Use and satisfaction of complementary and alternative medicine among diabetic patients in a tertiary care hospital

Background: Diabetes is a chronic disorder which requires long-term treatment. Non- adherence to treatment is a major factor responsible for morbidities and mortalities associated with diabetes. Complementary and alternative medicine (CAM) use has been one of the reasons for discontinuation of treatment. This study was conducted to assess the extent to which CAM and non-CAM users adhere to medical treatment.Methods: 200 patients attending the diabetic clinic over a period of 2 months participated in the study. After obtaining written informed consent, they were administered a CAM use and satisfaction questionnaire (TSQM) based on effectiveness, no side-effects, convenience and global satisfaction.Results: Out of 200 participants, 29% (58) used CAM. Naturopathy was the most commonly followed type of CAM (60 %; 35). Residing in the rural areas (OR-3.7), Socio- economic status above poverty line (OR- 9), diabetics with co- morbidities (OR- 6) and microvascular complications (OR-6) and using insulin (OR-3) was found to be the predictors of CAM use. However, the incidence of hypoglycemic episodes was 52 times higher among CAM users. (91%; 52) of the CAM users did not reveal the use to their physicians, out of which (70%; 40) did not disclose due to the fear of discouragement by the doctor. CAM was found to be better in all aspects of patient satisfaction like effectiveness, no- side-effects and global satisfaction than conventional medicine while conventional medicine users scored it to be more convenient to use than CAM.Conclusions: Doctors should enquire diabetics regarding CAM use since the voluntary disclosure is very less. Keeping lines of communication open for any discussions regarding pros and cons of CAM. Increasing patient awareness about potential drug interactions, when CAM is practised along with conventional medicine

A RANDOMIZED CONTROL STUDY TO EVALUATE THE ROLE OF HERBAL IMMUNOMODULATORS IN BOOSTING THE IMMUNITY AND OVERALL HEALTH OF HEALTHCARE WORKERS IN COVID-19 WARDS: AN EXPLORATORY, FEEDBACK CLINICAL STUDY

Objective: The objective of the study was to evaluate the role of the herbal immunomodulators Immusante and Guduchi in boosting the immunity and overall health of healthcare workers assigned to coronavirus disease 2019 (COVID-19) wards. Methods: An open-label, randomized, prospective, and single center clinical study was conducted among 100 healthcare workers assigned to COVID-19 wards. Eligible subjects (50 in each arm) were randomly assigned to either arm I (Immusante+Guduchi tablets) or arm II (treatment as per the institutional policy). Assessments after 30 days of treatment included respiratory symptoms, Adapted Immune Status Questionnaire (ISQ), improvement in quality of life (Short form 12 [SF-12] Health Survey), and safety and tolerability. Results: All 100 subjects completed the study as per the protocol. There were no respiratory symptoms in the subjects in arm 1. However, four subjects (8%) in arm II reported cough during the study period. A better Immune status improvement was seen through the adapted ISQ in arm I as compared to arm II. In each of the 8 SF-12 Health Survey domains, a statistically significant difference was observed in arm I compared to arm II. A retrospective assessment of COVID-19 infection showed only 8% of subjects as COVID-19 positive in arm I compared with 26% of subjects in arm II. Conclusion: Considering the positive trend observed in this study in terms of ISQ, SF-12, and COVID-19 infection rates, the combination of Immusante and Guduchi in healthcare workers at a high risk of contracting COVID-19 infection had a beneficial effect in boosting immunity and overall health

A comparative prospective study to assess the clinical efficacy and safety of pantoprazole monotherapy versus pantoprazole and itopride dual therapy in patients with gastroesophageal reflux disease in a tertiary care hospital

Background: Gastroesophageal reflux disease (GERD) is a common chronic, relapsing condition that carries a risk of significant morbidity and potential mortality from resultant complications. Proton pump inhibitors (PPIs) remained as the main stay in the therapy of GERD but they do not have any role in increasing the tone of lower esophageal sphincter which is the main pathophysiology of GERD. In this regard addition of prokinetic agent like Itopride may be beneficial in improving the symptoms associated with GERD. So the present study has been taken to compare the healing rates of esophagitis and reduction in symptom scores associated with GERD between Pantoprazole monotherapy and Pantoprazole plus Itopride combination.Methods: 100 patients diagnosed with GERD were randomly assigned into two groups, Group A and Group B. Group A received tablet Pantoprazole 40 mg twice daily alone and group B received tablet Pantoprazole 40 mg twice daily and tablet Itopride 50 mg thrice daily 30 minutes before food for 4 weeks. The patients were followed up at the end of 4 weeks and were given the questionnaire to assess the FSSG scores. Endoscopy and FSSG scores were recorded and then the percentage of responders in both groups was compared.Results: Endoscopic evidence of healing of esophagitis was similar in both the groups, 72% in Group A and 74% in Group B. The symptom relief was significantly more in Pantaprozole plus Itopride group 74.5% (4.2±1.6) than Pantaprozole alone 62.5% (6.4±1.1) after 4 weeks (p < 0.001).The occurrence of side effects was less in group B compared to group A (22% vs 30%, p= 0.172).Conclusions: Pantoprazole and combination of Pantoprazole plus Itopride provide more effective endoscopic healing of esophagitis. Pantoprazole and Itopride combination is more efficacious in ameliorating the symptoms of GERD than Pantoprazole alone

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

D1 Dopamine Receptor Signaling Is Modulated by the R7 RGS Protein EAT-16 and the R7 Binding Protein RSBP-1 in Caenoerhabditis elegans Motor Neurons

Dopamine signaling modulates voluntary movement and reward-driven behaviors by acting through G protein-coupled receptors in striatal neurons, and defects in dopamine signaling underlie Parkinson's disease and drug addiction. Despite the importance of understanding how dopamine modifies the activity of striatal neurons to control basal ganglia output, the molecular mechanisms that control dopamine signaling remain largely unclear. Dopamine signaling also controls locomotion behavior in Caenorhabditis elegans. To better understand how dopamine acts in the brain we performed a large-scale dsRNA interference screen in C. elegans for genes required for endogenous dopamine signaling and identified six genes (eat-16, rsbp-1, unc-43, flp-1, grk-1, and cat-1) required for dopamine-mediated behavior. We then used a combination of mutant analysis and cell-specific transgenic rescue experiments to investigate the functional interaction between the proteins encoded by two of these genes, eat-16 and rsbp-1, within single cell types and to examine their role in the modulation of dopamine receptor signaling. We found that EAT-16 and RSBP-1 act together to modulate dopamine signaling and that while they are coexpressed with both D1-like and D2-like dopamine receptors, they do not modulate D2 receptor signaling. Instead, EAT-16 and RSBP-1 act together to selectively inhibit D1 dopamine receptor signaling in cholinergic motor neurons to modulate locomotion behavior

Methamphetamine-Induced Dopamine-Independent Alterations in Striatal Gene Expression in the 6-Hydroxydopamine Hemiparkinsonian Rats

Unilateral injections of 6-hydroxydopamine into the medial forebrain bundle are used extensively as a model of Parkinson's disease. The present experiments sought to identify genes that were affected in the dopamine (DA)–denervated striatum after 6-hydroxydopamine-induced destruction of the nigrostriatal dopaminergic pathway in the rat. We also examined whether a single injection of methamphetamine (METH) (2.5 mg/kg) known to cause changes in gene expression in the normally DA-innervated striatum could still influence striatal gene expression in the absence of DA. Unilateral injections of 6-hydroxydopamine into the medial forebrain bundle resulted in METH-induced rotational behaviors ipsilateral to the lesioned side and total striatal DA depletion on the lesioned side. This injection also caused decrease in striatal serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) levels. DA depletion was associated with increases in 5-HIAA/5-HT ratios that were potentiated by the METH injection. Microarray analyses revealed changes (± 1.7-fold, p<0.025) in the expression of 67 genes on the lesioned side in comparison to the intact side of the saline-treated hemiparkinsonian animals. These include follistatin, neuromedin U, and tachykinin 2 which were up-regulated. METH administration caused increases in the expression of c-fos, Egr1, and Nor-1 on the intact side. On the DA-depleted side, METH administration also increased the expression of 61 genes including Pdgf-d and Cox-2. There were METH-induced changes in 16 genes that were common in the DA-innervated and DA-depleted sides. These include c-fos and Nor-1 which show greater changes on the normal DA side. Thus, the present study documents, for the first time, that METH mediated DA-independent changes in the levels of transcripts of several genes in the DA-denervated striatum. Our results also implicate 5-HT as a potential player in these METH-induced alterations in gene expression because the METH injection also caused significant increases in 5-HIAA/5-HT ratios on the DA-depleted side

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Use and satisfaction of complementary and alternative medicine among diabetic patients in a tertiary care hospital

Background: Diabetes is a chronic disorder which requires long-term treatment. Non- adherence to treatment is a major factor responsible for morbidities and mortalities associated with diabetes. Complementary and alternative medicine (CAM) use has been one of the reasons for discontinuation of treatment. This study was conducted to assess the extent to which CAM and non-CAM users adhere to medical treatment.Methods: 200 patients attending the diabetic clinic over a period of 2 months participated in the study. After obtaining written informed consent, they were administered a CAM use and satisfaction questionnaire (TSQM) based on effectiveness, no side-effects, convenience and global satisfaction.Results: Out of 200 participants, 29% (58) used CAM. Naturopathy was the most commonly followed type of CAM (60 %; 35). Residing in the rural areas (OR-3.7), Socio- economic status above poverty line (OR- 9), diabetics with co- morbidities (OR- 6) and microvascular complications (OR-6) and using insulin (OR-3) was found to be the predictors of CAM use. However, the incidence of hypoglycemic episodes was 52 times higher among CAM users. (91%; 52) of the CAM users did not reveal the use to their physicians, out of which (70%; 40) did not disclose due to the fear of discouragement by the doctor. CAM was found to be better in all aspects of patient satisfaction like effectiveness, no- side-effects and global satisfaction than conventional medicine while conventional medicine users scored it to be more convenient to use than CAM.Conclusions: Doctors should enquire diabetics regarding CAM use since the voluntary disclosure is very less. Keeping lines of communication open for any discussions regarding pros and cons of CAM. Increasing patient awareness about potential drug interactions, when CAM is practised along with conventional medicine