Risk of Post-ERCP Pancreatitis in Liver Transplant Patients: Single Center Experience

Introduction: Acute pancreatitis remains the most common severe complication of endoscopic retrograde cholangiopancreatography (ERCP). The exact cause of post-ERCP pancreatitis (PEP) is unclear. Regardless of the mechanism that initiates PEP, the pathways of inflammation are similar to other forms of acute pancreatitis and include the activation of various inflammatory cytokines, released from the acinar cells and subsequently from helper T lymphocytes and macrophages. Liver transplants (LTx) patients on immunosuppressive medications have impaired T-cell response and hence decreased ability to generate these cytokines. The aim of this study was to review incidence rates and risk factors of PEP in this LTx subset of patient population compared to non transplant (non-LTx) patients. Methods: Retrospective review of liver transplant database from January 2005 to September 2015 was performed. Liver transplant patients who underwent ERCP in the post-transplant period as part of their usual management were included in the study and compared with non-LTX patients who underwent ERCP. The study was approved by IRB. Electronic medical records were reviewed for any mention of pancreatic-type pain and pancreatic enzyme testing, if any after the ERCP. Diagnosis of Post-ERCP pancreatitis was made on the basis of both clinical and laboratory results as per standard definitions of PEP. Results: During this period, 109 LTx patients underwent 235 ERCP procedures. The data was compared with 348 non-transplant patients (not on any immunosuppression) who underwent total of 536 ERCP procedures. PEP developed in 24 (4.47%) cases in the non-LTx group as compared to 4 (1.7%) cases in the LTx group (p = 0.061, OR 2.70). History of LTx showed trend towards decrease in risk of PEP on univariate analysis (OR 0.36, p = 0.068, 95% CI = 0.12 - 1.07). However, on multivariate analysis only female gender (OR 2.35, P \u3c 0.038, CI 1.04 - 5.28), history of PEP (OR 5.77, P \u3c 0.001, CI 2.01 - 16.55) and pancreatic duct contrast injection (OR 6.20, P \u3c 0.001 CI 2.75 - 13.97) were significantly associated with risk of PEP. Also the severity of pancreatitis was mild in all 4 LTx patients as compared to 21 out of 24 patients (87%) with mild PEP in the non-LTx group (pConclusion:The risk of PEP in liver transplant patients on immunosuppression appears lower than the historical risk. Inhibition of the inflammatory transcriptional factors such as NF-kB and NFAT by the calcineurin inhibitors may be a potential explanation. Further studies are needed targeting calcineurin activation as a therapeutic approach in prevention of PEP

Study of drug utilization in intensive care management of neonates at tertiary care hospital

Background: Newborn infants form a highly vulnerable group. Compared to adults they are more prone to adverse drug events. Exposure to multiple drugs is also known to be a leading factor in their well-being. Many advances have been made in this area, yet there is a paucity of information to guide rational prescribing in newborns. This study was conducted to evaluate the drug prescribing trends in a Neonatal Intensive Care Unit (NICU) of a tertiary care hospital in Bidar.Methods: A prospective study was undertaken, over a period of 3 months at the government teaching hospital, Bidar. Neonates of either sex admitted to NICU were included. Data collection was done by scrutinizing the inpatient case sheets and investigation reports.Results: A total of 100 neonates were admitted and 11 deaths were noted. Most common cause for admission was septicaemia. The total number of drugs prescribed was 488. The average number of drugs per prescription was 4.9. Antimicrobials were the commonest agents prescribed and intravenous route was the commonest route of drug administration. Most of the drugs were prescribed by generic names.Conclusions: In our study it was observed that polypharmacy is commonly observed practice in NICU patients. Most of the antibiotics were prescribed empirically. The dose and frequency of administration was mostly as per the standard guidelines

Neurotoxicity of fluoride in ethanol fed rats: Role of oxidative stress, mitochondrial dysfunction and neurotransmitters

14-22Prolonged exposure to fluoride or alcohol affects brain. However, the understanding about their interactions and neurotoxicity following co-exposures is still poor. The present study was designed to assess oxidative stress, mitochondrial dysfunctions, acetylchonlineterase (AChE) activity, neurotransmitter levels and morphological alterations in brain of fluoride or/and ethanol fed rats. Six and eighteen month old animals received sodium fluoride (NaF, 25 mg/kg) and 30% ethanol (EtOH, 1 mL/kg) individually and in combination for 90 days. Brain showed elevation in oxidative stress with age and NaF/EtOH treatment. There was increased lipid peroxidation; decreased glutathione, total and protein thiol content; along with declined activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and glutathione-S-transferase under these conditions. Mitochondrial functions were impaired significantly with age and NaF/EtOH treatment. The activities of NADH dehydrogenase, succinate dehydrogenase and cytochrome c oxidase along with mitochondrial respiration rate were decreased whereas the levels of nitric oxide and citrulline were increased in treated animals. Administration of NaF/EtOH showed altered neurotransmitter levels and increased AChE activity in brain. The levels of dopamine and 5-hydroxytryptamine were decreased while 5-hydroxyindoleacetic acid and homovanillic acid were increased significantly. Histological examination showed morphological alterations in treated animals compared to controls. Interestingly, the observed effects were more pronounced in rats co-exposed to NaF and EtOH. It is concluded that neurotoxic effects of fluoride are age dependent and further amplified by alcohol co-administration. These effects are mediated through elevated oxidative stress, mitochondrial dysfunctions and impaired neurotransmitter functions

Synthesis, Spectral Studies and Antimicrobial Activity of imidazo[2,1-b][1,3,4]thiadiazole derivatives

Thiadiazole is a heterocyclic compound containg both two nitrogen atom and one sulfur atom as a part of the aromatic five-membered ring. The imidazo [2,1-b]-1,3,4-thiadiazole ring system is the core skeleton of well known immunomodulator levamisole. The synthesis and antimicrobial activity of nine 6-Phenyl-2- substituted imidazo [2,1-b]-1,3,4-thiadiazole derivatives were reported against Gram +ve bacteria Bacillius subtilis (MTCC 121), Staphyloccus aureus (MTCC 87), Gram –ve bacteria Pseudomonas aeruginosa (MTCC 424), Escherichia coli (MTCC 40), and fungal strains Candida albicans (MTCC 183), Fusarium solani (MTCC 2935), Fusarium oxyporium (MTCC 2840). Ciprofloxacin and Fluconazole were used as standard drug for antibacterial and antifungal activity respectively. The synthesized compound (6) and (5b) had moderate antibacterial activity especially with Gram negative Escherichia coli (MTCC 40) where (5a) and (5f) had good antibacterial activity. The structures of the synthesized compounds were established by IR, NMR and Mass spectral studies

The efficacy of sustainability of entrepreneurs on long term commitments and tradition : a case of India

Long-term orientation is the tendency to prioritize the long-range implications and impact of decisions and actions that come to fruition after an extended time period. This paper examines the sustainability of entrepreneurs based on long term commitments and respect for tradition. The specific influence of long term commitments and respect for tradition predictors on demographic outcome variables like Age, Gender, Internal Motivation, External motivation, Academic experience and technical experience has been attempted to develop an instrument to measure Hofstede’s cultural dimensions to evaluate its impact on entrepreneur development.peer-reviewe

Relationship of acute axonal damage, Wallerian degeneration, and clinical disability in multiple sclerosis

NPY-Y1R+ axon undergoing Wallerian degeneration do not co-localize with hypophosphorylated and low-molecular-weight NF in EAE. Double-labeling fluorescent IHC reveals that NPY-Y1R+ degenerating axons are only rarely labeled with antibodies recognizing hypophosphorylated NF (SMI35) (A-C). No colocalization is observed with the 68 kDa low-molecular-weight NF (D-F) in WT EAE lesional and perilesional tissue. Scale bars=(A-F) 100 μm. (JPG 343 kb

Alcohol and Smoking Mediated Modulations in Adaptive Immunity in Pancreatitis

Pancreatitis is a condition of pancreatic inflammation driven by injury to the pancreatic parenchyma. The extent of acinar insult, intensity, and type of immune response determines the severity of the disease. Smoking, alcohol and autoimmune pancreatitis are some of the predominant risk factors that increase the risk of pancreatitis by differentially influencing the adaptive immune system. The overall decrease in peripheral lymphocyte (T-, B- and (natural killer T-) NKT-cell) count and increased infiltration into the damaged pancreatic tissue highlight the contribution of adaptive immunity in the disease pathology. Smoking and alcohol modulate the responsiveness and apoptosis of T- and B-cells during pancreatic insult. Acute pancreatitis worsens with smoking and alcohol, leading to the development of systemic inflammatory response syndrome and compensatory anti-inflammatory response syndrome, suggesting the critical role of adaptive immunity in fatal outcomes such as multiple organ dysfunction. The presence of CD4+ and CD8+ T-lymphocytes and perforin-expressing cells in the fibrotic tissue in chronic pancreatitis modulate the severity of the disease. Due to their important role in altering the severity of the disease, attempts to target adaptive immune mediators will be critical for the development of novel therapeutic interventions

A quasi-experimental study on health insurance coverage and health services in Nigeria

Background: Nigeria has the highest maternal mortality rate among sub-Saharan African countries. Recently, universal health insurance coverage has been embraced as a means to enhance population health in low- and middle-income countries. Hitherto, the effect of health insurance coverage on the utilisation of facility-level delivery is largely unknown in the face of the earnest need to lower maternal mortality rates in developing countries. Aim: To empirically investigate the association of health insurance coverage on health services utilisation of facility-level delivery and the extent to which public- and private-sector facility delivery in Nigeria had a disproportionate associational effect with health insurance coverage, in the universal health coverage era. Setting: A cross-sectional study conducted for Nigeria. Methods: This study employed a quasi-experimental method using propensity scores along with different matching methods that were applied to the most recent wave of Nigeria’s Demographic and Health Survey (2020) data. Results: Evidence suggests that childbearing mothers from insured households had an average of 25% probability of utilising facility-level delivery relative to mothers from uninsured households in the year that preceded the survey. Moreover, private-sector facility delivery had a 31% higher associational effect with health insurance coverage than public-sector facility delivery, which had an estimated probability of 21%. Conclusion: Expansion of health insurance coverage in Nigeria will be a desirable way to stimulate the utilisation of facility-level delivery by women of childbearing age. Consequently, coverage expansion has the potential to save many maternal and newborn lives in Nigeria. Contribution: This study has contributed to the urgent attention of the federal government of Nigeria to monitor and revamp the health insurance coverage policies of the country for better facilitation of health services to the Nigerian population