Respiratory burst by dengue-virus-induced cytotoxic factor

This study investigates the induction and release of the superoxide anion (O- 2) and hydrogen peroxide (H2O2) by mouse spleen cells on stimulation with dengue type 2 virus (DV) and a DV-induced cytokine, the cytotoxic factor (mCF). Methods: Normal mice or their spleen cell cultures were inoculated with DV or mCF. At different time periods, the spleen cell supernatants were assayed for the production of O- 2 and H2O2. Results: Inoculation of DV in spleen cell cultures resulted in peak production of O- 2 and H2O2 at 48 and 72 h, respectively, while in DV-infected mouse spleen, the maximum production was on days 7 and 8, which correlated with the appearance of mCF in the milieu. Maximum O- 2 and H2O2 production occurred at 45 min and 1 h after inoculation of 5 µ g of mCF. Pretreatment of mCF with anti-mCF-antiserum inhibited O- 2 and H2O2 release indicating the specificity of the induction by mCF. The enriched subpopulations of macrophages and T cells produced O- 2 and H2O2 and not B cells. Treatment of the cells with superoxide dismutase increased H2O2 release but inhibited O- 2 release and the cytotoxicity in a dose-dependent manner. Conclusion: This showed that O- 2 is responsible for the cytotoxic activity of mCF and not H2O2. In conjunction with our earlier findings that pretreatment with NG-monomethyl-L-arginine inhibited mCF-induced production of NO and the cytotoxicity, it is concluded that the presence of both O- 2 and NO is required for the cytotoxic activity of mCF, thereby indicating a possible role of peroxynitrite

Improving empathy of physicians through guided reflective writing

Objectives: This study was designed to explore how guided reflective writing could evoke empathy and reflection in a group of practicing physicians. Methods: Total participants recruited included 40 staff physicians at Cleveland Clinic, a tertiary care academic medical center. Twenty physicians (intervention group) were assigned to participate in a 6-session faculty development program introducing narrative medicine and engaging in guided reflective writing. Ten physicians (comparison group 1) received the assigned course reading materials but did not participate in the course sessions. Ten physicians (comparison group 2) neither received the reading materials nor participated in the sessions. Qualitative analysis of the physicians\u27 reflective writings was performed to identify major themes. The Jefferson Scale of Empathy was administered three times during the course. Results: Qualitative analysis of physicians\u27 writings showed themes of both compassionate solidarity and detached concern. Exploration of negative emotions occurred more frequently than positive ones. The most common writing style was case presentation. A total of 36 staff physicians completed the Jefferson Scale of Empathy. Results of statistical analysis suggested an improvement in empathy in the intervention group at the end of the course (p \u3c 0 .05). Conclusions: These results suggest a faculty development program using guided narrative writing can promote reflection and may enhance empathy among practicing physicians. These findings should encourage medical educators to design additional strategies for enhancing reflection and empathic behavior in trainees and specifically practicing physicians who can role model these behaviors to achieve the ultimate goal of improving the quality of patient care

Randomized study to compare efficacy of short stretch bandage systems from KOB with locally used Cotton Crepe Bandages in the treatment of lower limb lymphoedema

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Testing of a Tool for Prostate Cancer Screening Discussions in Primary Care

BackgroundAs prostate cancer (PCa) screening decisions often occur in outpatient primary care, a brief tool to help the PCa screening conversation in busy clinic settings is needed.MethodsA previously created 9-item tool to aid PCa screening discussions was tested in five diverse primary care clinics. Fifteen providers were recruited to use the tool for 4 weeks, and the tool was revised based upon feedback. The providers then used the tool with a convenience sample of patients during routine clinic visits. Pre- and post-visit surveys were administered to assess patients’ knowledge of the option to be screened for PCa and of specific factors to consider in the decision. McNemar’s and Stuart–Maxwell tests were used to compare pre-and post-survey responses.Results14 of 15 providers completed feedback surveys and had positive responses to the tool. All 15 providers then tested the tool on 95 men aged 40–69 at the five clinics with 2–10 patients each. The proportion of patients who strongly agreed that they had the option to choose to screen for PCa increased from 57 to 72% (p = 0.018) from the pre- to post-survey, that there are factors in the personal or family history that may affect PCa risk from 34 to 47% (p = 0.012), and that their opinions about possible side effects of treatment for PCa should be considered in the decision from 47 to 61% (p = 0.009).ConclusionA brief conversation tool for the PCa screening discussion was well received in busy primary-care settings and improved patients’ knowledge about the screening decision

Role of Blockchain Technology Integration for Green Bonds Issuance with Sustainability Aspect

Green bonds have gained significant attention in supporting sustainable development goals for achieving sustainability. During the issuance of green bonds, there are a few concerns such as standardization, greenwashing, and lack of benefits that can be gained with green bonds. However, blockchain technology is a promising solution for green bond issuance because it has already shown its impact on different finance activities. This study aims to address and analyze the role and significance of green bond issuance for meeting sustainability with blockchain technology and also suggested recommendations for future research. Decentralized application based on the Algorand blockchain and high-level architecture proposed for the issuance of green bonds is at the primary level. There is no discussion regarding standardizing the environmental data, and the number of benefits gained by the green bond is not addressed in the previously published literature. From the analysis, it has been identified that a similar framework of blockchain cannot be implemented as the geographical and environmental parameters are quite different for every nation. So, every nation needs to customize the framework according to the nation's requirements. This study is the first attempt to combine information from previously published research about green bond issuance and integration of blockchain for green bond issuance, enlightening the disruption caused in the issuance of green

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

A STUDY ON CLINICAL PROFILE AND OUTCOME OF VISUAL PARAMETERS OF OPTIC NEURITIS PATIENTS IN A TERTIARY EYE CARE CENTRE: A STUDY ON CLINICAL PROFILE AND OUTCOME OF VISUAL PARAMETERS OF OPTIC NEURITIS PATIENTS

Introduction: Optic neuritis is the inflammation of the optic nerve secondary to autoimmune, infectious or inflammatory conditions. Objective: to study the clinical profile and changes in visual parameters after treatment of patients with optic neuritis. Materials and Methods: This prospective interventional research was done at the Ophthalmology department of a tertiary eye care centre.36 cases diagnosed with optic neuritis have been analyzed, treated and followed up for a period of one year, for the type of clinical presentation, rate of recurrence and changes in visual parameters. Results: The prevalence rate was bimodal, more common among age groups between 46 -55 yrs as 32% and age group 16 -25 as 27%. Higher prevalence rate was seen in females in 63 % cases. Bilateral presentation was observed in 18 %. 44% cases presented as retrobulbar neuritis (RBN) whereas 56% as papillitis. At 1 year follow up Optic disc edema suggestive of papillitis was seen in 17% cases, normal disc with RBN in 44% and disc palor in 32% discs. At final follow-up after 1 year, 75% patients could read maximum (10/13) colour plates, 64% cases showed standard contrast sensitivity and 47% showed normal visual field .VA of 6/60 or worse at presentation was seen in 53% cases and less than 6/12 in (84%) cases which improved to better than 6/12 in 58% cases and better than 6/60 in 67% cases at final follow up at 1 year.  Commonest Visual Field abnormality at presentation was generalized field constriction in (34%), Central or centrocecal scotoma in (18%), hemianopia or quadrantanopia in (12%) and enlarged blind spot in (06%) cases. During the final follow-up at 1 year, 22 cases (61%) showed normal field .Visual Field could not be tested in (30 %) at presentation as vision was <3/60, although Visual evoked potential was abnormal in all of 36(100%) cases with mean P 100 latency being 128 ms.Furthermore, 3(8%) cases demonstrated additional neurological symptoms till the final follow-up and were subsequently identified to be multiple sclerosis (MS). Recurrence rate was 08(22%) within 1 year follow up, of which 06(17%) cases were clinically RBN and 02(05%) were papillitis. Conclusion: In our study, findings of clinical profile and visual outcomes of optic neuritis patients were different from that of western studies as well as from those done previously in the Indian population, notably lesser prevalence of Multiple sclerosis, although other differences were not very significant

ETIOLOGY AND CLINICAL SPECTRUM OF ANTERIOR UVEITIS IN A TERTIARY EYE CARE HOSPITAL FROM EASTERN INDIA: A PROSPECTIVE INTERVENTIONAL STUDY: ETIOLOGY AND CLINICAL SPECTRUM OF ANTERIOR UVEITIS IN A TERTIARY EYE CARE HOSPITAL FROM EASTERN INDIA

Objective: To study the etiology, clinical spectrum, management and outcome of anterior uveitis in a tertiary eye care centre in Eastern India and compare with the data of other published reports. Methods: This study was a prospective interventional clinical research  performed on all (new and old) anterior uveitis patients visiting our Ophthalmology OPD for treatment between  January 2020 to December 2022.Thorough history, clinical examination  and investigation procedures  were performed to diagnose the exact etiology and clinical characteristic of anterior uveitis.After treatment, cases were followed up for 6 months. Results: Total cases of uveitis seen were 286, out of which anterior uveitis was the most common category with 150 cases(52%) which constituted the study population. Male patients were 71% whereas female were 29%. 61 % of cases were in age group of 20 - 40 yrs.60% of cases were in acute, 27% in chronic, whereas 13% in recurrent anterior uveitis stage.It was unilateral in 74 % cases. 72 % of the cases were clinically non granulomatous type.  Idiopathic etiology was significantly seen in (62%) cases. For identifiable diseases,Infectious cause was (16%), non-infectious (12%) and traumatic cause (10%).Infections of which the chief cause were Tuberculosis (10%),  viral  (04%) , Leprosy (02%)  , while in the Non-infectious category of uveitis  spondyloarthropathy (08%), Lens induced uveitis (04%) were the most common etiology. Before treatment vision in 15% cases was 6/12 or better, which improved after treatment to 6/12 or better in 62% cases. 34% of the patients had no residual complications after treatment, whereas most common complication was persistent posterior synaechia in 23% and cataract in 16%  cases. Conclusion: Cause in majority of the cases of anterior uveitis remained idiopathic. However, prompt diagnosis appropriate and adequate treatment and follow up could restore good vision without significant symptoms, sequelae or ocular morbidity in majority of cases