Inadvertent Treatment of a Vertical Banded Gastroplasty Stricture With a LAMS for Two Years

Introduction: Lumen-apposing metal stents (LAMS) are innovative endoscopic devices representing the next significant advancement in stent technology. LAMS have demonstrated success, most notably with improving drainage of pancreatic fluid collections. Other clinical indications for using LAMS include biliary drainage, gastroenterostomy, or the managment of luminal tract strictures. The stent has a larger lumen diameter than previously created stents as well as a unique "dumbbell" shape to limit migration. Studies have demonstrated advantages such as shorter procedure times and overall reduced repeat endoscopic procedures. As LAMS has gained notoriety, there have been increasing studies demonstrating potential complications of the device. Most common consequences of LAMS include bleeding, biliary stricture, and buried LAMS syndrome. As the anatomical design has decreased migration risk, prompt removal is recommended to prevent buried LAMS syndrome, where the stent is embedded in the wall of the gastric mucosa and can eventually not be visualized endoscopically. In this case, we will present a patient with an endoscopically placed LAMS, which was successfully removed with minimal complications after two years in place. Case Description/Methods: Our patient is a 68 year old female with a Vertical Banded Gastroplasty Stricture. She had required multiple repeat endoscopies for dilation therapy but the stricture was refractory to dilation, as a result, she underwent LAMS placement Due to the onset of the COVID pandemic, patient was lost to follow up. On a repeat EGD two years after placement, the stent remained in its original location. There were signs of mild gastric tissue overgrowth at the right lateral side of the LAMS. The stent was then removed easily with no signs of bleeding. After removal, the stricture remained dilated as the scope could be passed without difficulty. Over course of COVID she ate better than she had in years. (Figure) Discussion: LAMS have demonstrated significant success in a variety of endoscopic interventions. Their potential complications are well documented in various studies. This case is unique in regards to the length of time in which the LAMS remained in position. From a literature review, no study has demonstrated a LAMS in place as long as two years for stricture management. More remarkable is the lack of complications from the stent such as no bleeding with removal and no true buried LAMS syndrome as there was minimal tissue overgrowth. (Figure Presented).

Traditional washing formulations outstand commercial ones for washing Antheraea assamensis (Muga) silk cloth

Safe silk washing is an issue faced by its users for long because silk is prone to get damaged during conventional washing. The current study focused on the possible Antheraea assamensis (Muga) silk washing formulation which was a rare event until people realized the importance of cleaning and hygiene with the onset of covid-19 pandemic. Kolakhar, lemon (citrus) juice, and some commercially available washing products were studied for bond changes by FTIR, surface changes by SEM and colour deviations from control samples. The study showed that there was formation of new bands in all treated samples (except water wash) between 1513-1518 cm-1 that is attributed to beta-sheets;and 1698-1703 cm-1 linked with beta-turn conformation in all the treatments. The morphological observation illustrated fibrillation and peeling off fibers in the commercial washed fabrics. Colour change (E) was least in fabric conditioner (0.85) < citrus wash (1.06) < Kolakhar wash (1.13) and maximum for fabric whitener (5.46). Overall, the traditional agents proved excellent washing factor and has the potential in opening a window for optimized formulation that can be employed for Muga washing.

Pancreaticopleural fistula presenting as respiratory distress in previously healthy adolescent

Case Report: Respiratory distress is one of the most common complaints evaluated by pediatric providers in the office and emergency department setting. While primary cardiopulmonary processes represent the majority of cases of respiratory distress, pleural effusions of extravascular origin remain a rare but important differential. In this case, we present a previously healthy adolescent female who presented to our institution with respiratory distress and was subsequently found to have a pancreatic pleural effusion in the setting of a pancreaticopleural fistula. A 13 year old female with no chronic past medical history presented to the emergency department for three weeks of progressively worsening shortness of breath. History was notable for SARS-CoV-2 infection 6 months prior and intermittent night sweats and fevers for previous 4 weeks. She denied trauma, abdominal pain, nausea, vomiting, diarrhea, or anorexia. Her exam was notable for tachycardia, tachypnea, tripod positioning and absent breath sounds on her left. Chest computed tomography (CT) revealed left pleural effusion of entire left hemithorax with midline shift in addition to right sided pulmonary thromboembolism, small right sided pleural effusion and venous thromboses of the left internal jugular, subclavian, and proximal innominate veins. A left thoracentesis was performed, and patient was admitted to the PICU on a heparin infusion with subsequent left chest tube placement. Follow-up CT imaging revealed bilateral renal infarcts, iliac vein thrombosis, and a pancreatic fluid collection extending into the mediastinum with pancreatic ductal dilation. Magnetic resonance cholangiopancreatography further characterized the pancreatic lesion as a cystic tract traversing from the inferior mediastinum into the retroperitoneum and replacing the majority of the pancreatic gland suggesting a pancreaticopleural fistula as the source of a pancreatic pleural effusion. Serum amylase was 256 U/L and serum lipase was 575 U/L. Pleural fluid amylase was 1702 U/L and pleural fluid lipase was >2400 U/L, exceeding detection limit of this institution's lab. An extensive diagnostic work-up included infectious, hematologic, oncologic, autoimmune and rheumatologic etiologies and was largely unremarkable. Given concern for pancreaticopleural fistula, patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) which was diagnostic for pancreatic divisum. A pancreatic duct stent was placed with normalization of serumpancreatic enzymes prior to discharge and resolution of pleural effusion at one month post ERCP Although an initial episode of acute pancreatitis usually resolves with supportive care, this case is a reminder that pancreatitis can present with local and systemic complications including pulmonary effusion or venous thromboses and keeping a high index of suspicionfor it is crucial toavoid delaying diagnosis and care. Copyright © 2023 Southern Society for Clinical Investigation.

Staining effect of herbal immune boosters used during Covid-19 pandemic on teeth shade: In-vitro study

Objective: Assessment of staining effect of herbal immune boosters used during COVID-19 pandemic on teeth shade. Material and method: 70 extracted premolars (N=10) were assigned to different solutions which were formulated to mimic the impact of herbal immune boosters on teeth. A baseline reading was performed using in-vitro VITA Easy shade Advance 4.0 and one day later, seven days later, and fourteen days later. The data was entered into SPSS software version 26. Results: A statistically significant difference was noticed in orange, lemon, and curcuma. Conclusion: The consumption of some herbal products has an impact on teeth's shade. Moreover, some materials such as, orange, lemon, and curcuma had the ability to change the teeth shade faster and stronger effect on teeth shade.

Immunomodulatory effects of vinegar-egg juice: Potential pharmacological effects of a traditional Chinese food remedy?

Thousands of years of historical practice have proven that the ancient Chinese food, vinegar-egg juice, has immune-boosting effects with the presence of many nutritional factors. However, its mechanism of action in the body remains unclear. In this research project, vinegar-egg juice was chosen to analyze its immune-enhancing effects on mice. The immune enhancing effects of egg, vinegar and vinegar egg juice on lymphocytes of mouse spleen were compared. The effects on immune function of mice were analyzed by studying the organ index, natural killer(NK) cell activity, lymphocyte transformation function and cytokine changes in immune organs after treatment with vinegar-egg juice. The mechanism of immune enhancement was speculated by analyzing the changes of total IKKα/ß/IκBα/NF-κB and its phosphorylated protein kinase by Western blot. Experiments have shown that vinegar and eggs have less immune regulation than vinegar-egg juice. Vinegar-egg juice can regulate the cellular and humoral immunity of spleen lymphocytes, increase the phosphorylated kinases of IKKα/ß, reduce the total protein expression of IκBα, and activate the signaling pathway of IKK/IκB/NF-κB. In addition, compared with the control group, vinegar-egg juice reduced the Firmicutes/Bacteroidetes ratio and increased the relative abundance of beneficial bacteria. Furthermore, vinegar-egg juice can raise phosphatidylserine (PS) and serotonin (5-HT) levels in the body. The results showed that the vinegar-egg juice had obvious immunomodulatory activity. It was speculated that the intake of vinegar-egg juice can increase the activity of NK cells, T lymphocytes and B lymphocytes by increasing 5-HT levels, ultimately enhancing the body's immune function. PRACTICAL APPLICATIONS: In this work, we evaluated the immune regulation of vinegar, egg and vinegar-egg juice in mice. In addition, we investigated the effects of vinegar-egg juice on gut microbiota. And combined with the composition of the vinegar-egg juice, it was found that the intake of vinegar-egg juice could increase the activity of NK cells, T lymphocytes and B lymphocytes by increasing 5-HT levels, ultimately enhancing the body's immune function. On the basis of the results of this study, we recommend vinegar-egg juice can be a potential health food to resist the epidemic and improve autoimmunity in special times of the novel coronavirus outbreak.

Impact of covid-19 pandemic on the consumption of herbal products and its effect on oral and dental health: A cross-sectional study in Saudi Arabia

Objective: The purpose of the study was to investigate, assess and explore the impact of herbal products and their effects on oral and dental health in Saudi Arabia. Materials and methods: It is a cross-sectional analytical study conducted in Saudi Arabia. Data were collected from laypeople in Saudi Arabia using a convenient sampling technique distributed electronically. A total of 20 questions were entered, including demographic variables, the usage of herbal products, and possible effects of oral and dental health. Data were analyzed using the SPSS statistical software version 23, and results with a p-value of equal or less than a level of 0.05 were considered significant. Results: 282 females and 103 males have filled the questionnaire in a total of 385. It was observed that about two-thirds of participants 69.9% and 66.8% used lemon and orange. Most of the participants used the herbal immune boosters less than one month 41.8% and 80.5% used these products one time per day. The majority of the participants 94.0% continued dental hygiene practices. Conclusion: COVID-19 pandemic made people try to enhance their immunity by consuming herbal immune boosters' products that may have some consequences on their oral health and dental well-being.

Core shell stationary phase for a novel separation of some COVID-19 used drugs by UPLC-MS/MS Method: Study of grapefruit consumption impact on their pharmacokinetics in rats.

A sensitive and selective UPLC-MS/MS method was developed for the synchronized determination of four drugs used in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), namely, azithromycin, apixaban, dexamethasone, and favipiravir in rat plasma. using a Poroshell 120 EC-C18 column (50 mm × 4.6 mm, 2.7 m) with a high-resolution ESI tandem mass spectrometer detection with multiple reaction monitoring. We used an Agilent Poroshell column, which is characterized by a stationary phase based on non-porous core particles. With a remarkable improvement in the number of theoretical plates and low column backpressure. In addition, the developed method was employed in studying the potential food-drug interaction of grapefruit juice (GFJ) with the selected drugs which affects their pharmacokinetics in rats. The LC-MS/MS operated in positive and negative ionization mode using two internal standards: moxifloxacin and chlorthalidone, respectively. Liquid- liquid extraction of the cited drugs from rat plasma was accomplished using diethyl ether: dichloromethane (70:30, v/v). The analytes were separated using methanol: 0.1 % formic acid in water (95: 5, v/v) as a mobile phase in isocratic mode of elution pumped at a flow rate of 0.3 mL/min. A detailed validation of the bio-analytical method was performed in accordance with US-FDA and EMA guidelines. Concerning the in vivo pharmacokinetic study, the statistical significance between the results of the test groups receiving GFJ along with the cited drugs and the control group was assessed demonstrating that GFJ increased the plasma concentration of azithromycin, apixaban, and dexamethasone. Accordingly, this food-drug interaction requires cautious ingestion of GFJ in patients using (SARS-CoV-2) medications as it can produce negative effects in the safety of the drug therapy. A potential drug-drug interaction is also suggested between those medications requiring a suitable dose adjustment.

Switching strategy as an effort to survive during the pandemic (business in the citrus plantation sector)

The agricultural sector has an important role in national economic development because of the abundant potential of natural resources and can support economic growth in rural areas. According to the Center for Agricultural Data and Information Systems, the Indonesian Ministry of Agriculture in 2020 stated that during the Covid-19 pandemic, the agricultural sector in Indonesia has proven to be a mainstay in stabilizing the country's economy. Until 2020, Bocek Village is the only village in Karangploso District, Malang Regency that does not yet have a Village-Owned Enterprises (VOE). With the Doctoral Service Program (Program Doktor Mengabdi), Bocek Village has established VOE in 2020. The DSP program in Bocek Village aims to create jobs and improve community welfare. The DSP program which is under the auspices of the Institute for Research and Community Service (IRCS) Universitas Brawijaya, is expected to be able to produce Leading Assisted Villages for the development of the agricultural and agro-industrial sectors in Bocek Village. The implementation of the DSP Program in Bocek Village has entered its 2nd year (2021) with a focus on strengthening the role of VOE in developing the community business sector. The team of DSP plans community service activities in the form of strengthening Bocek VOE in agricultural, agro-industry clusters and dissemination of technology and information. An alternative solution for the Bocek VOE business unit is to create a derivative product from citrus fruits, namely orange juice. The raw material for orange juice is the result of the process of sorting ripe oranges that have fallen to the ground. Marketing of citrus fruit juice products is planned by opening a Marketplace that can reach a wider target market. In addition, the potential for online sales can now be said to be more profitable than conventional because it has been supported by the rapidly growing digitalization transformation making online sales and marketing more profitable.

Kombucha - An ancient fermented beverage with desired bioactivities: A narrowed review.

Kombucha, originated in China 2000  years ago, is a sour and sweet-tasted drink, prepared traditionally through fermentation of black tea. During the fermentation of kombucha, consisting of mainly acidic compounds, microorganisms, and a tiny amount of alcohol, a biofilm called SCOBY forms. The bacteria in kombucha has been generally identified as Acetobacteraceae. Kombucha is a noteworthy source of B complex vitamins, polyphenols, and organic acids (mainly acetic acid). Nowadays, kombucha is tended to be prepared with some other plant species, which, therefore, lead to variations in its composition. Pre-clinical studies conducted on kombucha revealed that it has desired bioactivities such as antimicrobial, antioxidant, hepatoprotective, anti-hypercholestorelomic, anticancer, anti-inflammatory, etc. Only a few clinical studies have been also reported. In the current review, we aimed to overhaul pre-clinical bioactivities reported on kombucha as well as its brief compositional chemistry. The literature data indicate that kombucha has valuable biological effects on human health.

Study of Water Distribution, Textural and Colour Properties of Cold Formulated and Air-Dried Apple Snacks.

Vacuum impregnation is considered a cold formulation technology since it allows the incorporation of a desired functional compound into porous plant tissue without applying any heat. It is widely used in combination with the drying process to obtain added-value snacks. The aim of this work was to evaluate the effect of two trehalose concentrations (5 and 10% w/w) on: (i) the water state and texture evolution during the air drying (50 °C, 8 h) of apple snacks vacuum impregnated with blueberry juice, and on (ii) the colour of the final dried apple snacks. The results of nuclear magnetic resonance (NMR) showed that trehalose affects the water mobility of the samples during drying especially after 200-300 min of drying. In terms of textural properties, trehalose could increase the crispier characteristic of the samples impregnated with trehalose at the end of drying. Significative changes were found in terms of chroma and hue angle.

Evaluation of il-6 levels in covid-19 patients whit smell disorders

Smell dysfunction is one of the most frequent symptoms in COVID-19 patients. In the early stages of the disease it allows to identify positive subjects. The odorous substances recognize two different systems in the olfactory epithelium: the olfactory and the trigeminal systems that coexist and interact in the processing of sensory information. In COVID-19 patients there is an inflammatory reaction of the nasal mucosa. Infected supporting cells of the nasal mucosa release molecules that activate the local antiviral innate immune response. In fact, macrophages spread inflammatory mediators, in particular TNF-η , IL-6 and IL-1. In this study we compared IL-6 levels with the degree of olfactory disorders and with the type of unperceived odour.Materials and methodsFrom 15 March to 30 November 2020 have been selected 82 patients (45 men age 62.3 ±14.2 and 37 women age 57.1± 12.8) with only smell dysfunctions were divided into mild and moderate patients. The evaluation of the smell disorder was carried out with a 14 questionnaire relating to the perception of domestic odorous: 6 questions for olfactory sensitivity (own perfume usually sprayed, oregano, olive oil, nutella, coffee aroma, orange juice) and 8 for olfactory-trigeminal sensitivity (alcohol, fish odor, vinegar, mint (gum), toothpaste, shampoo, cheese, ammonia).The IL-6 (v.n. 0 - 7 pg/ml) was measured with chemiluminescence assay using Cobas e801 (Roche Instrumentation). Statistical analyses were performed with Wilcoxon Rank test, and Mann-Whitney test (p <0.05). ResultsThe trigeminal and olfactory sensitivity are more compromised in moderate than mild patients (p <0.05). The statistically significant differences there were in IL6 levels in moderate versus mild patients when there was an impairment of trigeminal sensitivity (p <0.05). Conclusion In this study suggested that the smell disorders in Covid-19 patients couldn't be a deficit of the olfactory central nervous pathways but could be rather than mainly associated with the inflammatory process of the nasal mucosa and that deficit of the type of domestic unperceived odour ('olfactory' or 'trigeminal' sensitivity) could indicate the degree of severity of the disease.

An analysis of consumers' preferences for orange juice in India during COVID-19

Boosting the immune system's response through better nutrition has been suggested as a coping strategy to help fight COVID-19. Among other food products, orange juice, a rich source of Vitamin C, has been in huge demand in India since the outbreak of COVID-19. Panic buying has further added to this increased demand for orange juice. Using data collected through online surveys, this paper applies both conjoint and market simulation analysis to study consumers' preferences when purchasing orange juice. Nine important product attributes (flavour, preservatives, sweetener, brand, taste, pulp concentration, container, production method of orange and price) as well as different levels for each attribute are considered for the analysis. Among the selected attributes, relatively respondents gave more importance to the 'method of production' of orange, followed by 'brand', 'pulp concentration', 'sweeteners', and 'preservatives.' The market simulation analysis showed that a new product with the desired levels (high mean utility values) across the selected attributes would stand to enjoy a market share of around 32 percent. These findings support product differentiation as a strategy by firms in the food processing sector under conditions of intense competition.

A comprehensive review on the development of probiotic supplemented confectioneries.

Probiotics are living organisms that have beneficial effects on host by regulating the microbial balance of the intestinal system. While probiotics are naturally found in yogurt and other fermented foods, they can also be added to many products. Although mostly in dairy products, it is possible to see examples of food products supplemented by probiotics in bakeries, chocolates and confectioneries. Nowadays, the COVID-19 pandemic that the world suffers increased the demand for such functional food products including probiotics. Due to probiotics having potential effects on strengthening the immune system, confectioneries supplemented by probiotics were comprehensively discussed in this review together with the suggestion of a novel gelly composition. The suggested formulation of the product is a gel-like snack contains natural ingredients such as carrot, lemon juice and sugar provided from apples. This research review article provided a guide together with the recommendations for potential probiotic research in candy and confectionery industry.

Effects of pomegranate juice (Punica Granatum) on inflammatory biomarkers and complete blood count in patients with COVID-19: a structured summary of a study protocol for a randomized clinical trial.

OBJECTIVES: This study is conducted to investigate efficacy of pomegranate juice on inflammatory biomarkers, C-reactive protein (CRP), interleukin 6(IL-6), erythrocyte sedimentation rate (ESR) and complete blood count (CBC) in hospitalized patients with mild to moderate coronavirus disease 2019 (COVID- 19). TRIAL DESIGN: This is a randomized, placebo-controlled, double-blind, parallel 2-arm (1:1 ratio) clinical trial. PARTICIPANTS: Patients with COVID-19 admitted to hospitals in Yasuj City, Kohgiluyeh and Boyer-Ahmad Province, Iran. INCLUSION CRITERIA: Informed consent Patients 18 years of age or older Diagnosis of COVID-19 based on real-time polymerase chain reaction (RT-PCR) test EXCLUSION CRITERIA: Pregnancy or lactation Immunoglobulin A (IgA) level <61 mg/dl Disseminated intravascular coagulation or any other types of coagulopathy Severe congestive heart failure Participation in any clinical trial within 30 days prior to enrollment in this RCT Other contraindications determined by the specialist. INTERVENTION AND COMPARATOR: Intervention: 500 ml pomegranate juice and standard of care hospital treatment for COVID-19 Comparator: matching placebo containing 500 ml of red water and standard of care hospital treatment for COVID-19 Both intervention and comparator to be taken twice a day, after lunch and dinner, for 14 days. CRITERIA FOR DISCONTINUING: Transfer of patients to intensive care unit (ICU) Death Unwillingness to continue participating in the study MAIN OUTCOMES: The main outcomes of this study are levels of inflammatory biomarkers, CRP, IL-6, ESR, and CBC after 14 days of treatment. RANDOMIZATION: Eligible patients will be randomly assigned into the intervention or control group in a 1:1 ratio. Randomization will be performed based on 8 permuted blocks with block sizes of 6 and they will be stratified according to sex and age categories. Randomization sequences will be prepared by the trial's pharmacist using computer-generated random numbers. BLINDING (MASKING): This study is a double-blind clinical trial (participant, researcher). The pomegranate juice and placebo juice are packaged in identical bottles, and the researcher and all the patients will be unaware of the study assignment until the end of the study. To ensure blinding, the randomization sequences will be kept in identical, opaque, sealed, and sequentially numbered envelopes. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): The calculated total sample size is 48 patients, with 24 patients assigned into each group. TRIAL STATUS: The protocol is Version 1.0, on March 3, 2021. Recruitment started on February 28, 2021, and is anticipated to be completed by May 21, 2021. TRIAL REGISTRATION: The Name of registering trial Effects of Pomegranate Juice (Punica Granatum) on Inflammatory Biomarkers and CBC in Patients with COVID-19: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Iranian registry of clinical trials (IRCT) Registration Number: IRCT20150711023153N2 Date of Trial Registration February 28, 2021, retrospectively registered FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials҆ website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.