occupation 3.65[3.31-4.25]; information Source 2.64[2.19-3.26]; comorbidity 3.28[2.78-3.61]; and duration of chronic illness 1.59[1.31-2.04]., Conclusion: Comorbid COVID-19 patients showed good knowledge, positive attitude and good practice towards the management of the disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rehman, Tasleem, Muhammad, Rasool, Shah, Jabeen, Arif, Omar Babkair, Kadumi, Alghamdi, Almarzoky Abuhussain, Khayyat, Alharthi, Hossain, Abbas, Elrggal and Haseeb.)

Acetochlor is frequently applied to various food crops in agriculture sector, and long-term exposure can cause significant endocrine-disrupting effects in exposed animals including impacts on human health. This study aimed to evaluate the effects of acetochlor on the growth, hematology, serum biochemistry, and histopathological alterations in Japanese quail. Eighty male quail were obtained and divided into four groups (A-D) and given acetochlor orally for the period of 45 days. Group A was served as the control, while groups B, C, and D received 20mg/kg, 30mg/kg, and 40mg/kg acetochlor, respectively. The study found that Japanese quail administered higher doses of acetochlor exhibited reduced frequency of crowing and foam production. The results showed that increased concentrations of acetochlor led to adverse effects on the growth parameters of Japanese quail. Hematology analysis indicated that birds exposed to higher concentrations of acetochlor experienced a significant decrease in red blood cell count, hemoglobin concentration, hematocrit (HCT), mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC), along with a significant increase in white blood cell count compared to the control group. Additionally, higher concentrations of acetochlor led to a significant increase in various serological indices including urea, creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase (AST), while the values of total proteins, albumin, and plasma proteins declined. The histopathology results of treated Japanese quail exposed to higher concentrations of acetochlor showed a range of pathological lesions in the testes, heart, and brain. The study concluded that even low concentrations of acetochlor can cause slight to significant changes in Japanese quail, affecting their physical, hematological, histopathological and serum biochemical parameters., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Arshad et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Industrial effluents reaching to the aquatic ecosystem is one of the major causes of environmental pollution and exposure to industrial effluents containing harmful substances may be a serious threat to human health. Therefore, the present study aimed to determine the sub-lethal (1/5th of predetermined LC 50 ) impact of industrial effluents from Sundar Industrial Estate on Oreochromis niloticus with proper negative control. The physicochemical analysis of industrial effluents showed enormous loads of inorganic pollutants and exhibited high mean levels of heavy metals, Mn, Fe, Pb, Ni, Cr, Hg, As, Zn and Fe with statistically significant differences at p < 0.05. Highest level of Mn and Fe was detected in effluent's samples as 147.36 ± 80.91 mg/L and 90.52 ± 32.08 mg/L, respectively. Exposure led to increase in serum biochemical parameters alanine aminotransferase + 25%, aspartate aminotransferase + 20% and alkaline phosphatase + 7% over control although superoxide dismutase, catalase, glutathione peroxidase and reduced glutathione significantly increased as 3.42, 2.44, 4.8 and 8 folds, respectively in metabolically active tissue brain which indicated stress caused by industrial effluents. The results concluded that industrial effluent has potent oxidative stress inducers on one hand whereas histoarchitectural and physiological toxicity causing contaminants on the other. This condition may adversely affect the health of aquatic organisms, the fish and ultimately the human beings., (© 2023. The Author(s).)

Aquatic pollution mainly by industrial effluents has been a major concern since a few decades. The current study evaluated cyto-genotoxicity of industrial effluents on Oreochromis niloticus exposed to sublethal levels by hematotoxicity, blood biochemistry analysis, micronucleus assay, antioxidants and cerebral toxicity. The significant elevation in differential leukocytes of exposed fish was indicative of infections and compromised immune system. The acute and chronic industrial effluent exposure caused significant decline in aspartame transaminase (AST) and alanine transaminase (ALT) and renal function enzymes. Necrosis, hyperplastic growth, hypertrophy and toxicant accumulation exhibited cerebral toxicity potential of industrial toxicants. A significant decrease in antioxidants, GSH, SOD and catalase (0.14, 0.66 and 1549 unit/mg protein) in chronic exposure group in comparison to 0.18, 2.83, 7680 and 6200.8 values of GSH, SOD, GPx and CAT, respectively. Results showed that acute and chronic industrial effluent exposure caused genotoxicity with higher frequencies of formation of micronuclei and cytokaryotic fusion., Competing Interests: Declaration of Competing Interest I and my co-authors confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Probiotics play a significant role in aquaculture by improving the growth, health, and survival rate of fish against pathogenic organisms. In the present study, we have evaluated the effects of a Lactobacillus rhamnosus ( L. rhamnosus ) probiotic on growth performance and disease resistance in Oreochromis niloticus ( O. niloticus ) fingerlings. Four different concentrations of L. rhamnosus (T1: 0.5 × 10 10 , T2: 1 × 10 10 , T3: 1.5 × 10 10 , and T4: 2 × 10 10 CFU/kg feed) were administered to fish over a period of three months. L. rhamnosus treated fish revealed a high growth increment as compared to the control, and the values of macromolecules (amino acids, fatty acids, and carbohydrates) varied significantly among the treated and control groups. Levels of thyroid hormones were noted to be high in the probiotic-treated groups. A challenge assay was performed with Aeromonas hydrophila ( A. hydrophila ). The optimum calculated concentration of probiotics from the growth assay (1.5 × 10 10 CFU/kg feed) was used for the challenge assay. Fish were divided into four groups as follows: control (Con), probiotic-treated (PL), infected (I), and infected + probiotic-treated (I + PL) groups. Significant variations in hematological parameters were observed among control and treated groups. Histopathological changes were recorded in infected fish, while the infected + probiotic-treated group showed less deformations indicating the positive effect of the probiotic supplementation. The survival rate of fish was also better in the probiotic-treated group. Based on these findings, we conclude that probiotic supplementation enhances the growth and improves immunity of O. niloticus . Therefore, we propose that probiotics can be used as promising feed supplements for promoting fish production and disease resistance in aquaculture.

UV induced DNA damage can lead to the development of skin cancer, skin aging and cell death. In this study, we fabricated a fluorescence-based biosensor that can be applied to the detection of DNA damage caused by UV radiation with the help of nitrogen doped graphene quantum dots (N-GQDs) as the probe material. In this paper, N-GQDs with good fluorescence efficiency have been synthesized by the hydrothermal method and were used as a fluorescent probe for the detection of UV damaged DNA. The fluorescence intensity of N-GQDs was quenched by the static quenching of UV damaged DNA through the formation of a N-GQD/UV damaged DNA complex. Moreover, the effects of different values of pH, NaCl and glucose on analytical performances of the sensor were also studied. Thus, using a fluorescence based approach, we demonstrated a quite simple, rapid, and inexpensive biosensor for the detection of DNA damage caused by UV radiation., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Heat shock proteins (HSP) are highly conserved in their structure and released in case of stress. Increased metallothionein (MT) synthesis is associated with increased capacity for binding heavy metals. Healthy juveniles of grass carp were exposed to sublethal dose (1.495 mg L -1 ) of cadmium for 28 days. Simultaneously, a control group was also run to compare difference of total RNA expression levels in cadmium-treated and control groups. The cadmium levels in the tissues of treated fish recorded were 1.78 ± 0.10 mg L -1 , 1.60 ± 0.04 mg L -1 , and 2.00 ± 0.05 mg L -1 , respectively. Several histological alterations including edema, hemorrhage, dilated sinusoids, hypertrophy, hyperplasia, congestion of central vein, and nuclear alterations were observed in cadmium-exposed fish. Stress gene (metallothionein and heat shock proteins) mRNA transcription levels were studied by mRNA extraction and cDNA preparation by using PCR. The expression level of heat shock protein gene was higher as compared to metallothionein and beta-2-microglobulin gene after cadmium exposure. This study reports various stress-related immune-responsive changes of immune proteins, heat shock proteins, metallothionein, and histopathological changes in fish due to cadmium toxicity that make the fish immunocompromised which may be considered as the biomarkers of cadmium toxicity in other experimental species., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Ghazala Jabeen et al.)

From the past few decades, attention towards the biological evaluation of nanoparticles (NPs) has increased due to the persistent and extensive application of NPs in various fields, including biomedical science, modern industry, magnetic resonance imaging, and the construction of sensors. Therefore, in the current study, magnetic nickel ferrite (NiFe 2 O 4 ) nanoparticles (NFNPs) were synthesized and evaluated for their possible adverse effects in rabbits. The crystallinity of the synthesized NFNPs was confirmed using X-ray diffraction (XRD) technique. The saturation magnetization (46.7 emug -1 ) was measured using vibrating sample magnetometer (VSM) and 0.35-tesla magnetron by magnetic resonance imaging (MRI). The adverse effects of NFNPs on blood biochemistry and histoarchitecture of the liver, kidneys, spleen, brain, and heart of the rabbits were determined. A total of sixteen adult rabbits, healthy and free from any apparent infection, were blindly placed in two groups. The rabbits in group A served as control, while the rabbits in group B received a single dose (via ear vein) of NFNPs for ten days. The blood and visceral tissues were collected from each rabbit at days 5 and 10 of posttreatment. The results on blood and serum biochemistry profile indicated significant variation in hematological and serum biomarkers in NFNP-treated rabbits. The results showed an increased quantity of oxidative stress and depletion of antioxidant enzymes in treated rabbits. Various serum biochemical tests exhibited significantly higher concentrations of different liver function tests, kidney function tests, and cardiac biomarkers. Histopathologically, the liver showed congestion, edema, atrophy, and degeneration of hepatocytes. The kidneys exhibited hemorrhages, atrophy of renal tubule, degeneration, and necrosis of renal tubules, whereas coagulative necrosis, neutrophilic infiltration, and severe myocarditis were seen in different sections of the heart. The brain of the treated rabbits revealed necrosis of neurons, neuron atrophy, and microgliosis. In conclusion, the current study results indicated that the highest concentration of NPs induced adverse effects on multiple tissues of the rabbits., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2022 Muhammad Shahid Khan et al.)

Since human beings have a long tradition of coexistence with pandemics, which may profoundly impact them, adopting preventive measures is crucial for humankind's survival. This study explores the intention-based critical factors affecting the willingness of individuals to adopt pandemic prevention. To this end, a representative sample of 931 Pakistanis filled in an online questionnaire. However, only 828 questionnaires were found to be complete and valid for path modeling analysis. The core findings are as follows: Firstly, peer groups' beliefs, self-efficacy, perceived risk, pandemic knowledge, ease of pandemic prevention adoption, and risk-averse behavior are revealed as driving forces of the individuals' willingness to adopt pandemic prevention. Contrastingly, a lack of trust in political will and mythical attitude towards pandemics are uncovered as inhibitors. Nevertheless, moral values depict a neutral role. Secondly, the peer groups' beliefs are highest ranked, followed by the lack of trust in political will and a mythical attitude towards pandemic prevention. Finally, moral values are determined as the lowest-ranked critical factor. Based on these results, the government should promote awareness campaigns on lethality and fatality of the pandemic at both centralized and decentralized levels to win people's trust at the grass-roots level and overcome the mythical attitude of individuals at all societal levels. Besides, access to personal protective gears should be made feasible since an easier pandemic prevention adoption would increase the individuals' willingness to adopt such preventative measures.

Background: The researches investigating the influence factors of epidemic prevention are not only scarce, but also provide a gap in the domain of perception-based influence factors of intention to adopt COVID-19 epidemic prevention., Objective: This work has attempted to examine the perception-based influence factors of individuals' intention to adopt COVID-19 epidemic prevention in a modified behavioral framework., Theoretical Framework: A behavioral framework composed of the theory of reasoned action and the theory of planned behavior is developed to incorporate some additional perception-based influence factors., Methods: A partial least square-based path analysis has been employed to estimate the path coefficients of those factors in terms of drivers, barriers, and neutral factors based on questionnaire data of 302 respondents from six universities and two hospitals in China., Results: Among the perception-based influence factors, governments' guidelines on epidemic prevention is found to be the most important and influential factor, which was followed by risk perception. Finally, attitude towards epidemic prevention exhibited the least degree of impact on individuals' intention to adopt epidemic prevention. Moral norms did not show any contribution to individuals' intention to adopt epidemic prevention., Conclusion: Concerning importance ranking, the governments' guidelines on epidemic prevention, risk perception, and epidemic knowledge are revealed as the top three drivers of individuals' intention to adopt epidemic prevention, while the perceived feasibility to adopt epidemic prevention is found to be a barrier. Moreover, moral norms is identified to have an insignificant influence on individuals' intention to adopt epidemic prevention. Given the empirical results, dissemination of Governments' guidelines on epidemic prevention, proper risk perception, and knowledge about epidemic would help prevent the COVID-19 pandemic outbreak within China and worldwide., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Diagnosis of lower respiratory tract infections (LRTI) depends on the presence of clinical, radiological and microbiological findings. Endotracheal suction aspirate (ETSA) is the commonest respiratory sample sent for culture from intubated patients. Very few studies have compared quantitative and semi-quantitative processing of ETSA cultures for LRTI diagnosis. We determined the diagnostic accuracy of quantitative and semi-quantitative ETSA culture for LRTI diagnosis, agreement between the quantitative and semi quantitative culture techniques and the yield of respiratory pathogens with both methods., Methods: This was a cross-sectional study conducted at the Aga Khan University clinical laboratory, Karachi, Pakistan. One hundred and seventy-eight ETSA samples sent for routine bacteriological cultures were processed quantitatively as part of regular specimen processing method and semi-quantitatively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for both methods using clinical diagnosis of pneumonia as reference standard. Agreement between the quantitative and semi quantitative methods was assessed via the kappa statistic test. Pathogen yield between the two methods was compared using Pearson's chi-square test., Results: The quantitative and semi-quantitative methods yielded pathogens in 81 (45.5%) and 85 (47.8%) cases respectively. There was complete concordance of both techniques in 155 (87.1%) ETSA samples. No growth was observed in 45 (25.3%) ETSA specimens with quantitative culture and 37 (20.8%) cases by semi-quantitative culture. The diagnostic accuracy of both techniques were comparable; 64.6% for quantitative and 64.0% for semi-quantitative culture. The kappa agreement was found to be 0.84 (95% CI, 0.77-0.91) representing almost perfect agreement between the two methods. Although semi-quantitative cultures yielded more pathogens (47.8%) as compared to quantitative ETSA cultures (45.5%), the difference was only 2.3%. However, this difference achieved statistical (chi-square p-value < 0.001) favoring semi-quantitative culture methods over quantitative culture techniques for processing ETSA., Conclusion: In conclusion, there is a strong agreement between the performances of both methods of processing ETSA cultures in terms of accuracy of LRTI diagnosis. Semi-quantitative cultures of ETSA yielded more pathogens as compared to quantitative cultures. Although both techniques were comparable, we recommend processing of ETSA using semi-quantitative technique due to its ease and reduced processing time.

The current study aimed to evaluate lipid profile parameters in patients with chronic kidney disease (CKD). This case-control study was conducted at the Zoology Department of Lahore College for Women University, Lahore, Pakistan, from September 2016 to June 2017 and analysed lipid profiles of patients with CKD attending different hospitals of Lahore. Of the randomly collected 100 blood samples, 50 were healthy, while the remaining 50 were patients with CKD. Lipid profile parameters were analysed using Hitachi 704 Analyser. For data analysis Chi-square test was used by means of SSPS 17. Results showed that all the parameters, including high density lipoprotein, triglycerides and low density lipoprotein were considerably altered in patients with CKD as compared to the control group. The values of triglycerides and LDL parameters were higher, while HDL cholesterol was lower in patients with CKD as compared to controls.

Objective: To identify the microbial profile and susceptibility pattern of pathogens responsible for culture-proven postoperative endophthalmitis, and to investigate possible trends in both pathogens and antibiotic sensitivities., Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of ophthalmology patients from January 1, 2005, to December 31, 2016. Culture and sensitivity reports of vitreous and aqueous humor samples from all the patients were retrieved from the medical record section of the hospital. SPSS 19 was used for data analysis., Results: Of the samples of 202 patients with a mean age of 58.2±15.8 years, 106(52.5%) were culturepositive. Of them, 55(51.8%) had gram-negative bacteria, 41(38.6%) had gram-positive bacteria, and 10(9.4%) had fungi. Among gram-positive bacteria, coagulase-negative staphylococcus was the principal isolate 18(17%) and among gram-negative bacteria, it was pseudomonas species 20(18.8%). Spectrum of gram-positive sensitivities included vancomycin 100%, gentamicin 91.5%, amikacin 100%, ciprofloxacin 68%, chloramphenicol 100%, and tetracycline 84.6%. Among gram-negative organisms, the sensitivities were ciprofloxacin 52.9%, ofloxacin 66.6%, ceftazidime 91.8%, amikacin 100%, tobramycin 100% imipenem 91.6%, gentamicin 81.2% and tetracycline 75%., Conclusions: Vancomycin and ceftazidime were the best empirical antibiotic selection to treat postoperative endophthalmitis.

Candida albicans was considered as the principal cause of opportunistic candidiasis but nowadays, neglected non-albicans Candida (NAC) species are evolving as more virulent and drug resistant strains. This research was intended to assess pervasiveness of candidiasis mainly caused by NAC species in Karachi city. A total of 562 clinical isolates of Candida spp. collected during the period of one year were identified by microscopic as well as morphological (germ tube formation, characteristics on CHROM agar and Corn meal agar) and Biochemical (sugar assimilation and fermentation) characteristics. Doubtful species were further identified by using Remel RapID TM yeast plus kit. The results were statistically analyzed by SPSS 16.0 version software. Isolated strains of candida revealed slight predominance of C. albicans (54.5%) over non- albicans Candida species (45.5%). Among NAC species, C. tropicalis and C. glabrata were isolated as the predominant species. These clinical species were procured mainly from urine samples of females (73.7%) of age group 20-30 years. No significant correlations exist between Candida species and their months of isolation as well as their isolation from different districts of Karachi. Emergence of NAC species may predict an upcoming threat in health care facilities and hence, require prompt management and accurate identification to suggest empirical antifungal therapy.

In the present in vivo study, we provide a comparison of toxicological consequences induced by four different types of spherical nanoparticles (NPs)-silver nanoparticles (AgNPs, 40 ± 6 nm), nickel (NiNPs, 43 ± 6 nm), cobalt oxide (Co₃O₄NPs, 60 ± 6 nm), and chromium oxide (Cr₃O₄NPs, 50 ± 5 nm)-on freshwater fish Labeo rohita . Fish were exposed to NPs (25 mg/L) for 21 days. We observed a NPs type-dependent toxicity in fish. An altered behavior showing signs of stress and a substantial reduction in total leukocyte count was noticed in all NP-treated groups. A low total erythrocyte count in all NP-treated fish except for Co₃O₄NPs was discerned while a low survival rate in the case of Cr₃O₄NP-treated fish was observed. A significant decrease in growth and hemoglobin were noticed in NiNP- and Cr₃O₄NP-treated fish. A considerable total protein elevation was detected in NiNP-, Co₃O₄NP-, and Cr₃O₄NP-treated groups. An upgrading in albumin level was witnessed in Co₃O₄NP- and Cr₃O₄NP-treated groups while a high level of globulin was noted in NiNP- and Co₃O₄NP-exposed groups. In all NP-treated groups, a depleted activity of antioxidative enzymes and pathological lesions in liver and kidney were noticed.

Background Intestinal parasites cause significant morbidity and impact human development with an enormous global burden. Diagnosis of intestinal parasites by conventional methods has several limitations. The gauze filtration technique is a relatively simple method that has been shown to identify intestinal parasites with a high sensitivity and specificity. The aim of this study was to determine the diagnostic value of this technique as compared to more conventional methods in a large acclaimed laboratory within Pakistan. Methods A total of 50 stool samples collected for routine diagnostic workup from patients age between 2-70 years were collected from the parasitology section of the Aga Khan University Hospital Clinical Laboratory. A direct wet mount, sedimentation technique, and gauze filtration technique were performed on all of the stool samples, and the sensitivity, specificity, negative predictive value, and positive predictive value were analyzed. Results It was observed that the number of organisms observed by gauze filtration as compared to direct wet mount and sedimentation technique was higher for B. hominis , G. lamblia cysts and trophozoites, and I. bütschlii . Also, the detection rate was significantly higher for B. hominis and G. lamblia cysts using the gauze filtration technique. The sensitivity and specificity of the gauze filtration technique were found to be 95.8% and 100%, respectively. Conclusion There is a significantly better stool sample parasite detection rate using the gauze filtration technique as compared to the conventional sedimentation techniques. The utility of the gauze filtration technique seems economically and technically feasible for diagnostic laboratories in resource-limited settings., Competing Interests: The authors have declared that no competing interests exist.

Bio-electrochemical synthesis (BES) is a technique in which electro-autotrophic bacteria such as Clostridium ljungdahlii utilize electric currents as an electron source from the cathode to reduce CO2 to extracellular, multicarbon, exquisite products through autotrophic conversion. The BES of volatile fatty acids and alcohols directly from CO2 is a sustainable alternative for non-renewable, petroleum-based polymer production. This conversion of CO2 implies reduction of greenhouse gas emissions. The synthesis of heptanoic acid, heptanol, hexanoic acid and hexanol, for the first time, by Clostridium ljungdahlii was a remarkable achievement of BES. In our study, these microorganisms were cultivated on the cathode of a bio-electrochemical cell at -400 mV by a DC power supply at 37 degree Centrigrade, pH 6.8, and was studied for both batch and continuous systems. Pre-enrichment of bio-cathode enhanced the electroactivity of cells and resulted in maximizing extracellular products in less time. The main aim of the research was to investigate the impact of low-cost substrate CO2, and the longer cathode recovery range was due to bacterial reduction of CO2 to multicarbon chemical commodities with electrons driven from the cathode. Reactor design was simplified for cost-effectiveness and to enhance energy efficiencies. The Columbic recovery of ethanoic acid, ethanol, ethyl butyrate, hexanoic acid, heptanoic acid and hexanol being in excess of 80 percent proved that BES was a remarkable technology.

Triple X syndrome is a rare numerical chromosomal anomaly, occurring as a result of non dysjunction in meiosis I. Most cases have neurodevelopmental defects and functional problems. We report two cases diagnosed in our centre. The first was a fetus with cleft lip and palate, 47, XXX was identified by Fetal Blood Sampling. The second was a child with multisystem anomaly including cleft lip and palate, whose karyotype also revealed 47, XXX. Though isolated cases of associated abnormalities have been reported there have not been consistent phenotypic changes reported with this condition.