Association of Leukocyte Subpopulations Identified by Flow Cytometry with Outcomes of Sepsis in a Respiratory Intensive Care Unit: An Observational Study.

INTRODUCTION: The dysregulated host immune response in sepsis is orchestrated by peripheral blood leukocytes. This study explored the associations of the peripheral blood leukocyte subpopulations with early clinical deterioration and mortality in sepsis. METHODS: We performed a prospective observational single-center study enrolling adult subjects with sepsis within 48 h of hospital admission. Peripheral blood flow cytometry was performed for the patients at enrolment and after 5 days. The primary outcome was to explore the association between various leukocyte subpopulations at enrolment and early clinical deterioration [defined as an increase in the sequential organ failure assessment (SOFA) score between enrolment and day 5, or death before day 5]. Other pre-specified outcomes explored associations of leukocyte subpopulations at enrolment and on day 5 with in-hospital mortality. RESULTS: A total of 100 patients, including 47 with septic shock were enrolled. The mean (SD) age of the patients was 53.99 (14.93) years. Among them, 26 patients had early clinical deterioration, whereas 41 died during hospitalization. There was no significant association between the leukocyte subpopulations at enrolment and early clinical deterioration on day 5. On multivariate logistic regression, a reduced percentage of CD8 + CD25+ T-cells at enrolment was associated with in-hospital mortality [odds ratio (OR), 0.82 (0.70-0.97); p-value = 0.02]. A reduced lymphocyte percentage on day 5 was associated with in-hospital mortality [OR, 0.28 (0.11-0.69); p-value = 0.01]. In a post-hoc analysis, patients with "very early" deterioration within 48 h had an increased granulocyte CD64 median fluorescent intensity (MFI) [OR, 1.07 (1.01-1.14); p-value = 0.02] and a reduced granulocyte CD16 MFI [OR, 0.97 (0.95-1.00); p-value = 0.04] at enrolment. CONCLUSIONS: None of the leukocyte subpopulations showed an association with early clinical deterioration at day 5. Impaired lymphocyte activation and lymphocytopenia indicative of adaptive immune dysfunction may be associated with in-hospital mortality.

Improving Clinical Trials for Anticomplement Therapies in Complement-Mediated Glomerulopathies: Report of a Scientific Workshop Sponsored by the National Kidney Foundation.

Blocking the complement system as a therapeutic strategy has been proposed for numerous glomerular diseases but presents myriad questions and challenges, not the least of which is demonstrating efficacy and safety. In light of these potential issues and because there are an increasing number of anticomplement therapy trials either planned or under way, the National Kidney Foundation facilitated an all-virtual scientific workshop entitled "Improving Clinical Trials for Anti-Complement Therapies in Complement-Mediated Glomerulopathies." Attended by patient representatives and experts in glomerular diseases, complement physiology, and clinical trial design, the aim of this workshop was to develop standards applicable for designing and conducting clinical trials for anticomplement therapies across a wide spectrum of complement-mediated glomerulopathies. Discussions focused on study design, participant risk assessment and mitigation, laboratory measurements and biomarkers to support these studies, and identification of optimal outcome measures to detect benefit, specifically for trials in complement-mediated diseases. This report summarizes the discussions from this workshop and outlines consensus recommendations.

A report on extensive lateral genetic reciprocation between arsenic resistant Bacillus subtilis and Bacillus pumilus strains analyzed using RAPD-PCR.

The study involves isolation of arsenic resistant bacteria from soil samples. The characterization of bacteria isolates was based on 16S rRNA gene sequences. The phylogenetic consanguinity among isolates was studied employing rpoB and gltX gene sequence. RAPD-PCR technique was used to analyze genetic similarity between arsenic resistant isolates. In accordance with the results Bacillus subtilis and Bacillus pumilus strains may exhibit extensive horizontal gene transfer. Arsenic resistant potency in Bacillus sonorensis and high arsenite tolerance in Bacillus pumilus strains was identified. The RAPD-PCR primer OPO-02 amplified a 0.5kb DNA band specific to B. pumilus 3ZZZ strain and 0.75kb DNA band specific to B. subtilis 3PP. These unique DNA bands may have potential use as SCAR (Sequenced Characterized Amplified Region) molecular markers for identification of arsenic resistant B. pumilus and B. subtilis strains.

Quality Standards and Pharmacological Interventions of Natural Oils: Current Scenario and Future Perspectives.

Medicinal plants are rich sources of natural oils such as essential and fixed oils used traditionally for nutritive as well as medicinal purposes. Most of the traditional formulations or phytopharmaceutical formulations contain oil as the main ingredient due to their own therapeutic applications and thus mitigating several pathogeneses such as fungal/bacterial/viral infection, gout, psoriasis, analgesic, antioxidant, skin infection, etc. Due to the lack of quality standards and progressive adulteration in the natural oils, their therapeutic efficacy is continuously deteriorated. To develop quality standards and validate scientific aspects on essential oils, several chromatographic and spectroscopic techniques such as HPTLC, HPLC, NMR, LC-MS, and GC-MS have been termed as the choices of techniques for better exploration of metabolites, hence sustaining the authenticity of the essential oils. In this review, chemical profiling and quality control aspects of essential or fixed oils have been explored from previously reported literature in reputed journals. Methods of chemical profiling, possible identified metabolites in essential oils, and their therapeutic applications have been described. The outcome of the review reveals that GC-MS/MS, LC-MS/MS, and NMR-based chromatographic and spectroscopic techniques are the most liable, economic, precise, and accurate techniques for determining the spuriousness or adulteration of oils based on their qualitative and quantitative chemical profiling studies. This review occupies the extensive information about the quality standards of several oils obtained from natural sources for their regulatory aspects via providing the detailed methods used in chemoprofiling techniques. Hence, this review helps researchers in further therapeutic exploration as well as quality-based standardization for their regulatory purpose.

Kikuchi's Disease: A Rare Cause of Fever of Unknown Origin.

Kikuchi Fujimoto Disease (KFD) or histiocytic necrotizing lymphadenitis can present with unexplained fever and lymphadenopathy. It is often mistaken for more serious conditions like malignant lymphoma or tuberculosis. First case was described by Kikuchi in Japan, very few cases have been reported in Pakistan. A middle aged female presented with fever and body aches for one month. She was investigated extensively for pyrexia of unknown origin, all of which came out to be normal except a raised ESR. Anti-tuberculous drugs were started on clinical suspicion, with no improvement after a month. Later, a detailed physical examination revealed cervical lymphadenopathy. One of the lymph nodes was excised and biopsied. The histopathology suggested Kikuchi's disease. Oral Prednisolone was started showing improvement. Her fever subsided and lymph nodes disappeared at the follow-up visit. No relapse was encountered in the subsequent visits.

Gossypiboma as a cause of intestinal obstruction.

Gossypiboma / textiloma / retained surgical sponge is an avoidable surgical complication which can lead to patient morbidity, mortality and profound medicolegal implications. Retained surgical sponge can present early as abscess formation and septic complications or follow a silent course for many years to present later as intestinal obstruction, fistula formation or simply be extruded through rectum. A lady presented 8 months after laparotomy with symptoms of bowel obstruction due to a retained surgical sponge that had eroded into the rectosigmoid junction. The introduction of WHO Safety Checklist in operation theatres where advance tagging systems are not available, would lead to development of standard protocols and help in avoiding the occurrence of such retained surgical foreign bodies.

Evaluation of the effect of pelvic floor muscle training (PFMT or Kegel exercise) and assisted pelvic floor muscle training (APFMT) by a resistance device (Kegelmaster device) on the urinary incontinence in women: a randomized trial.

OBJECTIVE: To evaluate the effect of pelvic floor muscle training (PFMT) or Kegel exercise with and without assistance by a resistance device (Kegelmaster device) on the urinary incontinence in women. STUDY DESIGN: A randomized clinical trial was performed on 91 women with the complaint of urinary incontinence. In the assisted pelvic floor muscle training (APFMT) group (n=41), after complete training, Kegelmaster device were used twice daily for 15 min each session, for a total duration of 12 weeks. In the pelvic floor muscle training (PFMT) group (n=50) after complete training, kegel exercises were done (including perineal muscle contractions for 6-8s with 6s rest in between), twice daily for 15 min each session and for a total duration of 12 weeks. These two groups were then compared according to the scores of special questionnaires for quality of life, strength of pelvic floor muscles, capability to participate in social activities, severity of urinary incontinence, and the number of involuntary urine passage, taken before, and after 1 and 3 months after finishing interventions. RESULTS: 85 women out of 91 women finished the study (46 in the PFMT group and 39 in the APFMT group). Strength of pelvic floor muscles, capability to participate in social activities, score of quality of life according to three world questionnaires of IQOL (incontinence Quality Of Life), IIQ (Incontinence Impact Questionnaire), UDI (Urogenital Distress Inventory), showed no difference between the two groups 1 and 3 months after interventions. Pair t test showed a significant improvement in both groups 1 and 3 months after intervention, according to IQOL score (P=0.000), UDI score (P=0.000), IIQ score (P=0.000), strength of pelvic floor muscles, (P=0.000), capability to participate in social activities (P=0.000), severity of urinary incontinence (P=0.000) and the number of involuntary urine passage (P=0.000). CONCLUSION: Pelvic floor muscle training with or without Kegelmaster show no apparent difference to each other, however, these two methods are effective for improvement of urinary incontinence in women.