Evaluation of previous management against a developed clinical pathway for chronic rhinosinusitis with nasal polyposis in Universiti Kebangsaan Malaysia Medical Center

The study aims to evaluate previous management of CRSwNP patients in Universiti Kebangsaan Malaysia Medical Center (UKMMC) against a developed CP.Chronic rhinosinusitis with nasal polyposis (CRSwNP) has high economic burden and impacts patient''s quality of life. Implementation of clinical pathway (CP) can standardize care while optimizing resources.Analytical cross-sectionalThis study utilized medical records of 103 CRSwNP patients at UKMMC otorhinolaryngology clinic from 2010 to 2015. Patients were divided into groups who underwent or did not undergo surgery. Information was obtained regarding sociodemographic, follow-ups, pharmaceutical regimes, and treatment cost. Cost analysis was done using top-down analysis and activity-based costing and CP was formulated. Cost was calculated using year 2020 rates to adjust for inflation. (United States Dollars [USD]1 = Ringgit Malaysia [RM] 4.2015)Study showed non-CP patients were undertreated compared to CP. This affects clinical outcomes as optimal treatment demanded by CP was not achieved. Total cost for non-CP, non-surgery patients were lower (USD660) compared to CP (USD780) due to under treatment and shorter follow-ups. Meanwhile, total cost for non-CP surgery patients were higher (USD3600) compared to CP (USD2706) due to longer visit durations and hospital stays. Non-CP surgery group underwent lengthy follow-up duration (20.7 months) prior to operation compared to 12 months expected in CP.Study showed non-CP patients were undertreated compared to CP. We identified aspects which resulted in resource wastage and unnecessary burden to our healthcare system. This study enables development of a written CP by fine-tuning various aspects of CP which could be applied to our future practice.     

Design and development of highly sensitive PEDOT-PSS/AuNP hybrid nanocomposite-based sensor towards room temperature detection of greenhouse methane gas at ppb level

Herein, we present fabrication of a novel methane sensor based on poly (3,4-ethylenedioxythiophene:poly (styrene sulfonic acid)) (p-PEDOT-PSS) and gold nanoparticles (AuNPs) treated with dimethyl sulfoxide (DMSO) and Zonyl using a spin coating technique. The nanocomposite films were further post treated with H₂SO₄ to improve the charge transport mechanism. The structural and morphological features of the composites were analyzed through scanning electronic microscopy, transmission electron microscopy, Fourier transform infra-red spectroscopy, UV-Vis spectroscopy and thermogravimetric analysis. Treatment with organic solvents and post treatment of H₂SO₄ significantly enhances the conductivity of the composite to 1800 S cm⁻¹. The fabricated sensor shows an excellent sensing response, fast response and recovery time along with acceptable selectivity towards methane gas at ppb concentrations. Due to a simple fabrication technique, excellent conductivity, superior sensing performance and improved mechanical properties, the sensor fabricated in this study could potentially be used to detect greenhouse methane gas at low concentrations.

Fabrication of novel methane sensor based on PEDOT-PSS:AuNPs composite treated with DMSO and Zonyl using spin coating technique.     

Local urokinase delivery with the Channel balloon: Device safety,pharmacokinetics of intracoronary drug delivery,and efficacy of thrombolysis

The Channel balloon is a new local drug-delivery catheter that has the dual capability of high-pressure lesion dilation and low-pressure drug infusion. The purpose of this study was to assess the safety and efficacy of this device in the local delivery of urokinase in the porcine model. Three in vivo protocols were performed in 57 anesthetized swine to assess the safety of Channel balloon use in the coronary vasculature, the pharmacokinetics of local urokinase delivery, and the ability of the catheter to lyse intraluminal thrombus. First, safety studies were performed in 18 coronary vessels in 13 pigs to compare angiographic and histologic changes following use of the Channel balloon with conventional balloon angioplasty. Second, intramural deposition of ¹²³I-labeled urokinase was measured in 24 coronary arteries in 20 pigs to assess the efficiency and technical determinants of urokinase delivery and the time course of intramural drug retention. Finally, an in vivo thrombus model was used in 24 pigs to compare the thrombolytic capacity of local urokinase delivery with the Channel balloon in comparison with conventional urokinase infusion techniques. All balloon inflations and drug infusions with the Channel balloon were well tolerated in all animals without adverse angiographic, hemodynamic, or electrical sequelae. Comparative histologic studies with the Channel balloon demonstrated no additional vessel trauma beyond that seen with conventional balloon angioplasty. Between 0.09 and 0.35% of infused urokinase was intramurally deposited, with intracoronary persistence for at least 5 h. Drug infusion pressure did not significantly affect drug deposition, although larger amounts of urokinase were deposited with larger balloon:artery ratios and higher urokinase concentrations. In comparison to conventional systemic and guiding catheter infusions, local delivery of urokinase with the Channel balloon resulted in higher levels of clot dissolution. These studies have demonstrated safe intracoronary use of the Channel balloon in the porcine model. Local infusion of urokinase with this device results in significant intramural drug deposition that persists for at least 5 h. In comparison with conventional thrombolytic techniques, local urokinase delivery with the Channel balloon may result in enhanced intravascular thrombolysis. Cathet. Cardiovasc. Diagn. 41:254–260, 1997. © 1997 Wiley-Liss, Inc.     

Fertility inducing effect of aerial parts of Coccinia cordifolia L. in female rats

Ethnopharmacological relevance

The aerial parts of Coccinia cordifolia L. are used to treat female infertility in West Bengal state of India.

Aim of the study

The present study was undertaken to evaluate the fertility inducing effect of aerial parts of Coccinia cordifolia L. in female rats.

Materials and methods

The effect of aqueous extract of Coccinia cordifolia L. on hyperprolactinemia induced infertility, endometriosis induced infertility and androgen-induced infertility was studied. The effect on serum estrogen level, serum progesterone level and reproductive tract was also evaluated in normal healthy female rats. The extract was administered orally at two different doses of 500 mg/kg and 1000 mg/kg.

Results

In hyperprolactinemia induced infertility model, the numbers of uterine implants were almost 10 times more in the extract treated groups as compared to control. The high dose of extract also produced a significant increase in serum estrogen levels (p < 0.01) and number of corpus luteum (p < 0.05) in healthy female rats. The extract at both doses was effective in reducing the weight of endometrial implants by 70–80%, but failed to induce fertility in rats with endometriosis. The extract was ineffective in inducing fertility in androgen-induced infertility model.

Conclusions

The aqueous extract of Coccinia cordifolia L. induces fertility in hyperprolactinemia induced infertility model in female rats.     

Blueprint for aligned data exchange for research and public health

Making EHR Data More Available for Research and Public Health (MedMorph) is a Centers for Disease Control and Prevention-led initiative developing and demonstrating a reference architecture (RA) and implementation, including Health Level Seven International Fast Healthcare Interoperability Resources (HL7 FHIR) implementation guides (IGs), describing how to leverage FHIR for aligned research and public health access to clinical data for automated data exchange. MedMorph engaged a technical expert panel of more than 100 members to model representative use cases, develop IGs (architectural and content), align with existing efforts in the FHIR community, and demonstrate the RA in research and public health uses. The RA IG documents common workflows needed to automatically send research data to Research Patient Data Repositories for multiple use cases. Sharing a common RA and canonical data model will improve data sharing for research and public health needs and generate evidence. MedMorph delivers a robust, reusable method to utilize data from electronic health records addressing multiple research and public health needs.     

Guidelines for buccal smear collection in breast-fed infants

Buccal smear analysis is a noninvasive, fast, and relatively inexpensive diagnostic method. It is used commonly where rapid gender identification is necessary or, more recently, for detection of aneusomy, microdeletion syndromes, and a variety of polymerase chain reaction–based molecular genetic tests. Previously we have shown that maternal cells can contaminate buccal smears taken from breast-fed infants, resulting in difficulty with test interpretation. The aim of this study was to determine optimal timing and technique for buccal smear collection in breast-fed infants in order to avoid diagnostic errors. We analyzed prospectively 50 breast-fed male infants for presence of cells with XX signal pattern from buccal mucosa scrapings at different times after breast feeding. The efficiency of mucosal cleaning on elimination of maternal cells was evaluated by comparing the proportion of XX cells before and after wiping of buccal mucosa with a cotton swab. Maternal cells were present in 23 of 48 (47.9%) samples collected within 5 min of feeding. The proportion of XX signal pattern was significantly (P = 0.001) reduced in samples collected at 30 min (8/48, P = 0.001) and ≥60 min (2/29, P = 0.0002) after feeding. Mucosal cleaning prior to smear collection significantly decreased the number of XX positive samples from 23 of 48 to 10 of 48 (P = 0.002). Buccal smears should not be obtained in nursing neonates until at least 60 min after breast feeding. In addition, prior to sample collection, buccal mucosa should be cleaned thoroughly with a cotton swab applicator. The same guidelines are applicable to older nursing infants. Am. J. Med. Genet. 84:357–360, 1999. © 1999 Wiley-Liss, Inc.     

Cytotoxic activity of marine macro‐algae on Artemia salina (Brine shrimp)

A total of 22 ethanol extracts of seaweed species (13 brown, 6 green and 3 red) collected from the Karachi coast were investigated for brine shrimp cytotoxicity. Of all the species, only six namely Stoechospermum marginatum, Sargassum swartzii, S. binderi, Spatoglossum asperum, Stokeyia indica (brown) and Caulerpa racemosa (green) showed significant activity. n‐Hexane‐soluble fractions of the ethanol extract of S. marginatum and S. swartzii were found to be responsible for the activity, whereas the methanol‐soluble fractions of S. asperum and S. binderi were most active. The water extract of S. indica and C. racemosa exhibited the most prominent activity (LC₅₀ value below 70 µg/mL) when compared with the ethanol extracts and their fractions. Cytotoxic activity may be due to the compounds differing in polarity. Copyright© 1999 John Wiley & Sons, Ltd.     

Original research: Gut-focused hypnotherapy for children and adolescents with irritable bowel syndrome

ObjectiveSevere irritable bowel syndrome (IBS) in school children and adolescents often leads to stigmatisation, social withdrawal, disrupted education and psychological distress. While there are few effective treatment options for IBS in this age group, gut-focused hypnotherapy (GFH) has shown promise in several trials. Unfortunately, GFH is not widely available, and clinical data outside of trials are scarce. Here, we evaluated outcomes from GFH in patients with IBS, aged ≤18 years, from a tertiary referral centre.Design/MethodConsecutive patients aged ≤18 years with severe IBS received 12 sessions of GFH, at weekly intervals, using the Manchester Protocol. Clinical outcomes data, including IBS Symptom Severity Score (IBS-SSS), Hospital Anxiety and Depression Scale (HADS), Non-colonic Symptom Score and Quality-of-Life (QoL) score, were collected prospectively, and compared pre-GFH and post-GFH. Clinical response was defined as ≥50 point reduction in IBS-SSS.Results32 young patients fulfilling Rome III diagnostic criteria for IBS (median age 16 (range 8–18) years, n=23/32 (72%) female individuals) completed GFH. At baseline, the mean duration of IBS was 5.9±0.9 years, and the mean IBS-SSS was 313±14. After GFH, 28/32 (88%) responded, with a mean overall reduction in IBS-SSS −159±16 (p<0.0001), and 24/32 (75%) achieved ≥30% reduction in abdominal pain scores. GFH also improved: non-colonic symptoms (p<0.0001), HADS-anxiety (p<0.0001), HADS-depression (p=0.0002) and QoL Scores (p<0.0001).ConclusionGFH is highly effective in children and adolescents with IBS. Early intervention with GFH in childhood IBS may reduce the subsequent burden of this problem in adults.