Effect of Topical Insulin Versus Normal Saline Dressing on Diabetic Wound Healing: An Experimental Comparative Study

Introduction: Diabetic foot ulcer is one of the most significant and devastating complications and a major cause of hospitalization among patients with diabetes. It leads to severe economic and social burdens. The management of Diabetic foot ulcers remains a major therapeutic challenge. Hence, the present study was conducted to compare the topical insulin and normal saline dressing on wound healing among patients with a diabetic foot ulcers. Methods: An experimental research design was adopted to conduct the study with 60 samples matched with the inclusion criteria in Saveetha Medical College and Hospital. Samples were allocated into experimental group I (n=30) and experimental group II (n=30) by simple random sampling. The baseline outcomes were measured at the beginning of the study. Pre-assessment was done using the Bates-Jensen wound assessment tool in experimental I & II. Experimental group I received topical insulin dressing, and experimental group II received normal saline dressing daily for 14 days. Post-assessment was done on the seventh and fourteenth days using the same tool for both groups. Data were analyzed using SPSS. Results: A significant improvement in the level of wound healing was observed at the level of p< 0.001 within and between a group of pretest, post-test I, and Post-test II by repeated measures ANOVA. The overall comparison of wound healing between experimental groups I & II revealed that the calculated F value of F=12.679 shows a statistically (p

Molecular characterization and antifungal activity against non-dermatophyte molds causing onychomycosis

Onychomycosis is a fungal disease that caused by different types of fungi. Non-dermatophyte molds are a large saprophytic fungi group that live in nature and could affect traumatic nails. The aim of this study was to identify non-dermatophyte molds causing onychomycosis and evaluation of several antifungal activities against the isolates. The samples consisted of 50 non-dermatophyte molds isolated from patients with onychomycosis confirmed by direct and culture examination fungal. DNA was extracted, amplified, and sequenced. Disk diffusion method was used to evaluate itraconazole, fluconazole, ketoconazole, terbinafine, posaconazole, and econazole activity against the isolates. The species identified as: Aspergillus flavus 22 (44%), A. niger 12 (24%), A. fumigates, 3 (6%), A. sydowii 3 (6%), A. terreus 1 (2%), Penicillium commune 2 (4%), P. glabrum 2 (4%), P. chrysogenum, 1 (2%), Fusarium solani 3 (6%) and F. thapsinum 1 (2%). Most of the samples were sensitive to terbinafine, itraconazole, and econazole and 94% of the isolates were resistant to fluconazole. This study showed that Aspergillus species were the most common cause of non-dermatophyte mold onychomycosis and fluconazole was the most resistant antifungals. Care must be taken to choose the appropriate antifungal drug for a better cure.

Impact of the Iranian Registry of Infective Endocarditis (IRIE) and multidisciplinary team approach on patient management

BACKGROUNDS

The last 30 years have witnessed major improvements in understanding of all aspects of infective endocarditis (IE). The Iranian Registry of Infective Endocarditis (IRIE) was formed to address epidemiological aspects of IE vis-à-vis its main pathogens and underlying heart diseases over a 12-year period. Indeed, a multidisciplinary team (MDT) for IE was developed alongside.

METHODS

In a longitudinal observational study, data of adult patients with definite or possible IE based on modified Duke criteria were collected from 2007 to 2016 in our tertiary centre, Iran. From 2016 until 2019, we run a prospective observational study using formation of an IE MDT to provide better patient management and compared data before and after this.

RESULTS

Totally, 645 patients with mean age of 48 ± 17 years were enrolled. Data of 445 and 200 patients were compared before and after IRIE and MDT formation, respectively. We found significantly reduced type and number of applied antibiotics (p = 0.04) and higher rate of positive blood culture (p = 0.001). Hospital length of stay increased significantly after formation of the IRIE and IE MDT (p = 0.02). The rate of heart failure, new abscess formation and cerebral emboli were significantly decreased after IRIE and IE MDT (p < 0.001) and consequently in-hospital mortality reduced significantly (p = 0.05).

CONCLUSION

Developing national registries and MDTs has potential to enhance patient management and reduce IE burden. Our results demonstrated that establishment of the Iranian IRIE and IE MDT conferred better diagnoses, standardised treatments and significantly reduced cardiac and extra cardiac morbidity.

Magnetic MgFe2O4-CaFe2O4 S-scheme photocatalyst prepared from recycling of electric arc furnace dust

In this research, magnetic MgFe₂O₄-CaFe₂O₄ photocatalyst powder was prepared from recycling of electric arc furnace (EAF) dust as a secondary source through a two-step leaching process followed by co-precipitation method. To maximize the total Fe to Ca recovery ratio (F/C) and evaluate the effective parameters of sulfuric acid concentration and temperature, response surface methodology (RSM) as a design of experiment was used. The best temperature and acid concentration were obtained as 85 °C and 1 M, respectively for the second step of the leaching process. X-ray diffraction (XRD) results indicated that the synthesized nanocomposite sample contains MgFe₂O₄ and CaFe₂O₄ phases together with a small amount of Ca₂Fe₂O₅. The saturation magnetization and optical band gap of the synthesized composite powder were 24 emu/g and 2.17 eV, respectively. X-Ray photoelectron spectroscopy (XPS) result revealed the oxidation states as Fe³⁺, Ca²⁺, Mg²⁺ and O^2-. Energy dispersive X-ray spectroscopy (EDS) showed that the elements were uniformly distributed within the nanostructured particles. Field emission scanning electron microscope (FESEM) and transmission electron microscope (TEM) results indicated the presence of CaFe₂O₄ and MgFe₂O₄ nanoparticles with good contact between them. The nanocomposite sample showed the capability of 45% for degrading methylene blue (MB) dye under 240 min visible light irradiation. The reusability tests showed that the photocatalytic activity of the nanocomposite was not considerably changed after three cycles.

The influence of interferon-γ on cardiac and renal histopathological changes induced by carbamazepine

BACKGROUND

Carbamazepine (CBZ) is used for the treatment of epileptic seizures. This study was designed to evaluate the effect of Interferon-gamma on the fetal heart and kidney histopathological changes of CBZ-treated pregnant mice.

METHODS

Twenty pregnant mice were divided into four groups. The control group received distilled water. The second group received 240 mg/kg of CBZ by gastric gavage. The third group received intraperitoneal injection (IP) of IFN-γ. The fourth group received IP injection of IFN-γ with 240 mg/kg CBZ by gavage. The fetuses were delivered by hysterectomy on the 18th day of gestation.

RESULTS

The mean weight, crown-rump length, the total volume of the heart and kidney of the fetuses in the CBZ-treated group were significantly reduced when compared with the control, INF-γ and CBZ + INF-γ groups (p < 0.05). INF-γ prevented histopathological changes when used with CBZ (p < 0.05).

CONCLUSION

CBZ induced structural changes in the fetal tissues of the pregnant mice. However, IFN-γ could reduce these changes (Tab. 1, Fig. 4, Ref. 26).

Pretreatment with Ultrasonication Reduces the Size of Azelaic Acid-Chitosan Nanoparticles Prepared by Electrospray

Nowadays, electrospray is becoming a favourable approach for preparing monodispersed nanoparticles. However, this approach is quite recent and requires further works to optimize control over physicochemical properties of its products. This study aimed to determine the possible effects of sonication as a pretreatment to reduce the size of azelaic acid-chitosan particle before using electrospray. The results showed that sonication treatment can produce submicron particles of azelaic acid-chitosan. By diluting the solution and increasing sonication time and amplitude, smaller particles were obtained with the smallest one at 516 nm, sized by dynamic light scattering. The pretreated solution was then electrosprayed to reduce the size of nanoparticles to 80 nm, indicating that sonication may play an important role in reducing the size of electrosprayed nanoparticles. The electrosprayed nanoparticles were nearly monodispersed and almost spherical in shape.

In vitro proliferation and differentiation of human bone marrow mesenchymal stem cells into osteoblasts on nanocomposite scaffolds based on bioactive glass (64SiO2-31CaO-5P2O5)-poly-l-lactic acid nanofibers fabricated by electrospinning method

Electrospinning method was employed for fabrication of SiO₂-CaO-P₂O₅ bioactive glass (BG) nanofibers, poly-l-lactic acid (PLLA) nanofibers and nanocomposite scaffolds fabricated from as-prepared nanofibers. Characterization of the prepared nanofibers and scaffolds by XRD, FTIR, and SEM techniques revealed the formation of nanofibers with mean diameter of about 500nm and fully fibrous scaffolds with porous structure and interconnected pores. The growth, viability and proliferation of cultured human bone marrow mesenchymal stem cells in the fabricated nanofibers and bioactive glass-poly-l-lactic acid (BG-PLLA) nanocomposite scaffolds were studied using various biological assays including MTT, ALP activity, calcium deposit content, Alizarin red staining, and RT-PCR test. Based on the obtained results, incorporation of BG nanofibers in the nanocomposite scaffolds causes the better biological behavior of the scaffolds. In addition, three-dimensional and fibrous-porous structure of the scaffolds further contributes to their improved cell behavior compared to the components.

Strategies to avert preventable mortality among mothers and children in the Eastern Mediterranean Region: new initiatives, new hope

We conducted an assessment of maternal, newborn and child health and progress towards achieving Millennium Development Goals (MDG) 4 and 5 in the Eastern Mediterranean Region (EMR). We provide recommendations for scaling up and sustaining gains post-2015. Data were obtained from global data repositories. We constructed time trends from 1990 to 2013 and evaluated inequities across the Region. Under-5, neonatal and maternal mortality rates decreased 46%, 35%, and 50% respectively from 1990 to 2013. Pneumonia and diarrhoea accounted for 50% of all post-neonatal deaths; pregnancy- and delivery-related complications were the leading causes of neonatal and maternal deaths. Coverage of maternal, newborn and child health interventions is suboptimal, and poverty, food insecurity and conflict are pervasive across the Region. The EMR has made progress but is unlikely to attain MDG 4 and 5 targets. To sustain and further accelerate gains, the Region must reduce inequities and scale up implementation of recommendations made by the independent Expert Review Group.

Antiapoptotic effects of cerium oxide and yttrium oxide nanoparticles in isolated rat pancreatic islets

Type I diabetes mellitus is a metabolic disease caused by the impairment of pancreatic β-cells mainly mediated through oxidative stress and related apoptosis. Islets transplantation seems a promising treatment for these patients, but during islets transplant, various types of stresses related to the isolation and transplantation procedure compromise the function and viability of islets. We recently hypothesized that the combination of cerium oxide (CeO2) and yttrium oxide (Y2O3) nanoparticles with a potential free radical scavenger behavior should be useful to make isolated islets survive until transplanted. In the present study, oxidative stress-induced apoptosis in isolated rat pancreatic islets exposed to hydrogen peroxide (H2O2) and the protective effects of CeO2 and Y2O3 nanoparticles were investigated. Exposure of islets to H2O2 (50 µm, 2 h) increased intracellular oxidant formation such as reactive oxygen species and subsequently apoptosis and decreased viability, glucose-induced adenosine triphosphate (ATP) production and glucose-stimulated insulin secretion. Pretreatment with CeO2 and/or Y2O3 nanoparticles reduced the oxidant formation and apoptosis and increased viability, glucose-induced ATP production and glucose-stimulated insulin secretion. These results suggest that this combination may protect β-cell apoptosis by improving the oxidative stress-mediated apoptotic pathway.

Automated identification of neurons in 3D confocal datasets from zebrafish brainstem

Many kinds of neuroscience data are being acquired regarding the dynamic behaviour and phenotypic diversity of nerve cells. But as the size, complexity and numbers of 3D neuroanatomical datasets grow ever larger, the need for automated detection and analysis of individual neurons takes on greater importance. We describe here a method that detects and identifies neurons within confocal image stacks acquired from the zebrafish brainstem. The first step is to create a template that incorporates the location of all known neurons within a population - in this case the population of reticulospinal cells. Once created, the template is used in conjunction with a sequence of algorithms to determine the 3D location and identity of all fluorescent neurons in each confocal dataset. After an image registration step, neurons are segmented within the confocal image stack and subsequently localized to specific locations within the brainstem template - in many instances identifying neurons as specific, individual reticulospinal cells. This image-processing sequence is fully automated except for the initial selection of three registration points on a maximum projection image. In analysing confocal image stacks that ranged considerably in image quality, we found that this method correctly identified on average approximately 80% of the neurons (if we assume that manual detection by experts constitutes 'ground truth'). Because this identification can be generated approximately 100 times faster than manual identification, it offers a considerable time savings for the investigation of zebrafish reticulospinal neurons. In addition to its cell identification function, this protocol might also be integrated with stereological techniques to enhance quantification of neurons in larger databases. Our focus has been on zebrafish brainstem systems, but the methods described should be applicable to diverse neural architectures including retina, hippocampus and cerebral cortex.

The effects of aeration rate on generated compost quality, using aerated static pile method

To determine the most appropriate composting process in an active municipal solid waste system, an experiment was carried out using a nested design method with three aeration rates. During each aeration rate, parameters such as temperature, pH, EC, carbon-to-nitrogen ratio, NO(3)-N, nitrogen, potassium and phosphorous were measured and the efficiency of different composting processes was evaluated. The result of this study showed that the lower and medium aeration rates had a significant impact on nitrogen, carbon-to-nitrogen ratio and temperature profile, while higher aeration rates led to higher EC values. Furthermore, the thermophilic phase lasted 13, 9 and 4 weeks for the aeration rates of 0.4, 0.6 and 0.9 L min(-1)kg(-1), respectively. Accordingly, it was concluded that starting at a rate of 0.6 L min(-1)kg(-1) during first 2 months (about 9 weeks) of the process and continuing at a rate of 0.4 L min(-1)kg(-1)until the end of composting process would result in lower energy consumption.

Predictors of outcome in first-episode schizophrenia over the first 4 years of illness

BACKGROUND

The outcome of schizophrenia appears to be more favourable than once thought. However, methodological issues, including the reliance on diagnosis at first presentation have limited the validity of outcome studies to date.

METHOD

We conducted a first-episode follow-up study of 97 patients with DSM-IV schizophrenia over the first 4 years of illness. First presentation and follow-up assessments were compared using paired t tests and a forced-entry regression analysis was used to determine prognostic variables.

RESULTS

There were significant improvements in positive and negative symptoms and global assessment of functioning between first presentation and follow-up. At first presentation, fewer negative symptoms (t=-3.40, p<0.01), more years spent in education (t=3.25, p<0.01), and a shorter duration of untreated psychosis (DUP) (t=-2.77, p<0.01) significantly predicted a better outcome at follow-up.

CONCLUSIONS

The outcome of schizophrenia may not be as pessimistic as once thought and most patients did not display a downward deteriorating course of illness. This study supports the relationship between DUP and outcome beyond the early stages of illness.

A prospective evaluation of adherence to medication in first episode schizophrenia

The aim of this study was to identify the features of first episode schizophrenia that predict adherence antipsychotic medication at six-month follow-up. We used validated instruments to assess clinical and socio-demographic variables in all patients with first episode schizophrenia from a defined geographical area admitted to a Dublin psychiatric hospital over a four-year period (N=100). At six-month follow-up (N=60) we assessed adherence to medication using the Compliance Interview. One third of patients with schizophrenia were non-adherent with medication within six months of their first episode of illness. High levels of positive symptoms at baseline, lack of insight at baseline, alcohol misuse at baseline and previous drug misuse predict non-adherence. These results indicate that an identifiable subgroup of patients with first episode schizophrenia is at high risk of early non-adherence to medication. While high positive symptom scores pre-date and predict non-adherence in most patients, reduced insight is the best predictor of non-adherence in patients who do not misuse alcohol or other drugs.

Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder

OBJECTIVE

To map the development of insight in the 4 years after presentation with first-episode schizophrenia and schizophreniform disorder and to determine the effects of evolving insight on depression and the likelihood of attempted suicide.

METHOD

We assessed 101 individuals at presentation, 6 months and 4 years. We measured insight, including recognition of mental illness, recognition of need for treatment and ability to relabel psychotic symptoms. We measured depression and recorded all suicide attempts.

RESULTS

Insight improved with time. Recognition of mental illness at 6 months predicted depression and attempted suicide at 4 years.

CONCLUSION

Six months after presentation, the greater the acknowledgement by people that they had a mental illness, the more depressed they were at 4 years and the greater the likelihood that they would attempt suicide by 4 years. This may have implications for disclosure of diagnosis.

Clinical predictors of admission status in first episode schizophrenia

Having a diagnosis of schizophrenia is a risk factor for involuntary admission to psychiatric inpatient care, but we have a limited understanding of why some patients and not others require involuntary admission. We aimed to identify the predictors of involuntary admission in first episode schizophrenia. We used validated instruments to assess clinical and socio-demographic variables in all patients (n = 78) with first episode schizophrenia from a defined geographical area admitted to a Dublin psychiatric hospital over a 4-year period. Involuntary patients (n = 17) could not be distinguished from voluntary patients (n = 61) on the basis of age, gender, living status, marital status, drug abuse or duration of untreated psychosis. Neither positive nor negative symptoms were useful predictors of admission status. Lack of insight was a strong predictor of involuntary status.

Prospective evaluation of neurological soft signs in first-episode schizophrenia in relation to psychopathology: state versus trait phenomena

BACKGROUND

Although patients with schizophrenia have increased rates of neurological soft signs, few studies have examined prospectively their trait or state characteristics in relation to psychopathology.

METHOD

In a prospective study of 97 patients with first-episode schizophrenia (DSM-IV criteria) we assessed neurological soft signs and psychopathology at presentation and at 6 month follow-up for 73 cases. To establish whether soft signs were associated with variations in clinical state, neurological soft signs were measured using two validated examinations (Neurological Evaluation Scale and Condensed Neurological Examination); psychopathology was assessed using the Positive and Negative Syndrome Scale.

RESULTS

There was significant improvement in overall neurological function, primarily in motor-related and cortical signs, which were associated with improvement in psychopathology. Conversely, 'harder' signs were unrelated to improvement in psychopathology.

CONCLUSIONS

Neurological soft signs in schizophrenia are heterogenous. Motor and cortical signs evidence state-like characteristics and vary with clinical course, while 'harder' signs evidence more static, trait-like characteristics in accordance with a neurodevelopmental basis.

Understanding the neurobiology of suicidal behavior

Our current knowledge about the neurobiology of suicide is still limited. Technical limitations and the complexity of the CNS are major obstacles. However, there is evidence for a hereditary disposition to suicide, which appears to be independent of diagnosis. Clinical, postmortem, genetic, and animal studies suggest that serotonin has a central role. The main regions of interest in the CNS have been the dorsal and median raphe nuclei in the midbrain that host the main serotonergic cell bodies and the prefrontal cortex, particularly the ventral PFC, innervated by the serotonergic system. In vivo and postmortem studies indicate serotonergic hypofunction in suicide and serious suicide attempts. This deficiency in turn can lead to a predisposition to impulsive and aggressive behavior, probably due to a breakdown in the inhibitory function of the ventral prefrontal cortex as a result of less serotonin input. In the context of this predisposition and the development of mental illness or other life stressors, the individual is at risk of acting on suicidal thoughts. Such deficient serotonin input into the PFC may arise as a result of genetic, parenting, head injury, and other effects. Identifying psychiatric, social, and environmental predictors of suicide are studied to improve prediction and prevention of suicide. A better understanding of the neurobiology of suicide can help detect at risk populations and help develop better treatment interventions.

The prevalence of comorbid substance misuse and its influence on suicidal ideation among in-patients with schizophrenia

OBJECTIVE

To estimate the prevalence, and identify the clinical correlates of comorbid substance misuse (abuse or dependence) among readmissions with schizophrenia, particularly to establish whether comorbid substance misuse is associated with higher rates of depressive symptoms and suicidal ideation.

METHOD

Over 12 months, consecutive readmissions from a catchment area psychiatric service with DSM-IV schizophrenia/schizoaffective disorder were assessed using clinical assessments of symptomatology including depression, insight and compliance. Comorbid substance misuse was diagnosed using DSM-IV criteria.

RESULTS

Of 102 readmissions 40% had lifetime, while 20% had current comorbid substance misuse and were predominately young males. Comorbid substance misuse had no statistically significant impact on positive, negative or depressive symptomatology. However, those currently misusing substances reported more suicidal ideation compared with past or non-substance misusers.

CONCLUSION

Readmissions with comorbid substance misuse were more likely to report suicidal ideation, and may represent a group of individuals who are at higher risk of suicide.

Bilateral traumatic rupture of the infrapatellar tendon

This is a case report and discussion of the traumatic lesion of bilateral rupture of the infrapatellar tendon in a 52-year-old man. This injury is very rare and seems not to have been previously documented. The treatment consists of surgical repair and cast immobilization. Bilateral rupture of the infrapatellar tendon should be suspected when after injury a patient is unable to actively extend his knee.

Development of a diploid cell line from fetal calf lung for virus vaccine production

Details of isolation and replication of a fetal calf diploid cell (FCDC) is given. From the karyological point of view, the fairly large number of chromosomes existing in metaphase spreads made counting rather tedious. Lack of practical classification was another problem which made reference to individual chromosomes difficult. By increasing the population doubling of this cell, a tendency of telocentric chromosomes to undergo centric fusion was observed. Susceptibility of FCDC to different viruses is described.

Use of human diploid cell MRC-5, for production of measles and rubella virus vaccines

A further attenuated strain of measles virus, called AIK strain, developed by Makino and his colleagues at the Kitasato Institute, Tokyo, was adapted to human diploid cells (HDC), MRC-5. In a field trial it was found that this strain initiates a low rate of clinical reactions and 100% seroconversion in vaccines. An attenuated strain of rubella virus, called Takahashi strain, isolated by Shishido at the National Institute of Health, Japan, was also adapted to HDC, MRC-5. Brief details of production of an experimental rubella vaccine are given. Up to 20 harvests of virus were made from each culture without any apparent alteration of diploid cells.