Impact of high-salt diet in health and diseases and its role in pursuit of cancer immunotherapy by modulating gut microbiome.

Cancer chemotherapy remains an area of concern, as many of the therapies are uncomfortable involving side effects and unpleasant experiences. These factors could further reduce patient's quality of life, and even endanger their life. Many therapeutic strategies have been tried to reduce the unpleasant side effects and increase the treatment effectiveness; however, none have shown to have promising effects. One of the main hindrances to cancer therapy is the escape strategies by tumor cells to the immune attack. Promoting inflammation in the tumor microenvironment is the cornerstone and key therapeutic target in cancer chemotherapy. High-salt diet (HSD) intake, though it has deleterious effects on human health by promoting chronic inflammation, is found to be advantageous in the tumor microenvironment. Studies identified HSD favors an increased abundance of Bifidobacterium species in the tumor environment due to gut barrier alteration, which, in turn, promotes inflammation and favors improved response to cancer chemotherapy. A review of the literature was carried out to find out the effects of an HSD on health and diseases, with special mention of its effect on cancer chemotherapy. Studies emphasized HSD would block the myeloid-derived suppressor cells which will enhance the tumor immunity. Exploration of the precise mechanism of simple HSD regime/ingestion of specific bacterial species as probiotics will be effective and essential to formulate the game-changing cancer chemotherapy. With the modern era of healthcare moving toward precision medicine where the physician can choose the treatment option suitable for the individual, HSD regime/ingestion of specific bacterial species can be considered.

Evaluating the Effectiveness of Online Assessments and Their Parameters as Predictors of Academic Performance in Undergraduate Medical Education.

Background and objectives Considering the increasing utilization of online educational tools in medical education, it is essential to evaluate the reliability and validity of online assessments to accurately assess student proficiency and predict academic success. This study investigated the predictive efficacy of different online assessment methods in comparison to standard offline methods within the medical educational setting. Methods This study utilized a mixed-methods crossover design, involving 125 first-year medical students who were randomly assigned to either online or traditional examinations. The students then crossed over to the other type of assessment. The assessments consisted of multiple-choice questions (MCQs), viva voce, objective structured clinical examinations, and written theory examinations. Quantitative data on results, finishing times, and academic metrics were analyzed, along with qualitative data from student interviews exploring perceptions of each format. Results The online MCQs had the highest average scores and a moderately positive correlation with performance on the theory examination (r=0.326). Regression models indicated that online and offline MCQs were moderate positive predictors of theoretical marks (R2=0.106 and 0.107, respectively). Qualitative responses emphasized advantages such as flexibility and accessibility for online examinations but also concerns regarding technological challenges, interaction, and integrity compared to traditional formats. Conclusions Online MCQ assessments showed promise as indicators of medical student academic performance. However, additional online forms require improvement to match conventional assessments reliably. As medical education involves digital technologies, cautious implementation of online evaluations substantiated by further research is needed to preserve educational quality standards.

Brain-derived neurotrophic factor (BDNF) and other neurotrophic factors in type 2 diabetes mellitus and their association with neuropathy.

BACKGROUND: Diabetes mellitus (DM) is associated with increased risk of morbidity and premature mortality due to its various complications. In an Indian study, the prevalence of diabetic peripheral neuropathy (DPN) in type 2 diabetic subjects was shown to be 29.2%. There is increasing evidence that a deficiency of nerve growth factor (NGF) in diabetes, as well as the calcitonin gene-related peptide (CGRP), may also contribute to the development of DPN. The aim of the current study was to evaluate nerve growth factor levels with neuropathy in type 2 DM. MATERIALS AND METHODS: Forty healthy controls and 40 patients with type 2 DM were recruited; they were asked to report to Dept. of Physiology for initial history taking, general examination and neuropathy examination. A total of 5 mL of blood was collected for neurotrophic factor estimation as well as glycemic profile estimation. RESULTS: The brain-derived neurotrophic factor (BDNF) values were significantly lower in the DM group whereas the insulin levels were also quite high in DM. The hot thresholds for both the upper limb and lower limb were greater in the DM group suggesting the impending neuropathy. Similarly, the Michigan scores were also greater in the DM group. The neuropathy parameters especially the Michigan A and B and the hot thresholds were positively correlated with duration of DM and glucose profile. CONCLUSION: The neurotrophic factors especially BDNF are drastically reduced in DM patients and are negatively associated with neuropathy, and hence, BDNF can be utilized as a therapeutic target to treat and prevent neuropathy.

Association of serum cathelicidin and Vitamin D levels with infectiousness in patients with pulmonary tuberculosis: A prospective cohort study.

Background: The immunomodulatory effects of Vitamin D expand to induce the synthesis of an antimicrobial peptide, cathelicidin. There is evidence showing altered levels of cathelicidin in tuberculosis (TB). It has been suggested that Vitamin D-mediated antimicrobial activity depends on its ability to induce cathelicidin. The present study was designed to assess the alterations in serum anti-microbial peptide cathelicidin and 25-hydroxy Vitamin D levels in patients with newly diagnosed pulmonary TB at different treatment times and to study the association between serum Vitamin D levels and cathelicidin. Methods: Serum 25-hydroxyvitamin D and cathelicidin levels were estimated in 147 patients with newly diagnosed pulmonary TB at different times: at the start of anti-tubercular treatment, end of the intensive phase of treatment, and at the end of treatment. Results: There was a statistically significant difference between the levels of serum 25-hydroxyvitamin D and serum cathelicidin at different treatment periods. However, no significant correlation was found between serum Vitamin D and cathelicidin levels or between serum Vitamin D and cathelicidin levels with infectiousness in patients with pulmonary TB. Conclusion: Serum Vitamin D levels and serum cathelicidin levels were significantly reduced at diagnosis, and there was an incremental increase following treatment. However, there was no correlation between the levels of serum cathelicidin and serum Vitamin D or with the infectiousness of the illness.

Unraveling the Role of Tumor Necrosis Factor-Alpha in Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis.

Diabetic peripheral neuropathy (DPN) is a prevalent and debilitating complication of diabetes mellitus, leading to sensory abnormalities, decreased balance, and increased risk of foot problems. Although tumor necrosis factor-alpha (TNF-α) has emerged as a potential factor in the pathogenesis of DPN, its role remains contested. This study intends to thoroughly analyze the association between TNF-α and DPN by combining data from various global studies. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included 23 articles investigating TNF-α levels in DPN patients for systematic review and 11 articles for meta-analysis. Data were extracted, and heterogeneity was examined. A random-effect model was chosen due to high heterogeneity. The major outcome measure across studies was serum TNF-α levels. The meta-analysis found a significant mean difference of 15.2464 (95% confidence interval = 4.4963; 25.9965) under the random-effect model due to the substantial heterogeneity (I2 = 98.1%) among included studies. The meta-analysis indicates a consistent elevation in TNF-α levels in individuals with DPN compared to those without neuropathy. This underlines the potential of TNF-α as a biomarker and contributor to diabetic neuropathy. Despite heterogeneity, the study's extensive scope and systematic approach enhance the trustworthiness and generalizability of the findings.

High dietary salt intake activates inflammatory cascades via Th17 immune cells: impact on health and diseases.

The incidence of immune-mediated inflammatory diseases (IMIDs) is on the rise. A high salt content in the diet was found to play a crucial role in mediating IMIDs. It was demonstrated that increased salt concentration favors the differentiation of CD4+ cells to pathogenic Th17 cells, which predispose to several inflammatory diseases by modulating the immunological milieu. In auto-immune diseases increased salt concentration causes stable induction of Th17 cells. In cancer, increased salt concentration triggers chronic inflammation and increases vascular endothelial growth factor levels. Salt-mediated proliferation of Th17 cells has been found to reduce nitric oxide production in the endothelial cells, leading to hypertension. Increased salt concentration was found to alter the intestinal flora, which favors local inflammation. This review attempts to explain the role of high salt concentration and its molecular pathways in causing IMIDs.

A Comparative Study Between Vacuum Dressing and Normal Saline Dressing for Chronic Non-Healing Ulcers.

Introduction Isn't it a boon that all living organisms possess the ability to heal their injuries? The wound healing is faster when the normal physiology of the wound healing is maintained. Our understanding of wound healing has undergone dramatic changes in the recent past. Almost all materials and methods available on earth have been used and tested to facilitate the process of wound healing. The mental agony and the disability suffered by patients with chronic ulcers have led to the reappraisal of the basic components of the wound healing process and how they are influenced by biological, mechanical, and physical forces. The Department of General Surgery in our Government Chengalpattu Medical College and Hospital, Chengalpattu, Tamil Nadu, India, admits and treats a large volume of patients with wounds and ulcers. Here many materials are being used regularly for dressing to make wound healing faster. Vacuum dressings were also done on many patients, and promising results were observed. This kindled our interest in conducting this prospective study and comparing wound healing with vacuum dressing versus normal saline dressing. Materials and methods A total of 74 patients were included in the study, out of which 37 patients were randomly included in the experimental group and vacuum dressing was done, while the other 37 included in the control group were treated with dressing done with normal saline moistened gauze and bandage roll. Rates at which the wound healed were compared. Results We were able to observe a statistically significant difference in the rate of appearance of granulation tissue between the two and increased clearance of bacteria and toxins. The study group promised better progress as compared to the control group in various aspects. Conclusion Vacuum dressing brings an obvious improvement in the healing of non-healing ulcers and decreases the overall duration of stay in the hospital.

Sleep and Alzheimer: The Link.

Alzheimer's disease is the most common type of dementia which has both cognitive and non-cognitive disabilities. Recent research has proved that sleep deprivation and insomnia have been related to the pathophysiology of Alzheimer's disease and would influence the symptoms and progression of the disease. We look at the current research that supports the idea that the lack of sleep relates to cognitive decline and dementia, with an emphasis on Alzheimer's disease. We integrated the various possible mechanisms of sleep deprivation leading to Alzheimer's disease and cognitive decline. The role of neuroinflammation, generation of reactive oxidative species and sleep disturbances play a central role in tau generation and Aß deposition. An approach to manage sleep changes can widely prevent the cognitive decline of Alzheimer's disease.

COVID-19 and Dementia; Hard to Forget Yet Haunting Forgetfulness!

The current pandemic has affected almost everyone worldwide. Although the majority of people survive the illness, bad cognitive repercussions might last a long time, resulting in a lower quality of life and disability, particularly in severe cases. We tried to understand and bring together the various possible mechanisms leading to dementia in COVID-19. The link between COVID-19 and dementia will help public health workers plan and allocate resources to provide better care for a community suffering from sickness and improve quality of life. A conceptual framework for care of infected people in the older age group and care of dementia people is proposed.

Hand Hygiene Auditing: Is It a Roadway to Improve Adherence to Hand Hygiene Among Hospital Personnel?

Background Over the years, there has been an increase in hospital-acquired infections (HAIs) among patients in India. One of the main reasons is a lack of compliance with infection control guidelines, such as hand hygiene. So the present study was conducted to determine the compliance of hand hygiene among healthcare workers in a private tertiary care teaching hospital in South India. Materials and methods The prospective observational study was carried out between April 2017 and March 2020. Nineteen areas were directly observed for hand hygiene (HH) compliance. At each location, HH audit was conducted for one hour per day for five days per month. HH complete adherence rate (HHCAR) and HH partial adherence rate (HHPAR) were analyzed. Results Nine hundred and twenty observation periods were completed during the entire study period. Overall, hand hygiene complete adherence rate was 29.9% (11,981/39,998); partial adherence rate was 45.3% (18,131/39,998) and the non-adherence rate was 24.7% (9886/39,998). A better adherence rate was seen among nurses (44.7%), followed by other staff (33.7%) and doctors (33.04%). Moment-specific adherence rates show almost equal adherence rates of 50.7%, 50.75%, and 50.1%, respectively, for moments 2, 3, and 4, and comparatively low for moments 1 and 5 (48.4% and 47.6%, respectively). Conclusion Despite adequate hand hygiene facilities, compliance remains low. Hand hygiene is a bundle care approach that needs to consider factors including healthcare staff, clinical, institutional, environmental, and behavioral changes. Multimodal interventions and multidisciplinary commitment are mandatory for sustained compliance.

Clinical and Inflammatory Profile of COVID-19 Infection at a Tertiary Care Centre in Northern Part of Tamil Nadu - A Retrospective Study.

Introduction The coronavirus disease (COVID-19) pandemic has incurred high costs for the entire planet. The complex interactions between the host, virus, and environment have resulted in various clinical outcomes. It is crucial to comprehend sickness severity and outcome predictors to provide early preventative measures for a better outcome. The current study aimed to determine the association of clinical and inflammatory profiles with the outcome of COVID-19 infection in patients admitted to the intensive care unit. Methods This retrospective study was done in patients admitted to intensive care units for COVID-19 with a positive reverse transcriptase polymerase chain reaction (RTPCR) assay. A total of 125 patients above 18 years were included in the study. The patient's age, gender, and co-morbidities like type 2 diabetes mellitus, hypertension, respiratory illness, and coronary artery disease were noted. The patient's symptomatology, vital signs, oxygen saturation (Spo2), need for inotropes, and non-invasive positive pressure ventilator support (NIPPV) were observed. Computed tomography severity score (CTSS) and hematological and inflammatory parameters at the time of admission were noticed. Patient's management and treatment outcomes as survivors and non-survivors were noted. Results The mean age was significantly greater in non-survivors. The common symptoms were fever, respiratory distress, cough, muscle pain, and sore throat. The leucocyte count, C-reactive protein (CRP), urea, creatinine, interleukin-6 (IL-6), and lactate dehydrogenase (LDH) were greater, and platelet counts were lower significantly in the non-survivors group. On multivariable logistic regression, CT severity score, NIPPV, and IL-6 had an odds ratio of 1.17, 0.052, and 1.03, respectively. IL-6 had a sensitivity of 81.5% and a specificity of 81.8% with a cut-off value of 37.5. Conclusion Vigilant monitoring of leucocyte count, CRP, urea, creatinine, IL-6, LDH, platelet count, and CT severity score is essential for managing COVID-19 infection. IL-6 was found to be a significant marker as a predictor of outcome in our study.

Association of Serum Magnesium with Insulin Indices in Patients with Type 2 Diabetes Mellitus.

Introduction: Magnesium has a direct impact on glucose metabolism since it is a cofactor for numerous energy-metabolizing enzymes. Hypomagnesemia has been linked to poor glycemic control and a range of diabetes-related long-term complications. This study aimed to assess the association between blood magnesium levels and insulin sensitivity indices in patients with type 2 diabetes mellitus (T2DM). Material and methods:Two hundred newly diagnosed T2DM patients aged over 40 years were recruited after excluding those with a history of heart failure, kidney illness, liver disease, hypothyroidism, ascites, pregnancy, tumors, and complications such as diabetic ketoacidosis. Fasting glucose, serum magnesium, serum insulin, serum urea and creatinine were measured. Patients were divided into two groups based on their serum magnesium levels. Results:There were no age or sex differences between the subjects of the two groups. Participants in the group with low magnesium had significantly high fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1c), serum insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR) (P < 0.001). The multivariable logistic regression analysis showed significant associations with PPBS [odds ratio (OR) 0.98 (95% CI 0.97-0.99)], HbA1c [OR 0.05 (95% CI=0.005-0.55)] and creatinine [OR 0.004 (95% CI=0.00-0.074)]. Correlation statistics showed a negative correlation between magnesium and PPBS (r =-0.204), HOMA-IR (r = -0.819) and creatinine (r = -0.151). Conclusion:Serum magnesium levels have a negative correlation with FBS and PPBS, as well as HOMA-IR. It may well be essential to include serum magnesium level as a regular assessment in patients with diabetes mellitus.

Risk Assessment of COVID-19 Infection among the Elderly Population.

Introduction:Elderly patients are susceptible to COVID-19 infection. They usually present with atypical symptoms and multiple organ dysfunction. The poor outcome in elderly patients is due to multiple comorbidities, declining functional status, and frailty. This study aimed to assess the risk profile of COVID-19 infection in the elderly population. Materials and methods:Patients aged 60 years and above with COVID-19 positive by RT-PCR were included in the study. Patients' demographic data, co-morbidities and severity of illness, complete hemogram, blood sugar, renal, liver function test, lactate dehydrogenase, interleukin-6, ferritin, D-dimer were noted. Patients' outcome in terms of survival was observed. Results:The total count, neutrophil lymphocyte ratio, ESR, urea, creatinine, interleukin 6, D-dimer, and blood sugar value were significantly associated with non-survival even after adjustment for age and gender. Complications such as acute kidney injury (AKI), renal failure, acute respiratory distress syndrome, multiorgan dysfunction syndrome (MODS), and World Health Organization (WHO) severity were also associated with non-survival before and after adjustment for age and gender. On Cox regression survival analysis, . three co-morbidities had hazard ratio (HR) of 54.36 [95% CI 3.66 to 807.01], WHO severity had HR of 31.09 [95% CI 1.31 to 738.22], MODS had HR of 16.97 [95% CI 2.86 to 100.39], creatinine had HR of 8.44 [95% CI 1.99 to 35.77], AKI had HR of 6.71 [95% CI 1.11 to 40.56]. Conclusion:In elderly patients with COVID-19 infection, the presence of at least three co-morbidities, severity of infection by WHO criteria and presence of complications such as MODS, elevated creatinine and AKI were predictors of the survival rate and mortality.

Is the Gut Microbiota a Neglected Aspect of Gut and Brain Disorders?

The gut microbiota is a quickly developing bacterial ecosystem with biodiversity. It is an adaptive immunity that varies with food intake, environmental conditions, and human habits, among other factors. Various external stimuli, such as drugs, can influence the gut microbial environment and lead to gut dysbiosis. Recently, gut dysbiosis has been identified as an important factor that leads to several diseases either by the released metabolites or by the gut neuronal connection. In brain disorders, gut dysbiosis is involved in neuropsychiatric manifestations, including autism spectrum disorder, anxiety, and depression by interfering with neurotransmitter homeostasis, and neurodegenerative diseases, such as Alzheimer's disease and Parkinson's disease by releasing abnormal metabolites from the gut. Gut dysbiosis has been documented in gut disorders, including inflammatory bowel disease or irritable bowel syndrome. Immune cells in the gut are modulated by external factors such as stress, diet, and drugs to produce inflammatory cytokines, including interleukins (IL-4, IL-6, IL-17, IL-23, etc.). Inflammatory cytokines lead to a cascade of events, which lead to various ailments in the bowel. Beneficial bacteria in the form of probiotics ameliorate the condition and have healthful effects in disease conditions. This warrants further research to identify newer therapeutic strategies for diseases that cannot be cured or are difficult to treat.

Device-Associated Hospital-Acquired Infections: Does Active Surveillance With Bundle Care Offer a Pathway to Minimize Them?

Background and objective The prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital. Materials and methods A prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)'s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting. Results The surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. Klebsiella pneumoniae was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by Acinetobacter baumanii (30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in Enterococcus was 28.5% (2/7). Conclusion DUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.