Effect on serum potassium level in patients of diabetic nephropathy on spironolactone and ramipril over follow up period

Background: The study was conducted to evaluate the change in serum potassium level over follow up period in patients of diabetic nephropathy on spironolactone (25 mg) and ramipril (5 mg) and compare the results with diabetic nephropathy patients on Spironolactone (25 mg) alone.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70 yr.) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Inclusion criteria followed in study were Age 30-70 years, diagnosed type 2 diabetes mellitus, serum potassium level <5 meq/l, estimated GFR >30 ml/min/1.73m2 and HbA1c <10%. Exclusion criteria were type 1 diabetes mellitus, impaired glucose tolerance secondary to endocrine disease, exocrine pancreatic disease, SBP >180 mmHg DBP >110 mmHg, UTI, hematuria, acute febrile illness, vigorous exercise, short-term pronounced hyperglycemia, obstructive uropathy, confirmed or suspected renal artery disease by USG doppler study, Serum potassium level >5.5 meq/l. Patients were divided in two groups, group A (n= 28, spironolactone 25 mg and ramipril 5 mg) and group B (n=27, spironolactone 25 mg). Subjects were followed over 12 weeks and baseline and 12-week serum potassium being compared. Other baseline base line laboratory investigation such as serum lipid profile, HbA1c, eGFR, fundus examination, ultrasonography (KUB), serum urea, serum creatinine, hemoglobin, were taken at the starting point.Results: Both the group after receiving respective drug were followed for 3-month duration and serum potassium level measured at end of 3 months. Mean values of baseline and follow up serum potassium for group A and group B were 4.24±0.59, 4.07±0.61 and 4.35±0.55, 4.16±0.61 respectively, p value found to be >0.05 at 95% CI.Conclusions: In the study it was concluded that p value found to be >0.05 at 95% C.I denoting that there is no significant difference between mean value of base line and follow up serum potassium value in both group. None of patients in either group had experienced hyperkalaemia over follow up period though serum potassium level were slightly higher in group A, but this difference was statistically not significant. Follow up period of study should be long enough to comment on safety profile of combining spironolactone and ACE inhibitors in diabetic nephropathy patients

Analysis and establish a correlation between serum ceruloplasmin, serum apelin level and thyroid profile in patients with hypothyroidism and healthy controls

Background: Hypothyroidism is an endocrine disorder resulting from deficiency of thyroid hormone. It is often the primary process in which the thyroid gland produces insufficient amounts of thyroid hormone. It can also be secondary, i.e., lack of thyroid hormone secretion due to the failure of either adequate thyrotropin (TSH) secretion from the pituitary gland or thyrotropin-releasing hormone (TRH) from the hypothalamus (secondary or tertiary hypothyroidism). The patient's appearance may vary from asymptomatic to, rarely, coma with multisystem organ failure (myxoedema coma). Methods: The present observational descriptive, cross sectional study has been conducted on 120 newly diagnosed Subclinical Hypothyroidism patients of 20-50 years age group of both sex attending the OPD of department of medicine, RVRS medical college and associated group of hospitals, Bhilwara from May 2021 to May 2022. Diagnosis of thyroid disorder has been made according to the criteria recommended by the European thyroid association guidelines-2013. The result has been compared with age and gender matched 120 euthyroid subjects acting as controls. Detailed history of participants including age, history of any medications, addictions has been taken. Written consent from all the subjects has been obtained for the study.Results: The mean serum FT3 level was found to be slightly decreased in Subclinical hypothyroid subjects (group I) as compared to healthy controls (group II) but the difference was statistically significant (p<0.0001). The mean serum FT4 level was found to be slightly decreased in Subclinical hypothyroid subjects (group I) as compared to healthy controls (group II) but the difference was statistically significant (p<0.0001). A highly significant increase (p<0.0001) in mean serum TSH level has been observed in subclinical hypothyroid subjects (group-I) when compared to controls (group- II). In subclinical hypothyroid subjects, mean serum ceruloplasmin levels were found to be significantly lower in comparison to healthy subjects (p<0.0001).Conclusions: The overall findings of the present study thus confirm that serum Apelin level is significantly higher in subclinical hypothyroid subjects and serum ceruloplasmin level is significantly lower in the subclinical hypothyroid subjects. However, further experimental and observational studies are needed to illustrate the role of serum ceruloplasmin and serum apelin in subclinical hypothyroidism

Effectiveness of CBNAAT in the diagnosis of extrapulmonary tuberculosis

Background: Tuberculosis is still a major health problem worldwide. It is estimated that about one-third of the world's population is infected with mycobacterium tuberculosis. Whilepulmonary tuberculosis is most common presentation; extrapulmonary tuberculosis is also an important clinical problem. CBNAAT is cartridge based nucleic acid amplification test with a well-established role in the diagnosis of pulmonary tuberculosis (PTB). We determined the effectiveness of CBNAAT in the diagnosis of extrapulmonary tuberculosis (EPTB) cases in comparison to AFB smear.Methods: Retrospective study of suspected extrapulmonary tuberculosis patients in a tertiary care centre of the study area was conducted. The study period was from January 2017 to July 2018. Data of 166 consecutive suspected extrapulmonary tuberculosis patients was retrieved. Effectiveness of CBNAAT in the diagnosis of EPTB was assessed as compared to that of AFB smear.Results: Samples collected from 166 suspected EPTB patients were subjected to AFB smear and CBNAAT. Samples collected included lymph node, pus, pleural fluid, tissue, CSF, gastric lavage, cystic fluid, peritoneal fluid, ascitic fluid, colonic fluid, synovial fluid, urine. In AFB smear results, 17 cases were positive for TB bacilli and 149 were negative for the same. In CBNAAT results, 25 cases were positive for TB bacilli and 141 cases were negative. In comparative analysis, 8 cases were AFB smear negative but CBNAAT positive.Conclusions: CBNAAT is a useful tool in the diagnosis of EPTB cases because of its simplicity and rapid turnaround time. CBNAAT is more effective as compared to AFB smear in the diagnosis of EPTB cases

A serine protease KLK8 emerges as a regulator of regulators in memory: Microtubule protein dependent neuronal morphology and PKA-CREB signaling

The multitude of molecular pathways underlying memory impairment in neurological disorders and aging-related disorders has been a major hurdle against therapeutic targeting. Over the years, neuronal growth promoting factors, intracellular kinases, and specific transcription factors, particularly cyclic AMP response element-binding protein (CREB), have emerged as crucial players of memory storage, and their disruption accompanies many cognitive disabilities. However, a molecular link that can influence these major players and can be a potential recovery target has been elusive. Recent reports suggest that extracellular cues at the synapses might evoke an intracellular signaling cascade and regulate memory function. Herein, we report novel function of an extracellular serine protease, kallikrein 8 (KLK8/Neuropsin) in regulating the expression of microtubule associated dendrite growth marker microtubule-associated protein (MAP2)c, dendrite architecture and protein kinase A (PKA)-CREB signaling. Both knockdown of KLK8 via siRNA transfection in mouse primary hippocampal neurons and via intra-hippocampal administration of KLK8 antisense oligonucleotides in vivo reduced expression of MAP2c, dendrite length, dendrite branching and spine density. The KLK8 mediated MAP2c deficiency in turn inactivated PKA and downstream transcription factor phosphorylated CREB (pCREB), leading to downregulation of memory-linked genes and consequent impaired memory consolidation. These findings revealed a protease associated novel pathway of memory impairment in which KLK8 may act as a "regulator of regulators", suggesting its exploration as an important therapeutic target of memory disorders

PHENO-GENOTYPIC CHARACTERIZATION OF LISTERIA MONOCYTOGENES FROM BOVINE CLINICAL MASTITIS

ABSTRACT The present study was carried out for pheno-genotypic characterization of L. monocytogenes (L. monocytogenes). A total of three isolates of L. monocytogenes were recovered from 85 mastitic milk samples (47 buffalos and 38 cows). Confirmation of the L. monocytogenes were based on biochemical tests followed by phenotypic characterization by hemolysis on sheep blood agar, the Christie Atkins Munch-Petersen (CAMP) test, phosphatidylinositol-specific phospholipase C (PIPLC) assay and phosphatidylcholine-specific phospholipase C (PIPLC) assay. The isolates were subjected to genotypic characterization with the help of PCR assay for five virulence associated genes namely, plcA, prfA, hlyA, actA and iap. The L. monocytogenes isolates were further subjected to multiplex-PCR based serotyping. All the three isolates of L. monocytogenes were hemolytic, CAMP positive, PI-PLC, PC-PLC positive, hlyA, pclA, actA, iap and prfA positive by PCR. All the three isolates of L. monocytogenes were serotyped as 4b

Dokaz gena za toksine i antibiogram izolata bakterije Escherichia coli iz ovčjeg mesa na indijskom tržištu

Isolates (49) of Escherichia coli were isolated from 100 samples of mutton collected from dressed sheep carcasses by excision method. The isolates were typed into 12 different ‘O’ serogroups. The most frequent serovar isolated was O101, followed by O152, O76, O23, O139, O88, O110, O126, O8, O9, O15 and O133; two isolates were untypable while one was rough. All the isolates of Escherichia coli were screened for the presence of VT1, VT2, LT and ST genes by PCR and in vitro antibiotic resistance pattern. Nine (60.0%) and six (40.0%) isolates were found positive for VT1 and VT2 genes, respectively. Five (33.33%) were found positive for both the VT1 and VT2 genes. Four (26.67%) isolates were positive for LT gene, whereas only one (6.67%) isolate was found positive for ST gene. The percentage of isolates resistant to antibacterial agents was recorded as follows: sulphadiazine (93.33%), cephaloridine (80.00%), cephalexin (33.33%), penicillin G, ceftiofur and norfloxacin, carbenicillin and enrofloxacin (26.67% each), and oxytetracycline and amoxycillin (20.00% each).Ukupno je 49 izolata bakterije Escherichia coli bilo izdvojeno iz 100 uzoraka mesa uzetih ekscizijom iz obrađenih ovčjih trupova. Izolati su bili tipizirani i svrstani u 12 različitih seroloških skupina O. Najčešće je bio izdvojen serovar O101, a zatim serovarovi O152, O76, O23, O139, O88, O110, O126, O8, O9, O15 i O133. Dva izolata ostala su netipizirana, a jedan je bio s hrapavim kolonijama. Svi su izolati bili pretraženi lančanom reakcijom polimerazom na prisutnost gena VT1, VT2, LT i ST te im je in vitro određena osjetljivost prema antimikrobnim tvarima. Devet (60,0%) izolata bilo je pozitivno za gen VT1, a šest (40,0%) za VT2. Pet (33,33%) ih je bilo pozitivnih za oba gena, VT1 i VT2. Četiri izolata (26,67%) bila su pozitivna za gen LT, dok je samo jedan (6,67%) bio pozitivan za gen ST. Na sulfadiazin je bilo otporno 93,33% izolata, na cefaloridin 80,00%, na cefaleksin 33,33%, na penicilin G, ceftiofur, norfloksacin, karbenicilin i enrofloksacin 26,67% te na oksitetraciklin i amoksicilin 20,00% izolat

Functional quadriceps reconstruction : 3D gait analysis, EMG and environmental simulator outcomes

Limited objective evidence exists on the benefits of functional muscle transfers following quadriceps resection in sarcoma. In particular, no studies have compared patients with functional transfers to those without. In this study, objective and subjective assessments were performed with 3D Gait Analysis, Environmental Simulator, Electromyography (EMG) and Patient-Reported Outcomes. Thirty-four patients at the Scottish Sarcoma Network Glasgow Centre/ Canniesburn Plastic Surgery Unit underwent quadriceps resection for sarcoma between 2009 - 2019, including 24 patients with functional reconstruction and 10 without. Both groups were equivalent for the extent of quadriceps resection (2.58 versus 2.85 components, p=0.47). Primary outcome measure was 3D Gait Analysis and Gait Profile Score (GPS), and secondary outcome was the Toronto Extremity Salvage Score (TESS) score. Ancillary analyses included environmental simulation with the Motek CAREN system and EMG of transferred muscles. Outcomes measures were better in functional reconstruction patients when compared to those without - the GPS score was 8.04 versus 10.2 (p=0.0019), and the TESS score was 81.85 versus 71.17 (p=0.028). Environmental simulator tasks found that functional reconstruction patients could complete activities of daily living including shopping and collision avoidance tasks, without significantly slowing their walking speed. Patients without a functional reconstruction could not complete weighted shopping tasks. EMG showed that transferred hamstrings co-activated with the ipsilateral rectus femoris during the gait cycle. These are the first objective data demonstrating the superiority of muscle transfers for functional restoration in quadriceps resection versus patients without functional transfers. Critically, these also provide answers to patient-oriented questions relating to the recovery of function and activities of daily living. [Abstract copyright: Copyright © 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Closed incision negative pressure wound therapy versus conventional dressings following soft-tissue sarcoma excision: a prospective, randomized controlled trial

Aims: The primary objective of this study was to compare the postoperative infection rate between negative pressure wound therapy (NPWT) and conventional dressings for closed incisions following soft-tissue sarcoma (STS) surgery. Secondary objectives were to compare rates of adverse wound events and functional scores. Methods: In this prospective, single-centre, randomized controlled trial (RCT), patients were randomized to either NPWT or conventional sterile occlusive dressings. A total of 17 patients, with a mean age of 54 years (21 to 81), were successfully recruited and none were lost to follow-up. Wound reviews were undertaken to identify any surgical site infection (SSI) or adverse wound events within 30 days. The Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) score were recorded as patient-reported outcome measures (PROMs). Results: There were two out of seven patients in the control group (28.6%), and two out of ten patients in the intervention group (20%) who were diagnosed with a SSI (p &gt; 0.999), while one additional adverse wound event was identified in the control group (p = 0.593). No significant differences in PROMs were identified between the groups at either 30 days (TESS, p = 0.987; MSTS, p = 0.951) or six-month (TESS, p = 0.400) follow-up. However, neoadjuvant radiotherapy was significantly associated with a SSI within 30 days of surgery, across all patients (p = 0.029). The mean preoperative modified Glasgow Prognostic Score (mGPS) was also significantly higher among patients who developed a postoperative adverse wound event (p = 0.028), including a SSI (p = 0.008), across both groups. Conclusion: This is the first RCT comparing NPWT with conventional dressings following musculoskeletal tumour surgery. Postoperative wound complications are common in this group of patients and we observed an overall SSI rate of 23.5%. We propose proceeding to a multicentre trial, which will help more clearly define the role of closed incision NPWT in STS surgery