Anti-diabetic, Antioxidants, Anti-hepatorenaltoxicity Activities of Cyperus rotundus Rhizome Extract in Alloxan-induced Diabetic Rats

Objective: The hypoglycemic, hepatorenalprotective, and antioxidant Activities of Cyperus rotundus rhizomes extract in an alloxan-induced diabetic rat model were investigated in this work.Methods: 25 Male rats were divided into 5 groups: normal control, diabetic control, diabetic of C. rotundus (200 mg/kg b.w), diabetic of C. rotundus (400 mg/kg b.w), diabetic of glibenclamide (0.6mg/kg).Treatments were administered orally for 6 weeks.Results: A single injection of alloxan to rats (150mg/kg b.w) caused pathological alterations in all studied parameters and histological structure of the pancreas. On the other hand, results showed that oral administration of C. rotundus rhizomes extract in dose of 200 and 400 mg/kg caused significant reduction in glucose, HbA1C%, α-amylase level and plasma lactate together with significant elevation in serum insulin, serum pyruvate with an improvement in insulin resistance. In line with amelioration of the diabetic state, C. rotundus rhizomes extract improved of the liver and kidney functions, and oxidative marker levels. Moreover, the extract succeeded to reduce the elevated serum total cholesterol, triglyceride (TG) and low-density lipoprotein- cholesterol (LDL-C) levels and to elevate the reduced high-density lipoprotein- cholesterol (HDL-C) level of diabetic rats.Conclusion: The investigation data concluded that C. rotundus rhizomes extract could be used as alternative treatments as antidiabetic, antioxidant and antihyperlipidemic, and agent as well as in liver and kidney protective in alloxan induced-diabetic rats. This may be related to the presence of saponin glycosides, polyphenols, flavonoids, and terpenoids in the ethanolic extract of C. rotundus rhizomes, which was discovered by phytochemical screening in this study to be present in the plant.

Serum Amylase Level in Acute Organophosphorus Compound Poisoning in a Tertiary Level Hospital

Background: Organophosphorus compound (OPC) poisoning is an important clinical problem in the developing world and kills an estimated 3,00,000 people every year. In spite of high case fatality rate early and proper management is crucial to save the lives and alleviate the sufferings. Amylase level is an important biochemical marker, which is closely related to severity of acute OPC poisoning. Therefore, to assess Serum amylase level in acute organophosphorus compound poisoning in a tertiary level hospital was the objective of the study. Methods: This research was a hospital based descriptive cross-sectional study and was conducted at the inpatient department of Medicine in Dhaka Medical College. 50 Patient admitted in medicine department due to OPC poisoning and evidenced by history taking and physical examination were included in the study. Ethical issues were ensured properly. After written informed consent history and physical examination were done. Rest of the data were collected by interviewing each patient or from attendant of the patient by using a semi-structured questionnaire. Scoring of the severity were done by researcher himself by Peradeniya Organophosphorus Poisoning (POP) scale (Score range 0 to 11). Values of amylase level were collected from patient record file. All the Data was analysed by computer with the help of SPSS 16. Results: Out of a total of 50 patients, 24 (48%) were males and 26 (52%) were females. OPC poisoning was most frequent (52%) in age group 21-30 years. Mean age was 23.96 ± 6.071 SD. 96% (48) study population were Muslim and rest 4 % (2) were Hindus with diverse occupation. 86% population came from rural area whereas only 14% population reside in urban area. Among them suicidal attempts were seen significantly which was 96% and rest of them were accidental ingestion. Amylase level estimation were done in each case and 32 % (16) patient had elevated amylase level (>100U/L) and 68% (34) patient had amylase level within normal limit. Mean amylase concentration was 62.2U/L (SD±18.77) and among the 16 patients who had elevated serum amylase level mean concentration was 376.56U/L (SD±266.124). Mean amylase level differed significantly between these two groups (p value < 0.0001) estimated by one way ANOVA. Spearman Correlation and One way ANOVA both showed significant association between severity (assessed by POP scale) and elevated level of serum amylase (p value <0.0001). Outcome analysis showed that 47 patients recovered and 3 patients died. Their mean hospital stay was 3.87 (±1.76) days and relationship between serum amylase level and duration of hospital stay and was found to be significant in chi-square analysis (p value- <0.0001). Conclusion: Hyperamylasaemia in OPC poisoning can be used an important biomarker to assess the severity of the patient which may guide the clinicians for further management. J MEDICINE 2021; 22: 119-126

P-P45 Prognostic Value of CRP in Post-PPPD and Whipple’s Re-Intervention

Background Several studies have aimed to use different biochemical and haematological markers to predict relevant post-operatively pancreatic fistulas after hepatobiliary operations, however none has been defined as the gold-standard. This study aimed to evaluate the sensitivity and specificity of day 3 C-reactive protein (CRP) and drain amylase values in predicting re-intervention in patients who have undergone pancreatico-duodenectomy (PPPD) or Whipple’s procedure. Methods Retrospective collection of data from a prospective database of patients who underwent PPPD or Whipple’s procedure between January 2017 and February 2021. Serum CRP was collected from day one to day five post-operatively, and day three or the closest available result of post-surgery drain amylase values were considered. Cutoff values were determined as follows: day three CRP optimal level was determined by the median (175 mg/L), and drain amylase was determined by three times the upper limit of normal serum amylase level (330 U/L). Post-operative pancreatic fistulas (POPF) were classified as per the 2016 International Study Group for Pancreatic Surgery (ISGPS). Re-intervention was defined as any deviation from the normal post-surgical care – including interventional radiology procedures, embolisation, re-look laparotomies and re-admission to Intensive Care. Results A total of 217 patients were included in this study – 182 underwent pylorus preserving pancreaticoduodenectomy as opposed to those who had Whipple procedure. 55 (25%) patients required re-intervention post-operatively. A day three CRP above 175 showed a sensitivity of 78% and specificity of 66% in predicting re-intervention in these patients. The combination of this and elevated drain amylase proved to be more sensitive (85%) and specific (87%) than the CRP alone. Conclusions Day 3 CRP and drain amylase are accurate predictors of post-PPPD and Whipple’s re-interventions. We aim to include this as part of the local Enhanced Recovery Pathway to help identify patients that will potentially develop complications requiring further surgical management.

Non-invasive detection for work stress among the professional medical nurses during COVID-19 in Mongolia

COVID-19 pandemic has created a lot of work stress, especially among medical professionals, namely among nurses. The absence of the non-invasive stress detecting method using salivary alpha-amylase test in Mongolia served us to perform this study. We consider that the nurse immunization could be managed and boosted if the work stress is detected, and it would serve as the prevention method from the infections in the clinical settings. The study aims to investigate the stress level among medical professionals, particularly the nurses, using a self-report questionnaire, work stress profile, and salivary alpha-amylase during the initial period of the COVID pandemic. In the mid of March 2020, 356 professional medical nurses from three national tertiary centres of Mongolia were involved in this study. We employed a Work Stress Profile (WSP), a self-administered questionnaire that assists the personnel to identify their perceived stressors and assessing the stress at work. As the physical stress marker, we measured the saliva alpha-amylase level in these participants. The vital signs, heart rate, glucose and blood pressure were measured. The correlation method was used. There were 344 females and 12 males. The participants' mean age was 38±9.6 years old. The stress among the medical professionals was high by WSP - it was counted 342 or 96.1% of the personnel suffering from the stress at work: the WSP average was 151.49±26.81. However, age, education and work experience could influence stress at a certain level. The salivary alpha-amylase and WSP scores were correlated directly (p<0.01; r=0.187). The pulse, diastolic blood pressure and salivary alpha-amylase were interrelated. As one of the important personnel at the hospital, nurses are at high risk to get stressed in Mongolia. We concluded that the overloading of work leads to work stress among professional medical nurses, especially during the COVID-19 pandemic.

Combined effect of ultrasound-guided percutaneous abdominal paracentesis drainage and ulinastatin on severe acute pancreatitis

Purpose: To study the clinical effect of a combination of ultrasound-guided percutaneous abdominal paracentesis drainage (APD) and ulinastatin on severe acute pancreatitis (AP).Methods: A total of 94 patients with severe AP in Intensive Care Unit, Jiaozhou Central Hospital, Qingdao, from December 2017 to December 2018 were selected as the research subjects. They were divided into control and study groups, with 47 patients in each group. Patients in the control group underwent laparotomy drainage, while patients in the study group underwent ultrasound-guidedpercutaneous APD. Patients in both groups received ulinastatin perfusion. Subsequently, clinical effectsand other relevant indicators were determined.Results: Overall response was significantly higher in the study group than in the control group (p < 0.05). The times taken for disappearance of postoperative symptoms, normalization of serum amylase level, and hospitalization were significantly shorter in the study group than in the control group (p < 0.05). For every indicator, the study group exhibited more benefits after than before treatment; however, post-treatment levels of blood glucose, hemodiastase and urinary amylase were better than those in the control group (p < 0.05). Incidence of postoperative complications was lower in the study group than in control group (p < 0.05).Conclusion: The combination of ultrasound-guided percutaneous APD with ulinastatin produces marked beneficial effects on severe AP patients. It facilitates the remission of adverse symptoms, and enhances normalization of indicator levels. Moreover, it displays low incidence of complications, better prognosis and recovery, and absence of post-operation infections.

Acute pancreatitis following Pfizer-BioNTech COVID-19 vaccine

The coronavirus disease of 2019 (COVID-19) discovered in China in early December 2019. The Saudi Food and Drug Authority approved the registration of the Pfizer-BioNTech COVID-19 vaccine in Saudi Arabia on December 10, 2020, and on May 10, 2021, Pfizer-BioNTech was given emergency authorization for use of the vaccine in children aged 12 to 15 years. Saudi Arabia’s Ministry of Health started the vaccination phase for ages 12 to 18 years for the Pfizer-BioNTech COVID-19 vaccine on June 27, 2021. An insulin-dependent diabetic 15-year-old female patient admitted to the medical ward diagnosed with acute pancreatitis nine days after being administered her first dose of the Pfizer-BioNTech COVID-19 vaccine. She presented with an amylase level of 340 U/L, lipase level of 937 U/L. She was discharged after eight days of hospitalization with no complications. Medical investigations were unable to link the diagnosis to any known etiology. Medical journals have reported numerous cases of acute pancreatitis in the adult population after Pfizer-BioNTech COVID-19 vaccination. We believe that our case is the first to present with acute pancreatitis after the first dose of the Pfizer-BioNTech COVID-19 vaccine in a teenager population.

Exosomes Derived from Bone Marrow-Derived Mesenchymal Stem Cells (BM-MSC) Protect Submandibular Glands in Diabetic Rats

Our study assess whether exosomes derived from bone marrow mesenchymal stem cells (BM-MSC) ameliorates diabetic salivary gland complications. 10 SD rats were assigned into diabetes group I and exosome treatment group II. Diabetic rats were induced by streptozotocin (STZ) and injected with DMSO or exosomes through tail vein followed by collection of submandibular salivary gland samples for histological analysis and TGFβ, Smad2 and Smad3 level by PCR, saliva IgA and serum amylase level. Compared with control mice, exosome treatment mice showed less fibrosis of the submandibular salivary glands and duct components with a more complete structure. Exosome treatment inhibited TGFβ, Smad2 and Smad3 level to reduce diabetic salivary gland complications, effectively decreased blood sugar level, improved salivary glands function with significantly reduced serum amylase and salivary IgA levels. In conclusion, BM-MSC-derived exosomes may be a new therapeutic strategy for treating diabetic salivary gland complications.

Frequency of Left Plueral Effusion in Acute Necrotizing Pancreatitis

Objective: The aim of this study is to calculate the prevalence of left plueral effusion in acute necrotizing pancreatitis. Study Design: Observational/ case series Place and Duration: Conducted at surgery department of Saidu Teaching Hospital, Swat and Ibne Sina Hospital and Research Institute, Multan for duration of six months from January 2021 to June 2021. Methods: A total of 95 patients, both males and females, ranging in age from 15 to 65 years, were presented. After receiving informed written consent, the baseline comprehensive demographics of the patients presented were recorded, including age, gender, and body mass index. Patients with acute pancreatitis and serum amylase levels greater than 300U/dL were eligible to participate. Patients were subjected to X-ray and CT scans in their entirety. Prevalence of necrotizing pancreatitis was calculated by CT scan and for left plueral effusion X-ray of chest was taken. SPSS 24.0 version was used to analyze complete data. Results: Majority of the patients 65 (68.4%) were females and 30 (31.6%) were males with mean age 39.14+5.67 years. 26 (27.4%) cases had BMI less than 20kg/m2 and the majority were >20kg/m2. Gallstone was the most common cause of acute pancreatitis found in 45 (47.4%) cases, followed by alcoholism 25 (26.3%) and medications 12 (12.6%). Among 95 cases, prevalence of necrotizing pancreatitis was 42 (44.2%) in which 40 cases had left plueral effusion. Mortality rate among necrotizing pancreatitis was 13 (33.3%). Conclusion: We found that the majority of individuals with necrotizing pancreatitis experienced pleural effusion on the left side. Thus, patients with acute pancreatitis who have a high serum amylase level must be treated earlier if they have a left pleural effusion because of severity. Keywords: Plueral Effusion, Acute Necrotizing Pancreatitis, Mortality

Modulatory action of Moringa oleifera Lam. on L-arginine induced acute pancreatitis

Objectives Acute pancreatitis (AP) is an inflammatory disease of the pancreas with high morbidity and mortality. This study investigates the effect of Moring oleifera (MO) on L-arginine-induced AP in Wistar rats. Methods Male Wistar rats were randomly divided into seven groups. Control, AP, Magnesium groups, all fed with standard rat diet, MO leaf groups (5% MLF and 15% MLF), and MO seed groups (5% MSD and 15% MSD) were fed with five or 15% MO leaf or seed supplemented diet for four weeks prior to induction of AP. AP was induced by administration of double doses of L-arginine (320 mg/100 g i.p.) at 1 h interval. All animals were sacrificed 72 h thereafter. Results Weekly mean feed consumption and body weight were significantly higher in MO groups compared to the control. Amylase level, MDA, MPO, and NO were significantly higher in the AP group than in the control but decreased in Mg and MO groups. While CAT, SOD, GSH, and SH-group were significantly depleted in AP groups, which was attenuated in MO groups. Rats in AP groups showed severe inflammation, necrosis, and edema. These effects were significantly improved in MO groups resulting in lower histological scores compared to the AP group. Conclusions Pretreatment with MO could attenuate AP via its antioxidant and anti-inflammatory action.

EEG Mental Stress Assessment Using Hybrid Multi-Domain Feature Sets of Functional Connectivity Network and Time-Frequency Features

Exposure to mental stress for long period leads to serious accidents and health problems. To avoid negative consequences on health and safety, it is very important to detect mental stress at its early stages, i.e., when it is still limited to acute or episodic stress. In this study, we developed an experimental protocol to induce two different levels of stress by utilizing a mental arithmetic task with time pressure and negative feedback as the stressors. We assessed the levels of stress on 22 healthy subjects using frontal electroencephalogram (EEG) signals, salivary alpha-amylase level (AAL), and multiple machine learning (ML) classifiers. The EEG signals were analyzed using a fusion of functional connectivity networks estimated by the Phase Locking Value (PLV) and temporal and spectral domain features. A total of 210 different features were extracted from all domains. Only the optimum multi-domain features were used for classification. We then quantified stress levels using statistical analysis and seven ML classifiers. Our result showed that the AAL level was significantly increased (p < 0.01) under stress condition in all subjects. Likewise, the functional connectivity network demonstrated a significant decrease under stress, p < 0.05. Moreover, we achieved the highest stress classification accuracy of 93.2% using the Support Vector Machine (SVM) classifier. Other classifiers produced relatively similar results.