Changes of Testicular Histogenesis during Prenatal and Early Postnatal Life in Bisphenol A Exposed Rats by Ascorbic Acid

Objectives: In this study we aimed to investigate the conservation of testicular histogenesis in bisphenol A exposed rats by ascorbic acid during prenatal and early postnatal life. Material and Methods: Eight weeks old 15 pregnant rats were divided into 3 groups, each containing 5 rats. Pups were delivered by spontaneous vaginal delivery. Group A had 15 male rat pups, from 5 pregnant female rats, which were fed on standard diet during pregnancy and lactation till day 21. Group B had 15 male rat pups from 5 pregnant female rats which were given 250μg/kg/day Bisphenol A subcutaneously during pregnancy and lactation till day 21. Group C had 15 male rat pups from 5 pregnant female rats which were given 250μg/kg/day Bisphenol A subcutaneously and 150mg/kg/day ascorbic acid orally during pregnancy and lactation till day 21. Results: There was significant deterioration of seminiferous tubule and basement membrane regularity with BPA along with detachment of germinal epithelium and cell debris in group B. These parameters were conserved significantly with ascorbic acid in group C. Conclusion: Biphenol A adversely affects histogenesis of testes by causing oxidative stress when given during pregnancy and lactation and ascorbic acid conserves BPA exposed developing testes and may preserve spermatogenesis and male fertility. Key words: Bisphenol A, ascorbic acid, histogenesis, rat, developing testes, prenatal, early postnatal

Changes of Testicular Histogenesis during Prenatal and Early Postnatal Life in Bisphenol A Exposed Rats by Ascorbic Acid

Objectives: In this study we aimed to investigate the conservation of testicular histogenesis in bisphenol A exposed rats by ascorbic acid during prenatal and early postnatal life. Material and Methods: Eight weeks old 15 pregnant rats were divided into 3 groups, each containing 5 rats. Pups were delivered by spontaneous vaginal delivery. Group A had 15 male rat pups, from 5 pregnant female rats, which were fed on standard diet during pregnancy and lactation till day 21. Group B had 15 male rat pups from 5 pregnant female rats which were given 250μg/kg/day Bisphenol A subcutaneously during pregnancy and lactation till day 21. Group C had 15 male rat pups from 5 pregnant female rats which were given 250μg/kg/day Bisphenol A subcutaneously and 150mg/kg/day ascorbic acid orally during pregnancy and lactation till day 21. Results: There was significant deterioration of seminiferous tubule and basement membrane regularity with BPA along with detachment of germinal epithelium and cell debris in group B. These parameters were conserved significantly with ascorbic acid in group C. Conclusion: Biphenol A adversely affects histogenesis of testes by causing oxidative stress when given during pregnancy and lactation and ascorbic acid conserves BPA exposed developing testes and may preserve spermatogenesis and male fertility. Key words: Bisphenol A, ascorbic acid, histogenesis, rat, developing testes, prenatal, early postnatal

Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study.

Background:Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan. Methods: At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated, surveillance data from 2002 to 2007 was analyzed and compared with various risk factors. Results: During study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394, 28.5%) followed by registered nurses (n = 283, 20.4%). Highest number of incidents was reported during blood collection (19%). An increasing trend was observed in the pre intervention years (2002-04). However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/100 FTE/year). By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including, hospital admissions (p-value 0.01), surgeries and procedures performed (p = 0.01), specimens collected in the laboratory (p = 0.001) and Patients visits in clinics (p = 0.01). Conclusion: We report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project

Relative effectiveness and safety of pharmacotherapeutic agents for patent ductus arteriosus (PDA) in preterm infants: A protocol for a multicentre comparative effectiveness study (CANRxPDA)

Introduction Patent ductus arteriosus (PDA) is the most common cardiovascular problem that develops in preterm infants and evidence regarding the best treatment approach is lacking. Currently available medical options to treat a PDA include indomethacin, ibuprofen or acetaminophen. Wide variation exists in PDA treatment practices across Canada. In view of this large practice variation across Canadian neonatal intensive care units (NICUs), we plan to conduct a comparative effectiveness study of the different pharmacotherapeutic agents used to treat the PDA in preterm infants. Methods and analysis A multicentre prospective observational comparative-effectiveness research study of extremely preterm infants born 29 weeks gestational age with an echocardiography confirmed PDA will be conducted. All participating sites will self-select and adhere to one of the following primary pharmacotherapy protocols for all preterm babies who are deemed to require treatment. Standard dose ibuprofen (10 mg/kg followed by two doses of 5 mg/kg at 24 hours intervals) irrespective of postnatal age (oral/intravenous). Adjustable dose ibuprofen (oral/intravenous) (10 mg/kg followed by two doses of 5 mg/kg at 24 hours intervals if treated within the first 7 days after birth. Higher doses of ibuprofen up to 20 mg/kg followed by two doses of 10 mg/kg at 24 hours intervals if treated after the postnatal age cut-off for lower dose as per the local centre policy). Acetaminophen (oral/intravenous) (15 mg/kg every 6 hours) for 3-7 days. Intravenous indomethacin (0.1-0.3 mg/kg intravenous every 12-24 hours for a total of three doses). Outcomes The primary outcome is failure of primary pharmacotherapy (defined as need for further medical and/or surgical/interventional treatment following an initial course of pharmacotherapy). The secondary outcomes include components of the primary outcome as well as clinical outcomes related to response to treatment or adverse effects of treatment. Sites and sample size The study will be conducted in 22 NICUs across Canada with an anticipated enrollment of 1350 extremely preterm infants over 3 years. Analysis To examine the relative effectiveness of the four treatment strategies, the primary outcome will be compared pairwise between the treatment groups using χ 2 test. Secondary outcomes will be compared pairwise between the treatment groups using χ 2 test, Student\u27s t-test or Wilcoxon rank sum test as appropriate. To further examine differences in the primary and secondary outcomes between the four groups, multiple logistic or linear regression models will be applied for each outcome on the treatment groups, adjusted for potential confounders using generalised estimating equations to account for within-unit-clustering. As a sensitivity analysis, the difference in the primary and secondary outcomes between the treatment groups will also be examined using propensity score method with inverse probability weighting approach. Ethics and dissemination The study has been approved by the IWK Research Ethics Board (#1025627) as well as the respective institutional review boards of the participating centres. © 2021 Author(s). Published by BMJ

Outcomes and care practices for preterm infants born at less than 33 weeks’ gestation: A quality-improvement study

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23–32 weeks’ gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06–1.10, per year) across all gestational ages. Survival of infants born at 23–25 weeks’ gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02–1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants

Association of Co-Exposure of Antenatal Steroid and Prophylactic Indomethacin with Spontaneous Intestinal Perforation

Objective: To evaluate the association of a combined exposure to antenatal steroids and prophylactic indomethacin with the outcome of spontaneous intestinal perforation (SIP) among neonates born at \u3c26 weeks of gestation or \u3c750 g birth weight. Study design: We conducted a retrospective study of preterm infants admitted to Canadian Neonatal Network units between 2010 and 2018. Infants were classified into 2 groups based on receipt of antenatal steroids; the latter subgrouped as recent (≤7 days before birth) or latent (\u3e7 days before birth) exposures. The co-exposure was prophylactic indomethacin. The primary outcome was SIP. Multivariable logistic regression analysis was used to calculate aORs. Results: Among 4720 eligible infants, 4121 (87%) received antenatal steroids and 1045 (22.1%) received prophylactic indomethacin. Among infants exposed to antenatal steroids, those who received prophylactic indomethacin had higher odds of SIP (aOR 1.61, 95% CI 1.14-2.28) compared with no prophylactic indomethacin. Subgroup analyses revealed recent antenatal steroids exposure with prophylactic indomethacin had higher odds of SIP (aOR 1.67, 95% CI 1.15-2.43), but latent antenatal steroids exposure with prophylactic indomethacin did not (aOR 1.24, 95% CI 0.48-3.21), compared with the respective groups with no prophylactic indomethacin. Among those not exposed to antenatal steroids, mortality was lower among those who received prophylactic indomethacin (aOR 0.45, 95% CI 0.28-0.73) compared with no prophylactic indomethacin. Conclusions: In preterm neonates of \u3c26 weeks of gestation or birth weight \u3c750 g, co-exposure of antenatal steroids and prophylactic indomethacin was associated with SIP, especially if antenatal steroids was received within 7 days before birth. Among those unexposed to antenatal steroids, prophylactic indomethacin was associated with lower odds of mortality

Morbidity in Late Preterm Birth: A Retrospective Cohort Study Assessing the Role of Immaturity versus Antecedent Factors

Introduction: Late preterm infants (LPIs) are infants born between 340/7 and 366/7 weeks gestation. Morbidities in these infants are commonly considered a result of prematurity; however, some research has suggested immaturity may not be the sole cause of morbidities. We hypothesize that antecedents leading to late preterm birth are associated with different patterns of morbidities and that morbidities are the result of gestational age superimposed by the underlying etiologies of preterm delivery. Methods: This is a retrospective cohort study of late preterm neonates born at a single tertiary care center. We examined neonatal morbidities including apnea of prematurity, hyperbilirubinemia, hypoglycemia, and the requirement for continuous positive airway pressure (CPAP). Multivariable logistic regression analysis was performed to estimate the risk of each morbidity associated with 3 categorized antecedents of de- livery, that is, spontaneous preterm labor, preterm premature rupture of membranes (PPROM), and medically indicated birth. We calculated the predictive probability of each antecedent resulting in individual morbidity across gestational ages. Results: 279 LPIs were included in the study. Decreasing gestational age was associated with significantly increased risk of apnea of prematurity, hyperbilirubinemia, and requirement of CPAP. In our cohort, the risk of hypoglycemia increased with gestational age, with the great- est incidence at 360−6 weeks. There was no significant association of risk of selected morbidities and the antecedents of late preterm delivery, with or without adjustment for gestational age, multiple gestation, small for gestational age (SGA), antenatal steroids, and delivery method. Discussion and Conclusion: This study found no difference in morbidity risk related to 3 common antecedents of preterm birth in LPIs. Our research suggests that immaturity is the primary factor in determining adverse outcomes, intensified by factors resulting in prematurity

Oxidative Stress Mediates the Association between Thyroid Dysfunction and Breast Cancer

BACKGROUND: Breast Cancer (BC) and thyroid dysfunction are commonly observed ailments in females, and two may occur synchronously. The present study was conducted to find the role of oxidative stress and its association with thyroid dysfunction and BC. METHODS: In this cross-sectional study, 288 and 100 subjects were included in case and control groups, respectively. Serum samples were obtained from consented subjects. Thyroid profile, thyroid antibodies, antioxidant and oxidant profiles, as well as cathepsin S (CTSS), prolactin, and estradiol levels were estimated using specific enzyme-linked immunosorbent assay kits. The data was analyzed using independent Student's t-test and Pearson correlation test. RESULTS: BC cases had higher levels of thyroid antibodies and thyroid stimulating hormone than controls. Prolactin and estradiol levels were also deranged in the case group. Higher oxidative stress biomarkers were evident in the case group; 8-hydroxy-2'-deoxyguanosine (8-OHdG), a DNA damage marker, increased concomitantly. Correlation analysis showed a positive correlation between the antioxidant (catalase) and the oxidant (8-OHdG) levels. Furthermore, the higher level of CTSS in BC cases than in the controls is the hallmark of this study, demonstrating the pathogenesis and progression of the disease. CONCLUSION: Results suggest the mediating role of oxidative stress in the association between thyroid dysfunction and BC. It concludes that the parameters assessed in this study could be indicative of disease progression and metastasis in BC as well as thyroid dysfunction. KEYWORDS: breast cancer, thyroid, oxidant, antioxidant, RO

Dyspepsia in Cirrhotic Hepatitis C Patients

Abstract Background:To determine the frequency of patients with dyspepsia, its patterns of presentation and causes along with their associations with gender and age, amongst HCV cirrhotic patients presenting to a tertiary care health facility of Rawalpindi. Methods: In this cross sectional study 207 HCV cirrhotic patients,above 25 years of age irrespective of gender, were included. Patients receiving prolonged treatment of acid suppression prior to hospitalization were excluded. After taking history and performing thorough physical examination, routine laboratory investigations, abdominal ultrasonography and endoscopies were performed to determine the cause of dyspepsia. Results:Amongst 207 HCV cirrhotic patients 146 (70.5%) were presented with dyspepsia. Pain in epigastrium 92 (63.0%), heart burn 81 (55.5%) and water brash 65 (44.5%) were most common patterns of presentation of dyspepsia in HCV cirrhotic patients.Portal hypertensive gastropathy 77(52.7%) came out as leading etiology of dyspepsia, followed by gastritis 9(6.2%), ulcer 6(4.1%) and cholelithiasis4(2.7%). Amongst those diagnosed with Dyspepsia, 25(17.1%) patients were found to have functional dyspepsia i.e. no organic cause was found. Conclusion:Dyspepsia is very frequent phenomenon in HCV cirrhotic patients with most common patterns of presentation as pain in epigastrium and heart burn. The leading cause of dyspepsia was portal hypertensive gastropathy