Serum Prolactin as an Early Biomarker for Detection of Gestational Diabetes Mellitus-An Experience at CMH Quetta

Objective: To determine the association between elevated serum prolactin and the development of gestational diabetes mellitus in the first trimester. Study Design: Prospective longitudinal study. Place and Duration of Study: Pathology Department, Combined Military Hospital, Quetta Pakistan, from Apr 2021 to Mar 2022. Methodology: One hundred and twenty-one patients had a measurement of serum prolactin in the first trimester, along with an oral glucose tolerance test in the second and third trimester, at the Pathology Department Combined Military Hospital Quetta Pakistan. Results: In the study group, serum prolactin levels were raised in 51(42.1%) patients in the first trimester. A total of 44(36.3%) patients with raised serum prolactin had impaired oral glucose tolerance tests. A significant association was found between raised serum prolactin and subsequent development of gestational diabetes mellitus in pregnant females. Conclusion: Serum prolactin can be an important biomarker for early diagnosis and monitoring of gestational diabetes mellitus

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Effect of nonlinear thermal radiation and homogeneous-heterogeneous reactions on peristaltic propulsion of Johnson-Segalman fluid

The basic aim of this research is to investigate the main features of the peristaltic flow of Johnson-Segalman fluid in a curved flow channel in the presence of a homogeneous-heterogeneous reaction. The fluid is considered electrically conducting with a radial magnetic field effect. The constitutive relation for energy is formulated with the addition of viscous dissipation and nonlinear thermal radiation. The slip and flexible wall boundary conditions are taken into consideration. The lubrication technique is used for the mathematical the modelling of the problem. The solution of the resulting nonlinear system of ODE’s is computed numerically through NDSolve command of Mathematica, and graphical results are prepared for flow variables. It has been clearly noticed that flow is accelerated in the planer medium as compared to the curved channel, and the velocity of the fluid increases with a larger Weissenberg number. Moreover, the thermal profile has an inverse relation to the parameters, i.e., radiation, temperature ratio, and curvature. Furthermore, it is also observed that the magnitude of heat transfer coefficient rises significantly when a comparatively less curved channel is utilized, however, a reduction in concentration profile is witnessed in this case. Alternative impact of homogeneous and heterogeneous reactions on concentration profile are observed through graphical results. Application of the study include the usage of peristaltic pump in chemical industry and in pharmacology industry for the purpose of drug deliveries

Anti-Ulcerogenic Evaluation of Torilis Leptophylla Plant Extract on Indomethacin Induced Mice Gastric Ulcer

Introduction: Despite conventional anti-ulcer therapies for peptic ulcer diseases, medicinal plants might provide effective new anti-ulcer compounds or, alternatively, as adjuncts to existing therapies. Aims & Objectives: To evaluate the effects of Torilis leptophylla on indomethacin-induced gastric ulcer in mice. Place and duration of study: It was an experimental study carried out in the Department of Pharmacology, University of Health Sciences, Lahore, from March to December 2016. Material & Methods: Thirty six (36) adult healthy male BALB/C mice were divided equally in 6 groups and assigned as group I (control), group II (positive control), group III–V (TLM low, medium and high dose) and group VI (omeprazole). Gastric ulcers were induced by oral ingestion of indomethacin in groups II -VI. Acute oral toxicity of the plant was also tested. Antiulcer effect was assessed by measuring body weight, amount and pH of gastric juice, ulcer count, severity of gastric lesion, ulcer index, percentage (%) inhibition of ulcer and histopathology of gastric tissue. Results were analyzed by SPSS 20.0, P-value<0.05 was considered significant. Results: Gastric ulcer reduced the body weight in indomethacin induced animals (28 ± 2.53, 29.66 ± 3.88, 29.66 ± 2.33, 31 ± 3.52,32 ± 3.099 g in group II, III, IV, V and VI respectively) at day 3. Omeprazole and TLM treated groups reduced the gastric volume and pH as compared to positive control. Ulcer index (18.83, 5.14, 3.42, 1.71, 1.76 of the group II, III, IV, V and VI respectively) depicted significant reduction by treatment groups. Ulcer's percentage inhibition (72.7, 81.8, 90.88, 90.65 of low, median and high dose of TLM and standard drug respectively) was increased. Histopathological observations were remarkably reversed by TLM treated groups. Conclusion: Torilis leptophylla could significantly protect gastric mucosa from damage by indomethacin

Investigating the Role of Antibiotics on Induction, Inhibition and Eradication of Biofilms of Poultry Associated Escherichia coli Isolated from Retail Chicken Meat

Background: Widespread use of antibiotics as growth promoters and prophylactic agents has dramatic consequences for the development of antibiotic resistance. In this study, we investigated effects of selected antibiotics on bacterial biofilms and performed extensive antibiotic and VF profiling of poultry-meat associated E. coli strains. Methods: Antibiotic susceptibility was performed by a disc diffusion method, followed by molecular screening of resistance and virulence determinants. Further biofilm formation assays, MIC-p, MIC-b, MBIC and MBEC, were performed using standard tissue culture plate method. Results: In total, 83 (75%) samples were confirmed as E. coli from poultry sources, 26 different antibiotics were tested, and maximum numbers of the isolates were resistant to lincomycin (100%), while the least resistance was seen against cefotaxime (1%) and polymyxin B (1%). Overall, 48% of the isolates were ESBL producers and 40% showed carbapenemase activity; important virulence genes were detected in following percentages: fimH32 (39%), papC21 (25%), iutA34 (41%), kpsMT-II23 (28%), papEF9 (11%), papGII22 (27%) and fyuA13 (16%). Colistin showed remarkable anti-biofilm activity, while at sub-MIC levels, gentamicin, ceftriaxone and enrofloxin significantly (p &lt; 0.01) inhibited the biofilms. A strong induction of bacterial biofilm, after exposure to sub-minimal levels of colistin clearly indicates risk of bacterial overgrowth in a farm environment, while use of colistin aggravates the risk of emergence of colistin resistant Enterobacteriaceae, a highly undesirable public health scenario

Flaxseed (Linum usitatissimum); phytochemistry, pharmacological characteristics and functional food applications

Flaxseed (Linum usitatissimum) from the family Linaceae, is a valuable medicinal oil seed crop cultivated all around the world. Presence of proteins, dietary fiber, fatty acids, especially α-linolenic acid, vitamins, minerals, phenolics, flavonoids and other bioactive components in significant amounts, enhances medicinal, pharma food and commercial value of flaxseed. It has been added in a variety of bakery items, beverages and dairy products. Moreover, consumption of flaxseed upsurge due to its risk lowering ability of numerous degenerative (diabetes, obesity) and chronic disorders (cardiovascular diseases and cancer). Flaxseed also has prebiotic properties and improve the health of gut microbiota. Additionally, flaxseed also contains several antinutrients such as phytic acid, protease inhibitors, and cyanogenic glycosides, which can limit the bioavailability of certain essential nutrients and can reduce nutritional value. Flaxseed meal interactions, dosage and supplementations have also been discussed. The focus of the current review is on recent studies on humans and animals as well as flaxseed's commercial use in a variety of food products as proof of its phytochemical content and potential health benefits

Role of Ferrous Sulfate (FeSO4) in Resistance to Cadmium Stress in Two Rice (Oryza sativa L.) Genotypes

The impact of heavy metal, i.e., cadmium (Cd), on the growth, photosynthetic pigments, gas exchange characteristics, oxidative stress biomarkers, and antioxidants machinery (enzymatic and non-enzymatic antioxidants), ions uptake, organic acids exudation, and ultra-structure of membranous bounded organelles of two rice (Oryza sativa L.) genotypes (Shan 63 and Lu 9803) were investigated with and without the exogenous application of ferrous sulfate (FeSO4). Two O. sativa genotypes were grown under different levels of CdCl2 [0 (no Cd), 50 and 100 &micro;M] and then treated with exogenously supplemented ferrous sulfate (FeSO4) [0 (no Fe), 50 and 100 &micro;M] for 21 days. The results revealed that Cd stress significantly (p &lt; 0.05) affected plant growth and biomass, photosynthetic pigments, gas exchange characteristics, affected antioxidant machinery, sugar contents, and ions uptake/accumulation, and destroy the ultra-structure of many membranous bounded organelles. The findings also showed that Cd toxicity induces oxidative stress biomarkers, i.e., malondialdehyde (MDA) contents, hydrogen peroxide (H2O2) initiation, and electrolyte leakage (%), which was also manifested by increasing the enzymatic antioxidants, i.e., superoxidase dismutase (SOD), peroxidase (POD), catalase (CAT) and ascorbate peroxidase (APX) and non-enzymatic antioxidant compounds (phenolics, flavonoids, ascorbic acid, and anthocyanin) and organic acids exudation pattern in both O. sativa genotypes. At the same time, the results also elucidated that the O. sativa genotypes Lu 9803 are more tolerant to Cd stress than Shan 63. Although, results also illustrated that the exogenous application of ferrous sulfate (FeSO4) also decreased Cd toxicity in both O. sativa genotypes by increasing antioxidant capacity and thus improved the plant growth and biomass, photosynthetic pigments, gas exchange characteristics, and decrease oxidative stress in the roots and shoots of O. sativa genotypes. Here, we conclude that the exogenous supplementation of FeSO4 under short-term exposure of Cd stress significantly improved plant growth and biomass, photosynthetic pigments, gas exchange characteristics, regulate antioxidant defense system, and essential nutrients uptake and maintained the ultra-structure of membranous bounded organelles in O. sativa genotypes

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

BackgroundTranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding.MethodsWe did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.FindingsBetween July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).InterpretationWe found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial.</div