Increasing the use of perioperative risk scoring in emergency laparotomy: nationwide quality improvement programme

Background

Emergency laparotomy is associated with high morbidity and mortality. The early identification of high-risk patients allows for timely perioperative care and appropriate resource allocation. The aim of this study was to develop a nationwide surgical trainee-led quality improvement (QI) programme to increase the use of perioperative risk scoring in emergency laparotomy.

Methods

The programme was structured using the active implementation framework in 15 state-funded Irish hospitals to guide the staged implementation of perioperative risk scoring. The primary outcome was a recorded preoperative risk score for patients undergoing an emergency laparotomy at each site.

Results

The rate of patients undergoing emergency laparotomy receiving a perioperative risk score increased from 0–11 per cent during the exploratory phase to 35–100 per cent during the full implementation phase. Crucial factors for implementing changes included an experienced central team providing implementation support, collaborator engagement, and effective communication and social relationships.

Conclusions

A trainee-led QI programme increased the use of perioperative risk assessment in patients undergoing emergency laparotomy, with the potential to improve patient outcomes and care delivery.

Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity

OBJECTIVE

The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates.

METHODS

Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees.

RESULTS

Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation.

CONCLUSION

Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.

Involvement of atrial natriuretic peptide in abrogated cardioprotective effect of ischemic preconditioning in ovariectomized rat heart

BACKGROUND

Nitric oxide (NO) is an effective mediator of ischemic preconditioning (IPC)-induced cardioprotection. Atrial natriuretic peptide (ANP) is downregulated after ovariectomy, which results in reduction in the level of NO. The present study deals with the investigation of the role of ANP in abrogated cardioprotective effect of IPC in the ovariectomized rat heart.

METHODS

Heart was isolated from ovariectomized rat and mounted on Langendorff's apparatus, subjected to 30 min of ischemia and 120 min of reperfusion. IPC was given by four cycles of 5 min of ischemia and 5 min of reperfusion with Krebs-Henseleit solution. The myocardial infract size was estimated employing triphenyltetrazolium chloride stain, and coronary effluent was analyzed for creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) release to consider the degree of myocardial injury. The cardiac release of NO was estimated by measuring the level of nitrite in coronary effluent.

RESULTS

IPC-mediated cardioprotection was significantly attenuated in ovariectomized rat as compared to normal rat, which was restored by perfusion with ANP. However, this observed cardioprotection was significantly attenuated by perfusion with L-NAME, an endothelial nitric oxide synthase inhibitor, and Glibenclamide, a K_ATP channel blocker, alone or in combination noted in terms of increase in myocardial infract size, release of CK-MB and LDH, and also decrease in release of NO.

CONCLUSION

Thus, it is suggested that ANP restores the attenuated cardioprotective effect of IPC in the ovariectomized rat heart which may be due to increase in the availability of NO and consequent increase activation of mitochondrial K_ATP channels.

Health impacts of Facebook usage and mobile texting among undergraduate dental students: it's time to understand the difference between usage and an excessive use

BACKGROUND

Facebook and mobile texting are prevalent in the lives of almost every student. However, little is known about the relationship between Facebook usage or mobile texting and their impacts on health amongst undergraduate dental students. In this study, excessive Facebook use and excessive mobile texting were studied as they relate to impacts on health.

MATERIALS AND METHODS

A cross-sectional study was conducted at a private university in Malaysia. A total of 188 undergraduate dental students were interviewed using a pre-tested and self-rated questionnaire. Data collected from participants were analysed using SPSS version 18.0. Chi-square test, Fisher's exact test and multiple logistic regression analyses were applied to study the relationship between explanatory variables and excessive Facebook use and excessive mobile texting.

RESULTS

The prevalence of excessive Facebook use and excessive mobile texting amongst undergraduate dental students was found to be 33.2% and 33.0%, respectively. According to a multivariate analysis, texting habits, such as the presence of daytime sleepiness after texting late at night (aOR = 2.682, 95% CI = 1.142-6.301) and the presence of anxious feelings if students failed to receive a timely response (aOR = 3.819, 95% CI = 1.580-9.230), were determined to be significant predictors of excessive mobile texting. Excessive Facebook use was found to be significantly related to three variables as follows: fewer numbers of close friends (aOR = 2.275, 95% CI = 1.057-4.898), the checking of updates on the Facebook walls of their friends (aOR = 2.582, 95% CI = 1.189-5.605) and the absence of active and vigorous feelings during Facebook use (aOR = 3.401, 95% CI = 1.233-9.434).

CONCLUSIONS

Approximately one-third of undergraduate dental students in this study experienced excessive Facebook use and/or excessive mobile texting. Health education and promotion should be instituted to create awareness, whilst students should be advised to practise self-control with respect to both mobile texting and Facebook usage.

Hemin, a heme oxygenase-1 inducer, restores the attenuated cardioprotective effect of ischemic preconditioning in isolated diabetic rat heart

BACKGROUND

Attenuated cardioprotective effect of ischemic preconditioning (IPC) by reduced nitric oxide (NO) is a hallmark during diabetes mellitus (DM). Recently, we reported that the formation of caveolin-endothelial nitric oxide synthase (eNOS) complex decreases the release of NO, which is responsible for attenuation of IPC-induced cardioprotection in DM rat heart. Heme oxygenase-1 (HO-1) facilitates release of NO by disrupting caveolin-eNOS complex. The activity of HO-1 is decreased during DM. This study was designed to investigate the role of hemin (HO-1 inducer) in attenuated cardioprotective effect of IPC in isolated diabetic rat heart.

METHODS

DM was induced in male Wistar rat by single dose of streptozotocin. Cardioprotective effect was assessed in terms of myocardial infarct size and release of lactate dehydrogenase and creatine kinase in coronary effluent. The release of NO was estimated indirectly by measuring the release of nitrite in coronary effluent. Perfusion of sodium nitrite, a precursor of NO, was used as a positive control.

RESULT

IPC-induced cardioprotection and increased release of nitrite were significantly attenuated in a diabetic rat as compared to a normal rat. Pretreatment with hemin and daidzein, a caveolin inhibitor, alone or in combination significantly restored the attenuated cardioprotection and increased the release of nitrite in diabetic rat heart. Zinc protoporphyrin, a HO-1 inhibitor, significantly abolished the observed cardioprotection and decreased the release of nitrite in hemin pretreated DM rat heart.

CONCLUSION

Thus, it is suggested that hemin restores the attenuated cardioprotective effect in diabetic rat heart by increasing the activity of HO-1 and subsequently release of NO.

Clinical Spectrum of Chikungunya in Bikaner (North Western India) in 2006 and Follow up of Patients for Five Years

OBJECTIVE

To find out clinical and laboratory profile of patients of chikungunya outbreak in 2006 in Bikaner (North-West Rajasthan) and follow up of chikungunya patients for 5 years.

METHODS

Study was conducted among 50 chikungunya patients. For this study the inclusion criteria was clinical presentation consistent with chikungunya virus infection (e.g. abrupt onset of fever and/or polyarthralgia) and laboratory confirmation of chikungunya virus infection by IgM-capture ELISA. All patients were subjected for thorough clinical and general physical examination, investigations like CBC, ESR, CRP, rheumatoid factor, ECG, LFT, RFT, anti-CCP antibody were done in all patients and their follow up was done for 5 years.

RESULTS

Among the 50 patients of chikungunya arthritis 34 (68%) patients developed persistent arthritis. Among the patients with persistent arthritis 70.58% were shown positive for anti-ccp antibody. CRP (95.24%) and ESR level were raised (68%) in patient with persistent arthralgia. Level of CRP and ESR was proportionally related to number of partially recovered joints, higher the CRP positivity and raised ESR levels severe were the persistent arthralgias.

CONCLUSIONS

Our study shows that chikungunya patients who had persistent arthralgia on 5 year follow up mimicked rheumatological disorder like rheumatoid arthritis in 70.58%. Therefore DMARD can be effective.

Gut microbiota in health and disease: an overview focused on metabolic inflammation

In concern to the continuously rising global prevalence of obesity, diabetes and associated diseases, novel preventive and therapeutic approaches are urgently required. However, to explore and develop such innovative strategies, a meticulous comprehension of the biological basis of these diseases is extremely important. Past decade has witnessed an enormous amount of research investigation and advancement in the field of obesity, diabetes and metabolic syndrome, with the gut microbiota receiving a special focus in the triangle of nutrition, health and diseases. In particular, the role of gut microbiota in health and diseases has been one of the most vigorous and intriguing field of recent research; however, much still remains to be elucidated about its precise role in host metabolism and immune functions and its implication in the onset, progression as well as in the amelioration of metabolic ailments. Recent investigations have suggested a significant contribution of the gut microbiota in the regulation and impairment of energy homeostasis, thereby causing metabolic disorders, such as metabolic endotoxemia, insulin resistance and type 2 diabetes. Numerous inflammatory biomarkers have been found to be associated with obesity, diabetes and risk of other associated adverse outcomes, thereby suggesting that a persistent low-grade inflammatory response is a potential risk factor. In this milieu, this review intends to discuss potential evidences supporting the disturbance of the gut microbiota balance and the intestinal barrier permeability as a potential triggering factor for systemic inflammation in the onset and progression of obesity, type 2 diabetes and metabolic syndrome.

Abrogated cardioprotective effect of ischemic preconditioning in ovariectomized rat heart

BACKGROUND

Ischemic heart disease is the leading cause of death in postmenopausal women. The expression of caveolin, a membrane protein and a negative regulator of nitric oxide (NO), increases after menopause. The present study was designed to determine the effect of daidzein (DDZ), a phytoestrogen in attenuated cardioprotective effect of ischemic preconditioning (IPC) in ovariectomized rat heart.

METHODS

Heart was isolated from ovariectomized rat and mounted on Langendorff's apparatus, subjected to 30 min ischemia and 120 min reperfusion. IPC was mediated by four cycles of 5 min ischemia and 5 min reperfusion. The infarct size was estimated using triphenyltetrazolium chloride stain, and coronary effluent was analyzed for lactate dehydrogenase and creatine kinase MB (CK-MB) release to assess the degree of myocardial injury. The release of NO was estimated indirectly by measuring the release of nitrite in coronary effluent.

RESULTS

IPC-induced cardioprotection was significantly attenuated in ovariectomized rats as compared to normal rats, which was restored by treatment of DDZ, a caveolin inhibitor (0.2 mg/kg subcutaneously) for 1 week. However, this observed cardioprotection was significantly attenuated by perfusion of l-nitroarginine methyl ester, an endothelial nitric oxide synthase (eNOS) inhibitor (100 µM/L) and glibenclamide, an adenosine triphosphate-sensitive potassium ion channel blocker (10 µM/L) alone or in combination, noted in terms of increase in myocardial infarct size, release of LDH and CK-MB, and also decrease in the release of NO.

CONCLUSION

Thus, it is suggested that DDZ restores the attenuated cardioprotective effect in ovariectomized rat heart, which may be due to downregulation of caveolin and subsequent increase in the activity of eNOS.

Comparison of the anaesthetic efficacy of different volumes of 4% articaine (1.8 and 3.6 mL) as supplemental buccal infiltration after failed inferior alveolar nerve block

AIM

To compare the anaesthetic efficacy of different volumes (1.8 mL vs. 3.6 mL) of 4% articaine with 1 : 100 000 epinephrine injected as buccal infiltrations after a failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis.

METHODOLOGY

Two hundred and thirty-four adult patients, diagnosed with irreversible pulpitis in a mandibular tooth, participated in this multicentre, randomized double-blinded trial. Patients received IANB with 1.8 mL of 4% articaine with 1 : 100 000 epinephrine. Pain during treatment was recorded using the Heft-Parker visual analogue scale (HP VAS). The primary outcome measure, and the definition of 'success', was the ability to undertake pulp chamber access and canal instrumentation with no or mild pain (HP VAS score <55 mm). Patients who experienced 'moderate-to-severe' pain (HP VAS score ≥ 55 mm) were randomly allocated into two groups and received buccal infiltrations with either 1.8 mL or 3.6 mL of 4% articaine with 1 : 100 000 epinephrine. Root canal treatment was re-initiated after 10 min. Success was again defined as no pain or weak/mild pain during endodontic access preparation and instrumentation. Statistical analysis was performed using Mann-Whitney U and chi-square tests.

RESULTS

The initial IANB of 4% articaine gave an overall success rate of 37%. The success rate of supplementary buccal infiltration with 1.8 and 3.6 mL volumes was 62% and 64%, respectively. The difference between the success rates of the two volumes was not statistically significant.

CONCLUSIONS

Increasing the volume of 4% articaine with 1 : 100 000 epinephrine from 1.8 to 3.6 mL, given as supplementary buccal infiltrations after a failed primary IANB with 1.8 mL of 4% articaine with 1 : 100 000, did not improve the anaesthetic success rates in patients with symptomatic irreversible pulpitis.

Iron supplementation in young iron-deficient females causes gastrointestinal redox imbalance: protective effect of a fermented nutraceutical

The aim of this study was to assess whether the concomitant supplementation of certified fermented papaya preparation (FPP, ORI, Gifu, Japan) together with iron supplementation could beneficially affect lipid peroxidation either systemically and at a intraluminal gut level in women with low iron stores. Treatment compliance and iron absorption was assessed as well. Fifty-two non-pregnant, fertile, non-smokers, healthy women with iron deficiency were recruited. The women were given iron supplements (100 mg Fe/d as ferrous sulfate) to be taken daily for 12 weeks (group A). Group B patients were also supplemented with 6g/day of a FPP. A detailed life style questionnaire was administered to all subjects. Iron, ferritin, transferrin receptors (Tf R) and malondialdehyde (MDA) in plasma were measured. The RBCs lysate was used for the estimation of superoxide dismutase (SOD) and glutathione peroxidase (GPx). The total and free iron concentration as well as analysis of oxidative stress in the feces was measured. FPP-supplemented subjects showed a significantly lower degree of gastrointestinal discomfort (p less than 0.05) and abolished the iron supplementation-induced increase of MDA (p less than 0.001) and the depletion of SOD and GPx (p less than 0.01). Moreover, the nutraceutical co-administration brought about a significant reduction of gut oxidative damage and lower fecal content of either total and free iron (p less than 0.05 vs group A). Overall, group B showed a better TfR/ferritin ratio response (p less than 0.05 vs group A). While iron supplementation maintains its clinical relevance considering the prevalence of iron deficiency among females, a careful clinical evaluation and a protective nutraceutical co-administration, as our data suggest with FPP, should be considered.

Effective properties of a sturgeon-based bioactive compound on stress-induced hippocampal degeneration and on in vitro neurogenesis

The aim of this study is to test the activity of a marine bioactive compound containing high-purity caviar-derived DNA, collagen elastin and protein extracts from sturgeon (LD-1227, Caviarlieri, Laboratoires Dom, Switzerland) to exert neuroprotective properties in an experimental setting while also being potential triggers of neurogenesis in a separate in vitro study. Supplementation with high-DHA mixture of LD-1227 was applied for 30 days to stress model rats. Both supplementations significantly mitigated the histological brain damage when analyzing hippocampal subregions and corticosterone level. However, LD-1227 was most significantly efficient in preventing SOD, Catalase and ascorbic acid decrease in brain tissue. Both supplementations stimulated neurogenesis in vitro and neuron markers in particular but og olygodendrocyte markers and glia increased only in LD-1227-enriched medium. Taken together, these data suggest that LD-1227 is able to significantly protect the brain structure redox system to higher degree than DHA. Moreover, from in vitro study it appears that marine bioactive compound, through it wide array of small unsaturated fatty acids, phospholipids and neurotransmitter precursors, is likely to influence neuronal and glial lineage to act differently from a DHA-rich mixture.

Beneficial effect of a sturgeon-based bioactive compound on gene expression of tumor necrosis factor-alpha, matrix metalloproteinases and type-10 collagen in human chondrocytes

In the present study, we examined the effect of a marine bioactive compound containing high-purity caviar-derived DNA, collagen elastin and protein extracts from sturgeon (LD-1227, Caviarlieri, Laboratoires Dom, Switzerland) on IL-1beta-induced activation and production of TNFalpha and MMP-13 in human osteo-arthritis (OA) chondrocytes and intracellular signaling factors. Human chondrocytes were derived from OA cartilage and stimulated with IL-1beta. Gene expression of TNFalpha, MMP-13, MMP-1 and Col10A1 was measured by quantitative RT-PCR. TNFalpha protein in culture medium was determined using cytokine-specific ELISA. Western immunoblotting was used to analyze the MMP-13 production in the culture medium and the activation of NF-kB. DNA binding activity of NF-kB p65 was determined using a highly sensitive and specific ELISA. MMP-13 activity in the culture medium was assayed by gelatine zymography. LD-1227 significantly decreased IL-1beta-stimulated gene expression and production of TNFalpha, MMP-1, MMP-13 and Col10A1 in human chondrocytes. The inhibitory effect of LD-1227 on the IL-1beta-induced expression of these genes was mediated at least in part via suppression of NF-kB p65. These data show that LD-1227 can inhibit IL-1beta-induced proliferation and inflammatory reactions via inhibited activation of the transcription factor NF-kB pathway in human chondrocytes derived from OA patients. These novel pharmacological actions of LD-1227 on IL-1beta-stimulated human OA chondrocytes provide suggestions that this marine biology compound may inhibit cartilage degradation by suppressing IL-1beta-mediated activation and the catabolic response in human chondrocytes.

Is there a potential application of a fermented nutraceutical in acute respiratory illnesses? An in-vivo placebo-controlled, cross-over clinical study in different age groups of healthy subjects

The role of oxidants in viral diseases is fairly complex because it includes metabolic regulation both of host metabolism and viral replication. However, a role for reactive oxygen species (ROS) and reactive nitrogen species (RNS) as mediators of virus-induced lung damage is supported by studies and antioxidants can thus be expected to act at many different levels. The aim of the present pilot study was to test an antioxidant nutraceutical approach on some relevant immunological parameters known to be affected in common seasonal respiratory tract infection. The study population consisted of 90 sedentary healthy patients, previously selected as being GSTM1-positive, divided into three groups: A) 20-40 years; B) 41-65 years; B) over 65 years. Each patients was administered a life style and dietary questionnaire. Subjects were supplemented for 6 weeks with either 9g/day (4.5g twice a day sublingually) of a fermented papaya preparation (Osato Research Institute, Gifu, Japan) or placebo. After a further month period of wash out, subjects were treated again in a crossover manner. Parameters checked were as follows: routine blood tests with WBC formula, saliva flow rate and secretary IgA and lysozyme production and redox gene expression of Phase II enzyme and SOD from upper airways cells (from nasal lavage). Salivary secretion rate showed an age-related decline and was significantly increased by FPP supplementation only in the youngest age-group (p less than 0.05). Subjects treated with FPP showed a significantly higher lever of IgA and lisozyme production., irrespective of age group while their baseline production was significantly lower in the oldest age-group as compared to the youngest one (C vs A, p less than 0.05). FPP treatment brought about a significant upregulation of all phase II enzyme and SOD gene expression tested in nasal lavage cells. In conclusion, FPP supplementation during 1 month resulted in higher salivary IgA and increase in phase II and SOD enzyme expression, i.e the most important antioxidant in the respiratory tract. The biological significance of these effects i.e., whether it will help reducing the whole respiratory oxidative stress in the human airway and, hopefully, the incidence and/or severity of URTI remains to be demonstrated in longer clinical trials.

Milk, milk products, and disease free health: an updated overview

The cow and its milk have been held sacred in the world since the dawn of human civilization. Indian ancient Vedic texts describe the virtues of milk and dairy products, as is authenticated by modern scientific principles and proofs. Therefore, milk has been considered as one of the most natural and highly nutritive part of a daily balanced diet. Currently, the integration of advanced scientific knowledge with traditional information is gaining incredible momentum toward developing the concept of potential therapeutic foods. Furthermore, new advances toward understanding the therapeutic roles of milk and milk products have also given a new impetus for unraveling the age old secrets of milk. At present, the best-known examples of therapeutic foods are fermented milk products containing health promoting probiotic bacteria. In the present article, we have tried to review the various aspects of the therapeutic nature of milk and fermented dairy products in a highly up-dated manner, and offer an in-depth insight into the development of targeted therapeutic future foods as per the requirements of consumers.

Euglycemic ketoacidosis as a cause of a metabolic acidosis in the Intensive Care Unit

Euglycaemic ketoacidosis is a rare endocrine emergency, which can have disastrous consequences if left undiagnosed. We present the case of a 57 year old man with type 2 diabetes who developed ketoacidosis (DKA) following a myocardial infarction, despite being normoglycaemic, following discontinuation of his insulin infusion in an intensive care setting. The case highlights the importance of capillary ketone body testing in this scenario as well as the dangers of an over reliance on blood glucose values in the diagnosis of ketoacidosis. The notion that DKA can occur in both type 1 and type 2 diabetes is reaffirmed and the value of adequate insulin therapy in euglycaemic ketoacidosis is emphasized.

Factors influencing dyspepsia-related consultation: differences between a rural and an urban population

BACKGROUND

Dyspepsia is a common, chronic condition but medical consultation rates for symptoms remain variable. We aimed to examine two populations with varied health-care provision to determine predictive factors for dyspepsia-related consultation.

METHODS

A cross-sectional, population-based study in both an urban and a rural community within a single Asian country was conducted. Details on dyspepsia-related consultation rates over a fixed period and independent factors influencing them were identified.

KEY RESULTS

A total of 4039/5370 (75.2%) adults from representative rural and urban areas in this country agreed to participate in the study. Although mean ages of respondents were similar (40.4years), the demographics of both populations varied in terms of gender (62.7% female, rural vs 55.7% female, urban, P<0.0001), marital status (75.4% rural vs 70.5% urban, P=0.002), ethnicity, (79% Malay rural vs 45.3% Malays urban, P<0.0001) and socio-economic status (professional occupation 7.1% rural vs 47.3% urban, P<0.0001). Dyspepsia-related consultation rates were found to be higher among rural compared to urban adults (41.4%vs 28.7%, P<0.0001). Over-the-counter medication consumption was higher among urban compared to rural dyspepsia sufferers (n=157 vs n=35, P<0.0001). Following logistic regression, rural population (OR 3.14, 95% CI=1.65-6.0), low quality of life (OR 1.90, 95% CI=1.17-3.10), and self-medication (OR 0.40, 95% CI=0.25-0.62) were found to independently predict dyspepsia-related consultation.

CONCLUSIONS & INFERENCES

Dyspepsia-related consultation varied significantly between urban and rural communities. Factors within the rural population, self-medication practices, and a low quality of life independently influenced dyspepsia-related consultation.

Beneficial nutraceutical modulation of cerebral erythropoietin expression and oxidative stress: an experimental study

The main object of this study is to examine the effect of Klamin®, a nutraceutical containing phenylethylamine, phycocyanins, mycosporine-like aminoacids and aphanizomenon flos aquae-phytochrome on the learning and memory ability, the oxidative status and cerebral erythropoietin and its receptor EPO/EPOR system in prematurely senescent (PS) mice. A total of 28 PS mice, selected according to a prior T-maze test, and 26 non-prematurely senescent mice (NPS) mice were chosen. PS animals were divided into 3 groups and followed for 4 weeks: A) normal chow diet; B) added with Klamin® at 20 mg/kg/day (low dose); C) added with Klamin® at 100mg/kg/day (high dose). A further group of NPS mice given either normal food (group D) or high dose Klamin® (group E) was also considered. The behavioral procedures of spatial learning ability (Morris test) showed that PS mice had significantly longer learning time as compared to their NPS counterpart (p<0.01), but this effect was prevented especially in mice supplemented with high-dose Klamin® (p<0.05) which improved performances in NPS mice (p<0.05). High-dose Klamin® supplementation restored the depleted total thiol concentration in the brain observed in PS mice while normalizing their increased malonildialdehyde level (p<0.05). Moreover, the high-dosage only caused a significant upregulation of EPO/EPOR system both in PS and in NPS animals (p<0.05). Taken together, these data suggest that this specific alga Klamath extract has considerable antioxidant and adaptogenic properties, also through a stimulatory effect of cerebral EPO/EPO system.

Subclinical candiduria in patients with gastrointestinal malignancies: a preliminary study on the protective effect of a natural phytocompound

There is a great concern for the increasing incidence of candidiasis in cancer patients following immune-suppressive, cytostatic or antibiotic treatment. There are cancer patients with repeat asymptomatic recovery of candida in the urine in whom the choice of treatment, if any, is still a matter of debate. The aim of the study is to test the efficacy and tolerability of a natural anti-fungal phytocompound in patients with tumors of the gastrointestinal tract with prior or ongoing candiduria. Thirty-nine patients with operated gastrointestinal malignancies (18 still under current chemotherapy) with a history of repeated candiduria were enrolled. Eleven patients showed candiduria on enrolment and were treated with K-712, a natural antifungal phytocompound. Genomic analysis was carried out on blood samples of all patients on a monthly basis for 6 months. Within 3 weeks all 11 treated patients had negative cultures in the urine (10 patients after 2 weeks), 7 patients remained free of candiduria throughout the study period while 4 required a new treatment course. Three patients had positive genomic tests for systemic candidiasis and were treated with fluconazole. Eighteen (64 percent) out of the 28 patients who were free of candiduria on enrolment, developed a urinary candida infection during the 6-month follow-up and all cases were successfully treated with K-712. Seven (38 percent) of these cases presented a further recurrence at a later stage and all responded to a new course of K-172. No positive genomic tests were observed during the follow-up period. These data suggest that a consistent part of patients, mostly with gastrointestinal malignancies develop urinary candida infection when following chemotherapy treatment. A therapeutic approach with a natural antifungal phytocompound seems a safe and effective measure and a tentative prophylactic approach might also be envisaged.

Protective effect of a poly-phytocompound on early stage nephropathy secondary to experimentally-induced diabetes

Diabetic nephropathy (DN) is a severe and life-threatening complication of long-standing diabetes. As one of the main causes of end-stage renal disease, the prevention and treatment of DN in early stage, and the slowing down of DN progression are of utmost importance and are topics of several ongoing research studies. Nutraceuticals endowed with antioxidant-anti-inflammatory properties may offer an opportunity of integrative treatment for this condition. Male Wistar rats were randomly assigned to two groups. One group of rats (diabetic group) received a single tail-vein injection of STZ compound (50 mg/kg) under light anaesthesia. A protective dose of 0.5 ml of 5 percent dextrose was given intraperitoneally 30 min before the administration of STZ. One diabetic group was fed a normal pellet diet (group A) while group B was fed the diet added with DTS (panax pseudoginseng, eucommia ulmoides), (Kyotsu Jigyo, Tokyo, Japan) in the proportion of 50/25 (percent weight/weight), at the dose of 50 mg/kg/day throughout the experimental period. At the end of 8 weeks, 24-hour urine was collected for the measurement of the albumin concentration: blood samples were collected for serum biochemistry and the rats were sacrificed for kidney measurement of oxidative stress and histomorphological features. Nephrin and Macrophage Chemoattractant Protein-1 (MCP-1) gene expression were also assessed by fluorescence real-time quantitative PCR after RNA extraction and cDNA synthesis. STZ-treated animals showed significantly increased in lipid peroxidation in the kidney and in proteinuria. DTS supplementation did not affect plasma glucose but significantly decreased malonyldialdehyde (MDA) plasma level and the overall redox parameters together with a partial mitigation of proteinuria. Histological analysis showed also that DTS significantly reduced the glomerular volume together with glomerulosclerosis and interstitial fibrosis score (p less than 0.05), the latter two being correlated to proteinuria (p less than 0.05). DTS supplementation also enabled a reduction of diabetes-induced decrease of nephrin mRNA expression and a 67 percent reduction of MCP-1 mRNA up-regulation (p less than 0.01). Taken altogether, these data show that, besides the mandatory control of glycemia, intervention with a nutraceutical with antioxidant and anti-inflammatory properties may have beneficial effects when integrated in the mainstream of the therapeutic regimen.

Epigenomic derangement of hepatic glucose metabolism by feeding of high fructose diet and its prevention by Rosiglitazone in rats

BACKGROUND

The high consumption of fructose leads to the increasing incidence of insulin resistance by several unknown mechanisms. Hepatic glucose metabolism may also be an important target of fructose-induced-metabolic alterations.

AIM

The aim of present study was to investigate alterations in hepatic glycogenolysis, glycogenesis and gluconeogenic fluxes by feeding of 21% high fructose diet and the effects of Rosiglitazone treatment to prevent these derangements in rats.

METHODS

Rats were maintained on normal chow and high fructose diet with or without Rosiglitazone for 8 weeks and various biochemical and gene expression measures were estimated.

RESULTS

The feeding of high fructose diet impaired glucose, insulin and pyruvate tolerance tests and increased blood HbA(1c), insulin, triglyceride, free fatty acids and homeostasis model assessment after 8 weeks. In addition, high fructose diet feeding increased expression of phosphoenol-pyruvatecorboxykinase, glucose-6-phosphatase, sterol regulatory element binding proteins-1 and fatty acid synthase through enhanced expression of fork-head receptor, peroxisome proliferator activated receptor-gamma-co-activator 1 and cAMP reactive element binding protein. The treatment with Rosiglitazone inhibited all these derangements, i.e. hepato-lipogenic and gluconeogenic effects of high fructose diet feeding in rats.

CONCLUSIONS

Together these findings suggest that high fructose diet induced hepatic gluconeogenic and lipogenic rate, and increased circulating triglycerides and free fatty acids, which may be the major risk factors for glucose intolerance, hyperglycemia and insulin resistance in rats. In such situations high fructose flux also induces transcriptional cascade of gluconeogenic enzymes through the modulation of various associated transcriptional factors.

Sclerotherapy for hydrocele revisited: a prospective randomised study

PURPOSE

A prospective randomised trial to study the efficacy and safety of hydrocele sclerotherapy with phenol and polidocanol.

METHODS

Eighty-six patients with unilateral primary vaginal hydroceles were randomised into three groups: group 1 (phenol sclerotherapy) - 29 patients, group 2 (polidocanol sclerotherapy) - 29 patients and group 3 (operative treatment) - 28 patients. Sclerotherapy was performed on outpatient basis using either 5-10 ml of 5% phenol or 2-4 ml of 1% polidocanol, while patients in group 3 underwent surgical repair of hydrocele (Jaboulay's procedure). Statistical analysis was performed using ANOVA.

RESULTS

The cure rates in group 1, 2 and 3 were 96.5%, 51.7% and 100%, respectively. The pain scores (visual analogue scale) in group 1, 2 and 3 at 1 week and 1 month were 14.5 and 1.8; 10.1 and 1.3; 64.0 and 10.6, respectively. There was significant difference among the three groups in mean hospital stay (1.8, 1.5 and 9.7 hours, respectively) and time to work resumption (1.3, 1.1 and 12.7 days, respectively). Statistically significant differences in pain scores and complications were observed between sclerotherapy and operative groups.

CONCLUSION

Five percent phenol is a better sclerosant than 1% polidocanol and is as efficacious as operative treatment, with lesser morbidity and similar safety profile.

Inhibition of human breast cancer cell growth and enzymatic activity by a fermented nutraceutical: an in vitro and in vivo study

Human breast cancer cell lines MCF-7 (ER-positive) and Hs578T (ER-negative) were cultured and one lot incubated for 48 h with 5-50 mug/ml of a fermented phytocompound (MK: Manda-Koso, Innoshima, Japan). In vitro, it appeared a dose-dependent decrease of cell viability (5-57%) in MK group in both cell lines (P < 0.001, plateau: 30 microg/ml), decreased beta-galactosidase activity, enhanced apoptosis, and inversely increased Bax/Bcl2 ratio (P < 0.01) with an upregulation of p53 (P < 0.05). In the in vivo model, Balb-c mice were inoculated with tumor cells and the treatment group was fed with 20 mg of MK. Tumor weight in MK-fed group was time-course reduced by 22% to 51% at 2 and 4 weeks, respectively (P < 0.05) with increased survival (P < 0.05). Tumour tissue of MK-fed mice showed a downregulated Bcl-2 with increased Bax/Bcl-2 ratio, reduced PCNA, and activated caspase 3. Although more studies are ongoing to foster the clinical applicability of MK integrated within a rational chemopreventive and therapeutic strategy, a p53-mediated mechanism is likely to play a relevant role, besides its reported antioxidant capacity, NK cell activity enhancement, cancer-cytostatic activity properties.

Antimicrobial property of a herbal preparation containing Dalbergia sissoo and Datura tramonium with cow urine against pathogenic bacteria

In this study, a herbal preparation containing Dalbergia sissoo and Datura stramoium with cow urine (DSDS), was evaluated for its antibacterial potential against pathogenic strains of gram-positive (Staphylococcus aureus and Streptococcus pneumoniae) and gram-negative (Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae) bacteria. Antibacterial activity was compared to standard antibiotic drugs i.e. Chloramphenicol (30 mcg), Ampicillin (10 mcg), Nalidixic acid (10 mcg) and Rifampicin (30 mcg). Cow urine extract was found to be most active against both gram-positive as well as gram-negative bacteria. Clinical isolate of S. aureus showed higher sensitivity towards cow urine extract of DSDS than standard strains, and inhibited growth on most regulatory levels such as inhibition of protein, DNA, RNA and peptidoglycan synthesis. The results of the present study shows that the cow urine extract of DSDS may be used as a potent antiseptic preparation for prevention and treatment of chronic bacterial infections.

Dahi containing probiotic Lactobacillus acidophilus and Lactobacillus casei has a protective effect against Salmonella enteritidis infection in mice

Salmonella enteritidis infection has received attention during recent years owing to its high prevalence worldwide. In the present study, the protective effect of probiotic dahi (curd) supplemented with Lactobacillus acidophilus and L. casei against Salmonella enteritidis infection in mice is investigated. Seven days pre-feeding with probiotic dahi significantly increased anti-S. enteritidis sIgA (secretary IgA) antibodies and lymphocyte proliferation in S. enteritidis infected mice. IL-2, IL-6 and IFN-gamma production were significantly increased in supernatant of cultured splenocytes collected from mice pre-fed with probiotic dahi, while IL-4 levels were not changed significantly. Moreover, activities of beta-galactosidase and beta-glucuronidase, and counts of S. enteritidis in intestine, liver and spleen were decreased, whereas total lactobacilli in faeces were increased in mice pre-fed with probiotic dahi. Pre-feeding of probiotic dahi for 7 days was more effective than 2 days pre-feeding. Thus, the results indicate that, pre-feeding with probiotic dahi ameliorated S. enteritidis infection by stimulating specific and non-specific immune response. Above all, it lowered colonization of gastrointestinal tract as well as translocation of S. enteritidis.

Effect of modified alkaline supplementation on bone metabolic turnover in rats

This study aims to determine the effects of a high protein diet and alkaline supplementation on bone metabolic turnover in rats. Eight-week-old male Sprague-Dawley rats were investigated by bone status, including bone mineral density (BMD) and biomechanical markers from blood and urine. Thirty rats were randomly divided into three groups and treated for 8 weeks as follows: baseline control group (n. 10, C), high-protein supplemented diet group (n. 10, chronic acidosis, CA group) and supplemented chronic acidosis (n.10, SCA). Diet-treated rats were fed an acidic high-protein diet and the supplementation consisted in a modified alkaline formula (Basenpulver, NaMed, Italy). At the end of the experimental period, the rats were sacrificed, blood samples were drawn and femur and tibia were removed for analysis of bone mineral density (BMD) by dual energy X-ray absorptiometry (DEXA). In the CA group, 24-hour urinary calcium (Ca) and phosphorus (P) excretion were increased 2.1-fold (p<0.05 vs normal diet controls) as well as kidney weight. However, serum Ca and P concentration, as well as urinary Dpd excretion were not significantly changed. Femural and tibial BMD was significantly decreased in the CA group (p<0.05), but alkaline supplementation prevented such phenomenon (p<0.05 vs CA). These results suggest that blood Ca and P concentrations in chronic acidosis condition during the 12-week supplementation might be maintained by hypercalciuria and hyperphosphaturia at the expenses of bone structure. However, modified alkaline supplementation is able to prevent such derangements.

Assessing the development of children with disability in Malaysia

This is a cross-sectional study investigating the profile of children with disability registered with the primary health care clinics in Malaysia. The purpose of the study was to assess the developmental stage of children with disability. Secondary data from the pilot project conducted by the Family Health Development Division, Ministry of Health Malaysia was used in this study. The study period was for six months from 1st August 2004 until 31st January 2005. A total of 900 disabled children were selected in this study. Schedule of Growing Scale (SGS) II was used for analysis. Results showed more boys than girls were affected with a ratio of 6:4. The mean total SGS score increases as the age of the child increased. The score was highest in delayed speech cases and lowest in cerebral palsy cases. The performance among children with delayed speech was the highest while children with cerebral palsy were the lowest. There was a statistically significant difference between the major ethnic groups in delayed speech and attention deficit hyperactive disorder.

Reassessment on the development of children with disability in Malaysia

This is a cohort study investigating the profile of children with disability registered with the primary health care clinics in Malaysia. The purpose of the study was to determine whether reassessment on the development of children with disability under rehabilitation should be done at three months interval or six months interval. Secondary data from the pilot project conducted by the Family Health Development Division, Ministry of Health Malaysia was used in this study. The study was carried out for seven months from 1st August 2004 until 28th February 2005. A total of 168 disabled children followed up for six months were selected in this study. Schedule of Growing Scale (SGS) II was the tool used for analysis. Results showed a statistically significant difference in the mean total SGS score at six months interval but not at three months interval. The result suggests that reassessment on children with Down Syndrome, Autism, Cerebral Palsy, mental retardation and delayed speech under rehabilitation should be carried out every six months while children with gross developmental delay and slow learner might need a longer interval for reassessment.

Subjects with Impaired Glucose Tolerance Exhibit a High Degree of Tolerance to Honey

The present study compared the relative tolerance to honey and glucose of subjects with impaired glucose tolerance or mild diabetes. Thirty individuals 35-60 years old with a proven parental (mother or father) history of type II diabetes mellitus were subjected simultaneously to an oral glucose tolerance test (GTT) and a honey tolerance test (HTT). Glucose tolerance was found to be impaired in 24 subjects, while six of the subjects were diagnosed as mildly diabetic. All subjects with impaired glucose tolerance exhibited significantly lower plasma glucose concentrations after consumption of honey at all time points of the HTT in comparison to the GTT. The plasma glucose levels in response to honey peaked at 30-60 minutes and showed a rapid decline as compared to that to glucose. Significantly, the high degree of tolerance to honey was recorded in subjects with diabetes as well, indicating a lower glycemic index of honey. Thus, it is evident from the present investigation that honey may prove to be a valuable sugar substitute for subjects with impaired glucose tolerance or mild diabetes.

Community Residency Programme (CRP)--a tool for research and rural health training for medical students

Rural health training is an important element in the training of medical students in the University of Malaya. There is a need for the undergraduates to be familiar with the rural health infrastructure and to understand the social and economic aspects of the rural poor. The objective of the training is to make the students understand the problems faced by the poor in the rural areas so that when they practice in rural health areas, after graduation, they will understand the problems of the rural poor. They will have the knowledge of the diseases in the rural areas and also understand the community and the environmental factors that contribute to the disease. The training lasts' for 4 weeks, one week for lectures on health survey, two weeks for the field trip and one week of data analysis and presentation of their findings to an expert panel. During the field trip the students are divided into groups and they go to different parts of the country. Each group will do a field survey to find out the socio-demography, environmental, economic, nutritional and health problems in the village. In addition to the survey they also do a research project on any topic. The students also do social work, visit places of public health interest like the water treatment plant, sewage disposal, factory visits and others. Apart from technical skills in statistics and epidemiology, various other managerial skills like leadership, teamwork, communications and public relations are also learnt during the training. In conclusion this rural health training is an important aspect of the medical students training as it imparts several skills to them that are needed as a doctor.

Patient confidentiality, ethics and licensing in telemedicine

Telemedicine is fast becoming popular in many countries in the world. It has several advantages such as being cost saving and providing better access to health care in the remote areas in many parts of the world. However, it has some disadvantages as well. One of the major problems is the problem of patients' rights and confidentiality in the use of telemedicine. There are no standard guidelines and procedures in the practice of telemedicine as yet. Both the patient and the physician are unsure of the standard of practice and how to maintain confidentiality. The patient is uncertain as to how to protect her/his rights in the use of telemedicine. The issue of litigation is also unclear as to where the physician is practicing when he/she uses telemedicine. Is she/he practicing in the country where the patient is or is the physician practicing in the country of her/his origin? These issues need to be addressed urgently so that telemedicine will have standards of ethical practice and the patient's rights and confidentiality will be protected.

Teleprimary care in Malaysia: a tool for teleconsultation and distance learning in health care

Malaysia enjoys a comprehensive range of health services, the government being committed to the principles of universal access to high quality health care, which the Ministry of Health provides through a wide variety of nation wide network of clinics and hospitals. One of the major problems is the availability of comprehensiveness and quality of health care in remote health centres. When patients are transferred from the health centres to the hospitals for further treatment, this not only incurs inconvenience to the patients and their family but also increases the cost to the health care system. Teleprimary care is one of the tools to overcome this problem. The doctors in the remote clinics are able to discuss the problem cases through teleconsultation with the doctors and specialist in the hospitals using an audiovisual system to provide better care in the health centers without transferring the patients to the hospitals. Only the essential and needy patients are referred to the hospitals. This has not only reduced the number of patients referred to the hospitals but it has reduced the cost to the health care system. It has also provided a more comprehensive care to the patients in the health centres. The doctors in the health centers are also provided training and are also updated on the latest in medicine. This method of training has made doctors in the health centers more efficient and satisfied.

Breastfeeding practices among mothers in an urban polyclinic

A cross sectional descriptive study on breast feeding practices in an urban clinic was conducted among 136 mothers aged between 21-49 years who were interviewed using a questionnaire. Malays constituted 61% of the respondents, Chinese 22.8% and Indians 16.2%. Mojority of these were working mothers and although the initiation of breastfeeding was high (99.3%), exclusive breastfeeding was only 12.5%. A large proportion (33.8%) dtopped prior to 3 months. Majority of the Chinese mothers (61.3%) stipped before 3 months as compared to the Indian (40.9%) and Malay (21.7%) mothers (p<0.001). Mean age of introducing complementary foods at 3 months is below the accepted age of 4 to 6 months for weaning. Ever-breast feeding rate is high in this urban setting but more efforts are needed to effect a higher rate of exclusive breastfeeding and longer duration of breastfeeding.