The unique physicochemical properties inherent to nanoscale materials have unveiled numerous potential applications,spanning beyond the pharmaceutical and medical sectors into various consumer industries like food and...The unique physicochemical properties inherent to nanoscale materials have unveiled numerous potential applications,spanning beyond the pharmaceutical and medical sectors into various consumer industries like food and cosmetics.Consequently,humans encounter nanomaterials through diverse exposure routes,giving rise to potential health considerations.Noteworthy among these materials are silica and specific metallic nanoparticles,extensively utilized in consumer products,which have garnered substantial attention due to their propensity to accumulate and induce adverse effects in the liver.This review paper aims to provide an exhaustive examination of the molecular mechanisms underpinning nanomaterial-induced hepatotoxicity,drawing insights from both in vitro and in vivo studies.Primarily,the most frequently observed manifestations of toxicity following the exposure of cells or animal models to various nanomaterials involve the initiation of oxidative stress and inflammation.Additionally,we delve into the existing in vitro models employed for evaluating the hepatotoxic effects of nanomaterials,emphasizing the persistent endeavors to advance and bolster the reliability of these models for nanotoxicology research.展开更多
Apart from listening to the cry of a healthy newborn,it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents.The global incidence of children...Apart from listening to the cry of a healthy newborn,it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents.The global incidence of children born with congenital anomalies has been reported to be 3%-6%with more than 90%of these occurring in low-and middle-income group countries.The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons.These children are operated under several surgical disciplines,viz,paediatric-,plastic reconstructive,neuro-,cardiothoracic-,orthopaedic surgery etc.These conditions may be life-threatening,e.g.,trachea-oesophageal fistula,critical pulmonary stenosis,etc.and require immediate surgical intervention.Some,e.g.,hydrocephalus,may need intervention as soon as the patient is fit for surgery.Some,e.g.,patent ductus arteriosus need‘wait and watch’policy up to a certain age in the hope of spontaneous recovery.Another extremely important category is that of patients where the operative intervention is done based on their age.Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery(many as multiple stages of correction)at appropriate ages.There are advantages and disadvantages of intervention at different ages.In this article,we present a review of optimal timings,along with reasoning,for surgery of many of the common congenital anomalies which are treated by plastic surgeons.Obstetricians,paediatricians and general practitioners/family physicians,who most often are the first ones to come across such children,must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.展开更多
BACKGROUND A significant subset of individuals with epilepsy fails to respond to currently available antiepileptic drugs,resulting in heightened mortality rates,psychosocial challenges,and a diminished quality of life...BACKGROUND A significant subset of individuals with epilepsy fails to respond to currently available antiepileptic drugs,resulting in heightened mortality rates,psychosocial challenges,and a diminished quality of life.Genetic factors,particularly within the SCN1A gene,and the pro-inflammatory cytokine response is important in intricating the drug resistance in idiopathic epilepsy cases.In this extended study,we determined the correlation of rs6732655A/T single nucleotide polymorphism to understand the causative association of SCN1A gene with epilepsy drug resistance and inflammatory response.AIM To find the correlation of SCN1A gene rs6732655A/T polymorphism with the drug-resistant epilepsy and inflammatory response.METHODS The study enrolled 100 age and sex-matched patients of both drug-resistant and drug-responsive epilepsy cases.We analysed the rs6732655A/T polymorphism to study its association and causative role in drug-resistant epilepsy cases using restriction fragment length polymorphism technique.The diagnostic performance of interleukin(IL)-1β,IL-6,and high mobility group box 1(HMGB1)protein levels was evaluated in conjunction with genotypic outcome receiver operating characteristic analysis.RESULTS AT and AA genotypes of rs6732655 SCN1A gene polymorphism were associated with higher risk of drug resistance epilepsy.Serum biomarkers IL-6,IL1βand HMGB1 demonstrated diagnostic potential,with cutoff values of 4.63 pg/mL,59.52 pg/mL and 7.99 ng/mL,respectively,offering valuable tools for epilepsy management.Moreover,specific genotypes(AA and AT)were found to be linked to the elevated levels of IL-1βand IL-6 and potentially reflecting increased oxidative stress and neuro-inflammation in drug-resistant cases supporting the previous reported outcome of high inflammatory markers response in drug resistance epilepsy.CONCLUSION SCN1A genotypes AA and AT are linked to higher drug-resistant epilepsy risk.These findings underscore the potential influence of inflammation and genetics on epilepsy treatment resistance.展开更多
Background:The compound Luteolin-7-rutinoside(L7R)is a flavone derivative of luteolin,predominantly identified in plant species belonging to the families Asteraceae.Conversely,Myristic acid is characterized by its str...Background:The compound Luteolin-7-rutinoside(L7R)is a flavone derivative of luteolin,predominantly identified in plant species belonging to the families Asteraceae.Conversely,Myristic acid is characterized by its structure as a 14-carbon,unsaturated fatty acid.In this investigation,we endeavor to elucidate the putative mechanisms underlying the therapeutic effects of Myristic Acid and Luteolin 7-rutinoside in the context of oral cancer treatment,employing network pharmacology coupled with molecular docking methodologies.Methods:The protein targets of Myristic Acid and Luteolin 7-rutinoside were identified through a search on the Swiss Target Database.Subsequently,a compound-target network was constructed using Cytoscape 3.9.1.Targets associated with OC were retrieved from the OMIM and GeneCards databases.The overlap between compound targets and OC-related targets was determined,and the resulting shared targets were subjected to protein-protein interaction(PPI)network analysis using the STRING database.Additionally,gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were conducted on the identified targets.Molecular docking were performed to investigate the interactions between the core target and the active compound.Results:The component target network comprises 103 nodes and 102 edges.Among the proteins in the protein-protein interaction(PPI)network,those with higher degrees are TNF,PPARG,and TP53.Analysis through Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathways indicates that the treatment of OC with Myristic Acid and Luteolin 7-rutinoside primarily involves the regulation of miRNA transcription and inflammatory response.The identified signaling pathways include Pathways in cancer,PPAR signaling pathway,EGFR signaling pathway,and TNF signaling pathway.Molecular docking studies reveal that Luteolin 7-rutinoside and Myristic acid exhibit higher affinity towards TNF,PPARG,TP53,and EGFR.Conclusion:This study reveals the potential molecular mechanism of Myristic Acid and Luteolin 7-rutinoside in the treatment of oral cancer,and provides a reference for subsequent basic research.展开更多
Inflammatory bowel disease(IBD)is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract,which follows a relapsing and remitting course.Apart from affecting the gastrointestina...Inflammatory bowel disease(IBD)is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract,which follows a relapsing and remitting course.Apart from affecting the gastrointestinal tract,IBD also has extra-intestinal manifestations(EIMs).While the etiology of extraintestinal manifestation remains unclear,it is theorized to be based on immunological responses influenced by genetic factors.Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn’s disease.The renal manifes-tations in IBD patients encompass a range of conditions including nephrolithiasis,amyloidosis,tubulointerstitial nephritis,glomerulonephritis(GN),obstructive pathologies,and chronic kidney disease(CKD).The incidence of CKD in IBD patients varies from 5%-15%.The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury,or from complications like recurrent stones,amyloidosis,or GN.Additionally,nephrotoxic medications used in treating IBD,such as TNF-αinhibitors,calcineurin inhibitors,and aminosalicylates,can exacerbate the decline in renal function.Currently,there is a lack of consensus regarding these patients'screening and renal function monitoring.This review aims to assess the existing literature on the different renal complications among individuals with IBD,shedding light on their pathophysiology and management.展开更多
The gut microbiome is defined as an ecological community of commensal symbiotic and pathogenic microorganisms that exist in our body.Gut microbiome dysbiosis is a condition of dysregulated and disrupted intestinal bac...The gut microbiome is defined as an ecological community of commensal symbiotic and pathogenic microorganisms that exist in our body.Gut microbiome dysbiosis is a condition of dysregulated and disrupted intestinal bacterial homeostasis,and recent evidence has shown that dysbiosis is related to chronic inflammation,insulin resistance,cardiovascular diseases(CVD),type 2 diabetes mellitus(T2DM),and obesity.It is well known that obesity,T2DM and CVD are caused or worsened by multiple factors like genetic predisposition,environmental factors,unhealthy high calorie diets,and sedentary lifestyle.However,recent evidence from human and mouse models suggest that the gut microbiome is also an active player in the modulation of metabolic syndrome,a set of risk factors including obesity,hyperglycemia,and dyslipidemia that increase the risk for CVD,T2DM,and other diseases.Current research aims to identify treatments to increase the number of beneficial microbiota in the gut microbiome in order to modulate metabolic syndrome by reducing chronic inflammation and insulin resistance.There is increasing interest in supplements,classified as prebiotics,probiotics,synbiotics,or postbiotics,and their effect on the gut microbiome and metabolic syndrome.In this review article,we have summarized current research on these supplements that are available to improve the abundance of beneficial gut microbiota and to reduce the harmful ones in patients with metabolic syndrome.展开更多
BACKGROUND Extramedullary blast crisis in chronic myeloid leukemia(CML)is an uncommon occurrence of leukemic blast infiltration in regions other than the bone marrow.Malignant infiltration of the serosal membranes sho...BACKGROUND Extramedullary blast crisis in chronic myeloid leukemia(CML)is an uncommon occurrence of leukemic blast infiltration in regions other than the bone marrow.Malignant infiltration of the serosal membranes should be considered in cases where CML presents with ascites or pleural effusion.CASE SUMMARY A 23-year-old female with CML presented with progressively worsening ascites and pleural effusion despite first-line tyrosine kinase inhibitor treatment.Her blood work indicated leukocytosis with myelocyte bulge and 2%blasts.Analysis of the patient’s bone marrow confirmed the chronic phase of CML.Abdominal ultrasound revealed hepatosplenomegaly with ascites.The fluid investigation of both ascites and pleural effusion revealed a predominance of neutrophils with exudate.However,no acid-fast bacilli or growth was observed after culturing.Although hydroxyurea reduced cell counts,there was no observed effect on ascites or pleural effusion.Repeat investigation of the ascitic and pleural fluid revealed a polymorphous myeloid cell population consisting of myelocytes,metamyelocytes,band forms,neutrophils and a few myeloblasts.Extramedullary blast crisis was suspected,and mutation analysis was performed.We switched the patient to dasatinib.The patient’s symptoms were relieved,and ascites and pleural effusion diminished.CONCLUSION Serosal membrane involvement in CML is extremely rare.In this case,the patient responded well to dasatinib treatment.展开更多
AIM:The study was initiated to evaluate the reactogenicity and immunogenicity of a recombinant hepatitis B vaccine in age group >40 years and to study the response of a single booster dose in primary non-responders...AIM:The study was initiated to evaluate the reactogenicity and immunogenicity of a recombinant hepatitis B vaccine in age group >40 years and to study the response of a single booster dose in primary non-responders to the hepatitis B vaccination. METHODS:A total of 102 volunteers without markers of hepatitis B infection (negative for HBsAg,anti-HBc antibody, HBeAg and anti-HBs antibody) received 20μg of recombinant HB vaccine intramuscularly at 0,1,and 6 months.Anti HBs titers were evaluated by a quantitative Elisa kit at 90 and 210 days.A booster dose of 20μg HB vaccine was given after 6 months of the 3^(rd) vaccine dose to the 15 non- responders and anti-HBs titers were measured after i month. RESULTS:Seroprotection (anti-HBs GMT^3 10 IU/L) was achieved in 85.3 % (87/102) volunteers.The mean GMT titers of the vaccine responders was 136.1 IU/L.Of the seroprotected individuals,there were 32.4% (33/102) hyporesponders (anti- HBs titers <10-99 mIU/ml) and 52.9% (54/102) were responders (anti-HBs titers >100 IU/L).All the non-responders (15/15) responded to a single dose of the booster dose of recombinant HB vaccine and their mean anti-HBs antibody titers were more than 100.5 mIU/ml after the booster dose. CONCLUSION:Recombinant hepatitis B vaccine offers good seroprotection in the age group >40 years and has a good safety profile.A single booster dose after 6 months in primary non-responders leads to good seroprotective anti-HBs antibody titers.However,larger population based studies are needed to evaluate the role of a booster dose in selected group of non-responders and whether such an approach will be cost effective.展开更多
BACKGROUND:Xanthogranulomatous cholecystitis(XGC)is an uncommon variant of chronic cholecystitis,characterized by marked thickening of the gallbladder wall and dense local adhesions.It often mimics a gallbladder carci...BACKGROUND:Xanthogranulomatous cholecystitis(XGC)is an uncommon variant of chronic cholecystitis,characterized by marked thickening of the gallbladder wall and dense local adhesions.It often mimics a gallbladder carcinoma(GBC), and may coexist with GBC,leading to a diagnostic dilemma. Furthermore,the premalignant nature of this entity is not known.This study was undertaken to assess the p53,PCNA and beta-catenin expression in XGC in comparison to GBC and chronic inflammation. METHODS:Sections from paraffin-embedded blocks of surgically resected specimens of GBC(69 cases),XGC(65), chronic cholecystitis(18)and control gallbladder(10)were stained with the monoclonal antibodies to p53 and PCNA, and a polyclonal antibody to beta-catenin.p53 expression was scored as the percentage of nuclei stained.PCNA expression was scored as the product of the percentage of nuclei stained and the intensity of the staining(1-3).A cut-off value of 80 for this score was taken as a positive result. Beta-catenin expression was scored as type of expression-membranous,cytoplasmic or nuclear staining. RESULTS:p53 mutation was positive in 52%of GBC cases and 3%of XGC,but was not expressed in chronic cholecystitis and control gallbladders.p53 expression was lower in XGC than in GBC(P<0.0001).PCNA expression was seen in 65%of GBC cases and 11%of XGC,but not in chronic cholecystitis and control gallbladders.PCNA expression was higher in GBC than XGC(P=0.0001),but there was no significant difference between the XGC,chronic cholecystitis and control gallbladder groups.Beta-catenin expression was positive in the GBC,XGC, chronic cholecystitis and control gallbladder groups.But the expression pattern in XGC,chronic cholecystitis and control gallbladders was homogenously membranous,whereas in GBC the membranous expression pattern was altered to cytoplasmic and nuclear.CONCLUSION:The expression of p53,PCNA and beta-catenin in XGC was significantly different from GBC and similar to chronic cholecystitis,thus indicating the inflammatory nature of XGC and may not support a premalignant nature of the lesion.展开更多
Insulin resistance is a hallmark of obesity,diabetes,and cardiovascular diseases,and leads to many of the abnormalities associated with metabolic syndrome. Our understanding of insulin resistance has improved tremendo...Insulin resistance is a hallmark of obesity,diabetes,and cardiovascular diseases,and leads to many of the abnormalities associated with metabolic syndrome. Our understanding of insulin resistance has improved tremendously over the years,but certain aspects of its estimation still remain elusive to researchers and clinicians.The quantitative assessment of insulin sensitivity is not routinely used during biochemical investigations for diagnostic purposes,but the emerging importance of insulin resistance has led to its wider application research studies.Evaluation of a number of clinical states where insulin sensitivity is compromised calls for assessment of insulin resistance. Insulin resistance is increasingly being assessed in various disease conditions where it aids in examining their pathogenesis,etiology and consequences. The hyperinsulinemic euglycemic glucose clamp is the gold standard method for the determination of insulin sensitivity,but is impractical as it is labor-and time-intensive.A number of surrogate indices have therefore been employed to simplify and improve the determination of insulin resistance.The object of this review is to highlight various aspects and methodologies for current and upcoming measures ofinsulin sensitivity/resistance.In-depth knowledge of these markers will help in better understanding and exploitation of the condition.展开更多
BACKGROUND:Hypersplenism is commonly seen in patients with non-cirrhotic portal hypertension(NCPH).While a splenectomy alone can effectively relieve the hypersplenism,it does not address the underlying portal hyperten...BACKGROUND:Hypersplenism is commonly seen in patients with non-cirrhotic portal hypertension(NCPH).While a splenectomy alone can effectively relieve the hypersplenism,it does not address the underlying portal hypertension.The present study was undertaken to analyze the impact of shunt and non-shunt operations on the resolution of hypersplenism in patients with NCPH.The relationship of symptomatic hypersplenism,severe hypersplenism and number of peripheral cell line defects to the severity of portal hypertension and outcome was also assessed.METHODS:A retrospective analysis of NCPH patients with hypersplenism managed surgically between 1999 and 2009 at our center was done.Of 252 patients with NCPH,64(45 with extrahepatic portal vein obstruction and 19 with non-cirrhotic portal fibrosis) had hypersplenism and constituted the study group.Statistical analysis was done using GraphPad InStat.Categorical and continuous variables were compared using the chi-square test,ANOVA,and Student’s t test.The MannWhitney U test and Kruskal-Wallis test were used to compare non-parametric variables.RESULTS:The mean age of patients in the study group was 21.81±6.1 years.Hypersplenism was symptomatic in 70.3% with an incidence of spontaneous bleeding at 26.5%,recurrent anemia at 34.4%,and recurrent infection at 29.7%.The mean duration of surgery was 4.16±1.9 hours,intraoperative blood loss was 457±126(50-2000) mL,and postoperative hospital stay 5.5±1.9 days.Following surgery,normalization of hypersplenism occurred in all patients.On long-term followup,none of the patients developed hepatic encephalopathy and 4 had a variceal re-bleeding(2 after a splenectomy alone,1 each after an esophago-gastric devascularization and proximal splenorenal shunt).Patients with severe hypersplenism and those with defects in all three peripheral blood cell lineages were older,had a longer duration of symptoms,and a higher incidence of variceal bleeding and postoperative morbidity.In addition,patients with triple cell line defects had elevated portal pressure(P=0.001),portal biliopathy(P=0.02),portal gastropathy(P=0.005) and intraoperative blood loss(P=0.001).CONCLUSIONS:Hypersplenism is effectively relieved by both shunt and non-shunt operations.A proximal splenorenal shunt not only relieves hypersplenism but also effectively addresses the potential complications of underlying portal hypertension and can be safely performed with good long-term outcome.Patients with hypersplenism who have defects in all three blood cell lineages have significantly elevated portal pressures and are at increased risk of complications of variceal bleeding,portal biliopathy and gastropathy.展开更多
AIM To assess the adherence to self-care practices,glycemic status and influencing factors in diabetes patients.METHODS This was a cross-sectional observational analysis of baseline data from a quasi-experimental stud...AIM To assess the adherence to self-care practices,glycemic status and influencing factors in diabetes patients.METHODS This was a cross-sectional observational analysis of baseline data from a quasi-experimental study conducted among 375 diabetic patients aged between 18 to 65years at a major public tertiary care centre in New Delhi,India during February-September’2016.The Summary of Diabetes Self-care activities measure was used to assess medical adherence in diabetic patients.Open ended questions were used to identify facilitators and inhibitors of medical adherence.RESULTS Mean age of the study subjects was 49.7±10.2 years.A total of 201 men and 174 women were enrolled in the study.Three hundred nine(82.4%)subjects were adherent to their intake of anti-diabetic medication.On binary logistic regression,education level below primary school completion and absence of hypertensioncomorbidity were found to be independent predictors of medication non-adherence.Sociocultural resistance was an important factor impeding outdoor exercise among younger women.Knowledge of diabetes in the study subjects was low with mean score of 3.1±2(maximum score=10).Suboptimal glycemic control was found in259(69%)subjects which was significantly more likely in patients on Insulin therapy compared to those on Oral Hypoglycemic agents alone(P<0.006).DISCUSSION Our study found a large gap existed between selfreported medication adherence and glycemic control.This suggests the need for enhanced physician focus for diabetic patient management.展开更多
AIM： To undertake analysis of hepatitis A viral load, alanine aminotransferase （ALT）, and viral genotypes with duration of viremia, and to correlate these parameters with CD4^＋/ CD8^＋ lymphocyte populations that ...AIM： To undertake analysis of hepatitis A viral load, alanine aminotransferase （ALT）, and viral genotypes with duration of viremia, and to correlate these parameters with CD4^＋/ CD8^＋ lymphocyte populations that control cell-mediated immunity. METHODS： Cell counts were carried out using fresh whole blood collected in EDTA vials using a fluorescence activated cell sorter. Hepatitis A virus （HAV） RNA was extracted from blood serum, reverse transcribed into cDNA and quantified by Real-Time polymerase chain reaction and was genotyped. RESULTS： Among 11 patients, 10 could be analyzed completely. Of these, 3 had severe acute hepatitis （s-AH） and the remainder had a self-limited acute hepatitis A （AHA）, with one patient with fulminant disease （encephalopathy Grade IV） dying on the 4^th d. The ALT level was significantly higher both in AHA （1070.9±894.3; P = 0.0014） and s-AH （1713.9±886.3; P = 0.001） compared to normal controls （23.6±7.2）. The prothrombin time in s-AH patients （21.0 ±2.0; P=0.02） was significantly higher than in AHA （14.3±1.1;P = 0.44）. The CD4^＋/CD8^＋ ratio in AHA patients （1.17 ＋ 0.11; P = 0.22） and s-AH （0.83 ＋ 0.12; P = 0.0002） were lower than seen in normal healthy controls （1.52）. Self-limited cases had peak viral load at the beginning of analysis while in s-AH patients this occurred at the 15TM or 30^th d. In acute and severe groups, one patient each belonged to genotype IA, with the remaining 8 cases belonging to genotype IIIA. The only fulminant hepatic failure case belonged to genotype IA. HAV viral load and AIT values collected during the entire course of the selflimited infection were directly correlated but this was not the case for s-AH patients.CONCLUSION： Based on a small-scale study, the persistently higher viral load of s-AH might be due to diminished cellular immunity and hemolysis. The duration of viremia was dependent on the host, as the viral genotype had no apparent role in clinical outcome of AVH and s-AH cases.展开更多
As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few repo...As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized.展开更多
Airway evaluation and its management remainsan ever emerging clinical science. Present airway management tools are static and do not provide dynamic airway management option. Visualized procedures like ultrasound(US) ...Airway evaluation and its management remainsan ever emerging clinical science. Present airway management tools are static and do not provide dynamic airway management option. Visualized procedures like ultrasound(US) provide point of care real time dynamic views of the airway in perioperative, emergency and critical care settings. US can provide dynamic anatomical assessment which is not possible by clinical examination alone. US aids in detecting gastric contents and the nature of gastric contents(clear fluid, thick turbid or solid) as well. US can help in predicting endotracheal tube size by measuring subglottic diameter and diameter of left main stem bronchus. US was found to be a sensitive in detecting rotational malposition of LMA in children. Also, US is the fastest and highly sensitive tool to rule out a suspected intraoperative pneumothorax. In intensive care units, US helps torule out causes of inadequate ventilation, determine the tracheal width and distance from the skin to predict tracheotomy tube size and shape and assist with percutaneous dilatational tracheostomy. US can help in confirming the correct tracheal tube placement by dynamic visualisation of the endotracheal tube insertion, widening of vocal cords(children), and bilateral lung-sliding and diaphragmatic movement. Thus, ultrasonography has brought a paradigm shift in the practise of airway management. With increasing awareness, portability, accessibility and further sophistication in technology, it is likely to find a place in routine airway management. We are not far from the time when all of us will be carrying a pocket US machine like stethoscopes to corroborate our clinical findings at point of care.展开更多
India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset o...India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset of complications with associated economic costs indicates a high prevalence of poor self-management practices. It is well-established that achieving patient-centered primary care consistent with a chronic care model ensures optimum diabetes self-management support and improves long-term clinical and health outcomes in diabetes patients. The public sector primary care system in India provides services free of cost to beneficiaries but lacks patient-centered care that undermines diabetes selfmanagement education and support. Furthermore, factors like poor patient knowledge of diabetes, suboptimal medication adherence, persistent clinical inertia, lack of data for monitoring and evaluation through clinical audit worsens the standards of diabetes care in primary care settings of India. There is a need for government initiatives to be directed towards the provision of comprehensive outpatient care that is inclusive of uninterrupted supply of drugs, provision of essential laboratory investigators, training and availability of qualified diabetes educators and availability of specialist support when required. Furthermore, the integration of depression screening and smoking cessation services at the primary care level is warranted.展开更多
We present the complete set of physical and geometrical parameters of the visual close binary system GJ 9830 for the first time by applying Al-Wardat’s complex method.This method combines magnitude difference from sp...We present the complete set of physical and geometrical parameters of the visual close binary system GJ 9830 for the first time by applying Al-Wardat’s complex method.This method combines magnitude difference from speckle interferometry,synthetic spectral energy distributions of the binary components which are constructed based on grids of Kurucz blanketed models(ATLAS9),and the orbital solution using Tokovinin’s dynamical method to estimate the parameters of individual components.The analysis of the system by employing synthetic photometry resulted in the following set of parameters:Teff= 6220 ± 100 K,log g = 4.30 ± 0.12,R = 1.10 ± 0.08 R⊙for the primary component and Teff= 4870 ± 100 K,log g = 4.60 ± 0.11,R = 0.709 ± 0.07 R⊙for the secondary component.The recently published dynamical parallax from the Gaia space mission was used to calculate the total mass of the binary system as 1.75 ± 0.06 M⊙,which coincides with those estimated using Al-Wardat’s method as MA= 1.18 ± 0.10 M⊙,MB= 0.75 ± 0.08 M⊙.The analysis of the system reveals that both components are characteristic of main sequence stars and have an age of around 1.4 ± 0.50 Gyr.The evolutionary tracks and isochrones of the system’s components are discussed,and the fragmentation process is suggested as the most likely process for the formation of the system.展开更多
AIM： To study the effect of combined omeprazole（Ome） and domperidone（Dom） therapy on asthma symptoms and pulmonary function in asthmatics with gastroesoph- ageal reflux. METHODS： We selected 198 asthmatics with ...AIM： To study the effect of combined omeprazole（Ome） and domperidone（Dom） therapy on asthma symptoms and pulmonary function in asthmatics with gastroesoph- ageal reflux. METHODS： We selected 198 asthmatics with gastro- esophageal reflux diagnosed by 24-h esophageal pH moni- toring to receive Ome 20 mg twice daily and Dom 10 mg three times daily or placebo for 16 wk （1：1 double-blind randomization）. Spirometry was done at baseline and after 16 wk of treatment. The primary outcome measures were： mean daily daytime and nighttime asthma symptom scores. Mean daily reflux symptom scores, albuterol use as rescue medication （number of puffs）, daytime and nighttime peak expiratory flow rate （PEFR）, postbronchodilator forced expiratory volume in 1 second （FEVl） and postbronchodilator forced vital capacity （FVC） were secondary outcome measures. RESULTS： Comparison of mean change from baseline between antireflux therapy and placebo groups revealed significant reduction in daytime asthma symptom score （17.4% vs 8.9 %）, nighttime asthma symptom score （19.6% vs 5.4%）, reflux symptom score （8.7% vs 1.6%） and rescue medication use （23.2% vs 3.1%） after antireflux therapy compared to mean change in placebo group （P 〈 0.001）. There was significant improvement in morning PEFR （7.9% vs 0.2%）, evening PEFR （9.8% vs 0.5%）, FEW （11.1% vs 3.78%） and FVC （9.3%vs 1.52%） in the antireflux therapy group compared to placebo on comparng the mean change from baseline after 16 wk （P 〈 0.01） CONCLUSION： Combined therapy with Ome and Dom in adult asthmatics with gastroesophageal reflux may be beneficial by reducing asthma symptoms, rescuing medi- cation use, and improving pulmonary function.展开更多
Objective: To evaluate the outcome of ureteroscopic pneumatic lithotripsy in single lower ureteric calculus and correlate its success with different CT parameters like HU, size of calculus and hydrnephrosis, if presen...Objective: To evaluate the outcome of ureteroscopic pneumatic lithotripsy in single lower ureteric calculus and correlate its success with different CT parameters like HU, size of calculus and hydrnephrosis, if present. Patients and Methods: This study was conducted from October 2017 to March 2019 in Department of General Surgery, Maulana Azad Medical College, New Delhi. 30 patients (out of which 6 were excluded due to spontaneous passage of calculus), with single lower ureteric calculus were chosen and the outcome of URSL was compared with respect to CT parameters of Size, HU and Hydronephrosis and intra-operative clearance of calculus. Results: Success rate of URSL in single lower ureteric calculus was found to be 75%. Lower HU (774.12 ± 212.85) was associated with higher success rate. Similarly smaller size of calculus (9 ± 2.1) mm was associated with success group. Patients with gross hydronephrosis had a poor outcome of URSL. Lower urinary tract infection (8.33%) was the most common complication. Conclusion: Patients with small size calculus, low HU and absence of hydronephrosis have a better outcome of URSL.展开更多
BACKGROUND:Choledochal cysts in adults are more commonly associated with complications such as cystolithiasis,recurrent cholangitis,portal hypertension and malignancy,than in the pediatric age group.METHOD:We report a...BACKGROUND:Choledochal cysts in adults are more commonly associated with complications such as cystolithiasis,recurrent cholangitis,portal hypertension and malignancy,than in the pediatric age group.METHOD:We report a case of adult choledochal cyst with long-term complication of large stone cast and portal hypertension due to secondary biliary cirrhosis.RESULTS:A 50-year-old patient presented with obstructive jaundice and hepatosplenomegaly.On investigation,she was diagnosed as having a choledochal cyst with large stone cast and portal hypertension.Single stage resection of the choledochal cyst with Roux-en-Y hepaticojejunostomy was done by meticulous dissection and ligation of collaterals.CONCLUSION:Single stage resection of a choledochal cyst is possible in spite of associated portal hypertension,if the portal vein is patent.展开更多
文摘The unique physicochemical properties inherent to nanoscale materials have unveiled numerous potential applications,spanning beyond the pharmaceutical and medical sectors into various consumer industries like food and cosmetics.Consequently,humans encounter nanomaterials through diverse exposure routes,giving rise to potential health considerations.Noteworthy among these materials are silica and specific metallic nanoparticles,extensively utilized in consumer products,which have garnered substantial attention due to their propensity to accumulate and induce adverse effects in the liver.This review paper aims to provide an exhaustive examination of the molecular mechanisms underpinning nanomaterial-induced hepatotoxicity,drawing insights from both in vitro and in vivo studies.Primarily,the most frequently observed manifestations of toxicity following the exposure of cells or animal models to various nanomaterials involve the initiation of oxidative stress and inflammation.Additionally,we delve into the existing in vitro models employed for evaluating the hepatotoxic effects of nanomaterials,emphasizing the persistent endeavors to advance and bolster the reliability of these models for nanotoxicology research.
文摘Apart from listening to the cry of a healthy newborn,it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents.The global incidence of children born with congenital anomalies has been reported to be 3%-6%with more than 90%of these occurring in low-and middle-income group countries.The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons.These children are operated under several surgical disciplines,viz,paediatric-,plastic reconstructive,neuro-,cardiothoracic-,orthopaedic surgery etc.These conditions may be life-threatening,e.g.,trachea-oesophageal fistula,critical pulmonary stenosis,etc.and require immediate surgical intervention.Some,e.g.,hydrocephalus,may need intervention as soon as the patient is fit for surgery.Some,e.g.,patent ductus arteriosus need‘wait and watch’policy up to a certain age in the hope of spontaneous recovery.Another extremely important category is that of patients where the operative intervention is done based on their age.Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery(many as multiple stages of correction)at appropriate ages.There are advantages and disadvantages of intervention at different ages.In this article,we present a review of optimal timings,along with reasoning,for surgery of many of the common congenital anomalies which are treated by plastic surgeons.Obstetricians,paediatricians and general practitioners/family physicians,who most often are the first ones to come across such children,must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.
文摘BACKGROUND A significant subset of individuals with epilepsy fails to respond to currently available antiepileptic drugs,resulting in heightened mortality rates,psychosocial challenges,and a diminished quality of life.Genetic factors,particularly within the SCN1A gene,and the pro-inflammatory cytokine response is important in intricating the drug resistance in idiopathic epilepsy cases.In this extended study,we determined the correlation of rs6732655A/T single nucleotide polymorphism to understand the causative association of SCN1A gene with epilepsy drug resistance and inflammatory response.AIM To find the correlation of SCN1A gene rs6732655A/T polymorphism with the drug-resistant epilepsy and inflammatory response.METHODS The study enrolled 100 age and sex-matched patients of both drug-resistant and drug-responsive epilepsy cases.We analysed the rs6732655A/T polymorphism to study its association and causative role in drug-resistant epilepsy cases using restriction fragment length polymorphism technique.The diagnostic performance of interleukin(IL)-1β,IL-6,and high mobility group box 1(HMGB1)protein levels was evaluated in conjunction with genotypic outcome receiver operating characteristic analysis.RESULTS AT and AA genotypes of rs6732655 SCN1A gene polymorphism were associated with higher risk of drug resistance epilepsy.Serum biomarkers IL-6,IL1βand HMGB1 demonstrated diagnostic potential,with cutoff values of 4.63 pg/mL,59.52 pg/mL and 7.99 ng/mL,respectively,offering valuable tools for epilepsy management.Moreover,specific genotypes(AA and AT)were found to be linked to the elevated levels of IL-1βand IL-6 and potentially reflecting increased oxidative stress and neuro-inflammation in drug-resistant cases supporting the previous reported outcome of high inflammatory markers response in drug resistance epilepsy.CONCLUSION SCN1A genotypes AA and AT are linked to higher drug-resistant epilepsy risk.These findings underscore the potential influence of inflammation and genetics on epilepsy treatment resistance.
文摘Background:The compound Luteolin-7-rutinoside(L7R)is a flavone derivative of luteolin,predominantly identified in plant species belonging to the families Asteraceae.Conversely,Myristic acid is characterized by its structure as a 14-carbon,unsaturated fatty acid.In this investigation,we endeavor to elucidate the putative mechanisms underlying the therapeutic effects of Myristic Acid and Luteolin 7-rutinoside in the context of oral cancer treatment,employing network pharmacology coupled with molecular docking methodologies.Methods:The protein targets of Myristic Acid and Luteolin 7-rutinoside were identified through a search on the Swiss Target Database.Subsequently,a compound-target network was constructed using Cytoscape 3.9.1.Targets associated with OC were retrieved from the OMIM and GeneCards databases.The overlap between compound targets and OC-related targets was determined,and the resulting shared targets were subjected to protein-protein interaction(PPI)network analysis using the STRING database.Additionally,gene ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were conducted on the identified targets.Molecular docking were performed to investigate the interactions between the core target and the active compound.Results:The component target network comprises 103 nodes and 102 edges.Among the proteins in the protein-protein interaction(PPI)network,those with higher degrees are TNF,PPARG,and TP53.Analysis through Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathways indicates that the treatment of OC with Myristic Acid and Luteolin 7-rutinoside primarily involves the regulation of miRNA transcription and inflammatory response.The identified signaling pathways include Pathways in cancer,PPAR signaling pathway,EGFR signaling pathway,and TNF signaling pathway.Molecular docking studies reveal that Luteolin 7-rutinoside and Myristic acid exhibit higher affinity towards TNF,PPARG,TP53,and EGFR.Conclusion:This study reveals the potential molecular mechanism of Myristic Acid and Luteolin 7-rutinoside in the treatment of oral cancer,and provides a reference for subsequent basic research.
文摘Inflammatory bowel disease(IBD)is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract,which follows a relapsing and remitting course.Apart from affecting the gastrointestinal tract,IBD also has extra-intestinal manifestations(EIMs).While the etiology of extraintestinal manifestation remains unclear,it is theorized to be based on immunological responses influenced by genetic factors.Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn’s disease.The renal manifes-tations in IBD patients encompass a range of conditions including nephrolithiasis,amyloidosis,tubulointerstitial nephritis,glomerulonephritis(GN),obstructive pathologies,and chronic kidney disease(CKD).The incidence of CKD in IBD patients varies from 5%-15%.The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury,or from complications like recurrent stones,amyloidosis,or GN.Additionally,nephrotoxic medications used in treating IBD,such as TNF-αinhibitors,calcineurin inhibitors,and aminosalicylates,can exacerbate the decline in renal function.Currently,there is a lack of consensus regarding these patients'screening and renal function monitoring.This review aims to assess the existing literature on the different renal complications among individuals with IBD,shedding light on their pathophysiology and management.
文摘The gut microbiome is defined as an ecological community of commensal symbiotic and pathogenic microorganisms that exist in our body.Gut microbiome dysbiosis is a condition of dysregulated and disrupted intestinal bacterial homeostasis,and recent evidence has shown that dysbiosis is related to chronic inflammation,insulin resistance,cardiovascular diseases(CVD),type 2 diabetes mellitus(T2DM),and obesity.It is well known that obesity,T2DM and CVD are caused or worsened by multiple factors like genetic predisposition,environmental factors,unhealthy high calorie diets,and sedentary lifestyle.However,recent evidence from human and mouse models suggest that the gut microbiome is also an active player in the modulation of metabolic syndrome,a set of risk factors including obesity,hyperglycemia,and dyslipidemia that increase the risk for CVD,T2DM,and other diseases.Current research aims to identify treatments to increase the number of beneficial microbiota in the gut microbiome in order to modulate metabolic syndrome by reducing chronic inflammation and insulin resistance.There is increasing interest in supplements,classified as prebiotics,probiotics,synbiotics,or postbiotics,and their effect on the gut microbiome and metabolic syndrome.In this review article,we have summarized current research on these supplements that are available to improve the abundance of beneficial gut microbiota and to reduce the harmful ones in patients with metabolic syndrome.
文摘BACKGROUND Extramedullary blast crisis in chronic myeloid leukemia(CML)is an uncommon occurrence of leukemic blast infiltration in regions other than the bone marrow.Malignant infiltration of the serosal membranes should be considered in cases where CML presents with ascites or pleural effusion.CASE SUMMARY A 23-year-old female with CML presented with progressively worsening ascites and pleural effusion despite first-line tyrosine kinase inhibitor treatment.Her blood work indicated leukocytosis with myelocyte bulge and 2%blasts.Analysis of the patient’s bone marrow confirmed the chronic phase of CML.Abdominal ultrasound revealed hepatosplenomegaly with ascites.The fluid investigation of both ascites and pleural effusion revealed a predominance of neutrophils with exudate.However,no acid-fast bacilli or growth was observed after culturing.Although hydroxyurea reduced cell counts,there was no observed effect on ascites or pleural effusion.Repeat investigation of the ascitic and pleural fluid revealed a polymorphous myeloid cell population consisting of myelocytes,metamyelocytes,band forms,neutrophils and a few myeloblasts.Extramedullary blast crisis was suspected,and mutation analysis was performed.We switched the patient to dasatinib.The patient’s symptoms were relieved,and ascites and pleural effusion diminished.CONCLUSION Serosal membrane involvement in CML is extremely rare.In this case,the patient responded well to dasatinib treatment.
文摘AIM:The study was initiated to evaluate the reactogenicity and immunogenicity of a recombinant hepatitis B vaccine in age group >40 years and to study the response of a single booster dose in primary non-responders to the hepatitis B vaccination. METHODS:A total of 102 volunteers without markers of hepatitis B infection (negative for HBsAg,anti-HBc antibody, HBeAg and anti-HBs antibody) received 20μg of recombinant HB vaccine intramuscularly at 0,1,and 6 months.Anti HBs titers were evaluated by a quantitative Elisa kit at 90 and 210 days.A booster dose of 20μg HB vaccine was given after 6 months of the 3^(rd) vaccine dose to the 15 non- responders and anti-HBs titers were measured after i month. RESULTS:Seroprotection (anti-HBs GMT^3 10 IU/L) was achieved in 85.3 % (87/102) volunteers.The mean GMT titers of the vaccine responders was 136.1 IU/L.Of the seroprotected individuals,there were 32.4% (33/102) hyporesponders (anti- HBs titers <10-99 mIU/ml) and 52.9% (54/102) were responders (anti-HBs titers >100 IU/L).All the non-responders (15/15) responded to a single dose of the booster dose of recombinant HB vaccine and their mean anti-HBs antibody titers were more than 100.5 mIU/ml after the booster dose. CONCLUSION:Recombinant hepatitis B vaccine offers good seroprotection in the age group >40 years and has a good safety profile.A single booster dose after 6 months in primary non-responders leads to good seroprotective anti-HBs antibody titers.However,larger population based studies are needed to evaluate the role of a booster dose in selected group of non-responders and whether such an approach will be cost effective.
基金support from the Department of Science and Technology,Ministry of Science&Technology,Government of India,Fast Track Scheme
文摘BACKGROUND:Xanthogranulomatous cholecystitis(XGC)is an uncommon variant of chronic cholecystitis,characterized by marked thickening of the gallbladder wall and dense local adhesions.It often mimics a gallbladder carcinoma(GBC), and may coexist with GBC,leading to a diagnostic dilemma. Furthermore,the premalignant nature of this entity is not known.This study was undertaken to assess the p53,PCNA and beta-catenin expression in XGC in comparison to GBC and chronic inflammation. METHODS:Sections from paraffin-embedded blocks of surgically resected specimens of GBC(69 cases),XGC(65), chronic cholecystitis(18)and control gallbladder(10)were stained with the monoclonal antibodies to p53 and PCNA, and a polyclonal antibody to beta-catenin.p53 expression was scored as the percentage of nuclei stained.PCNA expression was scored as the product of the percentage of nuclei stained and the intensity of the staining(1-3).A cut-off value of 80 for this score was taken as a positive result. Beta-catenin expression was scored as type of expression-membranous,cytoplasmic or nuclear staining. RESULTS:p53 mutation was positive in 52%of GBC cases and 3%of XGC,but was not expressed in chronic cholecystitis and control gallbladders.p53 expression was lower in XGC than in GBC(P<0.0001).PCNA expression was seen in 65%of GBC cases and 11%of XGC,but not in chronic cholecystitis and control gallbladders.PCNA expression was higher in GBC than XGC(P=0.0001),but there was no significant difference between the XGC,chronic cholecystitis and control gallbladder groups.Beta-catenin expression was positive in the GBC,XGC, chronic cholecystitis and control gallbladder groups.But the expression pattern in XGC,chronic cholecystitis and control gallbladders was homogenously membranous,whereas in GBC the membranous expression pattern was altered to cytoplasmic and nuclear.CONCLUSION:The expression of p53,PCNA and beta-catenin in XGC was significantly different from GBC and similar to chronic cholecystitis,thus indicating the inflammatory nature of XGC and may not support a premalignant nature of the lesion.
文摘Insulin resistance is a hallmark of obesity,diabetes,and cardiovascular diseases,and leads to many of the abnormalities associated with metabolic syndrome. Our understanding of insulin resistance has improved tremendously over the years,but certain aspects of its estimation still remain elusive to researchers and clinicians.The quantitative assessment of insulin sensitivity is not routinely used during biochemical investigations for diagnostic purposes,but the emerging importance of insulin resistance has led to its wider application research studies.Evaluation of a number of clinical states where insulin sensitivity is compromised calls for assessment of insulin resistance. Insulin resistance is increasingly being assessed in various disease conditions where it aids in examining their pathogenesis,etiology and consequences. The hyperinsulinemic euglycemic glucose clamp is the gold standard method for the determination of insulin sensitivity,but is impractical as it is labor-and time-intensive.A number of surrogate indices have therefore been employed to simplify and improve the determination of insulin resistance.The object of this review is to highlight various aspects and methodologies for current and upcoming measures ofinsulin sensitivity/resistance.In-depth knowledge of these markers will help in better understanding and exploitation of the condition.
文摘BACKGROUND:Hypersplenism is commonly seen in patients with non-cirrhotic portal hypertension(NCPH).While a splenectomy alone can effectively relieve the hypersplenism,it does not address the underlying portal hypertension.The present study was undertaken to analyze the impact of shunt and non-shunt operations on the resolution of hypersplenism in patients with NCPH.The relationship of symptomatic hypersplenism,severe hypersplenism and number of peripheral cell line defects to the severity of portal hypertension and outcome was also assessed.METHODS:A retrospective analysis of NCPH patients with hypersplenism managed surgically between 1999 and 2009 at our center was done.Of 252 patients with NCPH,64(45 with extrahepatic portal vein obstruction and 19 with non-cirrhotic portal fibrosis) had hypersplenism and constituted the study group.Statistical analysis was done using GraphPad InStat.Categorical and continuous variables were compared using the chi-square test,ANOVA,and Student’s t test.The MannWhitney U test and Kruskal-Wallis test were used to compare non-parametric variables.RESULTS:The mean age of patients in the study group was 21.81±6.1 years.Hypersplenism was symptomatic in 70.3% with an incidence of spontaneous bleeding at 26.5%,recurrent anemia at 34.4%,and recurrent infection at 29.7%.The mean duration of surgery was 4.16±1.9 hours,intraoperative blood loss was 457±126(50-2000) mL,and postoperative hospital stay 5.5±1.9 days.Following surgery,normalization of hypersplenism occurred in all patients.On long-term followup,none of the patients developed hepatic encephalopathy and 4 had a variceal re-bleeding(2 after a splenectomy alone,1 each after an esophago-gastric devascularization and proximal splenorenal shunt).Patients with severe hypersplenism and those with defects in all three peripheral blood cell lineages were older,had a longer duration of symptoms,and a higher incidence of variceal bleeding and postoperative morbidity.In addition,patients with triple cell line defects had elevated portal pressure(P=0.001),portal biliopathy(P=0.02),portal gastropathy(P=0.005) and intraoperative blood loss(P=0.001).CONCLUSIONS:Hypersplenism is effectively relieved by both shunt and non-shunt operations.A proximal splenorenal shunt not only relieves hypersplenism but also effectively addresses the potential complications of underlying portal hypertension and can be safely performed with good long-term outcome.Patients with hypersplenism who have defects in all three blood cell lineages have significantly elevated portal pressures and are at increased risk of complications of variceal bleeding,portal biliopathy and gastropathy.
文摘AIM To assess the adherence to self-care practices,glycemic status and influencing factors in diabetes patients.METHODS This was a cross-sectional observational analysis of baseline data from a quasi-experimental study conducted among 375 diabetic patients aged between 18 to 65years at a major public tertiary care centre in New Delhi,India during February-September’2016.The Summary of Diabetes Self-care activities measure was used to assess medical adherence in diabetic patients.Open ended questions were used to identify facilitators and inhibitors of medical adherence.RESULTS Mean age of the study subjects was 49.7±10.2 years.A total of 201 men and 174 women were enrolled in the study.Three hundred nine(82.4%)subjects were adherent to their intake of anti-diabetic medication.On binary logistic regression,education level below primary school completion and absence of hypertensioncomorbidity were found to be independent predictors of medication non-adherence.Sociocultural resistance was an important factor impeding outdoor exercise among younger women.Knowledge of diabetes in the study subjects was low with mean score of 3.1±2(maximum score=10).Suboptimal glycemic control was found in259(69%)subjects which was significantly more likely in patients on Insulin therapy compared to those on Oral Hypoglycemic agents alone(P<0.006).DISCUSSION Our study found a large gap existed between selfreported medication adherence and glycemic control.This suggests the need for enhanced physician focus for diabetic patient management.
文摘AIM： To undertake analysis of hepatitis A viral load, alanine aminotransferase （ALT）, and viral genotypes with duration of viremia, and to correlate these parameters with CD4^＋/ CD8^＋ lymphocyte populations that control cell-mediated immunity. METHODS： Cell counts were carried out using fresh whole blood collected in EDTA vials using a fluorescence activated cell sorter. Hepatitis A virus （HAV） RNA was extracted from blood serum, reverse transcribed into cDNA and quantified by Real-Time polymerase chain reaction and was genotyped. RESULTS： Among 11 patients, 10 could be analyzed completely. Of these, 3 had severe acute hepatitis （s-AH） and the remainder had a self-limited acute hepatitis A （AHA）, with one patient with fulminant disease （encephalopathy Grade IV） dying on the 4^th d. The ALT level was significantly higher both in AHA （1070.9±894.3; P = 0.0014） and s-AH （1713.9±886.3; P = 0.001） compared to normal controls （23.6±7.2）. The prothrombin time in s-AH patients （21.0 ±2.0; P=0.02） was significantly higher than in AHA （14.3±1.1;P = 0.44）. The CD4^＋/CD8^＋ ratio in AHA patients （1.17 ＋ 0.11; P = 0.22） and s-AH （0.83 ＋ 0.12; P = 0.0002） were lower than seen in normal healthy controls （1.52）. Self-limited cases had peak viral load at the beginning of analysis while in s-AH patients this occurred at the 15TM or 30^th d. In acute and severe groups, one patient each belonged to genotype IA, with the remaining 8 cases belonging to genotype IIIA. The only fulminant hepatic failure case belonged to genotype IA. HAV viral load and AIT values collected during the entire course of the selflimited infection were directly correlated but this was not the case for s-AH patients.CONCLUSION： Based on a small-scale study, the persistently higher viral load of s-AH might be due to diminished cellular immunity and hemolysis. The duration of viremia was dependent on the host, as the viral genotype had no apparent role in clinical outcome of AVH and s-AH cases.
文摘As patients with carcinoma of the esophagus live longer, complications associated with the use of a gastric conduit are increasing. Ulcers form in the gastric conduit in 6.6% to 19.4% of patients. There are a few reports of perforation of a gastric conduit in the English literature. Almost all of these were associated with serious complications. We report a patient who developed a tension pneumothorax consequent to spontaneous perforation of an ulcer in the gastric conduit 7 years after the index surgery in a patient with carcinoma of the gastroesophageal junction. He responded well to conservative management. Complications related to a gastric conduit can be because of multiple factors. Periodic endoscopic surveillance of gastric conduits should be considered as these are at a higher risk of ulcer formation than a normal stomach. Long term treatment with proton pump inhibitors may decrease complications. There are no guidelines for the treatment of a perforated gastric conduit ulcer and the management should be individualized.
文摘Airway evaluation and its management remainsan ever emerging clinical science. Present airway management tools are static and do not provide dynamic airway management option. Visualized procedures like ultrasound(US) provide point of care real time dynamic views of the airway in perioperative, emergency and critical care settings. US can provide dynamic anatomical assessment which is not possible by clinical examination alone. US aids in detecting gastric contents and the nature of gastric contents(clear fluid, thick turbid or solid) as well. US can help in predicting endotracheal tube size by measuring subglottic diameter and diameter of left main stem bronchus. US was found to be a sensitive in detecting rotational malposition of LMA in children. Also, US is the fastest and highly sensitive tool to rule out a suspected intraoperative pneumothorax. In intensive care units, US helps torule out causes of inadequate ventilation, determine the tracheal width and distance from the skin to predict tracheotomy tube size and shape and assist with percutaneous dilatational tracheostomy. US can help in confirming the correct tracheal tube placement by dynamic visualisation of the endotracheal tube insertion, widening of vocal cords(children), and bilateral lung-sliding and diaphragmatic movement. Thus, ultrasonography has brought a paradigm shift in the practise of airway management. With increasing awareness, portability, accessibility and further sophistication in technology, it is likely to find a place in routine airway management. We are not far from the time when all of us will be carrying a pocket US machine like stethoscopes to corroborate our clinical findings at point of care.
文摘India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset of complications with associated economic costs indicates a high prevalence of poor self-management practices. It is well-established that achieving patient-centered primary care consistent with a chronic care model ensures optimum diabetes self-management support and improves long-term clinical and health outcomes in diabetes patients. The public sector primary care system in India provides services free of cost to beneficiaries but lacks patient-centered care that undermines diabetes selfmanagement education and support. Furthermore, factors like poor patient knowledge of diabetes, suboptimal medication adherence, persistent clinical inertia, lack of data for monitoring and evaluation through clinical audit worsens the standards of diabetes care in primary care settings of India. There is a need for government initiatives to be directed towards the provision of comprehensive outpatient care that is inclusive of uninterrupted supply of drugs, provision of essential laboratory investigators, training and availability of qualified diabetes educators and availability of specialist support when required. Furthermore, the integration of depression screening and smoking cessation services at the primary care level is warranted.
文摘We present the complete set of physical and geometrical parameters of the visual close binary system GJ 9830 for the first time by applying Al-Wardat’s complex method.This method combines magnitude difference from speckle interferometry,synthetic spectral energy distributions of the binary components which are constructed based on grids of Kurucz blanketed models(ATLAS9),and the orbital solution using Tokovinin’s dynamical method to estimate the parameters of individual components.The analysis of the system by employing synthetic photometry resulted in the following set of parameters:Teff= 6220 ± 100 K,log g = 4.30 ± 0.12,R = 1.10 ± 0.08 R⊙for the primary component and Teff= 4870 ± 100 K,log g = 4.60 ± 0.11,R = 0.709 ± 0.07 R⊙for the secondary component.The recently published dynamical parallax from the Gaia space mission was used to calculate the total mass of the binary system as 1.75 ± 0.06 M⊙,which coincides with those estimated using Al-Wardat’s method as MA= 1.18 ± 0.10 M⊙,MB= 0.75 ± 0.08 M⊙.The analysis of the system reveals that both components are characteristic of main sequence stars and have an age of around 1.4 ± 0.50 Gyr.The evolutionary tracks and isochrones of the system’s components are discussed,and the fragmentation process is suggested as the most likely process for the formation of the system.
基金a research grant from the University of Delhi, No. 52301/01Glaxo Smithkline Pharmaceuticals Limited and Dr. Reddy's Laboratories Ltd, No. 9834512
文摘AIM： To study the effect of combined omeprazole（Ome） and domperidone（Dom） therapy on asthma symptoms and pulmonary function in asthmatics with gastroesoph- ageal reflux. METHODS： We selected 198 asthmatics with gastro- esophageal reflux diagnosed by 24-h esophageal pH moni- toring to receive Ome 20 mg twice daily and Dom 10 mg three times daily or placebo for 16 wk （1：1 double-blind randomization）. Spirometry was done at baseline and after 16 wk of treatment. The primary outcome measures were： mean daily daytime and nighttime asthma symptom scores. Mean daily reflux symptom scores, albuterol use as rescue medication （number of puffs）, daytime and nighttime peak expiratory flow rate （PEFR）, postbronchodilator forced expiratory volume in 1 second （FEVl） and postbronchodilator forced vital capacity （FVC） were secondary outcome measures. RESULTS： Comparison of mean change from baseline between antireflux therapy and placebo groups revealed significant reduction in daytime asthma symptom score （17.4% vs 8.9 %）, nighttime asthma symptom score （19.6% vs 5.4%）, reflux symptom score （8.7% vs 1.6%） and rescue medication use （23.2% vs 3.1%） after antireflux therapy compared to mean change in placebo group （P 〈 0.001）. There was significant improvement in morning PEFR （7.9% vs 0.2%）, evening PEFR （9.8% vs 0.5%）, FEW （11.1% vs 3.78%） and FVC （9.3%vs 1.52%） in the antireflux therapy group compared to placebo on comparng the mean change from baseline after 16 wk （P 〈 0.01） CONCLUSION： Combined therapy with Ome and Dom in adult asthmatics with gastroesophageal reflux may be beneficial by reducing asthma symptoms, rescuing medi- cation use, and improving pulmonary function.
文摘Objective: To evaluate the outcome of ureteroscopic pneumatic lithotripsy in single lower ureteric calculus and correlate its success with different CT parameters like HU, size of calculus and hydrnephrosis, if present. Patients and Methods: This study was conducted from October 2017 to March 2019 in Department of General Surgery, Maulana Azad Medical College, New Delhi. 30 patients (out of which 6 were excluded due to spontaneous passage of calculus), with single lower ureteric calculus were chosen and the outcome of URSL was compared with respect to CT parameters of Size, HU and Hydronephrosis and intra-operative clearance of calculus. Results: Success rate of URSL in single lower ureteric calculus was found to be 75%. Lower HU (774.12 ± 212.85) was associated with higher success rate. Similarly smaller size of calculus (9 ± 2.1) mm was associated with success group. Patients with gross hydronephrosis had a poor outcome of URSL. Lower urinary tract infection (8.33%) was the most common complication. Conclusion: Patients with small size calculus, low HU and absence of hydronephrosis have a better outcome of URSL.
文摘BACKGROUND:Choledochal cysts in adults are more commonly associated with complications such as cystolithiasis,recurrent cholangitis,portal hypertension and malignancy,than in the pediatric age group.METHOD:We report a case of adult choledochal cyst with long-term complication of large stone cast and portal hypertension due to secondary biliary cirrhosis.RESULTS:A 50-year-old patient presented with obstructive jaundice and hepatosplenomegaly.On investigation,she was diagnosed as having a choledochal cyst with large stone cast and portal hypertension.Single stage resection of the choledochal cyst with Roux-en-Y hepaticojejunostomy was done by meticulous dissection and ligation of collaterals.CONCLUSION:Single stage resection of a choledochal cyst is possible in spite of associated portal hypertension,if the portal vein is patent.
