Peripheral Neuropathy and Foot Care Practices Among Patients with Diabetes Mellitus Attending a Tertiary Care Hospital: A Cross-sectional Study

Introduction: Peripheral neuropathy is the most common microvascular complication of diabetes mellitus. Foot care is an important part of diabetes management. This study aimed to identify the prevalence of peripheral neuropathy and foot care practices among diabetic patients. Methods: A descriptive cross-sectional study was conducted on 178 patients diagnosed with diabetes mellitus and attending out-patient and in-patient departments of Internal Medicine at Kathmandu University Hospital, Dhulikhel. The participants were conveniently selected. Face-to-face interviews and a foot examination were used to collect data. The Michigan Neuropathy Screening Instrument and the Nottingham Assessment of Functional Foot Care were used to determine the prevalence of peripheral neuropathy and to assess foot care practices. Results: The prevalence of peripheral neuropathy was 41% among the participants, and it was associated with increasing age. The majority (75.8%) of the participants had good foot care practices. Male gender was significantly associated with good foot care practices [AOR = 5.973, 95% CI (2.037-17.515)], whereas past smokers [AOR = 0.296, 95% CI (0.111-0.791)] and not receiving diabetes education [AOR = 0.367, 95% CI (0.151-0.892)] were significantly associated with poor foot care practices. Conclusion: The prevalence of peripheral neuropathy was found to be high, and it was linked to an increased age group. The majority of the participants had good foot care practices. However, in comparison, females were found less likely to practice foot care than males

A rare case report of haemolytic uremic syndrome in post caesarean section

Haemolytic uremic syndrome (HUS) is a clinical syndrome characterised by progressive kidney failure associated with microangiopathic haemolytic anemia and thrombocytopenia. Women may be genetically predisposed to develop HUS which gets aggravated by pregnancy. We presented a case of 25 year old G2p1l1 with h/o 9 months amenorrhoea was admitted in active labour, underwent emergency caesarean section for non-progression of labour. Postoperatively patient had decreased urine output with unexplained thrombocytopenia with deranged renal function tests and increased serum LDH with normal coagulation profile and no any evidence of foci of infection for which HUS was suspected. Patient was treated with hemodialysis, plasmapheresis and other supportive medical treatment

Acute pancreatitis and severe hyperbilirubinemia as initial presentation of Gilbert syndrome

Gilbert syndrome (GS) is benign, often familial condition characterized by recurrent but asymptomatic mild unconjugated hyperbilirubinemia in the absence of hemolysis or underlying liver disease. The coexistence of GS with other more clinically significant conditions could interfere with their diagnoses. The genetic variation described as GS may affect drug glucuronidation and could potentially precipitate. Gallstones are the commonest ailment affecting the hepato-biliary system. Associated jaundice is usually direct, commonly due to biliary obstructive lesions. Unconjugated hyperbilirubinemia with cholelithiasis is commonly seen with hemolytic disease. In the absence of hemolysis or systemic causes, congenital causes prevail, commonest of which is Gilbert’ Syndrome. Here we report a case of 21-year old male who presented to our hospital with complaint of pain abdomen and was diagnosed as gall stone induced pancreatitis which was further diagnosed as GS after genetic testing for UGT1A1 gene polymorphism

Bio-Guided Fractionation of Papaya Leaf Juice for Delineating the Components Responsible for the Selective Anti-proliferative Effects on Prostate Cancer Cells

Alternative therapies against cancer cells with minimal or no effect on healthy tissues are highly sought after. Prostate cancer (PCa) is the second most frequently diagnosed malignancy in males. The Carica papaya L. leaf extract has been traditionally used by Australian aboriginal people for anticancer properties. In this study, medium polar fraction of papaya leaf extract that had shown anti-proliferative activity in PCa cell lines in vitro, in earlier studies, was further fractionated to 28 fractions by semi-preparative HPLC. Nine of these fractions were identified to possess selective anti-proliferative responses on PCa cells in comparison to non-cancerous cells of prostate gland origin. When these nine sub-fractions were mixed in various combinations, a combination containing six of the specific fractions (FC-3) showed the best potency. FC3 inhibited the growth of BPH-1, PC-3, and LNCaP cells in a concentration-dependent manner with an IC50 value <20 μg/mL, while (unlike paclitaxel, the positive control) minimal effect was observed on the proliferation of non-cancerous, WPMY-1 and RWPE-1cells. Furthermore, synergistic interaction of FC-3 with paclitaxel was observed with combination index values in the range of 0.89–0.98 and 0.85–1.10 on PC-3 and LNCaP cells, respectively. Untargeted qualitative analysis using UHPLC (Ultra High-Performance Liquid Chromatography)-QToF (Quadrupole Time of-Flight) mass spectrometry and screening against the METLIN database indicated presence of multiple known anticancer compounds in the FC-3 extract. These outcomes show that the potent and selective anti-proliferative effects are due to a range of bio-active compounds within the medium polar fraction of papaya leaf juice

The Case for Community Self-Governance on Access and Benefit Sharing of Digital Sequence Information

Digital sequence information (DSI),  a placeholder term commonly understood to refer to information related to genetic sequences stored in a digital format, has become a foundational component to biological research and its applications, including biodiversity conservation and biotechnological innovation. DSI results from the physical access to and use of genetic resources, which falls under the purview of the Convention on Biological Diversity (CBD) and the Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization (NP). The CBD and the NP are legal frameworks governing access to genetic resources and the fair and equitable sharing of benefits arising from their use, a mechanism widely known as access and benefit sharing (ABS). Despite good intentions, a number of national regimes adopted in pursuance of the CBD and NP have created complex, ineffective frameworks that exacerbate the risk of counterproductive effects for biodiversity conservation and sustainable use. The debate on DSI focuses on what DSI includes, whether it is covered by the CBD or the NP and the possible implications of its inclusion or exclusion from these agreements. The CBD and NP parties agreed on a science- and policy-based process to debate the treatment of DSI. This process entailed the submission of views and information by parties, other governments, indigenous and local communities, and relevant organizations and stakeholders; the commissioning of technical studies; and the establishment of the Ad Hoc Technical Expert Group (AHTEG) on DSI. In the present article, we propose recommendations that can contribute to the upcoming discussion on DSI.Fil: Adler Miserendino, Rebecca A. Lewis Burke Associates; Estados UnidosFil: Meyer, Rachel Sarah. University of California; Estados UnidosFil: Zimkus, Breda M. Harvard University; Estados UnidosFil: Bates, John. Field Museum of National History; Estados UnidosFil: Silvestri, Luciana Carla. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Ciencias Humanas, Sociales y Ambientales; ArgentinaFil: Taylor, Crispin. American Society Of Plant Biologists ; Estados UnidosFil: Blumenfield, Tami. University of New Mexico; Estados Unidos. Yunnan University; ChinaFil: Srigyan, Megha. University of California; Estados UnidosFil: Pandey, Jyotsna L. American Institute Of Biological Sciences; Estados Unido

Comparison of the Success of Two Techniques for the Endotracheal Intubation with C-MAC Video Laryngoscope Miller Blade in Children: A Prospective Randomized Study

Background. Ease of endotracheal intubation with C-MAC video laryngoscope (VLS) with Miller blades 0 and 1 has not been evaluated in children. Methods. Sixty children weighing 3-15 kg with normal airway were randomly divided into two groups. Intubation was done with C-MAC VLS Miller blade using either nonstyletted endotracheal tube (ETT) (group WS) or styletted ETT (group S). The time for intubation and total procedure, intubation attempts, failed intubation, blade repositioning or external laryngeal maneuver, and complications were recorded. Results. The median (minimum/maximum) time for intubation in group WS and group S was 19.5 (9/48) seconds and 13.0 (18/55) seconds, respectively ( = 0.03). The median (minimum/maximum) time for procedure in group WS was 30.5 (18/72) seconds and in group S was 24.5 (14/67) seconds, respectively ( = 0.02). Intubation in first attempt was done in 28 children in group WS and in 30 children in group S. Repositioning was required in 14 children in group WS and in 7 children in group S ( = 0.06). There were no failure to intubate, desaturation, and bradycardia in both groups. Conclusion. Styletted ETT significantly reduces time for intubation and time for procedure in comparison to nonstyletted ETT

Comparison of the Success of Two Techniques for the Endotracheal Intubation with C-MAC Video Laryngoscope Miller Blade in Children: A Prospective Randomized Study

Background. Ease of endotracheal intubation with C-MAC video laryngoscope (VLS) with Miller blades 0 and 1 has not been evaluated in children. Methods. Sixty children weighing 3–15 kg with normal airway were randomly divided into two groups. Intubation was done with C-MAC VLS Miller blade using either nonstyletted endotracheal tube (ETT) (group WS) or styletted ETT (group S). The time for intubation and total procedure, intubation attempts, failed intubation, blade repositioning or external laryngeal maneuver, and complications were recorded. Results. The median (minimum/maximum) time for intubation in group WS and group S was 19.5 (9/48) seconds and 13.0 (18/55) seconds, respectively (p=0.03). The median (minimum/maximum) time for procedure in group WS was 30.5 (18/72) seconds and in group S was 24.5 (14/67) seconds, respectively (p=0.02). Intubation in first attempt was done in 28 children in group WS and in 30 children in group S. Repositioning was required in 14 children in group WS and in 7 children in group S (p=0.06). There were no failure to intubate, desaturation, and bradycardia in both groups. Conclusion. Styletted ETT significantly reduces time for intubation and time for procedure in comparison to nonstyletted ETT

Forward Thinking and Adaptability to Sustain and Advance IPECP in Healthcare Transformation Following the COVID-19 Pandemic

The proliferation of the novel SARS-CoV-2 (COVID-19) virus across the globe in 2020 produced a shared trauma internationally of unprecedented devastation, disruption, and death. At the same time, the pandemic has been a transformation catalyst accelerating the implementation and adoption of long overdue changes in healthcare education and practice, including telehealth and virtual learning. The COVID-19 pandemic has placed healthcare at a crossroads, either viewing it as a temporary situation that requires short-term solutions, or as a major disruption that presents opportunities for innovation for sustainable development and transformation. As COVID-19 transitions from pandemic to endemic, we have a unique opportunity to leverage lessons learned that can foster healthcare transformation through innovation, forward thinking, and interprofessional education and collaborative practice (IPECP). With the changing landscape of higher education and healthcare, IPECP leaders need to reflect on and implement ‘Forward Thinking and Adaptability’ and ‘Sustainability and Growth’ in their IPECP approaches and strategies to achieve the Quintuple Aim. To capitalize on this opportunity and based on a recent publication by InterprofessionalResearch Global, this paper explores and debates (from a global perspective) the impact and application of healthcare education and practice transformation on IPECP with the goal to identify best practices in integrating and sustaining IPECP and building a resilient workforce

Interprofessional Education and Collaborative Practice (IPECP) in Post-COVID Healthcare Education and Practice Transformation Era – Discussion Paper. Joint Publication by InterprofessionalResearch.Global, American Interprofessional Health Collaborative & Canadian Interprofessional Health Collaborative

In the past two years the world has experienced unprecedented devastation, disruption, and death due to the COVID-19 global Pandemic. At the same time, the Pandemic acts as a transformation catalyst that accelerated the implementation and adoption of long overdue changes in healthcare education and practice, including telehealth and virtual learning.Interprofessional collaboration during the pandemic was able to foster healthcare transformation in several ways at the policy and legislative level, such as the fast-tracking of internationally trained professions. The role and use of digital technologies in healthcare education and practice have been extended and solidified by the pandemic. Macro-level policies acknowledging the importance ofpopulation health are key for future interprofessional collaboration of stakeholders to address inequalities. Similarly, interprofessional collaboration is key to addressing the proliferation of misinformation. Interprofessional education and collaborative practice (IPECP) can be effectively utilized to combat misinformation by increasing health literacy amongst health professions and the communities they serve.Despite IPECP being an integral component of promoting patient safety, and holistic, quality care, silos continue to exist. Furthermore, implementation of the Quintuple Aim (better health, better care, better value, better work experience, and better health equity), particularly through the lens of equity, remains elusive. Going forward, the integration and sustainability of IPECP are crucial and the experience of IPECP within the context of the COVID-19 pandemic should be reflected on, researched, and evaluated to inform future global healthcare systems and the workforce to provide and achieve the Quintuple Aim; the goal ofall in healthcare.As we are emerging out of the Pandemic, we have a unique opportunity to leverage on the lessons learned from the pandemic in fostering the healthcare transformation through innovation and IPECP. To capitalize on this opportunity and in a collaborative effort, the InterprofessionalResearch.Global (IPR.Global), the American Interprofessional Health Collaborative (AIHC), and the CanadianInterprofessional Health Collaborative (CIHC) have developed this e-book as a Discussion Paper to explore and discuss (from a global perspective) the impact and application of healthcare education and practice transformation on IPECP as we emerge from the COVID Pandemic with the goal to identify best practicesto integrate and sustain IPECP. We call the interprofessional educators, practitioners, leaders, scholars, and policy makers to utilize ‘Forward Thinking and Adaptability’ and ‘Sustainability and Growth’ in their IPECP approaches and strategies, to achieve Quintuple Aim. As learned during the Pandemic, working together – across professions, institutions, nationally, and globally – is essential in emerging stronger and in transforming our healthcare education and practice

Enzymatic Depilation of Animal Hide: Identification of Elastase (LasB) from Pseudomonas aeruginosa MCM B-327 as a Depilating Protease

Conventional leather processing involving depilation of animal hide by lime and sulphide treatment generates considerable amounts of chemical waste causing severe environmental pollution. Enzymatic depilation is an environmentally friendly process and has been considered to be a viable alternative to the chemical depilation process. We isolated an extracellular protease from Pseudomonas aeruginosa strain MCM B-327 with high depilation activity using buffalo hide as a substrate. This 33 kDa protease generated a peptide mass fingerprint and de novo sequence that matched perfectly with LasB (elastase), of Pseudomonas aeruginosa. In support of this data a lasB mutant of MCM B-327 strain lacked depilatory activity and failed to produce LasB. LasB heterologously over-produced and purified from Escherichia coli also exhibited high depilating activity. Moreover, reintroduction of the lasB gene to the P. aeruginosa lasB mutant via a knock-in strategy also successfully restored depilation activity thus confirming the role of LasB as the depilating enzyme