Burden of Pulmonary Hypertension in End-Stage Renal Disease Patients Receiving Maintenance Hemodialysis: Evaluation Factors and Treatment Strategies.

Background Chronic kidney disease (CKD) is an emerging public health problem in India. Pulmonary hypertension (PH) is an overlooked cardiovascular complication of CKD. This study aimed to estimate the burden of PH among CKD patients undergoing hemodialysis in a selected tertiary care hospital. In addition, it aimed to determine the various factors associated with PH and response to various treatment modalities. Methodology This hospital-based, analytical, cross-sectional study was conducted in the nephrology department of a medical college hospital in Tamil Nadu from March 2023 to March 2024. The study included 150 adults diagnosed with stage 5 CKD and registered for hemodialysis. Results Of the 150 participants, 96 (64%) had PH. Of these, 81 (84%) were males and 15 (16%) were females. In the PH group, 58 (60.4%) had type 2 diabetes mellitus, 52 (54%) had been on dialysis for 6-12 months, 67 (69.8%) had chronic glomerulonephritis, 25 (26.04%) had chronic tubular interstitial nephritis, and 72 (75%) had microcytic anemia. PH patients had significantly higher rates of protein-energy malnutrition (26 (48.2%) vs. 67 (80.7%), p < 0.009) and more frequent hospitalizations (19 (35%) vs. 69 (71.9%)) compared to those without PH. Additionally, PH patients exhibited higher incidences of left ventricular hypertrophy (72% vs. 92%), pericardial effusion (0% vs. 65%), and tricuspid regurgitation (16% vs. 100%). Patients treated with a combination of isosorbide dinitrate (ISDN) and hydralazine; extended hemodialysis; and ISDN, hydralazine, and sildenafil showed significant improvement compared to other treatment modalities. Conclusions The high prevalence of PH among CKD patients undergoing hemodialysis underscores the importance of vigilant monitoring and targeted interventions.

Visual Field Defects and Retinal Nerve Fiber Layer Thickness in Migraine Patients: A Study From a Tertiary Care Center in India.

Background This study aimed to analyze the visual field changes and retinal nerve fiber layer (RNFL) thickness during the headache phase of migraine attacks among migraine patients compared with controls. Methodology A prospective, case-control study was conducted at a tertiary care center in Palakkad, Kerala from January 2022 to August 2023. This study included 50 migraine patients and 50 age/gender-matched controls. Adults aged 20-40 years with a more than three-year history of migraine were included in this study and those who had systemic or ocular pathologies were excluded. All 100 subjects underwent complete ocular examination, including full threshold 24-2 automated perimetry for visual field analysis and optical coherence tomography for analyzing RNFL thickness. Statistical analysis was done using SPSS Statistics Version 25 (IBM Corp., Armonk, NY, USA). Results In this study, the average age for cases was 29.24 ± 5.10 years, and for controls was 30.12 ± 6.20 years. Gender distribution was identical between cases and controls with 29 (58%) females and 21 (42%) males. Among the 50 migraine patients, 22 (44%) had generalized, while 28 (56%) had localized field defects during the headache phase of migraine attacks. There was a statistically significant (p < 0.001) difference in superior quadrant RNFL thickness between cases (114.08 ± 12.25) and controls. Conclusions We found that RNFL thinning in the superior quadrant and non-specific localized visual field changes occur during migraine attacks. We conducted this study in a tertiary care center as very few studies in our country have revealed visual field changes during migraine headache attacks.

Deciphering the Nexus: Exploring Learning Styles and Academic Success Among Medical Students Through a Comprehensive Study.

In the dynamic landscape of medical education, recognizing and catering to the diverse learning styles of students are pivotal for fostering academic success. This study investigates the intricate relationship between learning styles and academic performance among medical students. A sample comprising 201 second-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students from two batches participated in this cross-sectional study. Utilizing the Grasha-Riechmann Student Learning Style Scales, students were categorized into six distinct learning styles: independent, avoidant, collaborative, dependent, competitive, and participatory. Academic performance was assessed through cumulative scores at the end of the academic year. Statistical analyses, including descriptive statistics, Spearman's correlation analysis, and the Kruskal-Wallis H test, were conducted using IBM SPSS Statistics for Windows, Version 25, (Released 2017; IBM Corp., Armonk, New York, United States). The findings revealed a rich diversity of learning styles among medical students, with independent learning emerging as the most prevalent style. However, intriguingly, no statistically significant difference in academic performance was discerned across the various learning styles. Nonetheless, correlation analysis uncovered weak positive correlations between independent, dependent, and participatory learning styles with academic performance, while an equally weak negative correlation was observed for the avoidant style. These results underscore the necessity for tailored educational strategies that can accommodate the heterogeneous learning preferences exhibited by medical students. While certain learning styles may be favoured by students, their adoption does not guarantee academic success. Thus, educators are urged to embrace flexible teaching methodologies to accommodate the diverse learning styles present within medical education, ultimately fostering student engagement and achievement. This study illuminates the imperative of understanding and addressing diverse learning styles among medical students, laying the foundation for further research into optimizing teaching methodologies in medical education.

Evaluating the Impact of Cartoon-Based Learning on Student Performance and Engagement in Medical Education: An Experimental Study.

BACKGROUND: Pathology, a foundational yet challenging subject in medical education, is marked by its extensive content and intricate concepts. These complexities often pose a significant learning barrier for students, who must not only comprehend but also effectively apply this knowledge in their clinical practice. OBJECTIVE: This study aimed to investigate the impact of utilizing cartoons as a supplementary educational tool in pathology. Specifically, it focused on assessing whether incorporating cartoons into the learning process would enhance students' understanding, memory retention, and ability to recall complex topics, thereby augmenting the effectiveness of traditional teaching methodologies. MATERIALS AND METHODS: Conducted from June to September 2022, this experimental study involved 106 second-year MBBS (Bachelor of Medicine and Bachelor of Surgery) students. Participants were split into two groups: the "traditional group," which received standard interactive large-group teaching, and the "combination group," which benefited from both the standard teaching and additional cartoon-based instruction. The study focused on two selected chapters of the pathology curriculum. After completing the first chapter, the groups were crossed over for the second chapter. Evaluation of the students' learning was conducted through post-learning assessments using multiple-choice questions (MCQs). RESULTS: The combination group, which received both traditional and cartoon-based teaching, showed a significant improvement in their assessment scores compared to the traditional group. This improvement was consistent in both assessments conducted (t(102) = 8.41, p < .001 and t(99) = 6.85, p < .001). Additionally, feedback from the students through a post-learning survey indicated a strong preference for the use of cartoons. The majority of students agreed that cartoons facilitated a better understanding and retention of complex pathology topics (χ² = 130.9, p < 0.001). CONCLUSION: The incorporation of cartoons as a supplementary learning tool in pathology teaching shows promising results. This innovative approach not only complements but also enhances the traditional teaching methods, leading to improved comprehension, retention, and recollection of complex subjects among medical students. The study highlights the potential of cartoons in revolutionizing medical education, especially in teaching challenging subjects like pathology.

Repeat Mild Traumatic Brain Injury in Adolescent Rats Increases Subsequent ß-Amyloid Pathogenesis.

Single moderate-to-severe traumatic brain injuries (TBIs) may increase subsequent risk for neurodegenerative disease by facilitating ß-amyloid (Aß) deposition. However, the chronic effects on Aß pathogenesis of repetitive mild TBIs (rTBI), which are common in adolescents and young adults, remain uncertain. We examined the effects of rTBI sustained during adolescence on subsequent deposition of Aß pathology in a transgenic APP/PS1 rat model. Transgenic rats received sham or four individual mild TBIs (rTBIs) separated by either 24- or 72-h intervals at post-natal day 35 (before Aß plaque deposition). Animals were euthanized at 12 months of age and underwent immunohistochemical analyses of Aß plaque deposition. Significantly greater hippocampal Aß plaque deposition was observed after rTBI separated by 24 h relative to rTBI separated by 72 h or sham injuries. These increases in hippocampal Aß plaque load were driven by increases in both plaque number and size. Similar, though less-pronounced, effects were observed in extrahippocampal regions. Increases in Aß plaque deposition were observed both ipsilaterally and contralaterally to the injury site and in both males and females. rTBIs sustained in adolescence can increase subsequent deposition of Aß pathology, and these effects are critically dependent on interinjury interval.

Estimation of Palliative Care Need in the Urban Community of Puducherry.

CONTEXT: The coverage of palliative care services is inadequate in India. Data on number of people needing palliative care and disease conditions needing palliative care needs to be estimated prior to planning of service in any area. AIMS: To estimate the prevalence of need of palliative care in an urban area of Puducherry. SETTINGS AND DESIGN: Exploratory cross-sectional study conducted in two areas, Senthamarainagar and Thiruvalluvarnagar having about 500 households each in Muthialpet area in urban Puducherry. MATERIALS AND METHODS: All residents were interviewed using a structured questionnaire containing sociodemographic details, information regarding chronic illness and a screening tool to identify people in need of palliative care. STATISTICAL ANALYSIS: Variables such as sociodemographic characteristics were expressed in percentages. The main outcome variable, the number of people in need of palliative care was expressed in the prevalence percentages. RESULTS: A total of 3554 individuals were surveyed in 1004 households. A period prevalence of need of palliative care in this community was 6.1/1000 population. The prevalence among those aged ≥15 years was 8/1000 population. The mean age of people requiring palliative care was 62 years. The most common disease condition in need of palliative care was old age-related weakness (41%). Most of them were women (17/22) and from lower socioeconomic class (6/22). CONCLUSIONS: Around 6/1000 population was identified to be in need of palliative care. The prevalence was highest among the elderly women, low socioeconomic class, widowed, those with less education, and those suffering from age-related weakness.

Mitochondrial DNA STR analysis as a tool for studying the green sea turtle (Chelonia mydas) populations: the Mediterranean Sea case study.

The Mediterranean population of the green sea turtle Chelonia mydas is critically endangered. Genetic analysis of this population using the ordinary haplotyping system, based on sequence analysis of a segment of the mitochondrial DNA (mtDNA) D-loop (control region), revealed very little variation. The most common haplotype, CM-A13, was observed in all but three individuals in hundreds of samples in previous studies. In search for a more informative marker we sequenced the 3' of the mitochondrial control region which contains an AT-rich microsatellite. We found a unique pattern that consists of four AT short tandem repeats (STRs) with varying copy numbers. This allowed us to construct a new haplotyping system composed of four different STR sizes for each mtDNA sequence. Our new mitochondrial STR (mtSTR) haplotyping approach revealed 33 different haplotypes within the nesting and stranded sea turtles along the Mediterranean Israeli seashore. The Israeli coast nesting females had 10 different haplotypes that can be used for monitoring and conservation purposes. The mtSTR haplotyping system can clearly assist in fingerprinting of individual turtles. Moreover, it can be used for estimating phylogenetic distances within populations. This case study shows that the mtSTR haplotyping is applicable for the study of global green sea turtle populations and could also be considered as markers of genetic variability in other species.

Thematic analysis of readmission into inpatient units for adults with intellectual disabilities: two case studies.

This audit explores readmissions into inpatient services for adults with intellectual disabilities, using two case studies. Thirteen semi-structured interviews were conducted with professionals, to gain a multidisciplinary perspective, between February and March 2010, and analysed using thematic analysis. The main themes found in case study 1 were: narrow focus, environment, communication, early discharge, and deterioration. The main themes found in case study 2 were: deterioration, communication, discharge too soon, and environment. The aims of the audit were to contribute to good practice and provide a better understanding of readmission within our services.

Interaction of minor groove binding ligands with long AT tracts.

We have used quantitative DNase I footprinting to examine the ability of distamycin and Hoechst 33258 to discriminate between different arrangements of AT residues, using synthetic DNA fragments containing multiple blocks of (A/T)6or (A/T)10in identical sequence environments. Previous studies have shown that these ligands bind less well to (A/T)4sites containing TpA steps. We find that in (A/T)6tracts distamycin shows little discrimination between the various sites, binding approximately 2-fold stronger to TAATTA than (TA)3, T3A3and GAATTC. In contrast, Hoechst 33258 binds approximately 20-fold more tightly to GAATTC and TAATTA than T3A3and (TA)3. Hydroxyl radical footprinting reveals that both ligands bind in similar locations at the centre of each AT tract. At (A/T)10sites distamycin binds with similar affinity to T5A5, (TA)5and AATT, though bands in the centre of (TA)5are protected at approximately 50-fold lower concentration than those towards the edges. Hoechst 33258 shows a similar pattern of preference, with strong binding to AATT, T5A5and the centre of (TA)5. Hydroxyl radical footprinting reveals that at low concentrations both ligands bind at the centre of (TA)5and A5T5, while at higher concentrations ligand molecules bind to each end of the (A/T)10tracts. At T5A5two ligand molecules bind at either end of the site, even at the lowest ligand concentration, consistent with the suggestion that these compounds avoid the TpA step. Similar DNase I footprinting experiments with a DNA fragment containing T n (n = 3-6) tracts reveals that both ligands bind in the order T3< T4 << T5 = T6.

DNA sequence preferences of several AT-selective minor groove binding ligands.

We have examined the interaction of distamycin, netropsin, Hoechst 33258 and berenil, which are AT-selective minor groove-binding ligands, with synthetic DNA fragments containing different arrangements of AT base pairs by DNase I footprinting. For fragments which contain multiple blocks of (A/T)4 quantitative DNase I footprinting reveals that AATT and AAAA are much better binding sites than TTAA and TATA. Hoechst 33258 shows that greatest discrimination between these sites with a 50-fold difference in affinity between AATT and TATA. Alone amongst these ligands, Hoechst 33258 binds to AATT better than AAAA. These differences in binding to the various AT-tracts are interpreted in terms of variations in DNA minor groove width and suggest that TpA steps within an AT-tract decrease the affinity of these ligands. The behaviour of each site also depends on the flanking sequences; adjacent pyrimidine-purine steps cause a decrease in affinity. The precise ranking order for the various binding sites is not the same for each ligand.

Global brain ischemia and reperfusion: Golgi apparatus ultrastructure in neurons selectively vulnerable to death.

The neocortex and the hippocampus were examined for lipid peroxidation products and ultrastructural alterations by fluorescence and electron microscopy, respectively, in rats subjected to 10 min of cardiac arrest or 10 min cardiac arrest and either 90 or 360 min reperfusion. Lipid peroxidation products were observed after 90 min reperfusion in the perikarya and proximal dendrites of neocortical pyramidal neurons and in the hippocampal hilar cells and CA1, region; the fluorescence was most intense at the base of the apical dendrite, the region of the Golgi apparatus. After 90 min of reperfusion, the CA1, showed considerable stretches of rough endoplasmic reticulum devoid of ribosomes and the Golgi cisternae were shorter and widely dilated. The neocortex showed similar endoplasmic reticulum changes, but no significant alterations to the Golgi were noted. In addition there were areas where strings of ribosomes appear to be detaching from the endoplasmic reticulum. After 360 min reperfusion in both the neocortex and the hippocampus, the damage appeared more severe. The Golgi was fragmented into vacuoles, membranous whorls had appeared, and dense aggregates of smooth vesicles were seen coalescing with each other and the vacuoles. These observations suggest that early Golgi involvement is a more important marker of lethal injury than ribosome release from the endoplasmic reticulum. The areas of disturbed Golgi ultrastructure correspond to those areas that show evidence of lipid peroxidation and imply that lipid peroxidation may be causally related to the disturbance in Golgi ultrastructure.

Fluorescent histochemical localization of lipid peroxidation during brain reperfusion following cardiac arrest.

Rats were subjected to cardiac arrest and resuscitation, 90 min of reperfusion, and in situ perfusion fixation. Thiobarbituric acid (TBA) was included in the aldehyde-free perfusion fixative, the TBA reaction was driven in situ by heating, and fluorescence microscopy was utilized to characterize the location of products of the TBA reaction. Absorbance-difference spectra were performed on butanol-extracted brain homogenates to confirm in situ formation of TBA adducts with aldehydic products of lipid peroxidation. Nissl-stained sections revealed good cellular fixation without shrinkage artifacts. Fluorescence was not seen microscopically when TBA was omitted from the perfusion fixative, and little fluorescence was present in normal brains or brains after ischemia only. However, after 90-min reperfusion, intense granular fluorescence was seen in the neuronal perikarya (especially at the base of the apical dendrite) of numerous pyramidal neurons in cortical layers 5 and 6 and in the pyramidal layer of Ammon's horn in the hippocampus. The nuclei of these cells exhibited no fluorescence. Fluorescence was also present in some striatal neurons, but was absent in the adjacent radial bundles. Neither glia nor white matter exhibited similar fluorescence. These observations indicate that neurons in the selectively vulnerable zones of the cortex and hippocampus are early and specific targets of lipid peroxidation during post-ischemic reperfusion.

Evaluation of methods for detecting human papillomavirus deoxyribonucleotide sequences in clinical specimens.

Specimens from 26 condylomatous lesions, 24 invasive cancer cells, and 33 cervices, without evidence of the diseases, were tested for the presence of human papillomavirus (HPV) types 6, 11, 16, and 18 by Southern blot hybridization, in situ filter hybridization, or in situ tissue hybridization methods. A total of 89% (23 of 26) of the condylomatous lesions contained HPV DNAs, as determined by one or more of the methods. The positive rates for the detection of HPV DNA in condylomas by the different methods were 82% for Southern blot hybridization, 62% for in situ filter hybridization, and 72% for in situ tissue hybridization. Among the specimens from patients with cancer, HPV DNA was found in 83% (19 of 23) by one or more of the methods. Positive rates of 89 and 70%, respectively, were obtained for cancer lesions tested by the filter in situ and Southern blot hybridization methods; however, only 30% of those lesions were positive by the in situ tissue hybridization method. Thirteen percent of the control cervices were positive for HPV DNA by one or more of the assays. With respect to all disease categories, the methods had comparable sensitivities and specificities, except for the in situ tissue hybridization method, which revealed a specificity of 72% for condylomatous lesions and 30% for invasive cancer cells.

An immunohistochemical study of pleomorphic adenomas of the salivary gland: glial fibrillary acidic protein-like immunoreactivity identifies a major myoepithelial component.

An immunohistochemical study of 34 pleomorphic adenomas of the major salivary glands demonstrated phenotypic differences among the various morphologic regions in these tumors. The phenotypes expressed were comparable to those of normal salivary gland cells. In the normal glands, myoepithelial cells were immunoreactive for glial fibrillary acidic protein (GFAP), S-100 protein, and keratin; acinic cells exhibited strong, predominantly nuclear S-100 staining and weaker keratin staining; intercalated ducts had both cytoplasmic and nuclear S-100 positivity; and several epithelial antigens were observed throughout the ductal system. In the tumors, the presence of classic epithelial markers (including carcinoembryonic antigen, epithelial membrane antigen, secretory component, and keratin) in the luminal cells of ducts and the intense immunoreactivity with GFAP (with weaker keratin and S-100 staining) in periductal and stromal cells indicated distinct epithelial and myoepithelial differentiation. Solid epithelioid areas consisted phenotypically of intercalated duct/acinic cells and/or myoepithelial cells, the former exhibiting predominant nuclear S-100 positivity. The presence of GFAP-like immunoreactivity in normal myoepithelial cells strongly supports the extensive involvement of this cell in pleomorphic adenomas. The spectrum of phenotypes expressed adds weight to existing evidence for pleomorphism rather than a mixed origin of this tumor. The combination of keratin, S-100, and GFAP immunostaining is particularly useful in identifying the component cells in pleomorphic adenomas of the salivary glands.