In the present study, silver nanoparticles (AgNPs) were synthesized by green synthesis using Psidium guajava aqueous extract (PE) as a reducing agent and silver nitrate (AgNO3) as a precursor. The obtained AgNPs showed maximum absorbance at 455 nm. The results from energy-dispersive X-ray spectroscopy demonstrate Ag signal at 88.33% weight. The particle image under scanning electron microscopy is spherical shape. The average size of the freshly prepared AgNPs is 96 ± 4 nm but is dramatically increases during storage due to particle aggregation. Coating AgNPs with polymeric micelles of poloxamer 407 (F127) at the suitable ratio can decrease the size of the freshly prepared AgNPs to 70.4 ± 0.8 nm and significantly prevent AgNPs from aggregation. The obtained coated AgNPs showed high effective on inhibition of Candida albicans. Isotonic solutions of 0.9% NaCl and phosphate buffer solution pH 7.4 can cause some extend of aggregation and increase the particle size of the coated AgNPs but the increased size is in the colloidal range that no precipitation occurs during 90 days at room temperature. From our results, it is suggested that the 1:1 ratio of AgNPs/F127 is the most suitable ratio to obtain the AgNPs loaded polymeric micelles with high stability, small particle size, and high inhibitory activity against C. albicans. These AgNPs are the promising antifungal nanomaterials for further study in animal model.

The aim of this study was to synthesize silver nanoparticles (AgNPs) by using cellulose derivatives as a reducing agent. Methyl cellulose (MC), hydroxy ethylcellulose (HEC), and hydroxypropyl methylcellulose (HPMC) were compared for their reducing property. HPMC presented the highest reducing power, with equilibrium concentration (EC) of 84.6 ± 4.5 µmol Fe²⁺/g, followed by MC and HEC, with the EC of 62.3 ± 1.4, and 38.1 ± 3.2 µmol Fe²⁺/g, respectively. Using these cellulose derivatives as a reducing agent and silver nitrate as a precursor in fabrication of silver nanoparticles (AgNPs), three cellulose-AgNPs, HEC-AgNPs, MC-AgNPs, and HPMC-AgNPs, were obtained. The cellulose-AgNPs showed different maximum absorptions confirming AgNPs spectra at 415, 425, and 418 nm, respectively. Reaction parameters such as pH, temperature, and period of reaction affected intensity of the maximum absorptions and size of AgNPs. Using 0.3% cellulose solution at pH 9 and reaction at 70°C for 90 min, the particle size of MC-AgNPs, HEC-AgNPs, and HPMC-AgNPs was 97.7 ± 2.4, 165.6 ± 10.6, and 51.8 ± 1.6 nm, respectively. AgNPs obtained from different cellulose derivatives and various preparation parameters possess different inhibition potential against Escherichia coli and Staphylococcus aureus. The cellulose-AgNPs have higher effective against E. coli than S. aureus. HPMC-AgNPs showed significantly higher antibacterial activity than MC- AgNPs and HEC-AgNPs, respectively. These results suggest that the type of cellulose derivatives and the reaction parameters of the synthesis such as pH, temperature, and reaction period play an important role to the yield and physicochemical property of the obtained AgNPs.

Numerous published studies have investigated the relationship between the paraoxonase 1 (PON1) gene Q192R (rs662) polymorphism and the risk of coronary artery disease (CAD) in type 2 diabetes mellitus (T2DM) patients. However, the results are still conflicting and inconclusive. Potentially eligible articles were searched for in related databases. Odds ratios (OR) with 95% confidence intervals (CI) were used to estimate the associations. Subgroup analysis was performed based on ethnicity. Ten case-control studies were included. A significant increase in the susceptibility for CAD in T2DM patients was found in the allelic model (OR = 1.49, p < 0.001), homozygote model (OR = 2.47, p < 0.001), heterozygote model (OR = 1.47, p < 0.001), dominant model (OR = 1.64, p < 0.001), and recessive model (OR = 1.74, p = 0.001). In subgroup analysis by ethnicity, a significant increase susceptibility was found in Asian populations in the allelic model (OR = 1.39, p = 0.001), homozygote model (OR = 2.15, p = 0.002), heterozygote model (OR = 1.37, p = 0.006), recessive model (OR = 1.65, p = 0.012), and dominant model (OR = 1.54, p < 0.001). A similar significant increase in susceptibility was found in Caucasian populations in the allelic model (OR = 1.75, p = 0.002), homozygote model (OR = 3.39, p = 0.002), recessive model (OR = 1.98, p = 0.030), heterozygote model (OR = 1.64, p = 0.001), and dominant model (OR = 1.83, p < 0.001). The results suggest that the PON1 Q192R polymorphism is associated with a significantly increased risk of CAD in T2DM patients in both Asian and Caucasian populations.

Basic bronchoscopic diagnostic procedures like Broncho-alveolar lavage (BAL) are often performed without sedation, using lignocaine administered via the working channel of bronchoscope (spray-as-you-go technique) and other routes. Our aim was to evaluate the factors responsible for variation in the total dose of lignocaine administered in individual subjects. We prospectively included consecutive subjects undergoing BAL in an outpatient setting from August 2016 to November 2017 at our centre. The subjects were administered lignocaine via nebulization, nasal gel, oropharyngeal spray before and during bronchoscopy ("spray-as-you-go") as per a predefined protocol. The demographic details, high resolution computerized tomography (HRCT) characteristics, procedural details, doses of lignocaine administered and a visual analogue scale (VAS) for satisfaction with the procedure were recorded. Using lignocaine dose as outcome, variables were assessed for effect by univariate and multivariate regression analysis. 96 subjects were included with a mean age of 40 years and male predominance (60.4%). Cough was the most common presenting symptom (64.6%). Predisposing factors included tuberculosis (47.9%) and smoking (23.2%). Maximum variation in lignocaine dose occurred prior to intubating vocal cords using "spray-as-you-go", which was significantly related to history of past tuberculosis (p = 0.031), obstructive airway disease (p = 0.009), fibrotic sequelae (p = 0.011) and bronchiectasis (p = 0.049). Obstructive airway disease and fibrotic sequelae were also significant on multivariate analysis (p = 0.01 and 0.005 respectively). Obstructive airway disease and architectural distortion due to fibrotic sequelae leads to higher dose requirement for lignocaine during BAL by fibre-optic bronchoscopy. Caution must be maintained during bronchoscopic procedures to avoid exceeding recommended maximum doses in such patients.

Oligoarticular arthritis (inflammation of upto 4 joints) has a wide range of infectious and non-infectious etiologies. The aim of our study was to identify the features which could help in the differentiation of infectious from non-infectious arthritis. The study was prospective and observational, and included 100 patients with oligoarticular inflammatory arthritis. The final diagnosis was made using standard diagnostic criteria and the patients were categorized into infectious and non-infectious groups. Among the 100 patients who were recruited, the following final diagnosis were made: peripheral spondyloarthritis (n = 37), axial spondyloarthritis (n = 11), tuberculosis (n = 19), brucellosis (n = 6), septic arthritis (n = 6), gouty arthritis (n = 5), early rheumatoid arthritis (n = 5), non-tubercular mycobacteria (n = 2), SLE (n = 2), post-chikungunya arthritis (n = 2), acute lymphocytic leukaemia (n = 1), pachydermoperiostosis (n = 1), sarcoidosis (n = 1) and juvenile idiopathoic arthritis (n = 1). The patients were categorized into two groups: infectious (33) and non-infectious (60). The presence of monoarthritis, clinically-significant weight loss, hepatomegaly, splenomegaly and erosive arthritis were significantly more common in the infectious group as compared to the non-infectious group.

Acute febrile illness (AFI) is one of the commonest indications for hospitalization and can present with varying severity including single or multiple organ dysfunction syndrome (MODS). During monsoon season, there is a spurt of AFI often caused by vector borne diseases leading to substantial morbidity and mortality. Our aim was to determine distribution of etiological causes, differential organ involvement and predictors of mortality in critically ill patients with AFI. It was a hospital based observational study which included patients with AFI with dysfunction of at least one organ system. The study was conducted over 4 months during monsoon season. Admitted patients were included who had been subjected to a standard battery of tests and managed with standard hospital based management protocol. 145 patients were included and etiology of fever was ascertained in 81.4% of patients with the most common single infection being chikungunya (20.7%) followed by dengue (20%) fever. Thrombocytopenia and deranged liver biochemistry each were seen in nearly 75% of the patients. Renal (50.3%) and nervous system (46.2%) dysfunction were the predominant organ failures. 49 patients died (33.8%) which correlated with predicted mortality by APACHE (acute physiological assessment and chronic health evaluation) II score. Independent predictors for mortality were older age (> 55 years) (p = 0.01), acidemia (p = 0.01), altered sensorium (p = 0.02) and coagulopathy (p = 0.048). Sub-group analysis revealed that amongst patients with MODS, hypotension could help differentiate between bacterial and non-bacterial causes (p = 0.01). Critically ill patients with AFI suffer from significant morbidity and mortality. Features like the presence of hypotension in MODS may differentiate between a bacterial cause vis-à-vis viral or protozoal etiology.

Portal hypertension and its complications are the leading causes of morbidity and mortality in patients with liver cirrhosis. Noninvasive assessment of liver stiffness had been an effective tool for assessment of fibrosis progression in chronic liver disease. It was intended to assess liver stiffness measurement (LSM), portal vein diameter (PVD), splenic bipolar diameter (SD), and the platelet count/spleen diameter (PC/SD) ratio in patients who test positive for the hepatitis C virus (HCV) and to study the impact of non-selective beta blockers (NSBB) on the grade of esophageal varices (EVs) and liver elasticity. Subjects were 80 patients with Child-Pugh grade A or B compensated cirrhosis who tested positive for HCV. All of the patients underwent a laboratory workup including AFP, HCV antibodies, HCV RNA, HBsAg, LSM according to real-time elastography, upper gastrointestinal endoscopy (UGIE) to detect and grade EVs, calculation of the PC/SD ratio, and measurement of the PVD and SD according to real-time abdominal ultrasonography. All patients were given the maximum tolerated dose of NSBB for three months, and UGIE, LSM, PC/SD, PVD, and SD were subsequently reassessed and reported. LSM and the PC/SD ratio were exceptional noninvasive tools for prediction of significant EVs (grade ≥ II, p < 0.001) with a sensitivity 82.4% and a specificity 82.6% at a cutoff point 18 kPa for LSM, and a sensitivity 94.1% and specificity 69.6% at a cutoff point 880 for the PC/SD ratio. LSM is highly correlated with PVD, the PC/SD ratio, SD, and the Child-Pugh score. NSBB significantly decreased PVD. The percent change in PVD significantly correlated with LSM, the grade of EVs, and SD. Findings indicated that LSM is a noninvasive, rapid, and reproducible tool with which to detect portal hypertension and EVs. NSBB therapy can effectively decrease PVD and may consequently improve the EV grade with no significant impact on LSM in patients with liver cirrhosis.

Carbon dots prepared from different sources have been widely studied in various medical applications. Those dots have been reported to be able to inhibit the proliferation of cancer cells, such as prostate cancer cells. The current study used carbon dots prepared from red beans to determine their effect on 16 cell lines including liver cancer cells, pancreatic cancer cells, intrahepatic cholangiocarcinoma cells, and colorectal adenocarcinoma cells. In a cellular viability experiment, carbon dots were found suppress cancer cell viability in a time- and dose-dependent manner. In a cell migration experiment, cancer cells treated with carbon dots had less ability to heal, suggesting that carbon dots inhibit cell migration. In another cellular viability experiment, a combination of carbon dots and doxorubicin resulted in greater inhibition than cells treated with either therapy alone. These findings suggest that carbon dots could be an alternative and complementary medicine for the treatment of cancers.

Portal vein thrombosis (PVT) is a common complication of liver cirrhosis. The association between endoscopic injection sclerotherapy (EIS) and PVT is unclear. In this paper, we reported that a male cirrhotic patient developed acute mesenteric vein thrombosis after EIS for secondary prophylaxis of esophageal variceal bleeding. Immediate anticoagulation therapy was effective and safe in this patient.

No effective therapy exists for locally advanced or metastatic basal cell carcinoma (BCC). Vismodegib is a small molecule that is an inhibitor of the hedgehog pathway. An oral treatment to inactivate Smoothened would be a new therapeutic approach to treat advanced BCC. We studied two patients with advanced BCC and analysed variables, including age and sex of the patient, tumour location and size, time of evolution and nature of the tumour (primary or recurrent), type of treatment, route of administration, treatment duration, and treatment response. The most important side effects were determined. The patients received oral vismodegib (150 mg) daily. The male patient experienced difficulty in swallowing, which necessitated administration of the drug using a percutaneous endoscopic gastrostomy tube. In the first few months of treatment, both patients displayed significant improvement with almost complete disappearance of the skin lesions in one case and more than 50% in the other case. The median duration of response was 7.6 months. The side effects observed were of slight relevance; alopecia, dysgeusia, asthenia, and fatigue were easily resolved with the appropriate treatments. Vismodegib appears to be well tolerated and effective in treating advanced and metastatic BCC. No serious adverse events were reported.