Prevalence and causes of low birth weight in India

INTRODUCTION

The aims of the study are (i) to understand inter-zone and interstate variation of low birth weight (LBW) and (ii) to determine the key variables to reduce LBW in India.

METHODS

Using the latest National Family Health Survey (NFHS) data of 2005-06 which showed the percentage distribution of LBW infants, ANOVA and post-hoc test were performed to determine the spatial variation of birth weight. The covariates which influence LBW fell into three categories: (i) social variables which included location, mother's education, religion, access of mothers to newspapers, television and family structure; (ii) economic variable namely, the wealth index, and (iii) biological variables which consisted of sex of the children, birth order, and mother's body mass index (BMI). Three models of Logistic regression were carried out to examine the influence of the combinations of these direct and indirect factors.

RESULTS

In India, nearly 20% of new borns have LBW. Males have less frequency of LBW than females. The North-east zone has the lowest prevalence of LBW while the north zone has the highest. Mother's education, access to TV and nuclear family, and intake of iron tablets are the most important socio-economic influences on the determination of birth weight in India.

CONCLUSION

It is essential to provide proper diet and nutritional care of mothers during pregnancy. Increased education of mothers through programmes in TV and newspapers articles have significant roles to play in reducing LBW in India.

Adsorption kinetics of a fluorescent dye in a long chain fatty acid matrix

This work reports the adsorption kinetics of a highly fluorescent laser dye rhodamine B (RhB) in a preformed stearic acid (SA) Langmuir monolayer. The reaction kinetics was studied by surface pressure-time (π-t) curve at constant area and in situ fluorescence imaging microscopy (FIM). Increase in surface pressure (at constant area) with time as well as increase in surface coverage of monolayer film at air-water interface provide direct evidence for the interaction. ATR-FTIR spectra also supported the interaction and consequent complexation in the complex films. UV-vis absorption and Fluorescence spectra of the complex Langmuir-Blodgett (LB) films confirm the presence of RhB molecules in the complex films transferred onto solid substrates. The outcome of this work clearly shows successful incorporation of RhB molecules into SA matrix without changing the photophysical characteristics of the dye, thus making the dye material as LB compatible.

QRDR mutations, efflux system & antimicrobial resistance genes in enterotoxigenic Escherichia coli isolated from an outbreak of diarrhoea in Ahmedabad, India

BACKGROUND & OBJECTIVES

Diverse mechanisms have been identified in enteric bacteria for their adaptation and survival against multiple classes of antimicrobial agents. Resistance of bacteria to the most effective fluoroquinolones have increasingly been reported in many countries. We have identified that most of the enterotoxigenic Escherichia coli (ETEC) were resistant to several antimicrobials in a diarrhoea outbreak at Ahmedabad during 2000. The present study was done to identify several genes responsible for antimicrobial resistance and mobile genetic elements in the ETEC strains.

METHODS

Seventeen ETEC strains isolated from diarrhoeal patients were included in this study. The antimicrobial resistance was confirmed by conventional disc diffusion method. PCR and DNA sequencing were performed for the identification of mutation in the quinolone resistance-determining regions (QRDRs). Efflux pump was tested by inhibiting the proton-motive force. DNA hybridization assay was made for the detection of integrase genes and the resistance gene cassettes were identified by direct sequencing of the PCR amplicons.

RESULTS

Majority of the ETEC had GyrA mutations at codons 83 and 87 and in ParC at codon 80. Six strains had an additional mutation in ParC at codon 108 and two had at position 84. Plasmid-borne qnr gene alleles that encode quinolone resistance were not detected but the newly described aac(6')-Ib-cr gene encoding a fluoroquinolne-modifying enzyme was detected in 64.7 per cent of the ETEC. Class 1 (intI1) and class 2 (intI2) integrons were detected in six (35.3%) and three (17.6%) strains, respectively. Four strains (23.5%) had both the classes of integrons. Sequence analysis revealed presence of dfrA17, aadA1, aadA5 in class 1, and dfrA1, sat1, aadA1 in class 2 integrons. In addition, the other resistance genes such as tet gene alleles (94.1%), catAI (70.6%), strA (58.8%), bla TEM-1 (35.2%), and aphA1-Ia (29.4%) were detected in most of the strains.

INTERPRETATION & CONCLUSIONS

Innate gene mutations and acquisition of multidrug resistance genes through mobile genetic elements might have contributed to the emergence of multidrug resistance (MDR) in ETEC. This study reinforces the necessity of utilizing molecular techniques in the epidemiological studies to understand the nature of resistance responsible for antimicrobial resistance in different species of pathogenic bacteria.

Dynamic 'Spot Sign' Resolution following INR Correction in a Patient with Warfarin-Associated Intracerebral Hemorrhage

Hematoma expansion in intracerebral hemorrhage is associated with poor clinical outcome. The ‘spot sign’ is a radiological marker that is associated with hematoma expansion, and thought to represent active extravasation of contrast. This case demonstrates the use of dynamic CT angiography in identifying the time-dependent appearance of a spot sign in a patient with warfarin-associated intracerebral hemorrhage. Repeat imaging is also presented which verified cessation of the spot sign after INR correction.

Emergence and present status of Lu-177 in targeted radiotherapy: the Indian scenario

177Lu is presently considered to be a potential radionuclide for the development of agents for radionuclide therapy owing to its favorable nuclear decay characteristics [T 1/2 = 6.65 d, E β(max) = 0.497 MeV, E γ = 113 KeV (6.4%) and 208 KeV (11%)]. While the long half-life of this promising radioisotope offers distinct logistic advantage, particularly, in countries having limited reactor facilities, the feasibility of its large-scale production with adequate specific activity and excellent radionuclidic purity in medium flux research reactors constitute yet another desirable feature. Extensive studies have been carried out to optimize the production of this isotope, with high specific activity and radionuclidic purity by the (n,γ) route using the highest available flux and the optimum irradiation time. The gradual evolution of clin ical grade 177LuCl3 as a new radiochemical, ready for commercial deployment by Radiopharmaceuticals Division, Bhabha Atomic Research Centre, to nuclear medicine centers all over India was accomplished in 2010 in a stepwise manner with the commencement of the production of high specific activity 177Lu from enriched target in 2001. Research on 177Lu has demonstrated its immense potential in radiotherapeutic applications, a direct outcome of which has resulted in indigenous development of two agents viz. 177Lu-EDTMP and 177Lu-DOTA-TATE presently being evaluated in human patients for palliative care of bone pain due to skeletal metastases and treatment of malignancies of neuroendocrine origin, respectively. Using locally produced 177Lu, the radiolabeling of a plethora of other molecules with potential applicability in radiation synovectomy and targeted therapy of malignant tumors have been successfully demonstrated. A few of these agent such as a novel 177Lu-labeled porphyrin has shown considerable promise in initial studies and is presently evaluated. In the present article, our research efforts toward standardization of production methodology of 177Lu in high specific activity and its utilization in the devel opment of agents for targeted radiotherapy are being reported.

Can point doses predict volumetric dose to rectum and bladder: a CT-based planning study in high dose rate intracavitary brachytherapy of cervical carcinoma?

OBJECTIVE

Point doses, as defined by the International Commission on Radiation Units and Measurements (ICRU), are classically used to evaluate doses to the rectum and bladder in high dose rate intracavitary brachytherapy (HDR-ICBT) in cervical cancer. Several studies have shown good correlation between the ICRU point doses and the volumetric doses to these organs. In the present study we attempted to evaluate whether this correlation could be used to predict the volumetric doses to these organs.

METHODS

A total of 150 HDR-ICBT insertions performed between December 2006 and June 2008 were randomly divided into two groups. Group A (n=50) was used to derive the correlation between the point and volumetric doses using regression analysis. This was tested in Group B (n=100) insertions using studentised residuals and Bland-Altman plots.

RESULTS

Significant correlations were obtained for all volumetric doses and ICRU point doses for rectum and bladder in Group A insertions. The strongest correlation was found for the dose to 2 cc volumes (D(2cc)). The correlation coefficients for bladder and rectal D(2cc) versus the respective ICRU point doses were 0.82 and 0.77, respectively (p<0.001). Statistical validation of equations generated in Group B showed mean studentised residual values of 0.001 and 0.000 for the bladder and rectum. However, Bland-Altman analysis showed that the error range for these equations for bladder and rectum were ±64% and ±41% of the point A dose, respectively, which makes these equations unreliable for clinical use.

CONCLUSION

Volumetric imaging is essential to obtain proper information about volumetric doses.

Second primary cancers and their prognostic significance in patients with renal cell carcinoma

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Background: To study the overall and site specific risk and prognostic significance of second primary cancers (SPC) in patients diagnosed with renal cell carcinoma (RCC).

Methods: The Surveillance Epidemiology and End Results (SEER) database was queried for all patients with RCC as the first cancer and one or more SPC (1973-2006). SPC diagnosed within 1 month of diagnosis of RCC or at autopsy/death were excluded. Deidentified information was obtained to analyze the effect of SPC on overall survival (OS) of RCC patients.

Results: A total of 3,795 patients with RCC and ≥ 1 SPC were identified. The ratio of observed/expected cases (O/E ratio) of RCC and ≥ 1 SPCs was 1.18 (95% C.I. 1.15-1.22), significantly greater than the general population (p<0.05). The overall age-adjusted rate of SPC was 0.6 per 100,000 and rate of SPCs was higher in males and in blacks. The O/E ratio of SPCs was significantly higher in younger patients (6.6 vs. 1.3 and 1.13 for those aged <30, 30-59 and ≥60 yrs respectively), in blacks (1.38 vs. 1.15 in whites), for larger tumors (1.3, 1.2 and 1.05 for tumors <5cm, 5-<10cm and ≥10cm in diameter), and those who did not receive radiation. The risk was similar for both genders. There was variation in the site-specific risk of SPC depending on age at time of RCC diagnosis, gender, race, size of the tumor and presence or lack of radiation therapy. Patients with SPC had longer OS than those with RCC as the only primary tumor on univariate but not multivariate analysis. Older age (≥60yrs), radiation therapy, and a short interval (<12 mo) between the diagnosis of RCC and a SPC were associated with significantly shorter OS in RCC patients with SPC on multivariate analysis.

Conclusions: Our comprehensive analysis of SPCs in patients with RCC as the first primary malignancy using SEER data suggests that about 10% of RCC patients develop SPC and that several patient, tumor and treatment-related factors affect the risk of SPC at specific sites. Further, SPC can adversely influence the prognosis of patients with RCC, especially those >60 years old, receiving radiation or diagnosed with a SPC within 1 year after RCC diagnosis. These results may have significance in planning surveillance strategies to improve the survival of patients with RCC.

No significant financial relationships to disclose.

Activated KrasG¹²D is associated with invasion and metastasis of pancreatic cancer cells through inhibition of E-cadherin

Background:

Pancreatic cancer (PC) harbours an activated point mutation (Kras^G12D) in the Kras proto-oncogene that has been demonstrated to promote the development of PC.

Methods:

This study was designed to investigate the effect of the oncogenic Kras^G12D allele on aggressiveness and metastatic potential of PC cells. We silenced the oncogenic Kras^G12D allele expression in CD18/HPAF and ASPC1 cell lines by stable expression of shRNA specific to the Kras^G12Dallele.

Results:

The Kras^G12D knockdown cells exhibited a significant decrease in motility (P<0.0001), invasion (P<0.0001), anchorage-dependent (P<0.0001) and anchorage-independent growth (P<0.0001), proliferation (P<0.005) and an increase in cell doubling time (P<0.005) in vitro and a decrease in the incidence of metastases upon orthotopic implantation into nude mice. The knockdown of the Kras^G12D allele led to a significant increase in the expression of E-cadherin (mRNA and protein) both in vitro and in vivo. This was associated with a decrease in the expression of phoshpo-ERK-1/2, NF-κB and MMP-9, and transcription factors such as δEF1, Snail and ETV4. Furthermore, the expression of several proteins involved in cell survival, invasion and metastasis was decreased in the Kras^G12D knockdown cells.

Conclusions:

The results of this study suggest that the Kras^G12D allele promotes metastasis in PC cells partly through the downregulation of E-cadherin.

Dynamic nature of the CT angiographic "spot sign"

The "spot sign", first described in 2007, has shown that a focal area of contrast extravasation within an intracerebral haematoma (ICH) can be correlated with haematoma expansion. We describe a case where time-resolved dynamic CT angiography (dCTA) shows the appearance of the "spot sign" only in later images. This finding highlights the importance of timing of the static CT angiogram which, if performed too early, might result in a false-negative diagnosis.

Interaction of c-Cbl with myosin IIA regulates Bleb associated macropinocytosis of Kaposi's sarcoma-associated herpesvirus

KSHV is etiologically associated with Kaposi's sarcoma (KS), an angioproliferative endothelial cell malignancy. Macropinocytosis is the predominant mode of in vitro entry of KSHV into its natural target cells, human dermal microvascular endothelial (HMVEC-d) cells. Although macropinocytosis is known to be a major route of entry for many viruses, the molecule(s) involved in the recruitment and integration of signaling early during macropinosome formation is less well studied. Here we demonstrate that tyrosine phosphorylation of the adaptor protein c-Cbl is required for KSHV induced membrane blebbing and macropinocytosis. KSHV induced the tyrosine phosphorylation of c-Cbl as early as 1 min post-infection and was recruited to the sites of bleb formation. Infection also led to an increase in the interaction of c-Cbl with PI3-K p85 in a time dependent manner. c-Cbl shRNA decreased the formation of KSHV induced membrane blebs and macropinocytosis as well as virus entry. Immunoprecipitation of c-Cbl followed by mass spectrometry identified the interaction of c-Cbl with a novel molecular partner, non-muscle myosin heavy chain IIA (myosin IIA), in bleb associated macropinocytosis. Phosphorylated c-Cbl colocalized with phospho-myosin light chain II in the interior of blebs of infected cells and this interaction was abolished by c-Cbl shRNA. Studies with the myosin II inhibitor blebbistatin demonstrated that myosin IIA is a biologically significant component of the c-Cbl signaling pathway and c-Cbl plays a new role in the recruitment of myosin IIA to the blebs during KSHV infection. Myosin II associates with actin in KSHV induced blebs and the absence of actin and myosin ubiquitination in c-Cbl ShRNA cells suggested that c-Cbl is also responsible for the ubiquitination of these proteins in the infected cells. This is the first study demonstrating the role of c-Cbl in viral entry as well as macropinocytosis, and provides the evidence that a signaling complex containing c-Cbl and myosin IIA plays a crucial role in blebbing and macropinocytosis during viral infection and suggests that targeting c-Cbl could lead to a block in KSHV infection.

KSHV is etiologically associated with Kaposi's sarcoma (KS), the most common AIDS related neoplasm. The first key step in KSHV infection is its initial contact with target cells and entry. While it is known that KSHV uses macropinocytosis for its infectious entry into its natural target cells, HMVEC-d cells, we know little about the molecule(s) involved in this event. Here, we show that the adaptor protein c-Cbl plays a major role in regulating bleb associated macropinocytosis of KSHV. The results demonstrate that c-Cbl protein functions as an adaptor for the myosin II hexameric complex in macropinocytic events. Knocking down c-Cbl by shRNA induces defects in myosin II dependent blebbing and KSHV entry, indicating that c-Cbl uses myosin II to coordinate signaling pathways, resulting in bleb formation and bleb retraction. This work provides a clear understanding of the role of c-Cbl in the recruitment and integration of signaling molecules around the macropinosome during virus infection, and identifies potential targets to intervene in KSHV infection.

Heavy metal uptake and its effect on macronutrients, chlorophyll, protein, and peroxidase activity of Paspalum distichum grown on sludge-dosed soils. Heavy metal uptake and its effect on P. distichum

This study assessed the heavy metal (Cr, Mn, Ni, Cu, Zn, and Pb) uptake and its effect on biochemical parameters in Paspalum distichum, a wetland plant. Sludge collected from Bhalswa waste dump, New Delhi, was used as heavy metal source and dosed in different proportions viz. 20%, 40%, 60%, and 80% to the garden soil. The plants accumulated metals mostly in belowground organs. The metal accumulation followed the order: Cr>Mn>Cu>Zn>Ni>Pb. The range of heavy metal concentration in tissue of belowground organs after 180 days of growth was 1,778.65-4,288.01 ppm Cr, 828.11-1,360 ppm Mn, 236.52-330.07 ppm Ni, 155.79-282.35 ppm Cu, 27.05-91.16 ppm Zn, and 27.09-50.87 ppm Pb. The biochemical parameters viz. chlorophyll and protein contents and peroxidase (POD) activity exhibited no considerable adverse effect indicating the plants' tolerance towards heavy metals. The high POD activity and synthesis of new protein bands at high sludge-dosed plants were also in support of this fact.

Effect of nano-clay platelets on the J-aggregation of thiacyanine dye organized in Langmuir-Blodgett films: a spectroscopic investigation

In this paper we report the effect of the incorporation of nano-dimensional clay platelets, laponite, on the J-aggregation of a thiacyanine dye N,N'-dioctadecyl thiacyanine perchlorate (NK) assembled into Langmuir-Blodgett (LB) monolayers. pi-A isotherms and atomic force microscopic studies confirm the successful incorporation of clay platelets into the Langmuir monolayer of NK. J-aggregates of NK remain present in LB films lifted at lower as well as higher surface pressures in the absence of laponite clay platelets. However, with the incorporation of clay platelets, J-aggregates are formed only in LB films lifted at higher surface pressure of 30 mN/m and totally absent in the films lifted at lower surface pressures of 10 and 15 mN/m. This may be due to the formation of nano-trapping level by overlapping of clay platelets at higher surface pressure. NK molecules may get squeezed to these nano-trapping to form J-aggregates.

Cerebral haemorrhage from a remote varix in the venous outflow of an arteriovenous malformation treated successfully by embolisation

We describe a case of intracerebral haemorrhage in the temporal lobe arising from a distal varix related to the venous outflow of an ipsilateral frontal arteriovenous malformation (AVM). AVM itself and associated arterial aneurysms are well-known risk factors for haemorrhage. In this patient, haemorrhage had occurred from a distal varix. This is the first reported case of successful endovascular embolisation of a frontal AVM with spontaneous regression of an associated remote varix. [corrected].

Fusarium culmorum is a single phylogenetic species based on multilocus sequence analysis

Fusarium culmorum is a major pathogen of wheat and barley causing head blight and crown rot in cooler temperate climates of Australia, Europe, West Asia and North Africa. To better understand its evolutionary history we partially sequenced single copy nuclear genes encoding translation elongation factor 1-α (TEF), reductase (RED) and phosphate permease (PHO) in 100 F. culmorum isolates with 11 isolates of Fusarium crookwellense, Fusarium graminearum and Fusarium pseudograminearum. Phylogenetic analysis of multilocus sequence (MLS) data using Bayesian inference and maximum parsimony analysis showed that F. culmorum from wheat is a single phylogenetic species with no significant linkage disequilibrium and little or no lineage development along geographic origin. Both MLS and TEF and RED gene sequence analysis separated the four Fusarium species used and delineated three to four groups within the F. culmorum clade. But the PHO gene could not completely resolve isolates into their respective species. Fixation index and gene flow suggest significant genetic exchange between the isolates from distant geographic regions. A lack of strong lineage structure despite the geographic separation of the three collections indicates a frequently recombining species and/or widespread distribution of genotypes due to international trade, tourism and long-range dispersal of macroconidia. Moreover, the two mating type genes were present in equal proportion among the F. culmorum collection used in this study, leaving open the possibility of sexual reproduction.

Biodegradation of phenol by native microorganisms isolated from coke processing wastewater

The present investigation was undertaken to assess the biodegradation of phenol by native bacteria strains isolated from coke oven processing wastewater. The strains were designated ESDSPB1, ESDSPB2 and ESDSPB3 and examined for colony morphology Gram stain characters and biochemical tests. Phenol degrading performance of all the strains was evaluated initially. One of the strains namely ESDSPB2 was found to be highly effective for the removal of phenol, which was used as sole carbon and energy source. From an initial concentration of 200 mg I(-1) it degraded to 79.84 +/- 1.23 mg l(-1). In turn the effect of temperature (20 to 45 degrees C), pH (5-10) and glucose concentration (0, 0.25 and 0.5%) on the rate of phenol degradation by that particular strain was investigated. Observations revealed that the rate of phenol biodegradation was significantly affected by pH, temperature of incubation and glucose concentration. The optimal conditions for phenol removal were found to be pH of 7 (84.63% removal), temperature, 30 degrees C (76.69% removal) and 0.25% supplemented glucose level (97.88% removal). The main significance of the study is the utilization of native bacterial strains from the waste water itself having potential of bioremediation.

Using an automated recruitment process to generate an unbiased study sample of multiple sclerosis patients

The objective of this study was to test the efficiency of an automated recruitment methodology developed as a component of a practical controlled trial to assess the benefits of a Web-based personal health site to guide self-management of multiple sclerosis symptoms called Mellen Center Care On-line. We describe the study's automated recruitment methodology using clinical and administrative databases and assess the comparability between subjects who completed informed consent (IC) forms, and individuals who were invited to participate but did not reply, designated as patient nonresponders (PNR). The IC and PNR groups were compared on demographics, number of physician or advanced practice nurse/physician assistant visits during the 12 months prior to the initial invitation, and level of disability as measured by the Charlson Comorbidity Index (CCI). Out of a total dynamic potential pool of 2,421 patients, 2,041 had been invited to participate, 309 had become ineligible to participate during the study, and 71 individuals remained in the pool at the end of recruitment. The IC group had a slightly greater proportion of females. Both groups were predominantly white with comparable marital status. The groups had comparable mean household income, education level, and commercial insurance. The computed mean CCI was similar between the groups. The only significant difference was that the PNR group had fewer clinic visits in the preceding 12 months. The subjects were highly representative of the target population, indicating that there was little bias in our selection process despite a constantly changing pool of eligible individuals.

Isolation of a bacteriophage specific for CS7-expressing strains of enterotoxigenic Escherichia coli

Enterotoxigenic Escherichia coli (ETEC) is the most common bacterial cause of childhood diarrhoea in Bangladesh. Among the virulence factors of ETEC, toxins and colonization factors (CFs) play a major role in pathogenesis. Unlike Vibrio cholerae, the relationship between ETEC and ETEC-specific phages is poorly understood and the possible role of ETEC phages in the evolution of ETEC strains in the environment is yet to be established. This study was designed specifically to isolate phages that are specific for ETEC virulence factors. Among the 49 phages isolated from 12 different surface water samples, 13 were tested against 211 ETEC strains collected from clinical and environmental sources. One phage, designated IMM-001, showed a significant specificity towards CS7 CF as it attacked all the CS7-expressing ETEC. Electron microscopic analyses showed that the isolated phage possessed an isomeric hexagonal head and a long filamentous tail. An antibody blocking method and phage neutralization assay confirmed that CS7 pilus is required for the phage infection process, indicating the role of CS7 fimbrial protein as a potential receptor for IMM-001. In summary, this study showed the presence of a lytic phage in environmental water that is specific for the CS7 CF of ETEC.

Optical-ellipsometric study of the nematic-to-smectic transition in 8CB films adsorbed on silicon

The nematic-to-smectic-A (NA) transition in 8CB (4-octyl-4'-cyanobiphenyl) is especially interesting because experimentally, it has been observed to be second order, but theoretically, it has been predicted that it must have a latent heat. The effect on the NA transition due to confinement in an adsorbed film has hitherto not been investigated. Previous study of adsorbed 8CB films on silicon for coverages less than 100 nm showed the existence of a broad coexistence region, identified by the formation of thick and thin islands on the surface that extends between the bulk NA and the isotropic-to-nematic transition temperatures. In this paper, optical and ellipsometric measurements of 8CB films as a function of temperature are used to identify the location of the NA transition in the film in relation to the coexistence region. The NA transition temperature in the film is found to occur at 32.2+/-0.4 degrees C independent of film thickness for films between 62 to 270 nm thick, based on the decrease in the film anisotropy. This decrease in the anisotropy is found to be surprisingly abrupt. For thicknesses below 62 nm, the NA transition line is joined to the thin-thick coexistence region found previously.