Critical Assessment of Various Neurosurgery Training Programs of Pakistan.

AIM: To assess the real challenges faced by neurosurgery residents in developing countries with limited resources and massive workload. MATERIAL AND METHODS: This is a cross-sectional study based on the questionnaire filled by the neurosurgery trainees in Pakistan directed at their training, stress factors, surgical competency, research interest, job satisfaction, and future endeavors. RESULTS: A total of 75 neurosurgery residents participated in study; 73.3% were male. About 61.3% were working for more than 72 hours per week. Average sleeping hours per day were less than 7 hours for 92% of trainees. Only 78.6% were able to receive teaching sessions for at least once a week or more. Practical handling of neurosurgical gadgets like microscope and endoscope was never experienced by 26.7% and 18.7%, respectively. Even the senior most residents were able to perform only 41.08% of their surgeries independently. Financial support was only acceptable to 21.3%, and 60.9% want to leave the country upon training completion. CONCLUSION: The training programs in the developing countries need critical changes to provide favorable learning conditions with availability of appropriate surgical tools, structural changes of training programs, development of research interest, and improvement on the socioeconomic needs of the trainee.

An Out-of-Season Case of Coxsackie B Myocarditis with Severe Rhabdomyolysis.

A 21-year-old woman was found to have fulminant myocarditis as a result of Coxsackie B infection (a virus shown to exhibit summer-fall seasonality) in mid-December. In this case report, seasonality of enteroviruses is examined, as well as additional factors which may contribute to sporadic cases during winter months. The case report also discusses clinical criteria for endomyocardial biopsy, utility of PCR vs. antibody serological tests, coinfection with multiple serotypes, and rhabdomyolysis in Coxsackie B.

Adenosinergic signaling inhibits oxalate transport by human intestinal Caco2-BBE cells through the A2B adenosine receptor.

Most kidney stones (KS) are composed of calcium oxalate, and small increases in urine oxalate affect the stone risk. Intestinal oxalate secretion mediated by anion exchanger SLC26A6 (PAT1) plays a crucial role in limiting net absorption of ingested oxalate, thereby preventing hyperoxaluria and related KS, reflecting the importance of understanding regulation of intestinal oxalate transport. We previously showed that ATP and UTP inhibit oxalate transport by human intestinal Caco2-BBE cells (C2). Since ATP is rapidly degraded to adenosine (ADO), we examined whether intestinal oxalate transport is regulated by ADO. We measured [14C]oxalate uptake in the presence of an outward Cl gradient as an assay of Cl-oxalate exchange activity, ≥49% of which is PAT1-mediated in C2 cells. We found that ADO significantly inhibited oxalate transport by C2 cells, an effect completely blocked by the nonselective ADO receptor antagonist 8- p-sulfophenyltheophylline. ADO also significantly inhibited oxalate efflux by C2 cells, which is important since PAT1 mediates oxalate efflux in vivo. Using pharmacological antagonists and A2B adenosine receptor (A2B AR) siRNA knockdown studies, we observed that ADO inhibits oxalate transport through the A2B AR, phospholipase C, and PKC. ADO inhibits oxalate transport by reducing PAT1 surface expression as shown by biotinylation studies. We conclude that ADO inhibits oxalate transport by lowering PAT1 surface expression in C2 cells through signaling pathways including the A2B AR, PKC, and phospholipase C. Given higher ADO levels and overexpression of the A2B AR in inflammatory bowel disease (IBD), our findings have potential relevance to pathophysiology of IBD-associated hyperoxaluria and related KS.