Buttressing the Staple Line: A Randomized Comparison Between Staple-Line Reinforcement Versus No Reinforcement During Sleeve Gastrectomy

Bariatric surgery is recommended for Indian patients with body mass index (BMI) >32.5 kg/m(2) with at least one comorbidity and >37.5 kg/m(2) without a comorbidity. In laparoscopic sleeve gastrectomy, bleeding and leakage from the staple line are common post-operative events. Peri-Strips Dry® with Veritas® (PSD-V) is used in staple-line reinforcement. This was a single-investigator, multicenter, randomized study of 100 patients undergoing standard sleeve gastrectomy with a 34 or 36 French bougie. Patients were randomized 1:1 to PSD-V or control groups; no buttress material was used in the control group. The primary objective was to assess complication rates (any staple-line bleed or leak from the intra-operative visit through day 30) associated with sleeve gastrectomy. Surgical time (from first incision to closure of last incision) and the number of clips and/or sutures used to control bleeding were also assessed. Fewer staple-line bleeds were observed in the PSD-V group than the control group (23/51 [45.1 %] vs 39/49 [79.6 %] patients; p = 0.0005), and the bleeding was of a lower severity (p = 0.0002). No staple-line leaks were observed. Surgical time was shorter in patients who received PSD-V (58.8 vs 72.8 min; p = 0.0153), and fewer patients required hemostatic clips and/or sutures (10/51 [19.6 %] vs 33/49 [67.3 %] patients; p < 0.0001). Fewer patients in the PSD-V than the control group experienced adverse events (2/51 [3.9 %] vs 5/49 [10.2 %] patients). The use of PSD-V reduced the incidence and severity of staple-line bleeding and was associated with a reduction in surgical time compared with no staple-line reinforcement

Aldosterone deficiency adversely affects pregnancy outcome in mice

Circulating aldosterone levels are increased in human pregnancy. Inadequately low aldosterone levels as present in preeclampsia, a life-threatening disease for both mother and child, are discussed to be involved in its pathogenesis or severity. Moreover, inactivating polymorphisms in the aldosterone synthase gene have been detected in preeclamptic women. Here, we used aldosterone synthase-deficient (AS−/−) mice to test whether the absence of aldosterone is sufficient to impair pregnancy or even to cause preeclampsia. AS−/− and AS+/+ females were mated with AS+/+ and AS−/− males, respectively, always generating AS+/− offspring. With maternal aldosterone deficiency in AS−/− mice, systolic blood pressure was low before and further reduced during pregnancy with no increase in proteinuria. Yet, AS−/− had smaller litters due to loss of fetuses as indicated by a high number of necrotic placentas with massive lymphocyte infiltrations at gestational day 18. Surviving fetuses and their placentas from AS−/− females were smaller. High-salt diet before and during pregnancy increased systolic blood pressure only before pregnancy in both genotypes and abolished the difference in blood pressure during late pregnancy. Litter size from AS−/− was slightly improved and the differences in placental and fetal weights between AS+/+ and AS−/− mothers disappeared. Overall, an increased placental efficiency was observed in both groups paralleled by a normalization of elevated HIF1α levels in the AS−/− placentas. Our results demonstrate that aldosterone deficiency has profound adverse effects on placental function. High dietary salt intake improved placental function. In this animal model, aldosterone deficiency did not cause preeclampsi

Rare Case of Adult Onset Pompe’s Disease

Pompe’s disease is a lysosomal storage disease characterized by accumulation of glycogen primarily in muscle tissue. Infantile and late onset are the two common forms of this disease. We present a case of adult onset Pompe’s disease in a patient with type 1 diabetes mellitus (DM) with involvement of muscle, liver and bone. A 28-year-old male was being followed up for type 1 DM. He had long standing mild muscle weakness. Family history was significant for unknown muscle disorder in father and cardiomyopathy in grandfather. In addition to elevated CPK levels of 1340 (reference range \u3c 130IU/L) there was elevation of transaminases. A muscle biopsy showed autophagic activity producing rimmed vacuole like structures in the muscle fibers with increased staining of cytoplasm with Periodic acid Schiff. Further work up was delayed due to being busy with college education. Ten years later patient decided to undergo further work up, which showed persistently elevated CPK and transaminase levels. EMG studies showed generalized myopathic process. Serum acid maltase level was found to be low. Genetic testing with acid alpha Glucosidase gene sequencing showed c.-32-13T\u3eG and c.1655T\u3eC (p. L552P) mutation. He was started on enzyme replacement therapy (ERT) with acid maltase infusions, which led to improvement in symptoms, CPK and transaminases levels. Pompe’s disease is a type 2 glycogen storage disease; adult onset is characterized by partial deficiency of enzyme acid maltase. Buildup of the glycogen in Pompe’s disease causes lysosomes to expand leading to muscle damage. Presentation involves limb girdle weakness, respiratory insufficiency, often presents as asymptomatic CPK elevation. Glycogen hepatopathy associated with poorly controlled diabetes and myotonic dystrophy are important differentials to consider in patients with type 1 DM. Patient’s with Pompe’s disease are also found to have increased incidence of low bone density and should be screened periodically with DEXA. Since glycogen hepatopathy is associated with uncontrolled Type 1 DM, tight control of diabetes may help to reduce the impact of acid alpha glucosidase deficiency. Improvement of bone density after ERT suggests need for further studies to elucidate the pathophysiology of bone involvement in this disorder. Late-onset Pompe’s disease is a rare, progressive, autosomal recessive disorder; disease progression and symptomatology are variable between individuals, which often delays the diagnosis. Additional impact of type 1 DM is of concern in our patient. Use of ERT has substantially altered outcomes for the patients, underscoring the importance of early diagnosis with high index of suspicion.https://scholarlycommons.henryford.com/merf2019caserpt/1029/thumbnail.jp

A study of adverse drug reactions in tuberculosis patients in a tertiary care hospital

Background: Tuberculosis is the most rambling communicable infectious disease on earth. It is the single most common cause of death in individuals aged 15-49 years. Adverse drug reactions to antitubercular drugs causing significant morbidity, mortality, incurring substantial additional costs because of added outpatient visits, tests, and hospitalizations. Study was carried out with objectives of assessing the rate and type of adverse drug reactions (ADRs) and detecting serious and preventable ADRs with collection of demographic details of patients taking antitubercular drugs and developing ADRS.Methods: A cross sectional, prospective, observational study conducted in department of chest and TB of a tertiary Health care and teaching hospital in both IPD and OPD patients for a period of 18 months. 480 patients monitored.Results: Among 480 patients 120 i.e., 25% developed ADR. frequency being significantly higher in males (58%) and adult age group (>18 years) amongst hospitalized comparing to outdoor patients the gastrointestinal tract [GIT] (39%) followed by, generalized body disorders (19%) hepatobiliary system (17%) were organ systems most affected Majority (56%) ADRs reported in 0-2 month of starting therapy (63%) of cases were in “probable according to Naranjo causality assessment (37%) being possible. 55% ADRs were moderate in severity followed by 36% mild and 9% severe. 30% of ADRs were definitely preventable followed by 20% of probably prevented according to schumock thronstone preventability scaleConclusions: Study highlights the importance of routine monitoring and robust pharmacovigilance system for success of national tuberculosis programmes in India as well as worldwide

Absence of the calcium-binding protein calretinin, not of calbindin D-28k, causes a permanent impairment of murine adult hippocampal neurogenesis

Calretinin (CR) and calbindin D-28k (CB) are cytosolic EF-hand Ca2+-binding proteins and function as Ca2+ buffers affecting the spatiotemporal aspects of Ca2+ transients and possibly also as Ca2+ sensors modulating signaling cascades. In the adult hippocampal circuitry, CR and CB are expressed in specific principal neurons and subsets of interneurons. In addition, CR is transiently expressed within the neurogenic dentate gyrus (DG) niche. CR and CB expression during adult neurogenesis mark critical transition stages, onset of differentiation for CR, and the switch to adult-like connectivity for CB. Absence of either protein during these stages in null-mutant mice may have functional consequences and contribute to some aspects of the identified phenotypes. We report the impact of CR- and CB-deficiency on the proliferation and differentiation of progenitor cells within the subgranular zone (SGZ) neurogenic niche of the DG. Effects were evaluated (1) two and four weeks postnatally, during the transition period of the proliferative matrix to the adult state, and (2) in adult animals (3 months) to trace possible permanent changes in adult neurogenesis. The absence of CB from differentiated DG granule cells has no retrograde effect on the proliferative activity of progenitor cells, nor affects survival or migration/differentiation of newborn neurons in the adult DG including the SGZ. On the contrary, lack of CR from immature early postmitotic granule cells causes an early loss in proliferative capacity of the SGZ that is maintained into adult age, when it has a further impact on the migration/survival of newborn granule cells. The transient CR expression at the onset of adult neurogenesis differentiation may thus have two functions: (1) to serve as a self-maintenance signal for the pool of cells at the same stage of neurogenesis contributing to their survival/differentiation, and (2) it may contribute to retrograde signaling required for maintenance of the progenitor pool

Connaissances, perception et pratique des professionnels de la santé concernant les méthodes de mesure de la pression artérielle = Knowledge, perception, and practice of health professionals regarding blood pressure measurement methods

L'hypertension est un facteur de risque mondial majeur qui touche environ 23 % de la population canadienne. Si elle n'est pas diagnostiquée et traitée adéquatement, l'hypertension artérielle entraînera des complications affectant le cœur, le cerveau ou les reins. Le diagnostic et le traitement de l'hypertension dépendent en grande partie d'une mesure valide de la pression artérielle (PA). Les lignes directrices d'Hypertension Canada préconisent l'utilisation de méthodes de la mesure de la PA standardisé, à savoir à domicile (MPAD), ambulatoire (MAPA), en clinique (MPAC) et en clinique oscillométrique en série (MPAC-OS) pour la prise en charge de l'hypertension. Ces méthodes de mesure de la PA ont été étudiées de façons indépendantes en ce qui concerne les connaissances, la perception ou la pratique, mais pas systématiquement et seulement partiellement au Canada. Les professionnels de la santé, à savoir les médecins, les infirmières et les pharmaciens, jouent un rôle important dans la mesure de la PA et, par conséquent, une image plus claire de leurs connaissances, de leur perception et de leur pratique est nécessaire. L'objectif de cette étude était ainsi d'évaluer les connaissances, la perception et la pratique des médecins, infirmières et pharmaciens de travail en milieux de soins primaires à travers le Québec concernant les quatre méthodes de mesure de la PA. Pour identifier la littérature publiée sur ce sujet, une revue de la portée a été réalisée évaluer systématiquement la littérature pour les quatre méthodes de la mesure de la PA en regard des trois concepts pour les professionnels de la santé. Lorsque les résultats rapportés des études individuelles étaient supérieurs à 50%, les études étaient classées comme adéquates pour les connaissances, positives pour la perception et satisfaisantes pour la pratique. Au total, 72 études ont été identifiées. Les résultats ont montré que les perceptions des professionnels de la santé étaient positives, mais que leurs connaissances étaient insuffisantes et leur pratique insatisfaisante, et que les infirmières et les pharmaciens demeurent sous-étudiés. Ceci est le premier article de la thèse, et il a été publié. Une étude descriptive a été menée pour évaluer les connaissances, la perception et la pratique les professionnels de la santé concernant la mesure de la PA tant en clinique qu’en ambulatoire. À l'aide des lignes directrices d'Hypertension Canada et de la littérature pertinente, un questionnaire élaboré par la chercheure a été formulé et traduit en anglais et en français, puis validé par un panel de quatre experts dans le domaine de l'hypertension. La population de l’étude concernait tous les médecins, infirmières et pharmaciens exerçant en soins primaires au Québec ont été sélectionnés pour cette étude. Le recrutement des participants a été réalisé en collaboration avec leurs associations professionnelles respectives. Les médecins et pharmaciens ont été recrutés via la lettre d’information mensuelle de leurs associations, tandis qu'une invitation personnalisée a été envoyée par courriel aux infirmières. Un lien vers une plateforme sécurisée suivi de deux rappels a été transmis aux participants. La collecte des données a eu lieu entre novembre 2019 et janvier 2020. Un certificat d'éthique a été obtenu de l'UQTR. Les données ont été analysées à l'aide de statistiques descriptives comprenant la fréquence, le pourcentage, la moyenne et les écart types. Quant aux résultats, un total de 453 infirmières a participé au sondage. Le score global des connaissances était inférieur à 50%, ce qui a été jugé insuffisant. Cependant, le score global pour la perception était supérieur à 50%, ce qui montre leur accord sur l'utilité des méthodes la mesure de la PA pour la gestion de l'hypertension. La pratique n'était pas satisfaisante pour les méthodes ambulatoires, en particulier dans les domaines de l'éducation dispensée aux patients mais également des conseils dispensés. Une légère évolution dans l’utilisation des dispositifs oscillométriques plutôt que les mesures manuelles a été observée. Cependant, au Canada, l'MPAC-OS, qui est la méthode préférée en clinique, n'est utilisée de façon routinière que par un quart des infirmières. Il s’agit du deuxième article de la thèse. Pour les résultats des médecins et des pharmaciens, un total de 45 médecins et 30 pharmaciens ont participé à l'enquête. Leur score global de perception était supérieur à 50%, tandis que le score global de connaissance était légèrement supérieur à 50%, ce qui est assez adéquat. La pratique était assez satisfaisante pour toutes les méthodes de mesure de la pression artérielle. Cependant, un pourcentage substantiel de médecins (32%) et de pharmaciens (7%) utilisent encore l'auscultation manuelle comme méthode de routine en clinique, tandis que seulement 13% des médecins et 3% des pharmaciens utilisent la méthode MPAC-OS. À notre connaissance, il s'agit de la première étude au Québec à dresser un portrait complet de la connaissance, de la perception et de la pratique les professionnels de la santé pour les quatre méthodes la mesure de la PA. Les résultats de l'examen de portée ont mis en évidence qu'une connaissance inadéquate et une pratique insatisfaisante des méthodes de la mesure de la PA restent une préoccupation majeure dans le monde. Le fait est que les infirmières et les pharmaciens ont été peu étudiés, bien qu'une approche d'équipe multidisciplinaire soit fortement encouragée pour la gestion de l'hypertension. Les résultats pour les médecins, les infirmières et les pharmaciens soulignent que les connaissances et la pratique sont sous-optimales et doivent être améliorées. La généralisabilité des résultats est cependant limitée pour les médecins et les pharmaciens en raison de l'échantillon limité. Ces résultats pourraient aider à planifier d'autres stratégies pour mettre en œuvre la certification la mesure de la PA, guider l'application des connaissances, mener d'autres recherches à travers le Canada pour obtenir une vue d'ensemble, identifier les obstacles en la mesure de la PA et aider à combler le fossé entre les lignes directrices et la pratique. Les efforts d'Hypertension Canada et d'autres sociétés d'hypertension pour fournir des ressources éducatives et des outils aux professionnels de la santé sont louables. Il faut donc s'assurer que les ressources disponibles sont mises en œuvre et que la formation continue est encouragée.Hypertension is a leading global risk factor affecting approximately 23% of the Canadian population. If not diagnosed and treated accurately, hypertension will lead to complications affecting the heart, brain, or kidneys. The diagnosis and treatment of hypertension depend largely on accurate blood pressure measurement (BPM). Hypertension Canada Guidelines recommend using standardized BPM methods, namely home (HBPM), ambulatory (ABPM), office (OBPM), and automated (AOBP) for hypertension management. These BPM methods have been studied independently concerning either knowledge, perception, or practice, but not systematically and only partially in Canada. Health professionals (HPs), namely the physicians, nurses, and pharmacists, play a significant role in BPM, and therefore a clearer picture of their knowledge, perception, and practice is needed. The objective of this study was to assess the knowledge, perception, and practice of the physicians, nurses, and pharmacists working in the primary care settings across Quebec concerning the four BPM methods. To identify the published literature on this topic, a scoping review was performed that systematically appraised the literature for the four BPM methods and three concepts for HPs. When results reported from individual studies were above 50%, studies were classified as adequate for knowledge, positive for perception, and satisfactory for practice. A total of 72 studies were identified. The results showed that health professionals' perceptions were positive, but their knowledge was inadequate, the practice was unsatisfactory, and nurses and pharmacists remained understudied. This is the first article of the thesis, and it was published. A descriptive study was conducted to assess knowledge, perception and practice of HPs concerning ambulatory and clinic BPM methods. Using Hypertension Canada Guidelines and relevant literature, an investigator-initiated questionnaire was formulated and translated in English and French and further validated by a panel of four experts in the field of hypertension. All registered physicians, nurses, and pharmacists practicing in primary care across Quebec were selected for this study. Recruitment of participants was executed in collaboration with their respective professional associations. Physicians and pharmacists were recruited through the monthly newsletter of their associations, while a personalized invitation was sent by email to nurses. A link to a secured platform followed by two reminders was provided to participants. Data collection took place between November 2019-January 2020. An ethical certificate was obtained from UQTR. Data was analyzed using descriptive statistics including frequency, percentage, mean and standard deviation. As for results, a total of 453 nurses participated in the survey. The overall knowledge score was below 50%, which was considered inadequate. However, the overall perception score was above 50%, showing their agreement on the usefulness of BPM methods for hypertension management. The practice was unsatisfactory for HBPM and ABPM methods, especially in the areas of education and frequency of recommending it to patients, while a slight change from manual auscultation to the oscillometric device is observed. However, in Canada, AOBP, which is the preferred method in-clinic, is used routinely only by a quarter of the nurses. This is the second article of the thesis. For the results of physicians and pharmacists, a total of 45 physicians and 30 pharmacists participated in the survey. Their overall perception score was above 50%, while the overall knowledge score was slightly above 50%, which is fairly adequate. The practice was somewhat satisfactory for all BPM methods. However, a substantial percentage of physicians (32%) and pharmacists (7%) use manual auscultation as a routine in-clinic method, while only 13% of physicians and 30% of pharmacists use the AOBP method. To our best knowledge, this is the first study in Québec and Canada to depict a complete picture of the knowledge, perception, and practice of HPs for all four BPM methods. The results of the scoping review highlighted that inadequate knowledge and unsatisfactory practice of BPM methods remain a major concern worldwide. The fact is that the nurses and pharmacists were understudied, although a multidisciplinary team approach is strongly promoted for the management of hypertension. The results for physicians, nurses, and pharmacists highlight that the knowledge and practice are suboptimal and need improvement. However, the generalisability of the results is limited for physicians and pharmacists due to the limited sample. These findings could help plan further strategies to implement BPM certification, guide in knowledge translation, conduct further research across Canada to get a larger picture, identify barriers in BPM, and help bridge the gap between guidelines and practice. The efforts of Hypertension Canada and other hypertension societies to provide educational resources and tools for HPs are commendable. Therefore, it must be ensured that the available resources are implemented, and that continuing education is encouraged

Constraints and Improvements Suggestions Proposed in Adopting Recommended Cultivation Practices by Mandarin Growers

The present study was conducted  in Amravati district of Maharashtra. It was purposively carried out in two talukas i.e. Achalpur and Anjangaon Surji on the basis of maximum area under mandarin. From Achalpur and Anjangaon Surji talukas, 12 villages were selected purposively having area under mandarin. Again from each selected village, 10 mandarin growers were selected purposively having bearing orchard for the present study constituting a sample size of 120 respondents. An exploratory method of research design was used. The objective of the study was to to identify the constraints faced by mandarin growers and obtain suggestions. Findings revealed that majority of respondents (93.33%) faced the problem of unavailability of proper information about chemicals to control pests and diseases followed by the those (91.66%) who are facing the problem of fruit drop in recent years along with some other constraints. While in case of suggestions, guidance by concerned department to farmers at different levels by organizing field visits gained highest frequency followed by availability of inputs at affordable price and arrangement of training programes for the areas found with higher training need respectively