Skin Biopsy as a Diagnostic Tool for Synucleinopathies

Studies published in the last decade identified skin biopsies as a promising source of material for detecting alpha-synuclein (αSN). Alpha-synuclein gets deposited in the skin of patients with synucleinopathies, and therefore, a skin biopsy can be used to diagnose and confirm these diseases histopathologically. A skin biopsy can also be helpful for studies focusing on the nature of αSN deposits. The most important aspects of a biomarker are sensitivity, specificity, and technical feasibility. The potential for a skin biopsy to become the clinical tool of choice as a reliable biomarker for diagnosing synucleinopathies appears to be high, with consistently high sensitivity (>80%) and specificity approaching 100%. The review aims to provide an overview of the factors impacting skin biopsy's sensitivity, specificity, and feasibility in detecting dermal αSN deposits.

Estimation of genetic components, heterosis and combining ability of elite Pakistani wheat varieties for yield attributing traits and stripe rust response

Wheat (Triticum aestivum L.) is a staple food and major source of dietary calories in Pakistan. Improving wheat varieties with higher grain yield and disease resistance is a prime objective. The knowledge of genetic behaviour of germplasm is key. To achieve this objective, elite wheat varieties were crossed in 4 by 3, line × tester design, and tested in 2019 in a triplicate yield trial to estimate genetic variance, general and specific combining ability, mid-parent heterosis and stripe rust (Puccinia striiformis L.). High grain 3358 kg·ha-1 was recorded in F1 hybrid (ZRG-79 × PAK-13). Analysis of variance (ANOVA) revealed significant genotypic variance in grain yield. Broad sense heritability (H2) was recorded in the range of 28 to 100 %. General combining ability (GCA) significant for grain yield in parents except FSD-08 and PS-05 was recorded, while specific combining ability (SCA) was recorded to be highly significant for grain yield only in two crosses (ZRG-79 × NR-09 and ZRG-79 × PAK-13). Mid-parent heterosis was estimated in the range of -28 to 62.6 %. Cross combinations ZRG-79 × PAK-13 depicted highly significant mid-parent heterosis (62.6 %). Highly significant correlation was observed among spike length, spikelets per spike, plant height and 1000-grain weight. Rust resistance index was recorded in the range of 0 to 8.5. These findings suggest exploitation of GCA for higher grain yield is important due to the presence of additive gene action and selection in the filial generations will be effective with improved rust resistance, while cross combinations ZRG-79 × PAK-13 high GCA are best suited for hybrid development.

An Overview of Ascariasis Involvement in Gallbladder Disease: A Systematic Review of Case Reports

Ascaris lumbricoides is the most common type of helminth infection in humans. It affects more than one billion of the world's population. Children living in developing nations are prone to ascariasis, presenting with obstructive biliary illnesses. Migration of Ascaris worms through the major duodenal papilla to the hepatobiliary system leads to symptoms of biliary colic and complications along the biliary tree. In April 2022, we performed a systematic review of case reports to identify and examine cases of gallbladder ascariasis worldwide. A methodical search using PubMed, Semantic Scholar, ScienceDirect, and Directory of Open Access Journals yielded 2773 studies. After duplicate removal, title, abstract, and content screening, retrieval, and quality assessment, 13 studies met the criteria for this systematic review of case reports. The cases and results from these 13 studies revealed gallbladder ascariasis in different age groups worldwide. This systematic review discusses ascariasis, explicitly highlighting its presence in the gallbladder, symptomatic presentation, laboratory/imaging findings, complications, and approach to management.

Elements That Influence the Development of Attention Deficit Hyperactivity Disorder (ADHD) in Children

Various factors may have a role in the development of attention deficit hyperactivity disorder (ADHD). Although the specific pathophysiology of this disease is still not entirely understood, it is believed to be caused by a mix of genetic, maternal, dietary, and environmental factors. The effect of these factors can determine the severity of ADHD; for example, some of them are dose-dependent, but there is a typical pattern that all are known to be associated with either early childhood exposure or maternal exposure during pregnancy. Some factors share a similar mechanism of affecting pathways and increasing the risk of ADHD. ADHD is not a disorder that can be detected before symptoms appear in a child, making it more challenging to anticipate even if a child has been exposed to a known trigger. Environmental pollutants were investigated, and it was shown that there was a link between ADHD in childhood and exposure to pollutants throughout childhood or during pregnancy. It is well known that maternal health is a significant factor in the unborn child's development in many health aspects. The central nervous system (CNS) is a primary system that can suffer irreversible damage from health conditions, stress, depression, or specific nutritional deficiency when the pregnant mother is subjected to these conditions. Even though numerous studies have been conducted to investigate the probable causes of ADHD, with some of them having robust findings, no conclusive explanation can be provided to identify a definitive cause or a risk factor.

Effect of Thyroxine and Thyrotropin on Bone Mineral Density in Postmenopausal Women: A Systematic Review

The effect of thyroid hormones on bone mineral density in postmenopausal women has been reported but is not completely established. To better understand this relationship, this systematic review of the reported association, differences, and effects of thyroxine and/or thyrotropin levels on bone mineral density was conducted. An electronic literature search was conducted on MEDLINE, PMC, Google Scholar, Cochrane Library, and Science Direct from inception to April 2022; 20 studies were identified which include five quasi-experimental studies, three community cohort studies, and 12 hospital-based cross-sectional studies. Following an extensive evaluation, it was difficult to conclusively determine the association or effect of thyroxine or thyrotropin levels on bone mineral density in postmenopausal women. It is therefore suggested to conduct additional non-randomized or randomized control studies on this topic for the benefit of postmenopausal women. Particular attention should be given to the adjustment of age, body mass index, smoking status, alcohol consumption, and dietary calcium in future research on this topic for rigorous analysis.

The Role of Type 2 Diabetes in Pancreatic Cancer

The incidence of type 2 diabetes mellitus (T2DM) and its potential complications, such as cancers, are increasing worldwide at an astounding rate. There are many factors such as obesity, diabetes, alcohol consumption, and the adoption of sedentary lifestyles that are driving pancreatic cancer (PC) to become one of the leading causes of cancer mortality in the United States. PC is notorious for its generic symptoms and late-stage presentation with rapid metastasis. The connection between T2DM and the risk of PC development is multifaceted and complex. Some of the proposed theories reveal that chronic inflammation, insulin resistance, hyperinsulinemia, hyperglycemia, and abnormalities in the insulin and insulin-like growth factor axis (IGF) contribute to the disease association between these two conditions. This literature review aims to highlight relevant studies and explore the molecular mechanisms involved in the etiology of diabetes and its impact on PC development, as well as the role of anti-diabetic agents on PC. Despite extensive studies, the exact interaction between T2DM and PC remains obscure and will need further investigation. According to current knowledge, there is a substantial link between diabetes, obesity, and dietary patterns in the development and progression of PC. Consequently, focusing our efforts on preventive measures by reducing modifiable risk factors remains the most effective strategy to reduce the risk of PC at this time. Antidiabetic drugs can have various effects on the occurrence and prognosis of PC with metformin offering a clear benefit of inhibiting PC and insulin increasing the risk of PC. The development of future novel therapies will require a deeper knowledge of the triggering mechanisms and interplay between these two disease states.

Recognizing Histopathological Simulators of Melanoma to Avoid Misdiagnosis

Melanocytic lesions have a wide morphological spectrum, ranging from benign nevi to malignant melanoma. In contrast to a diagnosis of a benign nevus, a diagnosis of melanoma could mean intensive treatment, lifetime monitoring, and a worse prognosis. Therefore, melanocytic tumors are notoriously challenging and associated with a high risk of litigation in surgical pathology. After describing the basic features of nevi and melanoma, this article describes the detailed clinical and histological features of those lesions that share many similar features with melanoma. The entities included are Spitz nevi and atypical Spitz tumors (AST), Reed nevus, dysplastic nevus, cellular blue nevus (CBN), deep penetrating nevus, combined nevus, recurrent nevus, irritated nevus, congenital pattern nevus, acral nevus, and nevi of special sites. Knowledge of these imitators can help pathologists distinguish between benign and malignant cases and avoid misdiagnosis.

A Systematic Review of Maternal Serum Syndecan-1 and Preeclampsia

Exploration of novel biomarkers has been gaining popularity in preeclampsia, which is currently being diagnosed based on clinical criteria alone. Soluble syndecan-1, released from one of the proteoglycans associated with the syncytiotrophoblastic layer of the placenta, is affected in patients with abnormal placentation. This article is the first systematic literature review that evaluates the relationship between the antepartum serum levels of the syndecan-1 and preeclampsia. Eight studies were selected after screening and quality appraisal, and data were analyzed. The serum concentration of syndecan-1 was found to correlate positively with the gestational age in all pregnancies and negatively with the systolic blood pressure in patients with preeclampsia. Extremely low levels of soluble syndecan-1 may be helpful as a predictor for the development of preeclampsia during gestation.

Are There Any Cardioprotective Effects or Safety Concerns of Erythropoietin in Patients With Myocardial Infarction? A Systematic Review

Myocardial infarction (MI) is a global cause of morbidity and mortality. MI is the outcome of a chronic process termed atherosclerosis, a buildup of fatty and other substances called plaques inside the coronary vessels, causing hardening and thickening of the arterial wall. Erythropoietin (EPO) is a pleiotropic cytokine released mainly by the kidneys in adults. Besides its well-known erythropoietic functions, EPO possesses anti-apoptotic, mitogenic, and angiogenic effects. This review aims to analyze the strength of any therapeutic or protective value of EPO on the heart and safety concerns regarding its administration in MI individuals.

This systematic review was performed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Four databases (PubMed, PubMed Central, Google Scholar, and Sciences Direct) were employed to search for articles published in the last 10 years. Focused studies were relevant articles in the English language, trials, reviews, meta-analyses, and studies with a control group. Following the quality assessment process, nine studies were eligible and hence were included in the review consisting of six randomized controlled trials and three systematic reviews and meta-analyses. Contrary to preclinical studies, EPO administration did not significantly have notable effects on mortality, major adverse cardiovascular events, or infarction size reduction. Significant left ventricle ejection fraction amelioration was not appreciated either. However, EPO seems to reduce the incidence of post-MI arrhythmias.

Exercise Prescription and the Minimum Dose for Bone Remodeling Needed to Prevent Osteoporosis in Postmenopausal Women: A Systematic Review

The aim of this review is to analyze previously conducted randomized controlled trials and investigate the relationship between various exercise regimes and their effect on bone mineral density in postmenopausal women. To determine whether exercise can be used as a non-pharmacological modality for osteoporosis prevention, a thorough search was performed on various databases (PubMed, ScienceDirect, and Google Scholar). Only bone mineral density studies and trials with intervention versus control groups were included, and 13 randomized controlled trials were deemed relevant. The majority of trials concluded that exercise positively impacted bone mineral density in postmenopausal women. High-impact exercises seem to have the most significant effect on bone mineral density due to compression, shear stress, and high loading on the bone, causing bone remodeling. Considering all the limitations, exercise seems to be an effective tool for preventing postmenopausal osteoporosis.

Piloting opportunistic cardiovascular risk assessment at a faith community event

Funding Acknowledgements

Type of funding sources: None.

Background

Ethnic minority populations in the United Kingdom (UK) are known to have higher rates of undiagnosed and poorly controlled hypertension and metabolic disease (1). Muslims in the UK make up a significant proportion of these populations, and have lower reported rates of well-being and satisfaction with health services (2). Tailoring interventions to target under-served populations and activate positive health behaviours has been shown to improve uptake and outcomes (3).

Purpose

We undertook an opportunistic pilot intervention to explore the potential of using faith-placed community assets to identify undiagnosed and poorly managed cases of hypertension, diabetes, and explore cardiovascular disease (CVD) risk.

Methods

A community event was organised for Indian-origin Tamil speaking Muslims who gathered from across the UK in November 2021. We piloted a short CVD risk assessment intervention to take place during this event, delivered by doctors from the same community. Participants consented for assessment of body mass index (BMI), blood pressure (BP), random capillary blood glucose (CBG), and manual pulse rhythm check (with a commercially available smartphone based single-lead electrocardiogram device where needed). We also calculated the 10-year CVD risk using a nationally validated 10-year CVD risk calculator. The intervention was culturally tailored, specifically with men and women examined by the same sex and participants being given an Islamic reminder on good health to encourage their involvement.

Results

35 attendees were assessed in total. 33/35 (94%) attendees were 60-years-old or less. 18/35 (51%) had an elevated blood pressure reading (systolic BP ≥ 140mmHg or diastolic BP ≥ 90mmHg on both arms), with only 3/18 (17%) having a prior diagnosis of hypertension. Only 17/35 consented to CBG measurement, of which 4/17 (23%) had random CBG levels of >11.1 mmol/L with 3/17 having CBG levels of >25 mmol/L - none of them were known to have diabetes. 9/35 (26%) had 10-year CVD risk of >10%. 6/9 (67%) of these were not on statin therapy. 24/35 (69%) had elevated BMI, with 9/24 (37%) having a BMI of ≥ 30 kg/m2. None of the attendees had an irregular pulse to suggest arrhythmia. Full characteristics are shown in Figure 1 and results are further detailed in Figure 2. In Summary, 29/35 (83%) had at least one abnormal finding on assessment. All participants with abnormal findings were signposted to seek formal diagnosis and management through their general practitioner, and were offered lifestyle advice.

Conclusions

This brief and targeted intervention was successful at detecting undiagnosed cases of probable hypertension and hyperglycaemia, as well as identifying cases who would benefit from primary CVD risk prevention. Further research is needed to understand the scalability and feasibility of this approach to wider populations.

Skin Prick Test Reactivity to Common Aeroallergens among Allergic Rhinitis Patients

OBJECTIVE

To identify the common aeroallergens causing allergy symptoms among the allergic rhinitis patients.

STUDY DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Department of Immunology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from January to July 2016.

METHODOLOGY

Patients with a clinical diagnosis of allergic rhinitis were enrolled. Skin Prick Test (SPT) was performed on these patients using 12 common aeroallergens along with positive (histamine hydrochloride, 10 mg/ml) and negative (glycerin saline) controls. Results were recorded after 15 minutes, considering a wheal diameter >3 mm as positive. Chi-square test was used to compare frequencies; and p-value of less than 0.05 was considered significant.

RESULTS

Out of 130 patients, 78 (60%) were males and 52 (40%) were females. The rate of sensitization to any allergen was 90%. One hundred and two (78%) were poly-sensitized to more than two allergens and 20% were sensitized to more than six allergens. Most common outdoor and indoor allergens were Broussonetia papyrifera (50.7%) and Dermatophagoides farina (42.3%), respectively. Dog epithelia and aspergillus were the least prevalent allergens (13.8% each).

CONCLUSION

This study highlighted an increased overall frequency of sensitization to any allergen and significance of tree and weed allergens; especially, Broussonetia papyrifera and Cannabis sativa. It also emphasized increased prevalence of skin reactivity to indoor allergen, Dermatophagoides farina in the city.

Patient reported evaluation of functional symptoms (PREFS): a simple method of ascertaining patient satisfaction post cataract surgery

No abstract available.DOI: http://dx.doi.org/10.3126/nepjoph.v4i2.6562 Nepal J Ophthalmol 2012; 4 (2): 346-347  

Bilateral pneumothoraces treated with a single chest drain

Resolution of bilateral pneumothoraces with a single chest drain is seldom seen in clinical practice. A 76-year-old man underwent coronary artery bypass grafting following which he developed bilateral pneumothoraces.