AN IN-DEPTH ASSESSMENT OF THE TUMOR'S IMPACT ON SARCOPENIA.

Loss of muscle mass is a typical symptom of cancer and it is strongly correlated with poor prognosis. Cancer-related Sarcopenia is unresponsive to conventional dietary changes and exercise, in contrast to age-associated muscle atrophy. This particular type of weakness differs from different kinds of muscle loss in that it is triggered by a number of interrelated mechanisms, notably inflammatory processes, abnormal metabolic processes, proteolysis, and autophagy. This research is to examine evidence supporting the theory that tumors have a causal role in causing muscular atrophy. It seeks to investigate the precise regulators that the tumour generates and how they affect the processes that result in muscle waste. The evaluation looks for new directions for further studies and medical treatments. The analysis is based on a thorough examination of the scientific literature and research that shows how tumor and muscle atrophy are related. It concentrates on studies that clarify the numerous strategies by which malignancies cause the loss of muscle. This article highlights particular mechanisms by which these tumor-derived substances affect the development of muscle loss, including inflammatory processes, metabolic disturbance, proteolysis, and autophagy. The discovery of such targets offers hope for the creation of efficient treatment strategies that can enhance the long-term outlook and quality of life of cancer sufferers who are experiencing muscle loss.

AN EVALUATION OF ANTIBIOTIC PRESCRIPTION PRACTICES: PERSPECTIVES OF VETERINARY TRAINEES AND PRACTICING VETERINARIANS.

Antibiotic resistance is a major worldwide problem that has an impact on the well-being of humans as well as animals. Antibiotic resistance is caused by the misuse and excessive use of antibiotics. The key to reducing this issue lies in educating veterinary medical learners on the proper and accountable utilization of antibiotics for the care of animals. Objective - using awareness-raising and instruction as the foundation, this research of Indian veterinary learners can help resolve the issue of antibiotic resistance throughout the care of animals. The questionnaire survey was taken between June and July 2022 and it was aimed at learners registered in veterinary medical studies at academic and research institutions in India. The study included 500 pupils overall. The purpose of the survey was to gather information about students' knowledge of antibiotics, including antibiotic resistance, as well as their feelings on the consequences of antibiotic resistance on the globe at large and their acquaintance with the one health ideology. According to this study's findings, 83.3 percent of respondents thought antibiotic resistance was a serious problem. 57.92 percent of respondents understood the issue's worldwide consequences and its one health ideology. The study emphasizes the significance of expanding the veterinary educational program to include thorough instruction on prudent antibiotic usage and the concepts of one health.

Dense Deposit Disease Involving C3 and C4d Deposits.

Dense deposit disease (DDD), earlier called Type II membranoproliferative glomerulonephritis is distinct disease having frequent relapses reaching end-stage kidney disease by 10-year in up to 50%-60% of cases and high recurrence rate in the allograft. The term DDD is derived from its distinctive ribbon-like osmiophilic deposits in the lamina densa of glomerular basement membrane by electron microscopy. Pathogenetically, alternate pathway dysfunction leads to this disease, which is diagnosed by ultrastructure. Herein, we describe our observation of C4d positivity in an adolescent boy with DDD.

Comparison of irrigant penetration up to working length and into simulated lateral canals using various irrigating techniques.

AIM: To evaluate the effect of an apical negative pressure system, a passive ultrasonic irrigation system and a combination of both apical negative pressure and passive ultrasonic irrigation on the penetration of the irrigating contrast solution (ICS) up to working length and into simulated lateral canals. METHODOLOGY: The root canals of 64 single-rooted teeth were instrumented using the ProTaper rotary system. In each sample, three simulated lateral canals were created at 2, 4 and 6 mm levels from the root apex using a 06-size C+ file (Dentsply Maillefer, Ballaigues, Switzerland). Samples were randomly assigned into 4 experimental groups (n = 16): group I - conventional needle irrigation, group II - passive ultrasonic irrigation, group III - apical negative irrigation system and group IV - combination of passive ultrasonic irrigation and apical negative pressure irrigation system. To examine irrigating solution penetration, Indian ink was mixed with 5.25% NaOCl and delivered into the root canals. Samples were then assessed by direct observation of the images taken using Canon EOS rebel T3. The depth of penetration of ICS up to the working length and into the simulated lateral canals was analysed using chi-squared tests. RESULTS: The combination (ANP and PUI) and ANP group had significantly deeper ICS penetration up to the working length (P < 0.001). The combination (ANP and PUI) and the PUI group exhibited significantly greater ICS penetration into lateral canals at the 6 mm level (P < 0.001). At the 4 and 2 mm levels, the combination of ANP and PUI had significantly greater ICS penetration into the lateral canals than the other groups (P < 0.001). CONCLUSIONS: The combination of ANP and PUI was the only group able to achieve irrigating contrast solution penetration both up to the working length and into lateral canals.

Postrenal transplant laryngeal and visceral leishmaniasis - A case report and review of the literature.

Visceral leishmaniasis (kala-azar) is a disease caused by protozoa of genus Leishmania. It is currently regarded as the second most dreaded parasitic disease, next to malaria. There have been very few case reports of visceral leishmaniasis among the renal transplant recipients. We present a renal allograft recipient with symptoms of fever, sore throat, hoarseness of voice, lymphadenopathy, splenomegaly, and pancytopenia after 7 years post-transplant period. On investigating, he was diagnosed to have extensive visceral leishmaniasis with laryngeal involvement. Despite extensive PubMed literature search, we could not find any case report of postrenal transplant visceral and laryngeal leishmaniasis and to the best of our knowledge this is the first case report of this kind.

Diffuse mesangial sclerosis - Report of two cases.

Diffuse mesangial sclerosis (DMS) is a rare cause of nephrotic syndrome in the infantile and childhood period. DMS is a phenotypic expression of syndromic entities such as WAGR syndrome (Wilms' tumor, aniridia, genitourinary anomalies and mental retardation), Denys Drash syndrome, Pierson syndrome, Frasier syndrome, or Galloway-Mowat syndrome. We report two cases of DMS, one presenting in first year of life and another in second decade of life. Both of them had fatal outcome. Recognition of the disease is very important in modifying the management of patient and active surveillance of family members.

Minimally invasive radioguided surgery for parathyroid adenomas (MIRP).

BACKGROUND: Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Conventional surgical management includes bilateral neck exploration with removal of the adenoma(s) and biopsy of one of the other glands with visualization of all glands. It is associated with a risk of permanent hypoparathyroidism. Radioguided excision of parathyroid adenoma is a widely accepted technique which provides accurate localization and complete excision of the lesion with low morbidity. We report our experience with this technique. METHODS: We performed radioguided excision of parathyroid adenomas in 15 patients. All of them had preoperative localization of the adenoma using a dual tracer, dual phase 99mTc-Sestamibi scan. A dose of 8-10 mCi of 99mTc-Sestamibi was injected intravenously 2 hours before surgery. Under local anaesthesia, surgical excision of the lesion was done after localizing it using a hand-held gamma probe. Complete excision was confirmed by frozen. section of the excised lesion and an intraoperative quick parathormone assay. RESULTS: The 99mTc-Sestamibi scan revealed an increased uptake by the adenoma in all patients and complete excision was possible in all the patients. Frozen section confirmed the diagnosis and the quick parathormone assay (within 15 minutes) revealed a drop in parathormone levels to < 50% after excision in all of them. Three patients developed hypocalcaemia postoperatively and were treated with intravenous calcium supplementation. At a follow up of 2-29 months, all the patients were normocalcaemic. The renal functions improved in 2 of 6 patients who had renal failure. CONCLUSION: Minimally invasive radioguided excision of parathyroid adenomas is a simple, safe and effective technique associated with a low morbidity and can be done as a day-care procedure.

An outbreak of enzootic bovine leukosis in upper Egypt: clinical, laboratory and molecular-epidemiological studies.

In 1989, 220 Holstein Friesian cattle (212 heifers and eight bulls) were imported from Minnesota, USA, to form a closed dairy herd in Arab El-Aoumar, Assiut, Upper Egypt. In November 1996, some abnormal signs such as loss of weight, decreased milk yield, external lymphadenopathy and decreased appetite were observed on this farm. Serological screening by enzyme-linked immunosorbent assay revealed a seroprevalence of antibodies directed against bovine leukaemia virus (BLV) of 37.7% in cattle under 2 years old and of 72.8% in animals more than 2 years old. Diagnosis was confirmed by the detection of BLV proviral DNA using polymerase chain reaction with primers amplifying a fragment of the env gene. Out of 21 tested leucocyte fractions from individual animals, 15 were positive showing a BLV-specific amplicon of 444 base pairs. Analysis of the amplicons for restriction fragment length polymorphisms and DNA sequencing results allowed the isolates to be typed. Since this was the first recorded case of enzootic bovine leukosis in Upper Egypt, strict quarantine measures were adopted and all serologically positive animals in the herd were culled.

Helical CT angiography in evaluation of live kidney donors.

BACKGROUND: Live kidney donor evaluation mandates anatomical and functional assessment of the donor kidney. Helical computed tomography (CT) with advanced 3-D techniques provides detailed description of the vascular, parenchymal, and collecting system. METHODS: We compared the accuracy of helical CT angiography with intra-operative findings in the evaluation of 102 live kidney donors. RESULTS: Identification of vascular anomalies was best on direct viewing of the axial images using interactive scrolling through the images and cine-loop paging. In 204 kidneys evaluated, a single renal artery was present in 74.5% and a single renal vein in 87.5%. Multiple renal arteries were more common on the left side (31%) vs the right side (20%). Early branching of the arteries was seen with equal frequency (approximately equal to 10%) on either side. Multiple renal veins were more often on the right side (20%) vs the left side (5%), and one patient was found to have double inferior vena cava. CT angiographic findings were concordant with the intra-operative findings in 97% of the cases, missing a small renal vein, an accessory artery that was visualized in retrospect, and a very early branch that was read as accessory artery. CT also revealed cortical cysts (four cases), duplex collecting system (two cases), hydronephrosis (one case), renal stone (one case), and liver haemangioma (two cases). CONCLUSION: CT angiography is highly accurate for detecting vascular anomalies, and providing anatomical information. It may serve as the primary tool for donor evaluation.

High-frequency (10-18 kHz) hearing thresholds: reliability, and effects of age and occupational noise exposure.

The objective was to investigate the reliability and effects of age and noise on high-frequency hearing thresholds. A cross-sectional study was used involving 187 exposed and 52 non-industrial noise-exposed subjects selected randomly from noise-exposed and non-industrial noise-exposed subjects, respectively. Each subject was tested with both conventional-frequency (0.25-8 kHz) and high-frequency (10-18 kHz) audiometry. Test-retest results showed that high-frequency audiometry (HFA) was as reliable as the conventional procedure. Although the inter-subject variation was large, the intra-subject variation was small, indicating that HFA can be used more reliably than the conventional procedure to monitor individual cases over time. Both the hearing threshold at high frequencies and the upper frequency limit deteriorated as a function of age and frequency. The exposed subjects had significantly higher hearing thresholds than the non-exposed subjects at all the high frequencies tested, the difference between the two groups being greatest at 14 kHz. Multivariate analysis indicated that age was the primary predictor and noise exposure the secondary predictor of hearing thresholds in a high frequency range (10-18 kHz). In contrast, multivariate analysis indicated the reverse order-noise exposure as the primary predictor, then age-for a conventional frequency range (0.25-8 kHz). The results of this study suggest that HFA might be used as an early indicator for noise-induced hearing loss and acoustic trauma rather than audiometry at a conventional frequency (4 kHz), particularly for younger groups.

Occupational noise exposure and hearing loss of workers in two plants in eastern Saudi Arabia.

OBJECTIVE: To determine the prevalence of hearing loss associated with occupational noise exposure and other risk factors. DESIGN: A cross-sectional study involving 269 exposed and 99 non-exposed subjects (non-industrial noise exposed subjects) randomly selected. Current noise exposure was estimated using both sound level meter and noise-dosimeter. Past noise exposure was estimated by interview questionnaire. Otoscopic examination and conventional frequency (0.25-8 kHz) audiometry were used to assess the hearing loss in each subject. RESULTS: 75% (202 subjects) from the exposed group were exposed to a daily Leq above the permissible level of 85 dB(A) and most (61%) of these did not and had never used any form of hearing protection. Hearing loss was found to be bilateral and symmetrical in both groups. Bivariate analysis showed a significant hearing loss in the exposed vs non-exposed subjects with a characteristic dip at 4 kHz. Thirty eight percent of exposed subjects had hearing impairment, which was an 8-fold higher rate than that found for non-exposed subjects. Multivariate analysis indicated exposure to noise was the primary, and age the secondary predictor of hearing loss. Odds of hearing impairment were lower for a small sub-group of exposed workers using hearing protection (N=19) in which logistic regression analysis showed the probability of workers adopting hearing protective devices increased with noise exposure, education, and awareness of noise control. Hearing loss was also greater amongst those who used headphones to listen to recorded cassettes. CONCLUSION: Gross occupational exposure to noise has been demonstrated to cause hearing loss and the authors believe that occupational hearing loss in Saudi Arabia is a widespread problem. Strategies of noise assessment and control are introduced which may help improve the work environment.

Pulmonary function of workers exposed to ammonia: a study in the Eastern Province of Saudi Arabia.

To determine the effect of chronic exposure to ammonia on pulmonary function among ammonia workers, 77 workers were randomly selected from an ammonia factory in the Eastern Province of Saudi Arabia and 355 were selected as controls from the administrative staffs of four industrial groups in Eastern Province. Spirometry was carried out and FEV1, FVC, and FEV1/FVC% were calculated. The ammonia level in the working environment was determined spectrophotometrically. 30% of the air samples had ammonia concentrations that exceeded the threshold limit value. Significant reductions in FEV1 % predicted and FVC % predicted were observed in ammonia workers exposed to higher cumulative ammonia levels (above 50 mg/m3-years). FEV1% predicted and FEV1/FVC% were significantly lower in symptomatic than in asymptomatic workers in the exposed group. These findings may raise the possibility that exposure to a high cumulative ammonia level produces a combined restrictive/obstructive ventilatory defect.

Granulocyte-macrophage colony-stimulating factor as an adjuvant to hepatitis B vaccination in maintenance hemodialysis patients.

Patients on maintenance hemodialysis (HD) have poor seroconversion rate after hepatitis B vaccination. The present study was designed to test the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) as an adjuvant to hepatitis B vaccination for improving seroconversion rate in maintenance HD patients. Twelve chronic HD patients were randomly assigned to receive either hepatitis B vaccination alone or hepatitis B vaccination 24 h after 1 dose of GM-CSF for primary immunization. A group of 16 chronic HD patients who had not seroconverted after a standard two-dose hepatitis B vaccination were randomly assigned either to a booster dose of hepatitis B vaccine alone or a booster dose given 24 h after one dose of GM-CSF. In the primary immunization group only 2 of 6 patients (33%) who had received vaccination alone, versus 5 of 6 patients (83%) who had received hepatitis B vaccine after one dose of GM-CSF, developed seroprotective antibody titers. Moreover, seroprotective antibody titers (IU/ml) were significantly higher in the latter group (275 +/- 286.5 vs. 14 +/- 22, p < 0.05). In patients who had not seroconverted with prior hepatitis B vaccination, GM-CSF adjuvant therapy significantly increased the seroconversion rate versus booster dose alone (87.5 vs. 25%, respectively, p < 0.02), with significantly higher seroprotective antibody titers (84 +/- 80 vs. 19 +/- 33 IU/ml, respectively, p < 0. 05). These findings suggest that administration of one dose of GM-CSF, as adjuvant therapy, prior to primary or booster dose hepatitis B vaccination may significantly increase seroconversion rate and seroprotective antibody titers in chronic HD patients.

Intradialytic dobutamine therapy in maintenance hemodialysis patients with persistent hypotension.

Intradialysis hypotension is a common problem, especially in patients with poor left-ventricular function. We studied 6 patients who were on maintenance hemodialysis with left-ventricular ejection fraction of <40%, whose dialysis sessions were often complicated with severe hypotension (systolic blood pressure <90 mm Hg). Dobutamine infusion during dialysis significantly reduced the number of hypotensive episodes, increased left-ventricular ejection fraction, and decreased the number of emergency admissions to the hospital.

Clinical significance of erosive azotemic osteodystrophy: a prospective masked study.

OBJECTIVE: To determine the relationship between joint symptoms and radiographically identifiable erosions in patients on maintenance hemodialysis for 4 or more years. PATIENTS AND DESIGN: A prospective study was carried out on 21 patients, who underwent rheumatological evaluation and radiographic surveys of all clinically examined joints. The radiologist was masked to the clinical information and the clinicians were masked to the radiographic findings. Cuprophane dialyzers were used on all patients. The statistical analysis was performed by unpaired t-test and Fisher's exact test. RESULTS AND CONCLUSIONS: Ten men and 11 women comprised the 21 patients, of whom 10 had joint symptoms and clinical signs whereas 11 did not. Age, gender, and duration of hemodialysis did not differ significantly between the symptomatic and asymptomatic group. Of the 21 patients, 10 had radiological evidence of erosions and 11 did not. The average age of patients with erosions was 64.9 years; this was significantly different from the age of the group without erosions, which was 54.1 years. The group with radiographic evidence of erosions had been on dialysis for an average of 9.6 years, while those without erosions had received dialysis for an average of 6.4 years. Of the 11 patients without radiographic evidence of erosions, three were symptomatic. Of the 10 patients with erosions, seven had musculoskeletal symptoms, but only in four was there concordance between radiological findings and symptoms of the corresponding joints. The positive predictive value of radiographic erosions in predicting clinically significant disease was 40%. There was poor correlation between the presence of radiographic erosions and clinical signs and symptoms of joint disease.

Cyclosporine experience in nephrotic syndrome.

OBJECTIVE: To analyze the use of Cyclosporine (CyA) in nephrotic syndrome. METHODS: Thirty five children of mean age of 5.9 years with steroid dependent (n = 26) or steroid resistant (n = 9) primary nephrotic syndrome with normal renal functions and who received CyA were studied. CyA was used at a dosage of 6-7 mg/kg/day orally in two divided doses. The mean duration of therapy was 9.6 weeks. All received a minimum of 8 weeks of CyA therapy. In a few who received longer therapy, the dose was reduced to 4 mg/kg/day. All patients were monitored serially for hepatotoxicity and nephrotoxicity. The nephrotic state was evaluated serially with biochemical tests and followed up for a mean period of 2.55 years. RESULTS: Thirty one patients completed the study. The response to therapy was categorized into 5 groups-no response (4 patients), good response (4 patients), partial response (4 patients), cyclosporine dependence (16 patients), and infrequent relapsers (3 patients). Good response was defined as complete remission lasting for at least one year after cessation of therapy. Patients who showed partial response had reduction in quantitative proteinuria and needed less diuretics. Sixteen patients went into complete remission while on therapy but relapsed within 3 months of discontinuation (CyA dependence). The response to CyA correlated more with steroid-responsiveness than with the underlying histopathology. The drug was well tolerated. CONCLUSION: In steroid-dependent or steroid-resistant nephrotic children with normal renal functions, CyA therapy may be considered as one of the possible therapeutic options. Our results suggest that a longer duration of CyA therapy may possibly be indicated in these cases.

Pediatric renal transplantation--Indian experience.

OBJECTIVE: To analyze our experience with renal transplantation in children with end-stage renal disease (ESRD) in India. DESIGN: Retrospective study. METHODS: Over the last 7.5 years, 27 renal transplants were performed on children below 12 years of age, 8 children were less than 6 years old, 19 were between 6 and 12 years of age. Sixteen children had underlying glomerular disease while eleven had tubulointerstitial renal disease. Transperitoneal approach was used in smaller recipients weighing less than 12 kg. Extraperitoneal approach was used in the remainder. Triple immunosuppression with Cyclosporine, Azathioprine and Steroids was used in all cases. RESULTS: Follow-up period ranged from 6 months to 7.5 years (mean 3.7 years). There were 10 episodes of acute rejection. Three cases of acute rejection failed to respond to therapy. No surgical complications were encountered. Graft survival was 73.2% at one year and 71% at two years. Satisfactory rehabilitation was achieved in children with functioning grafts. CONCLUSIONS: Renal transplantation in children in India offers an acceptable choice in ESRD as anywhere in the world.

Pasteurella multocida infection in the chicken embryo.

Pasteurella multocida infection in embryonated chicken eggs was studied by chorio-allantoic membrane inoculation. Strain differences were demonstrated in terms of lesion severity and time to death, especially during the first 24 h post-inoculation. A strain of low virulence gave a clear dose response but more virulent strains did not. Comparable results were obtained by infecting 6-week-old chickens. The main lesions in inoculated embryos appeared as severe vascular involvement of the entire embryo and feather tracts, thickening of the chorio-allantoic membrane, and enlargement and congestion of the yolk sac. The bacteria were demonstrated by transmission electron microscopy, either extracellularly or multiplying intracellularly in hepatocytes, heart tissue, and in the hyperplastic layer of the chorio-allantoic membrane, with resulting damage to the cellular organelles, and severe tissue changes.

Consanguineous marriage in an urban area of Saudi Arabia: rates and adverse health effects on the offspring.

The objective of this cross-sectional study was to determine the pattern and time trend of consanguineous marriage and its adverse health effects on the offspring in Dammam city, Eastern Province, in the Kingdom of Saudi Arabia. This city is known to attract Saudis from different parts of the country because it is in the heart of this industrial region. Five primary health care centers were randomly selected from different sectors of the city in addition to the city's only Maternity and Children's Hospital. For inclusion in the study a wife must have at least one pregnancy that terminated in either full term liveborn baby, still birth, or abortion. A total of 1307 ever-married Saudis completed a pre-structured questionnaire during an interview. The rate of consanguineous marriage was 52.0% with an average inbreeding coefficient of 0.0312. First-cousin marriages were the commonest (39.3%) of all matings. The consanguineous groups had a significantly higher number of pregnancies. The mean birth weight of the offspring of consanguineous couples was not statistically significant being less than that of the non-consanguineous. However, within the consanguineous groups the more closely related couples had smaller babies on average. No significant differences were noted for the rates of inherited diseases and reproductive wastage. The rate of consanguineous marriage in this city was high and so was the inbreeding coefficient. These figures place this nation among the countries with a high rate of consanguineous marriages. A nationwide study to determine accurately the relationship between consanguinity and inherited diseases has much to commend it.