EVALUATION OF CHONDROPROTECTIVE EFFECTS OF HYALURONIC ACID IN A RAT MODEL OF OSTEOARTHRITIS

Objective: To evaluate the chondroprotective effects of hyaluronic acid in a rat model of osteoarthritis. Study Design: Laboratory based experimental study. Place and Duration of Study: Department of Pharmacology, Army Medical College, Rawalpindi, in alliance with National Institute of health, Islamabad and Department of Pathology, Army Medical College Rawalpindi, from Apr to Jun 2019. Methodology: Sixteen (16) rats of Sprague Dawley breed were procured in this study. Osteoarthritis was induced in right knee joint of rats by surgical resection of medial meniscus and anterior cruciate ligament. They were allocated into two (02) groups with eight (08) rats in both groups. Group-I was control group that was treated with 0.2 ml intra articular saline once weekly for four weeks. While group-II was treatment group that was intra particularly administered with 0.2ml hyaluronic acid once weekly for four weeks. One week after the last dosage, gait pattern of the animals was scored. Then animals were sacrificed and a part of proximal tibia was obtained for histopathologic analysis. Results: Mean gait score of control group and treatment group was 3.25 ± 0.707 and 1.00 ± 0.756 respectively with a statistically significant p-value of <0.001, while mean histopathological Modified Mankin score of control and treatment group was 11.5 ± 1.195 and 5.50 ± 1.195 respectively with a significant p-value of <0.001. Conclusion: Intra articular viscosupplementation of hyaluronic acid in rat model of osteoarthritis resulted in improved gait pattern and histopathology.

A Review of Brooke Army Medical Center Chaplaincy Service During the SARS-COV2 Pandemic: Implications for Service Structure and Patient Needs

ABSTRACT Introduction We aimed to evaluate the effect of the SARS-COV2 pandemic on chaplain utilization at Brooke Army Medical Center. Our hypothesis was that multiple pandemic-related factors led to a care environment with increased mental and spiritual stress for patients and their families, leading to an increased need for adjunct services such as chaplaincy. Materials and Methods This was a single-institution retrospective chart review study that evaluated the records of 10,698 patients admitted between July 1, 2019, and January 31, 2020, or between July 1, 2020, and January 31, 2021. Our primary study outcomes included the number of chaplain consultations, the number of visits per consultation, and the time of visits between the two study cohorts. Secondary outcomes included inpatient mortality and the number of end-of-life visits. We also isolated a subgroup of patients admitted with COVID-19 and compared their outcomes with the two larger cohorts. Statistical analysis included t-test or chi-squared test, based on the variable. This study was reviewed and approved by the Brooke Army Medical Center Institutional Review Board (IRB ID C.2021.010e). Results Fewer consults were performed during the study period affected by the SARS-COV2 pandemic (4814 vs. 5884, P-value &lt;.01). There were fewer individual visits per consult during the study period affected by the SARS-COV2 pandemic (1.44 vs. 1.64, P-value &lt;.01), which led to fewer overall time spent per consult (37.41 vs. 41.19 minutes, P-value &lt;.01). The 2020 cohort (without COVID-19 cases) demonstrated a higher mortality rate than the 2019 cohort (2.8% vs. 1.9%, P-value &lt;.01). The COVID-19 diagnosis cohort demonstrated a much higher mortality rate compared to other patients in the 2020 cohort (19.3% vs. 2.8%, P-value &lt;.01). We demonstrated the relative need for EOL consults by presenting the ratio of EOL consults to inpatient deaths. This ratio was highest for the COVID-19 diagnosis cohort (0.76) compared to the 2020 cohort (0.50) and the 2019 cohort (0.60). Conclusions This study demonstrates that factors related to the SARS-COV2 pandemic resulted in fewer chaplaincy consults in our inpatient setting. We did not find other reports of a change in the rate of chaplaincy consultation, but available reports suggest that many centers have had difficulty balancing the spiritual needs of patients with local exposure guidelines. Although fewer individual chaplain consults occurred during the SARS-COV2 pandemic, our chaplain service innovated by utilizing various phone, video, and web-based platforms to deliver spiritual support to our community. Our study also suggests that the patients most greatly affected by the pandemic have an increased need for spiritual support, especially at the end of life. Future studies in this subject should examine the effect of various types of chaplain services as they relate to the health and well-being of hospitalized patients.

200 COCHLEAR IMPLANTS – A MILESTONES

An event was held at Army Medical College on the 10th of June, commemorating the 200th successful cochlear implant at Combined Military Hospital(CMH) Rawalpindi. The Surgeon General, Lt. Gen Nigar Johar HI (M), DG MS (IS) was the chief guest of the occasion. The event was attended by high rankingofficers of Army Medical Corps, faculty members and cadets of Army Medical College, as well as by some recipients of cochlear implants with their families.

The United States Army Medical Command, becoming a learning organization

Purpose This study aims to describe how the Army and the Army Medical Department matured as a learning organizations (LOS) during the period after the 2014 Military Health System Review through the incorporation of changes aimed at improving patient safety, data transparency and becoming a high reliability organization. This study explores the relationship between HRO and LO concepts by adding to the body of knowledge in both disciplines. Design/methodology/approach Four large scale system changes are presented and evaluated against the principles of the LO. Metric data were collected longitudinally and presented as submitted to several nationally recognized organizations in health-care quality and safety. Post initiative observations are paired with a corresponding LO principle to assess MEDCOM’s maturation as a LO. System changes/improvements and the advancement of LO principles are discussed. Findings System improvements, analyzed critically alongside paired LO principles, show strong correlation between high reliability and LO principles. Despite inherent institutional barriers, this study demonstrates that when leveraged effectively, the leadership hierarchy and command culture can accelerate transformation into an LO. Originality/value This study explores changes implemented in the U.S. Army Medical Command (MEDCOM), as it evolved as a stronger LO. It demonstrates how health-care organizations and other high-risk industries that embrace high reliability concepts will become better LO, and expands current knowledge on how LO concepts in health care can affect better system accountability and improved patient safety. Organizations can learn from MEDCOM’s journey changes that can hasten progress toward adoption of LO principles, especially in hierarchical organizations.

EFFECT OF OBESTATIN ON PITUITARY GONADAL AXIS, LEPTIN AND MDA LEVELS IN OBESE SPRAGUE DAWLEY RATS

Objective: To determine the effect of obestatin administration on FSH, LH, testosterone, leptin and MDA levels in obese Sprague Dawley Rats. Study Design: Laboratory based animal study. Place and Duration of Study: Physiology department, Army Medical College Rawalpindi, from Mar to Jun 2015. Methodology: This randomized controlled trial was conducted at Physiology Department Army medical college. Male healthy Sprague Dawley rats were randomly divided into 3 groups (n–15 each) i.e. control group (group I) fed with normal pellet diet (NPD), obese group (group II) and obestatin treated obese group (group III) fed with high fat diet (HFD). After 10 weeks, group III was treated with obestatin (1nmol/100ml intraperitoneally). Blood samples were obtained by terminal intracardiac sampling for bioasssays of FSH, LH, testosterone, leptin and MDA by ELISA. Results: Obestatin supplementation in obese rats showed significant increase in LH levels (3.79 ± 0.05) and testosterone levels (2.07 ± 0.22) when compared to the non treated obese rats (2.19 ± 0.07) and (1.37 ± 0.15) respectively while significant decrease in leptin (3.85 ± 0.23) and MDA levels (1.62 ± 0.07) was observed when compared to the non-treated control groups (6.10 ± 1.18) and (1.95 ± 0.07) respectively. However, serum FSH levels remained unchanged among the treated and nontreated groups. Conclusion: Obestatin increases the testosterone levels by augmenting the pituitary gonadal axis through decrease in the oxidative stress and leptin levels in obese rats.

A Grave Turn on Hashimoto’s Thyroiditis - A Case Series on Four Patients With Autoimmune Hypothyroidism that Converted to Grave’s Disease

Disclaimer: The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, or the Department of Defense or the U.S. Government. Introduction: The most common cause of hypothyroidism is Hashimoto’s thyroiditis, a destructive autoimmune injury to the thyroid gland. Rarely, autoimmune hypothyroidism can be caused by thyroid-stimulating hormone (TSH) receptor blocking antibodies (TSHRab), and can be difficult to differentiate clinically from Hashimoto’s. Grave’s disease is the most common etiology of hyperthyroidism, and is typically caused by activation from TSHRab acting as an agonist for the TSH receptor. Patients with autoimmune thyroiditis, whether from TSHRab or Hashimoto’s, have been infrequently reported to convert to Grave’s disease1–3. Presentation: We present four cases whom initially presented with typical symptoms of hypothyroidism, were diagnosed with autoimmune hypothyroidism and started on levothyroxine. All four cases were later found to be hyperthyroid and ultimately diagnosed and treated for Grave’s disease. Conclusion: Primary hypothyroidism can rarely transition to a hyperthyroid state, although these cases may be underreported. The mechanism isn’t well understood, but is hypothesized to be from a switch of a predominance of TSH receptor blocking antibodies (TBAb) to that of thyroid stimulating antibodies (TSAb)1. Assays using competitive binding for TSH receptor antibodies will not differentiate between blocking and stimulating antibodies4. A high index of suspicion is needed to diagnose these individuals. References: 1. McLachlan SM, Rapoport B. Thyrotropin-blocking autoantibodies and thyroid-stimulating autoantibodies: Potential mechanisms involved in the pendulum swinging from hypothyroidism to hyperthyroidism or vice versa. Thyroid. 2013;23(1). doi:10.1089/thy.2012.03742. Takasu N, Matsushita M. Changes of TSH-stimulation blocking antibody (TSBAb) and thyroid stimulating antibody (TSAb) over 10 years in 34 TSBAb-positive patients with hypothyroidism and in 98 TSAb-positive graves’ patients with hyperthyroidism: Reevaluation of TSBAb and TSAb in TSH-receptor-antibody (TRAb)-positive patients. J Thyroid Res. 2012;2012. doi:10.1155/2012/1821763. Gonzalez-Aguilera B, Betea D, Lutteri L, et al. Conversion to graves disease from hashimoto thyroiditis: A study of 24 patients. Arch Endocrinol Metab. 2018;62(6). doi:10.20945/2359-39970000000864. Li Y, Kim J, Diana T, Klasen R, Olivo PD, Kahaly GJ. A novel bioassay for anti-thyrotrophin receptor autoantibodies detects both thyroid-blocking and stimulating activity. Clin Exp Immunol. 2013;173(3). doi:10.1111/cei.12129

Professor George Archibald Grant Mitchell (1906–1993): his work with penicillin during World War II

George Archibald Grant Mitchell, OBE, TD, MB, ChB, ChM, MSc, DSc, FRCS (1906–1993) was a professor of anatomy at the University of Manchester from 1946 to 1973. He is mainly remembered for his research in neuroanatomy, especially of the autonomic nervous system. He studied medicine at the Aberdeen University, and after qualifying in 1929 he held posts in surgery and anatomy and worked as a surgeon in the Highlands. In 1939, he joined the Royal Army Medical Corps. He was based in Egypt and the Middle East, where he carried out trials of sulphonamides and penicillin on wounded soldiers; in 1943, he returned to England as Adviser in Penicillin Therapy for 21 Army Group, preparing for the invasion of Europe.