Virgin coconut oil - its methods of extraction, properties and clinical usage: a review

Abstract

Virgin coconut oil (VCO) is a processed edible oil, which is removed from the mature coconuts. It is a colourless water insoluble liquid and obtained by the hot and cold extraction processes. The nutritional components of VCO are mainly contributed to by lauric acid, its primary content. VCO has shown its anticancer, antimicrobial, analgesic, antipyretic and antiinflammatory properties. Because of these medicinal properties, VCO has gained the wider attention among the medical field. Most evidently VCO has shown its potential antioxidant property, because of its phenolic compounds and medium chain fatty acids. It is one of the beneficial compounds used to prevent and treat the oxidative stress induced neurological disorders like stress, depression and Alzheimer's disease. Dietary supplementation of VCO is easy and economical and safer in daily life among all age groups. It is also beneficial for the cardiovascular, respiratory, dermatological, reproductive and bone health. It can also be applied to the skin as a moisturizer in the paediatric age group. Hence, exploration of antioxidant property as well as other beneficial effects of VCO in various health conditions will be valuable.

Impact of artificial intelligence on the diagnosis, treatment and prognosis of endometrial cancer

Endometrial cancer is one of the most prevalent tumours in females and holds an 83% survival rate within 5 years of diagnosis. Hypoestrogenism is a major risk factor for the development of endometrial carcinoma (EC) therefore two major types are derived, type 1 being oestrogen-dependent and type 2 being oestrogen independent. Surgery, chemotherapeutic drugs, and radiation therapy are only a few of the treatment options for EC. Treatment of gynaecologic malignancies greatly depends on diagnosis or prognostic prediction. Diagnostic imaging data and clinical course prediction are the two core pillars of artificial intelligence (AI) applications. One of the most popular imaging techniques for spotting preoperative endometrial cancer is MRI, although this technique can only produce qualitative data. When used to classify patients, AI improves the effectiveness of visual feature extraction. In general, AI has the potential to enhance the precision and effectiveness of endometrial cancer diagnosis and therapy. This review aims to highlight the current status of applications of AI in endometrial cancer and provide a comprehensive understanding of how recent advancements in AI have assisted clinicians in making better diagnosis and improving prognosis of endometrial cancer. Still, additional study is required to comprehend its strengths and limits fully.

Outcome measures of the surgery first approach for orthognathic correction of dentofacial deformities

In the surgery-first approach (SFA), orthognathic surgery is performed without the need for presurgical orthodontic treatment. This study was aimed at assessing the treatment durations and occlusal outcomes for a consecutive cohort of patients, with a range of dentofacial deformities, who had completed orthognathic treatment using SFA. The duration of orthognathic treatment was measured. The overall change in occlusion, and the quality of the final occlusion, were evaluated using the patients' study casts. A single, independent, calibrated operator carried out the occlusal scores, using the validated Peer Assessment Rating (PAR) index. This was repeated to test intraoperator reliability. A total of 51 patients completed surgery-first treatment during the study period. The mean (range) age at surgery was 23.3 (15-47) years. The pre-treatment skeletal jaw relationship was Class III in 39 cases, and Class II in 12 cases. The mean (SD) overall treatment duration was 11.7 (5.7) months. The intraexaminer reliability of assessing the occlusion was high. The PAR scores confirmed a significant improvement in the quality of occlusion at the completion of treatment, which compares favourably with previous studies on the conventional orthodontics-first approach. The surgery first approach can be effective at correcting both Class II and Class III malocclusion types with reduced treatment times.

Role of microRNA in colorectal carcinoma (CRC): a narrative review

MicroRNAs (miRNAs) are short non-coding RNAs that play a critical role in regulating gene expression by binding to target messenger RNAs (mRNAs). They were first discovered around 8 years after the identification of the first miRNA in 1993, and since then, there has been a significant increase in miRNA-related research and discoveries. MiRNAs have been implicated in various biological processes, including cancer, particularly in colorectal cancer (CRC). In CRC, miRNAs act as either oncogenes or tumor suppressors, influencing essential cellular functions such as cell proliferation, apoptosis, angiogenesis, and metastasis. The dysregulation of miRNAs in CRC can arise from different factors, leading to abnormal expression levels of their target mRNAs and subsequently affecting protein production. Consequently, miRNAs may directly target oncogenes or tumor suppressor genes, thereby contributing to cancer initiation and progression. Notably, tumors often exhibit reduced expression of mature miRNAs. In CRC research, miRNAs offer potential as diagnostic biomarkers and therapeutic targets. Specific miRNA profiles could serve as non-invasive tools for early CRC detection and risk assessment. Additionally, miRNA-based therapies present a promising approach for targeted cancer treatment by modulating miRNA expression. However, challenges related to delivery systems and long-term safety must be addressed to fully harness their therapeutic potential.

Revolutionizing healthcare by use of artificial intelligence in esophageal carcinoma - a narrative review

Esophageal cancer is a major cause of cancer-related mortality worldwide, with significant regional disparities. Early detection of precursor lesions is essential to improve patient outcomes. Artificial intelligence (AI) techniques, including deep learning and machine learning, have proved to be of assistance to both gastroenterologists and pathologists in the diagnosis and characterization of upper gastrointestinal malignancies by correlating with the histopathology. The primary diagnostic method in gastroenterology is white light endoscopic evaluation, but conventional endoscopy is partially inefficient in detecting esophageal cancer. However, other endoscopic modalities, such as narrow-band imaging, endocytoscopy, and endomicroscopy, have shown improved visualization of mucosal structures and vasculature, which provides a set of baseline data to develop efficient AI-assisted predictive models for quick interpretation. The main challenges in managing esophageal cancer are identifying high-risk patients and the disease's poor prognosis. Thus, AI techniques can play a vital role in improving the early detection and diagnosis of precursor lesions, assisting gastroenterologists in performing targeted biopsies and real-time decisions of endoscopic mucosal resection or endoscopic submucosal dissection. Combining AI techniques and endoscopic modalities can enhance the diagnosis and management of esophageal cancer, improving patient outcomes and reducing cancer-related mortality rates. The aim of this review is to grasp a better understanding of the application of AI in the diagnosis, treatment, and prognosis of esophageal cancer and how computer-aided diagnosis and computer-aided detection can act as vital tools for clinicians in the long run.

Role of microRNA in non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH): a comprehensive review

Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver condition that affects people who do not overconsume alcohol. Uncertainties exist over how microRNAs (miRNAs) in the blood and liver relate to NAFLD. The aim of this narrative review was to investigate the role of miRNAs in the onset and progression of non-alcoholic steatohepatitis (NASH) from NAFLD, and explore their potential as diagnostic tools and treatment targets for NAFLD patients. Liver miRNA-34a levels were found to accurately represent the degree of liver damage, with lower levels suggesting more damage. In patients with NAFLD and severe liver fibrosis, higher levels of miRNA-193a-5p and miRNA-378d were found. Moreover, miRNA-34a, miRNA-122, and miRNA-192 levels might aid in differentiating NASH from NAFLD. Similar to this, miRNA-21 and miRNA-27 levels in rats were able to distinguish between steatosis and steatohepatitis. High-fat diets enhanced the expression of 15 distinct miRNAs in rats, and there were substantial differences in the miRNA expression patterns between obese and lean people. The results from the present review imply that miRNA microarrays and sequencing may be helpful diagnostic tools, and miRNAs may be a possible treatment target for patients with NAFLD.

Association between severe retinopathy of prematurity (ROP) and poor motor neurodevelopmental outcome

During the final (third) trimester outside of the womb, the retina develops significantly and is vulnerable to problems. Similar to how the cerebral cortex does, the cerebellum also grows quickly during this time and is susceptible to upsetting environmental influences. The only factors that show promise for lowering the incidence and retinopathy of prematurity (ROP) severity among high-risk infants are prematurity prevention, preeclampsia control, and prudent use of oxygen therapy and ventilation. The third trimester is when the cerebral cortex, cerebellum, and retina develop. These areas are vulnerable to environmental influences if their development is interrupted. Throughout childhood and adolescence, neurodevelopmental defects have been linked to impaired cortical development and smaller brain volumes. Reduced cerebellar volumes have been linked to an increased risk of autism spectrum disorder, lower motor performance, impaired executive functioning, and poorer cognitive outcomes. The complete avascular retina, as well as the peripheral retina, should be treated during retinal ablation with laser photocoagulation (using a transpupillary diode, 11 argon, and three FD-YAG) or cryoablation as failing to do so promotes disease progression and results in unfavorable anatomical and refractive outcomes.

Beyond physical health: the role of psychosocial challenges and stigma in tackling the COVID-19 pandemic-A scoping review

Background

The socio-cultural response to the Coronavirus Disease 2019 (COVID-19) and the level of adherence to evidence-based guidelines played a crucial role in determining the morbidity and mortality outcomes during the pandemic. This review aims to evaluate the impact of stigma and psycho-socio-cultural challenges on efforts to control the COVID-19 pandemic and to identify ways to mitigate such challenges in future pandemics.

Methods

Using keywords including COVID-19, coronavirus, stigma, psychosocial challenges, and others, the authors searched seven major databases with a time limitation of July 2021, which yielded 2,038 results. Out of these, 15 papers were included in this review.

Results

The findings of the review indicated that several psychosocial, socio-economic, and ethno-cultural factors are linked to the transmission and control of COVID-19. The research revealed that stigma and related psychosocial challenges and others, such as anxiety, fear, and stigma-driven social isolation, have resulted in significant mental health problems.

Discussion

The review underscores the negative impact of stigma on COVID-19 patients, survivors, and the general population. Addressing stigma and psychosocial challenges is crucial to effectively manage the current pandemic and to prevent similar challenges during future public health crises.

Vitamin D and polycystic ovary syndrome (PCOS): a review

A common health problem known as polycystic ovarian syndrome (PCOS), is characterized by irregular periods, an excess of androgen production, and polycystic ovaries. It is one of the most prevalent endocrine disorders in women of reproductive age, affecting 4-20% of women worldwide. Numerous studies have found a connection between the onset and symptoms of PCOS and Vitamin D insufficiency. Vitamin D insufficiency causes calcium dysregulation and follicular arrest in women with PCOS, which is connected to menstrual irregularities and fertility issues. Studies have connected PCOS metabolic alterations to VDR polymorphisms such as iApa-I, Taq-I, Cdx2, and Fok-I. Insulin resistance is directly related to Vitamin D, is one of the most distinctive characteristics of the PCOS phenotype. Thus, it is suggested that Vitamin D therapy may help PCOS patients with their insulin sensitivity. In addition to insulin resistance, cardiovascular issues are a second metabolic disturbance that PCOS patients with low Vitamin D levels experience. Dyslipidemia is not linked to an increased risk of cardiovascular disease in PCOS-affected women. Vitamin D dramatically improves glucose metabolism by increasing insulin production, insulin receptor expression and reducing pro-inflammatory cytokines. The effect of Vitamin D on the metabolic and reproductive dysfunctions associated with PCOS may be mediated by an overall impact on insulin resistance. Vitamin D supplementation improved menstrual periods, increased folliculogenesis, and decreased blood testosterone levels in PCOS patients, all of which had a significant impact on the ability to procreate. As a result, it might be a cutting-edge therapeutic strategy for treating PCOS concurrently.

Digital Pulmonology Practice with Phonopulmography Leveraging Artificial Intelligence: Future Perspectives Using Dual Microwave Acoustic Sensing and Imaging

Respiratory disorders, being one of the leading causes of disability worldwide, account for constant evolution in management technologies, resulting in the incorporation of artificial intelligence (AI) in the recording and analysis of lung sounds to aid diagnosis in clinical pulmonology practice. Although lung sound auscultation is a common clinical practice, its use in diagnosis is limited due to its high variability and subjectivity. We review the origin of lung sounds, various auscultation and processing methods over the years and their clinical applications to understand the potential for a lung sound auscultation and analysis device. Respiratory sounds result from the intra-pulmonary collision of molecules contained in the air, leading to turbulent flow and subsequent sound production. These sounds have been recorded via an electronic stethoscope and analyzed using back-propagation neural networks, wavelet transform models, Gaussian mixture models and recently with machine learning and deep learning models with possible use in asthma, COVID-19, asbestosis and interstitial lung disease. The purpose of this review was to summarize lung sound physiology, recording technologies and diagnostics methods using AI for digital pulmonology practice. Future research and development in recording and analyzing respiratory sounds in real time could revolutionize clinical practice for both the patients and the healthcare personnel.

Gut-brain axis: altered microbiome and depression - review

The concept of a 'gut-brain axis' was recently developed when the complex communications between the brain and the gut became evident. The interaction may affect emotions, motivation, mood, and higher cognitive functions as well as gut homeostasis. Human microbe symbiosis's merits are now acknowledged to transcend human mental health. Research has recently indicated that the gut-brain axis plays a vital role in brain health maintenance. The term 'gut-brain axis' can only partially capture the intricacy of these interactions. Dysbiosis of the gut commensals has been seen in patients with psychiatric diseases, such as depression. Major depressive disorder is caused by complicated interactions between the individual gene and the environment. In a forced swimming test, P. Zheng et al. discovered that germ-free mice with no gut microbiota had a shorter immobility duration than healthy mice. More radical effects were expressed on the use of probiotics rather than prebiotics and postbiotics in reducing the symptoms of depression in patients with major depressive disorder. One of prime importance can be given to exploring more microbiota to investigate the better therapeutic effects of probiotics, prebiotics, and postbiotics.

Assessing the knowledge, attitude, and practice measures against tuberculosis in patients in ambulatory department facilities in Pakistan: a cross-sectional analysis

Tuberculosis (TB), at present, is the leading infectious etiology of death globally. In Pakistan, there are approximately 510,000 new cases annually, with more than 15,000 of them developing into drug-resistant TB, making the nation the fifth-leading country in TB prevalence in the world. Due to the ongoing COVID-19 pandemic, the focus has drifted away from TB screening, diagnostic and health awareness campaigns, and therapeutic measures endangering knowledge, attitude, and practices (KAP) towards TB in our population. We conducted a cross-sectional descriptive study in Pakistan to assess the KAP of Pakistani residents attending the adult outpatient departments of public hospitals for any health-related concerns. Our sample size was 856 participants, with a median age of 22 years. Occupation-wise, those who were employed had better knowledge of TB than those who were unemployed [odds ratio (OR): 1.011; 95% confidence interval (CI): 1.005-1.8005]. No differences were observed in TB knowledge between those adherents to common preventive practices versus those not adherent (OR: 0.875; 95% CI: 0.757-1.403). More than 90% of participants agreed that TB is dangerous for the community, and the majority opted against stigmatizing TB patients (79.1%). People who could read and write were 3.5 times more likely to have a good attitude towards TB compared to those who could not (OR: 3.596; 95% CI: 1.821-70.230; p=0.037). Similarly, employed subjects had better attitudes compared to unemployed ones (OR: 1.125; 95% CI: 0.498-1.852; p=0.024) and those with better knowledge of TB had a better attitude grade (OR: 1.749; 95% CI: 0.832-12.350; p=0.020). Age, occupation, and educational status were statistically significant among the two groups (p=0.038, p=0.023, p=0.000). Literate subjects had three times better practice towards TB than illiterate subjects (OR: 3.081; 95% CI: 1.869-4.164; p=0.000). Future education and awareness programs should target specific groups, such as the unemployed and illiterate, with practice-focused approaches. Our study outcomes can enable the concerned officials and authorities to take appropriate evidence-based steps to direct the efforts efficiently to curtail the burden of TB in Pakistan and to limit its progression, which could potentially lead our nation to become a multi drug-resistant TB endemic territory.

Ventriculoperitoneal Shunt Surgery for Hydrocephalus: One of the Common Neurosurgical Procedures and Its Related Problems

Objective This study was conducted to assess the outcome in patients with hydrocephalus who underwent ventriculoperitoneal (VP) shunt surgery. Methods This retrospective study was conducted at the neurosurgery department of a tertiary care hospital. The time frame was three years and five months from January 2017 to May 2020 with a follow-up of six months. Results This study included 1030 patients, out of whom 64.2% were male and 35.8% were female. While the majority of the patients were more than 11 years of age (466), age did not have any significant impact on the outcome of the ventriculoperitoneal shunt surgery. The most common cause of hydrocephalus was congenital (47.6%). A good outcome was seen in 63.4%, mortality was 10.6%, and complications were identified for 25.8%. The underlying pathology had a significant impact on the outcome in our study (p-value < 0.05) where the congenital cause of hydrocephalus showed a better outcome than any other cause. Conclusion Ventriculoperitoneal shunt is a good way to manage hydrocephalus, but there is always a high risk of complications.

Efficacy of Radial Endobronchial Ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL...s): A systematic review and meta-analysis

BACKGROUND

Transbronchial lung cryobiopsy (TBLC) is frequently described for the diagnosis of diffuse parenchymal lung diseases (DPLD). A few studies have reported transbronchial cryobiopsy for the diagnosis of peripheral pulmonary lesions (PPL...s). We aimed to study the utility and safety of transbronchial cryobiopsy for the diagnosis of PPL...s.

METHODS

We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yields of transbronchial cryobiopsy and bronchoscopic forceps biopsy.

RESULTS

Following a systematic search, we identified nine relevant studies (300 patients undergoing cryobiopsy). All used Radial Endobronchial Ultrasound (R-EBUS) for PPL localization. The pooled diagnostic yield of transbronchial cryobiopsy was 77% (95% CI, 71%...84%) (I^2=38.72%, p=0.11). The diagnostic yield of forceps biopsy was 72% (95% CI, 60%...83%) (I^2=78.56%, p<0.01). The diagnostic yield of cryobiopsy and forceps biopsy was similar (RR 1.05, 95% CI 0.96...1.15), with a 5% risk difference for diagnostic yield (95% CI, ...6% to 15%). There was significant heterogeneity (I^2=57.2%, p=0.017), and no significant publication bias. One severe bleeding and three pneumothoraxes requiring intercostal drain (ICD) placement (major complication rate 4/122, 1.8%) were reported with transbronchial cryobiopsy.

CONCLUSIONS

R-EBUS guided transbronchial cryobiopsy is a safe and efficacious modality. The diagnostic yields of TBLC and forceps biopsy are similar. More extensive multicentre randomized trials are required for the further evaluation and standardization of transbronchial cryobiopsy for PPL...s.

Nanostructured nickel doped zinc oxide material suitable for magnetic, supercapacitor applications and theoretical investigation

This Paper describes the synthesis of nickel doped ZnO is planned by chemical co-precipitation techniques. The prepared nanostructured nickel doped zinc oxide samples were analyzed by thermogravimetric differential thermal analysis (TG/DTA), X-ray diffraction (XRD), Fourier transform infra red (FTIR), field emission scanning electron microscopy (FESEM), high resolution transmission electron microscopy (HRTEM), electron paramagnetic resonance (EPR), and cyclic voltametry (CV). Nanostructure nickel doped ZnO materials have developed as promising for the basis of its broad range of employing in diverse areas. The attractive properties of nickel doped ZnO materials are highly demanded in high-energy potential applications. The nickel doped zinc oxide materials are hexagonal wurtzite arrangement is confirmed by XRD. The morphological -features of FE-SEM show nickel doped zinc oxide NPs are the structure of spherical type with agglomeration. The calculated particle size 11 nm is confirmed by HR-TEM. EPR spectra of nickel doped zinc oxide nanoparticles are ferromagnetic nature. Further, CV studies of Ni doped ZnO materials of the specific capacitance value is 133 Fg^-1 at the scan rate 10 mVs^-1 it is suitable for super capacitor application. The quantum chemical calculations were done by using DFT techniques through B3LYP/LANL2DZ level of basis set.

COVID-19 associated pulmonary aspergillosis (CAPA): An added potential burden on India's pre-existing fungal superinfection

The ongoing pandemic that initiated in Wuhan, China, has been an international public health emergency since January 2020. India has been battling a brutal COVID-19's second wave since April 2021. The healthcare system was struggling with a substantial increase in COVID-19 cases when the lack of necessary resources further aroused a major setback. Opportunistic fungal infections, specifically mucormycosis and candidiasis have become a pressing matter of concern. Recent cases of aspergillosis have also heightened public alarm. Hence, call for an immediate response to this public health crisis is the need of the hour by establishing countrywide surveillance, diagnostic, and management system, as well as public awareness to alleviate the burden of COVID-19 and fungal infections in India.

Global impact of vaccine nationalism during COVID-19 pandemic

Vaccines are the best chance to control the pandemic-unless leaders succumb to vaccine nationalism. Vaccine nationalism is a frequent recurrence, especially during a brand-new market distribution. The development of safe and effective COVID-19 vaccines in such a short space of time is a testament to modern scientific abilities. It will also test the world's political will and moral commitment to end this pandemic. As desperate as the COVID-19 pandemic, vaccine nationalism is already setting a foundation for itself and is considered socially and economically counterproductive. Vaccine equity is not just a theoretical slogan, and it protects people worldwide from new vaccine-resistant variants. Understanding and anticipating the consequences is vital, and creating a global solution approach to avoid them. This article evaluates the common issues previously faced and the plausible ones during this pandemic. A few recommendations are made to warn and accentuate the reality of this dire matter.

HIV/AIDS among children in Ratodero, Pakistan amidst the COVID-19 pandemic: Challenges, efforts, and recommendations

In Pakistan, HIV has increased at an alarming rate in recent decades, and the death toll has risen. It is a public health challenge amidst the COVID-19 pandemic that is not being given due importance. The present article looks at the challenges and efforts being made to deal with HIV among children in Ratodero, Pakistan, and addresses measures that can be taken to control the disease in the child population epidemiologically.

424 Improving Interprofessional Teamwork in Plastic Surgery: A Novel Approach to Microsurgical Skills Training for Theatre Nurses

Aim

Shared mental models between surgeons and scrub nurses allow them to effectively communicate with each other and react efficiently to intraoperative complications. Microsurgery poses unique challenges including the use of an operating microscope, fine instruments, and restricted views of the operative field. Our aim was to design and deliver a microsurgical skills session for theatre nurses and evaluate whether attendance influenced perceived understanding of microsurgery and ability in day-to-day role.

Method

A microsurgical training day for theatre nurses was delivered. This consisted of an introduction to and positioning of the operating microscope and three practical stations involving increasingly complex motor tasks, designed to highlight the importance of instrument handling and improve awareness of microsurgical challenges. Consultant plastic surgeons acted as scrub nurses to add an element of role-reversal. Qualitative and quantitative feedback was collected.

Results

Eight theatre nurses participated, all responded ‘strongly agree’ or ‘agree’ that the training was enjoyable, improved their understanding of microsurgery and was relevant and helpful to their day-to-day role. All attendees strongly agreed that they would partake in similar sessions in the future.

Conclusions

Role-reversal and skills-based training is a valuable tool in improving multidisciplinary collaboration in microsurgery. Increasing shared knowledge of complex procedures prospers effective teamwork and communication, which leads to improved efficiency and better patient care. Our study is a first step towards development of a standardized microsurgical skills course for theatre nurses and has broader implications for interprofessional education across all surgical specialties.

Self-Medication in Africa during COVID-19 Pandemic

Self-medication is known as “the usage of drugs, herbs or home remedies on one’s own initiative, or on the advice of another person, without consulting a doctor’. In Africa, self-medication has reached a critical stage, with people using and taking any drug regardless of how poisonous the material may be as long as unprofessional suggestions advocate it as a solution to their health problem. In this article, we looked at the consequences, effects, and recommendations for reducing the use of self-medication as a habit among Africans.

Malaria amidst COVID-19 in India: Challenges, Efforts, and Recommendations

Since the outbreak of COVID-19 in India, the country has faced a slew of new challenges, spawning a slew of other deadly viruses and diseases while also serving as a breeding ground for them. Not only did Malaria (a vector-borne disease) emerge as a coincidental outbreak during the pandemic, but many others did as well, causing severe diseases in humans due to flaws in health-care systems that were already overburdened with identifying, preventing, and treating the recently introduced coronavirus disease. Inadequate water cleanliness, as well as the delayed and misdiagnosis of Malaria with COVID-19 due to overlapping symptoms, are major impediments in the incidence of these unique outbreaks. Appropriate steps, such as providing clean water and diagnostic facilities to control Malaria cases, should be adopted to prevent such epidemics in the country.

Rampant Increase in Cases of Mucormycosis in India and Pakistan: A Serious Cause for Concern during the Ongoing COVID-19 Pandemic

COVID-19 is a global health crisis that continues to pose new challenges all around the world. Amidst the growing pandemic, a spike in the number of mucormycosis cases in India and Pakistan has been reported in COVID-19 patients and in those who have recovered from COVID-19. This increase in cases may be related to the overuse of steroids and zinc, the use of industrial oxygen, unsterilized medical equipment, frequent intubation, a weakened immune system, and pre-existing comorbidities such as diabetes. As a result, it is critical to take steps to handle the current increase in mucormycosis cases. Therefore, this article aims to highlight the existence of mucormycosis amidst the COVID-19 pandemic in India and Pakistan, focusing on possible causes and implications, and suggests important plans of action to be taken during this pandemic.

Dose-dense Paclitaxel and Carboplatin as Neoadjuvant Chemotherapy for Stage IIB/IIIA Non-small Cell Lung Cancer - A Phase II trial

AIMS

The approach to potentially resectable non-small cell lung cancer (NSCLC) remains controversial. There is a benefit of neoadjuvant chemotherapy (NACT), but the ideal regimen is unknown. We evaluated the efficacy and safety of dose-dense NACT in potentially resectable NSCLC in this phase II trial.

MATERIALS AND METHODS

Paclitaxel at 80 mg/m² on days 1, 8 and 15 with AUC-6 carboplatin on day 1, 3 weekly for four cycles was evaluated as NACT. Patients with Eastern Cooperative Oncology Group performance status 0-2, stage IIB and IIIA (with only non-bulky N2 nodes) were included. The primary end point was the objective response rate. Secondary end points included toxicity, progression-free survival, recurrence-free survival, complete resection rate and overall survival. The relative dose intensity (RDI) was calculated to define tolerability (CTRI/2016/05/006916).

RESULTS

In total, 37 patients were enrolled (median age 55 years). Most (78.8%) were smokers. Most patients had adenocarcinoma (57.6%) and stage IIIA disease (81.0%) according to the seventh American Joint Committee on Cancer staging system. Seventy-eight per cent of patients completed four cycles. The objective response rate was 75.6% with a complete response in 10.8%. The mean RDI of paclitaxel was 88.61%, with 68.0% of patients able to maintain an RDI ≥85.0%. In total, 187 toxicity events were recorded (120 grade 1, 64 grade 2 and three grade 3 events). Common toxicities were peripheral neuropathy (20.3%), myalgia (19.8%), nausea (15.7%) and neutropenia (10.2%). There were no treatment-related deaths. Seventeen patients underwent surgery (lobectomy 82.4%). After a median follow-up of 47 months (95% confidence interval 27-50.7 months), the median progression-free survival was 9.6 months (7.4-17.4) and overall survival was 29.2 months (16.0-37.2).

CONCLUSION

Dose-dense paclitaxel-carboplatin is feasible, safe and efficacious and should be evaluated further in potentially resectable NSCLC.

Epidemic of plague amidst COVID-19 in Madagascar: efforts, challenges, and recommendations

The plague has been wreaking havoc on people in Madagascar with the COVID-19 pandemic. Madagascar's healthcare sector is striving to respond to COVID-19 in the face of a plague outbreak that has created a new strain on the country's public health system. The goal and activities of the gradual epidemic of plague in Madagascar during COVID-19 are described in this research. In order to contain the plague and the COVID-19 pandemic in this country, we have suggested long-term recommendations that can help to contain the outbreak so that it may spread to non-endemic areas.

Epidemic of plague amidst COVID-19 in Madagascar: efforts, challenges, and recommendations

The plague has been wreaking havoc on people in Madagascar with the COVID-19 pandemic. Madagascar’s healthcare sector is striving to respond to COVID-19 in the face of a plague outbreak that has created a new strain on the country’s public health system. The goal and activities of the gradual epidemic of plague in Madagascar during COVID-19 are described in this research. In order to contain the plague and the COVID-19 pandemic in this country, we have suggested long-term recommendations that can help to contain the outbreak so that it may spread to non-endemic areas.

Telesurgery and Robotics: An Improved and Efficient Era

Telesurgery, or remote surgery, is widely known as a master-slave technology. It has achieved a milestone in surgical technology and intervention, providing widespread prospects of operating on a patient in a remote area with increased accuracy and precision. It consists of one or more arms controlled by a surgeon and a master controller in a remote area accessing all the information being transferred via a telecommunication system. This paper reviews the present advancements and their benefits and limitations in the field of telesurgery. A handful of operations have been done so far. However, due to time-lag (latency), global networking problems, legal issues and skepticism, and on top of the cost of robotic systems and their affordability have led to the concept of telerobotics and surgery to lag. However, with more information and high speed, 5G networking, which has been in a trial to reduce latency to its minimum, is beneficial. Haptic feedback technology in telesurgery and robotics is another achievement that can be improved; further, this allows the robotic arms to mimic the natural hand movements of the surgeon in the control center so that the master controller can perform surgeries with more dexterity and acuity. Due to coronavirus (COVID-19), this type of surgery approach can reduce the probability of contracting the virus, saving more lives and the future.

A microfluidic flow analyzer with integrated lensed optical fibers

Rapid optical interrogation of flowing cells or particles is a powerful tool in the field of biomedical diagnostics. Determination of size and composition of fast-flowing cells, with diameters in the range of 2- 15 μ m , often require complex open-space optics and expensive high-speed cameras. In this work, a method to overcome these challenges by using a hydrodynamic flow-based microfluidic platform coupled with on-chip integrated fiber optics is reported. The lab-scale portable device developed uses a combination of on-chip lensed and non-lensed optical fibers for precision illumination. The narrow light beam produced by the lensed fiber ( f = 150 μ m ) enables precise optical analysis with high sensitivity. A planar arrangement of optical fibers at various angles facilitates multi-parametric analysis from a single point of interrogation. As proof of concept, the laboratory-scale portable bench-top prototype is used to measure fluorescence signals from CD4 immunostained cells and human blood samples. The performance of microfluidic flow analyzer is also compared to the conventional Guava® easyCyte 8HT flow cytometer.

Craniopharyngiomas in children - experience of consecutive 152 operated cases

Context

Craniopharyngiomas (CPH) are benign tumors, rarely encountered in children, representing 5-6% of all intracranial tumors.

Objective

This study aimed to analyze the surgical management and quality of life in a series of CPH pediatric cases.

Design

This was a multicenter study performed over a 25-year period (1994 - 2019) in Bucharest.

Subjects and Methods

152 children (0-17 years old) were treated for CPH. Preoperative manifestations were intracranial hypertension, endocrine dysfunction, visual impairment, ataxia, intellectual performance decrease.

Results

Considering all surgical approaches used, we advocate for pterional approach to best fit in CPH. We achieved gross-total removal (GTR) in 83 cases (54.4%), near-total resection (NTR) in 13 cases (9%), partial resection (PTR) in 51 cases (33.3%). 5 cases were biopsies (3.2%). Gamma Knife Surgery was performed in 10 cases (6.5%), all recurrences. At 6 months GOS revealed: Good Recovery 70 cases (46.2%), Moderate Disability 62 cases (40.7%), Severe Disability 13 (8.5%), Vegetative State 2 cases (1.3%), Deceased 5 cases (3.2%). Complications were: diabetes insipidus (89.3%); hypopituitarism (66.4%); hypothalamic damage (17.7%); visual deterioration (18.4%).

Conclusions

Surgery remains the main option, but GTR complications prove the necessity for a multidisciplinary approach. Outcome predicting factors are: age, tumor size, hydrocephalus degree, hypothalamic dysfunction.

Effects of Pyruvic Acid, Succinic Acid, and Oregano Essential Oil on Salmonella, Natural Microflora, and Quality of Raw Ground Chicken

ObjectivesThe growing stringency of regulations related to pathogens in raw poultry and increasing consumer demand for more natural food ingredients makes it imperative to explore alternative antimicrobial agents. The aim of this study was to assess the anti-Salmonella effect of combinations of succinate or pyruvic acid with oregano essential oil in raw ground chicken. Additionally, their effect on natural microflora and quality of ground chicken over simulated retail display was evaluated.Materials and MethodsNalidixic acid (NA) adapted Salmonella Typhimurium was inoculated on skin-on broiler breast meat pieces. The antimicrobial treatments given to meat were 2 and 3% pyruvic acid (PA) or monosodium succinate (SA) in combination with 0.5% essential oil (EO). Agar at the concentration of 0.05% was added to water used to prepare antimicrobial solutions to disperse the essential oil. Mode of antimicrobial treatment was 30 s dip. The meat was then ground and evaluated for pathogen reduction. Data were analyzed using 1-way ANOVA. Surviving Salmonella were recovered on XLT-4 with 50 ppm NA. Non-inoculated meat was similarly treated with antimicrobial dip and ground. Ground chicken was packaged in foam trays with PVC overwrap, and evaluated for mesophilic aerobic plate count (APC), psychrotrophic count (PC), pH, instrumental color (CIE L*, a*, and b*), and expressible moisture over 8 d of simulated retail display.A factorial design was assigned to the experiment with antimicrobial treatments and display days as the fixed effect factors. Data were analyzed using a mixed general linear model that considered replicates as a random effect in addition to the mentioned fixed effects. All trials were conducted in three replicates.ResultsMaximum reduction obtained in Salmonella counts from ground chicken was 1.52 log CFU/g and 0.98 log CFU/g, resulting from 3% SA + 0.5% EO, and 3% PA + 0.5% EO, respectively. Three percent SA + 0.5% EO treatment resulted in ground chicken with approximately 1.2 log CFU/g lower APC on Day 8 that was significantly lower (P < 0.05) than all other treatments. This treatment also resulted in less pH variation over the entire shelf life duration and lighter color of ground meat on Day 8.ConclusionThese results indicate that combination of monosodium succinate and oregano essential oil provides effective reduction of Salmonella and improved raw quality of ground chicken. This antimicrobial combination can be employed as a clean label ingredient for raw chicken applications.

Effects of Drying, Lactic Acid, and an Antimicrobial Marinade on the Survival of Generic Escherichia coli on Biltong

ObjectivesThe objective of the experiment was to evaluate the effects of drying, lactic acid spray, and a certain marinade application on the survival of generic Escherichia coli on biltong.Materials and MethodsFrozen eyes of round (IMPS #171C) were obtained from a local beef purveyor. The eyes of round were thawed (at 4°C), trimmed of extra fat and connective tissues, and cut into strips (L × W × T; 6 in × 2 in × 0.75 in). The experiment was divided into 2 groups and replicated once. Experiment 1 was further sub-grouped into 3 treatments: (1) negative control (NC), (2) negative control for dip treatment (NCD), and (3) inoculated group (I). Experiment 2 was sub-grouped into 6 treatments: (1) negative control (NC), (2) negative control for dip treatment (NCD), (3) positive inoculated control (PIC), and inoculated treatments (4) marinated (M), (5) 2% lactic acid spray (LA), and (6) marinated and lactic acid spray (MLA). For both experiments 1 and 2, 12 strips of biltong were randomly selected for each treatment (n = 36 for experiment 1; n = 72 for experiment 2). The inoculated samples were dipped for 30 s in a cocktail (5-log) of 4 different strains of nalidixic adapted Escherichia coli (beef isolates) and allowed 2 h for attachment at 4°C. The lactic acid was sprayed to each side of the respective biltong and allowed a 10-min resting period. Marinade was applied to respective treatment groups by dipping, rubbing, and incubating overnight (at 4°C). All samples were kept in a smokehouse in a controlled environment with drying cycle at 78°F and 60% relative humidity. Experiment 1 was incubated in the smokehouse for a total of 12 d and experiment 2 was incubated for 9 d total. Samples from each treatment group were removed on Days 0, 2, 5, 7, 9, and 12 (experiment 1 only) for microbiological sampling and analysis. Samples were homogenized, serially diluted, enumerated on TSA plus 200 ppm nalidixic acid, and incubated at 35°C for 18–24 h. Colonies were counted after 24 h and colony counts were transformed into log10 CFU for reporting.ResultsThe data for experiment 2 showed that the treatments LA, M, MLA, and PIC were able to achieve a 2.5–3 log10 CFU reduction after 9 d of drying. The M and MLA treatments exhibited a 2–3 log10 CFU reduction after 2 d of drying as compared with LA and PIC that showed a similar reduction in microbial counts after 9 d of incubation. The NC and NCD treatment groups resulted in no microbial growth from Day 0 till Day 9 of incubation. The data for experiment 1 showed that there was a 1 log10 CFU reduction of E. coli in treatment group I. The NC and NCD groups did not show microbial growth from Day 0 till Day 9 of incubation. The water activity decreased overtime to 0.722 for experiment 1 and 0.711 for experiment 2. Overall, the M and the MLA samples appeared to have the greatest and quickest killing effect on generic E. coli.ConclusionResults from these experiments suggest that the combination of drying with a lactic acid spray and marinade application causes a decrease in the E. coli population on Biltong during incubation for 9 or 12 d. While the results show that there may be a small decrease from drying alone, the greatest decreasing effect appears to be the combination of the drying, lactic acid, and marinade. Future work will include additional replicates and experiments with pathogens such as E. coli O157:H7.

Anti-Salmonella Effects of Pyruvic and Succinic Acid in Combination with Oregano Essential Oil

ObjectivesEffective decontamination approaches will aid in improving safety of poultry products and help processors comply with pathogen performance standards. Increasing consumer demand for clean label and more natural ingredients presents a scope to explore alternative decontamination approaches for meat and food contact surfaces. This study aimed to evaluate the antimicrobial efficacy of combinations of pyruvic acid (PA), succinic acid (SA), and oregano essential oil (EO) against Salmonella Typhimurium in suspensions, cells inoculated on raw chicken, and cells attached to steel.Materials and MethodsMinimum bactericidal concentration (MBC) assays were conducted in Mueller-Hinton broth (5 mL). Bacterial cells were added to broth suspensions of antimicrobial agents or their combinations. A contact time not exceeding 10 s was provided. Surviving bacteria were recovered on tryptic soy agar (TSA). Bacterial inactivation was confirmed by enrichment in D/E broth. Experiment involved completely randomized design with each concentration of organic acid and essential oil being considered as one level. Data were analyzed using 1-way ANOVA. Aqueous solutions of PA, SA, EO, and the mixtures of PA+EO and SA+EO were prepared using 0.05% agar to suspend the essential oil. Skin-on raw chicken breast meat pieces (2.5 cu cm) were used as a substrate to inoculate nalidixic acid (NA) adapted Salmonella cells. Pieces were treated with antimicrobial agents for 30 s by dipping, and surviving Salmonella were recovered using D/E broth on XLT-4 agar with 50 ppm NA. Four different experiments with variable acid and essential oil concentrations were performed and data were analyzed using 1-way ANOVA. Each experiment included an inoculated untreated control. Stainless steel coupons (2 × 5 cm) were used as a substrate for Salmonella attachment. Cells were allowed to grow and attach on coupons submerged in tryptic soy broth for 24 h. Coupons were rinsed to remove planktonic cells. Attached cells remaining on the coupon were dip treated with antimicrobial agents for 5 min. Surviving cells were recovered on TSA. For antimicrobial treatments leading to no cell recovery, additional experiments were performed. The recovery broth was enriched in tryptic soy broth and streaked on TSA to confirm inactivation. Three different experiments were conducted while including their respective inoculated and untreated controls and analyzed using 1-way ANOVA. All experiments were conducted in three replicates.ResultsMBC for was found to be PA (0.5%), SA(3%), EO (0.04%), PA+EO (0.25 + 0.02%), SA+EO (0.25 + 0.02%), respectively. 1% PA + 0.08% EO combination produced the maximum reduction (1.42 ± 0.11 log CFU/cm2) followed by 6% SA + 0.08% EO (1.02 ± 0.08 log CFU/cm2) in Salmonella populations on raw chicken. More than 6 log CFU/coupon of attached Salmonella were inactivated by mixtures of 0.25% PA + 0.02% EO and 1.5% SA + 0.02% EO.ConclusionThe combinations of PA+EO and SA+EO both exhibited strong anti-Salmonella activity in cell suspensions, on cells attached to stainless steel, and were effective in reducing Salmonella populations on raw chicken. Therefore, these antimicrobial combinations merit further research for raw poultry, meat, and other sanitation applications.