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Background and Objective@#The focusing of resources to COVID-19 response hampered and disadvantaged primary care services including that for Non-Communicable Diseases (NCDs), compromising continuity of care and hence, patients’ disease status. However, studies from low- and middle-income countries (LMICs) remain sparse; therefore, evidence generation on how the pandemic impacted the provision of these primary care services in LMICs will help further understand how policies can be reframed, and programs be made more efficient and effective despite similar crises. To bridge this gap, the study investigated how the pandemic affected the implementation of NCD care at the primary care level in the Philippines.@*Methods@#Thirty-one online focus group discussions via Zoom Meetings were conducted among 113 consenting physicians, nurses, midwives, and community health workers from various facilities — community health centers and stations, free-standing clinics, infirmaries, and level 1 hospitals — located within two provinces in the Philippines. All interviews were video-recorded upon participants’ consent and transcribed verbatim. Inductive thematic analysis was employed through NViVo 12® to generate themes, identify categories, and describe codes. @*Results@#The impact of COVID-19 on NCD care at the primary care level revolved around heightened impediments to service delivery, alongside worsening of pre-existing challenges experienced by the healthcare workforce; subsequently compelling the public to resort to unhealthy practices. These detriments to the primary healthcare system involved resource constraints, discontinued programs, referral difficulties, infection, overburden among workers, and interrupted training activities. Citizens were also observed to adopt poor healthcare seeking behavior, thereby discontinuing treatment regimen. @*Conclusion@#Healthcare workers asserted that disadvantages caused by the pandemic in their NCD services at the primary care level possibly threaten patients’ health status. Besides the necessity to address such detriments, this also emphasizes the need for quantitative studies that will aid in drawing inferences and evaluating the effect of health crises like the pandemic on such services to bridge gaps in improving quality of care.
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COVID-19 , Noncommunicable Diseases , Primary Health Care , Philippines , Qualitative ResearchABSTRACT
Gas therapy is emerging as a highly promising therapeutic strategy for cancer treatment. However, there are limitations, including the lack of targeted subcellular organelle accuracy and spatiotemporal release precision, associated with gas therapy. In this study, we developed a series of photoactivatable nitric oxide (NO) donors NRh-R-NO (R = Me, Et, Bn, iPr, and Ph) based on an N-nitrosated upconversion luminescent rhodamine scaffold. Under the irradiation of 808 nm light, only NRh-Ph-NO could effectively release NO and NRh-Ph with a significant turn-on frequency upconversion luminescence (FUCL) signal at 740 nm, ascribed to lower N-N bond dissociation energy. We also investigated the involved multistage near-infrared-controlled cascade release of gas therapy, including the NO released from NRh-Ph-NO along with one NRh-Ph molecule generation, the superoxide anion O2⋅- produced by the photodynamic therapy (PDT) effect of NRh-Ph, and highly toxic peroxynitrite anion (ONOO‒) generated from the co-existence of NO and O2⋅-. After mild nano-modification, the nanogenerator (NRh-Ph-NO NPs) empowered with superior biocompatibility could target mitochondria. Under an 808 nm laser irradiation, NRh-Ph-NO NPs could induce NO/ROS to generate RNS, causing a decrease in the mitochondrial membrane potential and initiating apoptosis by caspase-3 activation, which further induced tumor immunogenic cell death (ICD). In vivo therapeutic results of NRh-Ph-NO NPs showed augmented RNS-potentiated gas therapy, demonstrating excellent biocompatibility and effective tumor inhibition guided by real-time FUCL imaging. Collectively, this versatile strategy defines the targeted RNS-mediated cancer therapy.
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SUMMARY: This study is to investigate the effect of home-based cardiac rehabilitation (HBCR) on quality of life, functional capacity, and readmission rates in patients with heart failure. Randomized controlled trials (RCTs) were screened from Cochrane Library, CINAHL, EMBASE, and MEDLINE. The intervention group received a standardized HBCR or a comprehensive rehabilitation strategy that included HBCR. The participants in the control group received CR at a medical center or usual care without CR intervention. The main outcome measurements included quality of life, exercise capacity, mortality and re-hospitalization. This meta-analysis included 20 RCTs, in which 16 studies compared HBCR with usual care, and 4 studies compared HBCR with center-based CR. In comparison with the usual care, HBCR improved the total quality of life score [MD=-5.85, 95 % CI (-9.76, - 1.94), P=0.003, I2=75 %]. Patients with HBCR and usual care were significantly different in VO2max [MD=1.05 mL/kg/min, 95 % CI (0.35, 1.75), P=0.003, I2=46 %]. However, VO2max of patients with HBCR was not significantly different from those with center-based CR [MD=0.08 mL/kg/min, 95 % CI (-1.29, 1.44), P=0.91, I2=0 %]. There was statistically significant difference in the 6-min Walk Distance between usual care and HBCR (for distance [MD=11.84, 95 % CI (7.41, 16.28), P<0.00001, I2=0 %]; and for feet [MD=98.93, 95 % CI (26.79, 171.08), P=0.007, I2=56 %]). However, there was no significant difference in 6-min Walk Distance between patients with HBCR and center-based CR [MD=12.45, 95 % CI (-9.81, 34.72), P=0.27, I2=0 %] , or in anxiety and depression between patients with usual care and HBCR (for anxiety, [MD=-0.25, 95 % CI (-0.56, 0.05), P=0.11, I2=0 %]; for depression, [MD=-0.18, 95 % CI (-0.51, 0.16), P=0.30, I2=0 %] . No significant difference was found in death number [RR=1.04, 95 % CI (0.55, 1.98), P=0.90, I2=0 %] or in the number of re-hospitalization [RR=0.88, 95 % CI (0.66, 1.18), P=0.40, I2=0 %] between usual care and HBCR. For patients with heart failure, compare with usual care and center-based CR, HBCR can improve the total quality of life. Compare with usual care, HBCR can improve VO2max and 6-min Walk Distance, but compare with center- based CR, there are no differences in mortality, re-hospitalization rate or incidence of anxiety and depression. Additionally, center- based CR and HBCR showed similar outcomes and medical costs.
El objetivo de este estudio fue investigar el efecto de la rehabilitación cardíaca domiciliaria (HBCR) sobre la calidad de vida, la capacidad funcional y las tasas de reingreso en pacientes con insuficiencia cardíaca. Se seleccionaron ensayos controlados aleatorios (ECA) de la Biblioteca Cochrane, CINAHL, EMBASE y MEDLINE. El grupo de intervención recibió un HBCR estandarizado o una estrategia de rehabilitación integral que incluía HBCR. Los participantes del grupo de control recibieron RC en un centro médico o atención habitual sin intervención de RC. Las principales medidas de resultado incluyeron la calidad de vida, la capacidad de ejercicio, la mortalidad y la rehospitalización. Este metanálisis incluyó 20 ECA, en los que 16 estudios compararon HBCR con la atención habitual y 4 estudios compararon que mejoró la puntuación total de calidad de vida [DM=-5,85, IC del 95 % (-9,76, -1,94), P=0,003, I2=75 %]. Los pacientes con HBCR y atención habitual fueron significativamente diferentes en el VO2máx [DM = 1,05 ml/kg/ min, IC del 95 % (0,35, 1,75), P = 0,003, I2 = 46 %]. Sin embargo, el VO2max de los pacientes con HBCR no fue significativamente diferente de aquellos con CR basada en el centro [DM = 0,08 ml/kg/min, IC del 95 % (-1,29, 1,44), P = 0,91, I2 = 0 %]. Hubo una diferencia estadísticamente significativa en la distancia de caminata de 6 minutos entre la atención habitual y HBCR (para la distancia [DM=11,84, IC del 95 % (7,41, 16,28), P<0,00001, I2=0 %]; y para los pies [DM= 98,93, IC 95 % (26,79, 171,08), P=0,007, I2=56 %]). Sin embargo, no hubo una diferencia significativa en la distancia de caminata de 6 minutos entre los pacientes con HBCR y CR basada en el cen- tro [DM = 12,45, IC del 95 % (-9,81, 34,72), P = 0,27, I2 = 0 %], o en la ansiedad y depresión entre pacientes con atención habitual y HBCR (para ansiedad, [DM=-0,25, IC del 95 % (-0,56, 0,05), P=0,11, I2=0 %]; para depresión, [DM=-0,18, 95 % IC (- 0,51, 0,16), P=0,30, I2=0 %] No se encontraron diferencias significativas en el número de muertes [RR=1,04, IC del 95 % (0,55, 1,98), P=0,90, I2=0 %] o en el número de reingresos [RR=0,88, IC 95 % (0,66, 1,18), P=0,40, I2=0 %] entre atención habitual y HBCR. Para los pacientes con insuficiencia cardíaca, en comparación con la atención habitual y la CR en un centro, la HBCR puede mejorar la calidad de vida total. En comparación con la atención habitual, la HBCR puede mejorar el VO2máx y la distancia recorrida en 6 minutos, pero en comparación con la CR basada en un centro, no hay diferencias en la mortalidad, la tasa de rehospitalización o la incidencia de ansiedad y depresión. Además, CR y HBCR basados en el centro mostraron resultados y costos médicos similares.
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Humans , Cardiac Rehabilitation/methods , Heart Failure/rehabilitation , Home Care Services , Patient Readmission , Quality of Life , ExerciseABSTRACT
Colorectal cancer （CRC） is one of the refractory malignant tumors of the digestive system worldwide. With limitations， the available clinical therapies are usually suspended or show unsatisfactory effect. Therefore， it is urgent to find and develop new candidate drugs specifically targeting the cancer with ideal efficacy， low toxicity， and low cost， and the solutions can be found in traditional Chinese medicine （TCM） which has a long history. In TCM， sovereign， ministry， assistant， and guiding medicinals are selected based on the syndrome differentiation， and it has shown remarkable efficacy on CRC in recent years. In particular， Chinese medicinal compounds and monomers from Chinese medicinals which have been applied in clinical settings are advantageous in the treatment of CRCs， as they improve the quality of life， alleviate clinical symptoms and toxic and side effects of chemotherapy， and prolong the survival of patients. Therefore， we retrieved the English and Chinese articles with "CRC"， "TCM"， "compound" and "monomer" as keywords， and summarized the progress in the treatment of CRC with Chinese medicinal compounds and monomers from Chinese medicinals from four aspects of "replenishing Qi and invigorating spleen"， "clearing heat and removing toxin"， "nourishing liver and kidney"， and "tonifying Qi and nourishing blood". However， Chinese medicine features multiple components， multiple targets， and multiple pathways， and in-depth research should be carried out on the application of Chinese medicinal compounds and monomers from Chinese medicinals in the treatment of CRC， in an attempt to minimize the pain and side effects and maximize the therapeutic effect. This study is expected to provide new insight into the treatment of CRC and a reference for further research on the efficacy and mechanism of Chinese medicine.
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1,4-alpha-D-glucan glucanohydrolase is among the most widely used commercial hydrolytic enzymes acting randomly on the glycosidic linkages of starch resulting in its saccharification and liquefaction. Its applicability in different industries can be improved by enhancing its stability and reusability. Therefore, in the present study attempts have been made to enhance the industrial applicability of 1,4-alpha-D-glucan glucanohydrolase from Bacillus subtilis KIBGE-HAR by adapting immobilization technology. The study developed mechanically stable, enzyme containing gel-frameworks using two support matrices including agar-agar, a natural polysaccharide and polyacrylamide gel, a synthetic organic polymer. These catalytic gel-scaffolds were compared with each other in terms of kinetics and stability of entrapped 1,4-α-D-glucan glucanohydrolase. In case of polyacrylamide gel, Km value for immobilized enzyme increased to 7.95 mg/mL, while immobilization in agar-agar resulted in decreased Km value i.e 0.277 mg/mL as compared to free enzyme. It was found that immobilized enzyme showed maximum activity at 70 °C in both the supports as compared to free enzyme having maximum activity at 60 °C. Immobilized 1,4-α-D-glucan glucanohydrolase exhibited no change in optimal pH 7.0 before and after entrapment in polyacrylamide gel and agar-agar. The enzyme containing gel-scaffold was found suitable for repeated batches of starch liquefaction in industrial processes. Agar-agar entrapped 1,4-α-D-glucanglucanohydrolase was capable to degrade starch up to seven repeated operational cycles whereas polyacrylamide entrapped enzyme conserved its activity up to sixth operational cycle.
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Polymers , Kinetics , AmylasesABSTRACT
Purpose: To study and describe clinical characteristics of congenital and developmental cataract at a tertiary eye care facility. Methods: In this retrospective study, 942 children (1311 eyes) presenting with congenital/developmental cataract over a 10?year study period were included. Gender, age at surgery, main presenting complaint, morphologic type of cataract, laterality, family history, and associated findings were recorded. Results: The overall proportion of boys and girls undergoing cataract surgery was approximately equal (P = 0.110). However, in the cases of bilateral cataract, the proportion of boys was larger than girls (P = 0.028). More than half (62.3%) of the patients underwent surgery at the age of >3 years. The main presenting complaint was white pupils, accounting for 48.1% of cases. Total cataract was the most common morphologic type in all age groups. In total, 133 children out of 942 (14.1%) had a positive family history of congenital/developmental cataract. Strabismus and nystagmus were seen in 27.2% and 19.3% of the eyes, respectively. Additional ocular dysmorphology was found in 97 (10.3%) of patients. Coexisting systemic disease was found in 149 (15.8%) cases. Among syndrome?associated cataracts, Down syndrome accounted for the majority of cases. Conclusion: High prevalence of total cataracts as well as frequent association with strabismus and nystagmus are likely to be the consequences of delayed presentation.
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Background: Stunting in children under 5 years of age is a condition where they have a length or height that is less than ?2 standard deviations of the growth standard of Indonesian children. Stunting is caused by chronic malnutrition in the first 1000 days of life. The spatial panel data method was developed to solve problems related to spatial objects that are measured periodically by involving elements of area and time. Objectives: The purpose of this study was to determine the best model and factors that influence stunting in children under 5 years of age in Indonesia using spatial panel data. Methods: The data used were from the website of the Central Statistics Agency and the publications of the Ministry of Health of the Republic of Indonesia in 2015–2019. Determination of the selected model is done by comparing the random effect spatial autoregressive model and spatial error model (SEM) random effect based on the value and Akaike information criterion (AIC). SEM random effect produces the largest value and the smallest AIC. Results: The selected spatial panel data model in determining the factors that influence stunting in children under 5 years of age in Indonesia is the SEM random effect based on the largest and AIC compared to other models. Conclusion: Based on the selected model, children under five with malnutrition and poor nutrition, receiving Vitamin A, and the average monthly per capita expenditure on food have a significant effect on the percentage of stunting in children under five in Indonesia.
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Aims@#Symbiotic bee fungus associated with the stingless bee larval food has been revealed to play a major role in performing a mutual relationship with the host. The fungus is believed capable to produce crucial nutrients that are required for larval pupation. However, detailed information on the fungus identification isolated from the larval food of our native Indo-Malaya stingless bee, Heterotrigona itama (Hymenoptera: Apidae), is poorly understood. Hence, this study was conducted to determine the effect of fungus isolated from the stingless bee larval food on the survival of H. itama larvae and identify the isolated fungus using both morphological and molecular analyses.@*Methodology and results@#Elisa plates designed with F-bottom type were used as artificial brood cells in a controlled condition. The eggs transferred to Elisa plates were kept in the incubator with 75%-100% humidity and 25 ± 2.5 °C of temperature. This study carried out in three different treatments: (1) microbes-free larval food, (2) fresh larval food and (3) microbes-free larval food with fungus supplement. Results showed that the survival of H. itama larvae depends on the presence of beneficial fungus with the highest survival rate (Treatment 2 = 85.71%). The absence of the beneficial fungus in the fluid food of H. itama showed the lowest survival rate (Treatment 1 = 37.14%). Microscopy analysis showed that the fungus had various forms, including unconjugated asci, round-shaped ascospore and pseudohyphae. The molecular characterisation of the isolated fungi was performed using 23S rRNA gene sequencing using universal primers ITS1 and ITS4. DNA barcoding of three isolated fungi confirmed all isolated fungi matched Panus lecomtei (Basidiomycetes; Poriales; Polyporaceae) with 99.70% of similarity.@*Conclusion, significance and impact of study@#This study provides information on the importance of whitish fungus in appearance that existed in the brood cell, which is proposed to be the crucial component of in-vitro stingless bee queen rearing protocol.
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@#Introduction: The COVID-19 pandemic has forced revolutionary changes in the delivery of medical education and imposed much stress on medical students and academicians. This study aimed at evaluating the level of exposure to COVID-19, COVID-related functional difficulties and concerns experienced by medical students, approximately one year after COVID-19 became significant health and socio-economic issues in Malaysia. Methods: A cross-sectional study using self-administered online questionnaire, was conducted among the undergraduate medical students of a private university in Malaysia. Results: A total of 243 medical students participated. They reported low level of exposure to COVID-19 infection. Majority of them demonstrate moderate level of difficulties in learning (median score of 3, highest score = 4) and high levels of COVID-related concerns (median scores of 4 to 5, highest score = 5). Lowest household income category was a significant predictor of high level of functional difficulties (OR = 3.878, 95%CI: 1.651, 9.110); whilst female gender was a significant predictor of high level of COVID-related concerns (OR = 7.400, 95%CI: 1.920, 28.514). Conclusion: One year following the onset of COVID-19 pandemic in Malaysia, medical students still reported significant functional difficulties in learning and demonstrated high levels of COVID-related concern. Collaborative efforts to mitigate the problems need to be intensified with emphasis on the delivery of online medical education and special attention to female and lower socio-economic group students to prevent detrimental consequences to medical students and medical education. Multi-center and longitudinal studies are recommended.
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Objective:To investigate the incidence rate, surgical rate and spontaneous cure of indirect inguinal hernia in children of Xinjiang region.Methods:Children, aged from 4?14 years, coming from 24 kindergartens, 18 primary schools and 9 junior middle schools of 3 countries and 5 cities in Xinjiang Uygur Autonomous Region were recruited to participate as respondents. The survey time for baseline data collection was from May 2013 to June 2014 and the retrospective cross-sectional survey was conducted. Parents of children were investigated by questionnaire, and children were examined on site. Observation indicators: (1) results of questionnaire survey; (2) illness and treatment of children involved in the study; (3) follow-up. Follow-up was conducted using telephone interview. Children who had been diagnosed and not been treated surgically at the time of questionnaire survey were followed up to detect disease progression and treatment in the past 5 years. If the symptoms of a child had disappeared during follow-up, parents of the child should accompany the child to hospital for physical examination and B-ultrasound examination to confirm the diagnosis, and then follow-up was conducted by telephone interview. The follow-up was up to January 2020. Count data were described as absolute numbers and percentages, and compari-son between groups was conducted using the chi-square test. Odds ratio and 95% confidence interval were calculated. Results:(1) Results of questionnaire survey. A total of 19 132 question-naires were distributed, and 19 132 complete questionnaires were recovered. Of the 19 132 children who completed the questionnaire survey, there were 9 670 males and 9 462 females. (2) Illness and treatment of children involved in the study. ① Incidence of indirect inguinal hernia in children with different sexes. Of the 19 132 children, 498 cases were diagnosed as indirect inguinal hernia, including 368 boys and 130 girls, with the prevalence as 3.806%(368/9 670) and 1.374%(130/9 462), respectively. There was a significant difference in the prevalence of indirect inguinal hernia between boys and girls ( χ2=111.54, P<0.05). The proportion of boys and girls in children with indirect inguinal hernia was 73.896%(368/498) and 26.104%(130/498), respectively, with the ratio of 2.8:1. The prevalence of boys was higher than girls ( odds ratio=2.84, 95% confidence interval as 2.32?3.48).② Age of children at first onset. Of the 498 children with indirect inguinal hernia, 59 cases were aged 1?4 years at first onset including 54 boys and 5 girls, 264 cases were aged 5?8 years including 196 boys and 68 girls, 148 cases were aged 9?12 years including 104 boys and 44 girls, 27 cases were aged 13?14 years including 14 boys and 13 girls. There was a significant difference in the age of children at first onset between boys and girls ( χ2=17.33, P<0.05). ③ Pathogenic factors in children with indirect inguinal hernia. Of the 498 children with indirect inguinal hernia, 457 cases had complete family history and crying history, and 41 cases were missing. Family history: of the 457 children with indirect inguinal hernia who had complete family history, there were 175 cases with the family history of indirect inguinal hernia and 282 cases without the family history. Of the 478 healthy children surveyed in the same period, there were 25 cases with the family history and 453 cases without the family history. There was a significant difference in the family history between the 457 children with indirect inguinal hernia and the 478 healthy children ( χ2=515.89, P<0.05). Crying history: of the 457 children with indirect inguinal hernia who had complete crying history, there were 194 cases with obvious crying history and 263 cases without obvious crying history. Of the 496 healthy children surveyed in the same period, there were 99 cases with obvious crying history and 397 cases without obvious crying history. There was a significant difference in the crying history between the 457 children with indirect inguinal hernia and the 496 healthy children ( χ2=56.51, P<0.05). ④ Surgical treatment. Of the 498 children with indirect inguinal hernia, 233 cases underwent surgical treatment including 217 boys and 16 girls, 265 cases were followed up without surgical treatment including 151 boys and 114 girls. The surgical rate for indirect inguinal hernia in boys and girls was 58.967%(217/368) and 12.308%(16/130), respectively, showing a significant difference between them ( χ2=84.01, P<0.05). The operation ratio of boys and girls was 13.6:1, and the surgical rate of boys was higher than girls ( odds ratio=10.24, 95% confidence interval as 5.83?17.98). (3) Follow-up. All the 265 children without surgical treatment for indirect inguinal hernia were followed up for 5 years. During the follow-up, there were 142 of 151 boys with surgical treatment and 9 boys without surgical treatments, showing negative in spontaneous cure. There were 27 of 114 girls with surgical treatment and 87 girls without surgical treatment, showing 55 cases positive in spontaneous cure and 32 cases still with indirect inguinal hernia. There was a significant difference in spontaneous cure between the 151 boys and the 114 girls ( χ2=143.79, P<0.05). Conclusion:In Xinjiang region, the incidence rate and surgical rate of indirect inguinal hernia are lower in girls compared with boys, and the spontaneous cure rate is higher in girls compared with boys.
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OBJECTIVE To study the regulatory mechanism of ethanol extract of Turkish Galls on proliferation and migration of colorectal cancer cells HCT- 116 and Caco- 2 based on janus kinase 2（JAK2）/signal transducer and activator of transcription 3 （STAT3）signaling pathway. METHODS CCK-8 method was used to detect the effects of 0.05，0.1，0.2，0.3，0.4 and 0.5 mg/mL ethanol extract of Turkish Galls on the proliferation of HCT- 116 and Caco- 2 cells after treated for 12，24，48 and 72 h. After treated with 0.1，0.3，0.5 mg/mL ethanol extract of Turkish Galls for 24 h，the migrations of HCT- 116 and Caco- 2 cells were detected by scratch test ；the level of reactive oxygen species （ROS）was detected by fluorescent probe method. The levels of interleukin-6（IL-6）and tumor necrosis factor-α（TNF-α）in cell supernatant were detected by ELISA . The phosphorylations of JAK2 and STAT 3 as well as the expressions of B-cell lymphoma- 2（Bcl-2）and Bcl- 2 associated protein X （Bax）were detected by Western blot assay. RESULTS Compared with blank control ，0.05，0.1，0.2，0.3，0.4 and 0.5 mg/mL ethanol extract of Turkish Galls could significantly inhibit cell proliferation after treated for 12，24，48，72 h（P＜0.05）. After treated with 0.1，0.3 and 0.5 mg/mL ethanol extract of Turkish Galls for 24 h，the scratch healing rate of 2 kinds of cells ，the levels of IL- 6 and TNF-α in the cell supernatant ，the phosphorylation of JAK 2 and STAT 3 as well as the expression of Bcl- 2 protein were all significantly decreased （P＜0.05）；the level of ROS and protein expression of Bax were increased significantly （P＜0.05）. CONCLUSIONS The ethanol extract of Turkish Galls can inhibit the proliferation and migration of HCT- 116 and Caco- 2 cells. The mechanism may be related with down-regulation of protein expression of Bcl- 2 and up-regulation of protein expression of Bax by increasing the accumulation of intracellular ROS ，down-regulating the expressions of inflammatory factors IL- 6 and TNF-α and the phosphorylation of JAK2 and STAT 3 in JAK 2/STAT3 signaling pathway.
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ObjectiveTo investigate the effects of gallic acid （GA） on human colon cancer HCT-116 and Caco-2 cell activities， intracellular Janus kinase （JAK）/signal transducer and activator of transcription factor （STAT） signaling pathway， and the expression of anti-apoptotic protein B-cell lymphoma-2 （Bcl-2） and pro-apoptotic protein B-cell lymphoma-2-associated X protein （Bax）， so as to explore its underlying molecular mechanism. MethodFollowing the classification of cells into GA group， blank group， and 5-fluorouracil （5-FU， 0.05 g·L-1） group， the HCT-116 and Caco-2 cells were treated with GA （0.02， 0.05， 0.1， 0.15， 0.2 g·L-1） for 12， 24， 48， and 72 h， respectively， and the cell proliferation inhibition rats were determined by cell counting kit-8 （CCK-8） assay to select the GA concentration that effectively inhibited proliferation. The colony formation ability was detected by crystal violet staining and the migration of cells by scratch test. The level of reactive oxygen species （ROS） was measured using a fluorescent probe （DCFH-DA）. The expression of interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） in cell supernatant were determined using the enzyme-linked immunosorbent assay （ELISA） kits. The expression levels of JAK2， phosphorylated （p）-JAK2， STAT3， p-STAT3， Bcl-2， and Bax were assayed by Western blot. ResultCCK-8 assay showed that after 12， 24， 48， and 72 h of treatment， GA （0.02， 0.05， 0.1， 0.15， 0.2 g·L-1） inhibited the proliferation of HCT-116 and Caco-2 cells in a dose- and time-dependent manner， and the inhibition rates were higher than those in the blank control group. Compared with the 5-FU group， GA （0.2 g·L-1） enhanced the inhibition of cell proliferation in a time-dependent manner. Compared with the blank control group， GA （0.1， 0.15， and 0.2 g·L-1） significantly decreased the number of cell colonies （P<0.01）， increased the inhibition rate of cell colony formation （P<0.01）， diminished the scratch healing rate （P<0.05， P<0.01）， elevated the fluorescence intensity of intracellular ROS （P<0.01）， and down-regulated the expression of IL-6 and TNF-α in the supernatant （P<0.01） in a dose-dependent manner. Compared with the 5-FU group， GA （0.2 g·L-1） decreased the scratch healing rate （P<0.01）， enhanced the fluorescence intensity of intracellular ROS （P<0.01）， and down-regulated the levels of IL-6 and TNF-α in cell supernatant （P<0.01）. According to Western blot analysis， compared with the blank control group， GA （0.1， 0.15， 0.2 g·L-1） obviously lowered the expression of p-JAK2， p-STAT3， Bcl-2， p-JAK2/JAK2， p-STAT3/STAT3， and Bcl-2/Bax （P<0.01） and raised Bax protein expression （P<0.05， P<0.01） in a dose-dependent manner. Compared with the 5-FU group， GA （0.2 g·L-1） down-regulated the expression of p-JAK2， p-STAT3， Bcl-2， p-JAK2/JAK2， p-STAT3/STAT3， and Bcl-2/Bax （P<0.05， P<0.01） and up-regulated the expression of Bax protein （P<0.05， P<0.01）. ConclusionGA significantly inhibits the proliferation of HCT-116 and Caco-2 cells， which may be related to the increased accumulation of intracellular ROS， down-regulation of inflammatory factors IL-6 and TNF-α， p-JAK2 and p-STAT3 protein expression in JAK/STAT signaling pathway， and Bcl-2， and up-regulation of Bax.
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Objective:To observe the clinical efficacy and adverse reactions of rituximab in the treatment of systemic sclerosis (SSc).Methods:Eight SSc patients who received rituximab treatment in the Department of Rheumatology of Shanghai Ruijin Hospital from November 2016 to May 2020 were treated with rituximab at week 0, week 2, week 4, week 24 and week 48. The clinical symptoms and laboratory parameters were evaluated at baseline, week 4, week 24 and week 48 respectively. All data were analyzed by Wilcoxon test.Results:All the patients were diagnosed as diffuse SSc, including seven females and one male, with a median disease course of 2.5 years. At week 0, week 24 and week 48, the modified Rodnon skin scores (MRss) were 16.5 (11.8, 29.5) , 14.5 (9.5, 27) ( Z=0.841) and 10.5 (7, 24.3) ( Z=0.420) respectively, which were significantly improved as compared with the baseline ( P<0.05). The patients' self-scores were 60(50, 77.5), 52.5(41.3, 67.5)( Z=0.113) and 47.5(36.3, 57.5)( Z=0.474) respectively, which were significantly improved at week 24 and week 48, and the High Resolution CT (HRCT) scores at baseline and week 48 were 2.7(1.02, 3.7) and 1.6(0.65, 2.95)( Z=0.964) respectively, significantly improved after treatment ( P<0.05). The pulmonary aterial hypertension (PAH) values were 48(41, 58.5) mmHg and 47(38.5, 57) mmHg ( Z=0.315) respectively. There was no significant difference between the two groups. Clinical observation showed that the condition was improved and no adverse reaction occurred at the same time period. Conclusion:The improvement of skin sclerosis, pulmonary interstitial lesion and pulmonary artery pressure can be observed during the treatment with rituximab, which may be a new choice for the treatment of SSc. There is no serious adverse reaction during the treatment, and the patients are well tolerated and safe.
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The increase in prevalence of diabetes in India is one of the leading causes of blindness due to micro vascular and macro vascular complications. The complications in retina and kidney are due to damage of small vessels. Studies have shown significant association between diabetic retinopathy and diabetic nephropathy. In our study, we are discussing the complications during intra and post-operative period and also both anatomical and functional outcome in these patients after vitrectomy for proliferative diabetic retinopathy. Both eye and kidney share same vascular pattern. One pre-existing condition can be followed by the other condition due to similar microvascular damage. We wanted to evaluate the outcome of vitrectomy in proliferative diabetic retinopathy patients associated with chronic kidney disease.METHODSThis is a retrospective study done at Sarojini Devi Eye Hospital, Telangana State, South India, over a two-year period from June 2017 to June 2019. Data was collected from old medical records of our institute, from patients who presented to Retina Dept. with various complaints. They were examined in detail, documented and treated based on clinical presentation after clearance from physician. Patients presented with different ocular manifestations like non-resolving vitreous haemorrhage, focal tractional retinal detachment, multi focal tractional retinal detachment like broad based, table top, combined retinal detachment and tractional maculopathy. Patients underwent pars plana vitrectomy with or without silicone oil endotamponade.RESULTSPrognosis in these patients was good only in cases of non-resolving vitreous haemorrhage and focal tractional retinal detachment (47.61%) whereas in cases like multifocal retinal detachment cases outcome was favourable (42.82%) but patients with combined retinal detachment (9.52%) had poor anatomical and visual outcome.CONCLUSIONSManagement of these patients is very difficult when there is severe proliferative diabetic retinopathy with multiple broad vitreo retinal adhesions. Outcome is very poor particularly in patients of severe proliferative diabetic retinopathy associated with chronic kidney disease and coronary artery disease due to intra operative complications
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Background: This modern era talks about women strength and empowerment where they are working either equally or one step ahead of men. However, a fall back in making decisions for contraception use and family planning can still be observed. It is most frequently seen among women belonging to some village as they are exposed to a minimal health care. Keeping this in mind, this crucial period was considered as opportunity to test the issue regarding the various choices of contraception available. Objective of this study was to find out the criteria and methods of contraception selected by women in the postpartum period.Methods: A cross-sectional study in the department of obstetrics and gynaecology was conducted over a period of 11/2 years in which a total of 150 postpartum women were interrogated and counselled regarding various methods of contraception.Results: The contraceptive methods most commonly selected in postpartum period are PPIUCD, Barrier, tubal ligation and injectable contraception of which condom is the most common method adopted. The important factors responsible for the choice of contraception include parity, breast- feeding, education and socio-economic status of the women.Conclusions: Postpartum period is particularly important for initiating contraception as the largest proportion with unmet need of contraception is found among those in their first year after child birth. In order to space birth in a healthy manner postpartum contraception should be emphasized upon.
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Background/Aims@#There has been a paucity of published data on the epidemiology of inflammatory bowel disease (IBD) in Central Asia and Kazakhstan. Therefore, we aimed to study IBD prevalence and patient awareness among adults in Kazakhstan. @*Methods@#The cross-sectional study was carried out among subjects of both sexes aged 18 years and older using IBD Alert Questionnaire (CalproQuest), single fecal calprotectin test, and endoscopy with biopsy to verify IBD from January to December 2017, across regions of Kazakhstan. All participants were included in the study after providing informed consent. @*Results@#Out of 115,556 subjects, there were 128 confirmed IBD cases, in which 36 Crohn’s disease (CD) and 92 ulcerative colitis (UC) cases identified. The age and sex-adjusted IBD prevalence were 113.9 (95% confidence interval [CI], 69.0–158.9) per 100,000 population. The age- and sex-adjusted prevalence for UC were 84.4 (95% CI, 44.8–123.9) and for CD were 29.5 (95% CI, 8.2–50.9) per 100,000 population. @*Conclusions@#This is the first report on the prevalence of IBD with a verified diagnosis in the Central Asia and could be used to better plan and allocate healthcare resources for IBD management program.
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These are dilated veins with in the anal canal in the sub epithelial region formed by radicles of the superior, middle and inferior rectal veins. The word “haemorrhoids ”is derived from the greek “heama”= blood and “rhoos”= flowing, and was originally used Hippocrates to describe the flow of blood from the veins of anus. Commonly in society it is known as piles. In Unani literature , haemorrhoids are known as” bawaseer”.According to Hippocrates (Buqrat) bawaseer is the varicosities of the internal mucous memane of rectum in which the veins get swollen similarly to the veins of the lower limb. It has been stated that the 50% of the population will experience symptomatic haemorrhoid disease in at some point in their lives , the peak incidence of symptomatic disease seems to be between the age of 45—65 years. According to the Unani system of medicine it is advised to treat the disease with mushily–e–Sauda, Mohalll awram, Musakkin, Habis–e–Dam, Mudamil–e–zakhim,and Mulaiyyan Adviya.There are many mufrad and murakkab drugs described in Unani literature to manage bawaseer. In this paper there is an isight of causes ,smptoms and management of bawaseer along with single and compound drugs being used in treatment of haemorrhoids.
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Background: Early detection of congenital heart disease is of paramount importance to improve the quality of life of children and prevent morbidity and mortality. Congenital heart disease (CHD) is one of the major causes of mortality and morbidity in the pediatric population of both the developing and developed countries. Present aim was to study the prevalence, age and sex wise distribution, and clinical spectrum of congenital heart disease (CHD) at Sopore, Kashmir, North India.Methods: Around 39829 children in the age group 0 months to 18 years were screened for Defects at birth, Diseases in children, Deficiency conditions and Developmental Delays including Disabilities over the period of 18 months under RBSK. Clinical examination, echocardiography and color Doppler were used as diagnostic tools.Results: A prevalence of 5.3 per 1000 population was observed. VSD (ventricular septal defect) was the commonest lesion (30.1%), followed by PDA (patent ductus arteriosus) in 21.6 % and ASD (atrial septal defect) in 20.2%. Tetralogy of Fallot was the commonest cyanotic heart disease (8.0%). Maximum numbers of children with heart disease were diagnosed in the age group 6 weeks to 6 years.Conclusions: For better estimation of prevalence of congenital heart diseases, more elaborate community-based studies are needed. Such community based studies can be easily done by collecting and analyzing data collected from screening programs like RBSK. Such community based screening programs helps in detecting silent cardiac ailments, their prevalence and pattern, and early therapeutic intervention. A few prevalence studies have been carried out piecemeal in different locations of India; and more such studies can be easily done by collecting and analyzing data collected under RBSK screening program.
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Introduction: Evaluating the patients who presents with feverand rash can be challenging because the differential diagnosisis extensive and includes minor and life threatening illnesses.Febrile rashes are classified into maculopapular rash,generalized diffuse erythema, and vesicular. Currently, viralexanthems are by far the most common cause of fever withrash in children. Study aimed to identify the patients presentingwith febrile rash and to confirm cases by laboratory diagnosticmethods to ensure fast, economical and speedy confirmationof the cause.Material and methods: A survey was carried out fromMay 2017 to Sep 2018 by the Department of Microbiologywith technical support from OP and IP staff. Blood sampleswere collected after informed consent. Serum samples werescreened for immunoglobulin M by ELISA, test was processedaccording to the manufacturer’s instructions.Results: This study covered 215 subjects out of which (55.9%)were males and (43.6%) were females, cases were segregatedwith different age groups 0 – 5 years, 6 – 12years, 13-18 yearsand adults > 18 years who developed febrile rash with fever.All the samples were screened for virus specific IgM.Conclusion: There is a need for routine surveillance programat every teaching Hospital setting to ensure the incidenceof the febrile rash with illness in children among differentage groups. Diagnosis can be established serologically byemphasizing the need for Clinico-serological correlationof rashes. As antibiotics will be required to treat bacterialdiseases, knowing the viral etiology will help in avoidingunnecessary administration of antibiotics.
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Objective: To determine the correlation of trainee selection scores [TSS] with subsequent performance in anesthesiology trainees at a university hospital
Study Design: Descriptive analytical study
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from August 2016 to January 2017
Methodology: Data were collected on 44 anesthesiology trainees completing their training between 2009 and 2015. TSS consisted of entrance test, final-year medical school scores, and interviews. Assessment included written tests, viva voce, and clinical assessment. Non-parametric Spearman rank correlation coefficient was computed to assess the relationship between scores
Results: Weak correlation was found between TSS and overall assessment scores for first three years of training. Correlation of TSS with clinical component of assessment was weak throughout training, while it was moderately significant with cognitive component of assessment in third and fourth years of training. Correlation between interview scores and cognitive as well as clinical assessment was non-significant. TSS showed weak correlation with success in exit level examination
Conclusion: Correlation between overall TSS and assessment scores was weak for first three years of training, and becoming moderately positive in later years of training. Cognitive component of TSS had moderately positive correlation with cognitive assessment, but not with clinical performance. Anesthesiology training programmes need to strengthen their selection criteria; and development of structured interviews might prove useful. Future research should focus upon identifying most useful traits in selecting high performers in anesthesiology training