Association of proton-pump inhibitor use with adverse health outcomes: A systematic umbrella review of meta-analyses of cohort studies and randomised controlled trials.

AIMS: The aim was to perform an umbrella review to summarise the existing evidence on proton-pump inhibitor (PPI) use and adverse outcomes and to grade the certainty of evidence. METHODS: Electronic databases were searched up to July 2021 for meta-analyses of cohort studies and/or randomised controlled trials (RCTs). Summary effect sizes from a random-effects model, between-study heterogeneity, 95% prediction interval, small-study effect, excess significance and credibility ceilings were devised to classify the credibility of evidence from meta-analyses of cohort studies, whereas the GRADE approach was used for meta-analyses of RCTs. RESULTS: In meta-analyses of cohort studies, 52 of the 91 examined associations were statistically significant (P ≤ .05). Convincing evidence emerged from main analysis for the association between PPI use and risk of all-site fracture and chronic kidney disease in the elderly population. However, none of these associations remained supported by convincing evidence after sensitivity analyses. The use of PPI is also associated with an increased risk of mortality due to COVID-19 infection and other related adverse outcomes, but the quality of evidence was weak. In meta-analyses of RCTs, 38 of the 63 examined associations were statistically significant. However, no associations were supported by high or moderate-quality evidence. CONCLUSION: This study's findings imply that most putative adverse outcomes associated with PPI use may not be supported by high-quality evidence and are likely to have been affected by underlying confounding factors. Future research is needed to confirm the causal association between PPI use and risk of fracture and chronic kidney disease.

Effectiveness of blended learning in pharmacy education: An experimental study using clinical research modules.

BACKGROUND &OBJECTIVES: Though there are studies to evaluate the effectiveness of blended learning in pharmacy education, most of them originate from USA and have used previous year students' scores as control. Also there is less research in comparing use of self -regulated learning strategies between blended and other learning strategies. Primary aim was to evaluate the effectiveness of blended learning on knowledge score using clinical research modules. Secondary objective was designed to compare the use of self-regulated learning strategies between blended learning, web-based e-learning and didactic teaching. MATERIALS AND METHODS: A prospective cluster randomized trial was conducted with didactic teaching as control and web-based e-learning and blended learning as interventions. The target population was final year Pharm D students. Outcome was assessed using a validated knowledge questionnaire, a motivated strategies for learning questionnaire and a feedback form. All statistical analyses were carried out using Statistical Package for Social Science (SPSS) Version 20. RESULTS: A total of 241 students from 12 colleges completed the study. Mean knowledge score of students in blended learning group was higher than those in the didactic teaching and web- based e- learning program (64.26±18.19 Vs 56.65±8.73 Vs 52.11±22.06,p<0.001).Frequency of use of learning strategies namely rehearsal, elaboration, organization and critical thinking was statistically significantly higher in the blended learning group compared to those of didactic and web-based e-learning group (p<0.05) But there were no statistically significant difference of motivational orientations between didactic and blended learning group except strategies of extrinsic goal orientation and self-efficacy. Students preferred blended learning (86.5%) over didactic and web-based e-learning. CONCLUSION: Blended learning approach is an effective way to teach clinical research module. Students of blended learning group employed all motivational and learning strategies more often than students of the didactic and web- based e-learning groups except strategies of intrinsic goal orientation, task value, control of learning belief and help seeking.

Survival Benefits of N-Acetylcysteine in Rodenticide Poisoning: Retrospective Evidence from an Indian Tertiary Care Setting.

RATIONALE & OBJECTIVE: Rodenticide poisoning, either accidental or intentional, is very common in rural India. The absence of a definite antidote made it a major concern with a high mortality rate. Therefore, this study aimed to assess the effectiveness of N-Acetyl Cysteine (NAC) in rodenticide poisoning as there are recent positive shreds of evidence on it. METHODOLOGY: A retrospective study was conducted in a tertiary care teaching hospital on patients admitted with rodenticide poisoning during a period of 2012-2017. The Fischer's exact test and relative risk were measured to analyze the outcome of treatment and risk factors, respectively. RESULTS: A total of 229 patients were enrolled in the study with a mean age of 30.04 ± 15.67 years. The suicidal attack was the major (86.0%) reason for poison consumption. The survival rate was significantly (p ≤ 0.03) higher in the NAC treatment group compared to the non-NAC group. Moreover, the majority (93.4%) of participants did not experience any adverse effects. The mean oral loading dose and maintenance dose was 7580.95 ± 2204.29 mg and 3694.53 ± 2322.58 mg, respectively. Yellow Phosphorus poisoning (Relative Risk [RR] 2.888 (1.179-7.079); p=0.020) and Time lag of ≥ 24 hours (RR 3.479 (1.137-10.645); p=0.029) were the significant risk factors for mortality. CONCLUSION: NAC is shown to have a significant survival benefit with a good safety profile among rodenticide poisoners. Further adequately powered prospective researches with more emphasis on dosing parameters are warranted for better quantification in different settings and for clinical implementation.

Evaluation of physicochemical characteristics of microwave vacuum dried mackerel and inhibition of oxidation by essential oils.

In the present study, Indian mackerel was dried by microwave vacuum drying (MVD) method and compared its physico chemical quality to mackerel dried by hot air drying (HAD) method. Antioxidant effects of thyme oil (TMO) and clove leaf oils (CLO) during storage were also evaluated. Brine salted mackerel was dried in hot air oven (50-55 °C) and microwave vacuum dryer (600 W and 600 Hg mm). For essential oil treatment, mackerel was dipped in 0.75% TMO and CLO for 5 min. Moisture content of MVD and HAD samples was reduced to 30-32% in 1.2 h and 12 h, respectively. Rehydration ability and water absorption index of MVD samples were significantly higher to that of HAD samples. Mackerel dried by HAD showed significantly higher salt soluble and water soluble protein nitrogen fractions than that of MVD samples. Significantly higher hardness and chewiness values were observed for HAD samples. Color and appearance of uncooked MVD sample was superior to that of HAD samples. As per the results of PV and TBARS, TMO exhibited better antioxidant effect compared to CLO. The study demonstrated that fast drying can be achieved by microwave vacuum dryer and it can produce dried fish having better sensory and textural attributes.

Characterisation of hydrolysates prepared from engraved catfish (Nemapteryx caelata) roe by serial hydrolysis.

Protein hydrolysates were prepared from defatted engraved catfish roe using alcalase enzyme by a two-stage serial hydrolysis process. The soluble hydrolysate formed after first stage of hydrolysis was removed (RH-1) and fresh enzyme was added at the same concentration to achieve further hydrolysis (RH-2). Further, compositional, surface-active and antioxidant properties of both hydrolysates were compared. The SDS-PAGE profile showed two distinct bands for RH-1, whereas no bands were visible for RH-2. On the other hand, gel filtration chromatography of the hydrolysates indicated 3-4 distinct fractions. Both the hydrolysates showed similar foam forming abilities, however, RH-1 exhibited poor foam stability. Emulsion properties of RH-1 were superior to that of RH-2. The major fractions eluted through gel filtration column were screened for antioxidant properties. Higher DPPH radical scavenging and metal chelating properties were observed for RH-1 second fragment, whereas FRAP and Fe(2+) reducing power was highest for second fragment of RH-2.

Combined effects of vacuum packaging and mint extract treatment on the biochemical, sensory and microbial changes of chill stored Indian mackerel.

The present study was aimed to investigate the combined effects of vacuum packaging and mint extract treatment on the quality changes of gutted Indian mackerel (Rastrelliger kanagurta) during storage at 0-2 °C for 22 days. Biochemical, total viable count and sensory quality of chill stored mackerel were analysed at periodic intervals. Mint extract treated [dipping in 0.5% (w/v) solution of mint extract for 30 min] and vacuum packed fishes (MEVP) had significantly lower total volatile base nitrogen and trimethyl amine nitrogen compared to those packed under vacuum (CVP) and air (CAP) without mint extract treatment. Nucleotide degradation rate was lower in MEVP followed by CVP and CAP. Vacuum packaging in combination with ME treatment significantly inhibited lipid hydrolysis and lipid oxidation in mackerel as observed from its lower free fatty acid, peroxide value and thiobarbituric acid reactive substances values. Synergistic use of mint extract and vacuum packaging has markedly controlled microbial proliferation in the samples. Based on sensory evaluation, shelf life of Indian mackerel stored at 0-2 °C was determined as 13 days for CAP group, 16 days for CVP group and 21 days for MEVP group, respectively. The present study revealed that combination of vacuum packaging and mint extract treatment can be a promising technology to improve the storage quality of chill stored gutted mackerel.

Biochemical, textural, microbiological and sensory attributes of gutted and ungutted sutchi catfish (Pangasianodon hypophthalmus) stored in ice.

Pangasianodon hypophthalmus (sutchi catfish) is a fresh water catfish extensively being cultured in the South East Asian countries in the recent years. The present study provides the first report on the effects of gutting on the quality characteristics of aquacultured sutchi catfish stored in ice. pH of whole ungutted and gutted catfish didn't show significant difference (p > 0.05) during ice storage period. Total Volatile Base Nitrogen (TVB-N), Alpha Amino Nitrogen (AAN), Free Fatty Acids (FFA) and Thio Barbituric Acid Reactive Substance (TBARS) were lower in gutted fish compared to whole ungutted fish at any particular day during ice storage. However, gutted fish expressed higher rate of primary lipid oxidation than ungutted fish. Textural degradation of the fish muscle as indicated by hardness, cohesiveness, springiness and chewiness was lower in gutted fish. Results of sensory evaluation revealed that gutting has significantly improved the sensory quality of the fish. However, microbiological analysis revealed higher Total Plate Count (TPC) and Enterobactereaceae count in gutted fish. The shelf life of gutted and whole ungutted sutchi cat fish as determined by microbiological analysis was 16-18 days and 18-20 days respectively while storage in ice.

Microbiological and shelf life characteristics of eviscerated and vacuum packed freshwater catfish (Ompok pabda) during chill storage.

The effect of vacuum packaging technique on the shelflife of eviscerated pabda catfish (Ompok pabda) during chill storage at 4 ± 2 °C was studied. The shelflife of pabda fish was predicted based on the cumulative observations of biochemical, microbiological and sensory parameters. There was no significant difference in the lipid quality parameters studied between the samples during the chill storage period, whereas, vacuum packaging significantly improved the sensory and microbiological quality. Based on microbiological parameters such as Total Viable Count, Enterobacteriaceae, Escherichia coli, Salmonella Spp, total Vibrios, Listeria monocytogenes, Staphylococcus aureus, faecal Streptococcus and anaerobic sulphite reducers, the shelflife of chilled gutted pabda catfish was estimated to be 14-16 and 18-20 days for air packed and vacuum packed samples, respectively. The sensory parameters showed extended shelflife by four more days for both the samples.