VAAFT for complex anal fistula: a useful tool, however, cure is unlikely.

BACKGROUND: Therapeutic options for complex anal fistula (CAF) are limited. Video-assisted anal fistula treatment (VAAFT) allows examination of these anatomically complex fistulae from within. The aim of the present study was to evaluate outcomes of VAAFT for a series of CAF. METHODS: A retrospective study was conducted on consecutive patients at a single centre with complex anal cryptoglandular and Crohn's fistulae managed with VAAFT from June 2016 to June 2019. CAF was diagnosed as high intersphincteric/transsphincteric tract, multiple/secondary tracts, horseshoe or anovaginal fistulae. Patients were treated with 'therapeutic intent' if the internal opening was closed at the time of ablation and 'diagnostic/staged/palliative' VAAFT if there was no ablation/partial treatment/ablation-only, respectively. Symptom improvement was a reduction in reported pain, discharge, or pad use. RESULTS: Eighty-four patients (73 cryptoglandular, 11 Crohn's, M:F 2.5:1, median age 43 [22-77] years), underwent 105 VAAFT procedures. Twenty patients had > 1 VAAFT. Median follow-up was 8 (1-46) months. 40 (48%) had multiple or secondary tracts; an additional 16 (19%) had horseshoe and 3 (4%) anovaginal fistulae. Of the 84 patients, 19 [16/73 (22%) cryptoglandular and 3/11 (27%) Crohn's fistulae] healed. 34 (40%) unhealed reported improved symptoms; 23 (27%) no improvement; and 6 (7%) were worse. Sixteen (19%) had CAF > 5 years of whom none healed, albeit 50% reported symptom improvement. Five patients (6%) developed faecal incontinence: 2 temporary, 1 to flatus only and 1 to liquid and 1 to solid, all managed conservatively. CONCLUSIONS: VAAFT is a useful minimally invasive procedure for complex fistula with no other minimally invasive options. Complete healing is rare, and, although symptoms can be improved in a number of cases, there is a small risk of incontinence.

Retrospective imaging audit and cost analysis of medical oncology inpatients admitted to Westmead Hospital.

BACKGROUND: Cancer patients often require complex and expensive admissions necessitating multiple investigations. We conducted an audit of cost of imaging performed on medical oncology inpatients in a teaching hospital in New South Wales. AIMS: Our overall aim was to assess cost and appropriateness of imaging studies in inpatients. METHODS: Data were collected on 219 consecutive evaluable inpatients admitted to Westmead Hospital (August-October 2012). A panel of oncology doctors assessed cost and appropriateness of imaging. RESULTS: The total expenditure for the cohort was $106,488.15 over 624 investigations (range: 0-26, median: two per admission). Of this sum, $8881.91 (8%) was deemed inappropriate. The most frequently ordered test was chest X-ray (251). Imaging cost per admission was $0-2478 (range), $324.95 (median), $486.99 (mean). Cost trended to increase with age of patient ($186.40 (18-40), $477.22 (41-65), $489.50 (66-75), $575.33 (>75) ). Mean cost was higher for patients treated with palliative ($493.98) vs curative ($307.59) intent. Mean cost was higher for patients consulted by palliative care and other subspecialties. There was variation of average cost by discharge destination - other hospital ($262.23), palliative care unit ($334.08), home ($480.84) and death ($769.93). Although imaging ordered was deemed overwhelmingly clinically appropriate, approximately $35,000/year is spent on inappropriate tests, mostly due to duplication or scans that could have been performed as an outpatient. CONCLUSION: Our audit supports that the current spending patterns on imaging within our department is predominantly appropriate and necessary. Duplication and expenditure may be reduced by improving electronic access from the ward to outpatient scan results.

Heterostructures of polyaniline and Ce-ZnO nanomaterial coated flexible PET thin films for LPG gas sensing at standard environment.

The n-type Ce doped ZnO (Ce-ZnO) and p-type polyaniline (PANI) heterojunction were successfully synthesized via simple chemical solution method for sensing liquefied petroleum gas (LPG) at standard environment. The morphology and structures of as-prepared Ce-ZnO & PANI nanoparticles were analyzed by numerous kinds of techniques. Ce-ZnO & PANI nanoparticles were mixed with n-methylpyrrolidone (NMP) which is coated over the gold coated PET electrode by doctor blade method and dried overnight at 60 °C to form p-n junction. The as-formed p-n junction is to be driven with the help of 1.5 V potential at ambient temperature. X-ray photoelectron spectroscopy results of Ce-ZnO nanoparticles confirmed the existence of Ce4+ and the improved amount of both chemisorbed oxygen and oxygen vacancy after the formation of Ce-ZnO heterojunction. The maximum response of 80% was realized for hollow Ce-ZnO/PANI sensor at 100 ppm. The proposed material is a novel candidate to detect the LPG even at low (30) ppm and this study reveals the possibility of developing a potentially inexpensive hollow Ce-ZnO/PANI sensor for sensing LPG efficiently.

Infertility and Social Issue Have the Most Significant Impact on Health-related Quality of Life among Polycystic Ovarian Syndrome Women in South India.

Background: Infertility can have a significant impact on the identity of women. Individual women, who are infertile, experience tragic emotions, as well as those who are sad for great losses, like the death of a loved one. In this case, the woman is experiencing the loss of the ability to procreate. Aim: In the present study, our major concern was to implement the health-related quality of life (HRQOL) Questionnaire on South Indian polycystic ovarian syndrome (PCOS) women to assess the impact of various clinical features of polycystic ovary syndrome on the HRQOL of South Indian women diagnosed. Settings and Design: A total of 126 females in the first phase and 356 females in the second phase between the age group of 18-40 years characterised under the Rotterdam criteria were selected for the study. Materials and Methods: The study was carried out in three different phases which included a one-to-one interview, group discussion and questionnaire session. In our study, we found that all the females who attend the study showed positivity for all the domains developed in the previous study and suggested that further domain can be developed. Statistical Analysis Used: Suitable statistical methods were used with Graph pad PRISM (version 6). Results: Hence, in our study, we developed a further new sixth domain called as 'social impact domain'. Among South Indian PCOS women, we found that infertility and social issue have the most significant impact on HRQOL. Conclusion: The revised questionnaire by including the sixth domain called 'Social issue' is likely to be useful in measuring the quality of health of female having PCOS in regard to South Indian population.

Gene polymorphism among hypertensive patients with coronary artery disease.

The obstruction of the coronary arteries causes Coronary Artery Disease (CAD). It has been reported that interleukin-6 gene is related to the development of cardiovascular diseases such as atherosclerosis and coronary artery disease. This was due to the large variability and short half-life of interleukin 6 (IL-6). There are few studies on the link between interleukin 6 and CAD on the patients with hypertension. Therefore, goal of this study was to see if there is a link between IL-6 gene polymorphisms and coronary artery disease with hypertension patients. The polymorphisms were carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The data was determined for statistical significance using chi-square analysis. A significant difference was found in the GG genotype of IL-6 -174, which was more frequent in cases of CAD (48.67 %) than in controls (8%) and 95% CI was 0.473455 - 0.500326; P<0.010620511. The GG genotype of IL-6-572C/G polymorphism was more frequent in cases of CAD (42.6%) compared with controls (8%) and 95% CI 0.386724 - 0.480945; P<0.017939631). likewise, significant association of variant allele G with CAD patients was reported. Hypertension was significantly higher among patients as compared to controls (P<0.022847535). Our findings indicated that both gene polymorphisms may be associated with development of CAD.

Correlation of inflammatory cytokines and uric acid levels in coronary artery disease with and without type 2 diabetes mellitus.

Serum levels of inflammatory cytokines such as IL-6, high-sensitivity C-reactive protein as well as uric acids have been considered as predictors of severe outcomes in patients with coronary artery disease (CAD) associated with hypertension (HTN) and Type 2 Diabetes Mellitus (T2DM). Anthropometric parameters were recorded and measured the levels of major risk factors in 80 patients with hypertension, coronary artery disease with and without Type 2 diabetes mellitus and 40 healthy controls were included. Comparison were performed by classifying the study subjects into 3 groups namely- Group I: Controls (n=40); Group II: HTN, CAD without T2DM(n=40); and Group III: HTN,CAD with T2DM(n=40).The values of BMI, weight, SBP, DBP were greater in patients with T2DM CAD group when compared to without diabetes group. Data shows that there is a positive correlation between IL-6, hs-CRP and uric acid concentrations and are statistically significant. The evaluated high levels of inflammatory cytokines and uric acids in hypertensive CAD patients with diabetes might be helpful in the diagnosis of patients at greater risk.

Chitosan as an environment friendly biomaterial - a review on recent modifications and applications.

Amongst the natural polymers, chitin is the second most abundant, present mainly in fungi and exoskeleton of crustaceans. It forms a major part of the seafood waste as compiled and presented in this review and is de-acetylated to produce chitosan. Structure and properties of chitosan have been described. Biocompatible and biodegradable characteristics of chitosan have been well studied. In addition to the environmental sustainability associated with its use, the malleability of chitosan due to its reactive amino and hydroxyl groups, adds to its wide repertoire in usage through various modifications. Recent publications of chitosan and derivatives have been classified into its various applications in food, pharmaceutical, biotechnology, medical, textile, paper, agriculture and environmental applications. The abundance of chitosan and diversity in modifications can be effectively utilized in various applications leading to environmental friendly solutions as highlighted in this review.

Mitochondrial pathway of apoptosis and necrosis contribute to tenofovir disoproxil fumarate-induced renal damage in rats.

Tenofovir disoproxil fumarate (TDF) is currently the only nucleotide analogue reverse-transcriptase inhibitor that is approved by the Food and Drug administration (FDA), USA, for the treatment of human immunodeficiency virus (HIV) infection. In recent days, renal toxicity is becoming common i HIV patients treated with TDF. However, the mechanism of tenofovir nephrotoxicity is not clear. We hypothesized that mitochondrial pathway of apoptosis, poly [ADP-ribose] polymerase (PARP) overactivation and neutrophil infiltration may contribute to tenofovir-induced renal damage. Renal damage was induced in adult male Wistar rats by the oral administration of 600 mg/kg body weight daily for five consecutive weeks. Kidneys were removed and used for histological and biochemical analyses. Apoptosis was detected by terminal deoxynucleotidyl transferase biotin-deoxyuridine triphosphate nick end-labelling (TUNEL) assay and caspase 3 activity and protein expression; mitochondrial pathway of apoptosis by cyt c release; and PARP activation by immunofluorescence, immunohistochemistry and Western blot techniques. Myeloperoxidase (MPO) activity was measured as a marker of neutrophil infiltration. TDF administration resulted in increased number of TUNEL-positive cells, activation of caspase 3 and release of cyt c from mitochondria into the cytosol in the kidneys. There was increased nuclear localization of PARP as well as increase in its protein level in the TDF-treated rat kidneys. In addition, renal MPO activity was increased ninefold as compared to controls. The results of the present study show that mitochondrial apoptotic pathway, PARP overactivation and neutrophil infiltration contribute to tenofovir-induced renal damage in rats.

Freestanding flexible, pure and composite form of reduced graphene oxide paper for ammonia vapor sensing.

Metal oxides based graphene nanocomposites were used for ammonia vapour sensing. The self-assembly process was adopted to prepare freestanding flexible pure rGO, CeO2-rGO and SnO2-rGO composite papers. The structural studies confirmed the formation of rGO composite papers. The ammonia vapor sensing was demonstrated using an impedance analyzer at different humidity levels as well as concentration. The CeO2-rGO composite paper achieved a sensitivity of 51.70 ± 1.2%, which was higher than that of pure rGO and SnO2-rGO composite paper. Both the surfaces (top and bottom) of the papers are active in efficiently sensing ammonia, which makes the present work unique. The results reveal that metal oxide/rGO papers can be effectively utilized in real time sensor application.

An effective integrated learning programme in the first year of the medical course.

BACKGROUND: An integrated approach to teaching medical subjects is an effective educational strategy. Yet, this has not become popular in medical colleges in India. We describe an integrated learning programme to teach the gastrointestinal system in the first year of the medical course. METHODS: The integrated learning programme was conducted for 3 years (2003-2005). It incorporated elements of problem-based learning, early clinical exposure, lectures and small group laboratory work. Student assessment was formative (for problem-based learning sessions) and summative (using problem-based learning and knowledge tests). Evaluation of the programme was based on feedback from the students and faculty members. RESULTS: Ninety-six per cent of the students obtained more than 60% marks in the problem-based learning test. The mean (SD) score in the knowledge test was 62 (0.89)%. The majority of students received satisfactory and more than satisfactory grades for their performance in the problem-based learning sessions. The feedback from faculty members and students was positive, which highlighted benefits such as integrated learning of the basic sciences, their application to clinical cases and active student learning. The challenges encountered included the higher input required from faculty members. Most of the faculty members and students recommended that the integrated programme should be continued and extended to other parts of the curriculum. CONCLUSION: An integrated learning programme is feasible within a conventional medical curriculum of an Indian medical college.

Nystatin increases hepatic alkaline phosphatase activity.

The activity of alkaline phosphatase is increased significantly in the livers of rats after the intraperitoneal administration of nystatin. Studies with cycloheximide suggested that de novo protein synthesis was essential for the effect of nystatin on alkaline phosphatase activity. The induction of hepatic alkaline phosphatase by nystatin is not secondary to the release of glucocorticoids because the response of the enzyme to the administration of nystatin was not affected by bilateral adrenalectomy.

Surgical resection of a liver metastasis from breast cancer.

We report a case of a solitary liver metastasis from breast cancer in a 65-year-old woman. The patient underwent a mastectomy and axillary lymph node clearance for right breast cancer in 1990. A solitary metastasis was found in the left lobe of the liver by ultrasonography, 20 years after the initial mastectomy. A left lateral segmentectomy was performed in January 2011 and adjuvant hormonal therapy was also initiated. At present, she remains disease free. This case demonstrates the implementation of liver resection to provide an effective treatment for metachronous metastatic breast cancer. We encourage surgeons to offer suitable patients this surgical treatment option, which is shown to provide a survival benefit.

Plasma fibrinogen--an independent risk factor for ischaemic heart disease.

Although several risk factors have been identified for ischaemic heart disease, yet their predictive value on an individual basis remains rather low. Hence there is a need to identify other variables that can be associated with ischaemic heart disease. Fibrinogen level has been associated as an independent risk factor in studies undertaken in the west. This study was done to find out whether fibrinogen level is a risk factor in Indian populations. Out of 131 consecutive male subjects undergoing coronary angiogram over a four-month period, 98 were found to have ischaemic heart disease based on angiogram. Fibrinogen levels (estimated using the Clauss method) were higher in patients with ischaemic heart disease when compared with controls (374 +/- 11.9 vs 268 +/- 14.9 p < 0.0001). In the multivariate analysis it was found that fibrinogen levels more than 300 mg percent had an odds ratio of 4.4 for ischaemic heart disease (confidence interval of 2.4 to 19). The only other variable associated with ischaemic heart disease other than fibrinogen, was low level of HDL. The fibrinogen levels were higher in patients with triple-vessel disease when compared with single or two-vessel disease. Our results are in agreement with the findings in the west that fibrinogen levels are a risk factor for ischaemic heart disease. This factor needs to be addressed seriously and steps taken to lower the fibrinogen level in clinical practice.

Mitochondrial dysfunction and respiratory chain defects in a rodent model of methotrexate-induced enteritis.

The efficacy of methotrexate (MTX), a widely used chemotherapeutic drug, is limited by its gastrointestinal toxicity and the mechanism of which is not clear. The present study investigates the possible role of mitochondrial damage in MTX-induced enteritis. Small intestinal injury was induced in Wistar rats by the administration of 7 mg kg(-1) body wt. MTX intraperitoneally for 3 consecutive days. MTX administration resulted in severe small intestinal injury and extensive damage to enterocyte mitochondria. Respiratory control ratio, the single most useful and reliable test of mitochondrial function, and 3-(4,5-dimethylthiazol-2-yll)-2,5-diphenyltetrazolium bromide reduction, a measure of cell viability were significantly reduced in all the fractions of MTX-treated rat enterocytes. A massive decrease (nearly 70%) in the activities of complexes II and IV was also observed. The results of the present study suggest that MTX-induced damage to enterocyte mitochondria may play a critical role in enteritis. MTX-induced alteration in mitochondrial structure may cause its dysfunction and decreases the activities of the electron chain complexes. MTX-induced mitochondrial damage can result in reduced adenosine triphosphate synthesis, thereby interfering with nutrient absorption and enterocyte renewal. This derangement may contribute to malabsorption of nutrients, diarrhea, and weight loss seen in patients on MTX chemotherapy.

Effect of sintering temperature on structural and optical properties of indium(III) oxide nanoparticles prepared with Triton X-100 by hydrothermal method.

Indium(III) hydroxide (In(OH)3) powders prepared via Triton X-100 mediated hydrothermal method was sintered at different temperatures (400, 500 and 600°C) to yield indium(III) oxide nanoparticles (In2O3 NPs). Thermal studies of In(OH)3 confirmed complete conversion to In2O3 around 400°C. Powder X-ray diffraction (XRD) pattern of sintered In2O3 nanoparticles revealed the formation of phase pure cubic In2O3. The crystallite size of In2O3 NPs was increased from 12 to 26nm upon increasing the sintering temperature from 400°C to 600°C, while the percentage crystallinity was increased up to 90% after sintering at 600°C. A red shift in the band gap energy was observed with increasing sintering temperature due to the larger size of sintered In2O3 NPs. Room temperature photoluminescence spectra of the indium oxide nanoparticles showed both near band and excitonic emission of In2O3 due to oxygen vacancies.

Bioactive potential of Streptomyces against fish and shellfish pathogens.

BACKGROUND AND OBJECTIVES: In the present study, isolation of Streptomyces associated with marine sponges and its bioactive potential against fish and shellfish pathogens were assessed. The Streptomyces sp. were isolated from the marine sponges namely Callyspongia diffusa, Mycale mytilorum, Tedania anhelans and Dysidea fragilis collected from Vizhinjam port, situated in the South-West coast of India. MATERIALS AND METHODS: The Streptomyces associated with marine sponges were isolated using specific ISP media. The isolates of Streptomyces were characterized for their colony characteristics, morphological properties, physiological and biochemical properties and were tentatively identified. The strains were cultivated on a lab scale level as shake-flask cultures and the crude extracts of the bioactive compounds obtained with ethyl acetate were screened biologically and chemically. By biological screening, the extracts were analyzed for their activity against fish and shellfish pathogens namely Aeromonas hydrophila, Serratia sp. and Vibrio spp, using the disk and agar-well diffusion bioassay method, while by chemical screening the crude culture extracts were analyzed by TLC and UV-Vis spectrophotometer. RESULTS: Ninety-four isolates were found to be associated with marine sponges, among them only seven strains showed antagonism against fish and shellfish pathogens. Analysis of morphological, physiological and biochemical characteristics suggested that these strains belonged to the genus Streptomyces. The initial screening of the isolates by spot inoculation method exhibited antibacterial activity against Aeromonas hydrophila. In-vitro screening of the submerge culture extracts showed positive inhibition against the fish and shellfish pathogens namely Aeromonas hydrophila, Serratia sp. and Vibrio spp. The screening of bioactive compounds confirmed the production of polyene substances by UV spectrum, which resulted in absorbance peaks ranging from 225 to 245 nm and TLC analysis yielded R(f) values ranging from 0.40 to 0.78. CONCLUSION: The results suggest that the seven Streptomyces strains isolated from marine sponges produce potential antibacterial compounds against fish and shellfish pathogens.

An adenylyl cyclase signaling pathway predicts direct dopaminergic input to vestibular hair cells.

Adenylyl cyclase (AC) signaling pathways have been identified in a model hair cell preparation from the trout saccule, for which the hair cell is the only intact cell type. The use of degenerate primers targeting cDNA sequence conserved across AC isoforms, and reverse transcription-polymerase chain reaction (RT-PCR), coupled with cloning of amplification products, indicated expression of AC9, AC7 and AC5/6, with cloning efficiencies of 11:5:2. AC9 and AC5/6 are inhibited by Ca(2+), the former in conjunction with calcineurin, and message for calcineurin has also been identified in the trout saccular hair cell layer. AC7 is independent of Ca(2+). Given the lack of detection of calcium/calmodulin-activated isoforms previously suggested to mediate AC activation in the absence of Gαs in mammalian cochlear hair cells, the issue of hair-cell Gαs mRNA expression was re-examined in the teleost vestibular hair cell model. Two full-length coding sequences were obtained for Gαs/olf in the vestibular type II-like hair cells of the trout saccule. Two messages for Gαi have also been detected in the hair cell layer, one with homology to Gαi1 and the second with homology to Gαi3 of higher vertebrates. Both Gαs/olf protein and Gαi1/Gαi3 protein were immunolocalized to stereocilia and to the base of the hair cell, the latter consistent with sites of efferent input. Although a signaling event coupling to Gαs/olf and Gαi1/Gαi3 in the stereocilia is currently unknown, signaling with Gαs/olf, Gαi3, and AC5/6 at the base of the hair cell would be consistent with transduction pathways activated by dopaminergic efferent input. mRNA for dopamine receptors D1A4 and five forms of dopamine D2 were found to be expressed in the teleost saccular hair cell layer, representing information on vestibular hair cell expression not directly available for higher vertebrates. Dopamine D1A receptor would couple to Gαolf and activation of AC5/6. Co-expression with dopamine D2 receptor, which itself couples to Gαi3 and AC5/6, will down-modulate levels of cAMP, thus fine-tuning and gradating the hair-cell response to dopamine D1A. As predicted by the trout saccular hair cell model, evidence has been obtained for the first time that hair cells of mammalian otolithic vestibular end organs (rat/mouse saccule/utricle) express dopamine D1A and D2L receptors, and each receptor co-localizes with AC5/6, with a marked presence of all three proteins in subcuticular regions of type I vestibular hair cells. A putative efferent, presynaptic source of dopamine was identified in tyrosine hydroxylase-positive nerve fibers which passed from underlying connective tissue to the sensory epithelia, ending on type I and type II vestibular hair cells and on afferent calyces.