Role of microRNAs in stroke recovery

Ischemic stroke is an important cause of morbidity and mortality across the globe. It is associated with physical, social, and economic disability. Immediately after the stroke, there is a critical period of spontaneous recovery during which there is maximal return to near normal. Following stroke, there is a period of neurogenesis, angiogenesis, axonal growth, and synaptic plasticity. There have been several studies focusing on neuroprotection and enhancing recovery following stroke. However, translation of these into clinical practice has been disappointing. The role of microRNAs in treatment of cancer has been well documented, but studying their role in stroke recovery has been minimal. MicroRNAs serve as critical mediators of recovery following stroke. In this review article, we discuss the role of microRNAs in stroke recovery.

Falciparum malaria mimicking acute myocardial infarction

Severe malaria is a concerning problem in developing country and is mostly due to Plasmodium Falciparum. Common organs involved are liver, central nervous system, lungs, kidneys, and vasculature. Cardiac involvement is very rare and is mostly underestimated. Cardiac involvement occurs in the form of myocardial dysfunction, arrhythmia, and ventricular systolic dysfunction. This is the rare case of acute pericarditis due to plasmodium falciparum mimicking as inferolateral ST elevation myocardial infarction (STEMI) due to suggestive electrocardiography (ECG) findings.

Marked Inhibition of Cellular Proliferation in the Normal Human Esophageal Epithelial Cells and Human Esophageal Squamous Cancer Cells in Culture by Carotenoids: Role for Prevention and Early Treatment of Esophageal Cancer

Background:

Globally Esophageal cancer is a common cancer arising from human esophageal mucosal tissue. Epidemiological studies suggest inverse correlation between carotenoid intake and incident risk of this devastating malignancy.

Methods:

In an effort to examine the modulatory role of carotenoids in human esophageal carcinogenesis at a cellular level, we examined the effects of α-carotene and β-carotenes, on cell proliferation and DNA synthesis in human esophageal epithelial (HEE) cells and human esophageal squamous cancer (HESC) cells in in-vitro cultures. HEE and HESC cells were incubated with different concentrations of α- and β-carotenes both individually and in combination.

Results:

Both Carotenes significantly inhibited (p<0.05) cellular proliferation and decreased DNA synthesis in HEE and HESC cells. The effect of α- and β-carotene together on DNA synthesis in HEE and HESC cells was significantly greater than either carotenoid alone, suggesting a synergistic effect. Greater magnitude of cellular inhibition of DNA synthesis was observed on HEE cells than HESC cells.

Conclusion:

Our results suggest that a combination of α-and β-carotene may provide a novel strategy for prevention and treatment of esophageal and upper aero digestive tract cancer in humans.

The effect of preload on electromyographic train-of-four ratio at the first dorsal interosseous muscle during spontaneous recovery from neuromuscular blockade

Accurate and reliable quantitative neuromuscular function monitoring is desirable for the optimal management of neuromuscular blockade, selection of the most appropriate reversal agent and dosage, and assessing the completeness of reversal to exclude residual neuromuscular blockade. Applying preload to the thumb may affect the precision of electromyography. This study compared the precision and agreement of electromyography with and without preload during recovery from non-depolarising neuromuscular blockade. After induction of anaesthesia and before neuromuscular blockade, the supramaximal current required at the first dorsal interosseous muscle with and without preload was determined. During recovery, train-of-four ratios were recorded using electromyography every 20 seconds. Alternating pairs of measurements (with and without preload) were obtained until spontaneous recovery was achieved. The preload device applied a resting tension of 75-150 g to the thumb. Bland-Altman analysis for repeated measurements was used to assess precision and agreement of electromyography responses with and without muscle preload. Two hundred and seventy-five sets of repeated measurements were collected from 35 participants. The repeatability coefficient for train-of-four ratios recorded by electromyography with a preload was 0.030 (95% confidence intervals, CI, 0.028 to 0.031) versus 0.068 (95% CI 0.064 to 0.072) without. Train-of-four ratios with preload demonstrated a bias of +0.038 (95% CI 0.037 to 0.042) compared to electromyography without, with 95% limits of agreement of 0.035-0.111. Preload significantly improved the precision of electromyographic train-of-four ratios, with 95% of consecutive measurements differing by less than 3%. Furthermore, electromyography with preload demonstrated a positive bias of 0.04 compared with electromyography alone, the clinical significance of which requires further research.

To assess the stethoscope cleaning practices, microbial load and efficacy of cleaning stethoscopes with alcohol-based disinfectant in a tertiary care hospital

Background

The objectives of our study were to study the stethoscope cleaning practices of medical personnel and to assess the microbial load on stethoscopes and efficacy of cleaning stethoscopes with alcohol-based disinfectant.

Methodology

A questionnaire-based cross-sectional study was conducted among medical personnel at a tertiary care hospital in India to assess their knowledge and cleaning practices regarding stethoscope disinfection. Samples from the stethoscopes were collected before and after cleaning with alcohol-based disinfectant.

Results

Out of 62 participants, 53.22% individuals had never cleaned their stethoscope. All the initial swab samples showed bacterial growth. There was mixed growth in the samples taken from 35 stethoscope bells and 31 diaphragms. Bacteria included coagulase negative staphylococci, bacillus species, diptheroids, S. aureus, Acinetobacter and Klebsiella pneumoniae. After cleaning with an alcohol-based disinfectant, there was a significant decrease in the average number of bacterial colony-forming units.

Conclusions

Regular cleaning practices should be followed to prevent growth and transmission of potentially pathogenic organisms.

Effect of oropharyngeal colostrum therapy in the prevention of necrotising enterocolitis among very low birthweight neonates: A meta-analysis of randomised controlled trials

BACKGROUND

Necrotising enterocolitis (NEC) is one of the most common life-threatening emergencies of the gastrointestinal tract in preterm neonates. The present study aimed to determine the efficacy of oropharyngeal colostrum with respect to reducing NEC in preterm neonates.

METHODS

A literature search was conducted for various randomised control trials by searching the Cochrane Central Register of Controlled Trials, PubMed, EMBASE and ongoing clinical trials. Randomised or quasi-randomised trials comparing oropharyngeal colostrum versus placebo in neonates (birthweight ≤ 1500 g or gestational age ≤ 32 weeks) were included in the review. The methodological quality of each trial was independently reviewed by the authors. For categorical and continuous variables, typical estimates for relative risk and typical estimates for weighted mean difference were calculated, respectively. A random effect model was assumed for meta-analysis.

RESULTS

In total, four eligible trials were included in the review. Oropharyngeal colostrum therapy was not associated with a statistically significant reduction in the incidence of NEC stage ≥2 [typical relative risk (RR) = 0.64; 95% confidence interval (CI) = 0.27-1.49], mortality from any cause (typical RR = 0.86; 95% CI = 0.15-4.80) and time to reach full feed [typical weighted mean difference (WMD) = -3.26; 95% CI = -8.87 to 2.35]. Duration of hospital stay was significantly less in the control group (typical WMD = 9.77; 95% CI = 3.96-15.59).

CONCLUSIONS

The current evidence is insufficient for recommending oropharyngeal colostrum as a routine clinical practice in the prevention of NEC. We emphasise the need for large randomised controlled trials with an adequate sample size and validated clinical outcomes in preterm neonates.

Portable out-of-hospital electrocardiography: A review of current technologies

Background

Availability of portable and home‐based electrocardiography (ECG) is an important medical innovation, which has a potential to transform medical care. We performed this review to understand the current state of out‐of‐hospital portable ECG technologies with respect to their scope, ease of use, data transmission capabilities, and diagnostic accuracy.

Methods

We conducted PubMed and Internet searches for “handheld” or “wearable” or “patch” electrocardiography devices to enlist available technologies. We also searched PubMed with names of individual devices to obtain additional citations. We classified available devices as a “single limb lead ECG recording devices” and chest‐lead “ECG recording devices.” If a device used more than three electrodes, it was defined as a conventional electrocardiography or Holter machine and was excluded from this review.

Results

We identified a total of 15 devices. Overall, only six of these devices (five single lead and one chest lead) featured in published medical literature as identified from PubMed search. A total of 13 citations were available for the single limb lead ECG recording devices and 6 citations for the chest‐lead ECG recording devices.

Conclusions

Despite the increase in number of such devices, published biomedical literature regarding their diagnostic accuracy, reproducibility, or utility is scant.

Population structure of the ash dieback pathogen, Hymenoscyphus fraxineus, in relation to its mode of arrival in the UK

The ash dieback fungus, Hymenoscyphus fraxineus, a destructive, alien pathogen of common ash (Fraxinus excelsior), has spread across Europe over the past 25 years and was first observed in the UK in 2012. To investigate the relationship of the pathogen's population structure to its mode of arrival, isolates were obtained from locations in England and Wales, either where established natural populations of ash had been infected by wind-dispersed ascospores or where the fungus had been introduced on imported planting stock. Population structure was determined by tests for vegetative compatibility (VC), mating type and single-nucleotide polymorphisms (SNPs). VC heterogeneity was high at all locations, with 96% of isolate pairings being incompatible. Frequencies of the MAT1-1-1 and MAT1-2-1 idiomorphs were approximately equal, consistent with H. fraxineus being an obligate outbreeder. Most SNP variation occurred within study location and there was little genetic differentiation between the two types of location in the UK, or between pathogen populations in the UK and continental Europe. There was modest differentiation between UK subpopulations, consistent with genetic variation between source populations in continental Europe. However, there was no evidence of strong founder effects, indicating that numerous individuals of H. fraxineus initiated infection at each location, regardless of the route of pathogen transmission. The ssRNA virus HfMV1 was present at moderate to high frequencies in all UK subpopulations. The results imply that management of an introduced plant pathogen requires action against its spread at the continental level involving coordinated efforts by European countries.

Selfies: A boon or bane?

Background:

Selfie deaths have become an emerging problem and we performed this study to assess the epidemiology of selfie-related deaths across the globe.

Subject and Methods:

We performed a comprehensive search for keywords such as “selfie deaths; selfie accidents; selfie mortality; self photography deaths; koolfie deaths; mobile death/accidents” from news reports to gather information regarding selfie deaths.

Results:

From October 2011 to November 2017, there have been 259 deaths while clicking selfies in 137 incidents. The mean age was 22.94 years. About 72.5% of the total deaths occurred in males and 27.5% in females. The highest number of incidents and selfie-deaths has been reported in India followed by Russia, United States, and Pakistan. Drowning, transport, and fall form the topmost reasons for deaths caused by selfies. We also classified reasons for deaths due to selfie as risky behavior or non-risky behavior. Risky behavior caused more deaths and incidents due to selfies than non-risky behavior. The number of deaths in females is less due to risky behavior than non-risky behavior while it is approximately three times in males.

Conclusion:

“No selfie zones” areas should be declared across tourist areas especially places such as water bodies, mountain peaks, and over tall buildings to decrease the incidence of selfie-related deaths.