Volume 34, Issue 1

CAUTIs (catheter-associated urinary tract infections) continue to be one of the most common health-care-related illnesses in the entire globe. CAUTIs are the cause of 40% of all hospital-acquired infections and 80% of all nosocomial urinary tract infections (UTIs). A urine catheter is implanted into a high percentage of inpatients at some point during their hospitalization, and indwelling urinary catheter adoption likely to be on the rise. Urinary catheters, made of plastic materials, inhibit the urinary tract’s natural defence mechanisms and enhance the bacterial colonization or biofilm formation on the catheter surface, which may cause CAUTIs. It is associated with increased burden of disease, mortality, hospital bills and length of hospital stay. Therefore, to prevent these infections, technological innovations in catheter materials that limit biofilm formation will be required. Unfortunately, many health-care practitioners are unclear of the precise indications for bladder catheterization and accurate CAUTI criteria, which can lead to unnecessary catheterization, antibiotic overuse for asymptomatic bacteriuria and the spread of resistant organisms. As a result, we discuss CAUTIs in general, including definitions, pathophysiology, causation, indications for catheterization and a variety of effective CAUTI-fighting strategies.

Liver and heart are anatomically and patho-physiologically related. In heart failure (HF) the increased right atrial pressure and volume overload cause histological changes in hepatocytes, leading to a condition known as “congestive hepatopathy” (CH), with consequent variations in liver functioning and ultrasound (US) findings. CH has specifical US findings especially regarding venous vessels aspect, easily detecting by gray-scale study, but many others can be distinguished by Doppler analysis. Usually, hepatic veins look enlarged and hypocollassing, together with signs of portal hypertension (hepatomegaly, ascites, splenomegaly, porto-systemic collaterals). Typically, in CH Doppler findings regard alterations in venous vessel flow and arterial resistance (venous system hyperpulsatility, reduced velocity flow, high resistance index in hepatic arterial Doppler spectrum). Sometimes CH and other primary hepatopathy can coexist, and therefore some of the expected variations may not manifest: it allows suspecting an unknown underlying liver disease. At last, US technologies of more recent applications, even if not routinely used, allow investigating additional aspects such as elastography that detects changes in liver elasticity or contrastographic US, able to show differences in hepatic venous opacification. However, most of these US signs are not pathognomonic, and therefore a multidisciplinary clinical reasoning must not be lacking. The aim of the present review is to easily provide US signs of liver alterations in HF, in particular right heart failure with volume overload, suggesting including liver US in instrumental diagnosis and therapeutic monitoring of HF.

Objectives To report our data on the total body water (TBW), intracellular volume (ICV), extracellular volume (ECV), and fat-free mass (FFM) from studies using whole-body bioimpedance (BIA) with the aim of contrasting them to commonly cited reference values. Methods Data were retrospectively retrieved from three single-center studies of adult healthy male volunteers and one study of women scheduled for abdominal hysterectomy where multifrequency BIA had been applied to obtain measurements of TBW, ICV, ECV, and FFM. Results Based on measurements performed in 44 males, the TBW, ICV, ECV, and FFM represented 49.1 (4.9)%, 23.32 (3.1)%, 25.8 (2.2)%, and 67.4 (7.4)% of the BW, respectively (mean, SD). In 15 females, these volumes were 40.4 (4.5)%, 18.0 (2.1)%, 22.4 (2.6)%, and 55.6 (6.1)% per kg BW, respectively. The deviation of these measurements from the reference values increased linearly with body weight and age. Conclusions Body fluid volumes indicated by BIA showed that TBW amounted to 80% of the reference volume, which is 60% per kg BW in adult males. The ratio between the ICV and the ECV was approximately 1:1, while this ratio is traditionally reported to be 2:1.

Objectives Infertility has disastrous consequences, particularly for women. Causes of infertility in developed countries have been investigated but there is a significant lack of data among Indian female population. The aim of the present study was to analyze the causes and the proportion of the individual factors contributing to infertility, considering the age factor. Methods The data of 204 infertile women (18–45 years) were collected from the files in tertiary care hospitals. Causes and age of infertile women were grouped. The prevalence of each cause was evaluated. Data analysis was done using SPSS (Statistical Package for Social Sciences) version 17.0. Results Polycystic ovarian syndrome (PCOS) was the most common (14.71%) cause of female infertility. Ovulatory dysfunctions (25.55%) were the foremost cause in primary infertility, whereas in secondary infertility, uterine factors (26.86%) were most common. The incidence of primary and secondary infertility was more evident in patients who were more than 30 years of age. Conclusions Causes of infertility vary according to the age. The causes of female infertility were unexplained infertility, ovulatory disorders and uterine factors most commonly affecting women at ≤30 years.

Objectives Ovariectomy induces heightened response to vasoconstrictors, alters vasorelaxation and consequently causes hypertension due to increased oxidative stress in rats. Methods This study evaluated the ameliorative effects of ramipril and vitamin E, on primary haemodynamic parameters and cardiac antioxidant defence status, in ovariectomised rats using 64 adult female rats of the Wistar strain randomly divided as follows: Control (sham); Ovariectomised (OVX); OVX plus Ramipril; OVX plus vitamin E; and OVX plus Ramipril plus vitamin E. Results The plasma level of oestrogen was significantly lower (p<0.05), in the ovariectomised rats compared with the sham. The systolic, diastolic and mean arterial blood pressure of ovariectomised rats increased significantly (p<0.05), but the alteration was significantly reduced by the administration of ramipril alone or in combination with vitamin E. Significant decrease (p<0.05) was observed in the serum level of nitric oxide in OVX group compared with Sham. Also, analysed markers of oxidative stress: Malondialdehyde (MDA) contents and hydrogen peroxide (H 2 O 2 ) generated decreased significantly (p<0.05), but systemic antioxidants: reduced glutathione (GSH) contents; glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities increased significantly (p<0.05) in the ovariectomised rats treated with ramipril and vitamin E compared with untreated ovariectomised rats. The study concludes that alteration, in the primary haemodynamic parameters, associated with ovariectomy in rats is potently ameliorated by co-administration of the antihypertensive drug ramipril and vitamin E. Conclusions The supplementation of antihypertensive regimen with antioxidants such as vitamin E in the treatment of hypertension is therefore justifiable especially in ovariectomised or hypogonadal patients.

Objectives The aim of this study was to recognize the efficacy and safety of curcumin ointment on patients with knee osteoarthritis (OA) compare to diclofenac as standard medication. Methods The topical effects of curcumin (10%) and diclofenac (1%) ointments were assessed through the visual analog scale (VAS) and Western Ontario and McMaster Universities Arthritis (WOMAC) index after three times a day administration for two weeks in 60 patients. Results Desirable effects compared to the pre-treatment period were observed after two weeks of continuous treatment. Based on our results, VAS and WOMAC index were altered after treatment significantly (p<0.0001). Conclusions Two-week use of curcumin ointment could ameliorate the pain, stiffness and function disability in patients with OA.

Objectives Stress urinary incontinence is defined by a complaint of any involuntary loss of urine on effort or physical exertion or on sneezing or coughing and represents a major complication after radical prostatectomy. According to surgical technique, incidence of post-prostatectomy incontinence varies from open (7–39.5%), laparoscopic (5–33.3%) or robotic-assisted (4–31%) approaches. The ProACT ® device (Uromedica, Inc., MN) is a possible surgical option for the treatment of this condition. Methods We retrospectively analyzed surgical records of consecutive patients underwent ProACT ® implantation in our department between January 2006 to November 2010. We collected data at 6 and 12 months after surgical approach about the daily pad use, International Prostatic Symptoms Score and its quality of life domain. Results 42 patients were included in the final analysis. Most patients (92.9%) received minimally invasive surgery for treating prostate cancer. During the follow up after 6 and 12 months, the daily pad, International Prostatic Symptom Score and its quality of life domain significantly improved compared to preoperative outcomes. The logistic regression analysis found that presence of comorbidities was the only predictive factor of low satisfaction rate (PGE-I > 2) in patients who underwent ProACT ® implant. Conclusions ProACT ® implant represents an effective and safe treatment for post-prostatectomy stress urinary incontinence with a high satisfaction degree and a low rate of complications.

Objectives Metformin is widely used in type 2 diabetic patients as an antihyperglycemic drug. The aim of this study was to investigate the effect of metformin on the metabolism of vascular smooth muscle cells in high glucose conditions. Materials and methods The vascular smooth muscle cells were cultured in DMEM F12 containing glucose as high as 25 mM. The preconditioned cells were then treated with metformin in doses of 1, 5, and 7 mM for 24 h. MTT method was used to determine cell viability. Biochemical parameters including lactate, glucose, total protein, creatinine, and triglyceride were measured in the cell culture after the treatment with metformin. Oil Red O staining method was used to stain the lipids in the cells. Results Metformin reduced significantly (p<0.001) VSMC proliferation in a concentration-dependent manner. With the increase of glucose uptake by VSMCs, the cell lipid deposition was not changed. Other biochemical parameters such as lactate, triglyceride, total protein, and creatinine were significantly changed in the cell culture (p<0.05). Conclusions Metformin increased the glucose uptake impacting metabolic pathways in VSMCs. It also increased the lactate efflux and protein metabolism without the change in cellular lipid deposition in high glucose conditions.

Objectives Overweight status decreases the growth hormone (GH) secretion, thus, increasing the risk factors for medical complications. However, proper exercise is reported to enhance GH and affect the energy balance. Therefore, exercise is proclaimed to be an accurate and engaging therapy to increase GH in preventing overweight. This study aims to investigate the physiological response of exercise in mediating the increase of GH secretion in female adolescents. Methods 22 overweight women aged 19–20 years old, with maximal oxygen consumption of 27–35 mL/kg/min, were selected as sample size. They were divided into three groups, namely (CONT, n=7) Control, (MIEE, n=7) Moderate-intensity interval endurance exercise, and (MCEE, n=8) Moderate-intensity continuous endurance exercise. The exercise was carried out by running for 30–35 min using treadmills with an intensity of 60–70% HR max . The blood sampling for GH examination was carried out four times before exercise, 10 min, 6 h, and 24 h after exercise. The enzyme-linked immunosorbent assay (ELISA) was used to measure the GH and IGF-1 levels. The data analysis was carried out using a one-way ANOVA test, with a significance level of 5%. Results The results of the one-Way ANOVA test suggested a significantly different average GH and IGF-1 before and after the exercise between the three groups (CON, MIEE, and MCEE) (p≤0.05). Conclusions MCEE increases the GH and IGF-1 levels more considerably than MIEE. Therefore, exercise is a mediator to increase GH and IGF-1 secretion in overweight individuals. Exercise could be a viable therapy for overweight people.

Introduction Hypertension (HTN) is a common and growing public health challenge with severe risk factors. Hence, this study aimed to assess the effect of Om chanting and Yoga Nidra on depression, anxiety, stress, sleep quality and autonomic functions on individuals with hypertension. Methods This prospective randomized controlled study was conducted in patients with hypertension at Little Flower Medical Research Center. A total of 80 patients with diagnosed hypertension were recruited and randomized equally to either the experimental group or control group. The experimental group received a combination of Om chanting and Yoga Nidra for five days a week for two months. The control group participants continued with their regular conventional medications. Depression anxiety stress scale (DASS), Pittsburgh sleep quality index (PSQI) and heart rate variability (HRV) scores were assessed at baseline, 30 and 60 day for both the groups. Results A total of 34 subjects in the experimental group and 31 subjects in the control group were included in the analysis. There was a significant (p<0.001) reduction in depression, anxiety, stress, and a significant (p<0.001) improvement in PSQI and HRV parameters in the experimental group was observed as compared to the control group. No adverse events were reported during the trial period. Conclusions The current study validates the effectiveness of Om chanting and Yoga Nidra in reducing depression, anxiety, stress and improving sleep quality and autonomic functions in hypertensive patients. These interventions could thus be considered a safer form of complementary therapy in managing stress and hypertension.

Objectives The present study was undertaken to observe the effectiveness of electrical vestibular stimulation in improving cognitive functions in patients with Parkinson’s disease. Methods Randomized controlled trial (ClinicalTrials.gov Identifier: NCT04450550). 30 cases of PD, including both males and females were recruited in the study by convenient sampling after obtaining written informed consent. After recruiting, the participants were randomly assigned into two groups. The control group (n=15) received placebo stimulation whereas the intervention group (n=15) received electrical vestibular stimulation administered for 12 weeks. Auditory, visual reaction time and spatial and verbal memory were recorded before and after 6 weeks and after 12 weeks of intervention and compared. Results There was a significant improvement in both auditory and visual reaction time of right and left-hand responses. Also, significant improvement was observed in both the spatial and verbal memory of the patients. Conclusions There was a significant improvement in the auditory and visual reaction time and spatial and verbal memory in the participants after the electrical vestibular nerve stimulation administration. No side effects were reported by the study participants and they have expressed willingness to continue the intervention after the study period also. The study recommends further detailed studies with a higher sample size to adopt electrical vestibular nerve stimulation as adjunctive therapy in the management of Parkinson’s disease.

Objectives Disease progression of tuberculosis (TB) depends on the balance between the microorganism’s virulence and the host defense systems (mainly T cell-mediated immune response). Interleukin-22 (IL-22) helps in cell proliferation and regeneration and provides protection against microbial diseases. The IL-22-producing T cells can migrate into the granulomas during TB infection. However, disparity exists in literature regarding its role. The present study aims to compare serum IL-22 levels and its’ expression in TB patients and healthy controls. Methods 87 TB patients and 85 healthy subjects were enrolled in the study. Under aseptic conditions, venous blood was withdrawn. Serum IL-22 levels were estimated using enzyme-linked immunosorbent assay, and its gene expression was assessed using SYBR green-based quantitative PCR technology. A statistical analysis was performed using SPSS. Results The median (interquartile range) of serum IL-22 levels was significantly lower in TB patients (18.55 (5.08) pg/mL) when compared to controls (49.38 (162.88) pg/mL) (p<0.0001). The IL-22 expression was significantly upregulated with a fold change value of 29.44 in TB patients. Conclusions The IL-22 levels were found to be significantly decreased in patients, contradictory to its expression, which is upregulated. It plays a crucial role for the modulation of tissues in response to TB infection.

Objectives Aspirin is an anti-inflammatory drug commonly used as an analgesic and in cardiovascular disorders. However, many studies have highlighted its anti-cancer properties, especially in colorectal, lung, head and neck, and breast cancers. In this work, we tried to study the effect of aspirin on the TNF-α-mediated cell survival and death pathways in two cell lines representing two different subtypes of breast cancer. TNF-α-mediated stimulation of a cell can result in its proliferation via the NF-κB pathway or its death via either apoptosis or a programmed form of necrosis called necroptosis. The latter is believed to come into the picture only when apoptosis is inhibited. Methods In this work, we studied the effect of aspirin on the TNF-α-mediated cell survival pathway and observed a decrease in expression of the NF-κB pathway regulators, its nuclear translocation, and phosphorylation in a dose-dependent manner. The effect of aspirin on the TNF-α-mediated cell death showed significant cytotoxicity at the higher doses (5–20 mM) of aspirin in both the breast cancer cell lines. The effect of aspirin on necroptosis was investigated after stimulating the cells with TNF-α and inhibiting apoptosis using Z-VAD-FMK. Results Though no significant effect was noted in breast cancer cell lines, the above protocol successfully induced necroptosis in L929, i.e., a positive control cell line for necroptosis having an intact necroptosis machinery. Even when combined with the chemotherapeutic drugs, the above regime failed to induce any significant necroptosis in breast cancer cells but was found effective in L929. Conclusions Overall, the findings show that while aspirin has the potential to inhibit the TNF-α-mediated cell survival pathway, it does not help sensitize breast cancer cells to necroptotic cell death induction. Highlights – Treatment with aspirin resulted in significant cytotoxicity in both [ER+(T47D) and TNBC(MDA-MB-231)] cell lines used in our study, especially at higher doses. – Interestingly, the lower doses were observed to cause more necrosis or a mixed pattern of cell death, whereas the highest concentration led to predominant apoptosis. –Low-dose aspirin treatment caused significant inhibition of the TNF-α-mediated survival pathway by inhibiting the phosphorylation and nuclear translocation of the P65 subunit of NF-κB. – Though low-dose aspirin caused downregulation of pro-apoptosis molecules to some extent, there was no significant change in the expression of necroptosis pathway molecules in the breast cancer cell lines. – Also, the breast cancer cells showed resistance to induction of necroptosis using an aspirin-based protocol, although the same resulted in a significant increase in necroptosis in L929 cells. – In future work, a low-dose aspirin-based induction protocol can be exploited to cause cell death by necroptosis in those cancers with well-developed necroptosis machinery.

Objectives Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system characterised by orthostatic intolerance and orthostatic tachycardia without hypotension. Heart rate variability (HRV) is the most reliable and objective tool for assessing autonomic dysfunction severity. In the present study, we aimed to investigate HRV changes in resting supine position, predicting severity and cardiovascular risk in patients with POTS. Methods We compared 100 POTS patients with 160 healthy controls matched for age and gender in a case-control design. Along with clinical characterization, heart rate variability was evaluated using ambulatory 5 min ECG in lead II and expressed in frequency and time-domain measures. Results The resting heart rate of patients with POTS was significantly higher than that of healthy controls. In HRV measures, root mean square successive difference of RR intervals (RMSSD), total and high frequency (HF) powers were statistically lower with an increased low frequency (LF) to high-frequency ratio in patients with POTS compared to healthy controls. Further, stepwise logistic regression analysis showed increased basal HR and LF/HF as significant predictors of POTS and its severity. Conclusions This is the first study on a large cohort of patients with POTS from India wherein HRV was assessed. The study showed reduced parasympathetic activity and increased sympathetic activity in patients with POTS compared to healthy controls. These findings of increased resting heart rate and LF/HF were found to be potential predictors of POTS and future cardiovascular risks, which need to be replicated in a larger and more homogenized cohort.

Objectives To establish the effect of intensity of effort during Valsalva’s manoeuvre (VM) on blood pressure and heart rate responses. Methods Fourteen participants consisting of eight powerlifters and six controls completed four 15-s VMs at 30 and 50% maximum expiratory pressure. Expiratory pressure (EP), systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded continuously during manoeuvres and response amplitudes were related to well-established phases (I–IV). Results For all participants, SBP and DBP responses during Phase I were significantly higher at 50% EP max than 30% EP max . Phase II responses were significantly higher at 50% EP max than 30% EP max for HR (39.9 ± 24.3 vs. 24.5 ± 12.5 bpm), SBP (43.6 ± 24.6 vs. 35.3 ± 18.3 mm Hg) and DBP (26.7 ± 7.1 vs. 21.1 ± 7.4 mm Hg). For Phase IV, only the HR response was affected significantly by intensity. These intensity-dependent effects were similar between powerlifters and controls. Powerlifters had significantly greater Phase II responses (HR, SBP and DBP), but in the whole group these cardiovascular responses were also significantly correlated with expiratory pressure (mm Hg) at 30% EP max (r=0.59–0.84) and 50% EP max (r=0.53–0.82) which was higher in powerlifters than controls. Conclusions This study demonstrates that heart rate and blood pressure responses during Phase II are affected by the relative intensity of VM, whereas during Phase IV only heart rate is affected. The higher Phase II responses in powerlifters can be attributed to the higher expiratory pressures they developed.