Medical Research Institute Research Articles

Responsive service design and workforce strengthening: Recommendations to improve aged care for Aboriginal and Torres Strait Islander peoples.

This study aimed to develop innovative and practical strategies and recommendations for aged care policy and practice that support the needs of Aboriginal and Torres Strait Islander peoples. A research symposium was held in June 2023 on Kaurna Country at the South Australian Health and Medical Research Institute. The symposium brought together 70 attendees including aged care consumers, Federal and State Government representatives, advocacy services, health, aged care and social service providers, and health and aged care researchers. Two roundtable sessions titled 'Responsive Service Design' and 'Workforce Strengthening' were conducted following a World Café approach. Data were analysed thematically. This paper proposes recommendations relating to innovation and improvement within aged care policy and practice. Recommendations for responsive service design and workforce strengthening include the following: (1) promote genuine engagement and involvement, (2) establish partnerships between sectors, (3) ensure compliance, (4) innovative communication and feedback pathways, (5) holistic approaches to well-being, (6) prioritise cultural safety and (7) flexible recruitment and retention strategies. Working together and building partnerships between diverse stakeholders including community members, workforce, service providers and policymakers is required for sustainable and meaningful innovation within the aged care sector. Our recommendations, driven by community needs, provide an opportunity to ensure the innovation and implementation of ongoing aged care reforms meet the needs and expectations of Aboriginal and Torres Strait Islander peoples.

FOSFOMYCIN SUSCEPTIBILITY IN MULTIDRUG-RESISTANT UROPATHOGENS: A RETROSPECTIVE STUDY IN THE ERA OF ANTIMICROBIAL RESISTANCE

Objective: Urinary tract infection (UTI) is one of the most prevalent clinical entities affecting people worldwide. The accelerating rate of Antimicrobial resistance due to the unimpeded and rampant use of antimicrobials with over-the-counter availability of drugs has limited the therapeutic options for the treatment of UTIs. Fosfomycin, an old broad-spectrum antimicrobial with good pharmacokinetics has regained importance for the treatment of multidrug-resistant (MDR) isolates. The purpose of this study was to determine the in vitro Fosfomycin susceptibility of common uropathogens and to study the resistance pattern of these organisms against commonly prescribed antimicrobial agents. Methods: A retrospective cross-sectional study was conducted in the Bacteriology section of the Microbiology laboratory at Adesh Institute of Medical Sciences and Research, Bathinda, Punjab for duration of 6 months from December 2022 to May 2023 from urine samples received from all clinically suspected cases of UTI. Samples were processed immediately as per standard microbiological techniques, followed by culture by a semi-quantitative method. Kass criteria was followed for interpretation of significant bacteriuria according to which significant growth was considered if the colony count was more than 105 colony forming units (CFU)/mL. Culture positives were analyzed by Gram staining and on the basis of colony characteristics, Gram staining, final identification, and Antimicrobial Susceptibility were done through Vitek 2 compact system. Results: A total of 2292 urine samples received in the Microbiology laboratory were processed and cultured during the study period, which yielded 509 significant bacterial isolates i.e.509/2292 (22.2%) culture positivity. Among 509 culture-positive samples, Escherichia coli 235/509 (46.1%) was the most common uropathogens isolated followed by Klebsiella pneumoniae 107/509 (21.1%), Enterococcus species 40/509 (7.8%). Fosfomycin depicted good in vitro susceptibility of a minimum of 94% in both Gram-negative and Gram-positive uropathogens as compared to Nitrofurantoin, which showed sensitivity of 74% and 85%, respectively. Maximum resistance was observed toward Cephalosporins i.e., Ceftriaxone in E. coli (60%) and K. pneumoniae (64%), respectively, followed by 50% in Acinetobacter baumannii. Maximum resistance to Ciprofloxacin (62%) was seen in case of A. baumannii. 172/405(42.4%) isolates of Enterobacteriaceae family were extended-spectrum β-lactamase (ESBL) producers with an average Fosfomycin susceptibility of 95.9%. Among the total isolated uropathogens, 135/509 (26.5%) were MDR, out of which 116/135 (85.9%) depicted Fosfomycin susceptibility. Metallo-beta-lactamase (MBL) production was seen in 14.3% of the isolated Gram-negative uropathogens. 63/73(86.3%) of the MBL producers were found susceptible to Fosfomycin. Conclusion: Fosfomycin has emerged as an effective alternative for the treatment of common uropathogens including the MDRs, ESBL producers, and the MBLs in the era of increasing antimicrobial resistance. It has the potential to act as a promising oral agent for the treatment of UTI in both community and healthcare setups.

Assessing the antiproliferative properties of various teas against the DU-145 prostate cancer cell line: A combined in vitro and in silico investigation

BackgroundPhytotherapy emerges as a promising solution to the challenges posed by cancer treatment. Black, green, and purple teas, renowned for their antioxidant properties, exhibit efficacy against various cancers, including prostate cancer. Study DesignThis was an experimental study conducted from the Kenya Medical Research Institute (KEMRI). Aim of the Studythe present study aimed to evaluate the Cytotoxic effect of black, green and purple teas against prostate cancer cell line DU-145 and in silico prediction of Tea catechins interaction with prostate cancer proteins such as 3D-crystal structures of Androgen-receptor(5T8E) and Human p38 MAPK(1KV2). MethodsThe study started by quantifying tea catechins (Epigallocatechin gallate (EGCG), Epigallocatechin EGC, Epicatechin gallate (ECG) and Epicatechin (EC) with high-liquid chromatography (HPLC), cytotoxicity analysis of black, green and purple tea crude extracts against DU-145 cell line at 24hr and 48 hrs by Resazurin assay and molecular docking was performed with Autodock Vina 1.1.2 software. ResultsEGCG appeared the most predominant catechin with 552.2 ± 10.61 (mg g-1 DW) while EC was the lowest detected with 118.08 ± 9.45 (mg g-1 DW). Purple tea extract exhibited high antiproliferative activity with IC50 of 98.69±1.99 µg/ml at 24hr and 91.21±6.91 µg/ml at 48hr, green tea followed with 121 ± 5.97µg/ml at 24hr and 107.1 ± 2.03 µg/ml at 48hr IC50; black tea was the least effective tea at both 24hr and 48hr with IC50 of 290.8 ± 2.46µg/ml and 237.8 ± 5.59µg/ml respectively. Prediction of catechin target genes and Prostate cancer (Pca)-related genes discovered 121 catechin target genes and 34,926 Pca-related genes. EGC exhibited high binding interaction to 5T8E with the lowest affinity of -9.1Kcal/mol followed by EGCG at -8.4 (Kcal/mol then EC with -8.2 (Kcal/mol) and EGC at -8.1 (Kcal/mol). Catechins interaction with 1KV2 was in the following order EGCG (-9.4 Kcal/mol) ˃ECG (-8.2 Kcal/mol) ˃EC (-8.2 Kcal/mol) ˃EGC (-8.1 Kcal/mol). ConclusionIn vitro experiment detected a very significant antiproliferative activity of black, green and purple tea crude extracts against the DU-145 cell line; furthermore, in silico analysis revealed a strong binding interaction with proteins associated with prostate cancer, indicating that black, green, and purple teas, along with catechins, hold promise as potential herbal remedies for combating prostate cancer.

Physiologists as medical scientists: An early warning from the German academic system.

"Medical scientists" are postgraduate investigators who are engaged in biomedical research, and either hold a biomedical PhD or are qualified in medicine but do not participate in patient care. Medical scientists constitute ~40% of staff at medical faculties and >90% at nonuniversity medical research institutions in Germany. However, medical scientists in Germany face limited long-term career prospects and a lack of dedicated training and support programmes. They also face time limits on their career progression arising from national academic employment legislation, and imminent reforms by the German government are likely to make this worse. Nevertheless, recent developments in the educational landscape including the introduction of increasingly focused MSc, pre-PhD, and doctoral programmes to train medically aware basic scientists, as well as improved general recognition of the roles and relevance of medical scientists in health research, are encouraging. Physiologists have taken essential steps to improve the recognition of medical scientists in Germany by introducing a "specialist physiologist" qualification; this initiative could be applied to support medical scientists in other fields and countries. In this review, we describe the particular challenges facing medical scientists in Germany and make recommendations that may apply to other academic systems.

Study of prescribing pattern of drugs in the management of migraine with psychiatric comorbidities at integral institute of medical science and research

Background: Migraine headaches, a prevalent and serious brain condition, often coincide with mental health issues. This study aims to explore drug prescribing patterns for migraine patients with psychiatric comorbidities. Methods: Over six months, a prospective observational study was conducted at the psychiatric department of IIMS&R Hospital. 100 prescriptions were analyzed based on specific criteria. Results: Total 14 different drugs were prescribed. NSAIDs were most common (87%), followed by multivitamins (50%), benzodiazepines (30%), and tricyclic antidepressants (23%).Naxdom (NSAIDs) was frequently used (87%). Patients aged 31-45 years had higher prevalence. Comorbidities associated are depression (18%), anxiety disorder (10%), insomnia (5%). Conclusions: The study highlights various orally administered drugs, including anti-migraine meds, antidepressants, anticonvulsants, and more. Patients within the 31-45years age group were significantly affected. Migraine correlated with depression, anxiety, and insomnia. The most common medication was naxdom 250mg taken orally.

A Comparative Study of Tackers Versus Sutures in Transabdominal Preperitoneal Hernia Repair: Tackers Versus Sutures in Mesh Fixation and Peritoneal Closure in Tapp

Background: This study evaluates the surgical outcomes of using tackers versus sutures for mesh fixation and peritoneal closure in transabdominal preperitoneal (TAPP) mesh repair of inguinal hernia, focusing on postoperative pain, quality of life, and other key metrics. Although there are many studies in studying various outcomes of Transabdominal preperitoneal mesh repair (TAPP), there exists only few trials that compare peritoneal closure techniques in TAPP Methods: A prospective comparative study was conducted at Mahatma Gandhi Medical College and Research Institute. Sixty patients undergoing TAPP were divided into two groups: one using non-absorbable sutures and the other using non-absorbable titanium tackers for mesh fixation and peritoneal closure. Intraoperative and postoperative outcomes were assessed, including time taken for procedures, postoperative pain (measured using the Visual Analog Scale), incidence of seroma formation, and short-term quality of life assessed using the Carolinas Comfort Scale. Results: The suture group demonstrated significantly less postoperative pain on postoperative day (POD) 1 and at 3 months compared to the tacker group (p=0.001 and p=0.004, respectively). The time taken for mesh fixation and peritoneal closure was shorter in the tacker group, but the overall operative time was significantly longer in the suture group (p=0.001). The cost of using sutures was substantially lower than tackers. Quality of life scores at 3 months indicated better outcomes in the suture group (p=0.001). Conclusions: Sutures for mesh fixation and peritoneal closure in TAPP repair provide better postoperative outcomes in terms of pain, quality of life, and cost compared to tackers, despite a longer operative time. These findings suggest that sutures may be a preferable option for TAPP inguinal hernia repair.

Prioritising Patients and Planet: Advocating for Change in Respiratory Care

The global burden of respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD), continues unabated. Suboptimal management places a significant strain on both patients and urgent or emergency care services. With an ageing population in many countries, the demand for these services is set to increase further. At the same time, healthcare systems are striving to reduce their carbon footprint and achieve net zero emissions, as the healthcare sector is a significant contributor to carbon emissions worldwide. Although these two goals may appear contradictory, they need not be in conflict. This article reviews an industry-sponsored symposium held at the European Respiratory Society (ERS) Congress 2024 in Vienna, Austria, in September 2024. The session addressed the urgent need to change the delivery model for respiratory healthcare in response to the increasing prevalence of respiratory diseases and the challenges posed by climate change. Co-chair John Hurst, Professor of Respiratory Medicine at University College London (UCL), UK, underscored the importance of innovative solutions for managing respiratory diseases and highlighted the challenges faced by healthcare decision-makers. This was further elaborated on by Omar Usmani, Professor of Respiratory Medicine at Imperial College London, UK, who emphasised the importance of clinical choice. He stated that inhaled medicines, which form the cornerstone of treatment, should not be considered interchangeable. He also discussed ongoing efforts to maintain access to essential medicines by developing novel next-generation propellants (NGP) for pressurised metered-dose inhaler (pMDI) devices, which will reduce their carbon footprint to levels comparable with dry powder inhalers (DPI). Additionally, he described the European Chemicals Agency (ECHA) proposal to restrict a broad range of chemicals classed as per- and polyfluoroalkyl substances (PFAS). This precautionary measure would affect both current propellants in pMDIs and the transition to NGPs, with global implications for inhaled medicines. Erika Penz, Associate Professor of Respirology, Critical Care, and Sleep Medicine at the University of Saskatchewan, Canada, noted that suboptimal management of respiratory disease is associated with a disproportionately high burden on both patients and the environment. The forthcoming availability of pMDI medicines with NGPs alone will not resolve this larger issue. As every healthcare interaction carries a carbon footprint, which increases with the intensity of treatment, the implementation of guidelines into clinical practice would improve patient outcomes and reduce the demand on healthcare services and the associated carbon emissions. Co-chair Helen Reddel, Clinical Professor and Research Leader at the Woolcock Institute of Medical Research, Australia, concluded by re-emphasising the urgent need to implement guidelines immediately for the benefit of both patients and the environment.

Single nucleotide polymorphism (SNP) characterisation of mouse inbred strains bred at MRC-National Institute for Medical Research.

Inbred mouse strains have long proved useful as tools for biomedical research. They remove the effects of genetic background as an experimental variable. Within all mouse colonies, genetic drift is a recognised phenomenon and monitoring and documenting changes is important for experimental design and consistency. This communication documents the initial characterisation through SNP analysis of the inbred mouse strains bred and used at the time at the Medical Research Council National Institute for Medical Research (MRC-NIMR), Mill Hill, now The Crick Institute. These inbred strains were part of the foundation colonies for the many genetically modified mouse strains made at Mill Hill. We found small genetic changes in four of the nine inbred strains. Although phenotypic differences have not yet been found between the NIMR and the correspondent parental strains, I cannot discard that these may arise or have already arisen. This work has also authenticated the 129/SvJEvNimr-Gpi1c strain that was widely used at MRC-NIMR for gene targeting. All these inbred strains have been renamed according to The International Committee on Standardized Genetic Nomenclature for Mice.

Investigation of probable Salmonella outbreak in the National Cancer Institute, Sri Lanka

Abstract Background An outbreak is the occurrence of case of disease in excess of what would normally be expected in a defined community. Outbreaks in immune compromised population can lead to devastating morbidity and mortality. Infection prevention and control (IPC) team has a pivotal role in both averting and managing outbreaks in health care settings. There were 7 cases of Salmonella spp, isolated from blood and stools since 12th July 2023 up to 11th August. Assuming of a possible outbreak, IPC team decided to investigate in order to find a possible source for the outbreak. Methods As soon as the outbreak was confirmed, immediate relevant control measures were taken after studying the available information. Working case definitions was constructed with clinical criteria and laboratory criteria with restrictions by time, place and person. Different categories of case definitions were used as the diagnosis was uncertain, such as “confirmed”, “probable” and “possible”. Active surveillance was conducted to collect information on additional case. Data collection tool was prepared with demographic information, clinical information and risk factor information. Then more cases were detected and line listing was created to organize important information for the investigation. Epidemic curve was drawn to see the pattern of spread and it was an irregularly jagged curve which interprets as intermittent common source epidemic. Specific control and prevention measures were implemented. Inquiries were made regarding the dietary intake of the patients over the last seven days and it was difficult to find a common source of food item however, all patients have consumed food prepared in the hospital kitchen. Therefore an audit was conducted in the hospital kitchen to identify probable source. Kitchen staff was educated about the food safety measures and personal hygiene. Kitchen staff was screened for Salmonella carrier state in their stool. Quality of the water from the kitchen and wards was checked for fecal contamination. No residual food was available for microbiological testing. Hypothesis was formulated to gather information after discussion with patients and staff. Findings were communicated to all relevant parties including Director and clinicians in the hospital. Salmonella isolates were sent to the Enteric Reference Laboratory, Medical Research Institute, Colombo for serotype identification. Results It was difficult find a common source. There were some malpractices in the kitchen and those were corrected immediately. Water quality in the hospital was satisfactory. Kitchen staff were not colonized with salmonella. However egg supplier to the kitchen was changed recently and eggs were supplied last minute and the eggs were not washed prior to cooking. Three isolates sent to the reference laboratory were identified as Salmonella Weltevreden, one as Salmonella Enteritidis, while the remaining three isolates could not be identified to serotype level with the available resources. Conclusion The exact contributory factor to the outbreak remained elusive. However, numerous food safety issues which can lead to cross contamination during the preparation of food were identified. Consequently, prompt investigation and control measures are essential to prevent further food borne outbreaks.

Pattern Of Medicolegal Cases Reported At Sri Madhusudan Sai Institute Of Medical Sciences And Research

Introduction: A medico-legal case is a case of injury or illness where the attending doctor, after eliciting history and examining the patient, thinks that some investigation by law enforcement agencies is essential to establish and fix responsibility for the case in accordance with the law of the land. Medico-legal cases are an integral part of medical practice that is frequently encountered by medical officers working in emergency department. Aims and Objectives: To analyze the pattern of medico-legal cases presented to the casualty at Sri Madhusudan Sai Institute of Medical Sciences and Research. Materials and Methods: This is a retrospective study of medico-legal cases registered in a casualty of Sri Madhusudan Sai Institute of Medical Sciences and Research, Muddenahalli, chikkaballapura, Karnataka for a period of one year from1st Janaury2023 to 31st December 2023. Results: Of the 218 cases, 171 were men and 47 were women with RTA constituting 66.05% (144 cases) of the cases and poisoning with 08.71% (19 cases) of the cases forming most of the case profile. Conclusion: The Casualty of Sri Madhusudan Sai Institute of Medical Sciences and Research deals with a reasonable number of MLCs due to the large semi urban to rural population and easy accessibility from nearby areas. The clinical forensic medicine branch should be developed well to deal with MLC documentation for the administration of proper justice in the court of law at a later stage.

A Clinicopathological Analysis of Membranous Nephropathy and Its Correlation With the Immunohistochemical Expression of Phospholipase A2 Receptor (PLA2R) in Renal Biopsies in a Tertiary Care Center.

Background Membranous nephropathy (MN) is the second most common adult-onset nephrotic syndrome worldwide. Traditionally, these were classified as primary and secondary, with primary causes showing higher positivity for various antigens, includingM-typephospholipase A2 receptor (PLA2R), a key antigen located in the podocyteagainstwhich antibodies are directed. Aim The aim of this study is to analyze the cases diagnosed as MN with clinicopathological parameters and PLA2R positivity by immunohistochemistry in renal biopsies. Methods A retrospective observational study of 65 cases of MN diagnosed in renal biopsiesby light microscopy and confirmed by ancillary studies from the Department of Pathology, Sri Ramachandra Medical College and Research Institute over a period of three years (2021-2023). The demographic profile and patient details were obtained from the hospital information system and archival case files.The description of categorical variables was expressed as frequency and percentage. The Chi-squared test and Fisher's exact test were employed to compare the distribution of qualitative variables between the groups. Results This case study includes 65 membranous nephropathy cases, of which 47.7% were diagnosed as primary MN and 52.3% as secondary MN. Of these, serum antinuclear antibody (ANA) positivity was seen in 80.6% of cases of primary MN and 58.8% of cases of secondary MN. Elevated serum C3/C4 levels were noted in 51.6% of primary MN and 47.1% of secondary MN (Ref. C3 = 90-180mg/dl; C4 = 10-40mg/dl). Immunofluorescence for IgG showed a nonspecificassociation between primary and secondary MN. Immunohistochemistry (IHC) for PLA2R showed positivity in 72.3% of primary MN cases and 27.7% of secondary MN cases. The Chi-squared test and Fisher's exact test showed statistical significance for these parameters. Conclusion This study signifies that primary MN is more frequently associated with positive immunohistochemical expression of PLA2R. These findings help in characterizing these cases as antigen-specific and have helped in the ongoing validation ofPLA2R IHC as a diagnostic marker, which aids in monitoring the disease progression, remission, and recurrence. Despite the availability ofvarious modalities for estimating the levels of anti-PLA2R, diagnostic challenges persist. Hence, most renal laboratories continue to adopt renal biopsy stainingfor IHC PLA2R to identify and monitor the disease progression.

8236 Hepatocyte Vitamin D Receptor (VDR) Regulates Liver Regeneration

Abstract Disclosure: J.E. Gunton: None. Harendran Elangovan [1], Rebecca A. Stokes [1], Jeremy Keane [1], Sarinder Chahal [1], Caroline Samer [1], Miguel Agoncillo [1], Josephine Yu [1], Jennifer Chen [1], Michael Downes 2, Ronald M. Evans 2, Christopher Liddle [1],2, Jenny E. Gunton [1] [1]Centre for Diabetes, Obesity and Endocrinology, The Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia 2 Salk Institute for Biological Studies, La Jolla, CA. USA Background: Vitamin D signals through the vitamin D receptor (VDR) to induce its end-organ effects. Hepatic stellate cells control development of liver fibrosis in response to stressors and vitamin D signaling decreases fibrogenesis. VDR expression in hepatocytes, however, is low in healthy liver, and the role of VDR in hepatocyte proliferation is unclear. Methods: In these studies, hepatocyte-VDR null mice (hVDR) were used to assess the role of VDR and vitamin D signaling in hepatic regeneration. Mice underwent 2/3 partial hepatectomy and liver regeneration and function were studied. Results: hVDR mice had impaired liver regeneration with impaired hepatocyte proliferation. This was associated with significant differential changes in bile salts. Notably, mice lacking hepatocyte VDR had significant increases in expression of conjugated bile acids after partial hepatectomy, consistent with failure to normalize hepatic function by the 14-day time point tested. CDCA (chenodeoxycholate) is an FXR ligand, which was increased after surgery in controls but not in hVDR mice. FXR signaling is important for hepatocyte proliferation. Real-time PCR of hVDR and control livers showed significant changes in expression of cell cycle genes including cyclins D1 and E1 and cyclin-dependent kinase 2. Gene expression profiling of hepatocytes treated with vitamin D or control showed regulation of groups of genes involved in liver proliferation, hepatitis, liver hyperplasia / hyperproliferation and liver necrosis / cell death. Conclusions: Together these studies demonstrate an important functional role for VDR in hepatocytes during liver regeneration. Combined with the known profibrotic effects of impaired VDR signaling in stellate cells, these studies provide a mechanism whereby vitamin D deficiency would both reduce hepatocyte proliferation and permit fibrosis, leading to significant liver compromise. Presentation: 6/2/2024

Comparative Electroencephalographic Profile of a New Anesthetic and Anticonvulsant That Is Selective for the GABAAR Slow Receptor Subtype.

Anesthetics like propofol increase electroencephalography (EEG) power in delta frequencies (0.1-4 Hz), with a decrease of power in bandwidths >30 Hz. Propofol is nonselective for gamma amino butyric acid type A receptor subtypes (GABAAR) as it enhances all 3 GABAAR subtypes (slow, fast, and tonic). Our newly developed anesthetic class selectively targets GABAAR-slow synapses to depress brain responsiveness. We hypothesized that a selective GABAAR-slow agonist, KSEB 01-S2, would produce a different EEG signature compared to the broad-spectrum GABAAR agonist (propofol), and tested this using rat EEG recordings. Male rats were studied after Institutional Animal Care and Use Committees (IACUC) approval from the US Army Medical Research Institute of Chemical Defense and the University of Michigan. Rats were anesthetized using isoflurane (3%-5% induction, 1%-3% maintenance) with oxygen at 0.5 to 1.0 L/min. Stainless steel screws were placed in the skull and used to record subcranial cortical EEG signals. After recovery, either propofol or KSEB 01-S2 was administered and effects on EEG signals were analyzed. As previously reported, propofol produced increased power in delta frequencies (0.1-4 Hz) compared to predrug recordings and produced a decrease in EEG power >30 Hz but no significant changes were seen within ±20 seconds of losing the righting reflex. By contrast, KSEB 01-S2 produced a significant increase in theta frequency percent power (median 14.7%, 16.2/13.8, 75/25 confidence interval; to 34.7%, 35/31.8; P < .015) and a significant decrease in low gamma frequency percent power (16.9%, 18.6/15.8; to 5.45%, 5.5/5.39; P < .015) for all rats at ± 20 seconds of loss of consciousness (LOC). Both anesthetics produced a flattening of chaotic attractor plots from nonlinear dynamic analyses, like that produced by volatile and dissociative anesthetics at LOC. KSEB 01-S2 produced a markedly different EEG pattern, with a selective increase observed in the theta frequency range. KSEB 01-S2 also differs markedly in its activity at the GABAAR-slow receptor subtype, suggesting a possible mechanistic link between receptor subtype specificity and EEG frequency band signatures. Increased theta together with depressed gamma frequencies is interesting because GABAAR slow synapses have previously been suggested to underlie theta frequency oscillations, while fast synapses control gamma activity. These reciprocal effects support a previous model for theta and nested gamma oscillations based on inhibitory connections between GABAAR fast and slow interneurons. Although each anesthetic produced a unique EEG response, propofol and KSEB 01-S2 both increased slow wave activity and flattened chaotic attractor plots at the point of LOC.

Generative artificial intelligence usage by researchers at work: Effects of gender, career stage, type of workplace, and perceived barriers

The integration of generative artificial intelligence technology into research environments has become increasingly common in recent years, representing a significant shift in the way researchers approach their work. This paper seeks to explore the factors underlying the frequency of use of generative AI amongst researchers in their professional environments. As survey data may be influenced by a bias towards scientists interested in AI, potentially skewing the results towards the perspectives of these researchers, this study uses a regression model to isolate the impact of specific factors such as gender, career stage, type of workplace, and perceived barriers to using AI technology on the frequency of use of generative AI. It also controls for other relevant variables such as direct involvement in AI research or development, collaboration with AI companies, geographic location, and scientific discipline. Our results show that researchers who face barriers to AI adoption experience an 11 % increase in tool use, while those who cite insufficient training resources experience an 8 % decrease. Female researchers experience a 7 % decrease in AI tool usage compared to men, while advanced career researchers experience a significant 19 % decrease. Researchers associated with government advisory groups are 45 % more likely to use AI tools frequently than those in government roles. Researchers in for-profit companies show an increase of 19 %, while those in medical research institutions and hospitals show an increase of 16 % and 15 %, respectively. This paper contributes to a deeper understanding of the mechanisms driving the use of generative AI tools amongst researchers, with valuable implications for both academia and industry.

Natural History and Microbiological Profiles of Patients With Acute Pancreatitis With Suspected Infected Pancreatic Necrosis.

Acute pancreatitis (AP) is a prevalent emergency. The clinical spectrum of the condition is varied, ranging from a mild to a malignant course with higher mortality rates. Infection of pancreatic/peri necrosis, extrapancreatic infections, and organ failure are significant complications in AP. In the recent era, microbiological composition has shifted more towards multi-drug-resistant organisms due to irrational antibiotic use. This study aims to understand the natural history of patients with suspected infected pancreatic necrosis (IPN), the prevalence of multi-drug-resistant organisms (MDROs), and their antibiotic susceptibility patterns. This prospective, observational study was performed on 130 cases of acute necrotizing pancreatitis (ANP) with suspected IPN that were evaluated during their period of admission in the department of gastroenterology, emergency medicine, or surgery ward of thePostgraduate Institute of Medical Education and Research, Chandigarh, India, a tertiary hospital. The details of outcomes were recorded. The organisms in cases with IPN and antibiotic resistance patterns of various organisms were studied. The most prevalent site of necrosis was combined pancreatic and peripancreatic tissues in 111 (85.4%) patients. The computed tomography severity index (CTSI) had a mean of 8.72±1.43. Of all participants, 36 (27.7%) patients had <30% necrosis, 47 (36.2%) had 30%-50% necrosis, and 47 (36.2%) had >50% necrosis. Overall, 80 (61.5%) patients had organ failure, with acute lung injury (ALI) being the most common. Rates of complications were markedly greater in cases with higher pancreatic necrosis and with infected necrosis (p<0.05). The most common organism isolated from necrotic tissue was Escherichia coli (E. coli) in 17 (32.07%) cases, followed by Acinetobacter baumannii (A. baumannii) in 12 (22.64%) cases. The most common extrapancreatic infection site was respiratory tract infections. Pseudomonas aeruginosa (P. aeruginosa) and A. baumannii revealed maximum resistance to most of the drugs. Conclusion: Infected pancreatic necrosis is linked to high rates of morbidity and mortality. Our study suggests that irrational usage of antibiotics increases the incidence of combined infection, especially with higher rates of multi-drug-resistant infections.

Neck Circumference: A Novel Anthropometric Tool for Screening Obesity Among Young Adults

Background: Obesity is a global health concern characterized by excessive fat accumulation, posing significant health risks that affect all age groups. Particularly among young adults, including medical students, obesity can lead to physical and psychosocial consequences, emphasizing the need for effective screening. The study was conducted to evaluate the effectiveness of using neck circumference as a screening tool for detecting obesity among young adults by assessing its correlation with other anthropometric measurements and determining the appropriate cut-off points Methodology: A cross-sectional study was conducted among 146 medical students at the Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh. Data were collected using a semi-structured questionnaire and various anthropometric measurements, including neck circumference. Results: Neck circumference was higher among males, with a mean of 34.4±2.1cm for males and 30.2±1.9cm for females. Neck circumference showed significant positive correlations with height, weight, Body Mass Index, waist-hip ratio, hip and waist circumference. Neck circumference is proposed as a screening tool for assessing obesity among young adults, with cut-off values of 34cm for males and 30cm for females. Conclusions: Neck circumference is an effective screening tool for obesity among young adults, correlating with conventional anthropometric measures.

Pixel to Pathology: A Prospective Cross-Sectional Study on the Role of Multidetector Computed Tomography in the Evaluation of Malignant Large Bowel Lesions With Histopathological Correlation.

Colorectal lesions can present as a mass or as focal or diffuse thickening of the colon wall and may also be associated with abnormalities in the perienteric region. Multidetector computed tomography (MDCT) enables simultaneous imaging of both extracolonic structures and the gut wall. It is instrumental in assessing tumor extent, detecting pericolic dissemination, including lymph node involvement, and identifying metastases. This study aims to evaluate the role of MDCT in diagnosing large bowel lesions in patients referred from the surgery department with suspected large bowel pathology and to correlate MDCT findings with histopathological results. In the Department of Radiodiagnosis at Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, this study was carried out from February 2023 to January 2024 over a one-year span. CT imaging was carried out utilizing a GE Optima 128 Slice MDCT scanner for instances of clinically suspected large bowel pathology. IV contrast, rectal, oral (positive), and plain CT were the imaging protocols that were used. Thirty of the 45 patients were female, and 15 were male; most of the patients were in the 46-60 age range. Twenty-three of the 24 instances with a CT diagnosis of malignancy had a histological confirmation. On CT, all 21 benign lesions were correctly detected. Benign lesions showed homogenous attenuation, mild symmetric wall thickening, and diffuse bowel involvement. Heterogeneous attenuation, pronounced asymmetric wall thickening, and localized bowel involvement were observed in malignant lesions. For the diagnosis and differentiation of benign from malignant colon and rectum lesions,MDCThas shown itself to be an excellent technique. MDCT provides additional information about related pericolic abnormalities, lymph node presence, neighboring organ infiltration, and distant metastases in addition to identifying the lesions.

AGO2 protein: a key enzyme in the miRNA pathway as a novel biomarker in adrenocortical carcinoma.

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy characterised by diagnostic challenges, high recurrence rates, and poor prognosis. This study explored the role microRNA (miRNA) processing genes in ACC, and their potential role as diagnostic and prognostic biomarkers. We analysed the mRNA expression levels of miRNA machinery components (DROSHA, DGCR8, XPO5, RAN, DICER, TARBP2 and AGO2) utilising mRNA-Seq data from The Cancer Genome Atlas (TCGA) and The Genotype-Tissue Expression (GTEx) projects. Additionally, protein levels were quantified in tissue samples from the Kolling Institute of Medical Research's tumour bank. Our results demonstrated that among all miRNA processing components, AGO2 exhibited significant overexpression in ACC compared to the normal adrenal cortex (NAC) and benign adrenal adenoma (AA) (p < 0.001). Kaplan-Meier survival analysis indicated that higher AGO2 expression correlated with significantly worse overall survival in ACC patients (HR 7.07, p < 0.001). Among 32 cancer types in TCGA, the prognostic significance of AGO2 was most prominent in ACC. This study is the first to report AGO2's potential as a diagnostic and prognostic biomarker in ACC, emphasising its significance in ACC pathogenesis and potential application as a non-invasive liquid biopsy biomarker.

Evaluating the effects, implementation experience and political economy of primary healthcare facility autonomy reforms within counties in Kenya: a mixed methods study protocol

IntroductionThere is a growing emphasis on improving primary healthcare (PHC) services and granting frontline service providers more decision-making autonomy. In October 2023, Kenya enacted legislation mandating nationwide facility autonomy. There...

Training and Developing Physician-Scientist Careers to Enhance Medical Research in Ghana

Summary A physician-scientist is a medical doctor who combines clinical practice with research. They often work in academic medical centers, research institutions, or hospitals, where they split their time between treating patients and conducting research to advance medical knowledge, develop new treatments, and improve public health. Their work is well recognized as they are reported to constitute 37% of Nobel Prize winners in Physiology or Medicine, and several prize winners in Chemistry. However, regardless of how inherently fulfilling this may be, in Ghana and many other regions of the world, increasingly fewer doctors aspire to become physician-scientists. Currently, there is a lack of clarity regarding the path to becoming a physician-scientist in Ghana and other African nations. So, for the young doctor of today who wishes to embark on a research career, there are more questions than answers. The authors emphasize the need for structured programs, early commitment, and resource allocation to nurture the next generation of physician-scientists. They also examine the potential of integrating research-focused training into existing medical programs and the role of various stakeholders, such as universities and the Ministry of Health, in supporting these initiatives. The authors call for innovative approaches and strategic planning to enhance the capacity of Ghanaian doctors to pursue careers in medical research, ultimately contributing to global scientific advancement and improving healthcare in low and middle-income countries. They conclude that more needs to be done to develop more physician scientists.