Enteral nutrition feeding strategies and their impact on relapse rate and quality of life in paediatric Crohn’s disease

MDAims: To study induction of remission and reduction in relapse rate of childhood Crohn’s disease with quality of life (QOL) assessment in subjects on long term continuous oral supplementation with ACD004. Methods: This study was performed in two phases. In Phase A, ACD004 was used to assess effectiveness based on proportion of full remission at 8 weeks. Children then reintroduced food over a 4 week phase reducing their ACD004 intake to 30% RDA, subsequently enrolling into randomised controlled part of the trial (Phase B), to assess reduction in relapse rate whilst receiving continuous oral ACD004 supplementation compared to no supplementation. Secondary objectives of this study were to examine QOL, safety, tolerance and growth. Results: 42 children were enrolled in Phase A with 78.6% (n=33) achieving remission with a significant improvement in endoscopic, histologic and QOL scores. One child developed refeeding syndrome. A further 8 children relapsed during the food reintroduction phase and 25 children were enrolled in the Phase B RCT. 12 were randomised to remain supplemented and 13 had no supplementation. Only 1/3rd of the calculated study power (n=72) was met due to collapse of trial following withdrawal of funding. 8/12 in the supplemented and 10/13 in the non-supplemented group relapsed by first year. At 2 years, 4/12 in the supplemented and 2/13 in the non-supplemented group were in remission. Deterioration in IBD and systemic QOL 7 symptoms related to disease were seen; however there was no change in emotional and social functioning. Conculsions: ACD004 is an effective remission inducing agent, which also improves QOL despite significantly limiting children’s diet. Due to early collapse of trial, its role as a supplement remains uncertain; no benefit seen with limited trial recruitment. In the long-term, emotional and social domains in QOL remain unaltered, despite relapse which may be due to disease acceptance

Assess the Nurses Knowledge and Standard Practice Regarding the Prevention of Infection in Neutropenic Patients

Neutropenia-associated infections can prolong hospitalization, increase re-admission, mortality and morbidity rates. Aim of research is to determine nurses' knowledge and infection control care practices in neutropenic patients. This descriptive study was conducted between January 2020 and April 2020, at tertiary hospital Lahore, Pakistan. Sample consisted of 150 staff nurses. Data were collected by a form included socio-demographic characteristics, neutropenia knowledge questions, and infection control care practices. Each nurse was observed by researcher for infection control care practices. For observation hand hygiene adherence was found low both in medication preparation, administration and vital signs assessment. Sterility disrupted in almost all preparation of parenteral medications. Even nurses' knowledge related with neutropenia and care of neutropenic patient was found above average their infection control care practices were found insufficient.Infected patients are a source of infection transmission to other patients, health care workers and visitors, in health care facilities. Healthcare-related infections have a significant influence on the morbidity and mortality rates in the hospital environment, resulting in an increase in the time spent in hospitalization, and are thus recognized as a serious world public health problem Neutropenia is one of the most common risk factors of serious infections in immune suppressed patients and can be the result of a variety of consequences, including from certain types of drugs, environmental toxins, vitamin deficiencies, metabolic abnormalities, as well as cancer or infections. In spite of the way that neutropenia bring about contaminations, numerous preventive treatment and care conventions are demonstrated to decrease the disease rates, and improve personal satisfaction. The counteraction and control of diseases are critical for a well-functioning health system. World Health Organization in 2011 defined infection control as infection prevention and control measures that aims to confirm the defense of those who might be susceptible to obtaining an infection both in the general community and in hospitals while obtaining care due to health problems. Keywords: Nurses, Knowledge, practice, prevention, neutropenic patients. DOI: 10.7176/JHMN/77-05 Publication date:July 31st 202

Constipation in children

Constipation remains a frequent presentation to paediatricians, with significant health resource implications. We present a practical guide to the management of paediatric constipation and evaluate the current evidence for treatment regimens, to help the clinician in treating a condition that can be distressing and has a significant impact on affected families

Diffusion weighted MR imaging (DWI) and ADC values in endometrial carcinoma

Objective: To determine the sensitivity of MR imaging utilizing diffusion weighted imaging (DWI) in detection of endometrial cancer and to compare the Apparent Diffusion Coefficient (ADC) values of malignant and normal endometrium. Study Design: Cross-sectional analytical study. Place and Duration of Study: Radiology Department, Aga Khan University Hospital Karachi, from January 2007 to December 2009. Methodology: Patients were defined as undergoing MRI for suspected endometrial malignancy, and the controls were female subjects who underwent MRI examination for indications other than endometrial malignancy. Studied variables included the signal characteristics of the endometrium and ADC values. The sensitivity of DWI for the detection of endometrial carcinoma was calculated using histopathology as the gold standard, and the ADC values of the endometrium in patients and controls were recorded. The mean ADC values were compared using two-sided t- test with significance at p \u3c 0.05 at 95% confidence interval. Results: Out of 52 patients, 10 had hyperintense, 40 had hypointense and 2 had isointense endometrium on T2 weighted imaging. On DWI, 42 patients had hyperintense and 10 patients had hypointense endometrium. In comparison, 40 controls had hypointense endometrium on DWI and 12 had hyperintense endometrium. The mean ADC value for abnormal endometrium was 0.730±0.215 x10-3 mm2/sec and of normal endometrium was 1.265±0.305 x10-3 mm2/sec (p \u3c 0.001). The sensitivity for detection of endometrial carcinoma on DWI was 77.77%. False positive cases were found to be due to secretory and hyperplastic endometrium. False negative findings were found in a few cases of adenocarcinoma, endometroid carcinoma and clear cell sarcoma. Conclusion: In patients with suspected endometrial carcinoma, MRI examination utilizing DWI was a sensitive tool in detecting endometrial cancers with significantly lower ADC values for carcinoma in general. Physiological and histopathological variants may be responsible for a few false results

Antimicrobial Peptides as Infection Imaging Agents: Better Than Radiolabeled Antibiotics

Nuclear medicine imaging techniques offer whole body imaging for localization of number and site of infective foci inspite of limitation of spatial resolution. The innate human immune system contains a large member of important elements including antimicrobial peptides to combat any form of infection. However, development of antibiotics against bacteria progressed rapidly and gained popularity over antimicrobial peptides but even powerful antimicrobials failed to reduce morbidity and mortality due to emergence of mutant strains of bacteria resulting in antimicrobial resistance. Differentiation between infection and inflammation using radiolabeled compounds with nuclear medicine techniques has always been a dilemma which is still to be resolved. Starting from nonspecific tracers to specific radiolabeled tracers, the question is still unanswered. Specific radiolabeled tracers included antibiotics and antimicrobial peptides which bind directly to the bacteria for efficient localization with advanced nuclear medicine equipments. However, there are merits and demerits attributed to each. In the current paper, radiolabeled antibiotics and radiolabeled peptides for infection localization have been discussed starting with the background of primitive nonspecific tracers. Radiolabeled antimicrobial peptides have certain merits compared with labeled antibiotics which make them superior agents for localization of infective focus

CD14 Gene (−159 C>T) Polymorphism and its Surface Expression on Monocytes in Pulmonary Tuberculosis Patients

BACKGROUND: Tuberculosis (TB) is an infectious disease that affects millions of people around the world. The innate immune response against TB starts by interaction of several receptors on monocytes with mycobacterium tuberculosis (MTB). CD14 is one of these receptors present on the monocytes which facilitate the entry of MTB into the cell. Certain polymorphisms in CD14 gene, for example, CD14 (−159 C>T) in the promotor region have suggested susceptibility of TB. AIM: This study was designed to determine and compare CD14 (−159 C>T) gene polymorphism and its surface expression in pulmonary TB patients (before and during anti-TB treatment) and healthy controls. MATERIALS AND METHODS: The study population comprised three groups (pulmonary TB patients before treatment, pulmonary TB patients during treatment, and healthy controls) whereas 53 blood samples were collected from each group. The percentage of monocytes and CD14 mean fluorescence intensity (MFI) was measured by flow cytometry whereas polymerase chain reaction-restriction fragment length polymorphism was used to determine gene polymorphism. RESULTS: CD14 MFI was significantly high in healthy controls than in TB patients (432 as compared to 193 and 365, p < 0.0001). There was no significant difference in CD14 single nucleotide polymorphism allele frequencies or genotypes between TB patients and healthy controls. CONCLUSION: CD14 gene (−159 C>T) polymorphism was not associated with pulmonary TB disease in a sample of Pakistani population and surface expression of CD14 receptor on peripheral blood monocytes decreases with active TB disease and during treatment

Bovine Feed Manipulation, Enhancement of Conjugated Linoleic Acid and Its Bioavailability

Diet is a pivotal contributing factor to the onset and progression of some chronic ailments nowadays. The conjugated linoleic acid (CLA), a bioactive component of ruminant fat, introduces more elucidates what we know polyunsaturated fats and diseases. CLA, a mixture of isomers c9, t11 and t10, c12, is the most abundant ranging from 80 to 90% of total CLA isomers and account for most known health benefits. Dairy milk and meat are the major dietary sources of CLA, and its concentration is of great interest to human health. The biofunctionalities of CLA from enriched dairy products are major attributes in the context of a substance present in our everyday diet. Thus, dietary modifications in animal feed, synthetic and microbial production have been made to increase CLA intake to enhance its clinical manifestations. However, the bioavailability and distribution of enriched or supplemented CLA has not been fully elucidated because of its response variation in different animal models. This chapter deals with different dietary sources, availability, enhancement of CLA in dairy products and its positive manifestation against different maladies. In conclusion, it is feasible to produce CLA-enriched dairy products with acceptable storage and sensory characteristics while deriving its nutritional benefits

Oral lichen planus and hepatitis C virus infection; a symbiotic relationship or a mere co-incidence?

Background: Lichen planus (LP) is a common idiopathic chronic inflammatory immune mediated mucocutanous disease that effects stratified squamous epithelia and appendices. Hepatitis C virus (HCV) infection is quite common across the world. A couple of reports have suggested positive association of HCV infection and oral lichen planus (OLP) and most of the studies are usually confined to Mediterranean and south European countries. Due to high incidence and suspected alliance between these two diseases in Pakistan, the following study was conducted with the view that it may help clinicians to set guidelines for HCV testing of lichen planus patients.Methods: Approximately 11500 patients from general population coming to dental diagnostics department of Fatima Memorial Hospital, Lahore (from March 2015-February 2016) were screened clinically for OLP and by ELISA for HCV infection. Out of these 11500 patients 103 were selected one of them incidental and the other pre-diagnosed or both incidental and both pre-diagnosed. These patients were unaware but had either one or both OLP and HCV infection which was confirmed clinically and by ELISA respectively.Results: Majority of patients presenting for other dental complaints were unaware of these diseases process going on in them and was mostly an incidental finding by the clinician. Either one or both OLP and HCV infection were more conjoint in females comprising 77.7% of the total subjects. OLP alone was most common finding comprising 66.67% of the cases. HCV infection alone was present in 15.53% whereas 16.50% subjects showed presence of both OLP and HCV infection.Conclusions: The current study could not detect statistically significant relationship between OLP and HCV infection in Pakistani population which could be due to genetic variation or may be geographic relationship

Spiritual medicine in the multi perspective of religion

Spiritual healing, also known as healing through prayer and meditation, has been widely studied by various scholars from different religions including Islam, Hindu, Buddhism and Christianity. The term spiritual medicine is increasingly popular with increasing mental disorders, degenerative diseases, metabolic, cancer and social illness such as drug abuse. Religions of Islam, Hinduism, Buddhism and Christianity have almost the same tradition in the spiritual aspect to create purity of self and inner peace through the practice of worship or prayer based on spiritual meditation. The application of spiritual medicine is mostly done to reduce stress and anxiety due to illness suffered by the patient. Spiritual medicine is commonly used to peace building, study self-control, anger management, empathy, affection, calmness, and also to sharpen brain activity and increase well being. Spirituality refers to the process of improvement done with the aim to restore humans to the true figure as a God creation and have the correct perception about the true image of god based on the holy book of the Qur'an, Torah, gospel and the main figure of world religions such as the Buddha and prophet of Muhammad PBUH. All religions teach the need to ask the Creator to be healthy, prosperous and free from the sufferings of illness. The benefits of spiritual medicine depend on the quality, intensity and frequency or quantity of practices or methods that are practiced by each religious believer

Analysis of single nucleotide polymorphisms encompassing toll like receptor (TLR) -7 (rs179008) and (TLR)-9 (rs352140) in systemic lupus erythematosus patients

Background: Multiple documentary evidence comprising genome wide association studies have established association of TLR7 and TLR9 gene polymorphisms with systemic lupus erythematosus (SLE). Present study was aimed to deduce and compare single nucleotide polymorphism (SNP) in TLR7 (rs179008) and TLR9 (rs352140) genes between local population of SLE patients and healthy controls.Methods: A case control study; blood samples from 80 controls (Group1) and 80 SLE subjects (Group2) were collected in EDTA tubes and processed for the analysis of gene polymorphism of TLR7 (rs179008) and TLR9 (rs352140) by PCR-RFLP after DNA extraction. Complete blood counts were also determined. Statistical analysis was carried out using Chi-square test for SNPs analysis and allele frequencies between two groups. TLR 7 and TLR 9 genes polymorphism with SLE alongside clinical parameters were assessed.Results: Genotypes of TLR7, AT and TT are not significantly associated with SLE. Whereas, TLR9 CT and TT genotypes, especially T allele are significantly associated with SLE reflecting noticeable interdependence of TLR9 gene polymorphism with respect to SLE subjects.Conclusion: TLR9 (rs352140) gene variation might be a key factor to etiology and pathogenesis of SLE.Keywords: Toll-like receptors; Restriction site; Single nucleotide polymorphism; Systemic lupus erythematosu