A study of the effect of pre-radiation on healing of surgical wounds in the treatment of cancers of the head and neck

Background: Radiation therapy is an established modality in the treatment of head and neck cancer patients. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to affect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. Compromised wound healing in irradiated tissues is a common and challenging clinical problem.Methods: A prospective observational study was done in a tertiary care teaching institute, Kolkata. The effect of radiation on surgery of cancers of head and neck was studied in 50 patients. The patients were divided into 2 groups of 25 each. The cases in the first group were irradiated prior to surgery and those on the second group were operated upon without any pre-radiation.Results: The highest incidence of wound complications in those patients who were operated upon within 2 weeks to 6 months of completion of RT (83.33%). Patients who had their blood Hb level at or above 11 gm% developed less number of wound complications (34.78%) as compared to those who had their blood Hb level between 8-11 gm% where complication rate was 48.15%. Those patients who had their oral cavity or pharynx opened during surgery had a much higher incidence of wound complications (54.54%) than whose oral cavity or pharynx were not interfered with (17.64%). Wound infection was 36% in the irradiated group and 12% in the non-irradiated group. Separation of wound edges or skin necrosis followed in 28% cases in the pre-radiated group and in 8% cases in the non-pre-radiated group.Conclusions: Radiotherapy is an integral modality of head and neck cancer therapy. Compromised wound healing is an important side effect of radiation therapy. All sorts of local complications as wound infection and necrosis, or ocutaneous fistulae, carotid artery perforation etc. are more pronounced in patients, who received prior radiotherapy. The complication of surgery after radiotherapy was found to be more pronounced between 2 weeks to 6 months in this series

Practices regarding prescription and dispensing of drugs in a tertiary care hospital in rural West Bengal, India

Background: Irrational prescription practices are a distressing global problem, especially in the developing countries. A study was conducted to assess the patterns of prescribing and dispensing drugs in a tertiary healthcare centre serving a large rural population in the eastern India.Methods: A cross-sectional observational study was conducted from July-September 2016 in the general out-patient department and the institution pharmacy of a tertiary care hospital of West Bengal, India. Data were congregated by collection and review of individual prescriptions, measuring the time of interaction between patients and prescribers/dispensers, and conducting patient interviews at exit.Results: Analysis of the collected and tabulated data revealed that after average, 2.5 medicines were prescribed per prescription, with 95.26% being under their generic name. Of the drugs prescribed, 95.79% were from the essential drug list. The average consultation time was 150.0s (SD 62.3s) and average dispensing time was 81.5s (SD 51.2s). Of the drugs prescribed, 86.12% of drugs were actually dispensed from the institution pharmacy but none of the drugs were labeled. The percentage of prescriptions with an antibiotic was 47.83%, while injections were recorded on in 2.83% of the prescriptions. Percentage of patients who had knowledge of the dosage of the drugs prescribed to them was 91.67%.Conclusions: While the study found high percentages of drugs prescribed under generic names high percentage of drugs actually prescribed from the Institution Pharmacy, prescription of drugs from the Essential Drugs List, and a low number of injections per prescription conforming to WHO set standards, it also found a lack of drug labelling, high percentage of prescription of antibiotics to be indicators that do not conform with the WHO set international standards

Financial Services for Young People: Prospects and Challenges

Released in 2015, this report reviews early insights and learning based on The MasterCard Foundation's youth financial services projects. This paper, which was prepared with The Boston Consulting Group, reviews four major areas of inquiry to provide emerging evidence that will help inform the future of financial inclusion for young people: exploring how to better understand youth populations through customer segmentation; studying the preliminary evidence of the impact financial services can have on young people's lives; understanding whether a business case exists for delivering traditional financial savings services to young people; and identifying the challenges involved in providing effective financial education

Centrosymmetric-noncentrosymmetric Structural Phase Transition in Quasi one-dimensional compound, (TaSe4_4)3_3I

(TaSe$_4$)$_3$I, a compound belonging to the family of quasi-one-dimensional transition-metal tetrachalcogenides, has drawn significant attention due to a recent report on possible coexistence of two antagonistic phenomena, superconductivity and magnetism below 2.5~K (Bera et. al, arXiv:2111.14525). Here, we report a structural phase transition of the trimerized phase at temperature, $T~\simeq$~145~K using Raman scattering, specific heat, and electrical transport measurements. The temperature-dependent single-crystal X-ray diffraction experiments establish the phase transition from a high-temperature centrosymmetric to a low-temperature non-centrosymmetric structure, belonging to the same tetragonal crystal family. The first-principle calculation finds the aforementioned inversion symmetry-breaking structural transition to be driven by the hybridization energy gain due to the off-centric movement of the Ta atoms, which wins over the elastic energy loss.Comment: 11 pages, 5 figures, Under review as a regular articl

Comparative analysis of chromatin landscape in regulatory regions of human housekeeping and tissue specific genes

BACKGROUND: Global regulatory mechanisms involving chromatin assembly and remodelling in the promoter regions of genes is implicated in eukaryotic transcription control especially for genes subjected to spatial and temporal regulation. The potential to utilise global regulatory mechanisms for controlling gene expression might depend upon the architecture of the chromatin in and around the gene. In-silico analysis can yield important insights into this aspect, facilitating comparison of two or more classes of genes comprising of a large number of genes within each group. RESULTS: In the present study, we carried out a comparative analysis of chromatin characteristics in terms of the scaffold/matrix attachment regions, nucleosome formation potential and the occurrence of repetitive sequences, in the upstream regulatory regions of housekeeping and tissue specific genes. Our data show that putative scaffold/matrix attachment regions are more abundant and nucleosome formation potential is higher in the 5' regions of tissue specific genes as compared to the housekeeping genes. CONCLUSION: The differences in the chromatin features between the two groups of genes indicate the involvement of chromatin organisation in the control of gene expression. The presence of global regulatory mechanisms mediated through chromatin organisation can decrease the burden of invoking gene specific regulators for maintenance of the active/silenced state of gene expression. This could partially explain the lower number of genes estimated in the human genome

Evaluation of the effect of Cooled HaEmodialysis on Cognitive function in patients suffering with end-stage KidnEy Disease (E-CHECKED): feasibility randomised control trial protocol

BACKGROUND: Cognitive impairment is common in haemodialysis (HD) patients and is associated independently with depression and mortality. This association is poorly understood, and no intervention is proven to slow cognitive decline. There is evidence that cooler dialysis fluid (dialysate) may slow white matter changes in the brain, but no study has investigated the effect of cooler dialysate on cognition. This study addresses whether cooler dialysate can prevent the decline in cognition and improve quality of life (QOL) in HD patients. METHODS: This is a multi-site prospective randomised, double-blinded feasibility trial. SETTING: Four HD units in the UK. PARTICIPANTS AND INTERVENTIONS: Ninety HD patients randomised (1:1) to standard care (dialysate temperature 36.5 °C) or intervention (dialysate temperature 35 °C) for 12 months. PRIMARY OUTCOME MEASURE: Change in cognition using the Montreal Cognitive Assessment (MoCA). SECONDARY OUTCOME MEASURES: Recruitment and attrition rates, reasons for non-recruitment, frequency of intradialytic hypotension, depressive symptom scores, patient and carers burden, a detailed computerised cognitive test and QOL assessments. ANALYSIS: mixed method approach, utilising measurement of cognition, questionnaires, physiological measurements and semi-structured interviews. DISCUSSION: The results of this feasibility trial will inform the design of a future adequately powered substantive trial investigating the effect of dialysate cooling on prevention and/or slowing in cognitive decline in patients undergoing haemodialysis using a computerised battery of neuro-cognitive tests. The main hypothesis that would be tested in this future trial is that patients treated with regular conventional haemodialysis will have a lesser decline in cognitive function and a better quality of life over 1 year by using cooler dialysis fluid at 35 °C, versus a standard dialysis fluid temperature of 36.5 °C. This also should reflect in improvements in their abilities for activities of daily living and therefore reduce carers' burden. If successful, the treatment could be universally applied at no extra cost. TRIAL REGISTRATION: ClinicalTrials.gov NCT03645733 . Registered retrospectively on 24 August 2018

Nursing Personnel Planning for Rural Hospitals in Burdwan District, West Bengal, India, Using Workload Indicators of Staffing Needs

Lack of appropriate human resources planning is an important factor in the inefficient use of the public health facilities. Workforce projections can be improved by using objective methods of staffing needs based on the workload and actual work undertaken by workers, a guideline developed by Peter J. Shipp in collaboration with WHO\u2014Workload Indicators of Staffing Need (WISN). A cross-sectional study was carried out to estimate the nursing stuff requirement for the rural hospitals and provide a quantitative description of imbalances, if there is any, in the allocation at the district level during 2011. The average WISN turns out to be 0.35 for entire district, which means only 35% of the required nurses is available or 65% understaffed. So, there is an urgent need for more allocations and deployment of staff so that workload can be tackled and evenly distributed among all nursing personnel

A small insulinomimetic molecule also improves insulin sensitivity in diabetic mice

Dramatic increase of diabetes over the globe is in tandem with the increase in insulin requirement. This is because destruction and dysfunction of pancreatic β-cells are of common occurrence in both Type1 diabetes and Type2 diabetes, and insulin injection becomes a compulsion. Because of several problems associated with insulin injection, orally active insulin mimetic compounds would be ideal substitute. Here we report a small molecule, a peroxyvanadate compound i.e. DmpzH[VO(O2)2(dmpz)], henceforth referred as dmp, which specifically binds to insulin receptor with considerable affinity (KD-1.17μM) thus activating insulin receptor tyrosine kinase and its downstream signaling molecules resulting increased uptake of [14C] 2 Deoxy-glucose. Oral administration of dmp to streptozotocin treated BALB/c mice lowers blood glucose level and markedly stimulates glucose and fatty acid uptake by skeletal muscle and adipose tissue respectively. In db/db mice, it greatly improves insulin sensitivity through excess expression of PPARγ and its target genes i.e. adiponectin, CD36 and aP2. Study on the underlying mechanism demonstrated that excess expression of Wnt3a decreased PPARγ whereas dmp suppression of Wnt3a gene increased PPARγ expression which subsequently augmented adiponectin. Increased production of adiponectin in db/db mice due to dmp effected lowering of circulatory TG and FFA levels, activates AMPK in skeletal muscle and this stimulates mitochondrial biogenesis and bioenergetics. Decrease of lipid load along with increased mitochondrial activity greatly improves energy homeostasis which has been found to be correlated with the increased insulin sensitivity. The results obtained with dmp, therefore, strongly indicate that dmp could be a potential candidate for insulin replacement therapy

Carlinoside reduces hepatic bilirubin accumulation by stimulating bilirubin-UGT activity through Nrf2 gene expression

Accu mulati on of biliru bin, prima rily because of its insol ubilit y, has bee n found to be associa ted with liver disea ses includ ing jaundice . Free bilir ubin is insol uble; its glucuro nidation by bilirubin -UGT enz yme (UGT1 A1) makes it soluble and elimina tes it throu gh urine and fae ces. Taki ng CCl 4 induced ra t liver dysfun ction m odel, we demonst rated that supp ression of UGT1A 1 activity in ra t liv er increa sed ser um biliru bin level wh ich could be reve rsed by carl inoside (Cln), a flavone glyc oside. Alth ough Cln is a flavone compou nd, it escaped self-glucu ronid ation in the intestin e and readily absorbe d. Kineti c stud y of mic rosoma l UGT1A 1 from HepG 2 cells sugg ested that Cln enhan ced enz yme activity by increa sing V max with out alterin g K m. This altered V max was foun d to be due to UGT1A 1 ove rexpre ssion by Cln wh ich wa s obser ved in both HepG 2 and rat prima ry hepa tocytes . Sin ce Nrf2 is the transc ription factor of UG T1A1, we exam ined whethe r Cln effe ct on UG T1A1 overexp ression is media ted th rough Nrf2. In Nrf2 knock -out cells, Cln cou ld not eleva te UG T1A1 activity indica ting Nrf2 to be its target. Cln signific antly increas ed Nrf2 ge ne expr ession in HepG2 cells wh ich was subse quently locali zed in nuclear region . Resu lts from Ch IP assa y show ed that Cln mar kedly augm ented Nrf2 bindi ng to UGT1A 1 prom oter that con sequentl y enhan ced report er act ivity. Our findings therefor e show that Cln upreg ulated Nr f2 gene expr ession, incr eased its nu clear tran slocation and stimula ted UGT1A 1 prom oter act ivity. Tota l outc ome of these even ts brought about a signific ant increase of biliru bin glucur onida tion. Cln ther efore could be a wor thy choice to int ervene hype rbilir ubinemi a due to liv er dysfunc tion