AN IN-DEPTH ASSESSMENT OF THE TUMOR'S IMPACT ON SARCOPENIA.

Loss of muscle mass is a typical symptom of cancer and it is strongly correlated with poor prognosis. Cancer-related Sarcopenia is unresponsive to conventional dietary changes and exercise, in contrast to age-associated muscle atrophy. This particular type of weakness differs from different kinds of muscle loss in that it is triggered by a number of interrelated mechanisms, notably inflammatory processes, abnormal metabolic processes, proteolysis, and autophagy. This research is to examine evidence supporting the theory that tumors have a causal role in causing muscular atrophy. It seeks to investigate the precise regulators that the tumour generates and how they affect the processes that result in muscle waste. The evaluation looks for new directions for further studies and medical treatments. The analysis is based on a thorough examination of the scientific literature and research that shows how tumor and muscle atrophy are related. It concentrates on studies that clarify the numerous strategies by which malignancies cause the loss of muscle. This article highlights particular mechanisms by which these tumor-derived substances affect the development of muscle loss, including inflammatory processes, metabolic disturbance, proteolysis, and autophagy. The discovery of such targets offers hope for the creation of efficient treatment strategies that can enhance the long-term outlook and quality of life of cancer sufferers who are experiencing muscle loss.

AN EVALUATION OF ANTIBIOTIC PRESCRIPTION PRACTICES: PERSPECTIVES OF VETERINARY TRAINEES AND PRACTICING VETERINARIANS.

Antibiotic resistance is a major worldwide problem that has an impact on the well-being of humans as well as animals. Antibiotic resistance is caused by the misuse and excessive use of antibiotics. The key to reducing this issue lies in educating veterinary medical learners on the proper and accountable utilization of antibiotics for the care of animals. Objective - using awareness-raising and instruction as the foundation, this research of Indian veterinary learners can help resolve the issue of antibiotic resistance throughout the care of animals. The questionnaire survey was taken between June and July 2022 and it was aimed at learners registered in veterinary medical studies at academic and research institutions in India. The study included 500 pupils overall. The purpose of the survey was to gather information about students' knowledge of antibiotics, including antibiotic resistance, as well as their feelings on the consequences of antibiotic resistance on the globe at large and their acquaintance with the one health ideology. According to this study's findings, 83.3 percent of respondents thought antibiotic resistance was a serious problem. 57.92 percent of respondents understood the issue's worldwide consequences and its one health ideology. The study emphasizes the significance of expanding the veterinary educational program to include thorough instruction on prudent antibiotic usage and the concepts of one health.

Comparison of irrigant penetration up to working length and into simulated lateral canals using various irrigating techniques.

AIM: To evaluate the effect of an apical negative pressure system, a passive ultrasonic irrigation system and a combination of both apical negative pressure and passive ultrasonic irrigation on the penetration of the irrigating contrast solution (ICS) up to working length and into simulated lateral canals. METHODOLOGY: The root canals of 64 single-rooted teeth were instrumented using the ProTaper rotary system. In each sample, three simulated lateral canals were created at 2, 4 and 6 mm levels from the root apex using a 06-size C+ file (Dentsply Maillefer, Ballaigues, Switzerland). Samples were randomly assigned into 4 experimental groups (n = 16): group I - conventional needle irrigation, group II - passive ultrasonic irrigation, group III - apical negative irrigation system and group IV - combination of passive ultrasonic irrigation and apical negative pressure irrigation system. To examine irrigating solution penetration, Indian ink was mixed with 5.25% NaOCl and delivered into the root canals. Samples were then assessed by direct observation of the images taken using Canon EOS rebel T3. The depth of penetration of ICS up to the working length and into the simulated lateral canals was analysed using chi-squared tests. RESULTS: The combination (ANP and PUI) and ANP group had significantly deeper ICS penetration up to the working length (P < 0.001). The combination (ANP and PUI) and the PUI group exhibited significantly greater ICS penetration into lateral canals at the 6 mm level (P < 0.001). At the 4 and 2 mm levels, the combination of ANP and PUI had significantly greater ICS penetration into the lateral canals than the other groups (P < 0.001). CONCLUSIONS: The combination of ANP and PUI was the only group able to achieve irrigating contrast solution penetration both up to the working length and into lateral canals.

Dense Deposit Disease Involving C3 and C4d Deposits.

Dense deposit disease (DDD), earlier called Type II membranoproliferative glomerulonephritis is distinct disease having frequent relapses reaching end-stage kidney disease by 10-year in up to 50%-60% of cases and high recurrence rate in the allograft. The term DDD is derived from its distinctive ribbon-like osmiophilic deposits in the lamina densa of glomerular basement membrane by electron microscopy. Pathogenetically, alternate pathway dysfunction leads to this disease, which is diagnosed by ultrastructure. Herein, we describe our observation of C4d positivity in an adolescent boy with DDD.

Minimally invasive radioguided surgery for parathyroid adenomas (MIRP).

BACKGROUND: Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Conventional surgical management includes bilateral neck exploration with removal of the adenoma(s) and biopsy of one of the other glands with visualization of all glands. It is associated with a risk of permanent hypoparathyroidism. Radioguided excision of parathyroid adenoma is a widely accepted technique which provides accurate localization and complete excision of the lesion with low morbidity. We report our experience with this technique. METHODS: We performed radioguided excision of parathyroid adenomas in 15 patients. All of them had preoperative localization of the adenoma using a dual tracer, dual phase 99mTc-Sestamibi scan. A dose of 8-10 mCi of 99mTc-Sestamibi was injected intravenously 2 hours before surgery. Under local anaesthesia, surgical excision of the lesion was done after localizing it using a hand-held gamma probe. Complete excision was confirmed by frozen. section of the excised lesion and an intraoperative quick parathormone assay. RESULTS: The 99mTc-Sestamibi scan revealed an increased uptake by the adenoma in all patients and complete excision was possible in all the patients. Frozen section confirmed the diagnosis and the quick parathormone assay (within 15 minutes) revealed a drop in parathormone levels to < 50% after excision in all of them. Three patients developed hypocalcaemia postoperatively and were treated with intravenous calcium supplementation. At a follow up of 2-29 months, all the patients were normocalcaemic. The renal functions improved in 2 of 6 patients who had renal failure. CONCLUSION: Minimally invasive radioguided excision of parathyroid adenomas is a simple, safe and effective technique associated with a low morbidity and can be done as a day-care procedure.

Bronchial asthma in two chemical fertilizer producing factories in eastern Saudi Arabia.

SETTING: Two urea fertilizer producing factories in Saudi Arabia. OBJECTIVE: To determine the prevalence of respiratory symptoms and diseases in employees exposed to ammonia gas. DESIGN: A cross-sectional study involving 161 exposed subjects and 355 controls. All completed a respiratory symptoms questionnaire, with additional questions on present and past occupations. Ammonia concentrations were measured in the different sections of the factories. RESULTS: The ammonia levels in factory B were well below the threshold limit value (TLV) (range 0.02-7.0 mg/m3 of air). In factory A the range was 2.0-130.4 mg/m3. The control and exposed groups were comparable with respect to their smoking habits. The exposed subjects in factory A had significantly higher relative risks (RR) for all respiratory symptoms; the same was true for haemoptysis (RR: 4.1, 95% confidence interval: 1.63-10.28). Bronchial asthma, chronic bronchitis, and a combined diagnosis were significantly higher among those exposed to high cumulative ammonia levels. However, in the logistic regression analysis ammonia concentration was significantly related to cough, phlegm, shortness of breath with wheezing and bronchial asthma. CONCLUSION: Exposure to ammonia gas in the workplace is significantly associated with increase in respiratory symptoms and bronchial asthma. Re-engineering measures to lower the levels of ammonia in factory A are strongly recommended. The affected employees should be removed from further exposure and followed up.

Occupational risk of hepatitis B and C infections in Saudi medical staff.

The prevalence of markers for hepatitis B virus (HBV) and hepatitis C virus (HCV) was studied among final year medical students and the medical staff at two university teaching hospitals in Saudi Arabia. At King Khalid University Hospital (KKUH) in Riyadh, evidence of exposure to HBV in the male medical staff (42.9%) was significantly greater than among medical students (25.3% males, 19.3% females; P = 0.0041) or the controls (28.6% males, 17.1% females; P = 0.0095). At King Fahad University Hospital (KFUH) in Al-Khobar, although the prevalence of exposure in the medical staff (28.3%) was higher than that in the controls (18.5%) the difference was not statistically significant (P > 0.05) and this could be due to the small numbers tested (46 physicians, 54 controls). Regarding exposure to HCV there was no significant difference in markers of the virus among the three categories investigated (1.7% in the controls, 2.6% in medical students and 1.9% in the medical staff). The low risk of transmission in the medical staff could be due to the small amount of the virus in the blood of HCV carriers. It can be concluded from the study that, in contrast to HCV, the occupational risk of HBV infection is high among Saudi physicians and hence HBV vaccination to unexposed medical staff is the only way for effective prevention of infection.

Pasteurella multocida infection in the chicken embryo.

Pasteurella multocida infection in embryonated chicken eggs was studied by chorio-allantoic membrane inoculation. Strain differences were demonstrated in terms of lesion severity and time to death, especially during the first 24 h post-inoculation. A strain of low virulence gave a clear dose response but more virulent strains did not. Comparable results were obtained by infecting 6-week-old chickens. The main lesions in inoculated embryos appeared as severe vascular involvement of the entire embryo and feather tracts, thickening of the chorio-allantoic membrane, and enlargement and congestion of the yolk sac. The bacteria were demonstrated by transmission electron microscopy, either extracellularly or multiplying intracellularly in hepatocytes, heart tissue, and in the hyperplastic layer of the chorio-allantoic membrane, with resulting damage to the cellular organelles, and severe tissue changes.

Pulmonary function of workers exposed to ammonia: a study in the Eastern Province of Saudi Arabia.

To determine the effect of chronic exposure to ammonia on pulmonary function among ammonia workers, 77 workers were randomly selected from an ammonia factory in the Eastern Province of Saudi Arabia and 355 were selected as controls from the administrative staffs of four industrial groups in Eastern Province. Spirometry was carried out and FEV1, FVC, and FEV1/FVC% were calculated. The ammonia level in the working environment was determined spectrophotometrically. 30% of the air samples had ammonia concentrations that exceeded the threshold limit value. Significant reductions in FEV1 % predicted and FVC % predicted were observed in ammonia workers exposed to higher cumulative ammonia levels (above 50 mg/m3-years). FEV1% predicted and FEV1/FVC% were significantly lower in symptomatic than in asymptomatic workers in the exposed group. These findings may raise the possibility that exposure to a high cumulative ammonia level produces a combined restrictive/obstructive ventilatory defect.

Cyclosporine experience in nephrotic syndrome.

OBJECTIVE: To analyze the use of Cyclosporine (CyA) in nephrotic syndrome. METHODS: Thirty five children of mean age of 5.9 years with steroid dependent (n = 26) or steroid resistant (n = 9) primary nephrotic syndrome with normal renal functions and who received CyA were studied. CyA was used at a dosage of 6-7 mg/kg/day orally in two divided doses. The mean duration of therapy was 9.6 weeks. All received a minimum of 8 weeks of CyA therapy. In a few who received longer therapy, the dose was reduced to 4 mg/kg/day. All patients were monitored serially for hepatotoxicity and nephrotoxicity. The nephrotic state was evaluated serially with biochemical tests and followed up for a mean period of 2.55 years. RESULTS: Thirty one patients completed the study. The response to therapy was categorized into 5 groups-no response (4 patients), good response (4 patients), partial response (4 patients), cyclosporine dependence (16 patients), and infrequent relapsers (3 patients). Good response was defined as complete remission lasting for at least one year after cessation of therapy. Patients who showed partial response had reduction in quantitative proteinuria and needed less diuretics. Sixteen patients went into complete remission while on therapy but relapsed within 3 months of discontinuation (CyA dependence). The response to CyA correlated more with steroid-responsiveness than with the underlying histopathology. The drug was well tolerated. CONCLUSION: In steroid-dependent or steroid-resistant nephrotic children with normal renal functions, CyA therapy may be considered as one of the possible therapeutic options. Our results suggest that a longer duration of CyA therapy may possibly be indicated in these cases.

Pediatric renal transplantation--Indian experience.

OBJECTIVE: To analyze our experience with renal transplantation in children with end-stage renal disease (ESRD) in India. DESIGN: Retrospective study. METHODS: Over the last 7.5 years, 27 renal transplants were performed on children below 12 years of age, 8 children were less than 6 years old, 19 were between 6 and 12 years of age. Sixteen children had underlying glomerular disease while eleven had tubulointerstitial renal disease. Transperitoneal approach was used in smaller recipients weighing less than 12 kg. Extraperitoneal approach was used in the remainder. Triple immunosuppression with Cyclosporine, Azathioprine and Steroids was used in all cases. RESULTS: Follow-up period ranged from 6 months to 7.5 years (mean 3.7 years). There were 10 episodes of acute rejection. Three cases of acute rejection failed to respond to therapy. No surgical complications were encountered. Graft survival was 73.2% at one year and 71% at two years. Satisfactory rehabilitation was achieved in children with functioning grafts. CONCLUSIONS: Renal transplantation in children in India offers an acceptable choice in ESRD as anywhere in the world.

Postrenal transplant laryngeal and visceral leishmaniasis - A case report and review of the literature.

Visceral leishmaniasis (kala-azar) is a disease caused by protozoa of genus Leishmania. It is currently regarded as the second most dreaded parasitic disease, next to malaria. There have been very few case reports of visceral leishmaniasis among the renal transplant recipients. We present a renal allograft recipient with symptoms of fever, sore throat, hoarseness of voice, lymphadenopathy, splenomegaly, and pancytopenia after 7 years post-transplant period. On investigating, he was diagnosed to have extensive visceral leishmaniasis with laryngeal involvement. Despite extensive PubMed literature search, we could not find any case report of postrenal transplant visceral and laryngeal leishmaniasis and to the best of our knowledge this is the first case report of this kind.

Diffuse mesangial sclerosis - Report of two cases.

Diffuse mesangial sclerosis (DMS) is a rare cause of nephrotic syndrome in the infantile and childhood period. DMS is a phenotypic expression of syndromic entities such as WAGR syndrome (Wilms' tumor, aniridia, genitourinary anomalies and mental retardation), Denys Drash syndrome, Pierson syndrome, Frasier syndrome, or Galloway-Mowat syndrome. We report two cases of DMS, one presenting in first year of life and another in second decade of life. Both of them had fatal outcome. Recognition of the disease is very important in modifying the management of patient and active surveillance of family members.

Respiratory symptoms and occupational bronchitis in chromite ore miners, Sudan.

Prevalence of respiratory symptoms and chronic bronchitis was determined in a group of 122 subjects (77 exposed miners, 18 partially exposed, 27 controls) working at chromite ore mines in Sudan. The mean ages (+/- s.d.) of the three groups were 36.4 (+/- 7.8), 35.2 (+/- 6.8) and 34.6 (+/- 7.5) years respectively. Methods included a respiratory symptoms questionnaire based on the British Medical Research Council (MRC 1976) questionnaire on respiratory symptoms, determination of FEV1, FVC and FEV1/FVC%. The majority (66%) of the exposed subjects were non-smokers (NS) and 20 (77%) of the 'ever-smokers' (current and ex-smokers) were smokers of less than 15 cigarettes day-1. Respiratory symptoms (cough, phlegm, dyspnoea) were more frequent among the miners and so was chronic bronchitis. The prevalence of the latter was 26% among the miners compared to 11% and 7% among the partially exposed and the controls respectively. These differences could not be accounted for by cigarette smoking. Sixty-five per cent of the miners diagnosed as having asthma, chronic bronchitis or both were non-smokers. Although the values for the FEV1/FVC% remained normal or near the lower limits of the normal range, the mean value was significantly lower among the miners. It was concluded that the mine dust was the prime cause of the respiratory symptoms and chronic bronchitis among the miners.

International controversies in interpreting the mantoux test with special reference to saudi arabia.

There is a general decline in the incidence of pulmonary tuberculosis (PTB) in developed countries, but infection by HIV has increased the incidence of PTB in affected countries. There are no signs of a similar decline in the incidence of PTB in some developing countries. The Mantoux technique for tuberculin testing continues to be among the effective diagnostic tools. The medical literature and textbooks of medicine show disagreement as to what constitutes a positive (specific) tuberculin reaction. This short review was intended to cite some examples of these differences and suggest a cutting point for use in the Kingdom of Saudi Arabia (KSA) based on the prevalence of environmental mycobacteria (Mycobacteria other than M. tuberculosis, MOTT). From this review different researchers within the KSA used different cut-off points at a time that the prevalence of MOTT was unknown, until 1993 when it was reported to be as low as 3.8/1000 population (based on sputum culture) and that the Kingdom is categorised among the middle PTB prevalent countries. Consequently, it seems appropriate to have 5 mm as a cutting point (positive) in all unvaccinated patients, particularly for those who were in contact with an infectious case, or having symptoms compatible with PTB, and also patients who were immuno-compromised as in HIV infection. This cut-off point can be revised and raised to 8 mm provided that the prevalence of PTB becomes lower than the current reported rate and MOTT prevalence remains low, but the 5 mm cutting point should remain for the aforementioned categories of patients.