Change in attitudes and perceptions of undergraduate health profession students towards inter-professional education following an educational experience in post natal care.

BACKGROUND: Inter-professional Education (IPE) has been identified as an educational program aimed at increasing collaboration among health professionals, and improving health care outcomes. IPE programs have been incorporated in several countries and have shown positive results. The same may not be true for Asian cultures which are typically more hierarchical than others. The purpose of this study was to examine the impact of IPE on undergraduate health professional students' attitudes and perceptions in an Indian context. METHODS: Following an IPE experience undergraduate health professional students (n = 96) from three professions (Medicine, Nursing and Physiotherapy) completed a validated retro-pre questionnaire. Paired-sample t test was used to compare pre-test and post-test scores and ANOVA was used to compare the magnitude of change. Qualitative analysis was done for the open ended questions. RESULTS: The three professions showed a significant improvement in attitude (p < 0.001). The physiotherapists were more comfortable (p = 0.021) with questioning and being questioned and the nurses showed a significantly (p = 0.012) greater increase in extent of reliability as compared to the other two professionals. Participants identified the concepts of "team work", "knowledge of roles of other professionals" and "communication" as important to their learning and practice. CONCLUSIONS: The study identified a positive attitude among students and the given intervention resulted in a significant improvement in their comfort levels and reliability on other professionals. It would be reasonable to conclude therefore that acceptability for Inter professional education in the Indian context is high in spite of the cultural differences and hierarchical nuances.

Urethral stricture after bipolar transurethral resection of prostate - truth vs hype: A randomized controlled trial.

INTRODUCTION: Bipolar transurethral resection of prostate (B-TURP) was introduced as an alternative procedure to minimize the surgical complications of monopolar TURP (M-TURP). However, there are concerns about increased incidence of stricture urethra (SU) post B-TURP. This study was designed to analyze the incidence of SU among patients undergoing M-TURP versus B-TURP. MATERIALS AND METHODS: This is a randomized controlled, single-blinded study; randomization was performed using a stratified permuted randomization algorithm (1:1 ratio) and only the patients were blinded. Both M-TURP and B-TURP were performed with a 26 Fr resectoscope; the electrosurgical generators were Karl Storz Autocon II 400 and Olympus UES-40 SurgMaster (TUR in saline [TURIS] method), respectively. Follow-up visits were scheduled at 3, 6, and 12 months post surgery and patients with lower urinary tract symptoms and a maximum urinary flow rate of <10 ml/sec on uroflowmetry underwent retrograde urethrography to assess for development of SU. RESULTS: Forty patients were randomised to each arm. None developed SU in the monopolar group, whereas there were three cases in the bipolar group (P = 0.2). Among these three patients, two belonged to the failed medical management subgroup and one to the refractory urinary retention subgroup (P = 1.0). CONCLUSION: The incidence of SU following B-TURP using the TURIS system was comparable to the conventional M-TURP. Moreover, the incidence of SU was same for both the techniques when sub-grouped according to the indication for surgery that is failed medical management versus refractory urinary retention.

Mesh erosion into urinary bladder following laparoscopic inguinal hernia repair.

Along with advantages, evolving surgical techniques bring unique complications. A young male developed urinary symptoms a few months after undergoing laparoscopic inguinal hernia repair. On evaluation, mesh erosion into the urinary bladder was found. Removal of mesh with repair of bladder was done. A vesico-cutaneous fistula resulted which was managed with repeat surgery. We review all such cases reported in literature; discuss the etiopathogenesis, presentation, management and possible preventive measures. To the best of our knowledge, this is only the 12th case being reported.

Association analysis of genes involved in maize (Zea mays L.) root development with seedling and agronomic traits under contrasting nitrogen levels.

A better understanding of the genetic control of root development might allow one to develop lines with root systems with the potential to adapt to soils with limited nutrient availability. For this purpose, an association study (AS) panel consisting of 74 diverse set of inbred maize lines were screened for seedling root traits and adult plant root traits under two contrasting nitrogen (N) levels (low and high N). Allele re-sequencing of RTCL, RTH3, RUM1, and RUL1 genes related to root development was carried out for AS panel lines. Association analysis was carried out between individual polymorphisms, and both seedling and adult plant traits, while controlling for spurious associations due to population structure and kinship relations. Based on the SNPs identified in RTCL, RTH3, RUM1, and RUL1, lines within the AS panel were grouped into 16, 9, 22, and 7 haplotypes, respectively. Association analysis revealed several polymorphisms within root genes putatively associated with the variability in seedling root and adult plant traits development under contrasting N levels. The highest number of significantly associated SNPs with seedling root traits were found in RTCL (19 SNPs) followed by RUM1 (4 SNPs) and in case of RTH3 and RUL1, two and three SNPs, respectively, were significantly associated with root traits. RTCL and RTH3 were also found to be associated with grain yield. Thus considerable allelic diversity is present within the candidate genes studied and can be utilized to develop functional markers that allow identification of maize lines with improved root architecture and yield under N stress conditions.

Genetic and agronomic assessment of cob traits in corn under low and normal nitrogen management conditions.

KEY MESSAGE: Exploring and understanding the genetic basis of cob biomass in relation to grain yield under varying nitrogen management regimes will help breeders to develop dual-purpose maize. With rising energy demands and costs for fossil fuels, alternative energy from renewable sources such as maize cobs will become competitive. Maize cobs have beneficial characteristics for utilization as feedstock including compact tissue, high cellulose content, and low ash and nitrogen content. Nitrogen is quantitatively the most important nutrient for plant growth. However, the influence of nitrogen fertilization on maize cob production is unclear. In this study, quantitative trait loci (QTL) have been analyzed for cob morphological traits such as cob weight, volume, length, diameter and cob tissue density, and grain yield under normal and low nitrogen regimes. 213 doubled-haploid lines of the intermated B73 × Mo17 (IBM) Syn10 population have been resequenced for 8575 bins, based on SNP markers. A total of 138 QTL were found for six traits across six trials using composite interval mapping with ten cofactors and empirical comparison-wise thresholds (P = 0.001). Despite moderate to high repeatabilities across trials, few QTL were consistent across trials and overall levels of explained phenotypic variance were lower than expected some of the cob trait × trial combinations (R (2) = 7.3-43.1 %). Variation for cob traits was less affected by nitrogen conditions than by grain yield. Thus, the economics of cob usage under low nitrogen regimes is promising.

Pharmacokinetics of vorapaxar and its metabolite following oral administration in healthy Chinese and American subjects.

AIM: Vorapaxar is a proteaseactivated receptor (PAR)-1 antagonist being developed for the prevention and treatment of thrombotic vascular events. To evaluate race/ethnic differences between Caucasians and Chinese in the pharmacokinetics of vorapaxar and its active metabolite SCH 2046273 (M20) or in the metabolite/parent ratio, we conducted a cross-study comparison on pharmacokinetic data of vorapaxar and M20 obtained from two similarly designed studies: one in healthy Chinese subjects and the other in a healthy Western (United States, [U.S.]) population. METHODS: The pharmacokinetic profiles of vorapaxar and M20 were characterized using open label, two treatment parallel group designs in men and women aged 18 - 45 years. Vorapaxar was administered orally as a single dose of 40 mg in Chinese subjects (n = 14) or 120 mg in U.S. subjects (n = 14), or 2.5 mg QD for 6 weeks in both studies (Chinese, n = 14; U.S., n = 23). RESULTS: Vorapaxar was rapidly absorbed in both Chinese and U.S. subjects. Vorapaxar and M20 had similar elimination half-lives. The range of metabolite/parent ratios after single dose or daily administration was largely overlapped in Chinese and U.S. subjects. Steady state was attained by day 21 for vorapaxar and M20 in both race/ethnic groups. The accumulation ratios for vorapaxar and M20 during daily administration were similar in Chinese and U.S. subjects. Vorapaxar was well-tolerated in Chinese and U.S. subjects. CONCLUSION: The pharmacokinetic profiles of vorapaxar and M20 and the metabolite/parent ratios in healthy Chinese were generally comparable to those in a healthy Western population.

Recent Developments and Application of Mass Spectrometry Imaging in N-Glycosylation Studies: An Overview.

Among the most typical posttranslational modifications is glycosylation, which often involves the covalent binding of an oligosaccharide (glycan) to either an asparagine (N-linked) or a serine/threonine (O-linked) residue. Studies imply that the N-glycan portion of a glycoprotein could serve as a particular disease biomarker rather than the protein itself because N-linked glycans have been widely recognized to evolve with the advancement of tumors and other diseases. N-glycans found on protein asparagine sites have been especially significant. Since N-glycans play clearly defined functions in the folding of proteins, cellular transport, and transmission of signals, modifications to them have been linked to several illnesses. However, because these N-glycans' production is not template driven, they have a substantial morphological range, rendering it difficult to distinguish the species that are most relevant to biology and medicine using standard techniques. Mass spectrometry (MS) techniques have emerged as effective analytical tools for investigating the role of glycosylation in health and illness. This is due to developments in MS equipment, data collection, and sample handling techniques. By recording the spatial dimension of a glycan's distribution in situ, mass spectrometry imaging (MSI) builds atop existing methods while offering added knowledge concerning the structure and functionality of biomolecules. In this review article, we address the current development of glycan MSI, starting with the most used tissue imaging techniques and ionization sources before proceeding on to a discussion on applications and concluding with implications for clinical research.

Inferior polar nephrectomy and vesicocalicostomy for complete ureteric stricture following antibody-mediated rejection in ABO-incompatible living donor kidney transplant: a report of a rare case.

Renal transplant recipients are prone to urological complications, the most common of which is stricture of the transplant ureter. We present a rare case of complete ureteric stricture in a 37-year-old man who had undergone spousal living donor kidney transplantation with ABO incompatibility. Initially, treatment involved creating an anastomosis between the native right ureter and the renal pelvis of the transplanted kidney. However, the stricture recurred. Subsequently, the patient was successfully treated with inferior polar nephrectomy and vesicocalicostomy, which entailed anastomosing the lower calyx of the transplanted kidney to the bladder. After 7 months of follow-up, the patient continued to exhibit stable renal function without stricture recurrence.

Desorption electrospray ionization mass spectrometry imaging (DESI-MSI) in disease diagnosis: an overview.

Tissue analysis, which is essential to histology and is considered the benchmark for the diagnosis and prognosis of many illnesses, including cancer, is significant. During surgery, the surgical margin of the tumor is assessed using the labor-intensive, challenging, and commonly subjective technique known as frozen section histopathology. In the biopsy section, large numbers of molecules can now be visualized at once (ion images) following recent developments in [MSI] mass spectrometry imaging under atmospheric conditions. This is vastly superior to and different from the single optical tissue image processing used in traditional histopathology. This review article will focus on the advancement of desorption electrospray ionization mass spectrometry imaging [DESI-MSI] technique, which is label-free and requires little to no sample preparation. Since the proportion of molecular species in normal and abnormal tissues is different, DESI-MSI can capture ion images of the distributions of lipids and metabolites on biopsy sections, which can provide rich diagnostic information. This is not a systematic review but a summary of well-known, cutting-edge and recent DESI-MSI applications in cancer research between 2018 and 2023.

Recent developments and applications of ambient mass spectrometry imaging in pharmaceutical research: an overview.

The application of ambient mass spectrometry imaging "MSI" is expanding in the areas of fundamental research on drug delivery and multiple phases of the process of identifying and developing drugs. Precise monitoring of a drug's pharmacological workflows, such as intake, distribution, metabolism, and discharge, is made easier by MSI's ability to determine the concentrations of the initiating drug and its metabolites across dosed samples without losing spatial data. Lipids, glycans, and proteins are just a few of the many phenotypes that MSI may be used to concurrently examine. Each of these substances has a particular distribution pattern and biological function throughout the body. MSI offers the perfect analytical tool for examining a drug's pharmacological features, especially in vitro and in vivo effectiveness, security, probable toxic effects, and putative molecular pathways, because of its high responsiveness in chemical and physical environments. The utilization of MSI in the field of pharmacy has further extended from the traditional tissue examination to the early stages of drug discovery and development, including examining the structure-function connection, high-throughput capabilities in vitro examination, and ex vivo research on individual cells or tumor spheroids. Additionally, an enormous array of endogenous substances that may function as tissue diagnostics can be scanned simultaneously, giving the specimen a highly thorough characterization. Ambient MSI techniques are soft enough to allow for easy examination of the native sample to gather data on exterior chemical compositions. This paper provides a scientific and methodological overview of ambient MSI utilization in research on pharmaceuticals.

Recent Advances and Applications of Ambient Mass Spectrometry Imaging in Cancer Research: An Overview.

Cancer metabolic variability has a significant impact on both diagnosis and treatment outcomes. The discovery of novel biological indicators and metabolic dysregulation, can significantly rely on comprehension of the modified metabolism in cancer, is a research focus. Tissue histology is a critical feature in the diagnostic testing of many ailments, such as cancer. To assess the surgical margin of the tumour on patients, frozen section histology is a tedious, laborious, and typically arbitrary method. Concurrent monitoring of ion images in tissues facilitated by the latest advancements in mass spectrometry imaging (MSI) is far more efficient than optical tissue image analysis utilized in conventional histopathology examination. This article focuses on the "desorption electrospray ionization (DESI)-MSI" technique's most recent advancements and uses in cancer research. DESI-MSI can provide wealthy information based on the variances in metabolites and lipids in normal and cancerous tissues by acquiring ion images of the lipid and metabolite variances on biopsy samples. As opposed to a systematic review, this article offers a synopsis of the most widely employed cutting-edge DESI-MSI techniques in cancer research.

Hemophagocytic lymphohistiocytosis: A scourge for the physician and bane to the bone marrow.

Background: Hemophagocytic lymphohistiocytosis (HLH) is a condition characterized by hyperinflammation. It can occur due to primary genetic defect or secondary to other etiology such as infection and rheumatological conditions. Clinical features include fever, cytopenia, organomegaly and several laboratory abnormalities. It can be a life-threatening condition secondary to worsening cytopenia and multiorgan dysfunction. Aims and Objectives: To study the clinical profile of HLH in a tertiary care hospital in Southern India. Materials and Methods: Our study has reviewed nine cases of HLH among adult patients presented over 5 years (2017-2022). Results: The majority of our cases were secondary to infection and had a hospital stay over two weeks and with a good response to steroid and immunomodulators. Conclusion: We would like to stress upon the importance of awareness of such a condition so that there can be early suspicion and workup including bone marrow examination, enabling early initiating of specific therapy for this fatal condition.

Résumé Contexte: L'hémophagocytose lymphohistiocytaire (HLH) est une affection caractérisée par une hyperinflammation. Elle peut survenir en raison d'un défaut génétique primaire ou être secondaire à d'autres étiologies telles que l'infection et les affections rhumatologiques. Les caractéristiques cliniques comprennent de la fièvre, une cytopenie, une organomégalie et plusieurs anomalies de laboratoire. Il s'agit d'une affection potentiellement mortelle en raison de l'aggravation de la cytopenie et du dysfonctionnement multi-organes. Objectifs: Étudier le profil clinique de l'HLH dans un hôpital de soins tertiaires du sud de l'Inde. Matériel et méthodes: Notre étude a examiné neuf cas d'HLH chez des patients adultes sur une période de 5 ans (2017-2022). Résultats: La majorité de nos cas étaient secondaires à une infection et ont nécessité une hospitalisation de plus de deux semaines, avec une bonne réponse aux stéroïdes et aux immunomodulateurs. Conclusion: Nous tenons à souligner l'importance de la sensibilisation à cette affection afin qu'il puisse y avoir une suspicion précoce et des examens approfondis, y compris une ponction de moelle osseuse, permettant ainsi de démarrer rapidement une thérapie spécifique pour cette affection mortelle. Mots-clés: Score H, hémophagocytose lymphohistiocytaire, immunosuppression, hémophagocytose lymphohistiocytaire secondaire.

Primary adenocarcinoma with yolk sac differentiation in the transplant ureter and salvage of the transplant kidney: a rare case report.

Renal transplant recipients are prone to a high risk of subsequent upper tract urothelial carcinoma, occurring in both native and transplant ureters. We report a rare case of adenocarcinoma with yolk sac differentiation of the transplant ureter, which was managed successfully with transplant ureterectomy and pyelovesicostomy, thereby salvaging the functioning transplant kidney.

Pharmacokinetics of the novel PAR-1 antagonist vorapaxar in patients with hepatic impairment.

PURPOSE: To determine whether hepatic impairment has an effect on the pharmacokinetics (PK) of vorapaxar or M20, its main pharmacologically active metabolite. METHODS: This was an open-label study in which a single 40-mg oral dose of vorapaxar was administered to patients with mild (n = 6), moderate (n = 6), and severe (n = 4) hepatic impairment and healthy controls (n = 16) matched for age, gender, weight, and height. Blood samples for vorapaxar and M20 assay were collected predose and at frequent intervals up to 8 weeks postdose. RESULTS: Plasma vorapaxar and M20 PK profiles were similar between patients with impaired liver function and healthy controls. Group mean values for vorapaxar C(max) and AUC(tf) were 206-279 ng/mL and 14,200-18,200 ng·h/mL, respectively, with the lowest values observed in patients with severe impairment. Vorapaxar median T(max) and mean t(1/2) values were 1.00-1.75 h and 298-366 h, respectively. There was no apparent correlation between vorapaxar or M20 exposure or t(1/2) values and disease severity. Vorapaxar was generally well tolerated; one serious adverse event (gastrointestinal bleeding secondary to ruptured esophageal varices) was reported in a patient with severe hepatic impairment. CONCLUSIONS: Hepatic impairment had no clinically relevant effect on the PK of vorapaxar and M20. No dose or dosage adjustment of vorapaxar will be required in patients with mild to moderate hepatic impairment. Although systemic exposure to vorapaxar does not appear to increase in patients with severe hepatic impairment, administration of vorapaxar to such patients is not recommended given their bleeding diathesis.

Pharmacokinetics and pharmacodynamics of the novel PAR-1 antagonist vorapaxar in patients with end-stage renal disease.

PURPOSE: To determine whether impaired renal function alters the pharmacokinetics (PK) of vorapaxar or its ability to inhibit thrombin receptor agonist peptide (TRAP)-induced platelet aggregation. METHODS: This was an open-label study in which 8 patients with end-stage renal disease (ESRD) on hemodialysis and 7 matched (based on age, gender, weight, and height) healthy controls were administered a single 10-mg oral dose of vorapaxar. Blood samples for vorapaxar PK and pharmacodynamic analysis were collected predose and at frequent intervals up to 6 weeks postdose. RESULTS: Mean vorapaxar bioavailability (based on area under the curve of plasma vorapaxar concentration over time) was identical in the two subject groups; the ESRD/healthy geometric mean ratio (GMR, expressed in percent) was 98. Mean maximum observed plasma concentration (77.4-98.2 ng/mL) was numerically lower in patients with ESRD compared with matched controls (GMR=76; 90% confidence interval=48 to 118). Median time of maximum observed plasma concentration was 2 h in both subject groups. The observed means for elimination half-life were 186 and 231 h in the ESRD and control groups, respectively. Inhibition of platelet aggregation was similar in the two groups. Four out of 15 (27%) subjects reported adverse events, all of which were characterized by the investigator as mild and unrelated to treatment. CONCLUSIONS: ESRD had no clinically relevant effect on the PK profile of vorapaxar or its ability to inhibit TRAP-induced platelet aggregation.

Bilateral Synchronous 3-Port Trans-peritoneal Laparoscopic Ureterolithotomy: a Case Report.

Trans-peritoneal laparoscopic ureterolithotomy is a well-established minimally invasive procedure for management of large impacted ureteric stones since the last 3 decades. We present a case of a 51-year old gentleman, who presented with bilateral large upper ureteric calculi with obstructive uropathy and azotemia, managed successfully with bilateral synchronous 3-port trans-peritoneal laparoscopic ureterolithotomy, and to our knowledge is the first such case to be reported in literature. Supplementary Information: The online version contains supplementary material available at 10.1007/s42399-022-01190-5.

Critical limb ischemia-need to look beyond limb salvage.

BACKGROUND: Revascularization is the optimal treatment for critical limb ischemia (CLI). Traditional measures of outcome of intervention are as follows: graft patency, limb salvage rates, and patient survival rates; however, these have little meaning for a patient if he/she cannot ambulate independently or go back to work. This study was undertaken to assess the functional outcome of intervention in these patients. METHODS: Fifty patients with CLI treated over a 3-year period were included in this prospective clinical study. After evaluation, treatment was given to each patient on the basis of the Transatlantic Inter-society Consensus II guidelines. The outcome of treatment and the functional restoration to pre-illness lifestyle were assessed at the end of 1 month, and then at 6 months. RESULTS: Fifty patients with CLI were included in the study; male to female ratio was 9:1, and the mean age at presentation was 45 years. After evaluation, only 38 patients (76%) were found suitable for revascularization. Traditional measures of success showed a graft patency rate of 75%, limb salvage rate of 89.5%, and patient survival rate of 96% at 6 months after treatment. All eight parameters of quality-of-life analysis showed significant improvement as assessed by the Research and Development (RAND) 36-Item Health Survey 1.0 form. However, among the 38 patients who were revascularized, 20 (52.6%) went back to their initial occupation after 6 months, 12 (31.6%) remained at home even though they were ambulant, and five (13.2%) were able to manage only limited activities; one patient succumbed to death. CONCLUSION: With only 53% of revascularized patients returning to work, a salvaged leg does not equate with return to premorbid ambulatory/occupational status, although there might be improvement in quality of life because of other reasons. As surgeons, we need to look beyond leg salvage and graft patency and take on a more holistic approach.

Synthesis and anti-histaminic activity of some novel pyrimidines.

Novel pyrimidines were prepared by the condensation of chalcones of 4'-piperazine acetophenone with guanidine HCl. The structures of the synthesized compounds RP 1-5 were assigned on the basis of elemental analysis, IR, (1)H NMR and mass spectroscopy. These compounds were also screened for anti-histaminic activity. The recorded percentage of histamine inhibition showed a significant anti-histaminic activity when compared to the reference anti-histaminic drug mepiramine.