Compliance of Physicians with Standard Precautions of Handling Patients with Infectious Respiratory Disease

Background: Standard precautions (SPs) are the minimum infection prevention practices that aim to protect Health care workers (HCWs) including physicians and prevent them from transmitting the infections to their patients. Purpose: To assess the level of compliance of physicians with standard precautions of handling patients with infectious respiratory disease. Method: A cross sectional questionnaire-based study was conducted in two tertiary level hospitals named M Abdur Rahim Medical College and Hospital, Dinajpur, Bangladesh and Rajshahi Medical College and Hospital, Rajshahi, Bangladesh to assess the level of compliance of physicians with standard precautions. Purposive sampling technique was applied as per inclusion criteria and data was collected by face to face interview from 285 physicians. Statistical analysis of the results was done by SPSS and a p value less than 0.05 was considered as significant. Result: The study revealed that maximum physicians (76.5%) handling patients with infectious respiratory disease had a moderate level of compliance with standard precautions. 78.6% of the physicians had moderate level of awareness about standard precautions. Only 20.35% of the physicians had training on infection control. 94.4% of the respondents didn’t know the component of standard precaution and most of the physicians were not aware of the sequence of wearing and removing the different components of PPEs. Conclusion: The study result implies that with increased awareness, the compliance of the physicians with standard precautions increased. The main reasons of non-compliance with standard precautions were found to be lack of resources, lack of regular training and excess workload.

Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience

Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting.

Pentoxifylline versus prednisolone for severe alcoholic hepatitis:A randomized controlled trial

AIM:To compare the efficacy of pentoxifylline and prednisolone in the treatment of severe alcoholic hepatitis,and to evaluate the role of different liver function scores in predicting prognosis.METHODS:Sixty-eight patients with severe alcoholic hepatitis(Maddrey score≥32)received pentoxifylline(n=34,groupⅠ)or prednisolone(n=34,groupⅡ) for 28 d in a randomized double-blind controlled study,and subsequently in an open study(with a tapering dose of prednisolone)for a total of 3 mo,and were followed up over a period of 12 mo.RESULTS:Twelve patients in groupⅡdied at the end of 3 mo in contrast to five patients in groupⅠ.The probability of dying at the end of 3 mo was higher in groupⅡas compared to groupⅠ(35.29%vs 14.71%,P=0.04;log rank test).Six patients in groupⅡ developed hepatorenal syndrome as compared to none in groupⅠ.Pentoxifylline was associated with a significantly lower model for end-stage liver disease(MELD)score at the end of 28 d of therapy(15.53±3.63 vs 17.78±4.56,P=0.04).Higher baseline Maddrey score was associated with increased mortality.CONCLUSION:Reduced mortality,improved risk-benefit profile and renoprotective effects of pentoxifylline compared with prednisolone suggest that pentoxifylline is superior to prednisolone for treatment of severe alcoholic hepatitis.

Prevalence and knowledge of hepatitis C in a middle-aged population,Dunedin,New Zealand

AIM:To determine the prevalence of infection with hepatitis C virus(HCV) in those most at risk of advanced liver disease and to identify gaps in knowledge of HCV.METHODS: Questionnaires were mailed to randomly selected residents aged 40-59 to assess the extent of their general knowledge about HCV. The questionnaire assessed demographics, the extent of general knowledge about viral hepatitis, potential risks for infection and the prevalence of risk factors associated with increased progression of liver fibrosis. Anonymised residual laboratory blood samples from 40-59 years old people from Dunedin taken in hospital or in the community, were tested for HCV antibodies and alanine transaminase(ALT), aspartate transaminase(AST), gamma-glutamyl transpeptidase(GGT). Linear regression was performed to examine whether the demographics sex, age, socio-economic status, qualification level and occupation sector(categorical variables) were predictors of level of general knowledge about hepatitis. For the demographics that werefound to be significant predictors of score outcome, multiple regression analysis was used to determine independent effects. χ2 tests were used to compare our selected sample and our responder population demographics, to the demographics of the entire 40-59 years old population in Dunedin using the 2006 NZ census data. Exact confidence intervals for the proportion positive for HCV and HBV were calculated using the binomial distribution.RESULTS: The response rate to the mailed questionnaire was 431/1400(30.8%). On average 59.4% questions were answered correctly. Predictors for higher scores, indicating greater knowledge about symptoms and transmission included sex(female, P < 0.01), higher level of qualification(P < 0.000) and occupation sector(P < 0.000). Sharing intravenous drug utensils was a known risk factor for disease transmission(94.4%), but the sharing of common household items such as a toothbrush was not. 93% of the population were unaware that HCV infection can be asymptomatic. 25% did not know that treatment was available in New Zealand and of those who did know, only 40% assumed it was funded. Six hundred and eighty-two residual anonymised blood samples were tested for HCV antibodies, ALT, AST and GGT. The prevalence for HCV was 4.01%, 95%CI: 2.6%-5.8%. Liver function tests were not useful for identifying likelyhood of HCV infection.CONCLUSION: Prevalence of HCV in our population is high, and the majority have limited knowledge of HCV and its treatment.

Ethnic variations in ulcerative colitis: Experience of an international hospital in Thailand

AIM: To investigate the clinical characteristics, treatment, medication use, and treatment response in patients with ulcerative colitis(UC) across ethnic groups.METHODS: This study retrospectively analyzed medical records of all 268465 patients who visited the Bumrungrad International Digestive Disease Center during 2005-2010. The demographics, clinical characteristics, medication use, results of investigations, and medical and surgical management for patients with UC were evaluated. Evaluation included sigmoidoscopy and colonoscopy performed in compliance with the American Society of Gastrointestinal Endoscopy practice guidelines. Patient ethnicities were categorized into seven groups: Thai, Oriental, South Asian(SA), Middle Eastern(ME), Caucasian, African, and Hispanic. UC pathological severity was classified into inactive, mild, moderate, and severe. Associations between categorical variables were analyzed using the χ2 or Fischer's exact test. Associations between categorical and interval variables were analyzed usingStudent's t-test and/or analysis of covariance.RESULTS: UC was diagnosed in 371 of the 268465 patients: male 56.33%; ME 42%, Caucasian 23%, and Thai 19%. Annual incidence of UC was 82 cases per 100000 with wide ethnic variation, ranging from 29 to 206 cases per 100000 in Oriental and ME patients, respectively. Of the patients with UC, 16.71% had severe UC with highest incidence among the patients from ME(20.39%) and lowest among the Caucasian population(11.90%). ME had highest proportion of pancolitis(52.90%), followed by Caucasian(45.35%) and Asian(34.40%). Only 20.93% of Caucasian patients received steroid, compared with 26.40% and 27.10% of Asian and Middle Eastern, respectively(P = 0.732). Overall, 13.72% of UC patients did not respond to steroid therapy, with non-significantly higher proportions of non-responders among Asian and Middle Eastern patients(15.22% and 15.04%, respectively)(P = 0.781). On average, 5.93% underwent surgical management with ethnic variation, ranging from 0% in African to 18% in SA. Cancer was found in three(Thai, ME, and African) cases(0.82 institution-specific incidence).CONCLUSION: Incidence, symptom duration, pathological severity, clinical manifestations, medication use, treatment response, need for surgical consultation, and cancer incidence of patients with UC potentially vary by ethnicity.

Gastroenterology service in a teaching hospital in rural New Zealand, 1991-2003

AIM: To retrospectively collect inpatient and outpatient data and to assess the use of endoscopic procedures during the years 1991, 1997 and 2003 to analyse for trends. METHODS: This retrospective survey was conducted in a University-associated Gastroenterology Unit offering secondary and tertiary health care services for a population of approximately 182 000 people in Southern New Zealand. Data collected included patient contacts (inand outpatients), gastroscopic and colonoscopic investigations. RESULTS: We observed a significant increase in the absolute numbers of patient contacts over the years (1991: 2308 vs 1997: 2022 vs 2003: 2783, P < 0.0001) with inflammatory bowel disease, other diseases of the colon, anus and rectum and iron studies related disorders decreasing significantly but liver disease and constipation increasing linearly over time. The use of endoscopy services remained relatively stable but colonoscopic investigations for a positive family history of colorectal cancer increased significantly while more gastroscopies were performed for unexplained anaemia. CONCLUSION: The whole spectrum of gastroenterology contacts was studied. A substantial proportion of colonoscopies and outpatient consultations were undertaken to screen for colorectal cancer. This proportion is likely to grow further. Our fi ndings have implications for the recruitment and training of the next generation of gastroenterologists.

Urine microscopy and neutrophilelymphocyte ratio are early predictors of acute kidney injury in patients with urinary tract infection

Objective:Urinary tract infection(UTI)is a common cause of morbidity and hospitalisation in the population worldwide.Upper UTI is indolent and causes subclinical acute kidney injury(AKI)resulting in preventable cause of scarring of renal parenchyma.We explored urinary and serum levels of kidney injury molecule-1(KIM-1),haematological parameters and quantitative urine microscopy parameters to predict kidney injury.Methods:Neutrophilelymphocyte ratio(NLR)is obtained by dividing absolute neutrophil count with absolute lymphocyte count.Quantitative urine sediment microscopy was performed and correlated with clinical,biochemical and haematological findings to predict AKI in patients with UTI.Quantitative ELISA was performed for serum and urine levels of KIM-1.Seventy two adult patients with UTI were enrolled,45 of whom had AKI while 27 were in the non-AKI group.Results:NLR(p=0.005)and renal tubular epithelial cell-granular cast score in quantitative urine microscopy(p=0.008)are strong predictors of AKI in patients with UTI while rest of quantitative urine microscopy parameters and serum and urinary levels of KIM-1 molecule were not found to be useful in prediction of AKI.Conclusion:NLR in haemogram is a novel and useful biomarker for predicting AKI in patients with UTI.

Comparison of Results of TIPU Repair for Hypospadias with “Spongioplasty Alone” and “Spongioplasty with Dorsal Dartos Flap”

Objective: The aim of our study was to compare the results of tubularized plate urethroplasty with interposing healthy tissue spongioplasty alone and spongioplasty with dorsal dartos flap to assess the role of dartos flap in prevention of fistulae. Patients and Methods: A retrospective study was performed on 80 patients, aged 4 months to 27 years who underwent hypospadias repair using the Snodgrass technique. The patients were assigned to two groups. In group I (40 patients) the neourethra was covered with spongioplasty only, and in group II (40 patients) the neourethra was covered with spongioplasty plus dartos flap. Integrity of the urethral plate was maintained in all the cases. The ventral curvature & torsion was corrected by penile de-gloving, mobilization of the urethral plate and spongiosum and mobilization of the proximal urethra if needed. The results were analysed in view of complication rates. The average period of hospital stay was 7 days & follow-up varied from 8 months to 28 months with a mean of 14 months. Results: In group I, hypospadias were distal penile in 31 (77.5%), mid-penile in 4 (10%) and proximal/peno-scrotal in 5 (12.5%) patients. In group II, hypospadias were distal penile in 17 (42.5%), mid penile in 9 (22.5%) and proximal/peno-scrotal in 14 (35%) patients. Sixty five percent in group I and 80% in group II had ventral curvature but the difference was not statistically significant. Good functional results were achieved in 97.5% patients in group I and in 95% patients in group II?which were statistically similar (p value—0.585). Urethral fistula was encountered in 2.5% in group I & in 2 cases (5%) in group II. Meatal stenosis was noted in 7.5% each in both groups, which responded to urethral dilatation. One patient in group II had complete disruption.?There was no statistically significant difference in early and late complications in both groups (p value—0.812). Conclusions:?Spongioplasty with healthy spongiosal tissue is strong enough and is?effective waterproofing?as an interposition layer. However, more prospective studies in different hands are needed to omit the step of dorsal dartos interposition.

Palm oil and the heart:A review

Palm oil consumption and its effects on serum lipid levels and cardiovascular disease in humans is still a subject of debate. Advocacy groups with varying agenda fuel the controversy. This update intends to identify evidence-based evaluations of the influence of palm oil on serum lipid profile and cardiovascular disease. Furthermore, it suggests a direction for future research. The sources of information were based on a Pub Med, Google Scholar, African Journal online and Medline search using key words including: palm oil, palmitic acid, saturated fatty acids and heart disease. Published animal and human experiments on the association of palm oil and its constituents on the serum lipid profile and cardiovascular disease were also explored for relevant information. These papers are reviewed and the available evidence is discussed. Most of the information in mainstream literature is targeted at consumers and food companies with a view to discourage the consumption of palm oil. The main argument against the use of palm oil as an edible oil is the fact that it contains palmitic acid, which is a saturated fatty acid and by extrapolation should give rise to elevated total cholesterol and low-density lipoprotein cholesterol levels. However, there are many scientific studies, both in animals and humans that clearly show that palm oil consumption does not give rise to elevated serum cholesterol levels and that palm oil is not atherogenic. Apart from palmitic acid, palm oil consists of oleic and linoleic acids which are monounsaturated and polyunsaturated respectively. Palm oil also consists of vitamins A and E, which are powerful antioxidants. Palm oil has been scientifically shown to protect the heart and blood vessels from plaques and ischemic injuries. Palm oil consumed as a dietary fat as a part of a healthy balanced diet does not have incremental risk for cardiovascular disease. Little or no additional benefit will be obtained by replacing it with other oils rich in mono or polyunsaturated fatty acids.

Should we use similar perioperative protocols in patients undergoing unilateral and bilateral one-stage total knee arthroplasty?

BACKGROUND Bilateral one-stage total knee arthroplasty(BTKA)is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy.However,postoperative pain and disablement during convalescence from BTKA,and procedure-related complications have been concerning issues for patients and surgeons.Although some studies reported that BTKA in selected patients is as safe as the staged procedure,well-defined guidelines for patient screening,and perioperative care and monitoring to avoid procedure-related complications are still controversial.AIM To compare the perioperative outcomes including perioperative blood loss(PBL),cardiac biomarkers,pain intensity,functional recovery,and complications between unilateral total knee arthroplasty(UTKA)and BTKA performed with a similar perioperative protocol.METHODS We conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols.The exclusion criteria of this study included patients with an American Society of Anesthesiologists score>3,and known cardiopulmonary comorbidity or high-sensitivity Troponin-T(hs-TnT)>14 ng/L.Outcome measures included visual analogue scale(VAS)score of postoperative pain,morphine consumption,range of knee motion,straight leg raise(SLR),length of stay(LOS),and serum hemoglobin(Hb)and hs-TnT monitored during hospitalization.RESULTS Of 210 UTKA and 137 BTKA patients,those in the BTKA group were younger and more predominately female.The PBL of the UTKA vs BTKA group was 646.45±272.26 mL vs 1012.40±391.95 mL(P<0.01),and blood transfusion rates were 10.48%and 40.88%(P<0.01),respectively.Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA,whereas preoperative Hb was only a determinant in UTKA patients.The BTKA group had significantly higher VAS scores than the UTKA group at 48,72,and 96 h after surgery,and also had a significantly lower degree of SLR at 72 h.The BTKA group also had a significantly longer LOS than the UTKA group.Of the patients who had undergone the procedure,5.71%of the UTKA patients and 12.41%of the BTKA patients(P=0.04)had hs-TnT>14 ng/L during the first 72 h postoperatively.However,there was no difference in other outcome measures and complications.CONCLUSION Following similar perioperative management,the blood transfusion rate in BTKA is 4-fold that required in UTKA.Also,BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA.Hence,BTKA patients may require more extensive perioperative management for blood loss and pain,even if having no higher risk of complications than UTKA.

Prevalence and Pattern of COVID-19 among Healthcare Workers in Rivers State Nigeria

Introduction: The evaluation of COVID-19 prevalence among healthcare workers (HCW) within the general population of COVID-19 cases is an important epidemiologic variable. The objective of this study is to describe the prevalence and patterns of COVID-19 infection in HCWs amongst a group of patients receiving care for COVID-19 in Rivers state, Nigeria. Methods: This study was a prospective descriptive study of all consenting patients who received care through hospitals, designated for COVID-19 treatment in Rivers state either as in-patient or out-patient following a laboratory-confirmed diagnosis of COVID-19 based on a positive SARS-CoV-2 RT-PCR from April to September 2020. Results: A total number of 646 COVID-19 patients were enrolled over the study period with 98 (15.2%) HCWs in the patient population. The HCWs with COVID-19 consisted largely of Doctors 47 (47.9%), Nurses 30 (30.6%), and socio-sanitary and hygiene workers 10 (10.2%). There were 46 (46.9%) female HCWs, compared to Non-HCWs with 112 (21.1%), females, p = 0.000. Sixty-eight (69.4%) HCWs had a source of contact for infection established compared to Non-HCWs with an established source of contact in 181 (34.2%), p = 0.000. Eight (8.2%) HCWs had Severe disease compared to 52 (9.8%) Non-HCWs with severe disease, p = 0.670. The case fatality in HCWs was 1% compared to 1.9% in Non-HCWs, p = 0.554. Conclusion: The prevalence of COVID-19 among HCWs in the study location is high with clinical and clinical support staff particularly, doctors and nurses are at higher risk of COVID-19 infection. This calls for action to improve and prevent HCWs infections in hospital settings in addition to improving HCW infection prevention behaviour in the community. The intensification of risk communication, provision of protective equipment (PPE), and training on the appropriate use of PPE;in addition to routine surveillance for infection is recommended.

Annoyance and Health-Related Quality of Life: A Cross-Sectional Study Involving Two Noise Sources

Noise remains a potent degrader of health in many global contexts, capable of inducing severe annoyance and sleep disturbance. An epidemiological study was undertaken to compare noise annoyance and health-related quality of life of individuals residing close to a major international airport or wind turbine complex with those located in demographically matched areas. Results indicate that domains of health-related quality of life may be degraded in those living in areas more likely to induce noise annoyance. Furthermore, the addition of aviation noise to environments already encroached by road noise may induce further annoyance and degradations in health-related quality of life, indicating that one noise sources may not mask the impact of another.

Comparative Study of Herbal Extracted Gel and 1% Hydrocortisone Gel in the Treatment of Mosquito Bite Reaction

Background: Mosquito bite reaction is a common skin disease. Topical steroids and oral antihistamines are the conventional treatment. However, the side effects from prolonged use of topical steroids are the limitation of the treatment. Recently, herbal extracts are emerging interest for an alternative anti-inflammatory dermatoses therapy. Objective: To assess the effectiveness of herbal extracted gel containing, Perilla frutescens, Portulaca oleracea, Ipomoea pescaprae, Aloe vera, Centella asiatica and Broussonetia papyrifera in comparing with 1% hydrocortisone (HC) gel. Material and Methods: An experimental study was conducted on 50 mosquito bite hypersensitive volunteers (15 - 19 years old) with double-blinded split randomized control method. After the volunteers were exposed for one bite on their arms by a non-infectious mosquito, Aedes albopictus, the drugs were applied twice daily. The diameter of lesion, pruritus analog score, erythema and melanin index were measured at 2, 6, 24 hours and 2, 3, 4 weeks. The volunteers “self-satisfaction” and side effects were recorded. Results: The mean age was 17.42 ± 1.14 years old. The diameter of lesion, pruritus analog score, erythema and melanin index were decreased on both sides at each visit with significant difference (p < 0.05). There was no significant difference between two agents of all parameters and the satisfaction of the volunteers (p > 0.05). The post-inflammatory hyperpigmentation rate of 1% HC and herbal gel was 64% and 54% respectively without significant difference (p = 0.267). Conclusion: The herbal gel was as effective as 1% HC for the treatment of acute and late reaction of mosquito bite reaction in adolescent. It may be used as the alternative treatment for mosquito bite reaction.

Exploring Gaps in Healthcare Workers Knowledge, Attitude, Perception and Practice of COVID-19 Prevention and Control in Rivers State Nigeria

Background Knowledge, attitude, perception, and practice of Covid-19 prevention affect the effectiveness of healthcare workers in the pandemic response. This study assessed gaps in awareness, knowledge, attitude, perception, and practice of Covid-19 prevention among healthcare workers in Rivers State, Nigeria. Methods This was a descriptive cross-sectional survey carried out six weeks into Rivers State response that commenced on February 20, 2020, in the 23 Local Government Areas (LGAs). State Disease Surveillance and Notification Officers used multistage sampling to recruit 555 healthcare workers for the survey. A self-designed structured interviewer-administered questionnaire built into the Open Data Kit application for android phones was used for data collection. Descriptive data analysis was done, and outputs presented as frequency and percentages. Results There was a total of 372 (67.0%) female respondents. Majority of study participants had tertiary education 453 (81.6%). The mean age of study participants was 40.6 years (Standard Deviation = 7.8 years). Furthermore, 285 (51.4%) were Community Health Workers, and had over ten years practicing experience 393 (70.8%). Most healthcare workers 554 (99.8%) had heard about Covid-19, through radio 539 (97.1%), and television 445 (80.2%) yet 213 (38.4%) respondents did not know that it is caused by a virus. Most respondents 415 (74.8%) had good knowledge about Covid-19. However, only 148 (26.7%) would refer suspected cases to a facility and only 365 (65.8%) respondents demonstrated the correct hand washing technique. Conclusion There are some gaps in health worker knowledge, attitude, perception, and practice of Covid-19 prevention. Interventions to bridge these gaps are needed for effective containment of this pandemic.

Comparison of Serum Lipid Profile between Gestational Diabetes Mellitus and Pregnant Women with Normal Glucose Tolerance

Background: Aberrant lipid metabolism presumed to have important relationship with gestational diabetes mellitus (GDM), though previous studies revealed inconsistent results on this area. Objectives: To identify the difference of serum lipid profile between gestational diabetes mellitus (GDM) and pregnant woman with normal glucose tolerance (NGT). Methods: This cross sectional study was conducted from January 2017 to December 2017 at Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with 31 GDM and equal number of NGT pregnant women diagnosed on the basis of WHO criteria-2013, during 24 - 40 weeks of gestation. Glucose was measured by glucose oxidase method and fasting serum lipid profile [Total cholesterol (TC), High Density Lipoprotein-cholesterol (HDL-C) and Triglyceride (TG)] was measured by enzymatic-colorimetric method. Data were analyzed and compared by statistical tests. Results: Among total sixty-two (62) study subjects, 31 were GDM (age: 27.52 ± 4.8 years, body mass index (BMI): 27.17 ± 3.3 kg/m2) and 31 were pregnant women with NGT (age: 24.94 ± 4.2 years, BMI: 25.43 ± 6.5 kg/m2). Mean age of GDM group was significantly higher than that of NGT group (p = 0.028). Women with GDM showed relatively higher BMI than NGT women but that was not statistically significant (p = 0.194). Fasting lipid profiles between GDM and NGT (GDM vs. NGT;total cholesterol: 194.21 ± 42.18 vs. 208.52 ± 42.18 mg/dl, p = 0.187;HDL-C: 47.50 ± 16.17 vs. 47.18 ± 11.71 mg/dl, p = 0.928;LDL-C: 109.25 ± 28.80 vs. 119.30 ± 34.76 mg/dl, p = 0.220 and triglyceride 204.78 ± 58.50 vs. 202.34 ± 79.18 mg/dl, p = 0.891) were not significantly different. The variations in all lipid fraction values were not statistically significant among GDM women when analyzed between BMI groups holding BMI cut-off at 23 kg/m2. No significant differences of any values of lipid profile were found in GDM women according to various age categories (Age < 25 years vs. ≥25 years). Conclusions: Lipid profile does not differ between women with GDM and pregnant woman with NGT.

Protection against symptomatic SARS-CoV-2 infection during the second wave among individuals with pre-existing binding antibodies to SARS-CoV-2: A population-based study from Puducherry, India

During the COVID-19 pandemic,several studies have shown that severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection is associated with a substantial reduction in the risk of subsequent reinfection with antigenically-related variants of the virus for at least 6 months[1,2].

Does topical vancomycin prevent fracture-related infections in closed fractures undergoing open reduction and internal fixation?A randomised controlled trial

Purpose:The role of topical vancomycin in fracture-related infection(FRI)is debatable.Very few studies have reported their efficacy in open and high-risk extremity fractures.This study aimed to assess topical vancomycin's role in reducing FRI in closed fractures undergoing open surgical intervention with an implant.Methods:This prospective randomized cohort study was carried out between February 2021 to January 2022.Patients with isolated closed fractures,who were planned for open reduction and internal fixation within 2 weeks from the time of injury were included for this study.The data collected included age,gender,socioeconomic status,mechanism of injury,diagnosis,Tscherne classification,and time interval to take up for surgery.Patients were randomized into the intervention and control groups using the block randomization technique.The control group received only systemic antibiotic prophylaxis,whereas the intervention group received topical application of vancomycin powder in the surgical wound alongside systemic antibiotic prophylaxis.The primary outcome measure was the incidence of FRI among these individuals.Clinical and radiological findings and culture reports(in cases with infection)were recorded during the post-operative period and at 6 weeks of follow-up.All relevant statistical calculations were done using STATA statistical/data analysis-parallel edition version 16.0(StataCorp LLC).The quantitative variables like age and duration of the surgery were assessed for normalcy by Shapiro-Wilk W test.An independent samples t-test with equal variances was applied to the age data.Fisher's exact test was used for the analysis of the primary outcome measure(presence of FRI following surgery),and"Risk of FRI"and"Risk difference"between the 2 groups was calculated.The strength of the association between qualitative variables was assessed using the Fisher's exact and Chi-square tests,respectively.Results:There were 88 patients included in this study.No statistical significance was found about FRI between both groups(p=0.494).At 6 weeks following surgery,no incidence of infection was observed in the intervention group.Two infections(4.5%)were found in the control group,with positive cultures reported in one of them but none in the treatment group.Radiologically,15.9%of patients in the control group showed lysis around the implant compared to 2.3%in the intervention group.Impaired fracture healing was observed in 22.7%of patients in the intervention group compared to 15.9%in the control group.Conclusion:Applying topical vancomycin in closed fractures undergoing open reduction and internal fixation does not significantly reduce the incidence of FRI until the end of 6 weeks following surgery.

Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs

AIM To investigate the long-term effect of dietary education on a low fermentable oligosaccharide, disaccharide and polyol(FODMAP) diet on irritable bowel syndrome(IBS) symptoms and quality of life(Qo L).METHODS Participants with IBS(Rome III) were randomized to two groups. Group I commenced a low FODMAP diet at baseline. At three months, group II, so far a comparator group, crossed over to a low FODMAP diet while group I started re-challenging foods. All patients completed the IBS SSS(IBS symptom severity scoring system, 0-500 points increasing with severity), IBS Qo L questionnaire(0-100 increasing with Qo L), a FODMAP specific food frequency questionnaire and provided a stool sample at baseline, three and six months for microbiome analysis.RESULTS Fifty participants were enrolled into group I(n = 23) or group II(n = 27). Participants in both groups were similar in baseline values but with more men in group I. There was a significantly lower IBS SSS(275.6 ± 63.6 to 128.8 ± 82.5 vs 246.8 ± 71.1 to 203.6 ± 70.1)(P < 0.0002) and increased Qo L(68.5 ± 18.0 to 83 ± 13.4 vs 72.9 ± 12.8 to 73.3 ± 14.4)(P < 0.0001) in group I vs group II at 3 mo. The reduced IBS SSS was sustained at 6 mo in group I(160 ± 102) and replicated in group II(124 ± 76). Fiber intake decreased on the low FODMAP diet(33 ± 17 g/d to 21 ± 8 g/d)(P < 0.01) and after re-introducing FODMAP containing foods increased again to 27 ± 9 g/d. There was no change seen in the intestinal microbiome when participants adopted a low FODMAP diet.CONCLUSION This study demonstrated that a reduction in FODMAPs improves symptoms in IBS and this improvement can be maintained while reintroducing FODMAPs.

Risk factors for the development of colorectal carcinoma:A case control study from South India

AIM:To study the association of colorectal carcinoma(CRC) with diet,smoking,alcohol,physical activity,body mass index,family history and diabetes.METHODS: All consecutive patients with CRC confirmed by histopathology diagnosis were included. Age(±5 years) and gender matched controls were selected among the patients admitted in surgery ward for various conditions without any co-existing malignancy. Food frequency questionnaire(FFQ) was developed and validated after pretesting by investigator trained in data col ection techniques. Cases and controls were interviewed ensuring privacy,in similar interview setting,with same duration of time for both cases and controls without any leading question. Biological variables like family history of CRC in first degree relatives,history of diabetes mellitus; behavioral factors like tobacco use both smoking and smokeless form,alcohol consumption and physical activity were recorded. Dietary details were recorded using a FFQ consisting 29 food items with seven categories. Analysis was done using appropriate statistical methods.RESULTS: Ninety-four histopathologically confirmed cases of CRC and equal number of age and gender matched controls treated over a period of two years were studied. Age distribution,mean age,male to female ratio,education level and socioeconomic status were similar in cases and controls. Intake of food items was categorized into tertile due to skewed distribution of subjects as per recommended cut off for consumption of food item. On univariate analysis red meat [OR=7.4(2.935-18.732)],egg [OR=5.1(2.26-11.36)],fish,fried food and oil consumption were found to be risk factors for CRC. On multivariate analysis red meat consumption of more than 2-3 times a month(OR=5.4; 95%CI:1.55-19.05) and egg consumption of more than 2-3 times a week(OR = 3.67; 95%CI:1.23-9.35) were found to be independent risk factors for the development of CRC.CONCLUSION: Egg and red meat consumption found to be independent risk factors for CRC. Smoking,alcohol,physical activity and family history were not associated with increased risk.

SGLT-2 inhibitors in non-alcoholic fatty liver disease patients with type 2 diabetes mellitus: A systematic review

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is a common comorbidity with type 2 diabetes.The existing therapeutic options for NAFLD are not adequate.Hypocaloric diet and exercise is the cornerstone of therapy in NAFLD.Pioglitazone is the only drug recommended in diabetes patients with biopsy proven non-alcoholic steatohepatitis.The frequent coexistence of NAFLD and type 2 diabetes with their combined adverse health consequences and inadequate therapeutic options makes it necessary to search for newer alternatives.AIM To assess the effect of sodium glucose cotransporter-2(SGLT-2)inhibitors on liver enzymes in type 2 diabetes patients with NAFLD.METHODS We searched PubMed/MEDLINE,Cochrane library,Google scholar,and Clinicaltrials.gov for the relevant articles to be included in this systematic review.Human studies done in type 2 diabetes patients with NAFLD treated with SGLT-2 inhibitors for at least 12 wk were included.Data from eight studies(four randomised controlled trials and four observational studies)were extracted and a narrative synthesis was done.A total of 214 patients were treated with SGLT-2 inhibitors in these studies(94 in randomised controlled trials and 120 in observational studies).RESULTS The primary outcome measure was change in serum alanine aminotransferase level.Out of eight studies,seven studies showed a significant decrease in serum alanine aminotransferase level.Most of the studies revealed reduction in serum level of other liver enzymes like aspartate aminotransferase and gamma glutamyl transferase.Five studies that reported a change in hepatic fat exhibited a significant reduction in hepatic fat content in those treated with SGLT-2 inhibitors.Likewise,among the three studies that evaluated a change in indices of hepatic fibrosis,two studies revealed a significant improvement in liver fibrosis.Moreover,there was an improvement in obesity,insulin resistance,glycaemia,and lipid parameters in those subjects taking SGLT-2 inhibitors.The studies disclosed that about 17%(30/176)of the subjects taking SGLT-2 inhibitors developed adverse events and more than 40%(10/23)of them had genitourinary tract infections.CONCLUSION Based on low to moderate quality of evidence,SGLT-2 inhibitors improve the serum level of liver enzymes,decrease liver fat,and fibrosis with additional beneficial effects on various metabolic parameters in type 2 diabetes patients with NAFLD.