Total pancreatectomy with islet autotransplantation outcomes in patients with pancreatitis of genetic etiology: A single-center experience with a large cohort of patients.

PURPOSE: Total pancreatectomy with islet autotransplantation (TPIAT) is an effective treatment for patients with chronic pancreatitis (CP) when other interventions are unsuccessful. CP has many etiologies including heredity. Metabolic and pain relief outcomes after TPIAT are presented among patients with a genetic CP etiology compared with those with a nongenetic etiology in a large cohort of patients who underwent this procedure at our center. METHODS: A retrospective analysis was performed of 237 patients undergoing TPIAT between 2006 and 2023. We analyzed the differences in patients with genetic (n = 56) vs nongenetic CP etiologies (n = 181) in terms of pre-TPIAT factors including patient characteristics and disease state, results from the isolation process, and outcomes such as long-term glycemic and pain control. RESULTS: Patients with genetic CP underwent TPIAT at a significantly younger age (32.3 vs 41.3 years nongenetic; P < .0001) and endured symptoms for a significantly longer period (10 vs 6 years; P < .01). A significantly lower mass of islets was isolated from patients with genetic CP (P < .01), which increased with body mass index in both groups. Despite lower yields, patients with genetic CP maintained metabolic function similar to patients with nongenetic CP, as indicated by insulin independence and C-peptide, blood glucose, and hemoglobin A1C levels after TPIAT. Post-transplant narcotic usage and pain scores significantly decreased compared with those before TPIAT, and more patients with genetic CP were pain free and narcotic free after TPIAT. CONCLUSION: Our data validate TPIAT as a beneficial procedure for patients enduring CP of genetic etiology. Pain that is inevitably recurrent after minor interventions owing to the nature of the disease and favorable TPIAT outcomes should be considered in the decision to perform early TPIAT in cases of genetic CP.

The overall quality of evidence of recommendations surrounding nutrition and diet in inflammatory bowel disease.

BACKGROUND AND AIM: Recently, there has been an increased focus on the role nutrition and diet play in maintaining health in inflammatory bowel disease (IBD). We aimed to assess the overall quality, strength, and transparency of conflicts among guidelines on nutrition/diet in IBD. METHODS: A systematic search was performed on multiple databases from inception until January 1, 2021, to identify guidelines pertaining to nutrition or diet in IBD. All guidelines were reviewed for disclosure of conflicts of interest (COI) and funding, recommendation quality and strength, external document review, patient representation, and plans for update-as per Institute of Medicine (IOM) standards. In addition, recommendations and their quality were compared between guidelines/societies.​ RESULTS: Seventeen distinct societies and a total of 228 recommendations were included. Not all guidelines provided recommendations on key aspects of diet-such as the role of supplements or the appropriate micro/macro nutrition in IBD. Fifty-nine percent of guidelines reported on COI, 24% underwent external review, and 41% included patient representation. 18.4%, 25.9%, and 55.7% of recommendations were based on high-, moderate-, and low-quality evidence, respectively. 10.5%, 24.6%, and 64.9% of recommendations were strong, weak/conditional, and did not provide a strength, respectively. The proportion of high-quality evidence (p = 0.12) and strong recommendations (p = 0.83) did not significantly differ across societies. CONCLUSIONS: Many guidelines do not provide recommendations on key aspects of diet/nutrition in IBD. As over 50% of recommendations are based on low-quality evidence, further studies on nutrition/diet in IBD are warranted to improve the overall quality of evidence.

Risks of khat chewing on the cardiovascular, nervous, gastrointestinal, and genitourinary systems: A narrative review.

Khat is an evergreen plant and its fresh green leaves and buds are chewed for several hours a day for its psychostimulant response. This study aimed to review the effects of khat chewing on the body. PubMed was searched for literature on the different aspects of khat chewing to summarize its effects on different body systems. The major effects of khat chewing are those on the cardiovascular system including increased blood pressure, increased heart rate, and increased risk of myocardial infarction. It causes insomnia, stress, depression, hallucination, and increased risk of brain stroke. It causes dental caries, bad oral hygiene, periodontitis, increased oral mucosal ulcers, and increased gingival bleeding and recession. Khat chewing causes loss of appetite, gastritis, constipation, and hemorrhoids, and increased risk of hepatotoxicity and liver cirrhosis. Ultimately, it causes weak micturition, decreased sperm motility and count, and low birth-weight offspring in khat chewing mothers. The published articles about khat chewing in journals indexed in the PubMed was reviewed. Inclusion criteria involved each article available with English language and have a reported new effect of khat chewing.

Influences of NaCl and Na2SO4 on the Micellization Behavior of the Mixture of Cetylpyridinium Chloride + Polyvinyl Pyrrolidone at Several Temperatures.

Herein, the conductivity measurement technique is used to determine the interactions that may occur between polyvinyl pyrrolidone (PVP) polymer and cetylpyridinium chloride (CPC) surfactant in the presence of NaCl and Na2SO4 of fixed concentration at variable temperatures (298.15-323.15 K) with an interval of 5 K. In the absence or presence of salts, we observed three critical micelle concentrations (CMC) for the CPC + PVP mixture. In all situations, CMC1 values of CPC + PVP system were found to be higher in water than in attendance of salts (NaCl and Na2SO4). Temperature and additives have the tendency to affect counterion binding values. Various physico-chemical parameters were analyzed and demonstrated smoothly, including free energy (ΔG0m), enthalpy (ΔH0m) and entropy change (ΔS0m). The micellization process is achieved to be spontaneous based on the obtained negative ΔG0m values. The linearity of the ΔHmo and ΔSmo values is excellent. The intrinsic enthalpy gain (ΔH0*m) and compensation temperature (Tc) were calculated and discussed with logical points. Interactions of polymer hydrophobic chains or the polymer + surfactant associated with amphiphilic surface-active drugs can employ a strong impact on the behavior of the gels.

Sol-Gel Co-Precipitation Synthesis, Anticoagulant and Anti-Platelet Activities of Copper-Doped Nickel Manganite Nanoparticles.

Copper-substituted nickel manganites Ni(1-x)CuxMn2O4 (Ni-TCE-NPs) were produced by co-precipitation route (sol-gel) at room temperature. Ni(1-x)CuxMn2O4-Bio (NCB) NPs were studied by powder X-ray diffraction technique, scanning electron microscopy and Raman spectroscopy. XRD spectra authenticated the copper-doped nickel manganites' formation with particle size 23-28 nm. A significant decrease in the lattice parameter confirmed the doping of copper ions into the nickel manganites. Microscopy (SEM) was used to estimate the grain size, shape and uniformity, revealing the non-uniform agglomerated polygon and plate-like microstructure. The NCB-NPs showed anticoagulant activity by enhancing the coagulation time of citrated plasma of human beings. NCB-NPs with x = 0.35 and 0.45 have increased clotting time from control 133 ± 4 s to 401 ± 7 s and 3554 ± 80 s, respectively, and others around 134 s. Additionally NCB-NPs with x = 0.35, 0.45 inhibited the platelet aggregation by 80% and 92%, while remaining inhibited with only 30%. NCB-NPs did not show hemolytic activity in RBC cells intimate its non-toxic nature. Finally, NCB-NPs were non-toxic and known to exhibit anti-blood-clotting and antiplatelet activities, which can be used in the field of biomedical applications, especially as antithrombotic agents.

Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for the prevention and control of peritoneal metastasis in patients with gastrointestinal malignancies: a systematic review of randomized controlled trials.

Peritoneal metastasis is associated with poor prognosis, with studies in the literature reporting the survival of peritoneal metastasis without treatment to be three to six months. Hyperthermic intraperitoneal chemotherapy (HIPEC) has shown positive outcomes by improving the prognosis in patients with gastrointestinal malignancies. This systematic review of randomized controlled trials was done to determine the prophylactic role of hyperthermic intraperitoneal chemotherapy in preventing and controlling peritoneal metastasis gastrointestinal origin. Randomized controlled trials published between January 2019 to June 2021 were included. The databases used were MEDLINE (PubMed), EMBASE (Ovid), and the Cochrane library. Cochrane handbook for systematic review of intervention was used to assess the risk of bias in included trials. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of five trials met the inclusion criteria. Two studies were on patients with gastric cancer, and the other three studies were on patients with colorectal cancer. HIPEC was given to a total of 116 gastric cancer patients and 308 colorectal cancer patients. In all the included studies on patients with gastric cancer, the peritoneal recurrence-free survival was significantly higher in the group that received HIPEC. There was no significant improvement in peritoneal-free survival in patients with colorectal cancer who received HIPEC. HIPEC appears to be effective in preventing peritoneal metastasis in patients with locally advanced gastric cancer without minimal postoperative complications. However, in patients with advanced colorectal malignancy, HIPEC does not seem to play a crucial role in preventing and controlling peritoneal metastasis.

Is Single-Dose Antimicrobial Prophylaxis Sufficient to Control Infections in Gastrointestinal Oncological Surgeries?

Surgical site infections (SSIs) represent one of the most important complications occurring postoperatively following surgical procedures. The SSI incidence is higher following gastrointestinal (GI) surgeries compared to any other surgery. It contributes to the majority of morbidity and mortality in patients undergoing GI surgeries. The accepted practice worldwide for the prevention and control of SSIs is providing antimicrobial prophylaxis. The appropriate antimicrobial and dose are chosen depending on the microbial flora, complications, and patient risk factors. The objective of this review was to determine the sufficient number of prophylactic antimicrobial doses that would be efficacious and safe in controlling the SSIs following GI oncological surgeries. Single-dose antimicrobial prophylaxis has shown the same efficacy as the multiple-dose antimicrobial regimen in controlling SSIs in esophageal, gastric, and colorectal surgeries. The advantages of a single-dose regimen include less chance of emergence of resistance, less chance for allergies or toxicity, and less cost. The addition of metronidazole with single-dose antimicrobial prophylaxis in colorectal surgery should be considered due to its beneficial effect in further reducing infections. Further randomized controlled trials are needed for the literature to determine the efficacy and safety of single-dose antimicrobial prophylaxis in patients undergoing esophageal and colorectal surgeries. In addition, studies are required to determine the individual effectiveness of metronidazole in controlling SSIs in colorectal surgeries.

Investigation of micellar and interfacial phenomenon of amitriptyline hydrochloride with cationic ester-bonded gemini surfactant mixture in different solvent media.

Herein, the interaction among the antidepressant drug amitriptyline hydrochloride (AMT) and a green gemini surfactant, ethane-1, 2-diyl bis(N,N-dimethyl-N-tetradecylammoniumacetoxy) dichloride (14-E2-14), via numerous techniques such as tensiometry, fluorimetry, FT-IR and UV-visible spectroscopy in three different media (aqueous 0.050 mol·kg-1 NaCl, 0.50 and 1.0 mol·kg-1 urea) were investigated. AMT is used to treat mental illness or mood problems, such as depression. The aggregation of biologically active ingredients can enhance the bioavailability of hydrophobic drugs. A significant interaction between AMT and 14-E2-14 was detected by tensiometric study as the critical micelle concentration (cmc) of AMT+14-E2-14 is reduced upon an increase of mole fraction (α1) of 14-E2-14. The decrease in cmc indicates the nonideality of studied mixtures of different compositions. Although, employed drug AMT is freely soluble in the aqueous and non-aqueous system but is not hydrophobic enough to act as its carrier. Instead, gemini surfactant formed spherical micelles in an aqueous system and their high solubilization capability, as well as their relatively lower cmc value, makes them highly stable in vivo. The cmc values of AMT+14-E-14 mixtures in all cases were further decreased and increased in NaCl and urea solutions respectively as compared with the aqueous system. Numerous micellar, interfacial, and thermodynamic parameters have been measured by applying various theoretical models. The obtained changes in the physicochemical assets of AMT upon adding of 14-E2-14 are likely to enhance the industrial and pharmaceutical applications of gemini surfactants. The negative interaction parameters (ßm and ßσ), indicate synergistic attraction is occurring in the mixed systems. The aggregation number (Nagg), Stern-Volmer constant (Ksv), etc. are attained through the fluorescence method, also supporting the attractive interaction behavior of AMT+14-E2-14 mixtures in all solvents. The Nagg was found to increase in the salt solution and decrease in the urea system compared with the aqueous solution. FT-IR and UV-visible analysis also depict the interaction between the constituent alike tensiometry and fluorimetry methods. The results suggested that gemini surfactants may serve as a capable drug delivery agent for antidepressants, improving their bioavailability.

Neuroimaging in Dementia: A Brief Review.

Dementia is a clinical syndrome that manifests itself with impairment in cognitive functions owing to various neurodegenerative etiologies causing severe disability in the older population. Although the diagnosis is largely dependent on clinical examination, biomarkers can significantly aid in early diagnosis of dementia, especially in those without any clinical evidence of neurocognitive impairment. These biomarkers can be discovered in cerebrospinal fluid (CSF) or can be assessed by neuroimaging. Our goal was to discuss and assess the role of different neuroimaging techniques in the early diagnosis of relatively common etiologies of dementia. We used PubMed as search engines to look for helpful articles; most of the sources used were peer reviewed. We discussed the utility of various neuroimaging techniques, such CT, MRI, positron emission tomography (PET) scan, and single-photon emission computed tomography (SPECT), in the diagnosis of dementia. We concluded that various modern neuroimaging techniques prove to be very helpful in early identification, diagnosis, and differentiation between subtypes. However, the actual clinical utility of these tests in terms of their cost-effectivity and availability remains to be seen. Ongoing research is required to further develop biomarkers for early identification and monitor the progression of different etiologies of dementia.

Parkinsonism: A Rare Adverse Effect of Valproic Acid.

Valproic acid (VPA) is an anti-epileptic drug (AED) used as a first-choice agent for most forms of epilepsy. It is used in the treatment of manic episodes, bipolar disorder, migraine prevention, and impulse control. Hence it is one of the most commonly prescribed drugs by physicians nowadays. VPA acts by increasing gama amino butyric acid (GABA) levels, and also reduces neuronal activation by blocking voltage-gated sodium, potassium, and calcium channels. VPA has various adverse effects like thrombocytopenia, hyperammonemia, teratogenicity causing spina bifida in newborns when exposed in utero. The focus of this review is to research one such easily overlooked adverse effect of VPA, which is VPA-induced Parkinsonism. We carried out a review of literature and gathered all comprehensive peer-reviewed articles from PubMed. The data for this research were collected ethically and legally after a thorough examination of the literature. Data obtained from the studies have suggested that Parkinsonism is an adverse effect of VPA. Chronic usage of VPA causes Parkinsonism. It occurs equally in males and females, more common in older people usually above the age of 55 years and not dose-dependent. According to the data obtained, all patients who developed Parkinsonism had serum levels in the therapeutic range (50-100 mcg/mL). Thus the chronic intake of maintenance dose of VPA seems to be the leading cause. The symptoms usually improve over a few weeks and fully resolve in a few months after stopping the drug. When the patient's symptoms do not improve, it means VPA has unmasked the underlying potential for developing Parkinson's disease. Such patients benefit from levodopa therapy. However, the mechanism of how VPA causes Parkinsonism remains unknown. Based on the articles reviewed, we hypothesize that VPA's mechanism of neuronal inactivation by blocking membrane channels across the neuronal membrane, primarily when used chronically could be the mechanism by which it causes Parkinsonism. VPA causes down regulation of sodium and potassium channels on neuronal membrane in order to stop the neurons from firing. Thereby a decrease in action potential across the neurons causes a temporary physiological inactivation of the neuron. When multiple neurons are inactivated in the basal ganglia of the brain, the patient develops symptoms of Parkinsonism. As the neurons are only temporarily inactivated physiologically, when the drug is stopped the membrane receptors are reactivated on the neuronal membranes. This leads to neuronal activation and neuronal membrane potential becomes the same as before. The above mechanism clarifies why the symptoms settle down when the medication is stopped.

Descriptive study of knee lesions using magnetic resonance imaging and correlation between medical imaging diagnosis and suspected clinical diagnosis.

OBJECTIVE: This study aimed to assess the meniscus and cruciate ligament lesions of the knee using magnetic resonance imaging (MRI) and to investigate the correlation between clinical and MRI diagnoses. PATIENTS AND METHODS: Herein, we reviewed the electronic medical records of 240 patients who underwent knee MRI. The images were evaluated and then the clinical and MRI diagnoses were compared. RESULTS: Of the 240 patients, 66% were male and the mean age was 40.6 ± 15.5 years (range, 2-79 years). Knee pain alone was the most common presenting symptom (50.64%) followed by pain after trauma (47.92%). Majority of the knee lesions were medial meniscus (MM) lesions (63%) followed by osteoarthritis (48%) and ACL lesions (35%). The majority of the MM and ACL lesions were tears (54.6% and 69.41%, respectively) followed by degeneration (33.55% and 17.65%, respectively). However, the MM lesions were predominantly observed in the posterior horn (Odds ratio [OR], 152; 95% confidence interval (CI), 21.550-1072.113; P < 0.001). The ACL lesions were significantly more common in men than in women (OR, 0.355; 95% CI, 0.191-0.661; P = 0.001), and altered signal intensity on T2- and proton density-weighted images was the most common sign (P < 0.001). A strong compatibility was observed between the clinical and MRI diagnoses (Kappa = 0.141; P < 0.001). CONCLUSION: MM and ACL lesions are the most common injuries of the knee, which can be diagnosed by physical examination in most cases. Further confirmation by MRI should be reserved for doubtful cases only.

Aggregation and interfacial phenomenon of amphiphilic drug under the influence of pharmaceutical excipients (green/biocompatible gemini surfactant).

In the current study, we have examined the interaction amongst an antidepressant drug amitriptyline hydrochloride (AMH) and ethane-1, 2-diyl bis(N,N-dimethyl-N-cetylammoniumacetoxy) dichloride (16-E2-16, a green gemini surfactant) through tensiometric and fluorimetric techniques in aqueous/electrolyte/urea solutions. Significant variations are observed in the various evaluated parameters in the present study. Gemini 16-E2-16 has outstanding surface properties along with a much lower cmc value, demonstrating very little toxicity as well as considerable antimicrobial activity. The cmc values of mixtures decrease through increase in mole fraction (α1) of 16-E2-16, which specifies the nonideality of the solution mixtures, along with demonstrating the occurrence of mixed micellization too. Negative ßRub values signify on the whole attractive force of interaction between constituents of mixed micelles. Owing to the incidence of electrolyte NaCl (50 mmol.kg-1), lowering of the micelles' surface charge happens, resulting in aggregation taking place at lower concentration while the presence of urea (NH2CONH2) halts micellization taking place, which means the cmc value increases in the attendance of urea. The [Formula: see text] values for all systems were negative along with the presence of electrolyte/urea. The excess free energy (Gex) of studied mixed systems was also estimated and found to be negative for all the systems. Using the fluorescence quenching method, the micelle aggregation number (Nagg) was evaluated and it was found that the contribution of gemini surfactant was always more than that of the AMH and their value enhances in the existence of electrolyte while decreasing in the attendance of NH2CONH2 in the system. In addition, other fluorescence parameters such as micropolarity (I1/I3), dielectric constant (Dexp) as well as Stern-Volmer binding constants (Ksv) of mixed systems were evaluated and the results showed the synergistic performance of the AMH + 16-E2-16 mixtures. Along with tensiometric and fluorimetric techniques, FT-IR spectroscopy was also engaged to reveal the interaction among constituents.

Effect of three surfactants on the bond strength of glass ionomer cement to dentin.

An invitro study was conducted to evaluate the effect of three surfactants on the Tensile Bond strength of Glass Ionomer Cement to dentin. The surface acting chemicals used on dentin in the analysis included combination of EDTA and sodium hypochlorite, orthophosphoric acid and sodium hypochlorite and the sodium hypochlorite alone. The results indicate that the combination of EDTA-sodium hypochlorite brought the best bonding followed by orthophosphoric acid & sodium hypochlorite and sodium hypochlorite in that order.