Serum sodium improvement: change in Comprehensive Geriatric Assessment parameters in geriatric patients with hyponatremia.

BACKGROUND: Hyponatremia presents with symptoms considered age-associated in the elderly. We assess the change in Comprehensive Geriatric Assessment (CGA) parameters after hyponatremia improvement in hospitalized geriatric patients. METHODS: We took 100 hyponatremic and same number of eunatremic geriatric patients (> 60 years) who were comorbidity, presenting-complaints, and age-matched. Four CGA parameters were utilized, the new Hindi Mental State Examination (HMSE), Barthel's index of activities of daily living (ADL), Timed up and go Test (TUG), and handgrip strength by hand dynamometer (HG). We analyzed these at admission and discharge, and their relationship with change in sodium levels. RESULTS: Average age was 68.1 ± 5.8 years, with males constituting 75%. The CGA parameters demonstrated worse values amongst the hyponatremia than the normonatremia group. Severe hyponatremia group showed worse CGA scores in comparison with moderate and mild. With improvement in sodium level, the improvements in ADL, TUG, and HMSE scores were greater in the hyponatremia group (8.8 ± 10.1, 2.2 ± 2.5, and 1.7 ± 2.3 respectively) in comparison to the normonatremia reference group (4.7 ± 9.0, 1 ± 2.0, and 0.7 ± 1.3 respectively, P < 0.05). CONCLUSION: Our study is the first utilizing HMSE to assess change in cognitive ability with improvement in serum sodium levels in the Indian elderly. Hyponatremic patients show worse baseline CGA parameters, and hyponatremia severity correlates with worse motor and cognitive function. Improvement in the serum sodium level improves the CGA parameters. Correction of hyponatremia in the geriatric age group significantly impacts life quality.

Insights into microRNA-mediated interaction and regulation of metabolites in tomato.

microRNAs direct regulation of various metabolic pathways in plants and animals. miRNAs may be useful in developing novel/elite genotypes, with enhanced metabolites and disease resistance. We examined miRNAs in tomato. In tomato, miRNAs in the carotenoid pathway have not been fully elucidated. We examined the potential role of miRNAs in biosynthesis of carotenoids, transcript profiling of miRNAs and their possible targets (genes and transcription factors) at different development stages of tomato using stem-loop PCR and RT-qPCR. We also identified miRNAs targeting key flavonoid genes, such as chalcone isomerase (CHI), and dihydroflavonol-4-reductase (DFR). Distinct expression profiles of miRNAs and their targets were found in fruits of three tomato accessions, suggesting carotenoid regulation by miRNAs at various stages of fruit development. This was also confirmed using HPLC of the carotenoids. The present study may help in understanding possible regulation of carotenoid biosynthesis. The identified miRNAs can be exploited to enhance biosynthesis of different carotenoids in plants.

Effectiveness of Preparedness Training Delivered to Pre-final and Final Year Nursing Undergraduates to Combat COVID-19: A Need-based Initiative.

A major concern during the COVID-19 pandemic has been the shortage of manpower for patient care. The recommendation of various authorised bodies encouraged the training of students from medical, nursing, and allied fields to manage COVID-19 cases by tele-consultation and monitoring of mild cases under the supervision of faculty. Anticipating a further shortage of human resources, leading to dire consequences, preparedness training for the final year and pre-final nursing undergraduates was initiated. The current study was conducted to evaluate the effectiveness of and feedback on COVID-19 preparedness training delivered to final-and pre-final-year undergraduate nursing students. A 3-day training was given to pre-final and final year nursing undergraduates on ECG, COVID-19 management protocols, personal protective equipment "donning and doffing", "hand hygiene", "biomedical waste management", "contact tracing" and cleaning and disinfection and simulation-based skills. Scores before and after training were conducted and mean scores were compared using a paired t-test. In total, 154 nursing students participated in the training program. Mean pre-test and post-test scores included: general instructions (21.69±2.5 and 25.09±3.29); skill procedures (5.4±1.21 and 6.3±1.2) and COVID management (22.84±3.26 and 26.48±2.06). There was a statistically significant improvement in knowledge and skills in all training sessions (p=0.0001). The mean post-test scores obtained at the OSCE stations for cardiac monitoring, prone positioning, compression-only CPR, airway, ECG and ABG ranged from 97.0% to 100.0% and all participants scored >70.0%. About 92.8% of the students felt that hands-on training enhanced their learning experiences. A need-based initiative of training final-and pre-final-year nursing students in COVID-19 support care effectively and efficiently created a skilled workforce.

[Profiling patients with early onset psychosis in Flanders]. / Profielschets van de minderjarige patiënt met psychose in een Vlaams kader.

BACKGROUND: Little is known about patients with early onset psychosis (EOP) because of the low prevalence and separation of mental health care for adolescents and adults. AIM: To describe characteristics of patients with EOP, their global functioning and their journey concerning healthcare, education, employment status, living situation and wellbeing in the years following onset of psychosis. METHOD: Data about demography, symptoms, treatment and functioning were collected from electronic patient records for 31 patients with EOP. Fourteen of these patients completed a questionnaire after discharge from inpatient treatment in ZNA University Child and Youth Psychiatry in Antwerp (UKJA) regarding after care, education, work and living conditions and wellbeing. RESULTS: Most patients developed severe psychotic symptoms before the age of 16 that required prolonged intensive psychiatric treatment. They showed multiple risk factors associated with psychosis. Following inpatient treatment most patients received special needs education and a majority transitioned into adult psychiatric care. Parents were the main source of social support for patients. CONCLUSION: During recovery access to support in different domains of life is needed. If we want to offer adequate care for each patient the organization of mental healthcare and assistance needs to be improved.

Retention of internal teat sealants over the dry period and their efficacy in reducing clinical and subclinical mastitis at calving.

Internal teat sealants (ITS) reduce the risk of new intramammary infections over the dry period by forming a physical barrier to pathogen ingress. As the first and last 2 wk of the dry period are high-risk periods for new infections, maintaining an effective barrier in this period is a key requirement. Few studies have systematically examined sealant retention and none have done so under New Zealand pastoral conditions, where cows frequently move to separate grazing for dry periods, typically 80 to 90 d long. This multi-herd study was a split-udder equivalence trial comparing 2 ITS formulations for retention and efficacy in preventing periparturient clinical and subclinical mastitis. Both ITS contained 65% (2.6 g) bismuth salts, which contribute to the barrier within the teat canal, emulsified in ≤1.4 g of mineral oil. However, one ITS additionally contained <10% amorphous silica. At dry-off, treatment was randomly allocated to diagonal teat-pairs within 409 cows on 4 farms. All cows met industry best practice criteria for ITS treatment alone. The study unit was quarter within cow and farm. Outcomes included clinical mastitis (CM) incidence for the last 7 d of the dry period and first 42 d of lactation, subclinical mastitis (SCM) incidence 96 h after calving, and quantity of residual after centrifuging 50 mL of colostrum collected from each quarter within 24 h of calving. Proportional outcomes were analyzed using Bayesian mixed models with a binomial distribution and logit link function, whereas the quantity of residual was analyzed using Bayesian finite mixture models and cluster bootstrapping. We set a region of probable equivalence (ROPE) of ±2.5% between proportions and ±0.2 g for residual weight. Records were available for 1,596 quarters (399 cows). We detected no meaningful difference in incidence of CM or SCM attributable to differences in sealant: the model predicted treatment differences of 0.00 with a 95% highest density interval (HDI) of ±1.00%. Across all cows and farms, the marginal difference in the percentage of quarters with CM was 0.11% (95% HDI: -2.11 to 2.49%), and for SCM 0.00 (95% HDI: -1.98 to 1.94%). Including the quantity of residual recovered at calving did not improve fit or predictive ability of the models predicting CM or SCM, and the coefficient spanned the null value. The distribution of the weight of material recovered at calving was multi-modal; for 25% of quarters, more residual was recovered than inserted. When the residual weight was less than or equal to the median residual weight (2.06 g; range: 0.19-6.03 g), there was a ≥90% probability that any treatment difference in residual was ≤0.2 g. When the residual weight was between the median and 75th percentile (4.40 g; 95% HDI: 4.00 to 4.75 g), there was no clear difference in residual between products. Above the 75th percentile, there was a 90% probability that the residual from quarters differed by product type (difference = 0.36 g, 90% HDI: 0.20 to 0.54 g). In conclusion, both products had equivalent efficacy for SCM and CM. As the quantity of residual increased, the difference in residual weight recovered increased but this may represent increases in debris rather than indicating a more effective barrier.

Retrospective analysis of local injection site adverse reactions associated with 230 allogenic administrations of bone marrow-derived mesenchymal stem cells in 164 horses.

BACKGROUND: Bone marrow-derived mesenchymal stem cells (BM-MSCs) are frequently used in the treatment of musculoskeletal injuries. Fully characterised cells that are readily available for use is optimum. Allogenic BM-MSCs can satisfy the need for rapid treatment, however, their safety has been questioned. OBJECTIVES: Objectives were to characterise BM-MSCs from an adult donor horse, in vitro, and to identify and describe adverse reactions that occurred following their injection into other horses. We hypothesised that BM-MSCs capable of proliferation, differentiation and lacking MHC II from one donor could be implanted into another individual without significant adverse reactions and the frequency of adverse reactions in clinical cases would be similar to that previously reported for autologous BM-MSCs. STUDY DESIGN: Retrospective clinical study. METHODS: BM-MSCs were proliferated and characterised from one donor and cryopreserved for clinical use. Medical records for horses injected with allogenic BM-MSCs from this donor at a single hospital were used. After routine lameness exam, lesions were identified using diagnostic ultrasound or MRI. Post injection reaction was defined as increased pain, swelling, or heat at or near injection site, or increased lameness. Treatments required for each reaction were noted. RESULTS: BM-MSCs proliferated and underwent differentiation. Cells were found to be negative for MHC-II (<2%) and were viable after cryopreservation and shipping. Ten of 230 (4.35%) injections were noted to be associated with an adverse reaction. Adverse reactions occurred in synovial structures (n = 3) and in soft tissues (n = 7). MAIN LIMITATIONS: This investigation could underestimate the number and severity of reactions. Mild reactions, such as synovitis, may have been missed. Also, anti-inflammatory drugs could overshadow mild reactions, making them less likely to be detected. CONCLUSIONS: Fully characterised allogenic BM-MSCs originating from a single donor horse can be administered to horses with soft tissue injuries with a low rate of adverse reaction. The Summary is available in Portuguese - see Supporting Information.

A comprehensive review of the pharmacological potential of Crocus sativus and its bioactive apocarotenoids.

Crocus sativus is an herbaceous plant that belongs to family Iridaceae. It is commonly known as saffron and has been used for medicinal purposes since many centuries in India and other parts of the world. Saffron of commercial importance comprises of dried stigmas of the plant and is rich in flavonoids, vitamins, and carotenoids. Carotenoids represent the main components of saffron and their cleavage results in the formation of apocarotenoids such as crocin, picrocrocin, and safranal. Studies conducted during the past two decades have revealed the immense therapeutic potential of saffron. Most of the therapeutic properties are due to the presence of unique apocarotenoids having strong free radical scavenging activity. The mode of action of these apocarotenoids could be: modulatory effects on detoxifying enzymes involved in combating oxidative stress, decreasing telomerase activity, increased the proapoptotic effect, inhibition of DNA, RNA and protein synthesis, and by a strong binding capacity of crocetin with tRNA. The present review focuses on the therapeutic role of saffron and its bio oxidative cleavage products and also highlights the possible molecular mechanism of action. The findings reported in this review describes the wide range of applications of saffron and attributes its free radical scavenging nature the main property which makes this spice a potent chemotherapeutic agent for the treatment of various diseases.

Transperineal template-guided prostate saturation biopsies in men with suspicion of prostate cancer: a pilot study from Pakistan.

Traditionally, transrectal ultrasound (TRUS)-guided biopsies are done for the diagnosis of prostate cancer (PCa) in Pakistan. The transperineal template-guided saturation biopsy (TTSB) approach has been recently introduced in Pakistan and we share diagnostic yields and pathological findings of specimens taken for PCa diagnosis in men with elevated serum total prostate specific antigen (PSA) and negative TRUS-guided prostate biopsies. In all, 16 patients investigated at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), underwent TTSB. The mean age of patients was 67.8 ± 8.8 (range: 55 - 84) years. The median PSA was 9.5 (IQR: 7.9 - 19.8) ng/ ml. The duration of symptoms before biopsy ranged from 1 month to 144 months. The prostate was enlarged with mean weight of 73.5 ± 55.5 g. Histopathology revealed PCa in 5 of 16 (31.2%) cases. The Gleason score was 6 (3+3), 7 (3+4) and 8 (4+4) in 1 case each (6.3%) and 10 (5+5) in 2 cases (12.5%). At least two cores were positive in all positive cases. None of the patients required antibiotics post-procedure. In conclusion, the TTSB technique is a promising option for patients with elevated PSA level and negative transrectal prostate biopsies for the detection of PCa in our setting.

Inhibitory control in euthymic bipolar disorder: Event related potentials during a Go/NoGo task.

OBJECTIVES: Patients with bipolar disorder (BD) are reported to have difficulties with inhibition, even in a euthymic state. However, the literature on cortical activity associated with response inhibition in BD remains ambiguous. This study investigates inhibition in euthymic BD using electrophysiological measures, while controlling for effects of specific medications. METHODS: Twenty patients with BD were compared with eighteen healthy controls on a Go/NoGo task while electroencephalogram was recorded. Behavioral and event-related potential (ERP) measurements were analyzed for the two groups. Medication effects were controlled for in the analysis. RESULTS: Patients with BD had marginally reduced NoGo N2 amplitudes and increased NoGo P3 amplitudes compared with healthy controls when patients using benzodiazepines were excluded from the study. No behavioral differences between the groups were found. CONCLUSIONS: Reduced NoGo N2 amplitudes in BD reflect aberrant conflict detection, an early stage of the inhibition process. In addition, increased NoGo P3 amplitudes in BD despite normal task performance reflect an overactive cortical system during a simple inhibition task. SIGNIFICANCE: Difficulties in early stages of inhibition in BD appear to have been compensated by increased cortical activation. This study extends current knowledge regarding cortical activations relating to inhibition in BD.

Effects of pro-inflammatory cytokines on chondrogenesis of equine mesenchymal stromal cells derived from bone marrow or synovial fluid.

Mesenchymal stromal cells (MSCs) have the capacity to differentiate into cells of mesenchymal lineage, such as chondrocytes, and have potential for use in regeneration of equine articular cartilage. MSCs instilled intra-articularly would be exposed to the inflamed environment associated with equine osteoarthritis (OA), which may compromise their function and ability to heal a cartilaginous defect. The aim of this study was to assess the ability of equine adult MSCs to differentiate into chondrocytes when stimulated with pro-inflammatory cytokines. MSCs derived from equine bone marrow (BM) and from synovial fluid (SF) were cultured in chondrogenic induction medium containing transforming growth factor (TGF)-ß1. BM-derived MSCs (BMMSCs) and SF-derived MSCs (SFMSCs) were stimulated with 100 ng/mL interferon (IFN)-γ and 10 ng/mL tumor necrosis factor (TNF)-α. Chondrogenic differentiation was measured quantitatively with the glycosaminoglycan (GAG) assay and qualitatively by immunofluorescence (IF) for SOX-9, TGF-ß1, aggrecan and collagen II. The viability of equine MSCs was maintained in the presence of IFN-γ and TNF-α, but production of GAGs from both types of MSCs was decreased in stimulated medium. Exposure of BMMSCs to pro-inflammatory cytokines reduced the levels of SOX-9, TGF-ß1, aggrecan and collagen II, whereas exposure of SFMSCs to these cytokines reduced the levels of aggrecan only. These data suggest that pro-inflammatory cytokines do not affect proliferation of MSCs, but could inhibit chondrogenesis of MSCs.

Cellulolytic Activity of Thermophilic Bacilli Isolated from Tattapani Hot Spring Sediment in North West Himalayas.

Eight thermophilic bacterial strains were isolated from Tattapani Hot spring and screened for various hydrolytic enzymes including cellulases. The isolated bacterial strains were identified as Geobacillus thermodenitrificans IP_WH1(KP842609), Bacillus licheniformis IP_WH2(KP842610), B. aerius IP_WH3(KP842611), B. licheniformis IP_WH4(KP842612), B. licheniformis IP_60Y(KP842613), G. thermodenitrificans IP_60A1(KP842614), Geobacillus sp. IP_60A2(KP842615) and Geobacillus sp. IP_80TP(KP842616) after 16S ribotying. Out of the eight isolates Geobacillus sp. IP_80TP grew best at 80 °C whereas rest of the isolates showed optimal growth at 60 °C. G. thermodenitrificans IP_WH1 produced a thermotolerant cellulase with maximum activity at 60 °C.

Premedication in an autistic, combative child: Challenges and nuances.

Children with autistic spectrum disorders are often encountered in anesthesia practice mainly for outdoor procedural sedation or anesthesia in endoscopy and magnetic resonance imaging suites. We describe a case of a 7-year-old autistic boy who required management of dental caries. He had a phobia to intravenous cannulation, displayed increasing anxiety and became combative on the day of surgery. With parental involvement and distraction, we succeeded in giving oral midazolam by concealing it, with the intent of avoiding intramuscular injection or unnecessary restraint. Lack of knowledge about the medical condition of such a patient can lead to inadequate preoperative preparation and use of restraint on the patient, which might cause anxiety or panic attacks in the operative room. To effectively manage children with special needs one needs to have clear guidelines on the management of uncooperative children, involve parents perioperatively, plan ahead with an emphasis on perioperative analgesia and sometimes incorporate the ethical use of restraint.

[Prevalence of the use of psychoactive medication to treat young persons with autism spectrum disorder in the province of Antwerp, Belgium]. / Gebruik van psychoactieve medicatie bij kinderen en jongeren met autisme-spectrumstoornis in de provincie Antwerpen.

BACKGROUND: Very little information is available concerning the prevalence of the use of medication for treatment of individuals with autism spectrum disorder (ASD), particularly in European countries. Earlier studies have shown that a large number of patients with ASD use at least one psychoactive drug and that the numbers are increasing. Even in the nineties, studies suggested that the frequent use of psychoactive medication was widespread, although at the time there were only limited grounds for this assumption. AIM: To assess the prevalence with which psychoactive medication and complementary and alternative medicine (CAM) are being used for treating young people with ASD, and also to investigate relations between medication use and a number of individual characteristics that are included in the Behavioral Model of Health Service Use. METHOD: The study sample (0-17 years) in the province of Antwerp, Belgium, was recruited by various means. We used a questionnaire that had been previously used in North American studies and that had to be completed by the parents of the young persons involved in the study. RESULTS: We included data from 263 questionnaires. In our sample 42.6% of the young persons used one or more one psychoactive drug. More than 12.2% used more than one drug. The most frequently used psychoactive drugs were ADHD-medication (31.6%) and antipsychotics (16.7%). About 14% used at least one CAM. We found a positive relationship between the use of medication and psychiatric comorbidity and/or epilepsy, the severity of autism and the parents' living conditions. CONCLUSION: We found a relatively low use of antipsychotics, antidepressants, mood stabilisers and sedatives, the prevalence being lower that that reported in North American studies. Our findings appear to be in accordance with current clinical guidelines.

[Case report: The child- and adolescent psychiatric phenotype of a brother and sister with 16p11.2 microduplication]. / Het kinder- en jeugdpsychiatrische fenotype bij een broer en zus met de 16p11.2-microduplicatie.

16p11.2 microduplication is linked with a vulnerability for a range of psychiatric and somatic problems, with variable expression and penetration rate. We discuss the phenotypical expression of this microduplication with the case of a brother and sister. Both subjects went through child psychiatric diagnostics and treatment, where a varying degree of developmental delay and symptoms that match an attention deficit/hyperactivity disorder were observed in combination with short stature and low body mass index.

A comparative hospital-based observational study of mono- and co-infections of malaria, dengue virus and scrub typhus causing acute undifferentiated fever.

Positive serology for dengue and/or scrub typhus infection with/without positive malarial smear (designated as mixed or co-infection) is being increasingly observed during epidemics of acute undifferentiated febrile illnesses (AUFIs). We planned to study the clinical and biochemical spectrum of co-infections with Plasmodium sp., dengue virus and scrub typhus and compare these with mono-infection by the same organisms. During the period from December 2012 to December 2013, all cases presenting with AUFIs to a single medical unit of a referral centre in Garhwal region of the north Indian state of Uttarakhand were retrospectively selected and categorised aetiologically as co-infections, malaria, dengue or scrub typhus. The groups thus created were compared in terms of demographic, clinical, biochemical and outcome parameters. The co-infection group (n = 49) was associated with milder clinical manifestations, fewer, milder and non-progressive organ dysfunction, and lesser need for intensive care, mechanical ventilation and dialysis as compared to mono-infections. When co-infections were sub-grouped and compared with the relevant mono-infections, there were differences in certain haematological and biochemical parameters; however, this difference did not translate into differential outcomes. Scrub typhus mono-infection was associated with severe disease in terms of both morbidity and mortality. Malaria, dengue and scrub typhus should be routinely tested in all patients with AUFIs. Co-infections, whether true or due to serological cross-reactivity, appear to be a separate entity so far as presentation and morbidity is concerned. Further insight is needed into the mechanism and identification of the protective infection.

[Hallucinations and obsessive behaviour in an infant with autism spectrum disorder: diagnostic problems]. / Hallucinaties en dwangmatig gedrag bij een kleuter met autismespectrum-stoornis: een diagnostisch vraagstuk.

Regular non-medical treatment of a 6-year-old female patient with autism spectrum disorder failed due to comorbid compulsions and hallucinations. Differential diagnosis included obsessive-compulsive disorder and psychosis. The patient's young age complicated accurate diagnosis and management. In this case we opted for a diagnostic follow-up, resulting in treatment with a selective serotonin reuptake inhibitor because of the patient's frequent compulsions. This reduced the symptoms significantly.

Mechanism of gene amplification via yeast autonomously replicating sequences.

The present investigation was aimed at understanding the molecular mechanism of gene amplification. Interplay of fragile sites in promoting gene amplification was also elucidated. The amplification promoting sequences were chosen from the Saccharomyces cerevisiae ARS, 5S rRNA regions of Plantago ovata and P. lagopus, proposed sites of replication pausing at Ste20 gene locus of S. cerevisiae, and the bend DNA sequences within fragile site FRA11A in humans. The gene amplification assays showed that plasmid bearing APS from yeast and human beings led to enhanced protein concentration as compared to the wild type. Both the in silico and in vitro analyses were pointed out at the strong bending potential of these APS. In addition, high mitotic stability and presence of TTTT repeats and SAR amongst these sequences encourage gene amplification. Phylogenetic analysis of S. cerevisiae ARS was also conducted. The combinatorial power of different aspects of APS analyzed in the present investigation was harnessed to reach a consensus about the factors which stimulate gene expression, in presence of these sequences. It was concluded that the mechanism of gene amplification was that AT rich tracts present in fragile sites of yeast serve as binding sites for MAR/SAR and DNA unwinding elements. The DNA protein interactions necessary for ORC activation are facilitated by DNA bending. These specific bindings at ORC promote repeated rounds of DNA replication leading to gene amplification.

Detection of Yersinia enterocolitica in food: an overview.

Yersinia enterocolitica is a gastrointestinal pathogen which causes yersiniosis, an illness characterized by diarrhea, ileitis, and mesenteric lymphadenitis. Y. enterocolitica is transmitted via the feco-oral route by the consumption of contaminated food or water. Several phenotypic and genotypic methods have been developed to reliably detect Y. enterocolitica in food. However, the source of infection of many recently reported foodborne outbreaks remains obscure. The detection of this pathogen in food is a challenging task, since it shares similarities with other enteric bacteria. The presence of other microorganisms in the food samples makes it even more difficult to identify this slow-growing pathogen. Therefore, the present-day emphasis is on the development of sensitive, easily automated methods suitable for in-situ detection, allowing quick and cost-effective characterization of food samples. This review summarizes and compares the currently available cultural, immunological, and molecular methods, particularly in relation to their specific merits or demerits when implemented for the detection of Y. enterocolitica in food.