Supervision and Quality Control Measures in Annual Sentinel Surveillance for HIV Infection in India

The National Institute of Health and Family Welfare (NIHFW) has been entrusted by the National AIDS Control Organisation (NACO) to undertake monitoring and supervision of annual Sentinel Surveillance (ASS) activity in India since 1998, to ensure that the data obtained are valid. Earlier Regional coordinating teams cooperated with NIHFW in this task. From 2006 onwards, NACO identified five regional institutes covering all the states and Union Territories and Central team members consisting of experts from various organisations for the monitoring and supervision of the ASS cycle to ensure quality control of both epidemiological data collection and HIV testing (NACO 2006a and b). We describe here the process of quality control and observations of the ASS rounds held from 2005 to 2007. The performance of a majority of sites was satisfactory. The testing laboratories usually adhered to standard operating procedures (SOPs). Lacunae observed during the supervisory visits have been enumerated along with the recommendations for the future surveillance rounds.

Chitosan-poly(butylene succinate) scaffolds and human bone marrow stromal cells induce bone repair in a mouse calvaria model

Tissue engineering sustains the need of a three-dimensional (3D) scaffold to promote the regeneration of tissues in volume. Usually, scaffolds are seeded with an adequate cell population, allowing their growth and maturation upon implantation in vivo. Previous studies obtained by our group evidenced significant growth patterns and osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs) when seeded and cultured on melt-based porous chitosan fibre mesh scaffolds (cell constructs). Therefore, it is crucial to test the in vivo performance of these in vitro 3D cell constructs. In this study, chitosan-based scaffolds were seeded and cultured in vitro with hBMSCs for 3 weeks under osteogenic stimulation conditions and analysed for cell adhesion, proliferation and differentiation. Implantation of 2 weeks precultured cell constructs in osteogenic culture conditions was performed into critical cranial size defects in nude mice. The objective of this study was to verify the scaffold integration and new bone formation. At 8 weeks of implantation, scaffolds were harvested and prepared for micro-computed tomography (µCT) analysis. Retrieved implants showed good integration with the surrounding tissue and significant bone formation, more evident for the scaffolds cultured and implanted with human cells. The results of this work demonstrated that chitosan-based scaffolds, besides supporting in vitro proliferation and osteogenic differentiation of hBMSCs, induced bone formation in vivo. Thus, their osteogenic potential in orthotopic location in immunodeficient mice was validated, evidencing good prospects for their use in bone tissue-engineering therapies.

Chondrogenic differentiation of human bone marrow mesenchymal stem cells in chitosan-based scaffolds using a flow-perfusion bioreactor

Native articular cartilage is subjected to synovial fluid flow during normal joint function. Thus, it is believed that the morphogenesis of articular cartilage may be positively regulated by the application of similar stimulation in vitro. In the present study, the effect of fluid flow over the chondrogenic differentiation of human bone marrow-derived mesenchymal stem cells (hBM-MSCs) was investigated. We intended to find out whether the shear stress caused by perfusion of the medium through the constructs was capable of augmenting the differentiation process. Human BMSCs were isolated from bone marrow aspirates and were characterized by flow cytometry. After expansion, hBM-MSCs were seeded statically onto fibre mesh scaffolds, consisting of a blend of 50:50 chitosan:poly(butylene terephthalate adipate) (CPBTA). Constructs were cultured in a flow-perfusion bioreactor for 28 days, using complete medium for chondrogenesis supplemented by TGFβ3. An enhanced ECM deposition and collagen type II production was observed in the bioreactor samples when compared to the static controls. Moreover, it was observed that hBM-MSCs, in static cultures, take longer to differentiate. ECM accumulation in these samples is lower than in the bioreactor sections, and there is a significant difference in the expression of collagen type I. We found that the flow-induced shear stress has a beneficial effect on the chondrogenic differentiation of hMSCs.

Posaconazole

Posaconazole is a novel second-generation Triazole oral antifungal agent. It is highly effective in the prophylaxis of invasive fungal infections in immunocompromised patients. It is used as a first-line agent as well as for salvage therapy in invasive fungal infections including aspergillosis, oropharyngeal and esophageal candidiasis. It has a good adverse effect profile. With the rising incidence of invasive fungal infections due to the HIV pandemic and medical advancements in transplantation and cancer therapy, these features make posaconazole a valuable addition in the family of antifungal agents.

Genetic and biochemical analyses of sensor kinase A in Bacillus subtilis sporulation

Temporal and spatial regulation of gene expression during endospore formation in Bacillus subtilis prompted us to investigate the molecular mechanisms that coordinate the phosphorelay. We targeted KinA for random mutagenesis. In addition, we constructed KinA-GFP transcriptional fusions for verification, via fluorescence. Four distinct types of sporulation-defective mutants were identified as inactive (no sporulation), hypoactive (low sporulation efficiency), isoactive (same efficiency as wild-type), and hyperactive (high efficiency) mutants. Surprisingly, the beta-galactosidase activity of hyperactive mutants was barely greater than that of the wild-type strain; the only noticeable difference was early synthesis of KinA, which could allow them to activate Spo0A precociously, undergo sporulation earlier, and yield more spores. There was no fluorescence emission by the spore-defective mutant, which confirmed the presence of a truncated KinA (nonsense mutation) in inactive strains; other mutants harbored missense or silent mutations. We determined the nucleotide sequences of KinA mutants and found a conserved C-terminus region; more variability was observed in the N-terminus region, involving the PAS-A and PAS-C domains. We speculate that PAS-A, notwithstanding its ATPase activity, has only a minor role in KinA activity, whereas PAS-B was found to be indispensable. Our results emphasize the importance of temporal coordination of gene expression during the sporulation process and corroborate the necessity of Spo0A phosphorylation by KinA, which stimulates SpoIIG expression. We further propose a novel hypothetical model that purposely dubbed the "C-shaped intertwined model", which requires both homodimerization and spatial proximity between PAS-A and histidine H(405) of two different KinA molecules.

Chitosan/polyester-based scaffolds for cartilage tissue engineering: assessment of extracellular matrix formation

Naturally derived polymers have been extensively used in scaffold production for cartilage tissue engineering. The present work aims to evaluate and characterize extracellular matrix (ECM) formation in two types of chitosan-based scaffolds, using bovine articular chondrocytes (BACs). The influence of these scaffolds' porosity, as well as pore size and geometry, on the formation of cartilagineous tissue was studied. The effect of stirred conditions on ECM formation was also assessed. Chitosan-poly(butylene succinate) (CPBS) scaffolds were produced by compression moulding and salt leaching, using a blend of 50% of each material. Different porosities and pore size structures were obtained. BACs were seeded onto CPBS scaffolds using spinner flasks. Constructs were then transferred to the incubator, where half were cultured under stirred conditions, and the other half under static conditions for 4 weeks. Constructs were characterized by scanning electron microscopy, histology procedures, immunolocalization of collagen type I and collagen type II, and dimethylmethylene blue assay for glycosaminoglycan (GAG) quantification. Both materials showed good affinity for cell attachment. Cells colonized the entire scaffolds and were able to produce ECM. Large pores with random geometry improved proteoglycans and collagen type II production. However, that structure has the opposite effect on GAG production. Stirred culture conditions indicate enhancement of GAG production in both types of scaffold.

Ertapenem

Ertapenem is a parenteral carbapenem licensed for use in adults and children more than 3 months of age. It is active against many Gram-positive and negative bacteria, including several anaerobic organisms but has a narrower spectrum of antimicrobial activity, compared with older carbapenems. It is highly stable against nearly all beta-lactamases, including AmpC and extended spectrum beta lactamases. Ertapenem can be given intramuscularly or intravenously and its favourable pharmacokinetic profile allows once daily dosing. Ertapenem has been proven to be clinically and bacteriologically efficacious in randomised controlled trials for the treatment of community acquired infections including complicated intra-abdominal infections, complicated skin and skin-structure infections, acute pelvic infections, complicated urinary tract infections, community-acquired pneumonia and for the prophylaxis of surgical-site infection following elective colorectal surgery. Ertapenem is suited for mild to moderately ill patients with community-acquired infections and for outpatient intravenous antibacterial therapy.

An assessment of institutional deliveries under JSY at different levels of health care in Jaipur District, Rajasthan

BACKGROUND & OBJECTIVE

Janani Suraksha Yojana (JSY) has been implemented in the country to enhance institutional deliveries. This study assess the gaps in delivery services and utilization of resources at Basic and Comprehensive Emergency Obstetric Care Centers (BEmOCs, & CEmOCs), accredited sub centers and private hospitals in district Jaipur, Rajasthan.

METHODS

The study was undertaken during October-December 2008 in 31 selected health facilities (5 CEmOCs, 4 BEmOCs, 14 accredited subcentres and 8 accredited private hospitals) in district Jaipur. Both primary and secondary data was collected using qualitative and quantitative techniques, by facility survey, interview of service providers (specialists, medical officers, and paramedical staff) and beneficiaries.

RESULTS

There is an increase in institutional deliveries following implementation of JSY. Though the normal deliveries were conducted 24 hours by the BEmOCs and CEmOCs however the necessary drugs like parental antibiotics, mesoprostol, magsulf etc were in short supply and use of partograph was absent at the health facilities. The quality of emergency obstetric care services was still poor due to the lack of blood storage units and anesthetists in CEmOCs. Private accredited hospitals fared better as they had the manpower and managed more complicated cases as compared to government facilities, for caesarean sections. The accredited sub centers were nonfunctional negating the very objective of accreditation. Community is still unaware of the 24 hour stay post delivery and provision of grievance redressal system.

CONCLUSION

The quality aspects of institutional deliveries are far from desired level mostly because of lack of resources, both manpower and materials; non achievement of IPHS standards etc. The service quality related to antenatal, intranatal and postnatal care need to be improved. The JSY is perceived as an effective scheme by the beneficiaries but gaps in resources and lack of quality of services needs to be adequately dealt with.

Derivatives of human beta-casein fragments (54-59) exhibit highly potent immunosuppressant activity

Human beta-casein fragment (54-59) having the amino acid sequence Val-Glu-Pro-Ile-Pro-Tyr, has shown potent immunostimulant activity. Several analogs of this hexapeptide have been synthesized with modification at the N-terminal region and two analogs, viz. peptide I and peptide II have shown significant immunosuppressant activity in-vivo mouse model. Effect on cell mediated immunity (CMI) and humoral immunity was studied in mouse/SRBC model. Both the peptides failed to stimulate immune response in vivo and showed inhibition of CMI and humoral response to sheep red blood cells (SRBC). Peptides showed inhibition in alloantigen induced lymphocyte proliferation, i.e., mixed lymphocyte reaction (MLR) in vitro. Treatment with peptides inhibited the production of interferon-gamma (IFN-gamma), and increased the production of interleukin-4 (IL-4) as well as improved the skin graft survival. Cyclosporine a known immunosuppressant showed similar effect on mouse model. Present study thus provides a lead for the development of safe and effective immunosuppressant.

Comparative study of syndromic and etiological diagnosis of reproductive tract infections/sexually transmitted infections in women in Delhi

BACKGROUND

The adequacy of the World Health Organization's syndromic approach for the diagnosis and management of sexually transmitted diseases (STDs), especially at primary health centers (PHCs) and at other levels, is still debatable in different settings in India and requires validation.

OBJECTIVES

A cross-sectional study was carried out in women attending the peripheral government clinics of Delhi in order to (1) enumerate their self-reported reproductive tract infection (RTI)/sexually transmitted infection (STI) symptoms; (2) assess their clinical status; (3) determine the syndromic diagnosis of RTI/STI in symptomatic women and etiological diagnosis in both symptomatic and asymptomatic women; and (4) compare the level of agreement between self-reporting of morbidity and syndromic and etiological diagnosis.

MATERIALS AND METHODS

The study was conducted over 26 months in 4090 women attending peripheral government healthcare centers, both rural and urban, in four zones of Delhi. They were recruited into four different study groups: group I, non-pregnant, reporting with symptoms of RTI/STI; group II, with a bad obstetric history or infertility; group III, pregnant women in any trimester attending the antenatal clinic; and group IV, the control group. Gynecological examination, followed by the collection of genital specimens and blood, were performed after informed and written consent was obtained. Every symptomatic patient was managed on the basis of algorithms of the syndromic approach as recommended by the National AIDS Control Organisation (NACO), India. All specimens were transported to the STD Reference Laboratory, Safdarjung Hospital, New Delhi and processed by standard methods to diagnose the various STDs. Laboratory reports were sent to the clinicians and appropriate treatment was instituted. Data were analyzed by applying statistical methods.

RESULTS

Overall, self-reporting of morbidity was 65.0%. However, the percentage of women with some STD-related syndrome was 71.4%. The rural women were observed to have significantly more STD syndromes than their urban counterparts. The etiological diagnosis could be established in only 32.2% of cases.

CONCLUSIONS

This study highlights the wide variation between self-reporting of morbidity and syndromic- and etiology-based diagnosis in women from both rural and urban settings. This has implications for the syndromic approach to STI case management. These observations call for a review of the diagnostic policy for RTIs/STIs by national authorities in order to avoid the overuse of antimicrobials. The study also highlights the need for the introduction and/or strengthening of facilities for simple diagnostic tests for RTIs/STIs, especially at the peripheral healthcare level.

Coupling nanomechanical cantilevers to dipolar molecules

We investigate the coupling of a nanomechanical oscillator in the quantum regime with molecular (electric) dipoles. We find theoretically that the cantilever can produce single-mode squeezing of the center-of-mass motion of an isolated trapped molecule and two-mode squeezing of the phonons of an array of molecules. This work opens up the possibility of manipulating dipolar crystals, which have been recently proposed as quantum memory, and more generally, is indicative of the promise of nanoscale cantilevers for the quantum detection and control of atomic and molecular systems.

Lattice resistance to dislocation motion at the nanoscale

In this Letter, we propose a model that demonstrates the effect of a free surface on the lattice resistance experienced by a moving dislocation in nanodimensional systems. This effect manifests in an enhanced velocity of dislocation due to the proximity of the dislocation line to the surface. To verify this finding, molecular dynamics simulations for an edge dislocation in bcc molybdenum are performed, and the results are found to be in agreement with the numerical implementations of this model. The reduction in this effect at higher stresses and temperatures, as revealed by the simulations, confirms the role of lattice resistance behind the observed change in the dislocation velocity.

Stress in mothers of preterm infants in Bangladesh: associations with family, child and maternal factors and children's neuro-development

BACKGROUND

The aim of this paper was to ascertain stress experienced by mothers of prospectively followed up preterm infants, and associations with family, child and maternal factors and children's neuro-development.

METHODS

Within a follow-up study of preterm infants<33 weeks gestational age at a Child Development Center in Dhaka Shishu Hospital, mothers were interviewed with the Self-Report Questionnaire (SRQ) at each visit. Association between SRQ scores and child, family and maternal variables at first and final visit and children's neuro-developmental outcomes was determined.

RESULTS

Low income mothers were more compliant (54%) compared with the defaulters (31%) (P=0.0001) among the 159 mothers enrolled. Of the 88 mothers who were followed up until a mean age of 22 months of their child, 29.3% were at high risk for psychiatric morbidity at first visit compared with 23.9% on their last visit. Use of abortifacients (P=0.026) and higher maternal age (P=0.040) were significantly associated with maternal stress at first visit; while at last follow-up, total number of visits had the most significant association (P=0.041). Twenty-five per cent and 19% of mothers were at risk for psychiatric morbidity in children developing normally and those with neuro-developmental impairments respectively.

CONCLUSIONS

Mothers at risk for psychiatric morbidity can be helped through follow-up support within public hospitals close to their homes, which is most availed by low income families. Neuro-developmental monitoring of high-risk infants closer to homes may be more feasible in resource poor countries than reliance on hospital visits, which increase stress. Biological markers of stress and coping strategies need further research.

A community-based, comparative evaluation of direct agglutination and rK39 strip tests in the early detection of subclinical Leishmania donovani infection

In the Indian state of Bihar, the sensitivities and specificities of direct agglutination tests (DAT) and rK39 test strips for the detection of Leishmania donovani infection in humans were explored and found to be generally good (92%-100%). When 172 asymptomatic individuals [16 'case-contacts' who lived in the same households as past or current, confirmed cases of visceral leishmaniasis (VL) and 156 other subjects from neighbouring households] were tested, the same 36 (21%) individuals, including all 16 'case-contacts', were found seropositive using each type of test. When followed-up after 3 months, 18 of the individuals who had been found seropositive in the baseline survey remained seropositive, and eight (44%) of these had developed symptomatic VL, with amastigotes in their splenic aspirates. Seven (44%) of the 16 'case-contacts' but only one (5%) of the other 20 subjects found seropositive at baseline went on to develop VL within 3 months. Although the strip test appeared slightly better than DAT for predicting the development of VL in the 172 subjects, either type of test may be very useful for the early detection of asymptomatic L. donovani infection and thus the identification of those at relatively high risk of developing VL.

Assessment of the metabolic profile in Type 2 diabetes mellitus and hypothyroidism through proton MR spectroscopy

The metabolic changes in the brain of patients affected with Type 2 diabetes mellitus (DM) alone, both Type 2 DM and hypothyroidism and hypothyroidism only were investigated using proton magnetic resonance spectroscopy ((1)H MRS). Single-voxel spectroscopy was carried out in right and left frontal lobe white matter, left parietal white matter and left occipital gray matter. Choline (Cho)/creatine (Cr) value was found to be increased in the left occipital gray matter of the subjects affected with Type 2 DM and both Type 2 DM and hypothyroidism as compared to controls. No significant change in the Cho/Cr value in the occipital gray matter was observed in hypothyroid subjects as compared to controls. However, they showed an increased level of Cho/Cr in the frontal white matter. High Cho is associated with altered membrane phospholipid metabolism. The high Cho in frontal white matter in hypothyroids and occipital gray matter in diabetic patients suggests that, though both the diseases are endocrine disorders, they differ from each other in terms of regional brain metabolite changes.