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1.
Pain Res Manag ; 2021: 6639801, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33613793

RESUMO

Background: Spinal cord stimulation (SCS) has been used over decades for pain management, but migration of percutaneous leads has been the most common complication. Better surgical techniques and newer SCS technologies likely reduced the incidence of lead migration requiring surgical revision, although data are sparse. This study aimed to retrospectively evaluate the incidence of clinically significant percutaneous lead migration in patients permanently implanted with a 10 kHz SCS system. Methods: Consecutive patients with chronic trunk and/or limb pain, permanently implanted between January 2016 and June 2019, were included in the analysis. Data were collected from the hospital's electronic medical records and the manufacturer's database. Clinically significant lead migration, defined as diminished pain relief followed by surgery to correct lead location, was assessed at the 6-month follow-up. Results: At the 6-month follow-up, there were no cases of clinically significant lead migration, average pain relief was 65.2%, 82% of patients had response (≥50% pain relief), improvement of function was noted in 72% of patients, and decrease of medication was observed in 42% of patients. Therapy efficacy was sustained in patients with >12 months follow-up; the average pain relief was 58.5%, and the response rate was 82%. Conclusions: The surgical techniques in use today are designed to minimise the risk of percutaneous lead migration and may have reduced its incidence. In addition, new SCS systems may give greater opportunity to mitigate cases of minor lead movement using alternative stimulation programs.

2.
Curr Oncol Rep ; 23(2): 25, 2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33559761

RESUMO

PURPOSE OF THE REVIEW: The definition of respite care remains unclear and its purpose and effectiveness are unproven till date. This paper reviews the current evidence regarding definition and efficacy of respite care, as well as the different programs, models, and interventions employed to deliver the same. RECENT FINDINGS: A scoping search identified the relevant literature to be included in the review. The current evidence reiterates the lack of clarity in defining and delineating the purpose of respite care. Recent empirical evidence supports the effectiveness of respite care with clear benefits for the carers, patients, their families, and the healthcare system. Along with inpatient, home, and hospice care, respite care is considered as an essential component of palliative care. Evidence, although weak, supports the efficacy of respite care. High-quality studies with clear outlining of the scope of the services and resolution of ambiguities pertaining to its definition are warranted to fill the gaps in knowledge.

3.
Cureus ; 12(10): e10880, 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33178532

RESUMO

Background In forensic proficiency, the distinct model applied for age estimation includes physical examination, i.e., evaluation of somatic maturity and post pubescence peculiarities, dental development, and radiological assessment of skeletal maturity usually of the hand and wrist. The Greulich and Pyle (GP) method of skeletal age (SA) determination is considered quicker and easier with a lower error percentage of prediction. The specificity and applicability of the GP atlas have been recapitulated in many studies. This study aims to assess the applicability and reproducibility of the GP atlas on a sample of the eastern Utter Pradesh (UP) population. Results Considering the whole study population, the SA of the male subjects was retarded by 0.89 years or 9.03 months, whereas the SA of females were retarded by 0.36 years or 4.33 months than the chronological age, respectively. Conclusion According to this study, it is concluded that the GP atlas may not be applicable for both males and females in the eastern Uttar Pradesh region. The factors responsible for delayed skeletal growth and maturation may vary depending on demographics, ethnicity, and genetics. Further, a detailed study will be conclusive on a greater population size assessing more accurate and precise insights on the applicability and reproducibility of GP atlas.

4.
J Family Med Prim Care ; 9(8): 4381-4385, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33110864

RESUMO

Background: Mouth self-examination (MSE) is shown as a speedy, economical, and effortless method of oral cancer detection. As previous studies were conducted in population with high literacy, the current survey was performed to explore the usefulness of MSE for finding the oral cancerous precancerous lesions in indigenous low literate population of Dehradun district. Materials and Methods: It is a cross-sectional survey which was done on the Buksa tribal communities in Dehradun district, India. Out of seven tehsils in the district, two were randomly selected, from which two villages were selected. Individuals belonging to Buksa tribe above the age of 18 years were gathered in commonplace. A total of 539 people who gave their consent were enrolled for study. Using a questionnaire, information regarding sociodemographic details, history of risk factors, and practice of MSE was obtained by interview method, followed by recording oral findings by a single expert. Later, performance of MSE was taught to the participants and they were asked to record the same. Descriptive analysis and Chi-square test were applied wherever applicable and significance level was kept at below 0.05. Results: It was observed that out of 539 participants, 220 (40.8%) practiced MSE and 319 (59.2%) have never practiced MSE. Further analysis showed that a total of 39% males and 42.7% females had MSE habits and this difference was not statistically significant (P > 0.05). In totality, the prevalence of oral lesions identified by health worker was 213 (39.5%), whereas MSE showed only prevalence rate of 69 (12.8%). MSE had low sensitivity (24.6%), whereas high specificity (87.4%) for all the lesions and most sensitive in detecting ulcers (72.7%), and highest specificity in identifying red lesions (99.2%). Conclusion: Even though the sensitivity of MSE for detecting oral premalignant/malignant lesions was low, specificity was very high. Frequent efforts to educate and encourage public on MSE may enhance efficacy and compliance.

5.
J Oral Biol Craniofac Res ; 10(4): 758-763, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33117644

RESUMO

Aim: The purpose of this study was to evaluate the stress distribution on the maxillary central incisors by various tooth movements using three-dimensional finite element modeling with varying periodontal ligament (PDL) thickness and different alveolar bone height (at the apex and alveolar crest). Material and methods: A Finite Element Modeling model was created using surface data of the tooth using SolidWorks Software. Different types of force (intrusion, extrusion, tipping, and bodily movement) were applied on the maxillary central incisor, with two different periodontal ligament thickness (0.15 mm and 0.24 mm) and alveolar bone height (at the apex and alveolar crest). Stress generated due to force applied due to different types of tooth movement was calculated and compared. Results: Maximum stresses generated under intrusion, extrusion, tipping, bodily movement were 9.0421 E-003 N/mm2 for 0.15 mm pdl at alveolar bone, 7.2833 E-5 N/mm2for 0.24 mm pdl labio-lingually, 9.1792 E-002 N/mm2 at 0.15 mm pdl at alveolar bone height and 6.2208 E-6 N/mm2 for 0.24 mm pdl at alveolar crest respectively. Conclusion: The stress pattern seen was nearly the same in all the cases in both PDL thickness. The maximum stress pattern was found to be at the apex of the central incisor, reducing from apex to the cervical region. Intrusion, extrusion, and tipping movement showed the greatest amount of relative stress at the apex of the maxillary central incisor. The bodily movement produced forces at root apex and distributed it all over.

6.
J Clin Rheumatol ; 2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33105313

RESUMO

AIM: Immunoglobulin G4-related disease (IgG4-RD) is often an unrecognized, rare fibroinflammatory condition that can involve various organ systems. This study aimed to identify the different clinical patterns of this disease in a single center in North India. METHODS: Patients were diagnosed on the basis of published diagnostic criteria for IgG4-RD. Patients' presenting complaints; epidemiologic profiles; and laboratory, radiologic, and histologic findings along with the treatment and outcomes were collected and analyzed. RESULTS: In total, 70 patients were diagnosed with the disease. The female-to-male ratio was 0.94:1, and it increased with multiorgan involvement. The mean age of patients was 41.4 years, and the majority of the patients (65.7%) were younger than 50 years. Patients were diagnosed as possible (38.57%), probable (32.85%), and definite (28.57%) IgG4-RD. The incidence of the involvement of orbital and periorbital tissues was the highest (52.9%); however, 13% of the patients had multiple organ involvement. Patients with involvement of the retroperitoneal tissues and the lymph nodes were 8.5% and 5.7%, respectively. Increased serum IgG4 levels were found in 74.3% of the patients with single-organ involvement, whereas all patients with multiorgan involvement had increased IgG4 levels. The majority of patients (94.3%) required immunosuppressive medications along with corticosteroids. Azathioprine was the most commonly used (72.8%) immunosuppressive medication. Rituximab was used in 17.1% of the patients, of whom only one had multisystem involvement. CONCLUSIONS: This study depicts the most common patterns of organ involvement, along with the epidemiologic, laboratory, histologic, and radiologic data and response to treatment, in IgG4-RD, with a definite ophthalmology referral bias.

7.
Appl Environ Microbiol ; 86(23)2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-32978122

RESUMO

Lytic polysaccharide monooxygenases (LPMOs) are crucial industrial enzymes required in the biorefinery industry as well as in the natural carbon cycle. These enzymes, known to catalyze the oxidative cleavage of glycosidic bonds, are produced by numerous bacterial and fungal species to assist in the degradation of cellulosic biomass. In this study, we annotated and performed structural analysis of an uncharacterized LPMO from Penicillium funiculosum (PfLPMO9) based on computational methods in an attempt to understand the behavior of this enzyme in biomass degradation. PfLPMO9 exhibited 75% and 36% sequence identities with LPMOs from Thermoascus aurantiacus (TaLPMO9A) and Lentinus similis (LsLPMO9A), respectively. Furthermore, multiple fungal genetic manipulation tools were employed to simultaneously overexpress LPMO and cellobiohydrolase I (CBH1) in a catabolite-derepressed strain of Penicillium funiculosum, PfMig188 (an engineered variant of P. funiculosum), to improve its saccharification performance toward acid-pretreated wheat straw (PWS) at 20% substrate loading. The resulting transformants showed improved LPMO and CBH1 expression at both the transcriptional and translational levels, with ∼200% and ∼66% increases in ascorbate-induced LPMO and Avicelase activities, respectively. While the secretome of PfMig88 overexpressing LPMO or CBH1 increased the saccharification of PWS by 6% or 13%, respectively, over the secretome of PfMig188 at the same protein concentration, the simultaneous overexpression of these two genes led to a 20% increase in saccharification efficiency over that observed with PfMig188, which accounted for 82% saccharification of PWS under 20% substrate loading.IMPORTANCE The enzymatic hydrolysis of cellulosic biomass by cellulases continues to be a significant bottleneck in the development of second-generation biobased industries. While increasing efforts are being made to obtain indigenous cellulases for biomass hydrolysis, the high production cost of this enzyme remains a crucial challenge affecting its wide availability for the efficient utilization of cellulosic materials. This is because it is challenging to obtain an enzymatic cocktail with balanced activity from a single host. This report describes the annotation and structural analysis of an uncharacterized lytic polysaccharide monooxygenase (LPMO) gene in Penicillium funiculosum and its impact on biomass deconstruction upon overexpression in a catabolite-derepressed strain of P. funiculosum Cellobiohydrolase I (CBH1), which is the most important enzyme produced by many cellulolytic fungi for the saccharification of crystalline cellulose, was further overexpressed simultaneously with LPMO. The resulting secretome was analyzed for enhanced LPMO and exocellulase activities and the corresponding improvement in saccharification performance (by ∼20%) under high-level substrate loading using a minimal amount of protein.


Assuntos
Celulose 1,4-beta-Celobiosidase/metabolismo , Celulose/metabolismo , Proteínas Fúngicas/metabolismo , Oxigenases de Função Mista/metabolismo , Penicillium/enzimologia , Polissacarídeos/metabolismo
8.
Int J Spine Surg ; 14(4): 544-551, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32986576

RESUMO

BACKGROUND: Ligamentum flavum cysts have been rarely described in the literature and are one of the rare causes of neural compression and canal stenosis. Very few cases of their association with neurologic deficits are reported to date, and association with acute onset weakness is even rarer. CLINICAL PRESENTATION: We report our experience with 3 cases of ligamentum flavum cyst that presented with acute onset weakness and also present a comprehensive literature review on lumbar ligamentum flavum cysts reported to date. All 3 patients had symptoms of severe neurogenic claudication and presented to us with acute onset of motor weakness in lower limbs. Ligamentum flavum cyst was located in the midline in 2 cases and laterally in 1 case. We performed excision of the cyst and decompression with fusion in 2 cases and decompression alone in 1 case. All 3 cases had significant improvement in their neurologic status postoperatively. Histopathological examination confirmed ligamentum flavum cyst in all 3 cases. We performed a PUBMED and EMBASE database search using the MeSH (Medical Subject Headings) terms "ligamentum flavum" and "cysts" for articles published to April 2019. We could identify 7 studies describing 20 cases of lumbar ligamentum flavum cysts with motor weakness in the literature. Only 1 case had been described with an acute onset of weakness. CONCLUSIONS: Ligamentum flavum cysts should remain in the differential diagnosis of a patient who has symptoms of lumbar canal stenosis and presents with acute onset of neurological deficits. Such patients have a good improvement with surgery.

9.
Int J Spine Surg ; 14(3): 391-396, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32699762

RESUMO

Background: Fibrocartilaginous embolic myelopathy (FCEM) is a rare cause of spinal cord infarction. It has been confirmed by autopsy in postmortem cases. Herein we describe a case of FCEM diagnosed based on clinical grounds. Methods: A 58-year-old man presented with acute onset of complete paraplegia with bladder and bowel involvement developing a few hours after a trivial trauma. There were no upper motor neuron signs. His magnetic resonance imaging (MRI) was suggestive of longitudinally extensive transverse myelitis from T5 to the conus. There was left paracentral disc protrusion at the T4-T5 level. However, no features of inflammatory, infectious, or autoimmune etiology were found on history, on examination, or in blood or cerebrospinal fluid analysis, and there was no contrast enhancement on MRI. Results: A diagnosis of anterior spinal artery occlusion was made based on clinical examination with sparing of posterior column sensations in the lower limbs, predominant involvement of anterior half of the spinal cord on MRI, and accompanying new onset of back pain with rapid symptom progression to nadir as opposed to inflammatory etiology. Fibrocartilaginous embolism was suspected after ruling out all other causes of vascular compromise and presence of disc herniation at T4-T5. He was managed with rehabilitation and showed no signs of recovery. Conclusion: FCEM, though rare, should be kept in mind as a differential diagnosis of acute medical myelopathy when no other cause can be identified.

10.
Pain Pract ; 20(8): 908-918, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32585742

RESUMO

BACKGROUND: Chronic postsurgical pain (CPSP) can be caused by peripheral nerve injury (PNI) resulting from surgical procedures and has a significant neuropathic component. This prospective, single-arm study was conducted to document the effectiveness of 10-kHz spinal cord stimulation (10-kHz SCS) as a treatment for patients with CPSP. METHODS: Subjects with CPSP who were refractory to conventional medical interventions and reported pain scores of ≥5 cm on a 10-cm VAS underwent trial stimulations lasting up to 14 days. Epidural leads were implanted at locations appropriate for the primary area of pain, and trials resulting in ≥40% pain relief were considered successful. Subjects with successful trials underwent implantation with a permanent 10-kHz SCS system and were followed for 12 months after implantation. RESULTS: Of the 34 subjects who underwent trial stimulation, 1 was withdrawn early and 29 (87.9%) had a successful trial and received a permanent implant. After 12 months of treatment, the mean VAS score decreased by 6.5 cm, the response rate was 88.0% (22/25), and 18 subjects (62.1%) were remitters with VAS scores sustained at ≤3.0 cm. Scores for all components of the short-form McGill Pain Questionnaire 2 were significantly reduced, including affective descriptors of pain. Pain catastrophizing and vigilance, patient function, physical and mental well-being, and sleep quality all improved over the course of the study. No neurologic deficits reported in the study. CONCLUSIONS: 10-kHz SCS is effective and tolerated in patients with CPSP, and further study of its clinical application in this population is warranted.

11.
Pain Physician ; 23(3S): S1-S127, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503359

RESUMO

BACKGROUND: Chronic axial spinal pain is one of the major causes of significant disability and health care costs, with facet joints as one of the proven causes of pain. OBJECTIVE: To provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions. METHODS: The methodology utilized included the development of objectives and key questions with utilization of trustworthy standards. The literature pertaining to all aspects of facet joint interventions, was reviewed, with a best evidence synthesis of available literature and utilizing grading for recommendations.Summary of Evidence and Recommendations:Non-interventional diagnosis: • The level of evidence is II in selecting patients for facet joint nerve blocks at least 3 months after onset and failure of conservative management, with strong strength of recommendation for physical examination and clinical assessment. • The level of evidence is IV for accurate diagnosis of facet joint pain with physical examination based on symptoms and signs, with weak strength of recommendation. Imaging: • The level of evidence is I with strong strength of recommendation, for mandatory fluoroscopic or computed tomography (CT) guidance for all facet joint interventions. • The level of evidence is III with weak strength of recommendation for single photon emission computed tomography (SPECT) . • The level of evidence is V with weak strength of recommendation for scintography, magnetic resonance imaging (MRI), and computed tomography (CT) .Interventional Diagnosis:Lumbar Spine: • The level of evidence is I to II with moderate to strong strength of recommendation for lumbar diagnostic facet joint nerve blocks. • Ten relevant diagnostic accuracy studies with 4 of 10 studies utilizing controlled comparative local anesthetics with concordant pain relief criterion standard of ≥80% were included. • The prevalence rates ranged from 27% to 40% with false-positive rates of 27% to 47%, with ≥80% pain relief.Cervical Spine: • The level of evidence is II with moderate strength of recommendation. • Ten relevant diagnostic accuracy studies, 9 of the 10 studies with either controlled comparative local anesthetic blocks or placebo controls with concordant pain relief with a criterion standard of ≥80% were included. • The prevalence and false-positive rates ranged from 29% to 60% and of 27% to 63%, with high variability. Thoracic Spine: • The level of evidence is II with moderate strength of recommendation. • Three relevant diagnostic accuracy studies, with controlled comparative local anesthetic blocks, with concordant pain relief, with a criterion standard of ≥80% were included. • The prevalence varied from 34% to 48%, whereas false-positive rates varied from 42% to 58%.Therapeutic Facet Joint Interventions: Lumbar Spine: • The level of evidence is II with moderate strength of recommendation for lumbar radiofrequency ablation with inclusion of 11 relevant randomized controlled trials (RCTs) with 2 negative studies and 4 studies with long-term improvement. • The level of evidence is II with moderate strength of recommendation for therapeutic lumbar facet joint nerve blocks with inclusion of 3 relevant randomized controlled trials, with long-term improvement. • The level of evidence is IV with weak strength of recommendation for lumbar facet joint intraarticular injections with inclusion of 9 relevant randomized controlled trials, with majority of them showing lack of effectiveness without the use of local anesthetic. Cervical Spine: • The level of evidence is II with moderate strength of recommendation for cervical radiofrequency ablation with inclusion of one randomized controlled trial with positive results and 2 observational studies with long-term improvement. • The level of evidence is II with moderate strength of recommendation for therapeutic cervical facet joint nerve blocks with inclusion of one relevant randomized controlled trial and 3 observational studies, with long-term improvement. • The level of evidence is V with weak strength of recommendation for cervical intraarticular facet joint injections with inclusion of 3 relevant randomized controlled trials, with 2 observational studies, the majority showing lack of effectiveness, whereas one study with 6-month follow-up, showed lack of long-term improvement. Thoracic Spine: • The level of evidence is III with weak to moderate strength of recommendation with emerging evidence for thoracic radiofrequency ablation with inclusion of one relevant randomized controlled trial and 3 observational studies. • The level of evidence is II with moderate strength of recommendation for thoracic therapeutic facet joint nerve blocks with inclusion of 2 randomized controlled trials and one observational study with long-term improvement. • The level of evidence is III with weak to moderate strength of recommendation for thoracic intraarticular facet joint injections with inclusion of one randomized controlled trial with 6 month follow-up, with emerging evidence. Antithrombotic Therapy: • Facet joint interventions are considered as moderate to low risk procedures; consequently, antithrombotic therapy may be continued based on overall general status. Sedation: • The level of evidence is II with moderate strength of recommendation to avoid opioid analgesics during the diagnosis with interventional techniques. • The level of evidence is II with moderate strength of recommendation that moderate sedation may be utilized for patient comfort and to control anxiety for therapeutic facet joint interventions. LIMITATIONS: The limitations of these guidelines include a paucity of high-quality studies in the majority of aspects of diagnosis and therapy. CONCLUSIONS: These facet joint intervention guidelines were prepared with a comprehensive review of the literature with methodologic quality assessment with determination of level of evidence and strength of recommendations. KEY WORDS: Chronic spinal pain, interventional techniques, diagnostic blocks, therapeutic interventions, facet joint nerve blocks, intraarticular injections, radiofrequency neurolysis.


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Manejo da Dor/métodos , Articulação Zigapofisária , Humanos , Estados Unidos
12.
Clin Transl Gastroenterol ; 11(2): e00133, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32463618

RESUMO

INTRODUCTION: Chronic abdominal pain (CAP) can arise from multiple conditions, including inflammatory disorders, trauma because of injury or surgery, or structural or functional causes. This prospective, single-arm study was designed to evaluate the safety and efficacy of 10-kHz spinal cord stimulation (SCS) in patients with intractable CAP over a 12-month follow-up period. METHODS: Subjects with CAP who had been refractory to conventional medical treatment for at least 3 months resulting in self-reported pain scores of ≥5 cm on a 10-cm visual analog scale were enrolled at 4 centers in the United States. Study subjects underwent a trial stimulation lasting up to 14 days with epidural leads implanted from the vertebral levels T4 through T8. Subjects who had ≥40% pain relief during the trial stimulation period were implanted with a Senza system (Nevro Corp., Redwood City, CA) and followed up to 12 months after surgery. RESULTS: Twenty-three of 24 subjects (95.8%) had a successful trial stimulation and proceeded to a permanent implant. After 12 months of treatment with 10-kHz SCS, 78.3% of subjects were responders (pain relief of ≥50%) and 14 of 22 subjects (63.6%) were remitters (sustained ≤3.0-cm visual analog scale scores). Secondary outcomes, including assessments of disability, mental and physical well-being, sleep quality, perception of improvement, and satisfaction, showed that 10-kHz SCS greatly improved the quality of life of patients with CAP. Observationally, most subjects also reported concurrent reduction or resolution of nausea and/or vomiting. DISCUSSION: 10-kHz SCS can provide durable pain relief and improve the quality of life in patients with CAP.

13.
Neurol Sci ; 41(10): 2703-2710, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32367326

RESUMO

The US government and other key stakeholders including professional medical bodies have amended recommendations in recent years to emphasize using no opioids or the lowest effective dose of opioids needed for treatment of chronic pain. However, there remains an unmet need for pain treatments that can both relieve the pain of patients and reduce the doses of opioids they require. The Center for Medicare and Medicaid Services (CMS) is currently considering such treatments through the SUPPORT ACT and has recently conferred with the Health and Human Services (HHS) Inter-agency Pain Management Task Force to consider such therapies. We reviewed literature evidence in PubMed on pain relief and opioid reduction following spinal cord stimulation (SCS) treatment. SCS presents an effective non-pharmacologic pain treatment modality that has been used for decades to reduce chronic pain from trauma or neuropathy and has been shown to either stabilize or reduce opioid use in some patients with painful conditions. A more recently developed high-frequency SCS modality, 10 kHz SCS, has the advantage of being paresthesia-independent. It has been shown to be associated with significant reductions in opioid consumption after stimulation therapy was initiated, and many patients even taking high doses of opioids (> 90 mg morphine equivalent dose per day) were able to reduce their opioid intake to levels associated with less risk. The evidence shows that reduction of opioids as early in the treatment process as possible is desirable to reduce patient risk and improve pain relief from stimulation therapy.

14.
Lung India ; 37(3): 232-237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32367845

RESUMO

Context: Tuberculosis (TB) and diabetes mellitus (DM) are converging epidemics, each worsening the morbidity of the other. A study of the prevalence of DM in TB patients assumes great importance. Aims: The study aims to evaluate the association between DM and TB over a 10-year period in a tertiary care hospital. Settings and Design: A retrospective observational study in a southern Indian tertiary care teaching hospital was conducted. Materials and Methods: All patients with TB diagnosed and treated during the 10-year study period were identified from the hospital database. All relevant clinical, microbiological, and laboratory results pertaining to diagnosis of DM were collected. The diagnosis of TB and DM was made as per the standard criteria. Statistical Analysis: Categorical variables were analyzed using Chi-square test while continuous variables using independent sample t-test. Results: From 2001 to 2012, we studied 1979 TB patients among whom data on DM were available. The prevalence of DM was 29%, 21%, and 14%, in smear positive, smear negative and extrapulmonary TB respectively (overall 24%). Diabetics were more likely to be men (77.3% vs. 61%;P = 0.001); >40 years of age (81.7% vs. 38.9%;P < 0.001); heavier (59.96 vs. 50.37;P = 0.004); tobacco smokers (16.1% vs. 8.1%;P < 0.001); and alcohol consumers (6.8% vs. 4%;P = 0.02). They were less likely to be HIV coinfected (1.8% vs. 6.1%;P < 0.001). HIV coinfection was seen in 5% of patients and was substantially higher in extrapulmonary TB group (19.4%). Multidrug-resistant TB was lower in DM (11.7%) compared to non-DM (15.9%) (P = 0.02). Overall, 48% of the DM patients were diagnosed at the time of TB diagnosis. Over 10 years, no obvious changes in the trend were evident. Conclusions: Over a 10-year study period, 24% of the TB patients were diabetic, nearly half were detected at the time of TB diagnosis. There may be a good case for screening all TB patients for DM.

15.
Niger J Surg ; 26(1): 66-71, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32165840

RESUMO

Background: An exponential rise in the prevalence of obesity and the associated type 2 diabetes mellitus (T2DM) has led to an explosion in the field of bariatric surgery worldwide. It has been proposed that laparoscopic sleeve gastrectomy (LSG) not only results in excess weight loss (EWL) but also leads to excellent glycemic control. Aims: However, not every patient benefits from the bariatric surgery. Furthermore, bariatric surgery is currently indicated based on body mass index (BMI), but BMI solely does not predict diabetes remission after the surgery. We aimed to study the outcome of LSG on the diabetic status and the factors predicting the disease remission. Subjects and Methods: This prospective study was conducted on 104 obese patients having T2DM who underwent LSG. Following surgery, the clinical outcome on weight loss, BMI, and glycemic control was studied for 6 months. Various positive and negative predictors of diabetic remission after the surgery were also determined. Student's t-test and Chi-square tests were applied. Results: LSG resulted in significant weight loss (P < 0.05); the percentage of EWL was 60.75 ± 6.30 at 6 months. Furthermore, surgery resulted in 78.9% remission of diabetes with fasting blood glucose and glycated hemoglobin values at 6 months being 121.13 ± 15.25 mg/dl and 6.19% ± 0.31%, respectively. Younger and heavier patients, those with lesser disease severity and shorter duration had better chances of disease remission. Gender had no correlation with disease remission. Conclusion: LSG is a successful treatment option for T2DM and is more beneficial if offered, not as a last option, but to younger, obese patients with mild disease severity and shorter disease duration after the failure of medical treatment.

16.
Pain Physician ; 23(2): E85-E131, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214287

RESUMO

BACKGROUND: The use of bone marrow concentrate (BMC) for treatment of musculoskeletal disorders has become increasingly popular over the last several years, as technology has improved along with the need for better solutions for these pathologies. The use of cellular tissue raises a number of issues regarding the US Food and Drug Administration's (FDA) regulation in classifying these treatments as a drug versus just autologous tissue transplantation. In the case of BMC in musculoskeletal and spine care, this determination will likely hinge on whether BMC is homologous to the musculoskeletal system and spine. OBJECTIVES: The aim of this review is to describe the current regulatory guidelines set in place by the FDA, specifically the terminology around "minimal manipulation" and "homologous use" within Regulation 21 CFR Part 1271, and specifically how this applies to the use of BMC in interventional musculoskeletal medicine. METHODS: The methodology utilized here is similar to the methodology utilized in preparation of multiple guidelines employing the experience of a panel of experts from various medical specialties and subspecialties from differing regions of the world. The collaborators who developed these position statements have submitted their appropriate disclosures of conflicts of interest. Trustworthy standards were employed in the creation of these position statements. The literature pertaining to BMC, its effectiveness, adverse consequences, FDA regulations, criteria for meeting the standards of minimal manipulation, and homologous use were comprehensively reviewed using a best evidence synthesis of the available and relevant literature. RESULTS/Summary of Evidence: In conjunction with evidence-based medicine principles, the following position statements were developed: Statement 1: Based on a review of the literature in discussing the preparation of BMC using accepted methodologies, there is strong evidence of minimal manipulation in its preparation, and moderate evidence for homologous utility for various musculoskeletal and spinal conditions qualifies for the same surgical exemption. Statement 2: Assessment of clinical effectiveness based on extensive literature shows emerging evidence for multiple musculoskeletal and spinal conditions. • The evidence is highest for knee osteoarthritis with level II evidence based on relevant systematic reviews, randomized controlled trials and nonrandomized studies. There is level III evidence for knee cartilage conditions. • Based on the relevant systematic reviews, randomized trials, and nonrandomized studies, the evidence for disc injections is level III. • Based on the available literature without appropriate systematic reviews or randomized controlled trials, the evidence for all other conditions is level IV or limited for BMC injections. Statement 3: Based on an extensive review of the literature, there is strong evidence for the safety of BMC when performed by trained physicians with the appropriate precautions under image guidance utilizing a sterile technique. Statement 4: Musculoskeletal disorders and spinal disorders with related disability for economic and human toll, despite advancements with a wide array of treatment modalities. Statement 5: The 21st Century Cures Act was enacted in December 2016 with provisions to accelerate the development and translation of promising new therapies into clinical evaluation and use. Statement 6: Development of cell-based therapies is rapidly proliferating in a number of disease areas, including musculoskeletal disorders and spine. With mixed results, these therapies are greatly outpacing the evidence. The reckless publicity with unsubstantiated claims of beneficial outcomes having putative potential, and has led the FDA Federal Trade Commission (FTC) to issue multiple warnings. Thus the US FDA is considering the appropriateness of using various therapies, including BMC, for homologous use. Statement 7: Since the 1980's and the description of mesenchymal stem cells by Caplan et al, (now called medicinal signaling cells), the use of BMC in musculoskeletal and spinal disorders has been increasing in the management of pain and promoting tissue healing. Statement 8: The Public Health Service Act (PHSA) of the FDA requires minimal manipulation under same surgical procedure exemption. Homologous use of BMC in musculoskeletal and spinal disorders is provided by preclinical and clinical evidence. Statement 9: If the FDA does not accept BMC as homologous, then it will require an Investigational New Drug (IND) classification with FDA (351) cellular drug approval for use. Statement 10: This literature review and these position statements establish compliance with the FDA's intent and corroborates its present description of BMC as homologous with same surgical exemption, and exempt from IND, for use of BMC for treatment of musculoskeletal tissues, such as cartilage, bones, ligaments, muscles, tendons, and spinal discs. CONCLUSIONS: Based on the review of all available and pertinent literature, multiple position statements have been developed showing that BMC in musculoskeletal disorders meets the criteria of minimal manipulation and homologous use. KEY WORDS: Cell-based therapies, bone marrow concentrate, mesenchymal stem cells, medicinal signaling cells, Food and Drug Administration, human cells, tissues, and cellular tissue-based products, Public Health Service Act (PHSA), minimal manipulation, homologous use, same surgical procedure exemption.


Assuntos
Transplante de Medula Óssea/normas , Medicina Baseada em Evidências/normas , Doenças Musculoesqueléticas/terapia , Manejo da Dor/normas , Médicos/normas , Sociedades Médicas/normas , Medula Óssea/fisiologia , Transplante de Medula Óssea/métodos , Medicina Baseada em Evidências/métodos , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Dor/diagnóstico , Dor/epidemiologia , Manejo da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration/normas
17.
Microbiol Resour Announc ; 9(7)2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054702

RESUMO

Here, we report the 4.34-Mb draft genome assembly of Bacillus marisflavi CK-NBRI-03 (or P3), a Gram-positive bacterium, with an average G+C content of 48.66%. P3 was isolated from agricultural soil from the Badaun (midwestern plain zone) region of Uttar Pradesh, India.

18.
Inorg Chem ; 59(3): 1810-1822, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-31965795

RESUMO

Two Cu(II)-based metal-organic frameworks (MOFs) having paddle-wheel secondary building units (SBUs), namely, 1Me and 1ipr, were synthesized solvothermally using two new bent di-isophthalate ligands incorporating different substituents. The MOFs showed high porosity (BET surface area, 2191 m2/g for 1Me and 1402 m2/g for 1ipr). For 1Me, very high CO2 adsorption (98.5 wt % at 195 K, 42.9 wt % at 273 K, 23.3 wt % at 298 K) at 1 bar was found, while for 1ipr, it was significantly less (14.3 wt % at 298 K and 1 bar, 54.4 wt % at 298 K at 50 bar). 1Me exhibited H2 uptake of 3.2 wt % at 77 K and 1 bar of pressure, which compares well with other benchmark MOFs. For 1ipr, the H2 uptake was found to be 2.54 wt % under similar experimental conditions. The significant adsorption of H2 and CO2 for 1Me could be due to the presence of micropores as well as unsaturated metal sites in these MOFs besides the presence of substituents that interact with the gas molecules. The experimental adsorption behavior of the MOFs could be justified by theoretical calculations. Additionally, catalytic conversions of CO2 and CS2 into useful chemicals like cyclic carbonates, cyclic trithiocarbonates, and cyclic dithiocarbonates could be achieved.

19.
Biotechnol Biofuels ; 12: 265, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31719844

RESUMO

Background: Efficient deconstruction of lignocellulosic biomass into simple sugars in an economically viable manner is a prerequisite for its global acceptance as a feedstock in bioethanol production. This is achieved in nature by suites of enzymes with the capability of efficiently depolymerizing all the components of lignocellulose. Here, we provide detailed insight into the repertoire of enzymes produced by microorganisms enriched from the gut of the crop pathogen rice yellow stem borer (Scirpophaga incertulas). Results: A microbial community was enriched from the gut of the rice yellow stem borer for enhanced rice straw degradation by sub-culturing every 10 days, for 1 year, in minimal medium with rice straw as the main carbon source. The enriched culture demonstrated high cellulolytic and xylanolytic activity in the culture supernatant. Metatranscriptomic and metaexoproteomic analysis revealed a large array of enzymes potentially involved in rice straw deconstruction. The consortium was found to encode genes ascribed to all five classes of carbohydrate-active enzymes (GHs, GTs, CEs, PLs, and AAs), including carbohydrate-binding modules (CBMs), categorized in the carbohydrate-active enzymes (CAZy) database. The GHs were the most abundant class of CAZymes. Predicted enzymes from these CAZy classes have the potential to digest each cell-wall components of rice straw, i.e., cellulose, hemicellulose, pectin, callose, and lignin. Several identified CAZy proteins appeared novel, having an unknown or hypothetical catalytic counterpart with a known class of CBM. To validate the findings, one of the identified enzymes that belong to the GH10 family was functionally characterized. The enzyme expressed in E. coli efficiently hydrolyzed beechwood xylan, and pretreated and untreated rice straw. Conclusions: This is the first report describing the enrichment of lignocellulose degrading bacteria from the gut of the rice yellow stem borer to deconstruct rice straw, identifying a plethora of enzymes secreted by the microbial community when growing on rice straw as a carbon source. These enzymes could be important candidates for biorefineries to overcome the current bottlenecks in biomass processing.

20.
Artigo em Inglês | MEDLINE | ID: mdl-31700684

RESUMO

Introduction: We report a case of pneumocephalus and pneumorachis i.e., air in the cranial cavity and the spinal canal, which are rarely associated with a primary spinal cause. Their concomitant occurrence and association with a late presenting dural leak are also uncommon. Case presentation: A 70-year-old man presented 1 month after decompressive surgery for lumbar canal stenosis with leakage of cerebrospinal fluid (CSF) from the wound site and severe headache. There were no signs of surgical site infection or meningitis. There was no intraoperative or immediate postoperative evidence of dural tear. He was neurologically intact. On detailed work-up, he was found to have air collections in the subarachnoid and intraventricular spaces in the brain and intraspinal air in both the cervical and the lumbar regions. He showed gradual resolution of these findings radiologically and symptomatic improvement through conservative management with analgesics, empirical antibiotics, high flow oxygen, and maintenance of hydration within 1 month. Discussion: Pneumocephalus and pneumorachis are commonly seen after trauma. Spine surgery is a rare cause. They may present with symptoms similar to meningitis and may be erroneously diagnosed and treated. No standard treatment guidelines exist in the literature. Most cases have been managed conservatively. Early detection may allow noninvasive management leading to complete resolution.


Assuntos
Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Procedimentos Neurocirúrgicos/efeitos adversos , Pneumocefalia/diagnóstico por imagem , Pneumorraque/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Vazamento de Líquido Cefalorraquidiano/complicações , Dura-Máter , Humanos , Vértebras Lombares/cirurgia , Masculino , Procedimentos Neurocirúrgicos/tendências , Pneumocefalia/complicações , Pneumorraque/complicações , Complicações Pós-Operatórias/etiologia , Fatores de Tempo
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