Nuclear factor erythroid-2-related factor 2 (Nrf2) is a stress-activated transcription factor regulating antioxidant genes, and a deficiency thereof, slowing lymphangiogenesis, has been reported in diabetic foot ulcer (DFU). The mode of Nrf2 regulation in DFU has been less explored. Emerging studies on miRNA-mediated target regulation show miRNA to be the leading player in the pathogenesis of the disease. In the present study, we demonstrated the role of miR-27b in regulating Nrf2-mediated angiogenesis in DFU. A lower expression of mRNA targets, such as Nrf2, HO-1, SDF-1α, and VEGF, was observed in tissue biopsied from chronic DFU subjects, which was in line with miR-27b, signifying a positive correlation with Nrf2. Similarly, we found significantly reduced expression of miR-27b and target mRNAs Nrf2, HO-1, SDF-1α, and VEGF in endothelial cells under a hyperglycemic microenvironment (HGM). To confirm the association of miR-27b on regulating Nrf2-mediated angiogenesis, we inhibited its expression through RNA interference-mediated knockdown and observed disturbances in angiogenic signaling with reduced endothelial cell migration. In addition, to explore the role of miR-27b and angiogenesis in the activation of Nrf2, we pretreated the endothelial cells with two well-known pharmacological compounds—pterostilbene and resveratrol. We observed that activation of Nrf2 through these compounds ameliorates impaired angiogenesis on HGM-induced endothelial cells. This study suggests a positive role of miR-27b in regulating Nrf2, which seems to be decreased in DFU and improves on treatment with pterostilbene and resveratrol.
The aim of the study is to identify UGI pathologies in patients with cholelithiasis and association of these pathologies with a relief of symptoms in cholecystectomy patients. The study was conducted in 150 patients, who attended the surgical outpatient block or referred to our department from other departments and also known case of cholelithiasis by imaging studies. They were divided into a typical or atypical group based on their symptomatic presentation. UGI scopy was done on these groups, 2 days prior to surgery. Postoperatively patients were followed up on 7th, 21st and 42nd day and pain if any was assessed by NRS scaling method. Following results were noted. A female preponderance was seen (96 (64%)). Determining on age, 51 % of cases were seen among 31-50 years. UGI scopy revealed UGI pathologies in 22 among 92 (24%) patients who had typical symptoms of biliary colic, while 47 of 58 (81%) atypical presentations had UGI pathologies. The most common UGI pathology was gastritis and duodenitis (42 of 69 (61%)). Medical management was initiated for these pathologies prior to surgery. Postoperatively on 7th day 114 (76%) had no symptoms and 36 (24%) were symptomatic, of which 25 (69.4%) of them were UGI Positive preoperatively. Medical Management for their Gastrointestinal pathologies was continued and reviewed on 21st day of surgery which showed symptom relief in 31 of 36 patients (86.1%) and relief of symptoms in remaining 5 by 42nd day of surgery. Hence, this study recommend preoperative UGI scopy in cholelithiasis, which will help in postoperative management.
BACKGROUND Gastrointestinal anastomosis plays a pivotal role in gastrointestinal surgeries. GI anastomosis can be done either by hand-sewn or stapler method. Recently stapling devices have created a great impact in GI anastomosis. Aim of this study is to compare the outcome of stapler versus hand-sewn anastomosis in elective GI surgeries. MATERIALS AND METHODS In this study, 50 patients requiring elective GI surgeries were included after satisfying the inclusion criteria. Patients were divided into four groups based on the site of anastomosis. Comparison between hand-sewn and stapled anastomosis in each group in terms of duration of anastomosis, duration of surgery, return of bowel activity, starting of oral feeds, acute postoperative complications and length of post-operative hospital stay were done. RESULTS In this study, we found significant difference between hand-sewn and stapler anastomosis in each group in terms of duration of anastomosis, duration of surgery, return of bowel activity, oral feeds starting day and length of postoperative hospital stay. It was stapled anastomosis that took lesser time for anastomosis, total operating time, return of bowel activity and length of hospital stay. Chi-square test was used to differentiate acute post-operative complications, which was insignificant between hand-sewn and stapler method with p-value > 0.05. CONCLUSION Due to shortened operating time, staplers are favourable for patients with poor general condition who would not tolerate prolonged anaesthesia. The insignificant difference in acute postoperative complications suggests both hand-sewn and stapled method can be done with same safety and accuracy when done with proper technique.
Background: Thyroid nodules are more common than previously realised, and the rate of prevalence is hugely impacted by the method of detection and their easy access. No single test is sufficient to access the thyroid nodule at any given time. Hence this necessitates the need for clinicians to use an evidence-based protocol for their assessment and diagnosis. Aims and objective: To determine the likelihood of malignancy in individuals who have thyroid nodules of any size, by a) performing a triple assessment, including a history and physical examination, an ultrasound of the neck and fine needle aspiration and cytology (FNAC) b) predicting the percentage of correlation between findings of malignancy on FNAC and final histopathological diagnosis c) identifying and validate individual risk factors in the clinical examination and ultrasound imaging that point towards a nodule being malignant Methods: Patients presenting with thyroid nodules in a clinically euthyroid state were studied over a time period of 18 months. Seventy-five patients were included in this study. Patients having external cytology and ultrasonography reports were reassessed if they consented to the study. If the pathologists thought the smears were sufficient, slide reviews were accepted. A senior consultant conducted the clinical evaluation. Prior to doing the FNACs, the designated radiologist performed the majority of the ultrasonograms. If the physicians believed it was necessary, ultrasound-guided FNACs were performed. According to Bethesda criteria, the cytology was reported. The outcome of the histopathological analysis was used as the gold standard for diagnosis in this investigation. Result: Out of 75 patients included in the study, the older age group (50-70) patients had mostly malignant lesions (92%). In the younger age group (20-39), about 77% had benign lesions. Benign lesions were more common in females than males according to the histopathology study. Seventy-three percent of fixed swellings turned out to be malignant. About 86% of patients who had extrathyroidal extension ended up being found to have malignant lesions but even 41% of patients who didn’t have any extrathyroidal extension also turned out to be having malignant lesions. However, the presence of pressure symptoms didn’t necessarily translate to being an indicator of malignancy. Ninety-seven percent of patients who had punctate microcalcifications turned out to have malignant lesions. Hypoechogenicity on imaging also is an important marker of malignancy, with about 87% of patients who had hypoechogenicity having malignant lesions proven on histopathology. All the patients who had solid lesions on imaging were proven to have malignant lesions. About 77% of patients who had cystic features ended up having benign lesions. Hence, it is a very significant marker. Intranodular vascularity, taller than wider lesions and positive lymph nodes on imaging were proven to have malignant lesions. FNAC is an important diagnostic tool. It is made ...
Trauma is the second largest cause of disease worldwide accounting for more than 16 % of global burden 1. By the next decade, the World Health Organization (WHO) estimates that trauma will be the leading cause of Years of Potential Life Lost (YPLL) amongst the world population. With advancement in infrastructure and economic prosperity, accidental trauma due to vehicular accidents has become more commonplace. A majority of victims of motor vehicular accidents present with Blunt abdominal trauma, which due to the complexity in diagnosis and management, presents with significant morbidity and mortality2. Introduced in the 1970s in Europe, point of care Ultrasonographic examination of the abdomen in trauma called as FAST (Focussed Assessment with Sonography for Trauma) has become a routine in emergency rooms worldwide 3. The Blunt Abdominal Trauma scoring system was developed to better diagnose intra-abdominal injury after blunt abdominal trauma 4. This study is aimed in comparing the findings of FAST and BATSS in predicting intra-abdominal injury accurately.
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