Changing Profile of Primary Hyperparathyroidism Over Two and Half Decades: A Study in Tertiary Referral Center of North India.

BACKGROUND: Most of the cases of PHPT in developing countries present in symptomatic stage, some even in very advanced stage but in recent years the trend seems to be changing. This has been corroborated from few recently published literature from developing countries. The scope of this study is to further carry out an in-depth analysis of various clinical and biochemical parameters of PHPT patients at a tertiary care center of northern India. METHODS: In this retrospective analysis, a total of 333 patients with PHPT from the year 1990 to 2016 were studied. The study population was divided into three subgroups based on the time span; 1990-1999 (n = 34), 2000-2009 (n = 112), 2010-2016 (n = 187), and clinical and biochemical parameters were compared. RESULTS: The clinical presentation has evolved progressively with increase in older age group (35 vs 39 vs 43.85, p < 0.001), less patients with musculoskeletal symptoms (85.3 vs 76.8 vs 61%, p = 0.002) and less patients with severe bone disease (29.4 vs 10.7 vs 10.7%, p = 0.088). Biochemical parameters also showed a changing trend with significant decrease in mean S. Alkaline phosphatase (1393 vs 965 vs 414.8 IU/L, p < 0.001) and S. iPTH (837.52 vs 812.89 vs 635.74 pg/mL, p = 0.02). Vitamin D nutrition status is still suboptimal but shows improvement, and more patients are insufficient as compared to previous deficient state (mean S. Vitamin D-10.31 vs 16.16 vs 25.30 ng/mL, p < 0.001). CONCLUSIONS: Our study reveals a change in trend in PHPT which is similar to evolution of this disease in western population and positively corroborated with observations from China, Hong Kong and Turkey.

Long-Term Outcome of Follicular Thyroid Carcinoma in Patients Undergoing Surgical Intervention for Skeletal Metastases.

BACKGROUND: A large proportion of follicular thyroid carcinoma (FTC) patients in developing countries present with overt skeletal metastases (SM). These patients often require surgical interventions for prevention of morbidity, palliation of symptoms, and facilitation of radioiodine therapy (RAIT). Scarce literature is available about the long-term outcome of such patients. The aim of this study was to evaluate the long-term outcome of FTC patients undergoing surgical intervention for SM. METHODS: We retrospectively reviewed the data of FTC patients with SM (January 1990-December 2011). Out of 91 patients with SM, 32 had surgical interventions for SM. All had total thyroidectomy performed. RESULTS: The mean age of the patients was 48.5 years (M:F = 1:2). Majority (93.7%) had synchronous metastases and 22% had multiple SM. The surgical interventions for SM included: laminectomy (50%), resection of skull metastases (18.8%), resection of manubrium sterni (18.8%), partial clavicle excision (9.4%), and hemimandibulectomy (3.1%). The main intents were palliation (50%) and facilitation of RAIT (37.5%). 84% patients received RAIT. Median follow-up was 52 months (mean = 50 ± 37). Five- (56 vs 63%) and 10-year (28 vs 23%) overall survival (OS) did not differ significantly (p = 0.968) from those not having interventions for SM. On univariate analysis tumor invasion (p = 0.006) and synchronous presentation of SM (p = 0.043) were significant risk factors for OS, whereas on multivariate analysis tumor invasion (p = 0.006) was significant. CONCLUSIONS: Surgical interventions directed at SM in FTC patients with overt multiple SM might not result in improve OS. However, considering reasonable long-term survival, interventions should be considered for desired palliation and preservation of body function.

Molecular Characteristics of Large Parathyroid Adenomas.

INTRODUCTION: The clinical entity of large parathyroid adenomas (LPTAs) has not been well defined. It is speculated that LPTAs would have biochemical, histological, and molecular characteristics different from small adenomas. Our study aimed to find out occurrence of atypia and carcinomas in large parathyroid lesions and the presence of distinct molecular abnormalities in LPTAs. MATERIALS AND METHODS: We divided the parathyroid lesions into large (>7 g, i.e., LPTAs) and small (<7 g) adenomas. We performed parafibromin, APC (adenomatous polyposis coli), galectin 3, and PGP9.5 (protein gene product 9.5) analysis by immunohistochemistry in adenomas without atypia, atypical adenomas, and carcinomas. RESULTS: Mean serum calcium, alkaline phosphatase, and intact PTH were significantly higher in large parathyroid tumor group. The presence of both atypical adenoma and carcinoma was higher in large parathyroid tumor group. There was higher percentage of atypia in patients with LPTAs >10 g (33%), and 68% of tumors showed at least one marker suggestive of malignancy in this group. Detailed analysis of immunohistochemical features of LPTA >10 g revealed that six patients showed complete loss of parafibromin immunoreactivity (out of these four showed atypia), while seven showed partial loss. In histopathologically proven malignancy (n = 9), six patients showed complete loss of parafibromin staining, 5 (55%) APC negativity, and 45% showed both galectin 3 and PGP9.5 positivity. Three out of these showed all IHC markers s/o malignancy, and all of them had evidence of metastases or recurrence. 32% of atypical adenoma and 13% of atypical adenoma showed complete loss of parafibromin staining, however none developed metastases or recurrence in follow-up (median follow-up 40 months). Loss of parafibromin staining (complete or partial) was higher in LPTA group (56%) than that in small adenoma (39%); however, it was not statistically significant. APC, galectin 3, and PGP9.5 markers suggestive were higher in LPTA group but were not significant. CONCLUSION: LPTAs may show some morphological and immunohistochemical features suggestive of malignancy and can be considered a separate entity. However, the immunohistochemical markers are unable to clearly segregate those LPTAs that may show premalignant potential. Further, we would like to recommend that LPTAs showing complete parafibromin loss together with atypia should be kept under close follow-up.

A Rare Complication of Left Open Adrenalectomy.

Chyle leakage after left open adrenalectomy is a quite rare complication. We encountered a young male patient who was operated for left adrenal pheochromocytoma, left laparoscopic adrenalectomy converted to open due to dense adhesions. Postoperatively patient developed chylous fluid drainage on day 2. He was managed conservatively with high protein and MCT oil diet. This case highlights the unusual complication of left adrenalectomy surgery and how it can be managed.

Prospective study to compare peri-operative hemodynamic alterations following preparation for pheochromocytoma surgery by phenoxybenzamine or prazosin.

BACKGROUND: Prospective studies comparing the efficacy of selective versus nonselective alpha blockers for preoperative preparation of pheochromocytoma (PCC) are lacking. In this prospective nonrandomized study, we compared the outcome of preoperative preparation with phenoxybenzamine (PBZ) and prazosin (PRZ) in terms of perioperative hemodynamic alterations. METHODS: The study was conducted at a tertiary referral center from July 2010 to December 2012. Thirty-two patients with PCC underwent operation after adequate preparation with PBZ (n = 15) or PRZ (n = 17). Five pediatric and adolescent patients were excluded because of different hemodynamics in this population. Perioperative monitoring was done for pulse rate (PR) and blood pressure(BP) alterations, occurrence of arrhythmias, and time taken to achieve hemodynamic stability. Groups were compared with the Mann-Whitney test, Student's t test, and the χ2 test as applicable. RESULTS: Patients in the two groups were similar in age,gender, 24 h urinary metanephrine and normetanephrine levels, and type of procedure. Patients prepared with PRZ had significantly more intraoperative episodes of transient hypertension (systolic BP ≥ 160 mmHg) and hypertensive urgency (BP >180/110 mmHg) (p 0.02, 0.03, respectively). More patients receiving PRZ suffered from transient severe hypertension (SBP ≥ 220 mmHg) (p 0.03). The PRZ group also had more median maximum SBP (233 mmHg vs PBZ 181.5 mmHg) (p = 0.01) and lesser median minimum SBP (71 mmHg vs PBZ 78 mmHg) (p 0.03). No significant differences were found between the study groups for changes in PR, postoperative BP alterations,occurrence of arrhythmias, and time taken to achieve hemodynamic stability. CONCLUSIONS: PBZ was found superior to PRZ in having fewer intraoperative hemodynamic fluctuations.

Role of telemedicine technology in endocrine surgery knowledge sharing.

INTRODUCTION: This retrospective study was designed to assess the outcome of telemedicine technology supportive of educational collaboration among endocrine surgery peers and its impact on knowledge and skill development. MATERIALS AND METHODS: The study was carried out in the Department of Endocrine Surgery in collaboration with School of Telemedicine and Biomedical Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India, during October 1999-December 2012. Telemedicine activities were divided into various modules (e.g., case/problem-based learning, clinical grand rounds, postgraduate course/continuing medical education/conference). Endocrine surgeons participating in such sessions were divided into two groups (faculty and residents). A multimodule questionnaire was constructed based on a Likert scale (2-7 points) to test various aspects (e.g., technical performance, role in knowledge exchange, skill development, level of satisfaction, and future recommendations). Responses were expressed in proportions, and the chi-squared test was used to find the differences in opinions of the study groups. RESULTS: The questionnaire was sent to 38 surgeons, of whom 36 replied (response rate, 94.74%); of these respondents, 14 were faculty and 22 were residents. More than 80% of participants felt that the technology helped in learning new things and strengthening relations with peers, whereas >90% were of the view that it helped in knowledge exchange and development of skills as well as was helpful in supporting clinical decisions. More than 90% of participants were satisfied and enjoyed using this technology and also were of the opinion that the technology should be integrated into other specialties. Satisfaction with the technology was excellent to good for 94.44% of participants. Both faculty and residents were of the same opinion, and there was no significant difference in their replies. CONCLUSIONS: Knowledge sharing in a collaborative environment using telemedicine technology has been found successful in a low-resource setting and is now adopted in the departmental educational program.

Assessment and spatial distribution of groundwater quality in industrial areas of Ghaziabad, India.

An attempt has been made in this study to evaluate the groundwater quality in two industrial blocks of Ghaziabad district. Groundwater samples were collected from shallow wells, deep wells and hand pumps of two heavily industrialized blocks, namely Bulandshahar road industrial area and Meerut road industrial area in Ghaziabad district for assessing their suitability for various uses. Samples were collected from 30 sites in each block before and after monsoon. They were analyzed for a total of 23 elements, namely, Ag, Al, As, B, Ba, Be, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, P, Pb, Se, U, V, and Zn. In addition to these elements, some other parameters were also studied viz: color, odor, turbidity, biological oxygen demand, chemical oxygen demand (COD), dissolved oxygen, total dissolved solids and total suspended solid. The water quality index was also calculated based on some of the parameters estimated. Out of the 23 elements, the mean values of 12 elements, namely, Al, As, Ca, Cd, Cr, Mg, Mn, Na, Ni, Pb, Se, and U, were higher than the prescribed standard limits. The concentrations (in milligram per liter) of highly toxic metals viz., Al, As, Cd, Cr, Ni, Pb, Se, and U, ranged from 1.33-6.30, 0.04-0.54, 0.005-0.013, 4.51-7.09, 0.14-0.27, 0.13-0.32, 0.16-2.11, and 0.10-1.21, respectively, in all groundwater samples, while the permissible limits of these elements as per WHO/BIS standards for drinking are 0.2, 0.01, 0.003, 0.05, 0.07, 0.01, 0.04, and 0.03 mg L(-1), respectively. The EC, pH, and COD in all samples varied from 0.74-4.21, 6.05-7.72, and 4.5-20.0 while their permissible limits are 0.7 dS m(-1), 6.5-8.5, and 10 mg L(-1), respectively. On the basis of the above-mentioned parameters, the water quality index of all groundwater samples ranged from 101 to 491, and 871 to 2904 with mean value of 265 and 1,174 based on two criteria, i.e., physico-chemical and metal contaminations, respectively while the prescribed safe limit for drinking is below 50. The results revealed that the groundwater in the two blocks is unfit for drinking as per WHO/BIS guidelines. The presence of elements like As, Se, and U in toxic amounts is a matter of serious concern.

Alterations in oxidant/antioxidant balance, high-mobility group box 1 protein and acute phase response in cross-bred suckling piglets suffering from rotaviral enteritis.

Rotaviral enteritis has emerged as a major cause of morbidity and mortality in piglets during their post-natal life. The present study was carried out to examine high-mobility group box 1 (HMGB1) protein, acute phase response and oxidative stress indices in the serum of suckling piglets suffering from enteritis with or without association of porcine group A rotavirus infection. The present investigation utilized 23 clinical cases with signs of acute enteritis and 12 more healthy piglets of a similar age group as control animals. Out of 23 enteritis cases, 12 cases were found to be positive for porcine group A rotavirus infection as confirmed by reverse transcription-polymerase chain reaction (RT-PCR) using specific primers for group A rotavirus, and the rest were found negative. The acute enteritis cases in piglets were associated with an elevated level of HMGB1 protein and serum haptoglobin and ceruloplasmin suggestive of an acute phase response. Among the oxidative stress indices, the concentrations of malondialdehyde (MDA) and nitric oxide (NO) in serum were significantly increased. A pronounced drop of total antioxidant capacity and the activity of antioxidant enzymes such as catalase and superoxide dismutase in the serum of piglets suffering from acute enteritis compared to healthy ones were also noticed. The alterations in HMGB1 protein, acute phase response and oxidative stress indices were more pronounced in cases with the involvement of porcine rotavirus as compared to rotavirus-negative cases. It is concluded that HMGB1 protein, markers of oxidative stress and acute phase proteins might play an important role in the aetiopathogenesis of porcine diarrhoea caused by rotavirus and might be true markers in diagnosing the conditions leading to the extension of the prompt and effective therapeutic care.

Intra-operative parathyroid hormone kinetics and influencing factors with high baseline PTH: a prospective study.

BACKGROUND AND OBJECTIVE: Intra-operative parathyroid hormone (IOPTH) kinetics and therefore the efficacy of IOPTH utilization as a predictor of cure are likely to be affected by baseline IOPTH levels, vitamin D deficiency and parathyroid weight. PATIENTS AND METHODS: Consecutive subjects with primary hyperparathyroidism (PHPT, n = 51) undergoing parathyroidectomy with IOPTH monitoring were studied prospectively during the period October 2009-November 2011. Samples were collected pre-incision, pre-excision and post-excision (5, 10, 15 min). Iterative analysis of IOPTH kinetics and half-life calculation was carried out in subgroups. Nonparametric testing was used for group statistics. RESULTS: Hypovitaminosis D (25(OH)D3 < 50 nm) was present in 39 (76%), serum PTH > 1000 ng/l in 23 (45%), and giant parathyroid adenoma (weight > 3000 mg) in 23 (45%). The percentage drop at 10 min was significantly higher in large adenomas (weight > 3000 mg). Miami and 5 min criteria showed the highest negative predictive value and maximum accuracy. The average percentage IOPTH drop observed at 5 min post-excision was 79.8%. Kinetic analysis showed a mean half-life of PTH of 2.57 ± 0.27 min (range: 0.07-11.55). CONCLUSION: IOPTH monitoring is reliable even in patients with extremely high baseline IOPTH value, with a greater percentage drop at 5 and 10 min post-excision. In patients with high baseline IOPTH, a 50% decay in PTH value at 5 min may be indicative of cure, obviating the need for 10 and 15 min samples. IOPTH kinetics are altered by adenoma weight but not affected by vitamin D status or baseline IOPTH levels.

Quality of life (QoL) in patients with benign thyroid goiters (pre- and post-thyroidectomy): a prospective study.

BACKGROUND: Preservation of quality of life (QoL) seems an important therapeutic goal in patients with benign thyroid diseases. The aim of the present study was to investigate the impact of thyroidectomy on QoL in patients with benign goiters and to assess the significance of various factors affecting the outcome. METHODS: A prospective study consisting of 100 patients with benign goiters was conducted between November 2009 and March 2011. Patients completed a disease-specific ThyPRO questionnaire to assess QoL before and 6 months after thyroidectomy. Preoperative and postoperative scores were compared; and univariate and multivariate analyses were performed. RESULTS: Mean age of the patients was 40.5 years (M:F = 1:4.3); 82 % of the patients had nodular goiters, and the remaining 18 % had diffuse disease. None of the patients had overt thyroid dysfunction at the time they completed the questionnaire. Operative treatment for 54 % of the patients involved total thyroidectomy, whereas 46 % underwent hemithyroidectomy. None of these patients developed any permanent morbidity following surgery. Mean scores of QoL in the 12 domains examined were low and improved significantly (p < 0.001) after surgery: symptoms, 19.4 versus 0.7; fatigue, 29.5 versus 1.5; vitality, 44.4 versus 3.0; memory and concentration, 25.7 versus 1.5; nervousness, 29.6 versus 1.8; psychological well-being, 33.9 versus 1.3; mood swings, 34.9 versus 0.8; relationship, 15.4 versus 1.4; daily activity, 18.7 versus 1.3; sex life, 20.9 versus 1.7; appearance, 14.7 versus 1.0; and overall, 27 versus 5.5. On univariate analysis, weight of goiter was found to be significantly associated with improvement in the scores of the memory and concentration domain (p = 0.03). On multivariate analysis, factors significantly associated with improvement in different domains were young age (nervousness, p = 0.009), female gender (fatigue, p = 0.02), and weight of goiter (symptoms, p = <0.001; vitality, p = <0.001; and memory and concentration, p = <0.001). CONCLUSIONS: Patients with benign goiters experience significant improvement in QoL after thyroidectomy.

Early-Life Intervention of Lactoferrin and Probiotic in Suckling Piglets: Effects on Immunoglobulins, Intestinal Integrity, and Neonatal Mortality.

The aim of this study was to determine the effects of early-life bovine lactoferrin and host specific probiotic interventions on growth performance, mortality, and concentrations of immunoglobulin A and immunoglobulin G and transforming growth factor beta 1 (a marker of intestinal integrity) in serum of neonatal piglets. A total of eight piglet litters from parity matched sows were randomly divided into four groups and assigned to one of the four interventions: control (sterile normal saline), bovine lactoferrin (100 mg bovine lactoferrin), probiotic (1 × 109 colony forming unit (cfu) of swine origin Pediococcus acidilactici FT28 probiotic), and bovine lactoferrin + probiotic (100 mg bovine lactoferrin and 1 × 109 CFU of P. acidilactici FT28 probiotic). All the interventions were given once daily through oral route for first 7 days of life. The average daily gain (p = 0.0004) and weaning weight (p < 0.0001) were significantly improved in the probiotic group. The piglet survivability was significantly higher in bovine lactoferrin and probiotic groups than control group in Log-rank (Mantel-Cox) test. The concentrations of immunoglobulin A on day 21 in bovine lactoferrin, probiotic, and bovine lactoferrin + probiotic groups increased significantly (p < 0.05). Immunoglobulin G concentrations on day 7 and 15 in bovine lactoferrin and bovine lactoferrin + probiotic groups and on day 15 in probiotic group were significantly (p < 0.05) elevated, whereas, the concentration of transforming growth factor-ß1 was significantly (p < 0.05) increased from day 7 to 21 in all the supplemented groups. In conclusion, the early-life bovine lactoferrin and P. acidilactici FT28 probiotic interventions reduced the mortality in the suckling piglets by promoting the systemic immunity and enhancing the intestinal integrity.

Assessment of swallowing function impairment in patients with benign goiters and impact of thyroidectomy: a case control study.

BACKGROUND: Swallowing-related quality of life (QoL) in patients with benign thyroid goiters is not much studied. The aim of this study was to assess swallowing function impairment in patients with benign goiters, compare it to a control population, and also find the impact of thyroidectomy and various factors on the outcome of swallowing function. METHODS: We performed a prospective case-control study from September 2009 to September 2011 which consisted of 124 patients who were to undergo primary thyroid surgery and 100 age- and sex-matched controls. A translated and validated modified swallowing quality-of-life (SWAL-QOL) questionnaire was used to assess patients' perception of dysphagia. Presurgery scores of patients and controls and pre- and postsurgery scores (>6 months after surgery) of patients were compared. RESULTS: The mean age of males and females in the control and patient groups were 37.7 vs. 39.5 years and 37.4 vs. 39.8 years, respectively. Twelve patients (9.7%) complained of dysphasia at presentation. Sixty-three patients (50.8%) underwent total thyroidectomy and 61 (49.2%) had hemithyroidectomy at the time of initial evaluation, 75, 23.4, and 1.6% of patients were euthyroid, hyperthyroid, and hypothyroid, respectively. Presurgery scores of patients in all of the 11 domains of the SWAL-QOL were lower compared to those of controls. Comparing separately with the matched controls, females had significant differences in nine domains (except for sleep and fatigue) of the SWAL-QOL questionnaire but males did not. Postoperatively, both male and female patients showed significant improvement in the scores of all the domains. Female gender, hyperthyroidism, thyroid nodularity, retrosternal extension, procedure, and weight of the resected specimen were the factors associated with significant improvement in various domains. CONCLUSION: Dysphagia seems to be an underestimated problem in patients with benign goiters. Uncomplicated thyroidectomy results in significant improvement in swallowing-related QoL irrespective of patient profile and extent of thyroidectomy.

Medullary thyroid cancer: clinico-pathological profile and outcome in a tertiary care center in North India.

BACKGROUND: Recent advances in genetic screening have ushered in a new era in diagnosis and management of medullary thyroid cancer (MTC). However, the same is not true for a resource-poor country, where clinicians are still struggling to diagnose and adequately manage this relatively uncommon thyroid malignancy. We hereby present our experience of managing MTC at a tertiary care referral center in North India. METHODS: This was a retrospective study conducted between January 1990 and July 2009. Demographics, clinical profiles, details of surgical procedures, and follow-up records were reviewed. RESULTS: A total of 71 patients with MTC were identified. Mean age of this group was 39.9±14.1 years, and men outnumbered women 1.7:1. Some 84.5% of patients had seemingly sporadic MTC, and 15.5% had familial MTC (MEN2a=14.1%, MEN 2b=1.4%). All patients had a thyroid nodule at the time of presentation. Mean tumor diameter was 4.9 cm. Cervical lymphadenopathy, mediastinal lymphadenopathy, extrathyroidal invasion, and distant metastases were present in 59%, 7.2%, 10%, and 4.2% of patients, respectively. Staging showed that 4.8% of patients were stage I, 17.5% stage II, 14.3% stage III, and 63.6% stage IV. Treatment was as follows: 92.6% of patients had total thyroidectomy (primary or secondary); 67.6% central compartment lymph node dissection, 62.3% lateral cervical lymph node dissection, and 7.2% trans-sternal mediastinal lymph node dissection performed. Some 66.7% of patients suffered from persistent hypercalcitoninemia, and 11.4% of those underwent reoperation. The 5-year and 10-year overall survival (OS) was 74.6% and 58%, respectively. CONCLUSIONS: The majority of the patients with MTC presented at stage IVa, contributing to the high rate of persistent hypercalcitoninemia. Despite a policy of observation and intervening only in overtly symptomatic patients with persistent hypercalcitoninemia, overall survival (OS) in our study was comparable to other series, reinforcing the belief that persistent hypercalcitoninemia has an indolent course in most patients.

Functional and probiotic characterization of Ligilactobacillus salivarius CPN60 isolated from calf faeces and its appraisal in rats.

Emerging concern about the emergence of antimicrobial resistance has limited the use of antibiotics in calves. Hence, there is a need to find suitable alternatives to antibiotics to manage gastrointestinal infections in neonatal calves. The objective of the present study was to develop a probiotic of calf-origin for its potential application in calf nutrition. Accordingly, 69 lactic acid bacteria (LAB) strains were isolated from faeces of newborn calves, out of which 10 strains were short-listed for further in vitro testing based on the aggregation time and cell surface hydrophobicity. The results of acid-, bile- and phenol-tolerance tests indicated that out of the ten strains, the isolate CPN60 had better resistance to these adverse conditions likely to be encountered in the gastrointestinal tract. The isolate also showed an optimal ability to produce biofilm. Further assessments reiterated its superiority in terms of co-aggregation and antagonistic activity against pathogenic strains of Escherichia coli. Subsequently, the isolate was identified through 16S rRNA sequencing and sequence homology and designated as Ligilactobacillus salivarius CPN60. The candidate probiotic was evaluated in vivo using 48 male (5 weeks old) Wistar rats, divided into two equal groups viz. control (CON) and probiotic (PRO). During the 4-weeks feeding trial, the PRO group rats were gavaged with one mL culture of L. salivarius CPN60 equivalent to 108 CFU/rat. The in vivo trial results indicated better nutrient utilization efficiency and growth performance (p < 0.001) of the PRO group of rats. The probiotic supplementation improved the faecal concentration of lactate (p < 0.001) and individual as well as total short-chain fatty acids (p < 0.001) production. The cell-mediated immune response, assessed as a delayed-type hypersensitivity reaction to phytohaemagglutinin-P, was improved (p < 0.001) in PRO compared to the CON rats. It is concluded that the calf-origin probiotic L. salivarius CPN60, in addition to possessing all the in vitro functional attributes of a candidate probiotic, also has desirable potential for its future use in young calves to promote gut health and immunity.

Long-term outcome of differentiated thyroid carcinoma: experience in a developing country.

BACKGROUND: The presentation and outcome of differentiated thyroid carcinoma (DTC) in developing countries are different from the developed nations. We report the clinicopathologic profile and long-term outcome of DTC in an iodine-deficient area (IDA) in a developing country. METHODS: This retrospective study included 302 patients with DTC operated between 1989 and 2002. These patients had been followed up for a minimum period of 5 years after surgery. Clinicopathological profile, intervention, and follow-up details were noted. RESULTS: Mean age of the patients was 42 +/- 14 years. Mean follow-up period was 80 +/- 34 (24-196) months. Papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), and poorly differentiated thyroid carcinoma (PDTC) was present in 62, 30, and 8% patients, respectively. Mean tumor size was 3.5 cm. Tumor multicentricity was noted in 40% of PTC, 22.2% of FTC, and 25% of PDTC patients. Lymphadenopathy was observed in 45, 10, and 67% patients with PTC, FTC, and PDTC, respectively. Extrathyroidal invasion and distant metastasis were observed in 36.8% (PTC 33%; FTC 36%; PDTC 71%) and 27% (PTC 17%; FTC 44%; PDTC 42%) of cases, respectively. Twenty percent of patients had synchronous metastases. Risk stratification ratio was 1:1.8 (high-risk vs. low-risk). Initial operative procedure was total thyroidectomy in 86.5% cases, and therapeutic lymph node dissection was performed in 37% cases. A total of 77.2% patients received adjuvant radioiodine therapy. Disease recurred in 26.6% of patients (thyroid bed recurrence 1.7%), and 21.2% patients died during follow-up. Overall survival (OS) rate at 10 years in both low-risk and high-risk groups of FTC (80 and 54%) was inferior to PTC (94 and 62%). Five-year OS for PDTC was 50%. Tumor multicentricity was a significant risk factor for OS in the low-risk group, whereas the presence of skeletal metastases and extrathyroidal invasion were significant factors for OS in the high-risk group. CONCLUSIONS: Advance stage at presentation and proportionately high rates of FTC and PDTC contribute to poor outcome of DTC in developing countries. Despite dismal outcome, total thyroidectomy seems to prevent thyroid bed recurrence in surviving patients.

Assessment of Prescription Medications for Indoor Patients and Effect of Interventions in a Medical College Hospital.

Introduction: Bharati Vidyapeeth University Medical College Hospital and Research Centre in Pune, India has been a pioneer institute with 831 beds, with learned faculty, residents, and trained nursing and supportive staff. Top management decided to further improve quality and safety in patient care and accordingly felt the need to acquire accreditation under the banner of National Accreditation Board for Hospitals and Healthcare Providers (NABH). As a first step toward this, a quality assurance department was established and entrusted with the task to identify areas needing improvement. "Prescription profile of medications" was identified as one of the core areas needing improvement as medication errors are mostly due to faulty prescriptions. The aim of this study was to measure the compliance of indoor patient prescriptions towards standard guidelines. Methods: Top management of the hospital envisaged that preparing for NABH accreditations would be one of the tools for improving patient safety and quality. Hence, in addition to a quality assurance department, a separate department of clinical pharmacy and pharmacovigilance was also established, specifically to take care of medication safety, including prescription profile. Interventions were designed based on observations in the preintervention phase. Interventions included regular monitoring of prescriptions, medication safety, and repeated training sessions for physicians by the department of clinical pharmacy and quality assurance. Results: Compliance by physicians regarding most of the components of prescriptions showed improvement. There has been a substantial reduction in medication errors (in patient days). Conclusion: The improvement in compliance of components of prescriptions and reduction in medication errors was attributable to applied interventions.

Magnetically recyclable catalytic nanoparticles grafted with Bacillus subtilis ß-glucosidase for efficient cellobiose hydrolysis.

This study reports covalent immobilization of ß-glucosidase (BGL) from Bacillus subtilis PS on magnetically recyclable iron nanoparticles for enhancing robustness, facile recovery and reuse of enzyme. Immobilized BGL iron nanoparticles (BGL-INPs) were characterized by various biophysical techniques viz. TEM, DLS, FTIR and CD spectroscopy. The efficiency and yield of immobilization were 89.78 and 84.80%, respectively. After immobilization, optimum pH remained 6.0 whereas optimum temperature upraised to 70 °C whereas apparent Km and Vmax shifted from 0.819 mM to 0.941 mM and 54.46 to 57.67 µmole/min/mg, respectively. Immobilization conferred lower activation energy and improved pH and thermal stabilities. The BGL-INPs retained 85% activity up to 10th cycle of reuse and hydrolyzed more than 90% of cellobiose to glucose within 30 min. Conclusively, improved pH, thermal stability and excellent reusability over free enzyme make BGL-INPs a promising candidate for sustainable bioethanol production and other industrial applications.

In ovo Administration of Nucleosides Improved the Performance, Apparent Metabolizable Energy and Gut Development in Broiler Chickens.

An in ovo study on the effect of the administration of a combination of nucleosides (25, 50, and 100 mg/egg) on hatchability, growth performance, energy metabolizability, and intestinal morphology in broilers was carried out. Four hundred eighty (480) fertile eggs were divided into four groups (in four replicates each having 30 eggs). On the 18th days of incubation of the eggs, candling was carried out and the fertile eggs were selected and given one of the four in ovo administrations. Group one served as control and was injected with phosphate-buffered saline (PBS). The other groups were given in ovo administration of nucleosides (25, 50, and 100 mg/egg) at 100 µl through the yolk sac route, and chicks of respective groups were hatched out. Among the experimental groups, the hatchability was comparable; however, the hatchability was affected in the group injected with a higher level of nucleosides at 100 mg/egg. The hatched out chicks from higher doses of nucleosides (50 and 100 mg) had higher body weight (BW) (P < 0.05) than the control. Higher energy metabolizability (%) was observed in nucleoside-injected groups. Plasma protein concentration was higher in groups administered with nucleosides (50 and 100 mg). Histologically, the intestinal villi length was maximum in 100 mg-injected group followed by 50 and 25 mg. Relative expression of homeobox (Cdx) in the jejunum was significantly (P < 0.05) upregulated in all the injected groups at 3, 7, and 14 days of age. Nucleoside-administered groups had better performance, energy metabolizability, and intestinal morphology. Among the experimental groups, the administration of nucleosides at 50 mg/egg resulted in higher growth performance, plasma protein, intestinal surface, and villi development in broiler chickens.

Prevalence of hypothyroidism in benign breast disorders and effect of thyroxine replacement on the clinical outcome.

BACKGROUND: The aim of this study was to determine the prevalence of hypothyroidism in patients with benign breast disorders (BBD). We then asked if thyroxine replacement in hypothyroid patients has any impact on the clinical outcome of the BBD. METHODS: This prospective study included 201 women with BBD. None of the included patients had previously suspected hypothyroidism. Clinical, laboratory, and follow-up details of the patients were noted. Baseline serum thyroxine, thyroid-stimulating hormone (TSH), and prolactin estimation was done in all cases. Thyroid peroxidase antibody (TPOAb) estimation was done in hypothyroid patients and/or patients with a goiter. In addition to the standard conservative management protocol, hypothyroid patients were given thyroxine replacement therapy. Their response to treatment was assessed at 3-month intervals. The clinical outcomes of euthyroid and hypothyroid groups were compared. RESULTS: The mean age of the patients was 34 +/- 8 years, and the mean length of follow-up was 13.0 +/- 4.2 months. The overall prevalence of hypothyroidism was 23.2% (nipple discharge 37%, mastalgia 23%, lump/lumpiness 17.4%). The rate of hypothyroidism and the mean serum TSH concentration were significantly higher among patients with nipple discharge than among those with mastalgia (P = 0.001) or a lump (P = 0.01). In all, 39% of hypothyroid women had TSH concentrations >10 mIU/l, and 53% had an elevated TPOAb titer. BBD symptoms were alleviated in 83% of the hypothyroid patients with only thyroxine replacement. The final clinical outcomes of hypothyroid patients with nipple discharge and mastalgia were significantly better than that of their euthyroid counterparts (P = 0.028 and 0.001, respectively); no significant difference was noted in patients with lumpiness (P = 0.144). CONCLUSIONS: All women with BBD should be screened for hypothyroidism because the prevalence of hypothyroidism is high among this group and correction of hypothyroidism results in significant clinical improvement of BBD in most of these patients.

Efficacy of species-specific probiotic Pediococcus acidilactici FT28 on blood biochemical profile, carcass traits and physicochemical properties of meat in fattening pigs.

The present study investigates the influence of supplementing Pediococcus acidilactici strain FT28 on serum biochemistry, carcass and physicochemical properties of meat in fattening pigs. A total of 36 piglets (28day) were randomly divided into three groups of four replicates of three animals in each. Each group was fed one of the experimental diet as basal diet alone (Control-T0); basal diet supplemented with Pediococcus acidilactici strain FT28 (swine origin probiotic-T1) and basal diet supplemented with Lactobacillus acidophilus NCDC-15 (dairy origin probiotic-T2). Increased (P<0.05) level of serum total protein and albumin, and decreased (P<0.05) triglyceride were observed with probiotic supplementation either of swine or dairy origin, compared to control. The level globulin and glucose were higher (P<0.05) in T1 group among the dietary groups. Carcass traits remained unaltered except for the weight of ham, kidney and spleen which were higher (P<0.05) in the T1 group. Water holding capacity and TBARS were improved (P<0.05) in the T1 group than control, however comparable to the T2 group. The ether extract, pH and sensory attributes (juiciness and appearance) were improved (P<0.05) in the T1 group among the dietary groups. It is evident from the present study that P. acidilactici FT28 could serve as probiotic for enhancing carcass quality and physicochemical properties of pork without influencing the blood metabolites.