Microplastic contamination in the agricultural soil-mitigation strategies, heavy metals contamination, and impact on human health: a review.

Microplastic pollution has emerged as a critical global environmental issue due to its widespread distribution, persistence, and potential adverse effects on ecosystems and human health. Although research on microplastic pollution in aquatic environments has gained significant attention. However, a limited literature has summarized the impacts of microplastic pollution the agricultural land and human health. Therefore, In the current review, we have discussed how microplastic(s) affect the microorganisms by ingesting the microplastic present in the soil, alternatively affecting the belowground biotic and abiotic components, which further elucidates the negative effects on the above-ground properties of the crops. In addition, the consumption of these crops in the food chain revealed a potential risk to human health throughout the food chain. Moreover, microplastic pollution has the potential to induce a negative impact on agricultural production and food security by altering the physiochemical properties of the soil, microbial population, nutrient cycling, and plant growth and development. Therefore, we discussed in detail the potential hazards caused by microplastic contamination in the soil and through the consumption of food and water by humans in daily intake. Furthermore, further study is urgently required to comprehend how microplastic pollution negatively affects terrestrial ecosystems, particularly agroecosystems which drastically reduces the productivity of the crops. Our review highlights the urgent need for greater awareness, policy interventions, and technological solutions to address the emerging threat of microplastic pollution in soil and plant systems and mitigation strategies to overcome its potential impacts on human health. Based on existing studies, we have pointed out the research gaps and proposed different directions for future research.

A comparison of the accuracy of Tzanakis and Alvarado Score in the diagnosis of acute appendicitis: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Acute appendicitis is one of the most commonly encountered surgical emergencies on a global level. Due to the requirement of an immediate clinical diagnosis and the presence of limited resources, clinicians and diagnosticians refer to scoring systems to diagnose this condition, among which Alvarado and Tzanakis scoring systems are widely used. This meta-analysis aims to compare the diagnostic accuracy of these two systems. METHODS: We searched PubMed, Google Scholar, and SCOPUS databases. All studies that reported diagnostic parameters of Alvarado and Tzanakis scores in patients with suspected acute appendicitis were selected. Diagnostic values such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were extracted from the selected studies and statistical analysis was performed with Meta Disc 1.4 software. Quality assessment of the selected studies was performed using the QUADAS-2 and QUADAS-C tools. Fourteen studies were included in our meta-analysis which enrolled 2235 patients. RESULTS: The overall sensitivity of the Tzanakis score was calculated as 0.86 (95% CI; 0.84-00.87) while the specificity was 0.73 (95% CI; 0.69-0.78). In addition, the area under the curve (AUC) was 0.9261 (SE; 0.0169) and the diagnostic Odds Ratio (OR) was 22.52 (95% CI; 9.47-53.56). The pooled sensitivity of Alvarado score was 0.67 (95% CI; 0.65-0.69) and the specificity was 0.74 (95% CI; 0.69-0.79). Moreover, the area under the curve (AUC) of the Alvarado score was 0.7389 (SE; 0.0489) and the diagnostic Odds Ratio was 4.92 (95% CI; 2.48-9.75). INTERPRETATION AND CONCLUSION: The Tzanakis scoring system has a higher sensitivity, area under the curve, and diagnostic odds ratio when compared to the Alvarado score. However, the Alvarado score has a marginally better specificity making it more reliable in excluding acute appendicitis.

OsRbohI Regulates Rice Growth and Development via Jasmonic Acid Signalling.

Reactive oxygen species (ROS) are highly reactive molecules, generated by nicotinamide adenine dinucleotide phosphate oxidases encoded by respiratory burst oxidase homologs. The functions of the OsRbohs gene family in rice are diverse and poorly understood. OsRbohI was recently identified as a newly evolved gene in the rice OsRbohs gene family. However, the function of OsRbohI in regulating rice growth is not yet reported. In this study, our results indicate that knockout (KO) OsRbohI mutants showed significantly shorter shoot and primary roots, along with lower ROS content than the control lines, whereas the overexpression (OE) lines displayed contrasting results. Further experiments showed that the abnormal length of the shoot and root is mainly caused by altered cell size. These results indicate that OsRbohI regulates rice shoot and root growth through the ROS signal. More importantly, RNA-seq analysis and jasmonic acid (JA) treatment demonstrated that OsRbohI regulates rice growth via the JA synthesis and signaling pathways. Compared with the control, the results showed that the KO mutants were more sensitive to JA, whereas the OE lines were less sensitive to JA. Collectively, our results reveal a novel pathway in which OsRbohI regulates rice growth and development by affecting their ROS homeostasis through JA synthesis and signaling pathway.

TOE1/TOE2 Interacting with GIS to Control Trichome Development in Arabidopsis.

Trichomes are common appendages originating and projecting from the epidermal cell layer of most terrestrial plants. They act as a first line of defense and protect plants against different types of adverse environmental factors. GL3/EGL3-GL1-TTG1 transcriptional activator complex and GIS family genes regulate trichome initiation through gibberellin (GA) signaling in Arabidopsis. Here, our novel findings show that TOE1/TOE2, which are involved in developmental timing, control the initiation of the main-stem inflorescence trichome in Arabidopsis. Phenotype analysis showed that the 35S:TOE1 transgenic line increases trichome density of the main-stem inflorescence in Arabidopsis, while 35S:miR172b, toe1, toe2 and toe1toe2 have the opposite phenotypes. Quantitative RT-PCR results showed that TOE1/TOE2 positively regulate the expression of GL3 and GL1. In addition, protein-protein interaction analysis experiments further demonstrated that TOE1/TOE2 interacting with GIS/GIS2/ZFP8 regulate trichome initiation in Arabidopsis. Furthermore, phenotype and expression analysis also demonstrated that TOE1 is involved in GA signaling to control trichome initiation in Arabidopsis. Taken together, our results suggest that TOE1/TOE2 interact with GIS to control trichome development in Arabidopsis. This report could provide valuable information for further study of the interaction of TOE1/TOE2 with GIS in controlling trichome development in plants.

C2H2 Zinc Finger Proteins Response to Abiotic Stress in Plants.

Abiotic stresses have already exhibited the negative effects on crop growth and development, thereby influencing crop quality and yield. Therefore, plants have developed regulatory mechanisms to adopt against such harsh changing environmental conditions. Recent studies have shown that zinc finger protein transcription factors play a crucial role in plant growth and development as well as in stress response. C2H2 zinc finger proteins are one of the best-studied types and have been shown to play diverse roles in the plant abiotic stress responses. However, the C2H2 zinc finger network in plants is complex and needs to be further studied in abiotic stress responses. Here in this review, we mainly focus on recent findings on the regulatory mechanisms, summarize the structural and functional characterization of C2H2 zinc finger proteins, and discuss the C2H2 zinc finger proteins involved in the different signal pathways in plant responses to abiotic stress.

Genome-wide identification and expression analysis of detoxification efflux carriers (DTX) genes family under abiotic stresses in flax.

The detoxification efflux carriers (DTX)/multidrug and toxic compound extrusion (MATE) transporters encompass an ancient gene family of secondary transporters involved in the process of plant detoxification. A genome-wide analysis of these transporters was carried out in order to better understand the transport of secondary metabolites in flaxseed genome (Linum usitassimum). A total of 73 genes coding for DTX/MATE transporters were identified. Gene structure, protein domain and motif organization were found to be notably conserved over the distinct phylogenetic groups, showing the evolutionary significant role of each class. Gene ontology (GO) annotation revealed a link to transporter activities, response to stimulus and localizations. The presence of various hormone and stress-responsive cis-regulatory elements in promoter regions could be directly correlated with the alteration of their transcripts. Tertiary structure showed conservation for pore size and constrains in the pore, which indicate their involvement in the exclusion of toxic substances from the cell. MicroRNA target analysis revealed that LuDTXs genes were targeted by different classes of miRNA families. Twelve LuDTX genes were chosen for further quantitative real-time polymerase chain reaction analysis in response to cold, salinity and cadmium stress at 0, 6, 12 and 24 hours after treatment. Altogether, the identified members of the DTX gene family, their expression profile, phylogenetic and miRNAs analysis might provide opportunities for future functional validation of this important gene family in flax.

Ethylene participates in zinc oxide nanoparticles induced biochemical, molecular and ultrastructural changes in rice seedlings.

Nowadays, the applications of engineered nanoparticles (ENPs) have been significantly increased, thereby negatively affecting crop production and ultimately contaminating the food chain worldwide. Zinc oxide nanoparticles (ZnO NPs) induced oxidative stress has been clarified in previous studies. But until now, it has not been investigated that how ethylene mediates or participates in ZnO NPs-induced toxicity and related cellular ultrastructural changes in rice seedlings. Here, we reported that 500 mg/L of ZnO NPs reduced the fresh weight (54.75% and 55.64%) and dry weight (40.33% and 47.83%) in shoot and root respectively as compared to control. Furthermore, ZnO NPs (500 mg/L) reduced chlorophyll content (72% Chla, 70% Chlb), induced the stomatal closure and ultrastructural damages by causing oxidative stress in rice seedlings. These cellular damages were significantly increased by exogenous applications of ethylene biosynthesis precursor (ACC) in the presence of ZnO NPs. In contrary, ZnO NPs induced damages on the above-mentioned attributes were reversed through the exogenous supply of ethylene signaling and biosynthesis antagonists such as silver (Ag) and cobalt (Co) respectively. Interestingly, ZnO NPs accelerate ethylene biosynthesis by up-regulating the transcriptome of ethylene biosynthesis responsive genes. The antioxidant enzymes activities and related gene expressions were further increased in ethylene signaling and biosynthesis associated antagonists (Ag and Co) treated seedlings as compared to sole ZnO NPs treatments. In contrary, the above-reported attributes were further decreased by ACC together with ZnO NPs. In a nutshell, ethylene effectively contributes in ZnO NPs induced toxicity and causing ultrastructural and stomatal damage in rice seedlings. Such findings could have potential implications in producing genetic engineered crops, which will be able to tolerate nanoparticles toxicity in the environment.

The WRKY6 transcription factor affects seed oil accumulation and alters fatty acid compositions in Arabidopsis thaliana.

In rapeseed, the oil content of the seed not only supplies energy for seed germination and seedling development but also provides essential dietary nutrients for humans and livestock. Recent studies have revealed that many transcription factors (TFs) regulate the accumulation of fatty acids (FAs) during seed development. WRKY6, a WRKY6 family TF, was reported to serve a function in the plant senescence processes, pathogen defense mechanisms and abiotic stress responses. However, the precise role of WRKY6 in influencing FA accumulation in seeds is still unknown. In this study, we demonstrate that WRKY6 has a high expression level in developing seeds and plays an essential role in regulating the accumulation of FAs in developing seeds of Arabidopsis. Mutation of WRKY6 resulted in significant increase in seed size, accompanied by an increase in FA content and changes in FA composition. Ultrastructure analyses showed that the absence of WRKY6 resulted in more and higher percentage of oil body in the cell of mature seeds. Quantitative real-time PCR analysis revealed changes in the expression of several genes related to photosynthesis and FA biosynthesis in wrky6 mutants at 10 or 16 days after pollination. These results reveal a novel function of WRKY6 influencing seed oil content and FAs compositions. This gene could be used as a promising gene resource to improve FA accumulation and seed yield in Brassica napus through genetic manipulation.

NbGIS regulates glandular trichome initiation through GA signaling in tobacco.

KEY MESSAGE: A novel gene NbGIS positively regulates glandular trichome initiation through GA Signaling in tobacco. NbMYB123-like regulates glandular trichome initiation by acting downstream of NbGIS in tobacco. Glandular trichome is a specialized multicellular structure which has capability to synthesize and secrete secondary metabolites and protects plants from biotic and abiotic stresses. Our previous results revealed that a C2H2 zinc-finger transcription factor GIS and its sub-family genes act upstream of GL3/EGL3-GL1-TTG1 transcriptional activator complex to regulate trichome initiation in Arabidopsis. In this present study, we found that NbGIS could positively regulate glandular trichome development in Nicotiana benthamiana (tobacco). Our result demonstrated that 35S:NbGIS lines exhibited much higher densities of trichome on leaves, main stems, lateral branches and sepals than WT plants, while NbGIS:RNAi lines had the opposite phenotypes. Furthermore, our results also showed that NbGIS was required in response to GA signal to control glandular trichome initiation in Nicotiana benthamiana. In addition, our results also showed that NbGIS significantly influenced GA accumulation and expressions of marker genes of the GA biosynthesis, might result in the changes of growth and maturation in tobacco. Lastly, our results also showed that NbMYB123-like regulated glandular trichome initiation in tobacco by acting downstream of NbGIS. These findings provide new insights to discover the molecular mechanism by which C2H2 transcriptional factors regulates glandular trichome initiation through GA signaling pathway in tobacco.

Ethylene mediates dichromate-induced inhibition of primary root growth by altering AUX1 expression and auxin accumulation in Arabidopsis thaliana.

The hexavalent form of chromium [Cr(VI)] causes a major reduction in yield and quality of crops worldwide. The root is the first plant organ that interacts with Cr(VI) toxicity, which inhibits primary root elongation, but the underlying mechanisms of this inhibition remain elusive. In this study, we investigate the possibility that Cr(VI) reduces primary root growth of Arabidopsis by modulating the cell cycle-related genes and that ethylene signalling contributes to this process. We show that Cr(VI)-mediated inhibition of primary root elongation was alleviated by the ethylene perception and biosynthesis antagonists silver and cobalt, respectively. Furthermore, the ethylene signalling defective mutants (ein2-1 and etr1-3) were insensitive, whereas the overproducer mutant (eto1-1) was hypersensitive to Cr(VI). We also report that high levels of Cr(VI) significantly induce the distribution and accumulation of auxin in the primary root tips, but this increase was significantly suppressed in seedlings exposed to silver or cobalt. In addition, genetic and physiological investigations show that AUXIN-RESISTANT1 (AUX1) participates in Cr(VI)-induced inhibition of primary root growth. Taken together, our results indicate that ethylene mediates Cr(VI)-induced inhibition of primary root elongation by increasing auxin accumulation and polar transport by stimulating the expression of AUX1.

Involvement of histone acetylation and deacetylation in regulating auxin responses and associated phenotypic changes in plants.

KEY MESSAGE: The most recent outcomes about the transcription factors and transcription complexes mediated auxin signaling pathway by the histone acetylation and deacetylation. The phytohormone auxin, is required to regulate its accumulation spatiotemporally and responses to orchestrate various developmental levels in plants. Histone acetylation and deacetylation modulate auxin biosynthesis, its distribution and accumulation. In the absence of auxin, histone deacetylase represses the expression of auxin-responsive genes. Various transcription factors and transcription complexes facilitate the proper regulation of auxin signaling pathway genes. The primary and lateral root development, promotion of flowering and initiation of seed germination are all regulated by auxin-mediated histone acetylation and deacetylation. These findings conclude the auxin mode of action, which is mediated by histone acetylation and deacetylation, and associated phenotypic responses in plants, along with the underlying mechanism of these modifications.

OsUGE2 Regulates Plant Growth through Affecting ROS Homeostasis and Iron Level in Rice.

BACKGROUND: The growth and development of rice (Oryza sativa L.) are affected by multiple factors, such as ROS homeostasis and utilization of iron. Here, we demonstrate that OsUGE2, a gene encoding a UDP-glucose 4-epimerase, controls growth and development by regulating reactive oxygen species (ROS) and iron (Fe) level in rice. Knockout of this gene resulted in impaired growth, such as dwarf phenotype, weakened root growth and pale yellow leaves. Biochemical analysis showed that loss of function of OsUGE2 significantly altered the proportion and content of UDP-Glucose (UDP-Glc) and UDP-Galactose (UDP-Gal). Cellular observation indicates that the impaired growth may result from decreased cell length. More importantly, RNA-sequencing analysis showed that knockout of OsUGE2 significantly influenced the expression of genes related to oxidoreductase process and iron ion homeostasis. Consistently, the content of ROS and Fe are significantly decreased in OsUGE2 knockout mutant. Furthermore, knockout mutants of OsUGE2 are insensitive to both Fe deficiency and hydrogen peroxide (H2O2) treatment, which further confirmed that OsUGE2 control rice growth possibly through Fe and H2O2 signal. Collectively, these results reveal a new pathway that OsUGE2 could affect growth and development via influencing ROS homeostasis and Fe level in rice.

Long-term clinical outcomes of intravascular imaging-guided percutaneous coronary intervention versus angiography-guided percutaneous coronary intervention in complex coronary lesions: a systematic review and meta-analysis.

Background: In this study, we aim to discuss the long-term clinical outcomes of intravascular ultrasound imaging-guided percutaneous intervention (IVUS-PCI) versus angiography-guided percutaneous coronary intervention (PCI) in complex coronary lesions over a mean period of 2 years. Methods: A systematic search and meta-analysis were conducted to assess the efficacy of using intravascular ultrasound or optical coherence tomography guidance in coronary artery stenting compared to angiography. Results: A total of 11 randomized controlled trials with 6740 patients were included. For the primary outcome, a pooled analysis (3.2 vs 5.6%). For secondary outcomes, the risk was significantly low in image-guided percutaneous intervention compared with angiography. Conclusion: Intravascular imaging-guided PCI is significantly more effective than angiography-guided PCI in reducing the risk of target lesion revascularization, target vessel revascularization, cardiac death, major adverse cardiovascular events and stent thrombosis.

A meta-analysis was conducted to compare intravascular ultrasound guidance/optical coherence tomography percutaneous coronary intervention with angiography percutaneous coronary intervention with target lesion revascularization as the primary outcome and target vessel revascularization, stent thrombosis, myocardial infarction, major adverse cardiovascular events, all cause death and cardiac death as the secondary outcomes.

Micro/nanoplastics: Critical review of their impacts on plants, interactions with other contaminants (antibiotics, heavy metals, and polycyclic aromatic hydrocarbons), and management strategies.

Microplastic/nanoplastics (MPs/NPs) contamination is not only emerging threat to the agricultural system but also constitute global hazard to the environment worldwide. Recent review articles have addressed the environmental distribution of MPs/NPs and their single-exposure phytotoxicity in various plant species. However, the mechanisms of MPs/NPs-induced phytotoxicity in conjunction with that of other contaminants remain unknown, and there is a need for strategies to ameliorate such phytotoxicity. To address this, we comprehensively review the sources of MPs/NPs, their uptake by and effects on various plant species, and their phytotoxicity in conjunction with antibiotics, heavy metals, polycyclic aromatic hydrocarbons (PAHs), and other toxicants. We examine mechanisms to ameliorate MP/NP-induced phytotoxicity, including the use of phytohormones, biochar, and other plant-growth regulators. We discuss the effects of MPs/NPs -induced phytotoxicity in terms of its ability to inhibit plant growth and photosynthesis, disrupt nutrient metabolism, inhibit seed germination, promote oxidative stress, alter the antioxidant defense system, and induce genotoxicity. This review summarizes the novel strategies for mitigating MPs/NPs phytotoxicity, presents recent advances, and highlights research gaps, providing a foundation for future studies aimed at overcoming the emerging problem of MPs/NPs phytotoxicity in edible crops.

Ethylene accelerates copper oxide nanoparticle-induced toxicity at physiological, biochemical, and ultrastructural levels in rice seedlings.

The enormous use of metal-based nanoparticles (NPs) in different sectors may result in enhanced accumulation in agricultural soil, which could impose negative effects on crop productivity. Hence, strategies are needed to explore the mechanisms of copper oxide nanoparticle (CuO NP)-induced toxicity in crops. The present study aimed to investigate the involvement of ethylene in CuO NP-induced toxicity in rice seedlings. Here, our results indicate that 450 mg L-1 of CuO NPs induced toxic effects in rice seedlings. Thus, it was evidenced by the reduced plant biomass accumulation, enhanced oxidative stress indicators, and cellular ultrastructural damages. More importantly, the exogenous supply of ethylene biosynthesis and signaling antagonists cobalt (Co) and silver (Ag) respectively provided tolerance and improved the defense system of rice seedlings against CuO NP toxicity. The ethylene antagonists could significantly reduce the extent of ultrastructural and stomatal damage by controlling the ROS accumulation in rice seedlings under CuO NP stress. Furthermore, Co and Ag augmented the antioxidant defense system against CuO NP-induced toxicity. Contrary to that, all oxidative damage attributes were further enhanced exogenous application of ethylene biosynthesis precursor [1-aminocyclopropane-1-carboxylic acid (ACC)] in the presence of CuO NPs. In addition, ACC could increase the CuO NP-induced stomatal and ultrastructural damages by reducing the ROS-scavenging ability in rice seedlings. Taken together, these results indicate the involvement of ethylene in CuO NP-induced toxicity in rice seedlings.

Efficacy of zinc-based nanoparticles in alleviating the abiotic stress in plants: current knowledge and future perspectives.

Due to sessile, plants are unable to avoid unfavorable environmental conditions which leads to inducing serious negative effects on plant growth, crop yield, and food safety. Instead, various approaches were employed to mitigate the phytotoxicity of these emerging contaminants from the soil-plant system. However, recent studies based on the exogenous application of ZnO NPs approve of their important positive potential for alleviating abiotic stress-induced phytotoxicity leads to ensuring global food security. In this review, we have comprehensively discussed the promising role of ZnO NPs as alone or in synergistic interactions with other plant growth regulators (PGRs) in the mitigation of various abiotic stresses, i.e., heavy metals (HMs), drought, salinity, cold and high temperatures from different crops. ZnO NPs have stress-alleviating effects by regulating various functionalities by improving plant growth and development. ZnO NPs are reported to improve plant growth by stimulating diverse alterations at morphological, physiological, biochemical, and ultrastructural levels under abiotic stress factors. We have explained the recent advances and pointed out research gaps in studies conducted in earlier years with future recommendations. Thus, in this review, we have also addressed the opportunities and challenges together with aims to uplift future studies toward effective applications of ZnO NPs in stress management.

Seed priming with nano-silica effectively ameliorates chromium toxicity in Brassica napus.

Plant yield is severely hampered by chromium (Cr) toxicity, affirming the urgent need to develop strategies to suppress its phyto-accumulation. Silicon dioxide nanoparticles (SiO2 NPs) have emerged as a provider of sustainable crop production and resistance to abiotic stress. But, the mechanisms by which seed-primed SiO2 NPs palliate Cr-accumulation and its toxic impacts in Brassica napus L. tissues remains poorly understood. To address this gap, present study examined the protective efficacy of seed priming with SiO2 NPs (400 mg/L) in relieving the Cr (200 µM) phytotoxicity mainly in B. napus seedlings. Results delineated that SiO2 NPs significantly declined the accumulation of Cr (38.7/35.9%), MDA (25.9/29.1%), H2O2 (27.04/36.9%) and O2• (30.02/34.7%) contents in leaves/roots, enhanced the nutrients acquisition, leading to improved photosynthetic performance and better plant growth. SiO2 NPs boosted the plant immunity by upregulating the transcripts of antioxidant (SOD, CAT, APX, GR) or defense-related genes (PAL, CAD, PPO, PAO and MT-1), GSH (assists Cr-vacuolar sequestration), and modifying the subcellular distribution (enhances Cr-proportion in cell wall), thereby confer tolerance to ultrastructural damages under Cr stress. Our first evidence to establish the Cr-detoxification by seed-primed SiO2 NPs in B. napus, indicated the potential of SiO2 NPs as stress-reducing agent for crops grown in Cr-contaminated areas.

The Multifaceted Role of Jasmonic Acid in Plant Stress Mitigation: An Overview.

Plants, being sessile, have developed complex signaling and response mechanisms to cope with biotic and abiotic stressors. Recent investigations have revealed the significant contribution of phytohormones in enabling plants to endure unfavorable conditions. Among these phytohormones, jasmonic acid (JA) and its derivatives, collectively referred to as jasmonates (JAs), are of particular importance and are involved in diverse signal transduction pathways to regulate various physiological and molecular processes in plants, thus protecting plants from the lethal impacts of abiotic and biotic stressors. Jasmonic acid has emerged as a central player in plant defense against biotic stress and in alleviating multiple abiotic stressors in plants, such as drought, salinity, vernalization, and heavy metal exposure. Furthermore, as a growth regulator, JA operates in conjunction with other phytohormones through a complex signaling cascade to balance plant growth and development against stresses. Although studies have reported the intricate nature of JA as a biomolecular entity for the mitigation of abiotic stressors, their underlying mechanism and biosynthetic pathways remain poorly understood. Therefore, this review offers an overview of recent progress made in understanding the biosynthesis of JA, elucidates the complexities of its signal transduction pathways, and emphasizes its pivotal role in mitigating abiotic and biotic stressors. Moreover, we also discuss current issues and future research directions for JAs in plant stress responses.

Efficacy of Probiotics in Management of Celiac Disease.

Objective The objective of this study was to interpret any rule of probiotics in the management of celiac disease and apply the results to improve the quality of life of patients with celiac disease if the result comes in favor of probiotics. Materials and methods It was a cross-sectional study conducted in the gastroenterology unit of Nishtar Medical University, Multan. A total of 170 children with celiac disease were enrolled in the study and divided into two groups (A and B) using a computer-generated table of random numbers. Group A was given only a gluten-free diet, while group B was given probiotics and a gluten-free diet. The efficacy of probiotics was measured in terms of reduction in stool frequency at the end of the 28 days of treatment. The data was recorded on the datasheet for every individual, and the statical analysis was performed using the Chi-square test. The patients were fully explained about the research purpose, and written consent was taken from them. Results The efficacy of probiotics in children with celiac disease was compared in both groups. Results showed a marked reduction in the frequency of stools to less than half, i.e., 90.59% (n=77) in group B and 63.53% (n=54) in group A. The Chi-Square test resulted in a p-value of 0.000027 showing a significant difference in both groups. Conclusion Probiotics are found to be highly efficient in terms of reduction in diarrhea in celiac disease. Probiotics will improve not only quality of life but also play an essential role in managing celiac disease.

Use of an Endobronchial Blocker Where a Double-Lumen Tube Failed to Ventilate: A Case Report of a Distorted Tracheobronchial Anatomy.

One-lung ventilation (OLV) during video-assisted thoracoscopic surgery (VATS) can be accomplished through several different techniques, including bronchial advancement of an endotracheal tube (ETT), use of a double-lumen tube (DLT), or placement of an endobronchial blocker. In most cases, a DLT is a mainstay of isolating and ventilating a single lung during cardiothoracic procedures. The reasons to deploy a DLT over other techniques include ease of placement, less chance of malposition, quick placement time, and quality of lung deflation. However, this case report highlights the importance of a bronchial blocker in a patient where a double-lumen tube failed to ventilate the lungs. Briefly, this young female patient had a right thoracic mass associated with ipsilateral lung collapse and moderate pleural effusion. CT-guided biopsy was planned but was deferred by the radiologist, as the patient was unable to lie in a prone position. The case was then referred to the cardiothoracic surgeon who planned a right VATS and biopsy of the lesion. In the operation theater, after induction of anesthesia, the patient could not be ventilated through a DLT, and high peak airway pressures were encountered. Initially, a size 37 left-sided DLT was used, and subsequently, sizes 35, 32, and 28 were also tried, but all these attempts to ventilate the patient remained futile. A bronchoscopy was done, which did not show any abnormality in the airway. The surgery was postponed due to an inability to ventilate the patient with a double-lumen tube. After a repeat CT scan and draining of 9.3 liters of pleural effusion over a week, the patient was again scheduled for the same procedure but with a changed anesthetic plan. This time around, the anesthetic plan was implemented successfully using a bronchial blocker to isolate the right lung. The surgery went ahead, and the patient had an uneventful postoperative period. The anesthetic management of this patient presented a unique set of challenges, which are shared in this case report.