Aldose reductase and glutathione in senile cataract nucleus of diabetics and non-diabetics.

PURPOSE: The aim is to evaluate the aldose reductase (AR) and glutathione (GSH) activity in the nucleus of senile cataract in type 2 diabetes and non-diabetic group of patients. METHODS: A total of 62 patients including 31 diabetics and 31 non- diabetics who were undergoing cataract surgery were included. Nucleus extracted was sent for analysis of AR and GSH activity while blood sample was taken for glycated haemoglobin (HbA1c) levels. STATISTICAL ANALYSIS: Data were analysed using IBM SPSS 25. Comparison was carried out by unpaired T-test and correlations were established by Pearson's correlation. The p value less than 0.05 was considered significant for all analyses. STUDY DESIGN: This is a prospective cross-sectional comparative study. RESULTS: In this study, diabetic group patients showed earlier progression of cataract as compared to the non-diabetic group (p-value 0.0310). Mean HbA1c in the diabetic group was 7.34% compared to the non-diabetic group of 5.7% (p value < 0.001). AR in the diabetic patients was 2.07 mU/mg while the non-diabetic group was 0.22 mU/mg (p-value < 0.001). GSH in the diabetic group was 3.38 µMol/g and the non-diabetic group was 7.47 µMol/g (p value < 0.001). HbA1c showed positive correlation with AR among the diabetic group (p-value 0.028). CONCLUSION: Elevated oxidative stress can be strongly attributed to high AR and low GSH activity among the diabetic group as compared to the non-diabetic group and can lead to early cataract formation.

New Ways to Protect the Host from SARS-CoV-2? Lung Microbiome Metabolites Inhibit STAT3 and Modulate the Immunological Network.

COVID-19 caused by the SARS-CoV-2 infection is a systemic disease that affects multiple organs, biological pathways, and cell types. A systems biology approach would benefit the study of COVID-19 in the pandemic as well as the endemic state. Notably, patients with COVID-19 have dysbiosis of lung microbiota whose functional relevance to the host is largely unknown. We carried out a systems biology investigation of the impact of lung microbiome-derived metabolites on host immune system during COVID-19. RNAseq was performed to identify the host-specific pro- and anti-inflammatory differentially expressed genes (DEGs) in bronchial epithelium and alveolar cells during SARS-CoV-2 infection. The overlapping DEGs were harnessed to construct an immune network while their key transcriptional regulator was deciphered. We identified 68 overlapping genes from both cell types to construct the immune network, and Signal Transducer and Activator of Transcription 3 (STAT3) was found to regulate the majority of the network proteins. Furthermore, thymidine diphosphate produced from the lung microbiome had the highest affinity with STAT3 (-6.349 kcal/mol) than the known STAT3 inhibitors (n = 410), with an affinity ranging from -5.39 to 1.31 kcal/mol. In addition, the molecular dynamic studies showed distinguishable changes in the behavior of the STAT3 complex when compared with free STAT3. Overall, our results provide new observations on the importance of lung microbiome metabolites that regulate the host immune system in patients with COVID-19, and may open up new avenues for preventive medicine and therapeutics innovation.

Design development and optimisation of multifunctional Doxorubicin-loaded Indocynanine Green proniosomal gel derived niosomes for tumour management.

This study presents the design, development, and optimization of multifunctional Doxorubicin (Dox)-loaded Indocyanine Green (ICG) proniosomal gel-derived niosomes, using Design of Experiments (23 factorial model). Herein, the multifunctional proniosomal gel was prepared using the coacervation phase separation technique, which on hydration forms niosomes. The effect of formulation variables on various responses including Zeta potential, Vesicle size, entrapment efficiency of Dox, entrapment efficiency of ICG, Invitro drug release at 72nd hour, and NIR hyperthermia temperature were studied using statistical models. On the basis of the high desirability factor, optimized formulation variables were identified and validated with the experimental results. Further, the chemical nature, vesicle morphology, surface charge, and vesicle size of optimized proniosomal gel-derived niosomes were evaluated. In addition, the effect of free ICG and bound ICG on NIR hyperthermia efficiency has been investigated to demonstrate the heating rate and stability of ICG in the aqueous environment and increased temperature conditions. The drug release and kinetic studies revealed a controlled biphasic release profile with complex mechanisms of drug transport for optimized proniosomal gel-derived niosomes. The potential cytotoxic effect of the optimised formulation was also demonstrated invitro using HeLa cell lines.

Genetic Exchange of Lung-Derived Exosome to Brain Causing Neuronal Changes on COVID-19 Infection.

The pandemic of novel coronavirus 2 (SARS-CoV-2) has made global chaos for normal human living. Despite common COVID-19 symptoms, variability in clinical phenotypes was reported worldwide. Reports on SARS-CoV-2 suggest causing neurological manifestation. In addition, the susceptibility of SARS-CoV-2 in patients with neurodegenerative diseases and its complexity are largely unclear. Here, we aimed to demonstrate the possible transport of exosome from SARS-CoV-2-infected lungs to the brain regions associated with neurodegenerative diseases using multiple transcriptome datasets of SARS-CoV-2-infected lungs, RNA profiles from lung exosome, and gene expression profiles of the human brain. Upon transport, the transcription factors localized in the exosome regulate genes at lateral substantia nigra, medial substantia nigra, and superior frontal gyrus regions of Parkinson's disease (PD) and frontal cortex, hippocampus, and temporal cortex of Alzheimer's disease (AD). On SARS-CoV-2 infection, BCL3, JUND, MXD1, IRF2, IRF9, and STAT1 transcription factors in the exosomes influence the neuronal gene regulatory network and accelerate neurodegeneration. STAT1 transcription factor regulates 64 PD genes at lateral substantia nigra, 65 at superior frontal gyrus, and 19 at medial substantia nigra. Similarly, in AD, STAT1 regulates 74 AD genes at the temporal cortex, 40 genes at the hippocampus, and 16 genes at the frontal cortex. We further demonstrate that dysregulated neuronal genes showed involvement in immune response, signal transduction, apoptosis, and stress response process. In conclusion, SARS-CoV-2 may dysregulate neuronal gene regulatory network through exosomes that attenuate disease severity of neurodegeneration.

Interesting case of retrieval of intrathoracic Kirschner wire.

Kirschner wires are used in orthopedic surgery for fixation of fractures. We have recently treated a patient who presented with intrathoracic migration of a sharp Kirschner wire which was used for fixing acromioclavicular fracture. She underwent successful thoracotomy with retrieval of the wire from the right upper lobe. Close follow- up and early detection will allow successful treatment of this dangerous complication.

Clinical Profile of Unilateral Proptosis in a Tertiary Care Centre.

Proptosis, the forward protrusion of the eyeball, is a common manifestation of a wide variety of diseases inside the orbit and its spaces. Its diagnosis is usually a combined effort of the ophthalmologist, otolaryngologist, neurosurgeon, and radiologist. A clinical study of twenty-five cases with unilateral proptosis were studied in different age groups over a period of about 3 years under different headings like distribution, clinical features, radiological features, histopathological aspects, management, and outcomes of diseases. Proptosis measurement was done by simple/plastic ruler exophthalmometry, and diagnosis was made after a detailed clinical examination and ancillary tests. Treatment modality was decided based on radiological and histopathological examination reports, which included medical surgery, radiotherapy, and chemotherapy or a combination of all. In our study, most of the patients were in the age group of more than 60 years. The M : F ratio is 3 : 1. One case had a large proptosis of 18 mm above normal and 2 cases were as small as 3 mm. Diagnosis was mainly done by clinical features and confirmed by radiological and histopathological features. Most of them were treated medically (13 cases, i.e., 52%) and the rest by surgery with a combination of radiotherapy/chemotherapy (12 cases, i.e., 48%).

Anesthetic management of an elderly patient with kyphoscoliosis and dilated cardiomyopathy posted for abdominal hysterectomy and salpingo-oophorectomy.

A 76-year-old kyphoscoliotic female patient presented with severe pain and sudden acute abdominal distension for 1-week and was diagnosed to have right-sided massive twisted ovarian cyst. The patient was a known case of hypertension, dilated cardiomyopathy with low 20% cardiac ejection fraction. Though very few incidences of multiple co-morbid conditions existing together in a single elderly patient have been reported in the past, it is important to titrate the dosage, type of anesthetic agents and their routes of administration in high risk patients.

Polycaprolactone scaffold engineered for sustained release of resveratrol: therapeutic enhancement in bone tissue engineering.

Biomaterials-based three-dimensional scaffolds are being extensively investigated in bone tissue engineering. A potential scaffold should be osteoconductive, osteoinductive, and osteogenic for enhanced bone formation. In this study, a three-dimensional porous polycapro-lactone (PCL) scaffold was engineered for prolonged release of resveratrol. Resveratrol-loaded albumin nanoparticles (RNP) were synthesized and entrapped into a PCL scaffold to form PCL-RNP by a solvent casting and leaching method. An X-ray diffraction study of RNP and PCL-RNP showed that resveratrol underwent amorphization, which is highly desired in drug delivery. Furthermore, Fourier transform infrared spectroscopy indicates that resveratrol was not chemically modified during the entrapment process. Release of resveratrol from PCL-RNP was sustained, with a cumulative release of 64% at the end of day 12. The scaffold was evaluated for its bone-forming potential in vitro using human bone marrow-derived mesenchymal stem cells for 16 days. Alkaline phosphatase activity assayed on days 8 and 12 showed a significant increase in activity (1.6-fold and 1.4-fold, respectively) induced by PCL-RNP compared with the PCL scaffold (the positive control). Moreover, von Kossa staining for calcium deposits on day 16 showed increased mineralization in PCL-RNP. These results suggest PCL-RNP significantly improves mineralization due to its controlled and prolonged release of resveratrol, thereby increasing the therapeutic potential in bone tissue engineering.

Evaluation of the Truview™ EVO2 laryngoscope for nasotracheal intubation.

BACKGROUND: The Truview™ EVO2 laryngoscope, with its unique optical lens system and blade tip angulation, has proved its usefulness in providing adequate laryngeal exposure and intubation via the oral route. However, the same has not been evaluated for nasotracheal intubation. AIM: We evaluated the suitability of the Truview™ EVO2 laryngoscope for nasotracheal intubation. METHODS: Fifty ASA grade I and II elective surgical patients were studied. Patients aged below 15 years or having difficult airway were excluded. Under standard anesthesia protocol, nasotracheal intubation was performed using a Truview™ EVO2 laryngoscope and, in cases of inability to complete intubation in three attempts, the Macintosh laryngoscope was used. Time taken for intubation, use of Magill's forceps and need for optimization maneuvers were noted. The primary outcome was percentage of successful intubation, while hemodynamic changes and duration of intubation were taken as secondary outcomes. RESULTS: Majority (94%) could be intubated successfully with the Truview™ EVO2 laryngoscope. Average time taken for intubation was 50.1 s. The hemodynamic changes were not clinically significant. Regression analysis revealed lack of association between duration of intubation and hemodynamic changes. There were no serious complications. CONCLUSION: The Truview™ EVO2 laryngoscope is a useful tool in performing nasotracheal intubation, ensuring a high level of success rate among patients with normal airway anatomy.

Cardiac myxoma mimicking extension of renal cell carcinoma.

Cardiac myxomas are the commonest benign tumour of the heart. We are describing a rare presentation of a myxoma in a patient with renal cell carcinoma (RCC). Since there was no single reported case of myxoma with RCC, a presumptive diagnosis of RCC with right atrial extension of tumour thrombus was made. Both the tumours were resected in the same operation by radical nephrectomy with open heart surgery.

Comparative study of greater palatine nerve block and intravenous pethidine for postoperative analgesia in children undergoing palatoplasty.

SUMMARY: Greater palatine nerve block anaesthetizes posterior portions of the hard palate and its overlying soft tissues. This study compared the efficacy, safety, and ease of the nerve block for cleft palate surgeries in children with i.v. pethidine for postoperative pain management. A prospective, double blind, randomized trial, enrolled 50 children aged below 10 years scheduled for palatoplasty and were alternatively allocated to two groups. Group A received intravenous pethidine 1mg.kg(-1), whereas Group B, bilateral greater palatine nerve block with bupivacaine 0.25%, 1ml on each side, before the surgical stimulation. Modified Aldrete Scoring System, Children's Hospital Eastern Ontario Pain Scale (CHEOPS) and Brussels Sedation Score were employed to assess recovery, quality of analgesia and sedation respectively, by the nursing staff. Whenever pain score was >8, 0.5mg.kg(-1) of pethidine was given intravenously for rescue analgesia in both groups. Recovery scores were better in Group B (p=0.007). In the immediate postoperative period, pain score was more in Group A (number of patients with pain score >8, 44% v/s 12%, p= .0117). Requirement for rescue analgesia was more in Group A (60 times v/s 7). The average sedation scores were similar. There was a higher incidence of agitation in Group A (66 vs. 30). The incidence of deep sedation was nearly half in Group B (34 Vs 63). Greater palatine nerve block was considered successful in 88% of cases. Greater palatine nerve block produces more effective, consistent and prolonged analgesia than pethidine.