Nursing Intervention Strategies and Their Effectiveness on Restless Leg Syndrome and Psycho-Social Problems in Chronic Kidney Disease Patients.

Background: Chronic kidney disease is a global health problem affecting 843.6 million people with 1 million deaths and the 12th leading non-communicable cause of death worldwide. Insomnia is a disturbing problem found in chronic kidney disease patients, leading to physiological problems like fatigue, edema, and restless leg syndrome most of the time. The objective of this study was to assess the effectiveness of nursing intervention strategies on physiological and psycho-social problems. Materials and Methods: A quantitative research approach with quasi-experimental pre-test and post-test design was used to assess the effectiveness of nursing intervention strategies on physiological and psycho-social problems among 30 chronic kidney disease patients, 15 in control and experimental each, admitted in a selected hospital of Punjab. Convenience sampling was used to assign the samples, and data were collected through an interview schedule by using standardized scales. IEC number: 2017/08/5051. Results: The result of the study showed that the baseline restless leg syndrome mean score was 9.67, whereas the psycho-social problem baseline mean score was 79.80, and after post-test, the mean score was reduced to 7.67 in physiological and 66.87 in psycho-social problems in the experimental group. Intervention was found to be effective in reduction of physiological and psycho-social symptoms of chronic kidney disease patients significantly (P ≤ 0.05). Conclusions: The study showed that nursing intervention strategies were effective in reduction of physiological and psycho-social symptoms.

Systemic delivery of proteins using novel peptides via the sublingual route.

Therapeutic proteins often require needle-based injections, which compromise medication adherence especially for those with chronic diseases. Sublingual administration provides a simple and non-invasive alternative. Herein, two novel peptides (lipid-conjugated protamine and a protamine dimer) were synthesized to enable sublingual delivery of proteins through simple physical mixing with the payloads. It was found that the novel peptides promoted intracellular delivery of proteins via increased pore formation on the cell surface. Results from in vitro models of cell spheroids and human sublingual tissue substitute indicated that the novel peptides enhanced protein penetration through multiple cell layers compared to protamine. The novel peptides were mixed with insulin or semaglutide and sublingually delivered to mice for blood glucose (BG) control. The effects of these sublingual formulations were comparable to the subcutaneous preparations and superior to protamine. In addition to peptide drugs, the novel peptides were shown to enable sublingual absorption of larger proteins with molecular weights from 22 to 150 kDa in mice, including human recombinant growth hormone (rhGH), bovine serum albumin (BSA) and Immunoglobulin G (IgG). The novel peptides given sublingually did not induce any measurable toxicities in mice.

To Evaluate the Efficacy of Biomarkers as Monitoring Tool in Patients with Fascial Space Infections of Odontogenic Origin: A Clinical Study.

Introduction: The objective was to evaluate the efficacy of biochemical markers (WBC, CRP and fibrinogen) and the course of odontogenic space infections in 50 patients. Material and Methods: Blood samples were taken preoperatively and postoperatively at day 0, day 4, day 8 and day 12 for measuring the levels of all three biomarkers. The trends of the biomarkers were observed and compared with assessment parameters such as dental etiology, number of teeth involved, number of spaces involved, mouth opening and pain. Active pus discharge, dysphagia, hoarseness and swelling were assessed and scored accordingly. Results: The data were subjected to paired 't' test, McNemar's and Pearson's bivariate correlation as appropriate. Statistical analysis found strong correlation between laboratory values of markers and parameters used to measure severity of infection. All three biomarkers (WBC, CRP and fibrinogen) are significant markers for hospital stay (p < 0.01). Prospective analysis indicates that only one biomarker cannot be used to rule out specific diagnosis. Conclusion: The combination of three biochemical markers assessed in the present study (WBC, CRP and fibrinogen) should be used as prognostic factor in assessment, clinical severity and efficacy of treatment regime for patients as these can reliably predict the clinical course of odontogenic infection.

Ultrasound in Causes of Stridor in Children.

Airway ultrasound (US) is an easily available, portable, radiation-free imaging modality for quick, non-invasive, dynamic evaluation of the airway without sedation. This is useful in children with stridor, which is an emergency due to upper airway obstruction requiring immediate management. Several causes of stridor including laryngomalacia, laryngeal cyst, subglottic hemangioma, vocal cord palsy, and lymphatic malformations can be evaluated accurately. Thin musculature and unossified cartilages in children provide a good acoustic window. Thus, airway US is valuable, but underutilized for the evaluation of children with stridor. In this case-based review, we describe the technique, indications, anatomy, and pathologies on airway US.

Prediction and analysis of cis-regulatory elements in Dorsal and Ventral patterning genes of Tribolium castaneum and its comparison with Drosophila melanogaster.

Insect embryonic development and morphology are characterized by their anterior-posterior and dorsal-ventral (DV) patterning. In Drosophila embryos, DV patterning is mediated by a dorsal protein gradient which activates twist and snail proteins, the important regulators of DV patterning. To activate or repress gene expression, some regulatory proteins bind in clusters to their target gene at sites known as cis-regulatory elements or enhancers. To understand how variations in gene expression in different lineages might lead to different phenotypes, it is necessary to understand enhancers and their evolution. Drosophila melanogaster has been widely studied to understand the interactions between transcription factors and the transcription factor binding sites. Tribolium castaneum is an upcoming model animal which is catching the interest of biologists and the research on the enhancer mechanisms in the insect's axes patterning is still in infancy. Therefore, the current study was designed to compare the enhancers of DV patterning in the two insect species. The sequences of ten proteins involved in DV patterning of D. melanogaster were obtained from Flybase. The protein sequences of T. castaneum orthologous to those obtained from D. melanogaster were acquired from NCBI BLAST, and these were then converted to DNA sequences which were modified by adding 20 kb sequences both upstream and downstream to the gene. These modified sequences were used for further analysis. Bioinformatics tools (Cluster-Buster and MCAST) were used to search for clusters of binding sites (enhancers) in the modified DV genes. The results obtained showed that the transcription factors in Drosophila melanogaster and Tribolium castaneum are nearly identical; however, the number of binding sites varies between the two species, indicating transcription factor binding site evolution, as predicted by two different computational tools. It was observed that dorsal, twist, snail, zelda, and Supressor of Hairless are the transcription factors responsible for the regulation of DV patterning in the two insect species.

Comparative analysis of the antibacterial efficacy and bioactive components of Thuja occidentalis obtained from four different geographical sites.

The purpose of this study was to determine whether or not there were significant differences in the antibacterial potential of Thuja occidentalis collected from four distinct geographical sites, namely Chamba (Himachal Pradesh, India), Jalandhar (Punjab, India), Aurangabad (Bihar, India) and Kakching (Manipur, India). The plant extracts were prepared in three different solvents: ethanol, methanol, and acetone. The antibacterial potential of the plant extracts was tested against five different bacterial species using well diffusion test. The minimum inhibitory and bactericidal concentrations of the plant sample exhibiting maximum zone of inhibition against different bacterial strains were calculated. Further, the total phenols, flavonoids, and antioxidant efficacy (using DPPH assay) were also analysed biochemically. The activity of different antioxidant enzymes including SOD, CAT and APX were also recorded as these enzymes protect the cells from free radical damage. GC-MS analysis was also performed on all plant extracts to identify the bioactive components. The results showed that the T. occidentalis collected from the Kakching, Manipur, East side of India showed the highest zone of inhibition against all the bacterial strains, followed by Chamba, Jalandhar, and lastly Aurangabad. To analyse the impact of phytochemicals on the antibacterial efficacy, a correlation was drawn between the biochemical parameters and zone of inhibition using Karl Pearson's method. Most bacterial species demonstrated a positive correlation between antibacterial effectiveness (zone of inhibition) and biochemical markers. The GC-MS study revealed positive correlation between zone of inhibition and peak area percentages of α-Pinene, ß-caryophyllene, Germacrene-D, and Humulene in all bacterial species indicating that these chemicals may play a key role in the bactericidal potential of T. occidentalis. Based on the results of this investigation, it is evident that the antibacterial effectiveness of T. occidentalis varies with its geographical location which may be attributed to the differences in the phytochemical makeup.

Distinguishing Swine Flu (H1N1) from COVID-19: Clinical, Virological, and Immunological Perspectives.

This article provides an in-depth examination on the differences between the influenza A strain, H1N1 (also called Swine Flu) and Covid-19 focusing on the immune response and clinical symptoms. Flu symptoms due to influenza A strain, H1N1, were initially discovered in 2009. This variant of influenza A is believed to have emerged through reassortment, a process where the resulting virus inherits gene segments from each of its parental viruses. This reassortment event has resulted in a variant with altered characteristics, potentially affecting the level of immunity in humans. The symptoms of this strain typically manifest 1-4 days after exposure and include fever, cough, sore throat, runny/stuffy nose, body aches, fatigue, and gastrointestinal symptoms such as diarrhea. The transmission dynamics of this new variant, including human-to-human transmission, are still under investigation by health authorities. Individuals with weakened immune systems are generally more susceptible to severe illness. Risk factors associated with swine flu can include older adults, young children, pregnant women, and individuals with obesity. Historical variants of swine flu, such as the 2015 variant in India, have been associated with significant case numbers and deaths, often due to respiratory failure. Since the epidemic of Covid-19 due to SARS-CoV2 in early 2020, several symptoms of COVID-19 and swine flu overlap. In this article, we critically reviewed the differences and similarities in the immune response and clinical symptoms due to H1N1 virus and SARS-CoV2 in human.

In-silico identification and comparison of transcription factor binding sites cluster in anterior-posterior patterning genes in Drosophila melanogaster and Tribolium castaneum.

The cis-regulatory data that help in transcriptional regulation is arranged into modular pieces of a few hundred base pairs called CRMs (cis-regulatory modules) and numerous binding sites for multiple transcription factors are prominent characteristics of these cis-regulatory modules. The present study was designed to localize transcription factor binding site (TFBS) clusters on twelve Anterior-posterior (A-P) genes in Tribolium castaneum and compare them to their orthologous gene enhancers in Drosophila melanogaster. Out of the twelve A-P patterning genes, six were gap genes (Kruppel, Knirps, Tailless, Hunchback, Giant, and Caudal) and six were pair rule genes (Hairy, Runt, Even-skipped, Fushi-tarazu, Paired, and Odd-skipped). The genes along with 20 kb upstream and downstream regions were scanned for TFBS clusters using the Motif Cluster Alignment Search Tool (MCAST), a bioinformatics tool that looks for set of nucleotide sequences for statistically significant clusters of non-overlapping occurrence of a given set of motifs. The motifs used in the current study were Hunchback, Caudal, Giant, Kruppel, Knirps, and Even-skipped. The results of the MCAST analysis revealed the maximum number of TFBS for Hunchback, Knirps, Caudal, and Kruppel in both D. melanogaster and T. castaneum, while Bicoid TFBS clusters were found only in D. melanogaster. The size of all the predicted TFBS clusters was less than 1kb in both insect species. These sequences revealed more transversional sites (Tv) than transitional sites (Ti) and the average Ti/Tv ratio was 0.75.

Increased renal elimination of endogenous and synthetic pyrimidine nucleosides in concentrative nucleoside transporter 1 deficient mice.

Concentrative nucleoside transporters (CNTs) are active nucleoside influx systems, but their in vivo roles are poorly defined. By generating CNT1 knockout (KO) mice, here we identify a role of CNT1 in the renal reabsorption of nucleosides. Deletion of CNT1 in mice increases the urinary excretion of endogenous pyrimidine nucleosides with compensatory alterations in purine nucleoside metabolism. In addition, CNT1 KO mice exhibits high urinary excretion of the nucleoside analog gemcitabine (dFdC), which results in poor tumor growth control in CNT1 KO mice harboring syngeneic pancreatic tumors. Interestingly, increasing the dFdC dose to attain an area under the concentration-time curve level equivalent to that achieved by wild-type (WT) mice rescues antitumor efficacy. The findings provide new insights into how CNT1 regulates reabsorption of endogenous and synthetic nucleosides in murine kidneys and suggest that the functional status of CNTs may account for the optimal action of pyrimidine nucleoside analog therapeutics in humans.

Exploiting the Biophysical Cues toward Dual Differentiation of hMSC's within Geometrical Patterns.

A wide variety of cues from the extracellular matrix (ECM) have been known to affect the differentiation of stem cells in vivo. In particular, the biophysical cues and cell shape have been known to affect the stem cell function, yet very little is known about the interplay between how these cues control differentiation. For the first time, by using photolithography to pattern poly(ethylene glycol) (PEG), patterns of square and triangular geometries were created, and the effect of these structures and the biophysical cues arising were utilized to differentiate cells into multiple lineages inside a same pattern without the use of any adhered protein or growth factors. The data from these studies showed that the cells present at the edges were well elongated, exhibit high aspect ratios, and differentiated into osteogenic lineage, whereas the cells present at the center exhibit lower aspect ratio and were primarily adipogenic lineage regardless of the geometry. This was correlated to the higher expression of focal adhesion proteins at the edges, the expression of which have been known to affect the osteogenic differentiation. By showing MSC lineage commitment relationships due to physical signals, this study highlights the importance of these cues and cell shape in further understanding stem cell behavior for tissue engineering applications.

Development and characterization of solvent-based 3D printed polylactic acid/45S5 bioactive glass composites for soft and hard tissue engineering.

With the benefit of offering hydrolysis breakdown and bio-resorption of its products, polylactic acid (PLA) is among the most frequently utilized polymers for many biomedical applications. Composites made of polylactic acid (PLA) and bioactive substances such as bioactive glass (BG) are developing as novel biomaterials because they comprise the mechanical properties and bioactivity of bioactive glass (BG) with the conformability and bio absorption of PLA. In this work, composites of PLA/BG were produced by employing the solvent-based three-dimensional printing process. To accomplish this, 0-2 wt% of BG particles (size ≤ 2 µm) were added to PLA. The resulting composite mix was then fed into a solvent-based 3D printer for the layer-by-layer construction of composites. According to the SEM/EDX investigation, BG particles were evenly dispersed throughout the polymer matrix which resulted in the interfacial bonding between them. FTIR and XRD analysis showed that PLA and BG did not interact chemically. All the composites were evaluated for cytocompatibility by in vitro cellular tests, which also proved their suitability as a substrate for NIH 3T3 cell adherence and growth. The composites were also found to be good in terms of hemocompatibility and platelet adhesion. In conclusion, additional studies on these materials were encouraged by the successful outcomes, which suggested that 3D-printed composite scaffolds consisting of PLA and BG particles might be useful in soft and hard tissue engineering.

Impact of Structured Reporting of Skeletal Survey in Skeletal Dysplasia: A Single Institution Experience.

Background Structured reporting has the advantages of reducing ambiguity in written radiology reports with greater uniformity and comparability of reports amongst different institutes. It has multiple facets: structured format, structured content, and standardized language. While structured reporting initiative has been used in various radiology subspecialties such as oncology, cardiothoracic, abdominal and interventional radiology; skeletal dysplasia is a domain that remains largely untouched by this concept. Purpose To evaluate the impact of structured reporting in skeletal dysplasia. Methods and Materials This was an ethically approved pragmatic clinical trial. A defined number (75) of clinically diagnosed and/or genetically confirmed skeletal dysplasia radiographs were evaluated by two radiologists (reader A and reader B) with 5-and 7-years' experience in general radiology, respectively. A pre-defined structured reporting format for skeletal dysplasia was used as an interventional tool. Both the readers interpreted the radiographs before and after the training session. In addition to diagnosis, diagnostic confidence was noted using a semiquantitative scale. Improvement in diagnostic accuracy and diagnostic confidence after training were assessed. McNemar's test was used to assess the statistical significance of difference in proportion of correct diagnoses in pre- and post-education phases. An interrater reliability analysis using the Kappa statistic was performed to determine interobserver agreement between readers both in pre- and post-education phases. Results In the post-education phase, the proportion of accurate diagnosis improved from 48% (36/75) to 64% (48/75) for reader A, and from 44% (33/75) to 60% (45/75) for reader B as compared with the pre-education phase. Amongst the cases with a correct radiologic diagnosis, an increase in diagnostic confidence was noted in 18 cases for reader A, and 15 cases for reader B. In none of the cases, there was a reduction in diagnostic confidence after training. A McNemar's test determined that there was a statistically significant difference in the proportion of correct diagnoses in pre- and post-education phases, p < 0.001. The interobserver agreement between the readers was found to increase from Kappa = 0.33 ( p = 0.004) using non-structured reporting in pre-education phase to Kappa = 0.46 ( p < 0.001) using structured reporting in the post-education phase. Conclusion A structured reporting of skeletal survey can improve accuracy and confidence in diagnosing skeletal dysplasia.

Morrison's Pouch: Anatomy and Radiological Appearance of Pathological Processes.

Morrison's pouch is the intraperitoneal space in the supramesocolic compartment located between the right liver lobe and right kidney. Pathological conditions that can involve this peritoneal space include fluid collections, infectious or inflammatory processes, and neoplasms. Frequent involvement by disease entities can be attributed to its dependent location, communication with the inframesocolic compartment, close proximity to the adjacent organs and peritoneal fluid dynamics. Knowledge of the appearance of pathological entities on various imaging modalities helps the radiologist in making the correct diagnosis.

Human monkeypox: epidemiology, transmission, pathogenesis, immunology, diagnosis and therapeutics.

"Zoonoses" describe diseases that may be acquired by humans from animals. Due to the constant contact between humans and other animals, many infectious diseases are disseminated. This may happen via direct contact, such as bites or scratches, or by indirect contact, such as when eating bush meat or using contaminated animal parts. Monkeypox disease is one such zoonotic infection which is now emerging as a disease of global concern, and the World Health Organization has already labelled it a public health emergency. The virus is related to other orthopox viruses and may be further classified into two genetically separate clades, the West African and the Central African. The latter is far more pathogenic than the former. Utilizing virotransducer and virostealth proteins, the virus is able to control the host's T-cell-mediated responses and impede the release of cytokines and chemokines.Monkeypox may be treated with tecovirimat, cidofovir, or brincidofovir, and prevention with the vaccination JYNNEOS is recommended. The disease's fast global expansion warrants concern despite the fact that it is less fatal than that caused by the variola virus. Before the sickness reaches catastrophic proportions, we must draw on our prior experiences and act prudently. This article serves as an introduction to the monkeypox virus and its associated pathology, treatments, diagnostics, and preventative measures.

Light-Mediated 3D Printing of Micro-Pyramid-Decorated Tailorable Wound Dressings with Endogenous Growth Factor Sequestration for Improved Wound Healing.

Medical dressings play an important role in the field of tissue engineering owing to their ability to accelerate the process of wound healing. Great efforts have been made to fabricate wound dressings with distinctive features for promoting wound healing. However, most of the current synthesis methods either generate dressings of uniform size or involve complex fabrication techniques, thus limiting their commercialization for the personalized dressings. We report here a dressing, which presents a paradigm shift in the design of the dressing from uniform films to a micro-patterned film. The hypothesis driving the design is the ability of the 3D patterns to provide an efficient transient matrix filling the depth of the wound rather than just providing a barrier and slight re-epithelialization. We demonstrate the use of the digital light processing 3D printing technique to generate micro-pyramid-decorated wound healing dressings with individualized design and with bio-compatible gelatin methacryloyl to contact the wounded areas. In addition to providing better adhesion to the migratory cells, the micro-pyramids also enable covalent conjugation of heparin, providing capability to sequester endogenous growth factors (GFs). Based on these advantages, the developed dressing not only adheres strongly to the wound bed but also promotes the treatment of a rat wound model by utilizing the power of endogenous GFs for tissue regeneration. Thus, it is believed that the developed dressing can break through the limitation of traditional wound treatment and be an ideal candidate for wound healing.

Clinico-epidemiological Aspects of Cutaneous Lesions in Injecting Drug Users Visiting an Oral Substitution Therapy Centre in Northern India: A Cross-Sectional study.

Introduction: Drug abuse has been taking a great toll on the health and well-being of the community for the past few decades. Substance abuse can lead to several cutaneous manifestations as direct injuries by the offending drug or the practices of drug usage cause secondary damage to the skin. The early recognition of these signs is of utmost importance to prevent long-term complications. Objectives: To study the clinical-epidemiological profile of the skin diseases in Injecting Drug Users (IDU) attending an Oral Substitution Therapy (OST) Center in Northern India and to assess the psychological impact of skin conditions in IDUs attending OSTs. Methods: This cross-sectional observational study involved 100 IDUs enrolled from the OST center who were subjected to brief history taking and clinical and dermoscopic evaluation of skin lesions. Dermatological quality of life index (DLQI), Depression, Anxiety, Stress Scale (DASS), and WHO-quality of life (QoL) questionnaire were used to evaluate the impact of skin lesions on psycho-social health and QoL of IDUs. Results: Cutaneous lesions ranged from track marks to severe ulcerations and scarring. Mucosal lesions also took a toll on several patients. The patients had varying degrees of anxiety, depression, and mental stress. Conclusions: Injecting Drug Abusers are prone to acquire skin diseases due to injury caused by drugs as well as by drug practices adopted and the degree of neglect may worsen these conditions. These cutaneous lesions hamper QoL and cause psychosocial disturbances.