Malnutrition in hospitalised patients; a real concern in surgical outcomes

Background:Lack of appropriate nutritional support during hospitalization may worsen patients’ nutritional status and increases risk for infection, organ failure, decreased wound healing and suboptimal response to regular medical treatment. The prevalence and intensity of hospital malnutrition have been recognized as an important parameter in the outcome of disease. The study aimed at to determine incidence of malnutrition in hospitalized patients, the change in nutrition status during hospital stay and its effects on outcome of disease.Methods: It was a prospective study and conducted at a tertiary care hospital. Total 70 patients were studied. Each patient's nutritional status was determined from anthropometric data - body mass index, triceps skinfold thickness, mid-arm circumference, mid arm muscle circumference, MNA scoring, serum protein level changes during hospital stay. The next recording was done at 15 days and 30 days after discharge. Student’s t is test used for statistical analysis.Results:The statistical difference for various parameters of nutritional status was found significant at admission and discharge.Conclusions: The change in various parameter of nutritional status was observed in hospitalized patients. The treatment should be aimed at treating specific disorders along with nutritional correction. It is recommended to have dietary plans at the time of admission in consultation with the dietician.

Site selection for vascular access creation in hemodialysis in end stage renal disease

Background: Chronic kidney failure is characterized with progressive and irreversible diminishing of glomerular filtration rate. AVF has been unanimously considered the gold standard vascular access of choice for hemodialysis. Arterio-venous fistula (AVF) for hemodialysis should be created in patients with endogenous creatinine clearance < 20 mL/min/1,73m2. Aim of current study was to choose the proper site for arteriovenous fistula creation with minimal complications.Methods: It was a prospective study, carried out in the dept. of surgery from April 2008 to August 2013. A total of 140 patients were studied over the period. The fistulae were created using radial artery cephalic vein side to side and brachial artery cephalic vein side to side or end to side anastomosis. Statistical analysis used: Mean, Standard deviation, Standard error.Results: A total 140 patients were studied, out of them 104 were males and 36 were females. The radiocephalic site was used for 82 (58.57%) patients and 58 (41.43%) patients were operated on brachiocephalic site. The mean inner diameter of radial artery, brachial artery and cephalic vein (intima to intima) at elbow and wrist were 21.49001 ± 0.901 (SE - 0.28492), 3.72533 ± 1.06837 (SE - 0.30841) and 0.68079 ± 0.49551 (SE - 0.116790) respectively. The mean flows velocity of brachial and radial artery were 76.10526 ± 4.54477 (SE - 1.04264) and 52.64286 ± 5.5968 (SE - 1.495810) respectively. The success rate of AV fistula on table was 97.85% (137 out of 140). The incidence of complication was 18.57%.Conclusion: The site for fistula creation depends on the quality of the artery and vein. To achieve good success rates preoperative color Doppler is essential to evaluate the vessels. The complication rates can be minimised by following standard operating protocols.

Defined Microenvironments Trigger In Vitro Gastrulation in Human Pluripotent Stem Cells

Gastrulation is a stage in embryo development where three germ layers arise to dictate the human body plan. In vitro models of gastrulation have been demonstrated by treating pluripotent stem cells with soluble morphogens to trigger differentiation. However, in vivo gastrulation is a multistage process coordinated through feedback between soluble gradients and biophysical forces, with the multipotent epiblast transforming to the primitive streak followed by germ layer segregation. Here, the authors show how constraining pluripotent stem cells to hydrogel islands triggers morphogenesis that mirrors the stages preceding in vivo gastrulation, without the need for exogenous supplements. Within hours of initial seeding, cells display a contractile phenotype at the boundary, which leads to enhanced proliferation, yes-associated protein (YAP) translocation, epithelial to mesenchymal transition, and emergence of SRY-box transcription factor 17 (SOX17)+ T/BRACHYURY+ cells. Molecular profiling and pathway analysis reveals a role for mechanotransduction-coupled wingless-type (WNT) signaling in orchestrating differentiation, which bears similarities to processes observed in whole organism models of development. After two days, the colonies form multilayered aggregates, which can be removed for further growth and differentiation. This approach demonstrates how materials alone can initiate gastrulation, thereby providing in vitro models of development and a tool to support organoid bioengineering efforts.Pallavi Srivastava, Sara Romanazzo, Chantal Kopecky, Stephanie Nemec, Jake Ireland, Thomas G. Molley, Kang Lin, Pavithra B. Jayathilaka, Elvis Pandzic, Avani Yeola, Vashe Chandrakanthan, John Pimanda, and Kristopher Kilia

Proteomic level changes associated with S3I201 treated U87 glioma cells

Glioblastoma multiforme is Grade IV brain tumor associated with high mortality and limited therapeutics. Signal Transducer and Activator of Transcription 3 (STAT3) is persistently active in several cancers including gliomas, and plays a major role in disease progression and survival of glioma patients, thus being a potential therapeutic target for treatment. S3I201 and its analogs inhibit the transcriptional functions of STAT3 and reduce growth of tumor tissues. Here we have studied proteomic alteration associated with S3I201 treated U87 cells using 2-DE and Isobaric tags for relative and absolute quantitation coupled with mass spectrometry. This analysis revealed 136 differentially expressed proteins which were functionally classified with gene ontology analysis. Results showed metabolism, apoptosis, cytoskeletal behaviour, cell redox homeostasis and immune response as the most affected biological processes on S3I201 treatment. Apoptosis-inducing factor 1 mitochondrial, cyclophilin A and chloride intra-cellular channel protein 1 were found to be up-regulated which possibly contributes to its anti-tumorigenic function. Several glycolytic enzymes like phosphoglycerate mutase 1 were also found to be up-regulated and its expression was validated using immunoblot. Conclusively, our study shows the downstream effects of S3I201 in U87 glioma cells and suggests its therapeutic potential. Significance: Gliomas with constitutive expression can be treated with STAT3 inhibitors. S3I201, a STAT3 inhibitor, reduces the growth of glioma cells thus could be studied further for its application as anti-glioma agent. This study investigated proteomic alteration associated with S3I201 in U87 cells using complementary proteomic approaches, and our findings suggest that S3I201 influences central metabolism, apoptosis, cytoskeletal behaviour, cell redox homeostasis and immune response as the most affected biological processes which altogether contribute to its anti-tumorigenic activity. Several proteins were identified which may serve as prognostic or predictive markers in GBM. Apoptosis-inducing factor 1 mitochondrial and cyclophilin A were identified as potential therapeutic targets and further investigations on these candidates may facilitate therapeutic development and suggests that GBM therapy can be improved by targeting cellular metabolism and by using immunotherapy. (C) 2016 Elsevier B.V. All rights reserved

Aliskiren, the first direct renin inhibitor for treatment of hypertension: The path of its development

Standard treatments available today for treating hypertension is diuretics, β-blockers, angiotensin converting enzyme inhibitors (ACEs), angiotensin receptor blockers (ARBs), calcium channel blockers, a-blockers, vasodilators, and centrally acting drugs. It is difficult to achieve the optimized renin angiotensin aldosterone system suppression with currently available antihypertensive agents, because ACE inhibitors, ARBs, and diuretics all activate the compensatory feedback mechanism that increases renin release and increase plasma renin activity. The first orally active direct renin inhibitors (DRIs) were developed in 1980s, including enalkiren, remikiren, and zankiren. However, poor absorption from the gastrointestinal tract, less bioavailability (<2%), short half life, and low potency hindered the development of these compounds. Aliskiren is the first DRI for the treatment of hypertension. Aliskiren is designed through a combination of molecular modeling techniques and crystal structure elucidation. Aliskiren effectively reduces the blood pressure as a mono therapy as well in combination therapy

Orbital floor dermoid: An unusual presentation

Dermoid cysts are developmental abnormal arrangement of tissues and are often evident soon after birth. Its occurrence in the orbit is relatively rare. We report a case of orbital floor dermoid in an 18-year-old female patient who presented with progressive, painless swelling in the lower eyelid associated with mild proptosis of three months duration. The lesion was excised completely, and histopathology confirmed the diagnosis of dermoid cyst

Orbital floor dermoid: An unusual presentation

Dermoid cysts are developmental abnormal arrangement of tissues and are often evident soon after birth. Its occurrence in the orbit is relatively rare. We report a case of orbital floor dermoid in an 18-year-old female patient who presented with progressive, painless swelling in the lower eyelid associated with mild proptosis of three months duration. The lesion was excised completely, and histopathology confirmed the diagnosis of dermoid cyst