Impact of USMLE Step 1 transition to pass/fail scoring system on medical students' anxiety, sleep quality, and burnout.

INTRODUCTION: Originally designed to evaluate the application of foundational scientific knowledge in clinical contexts, the United States Medical License Exam (USMLE) Step 1 evolved into a comparative tool for assessing candidates with similar educational foundations. This transition heightened the pressure on medical students to excel in the exam. In response, collaborative efforts involving the National Board of Medical Examiners prompted a change from reporting scores to a pass/fail system. The true impact of this shift remains insufficiently explored. This study aims to assess the emotional toll - encompassing burnout, anxiety, depression, and sleep quality - experienced prior to taking the Step 1 exam. Additionally, it aims to uncover potential gender-based disparities in perceived anxiety and depression. METHODS: The study encompasses the entirety of third-year medical students at Drexel University College of Medicine, who were invited to participate in a comprehensive survey. Drawing from retrospection, the survey relies on self-reported data regarding anxiety, depression, sleep quality, and burnout. Data compilation was anonymized and executed via Qualtrics platform. RESULTS: A total of 102 medical students completed the survey, with a 97% pass rate for the USMLE Step 1. Despite their excellent performance, 75% of students reported inadequate sleep quality, and 68% exhibited mild to moderate anxiety levels. Among them, a higher percentage of females (83%) experienced anxiety compared to their male counterparts (50%). Furthermore, 66% of students felt that their commitment to education exceeded what was reasonable for their well-being. CONCLUSIONS: The transition from traditional scoring to a pass/fail system was ostensibly intended to enhance the mental well-being of medical students. Nevertheless, our findings underscore that students continue to endure heightened levels of stress, anxiety, and burnout during the pivotal month leading up to the Step 1 examination.

Hysterectomy Profile in King Edward Memorial Hospital, Pune, India: Indications, Routes of Surgery, and Complications.

Introduction Hysterectomy is the most common procedure performed in females worldwide in response to a variety of indications. Abdominal and vaginal hysterectomies are the most common routes preferred but laparoscopic hysterectomy is one of the minimal access methods that are being used more often for hysterectomies. Additionally, there are numerous postoperative complications associated with hysterectomies; therefore, the goal of the present study was to determine the indications, commonly preferred routes of surgery, and associated postoperative complications in hysterectomy. Methodology A prospective observational study was carried out for 14 months in 2018 and 2019. Based on the selection criteria 120 patients who underwent hysterectomy were recruited for the study in which indications for hysterectomy, route of surgery, and associated postoperative complications were assessed. Results The age range of 36-45 accounted for the greatest number of hysterectomies consisting of 47 patients (39.2%) out of 120 participated. Hypertension was the most commonly associated comorbidity in 33 patients (27.5%). The most common indication for hysterectomy was a fibroid in 34 (28.3%) patients and the most preferred route of surgery was through the abdomen in 52 (43.3%) patients. The postoperative complications were more in peripartum hysterectomy and least in vaginal hysterectomy. Conclusion Although hysterectomy is frequently performed to enhance quality of life, it can also be a life-saving treatment. As there is a chance of problems with any surgical operation, the indication needs to be carefully considered. Since there are now a lot of conservative methods available for treating benign gynecological disorders, it is wise to talk to the patient about her options before deciding to remove her uterus surgically.

Clinical covariates that improve the description of high dose methotrexate pharmacokinetics in a diverse population to inform MTXPK.org.

The MTXPK.org webtool was launched in December 2019 and was developed to facilitate model-informed supportive care and optimal use of glucarpidase following the administration of high-dose methotrexate (HDMTX). One limitation identified during the original development of the MTXPK.org tool was the perceived generalizability because the modeled population comprised solely of Nordic pediatric patients receiving 24-h infusions for the treatment of acute lymphoblastic leukemia. The goal of our study is to describe the pharmacokinetics of HDMTX from a diverse patient population (e.g., races, ethnicity, indications for methotrexate, and variable infusion durations) and identify meaningful factors that account for methotrexate variability and improve the model's performance. To do this, retrospectively analyzed pharmacokinetic and toxicity data from pediatric and adolescent young adult patients who were receiving HDMTX (>0.5 g/m2 ) for the treatment of a cancer diagnosis from three pediatric medical centers. We performed population pharmacokinetic modeling referencing the original MTXPK.org NONMEM model (includes body surface area and serum creatinine as covariates) on 1668 patients, 7506 administrations of HDMTX, and 30,250 concentrations. Our results support the parameterizations of short infusion duration (<8 h) and the presence of Down syndrome on methotrexate clearance, the parameterization of severe hypoalbuminemia (<2.5 g/dL) on the intercompartmental clearance (Q2 and Q3), and the parameterization of pleural effusion on the volume of distribution (V1 and V2). These novel parameterizations will increase the generalizability of the MTXPK.org model once they are added to the webtool.

Deep Learning Diagnosis and Classification of Rotator Cuff Tears on Shoulder MRI.

BACKGROUND: Detection of rotator cuff tears, a common cause of shoulder disability, can be time-consuming and subject to reader variability. Deep learning (DL) has the potential to increase radiologist accuracy and consistency. PURPOSE: The aim of this study was to develop a prototype DL model for detection and classification of rotator cuff tears on shoulder magnetic resonance imaging into no tear, partial-thickness tear, or full-thickness tear. MATERIALS AND METHODS: This Health Insurance Portability and Accountability Act-compliant, institutional review board-approved study included a total of 11,925 noncontrast shoulder magnetic resonance imaging scans from 2 institutions, with 11,405 for development and 520 dedicated for final testing. A DL ensemble algorithm was developed that used 4 series as input from each examination: fluid-sensitive sequences in 3 planes and a sagittal oblique T1-weighted sequence. Radiology reports served as ground truth for training with categories of no tear, partial tear, or full-thickness tear. A multireader study was conducted for the test set ground truth, which was determined by the majority vote of 3 readers per case. The ensemble comprised 4 parallel 3D ResNet50 convolutional neural network architectures trained via transfer learning and then adapted to the targeted domain. The final tear-type prediction was determined as the class with the highest probability, after averaging the class probabilities of the 4 individual models. RESULTS: The AUC overall for supraspinatus, infraspinatus, and subscapularis tendon tears was 0.93, 0.89, and 0.90, respectively. The model performed best for full-thickness supraspinatus, infraspinatus, and subscapularis tears with AUCs of 0.98, 0.99, and 0.95, respectively. Multisequence input demonstrated higher AUCs than single-sequence input for infraspinatus and subscapularis tendon tears, whereas coronal oblique fluid-sensitive and multisequence input showed similar AUCs for supraspinatus tendon tears. Model accuracy for tear types and overall accuracy were similar to that of the clinical readers. CONCLUSIONS: Deep learning diagnosis of rotator cuff tears is feasible with excellent diagnostic performance, particularly for full-thickness tears, with model accuracy similar to subspecialty-trained musculoskeletal radiologists.

Dyslipidaemia and inflammatory markers as the risk predictors for cardiovascular disease in newly diagnosed premenopausal hypothyroid women.

Background: Hypothyroidism can predispose systolic and diastolic cardiac dysfunction, increased peripheral vascular resistance, endothelial dysfunction, altered coagulopathy, and dyslipidemia resulting in atherosclerosis. Thyroid hormones can influence homocysteine metabolism by regulating the methylenetetrahydrofolate reductase (M THR). So, this study aimed to compare the markers homocysteine, high sensitive C-reactive protein (hs-CRP), and Atherogenic Indices (AI) between newly diagnosed hypothyroid and euthyroid premenopausal women. Methods: 80 Female patients between 20 and 45 years were enrolled in this study and were equally divided into cases and controls group. Laboratory tests included: i) Serum T3, T4, TSH was measured using electrochemiluminescence, ii) lipid profile, homocysteine, and hs-CRP were measured for all the participants. Atherogenic indices: Castelli risk indices I&II, Atherogenic coefficient (AEC), and Atherogenic Index of Plasma (AIP) were calculated using formulas. A comparison between the study groups was made by using the Independent t-test and Mann-Whitney U test. p-value < 0.05 was considered significant. Results: The hypothyroid group had significantly higher levels of homocysteine (p= 0.014), and hs-CRP (hs-CRP> 3.0 mg/L, 70% of participants have intermediate to high risk for a cardiovascular event) and elevated BMI compared to participants in the euthyroid group. Atherogenic indices (p< 0.001) was significantly increased in the hypothyroid participants' group. TC, TG , and LDL were significantly elevated in the hypothyroid group but did not show any association with systolic and diastolic blood pressure. Conclusions: Premenopausal women with hypothyroidism have a greater predisposition for cardiovascular disease compared to euthyroid.

Factors influencing burnout in millennial medical students during the COVID-19 pandemic!

BACKGROUND: Burnout among millennial medical students is an important health issue with a possibility of potential professional dissatisfaction. The reason for burnout is multifactorial. The gender of the medical student may play a significant role when choosing a residency specialty and making a career choice. Gender may also influence while establishing the burnout seen in students. Here we tested the association between burnout in medical students based on gender and residency specialty choice during COVID-19. METHODS: A multicentric cross-sectional study, using a questionnaire-based survey on the items related to gender, educational interest, status, residency aspiration, changes to career aspiration based on gender, and COVID-19 and an indigenous burnout assessment tool that was administered to all the medical students in the study. Reliability and validity of the tool were assessed, and the burnout was calculated for emotional exhaustion, personal achievement, and depersonalization domain. RESULTS: A total of 487 medical students (42.5% males, 57.2% females) completed the survey. A higher number of female participants felt that COVID-19 affected their energy levels (68.9%), interest in education (53.2%), and developed reservations about residency specialty of choice (46%); emotional and physical exhaustion (2.88 ± 0.69 & 2.34 ± 0.76) was higher than the male participants (3.16 ± 0.67 & 2.75 ± 0.85). CONCLUSION: More female participants experienced emotional distress, depersonalization or professional disengagement, and psychological and physical stress and exhaustion due to the COVID-19 pandemic. An important association observed in the study was between residency choice and burnout.

VARK preference and perception of online versus offline professional development training of medical laboratory technologists.

OBJECTIVE: This study aims to understand the learning preferences and perception of medical laboratory technologists on sudden shift from offline to online training sessions during COVID-19 pandemic. METHODS: Microsoft form containing twenty-four questions was circulated to the twenty-five laboratory technologists after 1 year of online continuous professional development training. VARK questionnaire was circulated to understand the learning style. RESULTS: Provision of recording lectures, significant reduction of performance anxiety, anxiety associated with criticism, and QA sessions emerged as the major positive aspects of a virtual training platform. Analysis of learning preferences revealed that most technologists had a unimodal aural (45%) or kinesthetics (33%) than visual (11%) and reading (11%) learning preference. In bimodal learning preference, AK (44.44%) emerged as the predominant form. Forty percent of the technologists showed trimodal learning pattern with 50% among them showing an ARK pattern while 25% each showing VAK and VRK patterns of learning preferences. CONCLUSION: Medical laboratory technologists adapted well to the sudden shift from offline to online continuous development programs. However, efficient managerial mechanisms to address the major perceived hurdles and designing a multimodal training module to accommodate the learning preferences of our technologists can ensure enthusiastic participation and effective learning among medical laboratory technologists.

Variability in Platelet-Rich Plasma Preparations Used in Regenerative Medicine: A Comparative Analysis.

Background: Platelet-rich plasma (PRP) and its derivatives are used in several aesthetic, dental, and musculoskeletal procedures. Their efficacy is primarily due to the release of various growth factors (GF), interleukins, cytokines, and white blood cells. However, the PRP preparation methods are highly variable, and studies lack consistency in reporting complete procedures to prepare PRP and characterize PRP and its derivatives. Also, all the tissue-specific (in vivo and in vitro) interactions and functional properties of the various derivatives/factors of the PRP have not been taken into consideration by any study so far. This creates a potential space for further standardization of the PRP preparation methods and customization of PRP/PRP derivatives targeted at tissue-specific/pathology specific requirements that would enable efficacious and widely acceptable usage of PRP as main therapy, rather than being used as adjuvant therapy. The main objective of our study was to investigate the variability in PRP preparation methods and to analyze their efficacy and reliability. Method: This study considered articles published in the last 5 years, highlighting the variability in their PRP preparation methods and characterization of PRP. Following the PRISMA protocol, we selected 13 articles for the study. The selected articles were assessed using NHLBI quality assessment tool. Results: We noted differences in (1) approaches to producing PRP, (2) extent of characterization of PRP, (3) small scale and large-scale preparation methods, (4) in vitro and in vivo studies. Conclusion: We identified two studies describing the procedures which are simple, reproducible, economical, provide a good yield of platelets, and therefore can be considered methods for further tissue-specific and pathology-specific standardizations of PRP and its derivatives. We recommend further randomized studies to understand the full therapeutic potential of the constituents of PRP and its derivatives.

Prevalence of Dental Caries With Salivary Assessment in Six to Twelve Years Old School-Going Children in Shahpura Tehsil, Jaipur.

Introduction Dental caries is a chronic, infectious, and irreversible disease of the calcified tissues of teeth, which demineralises the inorganic portion and destroys the organic substance of the tooth, which often leads to cavitation. Epidemiological studies measuring the prevalence and severity of dental caries have used modified versions of Klein and colleagues' decayed, missing, and filled (DMF) or Gruebbel's decayed, extraction indicated, and filled (def) indexes; however, these indexes only capture cavitated lesions. Saliva plays a vital role in caries prevention; significant reduction or deterioration of salivary function can aggravate the development of dental caries. Saliva affects the incidence of dental caries in four ways: as a mechanical cleansing agent that results in less accumulation of plaque, by reducing enamel solubility using calcium, phosphate, and fluoride, by buffering and neutralising the acids produced by cariogenic organisms, or by introducing directly through diet and by antibacterial activity. The study aims to assess the prevalence of dental caries and salivary parameters such as salivary pH, flow, and buffering capacity in six to 12 years old children of a rural tehsil of Jaipur. Materials and methods The study was done on a population consisting of 400 school-going children in the age group of six to 12 years. Oral examination was undertaken by a single examiner, who is the study's principal investigator, to avoid inter-examiner variability. Testing of resting saliva was done for evaluation of visual inspection of the level of hydration, saliva consistency, pH measurement, saliva quantity, and buffering capacity. Statistical analysis The data were analysed using the chi-square test, t-test, and statistical software SPSS version 17.00 (SPSS Inc., Chicago, IL). The chi-square test was used to compare and analyse qualitative data, whereas the unpaired t-test was used to analyse and compare quantitative data. Quantitative data were summarised as mean and standard deviation. A p-value of 0.001 or less was considered for standard significance. Results There was no significant difference in resting salivary flow rate between children with decayed, missing, and filled teeth (DMFT) scores less than 5 and DMFT scores of 5. The mean buffering capacity of stimulated saliva was found to be significantly more among children with DMFT scores less than 5 than children with DMFT scores of 5 or more. The mean pH of resting saliva was found to be significantly higher among children with DMFT scores less than 5 than children with DMFT scores of 5 or more. Conclusion The prevalence of caries based on age was maximum in mixed dentition and minimum in primary dentition. In contrast, the difference in severity based on age was maximum in permanent dentition. The prevalence of caries was higher in children whose parents were aware of dental health; the difference was more significant in children with primary and mixed dentition. This study showed that salivary parameters such as salivary flow rate, salivary pH, and salivary buffering capacity among school-going children correlated with the prevalence of caries.

Targeting the complement system in pancreatic cancer drug resistance: a novel therapeutic approach.

Pancreatic cancer is ranked as the fourth leading cause of cancer-related mortality and is predicted to become the second leading cause of cancer-related death by 2030. The cause of this high mortality rate is due to pancreatic ductal adenocarcinoma's rapid progression and metastasis, and development of drug resistance. Today, cancer immunotherapy is becoming a strong candidate to not only treat various cancers but also to combat against chemoresistance. Studies have suggested that complement system pathways play an important role in cancer progression and chemoresistance, especially in pancreatic cancer. A recent report also suggested that several signaling pathways play an important role in causing chemoresistance in pancreatic cancer, major ones including nuclear factor kappa B, signal transducer and activator of transcription 3, c-mesenchymal-epithelial transition factor, and phosphoinositide-3-kinase/protein kinase B. In addition, it has also been proven that the complement system has a very active role in establishing the tumor microenvironment, which would aid in promoting tumorigenesis, progression, metastasis, and recurrence. Interestingly, it has been shown that the downstream products of the complement system directly upregulate inflammatory mediators, which in turn activate these chemo-resistant pathways. Therefore, targeting complement pathways could be an innovative approach to combat against pancreatic cancer drugs resistance. In this review, we have discussed the role of complement system pathways in pancreatic cancer drug resistance and a special focus on the complement as a therapeutic target in pancreatic cancer.

Ovarian follicular dynamics, hormonal profiles and ovulation time in Mithun cows (Bos frontalis).

The study aimed to evaluate follicular dynamics and concentrations of estradiol-17ß (E2), progesterone (P4), follicle stimulating hormone (FSH) and luteinizing hormone (LH) during the oestrous cycle and to determine ovulation time in Mithun cows. Ovaries of experimental cows (n = 7) were examined daily by transrectal-ultrasonography for three consecutive oestrous cycles (n = 21). The characteristics of follicular waves, dominant follicle, largest subordinate follicle and corpus luteum and ovulation time were evaluated. The plasma samples were analysed throughout the interovulatory interval to determine the differences in the hormonal profiles (E2, P4, FSH and LH) between different follicular wave cycles. Out of eighteen oestrous cycles analysed, three-wave follicular cycles were maximum (n = 12: 66.66%) followed by two (n = 4: 22.22%) and four waves (n = 2: 11.11%). The two and three waves were statistically compared, and no significant (p > .05) differences were observed in day of wave emergence, number of follicles (≥3 mm) recruited, maximum diameter of the ovulatory dominant follicle, growth rates of ovulatory and anovulatory dominant follicles and maximum diameter of corpus luteum. The diameter of dominant follicles was significantly (p < .05) greater than subordinate follicles in both ovulatory and anovulatory waves. No significant differences were observed in peak concentrations of estradiol-17ß and follicle stimulating hormone between ovulatory and anovulatory waves in all wave cycles. A preovulatory luteinizing hormone surge was observed a day before ovulation in all wave cycles. Progesterone concentrations were lower than 0.5 ng/ml during oestrus and increased sharply to the maximum levels of ≥3.8 ng/ml in all wave cycles. Ovulation time (mean ± SEM), irrespective of follicular waves was 10.5 ± 0.64 h after the end of oestrus. It was concluded that Mithun cows have a preponderance of three follicular waves with little difference between the two- and three-follicular waves and ovulation occurred 10.5 h after the end of oestrus.

Time in range, as measured by continuous glucose monitor, as a predictor of microvascular complications in type 2 diabetes: a systematic review.

Continuous glucose monitoring (CGM)-derived time in range (TIR) correlates with hemoglobin A1c (A1c) among patients with type 2 diabetes mellitus (T2DM); however, there is a paucity of data evaluating its association with microvascular complications. We conducted this systematic review to examine the association between TIR and microvascular complications of diabetic retinopathy (DR), diabetic nephropathy (DN), and diabetic peripheral neuropathy (DPN). We conducted a comprehensive literature search on PubMed, Scopus, and Web of Science online databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text original articles that evaluated the association between CGM-derived TIR and risk of microvascular complications and were published between 2010 and June 2021 were included in our systematic review. The quality of the included studies was evaluated using the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were analyzed using qualitative synthesis. Eleven studies on a total of 13 987 patients were included in the systematic review. The median sample size, baseline A1c, and diabetes duration were 466 patients (range: 105-5901), 8.2% (SD 0.5%), and 11.3 years (1.0), respectively. Majority of the studies were conducted in Asia (10 out of 11). Four studies evaluated the relationship between CGM-derived TIR and DR and CGM-derived TIR and DN, while seven studies evaluated the relationship between CGM-derived TIR and DPN. A 10% increase in TIR was associated with a reduction in albuminuria, severity of DR, and prevalence of DPN and cardiac autonomic neuropathy. In addition, an association was observed between urinary albumin to creatinine ratio but not with estimated glomerular filtration rate. This review summarizes recent evidence supporting an association between CGM-derived TIR and microvascular complications among patients with T2DM. A larger-scale multicenter investigation that includes more diverse participants is warranted to further validate the utility of TIR as a predictor of diabetic microvascular complications.

Aortic clamping for limiting blood loss at cesarean hysterectomy for placenta percreta: A case series.

OBJECTIVE: In women with placenta percreta, cesarean hysterectomy is associated with massive blood loss during dissection of bladder from lower uterine segment. We studied the safety and effectiveness of temporary aortic clamping as a method of limiting blood loss at cesarean hysterectomy in women with placenta percreta. METHODS: This was a retrospective case series of 15 women with placenta percreta who underwent cesarean section with total hysterectomy at KEM Hospital, Pune, India, with a technique of temporary clamping of the infra-renal aorta for reducing blood loss during hysterectomy. RESULTS: Fifteen women with placenta percreta underwent classical cesarean section followed by total hysterectomy with temporary clamping of the aorta. The procedure was associated with median estimated intra-operative blood loss of 650 ml. No woman had ureteric injury or needed post-operative intensive care. Aortic clamping for 28-70 min was not associated with any intra-operative vascular complications or post-operative ischemic lesions in the lower limbs, kidneys, or bowel. CONCLUSION: Aortic clamping safely and effectively limited blood loss during cesarean hysterectomy for placenta percreta and thereby reduced transfusion requirements. It compares favorably with reported outcomes of other strategies of managing placenta percreta.

Importance of Microminerals for Maintaining Antioxidant Function After COVID-19-induced Oxidative Stress.

Background: COVID-19 is caused by the Severe Acute Respiratory Distress Syndrome Coronavirus 2. Since the antioxidant mechanisms such as glutathione peroxidase or superoxide dismutase are downregulated during infection by the virus, there is an imbalance in the oxidant-antioxidant system. In this study we aimed to identify the effect of COVID-19 on the antioxidant defense mechanism by comparing the concentrations of antioxidants and microminerals in COVID-19 patients and healthy controls. Methods: This cross-sectional analytical study involved 200 patients at Kasturba Hospital, Manipal University. The serum concentrations of antioxidants and minerals were determined to establish the impact of COVID-19 on antioxidants mechanism and nutrient status in COVID-19 patients. Results: The serum concentrations of GPX (10.36 ± 2.70 ≥ 5.82 ± 1.64 mKAT/L, p < 0.0001) and copper (2192.5 ± 449.8 ≥ 782.15 ± 106.5 µg/dL, p < 0.0001) were significantly greater, and zinc (34.78 ± 4.5 ≤ 81.07 ± 10.13 µg/dL, p < 0.0001) was significantly less, in the study group than in controls. The Pearson correlation between serum SOD and zinc was significant (r = 0.491, p < 0.0001) indicating the importance of zinc in maintaining and improving SOD activity. No significant correlations were observed between copper and SOD (r = -0.089) or iron and CAT (r = -0.027). Conclusion: Our study demonstrated the expected increase in oxidant-radical production during COVID-19 by estimating the altered concentrations of antioxidants and the minerals required to neutralize the elevated ROS. This finding is not novel but adds to the existing literature, which recommends nutritional supplementation of microminerals and antioxidants.

Porcine scabies induces marked apoptosis, increased pro-inflammatory cytokines IL-1, TNF-α and shedding of ICAM-1.

BACKGROUND: Scabies is one of the leading causes of morbidity in pigs worldwide. Limited data are available regarding the role of immune reactions in the development of porcine scabies. MATERIALS AND METHODS: The aim of this study was to investigate key pro-inflammatory cytokines (IL-1, TNF-α), soluble variant of adhesion molecule ICAM-1 and mite-mediated apoptosis of peripheral leukocytes in 20 pigs with scabies, in addition to 10 healthy controls. The pigs with at least three typical clinical signs and found positive for Sarcoptes scabiei var. suis in microscopy were recruited for the present study. RESULTS: IL-1 acted as the major pro-inflammatory cytokine as serum IL-1 concentrations showed significantly (p < .05) higher levels (7-fold increase) in cases than in controls. The minor cytokine TNF-α was 4-fold higher during scabies, and its mean serum concentration was significantly increased (p < .05) in cases when compared to healthy controls. Soluble ICAM-1 levels were significantly higher (p < .05) in all the pigs of infested group compared with the controls. The percentage of apoptotic and necrotic leukocytes was found to be significantly higher (p < .05) in scabies positive pigs as compared to the healthy controls. CONCLUSION: It is concluded that systemic elevation in pro-inflammatory cytokines IL-1 and TNF-α, shedding of soluble ICAM-1 variant in peripheral blood and increased rate of host-cell apoptosis in peripheral leukocytes might be implicated in the immunopathology of naturally acquired porcine scabies.

Defaecation disorders among information technology personnel: A cross-sectional study.

Background Individuals working in the information technology (IT) industry are likely to develop lifestyle disorders. We aimed to determine the presence of defaecation-related disorders in IT personnel in Chennai. Methods This cross-sectional, questionnaire-based study was done from June to December 2018. We included employees between 18 and 60 years of age and excluded those with <1 year stay in Chennai, pregnancy and those who sent incomplete responses. The cohort was classified as normal, irritable bowel syndrome (IBS), faecal evacuation disorder (FED) and a combination of the latter two. Results The overall response rate was 95.6%. The study included 54.7% of men, and the median age was 31 years. The majority of respondents used an Indian toilet (554; 58%). Almost all (96.2%) passed stools daily, and stool consistency was soft in 59%. Based on the study criteria, 180 (18.8%) had FED, 56 (5.9%) had IBS and a small group had a combination of symptoms of IBS and FED (20; 2.1%). Respondents with symptoms of IBS had a higher proportion of comorbid states (p<0.0001), lesser stool frequency (p<0.0001) and required more toilet time (p<0.00001). Conclusion Over one-fourth (26.7%) of the respondents had defaecation-related issues, 18.8% had symptoms suggestive of FED and 5.6% that of IBS, often above 30 years of age.

Role of therapeutic plasma exchange in acute liver failure due to yellow phosphorus poisoning.

BACKGROUND: Therapeutic plasma exchange (TPE) has been utilized in various liver disorders. There is limited data on the efficacy of TPE in patients with acute liver failure (ALF). METHODS: Study group consisted of patients who underwent TPE for ALF due to yellow phosphorous poisoning (YPP) between 2015 and 2019. Demographic data and biochemical parameters were recorded before and after TPE. Overall survival and transplant-free survival (based on King's College Hospital Criteria [KCHC]) were analyzed. RESULTS: Forty-three patients underwent TPE for ALF due to YPP. Most of them were young males. Overall survival was 34 (79.06%). In our study population, 20 patients fulfilled KCHC (Group A) and 23 did not fulfill KCHC (Group B). Both the groups showed significant improvement in alanine aminotransferase, aspartate aminotransferase, and international normalized ratio (INR) after TPE (p < 0.05). In Group B, there was significant improvement in ammonia after TPE (p < 0.05) and all 23 patients (100%) survived after TPE. In Group A, 4 underwent liver transplantation (LT), 7 survived without LT, and the remaining 9 died without LT. Mean survival after completing TPE was 41.2 ± 44.5 days in Group A and 90 days in Group B. This difference was statistically significant (p = 0.001). There was statistically significant difference in post-TPE values of INR (p = 0.012) and ammonia (p = 0.011) between non-survivors and survivors. Adverse events such as hypotension (11.62%) and minor allergic reaction (4.65%) were managed conservatively. CONCLUSION: TPE is an effective procedure in ALF due to YPP, not fulfilling KCHC for LT. In KCHC fulfilled group, though it shows LT-free survival benefit, there is requirement of prospective, large volume, multi-center study to assess its efficacy.

Heterotopic Quadruplet Pregnancy After ICSI Conception.

BACKGROUND: Heterotopic pregnancy (HP) is a condition characterized by the coexistence of multiple fetuses at two or more implantation sites. It occurs in 1% of pregnancies after assisted reproductive techniques (ART). Presence of triplet intrauterine pregnancy with ectopic gestational sac is one of the rarest forms of HP. Ectopic pregnancy is implanted in the ampullary segment of the fallopian tube in 80% of cases. Most of the patients present with acute abdominal symptoms due to rupture of the tube. CASE PRESENTATION: This article reports a case of quadruplet heterotopic pregnancy after intracytoplasmic sperm injection (ICSI) with an ampullary ectopic pregnancy and intrauterine triplet pregnancies. The ruptured ampullary pregnancy was emergently managed by right salpingectomy. This was followed by embryo reduction at 12 + 6 weeks and successful outcome of intrauterine twin pregnancy.

Strat-M® synthetic membrane: Permeability comparison to human cadaver skin.

The aim of this work was to investigate the correlation of permeation behavior of transdermal formulations through a novel synthetic membrane (Strat-M® EMD Millipore, MA) and human cadaver skin. Strat-M® membranes were designed with the intent to share similar structural and chemical characteristics found in the human skin however, omitting any biological behavior due to the absence of viable cells. Both human skin and the membrane display a layered structure with a very tight top layer. Additionally, the Strat-M® membrane contains a combination of lipids in a specific ratio similar to what is found in the human stratum corneum (SC). Formulations containing nicotine and a chemical penetration enhancer (CPE) were used for evaluating drug penetration to understand how each enhancer impacts the permeability of nicotine as a model compound. The permeability measurements of human cadaver skin and Strat-M® membrane were performed with Franz diffusion cell methods accompanied by HPLC analysis. A good correlation of the permeability data was obtained through human cadaver skin and Strat-M® membrane. Thus, Strat-M® has the potential to be used as a screening tool for evaluating topical/transdermal formulations through the human cadaver skin.