IPA and its precursors differently modulate the proliferation, differentiation, and integrity of intestinal epithelial cells

BACKGROUND/OBJECTIVES@#Indole-3-propionic acid (IPA) is a tryptophan-derived microbial metabolite that has been associated with protective effects against inflammatory and metabolic diseases. However, there is a lack of knowledge regarding the effects of IPA under physiological conditions and at the intestinal level.MATERIALS/METHODS: Human intestinal epithelial Caco-2 cells were treated for 2, 24, and/ or 72 h with IPA or its precursors – indole, tryptophan, and propionate – at 1, 10, 100, 250, or 500 μM to assess cell viability, integrity, differentiation, and proliferation. @*RESULTS@#IPA induced cell proliferation and this effect was associated with a higher expression of extracellular signal-regulated kinase 2 (ERK2) and a lower expression of c-Jun. Although indole and propionate also induced cell proliferation, this involved ERK2 and c-Jun independent mechanisms. On the other hand, both tryptophan and propionate increased cell integrity and reduced the expression of claudin-1, whereas propionate decreased cell differentiation. @*CONCLUSIONS@#In conclusion, these findings suggested that IPA and its precursors distinctly contribute to the proliferation, differentiation, and barrier function properties of human intestinal epithelial cells. Moreover, the pro-proliferative effect of IPA in intestinal epithelial cells was not explained by its precursors and is rather related to its whole chemical structure.Maintaining IPA at physiological levels, e.g., through IPA-producing commensal bacteria, may be important to preserve the integrity of the intestinal barrier and play an integral role in maintaining metabolic homeostasis.

Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia

@#Introduction: Trauma is a Global threat and the 5th highest cause of all-cause mortality in Malaysia caused predominantly due to road traffic accidents. Majority of trauma victims are young adults aged between 21-40 years old. In Malaysia, 24 out of 100,000 population die annually due to trauma, rating us amongst the highest in South East Asia. These alarming figures justify aggressive preventive and mitigation strategies. The aim of this paper is to promote the implementation of evidence-based interventions that will reduce the rate of preventable death because of trauma. Tranexamic acid is one of the few interventions in the early management of severe trauma with level-one evidence. Tranexamic acid has been proven to reduce all causes of mortality and mortality due to bleeding. Evidence proves that it is most effective when administered early, particularly within the 1st hour of trauma. This proposed guideline is formulated based upon quality evidence from multicentre studies, clinical practices in other countries and consideration of the local demographic factors with the intent of enabling an easy and simple pathway to administer tranexamic acid early in the care of the severely injured. Conclusion: The guideline highlights select pre-hospital criteria’s and the methods for drug administration. The authors recognise that some variants may be present amongst certain institutions necessitating minor adaptations, nevertheless the core principles of advocating tranexamic acid early in the course of pre-hospital trauma should be adhered to.

Duodenal neuroendocrine tumor, adenocarcinoma and gastrointestinal stromal tumor in association with neurofibromatosis type 1: An unique occurrence

Mixed endocrine–nonendocrine neoplasms are rare tumors and pose challenges in diagnosis and management. Neurofibromatosis-1 (NF-1) patients are known to develop malignancies. Although neuroendocrine tumors and gastro-intestinal stromal tumors are seen in NF-1, its association with adenocarcinoma is rare. The existence of these three entities with NF-1 is extremely rare. NF1 patients presenting with symptoms suggestive of malignancies should alert the physician for a detailed clinical work up. Diagnosis of these malignancies often requires a meticulous histopathological and immunohistochemical examination. We report the first case from Indian experience.

Hand hygiene amongst health workers in a teaching hospital: a study of knowledge, attitude and practices

@#Though a relatively simple procedure, Hand Hygiene compliance rates tend to be highly variable and poor. This cross-sectional knowledge, attitude and practices (KAP) study was conducted at Shri Maharaja Hari Singh (SMHS) Hospital, a teaching hospital in Srinagar, India. The subjects that participated in this study included 106 nursing staff working in different departments of the Hospital. The Self-structured one plus WHO,s hand hygiene questionnaire for health care workers was used in this study. Almost 80% of the respondents skipped hand washing when in hurry. Only 12% and 28% used to hand wash before touching a patient and before doing simple procedures respectively. This study depicts the poor compliance of health workers regarding hand hygiene.

Hepatitis B: knowledge, attitude and practices of dental house officers

Hepatitis B is a virus of great concern for healthcare providers, with an increasing prevalence in Pakistan. Dentists are blamed for this as negligence in infection control procedures [improper instru-ment sterilization, reuse] has led to this surge. The study was aimed to collect information regarding knowledge, attitude as well as practices about Hepatitis B infection by 200 house officers in dental colleges of Rawalpindi and Islamabad.A KAP survey was done in Dec 2017 with pretested questionnaire having queries regarding knowl-edge, attitude and protective measures to prevent transmission of Hepatitis B. SPSS 16.0 software was utilized for data analysis. There were 136 [68%] female participants and 64 [32%] males were participants with mean age of 23.6+1.2 .The results showed that the dental professionals were quite aware of Hepatitis B and its transmission [62.5%].92.5% responded that without proper infection control measures one can acquire it. They were well informed about Hepatitis B vaccination [89.5%], precautions and droplet isolation procedures. However, continuous educational programs on isolation precautions and infection control measures can reduce the chances of cross infection

Comparison of outcome in women with non-reactive cardiotocography versus non-reactive cardiotocography and fetal scalp blood sampling

Background: Intrapartum assessment of the fetus is a challenging task. And a good fetal surveillance during labour often entails monitoring the fetal heart rate with cardiotocography[CTG]. The fetal heart rate pattern is an indicator of medullary response of fetal brain to the acidemia, blood volume changes and hypoxemia, as the brain modulates the fetal heart rate. But specificity of CTG is low that's why generally intrapartumcardiotocography is combined with a second variable, such as Fetal Scalp Blood sampling, to improve its specificity. The increased intervention rates associated with non-reactive cardiotocography can be reduced with the use of fetal scalp blood sampling

Objectives: To compare frequency of caesarean section with use of non- reactive Cardiotocography versus non-reactive Cardiotocography and fetal scalp blood sampling. To determine the immediate neonatal outcome in terms of death, Apgar score and need for intensive care unit admission after delivery

Study Design: This study was cross sectional analytical study

Settings: Obstetrics and Gynaecology department, Unit-I, Lady Willingdon Hospital, Lahore, affiliated with King Edward Medical University

Duration: The duration of study was 1 year

Methodology: The non-probablity purposive sampling technique was used in this study. 100 patients in labour at term presented to labour room of Lady Willingdon Hospital, and fulfilling the inclusion criteria were enrolled in this study. After taking informed written consent, the patients were divided into two groups [A and B]. In group A, 50 cases having non-reactive Cardiotocography were taken and according to fetal assessment by Cardiotocography all were taken for caesarean section. In group B, 50 cases having non-reactive Cardiotocography were taken and fetal assessment was done by continuous Cardiotocography as well as fetal scalp blood sampling. In group B, fetal hypoxia was assessed by fetal blood pH. Only those cases in group B underwent caesarean section, where fetal hypoxia was confirmed by fetal blood pH [pH=<7.20]. Apgar score at 1 min and 5 min and admission to neonatal intensive care unit [NICU] was noted for postnatal fetal assessment in both the groups. Data was entered and analyzed through SPSS version 21. To calculate sensitivity, specificity, Positive predictive value [PPV], negative predictive value [NPV] and fetal scalp blood pH 2x2 tables were generated, taking pH as gold standard

Results: In this study among 100 patients, the mean age of the patients was noted as 27.64+/-4.38 years and the mean gestational age was noted as 39.30+/-1.05 weeks. The mean Apgar score at 1 minute of the baby was noted as 5.62+/-1.39, whereas at 5 minutes was noted as 6.76+/-2.09. In group B among 50 cases the mean pH value of fetal scalp blood was noted as 7.25+/-0.048. Fetal scalp blood sampling was normal in 20/50 [40 percent] patients, borderline in 24/50 [48 percent] patients, whereas it was abnormal in 6/50 [12 percent] patients. In group A, among 50 cases all underwent lower segment Caesarean section [LSCS]. In group B, among 50 cases, 30/50 [60 percent] cases underwent LSCS while 20/50 [40 percent] underwent spontaneous vaginal delivery. In group A, 28/50 [56 percent] cases had Apgar <7 at 5 minutes while in group B, 18/50 [36 percent] cases had Apgar <7 at 5 minutes. In group A, 4/50 [8 percent] cases died while in group B, no mortality was observed. There was significant difference observed between group A and cases in group B for all these factors. In group A, 10/50 [20 percent] cases had NICU admission while in group B, only 6/50[12 percent] cases had NICU admission. There was no significant difference observed between two groups in NICU admission

Conclusion: It was concluded that CTG coupled with fetal blood sampling for fetal pH versus carditocography alone is an accurate method for assessment of fetal condition in labour to decide the mode of delivery and neonatal outcome after birth

Association of the knowledge of nurses about the pain management with their attitude towards cancer patients

Objective: Proper training and knowledge about pain and pain management can help nurses during their task of active management to relieve pain, but it also builds positive attitude towards patients. We aimed to determine the association between knowledge and attitudes of the nurses about pain management of cancer patients and the relationship to different demographic and educational factors

Methodology: This cross-sectional study was conducted in four hospitals of Lahore, [Pakistan] from 1st July 2013 to 1st July 2014. A self-administered questionnaire was used to collect data. 100 nurses working in cancer units [both medical and surgical oncology wards] were included in the study using convenient sampling technique. Nurses not working in cancer units, high positioned [head nurses] and nurses with higher education [e.g. MSc [N], post RN-BSc [N], other courses] were excluded from the study. Questionnaire used based upon the "Knowledge and Attitudes Survey Regarding Pain [KASRP]" for knowledge and attitude. Data was collected and analyzed using SPSS version 21.0

Results: Out of one hundred nurses 90% were females while 10% were males. The mean age of participants was 30.88 +/- 8.91 years. Majority of the nurses i.e., 59% had inadequate knowledge. Attitude score regarding the cancer pain management was 60%. Knowledge of pain management was significantly associated with nurses attitude towards pain management [p = .001]

Conclusion: There is positive association between the knowledge and attitude towards cancer pain management. Thus, by showing good attitude, the nurses, who spend most of their time with patients can help to minimize their pain. This is only possible if the nurses have proper knowledge and education in this field

Frequency of group B streptococci in pregnant women in a tertiary care hospital

Objective: To determine the frequency and risk factors of Group B Streptococci [GBS] in pregnant patients in third trimester in a tertiary care hospital in Lahore

Study Design: Cross-sectional, prospective study

Place and Duration of Study: Lady Willingdon Hospital, Lahore, from October 2014 to March 2015

Methodology: Sterile lower vaginal swabs were taken from 200 women aged 20 years and over, in third trimester, with no history of vaginal bleeding, ruptured membrane, recent intake of antibiotics or chronic illness. These swabs were cultured for detection of GBS. The risk factors of GBS and its frequency were noted in the pregnant population. Quantitative and qualitative data was analyzed by SPSS version 20. Chi-square test was applied to see association between diagnosis of GBS and other categorical variables. P-value

Results: In this study, the mean age of all the females was 26.36 +/- 4.32 years and mean duration of pregnancy was 35.54 +/- 2.65 weeks. Frequency of GBS in pregnant women was found as 14%. We observed significant association of GBS with parity and previous history of miscarriage [p-value = 0.033 and 0.010 respectively]. Moreover, significant association between vaginal discharge and GBS was also found [p = 0.027]

Conclusion: GBS is present in a small but significant number of pregnant women in our setting and it has association with multiparity, vaginal discharge during pregnancy, and previous history of miscarriage

Evaluation of anti-streptolysin o titers in rheumatic heart disease patients

Background: Anti-streptolysin O titer is related to rheumatic heart disease

Objective: To assess anti-streptolysin O titer in rheumatic heart disease patients at Punjab Institute of Cardiology Lahore

Methodology: It was a cross-sectional study, 130 consecutive patients of rheumatic heart disease admitted at Punjab Institute of Cardiology Lahore between 1[st] January to 31[st] December, 2014, fulfilling the inclusion and exclusion criteria were enrolled. Their laboratory findings were taken; CRP and ESR levels were measured. ASO titer was measured by latex agglutination test. ASO Titer more than 200IU/ml was taken as significant

Results: It was found that 81[62.31%] patients of rheumatic heart disease has ASO levels more than 200IU/ml and 49[37.69%] patients has ASO less than 200IU/ml. Fifty two percent study subjects were female and 60% were between 4-15 years of age

Conclusion: Majority of the patients admitted with RHD has raised level of ASOT

Effect of myomectomy on endometrial glutathione peroxidase 3 [GPx3] and glycodelin mRNA expression at the time of the implantation window

In fertile women, glycodelin and glutathione peroxidase 3 [GPx3] genes expression rises during the luteal phase, with a peak occurring during the implantation window. The expression of these genes decreases in women with myomas. To determine whether myomectomy would reverse glycodelin and GPx3 expression, we evaluated the transcript levels of these genes in the endometrium of patients before and after myomectomy. Expression of glycodelin and GPx3 genes were examined prospectively during the midluteal phase in the endometrium obtained from infertile women with myoma [n = 12] before and three months after myomectomy. Endometrial expression of these genes was evaluated using quantitative real-time RT-PCR. Endometrial glycodelin mRNA expression levels [normalized to 18S rRNA expression] were increased significantly in endometrium of patients after myomectomy [P = 0.02]. GPx3 mRNA expression was increased insignificantly after myomectomy [P = 0.43]. The results showed that myomectomy increased endometrial glycodelin [significantly] and GPx3 [not significantly] gene expression after 3 months. Study at different times and detecting expression of these genes can reveal more details

Effect of intramural myomectomy on endometrial HOXA10 and HOXA11 mRNA expression at the time of implantation window

HOXA11 and HOXA10 are expressed in endometrium throughout the menstrual cycle and show a dramatic increase during the mid-luteal phase at the time of implantation. The expression of these genes is decreased in women with myomas. To determine whether myomectomy would reverse HOXA11 and HOXA10 expression, we evaluated the transcript levels of these genes in the endometria of patients before and after myomectomy. Expression of HOXA11 and HOXA10 were examined prospectively during the midluteal phase in endometrium obtained from infertile women [n=12] with myoma before and three months after myomectomy. Endometrial HOXA11 and HOXA10 expression were evaluated using quantitative real-time reverse transcriptase-polymerase chain reaction [RT-PCR]. Endometrial HOXA11 and HOXA10 mRNAs expression levels [normalized to 18SrRNA] were increased insignificantly in endometrium of patients after myomectomy [p=0.7 and p=0.15 respectively]. The results suggest that the alteration in expression pattern of these genes could not account for some aspects of fertility after myomectomy

Comparison of dexamethasone and ondansetron for the prophylaxis of post operative nausea and vomiting in laparoscopic gynaecological procedures

Introduction: Post-operative nausea and vomiting [PONV] is one of the important complications after laparoscopic surgery resulting in patient dissatisfaction and consumption of healthcare resources

Objectives: We compared the efficacy of dexamethasone and ondansetron in preventing post operative nausea and vomiting in gynaecological laparoscopic surgeries

Methods: After approval from ethical committee and informed consent, the patients were randomly assigned to receive dexamethasone 8 mg or ondansetron 4 mg i.v. at induction. Postoperative PONV scores, pain scores, morphine consumption and Richmond Agitation sedation scores were compared one hourly for 6 hours and at 12 and 24 hours

Results: Both patient groups were similar in age, weight, height, duration of surgery and ASA distribution. No difference was observed in PONV scores at 1 hour [p=0.33], 2-3 hours [p=0.27], 4-6 hours [p=0.13] and 7-12 hours [test p=0.48]; first episode of vomiting [4.87 sd +/- 2.29 vs. 4.29 sd +/- 1.32 hours, p=0.59]; maximum pain scores at 1 hour [p=0.61], between 2-3 hours [p=0.32], 4-6 [p=0.47], 7-12 [p=0.57] and 13-24 hours [p=0.79]; and post-operative Richmond Agitation Sedation scores [p =0.33; 0.48, and 0.50 at 1-3, 4-6, and 7-12 hours]. Mean morphine consumption was similar in two groups at 1-3 hours [2.44 +/- 2.18 vs. 3.0 +/- 2.0 mg; p=0.24], 4-6 [3.73 +/- 2.85 vs. 4.41 +/- 2.72 mg; p=0.31], 7-12 [3.81 +/- 2.91 vs. 4.75 +/- 2.96 mg; p=0.18] and 13-24 hours intervals [3.94 +/- 2.97 vs. 4.80 +/- 2.97 mg; p=0.23]. The time to first occurrence of nausea was significantly delayed in dexamethasone group, [3.85 +/- 2.24 vs. 2.25 +/- 1.38 hours; p=0.02]

Conclusion: The efficacy of dexamethasone and ondansetron in preventing post-operative nausea and vomiting in gynaecological laparoscopic procedures is comparable; onset of nausea is significantly delayed in dexamethasone group

Ovarian dermoid cyst

Mature teratoma is the most common germ cell tumor [and the most common tumor] of the ovary, composing more than 20% of all ovarian neoplasms. Super infection of dermoid ovarian cyst is very rare. A 72 years-old woman admitted to the gynecological outpatient clinic because of lower abdominal pain and fever. Gynecological examination and ultrasonography revealed a heterogeneous cystic mass in the right ovary. Abdominopelvic CT scan revealed a right ovarian mass [15 x 15cm] thought to be a dermoid cyst. Right adnexectomy was performed. The pathological evaluation suggested infected benign ovarian dermoid. Infection of a mature teratoma is a relatively uncommon event. However, based on our case and others, superinfection with abscess formation should be considered in the differential diagnosis whenever a patient with a documented pelvic mass and fever

Airway device; comparison of l-GEL supraglottic with laryngeal mask airway

Intersurgical-gel [I-gel] is a new supraglottic airway device that is widely being used to secure airway during general anaesthesia. The objective of the study is to compare the ease of insertion of Intersurgical-gel and Laryngeal mask airway [LMA]. This study was conducted in Department of anaesthesia Hameed Latif Hospital, Lahore. 100 American Society of Anesthesiologists [ASA] I-II, patients were enrolled in this study for elective surgery divided in 2 groups of 50 each. LMA and l-gel were used in groups A and B respectively for intra operative maintenance of airway. Randomization through random number table in Statistical Package for Social Sciences [SPSS] version 17 was used. There were 50 patients in both groups. There were no statistical significant difference between the patients age of two groups. There was absolutely no difference between 2 groups regarding ease of insertion because both groups had 84% easy and 16% satisfactory insertions. Insertion time of LMA and l-gel in first and second attempt were also comparable and statistically nonsignificant. Airway manipulations was required in both groups for insertion of device, in LMAgroup 30% required and 70% did not require and in i-gel group 48% required and 52% did not require. There is no statistical significant difference between both groups. Bleeding was noticed on 2% of i-gel and with LMA no bleeding occurred and 2% laryngospasm incidence noticed in both groups. we found that regarding ease of insertion there is statistically no significant difference between l-gel and LMA