Appendicitis in pregnancy: management

Background:Acute appendicitis is an infrequent, yet one of the commonest surgical emergency encountered in pregnancy. Recorded incidence is about 1:1500 pregnancies. The aim of this study was to determine the risk factors associated with prenatal outcome in acute appendicitis during second and third trimester pregnancies. Open access surgery was done due to non-availability of laparoscopy.Methods:A total of 10 pregnant women who were diagnosed with acute appendicitis between Jan 2011 to Jan 2013 were presented and 7 of them operated by open access surgery.Results: Seven pregnant women who were diagnosed with acute appendicitis were operated upon during late pregnancy. The interval between symptom onset and surgery was the only predictive variable. A longer interval between symptom onset and surgery was associated with appendix perforation than with no appendix perforation. There was a significant difference in the rate of preterm labor (5.1% vs. 1.3%) and the rate of fetal mortality (25% vs. 1.7%) between patients with and without a perforated appendix.Conclusion:Delaying surgery correlates to more advanced disease with an increased risk of perforation. This contributes to an increased risk of further complications, including premature labor or abortion, and to higher maternal complication rates. Prompt diagnosis may improve the prenatal outcome.

Hormonal and non-hormonal oral contraceptives given long-term to pubertal rats differently affect bone mass, quality and metabolism

IntroductionWe investigated the effects of hormonal and non-hormonal oral contraceptives (OCs) on bone mass, mineralization, composition, mechanical properties, and metabolites in pubertal female SD rats.MethodsOCs were given for 3-, and 7 months at human equivalent doses. The combined hormonal contraceptive (CHC) was ethinyl estradiol and progestin, whereas the non-hormonal contraceptive (NHC) was ormeloxifene. MicroCT was used to assess bone microarchitecture and BMD. Bone formation and mineralization were assessed by static and dynamic histomorphometry. The 3-point bending test, nanoindentation, FTIR, and cyclic reference point indentation (cRPI) measured the changes in bone strength and material composition. Bone and serum metabolomes were studied to identify potential biomarkers of drug efficacy and safety and gain insight into the underlying mechanisms of action of the OCs.ResultsNHC increased bone mass in the femur metaphysis after 3 months, but the gain was lost after 7 months. After 7 months, both OCs decreased bone mass and deteriorated trabecular microarchitecture in the femur metaphysis and lumbar spine. Also, both OCs decreased the mineral: matrix ratio and increased the unmineralized matrix after 7 months. After 3 months, the OCs increased carbonate: phosphate and carbonate: amide I ratios, indicating a disordered hydroxyapatite crystal structure susceptible to resorption, but these changes mostly reversed after 7 months, indicating that the early changes contributed to demineralization at the later time. In the femur 3-point bending test, CHC reduced energy storage, resilience, and ultimate stress, indicating increased susceptibility to micro-damage and fracture, while NHC only decreased energy storage. In the cyclic loading test, both OCs decreased creep indentation distance, but CHC increased the average unloading slope, implying decreased microdamage risk and improved deformation resistance by the OCs. Thus, reduced bone mineralization by the OCs appears to affect bone mechanical properties under static loading, but not its cyclic loading ability. When compared to an age-matched control, after 7 months, CHC affected 24 metabolic pathways in bone and 9 in serum, whereas NHC altered 17 in bone and none in serum. 6 metabolites were common between the serum and bone of CHC rats, suggesting their potential as biomarkers of bone health in women taking CHC.ConclusionBoth OCs have adverse effects on various skeletal parameters, with CHC having a greater negative impact on bone strength

Spectral domain optical coherence tomography for measuring tear film meniscus height and its relationship with epiphora

Purpose: To evaluate the relationship between tear meniscus height (TMH) values measured by optical coherence tomography (OCT) and the severity of epiphora (Munk scoring). Methods: In this prospective cross-sectional study, consecutive patients with epiphora were studied. All patients underwent Munk epiphora scoring, lacrimal syringing, and detailed ophthalmological examination. Using OCT, the TMH (i.e., the line intersecting level of tear meniscus and lower eyelid) values were calculated. The relationship between TMH and epiphora was analyzed by comparing TMH values across various grades of epiphora using Kruskal–Wallis test. Results: A total of 38 patients (56 eyes) were included. The mean age was 55 ± 11.1 years with equal distribution of males and females. The mean TMH values were 238 ± 141.3, 396.6 ± 159.5, 707.1 ± 288.8, and 809.5 ± 419.4 μm in grades 1, 2, 3, and 4 of epiphora, respectively. A significant difference in TMH was found among grades 2, 3, and 4 (P = 0.0007). On post hoc analysis, only grade 2 was significantly different from grades 3 and 4 (P = 0.0008 and P = 0.002 respectively), but grades 3 and 4 were comparable (P = 0.62). Conclusion: Levels of TMH were found to increase with increasing severity of epiphora. TMH values were comparable in Munk grades 3 and 4

Nanofibers: A current era in drug delivery system

Nanofibers have a large area of surface variable 3D topography, porosity, and adaptable surface functions. Several researchers are researching nanofiber technology as a potential solution to the current problems in several fields. It manages cardiovascular disorders, infectious diseases, gastrointestinal tract-associated diseases, neurodegenerative diseases, pain treatment, contraception, and wound healing. The nanofibers are fabricated using various fabrication techniques, such as electrospinning, phase separation, physical Fabrication, and chemical fabrication. Depending on their intended use, nanofibers are manufactured using a variety of polymers. It comprises natural polymers, semi-synthetic polymers, synthetic polymers, metals, metal oxides, ceramics, carbon, nonporous materials, mesoporous materials, hollow structures, core-shell structures, biocomponents, and multi-component materials. Nanofiber composites are a good alternative for targeted gene delivery, protein and peptide delivery, and growth factor delivery. Thus, nanofibers have huge potential in drug delivery, which enables them to be used for various applications and can revolutionize these therapeutic areas. This review systematically studied nanofibers' history, advantages, disadvantages, types, and polymers used in nanofiber technology. Further, polymers and their types used in the preparation of nanofibers were summarised. Mainly review article focuses on the fabrication method, i.e., electrospinning and its types. Finally, the article discussed the applications and recent advancements of nanofabrication technology

Urine Zinc-alpha-2-glycoprotein as a potential biomarker for incipient diabetic nephropathy: A pilot study at a tertiary care hospital

Introduction: Urine albumin-creatinine ratio (UACR) continues to be used as ana indicator for detecting diabetic nephropathy (DN); however, damage starts much before that. Currently, no biomarkers are there to indicate incipient damage. As a result, researchers are looking for new biomarkers that could be used to detect DN threats sooner and perhaps hinder the development of end-stage renal disease. The present study intended to know if urine Zinc-alpha-2-glycoprotein (ZAG) levels correlate with glomerular filtration rate (GFR) in the study participants of type 2 diabetes mellitus (T2DM). Materials and Methods: The study included 68 participants with a known history of T2DM. Serum urea and creatinine levels, fasting plasma glucose, serum cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total protein, glycated hemoglobin (HbA1c) and urine ZAG were estimated and UACR along with estimated GFR (eGFR) were calculated for all individuals. The characteristics of the study participants in the microalbuminuric and normoalbuminuric groups were compared. Results: The levels of urine ZAG in the microalbuminuric and normoalbuminuric groups were not observed to be substantially different. The relationship between urine ZAG and diabetes mellitus duration was found to be highly significant in normoalbuminuric patients. Urinary ZAG and correlation with categories of HbA1c % (good 9 poor) among normoalbuminuric individuals were not found to be significant. Conclusion: Despite previous research, we were unable to find a positive relationship between urinary ZAG concentrations and eGFR in this study. Prospective studies with greater sample sizes and follow-up are required to fully comprehend the possible use of ZAG as a biomarker in diabetic nephropathy

Role of FNAC in the diagnosis of cysticercosis

Background and Objectives: Cysticercosis is a common tropical disease. Human cysticercosis is caused by the dissemination of the embryo of Taenia solium in the intestine via the hepatoportal system to the tissues and organs of the body. The organs most commonly affected are the subcutaneous tissues, skeletal muscles, lungs, brain, eyes, liver, and occasionally the heart, thyroid, and pancreas. Fine needle aspiration cytology (FNAC) plays an important role in prompt recognition of this disease. Aims: To study the role of FNAC in the diagnosis of cysticercosis. Methods: Fifteen patients with subcutaneous and intramuscular nodules, who were clinically diagnosed as lipoma, neurofibroma, lymphadenitis, cold abscess, epidermal inclusion cyst, sebaceous cyst, fibroadenoma and cysticercosis were included in the present study. Results: In 4 (26.6%) cases, a definitive diagnosis of cysticercosis was obtained in the form of fragments of parasite bladder wall and, biopsy confirmed the diagnosis. In the rest 11 (73.3%) cases, larval fragments could not be identified on the aspirates and the diagnosis of parasitic inflammation was suggested on the basis of other cytomorphological findings. Follow-up biopsy confirmed the diagnosis of cysticercosis. Conclusions: Cysticercosis is continuing to be a major health problem in developing countries. Fine needle aspiration cytology (FNAC) is cost effective and simple procedure. The cytological diagnosis is quite straightforward in cases where the actual parasite structure is identified in the smears. However, in other cases, presence of eosinophils, histiocytes, a typical granular dirty background are the features which should always alert the pathologist to this possibility

Correlation of thyroid hormone profile with biochemical markers of renal function in patients with undialyzed chronic kidney disease

Objective: The present study was conducted to evaluate the correlation of renal functions with thyroid hormone levels in patients with undialyzed chronic kidney disease (CKD). Literature shows significant alteration in thyroid hormone function tests in CKD patients who are receiving long-standing dialysis treatment. However, not much is described in those receiving conservative management without dialysis. Although CKD is associated with an increased prevalence of primary hypothyroidism, various studies on thyroid hormone status in uremic patients have reported conflicting results. Methodology: Thyroid hormone levels and biochemical markers of renal function were estimated in 30 undialyzed CKD patients and similar number of age- and sex-matched healthy controls, followed by statistical analysis and correlation. Results: Free triiodothyronine (FT3) and free thyroxine (FT4) were found to be significantly reduced (P < 0.001 for each) in undialyzed CKD patients whereas thyroid-stimulating hormone (TSH) levels showed statistically insignificant alteration in both groups. We also observed that urea and creatinine were negatively correlated whereas creatinine clearance was positively correlated with both FT3 and FT4 having high statistical (two tailed) significance with P < 0.001. Nonsignificant correlation was seen between blood urea and TSH (r = 0.236, P = 0.069), creatinine clearance, and TSH (r = 0.206, P = 0.114 Pearson's correlation coefficient). There is just significant positive correlation between the serum creatinine values and TSH (r = 0.248, P = 0.049). Conclusions: Thyroid hormones were significantly decreased in undialyzed CKD patients as compared to healthy controls

Resource-Based Analysis of E-Commerce Business Value

In this study, we developed a set of constructs to measure e-commerce capability in Internet savvy customers. Our study has two dimensions customer awareness and customer experience, which consist of factors such as information, transactions customization and supplier connection. This conceptual framework provides good theoretical platform for empirically grounded research on how customers perceive e-commerce trading. E-commerce is the pre-eminent buzzword of the online business revolution. Electronic commerce is the paper less exchange of business information using electronic data interchange (EDI).This study aims to understand how people view e-commerce as an emerging trend in lieu of their satisfaction and preferences with products, services, safety of personal data etc