Terlipressin-Induced Skin Necrosis While Managing Hepatorenal Syndrome: A Rare Case Report From North India.

Terlipressin is an analogue of vasopressin and is often used in the treatment of bleeding esophageal varices and also in the treatment of hepatorenal syndrome associated with liver cirrhosis. Although terlipressin is a safe drug, but it has been rarely associated with potentially serious adverse effects like ischemic necrosis of skin involving the abdominal skin, extremities, and scrotal skin. We present one such rare case where terlipressin-induced skin necrosis in bilateral lower extremities in a 48-year-old male while we were managing hepatorenal syndrome in the same.

Acute necrotising encephalopathy: A rare complication providing a clue for the outbreak of H1N1 among medical students in Kanpur, India.

Kanpur, India, recently witnessed an outbreak of undifferentiated febrile illness among medical students. Several students developed high-grade fever with altered sensorium within 2-3 days after the index case. Surprisingly, this outbreak coincided with the death of several pigs in the vicinity. Acute necrotising encephalitis, although rare, was noted in some patients. When correlated with each other, all of these incidents were suggestive of an outbreak of H1N1.

Necroptosis is associated with Rab27-independent expulsion of extracellular vesicles containing RIPK3 and MLKL.

Extracellular vesicle (EV) secretion is an important mechanism used by cells to release biomolecules. A common necroptosis effector-mixed lineage kinase domain like (MLKL)-was recently found to participate in the biogenesis of small and large EVs independent of its function in necroptosis. The objective of the current study is to gain mechanistic insights into EV biogenesis during necroptosis. Assessing EV number by nanoparticle tracking analysis revealed an increased number of EVs released during necroptosis. To evaluate the nature of such vesicles, we performed a newly adapted, highly sensitive mass spectrometry-based proteomics on EVs released by healthy or necroptotic cells. Compared to EVs released by healthy cells, EVs released during necroptosis contained a markedly higher number of unique proteins. Receptor interacting protein kinase-3 (RIPK3) and MLKL were among the proteins enriched in EVs released during necroptosis. Further, mouse embryonic fibroblasts (MEFs) derived from mice deficient of Rab27a and Rab27b showed diminished basal EV release but responded to necroptosis with enhanced EV biogenesis as the wildtype MEFs. In contrast, necroptosis-associated EVs were sensitive to Ca2+ depletion or lysosomal disruption. Neither treatment affected the RIPK3-mediated MLKL phosphorylation. An unbiased screen using RIPK3 immunoprecipitation-mass spectrometry on necroptotic EVs led to the identification of Rab11b in RIPK3 immune-complexes. Our data suggests that necroptosis switches EV biogenesis from a Rab27a/b dependent mechanism to a lysosomal mediated mechanism.

Chitosan nanoemulsion: Gleam into the futuristic approach for preserving the quality of muscle foods.

Trend for consumption of healthy meat without synthetic additives is blooming globally and has attracted the interest of consumers and research sphere to look for enhancement of quality and safety of food. Chitosan is multi-functional marine biopolymer with several befitting properties such as non-toxicity, ease of modification, antimicrobial activity, biodegradability and bio-compatibility, making it suitable for use in meat based food systems, which are highly prone to putrescence due to availability of high level protein, micronutrients and moisture. Bioactive components from plant extracts on account of their natural lineage are exquisite determinants for meat preservation in association with chitosan to replace synthetic molecules, which are considered to evince toxicological effects. Nanoemulsions are viable systems for integrating a myriad of active constituents framed by microfluidization, high-pressure homogenization, ultra-sonication, phase inversion (PIC and PIT) and spontaneous-emulsification with benefits of droplet size reduction, improved solubility, stability and their biological activity. This article summarizes the most important information on formulation, fabrication and advancements in chitosan-based nanoemulsions highlighting their potential benefit for applications in the muscle food system. Supervising the all-around executions of chitosan nanoemulsions for various food systems, the current review has been framed to lay down understandings regarding improvements made in the production and functionality of chitosan nanoemulsions for quality retention of meat products. Furthermore, it highlights the novel trends in chitosan-nanoemulsions application in meat based food systems from a preservation and shelf-life prolongation perspective.

Flower lose, a cell fitness marker, predicts COVID-19 prognosis.

Risk stratification of COVID-19 patients is essential for pandemic management. Changes in the cell fitness marker, hFwe-Lose, can precede the host immune response to infection, potentially making such a biomarker an earlier triage tool. Here, we evaluate whether hFwe-Lose gene expression can outperform conventional methods in predicting outcomes (e.g., death and hospitalization) in COVID-19 patients. We performed a post-mortem examination of infected lung tissue in deceased COVID-19 patients to determine hFwe-Lose's biological role in acute lung injury. We then performed an observational study (n = 283) to evaluate whether hFwe-Lose expression (in nasopharyngeal samples) could accurately predict hospitalization or death in COVID-19 patients. In COVID-19 patients with acute lung injury, hFwe-Lose is highly expressed in the lower respiratory tract and is co-localized to areas of cell death. In patients presenting in the early phase of COVID-19 illness, hFwe-Lose expression accurately predicts subsequent hospitalization or death with positive predictive values of 87.8-100% and a negative predictive value of 64.1-93.2%. hFwe-Lose outperforms conventional inflammatory biomarkers and patient age and comorbidities, with an area under the receiver operating characteristic curve (AUROC) 0.93-0.97 in predicting hospitalization/death. Specifically, this is significantly higher than the prognostic value of combining biomarkers (serum ferritin, D-dimer, C-reactive protein, and neutrophil-lymphocyte ratio), patient age and comorbidities (AUROC of 0.67-0.92). The cell fitness marker, hFwe-Lose, accurately predicts outcomes in COVID-19 patients. This finding demonstrates how tissue fitness pathways dictate the response to infection and disease and their utility in managing the current COVID-19 pandemic.

Chitosan nanoemulsions as advanced edible coatings for fruits and vegetables: Composition, fabrication and developments in last decade.

The rejection of chemical additives has attracted the attention of consumers and research personals to continuously improve quality and safety of food. Chitosan is a polyelectrolyte non-toxic, antimicrobial and biocompatible polysaccharide. The annual production of chitin (poly-ß-(1-4)-N-acetyl-D-glucosamine), the acetylated form of chitosan has been estimated 105 million tons and is approved by EU for use in plant protection (Reg. EU 2014/563). The film formation presents 20 to 30% of total chitosan activity apart from elicitation (30 to 40%) and antimicrobial activity (35 to 45%). Chitosan polymer scaffolds particularly nanoemulsions provides a protective covering to the fresh produce and acts as a carrier for antimicrobial agents and various functional compounds. The nanoemulsions are designed as smart functional coatings by microfluidization, high-pressure homogenization, ultra-sonication, phase inversion (PIC and PIT) and spontaneous emulsification. Considering the research reports available in the last decade, chitosan film production and related issues alluded to the possibilities for explorations of commercial applications on fresh foods. Chitosan-based biofilms with specific barriers and functional properties can be produced to address specific requirements of target food. Keeping in view the widespread applications of chitosan nanoemulsions for various food applications, the present review has been compiled to provide an insight into the developments and improvements made in the production, functionality, and delivery of bioactive substances for quality retention of fresh horticultural produce.

Shape-based reconstruction for transrectal diffuse optical tomography monitoring of photothermal focal therapy of prostate cancer: simulation studies.

We develop and demonstrate a simple shape-based approach for diffuse optical tomographic reconstruction of coagulative lesions generated during interstitial photothermal therapy (PTT) of the prostate. The shape-based reconstruction assumes a simple ellipsoid shape, matching the general dimensions of a cylindrical diffusing fiber used for light delivery in current clinical studies of PTT in focal prostate cancer. The specific requirement is to accurately define the border between the photothermal lesion and native tissue as the photothermal lesion grows, with an accuracy of ? 1 ?? mm , so treatment can be terminated before there is damage to the rectal wall. To demonstrate the feasibility of the shape-based diffuse optical tomography reconstruction, simulated data were generated based on forward calculations in known geometries that include the prostate, rectum, and lesions of varying dimensions. The only source of optical contrast between the lesion and prostate was increased scattering in the lesion, as is typically observed with coagulation. With noise added to these forward calculations, lesion dimensions were reconstructed using the shape-based method. This approach for reconstruction is shown to be feasible and sufficiently accurate for lesions that are within 4 mm from the rectal wall. The method was also robust for irregularly shaped lesions.

Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain.

BACKGROUND: Ongoing opioid analgesic use in patients suffering from chronic nonmalignant pain (CNMP) has been associated with the development of opioid misuse, abuse, addiction, and overdose. To prevent these adverse outcomes, it is important that family nurse practitioners (FNPs) implement recommended risk mitigation practices (RMPs) when treating CNMP patients with opioids. METHODS: A national sample of 856 FNPs was invited to answer an online survey about their utilization of opioids and RMPs in treating CNMP. RESULTS: One hundred sixty-eight FNPs responded (20% response rate), of whom 51.2% affirmed that they prescribe opioids for CNMP. Of the 86 FNPs who prescribe opioids, 66.7% said that less than 25% of their patients were receiving ongoing opioid therapy. The most frequently prescribed opioids were hydrocodone (77.9%) and oxycodone (58.1%). With respect to RMPs, 50 of the 86 opioid-prescribing FNPs (58.8%) reported using treatment contracts with their CNMP patients. Far fewer (20.9%) used formal screening tools to gauge the risk of opioid abuse and misuse. Most respondents (54.94%) reported using prescription monitoring programs, whereas only 33.0% reported using urine toxicology to monitor opioid use. Of the prescribing FNPs, 15.1% reported using abuse-deterrent opioid formulations. Age was found to be a correlate for prescribing opioids for CNMP, with those under 40 years of age less likely to use urine toxicology than those over 41 (45.2% vs. 4.2%; χ2(6) = 11.90, P = .06). Additionally, respondents who did not use treatment contracts reported significantly fewer years in practice (10.5 years, SD = 6.1) than those who did (13.6 years, SD = 1.54, df = 2.82, P = .02). CONCLUSIONS: Although RMPs are recommended for use in all CNMP patients receiving ongoing opioid therapy, FNPs do not consistently implement them. In the midst of the current opioid epidemic, FNPs must be vigilant about using appropriate opioid prescription practices.