Closure of Anal Fistula with Laser- FiLaC™: a Novel Sphincter-Saving Procedure for Complex Fistula In-Ano

There are several surgical options described for the treatment of anorectal fistulas, specially in complex cases where recurrence rates and the possibility of postoperative complications are still high. Laser- FiLaC™ has been described in this study as an option in the management of anorectal fistula. The aim of this study was to assess the novel radial laser probe treatment in complex fistula in-ano and report the success rate and recurrence rate. We studied retrospectively 56 patients who, according to our hospital patient records, underwent radial laser probe surgery between March 2019 and August 2020. In a mean follow-up time of 6 months, the success rate at 2 months was 86.0%. Most operations were done under spinal anesthesia. The recovery time was rapid and median sick leave was 7 days. Of those initially successfully treated, 3.0% developed a recurrence. Altogether 4.0% of the patients underwent a re-operation. There is a good success rate using FiLaC™ treatment. FiLaC™ is very effective in treatment of complex fistula and as well as recurrence of fistula. It has a short hospital stay and as well as it is painless surgical technique that should be largely used in our country.

Treatment of Pyoderma Gangrenosum With Mycophenolate and Hyperbaric Oxygen Therapy: A Case Report and Literature Review

Pyoderma gangrenosum is an uncommon inflammatory ulcerative skin disorder with an unclear etiology. In many cases, it is associated with several underlying systemic diseases, with inflammatory bowel disease being the most common one. Since it does not have any specific clinical or laboratory findings, it is a diagnosis of exclusion. A multidisciplinary approach is vital in treating pyoderma gangrenosum. Its recurrence remains common, and it also has an unpredictable prognosis. Here, we report a case report of pyoderma gangrenosum, which was successfully treated with mycophenolate and hyperbaric oxygen therapy.

P4988Beta-blockers in diabetes with stable coronary heart disease - a cause for concern?

Background

Beta-blocker (BB) therapy is a cornerstone for the treatment of coronary heart disease (CHD). The evidence of the benefit from long-term BB therapy in diabetic patients with stable CHD is scarce. This meta-analysis summarises the evidence relating to the BB therapy in diabetic patients with stable CHD.

Methods

A meta-analysis was performed according to PRISMA and MOOSE guidelines for reporting of systematic reviews of observational studies. PubMed, Embase, and Cochrane central were searched and two authors independently screened studies for eligibility. The quality of studies was assessed with the Newcastle Ottawa scale. The primary outcome of interest was all-cause mortality, cardiovascular (CV) mortality and major adverse cardiovascular events (MACE) in diabetic patients with and without BB therapy. A generic inverse variance model was used to pool the odds ratio or hazards ratio from included studies to calculate the overall effect estimate. The significance threshold was set at p-value <0.05. Heterogeneity was assessed by I2.

Results

Four non-randomized studies with 9,515 participants were selected for the analyses. Four studies were post-hoc analyses of randomised controlled trials, and 1 article was an analysis of a nationally representative survey. In a fixed effects model, BB therapy in diabetic patients with stable CHD was found to be associated with increased risk of CV mortality, and MACE (27%, and 32% respectively; p-value <0.05) and was not associated with a reduction in all-cause mortality (HR 1.12; 95% CI 0.94–1.33; p-value =0.22).

Conclusion

BB therapy in diabetic patients with stable CHD appears to be linked to higher mortality. Large randomised trials are needed in this population to confirm these findings.

Acknowledgement/Funding

None

Coenzyme Q10 ameliorates cadmium induced reproductive toxicity in male rats

This study aimed at investigating the protective role of CoQ10 against cadmium (Cd)-induced reproductive toxicity in male rats. Adult male Wistar rats were exposed to an acute dose of Cd (25 mg/kg bwt; Cd group), Cd+CoQ10 (25 mg/kg bwt Cd+10 mg CoQ10; Cd-Q10 group) and distilled water (control) in vivo for 15 consecutive days and semen quality was assessed. A significant reduction was noted in sperm concentration, progressive motility, morphology and DNA integrity in both Cd- and Cd-Q10 groups in comparison to control indicating Cd-induced testicular lipid per oxidation (LPO) and decline in indigenous antioxidant defense system as measured by total antioxidant capacity (TAC) (p<0.05). However, simultaneous co-administration of CoQ10 along with Cd (Cd-Q10 group) was able to improve sperm concentration, motility, progressive motility, morphology, DNA integrity, and testicular TAC as well as lower LPO compared to Cd group (p<0.05). Results indicate that used dose of CoQ10 is capable of moderately ameliorating reproductive toxicity of Cd by improving semen quality and reducing testicular oxidative stress.

A multidisciplinary approach for teaching systems-based practice to internal medicine residents

BACKGROUND

Rapid growth in the complexity of the health care environment (including monitoring systems for health care quality and patient safety) may result in graduating internists not being adequately prepared for the demands the system places on them. In response, the Residency Review Committee for Internal Medicine created the Educational Innovations Project (EIP) to encourage select residency training programs to develop new strategies and methods to meet changing demands in graduate medical education.

METHODS

As part of the EIP, our program created an innovative administrative internship. This multiyear curriculum provides systems-based practice training and consists of a series of rotations that take place during the 3 years of internal medicine residency. Each session involves close interaction with the nonphysician personnel who are instrumental in making our institution a functional and cohesive unit. To assess the potential impact of the rotations, we survey senior residents, recent graduates, and faculty educators. In conjunction with the Performance and Patient Experience departments of the hospital, we track several systems-based practice metrics for residents, including compliance with core health care measures, length of stay, and patient satisfaction.

RESULTS

Residents recognize the need to develop systems-based practice skills, to readily participate in structured curricula designed to enhance such skills, and to provide leadership in organizing and publishing quality improvement initiatives, and upon graduation, they may lament that they did not receive even more vigorous training in these areas.

CONCLUSION

Although internal medicine residencies continue to improve their training in systems-based practice, our experience suggests that an even greater emphasis on these skills may be warranted.

HIV, hepatitis B and C infection status of the blood donors in a blood bank of a tertiary health care centre of Orissa

A record based retrospective study was conducted at the blood bank of SCB Medical College, Cuttack. All the donors who had donated blood from June to December 2005 were considered. 91.7%of the donors were males and majority belonged to 21-30 years age group. 1.98% of the donors were positive for hepatitis C, 1.13% for hepatitis B and 0.35% for HIV. For HBV infection, majority belonged to 31-40 years age group. But for HCV and HIV infection more were in the 21-30 year age group. Significantly more number of exchange donors was positive for HBV and HCV in comparison to voluntary donors in blood bank and camp. No voluntary donors from the camp were HIV positive.

Group symmetries in two-body random matrix ensembles generating order out of complexity

The two-body random matrix ensembles with spin TBRE-s and in a single j shell TBRE-j introduced recently in the context of ground state structures in complex interacting particle systems, possess U(N) superset U(N/2)multiply sign in circle SU(2) and U(N)superset O(3) group symmetries, respectively, with N the number of single particle states. It is shown that both these group symmetries give rise to simplicities in the ground state structures but in different ways.

Synthesis and SAR studies of 1-substituted-n-(4-alkoxycarbonylpiperidin-1-yl)alkanes as potent antiarrhythmic agents

Synthesis and SAR studies of the title compounds have resulted in the identification of structural and physicochemical parameter (Vw) contributing for antiarrhythmic activity. Among the two most promising compounds 3a & 3b, the 3a has shown antiarrhythmic activity comparable to quinidine.

Folic acid the essential supplement to brain heart infusion broth for cultivation and cloning of Leishmania donovani promastigotes

Multiplication of virulent and avirulent Leishmania donovani promastigotes was inhibited by brain heart infusion broth (BHI) (3.7%) supplemented with haemolysed or whole blood (2.5-10%) or heat-inactivated foetal bovine serum (HIFBS) (10-20%). Peptone, glutamine, tryptophan, purine bases, ribonucleosides, deoxyribonucleosides, B-vitamins and vitamin C were evaluated for the reversal of this growth inhibition. Supplementation of BHI with folic acid further supplemented with haemolysed rabbit blood or HIFBS and haemin supported propagation in serial subpassages of 2 primary isolates and 3 other virulent strains of L. donovani and 1 strain of L. major. Folic acid supplemented BHI with 3% rabbit blood in solid phase with 0.7% agar also supported the colony formation of L. donovani. This manuscript documents the development of high efficiency media for the cultivation of L. donovani promastigotes in liquid phase and as colonies on agar plates using BHI as a basal medium.

Serodiagnosis of leishmaniasis

Leishmaniasis is a spectrum of diseases ranging in severity from cutaneous (CL), post-kala-azar dermal (PKDL), and diffuse cutaneous (DCL) to mucocutaneous (MCL) and visceral (VL) infections that are endemic in 86 tropical and subtropical countries around the world, accounting for 75,000 deaths per year. Different forms of leishmaniases are generally caused by different distinct species of Leishmania having a digenetic life cycle alternating between an aflagellated amastigote form replicative within the macrophages of the host and a flagellated promastigote form that multiplies within the gut of the sandfly. VL, MCL, PKDL, DCL, and CL forms of the disease can be arranged on a priority basis in accordance with the humoral immune responses of host. Generally, the cell-mediated immunity, particularly the delayed-type hypersensitivity to leishmanial antigens, is associated with CL, MCL, PKDL, and cured VL cases. The serodiagnosis of leishmaniasis appears to be an alternative to parasite detection in biopsy samples either by the staining of amastigotes or by culturing the amastigotes, which transform to a promastigote form and replicate. A battery of immunological procedures have been developed or adapted to demonstrate either humoral or cell-mediated immune responses against Leishmania for diagnosis and epidemiological survey. The sensitivity and specificity of such diagnostic methods depend on the type, source, and purity of antigen employed, as some of the leishmanial antigens have common cross-reactive epitopes shared with other microorganisms, particularly Trypanosoma, Mycobacteria, Plasmodia, and Schistosoma. Serodiagnostic techniques for the detection of antileishmanial antibodies have been employed with about 72 to 100, 23 to 90, 83, and 33 to 100% success in VL, CL, MCL, and PKDL patients, respectively. The Leishmanin skin test (LST) is useful to detect MCL and CL, with about 100 and 84% success, respectively. In PKDL, the gradual fall of antileishmanial antibody titer to some extent and the rise of delayed hypersensitivity to the parasite antigen are the characteristic features associated with the chronicity of the disease. The use of whole promastigote as the source of antigens in the direct agglutination test (DAT) and immunofluorescent test (IFAT) gave cross-reactions with the sera of leprosy, tuberculosis, and African trypanosomiasis patients. Again, the use of cell-free extracts of promastigotes generally gave false positive results with the sera of normal human and Chagas' disease, leprosy, tuberculosis, and malaria patients in enzyme-linked immunosorbent assay (ELISA), dot ELISA, immunodiffusion, immunoelectrophoresis, and counter-current immunoelectrophoresis tests.(ABSTRACT TRUNCATED AT 400 WORDS)

Experimental visceral leishmaniasis: role of trans-aconitic acid in combined chemotherapy

We previously reported the effectiveness of trans-aconitic acid (TAA) as an antileishmanial compound. Inhibitory effects of TAA along with other antileishmanial compounds on transformation and in vitro multiplication in macrophage cultures of Leishmania donovani have been assessed. The efficacy of TAA in combined chemotherapy of experimental visceral leishmaniasis has also been evaluated along with those of commonly used antileishmanial compounds such as sodium stibogluconate, pentamidine, and allopurinol. TAA (2 mM) inhibited transformation of L. donovani amastigotes to promastigotes by 95.2%, whereas in combination with pentamidine (5 micrograms/ml), allopurinol (10 micrograms/ml), and sodium stibogluconate (50 micrograms of Sb per ml), it inhibited transformation by about 100, 99, and 98.5%, respectively. Sodium stibogluconate (20 micrograms of Sb per ml), pentamidine (2 micrograms/ml), and allopurinol (5 micrograms/ml) suppressed the amastigote burden in peritoneal macrophage cultures from BALB/c mice by 32.6, 56.1, and 46.3%, respectively. When these three drugs were used along with TAA (5 mM), the parasite loads were reduced by 100, 100, and 88.1%, respectively. TAA (5 mM) alone suppressed the amastigote burden by 59.5%. In experimental visceral leishmaniasis in hamsters (1-month model), TAA at a dose of 200 mg/kg of body weight per day suppressed the spleen parasite load by 73.5%, and TAA in combination with sodium stibogluconate (50 mg of Sb per kg per day), pentamidine (8 mg/kg/day), and allopurinol (15 mg/kg/day) inhibited the spleen parasite load by 98, 98.9, and 97%, respectively. Individually, these three drugs inhibited the parasite load by 35, 20, and 22%, respectively. TAA (400 mg/kg/day) inhibited the spleen parasite load by 99.8%, but an inhibitory effect of approximately 100% was noted when TAA was supplemented with an antileishmanial drug. TAA was administered in experimental animals through oral, intraperitoneal, and intramuscular routes; the intramuscular route was most effective.

Biochemical and immunological characterization of exometabolites from an Indian strain of Leishmania donovani promastigotes grown in a chemically defined medium

Exometabolites (EXOM) of an Indian strain of Leishmania donovani promastigotes isolated from a chemically defined medium by ultrafiltration consisted of proteins, glycoproteins, lipid and lipophosphopolysaccharide (LPPS). LPPS of Mr 40-28 kDa in SDS-PAGE could be labelled metabolically with [32P]-phosphate and recovered in the aqueous phase of hot-phenol-water extraction of EXOM (PE-Aq) along with a glycoprotein of Mr 150-130 kDa (GP150-130). These two molecules could be eluted from DE-52 column with 200 mM NaCl (D2). The 300 mM NaCl (D3) and 400 mM NaCl (D4) eluates from DE-52 column contained one unsaturated polar lipid component. The LPPS had Rf value of 0.65-0.75 in Thin Layer Chromatography (TLC) using saturated phenol water solvent system. EXOM revealed 15 bands in SDS-PAGE of which proteins of Mr 84, 66, 56, 50 and 29 kDa were prominent. When EXOM were fractionated through Con A-Sepharose column, the fraction eluted with alpha-methyl-D-mannoside (Con A-E) had seven bands as revealed by SDS-PAGE of which 25, 16, 13 and 12 kDa glycoproteins were prominent. The antigens present in EXOM can be classified as slower anodic migrating and faster anodic migrating antigens as revealed by immunoelectrophoresis (IEP). The slower anodic migrating antigens, LPPS and GP150-130 recovered in PE-Aq and D2 did not cross-react with kala-azar patients' sera but cross-reacted with homologous anti-promastigote sera. Two faster anodic migrating antigens which could be recovered in organic phase of hot phenol extraction of EXOM (PE-O) and eluted in D3 and D4 and Con A-E, cross-reacted with kala-azar patients' sera. The antigens of both the classes were sensitive to periodic acid oxidation.

Leishmania donovani: a chemically defined medium suitable for cultivation and cloning of promastigotes and transformation of amastigotes to to promastigotes

A chemically defined medium using commercially available alpha-MEM supplemented with hemin, HEPES, L-glutamine, D-glucose, folic acid, D-biotin and adenine supports the luxuriant growth and propagation of Leishmania donovani promastigotes. A peak parasite population of about 7.0 x 10(7)/ml at stationary phase and a population doubling time of 11.4 h for high-subpassage promastigotes were obtained. The medium was suitable for transformation of isolated amastigotes from infected hamster spleen. Promastigotes could be detected by culturing kala-azar patients' bone-marrow aspirate or spleen puncture material in this medium. Four out of six freshly transformed isolates gradually adapted and grew well in this medium. Macroscopic colonies appeared on agar plates prepared with the medium within 16-20 days after inoculation. The cloning efficiency was increased about five-fold by glycerol supplementation.

Effect of alpha-adrenergic receptor blockers on the vulnerability of cat heart to ventricular fibrillation

Recently, alpha-adrenergic receptors have been implicated in the precipitation of arrhythmias associated with myocardial ischemia and reperfusion. The present investigation has been undertaken to study the effect of alpha-adrenoceptor antagonists on electrically induced ventricular fibrillation. The effect of ventricular fibrillation on the alpha-adrenergic receptor population in myocardium and its modification by phentolamine pretreatment has also been investigated. Phentolamine and prazosin raised the ventricular fibrillation threshold significantly. However, yohimbine was protective at high doses only (3 and 5 mg/kg). There was no change in alpha-receptor population and affinity after ventricular fibrillation. Cyclic AMP levels increased in the fibrillating myocardium. Pretreatment with phentolamine did not prevent the decrease in blood flow observed after electrically induced ventricular fibrillation. It is concluded that alpha 1-adrenergic receptor blockade is protective against ventricular fibrillation in cats.

Ultrastructural changes in the neural lobe of the rat pituitary following nicotine pretreatment

The effect of nicotine on the ultrastructural changes and hormone contents of the neural lobe of the pituitary were studied in the rat. Nicotine caused a significant release of both vasopressin and oxytocin from the neural lobe. The examination of the neural lobe with electron microscope reveals the nerve terminals depleted of neurosecretory granules. These results suggest that a definite correlation exists between hormone contents and ultrastructural morphology.

Effect of antiarrhythmic drugs on serum free fatty acid levels during experimental cardiac arrhythmias in the cat

The level of free fatty acid (FFA) in serum has been estimated before and after ventricular fibrillation (VF) induced by electrical stimulation, intravenous administration of ouabain, aconitine or ligation of the left anterior descending branch of coronary artery. FFA contents were found to be significantly increased after VF. Quinidine, disopyramide, lidocaine and phenoxybenzamine, when administered intravenously 30 min before electrical stimulation (E.S.), have no effect on serum FFA contents by themselves. All the antiarrhythmic drugs except phenoxybenzamine prevent the rise in FFA contents normally observed after VF. These drugs in appropriate doses also protect the animals against VF upto 100 volts. Propranolol did not provide protection against VF but prevented increase in FFA levels. Verapamil neither showed any protection against VF nor blocked the elevation of FFA after E.S. These results indicate that most of the antiarrhythmic drugs which are effective against the precipitation of VF by E.S. block the increase in serum FFA levels.

Supra spinal influence on ventricular fibrillation threshold and cardiac stores of norepinephrine in the cat

The relationship between ventricular fibrillation threshold (VFT) as measured by voltage required to evoke ventricular fibrillation and the concentration of norepinephrine (NE) in different parts of the myocardium under experimental interventions has been studied in anaesthetized cats. A selective increase in VFT and a marked reduction in NE content have been observed after spinal transection, removal of spinal cord from cervical 6 to thoracic 6 or carotid sinus denervation. Reserpine pretreatment significantly reduces NE content of myocardium but fails to affect VFT. The fibrillating left ventricle shows a marked decline in NE content from the control level of 1.55 +/- 0.32 to 0.82 +/- 0.09 micrograms/g and there is also a similar concomitant reduction in NE content of the entire heart. Defibrillation brings back normal rhythm, but does not restore the NE content immediately. The results suggest that a marked reduction in cardiac stores of norepinephrine significantly affect VFT and that the central nervous system plays an important role in the genesis of sustained ventricular arrhythmia.

UDP-glucose 4-epimerase from Saccharomyces fragilis. Involvement of sulfhydryl group(s) at the active site

UDPglucose-4-epimerase (EC 5.1.3.2) from Saccharomyces fragilis is inactivated by 0.1 mM 5,5'-dithiobis-(2-nitrobenzoate) in 6 min. Unlike p-chloromercuribenzoate-inactivated or heat-inactivated enzymes, the dithiobisnitrobenzoate-inactivated enzyme retains the dimeric structure and NAD is not dissociated from the protein moiety. Inactivation of the enzyme by dithiobisnitrobenzoate can not therefore be attributed to any subsequent loss of structural integrity or to the detachment of the cofactor from the apoenzyme. The inactivated enzyme can be almost fully reactivated in the presence of mercaptoethanol and characteristic properties of native enzyme are regained. The inactivation by dithiobisnitrobenzoate can be substantially protected by UDPglucose or UDPgalactose indicating a possible critical involvement of one or more sulfhydryl groups at the active site.

Spasmolytic constituents of Cedrus deodara (Roxb.) Loud: pharmacological evaluation of himachalol

Himachalol has been identified as the major antispasmodic constituent in the wood of Cedrus deodara. The pharmacological studies of himachalol on various isolated smooth muscles (guinea pig ileum, rabbit jejunum, rat uterus, and guinea pig seminal vesicle) and against different agonists (acetylcholine, histamine, serotonin, nicotine, and barium chloride) indicated spasmolytic activity similar to that of papaverine. It was a more potent antagonist of barium chloride-induced spasm of guinea pig ileum than papaverine but less effective in reverting a similar spasm of rabbit jejunum and had no relaxing effect alone. In the conscious immobilized cat, intragastric administration of himachalol or papaverine (100 mg/kg) produced equal inhibition of carbachol-induced spasm of the intestine, lasting about 2 hr, but himachalol had a faster onset of action. Himachalol was devoid of spasmolytic effect on the bronchial musculature of guinea pig but was 3.3 times more potent than papaverine in antagonizing epinephrine-induced contraction of the guinea pig seminal vesicle. Intravenous injection of himachalol (3-10 mg/kg) in the cat produced a dose-dependent fall in blood pressure and an increased femoral blood flow.