A study of the outcome of pregnancy complicated by obstetric cholestasis

Background: Obstetric cholestasis is one of the most common causes of liver disease in pregnancy. Present study was carried out to study the incidence of Obstetric Cholestasis and its feto-maternal outcome in a tertiary care hospital.Methods: It is a prospective epidemiologycal study during a period of one year (2014 to 2015) over 100 pregnant ladies suffering from pruritus and detected as having Obstetric Cholestasis. They were followed up and maternal as well as fetal-neonatal outcome recorded. Appropriate statistical analysis done as applicable.Results: The incidence of Obstetric Cholestasis in our hospital was 9.9%. Majority of cases (43.0%) are diagnosed in late gestational age, mostly during 28 to 32 weeks period of gestation. Maternal morbidities are due to sleep disturbance (60/100), dyslipidemia, coagulation abnormality, PPH (10.0%) and increase chance of operative delivery (66.0%). Neonatal morbidities are mainly due to fetal distress, prematurity (22.0%), low birth weight (32/100) and meconium staining of amniotic fluid (42.0%). Maximum number of patients are delivered at 37 to 38 weeks, due to active and early intervention.Conclusions: Early diagnosis and active maternal and fetal surveillance is of utmost importance to avoid adverse outcomes

CDK11 Promotes Cytokine-Induced Apoptosis in Pancreatic Beta Cells Independently of Glucose Concentration and Is Regulated by Inflammation in the NOD Mouse Model

Background: Pancreatic islets are exposed to strong pro-apoptotic stimuli: inflammation and hyperglycemia, during the progression of the autoimmune diabetes (T1D). We found that the Cdk11(Cyclin Dependent Kinase 11) is downregulated by inflammation in the T1D prone NOD (non-obese diabetic) mouse model. The aim of this study is to determine the role of CDK11 in the pathogenesis of T1D and to assess the hierarchical relationship between CDK11 and Cyclin D3 in beta cell viability, since Cyclin D3, a natural ligand for CDK11, promotes beta cell viability and fitness in front of glucose. Methods: We studied T1D pathogenesis in NOD mice hemideficient for CDK11 (N-HTZ), and, in N-HTZ deficient for Cyclin D3 (K11HTZ-D3KO), in comparison to their respective controls (N-WT and K11WT-D3KO). Moreover, we exposed pancreatic islets to either pro-inflammatory cytokines in the presence of increasing glucose concentrations, or Thapsigargin, an Endoplasmic Reticulum (ER)-stress inducing agent, and assessed apoptotic events. The expression of key ER-stress markers (Chop, Atf4 and Bip) was also determined. Results: N-HTZ mice were significantly protected against T1D, and NS-HTZ pancreatic islets exhibited an impaired sensitivity to cytokine-induced apoptosis, regardless of glucose concentration. However, thapsigargin-induced apoptosis was not altered. Furthermore, CDK11 hemideficiency did not attenuate the exacerbation of T1D caused by Cyclin D3 deficiency. Conclusions: This study is the first to report that CDK11 is repressed in T1D as a protection mechanism against inflammation-induced apoptosis and suggests that CDK11 lies upstream Cyclin D3 signaling. We unveil the CDK11/Cyclin D3 tandem as a new potential intervention target in T1D

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Cyclin D3 and CDK11 partnership in pancreatic beta cell homeostasis in autoimmune diabetes. Studies on the NOD mouse model

Cyclin D3 and CDK11 are downregulated in pancreatic islet endocrine cells during the autoimmune attack progression in autoimmune-prone NOD (Non-obese diabetic) mouse strain. D-type cyclins are crucial in order to connect mitogenic signals with the Rb/E2F pathway, which regulates transcription of factors involved in further cell cycle progression. CDK11, protein-kinase PITSLRE, exhibits two gene products: p58 and p110 (p130 in mouse) in humans. CDK11p110 regulates transcription and RNA splicing. CDK11p110 is expressed in all cell cycle phases, while CDK11p58 is only expressed during mitosis (G2/M) and is essential in apoptosis. The interaction between CDK11p58 and cyclin D3 has been reported and it represses certain nuclear receptors action. This observation may suggest that in pancreatic beta cells simultaneous downregulation of cyclin D3 and CDK11 may obey to a coordinated regulation of both molecules. In this thesis we have studied whether there is a causal relationship between coordinated cyclin D3 and CDK11 downregulation and type 1 diabetes in vivo and in vitro.The outcome of our research will allow us to establish whether cyclin D3 and CDK11 are molecular targets in type1 diabetesLa ciclina D3 i CDK11 estan regulades a la baixa en les cèl•lules endocrines de l'illot pancreàtic durant la progressió atac autoimmune en la soca de ratolins NOD propensos a la diabetis autoimmune. Les ciclines de tipus D són crucials per connectar senyals mitogèniques amb la via Rb/E2F , que regula la transcripció de factors implicats en la progressió del cicle cel • lular . El gen que codifica per a la CDK11 , proteïna-quinasa PITSLRE, té dos productes gènics en humans: p58 i p110 ( p130 al ratolí ). LaCDK11p110 regula la transcripció i processament del 'ARN. La CDK11p110 s'expressa en totes les fases del cicle cel•lular , mentre que la CDK11p58 només s'expressa durant la mitosi (G2 / M) i participa en processos apoptòtics . La interacció entre CDK11p58 i ciclina D3 reprimeix certa acció d'alguns receptors nuclears, per exemple afecta negativament l'activitat transcripcional del receptor d'andrògens . Aquesta observació pot suggerir que en les cèl•lules beta del pàncrees la regulació a la baixa simultània de ciclina D3 i CDK11 pot obeir a una regulació coordinada de les dues molècules . En aquesta tesi s'ha estudiat si hi ha una relació causal entre la regulació a la baixa coordinada de ciclina D3 i CDK11 i l'aparició de la diabetis tipus 1 , in vivo i in vitro .El resultat de la nostra recerca ens permetrà establir si la ciclina D3 i la CDK11 podran ser blancs moleculars en la diabetis tipus 1.Ciclina D3 y CDK11 están regulados a la baja en las células endocrinas del islote pancreático durante la progresión ataque autoinmune en la cepa de ratones NOD predispuesta genéticamente a la autoinmunidad. Los ciclinas de tipo D son cruciales para conectar las señales mitogénicas con la vía Rb/E2F, la cual regula la transcripción de factores implicados en la progresión del ciclo celular. El gen que codifica para la CDK11, la proteína-quinasa PITSLRE, tiene dos productos génicos en humanos: p58 y p110 ( p130 en el ratón). CDK11p110 regula la transcripción y procesameinto del ARN. CDK11p110 se expresa en todas las fases del ciclo celular, mientras que CDK11p58 sólo se expresa durante la mitosis (G2 / M) y está implicada en procesos apoptóticos. La interacción entre CDK11p58 y ciclina D3 reprime cierta acción de algunos receptores nucleare, por ejemplo, afecta negativamente a la actividad transcripcional del receptor de andrógenos. Esta observación puede sugerir que en las células beta del páncreas la regulación a la baja simultánea de ciclina D3 y CDK11 puede obedecer a una regulación coordinada de ambas moléculas. En esta tesis se ha estudiado in vivo e in vitro si existe una relación causal entre la regulación a la baja coordinada de ciclina D3 y CDK11 y la aparición de la diabetes tipo 1.El resultado de nuestra investigación nos permitirá establecer ciclina D3 y CDK11 como blancos moleculares en la diabetes tipo 1

A study of the outcome of pregnancy complicated by obstetric cholestasis

Background: Obstetric cholestasis is one of the most common causes of liver disease in pregnancy. Present study was carried out to study the incidence of Obstetric Cholestasis and its feto-maternal outcome in a tertiary care hospital.Methods: It is a prospective epidemiologycal study during a period of one year (2014 to 2015) over 100 pregnant ladies suffering from pruritus and detected as having Obstetric Cholestasis. They were followed up and maternal as well as fetal-neonatal outcome recorded. Appropriate statistical analysis done as applicable.Results: The incidence of Obstetric Cholestasis in our hospital was 9.9%. Majority of cases (43.0%) are diagnosed in late gestational age, mostly during 28 to 32 weeks period of gestation. Maternal morbidities are due to sleep disturbance (60/100), dyslipidemia, coagulation abnormality, PPH (10.0%) and increase chance of operative delivery (66.0%). Neonatal morbidities are mainly due to fetal distress, prematurity (22.0%), low birth weight (32/100) and meconium staining of amniotic fluid (42.0%). Maximum number of patients are delivered at 37 to 38 weeks, due to active and early intervention.Conclusions: Early diagnosis and active maternal and fetal surveillance is of utmost importance to avoid adverse outcomes