Antioxidant potential and protective effects of bee pollen extract against Salmonella induced hepatic and renal toxicity in BALB/c mice

Apicultural products comprise honey, bee pollen, propolis, bee wax and royal jelly which are known for their medicinal and health promoting properties. Among these, bee collected pollen allure much attention for its high nutritional properties. Here, we have investigated the protective role of bee pollen against Salmonella typhimurium induced biochemical alteration in BALB/c mice. Experimental animals (BALB/c mice) were divided equally into 10 different groups including normal and treated. Oxidative stress was induced by injecting Salmonella typhimurium (0.2 mL of 2×104 CFU/mL) intraperitoneally in mice. Bacteria induced sufficient alterations in serum enzymes within 5 days. Aqueous extracts of bee pollen of different crops (250 mg/kg) were administrated orally to control and experimental mice for 21 days. Then, hepatic and renal enzymes were measured with the help of standardized kits. Results of this study have revealed that bacterial infection increases the levels of the hepatic and renal enzymes levels (P <0.001) but after treatment with bee pollen extracts, altered levels of enzymes were normalized up to the normal levels. This normalization was highest with bee pollen of Helianthus annus. Administration of bee pollen alone did not produce any negative effects in mice.

Multiple Grade IV Pressure Injuries in a Young Boy: A Look Into the Pathognomic and Management of Iliac Crest Pressure Injury

Pressure injury (PI) not only exerts a physical burden on a patient’s body but also adds to his mental and economic stress. We, hereby, present a case report of a 17-year-old boy, who sustained a cervical spine injury after a road traffic accident, 10 months back, and later developed multiple pressure injuries over the bilateral trochanter and the left ilium. We discuss the pathognomic of the occurrence of PI at unusual sites like the ilium and our management for coverage of such defects.

Development of a cost-effective ex vivo lung perfusion system for lung transplantation in India

Background & objectives: Standard donor lung preservation with cold flush and storage allows up to six hours between retrieval of lungs from the donor and transplantation in the recipient. Ex vivo lung perfusion (EVLP) systems mimic physiological ventilation and perfusion in the donor lungs with potential for prolonged lung preservation and donor lung reconditioning. In this study, it was aimed to perform EVLP on discarded donor lungs using a locally developed EVLP system. Methods: Equipment that are routinely used for cardiac surgeries were collected and a functional EVLP system was assembled. This system was used on five pairs of lungs retrieved from brain-dead organ donors. The lungs were ventilated and pulmonary circulation was continuously perfused with a solution containing oxygen and nutrients for four hours. The system was tested without red blood cells (RBCs) added to the solution (acellular group; n=3; A1, A2 and A3) and also with RBCs added to the solution (cellular group; n=2; C1 and C2). Results: The EVLP system was successfully used in four (A1, A2, A3 and C2) of the five lung pairs. Mechanical and gas exchange functions of the lungs were preserved in these lung pairs. One lung pair (C1) worsened and developed pulmonary oedema. Histopathological examination of all five lung pairs was satisfactory at the end of the procedure. Major challenges faced were leakage of solution from the system and obstruction to drainage of RBCs containing solution from the lungs. Interpretation & conclusions: The results of the present study suggest that, it is possible to maintain the lungs retrieved for transplantation in a physiological condition using a locally prepared EVLP system and a solution without RBCs.

Peutz-Jeghers Syndrome: An outline on Diagnosis and Management

Peutz-Jeghers Syndrome (PJS) is a rare inherited autosomal dominant disorder characterized by pigmented mucocutaneous melanotic macules and hamartomatous polyps. PJS arises due to mutations in STK11 gene located on chromosome 19q 13.3 and predisposes the patients to a multitude of malignancies with an estimated cumulative risk of 81% - 93%. Breast, gastrointestinal tract, pancreas, reproductive system and lung are common sites of development of malignancies in these patients. Anemia, rectal bleeding, abdominal pain, obstruction and intussusception are the usual complications in patients with PJS leading to multiple interventions. Upper GI endoscopy and Double Balloon Enteroscopy (DBE) allows screening of the gastrointestinal tract. Polypectomy of hamartomas more than 1 cm carried out at the time of surveillance endoscopy, abates the complications like bleeding, obstruction and intussusception. When DBE is not feasible, intraoperative endoscopy (IOE) is helpful to evaluate the entire gastrointestinal tract during surgery. IOE is also crucial for removal of all small intestinal polyps. Imaging techniques like magnetic resonance enterography and computed tomography enterography and video capsule endoscopy are non-invasive options for evaluation and screening in these patients. Sixty eight percent of the patients require emergency surgery during their lifetime. Regular cancer screening protocols should be instituted for early detection of malignancies. Genetic counseling and screening of other first degree family members helps in their preemptive identification and management. Chemoprevention using mTOR inhibitors, COX-2 inhibitors could be helpful in polyp reduction.

Pancreatic tuberculosis: An unusual presentation

Tuberculosis (TB) of pancreas is a rare presentation in both immune-competent and immune-suppressed patients. Its presenting clinical features are usually vague and non-specific, while radiological features mimic other common pancreatic conditions such as malignancy, so it is often misdiagnosed. It commonly involves the head and the uncinate process of the pancreas. We report a middle-aged immune-compromised man who presented with left-sided tubercular pleural effusion and later was diagnosed as pancreatitis by clinical presentation and TB of pancreas on computed tomography of the abdomen.

Association of Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus- An Analytical Cross-Sectional Study

Nonalcoholic fatty liver disease (NAFLD) is a common liver disorder but is often ignored especially in diabetes mellitus and thus carries serious complications in the long run. We aim to study the association of NAFLD with type 2 diabetes mellitus.METHODSA prospective observational case control study of diabetic patients was done in a tertiary care teaching hospital. A total of 50 diabetic patients fulfilling the inclusion criteria were selected as cases while 50 age sex matched non-diabetic patients were included as controls. Complete clinical, laboratory and radiological data was collected from each patient and analyzed. Data was analyzed using statistical software SPSS ver. 21.RESULTSMean value of age in cases was 52.42 ± 10.24 years and in control was 54.04 ± 10.16 years (p>0.05). There were 56% males and 44% females in both the groups. Among the cases, majority (84%) of the patients were on Oral Hypoglycemic Agents (OHA). As compared to controls, cases had significantly higher SGOT and SGPT but significantly lower total bilirubin levels (p<0.05). In the lipid profile, cases had significantly higher TG, LDL and VLDL levels (p<0.05). Significant difference was seen in the USG findings between cases and controls. Majority (66%) of the patients in cases had abnormal USG findings showing liver thickness, as compared to 30% in controls.CONCLUSIONSType 2 diabetes was strongly found to be associated with development of NAFLD, and since most patients of NAFLD remain asymptomatic, all diabetic patients must be screened for development NAFLD.

Influence Of Post Space Preparation On The Marginal Integrity Of Mineral Trioxide Aggregate (MTA), A Root End Restoration: An In Vitro Study

The aim of this study was to compare and evaluated the influence of post space preparation on the marginal integrity of MTA root end restoration. Methodology: 60 Freshly extracted human maxillary anterior teeth were collected, and decoronated to obtain a uniform root length of 14mm. Cleaning, shaping and obturation of root canals was performed. These teeth were then randomly divided into three groups of twenty each. In Group I, post space preparation was followed by retrograde preparation and restoration by MTA. In Group II, firstly root end cavity preparation and restoration was done. Post space preparation was done after the completion of above procedures. Group III, served as positive control. These samples were covered with fingernail polish and immersed in 0.2% rhodamine B dye for 48 hours. The specimens were sectioned longitudinally using a diamond disc to measure dye penetration under stereomicroscope. Results revealed that, Group I, showed minimum mean dye penetration of 52.50 µm whereas the mean leakage scores observed in Group II i.e of 1087.50. Conclusion: The post space should be prepared before the root end surgery

Optimization of sentinel lymph node identification techniques in the Indian setting: A randomized clinical trial

INTRODUCTION: The recommended technique of sentinel lymph node biopsy (SLNB) in breast cancer is a combination of blue dye and radiotracer. In the Indian scenario, SLNB is still not routinely practiced due to lack of nuclear medicine facilities and unavailability of isosulfan blue or patent blue violet (PBV). This study was conducted for optimizing SLN identification techniques by comparing the identification rate using PBV and methylene blue (MB) in combination with radiotracer. MATERIALS AND METHODS: Single-blinded two-arm parallel design randomized control trial was conducted at an apex teaching and research medical institute in India. Patients with axillary LN–negative breast cancer were included. Blue dye and radio tracer were injected preoperatively, and SLNB was performed using a combination technique. Frozen section was performed. Demographic, clinical, radiological, operative, and histopathological data were recorded. Descriptive statistics were used to represent patient characteristics. Baseline characteristics for entire cohort and between groups were compared using Student's t-test for quantitative variables and Chi-square test for qualitative variables. RESULTS: A total of 119 patients were randomized for mapping with MB and 118 patients with PBV between 2011 and 2015. SLN was identified in 116 patients with MB and 115 with PBV. SLN identification proportions were 97.4% (MB) and 96.6% (PBV). In patients undergoing axillary lymph node dissection, concordance with SLNB was 98.5% and 96.61% in MB and PBV, respectively. False-negative proportion for MB was 2.56% and 7.69% for PBV, respectively. The cost of MB is about INR 15 per ~10-mL vial. The cost of PBV is approximately ~$91 per ampoule (equivalent to approximately INR 8190). CONCLUSION: SLNB using MB can be recommended as the technique of choice in low-resource settings.

Nurses' perspectives about communication with patients in an intensive care setting using a communication board: a pilot study

Background: Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support. Aim: This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session. Setting: A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting. Methods: A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital. Results: Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses' perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board. Conclusions: Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised

Platelet-rich fibrin along with a modified minimally invasive surgical technique for the treatment of intrabony defects: a randomized clinical trial

PURPOSE: The modified minimally invasive surgical technique (M-MIST) has been successfully employed to achieve periodontal regeneration. Platelet-rich fibrin (PRF) is known to enhance wound healing through the release of growth factors. This study aimed to observe the outcomes of periodontal surgery when M-MIST was used with or without PRF for the treatment of isolated intrabony defects.METHODS: This randomized clinical trial was conducted on 36 systemically healthy patients, who had chronic periodontitis associated with a single-site buccal probing pocket depth (PPD) and clinical attachment level of ≥5 mm. Patients were randomly divided into 2 groups: the test group treated with M-MIST and PRF, and the control group treated with M-MIST alone. The primary periodontal parameters analyzed were PPD, relative attachment level (RAL), and relative gingival margin level. The radiographic parameters analyzed were change in alveolar crest position (C-ACP), linear bone growth (LBG), and percentage bone fill (%BF). Patients were followed up to 6 months post-surgery.RESULTS: Intragroup comparisons at 3 and 6 months showed consistently significant improvements in PPD and RAL in both the groups. In intergroup comparisons, the improvement in PPD reduction, gain in RAL, and the level of the gingival margin was similar in both groups at 3 and 6 months of follow-up. Furthermore, an intergroup comparison of radiographic parameters also demonstrated similar improvements in C-ACP, LBG, and %BF at 6 months of follow-up.CONCLUSIONS: M-MIST with or without PRF yielded comparable periodontal tissue healing in terms of improvements in periodontal and radiographic parameters. Further investigation is required to confirm the beneficial effects of PRF with M-MIST.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03169920

Vitamin A, C and E Status in Type II Diabetes Mellitus Patients of Sub-Himalayan Region

Background:Vitamin A, vitamin C, and vitamin E are an integral part of non-enzymatic antioxidant defense system in humans. The present study was designed to estimate and investigate the role of vitamin A, C and E levels in patients with type 2 diabetes mellitus (T2DM). Methods: The study design involved 200 subjects viz. 100 healthy controls and 100 T2DM cases. Glycosylated hemoglobin (HbA1c) levels were estimated in whole blood sample and serum obtained was analyzed for quantitative estimation of vitamin A, C and E by enzyme linked imunosorbent assay (ELISA). Results: A significant increase (p < 0.005) was observed in the mean HbA1c levels in patients with T2DM as compared to healthy controls. On the contrary, a significant decrease (p < 0.005) was witnessed in the serum vitamin A, vitamin C, and vitamin E. A negative correlation was seen between HbA1c and vitamin A (r = -0.327); HbA1c and vitamin C (r = -0.174); HbA1c and vitamin E (r = -0.226). Conclusion: Reduced levels of serum vitamin A, C and E with poorly controlled HbA1c were observed inT2DM patients. Hence supplementation of these vitamins along with periodic estimation should be done in T2DM for risk prediction in diabetes and to prevent diabetic complications.

Comparison of resection margins and cosmetic outcome following intraoperative ultrasound-guided excision versus conventional palpation-guided breast conservation surgery in breast cancer: A randomized controlled trial

INTRODUCTION: Use of intraoperative ultrasound (IOUS) has been shown to help achieve satisfactory cosmesis and negative margins in breast conserving surgery (BCS). This study has been done to compare the oncological and cosmetic outcomes following BCS using conventional palpatory method and IOUS. MATERIALS AND METHODS: This is a prospective randomized controlled trial conducted at a tertiary care teaching and research institute in India. Patients with early operable breast cancer willing for BCS were included. Tumors were excised with 1 cm margin. In palpatory group, tumor was palpated and 1 cm margin was taken with a measuring scale while in the second group, IOUS was used to mark the margins. Histopathological evaluation was done to assess margins and cosmesis was assessed by patient, resident doctor, and nurse independently. RESULTS: Sixty patients were included, 32 in the ultrasonography-guided and 28 in palpation-guided wide local excision. The mean age of patients was 48.78 years. In both groups, mean tumor size was 3.18 cm. Margin thickness and positivity was higher in palpatory group (though P > 0.05). Most patients were satisfied with cosmesis. There was no significant difference in complications and specimen volume in both groups. Presence of ductal carcinoma in situ component and expression of Her2neu by tumor cells had a significant impact on margin positivity. CONCLUSIONS: Intraoperative use of ultrasound offers a real-time assessment of margin status and may reduce the margin positivity rate compared to conventional palpation-guided method.

Apolipoprotein A and Apolipoprotein B Levels Along With Standard Lipid Profile in Type II Diabetes Mellitus Patients in a Tertiary Care Centre in Sub Himalayan Region

Background: Apolipoprotein A (Apo A) and apolipoprotein B (Apo B) are the key structural components of high density lipoprotein (HDL) particles and atherogenic lipoproteins respectively. The present study was designed to estimate and investigate the role of Apo A and Apo B levels along with standard lipid profile in patients with type 2 diabetes mellitus (T2DM). Methods: The study was carried out on 200 subjects viz. 100 healthy controls and 100 T2DM cases. Whole blood sample was utilized for glycosylated hemoglobin (HbA1c) and serum obtained was analyzed for quantitative estimation of total cholesterol, triglycerides, low density lipoprotein (LDL), HDL, Apo A and Apo B by automated chemistry analyzer. Results: A significant increase (p < 0.005) was observed in the mean HbA1c, cholesterol, triglycerides, LDL and Apo B levels in patients with T2DM as compared to healthy controls. On the contrary, a significant decrease (p < 0.005) was witnessed in the mean HDL and Apo A values of T2DM patients as compared to healthy controls. A positive correlation was seen between HbA1c and total cholesterol (r = 0.427); HbA1c and triglyceride levels (r = 0.281); HbA1c and LDL (r = 0.399); HbA1c and Apo B (r = 0.403). However, a negative correlation was observed between HbA1c and HDL (r = -0.337); HbA1c and Apo A (r = -0.426). Conclusion: There is a high prevalence of dyslipidemia with poorly controlled HbA1c in T2DM patients. Apo A and Apo B assays should be incorporated in the standard lipid profile, for better risk prediction in diabetics and to curtail the risk of future cardiovascular mortality.

Prevalence of osteoporosis and osteopenia in an apparently healthy Indian population

OBJECTIVES: An understanding of bone mineral density (BMD) pattern in a population is crucial for prevention and diagnosis of osteoporosis and management of its complications in later life. This study aimed to screen the bone health status and factors associated with osteoporosis in an apparently healthy Indian population. METHODS: A retrospective review of medical records was done in a tertiary-care hospital for the subjects who had undergone preventive health-check-ups that included BMD measurements at femur-neck, total-femur, and lumbar-spine. RESULTS: We evaluated 524 subjects (age, 50.0 ± 12.4 years) including 41.2% female and 58.8% male subjects. Osteoporosis was present in 6.9% subjects (female, 11.1%; male, 4.2%) and osteopenia in 34% subjects (female, 40.3%; male, 29.9%). Absolute BMD was higher in male subjects (P 0.05) at any site. CONCLUSIONS: Further data on absolute BMD, T scores, and prevalence rates of osteoporosis/osteopenia on multiple bone sites have been presented in this article.

Genome sequencing of four strains of Phylotype I, II and IV of Ralstonia solanacearum that cause potato bacterial wilt in India

Abstract Ralstonia solanacearum is a heterogeneous species complex causing bacterial wilts in more than 450 plant species distributed in 54 families. The complexity of the genome and the wide diversity existing within the species has led to the concept of R. solanacearum species complex (RsSC). Here we report the genome sequence of the four strains (RS2, RS25, RS48 and RS75) belonging to three of the four phylotypes of R. solanacearum that cause potato bacterial wilt in India. The genome sequence data would be a valuable resource for the evolutionary, epidemiological studies and quarantine of this phytopathogen.

Perioperative utility of goal‑directed therapy in high‑risk cardiac patients undergoing coronary artery bypass grafting: “A clinical outcome and biomarker‑based study”.

Goal‑directed therapy (GDT) encompasses guidance of intravenous (IV) fluid and vasopressor/inotropic therapy by cardiac output or similar parameters to help in early recognition and management of high‑risk cardiac surgical patients. With the aim of establishing the utility of perioperative GDT using robust clinical and biochemical outcomes, we conducted the present study. This multicenter randomized controlled study included 130 patients of either sex, with European system for cardiac operative risk evaluation ≥3 undergoing coronary artery bypass grafting on cardiopulmonary bypass. The patients were randomly divided into the control and GDT group. All the participants received standardized care; arterial pressure monitored through radial artery, central venous pressure (CVP) through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour, and frequent arterial blood gas (ABG) analysis. In addition, cardiac index (CI) monitoring using FloTrac™ and continuous central venous oxygen saturation (ScVO2) using PreSep™ were used in patients in the GDT group. Our aim was to maintain the CI at 2.5–4.2 L/min/m2, stroke volume index 30–65 ml/beat/m2, systemic vascular resistance index 1500–2500 dynes/s/cm5/m2, oxygen delivery index 450–600 ml/min/m2, continuous ScVO2 >70%, and stroke volume variation <10%; in addition to the control group parameters such as CVP 6–8 mmHg, mean arterial pressure 90–105 mmHg, normal ABG values, oxygen saturation, hematocrit value >30%, and urine output >1 ml/kg/h. The aims were achieved by altering the administration of IV fluids and doses of inotropes or vasodilators. The data of sixty patients in each group were analyzed in view of ten exclusions. The average duration of ventilation (19.89 ± 3.96 vs. 18.05 ± 4.53 h, P = 0.025), hospital stay (7.94 ± 1.64 vs. 7.17 ± 1.93 days, P = 0.025), and Intensive Care Unit (ICU) stay (3.74 ± 0.59 vs. 3.41 ± 0.75 days, P = 0.012) was significantly less in the GDT group, compared to the control group. The extra volume added and the number of inotropic dose adjustments were significantly more in the GDT group. The two groups did not differ in duration of inotropic use, mortality, and other complications. The perioperative continuation of GDT affected the early decline in the lactate levels after 6 h in ICU, whereas the control group demonstrated a settling lactate only after 12 h. Similarly, the GDT group had significantly lower levels of brain natriuretic peptide, neutrophil gelatinase‑associated lipocalin levels as compared to the control. The study clearly depicts the advantage of GDT for a favorable postoperative outcome in high‑risk cardiac surgical patients.

Squamous Cell carcinoma (Moderately Differentiated) of Conjunctiva – A Rare Case in a Five Year Retrospective Study.

Worldwide squamous cell carcinoma (SCC) of the conjunctiva is a rare malignancy; however, it is reported to be the most common malignant tumour of the ocular surface. Its incidence varies between 0.02 and 3.5/100.000. We report a case of squamous cell carcinoma of conjunctiva presented with triangular pedunculated mass of left eye of 75 years old female. It is diagnosed on FNAC and confirmed on histopathological examination after excision. On analyzing the data of FNA done (19150) and biopsies received (23158) in 5 years in the department of pathology, we found only five cases of eye region came for FNA while 25 biopsies of eye region received and diagnosed rightly. Out of all these cases, this is the only case of squamous cell carcinoma of conjunctiva in this study. Incidence of SCC of conjunctiva in our retrospective study of data of total pathological biopsies received found to be 4.3/100000.