Effect of calorie restriction and intermittent fasting on glucose homeostasis, lipid profile, inflammatory, and hormonal markers in patients with polycystic ovary syndrome: a systematic review.

Background and objective: Polycystic ovary syndrome (PCOS) is a complex hormonal disorder that leads to ovarian cysts, irregular ovulation, and hormonal swings in women. It is a complex and heterogeneous condition that affects 4 to 20% of women of reproductive age worldwide and relates to reproductive, metabolic, and psychosocial dysfunction. Dietary and lifestyle modifications have been proposed to play a central role in the management of PCOS. This study aimed to provide a comprehensive systemic overview of the existing literature on the effects of intermittent fasting (IF) and calorie restriction (CR) regimens on disease markers of PCOS. Designs and methods: Several databases, such as CINAHL, Cochrane, EBSCOhost, EMBASE, Google Scholar, ProQuest Medical, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science databases were searched for clinical trials and observational studies examined the effects of IF regimens such as time-restricted eating and Ramadan model of IF (RIF) on glucose homeostasis, lipid profile, inflammatory and hormonal markers in patients with PCOS. Results: This systematic review solicited three articles, comprising a collective sample size of 75 females diagnosed with PCOS. The studies were published between 2015 to 2023 and were undertaken in three countries: China, Turkey, and Iran. The research articles examined the effects of intervention with IF and CR on PCOS-related parameters such as anthropometric measures and biochemical tests which included enzymes, glycemic control, lipid profile, hormonal, and oxidative stress, and inflammatory markers. The articles yielded mixed results, with two of them showing significant changes across all tested parameters. One of the three studies did not exhibit any significant changes. Conclusion: Very limited studies examined the relationship between IR and CR with markers of PCOS. Further well-controlled studies need to be undertaken the combined results from the limited studies illustrate the intricate and diverse nature of IF, including the RIF, and its influence on measurements of body composition and biochemical markers related to PCOS.

Treatment algorithm for post sternotomy wound infection - our experience.

INTRODUCTION: Median sternotomy is the most commonly used approach in open cardiac surgery. As in any other surgery, surgical site infections are a known phenomenon, but morbidity depends on the depth of infection. Superficial wound infections can be managed conservatively; however, deep sternal wound infections need an aggressive approach to prevent disastrous consequence like mediastinitis. Hence, this study was conducted with the aim to classify sternotomy wound infection and to develop a treatment algorithm for superficial and deep sternotomy wound infections. MATERIAL AND METHODS: Between January 2016 to August 2021, 25 patients who had sternotomy wound infections were studied. These wound infections were classified as superficial or deep sternal wound infections. RESULTS: Superficial wound infections underwent treatment with diluted vinegar dressings and deep infections underwent treatment with bilateral pectoralis major muscle advancement flaps. Patients were followed up till the wounds healed completely without complications. Patient characteristics, comorbidities, duration of treatment and outcomes of treatment were analyzed. Superficial sternal wound infection patients responded favorably to diluted vinegar dressings and deep sternal wound infection patients to pectoralis major muscle advancement flaps. Average time duration of healing for superficial and deep wound infections was 66.2 days and 18 days respectively. None of the patients had an increased severity of infection or re-dehiscence following treatment and during follow-up. CONCLUSION: Relatively conservative approach using diluted vinegar (1% acetic acid) dressing for superficial sternal wound infections was efficacious, whereas aggressive debridement and bilateral pectoralis major advancement muscle flaps for deep sternal wound infections are necessary for favorable outcomes. However, more studies are needed to ascertain this treatment algorithm.

Emotional impact of compassionate extubation on respiratory therapists and nurses: A pilot study.

Background: Compassionate extubation (CE) refers to withdrawing mechanical ventilation and allowing a patient to die peacefully at the end of life. The primary objective of this pilot study was to quantify the emotional impact of CE on Respiratory Therapists (RT) and Registered Nurses (RNs). Methods: This pilot survey was conducted between March and April 2021 at an academic medical center among RTs and RNs. It included questions on participants' demographics, work characteristics, and Impact of Events (IES) scale to assess the subjective stress caused by CE. Data were analyzed using descriptive and χ2 statistics. Results: Among 20 participants, 18 (90%) were females, 12 (60%) were in the 20-40-year age group, 12 (60%) were RTs, and 8 (40%) RNs. Around 15 (75%) participants worked day shifts with a weekly average of 3-4 shifts, and 14 (70%) performed/observed CE within 1 month before taking this survey. CE performed/observed in a month was ≤2 among 15 (75%) and 3-5 among 4 (20%) participants. Mean total IES score was 16.7 (12.3) among all participants representing 7 (35%) having low, 6 (30%) moderate, and 7 (35%) high emotional impact when performing CE. Risk of developing post-traumatic stress disorder (PTSD) was present in 6 (30%) participants. A significantly higher number of participants in the low impact group were satisfied with the institutional CE process (p = 0.043) than those in the medium/high impact group. Conclusion: This pilot study findings reveal that RTs and RNs experience moderate to high levels of subjective stress when performing CE. One-third of the survey participants were at risk of developing PTSD.

A Comparative Study of Collagen Sheet versus 1% Silver Sulfadiazine Dressing in Superficial Partial Thickness Burns.

Burn injury causes a lot of suffering. The goal of burn management is to achieve rapid wound healing, pain relief, rehabilitation with minimum scars and optimal functional ability. Objective of this study was to compare the efficacy of collagen sheets and 1% silver sulfadiazine dressing (SSD) for superficial partial thickness burns. This prospective observational study was conducted among the patients of Department of Plastic surgery, Dhaka Medical College Hospital, and Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, from 1st April 2020 to 31st March 2021. Total 60 patients with superficial partial thickness burns by purposive sampling 30 patients of them were treated with collagen sheet dressing (Group A) and 30 patients with 1.0% silver sulfadiazine dressing (Group B). First case was selected by tossing a coin. Then every alternate patient was provided the same kind of dressing material (either collagen sheet or 1.0% silver sulfadiazine). Data were collected by semi structured data collection sheets. Pearson's chi-square test and student's 't' test were used for data analysis (p value was significant at <0.05). It was observed that a total of 18(60.0%) patients belonged to age <10 years in Group A and 17(56.7%) patients in Group B. The mean age was 14.9±14.2 years in Group A and 11.6±10.2 years in Group B. Good quality of healing was significantly higher in the collagen group compared to the SSD group (<0.05). The mean complete healing time in the collagen group was 10.47±2.21 days and in the 1.0% SSD group were 13.07±2.33 days. The mean healing time was significantly lower in the collagen group compared to the 1.0% SSD group (p<0.001). There was no significant difference in infection rate between the two groups (p>0.05). Considering the overall outcome, Collagen sheet dressing decreases pain, reduces the need for analgesics, aids in early healing as compared to the patients treated with 1% silver sulfadiazine.

Comparative growth kinetic study of Newcastle disease virus, infectious bursal disease virus and avian influenza virus in chicken embryo fibroblast and DF-1 cell lines.

Viral diseases have caused devastating effect on poultry industry leading to significant losses in economy of world. In the presented study, the ability of Newcastle disease virus (NDV), infectious bursal disease virus (IBDV) and avian influenza virus (AIV) to grow in two cell lines was evaluated. Both chicken embryo fibroblast (CEF) and DF-1 cells were used and cytopathic effects (CPE) produced by these viruses were observed. The titer of virus in terms of TCID was determined after 24h up to four days for each virus. The same type of CPE was observed for all virus- es used in the study in both DF-1 and CEF cells. IBDV showed CPE causing rounding of cells while NDV caused formation of multicellular large nuclei, cell fusion and rounding of cells. Giant cells with inclusions and aggregation of cells with intact monolayer was observed for AIV. In growth kinetic study, higher titer of IBDV and NDV was observed in CEF cells than DF-1 cells while for AIV, DF-1 cells showed higher titer than CEF cells. These results would be useful for furthers comparative studies on growth of different cell lines of various viruses to find a suitability for vaccine production.

Drug delivery to macrophages: a review of nano-therapeutics targeted approach for inflammatory disorders and cancer.

INTRODUCTION: Macrophages are involved in the normal defense of the body; however, the varying phenotypes of macrophages and imbalance in their ratio lead to the impairment of immune response initiating the production of inflammation. As the role of macrophages in immunological disorders and their surface receptors modulation has already been manifested; hence, macrophages can be exploited to make them a viable candidate for targeted delivery, which was not possible with previously designed conventional therapies for the immune disorders. AREAS COVERED: Nanotechnology is a promising, clear cut, efficient, and adequate approach for targeting macrophages. Literature addresses the receptors available for targeting and the novel small dimensional therapeutic delivery vehicles to target them along with a brief overview of the role of macrophages in these diseases. Furthermore, the patents based on this idea are also listed. EXPERT OPINION: Targeted drug delivery to macrophages should take into consideration the plasticity of macrophages and their modulation over time in the diseases. A cost-effective scale-up method of development will further facilitate the clinical trials. Besides, the implementation of safety guidelines to target macrophages and the studies of long-term effects of targeted approaches in humans would highly encourage the clinical outcomes.

Neurodevelopmental Outcomes Following Intravitreal Bevacizumab With Laser Versus Laser Photocoagulation Alone for Retinopathy of Prematurity.

BACKGROUND AND OBJECTIVE: To assess neurodevelopmental outcomes of infants with treatment-warranted retinopathy of prematurity (TW-ROP) treated with intravitreal bevacizumab (IVB) plus diode laser photocoagulation (DLP) compared to DLP alone. PATIENTS AND METHODS: A retrospective review was performed of infants who underwent treatment for TW-ROP with IVB+DLP or DLP alone from 2010 to 2017. Baseline characteristics and coexisting medical comorbidities were recorded. The presence of neurodevelopmental delay (NDD) at 2-year follow-up and composite Bayley-III scores were recorded. RESULTS: Sixty-six infants were included in the study; 18 received IVB+DLP, and 48 received DLP alone. Average Bayley-III scores for cognition, language, and motor, as well as rates of documental NDD, did not differ between the groups. CONCLUSION: This study does not demonstrate an increased risk of NDD in infants with TW-ROP treated with IVB+DLP compared with DLP alone. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:220-224.].

Coronary Plaque Boundary Enhancement in IVUS Image by Using a Modified Perona-Malik Diffusion Filter.

We propose a modified Perona-Malik diffusion (PMD) filter to enhance a coronary plaque boundary by considering the conditions peculiar to an intravascular ultrasound (IVUS) image. The IVUS image is commonly used for a diagnosis of acute coronary syndrome (ACS). The IVUS image is however very grainy due to heavy speckle noise. When the normal PMD filter is applied for speckle noise reduction in the IVUS image, the coronary plaque boundary becomes vague. For this problem, we propose a modified PMD filter which is designed in special reference to the coronary plaque boundary detection. It can then not only reduce the speckle noise but also enhance clearly the coronary plaque boundary. After applying the modified PMD filter to the IVUS image, the coronary plaque boundaries are successfully detected further by applying the Takagi-Sugeno fuzzy model. The accuracy of the proposed method has been confirmed numerically by the experiments.

"Pulling the plug"--management of meconium plug syndrome in neonates.

BACKGROUND: The significance of meconium plug syndrome (MPS) is unclear but has been associated with Hirschsprung's disease and magnesium tocolysis. We reviewed our experience to attempt to identify any potential association with these conditions and to review our outcomes. METHODS: Using the International Classification of Diseases, Ninth revision, code for meconium obstruction, patient charts were identified during the 1998-2008 period. A total of 61 cases of MPS were found, after excluding 7 of meconium ileus. Data regarding the hospital course and outcomes were collected and analyzed. RESULTS: Approximately 30% of patients had spontaneous resolution of the meconium plug without any treatment. Of those patients requiring treatment, contrast barium enema was used, with 97% success. Only 2 patients required surgical intervention owing to worsening distension and subsequent peritonitis. When we stratified the patients according to gestational age of >36 and <36 wk, contrast barium enemas were performed 2.2 ± 1.8 versus 8.6 ± 7.8 d after birth (P = 0.003), respectively, and the lower gestational age patients had a longer length of stay. Contrast barium enema was still successful in 94% of patients with a gestational age of <36 wk. Magnesium tocolysis was noted in 16% of the cases, and Hirschsprung's disease was only found in 3.2% of patients. CONCLUSIONS: Patients with MPS have excellent outcomes, independent of gestational age. Contrast barium enema remains the initial diagnostic and treatment of choice for patients with MPS. Also, although previous reports have shown a link between magnesium tocolysis and Hirschsprung's disease with MPS, our experience suggests otherwise.