Occupational Nerve Injuries due to Metallic Foreign Bodies: A Case Series of Eighteen Patients

Introduction

Peripheral nerve injuries (PNIs) remain an important health problem. PNIs mostly affect young men as this age group is mostly involved in road traffic accidents and other injuries at workplace. PNI can occur from foreign bodies like metal chips while working in industries using lathe machines. Among PNI's, injuries to the ulnar nerve, the brachial plexus and the median nerve are the most frequent lesions encountered.

Materials and methods

This presentation is on a series of 18 cases of nerve injuries among industrial workers located from finger level up to the arm excluding the brachial plexus due to metallic foreign bodies entering while operating lathe machines over a period of two years with patients being followed-up over a one year period.

Results

Mean age in this series was 31.3 years with age range 16-40 years and all were males. Two patients had more than one nerve involvement and one patient had associated vascular injury. All the patients showed functional improvement. Most common nerve injured was median nerve. Most common site for nerve injury was forearm. Combined lesions most commonly involved the ulnar and median nerves.

Conclusion

Social cost of traumatic peripheral nerve injuries is significant since it has a higher incidence in young, previously healthy, and economically active people.

A LONGITUDINAL STUDY OF CHILDHOOD SEPARATION ANXIETY DISORDER AND ITS IMPLICATIONS FOR ADOLESCENT PSYCHOPATHOLOGY

A prevalent psychiatric disorder called Child Separation Anxiety Disorder (SAD) is characterized by extreme discomfort when a child gets separated from their primary carers. While SAD's quick consequences on kids are well-researched, its long-term implications for teenage psychopathology have received less attention. This longitudinal study aims to ascertain the connection between child SAD and future psychopathological consequences in adolescents. 500 adolescents were chosen as part of the adolescent depression project, and at the age of 17, we retrospectively evaluated past and present mental disorders. At ages 25 and 32, they conducted diagnostic evaluations of these people during adolescence while they continued to monitor them. Based on childhood/adolescent assessments, the participants were split into different groups: SAD (n=34), other forms of Anxiety (n=76), a control group with combined psychiatric conditions (n=205), and mentally sound control group (n=185). Statistics were evaluated by hierarchical multiple logistic regression after various illnesses and pertinent demographic variables were considered. It implies that SAD has a high risk (80.2%) of being a significant risk indicator for the emergence of mental illnesses in young adults. This study highlights the importance of early SAD management and therapy and the possible advantages of treating SAD in lowering the likelihood of developing other mental health problems in adolescence. It also emphasizes the value of continuous studies to comprehend these connections and enhance the effects on SAD sufferers' psychological well-being.

EFFECTS OF SOCIAL ESTRANGEMENT ON YOUNG PEOPLE'S MATURATION: A REVIEW OF THE RESEARCH

A major issue among adolescents in recent years has been social isolation, or the sensation cut off and alone from peers and society. The effects of social isolation on youngsters and adolescents are investigated with special attention paying to the possible negative effects on their physical and mental health. Multiple studies have shown a link between adversity in life domains and adolescent social isolation. Firstly, it can have a major effect on mental health, raising the probability of experiencing things like anxiety, sadness and even suicidal thoughts. Second, it prevents the development of vital social abilities, making it harder to make and keep close friends. In addition, social isolation is associated with worse academic performance, which in turn reduces the number of courses a student can take and the number of jobs they can have in the future. After looking over 520 papers, 15 were chosen for the systematic review. Four researches reported the implications on general health, while two investigations reported on ramifications affecting the Hypothalamic-pituitary-adrenal (HPA) axis area along with social and mental growth of children. In conclusion, social isolation affects youth development across a wide spectrum, including psychological well-being, interpersonal skills, and academic success. Children and adolescents who experience isolation are more likely to suffer from anxiety and sadness, according to the review's findings. Cortical levels rise and mental growth slows in socially isolated children. Children and adolescents should be monitored by health professionals during and after the COVID-19 pandemic to ensure that their mental and physical health needs are met.

Alternaria alternata (SDHY01/02), a fungus associated with Lamellodysidea herbacea: its anticancer potential and responsible constituent(s)

One of the biggest global causes of death is cancer. The side effects of currently available therapies have triggered the search for new drugs. The marine environment, with its vast biodiversity, including sponges, is a rich source of natural products with immense pharmaceutical potential. The aim of the study was to analyze the microbes associated with the marine sponge, Lamellodysidea herbacea, and explore them as resources for anticancer ability. This study includes the isolation of fungi from L. herbacea, and their evaluation for cytotoxic potential against human cancer cell lines such as A-549 (lung), HCT-116 (colorectal carcinoma), HT-1080 (Fibrosarcoma), and PC-3 (prostate) using MTT assay. This revealed that fifteen extracts showed significant anticancer ability (IC50 ≤ 20 µg/mL), at least against one of the cell lines. Three extracts, SPG12, SPG19, and SDHY 01/02, were found significant in terms of anticancer activity, at least against three to four cell lines (IC50 values ≤ 20 µg/mL). The fungus SDHY01/02 was identified by sequencing the internal transcribed spacer (ITS) region as Alternaria alternata. Its extract showed IC50 values < 10 µg/mL against all the tested cell lines and was further analysed through light and fluorescence microscopy. The extract of SDHY01/02 was active (lowest IC50 4.27 µg/mL) against A549 cells in a dose-dependent manner and caused apoptotic cell death. Further, the extract was fractionated and analyzed the constituents by GC-MS (Gas Chromatography-Mass Spectrometry). Di-ethyl ether fraction revealed the constituents (having anticancer activity) such pyrrolo[1,2-a] pyrazine-1,4-dione, hexahydro-3-(2-methyl propyl); 4,5,6,7-tetrahydro-benzo[C]rhiophene-1-carboxylic acid cyclopropylamide; 17-pentatriacontene; 9,12-octadecadienoic acid (Z, Z)-, methyl ester; while DCM fraction contained Oleic acid, eicosyl ester. This is the first report of A. alternata with anticancer potential that has been isolated from the sponge L. herbacea, as far as we are aware.This A. alternata can be exploited to get anticancer molecule(s) in the future.

Nasopharyngeal carriage of Streptococcus pneumoniae serotypes among sick and healthy children in northern India: A case-control study

BACKGROUND

Streptococcus pneumoniae is leading bacterial cause of community acquired pneumonia and according to World Health Organization, responsible for 14 % death in children. There is effective vaccine available against Streptococcus pneumoniae. Hence the primary objective was to isolate Streptococcus pneumoniae from nasopharyngeal swabs in children aged 2-59 months with and without community acquired pneumonia and to assess their serotypes.

METHODS

This case-control study was conducted in tertiary teaching institutes in northern India. Hospitalized children, aged 2-59 months, with World Health Organization-defined community acquired pneumonia were included as cases. Age matched healthy controls were recruited from immunization clinic. All enrolments were done after written informed parental consent. Nasopharyngeal swabs were taken from both cases and controls, and were cultured on 5 % sheep blood agar with gentamycin plate for growth of Streptococcus pneumoniae and incubated in a jar at 370 for 18-24 hrs. Quellung reaction test was used for serotyping.

RESULTS

From March 2017 to December 2022, 2693 children (1910 cases and 783 controls), were recruited. The median age of cases was 7 months and controls 10 months. Almost all the cases had received antibiotics prior to hospitalization. Streptococcus pneumoniae positivity in nasopharyngeal swab was 8.1 % in cases, of which 56.8 % were vaccine serotypes and 23.6 % in controls, of which 37.8 % were vaccine serotypes. Adjusted odds ratio of isolating vaccine serotypes among cases as compared to controls was 1.77 (95 % CI, 1.09-2.88).

CONCLUSION

Streptococcus pneumoniae isolation from nasopharyngeal was found to be in lower proportion in cases as compared to control, though colonization with vaccine serotypes was higher in cases as compared to control. Therefore, pneumococcal vaccine coverage must be increased to prevent community acquired pneumonia.

EXPLORING MEDICAL STUDENTS' COMPETENCY IN UNDERSTANDING PRIMARY IMMUNODEFICIENCY DISEASES IN INDIA

Primary Immunodeficiency Disease (PID) represents a class of diverse illnesses marked by compromised immune system performance. For better patient outcomes, PIDs must be diagnosed and treated quickly. Medical graduates are essential to the detection and treatment of these illnesses. The purpose of this study was to evaluate medical students' knowledge about PIDs in different Indian medical colleges. To perform this analytical investigation, college students from Maharashtra-area universities were enlisted between March and April of 2023. The participants received a questionnaire from mediators from every institution. Of the 500 students in the study, 66% were between the ages of 22 and 24 and 52% were female. Their understanding ratings had an average of 16.3±6.2 and varied between 4 and 32. A set of students classified as below average (86%) and a mean/above average (14%), were separated among the students. The largest percentage of above-average knowledge was demonstrated by VI-year participants (p<0.05). This investigation emphasizes how critical it is to provide focused educational activities to improve medical students' comprehension of PIDs in India.

PLGA and PEG based porous microparticles as vehicles for pulmonary somatropin delivery

Breakthrough advances in protein therapeutics and sustained release systems continue to fuel innovation in novel, non-invasive polymeric platforms for delivery of biologicals. Despite the bench potential and proof-of-concept work, market analysis still shows biologicals to be predominantly injections. Characterized by insufficient secretion of growth hormone by the pituitary gland, growth hormone deficiency (GHD) is a rare disorder. Currently, chronic somatropin (r-hGH) replacement therapy is only available as subcutaneous injections administered several times a week. We aim to prepare large, porous, biodegradable and aerodynamically light microparticles as tunable carriers for pulmonary r-hGH delivery. We developed a range of microparticles using PLGA 5050 1Awith sizes between 5 μm and 13 μm, densities lower than 0.4 g/cc and aerodynamic diameters lower than 6 μm. Polyethylene glycol's multitude of advantages - plasticizing PLGA, improving the biocompatibility of the system and preventing protein burst release - have been extensively studied, making it our excipient (pore-former) of choice. Drug loading was characterized at pH 4.0 (acidic), 5.3 (pI) and pH 7.2 (neutral) and was a result of an interplay of electrostatic and hydrophobic interactions between the polymer and somatropin. Considering the physicochemical interactions, we observed some pH dependent protein unfolding characterized by reduction in intrinsic fluorescence of the Tryptophan 86 residue at 331 nm. The secondary ⍺-helix structure characterized by 2 negative minima at 209 nm and 222 nm in the circular dichroism spectra, was intact at all pH values. R-hGH was released over a period of seven days, and the release profile was a function of the microparticle porosity.

Ythdf2 regulates cardiac remodeling through its mRNA target transcripts

m6A mRNA methylation controls cardiomyocyte function and increased overall m6A levels are a stereotyping finding in heart failure independent of the underlying etiology. However, it is largely unknown how the information is read by m6A reader proteins in heart failure. Here we show that the m6A reader protein Ythdf2 controls cardiac function and identified a novel mechanism how reader proteins control gene expression and cardiac function. Deletion of Ythdf2 in cardiomyocytes in vivo leads to mild cardiac hypertrophy, reduced heart function, and increased fibrosis during pressure overload as well as during aging. Similarly, in vitro the knockdown of Ythdf2 results in cardiomyocyte growth and remodeling. Mechanistically, we identified the eucaryotic elongation factor 2 as post-transcriptionally regulated by Ythdf2 using cell type specific Ribo-seq data. Our study expands our understanding on the regulatory functions of m6A methylation in cardiomyocytes and how cardiac function is controlled by the m6A reader protein Ythdf2.

Frequency-Dependent Squeezed Vacuum Source for the Advanced Virgo Gravitational-Wave Detector

In this Letter, we present the design and performance of the frequency-dependent squeezed vacuum source that will be used for the broadband quantum noise reduction of the Advanced Virgo Plus gravitational-wave detector in the upcoming observation run. The frequency-dependent squeezed field is generated by a phase rotation of a frequency-independent squeezed state through a 285 m long, high-finesse, near-detuned optical resonator. With about 8.5 dB of generated squeezing, up to 5.6 dB of quantum noise suppression has been measured at high frequency while close to the filter cavity resonance frequency, the intracavity losses limit this value to about 2 dB. Frequency-dependent squeezing is produced with a rotation frequency stability of about 6 Hz rms, which is maintained over the long term. The achieved results fulfill the frequency dependent squeezed vacuum source requirements for Advanced Virgo Plus. With the current squeezing source, considering also the estimated squeezing degradation induced by the interferometer, we expect a reduction of the quantum shot noise and radiation pressure noise of up to 4.5 dB and 2 dB, respectively.

Entrapment of subscapular artery by the splitting of radial nerve- putative clinical implications

The third part of the axillary artery has an intimate relationship with the cords of the brachial plexus. The subscapular artery, the largest branch of the axillary artery, arises from its third part. The radial nerve is a branch of the posterior cord of the brachial plexus and its supplies the extensors of the arm, forearm and dorsum of the hand. During routine undergraduate dissection of the axilla of a formalin-fixed cadaver of about 70 years, the subscapular artery was found sandwiched between two divisions of the radial nerve. These anterior and posterior divisions of the radial nerve arose immediately after the formation of the radial nerve and encircled the subscapular artery and fused to form a single nerve subsequently. This variant anatomy can lead to conditions like subscapular entrapment causing ischemia of the scapular region and radial nerve compression causing weakness of the extensors of the upper limb. Injury to the nerve and vessel can occur while performing diagnostic and therapeutic procedures in the area. Knowledge of these variations provides a precautious approach by surgeons and other interventionists while working on this area.

Correction to: 'Current strategies with implementation of 3D cell culture: The challenge of quantification' (2022) by Temple et al

[This corrects the article DOI: 10.1098/rsfs.2022.0019.][This corrects the article DOI: 10.1098/rsfs.2022.0019.].

Clinical variables and pre-operative depression levels for prediction of pain severity in patients undergoing heart surgery

Objective: In patients undergoing heart surgery, severe pain is common and may raise the risk of heart conditions, morbidity, and death. The study's goals were to evaluate post-cardiac surgery pain predictors, such as clinical variables and depression, as well as perioperative Pain Severity (PS). Methods: The research included 98 heart surgery patients in total. PS was analysed utilizing a Numerical Rating System (NRS). From the second day after surgery through the seventh day, pain levels were monitored daily. Clinical data was obtained, and depression levels were determined utilizing the Center for Epidemiological Study of Depression (CES-D). Results: From pre-operative levels, pain severe dramatically increased while hospitalized, peaking at day 2 after surgery. Higher CES-D preoperative values in gender, heart function, smoking, and a high Body mass index (BMI). Preoperative CES-D ratings were considerably higher for patients in severe pain than for those with no pain or mild pain. Patients experiencing severe pain (NRS 7 to 10) exhibited considerably greater white blood cell (WBC) counts than those free of pain or mild pain (NRS 0 to 6) (p=0.01). However, there was no association between maximum WBC levels after surgery and CES-D scores. Conclusion: Following surgery, PS considerably increased and was linked to depressive symptoms, gender, heart function, BMI, and smoking. These variables could be used as a starting point for detection and treatment to help stop the progression of acute pain into chronic pain.

Nasopharyngeal Carriage of Streptococcus pneumoniae Serotypes Among Healthy Children in Northern India

Streptococcus pneumoniae (SP) infections cause morbidity and mortality among children worldwide. Hence India introduced 13-valent pneumococcal conjugate vaccine (PCV-13) in 2017 in a phased manner. The primary objective of this study was to assess the proportion of healthy children having nasopharyngeal colonization (NP) with SP. Secondary objective was to determine prevalent serotype of SP among the PCV13 vaccinated and non-vaccinated children. This cross-sectional study was conducted in 4 hospitals of Lucknow District, Northern India. Three hundred healthy children (2-59 months) were recruited between July and August 2019 from vaccination-clinics of hospitals. NP specimen was cultured using 5% sheep blood agar plate containing gentamicin. Pneumococcal isolates were identified by optochin sensitivity and bile-solubility tests. Serotyping was done using Quellung Method. Of the 300 healthy children, 56.7% (170/300) were males and 59.3% (181/300) had received at least one dose of PCV13 vaccine. The NP carriage rate of SP among healthy children was 37.7% (113/300). Vaccine serotypes were found in 33.3% (22/66) in PCV vaccinated children and 48.9% (23/47) in non-vaccinated children (p 0.09). Common vaccine serotypes that isolated were: 18C, 19A, 19F, 23F, 3, 4, 6A, 6B, 9 V. Thus more than one-third of healthy children had NP colonization with SP. Adjusting for age, there was a trend for significant reduction in vaccine serotypes in the NP with one doses versus two or more doses (ptrend = 0.04).

Single dose topical inserts containing tenofovir alafenamide fumarate and elvitegravir provide pre- and post-exposure protection against vaginal SHIV infection in macaques

BACKGROUND

Vaginal products for HIV prevention that can be used on-demand before or after sex may be a preferable option for women with low frequency or unplanned sexual activity or who prefer not to use daily or long-acting pre-exposure prophylaxis (PrEP). We performed dose ranging pharmacokinetics (PK) and efficacy studies of a vaginally applied insert containing tenofovir alafenamide fumarate (TAF) and elvitegravir (EVG) in macaques under PrEP or post-exposure prophylaxis (PEP) modalities.

METHODS

PK studies were performed in 3 groups of pigtailed macaques receiving inserts with different fixed-dose combinations of TAF and EVG (10/8, 20/16 and 40/24 mg). PrEP and PEP efficacy of a selected insert was investigated in a repeat exposure vaginal SHIV transmission model. Inserts were administered 4 h before (n = 6) or after (n = 6) repeated weekly SHIV exposures. Infection outcome was compared with macaques receiving placebo inserts (n = 12).

FINDINGS

Dose ranging studies showed rapid and sustained high drug concentrations in vaginal fluids and tissues across insert formulations with minimal dose proportionality. TAF/EVG (20/16 mg) inserts were selected for efficacy evaluation. Five of the 6 animals receiving these inserts 4 h before and 6/6 animals receiving inserts 4 h after SHIV exposure were protected after 13 challenges (p = 0.0088 and 0.0077 compared to placebo, respectively). The calculated PrEP and PEP efficacy was 91.0% (95% CI = 32.2%-98.8%) and 100% (95% CI = undefined), respectively.

INTERPRETATION

Inserts containing TAF/EVG provided high protection against vaginal SHIV infection when administered within a 4 h window before or after SHIV exposure. Our results support the clinical development of TAF/EVG inserts for on-demand PrEP and PEP in women.

FUNDING

Funded by CDC intramural funds, an interagency agreement between CDC and USAID (USAID/CDC IAA AID-GH-T-15-00002), and by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID) under a Cooperative Agreement (AID-OAA-A-14-00010) with CONRAD/Eastern Virginia Medical School.

Management of dog bite wounds: Our protocol and experience with early surgical intervention

Dog bites injuries are a significant cause of morbidity and mortality. Conventionally, it was suggested to leave the wounds open due to probable increased risk of infections and occurrence of rabies with suturing.Recent publications indicate that primary closure does not necessarily affect the chances of infection but definitely helps in improving the quality of scar. We are presenting our experience and protocol for primary closure of all dog bite wounds. From March 2020 to February 2021, 10 consecutive patients of all ages coming to the emergency of our hospital with category 3 dog bite that penetrated the epidermis and dermis and presenting within 48 hours of injury were included. Every patient was administered first dose of anti rabies vaccine (ARV) (zero dose) for active immunisation and was also given injection tetanus intramuscularly. Mean age of patients in our study was 20.9 with range from 2 years to 90 years. Only 2/10 patients developed infections which were managed conservatively with drainage of abscess and antibiotics. Rest all patients recovered without complications. Primary closure of dog bite wounds when associated with debridement, sufficient irrigation, povidine iodine cleansing and antibiotic administration resulted in improved cosmetic appearance without increase in the rate of infection.

Search for Subsolar-Mass Binaries in the First Half of Advanced LIGO's and Advanced Virgo's Third Observing Run

We report on a search for compact binary coalescences where at least one binary component has a mass between 0.2  M_{⊙} and 1.0  M_{⊙} in Advanced LIGO and Advanced Virgo data collected between 1 April 2019 1500 UTC and 1 October 2019 1500 UTC. We extend our previous analyses in two main ways: we include data from the Virgo detector and we allow for more unequal mass systems, with mass ratio q≥0.1. We do not report any gravitational-wave candidates. The most significant trigger has a false alarm rate of 0.14  yr^{-1}. This implies an upper limit on the merger rate of subsolar binaries in the range [220-24200]  Gpc^{-3} yr^{-1}, depending on the chirp mass of the binary. We use this upper limit to derive astrophysical constraints on two phenomenological models that could produce subsolar-mass compact objects. One is an isotropic distribution of equal-mass primordial black holes. Using this model, we find that the fraction of dark matter in primordial black holes in the mass range 0.2  M_{⊙}<m_{PBH}<1.0  M_{⊙} is f_{PBH}≡Ω_{PBH}/Ω_{DM}≲6%. This improves existing constraints on primordial black hole abundance by a factor of ∼3. The other is a dissipative dark matter model, in which fermionic dark matter can collapse and form black holes. The upper limit on the fraction of dark matter black holes depends on the minimum mass of the black holes that can be formed: the most constraining result is obtained at M_{min}=1  M_{⊙}, where f_{DBH}≡Ω_{DBH}/Ω_{DM}≲0.003%. These are the first constraints placed on dissipative dark models by subsolar-mass analyses.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

P-323 Should We Measure Oxidative Stress Biomarkers In Follicular Fluid Of Women With Endometriosis Undergoing IVF?

Study question

Do levels of Oxidative stress (OS) biomarkers differ in the follicular fluid of women with endometriosis compared to tubal factor infertility?

Summary answer

8-Isoprostane is a promising biomarker in diagnosing oxidative stress in women with endometriosis opening a window of opportunity for improving outcomes.

What is known already

A delicate balance between oxidants and antioxidants is required for oocyte development and maturation. Any perturbation in the oocyte microenvironment which is the follicular fluid results in hampered oocyte quality and further affects the embryo development. As endometriosis causes destruction of the oocyte milieu, various OS biomarkers have been explored with inconclusive results. The present study aimed to compare these biomarkers in follicular fluid of women with endometriosis and tubal factor infertility undergoing in-vitro fertilization and correlate with ART outcomes.

Study design, size, duration

In a cross sectional study conducted at the assisted conception unit at a tertiary care hospital from 2017-2018 women undergoing their first IVF cycles for endometriosis and tubal factor infertility were recruited in the study. The study included a total of 107 patients with 50 in the endometriosis group (Group1) and 57 in the tubal group (Group 2).

Participants/materials, setting, methods

Follicular fluid from women undergoing IVF in both the groups was collected and evaluated for Oxidative stress biomarkers including Reactive Oxygen species (ROS), Total Antioxidant Capacity (TAC), 8-Isoprostane (8-IP) levels. ROS levels were detected by chemiluminescence and TAC and 8-IP using enzyme immunoassays.

Main results and the role of chance

Levels of ROS {(39.6 cpm vs 54.8 cpm) (p = 0.2)}were comparable in both the groups. Levels of 8-IP were significantly higher in group 1 as compared to the group 2 {(85.2  pg/ul vs 39.2  pg/ul) (p = 0.01)}. TAC levels were higher in endometriosis group compared to the tubal group {(5.4 mM of Trolox vs 4.1 mM of Trolox) (p = 0.005)} which could explain comparable ongoing clinical pregnancy rate in both groups (24.0% vs 24.5%, p = 0.34). There was no correlation of OS biomarkers with ART outcomes in tubal factor. Follicular fluid in Group 1 revealed a negative correlation of ROS with cleavage rate (r = - 0.42, p = 0.002) and positive correlation of TAC with fertilization rate (r = 0.44, p = 0.001) and Good grade embryos (r = 0.4, p = 0.001).

Limitations, reasons for caution

The main limitation is the inability to assess the dietary intake and blood oxidative stress biomarkers in both the groups.

Wider implications of the findings

OS biomarkers especially 8-IP could be useful in prognosticating IVF outcomes in women with endometriosis with a potential role of addition of antioxidants in culture media during IVF in these women.

Trial registration number

Not Applicable

AB0022 SELECTIVE ESTROGEN RECEPTOR MODULATORS AND TISSUE-SELECTIVE ESTROGEN COMPLEX DO NOT SHARE ESTROGENIC EFFECTS ON IGG SIALYLATION IN AUTOIMMUNE CONDITIONS

Background

Women entering menopause, with a decrease in estrogen levels, display an increased incidence of rheumatoid arthritis (RA). Estrogen (E2) treatment has beneficial effects on IgG pathogenicity by altering the sialylation grade which affect the binding ability to FcR1. E2 replacement may therefore be beneficial in pre-RA patients having autoantibodies. Exposure to estrogen is associated with negative side effects, therefore selective estrogen receptor modulators (SERMs) have been developed with estrogenic protective effect on bone but minimal impact on the reproductive system2. The SERM, Bazeodoxifene (BZA), as well as tissue-selective estrogen complex (TSEC), a combination of conjugated estrogen and BZA, have been approved for treatment of postmenopausal bone loss3-5

Objectives

The purpose of this study was to investigate the impact of BZA and TSEC on IgG sialylation grade which affects the pathogenicity as well as to determine the effects on total serum protein sialylation.

Methods

C57Bl6 mice were subjected to ovariectomy to stop the endogenous E2 production and mimicked the postmenopausal status. Mice were then treated with E2, BZA, TSEC, or vehicle, followed by ovalbumin (OVA) immunization to induce the IgG levels. Blood was collected before treatment started and at termination. In serum total IgG, OVA specific IgG and the degree of IgG-sialylation were quantified with ELISA. Sialyation of total serum proteins was determined with sialic acid assay quantification kit. Expression of sialyltransferase protein was analyzed in the bone marrow (BM) and spleen cell compartment using flow cytometry. The mRNA expression of glycosyltransferase was analyzed by qPCR analysis.

Results

Neither BZA nor TSEC significantly altered the total IgG levels or sialylation grade of IgG. Indeed, E2 significantly altered IgG sialylation. We showed that BZA increased sialyltransferase protein in plasma cells in a similar manner as E2. Further, neither E2, BZA or TSEC had any significant impact on sialic acids in whole serum protein and not in the mRNA expression of glycosyltransferase in the liver, BM, or gonadal fat.

Conclusion

In this study, we were not able to detect any alteration by TSEC or BZA treatment on IgG-sialylation grade and thereby pathogenicity of the IgG. Neither E2 nor BAZ or TSEC show any significant alteration on general sialylation, but our results suggest that further studies are required to understand E2, SERM, and TSEC full effect on protein sialylation in autoimmune conditions.

Keywords: IgG sialylation, protein glycosylation, SERMs

References

[1]Engdahl C, Bondt A, Harre U, et al. Estrogen induces St6gal1 expression and increases IgG sialylation in mice and patients with rheumatoid arthritis: a potential explanation for the increased risk of rheumatoid arthritis in postmenopausal women. Arthritis Research & Therapy. 2018/05/02 2018;20(1):84. doi:10.1186/s13075-018-1586-z

[2]Pinkerton JV, Thomas S. Use of SERMs for treatment in postmenopausal women. J Steroid Biochem Mol Biol. Jul 2014;142:142-54. doi:10.1016/j.jsbmb.2013.12.011

[3]Miller PD, Chines AA, Christiansen C, et al. Effects of bazedoxifene on BMD and bone turnover in postmenopausal women: 2-yr results of a randomized, double-blind, placebo-, and active-controlled study. J Bone Miner Res. Apr 2008;23(4):525-35. doi:10.1359/jbmr.071206

[4]Pinkerton JV, Pickar JH, Racketa J, Mirkin S. Bazedoxifene/conjugated estrogens for menopausal symptom treatment and osteoporosis prevention. Climacteric. Oct 2012;15(5):411-8. doi:10.3109/13697137.2012.696289

[5]Silverman SL, Christiansen C, Genant HK, et al. Efficacy of bazedoxifene in reducing new vertebral fracture risk in postmenopausal women with osteoporosis: results from a 3-year, randomized, placebo-, and active-controlled clinical trial. J Bone Miner Res. Dec 2008;23(12):1923-34. doi:10.1359/jbmr.080710

Disclosure of Interests

None declared

POS0351 NEITHER ANTI-CITRULLINATED PROTEIN ANTIBODIES (ACPA) NOR POLYCLONAL IgG ARE ASSOCIATED WITH BONE MASS, IN ELDERLY MEN

Background

Bone loss is associated with anti-citrullinated protein antibodies (ACPA) positivity in rheumatoid arthritis (RA) patients. This is shown in both in pre-clinical RA, and in more pronounced bone loss in serum positive patients compared to serum negative patients. Further, both ACPA and activated IgG stimulate osteoclastogenesis in vitro and in murine arthritis-mediated bone loss.

Objectives

Whether polyclonal IgG or autoantibodies are important for general bone architecture, and not only in arthritis-mediated bone loss, has not been determined but they may represent an important link between the immune system and bone.

Methods

Polyclonal IgG and ACPA were measured with ELISA in serum of 600 elderly men (mean age 80.2±3.5 years), in the cohort MrOS Gothenburg. In this cohort, bone was investigated with Dual-energy-x-ray absorptiometry (DXA) and high-resolution 3D peripheral quantitative computed tomography (HR-pQCT). In C57/BL6 mice, high dose heat-activated polyclonal IgG was repetitively injected systemically or intraarticularly, and the bone was investigated with DXA and micro-CT.

Results

No association was determined between existing serum polyclonal IgG and ACPA, with the measured bone parameters, not total bone density, trabecular or cortical bone in the MrOS cohort. Systemic injection of activated IgG in mice did not affect general bone health, not total, trabecular, or cortical bone. Intraarticular injection of activated IgG was shown to give a local reduction in trabecular bone density of the tibia.

Conclusion

These data indicate that serum polyclonal IgG and ACPA do not influence general bone health in elderly men. However, in mice injection with activated IgG intraarticularly leads to a local reduction in trabecular bone. In conclusion, our data imply that ACPA and activated IgG need to be present in close connection to the bone, e.g., in the synovial area, to be able to mediate a reduction in bone mass.

Disclosure of Interests

Merja Nurkkala: None declared, Marie Lagerquist: None declared, Priti Gupta: None declared, Dan Mellström: None declared, Claes Ohlsson Grant/research support from: Novo Nordisk, Cecilia Engdahl: None declared

Giant celiac artery aneurysm – a rare experience

Giant celiac artery aneurysm is a rare entity. We describe a case of a 45-year-old male with chronic kidney disease who presented with abdominal pain for the past 6 months. CT showed a celiac artery aneurysm of size 6×6.2cm involving the common hepatic artery and compressing the portal vein posteriorly. During the procedure the supra celiac aorta was exposed, and the neck of the aneurysm was identified. After taking control of branches of the celiac and common hepatic arteries, the neck of the aneurysm was clamped and divided. In view of diminished flow in the hepatic arteries aorto hepatic bypass was done using PTFE graft from supra celiac aorta to right hepatic artery; as there was retrograde flow from the left hepatic artery it was ligated. Post operatively the patient's liver functions were normal, and he was followed up by Doppler sonography which detected good flow in the hepatic artery distal to anastomosis. Celiac artery aneurysms are rare, and management options vary from the endovascular to surgery; regardless of the approach used, revascularisation is needed if there is no adequate collateral flow.

Developing a competency-based undergraduate logbook for pediatrics: Process and lessons

With the first MBBS batch admitted under the new National Medical Commission (NMC) undergraduate curriculum entering pediatric clinical posting soon, creation of a Pediatric logbook in consonance with this competency-based curriculum was felt to be a need of the hour. No such document is yet available in the public domain. The logbook template, created after enormous brainstorming amongst authors, includes 176 Shows (S), Shows How (SH) and Perform (P) level competencies. These were further segregated into certifiable (23), affective domain (25) and clinic/field visits (9) leaving 51 as documentable competencies. The institutions may use this template to build their own institute-specific logbook based on the infrastructure, faculty strength, clinical patient load, student intake and preferred assessment method(s). It would also be worthwhile to integrate this with the internship logbook (and later the postgraduate one for students opting for post-graduation in pediatrics) to provide a longitudinal record of each student's trajectory of learning.

The development of QERM scoring system for comprehensive assessment of the Quality of Empirical Research in Medicine - Part 1

Purpose

Whereas a large number of features are mentioned to connote the quality of medical research, no tool is available to comprehensively measure it objectively across different types of studies. Also, all the available tools are for reporting, and none includes quality of the inputs and the process of research. The present paper is aimed to initiate a discussion on the need to develop such a comprehensive scoring system (in the first place), to show that it is feasible, and to describe the process of developing a credible system.

Method

An expert group comprising researchers, reviewers, and editors of medical journals extensively reviewed the literature on the quality of medical research and held detailed discussions to parse quality at all stages of medical research into specific domains and items that can be assigned scores on the pattern of quality-of-life score.

Results

Besides identifying the domains of the quality of medical research, a comprehensive tool for scoring emerged that can be possibly used to objectively measure the quality of empirical research comprising surveys, trials, and observational studies. Thus, this can be used as a tool to assess Quality of Empirical Research in Medicine (QERM). The expert group confirmed its face and content validity. The tool can be used by the researchers for self-assessment and improvement before submission of a paper for publication, and the reviewers and editors can use this for assessing the submissions. Published papers can also be rated such as those included in a meta-analysis.

Conclusion

It is feasible to devise a comprehensive scoring system comprising domains and items for assessing the quality of medical research end-to-end from choosing a problem to publication. The proposed scoring system needs to be reviewed by the researchers and needs to be validated.

Mandibular metastasis of follicular thyroid carcinoma: A case report along with the concise review of literature

Metastasis is one of the most common consequences of malignant tumors, and it is one of the leading causes of morbidity and mortality. Metastatic cancers to oral cavity are extremely rare. Moreover, the true incidence has yet to be determined. Despite their rarity, they are important clinically, since they can be the first and the only evidence of spread in many situations. Breast, kidney, lung, prostate and gastrointestinal tract are the most common sources of metastases in the oral cavity. Thyroid carcinoma is the most prevalent type of endocrine cancer, yet it rarely spreads to the oral cavity. After papillary thyroid carcinoma, follicular thyroid carcinoma is the second-most frequent kind of thyroid cancer. Jawbones are more commonly affected than soft tissues. Literature research revealed that till date, 44 cases of metastatic follicular thyroid cancer to the jawbones have been documented with mandibular preponderance (40 cases). With the rising occurrence of oral metastatic tumors in recent years, it has become increasingly important to diagnose them early to avoid future consequences. We present here an unusual case of metastatic follicular thyroid cancer in the mandible of an elderly adult along with a comprehensive review of the literature.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effectiveness of blockchain to solve the interoperability challenges in healthcare

This study aims to explore the potential of Blockchain to transformhealthcare, build the patient-driven healthcare ecosystem ratherthan the current institutional driven and enhance the privacy, security,and interoperability of healthcare data and check the counterfeitdrugs. Interview excerpts from Industry experts/developersin the field of IT and experience from the implementation of thetechnology in the financial world will help understand its viabilityin healthcare. Consulting with domain experts is a qualitative processthat involves comprehending the perception of the experts.The research paper will help the healthcare sector lay down futurebusiness strategies to redefine its businesses by overcoming theincreasing threat on patients’ private data and resolving complexsupply chain issues. A decentralized ledger can prevent massiverevenue loss due to counterfeit drugs to track and verify eachdrug’s movement on the unchangeable record. The primary andsecondary research is original, adding its authenticity with interviewexcerpts of domain experts. The results of this research paperwill help identify the transparency, immutability, cost-saving, andstreamlining of business to be brought by Blockchain in healthcare. It would be the transformational journey from innovation tomarket the quality products to the end consumer.

Comparative analysis of the diagnostic performance of five commercial COVID-19 qRT PCR kits used in India

To meet the unprecedented requirement of diagnostic testing for SARS-CoV-2, a large number of diagnostic kits were authorized by concerned authorities for diagnostic use within a short period of time during the initial phases of the ongoing pandemic. We undertook this study to evaluate the inter-test agreement and other key operational features of 5 such commercial kits that have been extensively used in India for routine diagnostic testing for COVID-19. The five commercial kits were evaluated, using a panel of positive and negative respiratory samples, considering the kit provided by National Institute of Virology, Indian Council of Medical Research (2019-nCoV Kit) as the reference. The positive panel comprised of individuals who fulfilled the 3 criteria of being clinically symptomatic, having history of contact with diagnosed cases and testing positive in the reference kit. The negative panel included both healthy and disease controls, the latter being drawn from individuals diagnosed with other respiratory viral infections. The same protocol of sample collection, same RNA extraction kit and same RT-PCR instrument were used for all the kits. Clinical samples were collected from a panel of 92 cases and 60 control patients, who fulfilled our inclusion criteria. The control group included equal number of healthy individuals and patients infected with other respiratory viruses (n = 30, in each group). We observed varying sensitivity and specificity among the evaluated kits, with LabGun COVID-19 RT-PCR kit showing the highest sensitivity and specificity (94% and 100% respectively), followed by TaqPath COVID-19 Combo and Allplex 2019-nCoV assays. The extent of inter-test agreement was not associated with viral loads of the samples. Poor correlation was observed between Ct values of the same genes amplified using different kits. Our findings reveal the presence of wide heterogeneity and sub-optimal inter-test agreement in the diagnostic performance of the evaluated kits and hint at the need of adopting stringent standards for fulfilling the quality assurance requirements of the COVID-19 diagnostic process.

The vascular clock: a new insight into endothelial cells and pericytes crosstalk

Background/Introduction

Circadian rhythms, defined as biological oscillations with a period of circa 24h, regulate many physiological processes in the cardiovascular system, such as vascular function, vascular tone, blood pressure, heart rate and thrombus formation [1]. The vasculature responds to the main pacemaker located in the brain, but it also possesses its own clock. Indeed, a molecular clock has been identified in endothelial cells (EC) and smooth muscle cells (SMC). The disruption of the circadian clock profoundly affects cardiovascular functionality with adverse cardiovascular events such as myocardial infarction or stroke showing a 24h rhythmicity with a peak incidence in the early morning. Among several mechanisms affected by circadian dysregulation, angiogenesis plays a fundamental role in homeostasis and development of new blood vessels. EC and pericytes (PC) are the two main cell populations in the capillaries, and their physical and paracrine interaction drives and regulates the sprouting. However, the presence and the role of circadian rhythms in pericytes and whether the molecular clock affects the endothelial/pericyte interactions remain unexplored.

Purpose

The aim of this study is to identify a molecular clock in human vascular pericytes and elucidate the impact of the circadian clock on the formation of new blood vessels.

Methods

Human primary PC were synchronised and the rhythmicity of clock genes measured by luminescence, immunofluorescence, and qPCR. Synchronised PC were co-cultured with Bmal1::LUC human primary EC. The effect of PC synchronisation and circadian clock disruption by shRNA on EC clock genes and angiogenic potential were measured by luminescence and Matrigel assay, respectively. A macroporous polyurethane scaffold was developed for 3D co-cultures.

Results

PC presented rhythmic expression of the principal circadian genes with a circa 24h period but in our experimental setting, EC did not show circadian rhythmicity. Synchronised PC supported the rhythmic expression of the clock gene Bmal1 in EC in a contact co-culture system, suggesting a secondary form of EC molecular clock regulation. Non-contact co-cultures failed to synchronise EC. Furthermore, when the clock was disrupted in PC, their capacity to support EC's tube-forming capacity on Matrigel was impaired; clock disruption in EC did not affect angiogenesis, supporting the hypothesis that a disrupted clock in perivascular cells affects angiogenesis. In a 3D tissue engineering scaffold seeded with both EC and PC, the synchronisation of the clock led to the development of organised vascular-like structures around the scaffold's pores, as compared to the non-synchronised condition where cells appeared disorganised.

Conclusion

This study defines for the first time the existence of an endogenous molecular circadian clock in perivascular cells and suggests implications for circadian clock synchronisation in physiological and therapeutic angiogenesis.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): University of Surrey Doctoral CollegeUniversity of Surrey Bioprocess and Biochemical Engineering (BioProChem) Group.

Clustered papulonodular lesions in an infant

Non-Langerhans cell histiocytosis is a collective term encompassing a vast group of benign proliferative disorders of histiocytes, macrophages and dendritic cells that do not meet the criteria of Langerhans cell histiocytosis. We describe a case of juvenile xanthogranuloma with an unusual clustered distribution.

Addressing strategic human resource management practices for TQM: the case of an Indian tire manufacturing company

Purpose

This study aims to identify SHRM (strategic human resource management) essential practices for the TQM (total quality management) program regarding an Indian tire manufacturing company and formulate an inclusive interrelationship to prioritize them.

Design/methodology/approach

Semistructured interview with ten experts from the company was made to give SHRM practices scores. The SLR (systematic literature review) and TOPSIS (technique for order of preference by similarity to ideal solution) techniques are used to establish the model for 12 key practices and rank them afterward.

Findings

The findings clearly show that strategic planning and staffing, teamwork and leadership development have appeared as the top three essential practices. Simultaneously, performance measurement and evaluation, work design and analysis and promotion are identified as the bottom three practices. These essential practices are identified as contributing attributes.

Practical implications

The findings prioritize the SHRM practices as contributing attributes that help other tire manufacturing industries identify their key practices. Moreover, it provides the necessary inputs comprised of ten experts' decisions to become more active and well prepared.

Originality/value

The novelty of this study is to identify the key practices by using SLR and measured by the TOPSIS method to rank and consider a tire manufacturing company as a case-based approach to gain high productivity and competitive advantage.

Reducing mortality in mucormycosis of the head and neck in diabetic patients: A CARE case series

INTRODUCTION

Rhinocerebral mucormycosis is extremely fatal, with mortality rates ranging from 85-93% despite the best treatment in immunocompromised patients. We emphasize the importance of early diagnosis, repeated debridement, and aggressive antifungal treatment to reduce mortality.

CASE SUMMARY

We report six cases (five male and one female), with a mean age of 51 years who were diagnosed to have mucormycosis from 2017 to 2019. All patients were diabetic. Intracranial involvement and orbital involvement were found in four cases. Facial nerve palsy was seen in two cases, one without any apparent otological involvement. Aggressive serial debridement and amphotericin B was started. Posaconazole was added subsequently to the treatment in two cases. One patient succumbed to the disease five months after discharge. The other five patients are on regular follow-up for a mean duration of 14 months at the end of which two had residual disease which was under control.

DISCUSSION

Repeated surgical debridement with an early aggressive and combination antifungal therapy can result in good outcomes even in advanced mucormycosis. Concurrent management of the underlying pathology, monitoring of liver and kidney functions, and therapeutic drug monitoring are useful to ensure smooth and effective treatment.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.