Impact of COVID-19 pandemic (wave 2) and associated lockdown on wound care and the resultant increase in the number of amputations

Background: The COVID-19 pandemic has had an unparalleled impact on the socio-economic and healthcare structure of the entire world, including India. The risk of major amputations has increased during the COVID-19 lockdown.Aim of the study was to conduct a single-centered study on the prevalence of major amputations during the pre-pandemic and pandemic period to evaluate the indirect effect of the COVID-19 lockdown on people with lower limb cellulites and wounds. This study also emphasizes on the importance of easy and routine access to foot-care specialist.Methods: The data of patients attending the outpatient and emergency room of general surgery in K. R. Hospital with complaints of cellulites/wounds/ulcers during the months of March to July was evaluated. The number of amputations done during same time period was analyzed.Results: The patients attending outpatient department (OPD) during the lockdown had a fall, while cases and amputations immediately after lockdown had increased.Conclusions: The findings of the present study, reiterate the role of preventive actions in wound care and stress on the importance awareness of complications if such wounds are ignored.

Regulation of MDM2 E3 ligase-dependent vascular calcification by MSX1/2

Vascular calcification increases morbidity and mortality in patients with cardiovascular and renal diseases. Previously, we reported that histone deacetylase 1 prevents vascular calcification, whereas its E3 ligase, mouse double minute 2 homolog (MDM2), induces vascular calcification. In the present study, we identified the upstream regulator of MDM2. By utilizing cellular models and transgenic mice, we confirmed that E3 ligase activity is required for vascular calcification. By promoter analysis, we found that both msh homeobox 1 (Msx1) and msh homeobox 2 (Msx2) bound to the MDM2 promoter region, which resulted in transcriptional activation of MDM2. The expression levels of both Msx1 and Msx2 were increased in mouse models of vascular calcification and in calcified human coronary arteries. Msx1 and Msx2 potentiated vascular calcification in cellular and mouse models in an MDM2-dependent manner. Our results establish a novel role for MSX1/MSX2 in the transcriptional activation of MDM2 and the resultant increase in MDM2 E3 ligase activity during vascular calcification.

Therapy for Pulmonary Arterial Hypertension: Glance on Nitric Oxide Pathway

Pulmonary arterial hypertension (PAH) is a severe disease with a resultant increase of the mean pulmonary arterial pressure, right ventricular hypertrophy and eventual death. Research in recent years has produced various therapeutic options for its clinical management but the high mortality even under treatment remains a big challenge attributed to the complex pathophysiology. Studies from clinical and non-clinical experiments have revealed that the nitric oxide (NO) pathway is one of the key pathways underlying the pathophysiology of PAH. Many of the essential drugs used in the management of PAH act on this pathway highlighting its significant role in PAH. Meanwhile, several novel compounds targeting on NO pathway exhibits great potential to become future therapy medications. Furthermore, the NO pathway is found to interact with other crucial pathways. Understanding such interactions could be helpful in the discovery of new drug that provide better clinical outcomes.

INNV-05. MULTIDISCIPLINARY SPINE ONCOLOGY CARE ACROSS THE DISEASE CONTINUUM - UPDATES FOR THE BEDSIDE AND THE BOARDS

In response to the increased prevalence and complexity of metastatic and primary spine oncology, there has been a resultant increase in stakeholders, treatments and outcomes. A subset of the global multidisciplinary authors will present a timely and concise review of the contents of NOP’s Volume-7, supplement-1, “Multidisciplinary Spine Oncology Care Across the Disease Continuum”. The first portion will review: Epidemiology, Tumor Types, Presentation, Initial Tumor-directed Management, Initial Symptom-directed Management, Subsequent Tumor-directed Management, Subsequent Symptom-directed Management, and Multidisciplinary Program Development and Resources for Stakeholders. The second portion will challenge the current state of care and engage the attendees toward developing initiatives needed for a future state of care. Attendees will receive an update for both the bedside and the boards.

Endothelial Upregulation of Mechanosensitive Channel Piezo1 in Pulmonary Hypertension

Piezo is a mechanosensitive cation channel responsible for stretch-mediated Ca2+ and Na+ influx in multiple types of cells. Little is known about the functional role of Piezo1 in the lung vasculature and its potential pathogenic role in pulmonary arterial hypertension (PAH). Pulmonary arterial endothelial cells (PAECs) are constantly under mechanic stretch and shear stress that are sufficient to activate Piezo channels. Here we report that Piezo1 is significantly upregulated in PAECs from patients with idiopathic PAH and animals with experimental pulmonary hypertension (PH) compared to normal controls. Membrane stretch by decreasing extracellular osmotic pressure or by cyclic stretch (18% CS) increases Ca2+-dependent phosphorylation (p) of AKT and ERK, and subsequently upregulates expression of Notch ligands, Jagged1/2 (Jag1 and Jag-2), and Delta like-4 (DLL4) in PAECs. siRNA-mediated downregulation of Piezo1 significantly inhibited the stretch-mediated pAKT increase and Jag-1 upregulation, while downregulation of AKT by siRNA markedly attenuated the stretch-mediated Jag1 upregulation in human PAECs. Furthermore, the mRNA and protein expression level of Piezo1 in the isolated pulmonary artery, which mainly contains pulmonary arterial smooth muscle cells (PASMCs), from animals with severe PH was also significantly higher than that from control animals. Taken together, our study suggests that membrane stretch-mediated Ca2+ influx through Piezo1 is an important trigger for pAKT-mediated upregulation of Jag-1 in PAECs. Upregulation of the mechanosensitive channel Piezo1 and the resultant increase in the Notch ligands (Jag-1/2 and DLL4) in PAECs may play a critical pathogenic role in the development of pulmonary vascular remodeling in PAH and PH.

Influence of Terrestrial Precipitation on the Variability of Extreme Sea Levels along the Coast of Bangladesh

The coastal area of Bangladesh is highly vulnerable to extreme sea levels because of high population exposure in the low-lying deltaic coast. Since the area lies in the monsoon region, abundant precipitation and the resultant increase in river discharge have raised a flood risk for the coastal area. Although the effects of atmospheric forces have been investigated intensively, the influence of precipitation on extreme sea levels in this area remains unknown. In this study, the influence of precipitation on extreme sea levels for three different stations were investigated by multivariate regression using the meteorological drivers of precipitation, sea level pressure, and wind. The prediction of sea levels considering precipitation effects outperformed predictions without precipitation. The benefit of incorporating precipitation was greater at Cox’s Bazar than at Charchanga and Khepupara, reflecting the hilly landscape at Cox’s Bazar. The improved prediction skill was mainly confirmed during the monsoon season, when strong precipitation events occur. It was also revealed that the precipitation over the Bangladesh area is insensitive to the El Niño-Southern Oscillation and Indian Ocean Dipole mode. The precipitation over northern Bangladesh tended to be high in the year of a high sea surface temperature over the Bay of Bengal, which may have contributed to the variation in sea level. The findings suggest that the effect of precipitation plays an essential role in enhancing sea levels during many extreme events. Therefore, incorporating the effect of terrestrial precipitation is essential for the better prediction of extreme sea levels, which helps coastal management and reduction of hazards.

Consumption of Cattle Hide Singed with Scrap Tyre is Detrimental to the Liver, Heart and Kidney of Rats

The presence of essential amino acids in meat makes it a complete protein, this makes meat a highly sort after source of protein in the human diet. The World’s demand for animal-derived protein has been projected to double by 2050. As a result there is a resultant increase in livestock industries to meet this demand. While meat is generally consumed as a source of protein, processed cattle hide popularly known as “Kanda” in southeastern Nigeria is consumed as a substitute for meat though it may not necessarily provide the same level of nutritional value with meat. The method of processing this food delicacy (Kanda) by singeing with scrap tyre or firewood has opened the door for heavy metal and or polycyclic aromatic hydrocarbon (PAHs) contamination, thereby putting unsuspecting consumers at health risk. This study therefore investigated the effects of consuming scrap tyre and firewood singed cattle hide on the kidney, liver and heart of male Wistar rats. The study took place for 21 days at the department of Biochemistry, Federal University of Technology Owerri. 35 rats were divided into 7 groups of 5 each, allowed to acclimatize for 7 days and fed with the cattle hide processed with scrap tyre (group 1-3) and cattle hide processed with firewood (group 4-6) while group 7 which served as control was fed with normal standard rat pellet feed. It was observed that consuming these processed hides increased the marker enzymes for heart, kidney and liver damage like lactate dehydrogenase, alanine and aspartate aminotransferases, creatine kinase and alkaline phosphatase with groups that were fed with the hide singed with scrap tyre showing severe elevations. Consuming the singed Kanda also significantly decreased the serum concentrations of K+, Na+, Cl- , and significantly increased HCO3- and urea concentration. An examination of the organ tissues also revealed serious morphological changes. In conclusion, consuming singed Kanda had detrimental effects on the vital organs studied.

Quantifying economic activity in the informal recycling sector in South Africa

Informal waste reclaimers are a key part of South Africa’s recycling economy, being responsible for around 51% of all paper and packaging waste collected in South Africa in 2017. Active in the waste and recycling landscape for more than three decades, their activity predates the earliest voluntary paper and packaging Extended Producer Responsibility schemes. However, these voluntary schemes have been instrumental in scaling South Africa’s recycling economy. Investment by brand owners, retailers, converters and recyclers has helped develop local end-use markets, creating a demand for paper and packaging recyclables and a resultant increase in their collection. An analysis of tonnage and price data shows that the mean estimate of money paid by the private sector to the informal waste sector through the purchase of recyclables at intermediaries such as buy-back centres, was ZAR625 million in 2012, increasing to ZAR872 million in 2017. This private sector ‘investment’ in the local recycling economy has led to direct and indirect job creation and improved livelihoods, particularly for a large, well-established and effective informal waste sector, and has indirectly funded municipal waste diversion strategies, saving municipalities in both the collection and disposal of waste.

Self-inflicted injury and the older trauma patient: a 20 year review of suicide attempts and outcomes

Purpose Older patients (Older) have complex health management needs often requiring additional resources. Mental health disorders are common among trauma patients, yet minimal information on older suicidal related injury and outcomes exists. A review of trauma patients with intentional self-inflicted injury at one trauma center was done to describe and identify unique elements of this cohort of patients. Methods Trauma registry data from 2000 to 2019 were reviewed for intentional injury and data abstracted included demographics, injury severity, diagnoses, comorbidities and outcomes. Cohorts by age were compared: Older (65 +) vs Younger (< 65). Values considered significant at p ≤ 0.05. Results 557 suicide attempts were identified with 9% among Older patients. Most patients were male with median age of 75 years for Older and 35 years for Younger cohort, with similar length of stay (LOS) and injury severity scores (ISS). Penetrating injury was more common among Older patients with firearm used most often, 34% vs 14% for Younger. Differences were evident between male and female Older patients with ISS 16.7 vs 5, p < 0.01 and mortality, p = 0.03. The outcome of discharge to home was significantly different between Older and Younger, 6% vs 20% (p < 0.05). A difference in mortality was evident, Older 38% vs Younger 18% (p < 0.05). Conclusion With the growing aging population, it is important to acknowledge the resultant increase in concomitant mental health issues and suicidality among older patients, where depression may be undiagnosed and untreated. Providing care within this cohort may reduce future attempts and lessen the burden on the health care system.

A Study of “Osteoporosis due to lack of Vitamin - D deficiency” through a small Survey in Kolkata, (West Bengal)

Bone loss and osteoporosis with the resultant increase in fracture risk should be major concerns for patients and health care providers. As the population ages, the long-term effects of osteoporosis including pain, loss of independence and institutionalized care will become more prevalent. Efforts to prevent bone loss and osteoporosis should start with proper education about a healthy lifestyle, including optimal calcium and vitamin D and exercise in adolescence. This education should continue throughout life, with emphasis during times of increased bone loss such as the menopause transition. This paper reviews the cornerstone of bone health; calcium and vitamin D. Although dietary sources of both nutrients are available, most people do not receive adequate amounts for proper bone health. In addition, the heightened awareness of damaging effects of sunlight has limited vitamin D synthesis from the skin. Fortunately, supplements are available that can supply the body with amounts necessary for bone health.