Biochemical Studies on the Cardioprotective Effect of Glutamine on Tissue Antioxidant Defense System in Isoprenaline-Induced Myocardial Infarction in Rats

Oxidative stress is one of the mechanisms with a central role involved in the pathogenesis of myocardial infarction. The protective effect of glutamine on myocardial antioxidant defense system was investigated during isoprenaline-induced myocardial infarction, an animal model of myocardial infarction of human beings. Levels of diagnostic marker enzymes in plasma, reduced glutathione (GSH) and lipid peroxides and the activities of glutathione peroxidase, glutathione-S-transferase, catalase and superoxide dismutase in heart tissue were determined. Injection of isoprenaline caused significant increases in the levels of diagnostic marker enzymes in plasma and lipid peroxidation in heart tissue. A parallel decline in the levels of ATP (Adenosine triphosphate) and GSH and the activities of glutathione-dependent antioxidant enzymes and antiperoxidative enzymes in heart tissue was also observed. Prior oral administration of glutamine significantly prevented isoprenaline-induced adverse effects and maintained myocardial antioxidant status at near normal status. The cardioprotective effect of glutamine is probably related to a strengthening of the myocardial membrane by its membrane stabilizing action, or to a counteraction of free radicals by its antioxidant property, or to its ability to maintain near to normal status the activities of free radical scavenging enzymes and the level of GSH, which protect myocardial membrane against oxidative damage by decreasing lipid peroxidation

Protective effect of L-glutamine on lysosomal integrity in isopoterenol-induced myocardial infarction in rats

Lysosomal acid hydrolases play an imperative part in the initiation of inflammation processes associated with myocardial infarction. In the present investigation, we have studied the protective effect of L-glutamine on isoproterenol-induced myocardial damage in male albino rats with respect to alterations in lysosomal function. The myocardial infarction in experimental animals was induced by intraperitoneal (i.p.) injection of isoproterenol (11 mg/100 g body weight/day) for 2 days. The total and free activities of lysosomal acid hydrolases (β-glucuronidase, β-galactosidase, β-glucosidase and acid phosphatase) were determined in plasma and heart tissue of control and treated rats. Significant elevation in the total activities of lysosomal hydrolases was observed in plasma and heart tissue of isoproterenol administered rats. A parallel (p<0.05) rise in the free activities of these acid hydrolases in the cardiac tissue was also noticed. Isoproterenol-mediated lysosomal membrane fragility was evident from the altered subcellular distribution of heart β-glucuronidase activity. Prior oral administration of L-glutamine (100 mg/kg body weight/day for a period of 20 days) significantly attenuated the isoproterenol-induced release of these lysosomal hydrolases into the systemic circulation from the cardiac lysosomes and maintained the lysosomal stability at level comparable to that of control rats. The results of the present study suggested that the cardioprotective activity of glutamine might be related to its membrane-stabilizing property

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Primary multicentric cutaneous epithelioid angiosarcoma

Cutaneous epithelioid angiosarcoma is a rare malignant vascular tumor, most commonly affecting elderly men, and is usually located on the extremities. We report a case of an 81-year-old lady who presented with two ulcerated plaques over the right temporal and parietal scalp of 1 year duration. The right submaxillary and submandibular lymph nodes were enlarged and tender. Computed tomography (CT) scan of the head showed soft tissue swelling over parietal and temporal areas and there was no intracranial extension. Ultrasonogram of the abdomen showed hyperechoic areas in liver suggestive of secondaries. Histopathology of the skin lesion showed the dermis and subcutis composed of clusters of atypical epithelioid cells with vesicular nuclei, prominent nucleoli and eosinophilic cytoplasm with increased mitotic figures. Immunohistochemical staining revealed CD-31, 33, 34 and vimentin positivity, while cytokeratin was negative confirming the diagnosis of epitheloid angiosarcoma. This case report highlights the unusual occurrence of multicentric epitheloid angiosarcoma on the scalp with secondaries in the liver

A Comprehensive Review on Sustainable Aspects of Big Data Analytics for the Smart Grid

The role of energy is cardinal for achieving the Sustainable Development Goals (SDGs) through the enhancement and modernization of energy generation and management practices. The smart grid enables efficient communication between utilities and the end- users, and enhances the user experience by monitoring and controlling the energy transmission. The smart grid deals with an enormous amount of energy data, and the absence of proper techniques for data collection, processing, monitoring and decision-making ultimately makes the system ineffective. Big data analytics, in association with the smart grid, enable better grid visualization and contribute toward the attainment of sustainability. The current research work deals with the achievement of sustainability in the smart grid and efficient data management using big data analytics, that has social, economic, technical and political impacts. This study provides clear insights into energy data generated in the grid and the possibilities of energy theft affecting the sustainable future. The paper provides insights about the importance of big data analytics, with their effects on the smart grids’ performance towards the achievement of SDGs. The work highlights efficient real-time energy data management involving artificial intelligence and machine learning for a better future, to short out the effects of the conventional smart grid without big data analytics. Finally, the work discusses the challenges and future directions to improve smart grid technologies with big data analytics in action

A Comprehensive Review on Sustainable Aspects of Big Data Analytics for the Smart Grid

The role of energy is cardinal for achieving the Sustainable Development Goals (SDGs) through the enhancement and modernization of energy generation and management practices. The smart grid enables efficient communication between utilities and the end- users, and enhances the user experience by monitoring and controlling the energy transmission. The smart grid deals with an enormous amount of energy data, and the absence of proper techniques for data collection, processing, monitoring and decision-making ultimately makes the system ineffective. Big data analytics, in association with the smart grid, enable better grid visualization and contribute toward the attainment of sustainability. The current research work deals with the achievement of sustainability in the smart grid and efficient data management using big data analytics, that has social, economic, technical and political impacts. This study provides clear insights into energy data generated in the grid and the possibilities of energy theft affecting the sustainable future. The paper provides insights about the importance of big data analytics, with their effects on the smart grids&rsquo; performance towards the achievement of SDGs. The work highlights efficient real-time energy data management involving artificial intelligence and machine learning for a better future, to short out the effects of the conventional smart grid without big data analytics. Finally, the work discusses the challenges and future directions to improve smart grid technologies with big data analytics in action

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit