Hybrid argon plasma coagulation in Barrett’s esophagus: a systematic review and meta-analysis

Background/Aims@#Patients with Barrett’s esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC. @*Methods@#We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett’s esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM. @*Results@#Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872–0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005–0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007–0.055; I2=0%). @*Conclusions@#Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

Social dilemma and vitamin D deficiency: a cross-sectional study of nutritional rickets in children ages 6 months to 24 months

Background: In developing countries, malnutrition's is one of the challenges that still need to be addressed. Undernutrition is usually a result of the unavailability of food and/or repeated infections in children. Countries with comparatively lower per-capita incomes as well as those with middle per-capita income have its increased prevalence in younger age. Social dilemma of mothers, like exclusively breastfeeding, heavy clothing's and practice of keeping babies inside the doors, lead vitamin D deficiency and ultimately into nutritional rickets. The objective of this study was to determine the frequency of factors leading to nutritional rickets in children ages 6 months to 24 months.Methods: This cross-sectional study was conducted at Department of Pediatrics, Ayub Teaching Hospital, Abbottabad, Pakistan from March to December 2017. After inclusion/exclusion criteria, total 160 patients of rickets were observed. Detailed history followed by vitamin D level (<15 ng/ml) was measure. Data was analyzed by SPSS-22 and all documents were locked with principal author.Results: Present study showed that 62% children were in age ranged 6-12 months and 38% children were in age range 13-24 months. Mean age was 12 months with SD'2.16. Seventy nine percent children were male, and 21% children were females. More over 52% children had exclusive breast feeding, and 48% children did not have exclusive breast feeding. Similarly, 15% children had limited sun-light exposure and 85% children did not have limited sun-light exposure.Conclusions: Present study concluded that a lack of health education and sunlight exposure and exclusive breastfeeding were the significant risk factors contributed to nutritional rickets among children of Abbottabad, Pakistan.

Tutor evaluation on the scoring criterion for non-technical skills in surgeons / 中华医学教育探索杂志

Objective@#Non-technical skills (NTS) are necessary to evaluate the comprehensive quality of surgeons. In this study, we proposed the concept of C-NTS, a scoring criterion for NTS based on real scenarios (for example, history taking) and video recording, and verified its practical application effects.@*Methods@#Study objects were divided into the tutor group and the student group. The tutor group contained four senior attending physicians in gastrointestinal surgery department of one tertiary hospital (all male with doctor degree). The student group had four rotating surgeons who were randomly selected from the same department in 2018 (two males and two females). Before and after the training, the tutor rated the same anonymous video by C-NTS. One-factor analysis of variance was used to compare the differences between and within the groups, and Kendall concordant coefficient was used to test the consistency by SPSS 22.0.@*Results@#After the tutor receiving training, Kendall concordant coefficient was increased from 0.425 to 0.853 and the latter suggested the difference had statistical significance (P=0.017), which confirmed the effectiveness of the training.@*Conclusion@#C-NTS has preliminarily solved the difficulty of homogenization of NTS assessment. Relevant C-NTS discussions and trainings for clinical tutors may be beneficial to save time and manpower in clinical teaching and evaluation.

Extensive Surgical Wound Lavage Reduces the Incidence and Severity of Heterotopic Ossification in Primary Total Hip Replacement: A Study of 175 Hip Replacements / 대한고관절학회지

PURPOSE: One of the local factors contributing to the formation of heterotopic ossification includes bone debris generated during the surgery. This risk can be partially nullified by use of saline wash. Our research aim was to ascertain if extensive intraoperative lavage can reduce the incidence and severity of heterotopic ossification in primary total hip arthroplasty. MATERIALS AND METHODS: A retrospective case control radiological study of 145 patients (175 hip replacements). The control group received minimal intra-operative lavage ( 3,000 mL), and included 85 primary hip replacements. Brooker classification was used to grade radiographs at one year for development of heterotopic ossification. RESULTS: Sixty-six patients in control group had heterotopic ossification, with six showing a significant grade (grade 3 or 4). Thirty-five patients in the index group had heterotopic ossification with no incidence of severe grade. Majority patients in the index group showed a predominantly grade 1 heterotopic ossification; 28 out of 35, as compared to 37 out of 66 in control group. There was a statistically significant difference in the incidence (P < 0.05) as well as severity of heterotopic ossification between the groups (P < 0.05). CONCLUSION: We conclude that use of extensive lavage during total hip replacement reduces the incidence as well as severity of heterotopic ossification.

Pharmacovigilance and adverse drug reporting system; awareness in Pakistan: pharmacy students and professionals approach and facts

ABSTRACT: This study was conducted to assess the pharmacy students and graduate knowledge and awareness about pharmacovigilance and adverse drug reporting [ADR] system in Karachi, Pakistan

Objectives: This study was designed to identify the trends, perception and approaches of pharmacy students and graduate towards current scenarios of pharmacovigilance and ADR contextual to our setting. Study Design: It was cross sectional, qualitative study. Setting: Pharmacy final year students and fresh graduates of two public and two private sector universities were included in the study. Period: Data was collected between January to August, 2015

Method: Relevant information was collected using questionnaire with 18 open ended and 7 close ended questions. 400 final year participants and 150 fresh graduates were incorporated in this survey. SPSS 20.0 was used to analyze the results and Percent, frequencies and mean scores were calculated for various outcomes

Results: Response rate of final year students and fresh graduates was found [97%, n = 388] and [88%, n= 132] respectively. Students level of awareness about pharmacovigilance was found [54%, n =216] in final year students while little higher rates were observed [78%, n=110] in graduates. Concept of pharmacovigilance gained through pharmacy curriculum was calculated 45% rated by final year students. The pharmacovigilance knowledge mean score was found to be 2.368.5 and 2.886.3 for final year students and fresh graduates respectively. 58% total respondents were aware with relationship between the drug and the ADR

Conclusion: The results of this study demonstrate that pharmacy students of final year in public and private sector universities of Pakistan are aware with some basic knowledge of ADRs and pharmacovigilance, but it is a need of time to incorporate more contents of such aspects in curriculum with some practical exposure that how to report ADRs

Frequency of acute kidney injury in patients undergoing coronory artery bypass grafting

Objective: To find the frequency of acute kidney injury in patients undergoing coronary artery bypass grafting

Methodology: The study was conducted in cardiovascular unit Lady Read-ing Hospital Peshawar. It was cross sectional study. Sampling technique was non probability convenient sampling. Data was collected from 20.2.2013 to 20.8.2013. Total 179 patients included in the study. All patients with known coronary artery disease were included in the study whom were planned for revascularization in the form of coronary artery bypass grafting [CABG]. Post-operatively all patients' serum creatinine till 48th post op hour was observed to detect acute kidney injury. Acute Kidney Injury [AKI] was defined as more than 50% or elevation of 0.3 mg/dl of creatinine level from base line

Results: A total of 179 patients undergoing coronary artery bypass grafting were included in the study. Average age of the patients was 46.88 years +/- 9.91 with range 20-60 years. Patients were divided into four groups according to age. The acute kidney injury after coronary artery bypass grafting was observed in 14 [7.82%] patients. Acute kidney injury was more common in old age and it was non significantly more common in male gender

Conclusion: In spite of current highly advance cardiac surgery techniques and post operative care still there is high incidence of acute kidney injury following revascularization and subsequent worst outcomes

Multiplex Real-Time PCR Method for Simultaneous Identification and Toxigenic Type Characterization of Clostridium difficile From Stool Samples

BACKGROUND: The aim of this study was to develop and validate a multiplex real-time PCR assay for simultaneous identification and toxigenic type characterization of Clostridium difficile. METHODS: The multiplex real-time PCR assay targeted and simultaneously detected triose phosphate isomerase (tpi) and binary toxin (cdtA) genes, and toxin A (tcdA) and B (tcdB) genes in the first and sec tubes, respectively. The results of multiplex real-time PCR were compared to those of the BD GeneOhm Cdiff assay, targeting the tcdB gene alone. The toxigenic culture was used as the reference, where toxin genes were detected by multiplex real-time PCR. RESULTS: A total of 351 stool samples from consecutive patients were included in the study. Fifty-five stool samples (15.6%) were determined to be positive for the presence of C. difficile by using multiplex real-time PCR. Of these, 48 (87.2%) were toxigenic (46 tcdA and tcdB-positive, two positive for only tcdB) and 11 (22.9%) were cdtA-positive. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the multiplex real-time PCR compared with the toxigenic culture were 95.6%, 98.6%, 91.6%, and 99.3%, respectively. The analytical sensitivity of the multiplex real-time PCR assay was determined to be 103colonyforming unit (CFU)/g spiked stool sample and 0.0625 pg genomic DNA from culture. Analytical specificity determined by using 15 enteric and non-clostridial reference strains was 100%. CONCLUSIONS: The multiplex real-time PCR assay accurately detected C. difficile isolates from diarrheal stool samples and characterized its toxin genes in a single PCR run.

anti-inflammatory activity of the leaves of Colocasia esculenta

Anti-inflammatory activity of the ethanolic extract of the leaves of Colocasia esculenta Linn. was studied in wistar rats using the carrageenan induced left hind paw edema, carrageenan induced pleurisy and cotton pellet induced granuloma model. The ethanolic extract [100 mg/kg, p.o.] inhibited carrageenan induced rat paw edema. It also showed an inhibitory effect on leukocyte migration and a reduction on the pleural exudates as well as reduction on the granuloma weight in the cotton pellet granuloma method. The results indicated that the ethanolic extract produced significant [p<0.05] anti-inflammatory activity when compared with the standard and untreated control

Prevalence and pattern of tobacco use in rural area of Peshawar

2975 cases were studied in two villages of Peshawar District. 48.44% were found tobacco users. Out of these 43.79% were males whereas females were only 4.4%. Nasswar was being the most frequently used [64.5%] type of tobacco followed by chillum [17.5%]