Variations in morphology of cystic artery: systematic review and meta-analysis

Background

Variations in cystic artery anatomy are not unusual in occurrence, hence considerably crucial during hepatobiliary surgical planning and execution. This systematic review and meta-analysis of the anatomical variations of cystic artery (CA) was undertaken to emphasize their significance in surgical practice.

Methods

The PICO model was adopted, both MeSH term and free keywords were utilized for the search strategy. The risk of bias in each study was calculated by the anatomy quality assurance (AQUA) tool.

Result

The search strategy identified 8204 records, extracted 5529 studies, and evaluated 117 abstracts. Out of these 117 studies, 53 met the eligibility criteria. The CA was absent in 2% of instances (95% CI: 0.01-0.04), indicating that 98% of cases had the CA. In 10071 participants from 29 investigations, double cystic arteries were found in 13% (95% CI: 11-16%), with significant heterogeneity (I2 = 91%). In 46 studies with a total of 9928 participants, 89% of the individuals had CA originating from RHA (95% CI: 85%-92%) with significant heterogeneity (I2=94.3%) and a predictive range of 43%-99%.

Conclusion

The cystic artery is primarily derived from the right hepatic artery, followed by aberrant, proper, and left hepatic arteries. It is located anterior to common hepatic ducts and cystic ducts. The mean length and diameter of CA were 20.77 mm and 1.91 mm Short cystic arteries are common (20%) Congenital anomalies like absent and double cystic arteries have low prevalence but must be conside-red during surgery.

An insights into emerging trends to control the threats of antimicrobial resistance (AMR): an address to public health risks

Antimicrobial agents are used to treat microbial ailments, but increased use of antibiotics and exposure to infections in healthcare facilities and hospitals as well as the excessive and inappropriate use of antibiotics at the society level lead to the emergence of multidrug-resistant (MDR) bacteria. Antimicrobial resistance (AMR) is considered a public health concern and has rendered the treatment of different infections more challenging. The bacterial strains develop resistance against antimicrobial agents by limiting intracellular drug accumulation (increasing efflux or decreasing influx of antibiotics), modification and inactivation of drugs and its targets, enzymatic inhibition, and biofilm formation. However, the driving factors of AMR include the sociocultural and economic circumstances of a country, the use of falsified and substandard medicines, the use of antibiotics in farm animals, and food processing technologies. These factors make AMR one of the major menaces faced by mankind. In order to promote reciprocal learning, this article summarizes the current AMR situation in Pakistan and how it interacts with the health issues related to the COVID-19 pandemic. The COVID-19 pandemic aids in illuminating the possible long-term impacts of AMR, which are less immediate but not less severe since their measures and effects are equivalent. Impact on other sectors, including the health industry, the economy, and trade are also discussed. We conclude by summarizing the several approaches that could be used to address this issue.

A Closer Look at Anatomy Educator Safety: Identifying and Preventing Workplace Hazards: A narrative review

Abstract

Anatomy, one of medicine's vital subjects, demands extreme visualization to understand the intricate architecture of the human body. Although various other methods of virtual dissections are in place, an increasing number of anatomists, clinicians, and surgeons are advocating for re-enhancing anatomical education through traditional cadaveric dissection. These traditional pedagogies potentially expose anatomy educators to various risks in the dissection laboratory, which endangers their health and well-being. Unfortunately, no one is counting on them or the hazards they face. It's like saying, "Fall ill at your own peril." Various studies have revealed the occupational hazards anatomists are exposed to, but the issue remains unheard of or relatively heard. Hence, this narrative review aims to highlight numerous occupational risks that anatomists face worldwide, particularly in underdeveloped or developing nations. Simultaneously, the authors strongly advocate that competent authorities review and evaluate the working conditions of anatomy laboratories and frame policies that ensure the rights and optimal health of anatomy educators.

Spina bifida occulta with the persistent spinous process in living: A three-dimensionally reconstructed sacrum from computed tomographic imaging

Background

Here we aim to report the persistent spinous process in the 'pan sacral type' of spina bifida occulta in an asymptomatic male and discuss its clinical significance. The presence of this type of dorsal wall defect with a bony spur attached to it has never been described in the literature to the best of our knowledge after extensive literature search. Our work presents the first anatomic description where the spinous and paraspinous cleft are seen in a sacrum of a live subject.

Case Report

During a morphometric study of the sacra, normal subject computed tomography imaging (CT) was procured from the Department of Radio-diagnosis. A three-dimensional (3D) image of the sacrum was created using Dicom to Print and Geomagic freeform plus software. A complete dorsal wall defect was observed in a 3D reconstructed sacrum of an adult male. The sacral canal was converted into a groove with a bony spur hanging in the centre. The longitudinal bony spur attached to the lamina was the persistent spinous process.

Conclusion

Such congenital defects are clinically significant for the anaesthetist during caudal epidural block and for orthopaedic surgeons before any surgical procedure. It may be misdiagnosed as an abnormal bony injury on CT. Thus, it is essential to ensure that patients with congenital anomalies are not treated unnecessarily for spinal fractures.

The cross-sectional morphology of median nerve in carpal tunnel of healthy, adult population: A systematic review and meta-analysis

The cross-section area is a crucial parameter to assess peripheral neuropathy. The ultrasonographic evaluation of cross-section area of median nerve is a low-cost and readily available tool for diagnosis and assessment. However, the intra-nerve dimensional variability and its normative reference value in a healthy subject are missing. The current meta-analysis aims to capture the median nerve cross-section area for healthy subjects and generate a comprehensive ultrasonographic reference data set for each population.

METHODS

The full text of manuscripts were collected after short-listing the abstracts collected from search strategy. A quality assurance tool was used to capture the risk of bias of each study after reviewing the included manuscripts. The pooled estimate of cross-section area was stratified according to anatomical landmarks, sex, and ancestry.

RESULTS

A total of 97 observational studies dealt with 6679 wrists of healthy subjects were included. The pooled estimate of the cross-section area of median nerve at carpal tunnel inlet was 8.54mm² [95% CI: 8.34-8.74mm²]. The same pooled estimate at carpal tunnel outlet was 8.03mm² [95% CI: 7.46-8.60mm²]. Both these pooled estimates have significant correlation with mean age of population. Age and sex were two primary predictors of the cross-section of median nerve. The flattening ratio, circularity, and wrist-forearm ratio of median nerve were also computed.

CONCLUSION

These normative data could serve as a reference for assessing median nerve pathologies, including carpal tunnel syndrome. The ethnic variation of pooled estimate and heterogeneity will guide clinician set up the reference value for diagnostic criteria.

Celiac Disease Masquerading as Arthralgia

Celiac disease is an immune-mediated disorder triggered by dietary gluten. It classically presents with gastrointestinal symptoms. It may also present with atypical manifestations like anemia, arthritis, infertility, or other neurological symptoms. However, arthralgia as a sole manifestation of celiac disease is a rare clinical scenario. Even though the clinical spectrum of celiac disease is broad, prompt diagnosis and management exert a protective effect against complications of celiac disease. We want to highlight and expand on the existing knowledge on atypical presentations about celiac disease.

A randomised controlled trial of intracuff lidocaine and alkalised lidocaine for sedation and analgesia requirements in mechanically ventilated patients

Background

Airway irritation caused by prolonged inflation of endotracheal tube (ETT) cuff results in post-intubation morbidities.

Objectives

We aimed to study intracuff lidocaine and alkalised lidocaine on sedation or analgesia requirements of patients undergoing mechanical ventilation in the intensive care unit (ICU). The primary outcome was to calculate the total dose of propofol and fentanyl required to obtund the unwanted airway and circulatory reflexes. Secondary outcomes were to determine the frequency and severity of cough and haemodynamic parameters.

Methods

It was a double-blinded, randomised controlled study in the ICU after emergency laparotomy, in patients aged 20 - 55 years, and classified as American Society of Anesthesiologists (ASA) classes 1E and 2E with tube in situ. Exclusion criteria were patients with body mass index >30 kg/m² , haemodynamic instability, requiring positive end-expiratory pressure ≥7 cm H2O, and a history of chronic obstructive pulmonary disease. After ethics clearance and written consent, patients were randomly assigned into two groups (36 in each), Group L (ETT cuff inflated with lidocaine 2%) and Group AL (cuff inflated with a mixture of lidocaine 2% and sodium bicarbonate 1:1).

Results

Mean dose of propofol consumed in Group AL was significantly less than that in Group L (p<0.001). The mean standard deviation (SD) fentanyl utilisation in Group AL was 1 323.61 (187.27) µg, and that in Group L was 1433.09 (42.58) µg (p=0.040). Group L patients had a significantly higher incidence of cough than those in Group AL (p=0.01). There was no significant difference in the mean arterial pressure (p=0.22), although heart rate was significantly higher in Group L (p<0.001).

Conclusion

Alkalised lidocaine reduces the requirement of sedation, analgesia, and the incidence of cough in intubated patients maintaining haemodynamic stability when compared with lidocaine.

Contributions of the study

Alkalised lidocaine when used in endotracheal tube cuff inflation reduces the need for sedation and analgesia in mechanically-ventilated patients, and improves haemodynamic stability.

The morphological and morphometric analysis of the variant patterns of the tricipital aponeurosis: a new anatomical classification with possible clinical implications

BACKGROUND

Tricipital aponeurosis (TA) has gained attraction as a constant and reliable landmark to identify the location of radial nerve in the setting of fracture distal humeri. The aponeurosis itself shows variant anatomical patterns. In this study, we intend to provide a comprehensive description and functional classification of observed anatomical variations with possible clinical implications.

MATERIALS AND METHODS

Sixty arms belonging to 30 adult cadavers were studied. TA was examined grossly to document variations in its shape and classified accordingly. Subsequently, length and breadth of TA were measured. The distance of the radial nerve (RN) from the point of confluence and from the lateral border of TA was also measured (tricepso-radial distance [TRD]). These distances were correlated with the different patterns of TA obtained.

RESULTS

Based on the shape of the proximal apex of TA or point of confluence and frequency of their occurrence, we propose a new classification of 4 patterns for the TA anatomy. Pattern I: classically seen as the triangular proximal apex (76.67%); pattern II: tongue shaped or blunt proximal apex (18.33%); pattern III: bifurcated or dual proximal apex (3.33%); pattern IV: as the absence of TA (1.67%). The mean of length and breadth of TA was 16.58 ± 2.05 cm and 3.61 ± 0.61 cm, respectively. The mean distance of RN from point of confluence and lateral border of TA was 3.57 ± 0.19 cm and 2.04 ± 0.56 cm, respectively. The length, breadth of TA and TRD differs amongst the different patterns of TA.

CONCLUSIONS

Anatomical variations in the shape and size of TA are frequently encountered. The proposed, hitherto undescribed, classification may make operating surgeon aware of these morphological variations and help prevent iatrogenic injury to RN. Such classification is simple and unique; however, its success relies upon universal acceptance.

Adrenal Myelolipoma Mimics Ectopic Adrenal or Renal Tissue: An Incidental Finding During Cadaveric Dissection

Context

On naked eye examination adrenal myelolipoma (AML) tissue appears to be an ectopic adrenal or renal tissue, based on the similarity to their external texture. This necessitates a histo-pathological study for confirming the origin of the tissue.

Objective

To establish the origin and histological features of the incidental AML tissue found during cadaveric dissection and review the literature for similar findings with clinical picture and treatment description.

Subjects and Methods

Unilateral adrenal gland obtained from cadaveric dissection was subjected to histological study by H & E staining of the slides prepared. The literature review was done from articles published in PubMed indexed journals.

Case report

A case of an incidental finding of AML during cadaveric dissection is presented which on naked eye examination was appearing to be an ectopic adrenal or renal tissue, based on the similarity to their external texture. On histological examination, a thin rim of adrenocortical tissue, surrounding the mature adipose tissue, and attenuated by islets of myeloid, erythroid and megakaryocytic cell lines in varying proportions, resembling the mature bone marrow morphology, was observed. The literature review on PubMed explains similar incidental post-mortem autopsy findings due to the asymptomatic nature of the tumor. The incidence of AML varied between 0.08% and 0.2% in the last decade of the 20^th century, which increased up to 10 - 15% of incidental adrenal masses due to the widespread use of non-invasive imaging modalities leading to an increase in the diagnosis of the pathology.

Conclusions

Before considering the ectopic incidence of tissue during cadaveric dissection, a histo-pathological examination is mandatory for confirmation. Adreno-myelolipoma is an asymptomatic post-mortem finding in 10-15% of cases of adrenal tissue which mimics ectopic adrenal gland or renal tissue due to its external texture.

The transverse arch in the human feet: A narrative review of its evolution, anatomy, biomechanics and clinical implications

The dominant characteristics of the human foot are its shock-absorbing capability during walking or gait cycle and its adaptation to uneven surfaces. On the stance phase of the gait, the foot has to be flexible at first for shock absorption and adapt to the terrain; whereas, during the propulsive phase, it has to be dynamically rigid to function as a lever. Foot flexibility and rigidity are mainly controlled at the subtalar and midtarsal joints by tendons and ligaments. The subtalar joint is part of the longitudinal arch, but the midtarsal joint along with the tarsometatarsal joint are components of the transverse arch. However, the existence and functional role of transverse arch in human was challenged by some authors. But recent studies have revealed that the transverse arch has a predominant role in midfoot stiffness (Venkadeshan et al., 2020, & Holowoka et al., 2017). This midfoot stiffness allows the human foot to store elastic energy at the time of heel strike, which is utilized during the push-off mechanism for propulsion, thus making bipedalism more energy-efficient. Moreover, the transverse arch allows the longitudinal arch to be flexible like a lever and, at the same time, makes the arch of the foot rigid to behave like a stiff spring lever. Understanding the role of the transverse arch is obligatory to study the biomechanics of foot injuries and Charcot or diabetic foot. Studies on diabetic foot have shown that the modulation of transverse arch biomechanics and off-loading modalities would improve outcomes in the form of wound-healing and prevention of re-ulceration.

Assessment of nutritional status of the cirrhotic patients on enteral and parenteral feeding

BACKGROUND

Cirrhosis is an irreversible disease that replaces healthy tissues with scar tissues. According to the Pakistan Medical Research Council's national general population survey (2008-2014), the ratio of cirrhosis was 4.8% among the population.

OBJECTIVES

To assess the nutritional status of cirrhotic patients on enteral and parenteral nutrition and to assess the degree of malnutrition among cirrhotic patients.

METHODS

A cross-sectional study was conducted at Shalamar and Shiekh Zayed Hospitals of Lahore from January-April 2017. The convenient sampling technique was used. Inclusion criteria were the patients with decompensated liver cirrhosis, whereas compensated patients were excluded from the study. Data were collected through the patient's file, nurse's, and dietitian's notes. The nutritional status of participants was assessed based on socio-demographic characteristics, anthropometric measurements, biochemical assessment, clinical signs, and dietary recall. Variables were categorized and compared to observe the level of significance in enteral and parenteral nutrition. SPSS version 22 was used to analyze data.

RESULTS

Patients on parenteral nutrition had a higher ratio of malnutrition with a significant Child-Pugh score-61.8% of patients belonged to Class C and 35.3% Class B, while in enteral support, 7.3% belonged to Class C and 43.9% patients belonged to Class B (p-value = 0.000). There was a definite relationship observed in the route of intake and malnutrition among cirrhotic patients.

CONCLUSION

Enteral route of nutrition is an effective and the safest way to provide appropriate nutrients according to the patient's demands.

Physical and Psychological Symptoms Associated With Premenstrual Syndrome and Their Impact on the Daily Routine of Women in a Low Socioeconomic Status Locality

Introduction

The constellation of the physical and psychological symptoms that appear several days before menstrual period is regarded as the premenstrual syndrome (PMS). The current study evaluated the symptoms associated with PMS and their impact on the day-to-day activities of women.

Methodology

An observational cross-sectional study was conducted at a squatter settlement in Karachi, Pakistan, from January 2019 to February 2020. Amenorrheic, pregnant women, and women who were on birth control at the time of data collection were excluded from the study. The demographics, symptoms of PMS experienced by the participants, and the impact of PMS symptoms on the daily lives of women were recorded. Statistical Package for the Social Sciences v.25 (IBM Corp., Armonk, NY) was used for data analysis. 

Results

The mean age ± standard deviation of 23.93 years ± 9.41 years was recorded. As many as 213 (63%) women reported dysmenorrhea, followed by fatigue in 108 (32%), bloating in 64 (18.9%), and back pain in 45 (13.3%) women. Irritability and anxiety were experienced by 134 (39.6%) and 117 (34.6%) women, respectively. When asked about their attitude and perception towards menstruation, more than four-fifth respondents confessed that they feel impure when they are experiencing their monthly period. About 38 women (11.2%) believed that menstruation is God’s way of punishing the womankind. For the question, “Do you feel that your normal routine is significantly disturbed during your period?”, 40% responded in affirmation.

Conclusion

The findings of the current study reflected a generally negative attitude towards menstruation, which significantly affected the routine lives of women in our setting. The study further concluded that dysmenorrhea, fatigue, irritability, and anxiety were the most common symptoms of PMS experienced by women.

Ossification around intercavernous sinus: An osteological finding that can complicate trans - sphenoidal surgery

The aim of the study was to document an anatomical variation around the sella turcica which was unique and lacked any reference in the literature. A low lying osseous bar connecting the right middle clinoid process to the midpoint of the right lateral border of the dorsum sella was observed in a human skull specimen. The osseous bar was forming a foramen close to the floor of the sella, and the structure in association with this part of sella is the inferior intercavernous sinus. Measurements of the sella turcica bridge (STB), carotico-clinoid foramen (CCF), interclinoid foramen (ICF) on both sides and that of the ossified bar and foramen formed by itself were taken with the help of ImageJ software. The values observed for the measurements of different parameters of STB and its components, for CCF and ICF were bilaterally different. While the values for the osseous bar and foramen formed by it cannot be compared because of its unilateral occurrence. The presence of foramen around the inferior intercavernous sinus may lead to difficulty in performing procedures like transsphenoidal surgery (TSS) or extended TSS (eTSS) while extracting intradural lesions, thus increasing the chances of haemorrhage.

90 Establishment and characterization of Day 30 equine chorionic girdle and allantochorion cell lines

Establishing cell lines is a good model for experimental applications to study molecular mechanisms and cell-specific gene expression. Equids have a diffuse epitheliochorial placenta, where the invasive trophoblast is represented by the chorionic girdle (CG) and the noninvasive trophoblast by the allantochorion (AC). Embryonic CG cells are unique to horses and have a crucial role in equine chorionic gonadotropin (eCG) production and maintenance of pregnancy during the first trimester. This study had three objectives: (1) establishing a stable cell line from Day 30 CG cells and AC using lentivirus encoding hTERT; (2) characterisation of Day 30 CG cells and AC cell morphology and expression of eCG α (eCGA) and β (eCGB) subunits, major histocompatibility complex class II (MHCII), and Kisspeptin receptor (KISS1R) in CG and AC cells; (3) investigating eCG protein production invitro from Day 30 CG and AC cells. Three mares (n=3) were used to collect Day 30 conceptuses by non-surgical uterine lavage on Day 30 of pregnancy. All 3 conceptuses were dissected for CG and AC cells then cultured invitro to confluency in cell culture plates. Second-generation lentiviral particles were generated using a three-vector system including transfer vector pLV-hTERT-IRES-hygro, and human telomerase reverse transcriptase (hTERT) lentivirus was utilised to establish stable hygromycin-resistant equine embryonic cell lines. Reverse-transcription PCR (RT-PCR) was used to study gene expression in cells and radioimmunoassay was used to investigate protein presence in the media. We established a hygromycin-resistant Day 30 CG and AC cell lines that express eCGA, eCGB, and hTERT and confirmed using RT-PCR yielding the predicted bands. The cell lines were maintained for 16 passages (7±2 days/passage), 10 of which were cultured after the lentiviral infection steps. Also, we characterised CG cells as fast-growing, large, binucleated, and epithelioid, and AC cells as rapid-growing showing smaller, squamous, mononucleate, epithelioid, and elongated fibroblastic cells. The RT-PCR results showed eCGA and eCGB subunits are expressed by both Day 30 CG and AC cells, but MHCII and KISS1R genes were not expressed in either of cells. Moreover, radioimmunoassay results showed that Day 30 CG cells did produce eCG protein (35.42ngmL−1) invitro earlier than what previous literature has shown. However, Day 30 AC cells did not produce eCG protein (0.042ngmL−1) invitro, and both CG and AC cell lines stopped secreting eCG in the media after the lentiviral infection. To conclude, establishing stable and hygromycin-resistant cell lines from Day 30 equine CG and AC cells using lentivirus encoding pLV-hTERT-IRES-hygro is attainable. Also, equine chorionic gonadotropin eCG protein is produced invitro as early as Day 30 from CG cells.

Parental Rejection and Mental Health Problems in College Students: Mediating Role of Interpersonal Difficulties

College students are said to have an increasing trend of mental health problems that lead to various negative academic, personal and social outcomes. The current study aimed to determine the mediating role of interpersonal difficulties between parental rejection and mental health problems of college students. A total of 321 college students selected through purposive sampling aged 15to 20 years provided self-report data on EMBU-A (Gerlsma, Arrindell, Van der Veen, & Emmelkamp, 1991), Urdu version of Depression Anxiety Stress Scale (DASS; Aslam, 2007) and Interpersonal Difficulties Scale (IDS; Saleem, Ihsan, & Mahmood, 2014). Pearson Correlation was used to ensure that parental rejection, mental health problems and interpersonal difficulties are related. Results of path analysis revealed that parental rejection has an indirect effect on mental health through interpersonal difficulties. Implications for counselling services are discussed.

Assessment of Academic Motivation Level of Undergraduate Medical Students of Azad Kashmir, Pakistan

Objective

To assess the academic motivation level of undergraduate medical students of Azad Kashmir, Pakistan.

Methods

A total of 378 Poonch Medical College (PMC) students were included in this cross-sectional study. The academic motivation scores of the study subjects were measured using a 28-item, five-point Academic Motivation Scale (AMS) questionnaire originally developed by Deci and Ryan (1985). The tool was checked for internal consistency and was interviewer-administered. Motivation level was quantitatively presented and compared across gender and medical years.

Results

The highest mean motivation score (4.04 ± 2.71) was observed for the statement "Because this will help me make a better choice regarding my career orientation." The following statements showed a statistically significantly higher mean motivation level in females as compared to males: "Because eventually, it will enable me to enter the job market in a field that I like" (p .008) and "for the pleasure that I experience when I read interesting authors" (p .001). But for the statement, "I once had good reasons for going to college; however, now I wonder whether I should continue," males showed a higher motivation level (p. 0.19). A statistically significant difference in mean motivation level was seen across medical years for the following statements: "For the intense feelings I experience when I am communicating my own ideas to others," "For the pleasure that I experience when I read interesting authors," "Because this will help me make a better choice regarding my career orientation," "For the satisfaction I feel when I am in the process of accomplishing difficult academic activities," and "Because I want to show myself that I can succeed in my studies" (p-value <.05).

Conclusion

This study analyzed mean motivation scores for all AMS questions. The study identified that the most common motivational factor for pursuing medical education was because the students thought this will help them make a better choice regarding their career orientation.

Frequency of Pre-obesity and Obesity in Medical Students of Karachi and the Predisposing Lifestyle Habits

Background: The global incidence of pre-obesity and obesity is rising noticeably. Where medical students should be advocating healthy lifestyles, they are actually indulging in unhealthy eating habits and sedentary lifestyle. This is resulting in an increased incidence of obesity in this population.

Methods: It was a descriptive cross-sectional study conducted from September 2018 till January 2019 in four medical colleges of Karachi. Sociodemographic profile, body mass index (BMI), food habits, and exercise routine of the students were recorded. Data was entered and analyzed using SPSS version 22 (IBM Corp., Armonk, NY).

Results: The mean BMI of the study population was 21.717 ± 4.33 kg/m² (range: 16.24–38.19). The mean age was 21.345 ± 1.4709 years with a minimum of 17 years and maximum of 25 years. The combined frequency of pre-obese and obese students was 33.2%. Among these, there were more women (60.6%) than men (39.3%). Among these pre-obese and obese students, 55% had breakfast rarely to sometimes, 47.9% took four or more meals per day, 39.3% consumed fast food thrice weekly or more, and 58.1% consumed soft-drinks/juices alternate to every day. Among the students who indulged into binge eating when stressed, 56.9% were pre-obese to obese. The nutritional status of the study sample was significantly associated with female gender, living status with parents, irregular breakfast, infrequent daily meals, increased consumption of fast food and beverages, decreased consumption of red meat, sedentary lifestyle, and altered eating habits when stressed.

Conclusion: The incidence of pre-obesity and obesity is noticeably escalating among young adults. If this trend continues, obesity-related complications will form the major chunk of medical illnesses in the near future. Strategies are needed to nip this dilemma in the bud by indulging in healthy and clean eating habits and performing regular physical activity.

Evaluation of functional properties of Zein extracted from various maize varieties

Zein is the major storage protein of maize and was identified initially on the basis of solubility in aqueous alcohol solution. It is comprised of 45-50% grain portion and has a wide range of application as a functional ingredient in the food industry. In the current study, five different maize varieties were analyzed and compared for the physicochemical, mineral and functional characteristics. Zein protein was extracted at different concentrations of ethanol and was further characterized for its antioxidant and functional properties. Significant variations in the characteristics were observed in different varieties related to their mineral and chemical composition. Likewise, antioxidant properties of zein extracted from Agaiti-2002 variety were 32.61% and minimum value (30%) was observed in the Pearl variety. Zein protein has the potential to be used as encapsulating material for controlled release of different bioactive compounds.

A review of the applications of organo-functionalized magnetic graphene oxide nanocomposites for heavy metal adsorption

Graphene-based adsorbents have attracted wide interests as effective adsorbents for heavy metals removal from the environment. Due to their excellent electrical, mechanical, optical and transport properties, graphene and its derivatives such as graphene oxide (GO) have found various applications. However, in many applications, surface modification is necessary as pristine graphene/GO may be ineffective in some specific applications such as adsorption of heavy metal ions. Consequently, the modification of graphene/GO using various metals and non-metals is an ongoing research effort in the carbon-material realm. The use of organic materials represents an economical and environmentally friendly approach in modifying GO for environmental applications such as heavy metal adsorption. This review discusses the applications of organo-functionalized GO composites for the adsorption of heavy metals. The aspects reviewed include the commonly used organic materials for modifying GO, the performance of the modified composites in heavy metals adsorption, effects of operational parameters, adsorption mechanisms and kinetic, as well as the stability of the adsorbents. Despite the significant research efforts on GO modification, many aspects such as the interaction between the functional groups and the heavy metal ions, and the quantitative effect of the functional groups are yet to be fully understood. The review, therefore, offers some perspectives on the future research needs.

Validation of acute physiologic and chronic health evaluation II scoring system software developed at The Aga Khan University, Pakistan

Objective:

To assess the predictive performance of Acute Physiologic and Chronic Health Evaluation II (APACHE II) software available on the hospital intranet and analyze interrater reliability of calculating the APACHE II score by the gold standard manual method or automatically using the software.

Materials and Methods:

An expert scorer not involved in the data collection had calculated APACHE II score of 213 patients admitted to surgical Intensive Care Unit using the gold standard manual method for a previous study performed in the department. The same data were entered into the computer software available on the hospital intranet (http://intranet/apacheii) to recalculate the APACHE II score automatically along with the predicted mortality. Receiver operating characteristic curve (ROC), Hosmer-Lemeshow goodness-of-fit statistical test and Pearson's correlation coefficient was computed.

Results:

The 213 patients had an average APACHE II score of 17.20 ± 8.24, the overall mortality rate was 32.8% and standardized mortality ratio was 1.00. The area under the ROC curve of 0.827 was significantly >0.5 (P < 0.01) and had confidence interval of 0.77-0.88. The goodness-of-fit test showed a good calibration (H = 5.46, P = 0.71). Interrater reliability using Pearson's product moment correlations demonstrated a strong positive relationship between the computer and the manual expert scorer (r = 0.98, P = 0.0005).

Conclusion:

APACHE II software available on the hospital's intranet has satisfactory calibration and discrimination and interrater reliability is good when compared with the gold standard manual method.

Acute sarcoidosis: 3 cases in an acute medical clinic

Sarcoidosis is a cryptogenic multisystem granulomatous disorder. We present three patients who presented acutely with erythema nodosum in our Medical Assessment Unit (MAU) or attended our clinic, subsequently diagnosed with acute sarcoidosis. In doing so, we aim to demonstrate that this presentation can easily be seen on the acute medical take, focussing on the management of acute sarcoidosis in association with erythema nodosum. Although patients will often not display florid systemic upset on presentation, we recommend follow-up after initial presentation, to ensure good resolution of symptoms.

A rare cause of abdominal pain

Pacemaker migration is a rare, but important, complication of pacemaker insertion mainly documented in children. We report the case of a 60-year-old woman who was admitted with right iliac fossa pain thought to be caused by appendicitis. She was noted to have both an epicardial and endocardial pacemaker in situ. Imaging and laparoscopy revealed migration of the epicardial pacemaker to the right iliac fossa. We describe the possible mechanisms of pacemaker migration.

Diltiazem inhibits human intestinal cytochrome P450 3A (CYP3A) activity in vivo without altering the expression of intestinal mRNA or protein

AIMS

To determine the effect of diltiazem on intestinal CYP3A activity and protein and mRNA expression in vivo in healthy subjects.

METHODS

Intestinal biopsies were obtained from ten healthy controls and from ten healthy subjects after receiving diltiazem 120 mg bid for 7 days. Intestinal CYP3A activity, CYP3A4 protein and mRNA concentrations were quantified in both groups. Intestinal CYP3A activity was determined by incubation of small bowel homogenate with midazolam (25 microM) and NADPH for 5 min and the rate of formation of 1'-hydroxymidazolam was quantified.

RESULTS

All subjects in the treatment group had detectable diltiazem concentration in the serum. While there was no significant difference in CYP3A4 protein and mRNA expression between the control and treatment groups, the formation of 1'-hydroxymidazolam (446 pmol min(-1) mg(-1) 6 (control) vs. 170 (CI 112, 228) pmol min(-1) mg(-1) 95% confidence interval (CI 269, 623) (diltiazem group)) was significantly reduced (P < 0.05).

CONCLUSION

Diltiazem decreased small bowel CYP3A activity by 62% as a result of irreversible inhibition with no corresponding change in intestinal CYP3A4 mRNA or protein concentrations.

Palliative surgery for advance osteosarcoma of shoulder region

We are presenting here eight cases of advanced osteosarcoma of shoulder region involving scapula and upper humerus in children upto the age of thirteen years. All patients had complete loss of movement. Five patients underwent fore quarter amputation. Extensive amputation although a major mutilating procedure, provides patients a dramatic relief for the period that he survives.

Detection of Helicobacter pylori DNA in fecal samples from infected individuals

Stool, gastric biopsy, and serum samples were collected from 22 subjects. DNA from stool was extracted, amplified, and hybridized with primers specific for the 16S rRNA gene of Helicobacter pylori. DNA from gastric biopsy specimens was analyzed similarly for comparison. Universal primers were used to confirm successful extraction of DNA from samples. Histologic, serologic, and DNA analyses were scored in a blinded fashion. Universal primer amplification verified successful DNA extraction from all stool and gastric tissue specimens. The gastric tissue DNA assay was positive for H. pylori in 11 of the 22 subjects, correlating completely with histologic and serologic results. Stool DNA was positive for H. pylori by our molecular assay in 8 of these 11 H. pylori-positive subjects. All subjects who were negative by histologic, serologic, and gastric tissue DNA analyses were also negative by stool DNA analysis. Compared to histology, serology, and gastric tissue DNA analyses, the sensitivity of our stool DNA assay was 73%, with a specificity of 100%.

Smoking in Oklahoma: the seven-year trend

BACKGROUND

The serious health consequences of smoking have been known to us for more than 30 years. Every year, research brings forth more serious consequences of this risk factor. These are reviewed by us. The year 2000 will soon be with us. We need to know where we stand in relation to the year 2000 objectives with regard to smoking.

STUDY DESIGN

The study design is cross-sectional.

METHODS

This study is based on the data obtained during the years 1989 through 1995 from the Oklahoma Behavioral Risk Factor Surveillance System.

RESULTS AND CONCLUSIONS

There has been a significant decrease in the prevalence of smoking in Oklahoma in the last seven years. Although there has been no significant change in smoking among females in the last seven years, smoking among males has dropped significantly, especially in the last two years of the study, 1994 and 1995. The prevalence of smoking in 1995 was the same among males and females, at about 22%. In age groups 18-24 and 25-34, there has been no significant change in smoking since 1990. The prevalence of smoking is related to the level of education; the higher the education the lower the prevalence of smoking. Smoking among those with college or higher level education has remained at about the same level, 15%, in the last seven years. Among those with less than high school education, smoking has remained the same at about 30% over the last seven years. Prevalence of smoking is the highest among American Indians. Smoking among whites (non-Hispanic) shows a significant decrease from about 26% in 1990-91 to about 22% in 1994-95. Among white males, smoking has significantly dropped from 31% in 1989 to about 22% in 1995. In 1995, smoking was almost the same in the two sexes at about 22%. We need to achieve a reduction of 7% in the overall prevalence rate of smoking in the coming years to achieve the Year 2000 objective. To effect this reduction, our efforts at health promotion and community mobilization will have to be strengthened. Further, with the prevalence rate of around 25% in 1995 among women of reproductive age, and the year 2000 target of 12%, it is apparent that very strenuous efforts will have to be made among this group in our population to achieve Year 2000 objectives.

Prevalence of overweight and associated factors among Oklahomans

BACKGROUND

Obesity among adults in the, United States has been increasing for the last three decades. Overweight is associated with numerous health risks such as diabetes, atherosclerosis, hypertension, sedentary lifestyle, etc. It also throws a very heavy economic burden on society, estimated at $39.3 billion in 1986.

OBJECTIVE

To estimate the prevalence of obesity and its associated factors so that efforts to achieve the Healthy Oklahomans 2000 objectives may be brought into sharper focus.

STUDY DESIGN

The study design is cross-sectional.

METHODS

The study is based on the data from the Behavioral Risk Factor Surveillance System (a three-stage cluster sample survey) for the years 1991 through 1994. Statistical analysis was done with SUDAAN software for complex survey.

RESULTS

More than 25% of Oklahomans are overweight. To reach the Year 2000 objectives, a reduction of 10% in overweight will have to be achieved in about three and one-half years. Prevalence of moderate obesity among women is higher than among men. Prevalence of severe obesity is higher among the black community than among other communities. However, prevalence of moderate obesity is the same among blacks and whites. Severe obesity is significantly higher among those with less than a high school education than among those with college education. The prevalence of moderate obesity among non-smokers is significantly higher than among smokers. Among the severely obese, hypertension is more than twice as prevalent as normal blood pressure. Among the moderately obese, high blood pressure is more than one and one-half times more prevalent than normal blood pressure. Obesity increases with age in a predictive manner; it drops after the age of 54. Moderate obesity is significantly higher among women who have had a hysterectomy than those who have not had a hysterectomy. Prevalence of severe obesity as well as moderate obesity is very much higher among diabetics than among non-diabetics. A large proportion of severely obese people are physically inactive. We did not find an association between consumption of fruits and vegetables as a part of normal diet and prevalence of obesity.

CONCLUSION

Strenuous and focused efforts need to be made among the vulnerable groups, in view of the short time left until year 2000, to reduce the prevalence of obesity to the level laid down in the Year 2000 objectives.

Characterization of the APC gene in sporadic gastric adenocarcinomas

The prominent role of the APC gene in colorectal tumor development is well established. However, its role in tumorigenesis in other tissues is not clear. Hence, DNA from 30 primary sporadic gastric adenocarcinomas was obtained from patients living in a high risk area of the world (North-Central Italy) in order to further define APC's role in gastric tumorigenesis. We thoroughly examined that region of APC which is commonly mutated in colorectal tumors using proven sensitive methods. The IVS protein assay and DNA sequence analysis of APC codons 686 through 1693 revealed no intragenic mutations. However, allelic loss of loci near APC was detected in 7 (28%) of 25 informative gastric adenocarcinomas using two 5q dinucleotide repeat markers for LOH analysis. These results suggest that genetic alteration of a region of APC commonly mutated in colorectal cancer is not a common event during sporadic gastric tumor development, at least in patients from North-Central Italy. Further analysis of chromosome 5q might identify another gene to be significantly altered in these gastric cancers.

Smoking: high hazards in high school

BACKGROUND

Young people in school are at an impressionable age, peer pressures are intense, and the probability that they will pick up a high-risk behavior, such as smoking, is high. The key to reduction of smoking among adults is to target our prevention efforts at young adults and teens.

OBJECTIVE

To study the prevalence and trend of smoking among young adults and teens and to formulate guidelines on smoking reduction to guide those who counsel young people.

STUDY DESIGN

The study design is cross sectional.

METHODS

This study is based on the data from the Oklahoma Behavioral Risk Factor Surveillance System and the National Youth Risk Behavioral Surveillance System - the two systems that monitor the prevalence of behaviors that most influence health.

RESULTS

The prevalence of smoking among young adults (age 18-24) in Oklahoma is high at more than 21%. The disturbing feature is that it is higher among young females than among young males. The prevalence of smoking among young adults is the highest among high school dropouts and is more than 38%. It is lower among high school graduates (about 28%) and lowest among college graduates (about 18%). The percentage of smoking among students who classify themselves as current smokers rises from 23% to 30% as the students progress from grade 9 to 12 and the percentage of frequent smokers increases from 8% to 16%.

CONCLUSIONS

Guidelines suggested for counselors are: 1. Along with smoking, look for comorbid behaviors such as alcohol use, drug abuse, and high-risk sexual behavior. 2. Ask whether the student has easy access to free cigarette samples. 3. Check whether the teen is trying to lose weight; suggest appropriate methods for losing weight if smoking is being used for losing weight. 4. Target health education efforts early in a student's school career starting in elementary school, but concentrate especially at the 8th or 9th grade level to have maximum preventive impact.

Effects of oxidised dietary oil and antioxidant supplementation on broiler growth and meat stability

1. Broilers were fed on diets containing oxidised sunflower oil, sunflower oil and sunflower oil supplemented with alpha-tocopherol, butylated hydroxyanisole (BHA) or butylated hydroxytoluene (BHT). 2. Oxidised oil caused a significant reduction in broiler body and carcase weights, whereas alpha-tocopherol and BHA/BHT supplementation improved growth. 3. Meat samples from these broilers were stored at 4 degrees C and -20 degrees C and their oxidative stability evaluated. Feeding oxidised oil to broilers resulted in meat that underwent rapid oxidative changes during refrigerated and frozen storage. 4. On the other hand, dietary alpha-tocopherol and BHA/BHT supplementation increased alpha-tocopherol and BHA/BHT concentrations in meat and significantly (P less than 0.05) improved the oxidative stability of meat during refrigerated and frozen storage.

Influence of oxidised dietary oil and antioxidant supplementation on membrane-bound lipid stability in broiler meat

1. The effects of oxidised oil, dietary alpha-tocopherol and BHA/BHT-supplementation on the fatty acid composition of mitochondrial, microsomal and soluble protein fractions of broiler muscles, and on their lability to metmyoglobin/hydrogen peroxide-catalysed peroxidation were investigated. 2. Oxidised oil in the broiler diets induced rapid oxidation of the membrane-bound lipids and decreased their stability towards metmyoglobin-hydrogen peroxide-catalysed peroxidation. 3. Supplementation of the broiler diets with alpha-tocopherol increased the alpha-tocopherol concentrations in the microsomal and soluble protein fractions of the dark meat as well as the soluble protein fraction of the white meat. This, in turn, stabilised the membrane-bound lipids against metmyoglobin/hydrogen peroxide-initiated peroxidative changes.

The role of shigella spp. in childhood diarrhoea in Iran and their antibiotic resistance

The incidence of shigellae was measured in 445 children with diarrhoea in Sanandaj, Kordestan, and 715 in Tehran during a 1-year study. 18 (4%) patients in Sanandaj and 41 (5.7%) patients in Tehran were positive for various shigella species. Sh. boydii (7 strains) and Sh. sonnei (25 strains) were the commonest species in Sanandaj and Tehran respectively. Among the isolates from Sanandaj the highest resistance was to tetracycline (55.5%), whereas in Tehran it was to sulfamethoxazole/trimethoprim (68.3%).