Introduction: Pediatric tumors account for a small proportion of all cancers;amongst them neuroblastoma is the most common solid tumor as well as malignant tumor. They have varied clinical presentation. Recent advance...Introduction: Pediatric tumors account for a small proportion of all cancers;amongst them neuroblastoma is the most common solid tumor as well as malignant tumor. They have varied clinical presentation. Recent advances in diagnostic methods and multidisciplinary treatment approach have resulted in early diagnosis, treatment, better prognosis and survival. Aims and Objectives: To study the clinical profile, histopathology, grading and correlate that with clinical diagnosis, efficacy of various investigations for early diagnosis, and management of neuroblastoma in our hospital. Material and Methods: A total of nine patients of neuroblastoma were studied from May 2013 to January 2015. All the nine patients were operated. Neuroblastoma was staged according to the International Neuroblastoma Staging system. Follow-up was carried in all the patients. Results: Two patients in our study were Stage 1, two were Stage 2A and 5 patients were Stage 4S. In Stage 1, pre-operative chemotherapy was not given. Tumor was excised in toto. Post-operatively, no adjuvant therapy was given. Patients are alive till date. In Stage 2A, patients were operated and received post-operative chemotherapy. One patient is alive and disease-free. Other patient died in post-op. period while on chemotherapy. Patients in Stage 4S were operated after receiving pre-op radiotherapy of 500 - 1000 radians and adjuvant chemotherapy. One patient expired in follow-up while four patients are still alive. We have achieved 100% survival rate in Stage 1, 50% in Stage 2 and 80% in Stage 4S.展开更多
BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence ...BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence exists regarding efficacy,risk,benefit,and cost-effectiveness.AIM To identify the role and effectiveness of SLE in ESD and PUD,associated rebleeding and PUD-related outcomes like mortality,hospital length of stay,need for endoscopic or surgical intervention and blood transfusions.METHODS A systematic review of literature databases PubMed,Cochrane,and Embase was conducted from inception to January 5,2023.Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included.The study was conducted per PRISMA guidelines,and the protocol was registered in PROSPERO(ID CRD42023427555:).RevMan was used to perform meta-analysis,and Mantel-Haenszel Odds ratio(OR)were generated using random effect models.RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis,of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding.In ESD,the rates of rebleeding were 7%in the SLE group compared to 4.4%in the non-SLE group with OR 1.65,95%confidence intervals(CI)of 0.96 to 2.85;P=0.07,whereas it was 11%in the SLE group compared to 13%in the non-SLE group with OR 0.895%CI:0.50 to 1.29;P=0.36.The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01,95%CI:-0.22 to 0.25;P=0.91.In SLE vs non-SLE groups with PUD,the OR for Endoscopic intervention was 0.29,95%CI:0.08 to 1.00;P=0.05 while it was OR 2.03,95%CI:0.95 to 4.33;P=0.07,for surgical intervention.The mean difference in the hospital length of stay was-3.57 d between the SLE and no SLE groups in PUD with 95%CI:-7.84 to 0.69;P=0.10,denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE.For mortality between SLE and non-SLE groups in PUD,the OR was 0.88,95%CI:0.45 to 1.72;P=0.70.CONCLUSION SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding.SLE also does not provide any significant improvement in mortality,need for interventions,or blood transfusions in PUD patients.SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.展开更多
BACKGROUND Violence against healthcare workers(HCWs)in the Caribbean continues to prevail yet remains underreported.Our aim is to determine the cause,traits,and consequences of violence on HCWs in the Caribbean.AIM To...BACKGROUND Violence against healthcare workers(HCWs)in the Caribbean continues to prevail yet remains underreported.Our aim is to determine the cause,traits,and consequences of violence on HCWs in the Caribbean.AIM To determine the cause,traits,and consequences of violence on HCWs in the Caribbean.METHODS This research adopted an online cross-sectional survey approach,spanning over eight weeks(between June 6th and August 9th,2022).The survey was generated using Research Electronic Data Capture forms and followed a snowballing strategy to contact individuals using emails,social media,text messages,etc.Logistic regression analysis was performed to evaluate the variables that influence violence,including gender,age,years of experience,institution type,and night shift frequency.RESULTS The survey was completed by 225 HCWs.Females comprised 61%.Over 51%of respondents belonged to the 21 to 35 age group.Dominica(n=61),Haiti(n=50),and Grenada(n=31)had the most responses.Most HCWs(49%)worked for government academic institutions,followed by community hospitals(23%).Medical students(32%),followed by attending physicians(22%),and others(16%)comprised the most common cadre of respondents.About 39%of the participants reported experiencing violence themselves,and 18%reported violence against colleague(s).Verbal violence(48%),emotional abuse(24%),and physical misconduct(14%)were the most common types of violence.Nearly 63%of respondents identified patients or their relatives as the most frequent aggressors.Univariate logistic regression analyses demonstrated that female gender(OR=2.08;95%CI:1.16-3.76,P=0.014)and higher frequency of night shifts(OR=2.22;95%CI:1.08-4.58,P=0.030)were associated with significantly higher odds of experiencing violence.More than 50%of HCWs felt less motivated and had decreased job satisfaction post-violent conduct.CONCLUSION A large proportion of HCWS in the Caribbean are exposed to violence,yet the phenomenon remains underreported.As a result,HCWs’job satisfaction has diminished.展开更多
The lack of modern technology in healthcare has led to the death of thousands of lives worldwide due to COVID-19 since its outbreak.The Internet of Things(IoT)along with other technologies like Machine Learning can re...The lack of modern technology in healthcare has led to the death of thousands of lives worldwide due to COVID-19 since its outbreak.The Internet of Things(IoT)along with other technologies like Machine Learning can revolutionize the traditional healthcare system.Instead of reactive healthcare systems,IoT technology combined with machine learning and edge computing can deliver proactive and preventive healthcare services.In this study,a novel healthcare edge-assisted framework has been proposed to detect and prognosticate the COVID-19 suspects in the initial phases to stop the transmission of coronavirus infection.The proposed framework is based on edge computing to provide personalized healthcare facilities with minimal latency,short response time,and optimal energy consumption.In this paper,the COVID-19 primary novel dataset has been used for experimental purposes employing various classification-based machine learning models.The proposed models were validated using kcross-validation to ensure the consistency of models.Based on the experimental results,our proposed models have recorded good accuracies with highest of 97.767%by Support Vector Machine.According to the findings of experiments,the proposed conceptual model will aid in the early detection and prediction of COVID-19 suspects,as well as continuous monitoring of the patient in order to provide emergency care in case of medical volatile situation.展开更多
BACKGROUND Cardiovascular disease is a significant contributor to the disease burden in geriatric patients.Underlying systemic inflammation is thought to be the cause of age-related changes in the bone marrow and a ma...BACKGROUND Cardiovascular disease is a significant contributor to the disease burden in geriatric patients.Underlying systemic inflammation is thought to be the cause of age-related changes in the bone marrow and a major risk factor for atherosclerosis.The purpose of the study was to assess the accuracy of these hematological biomarkers in predicting 30-day mortality in older patients with acute coronary syndrome(ACS).METHODS This was a prospective observational study of 601 older adult patients(age>60 years)with ACS who underwent percutaneous coronary intervention over two years(2017-2019).The relationship between baseline hematological parameters and mortality was assessed during the 30-day follow-up.Logistic regression analysis and receiver operating characteristic curve analysis were done to evaluate for diagnostic accuracy of various hematological parameters.RESULTS The mean age of presentation was 77±17 years.The mean neutrophil-lymphocyte ratio(NLR)value was 5.07±4.90 and the mean platelet-lymphocyte ratio(PLR)value was 108.65±85.82.On univariate analysis,total leucocyte count[odds ratio(OR)=0.85,P=0.021],hematocrit(OR=0.91,P=0.018),NLR(OR=1.10,P=0.001)and PLR(OR=1.05,P=0.001)were associated with mortality.On receiver operating characteristic curve analysis,NLR predicted mortality with 68.1%and PLR with 65.7%accuracy.On multivariate analysis,NLR(OR=1.096,95%CI:1.006-1.15,P=0.035)was an independent predictor of 30-day mortality.CONCLUSIONS For the risk classification of all elderly ACS patients,we highly advise using NLR rather than the total white blood cell count.展开更多
Diabetes mellitus is increasing at an alarming rate and has become a global challenge.Insulin resistance intarget tissues and a relative deficiency of insulin secretion from pancreatic β-cells are the major features ...Diabetes mellitus is increasing at an alarming rate and has become a global challenge.Insulin resistance intarget tissues and a relative deficiency of insulin secretion from pancreatic β-cells are the major features of type 2 diabetes(T2D).Chronic low-grade inflammation in T2 D has given an impetus to the field of immuno-metabolism linking inflammation to insulin resistance and β-cell dysfunction.Many factors advocate a causal link between metabolic stress and inflammation.Numerous cellular factors trigger inflammatory signalling cascades,and as a result T2 D is at the moment considered an inflammatory disorder triggered by disordered metabolism.Cellular mechanisms like activation of Tolllike receptors,Endoplasmic Reticulum stress,and inflammasome activation are related to the nutrient excess linking pathogenesis and progression of T2 D with inflammation.This paper aims to systematically review the metabolic profile and role of various inflammatory pathways in T2 D by capturing relevant evidence from various sources.The perspectives include suggestions for the development of therapies involving the shift from metabolic stress to homeostasis that would favour insulin sensitivity and survival of pancreatic β-cells in T2 D.展开更多
Hepatitis E was identified as an epidemic of non-A, non-B hepatitis from Kashmir, India in 1978. Hepatitis E virus(HEV), the etiological agent is the sole member of family Hepeviridae. The virus has marked heterogenei...Hepatitis E was identified as an epidemic of non-A, non-B hepatitis from Kashmir, India in 1978. Hepatitis E virus(HEV), the etiological agent is the sole member of family Hepeviridae. The virus has marked heterogeneity and infects many animals like bats, camel, chicken, deer, boar, mongoose, pigs, rats, rabbit and cutthroat trout. Hepatitis E is a disease with a major global impact and has two distinct epidemiological patterns. Hepatitis E is an imperative health issue in developing nations, transmitted through sullied water and happens most every now in young adults. The disease is particularly severe during pregnancy and in people with underlying liver cirrhosis. Autochthonous hepatitis E is increasingly recognized in developed countries. The virus infects domestic pigs, wild boar and Sika deer in these countries. HEV infections in humans occur by eating the undercooked game flesh, raw liver from supermarkets and Figatelli sausages. Blood transfusion-associated HEV infections occur in many countries and screening of donors for HEV RNA is under consideration. Hepatitis E causes a number of extrahepatic diseases, including a wide spectrum of neurological syndromes. HEV genotype 3 causes prolonged viremia, chronic hepatitis, liver fibrosis and cirrhosis in organ transplant patients. The virus is amenable to ribavirin monotherapy and most patients clear the virus in a few weeks. Hepatitis E vaccine-239, marketed in China, has shown high efficacy with sustained protection for over four years.展开更多
Objective:To find the effectiveness of essential oil of lemongrass for the treatment of pathogenic organisms.Methods:Lemongrass oil was investigated for activity against Staphylococcus aureus (S.aureus),Bacillus cereu...Objective:To find the effectiveness of essential oil of lemongrass for the treatment of pathogenic organisms.Methods:Lemongrass oil was investigated for activity against Staphylococcus aureus (S.aureus),Bacillus cereus(B.cereus),Bacillus subtilis(B.subtilis),Escherichia coli(E.coli), Klebsiella pneumoniae(K.pneumoniae) and Pseudomonas aeruginosa(P.aeruginosa),using Agar Diffusion Method and Broth Dilution Method.Minimum inhibitory concentration(MIC) and minimum bactericidal concentration(MBC) were determined by the Broth Dilution Method. The antibiotic susceptibility test against the test organisms was performed by Disc Diffusion Method.Results:Lemongrass was found effective against all the test organisms except P. aeruginosa.Gram positive organisms were found more sensitive to lemon grass oil as compared to gram negative organisms.The test organisms were found inhibited by Lemon grass oil at lower concentrations in Broth Dilution Method as compared to Agar Diffusion Method.Conclusions: The tested organisms,particularly gram-negative organisms had shown high resistance towards different antibiotics whereas they were found to be inhibited by lemongrass oil even at lower concentration.Thus lemongrass oil is effective against drug resistant organisms.It can be suggested that use of lemongrass oil would be helpful in the treatment of infections caused by multidrug resistant organisms.展开更多
BACKGROUND： Major complications after pancreaticoduo- denectomy are usually caused by a leaking pancreaticojejunal anastomosis. Omental flaps around various anastomoses were used to prevent the formation of fistula.
AIMTo determine whether addition of simvastatin could be an important pharmacological rescue therapy for carvedilol non-responders. METHODSOne hundred and two consecutive patients of cirrhosis of liver with significan...AIMTo determine whether addition of simvastatin could be an important pharmacological rescue therapy for carvedilol non-responders. METHODSOne hundred and two consecutive patients of cirrhosis of liver with significant portal hypertension were included. Hepatic venous pressure gradient (HVPG) was measured at the base line and after proper optimization of dose; chronic response was assessed at 3 mo. Carvedilol non-responders were given simvastatin 20 mg per day (increased to 40 mg per day at day 15). Carvedilol plus simvastatin was continued for 1 mo and hemodynamic response was again measured at 1 mo. RESULTSA total of 102 patients with mean age of 58.3 ± 6.6 years were included. Mean baseline HVPG was 16.75 ± 2.12 mmHg and after optimization of dose and reassessment of HVPG at 3 mo, mean reduction of HVPG from baseline was 5.5 ± 1.7 mmHg and 2.8 ± 1.6 mmHg among responders and non-responders respectively (P CONCLUSIONAddition of simvastatin to carvedilol non-responders may prove to be an excellent rescue therapy in patients with portal hypertension.展开更多
Hepatobiliary and pancreatic ascariasis(HPA) was described as a clinical entity from Kashmir,India in 1985. HPA is caused by invasion and migration of nematode,Ascaris lumbricoides,in to the biliary tract and pancreat...Hepatobiliary and pancreatic ascariasis(HPA) was described as a clinical entity from Kashmir,India in 1985. HPA is caused by invasion and migration of nematode,Ascaris lumbricoides,in to the biliary tract and pancreatic duct. Patients present with biliary colic,cholangitis,cholecystitis,hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly,get trapped and die,leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir,one such region,HPA is the etiological factor for 36.7%,23%,14.5% and 12.5% of all biliary diseases,acute pancreatitis,liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.展开更多
Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedocha...Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures(hepaticojejunostomy or choledechoduodenostomy).展开更多
BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to...BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduo-denectomy (PD) from an individual unit during transit from low to a high volume center. METHODS: A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received convention-al surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postopera-tive recovery, length of hospital stay and patient readmission requirement. RESULTS: The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally (7.8 vs 12.1 days). The intraoperative events like operative blood loss (417.9±83.8 vs 997.4 ±151.8 mL, P<0.001), blood transfused (a median of 0 vs 1 unit,P<0.001) and operative time taken (125 vs 245 minutes,P<0.001) were signiifcantly lower in the fast track group. The frequency of pancreatic ifstula (4.9% vs 13.0%) and delayed gastric empty-ing (7.0% vs 17.4%) was also signiifcantly reduced with fast track treatment. Nevertheless, the readmission rate (11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol. CONCLUSIONS: This preliminary analysis suggests that the fast track approach might be beneifcial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and signiifcantly shortens their length of hospital stay.展开更多
BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary...BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.展开更多
BACKGROUND Pancreatic cancer(PC)is one of the deadliest malignancies with an alarming mortality rate.Despite significant advancement in diagnostics and therapeutics,early diagnosis remains elusive causing poor prognos...BACKGROUND Pancreatic cancer(PC)is one of the deadliest malignancies with an alarming mortality rate.Despite significant advancement in diagnostics and therapeutics,early diagnosis remains elusive causing poor prognosis,marred by mutations and epigenetic modifications in key genes which contribute to disease progression.AIM To evaluate the various biological tumor markers collectively for early diagnosis which could act as prognostic biomarkers and helps in future therapeutics of PC in Kashmir valley.METHODS A total of 50 confirmed PC cases were included in the study to evaluate the levels of carbohydrate antigen 19-9(CA 19-9),tissue polypeptide specific antigen(TPS),carcinoembryonic antigen(CEA),vascular endothelial growth factor-A(VEGF-A),and epidermal growth factor receptor(EGFR).Mutational analysis was performed to evaluate the mutations in Kirsten rat sarcoma(KRAS),Breast cancer type 2(BRCA-2),and deleted in pancreatic cancer-4(DPC-4)genes.However,epigenetic modifications(methylation of CpG islands)were performed in the promoter regions of cyclin-dependent kinase inhibitor 2A(p16;CDKN2A),MutL homolog 1(hMLH1),and Ras association domain-containing protein 1(RASSF1A)genes.RESULTS We found significantly elevated levels of biological markers CA 19-9(P≤0.05),TPS(P≤0.05),CEA(P≤0.001),and VEGF(P≤0.001).Molecular genetic analysis revealed that KRAS gene mutation is predominant in codon 12(16 subjects,P≤0.05),and 13(12 subjects,P≤0.05).However,we did not find a mutation in DPC-4(1203G>T)and BRCA-2(617delT)genes.Furthermore,epigenetic modification revealed that CpG methylation in 21(P≤0.05)and 4 subjects in the promoter regions of the p16 and hMLH1 gene,respectively.CONCLUSION In conclusion,CA 19-9,TPS,CEA,and VEGF levels were significantly elevated and collectively have potential as diagnostic and prognostic markers in PC.Global data of mutation in the KRAS gene commonly in codon 12 and rare in codon 13 could augment the predisposition towards PC.Additionally,methylation of the p16 gene could also modulate transcription of genes thereby increasing the predisposition and susceptibility towards PC.展开更多
BACKGROUND Connective tissue growth factor(CTGF)is a mediator of transforming growth factor-beta signaling and plays a key role in connective tissue remodeling,inflammatory processes and fibrosis in various illnesses ...BACKGROUND Connective tissue growth factor(CTGF)is a mediator of transforming growth factor-beta signaling and plays a key role in connective tissue remodeling,inflammatory processes and fibrosis in various illnesses including cancer.AIM To investigate the role of CTGF in colorectal cancer(CRC)progression and to compare the CTGF expression with different clinicopathological parameters.METHODS Real-time polymerase chain reaction,immunohistochemistry and Western blotting was performed to evaluate the CTGF expression and the results were statistically analyzed against the clinicopathological variables of patient data using STATA software version 16.RESULTS CTGF expression levels in tumor specimens were significantly higher than their paired normal specimens.The higher protein expression levels showed a significant association with smoking,staging,tumor grade,invasion depth,necrosis of tumor tissue,and both lymphovascular and perineural invasion.As per the cox regression model and classification tree analysis,tumor-nodemetastasis stage and perineural invasion were important predictors for CTGF expression and prognosis of CRC patients.Survival analysis indicated that CTGF overexpression was associated with poorer overall and disease-free survival.CONCLUSION Expression of CTGF was increased in CRC and was linked with poor overall and disease-free survival of CRC patients.These findings support prior observations and thus CTGF may be a possible prognostic marker in CRC.展开更多
Background: Although COPD is traditionally associated with polycythemia, the systemic inflammation that is now recognized as a feature of COPD makes it a possible cause of Anemia of Chronic Disease (ACD). Preliminary ...Background: Although COPD is traditionally associated with polycythemia, the systemic inflammation that is now recognized as a feature of COPD makes it a possible cause of Anemia of Chronic Disease (ACD). Preliminary evidences suggest that anemia in COPD may be more prevalent than expected occurring in 10% - 15% of patients. While in states like chronic heart failure and renal insufficiency, anemia has been extensively studied;little attention has been given to it in COPD. Objectives: To see the prevalence of anemia in patients with COPD and its potential impact on morbidity of COPD patients. Design and Setting: A university hospital-based cross-sectional study in Kashmir, India. Methods: Two hundred patients (119 males and 81 females) with spirometery documented COPD were evaluated for frequency of anemia. In addition to routine investigations, erythropoietin levels were done in a subgroup of patients. Results: A total of 36 cases (20 males and 16 females) of anemia were detected giving a frequency of 18%. Normocytic normochromic type of anemia was present in 32 (88.89%) patients while the rest had normocytic hypochromic type of anemia. Majority of patients were in GOLD stage 11 and had decreased serum iron, transferrin saturation and TIBC. Erythropoietin levels were significantly raised in anemic COPD patients compared to non-anemic COPD patients. The various factors significantly associated with anemia were: No. of exacerbations of COPD, No. of hospital admissions, BMI and erythropoietin levels. Conclusion: Anemia occurs frequently in patients of COPD and is associated with increased morbidity in the form of No. of exacerbations and hospital admissions. Correcting anemia in these patients may improve their clinical outcome.展开更多
AIM To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy(PD) on surgical outcome.METHODS A retrospective collection of data was done for patients who under...AIM To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy(PD) on surgical outcome.METHODS A retrospective collection of data was done for patients who underwent PD.According to the number of PDs undertaken per year,we categorized the volume into low volume(< 10 PDs/year),medium volume(10-24 PDs/year) and high volume(> 25 PDs/year) groups.RESULTS From 2002 to 2013,200 patients underwent PD.The annual number of PD increased from 4 in 2002 to 34 in 2013.The mean operative time,operative blood loss and need for intraoperative blood transfusion decreased considerably over the volume categories(P < 0.001,P < 0.001 and P < 0.001,respectively).Increased procedural volume was associated with a lower morbidity(P = 0.021) and shorter length of hospital stay(P < 0.001).Similarly the rate of mortality dropped from 10% for the low volume group to 2.2% for the medium volume group and 0.0% for the high volume group(P = 0.007).CONCLUSION The transformation from a low volume to a high volume provider of PD resulted in most favourable outcomes favouring the continued centralization of this high risk procedure.展开更多
Objective: Migraine, a common chronic neurological disorder involves a pathophysiology having both multiple genetic and environmental factors. 5, 10-Methylenetetrahydrofolate reductase (MTHFR) involved in folate metab...Objective: Migraine, a common chronic neurological disorder involves a pathophysiology having both multiple genetic and environmental factors. 5, 10-Methylenetetrahydrofolate reductase (MTHFR) involved in folate metabolism has an important role in a cell for folate availability which is critical for DNA integrity. Methods: This case-control study conducted in Srinagar, Kashmir (North India) between 2013 and 2015 was designed to evaluate risk induced due to MTH-FR 677C>T gene polymorphisms to contribute in susceptibility for migraine in Kashmir population (North India). Using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, we tested the genotype distribution of 100 migraine patients in comparison with 120 healthy migraine-free controls from the same geographical region. Results: The genotypic frequencies of the patients and controls were not significantly associated (p > 0.05). Higher distribution of TT mutant genotype was found in controls as against the cases (5% versus 1%) but association was not significant (p > 0.05). Per copy frequency of T allele (Val) was found to be 0.14 in cases versus 0.19 in controls (p 0.05). Similar scenario was observed when migraine without aura was compared with controls where variant genotype (16% cases versus 39.0% controls: p > 0.05) as well as allele frequency was found to be less in cases (cases 0.15 versus 0.19 controls: p > 0.05). Conclusions: We conclude that MTHFR gene C677T polymorphism has no role in predisposition to the migraine in our population and cannot serve as a predictive factor for the risk of migraine.展开更多
The world is engaged in containing the COVID Pandemic and controlling further spread and deaths. The global spread of the virus has overwhelmed health systems, and caused widespread social and economic disruption. Som...The world is engaged in containing the COVID Pandemic and controlling further spread and deaths. The global spread of the virus has overwhelmed health systems, and caused widespread social and economic disruption. Some nations have done a better job than rest of the world. The global spread of the virus has overwhelmed health systems, and caused widespread social and economic disruption. There is a strong case that COVID-19 could be with us in one way or another until a vaccine comes on the market or herd immunity is achieved. A long crisis, could stretch the international order to its breaking point. The virus has succeeded in confining almost all human beings in their homes. Balancing act between public health crisis and complex societal implications is an inescapable necessity. The pandemic will alter the world forever. An economic slowdown, severe recession, plummeting revenue, increased expenditure, and mental health issues could be the emerging challenges. There will be increased confidence in technology and nations will invest more in public health. We are passing through fragile and critical times in history. People around the world can prevail in response to this extraordinary challenge. Investing in public health, preparedness, and relying on science will bring a better future. Think of one world, one humanity to shape and secure our future.展开更多
文摘Introduction: Pediatric tumors account for a small proportion of all cancers;amongst them neuroblastoma is the most common solid tumor as well as malignant tumor. They have varied clinical presentation. Recent advances in diagnostic methods and multidisciplinary treatment approach have resulted in early diagnosis, treatment, better prognosis and survival. Aims and Objectives: To study the clinical profile, histopathology, grading and correlate that with clinical diagnosis, efficacy of various investigations for early diagnosis, and management of neuroblastoma in our hospital. Material and Methods: A total of nine patients of neuroblastoma were studied from May 2013 to January 2015. All the nine patients were operated. Neuroblastoma was staged according to the International Neuroblastoma Staging system. Follow-up was carried in all the patients. Results: Two patients in our study were Stage 1, two were Stage 2A and 5 patients were Stage 4S. In Stage 1, pre-operative chemotherapy was not given. Tumor was excised in toto. Post-operatively, no adjuvant therapy was given. Patients are alive till date. In Stage 2A, patients were operated and received post-operative chemotherapy. One patient is alive and disease-free. Other patient died in post-op. period while on chemotherapy. Patients in Stage 4S were operated after receiving pre-op radiotherapy of 500 - 1000 radians and adjuvant chemotherapy. One patient expired in follow-up while four patients are still alive. We have achieved 100% survival rate in Stage 1, 50% in Stage 2 and 80% in Stage 4S.
文摘BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence exists regarding efficacy,risk,benefit,and cost-effectiveness.AIM To identify the role and effectiveness of SLE in ESD and PUD,associated rebleeding and PUD-related outcomes like mortality,hospital length of stay,need for endoscopic or surgical intervention and blood transfusions.METHODS A systematic review of literature databases PubMed,Cochrane,and Embase was conducted from inception to January 5,2023.Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included.The study was conducted per PRISMA guidelines,and the protocol was registered in PROSPERO(ID CRD42023427555:).RevMan was used to perform meta-analysis,and Mantel-Haenszel Odds ratio(OR)were generated using random effect models.RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis,of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding.In ESD,the rates of rebleeding were 7%in the SLE group compared to 4.4%in the non-SLE group with OR 1.65,95%confidence intervals(CI)of 0.96 to 2.85;P=0.07,whereas it was 11%in the SLE group compared to 13%in the non-SLE group with OR 0.895%CI:0.50 to 1.29;P=0.36.The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01,95%CI:-0.22 to 0.25;P=0.91.In SLE vs non-SLE groups with PUD,the OR for Endoscopic intervention was 0.29,95%CI:0.08 to 1.00;P=0.05 while it was OR 2.03,95%CI:0.95 to 4.33;P=0.07,for surgical intervention.The mean difference in the hospital length of stay was-3.57 d between the SLE and no SLE groups in PUD with 95%CI:-7.84 to 0.69;P=0.10,denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE.For mortality between SLE and non-SLE groups in PUD,the OR was 0.88,95%CI:0.45 to 1.72;P=0.70.CONCLUSION SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding.SLE also does not provide any significant improvement in mortality,need for interventions,or blood transfusions in PUD patients.SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.
文摘BACKGROUND Violence against healthcare workers(HCWs)in the Caribbean continues to prevail yet remains underreported.Our aim is to determine the cause,traits,and consequences of violence on HCWs in the Caribbean.AIM To determine the cause,traits,and consequences of violence on HCWs in the Caribbean.METHODS This research adopted an online cross-sectional survey approach,spanning over eight weeks(between June 6th and August 9th,2022).The survey was generated using Research Electronic Data Capture forms and followed a snowballing strategy to contact individuals using emails,social media,text messages,etc.Logistic regression analysis was performed to evaluate the variables that influence violence,including gender,age,years of experience,institution type,and night shift frequency.RESULTS The survey was completed by 225 HCWs.Females comprised 61%.Over 51%of respondents belonged to the 21 to 35 age group.Dominica(n=61),Haiti(n=50),and Grenada(n=31)had the most responses.Most HCWs(49%)worked for government academic institutions,followed by community hospitals(23%).Medical students(32%),followed by attending physicians(22%),and others(16%)comprised the most common cadre of respondents.About 39%of the participants reported experiencing violence themselves,and 18%reported violence against colleague(s).Verbal violence(48%),emotional abuse(24%),and physical misconduct(14%)were the most common types of violence.Nearly 63%of respondents identified patients or their relatives as the most frequent aggressors.Univariate logistic regression analyses demonstrated that female gender(OR=2.08;95%CI:1.16-3.76,P=0.014)and higher frequency of night shifts(OR=2.22;95%CI:1.08-4.58,P=0.030)were associated with significantly higher odds of experiencing violence.More than 50%of HCWs felt less motivated and had decreased job satisfaction post-violent conduct.CONCLUSION A large proportion of HCWS in the Caribbean are exposed to violence,yet the phenomenon remains underreported.As a result,HCWs’job satisfaction has diminished.
基金The authors would like to thank the SKIMS(Sher-i-Kashmir Institute of Medical Sciences)for permitting us to collect the COVID-19 data from various departments.
文摘The lack of modern technology in healthcare has led to the death of thousands of lives worldwide due to COVID-19 since its outbreak.The Internet of Things(IoT)along with other technologies like Machine Learning can revolutionize the traditional healthcare system.Instead of reactive healthcare systems,IoT technology combined with machine learning and edge computing can deliver proactive and preventive healthcare services.In this study,a novel healthcare edge-assisted framework has been proposed to detect and prognosticate the COVID-19 suspects in the initial phases to stop the transmission of coronavirus infection.The proposed framework is based on edge computing to provide personalized healthcare facilities with minimal latency,short response time,and optimal energy consumption.In this paper,the COVID-19 primary novel dataset has been used for experimental purposes employing various classification-based machine learning models.The proposed models were validated using kcross-validation to ensure the consistency of models.Based on the experimental results,our proposed models have recorded good accuracies with highest of 97.767%by Support Vector Machine.According to the findings of experiments,the proposed conceptual model will aid in the early detection and prediction of COVID-19 suspects,as well as continuous monitoring of the patient in order to provide emergency care in case of medical volatile situation.
文摘BACKGROUND Cardiovascular disease is a significant contributor to the disease burden in geriatric patients.Underlying systemic inflammation is thought to be the cause of age-related changes in the bone marrow and a major risk factor for atherosclerosis.The purpose of the study was to assess the accuracy of these hematological biomarkers in predicting 30-day mortality in older patients with acute coronary syndrome(ACS).METHODS This was a prospective observational study of 601 older adult patients(age>60 years)with ACS who underwent percutaneous coronary intervention over two years(2017-2019).The relationship between baseline hematological parameters and mortality was assessed during the 30-day follow-up.Logistic regression analysis and receiver operating characteristic curve analysis were done to evaluate for diagnostic accuracy of various hematological parameters.RESULTS The mean age of presentation was 77±17 years.The mean neutrophil-lymphocyte ratio(NLR)value was 5.07±4.90 and the mean platelet-lymphocyte ratio(PLR)value was 108.65±85.82.On univariate analysis,total leucocyte count[odds ratio(OR)=0.85,P=0.021],hematocrit(OR=0.91,P=0.018),NLR(OR=1.10,P=0.001)and PLR(OR=1.05,P=0.001)were associated with mortality.On receiver operating characteristic curve analysis,NLR predicted mortality with 68.1%and PLR with 65.7%accuracy.On multivariate analysis,NLR(OR=1.096,95%CI:1.006-1.15,P=0.035)was an independent predictor of 30-day mortality.CONCLUSIONS For the risk classification of all elderly ACS patients,we highly advise using NLR rather than the total white blood cell count.
基金Supported by Department of Science and Technology,Government of India to Iqra Hameed,No.Wos-A LS 509/2012
文摘Diabetes mellitus is increasing at an alarming rate and has become a global challenge.Insulin resistance intarget tissues and a relative deficiency of insulin secretion from pancreatic β-cells are the major features of type 2 diabetes(T2D).Chronic low-grade inflammation in T2 D has given an impetus to the field of immuno-metabolism linking inflammation to insulin resistance and β-cell dysfunction.Many factors advocate a causal link between metabolic stress and inflammation.Numerous cellular factors trigger inflammatory signalling cascades,and as a result T2 D is at the moment considered an inflammatory disorder triggered by disordered metabolism.Cellular mechanisms like activation of Tolllike receptors,Endoplasmic Reticulum stress,and inflammasome activation are related to the nutrient excess linking pathogenesis and progression of T2 D with inflammation.This paper aims to systematically review the metabolic profile and role of various inflammatory pathways in T2 D by capturing relevant evidence from various sources.The perspectives include suggestions for the development of therapies involving the shift from metabolic stress to homeostasis that would favour insulin sensitivity and survival of pancreatic β-cells in T2 D.
文摘Hepatitis E was identified as an epidemic of non-A, non-B hepatitis from Kashmir, India in 1978. Hepatitis E virus(HEV), the etiological agent is the sole member of family Hepeviridae. The virus has marked heterogeneity and infects many animals like bats, camel, chicken, deer, boar, mongoose, pigs, rats, rabbit and cutthroat trout. Hepatitis E is a disease with a major global impact and has two distinct epidemiological patterns. Hepatitis E is an imperative health issue in developing nations, transmitted through sullied water and happens most every now in young adults. The disease is particularly severe during pregnancy and in people with underlying liver cirrhosis. Autochthonous hepatitis E is increasingly recognized in developed countries. The virus infects domestic pigs, wild boar and Sika deer in these countries. HEV infections in humans occur by eating the undercooked game flesh, raw liver from supermarkets and Figatelli sausages. Blood transfusion-associated HEV infections occur in many countries and screening of donors for HEV RNA is under consideration. Hepatitis E causes a number of extrahepatic diseases, including a wide spectrum of neurological syndromes. HEV genotype 3 causes prolonged viremia, chronic hepatitis, liver fibrosis and cirrhosis in organ transplant patients. The virus is amenable to ribavirin monotherapy and most patients clear the virus in a few weeks. Hepatitis E vaccine-239, marketed in China, has shown high efficacy with sustained protection for over four years.
基金supported by Sher-I- Kashmir Institute of Medical Science Srinagar Kashmir
文摘Objective:To find the effectiveness of essential oil of lemongrass for the treatment of pathogenic organisms.Methods:Lemongrass oil was investigated for activity against Staphylococcus aureus (S.aureus),Bacillus cereus(B.cereus),Bacillus subtilis(B.subtilis),Escherichia coli(E.coli), Klebsiella pneumoniae(K.pneumoniae) and Pseudomonas aeruginosa(P.aeruginosa),using Agar Diffusion Method and Broth Dilution Method.Minimum inhibitory concentration(MIC) and minimum bactericidal concentration(MBC) were determined by the Broth Dilution Method. The antibiotic susceptibility test against the test organisms was performed by Disc Diffusion Method.Results:Lemongrass was found effective against all the test organisms except P. aeruginosa.Gram positive organisms were found more sensitive to lemon grass oil as compared to gram negative organisms.The test organisms were found inhibited by Lemon grass oil at lower concentrations in Broth Dilution Method as compared to Agar Diffusion Method.Conclusions: The tested organisms,particularly gram-negative organisms had shown high resistance towards different antibiotics whereas they were found to be inhibited by lemongrass oil even at lower concentration.Thus lemongrass oil is effective against drug resistant organisms.It can be suggested that use of lemongrass oil would be helpful in the treatment of infections caused by multidrug resistant organisms.
文摘BACKGROUND： Major complications after pancreaticoduo- denectomy are usually caused by a leaking pancreaticojejunal anastomosis. Omental flaps around various anastomoses were used to prevent the formation of fistula.
文摘AIMTo determine whether addition of simvastatin could be an important pharmacological rescue therapy for carvedilol non-responders. METHODSOne hundred and two consecutive patients of cirrhosis of liver with significant portal hypertension were included. Hepatic venous pressure gradient (HVPG) was measured at the base line and after proper optimization of dose; chronic response was assessed at 3 mo. Carvedilol non-responders were given simvastatin 20 mg per day (increased to 40 mg per day at day 15). Carvedilol plus simvastatin was continued for 1 mo and hemodynamic response was again measured at 1 mo. RESULTSA total of 102 patients with mean age of 58.3 ± 6.6 years were included. Mean baseline HVPG was 16.75 ± 2.12 mmHg and after optimization of dose and reassessment of HVPG at 3 mo, mean reduction of HVPG from baseline was 5.5 ± 1.7 mmHg and 2.8 ± 1.6 mmHg among responders and non-responders respectively (P CONCLUSIONAddition of simvastatin to carvedilol non-responders may prove to be an excellent rescue therapy in patients with portal hypertension.
基金Supported by Dr.Khuroo’s Medical Trust,a nonprofit organization which supports academic activities,disseminates medical education and helps poor patients for medical treatment
文摘Hepatobiliary and pancreatic ascariasis(HPA) was described as a clinical entity from Kashmir,India in 1985. HPA is caused by invasion and migration of nematode,Ascaris lumbricoides,in to the biliary tract and pancreatic duct. Patients present with biliary colic,cholangitis,cholecystitis,hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly,get trapped and die,leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir,one such region,HPA is the etiological factor for 36.7%,23%,14.5% and 12.5% of all biliary diseases,acute pancreatitis,liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.
基金Supported by Dr.Khuroo’s Medical Trust,a nonprofit organization which supports academic activities,disseminates medical education and helps poor patients for medical treatment
文摘Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures(hepaticojejunostomy or choledechoduodenostomy).
文摘BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduo-denectomy (PD) from an individual unit during transit from low to a high volume center. METHODS: A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received convention-al surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postopera-tive recovery, length of hospital stay and patient readmission requirement. RESULTS: The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally (7.8 vs 12.1 days). The intraoperative events like operative blood loss (417.9±83.8 vs 997.4 ±151.8 mL, P<0.001), blood transfused (a median of 0 vs 1 unit,P<0.001) and operative time taken (125 vs 245 minutes,P<0.001) were signiifcantly lower in the fast track group. The frequency of pancreatic ifstula (4.9% vs 13.0%) and delayed gastric empty-ing (7.0% vs 17.4%) was also signiifcantly reduced with fast track treatment. Nevertheless, the readmission rate (11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol. CONCLUSIONS: This preliminary analysis suggests that the fast track approach might be beneifcial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and signiifcantly shortens their length of hospital stay.
文摘BACKGROUND： Pancreaticoduodenectomy is a high risk, complex, technically challenging operation associated with significant perioperative morbidity and mortality. This study on the surgical management of periampullary cancer patients is based on our experience in a period of nearly 13 years. METHODS： The study was conducted on two groups of patients： group A included 42 patients who were treated between January 2000 and September 2005 and group B included 134 patients who were treated between October 2005 to October 2012. Preoperative, intraoperative and postoperative details of all these patients were collected, tabulated and analyzed to assess the impact of the selective approach introduced in the department with effect from October 2005. RESULTS： Intraoperative details revealed highly significant differences in the management of the two groups of patients in respect of operative time （250.4 vs 126.6 minutes; P〈0.001）, operative blood loss （1070.2 vs 414.9 mL; P〈0.001） and intraoperative blood transfusion （1A vs 0.2 units; P〈0.001）. Variations between the two groups in the frequency of complications were found to be statistically insignificant. However, the difference between the two groups in the overall morbidity of patients （47.6% vs 26.1%; P=0.009） and the length of their hospital stay （11.8 vs 7.8 days; P〈0.001） were significant. CONCLUSION： A selective approach applied to the surgical management of periampullary cancer patients is a step in the right direction.
文摘BACKGROUND Pancreatic cancer(PC)is one of the deadliest malignancies with an alarming mortality rate.Despite significant advancement in diagnostics and therapeutics,early diagnosis remains elusive causing poor prognosis,marred by mutations and epigenetic modifications in key genes which contribute to disease progression.AIM To evaluate the various biological tumor markers collectively for early diagnosis which could act as prognostic biomarkers and helps in future therapeutics of PC in Kashmir valley.METHODS A total of 50 confirmed PC cases were included in the study to evaluate the levels of carbohydrate antigen 19-9(CA 19-9),tissue polypeptide specific antigen(TPS),carcinoembryonic antigen(CEA),vascular endothelial growth factor-A(VEGF-A),and epidermal growth factor receptor(EGFR).Mutational analysis was performed to evaluate the mutations in Kirsten rat sarcoma(KRAS),Breast cancer type 2(BRCA-2),and deleted in pancreatic cancer-4(DPC-4)genes.However,epigenetic modifications(methylation of CpG islands)were performed in the promoter regions of cyclin-dependent kinase inhibitor 2A(p16;CDKN2A),MutL homolog 1(hMLH1),and Ras association domain-containing protein 1(RASSF1A)genes.RESULTS We found significantly elevated levels of biological markers CA 19-9(P≤0.05),TPS(P≤0.05),CEA(P≤0.001),and VEGF(P≤0.001).Molecular genetic analysis revealed that KRAS gene mutation is predominant in codon 12(16 subjects,P≤0.05),and 13(12 subjects,P≤0.05).However,we did not find a mutation in DPC-4(1203G>T)and BRCA-2(617delT)genes.Furthermore,epigenetic modification revealed that CpG methylation in 21(P≤0.05)and 4 subjects in the promoter regions of the p16 and hMLH1 gene,respectively.CONCLUSION In conclusion,CA 19-9,TPS,CEA,and VEGF levels were significantly elevated and collectively have potential as diagnostic and prognostic markers in PC.Global data of mutation in the KRAS gene commonly in codon 12 and rare in codon 13 could augment the predisposition towards PC.Additionally,methylation of the p16 gene could also modulate transcription of genes thereby increasing the predisposition and susceptibility towards PC.
基金Supported by Sher-I-Kashmir Institute of Medical Sciences,Srinagar Kashmir,India,No.SIMS/DF/17-467-73.
文摘BACKGROUND Connective tissue growth factor(CTGF)is a mediator of transforming growth factor-beta signaling and plays a key role in connective tissue remodeling,inflammatory processes and fibrosis in various illnesses including cancer.AIM To investigate the role of CTGF in colorectal cancer(CRC)progression and to compare the CTGF expression with different clinicopathological parameters.METHODS Real-time polymerase chain reaction,immunohistochemistry and Western blotting was performed to evaluate the CTGF expression and the results were statistically analyzed against the clinicopathological variables of patient data using STATA software version 16.RESULTS CTGF expression levels in tumor specimens were significantly higher than their paired normal specimens.The higher protein expression levels showed a significant association with smoking,staging,tumor grade,invasion depth,necrosis of tumor tissue,and both lymphovascular and perineural invasion.As per the cox regression model and classification tree analysis,tumor-nodemetastasis stage and perineural invasion were important predictors for CTGF expression and prognosis of CRC patients.Survival analysis indicated that CTGF overexpression was associated with poorer overall and disease-free survival.CONCLUSION Expression of CTGF was increased in CRC and was linked with poor overall and disease-free survival of CRC patients.These findings support prior observations and thus CTGF may be a possible prognostic marker in CRC.
文摘Background: Although COPD is traditionally associated with polycythemia, the systemic inflammation that is now recognized as a feature of COPD makes it a possible cause of Anemia of Chronic Disease (ACD). Preliminary evidences suggest that anemia in COPD may be more prevalent than expected occurring in 10% - 15% of patients. While in states like chronic heart failure and renal insufficiency, anemia has been extensively studied;little attention has been given to it in COPD. Objectives: To see the prevalence of anemia in patients with COPD and its potential impact on morbidity of COPD patients. Design and Setting: A university hospital-based cross-sectional study in Kashmir, India. Methods: Two hundred patients (119 males and 81 females) with spirometery documented COPD were evaluated for frequency of anemia. In addition to routine investigations, erythropoietin levels were done in a subgroup of patients. Results: A total of 36 cases (20 males and 16 females) of anemia were detected giving a frequency of 18%. Normocytic normochromic type of anemia was present in 32 (88.89%) patients while the rest had normocytic hypochromic type of anemia. Majority of patients were in GOLD stage 11 and had decreased serum iron, transferrin saturation and TIBC. Erythropoietin levels were significantly raised in anemic COPD patients compared to non-anemic COPD patients. The various factors significantly associated with anemia were: No. of exacerbations of COPD, No. of hospital admissions, BMI and erythropoietin levels. Conclusion: Anemia occurs frequently in patients of COPD and is associated with increased morbidity in the form of No. of exacerbations and hospital admissions. Correcting anemia in these patients may improve their clinical outcome.
文摘AIM To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy(PD) on surgical outcome.METHODS A retrospective collection of data was done for patients who underwent PD.According to the number of PDs undertaken per year,we categorized the volume into low volume(< 10 PDs/year),medium volume(10-24 PDs/year) and high volume(> 25 PDs/year) groups.RESULTS From 2002 to 2013,200 patients underwent PD.The annual number of PD increased from 4 in 2002 to 34 in 2013.The mean operative time,operative blood loss and need for intraoperative blood transfusion decreased considerably over the volume categories(P < 0.001,P < 0.001 and P < 0.001,respectively).Increased procedural volume was associated with a lower morbidity(P = 0.021) and shorter length of hospital stay(P < 0.001).Similarly the rate of mortality dropped from 10% for the low volume group to 2.2% for the medium volume group and 0.0% for the high volume group(P = 0.007).CONCLUSION The transformation from a low volume to a high volume provider of PD resulted in most favourable outcomes favouring the continued centralization of this high risk procedure.
文摘Objective: Migraine, a common chronic neurological disorder involves a pathophysiology having both multiple genetic and environmental factors. 5, 10-Methylenetetrahydrofolate reductase (MTHFR) involved in folate metabolism has an important role in a cell for folate availability which is critical for DNA integrity. Methods: This case-control study conducted in Srinagar, Kashmir (North India) between 2013 and 2015 was designed to evaluate risk induced due to MTH-FR 677C>T gene polymorphisms to contribute in susceptibility for migraine in Kashmir population (North India). Using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, we tested the genotype distribution of 100 migraine patients in comparison with 120 healthy migraine-free controls from the same geographical region. Results: The genotypic frequencies of the patients and controls were not significantly associated (p > 0.05). Higher distribution of TT mutant genotype was found in controls as against the cases (5% versus 1%) but association was not significant (p > 0.05). Per copy frequency of T allele (Val) was found to be 0.14 in cases versus 0.19 in controls (p 0.05). Similar scenario was observed when migraine without aura was compared with controls where variant genotype (16% cases versus 39.0% controls: p > 0.05) as well as allele frequency was found to be less in cases (cases 0.15 versus 0.19 controls: p > 0.05). Conclusions: We conclude that MTHFR gene C677T polymorphism has no role in predisposition to the migraine in our population and cannot serve as a predictive factor for the risk of migraine.
文摘The world is engaged in containing the COVID Pandemic and controlling further spread and deaths. The global spread of the virus has overwhelmed health systems, and caused widespread social and economic disruption. Some nations have done a better job than rest of the world. The global spread of the virus has overwhelmed health systems, and caused widespread social and economic disruption. There is a strong case that COVID-19 could be with us in one way or another until a vaccine comes on the market or herd immunity is achieved. A long crisis, could stretch the international order to its breaking point. The virus has succeeded in confining almost all human beings in their homes. Balancing act between public health crisis and complex societal implications is an inescapable necessity. The pandemic will alter the world forever. An economic slowdown, severe recession, plummeting revenue, increased expenditure, and mental health issues could be the emerging challenges. There will be increased confidence in technology and nations will invest more in public health. We are passing through fragile and critical times in history. People around the world can prevail in response to this extraordinary challenge. Investing in public health, preparedness, and relying on science will bring a better future. Think of one world, one humanity to shape and secure our future.
