PROTON PUMP INHIBITORS AND THE RISK OF CHRONIC KIDNEY DISEASES: A CRITICAL REVIEW

Proton pump inhibitors (PPIs) are most widely used medications for acid related gastrointestinal disorders. Accessible evidence based studies suggest that the increased use of PPI is linked to a greater risk of developing kidney diseases. This review aims to determine the association of kidney disease with the use of proton pump inhibitor with various study designs. PubMed, Scopus and Google Scholar databases as well as a reference list of relevant articles were systematically searched for studies by using the following search terms; ‘proton pump inhibitors’, ‘acute kidney injury’, ‘chronic kidney disease’ and ‘end stage renal disease’. Both observational and randomized controlled trials (RCTs) exploring the association of PPI use with kidney disease were eligible for inclusion. A total of 8 articles, including 9 studies (n = 794,349 participants) were identified and included in the review. Majority of the studies showed a higher risk of kidney outcomes in patients taking PPIs, with effect higher of acute kidney injury (4-to 6-fold) compared with chronic kidney disease and end stage renal disease (1.5-to 2.5-fold). However, the studies suggest that the strength of evidence is weak and could not prove causation. The risk increased considerably with the use of high dose of PPIs and prolonged duration of exposure necessitates the monitoring of renal function. Exercising vigilance in PPI use and cessation of proton pump inhibitor when there is no clear indication may be a reasonable approach to reduce the population burden of kidney diseases

Basal cell carcinoma- a prospective clinico epidemiological and pathological study

Background: Basal cell carcinoma is the most common malignant tumour of the skin worldwide. The objective was to find out the age and sex incidence of basal cell carcinoma in patients attending the outpatient department of dermatology and to find out the various clinical and histopathological features of basal cell carcinoma.Methods: It was a prospective observational study carried out in a tertiary care hospital, Chennai, Tamilnadu, India. Patients with clinical diagnosis of basal cell carcinoma were included in the study after thorough history, clinical examination, routine and special investigations like skin biopsy.Results: Out of 20 patients with basal cell carcinoma 6 were males and 14 were females with a male to female ratio of 1:2.33. Most commonly affected age group was 50-70 years (70%). Distribution of BCC in our study was confined to head and neck area. Most common morphological subtype encountered in this study was nodular/nodulo-ulcerative BCC (70%), followed by pigmented type (25%) and superficial BCC (5%). The most common histological variant observed in present study was nodular type (55%), followed by pigmented variant (25%), adenoid (5%), basisquamous (5%), superficial BCC (5%) and BCC with sebaceous differentiation (5%).Conclusions: This study highlights a paradoxically increasing trend of BCC with female predilection. Early detection and treatment of lesions are crucial to decrease the functional and cosmetic disfigurement and also this study highlights the importance of improving awareness among general practitioners, public health workers and general population

The integral membrane protein, ponticulin, acts as a monomer in nucleating actin assembly

Ponticulin, an F-actin binding transmembrane glycoprotein in Dictyostelium plasma membranes, was isolated by detergent extraction from cytoskeletons and purified to homogeneity. Ponticulin is an abundant membrane protein, averaging approximately 10(6) copies/cell, with an estimated surface density of approximately 300 per microns2. Ponticulin solubilized in octylglucoside exhibited hydrodynamic properties consistent with a ponticulin monomer in a spherical or slightly ellipsoidal detergent micelle with a total molecular mass of 56 +/- 6 kD. Purified ponticulin nucleated actin polymerization when reconstituted into Dictyostelium lipid vesicles, but not when a number of commercially available lipids and lipid mixtures were substituted for the endogenous lipid. The specific activity was consistent with that expected for a protein comprising 0.7 +/- 0.4%, by mass, of the plasma membrane protein. Ponticulin in octylglucoside micelles bound F-actin but did not nucleate actin assembly. Thus, ponticulin-mediated nucleation activity was sensitive to the lipid environment, a result frequently observed with transmembrane proteins. At most concentrations of Dictyostelium lipid, nucleation activity increased linearly with increasing amounts of ponticulin, suggesting that the nucleating species is a ponticulin monomer. Consistent with previous observations of lateral interactions between actin filaments and Dictyostelium plasma membranes, both ends of ponticulin-nucleated actin filaments appeared to be free for monomer assembly and disassembly. Our results indicate that ponticulin is a major membrane protein in Dictyostelium and that, in the proper lipid matrix, it is sufficient for lateral nucleation of actin assembly. To date, ponticulin is the only integral membrane protein known to directly nucleate actin polymerization

An Empirical Study of the Effects of Key Quality Parameters on Operational Performance in the Soft Drink Industry

The companys managements interests are concerned with the critical factors of quality and operational performance, which contributes to their potential for providing quality products that meet the needs of customers and their desires while simultaneously allowing them to produce competitive products. This research sought to determine the relationship and impact between the factors critical to quality and performance operations in the Karawanchi Group of Companies in Kirkuk. Consequently, several research questions were addressed, and a general framework for the problem was defined to determine the relationship and impact between the relevant quality factors and the operational performance within the company being investigated. This study concluded a correlation and a significant effect between the determinants of critical quality factors and operational performance. Each of the determinants of quality (the processing chain, the inspection process, the cost of operations, and customer satisfaction) was associated with operational performance. The collective crucial success elements notable and constructively influence operational performance. The quality of the testing process plays a crucial role in determining the success of activities inside the organization, particularly when materials are tested and compared against standard requirements. It was recommended that the company develop standards to assess the performance of the leaders and employees and adopt a comprehensive learning, training, and development system

A rare cause of epididymo-orchitis

Epididymo-orchitis is an inflammatory lesion of the testis and epididymis with a lymphocytic exudate. Patients with acute epididymo-orchitis typically present with scrotal pain, swelling, tenderness and fever. Here, we present a patient with scrotal pain and hemiscrotal swelling as the main complaints; however further investigations revealed a completely different and rare diagnosis. Zinner’s syndrome is a very rare developmental anomaly of the Wolffian duct. To date, only about 200 cases have been diagnosed. It is a triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ejaculatory duct obstruction. Some patients remain asymptomatic and discovered incidentally, while others present with symptoms related to seminal vesicle cysts or ejaculatory duct obstruction: voiding or ejaculatory difficulty or pain. Treatment options include transurethral or transrectal aspiration and percutaneous drainage, however both are linked to an increased risk of recurrence. Symptomatic, complicated and recurrent cyst will require excision of the cyst, either laparoscopically or robotically

Seasonal variation in hospital encounters with hypoglycaemia and hyperglycaemia

Aim To assess whether rates of hospital encounters with hypoglycaemia and hyperglycaemia display seasonal variation. Methods Time series analyses of the monthly rates of hospital encounters (emergency room visits or inpatient admissions) with hypoglycaemia and hyperglycaemia from 2003 to 2012 using linked healthcare databases in Ontario, Canada. Results Over the study period, there were 129 887 hypoglycaemia and 79 773 hyperglycaemia encounters. The characteristics of people at the time of their encounters were similar across the seasons in 2008 (median age 68 years for hypoglycaemia encounters and 53 years for hyperglycaemia encounters; 50% female; 90% with diabetes). We observed moderate seasonality in both types of encounters (R2 autoregression coefficient 0.58 for hypoglycaemia; 0.59 for hyperglycaemia). The rate of hypoglycaemia encounters appeared to peak between April and June, when on average, there was an additional 49 encounters per month (0.36 encounters per 100 000 persons per month) compared with the other calendar months (5% increase). The rate of hyperglycaemia encounters appeared to peak in January, when on average, there was an additional 69 encounters per month (0.50 encounters per 100 000 persons per month) compared with the other calendar months (11% increase). Conclusions In our region, there is seasonal variation in the rate of hospital encounters with hypoglycaemia and hyperglycaemia. Our findings may help to highlight periods of vulnerability for people, may inform future epidemiological studies and may aid in the appropriate planning of healthcare resources

Survival of patients with subglottic squamous cell carcinoma

Objective: Subglottic squamous cell carcinoma is a rare subsite of laryngeal cancer that behaves more aggressively and portends a worse prognosis. Using a population-based cancer registry, our objective was to report overall survival (OS) and laryngectomy-free survival (LFS) in patients diagnosed with subglottic squamous cell carcinoma, and to determine whether primary laryngectomy results in improved survival. Methods: This retrospective population-based study considered patients with a new diagnosis of squamous cell carcinoma in the province of Ontario over a 15-year period (1995-2009). The Ontario Cancer Registry was examined for patients with the diagnosis of interest during the period of interest. Linked population-based databases were used to obtain patient demographics, comorbidity measures, staging, survival, and primary treatment with laryngectomy. Results: Of 4927 patients identified to have laryngeal carcinoma, 89 were defined as having primary subglottic carcinoma (1.8%). In the subglottic cohort, 68 patients were men (76.4%), and mean age at diagnosis was 68 years (interquartile range: 60-77 years). The 5-year OS was 47.2%, and the 5-year LFS was 31.5%. In 13 patients (15%), the primary treatment was laryngectomy, which, compared with primary radiation, did not predict for improved OS. No differences in OS or LFS were observed during the 15-year study period (OS p=0.42, LFS p=0.83). Conclusions: The survival of patients with subglottic carcinoma is poor and has remained stable over time (1995-2009). Compared with primary radiation, primary treatment with laryngectomy does not appear to improve OS

Growth and nutritional value of a Tropical Green Alga, Ankistrodesmus convolutus corda, in Agro-industrialeffluents

Use of agro-industrial effluents for microalgal culture was investigated using a tropical freshwater green alga, Ankistrodesmus convolutus cultured in various dilutions of latex concentrate effluent (LCRE), standard Malaysian rubber effluent (SMRE) and digested palm oil mill effluent (POMED). Ankistrodesmus convolutus grown in 40%and 60%LCRE, 60%SMRE and 10% POMED showed significantly higher (P < 0.05) specific growth rate in terms of cell number and chlorophyll a than that grown in other effluent media and inorganic fertiliser (N:P:K = 1:1:0.5) as control. Total biomass of this microalgae grown in 60%LCRE, 60%SMRE and 10% POMED was significantly higher (P < 0.05) than that cultured in other effluent media and the control. Ankistrodesmus convolutus cultured in 40% and 60% LCRE, 60% SMRE and 10% POMED showed significantly (P < 0.05) higher amount of crude protein and lipid than that grown in other effluent media and the control. Significantly higher (P < 0.05) amount of most of the essential amino acids (EAAs) except a few were found in A. convolutus cultured in 60% LCRE and 60% SMRE than that grown in other effluent media and control. Ankistrodesmus convolutus cultured in 10% POMED resulted in significantly higher (P < 0.05) amount of all the EAAs except threonine and tyrosine that were grown in other POMED media and control. Ankistrodesmus convolutus grown in 40% and 60% LCRE, contained significantly higher (P < 0.05) amounts of all the C18 and C20 polyunsaturated fatty acids (PDFAs) than that cultured in other SMRE media and control, except eicosadienoic acid (20: 2n-11). A similar trend of PUFAs was recorded in A. convolutus cultured in 60% SMRE except eicosatrienoic acid (20:3n-6) and arachidonic acid (20:4n-6). It was found that A. convolutus contained significantly (P < 0.05) higher amount of PUFAs such as linoleic acid (l8:2n-6), linolenic acid (18:3n-3) and arachidonic acid (20:4n-6) when grown in 10% POMED than that cultured in other POMED media and control. This study showed that A. convolutus grown in 40-60% rubber and 10% POMED has higher nutritional value that that cultured in other effluent media and inogranic fertilizer

Standardizing type Ia supernovae optical brightness using near-infrared rebrightening time

Accurate standardization of Type Ia supernovae (SNIa) is instrumental to the usage of SNIa as distance indicators. We analyse a homogeneous sample of 22 low-z SNIa, observed by the Carnegie Supernova Project in the optical and near-infrared (NIR). We study the time of the second peak in the J band, t2, as an alternative standardization parameter of SNIa peak optical brightness, as measured by the standard SALT2 parameter mB. We use BAHAMAS, a Bayesian hierarchical model for SNIa cosmology, to estimate the residual scatter in the Hubble diagram. We find that in the absence of a colour correction, t2 is a better standardization parameter compared to stretch: t2 has a 1\u3c3 posterior interval for the Hubble residual scatter of \u3c3\u394\u3bc = (0.250, 0.257) mag, compared to \u3c3\u394\u3bc = (0.280, 0.287) mag when stretch (x1) alone is used. We demonstrate that when employed together with a colour correction, t2 and stretch lead to similar residual scatter. Using colour, stretch and t2 jointly as standardization parameters does not result in any further reduction in scatter, suggesting that t2 carries redundant information with respect to stretch and colour. With a much larger SNIa NIR sample at higher redshift in the future, t2 could be a useful quantity to perform robustness checks of the standardization procedure