Diabetes mellitus and the risk of progression or malignancy of pancreatic cystic neoplasms in patients undergoing surveillance: A systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: Patients with pancreatic cystic neoplasms (PCN) generally undergo surveillance by cross-sectional imaging or endoscopic-ultrasound due to their pre-malignant potential. Appearance of certain cyst characteristics during surveillance is associated with aggressive behavior or presence of malignancy. Patient characteristics associated with progression or induction of malignancy in PCN is unclear from current studies. We performed this meta-analysis to determine the patient characteristics associated with progression or malignancy in patients with PCN who undergo surveillance. METHODS: We performed a systematic research of several electronic databases for all the studies on surveillance of PCN which reported demographic data of patients who had progression or malignancy and controls. We calculated Risk ratio (RR) or Hazard ratio (HR) with 95% confidence interval (CI) for each variable. Mantel- Haenszel method or Inverse-variance model was used to pool data of progression or malignant transformation into fixed or random effect model meta-analysis. RESULTS: 11observational studies, 4 assessing risk factors for malignancy (3955 patients) and 7 evaluating risk factors for progression of PCN (3144 patients) were included in the meta-analysis. Diabetes mellitus was associated with higher risk for malignant transformation as well as progression of PCN (RR = 1.54, CI 1.23, 1.92). Advanced age was associated with higher risk of progression. Male gender had higher risk for malignant transformation but not progression of PCN. CONCLUSION: Diabetes is associated with an increased risk of both malignancy and progression of PCN in patients who undergo surveillance. Advanced age is also associated with higher risk of progression of PCN.

Hyperinsulinemia Associated Depression.

Hyperinsulinemia promotes fat accumulation, causing obesity. Being an inflammatory state, obesity can induce further inflammation and is a risk factor for HPA (hypothalamic pituitary axis) dysregulation through hypercortisolism-related hyperglycemia. In another hypothesis, the sympathetic nervous system (SNS) plays a significant role in the regulation of hormone secretion from the pancreas such as an increase in catecholamines and glucagon as well as a decrease in plasma insulin levels, a disruption on SNS activity increases insulin levels, and induces glycogenolysis in the liver and lipolysis in adipose tissue during hypoglycemia. Hyperglycemia-hyperinsulinemia exacerbates inflammation and increases the oxidative stress along with regulating the levels of norepinephrine in the brain sympathetic system. Increased inflammatory cytokines have also been shown to disrupt neurotransmitter metabolism and synaptic plasticity which play a role in the development of depression via inhibiting serotonin, dopamine, melatonin, and glutamate signaling. An increased level of plasma insulin over time in the absence of exercising causes accumulation of lipid droplets in hepatocytes and striated muscles thus preventing the movement of glucose transporters shown to result in an increase in insulin resistance due to obesity and further culminates into depression. Further hyperinsulinemia-hyperglycemia condition arising due to exogenous insulin supplementation for diabetes management may also lead to physiological hyperinsulinemia associated depression. Triple therapy with SSRI, bupropion, and cognitive behavioral therapy aids in improving glycemic control, lowering fasting blood glucose, decreasing the chances of relapse, as well as decreasing cortisol levels to improve cognition and the underlying depression. Restoring the gut microbiota has also been shown to restore insulin sensitivity and reduce anxiety and depression symptoms in patients.

Comparison of clinical outcomes of multiple plastic stents and covered metal stent in refractory pancreatic ductal strictures in chronic pancreatitis- a systematic review and meta-analysis.

BACKGROUND: Symptomatic pancreatic duct (PD) strictures in chronic pancreatitis refractory to single plastic stenting are usually managed by placement of multiple plastic stents (MPS). Fully covered self-expanding metallic stents (FCSEMS) have also been used in the management of these patients. However, the overall efficacy and safety of different types of stents is unclear from the currently available studies. We performed this meta-analysis to assess the efficacy and complications from MPS and FCSEMS in patients with PD strictures refractory to treatment with single plastic stents. METHODS: Several electronic databases were searched for all the studies evaluating the outcome of placement of multiple plastic stents and fully covered metal stents in patients with PD strictures refractory to single plastic stenting. We calculated the Weighted Pooled Ratio (WPR) with Confidence Interval (CI) between the MPS and FCSEMS. RESULTS: A total of 13 studies (including 2 abstracts) were included in the analysis. MPS were placed in 106 patients and FCSEMS in 192 patients. Improvement in pain after stenting (P = 0.794), risk of recurrence of pain after removal of stent (P = 0.48) and stricture recurrence after stent removal (P = 0.52) were comparable between MPS and FCSEMS. Risk of endoscopic re-intervention was also comparable between metal stents and MPS. However, FCSEMS was associated with overall higher risk of adverse events (P < 0.0001). CONCLUSION: FCSEMS are comparable to multiple plastic stents in the treatment of symptomatic refractory PD strictures. However, use of FCSEMS is associated with increased risk of adverse events.

Prevalence of poultry coccidiosis in Jammu region of Jammu & Kashmir State.

In this study prevalence of chicken coccidiosis in Jammu division were undertaken in both organized and backyard chickens during the year 2010-2011, with an overall prevalence of 39.58 % on examination of 720 faecal samples. Five Eimeria species were identified viz., E. tenella, E. necatrix, E. maxima, E. acervulina and E. mitis. E. tenella was the predominant species in both organized and unorganized farms. The highest prevalence percentage was found in July, 2011 (68.9 %) and the lowest percentage was found in May, 2011 (12.5 %). Coccidial prevalence was found to be 53.61 % in unorganized (backyard poultry birds) as compared to organized birds (25.55 %). Maximum positive cases of coccidian infection was found in monsoon season (60.55 %) and least in summer season (21.66 %). Birds of age 31-45 days showed more prevalence percentage (58.86 %). Higher oocysts count was recorded from July to September with a peak value (38973.00 ± 3075.6) in July and lowest (12914.00 ± 595.48) in the month of May.

Antibacterial activity of bark extracts of Moringa oleifera Lam. against some selected bacteria.

The methanol, chloroform, ethyl acetate and aqueous bark extracts of Moringa oleifera were evaluated for their antibacterial activity against four bacteria viz. Staphylococcus aureus, Citrobacter freundii, Bacillus megaterium and Pseudomonas fluorescens using erythromycin as positive control. The activity was analyzed using paper disc diffusion method at different concentration of the extract. The study revealed that all the bark extracts irrespective of their types, in different concentrations inhibited growth of the test pathogens to varying degrees. Ethyl acetate extract showed maximum activity against all the bacterial strains followed in descending order by chloroform, methanol and aqueous extracts. The activity decreased with decrease in concentration of the extract. Staphylococcus aureus was found to be the most sensitive test organism to different extracts of Moringa oleifera. Looking to these results it may be concluded that M. oleifera may be a potential source for the treatment of different infections caused by the resistant microbes.

Effect of long dose exposure of Podophyllum hexandrum methanol extract on antioxidant defense system and body and organ weight changes of albino rats

Objective: The present study was undertaken to investigate the effect of long dose administration of methanol rhizome extract of Podophyllum hexandrum and hydrogen peroxide on lipid peroxidation of erythrocytes, antioxidant enzyme status of rat liver, kidney, lung and brain tissue and body weight and organ weight changes of albino rats. Methods: The body and organ weight was monitored with digital scale balance and lipid peroxidation of RBC ghost membrane was monitored by measuring malonaldehyde (MDA). Antioxidant enzymes were assayed by standard procedures. Results: Our study showed that administration of H2O2 (0.1%) in drinking water of the rats for 25 weeks increased the malondialdehyde levels in erythrocytes of all the rats. However, rats receiving Podophyllum hexandrum extract and α- tocopherol had lower MDA levels in a dose dependent manner, which indicates decreased lipid peroxidation in these rats. Our results also showed decrease in the activity of glutathione reductase, glutathione-S-transferase and reduced glutathione levels in different organs of H2O2 treated rats. Rats receiving methanolic extract of Podophyllum hexandrum at the concentration of 5, 10 and 15mg% for 25 weeks increased the activity of glutathione reductase, glutathione-S-transferase and glutathione levels in different organs of the rats indicates the protective effect of the plant in combating oxidative stress undergone by the rats. No significant variation (P< 0.05) in the organ weights between the control and the treated groups was observed after 25 weeks of treatment. Conclusions: In conclusion, this study presents strong evidence of the nontoxic effect of the methanol extract of Podophyllumhexandrum. The findings also demonstrate that Podophyllum hexandrum methanol extract increased the levels of antioxidant enzymes and decreased lipid peroxidation in albino rats and explained the extensive utilization of the plant in traditional medicine.

Colon targeted curcumin delivery using guar gum.

Curcumin is used in the treatment of colon cancer, but its very poor absorption in the upper part of the GIT is a major concern. As a site for drug delivery, the colon offers a near neutral pH, reduced digestive enzymatic activity, a long transit time and an increased responsiveness to absorption enhancers. The aim of the present study was to identify a suitable polymer (guar gum) based matrix tablet for curcumin with sufficient mechanical strength and promising in vitro mouth-to-colon release profile. Three formulations of curcumin were prepared using varying concentrations of guar gum containing 50 mg curcumin by the wet granulation method. Tablets were subjected to evaluation by studying parameter like hardness, friability, drug content uniformity, and in-vitro drug release. In vitro drug release was evaluated using simulated stomach, intestinal and colonic fluids. The susceptibility of guar gum to colonic bacteria was also assessed by a drug release study with rat caecal contents. The 40% guar gum containing formulation (F-1) showed better drug release (91.1%) after 24 hours in the presence of rat caecal contents in comparison with the 50% guar gum containing formulation (F-2) (82.1%). Curcumin could, thus, be positively delivered to the colon for effective colon cancer treatment using guar gum.

Removal of foreign body from the trachea: An unusual method.

Tracheobronchial foreign bodies can be sometimes very difficult to remove. This may be related to the location and type of foreign body, experience of the bronchoscopist and the availability of appropriate instruments.([1]) We report a case of an uncommon foreign body (artificial denture) in the trachea in an adult female following extubation after Lower Segment Caesarian Section (LSCS) in whom conventional methods to remove it failed. The foreign body was eventually removed via tracheostome using rigid bronchoscope and forceps.