Maternal Serum Ferritin Levels and its effect on Cord Blood Hemoglobin in patients with Gestational Diabetes Mellitus

Background Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy that can have harmful impacts on maternal and neonatal outcomes. Literature shows that elevated serum maternal ferritin levels may cause dysregulation in glucose metabolism in GDM. This study aims to determine the association between serum ferritin, iron and hemoglobin levels in GDM patients at the time of delivery as well as cord hemoglobin and iron levels in newborns. Methods In this case-control study, a total of 100 patients were included i.e., 50 cases (GDM) and 50 controls (non-GDM) having aged-matched individuals of normal pregnancy. The hemoglobin, iron and serum ferritin, and hsCRP levels of the mother were determined using maternal blood. A cord blood sample was taken to determine neonatal iron and hemoglobin levels. Results The  study participants mean age  was 29.2 ± 5.6 years. The ferritin levels of GDM mothers (42.3 ± 6.7) were significantly higher than non-GDM patients (34.4 ± 3.8) with p<0.001. Similarly, Cord hemoglobin levels of newborns of GDM mothers were significantly higher than newborns of non-GDM patients (p<0.01). In GDM mothers, maternal ferritin levels were inversely correlated to cord hemoglobin levels (r= - 0.29, p =0.004). Conclusions Elevated maternal serum ferritin levels are linked to increased oxidative stress and effects fetal intrauterine and post-partum health. The placental iron transfer and fetal hemoglobin synthesis will be affected by oxidative stress

PCR-based efficacy assessment of hepatitis B core antibody and hepatitis B surface antigen screening tests in the blood donor population

Objectives: To assess the screening efficacy of HBsAg and HBcAb serological assays in comparison with Polymerase Chain Reaction (PCR), as the gold standard.Methodology: This was a cross-sectional prospective study was conducted from November 2019 to February 2020, at the Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan. A total of 7,550 donations were screened for HBsAg through Chemiluminescence Microparticle Immunoassay. Out of 7,550, 186 HBsAg reactive, and 208 HBsAg non-reactive samples were selected randomly for the study. The screening tests for HBsAg and HBcAb were run in parallel with PCR as the gold standard. In the statistical analyses, the specificity, sensitivity, and positive and negative predictive values were calculated using the PCR results as the gold standard. Kappa agreement was also calculated. Results: A total of 394 blood samples were tested with reactivity rate of HBsAg (n= 186) 47.2% (186/394), HBcAb (n= 210) 53.2% (210/394) and PCR (n= 188) 47.7% (188/394). Kappa agreement for HBsAg and HBcAb were calculated as 0.961 and 0.886 respectively. The results showed 5.5% false positive results by HBcAb test.Conclusion: HBcAb screening showed false-positive results. HBsAg screening found to be the best possible choice that can give credible results, considering the high cost of the molecular assays

Principles and applications of CRISPR toolkit in virus manipulation, diagnosis, and virus-host interactions

Viruses are one of the most important concerns for human health, and overcoming viral infections is a worldwide challenge. However, researchers have been trying to manipulate viral genomes to overcome various disorders, including cancer, for vaccine development purposes. CRISPR (clustered regularly interspaced short palindromic repeats) is becoming one of the most functional and widely used tools for RNA and DNA manipulation in multiple organisms. This approach has provided an unprecedented opportunity for creating simple, inexpensive, specific, targeted, accurate, and practical manipulations of viruses, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus-1 (HIV-1), and vaccinia virus. Furthermore, this method can be used to make an effective and precise diagnosis of viral infections. Nevertheless, a valid and scientifically designed CRISPR system is critical to make more effective and accurate changes in viruses. In this review, we have focused on the best and the most effective ways to design sgRNA, gene knock-in(s), and gene knock-out(s) for virus-targeted manipulation. Furthermore, we have emphasized the application of CRISPR technology in virus diagnosis and in finding significant genes involved in virus-host interactions

Differentiating Axonal from Demyelinating Neuropathies using Multiparametric Quantitative MRI of Peripheral Nerves

Objectives: To develop a multiparametric quantitative MRI (qMRI) method to track pathological changes in the peripheral neuropathies. Background: Irrespective of the causes or types of polyneuropathies, peripheral nerves are mainly afflicted by two kinds of pathologies – axonal loss and demyelination. It is critical to differentiate between the two as treatments are different for the two conditions. While nerve conduction studies (NCS) have been used to differentiate the two pathologies in the distal nerves, there are no tools to probe the pathologies in the proximal peripheral nerves. This is particularly needed when distal nerves become non-responsive in NCS. Methods: We have developed a qMRI method that quantifies the sciatic and tibial nerves with 10 parameters that are sensitive to different aspects of myelin and axonal pathologies: magnetization transfer ratio (MTR), magnetization transfer saturation index (MTsat), longitudinal relaxation time (T1), proton density (PD), effective transverse relaxation time (T2*), fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and nerve fascicular volume (fVol). In this pilot study, we studied 4 patients with Charcot-Marie-Tooth type-1A (CMT1A), 2 patients with CMT type-2S (CMT2S), and 17 healthy controls. Results: Compared with the healthy controls, patients with CMT2S (axonal type) had a comparable MTR, MTsat, T1, PD and fVol, but a reduced T2*. While patients with CMT1A (demyelinating type) had a reduced MTR and MTsat, increased fVol, T1 and PD, and comparable T2*. All 6 patients with CMT shared a change in reduced FA, which was driven by a reduced AD and an increased RD. Conclusions: The data show different qMRI patterns between axonal and demyelinating neuropathies. The differential changes will be further verified in a larger cohort of patients with peripheral neuropathies

Variations in physico-chemical and antioxidant attributes of grape seed oil as function of extraction techniques

The aim of the current research work was to assess and compare the impact of two extraction techniques on the physico-chemical, and antioxidant parameters of grape seed oil (GSO). The GSO extracted by Soxhlet and Folch methods indicated a notable variation in the oil yield (8.58 % and 10.19%) and saponification value (196.35 and 189.33 mg of KOH g-1), respectively. However, no significant (p<0.05) variation was detected for density, acid value, refractive index, iodine no, unsaponifiable matter, and free fatty acids between the tested two oils. Meanwhile, the oil produced by Soxhlet method exhibited relatively a higher extent of unsaturated dienes, trienes, peroxide value, p-anisidine value, and thus poor oxidation state. A notable variation in the content of principal fatty acid (linoleic acid) was recorded between Folch extracted oil (70.11%) and Soxhlet extracted oil (66.57%). The contents of total tocopherols were noted to be considerably higher for Folch extracted oil (105.55 mg kg-1) than the Soxhlet extracted oil (73.70 mg kg-1). Among the individual phenolics analyzed by HPLC, gallic acid (14.02 mg kg-1) and caffeic acid (5.20 mg kg-1) were detected as major component in Folch extracted oil and Soxhlet extracted oil, respectively. The results of the present comparative study support that Folch method is relatively a good choice for the extraction of GSO with promising nutritive quality in terms of oxidation parameters, contents of linoleic acid and antioxidant phenolics

Application of Artificial Intelligence in Medical Education: Current Scenario and Future Perspectives

Introduction: Medical education is a lifetime learning process stretching from undergraduate to postgraduate, specialty training, and beyond. It also applies to various healthcare professionals, including doctors, nurses, and other allied healthcare professionals. Therefore, it is essential to acknowledge the immense role of artificial intelligence in medical education in the current era of rapidly growing technology.Methods: High-quality data that met the study objectives were included. In addition, comprehensive investigations on articles available in reputable databases such as PubMed, Research Gate, PubMed central, Web of Science, and Google Scholar were considered for literature review.Results: Artificial intelligence has fixed various issues in education during the last decade, including language processing,reasoning, planning, and cognitive modelling.Conclusion: It can be used in medical education in the following forms: Virtual Inquiry System, Medical Distance Learning and Management, and Recording teaching videos in medical schools. It can also enhance the value of the non-analytical humanistic aspects of medicine. The goal of this review article was to present the implications of AI in medical education, now and in the coming years

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial