Management and treatment outcomes of MDR-TB: results from a setting with high rates of drug resistance

SETTINGS

Although Pakistan has a high burden of multidrug-resistant tuberculosis (MDR-TB), little is known about the management and treatment outcomes of MDR-TB patients in Pakistan.

OBJECTIVE

To evaluate management and predictors of unsuccessful treatment outcomes among MDR-TB patients.

METHODS

In this observational cohort study, 196 MDR-TB patients enrolled at the Programmatic Management Unit for drug-resistant TB of Lady Reading Hospital, Peshawar, Pakistan, between 1 January 2012 and 28 February 2013 were included. Patients were followed until an outcome was recorded or 31 January 2015.

RESULTS

Extensive concurrent resistance to ofloxacin (OFX) and pyrazinamide (54.6%) was observed. Among 181 patients for whom treatment outcome was available, 135 (74.6%) were cured, 1 (0.6%) completed treatment, 35 (19.3%) died, 8 (4.4%) failed treatment and 2 (1.1%) defaulted. In multivariate analysis, predictors of unsuccessful treatment outcome (death, failure and default) were age >40 years (OR 3.412, P = 0.009), baseline body weight <40 kg (OR 2.966, P = 0.020), concurrent comorbidity (OR 3.785, P = 0.023), resistance to OFX (OR 2.777, P = 0.023), lung cavitations at baseline chest X-ray (OR 5.253, P < 0.001) and regimen modification due to adverse events (OR 3.492, P = 0.037).

CONCLUSION

The treatment outcome results were encouraging. Patients with identifiable predictors of poor treatment outcome should receive enhanced clinical management. Early detection and management of mild adverse effects can help prevent regimen modification and may improve treatment outcomes.

A prospective interventional study of effect of accelerated orthokeratology on the corneal curvature and refraction among young adults with myopia

BACKGROUND

Orthokeratology with reverse geometry contact lens is a non-surgical alternative to conventional contact lenses for correction of myopia. However, the strength of evidence for its efficacy and safety is limited to retrospective studies and only a few prospective studies. This prospective study, the first on Indian subjects, evaluated the outcome of orthokeratology among young myopes.

METHODS

Fifty eyes of 25 young myopes (age 19-29 years) with myopia of -1 to 5.0 diopter underwent accelerated orthokeratology using the reverse geometry ortho K - LK lenses for correction of myopia. They were followed up prospectively with weekly vision, refraction, corneal topography, and pachymetry to assess the correction of myopia.

RESULTS

The mean Log MAR vision corrected from 0.748 ± 0.225 at base line to 0.025 ± 0.0630 at 12 weeks with 86% achieving 6/6 unaided day time vision. This was associated with significant central corneal flattening and thinning. The lenses were well tolerated with no significant complications.

CONCLUSION

Overnight accelerated orthokeratology effectively corrects moderate degree of myopia and provide excellent spectacle free day time vision without any significant adverse effects in the short term.

Reducing crude protein and rumen degradable protein with a constant concentration of rumen undegradable protein in the diet of dairy cows: Production performance, nutrient digestibility, nitrogen efficiency, and blood metabolites

The goals of ruminant protein nutrition are to provide adequate amounts of RDP for optimal ruminal efficiency and to obtain the desired animal productivity with a minimum amount of dietary CP. The aim of the present study was to examine effects of decreasing dietary protein by decreasing RDP with the optimum concentration of RUP on production performance, nutrient digestibility, N retention, rumen fermentation parameters, and blood metabolites in high-producing Holstein cows in early lactation. Nine multiparous lactating cows (second parities, averaging 50 ± 12 d in milk and milk yield of 48 ± 5 kg/d) were used in a triplicate 3 × 3 Latin square design with 3 rations: 1) a total mixed ration (TMR) containing 16.4% CP (10.9% RDP based on DM), 2) a TMR containing 15.6% CP (10% RDP), and 3) a TMR containing 14.8% CP (9.3% RDP). The level of RUP was constant at 5.5% DM across the treatments. All diets were calculated to supply a postruminal lysine to methionine ratio of about 3:1. Dry matter intake, milk yield and composition, 4% fat-corrected milk, and energy-corrected milk were not significantly affected by decreasing dietary CP and RDP levels. Cows fed 16.4% CP diets had greater ( < 0.01) CP and RDP intakes, which resulted in a trend toward greater concentrations of plasma urea N compared with other treatments. Daily N intake linearly decreased ( < 0.01) with decreasing dietary CP and RDP levels, whereas the intake of RUP and fecal N excretion (g/d) did not change. Apparent digestibility of nutrients, ruminal pH, and NH-N concentration were not affected with decreasing dietary CP and RDP levels. Apparent N efficiency increased, and RDP N intake and predicted urine N output decreased with decreased concentration of dietary CP and RDP in the diets ( < 0.01). Blood metabolites were not affected by treatments. In conclusion, to improve the efficiency of N utilization by early-lactation dairy cows, 9.3% RDP in rations provides adequate protein to optimize milk production while minimizing N excretion in urine when the amounts of lysine and methionine and the lysine to methionine ratio are balanced with sufficient dietary RUP.

Plastic surgical operative workload in major trauma patients following establishment of the major trauma network in England: A retrospective cohort study

INTRODUCTION

The introduction of major trauma centres (MTCs) in England has led to 63% reduction in trauma mortality.(1) The role of plastic surgeons supporting these centres has not been quantified previously. This study aimed to quantify plastic surgical workload at an urban MTC to determine the contribution of plastic surgeons to major trauma care.

METHODS

All Trauma Audit and Research Network (TARN)-recorded major trauma patients who presented to an urban MTC in 2013 and underwent an operation were identified retrospectively. Patients who underwent plastic surgery were identified and the type and date of procedure(s) were recorded. The trauma operative workload data of another tertiary surgical specialty and local historical plastics workload data from pre-MTC go-live were collected for comparison.

RESULTS

Of the 416 major trauma patients who required surgical intervention, 29% (n = 122) underwent plastic surgery. Of these patients, 43% had open lower limb fractures, necessitating plastic surgical involvement according to British Orthopaedic Association Standards for Trauma (BOAST) 4 guidance. The overall plastic surgery operative workload increased sevenfold post-MTC go-live. A similar proportion of the same cohort required neurosurgery (n = 115; p = 0.589).

DISCUSSION

This study quantifies plastic surgery involvement in major trauma and demonstrates that plastic surgical operative workload is at least on par with other tertiary surgical specialties. It also reports one centre's experience of a significant change in plastic surgery activity following designation of MTC status. The quantity of plastic surgical operative workload in major trauma must be considered when planning major trauma service design and workforce provision, and for plastic surgical postgraduate training.

Dirac electrons in the presence of a matrix potential barrier: application to graphene and topological insulators

Scattering of 2D Dirac electrons on a rectangular matrix potential barrier is considered using the formalism of spinor transfer matrices. It is shown, in particular, that in the absence of the mass term, the Klein tunneling is not necessarily suppressed but occurs at oblique incidence. The formalism is applied to studying waveguiding modes of the barrier, which are supported by the edge and bulk states. The condition of the existence of the uni-directionality property is found. We show that the band of edge states is always finite with massless excitations, while the spectrum of the bulk states, depending on the parameters of the barrier, may consist of the infinite or finite band with both, massive and massless, low-energy excitations. The effect of the Zeeman term is considered and the condition of the appearance of two distinct energy-dependent directions corresponding to the Klein tunneling is found.

[On quality of life of children of senior school age in the Republic of Udmurtia]

The article presents results of population study of quality of life of children aged 2-17 years. The study of quality of life of children of senior school age using questionnaire PedsQL was carried out. The comparative characteristic of indices of quality of life of children ofjunior and senior school age in the Republic of Udmurtia is presented. The regional indices of quality of life of children of senior school age are determined. Among all aspects of quality of life the highest values had «physical functioning» and «social functioning». The scales «emotional functioning» and «social functioning» differed by their lesser level. The quality of life of girls of senior school age was lower than in boys in all aspects but more concerned emotional sphere. The residence in urban or rural territory effects indices of quality of life of children of senior school age in Udmurtia. The urban children had higher indices of quality of life on aspects «physical functioning» and «emotional functioning». The level of aspects of «social functioning» and «school functioning» is characterized by absence of disagreements between urban and rural children. The geographical area of residing of children of senior school age in Udmurtia has no effect on indices of quality of life. The aspects of «social functioning», «emotional functioning» and «school functioning» have particular characteristics depending on age (8-12 years and 13-17 years). The age characteristics consist in increasing of level of social functioning; age trend of aspects «emotional functioning» and «school functioning» has negative dynamics.

Bupropion Hydrochloride

Bupropion hydrochloride is a norepinephrine-dopamine disinhibitor (NDDI) approved for the treatment of depression and smoking cessation. Bupropion is a trimethylated monocyclic phenylaminoketone second-generation antidepressant, which differs structurally from most antidepressants, and resides in a novel mechanistic class that has no direct action on the serotonin system. Comprehensive chemical, physical, and spectroscopic profiles are presented. This analytical profile provides an extensive spectroscopic investigation utilizing mass spectrometry, one- and two-dimensional NMR, solid-state NMR, IR, NIR, Raman, UV, and X-ray diffraction. The profile also includes significant wet chemistry studies for pH, solubility, solution, and plasma stability. Both HPLC and UPLC methodology are presented for bupropion and its related impurities or major metabolites. The profile concludes with an overview of biological properties that includes toxicity, drug metabolism, and pharmacokinetics.

[The application of laser therapy for the medical rehabilitation of the children presenting with chronic osteomyelitis]

The objective of the present study was to develop a scientifically sound rationale for the application of infrared laser radiation (IRLR) either separately or in the combination with fluctuation magnetic therapy in the medical rehabilitation of the children presenting with chronic hematogenous osteomyelitis. Another objective was to evaluate the clinical effectiveness of this therapeutic modality. Two achieve these goals, the clinical observations and special research studies were conducted in two directions with the participation of 95 patients at the age varying from 1 to 15 years. The study has demonstrated the effectiveness of the inclusion of IRLR in the medical rehabilitation program for the children with chronic hematogenous osteomyelitis in different periods of the disease. It was shown that the transcutaneous infrared irradiation of the affected area during the exacerbation of chronic osteomyelitis had a well apparent immunostimulatory effect and reduced the activity of the inflammatory process. The application of IRLR in combination with fluctuation magnetic therapy during the period of partial remission, had a more pronounced influence on the microcirculation and stimulated the regenerative and trophic processes.

[The medical rehabilitation of the children presenting with the hyperactive urinary bladder]

The present article is focused on the modern technologies for the medical rehabilitation of the children presenting with the hyperactive urinary bladder (UB) designed to promote the act of urination in the children at all levels of bladder innervation.

Effects of physical form of starter and forage provision to young calves on blood metabolites, liver composition and intestinal morphology

This study evaluated the effects of physical form of starter feed and forage provision on the performance, blood metabolites, liver composition and intestinal morphology of dairy calves. Individually housed calves (n = 52; body weight = 41.5 ± 2.5 kg) were randomly allocated (n = 13 per treatment) to one of the following four treatments: (i) ground starter feed (GS; mean particle size = 0.72 mm in diameter), (ii) textured starter feed (TS; mean particle size = 3.61 mm in diameter, including steam-flaked corn and barley), (iii) pelleted starter feed (PS; mean particle size = 4.53 mm in diameter) and (iv) ground starter feed with chopped alfalfa hay (GS + AH; mean particle size = 1.02 mm in diameter). The calves fed GS + AH diets had greater (p < 0.01) starter intake, final body weight and average daily gain compared with the other groups, while GS and TS groups both had greater (p < 0.01) starter intake than the PS group. Feed efficiency was found to be better (p < 0.05) in the TS group than in the GS or PS group, but not different from the GS + AH one. Compared with the other groups, the GS + AH group had the highest (p < 0.01), while the PS one had the lowest (p < 0.01) concentrations of blood glucose and triglyceride. The calves fed GS + AH had the highest blood concentrations of total protein, globulin, triiodothyronine (T3), thyroxin (T4), T3 : T4 ratio (p < 0.05) and levels of fat and glycogen in the liver (p < 0.01) compared with the other groups. The highest (p < 0.05) liver glycogen contents were observed in the GS + AH and TS groups. The duodenum, ileum and jejunum in the calves fed GS + AH exhibited a greater muscle layer thickness (p < 0.05) compared with the other groups. Based on the results obtained, the addition of dietary forage to starter diets positively influenced performance, liver composition and intestinal morphology in developing calves.

[The topical problems of pediatric balneotherapy and the spa and health resort-based treatment of the children]

This article is devoted to the topical problems of pediatric balneotherapy with special reference to the organization of the spa and health resort-based treatment of the children in the Russian Federation. The main issues discussed by the authors include the current state of health resort care for the children, the problem of statutory regulation of the activities of the children's spa and health resort facilities, the approaches to increasing the availability of the spa and health resort-based treatment for the children at the enhanced risk of the development of chronic diseases, disabilities, and tuberculosis. Also considered are the problems of the development of the regulatory framework for the medical rehabilitation of the children based at the spa and health resort facilities. The principal goals to be sought in climatotherapy, physiotherapy, balneotherapy, and pelotherapy in the pediatric context are outlined along with the further prospects for the development of the main areas of pediatric balneology.

[The medical rehabilitation of the children presenting with atopic dermatitis (a literature review)]

Atopic dermatitis takes the predominant position in the structure of skin pathologies in the children of various age. Both the scientifically based forecasts and the data of numerous investigations give evidence not only of the significant increase in the number of patients presenting with this condition but also of the growing severity of this disease. Taken together, these facts account for the serious medico-social importance of the problems arising in connection with this pathology. The introduction of the eliminative actions, a hypoallergenic diet, local and systemic pharmacotherapeutic modalities do not always allow to prevent or arrest the inflammatory process and achieve the long-standing remission. The high frequency of undesirable reactions to the pharmacological products turns the attention of many clinicians to the application of the non-pharmacological factors and methods for the treatment of atopic dermatitis in the children. The main objectives of physical therapy in the case of atopic dermatitis include the normalization of the state of the central and vegetative nervous system, the achievement of hyposensitization, sedative, anti-toxic, and anti-inflammatory effects, as well as the application of the dissolving, trophic, and antipruritogenic agents, strengthening of the general health status of the children.

[The health promotion programs for the children based at health promotion institutions]

The research carried out in the framework of the health promotion programs for the children made it possible to obtain characteristics of the patients admitted to health promotion facilities, identify the risk factors for the development of acute respiratory diseases, and substantiate the principles of the differentiated approach to the rehabilitation of such patients based at the institutions of this type taking into consideration the health group to which a concrete patient is referred and the risk factors of acute respiratory diseases. The feasibility and effectiveness of the addition of aromatherapy and treatment with the use of polarized light into the health promotion programs for the children presenting with acute respiratory diseases that they develop during the period of adaptation based at health promotion institutions are discussed.

Invited review: Transitioning from milk to solid feed in dairy heifers

Calves are born with a physically and metabolically underdeveloped rumen and initially rely on milk to meet nutrient demands for maintenance and growth. Initiation of solid feed consumption, acquisition of anaerobic microbes, establishment of rumen fermentation, expansion of rumen in volume, differentiation and growth of papillae, development of absorption and metabolic pathways, maturation of salivary apparatus and development of rumination behavior are all needed as the calf shifts from dependence on milk to solid feed. In nature and some production systems (e.g., most beef calves), young ruminants obtain nutrients from milk and fresh forages. In intensive dairying, calves are typically fed restricted amounts of milk and weaned onto starter feeds. Here we review the empirical work on the role of feeding and management during the transition from milk to solid feed in establishing the rumen ecosystem, rumen fermentation, rumen development, rumination behavior, and growth of dairy calves. In recent years, several studies have illustrated the benefits of feeding more milk and group rearing of dairy calves to take advantage of social facilitation (e.g., housing with peers or dam), and this review also examines the role of solid feed on rumen development and growth of calves fed large quantities of milk and reared under different housing situations. We conclude that the provision of high-starch and low-fiber starter feeds may negatively affect rumen development and that forage supplementation is beneficial for promoting development of the gut and rumination behavior in young calves. It is important to note that both the physical form of starter diets and their nutritional composition affect various aspects of development in calves. Further research is warranted to identify an optimal balance between physically effective fiber and readily degradable carbohydrates in starter diets to support development of a healthy gut and rumen, rumination behavior, and growth in young calves.

[The role of non-medicamental technologies in the rehabilitation of the children presenting with acute rhinosinusitis]

Despite the recent achievements in diagnostics and pharmacotherapy of acute rhinosinusitis in the children, the problem of management of this pathology, thus far remains a serious challenge for practical medicine. The objective of the present study was to develop a scientifically sound rationale for the application of halotherapy (HT) and magnetic therapy (MT) or their combination for the treatment of acute rhinosinusitis in the children. The clinical observations and special investigations were carried out in the comparative aspect and encompassed 120 children at the age varying from 5 to 15 years suffering from acute rhinosinusitis. The therapeutic effectiveness of the rehabilitative treatment was evaluated based on the results of the endoscopic study of the nasal cavity, analysis of the X-ray images of paranasal sinuses, rhinomanometry, investigations into the ciliary activity, and assessment of the mucosal immunity. The results of the present study gave evidence of the feasibility of incorporating HT and MT in the combined treatment of the children presenting with acute rhinosinusitis. The integrated use of the two methods proved to have the advantage over the separate application of either of them. The specific effects of HT and MT on the clinical course of acute sinusitis and the functional state of intranasal mucosa are described. The optimal methods of the treatment are proposed.

Targeted complement inhibition and microvasculature in transplants: a therapeutic perspective

Active complement mediators play a key role in graft-versus-host diseases, but little attention has been given to the angiogenic balance and complement modulation during allograft acceptance. The complement cascade releases the powerful proinflammatory mediators C3a and C5a anaphylatoxins, C3b, C5b opsonins and terminal membrane attack complex into tissues, which are deleterious if unchecked. Blocking complement mediators has been considered to be a promising approach in the modern drug discovery plan, and a significant number of therapeutic alternatives have been developed to dampen complement activation and protect host cells. Numerous immune cells, especially macrophages, develop both anaphylatoxin and opsonin receptors on their cell surface and their binding affects the macrophage phenotype and their angiogenic properties. This review discusses the mechanism that complement contributes to angiogenic injury, and the development of future therapeutic targets by antagonizing activated complement mediators to preserve microvasculature in rejecting the transplanted organ.

Relationship between SPOP mutation and breast cancer in Chinese population

SPOP protein has been found to have ubiquitin ligase activity. Mutations in SPOP gene have been recently reported in some cancers such as prostate, gastric, colorectal cancer. We investigated SPOP DNA mutation in tumor tissues collected from 70 Chinese female breast cancer patients in Southwestern China by DNA sequencing. The results did not show mutation in our tissue samples, indicating that a mutation in the SPOP gene may not be associated with breast cancer, particularly in Chinese women. This DNA mutation analysis or DNA genotyping may provide useful and important information for genetic counseling and personalized medical treatment for different types of cancers.

Establishment and rapid detection of a heterozygous missense mutation in the CACNA1F gene by ARMS technique with double-base mismatched primers

Retinitis pigmentosa (RP) is a retinal degenerative disorder that often causes complete blindness. Mutations of more than 50 genes have been identified as associated with RP, including the CACNA1F gene. In a recent study, by employing next-generation sequencing, we identified a novel mutation in the CACNA1F gene. In this study, we used the amplification refractory mutation system (ARMS) and identified a single nucleotide change c.1555C>T in exon 13 of the CACNA1F gene, leading to the substitution of arginine by tryptophan (p.R519W) in a Chinese individual affected by RP. This study actually confirms this novel mutation, and establishes the ARMS technique for the detection of mutations in RP.

Xpert(®) MTB/RIF under routine conditions in diagnosing pulmonary tuberculosis: a study in two hospitals in Pakistan

Xpert(®) MTB/RIF testing was offered to consecutive patients with presumptive tuberculosis (TB) attending two hospitals in Pakistan during April-May 2012, in addition to routine diagnostic protocol (smear microscopy, chest radiography and clinical judgement). We assessed the relative contribution of each tool in detecting pulmonary TB under routine conditions. Of 606 participants, 121 (20%) were detected as pulmonary TB: 46 (38%) by microscopy, 38 (31%) by Xpert alone and 37 (31%) on clinical and radiological grounds; 41 (65%) were detected by both Xpert and microscopy. One patient had rifampicin resistance. Although Xpert detected approximately twice as many TB cases as microscopy (n = 79, 65%), clinical judgement remained favoured by clinicians even when smear and Xpert were negative.

Epitope-based peptide vaccine design and target site depiction against Ebola viruses: an immunoinformatics study

Ebola viruses (EBOVs) have been identified as an emerging threat in recent year as it causes severe haemorrhagic fever in human. Epitope‐based vaccine design for EBOVs remains a top priority because a mere progress has been made in this regard. Another reason is the lack of antiviral drug and licensed vaccine although there is a severe outbreak in Central Africa. In this study, we aimed to design an epitope‐based vaccine that can trigger a significant immune response as well as to prognosticate inhibitor that can bind with potential drug target sites using various immunoinformatics and docking simulation tools. The capacity to induce both humoral and cell‐mediated immunity by T cell and B cell was checked for the selected protein. The peptide region spanning 9 amino acids from 42 to 50 and the sequence TLASIGTAF were found as the most potential B and T cell epitopes, respectively. This peptide could interact with 12 HLAs and showed high population coverage up to 80.99%. Using molecular docking, the epitope was further appraised for binding against HLA molecules to verify the binding cleft interaction. In addition with this, the allergenicity of the epitopes was also evaluated. In the post‐therapeutic strategy, docking study of predicted 3D structure identified suitable therapeutic inhibitor against targeted protein. However, this computational epitope‐based peptide vaccine designing and target site prediction against EBOVs open up a new horizon which may be the prospective way in Ebola viruses research; the results require validation by in vitro and in vivo experiments.

Conversion, shrinkage, water sorption, flexural strength and modulus of re-mineralizing dental composites

OBJECTIVES

Cure, volumetric changes and mechanical properties were assessed for new dental composites containing chlorhexidine (CHX) and reactive calcium phosphate-containing (CaP) to reduce recurrent caries.

METHODS

20wt.% of light curable urethane dimethacrylate based liquid was mixed with 80wt.% glass filler containing 10wt.% CHX and 0-40wt.% CaP. Conversion versus depth with 20 or 40s light exposure was assessed by FTIR. Solidification depth and polymerization shrinkage were determined using ISO 4049 and 17304, respectively. Subsequent volume expansion and biaxial flexural strength and modulus change upon water immersion were determined over 4 weeks. Hydroxyapatite precipitation in simulated body fluid was assessed at 1 week.

RESULTS

Conversion decreased linearly with both depth and CaP content. Average solidification depths were 4.5, 3.9, 3.3, 2.9 and 5.0 with 0, 10, 20, and 40% CaP and a commercial composite, Z250, respectively. Conversions at these depths were 53±2% for experimental materials but with Z250 only 32%. With Z250 more than 50% conversion was achieved only below 1.1mm. Shrinkage was 3% and 2.5% for experimental materials and Z250, respectively. Early water sorption increased linearly, whilst strength and modulus decreased exponentially to final values when plotted versus square root of time. Maximum volumetric expansion increased linearly with CaP rise and balanced shrinkage at 10-20wt.% CaP. Strength and modulus for Z250 decreased from 191 to 158MPa and 3.2 to 2.5GPa. Experimental composites initial strength and modulus decreased linearly from 169 to 139MPa and 5.8 to 3.8GPa with increasing CaP. Extrapolated final values decreased from 156 to 84MPa and 4.1 to 1.7GPa. All materials containing CaP promoted hydroxyapatite precipitation.

SIGNIFICANCE

The lower surface of composite restorations should both be solid and have greater than 50% conversion. The results, therefore, suggest the experimental composite may be placed in much thicker layers than Z250 and have reduced unbounded cytotoxic monomer. Experimental materials with 10-20wt.% additionally have volumetric expansion to compensate shrinkage, antibacterial and re-mineralizing components and competitive mechanical properties.

The long-lasting antidepressant effects of rapastinel (GLYX-13) are associated with a metaplasticity process in the medial prefrontal cortex and hippocampus

Rapastinel (GLYX-13) is an N-methyl-d-aspartate receptor (NMDAR) modulator that has characteristics of a glycine site partial agonist. Rapastinel is a robust cognitive enhancer and facilitates hippocampal long-term potentiation (LTP) of synaptic transmission in slices. In human clinical trials, rapastinel has been shown to produce marked antidepressant properties that last for at least one week following a single dose. The long-lasting antidepressant effect of a single dose of rapastinel (3mg/kg IV) was assessed in rats using the Porsolt, open field and ultrasonic vocalization assays. Cognitive enhancement was examined using the Morris water maze, positive emotional learning, and contextual fear extinction tests. LTP was assessed in hippocampal slices. Dendritic spine morphology was measured in the dentate gyrus and the medial prefrontal cortex. Significant antidepressant-like or cognitive enhancing effects were observed that lasted for at least one week in each model. Rapastinel facilitated LTP 1day-2weeks but not 4weeks post-dosing. Biweekly dosing with rapastinel sustained this effect for at least 8weeks. A single dose of rapastinel increased the proportion of whole-cell NMDAR current contributed by NR2B-containing NMDARs in the hippocampus 1week post-dosing, that returned to baseline by 4weeks post-dosing. The NMDAR antagonist 3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP) blocked the antidepressant-like effect of rapastinel 1week post dosing. A single injection of rapastinel also increased mature spine density in both brain regions 24h post-dosing. These data demonstrate that rapastinel produces its long-lasting antidepressant effects via triggering NMDAR-dependent processes that lead to increased sensitivity to LTP that persist for up to two weeks. These data also suggest that these processes led to the alterations in dendritic spine morphologies associated with the maintenance of long-term changes in synaptic plasticity associated with learning and memory.

Rumen fermentation, blood metabolites, and growth performance of calves during transition from liquid to solid feed: Effects of dietary level and particle size of alfalfa hay

This study evaluated the effects of particle size (PS) and dietary level of alfalfa hay (AH) on rumen fermentation parameters, blood metabolites, eating behavior, and growth performance in dairy calves during transition from liquid to solid feed. Sixty newborn dairy calves (41 ± 2.5,kg of body weight) were used in a 2 × 2 factorial arrangement with the factors dietary AH level (medium, 12.5%, or high, 25%, on DM basis) and PS (fine = 1mm or medium = 3mm, as geometric means) of AH. Hence, the dietary treatments were (1) medium level of AH with fine PS (M-FPS), (2) medium level of AH with medium PS (M-MPS), (3) high level of AH with fine PS (H-FPS), and (4) high level of AH with medium PS (H-MPS). Particle size of AH did not affect total DMI (TDMI) during the preweaning period, although TDMI was greater for calves fed MPS than in those fed FPS during the postweaning and overall periods. Calves fed MPS spent more time eating solid feed and ruminating and less time on nonnutritive oral behaviors compared with FPS calves. The dietary level of AH did not affect behavioral parameters. Average daily gain of calves was not affected by dietary treatment before weaning. During the postweaning and overall periods, average daily gain was greater in calves fed MPS than in those fed FPS at the 25% AH level, but this effect was absent with 12.5% AH. Furthermore, the rumen pH values on d 35 and 70 of the study were greater for MPS than for FPS, regardless of the dietary level of AH. Effects of AH level, PS, and their interaction did not affect blood glucose concentrations in developing calves. These results indicate that feed intake, feeding behavior, rumen fermentation parameters, and blood β-hydroxybutyrate concentration may be affected by rations differing in forage PS; thus, providing calves with MPS can improve calf performance and reduce their nonnutritive oral behaviors.

Development of multigrain premixes-its effect on rheological, textural and micro-structural characteristics of dough and quality of biscuits

Four different Multigrain Premixes (MGPs) namely MGP I, MGP II, MGP III, MGP IV were developed to select the best premix for preparation of biscuits based on nutritional value and biscuit quality. The MGPs were prepared using cereals (barley, sorghum, maize, oats), pulses (chickpea dhal, green gram, peas, soya flour), millets (pearl millet, finger millet) and wheat germ each at 20 % level. The MGPs developed had 22.91-27.84 % protein, 16.82-18.72 % dietary fiber and 3.11-3.46 % minerals. The wheat flour was replaced with MGPs separately at different levels of 10, 20, 30, 40 and 50 %. The incorporation of these MGPs significantly (p ≤ 0.05) decreased the water absorption (56.0-50.9 %), peak viscosity (273.67-154.92 RVU), biscuit spread ratio (10.28-8.15) and increased the pasting temperature (67.10-79.20 °C), dough hardness (311.66-460.26 N) and biscuit breaking strength (13.25-28.68 N). SEM studies showed that incorporation of MGP disrupted the protein matrix. Among the MGPs, MGP III was found to be more suitable even at the 40 % level for obtaining nutritious multigrain biscuits with higher protein, dietary fiber, and mineral content.

[The application of the pulsed low-frequency electrostatic field for the combined treatment of the children presenting with bronchial asthma]

The objective of the present study was to develop a scientifically sound rationale for the application of the pulsed low-frequency electrostatic fields (PLIESF) for the combined treatment of the children presenting with bronchial asthma and the comparative assessment of the effectiveness of the use of this method either as monotherapy or together with therapeutic physical exercises based on the immediate and long-term results of the treatment. The dynamic clinical observations and special investigations were carried out on 101 children at the age varying from 5 to 15 years who suffered from bronchial asthma. PLIESF were shown to produce the beneficial effect on dynamics of clinical symptoms in the children manifested as the disappearance or reduced frequency of episodes of laborious respiration and the improvement of sputum discharge, auscultation picture, bronchial patency, and respiratory excursions of the chest. The application of PLIESF significantly increased the level of the general physical performance in the children with bronchial asthma, improved the functional conditions of the cardiovascular system, normalized both the cardiac rhythm and the heart rate. It was shown based on the analysis of the short-term and long-term outcomes of the treatment that the combined therapy with the use of the two physical factors, i.e. the pulsed low-frequency electrostatic fields and therapeutic physical exercises, ensures the significantly higher effectiveness of the treatment than the separate application of either of them.

Prevalence of molecular subtypes of invasive breast cancer: A retrospective study

BACKGROUND

Classification of breast cancers into different molecular subtypes using immunohistochemistry as a surrogate tool to DNA microarray technology has been identified. Aim of this study was to find the precise prevalence of molecular subtypes of invasive breast carcinoma using immunohistochemistry and to correlate it with histological and clinical prognostic factors.

METHODS

A descriptive study design wherein 56 breast carcinoma cases diagnosed between May 2012 and Apr 2014 were reviewed and molecular subtyped using relevant immunohistochemical markers. Age, histological type, tumor size, tumor grade, lymphovascular emboli (LVE), nodal status and basal marker expressions were analyzed for all cases. Correlations between molecular subtypes and clinico-pathological characteristics were evaluated statistically.

RESULTS

In our study group, average age of patients was 50.5 years and most of patients were diagnosed in stage II (54%). Luminal A subtype was most prevalent 34%, followed by Basal like/Triple negative subtype 25%. Luminal B and Her2/neu subtypes had same prevalence i.e. 18% each and Breast Tissue like/Unclassified subtype/Penta Negative subtype was 5%. All cases demonstrated positivity for the luminal cytokeratins 8/18. Histological grade and ER negative status showed strong correlations with basal markers.

CONCLUSION

On the basis of hormone receptor, Her2 neu, EGFR and CK 5/6 expressions, breast carcinoma cases were classified into five distinct molecular subtypes which show significant differences in regards to morphological features, prognostic markers and there by predicting possible clinical outcome.

Prevalence of Anaplasma phagocytophilum in horses from Southern Punjab (Pakistan)

The present study was designed to optimize a PCR-RFLP protocol for the molecular detection of Anaplasma sp. and to compare its prevalence in blood samples of equines from Southern Punjab (Pakistan) and to find out the risk factors involved in the spread of anaplasmosis. A total of 210 blood samples were collected from equines from 2 sampling sites (Dera Ghazi Khan and Khanewal districts). Data on the animals' characteristics (age, species and gender) were collected through survey. PCR amplified the 577bp product specific for 16S rRNA gene of Anaplasma spp. in 9 blood samples (4.3% of total), [Dera Ghazi Khan (N = 3) and Khanewal (N = 6)]. These Anaplasma spp. positive blood samples were used for PCR amplification using A. phagocytophilum specific primers and parasite was detected in all of them. Also it was revealed that the characteristics of the animals i.e. age, gender, species had no significant association with the presence of Anaplasma sp. Hematological parameters remained unaffected while lymphocyte count was significantly lowered in A. phagocytophilum positive samples.

Development of RAPD-SCAR markers for different Ganoderma species authentication by improved RAPD amplification and molecular cloning

The sequence-characterized amplified region (SCAR) is a valuable molecular technique for the genetic identification of any species. This method is mainly derived from the molecular cloning of the amplified DNA fragments achieved from the random amplified polymorphic DNA (RAPD). In this study, we collected DNA from 10 species of Ganoderma mushroom and amplified the DNA using an improved RAPD technique. The amplified fragments were then cloned into a T-vector, and positive clones were screened, indentified, and sequenced for the development of SCAR markers. After designing PCR primers and optimizing PCR conditions, 4 SCAR markers, named LZ1-4, LZ2-2, LZ8-2, and LZ9-15, were developed, which were specific to Ganoderma gibbosum (LZ1-4 and LZ8-2), Ganoderma sinense (LZ2-2 and LZ8-2), Ganoderma tropicum (LZ8-2), and Ganoderma lucidum HG (LZ9-15). These 4 novel SCAR markers were deposited into GenBank with the accession Nos. KM391935, KM391936, KM391937, and KM391938, respectively. Thus, in this study we developed specific SCAR markers for the identification and authentication of different Ganoderma species.

[Inhalation of Myramistin in the children presenting with acute respiratory diseases]

This paper reports the results of the clinical observations and special investigations carried out with the involvement of the children presenting with acute respiratory diseases treated with the use of a Myramistin solution for inhalation.

MATERIAL AND METHODS

The study included a total of 60 children with the above condition at the age varying between 2 and 17 years. Forty patients inhaled the Myramistin solution through a face mask connected to the nebulizer. The remaining 20 children that comprised the control group inhaled Myramistin in the form of a spray.

RESULTS

The study has demonstrated the effectiveness of the proposed method that produced beneficial effect on the clinical symptoms of the respiratory diseases and characteristics of peripheral blood. Moreover, it accelerated the recovery of the patients due to the anti-inflammatory and trophic action of the inhaled solution and promoted normalization of mucociliary clearance. The therapeutic effectiveness of the Myramistin spray was significantly lower than that of the solution.

CONCLUSION

The results of the study provided a basis for the development of the optimal technologies for the application of the Myramistin inhalation solution to the treatment of the children presenting with acute respiratory diseases of the upper and lower parts of the respiratory tract.

[Sensitivity and specificity of the cerebral blood flow reactions to acupuncture in the newborn infants presenting with hypoxic ischemic encephalopathy]

OBJECTIVE

To evaluate the effects of acupuncture integrated into the standard therapy, the condition of cerebral blood flow, and other syndromes associated with cerebral ischemia in the newborn infants. MATERIAL AND METHODS. A total of 131 pairs of puerperae and newborns with hypoxic ischemic encephalopathy were divided into four treatment groups. 34 children of the first group were given standard therapy (control), in the second group comprised of 33 mothers and children the standard treatment was supplemented by acupuncture, the third group included only 32 mothers given the acupuncture treatment alone, and the fourth group contained only 32 newborn infants treated by acupuncture. Each course of acupuncture treatment consisted of five sessions. Sensitivity and specificity of cerebral blood flow reactions were determined based on the results of the ROC-analysis and the area under the curve before and after the treatment.

RESULTS

The treatment with the use of acupuncture greatly improved the cerebrospinal hemodynamics (p < 0.05). Other symptoms, viz. sleep disorders, vegetative reactivity and excitability were significantly reduced. The ROC analysis confirmed the effectiveness of acupuncture as a tool for the treatment of the impaired cerebral blood flow in the newborn babies. The high level of sensitivity (84.4-94.8%) associated with good specificity makes it possible to distinguish between the true positive and true negative cases.

CONCLUSION

Acupuncture integrated into the treatment of "mother-baby" pairs presenting with hypoxic ischemic encephalopathy can be used to improve the initially low level of cerebral blood flow in neonates presenting with this condition.

Efficiency of antifreeze glycoproteins for cryopreservation of Nili-Ravi (Bubalus bubalis) buffalo bull sperm

Experiments were conducted to evaluate the effect of Antarctic fish antifreeze glycoproteins, (AFGP) size 1-5 (34-10.5 kDa) and 7-8 (3.2 and 2.4 kDa) in extender on buffalo bull sperm at cooling (4 °C) and at post thawing. Semen was collected from three Nili-Ravi buffalo bulls with artificial vagina for 3 weeks. Qualifying ejaculates from each buffalo bull were diluted (at 37 °C having 50×10(6) sperm/mL) in tris-citric acid extender containing AFGP at 0 (control), 0.1, 1 and 10 μg/mL. An aliquot of diluted semen was evaluated for sperm progressive motility and plasma membrane integrity, while the remaining fraction was cooled to 4 °C in 2 h. Further, an aliquot of cooled semen was evaluated for the previously described variables and the remaining fraction was cryopreserved (-196 °C). After 24 h of storage, straws were thawed at 37 °C for 30 s to assess post-thaw sperm quality. Inclusion of AFGP in the extender did not affect (P>0.05) sperm progressive motility and plasma membrane integrity of buffalo bull sperm at cooling stage (4 °C). However, at post thawing, improvement (P<0.05) in sperm progressive motility and plasma membrane integrity was recorded in extender containing AFGP 1-5 and AFGP 7-8 at 1 μg/mL compared to the control. Percentage of live sperm with an intact acrosome remained similar (P>0.05) in extenders containing different amounts of AFGP and control. In conclusion, supplementation of 1 μg/ml of AFGP in extender improved the motility and plasma membrane integrity of Nili-Ravi buffalo sperm after thawing.

Application of SCAR markers linked with mungbean yellow mosaic virus disease-resistance gene in Pakistan mungbean germplasm

Mungbean yellow mosaic virus disease (MYMVD) caused by single-stranded DNA begomovirus is the most prominent threat to the mungbean crop in Pakistan. Mungbean genotypes consisting of 127 varieties/lines were screened for MYMVD under natural field conditions. No genotypes were found to be immune or highly resistant against MYMVD. Genotypes showing resistant and tolerant responses in field screening trials were screened using sequence characterized amplified region (SCAR) markers linked with the MYMVD-resistance gene. SCAR markers amplified the desired band only in the resistant and tolerant genotypes, while no amplification was observed in susceptible genotypes. SCAR markers will be useful for future breeding and varietal developmental programs and mungbean genotypes can be screened on the molecular level.

Long-term stability study of Prussian blue-A quality assessment of water content and cyanide release

CONTEXT

Prussian blue, ferric hexacyanoferrate is approved for (oral) treatment of internal contamination with radioisotopes of cesium or thallium. Cyanide makes up 35-40% of Prussian blue's molecular composition; thus, cyanide may be released during transit through the digestive tract under physiological pH conditions.

OBJECTIVES

The purpose of this study is to assess the long-term stability of Prussian blue drug products and active pharmaceutical ingredients and its impact on cyanide release. The study involves the determination and comparison of the loss in water content and cyanide released from Prussian blue under pH conditions that bracket human physiological exposure.

METHODS

Test samples of active pharmaceutical ingredient and drug product were stored for 10 years at ambient temperatures that mimic warehouse storage conditions. Water loss from Prussian blue was measured using thermogravimetric analysis. An in vitro physiological pH model that brackets gastric exposure and gastrointestinal transit was utilized for cyanide release. Prussian blue was incubated in situ at pH: 1.0, 5.0, and 7.0 @ 37°C for 1-24 h. Cyanide was measured using a validated colorimetric method by UV-Vis spectroscopy.

RESULTS

Although the water content (quality attribute) of Prussian blue active pharmaceutical ingredient and drug product decreased by about 10.5% and 13.8%, respectively, since 2003, the cyanide release remained comparable. At pH of 7.0 for 24 h cyanide released from active pharmaceutical ingredient-1 was 21.33 ± 1.76 μg/g in 2004, and 28.45 ± 3.15 μg/g in 2013; cyanide released from drug product-1 was 21.89 ± 0.56 μg/g in 2004, and 27.31 ± 5.78 μg/g in 2013. At gastric pH of 1.0 and upper gastrointestinal pH of 5.0, the data for active pharmaceutical ingredients and drug products were also comparable in 2013. The cyanide release is still pH-dependent and follows the same trend as observed in 2003 with minimum release at pH of 5.0 and maximal release at pH of 1.0. In summary, this is the long-term stability study of Prussian blue which correlates cyanide release to water loss. Cyanide released from Prussian blue was maximum at pH of 1.0 (47.47 μg/g) and minimum at pH of 5.0-7.0 (20.01 μg/g).

CONCLUSIONS

Based on maximal dose, maximal residence time in stomach and intestine, the maximal cyanide released from Prussian blue is about 1.31 mg, which is far below the minimal lethal dose of cyanide of 50 mg, and therefore does not present a safety concern following long-term storage.

Matrix solid-phase dispersion extraction and quantification of alpinetin in amomum seed using validated HPLC and HPTLC methods

Alpinetin is a flavonoidal constituent of seeds of Amomum subulatum Roxb., recently reported to possess vasorelaxant and antiHIV activities. Simple, accurate and precise HPLC and HPTLC methods were developed for the analysis of alpinetin in A. subulatum seed extracts and extraction technique was optimized to get maximum yield using conventional, ultrasonic and matrix solid phase dispersion extraction. HPLC was performed on a C18 column with methanol and water (70:30, v/v) as mobile phase at a flow rate of 1.0 ml/min whereas HPTLC on silica aluminum sheet (60F₂₅₄) using toluene, dichloromethane and ethyl acetate as solvent system. A sharp peak was obtained for alpinetin at a retention time (R_t) of 5.7 min by HPLC and retardation factor (R_f) of 0.48 by HPTLC. Both methods were validated as per the ICH guidelines and the content of alpinetin was estimated in different extracts. Matrix solid phase dispersion technique was found most suitable for extracting alpinetin as compared to other techniques. Validation data are indicative of good precision and accuracy and proved the reliability of the methods.

Salivary and serum leptin concentrations in patients with chronic periodontitis

BACKGROUND

The discovery of leptin has led to the elucidation of a robust physiologic system that not only maintains fat stores but is also an integral part of the host defense mechanism. However, leptin concentrations in the saliva of patients with chronic periodontitis (CP) has not been explored despite the potential role of salivary biomarkers in determining the presence, risk, and progression of periodontal disease.

METHODS

Eighty-four participants (44 with generalized severe CP and 40 without periodontitis) were enrolled. For each patient, the values of periodontal parameters were recorded, such as plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (AL), and percentage of sites with bleeding on probing (BOP) and clinical AL ≥5 mm. Saliva and serum samples were collected to estimate the leptin concentrations using enzyme-linked immunosorbent assay kits. Statistical analysis was performed using software.

RESULTS

Participants with CP demonstrated significantly higher BOP, PI, GI, and percentage of sites with clinical AL >5 mm (P <0.05). Leptin was detectable in all the clinical samples. Salivary leptin concentrations in patients with CP were significantly lower than in healthy volunteers (6,200.61 ± 2,322.11 versus 8,799.60 ± 901.70 pg/mL), whereas serum leptin concentrations were significantly higher in patients with CP than in healthy volunteers (11,600.00 ± 1,705.01 versus 7,616.62 ± 1,169.83 pg/mL). In addition, the results reflected a significant negative correlation of salivary leptin and a positive correlation of serum leptin with PD (P <0.05).

CONCLUSION

The results suggest that leptin concentrations in saliva and serum are significantly altered in CP and relate closely to current disease activity; however, further studies are needed to confirm the findings.

Interaction between the physical form of the starter feed and straw provision on growth performance of Holstein calves

Two experiments were conducted to assess the effect of physical form of a starter feed with or without straw supplementation on growth performance of Holstein calves. In experiment 1, a total of 32 calves were randomly assigned at 7 d of age to texturized starter feed (containing rolled barley, corn, and oats) without straw, texturized starter feed with chopped straw, and pelleted starter feed with chopped straw. All calves were offered 4 L of pasteurized whole milk twice daily from 7 to 35 d of age, 2 L of milk twice daily from 36 to 42 d of age, and 2 L of milk from 43 to 49 d of age. Animals were weaned at 50 d of age, and the study finished when calves were 63 d old. In experiment 2, a total of 60 calves (8 d of age) were randomly assigned to texturized starter feed (containing whole corn) without straw, pelleted starter feed without straw, and pelleted starter feed with chopped straw. All calves were offered the same milk replacer (MR; 23% crude protein and 19.5 fat) at 11% dry matter concentration, 4 L/d of MR until 14 d of age, 6 L/d of MR from 14 to 37 d, 3 L/d of MR from 38 to 44 d, and 1.5 L/d of MR from 45 to 52 d of age. The experiment finished when calves were 58 d old (1 wk after weaning). Rumen liquid pH was measured after weaning. In both studies, calves were individually housed in pens on sawdust bedding and starter feed and chopped straw were offered free choice in separate buckets. In experiment 1, starter feed and straw intake and growth did not differ among treatments. However, calves receiving straw showed a greater rumen pH compared with those not receiving straw. In experiment 2, pelleted started feed supplemented with straw fostered an increase in solid feed intake (as percentage of body weight) compared with a pelleted or texturized starter feed without straw supplementation. However, calves that received the texturized starter feed containing whole corn had rumen pH similar to those fed a pelleted starter feed with straw. Feeding a texturized starter feed containing rolled barley, corn, and oats (with or without straw provision) was not able to maintain rumen pH or promote growth and intake compared with offering a pelleted starter feed with chopped straw. However, when whole corn was used in the texturized starter feed, rumen pH was equivalent to that obtained with a pelleted starter feed and straw supplementation.

Leukoaraiosis predicts a poor 90-day outcome after endovascular stroke therapy

BACKGROUND AND PURPOSE

Leukoaraiosis is a common finding among patients with ischemic stroke and has been associated with poor stroke outcomes. Our aim was to ascertain whether the severity of pre-existing leukoaraiosis is associated with outcome in patients with acute ischemic stroke who are treated with endovascular stroke therapy.

MATERIALS AND METHODS

We retrospectively analyzed data from 129 consecutive, prospectively enrolled patients with stroke undergoing endovascular stroke therapy at a single tertiary care center between January 2006 and August 2013. Leukoaraiosis was assessed as supratentorial white matter hypoattenuation on admission head CT and graded as 0-2 (absent-to-moderate) versus 3-4 (severe) according to the van Swieten scale. We dichotomized the 90-day mRS into good (0-2 or return to baseline) versus poor (3-6) as the primary study outcome. Incremental multivariable logistic regression analyses were performed to identify independent predictors of a poor 90-day outcome.

RESULTS

In all multivariable models, severe leukoaraiosis was independently (P < .05) associated with a poor outcome at 90 days (fully adjusted model: OR, 6.37; 95% CI, 1.83-12.18; P = .004). The independent association between leukoaraiosis and a poor outcome remained when the analysis was restricted to patients who were alive at discharge (n = 87, P < .05). Last, among patients who were alive at discharge, those with severe leukoaraiosis had significantly less frequent improvement on the mRS from discharge to 90 days compared with patients with absent-to-moderate leukoaraiosis (P = .034).

CONCLUSIONS

The severity of pre-existing leukoaraiosis is independently associated with 90-day functional outcome in patients with stroke who underwent endovascular stroke therapy. These results highlight the need to further explore leukoaraiosis as a promising surrogate marker for poor outcome after endovascular stroke therapy to improve risk assessment, patient selection, and early prognostic accuracy.

Polymer ferroelectric field-effect memory device with SnO channel layer exhibits record hole mobility

Here we report for the first time a hybrid p-channel polymer ferroelectric field-effect transistor memory device with record mobility. The memory device, fabricated at 200°C on both plastic polyimide and glass substrates, uses ferroelectric polymer P(VDF-TrFE) as the gate dielectric and transparent p-type oxide (SnO) as the active channel layer. A record mobility of 3.3 cm(2)V(-1)s(-1), large memory window (∼16 V), low read voltages (∼-1 V), and excellent retention characteristics up to 5000 sec have been achieved. The mobility achieved in our devices is over 10 times higher than previously reported polymer ferroelectric field-effect transistor memory with p-type channel. This demonstration opens the door for the development of non-volatile memory devices based on dual channel for emerging transparent and flexible electronic devices.

Novel p53 codon 240 Ser > Thr coding region mutation in the patients of oral squamous cell carcinoma (OSCC)

Chewing habits of tobacco, betel quid (paan), and betel nut (chhaliya) are common traditions in Pakistan. Different other preparations and combination of flavors with tobacco, paan, and chhaliya ingredients are commonly available in the market and have received considerable attention as sources of carcinogens that promote OSCC. Mutagens can damage DNA and generate promutagenic lesions. The germ line mutation/polymorphism of p53 gene has been reported to be involved in multiple steps of carcinogenesis. This study aims to find out the loss of TP53 functions due to mutation/polymorphism caused by genomic alteration and interaction with tobacco-related ingredients.Tissue and blood specimens from 260 OSCC patients were collected and compared with blood samples of 260 age- and sex-matched controls. Mutations in exons 2-11 of p53 gene were examined by PCR-SSCP and directly sequenced.A novel mutation was found in exon 7 of p53 gene. This mutation was observed in the tumors of the OSCC patients. The blood samples of the patients and the controls did not show the nucleotide change in this region. The "AGT" to "ACT" missense mutation was identified at position 719 at TP53. This results in the substitution of amino acid serine with threonine at codon 240 of p53 protein.This novel missence mutation in the DNA-binding domain indicated that the DNA structure may be damaged by the use of exogenous DNA-damaging agents, including tobacco-related carcinogens present in gutka, niswar, and manpuri, which may result in the loss of p53 protein function.

[The use of high-frequency chest wall oscillation for the combined treatment of the children presenting with mucoviscidosis]

Mucoviscidosis is a hereditary disease characterized by the severe clinical course which requires its continuous management by means of appropriate therapeutic and rehabilitative modalities. The objective of the present study was to develop the scientifically grounded rationale for the application of vibration and compression impacts with the use of The Vest clearance system for the clearance of the airways in 30 children at the age varying from 5 to 17 years presenting with mucoviscidosis. The results of the study suggest high effectiveness of high-frequency oscillation of the chest wall in such patients. Moreover, the new data have been obtained illustrating the beneficial influence of this therapeutic modality on the clinical symptoms of the disease, characteristics of the external respiration function, and results of pulseoxymetry.

Alternating temperatures affect the performance of Trichogramma species

The environmental compatibility of a biological control agent is an important aspect of successful reduction of agricultural pests. Temperature fluctuations during the day have a strong influence on the performance of laboratory-reared parasitoids. In field conditions, Trichogramma (Hymenoptera: Trichogrammatidae) wasps are exposed to variable temperatures during their development, which has a significant impact on their ability to control pest species. A simulation-based study was undertaken to evaluate the impact of variations in daily temperature on the pest-control abilities of female Trichogramma and their immature progenies. Considering the temperature variability of different agricultural zones of India, five temperature levels ranging from 20ºC to 40ºC were selected for daily short-term heat shocks to the immature progenies and egg-laying females of two major Trichogramma species. Intensity and frequency of thermal shocks showed inverse relationships with adult emergence, fecundity, and longevity of T. chilonis and T. poliae. Parasitoid pupae were found to be more tolerant to temperature variations than eggs and larvae. Fecundity and longevity of parasitoids were significantly reduced under high temperature shocks to egg-laying females. Sex ratio was significantly affected by high temperature shocks to the immature and adult stages. However, the effect was more severe in eggs. A female-biased sex ratio was apparent in both parasitoids throughout the experiment. Overall, daily short-term temperature shocks to different developmental stages of parasitoids showed radical effects on emergence, fecundity, longevity, and sex ratio of the progeny. Therefore, releases of parasitoids should be conducted when they are in their pupal stages during the morning and evening in order to achieve their highest effectiveness for pest management.

Development of a health index in patients with ankylosing spondylitis (ASAS HI): final result of a global initiative based on the ICF guided by ASAS

OBJECTIVES

The burden of disease in patients with ankylosing spondylitis (AS) can be considerable. However, no agreement has been reached among expert members of Assessment of SpondyloArthritis International Society (ASAS) to define severity of AS. Based on the International Classification of Functioning, Disability and Health (ICF), a core set of items for AS has been selected to represent the entire spectrum of possible problems in functioning. Based on this, the objective of this study was to develop a tool to quantify health in AS, the ASAS Health Index.

METHODS

First, based on a literature search, experts' and patients' opinion, a large item pool covering the categories of the ICF core set was generated. In several steps this item pool was reduced based on reliability, Rasch analysis and consensus building after two cross-sectional surveys to come up with the best fitting items representing most categories of the ICF core set for AS.

RESULTS

After the first survey with 1754 patients, the item pool of 251 items was reduced to 82. After selection by an expert committee, 50 items remained which were tested in a second cross-sectional survey. The results were used to reduce the number of items to a final set of 17 items. This selection showed the best reliability and fit to the Rasch model, no residual correlation, and absence of consistent differential item function and a Person Separation Index of 0.82.

CONCLUSIONS

In this long sequential study, 17 items which cover most of the ICF core set were identified that showed the best representation of the health status of patients with AS. The ASAS Health Index is a linear composite measure which differs from other measures in the public domain.

An evidence-based warfarin management protocol reduces surgical delay in hip fracture patients

Background

Up to 4 % of patients presenting with a hip fracture may be on warfarin at admission. There is little consensus on the timing, dosage or route of vitamin K administration. We aimed to evaluate the impact of a locally developed, evidence-based protocol for perioperative warfarin management on the admission-to-operation time (AOT) in hip fracture patients.

Materials and methods

Clinical and demographic data were collected prospectively for hip fracture patients who were on warfarin at the time of admission (post-protocol group) and compared to a historical control group of patients who were on warfarin before implementation of the protocol (pre-protocol group). Univariate analysis was undertaken to identify any significant differences between the two groups.

Results

Twenty-seven patients in the pre-protocol group (27/616, 4.4 %) and 40 patients in the post-protocol group (4.7 %, 40/855) were on warfarin at admission. There was a significant reduction in the median AOT from 73 h (IQR 46–105) to 37.7 h (IQR 28–45) after implementation of the warfarin protocol (p < 0.001). The proportion of patients operated on within 48 h of admission increased from 30 % (8/27) in the pre-protocol group to 80 % (32/40) in the post-protocol group (p < 0.001). No significant differences in hospital length of stay (p = 0.77) or the postoperative warfarin recommencement time (p = 0.90) were noted between the two groups.

Conclusion

Implementation of a perioperative warfarin management protocol can expedite surgery in hip fracture patients, but did not reduce hospital stay in our cohort, possibly because of a delay in recommencing warfarin in these patients postoperatively.

Level of evidence

Level III.

Anaphylactic reaction to intraurethral chlorhexidine: sensitisation following previous repeated uneventful administration

Instillagel(®) (CliniMed, High Wycombe, UK) is commonly used in urethral catheterisation and to facilitate the passage of instruments into the bladder in urological practice. Its active ingredients include 0.25% chlorhexidine, 2% lidocaine, 0.06% methyl hydroxybenzoate and 0.025% propyl hydroxybenzoate. We discuss the case of an 84-year-old man who received intraurethral Instillagel(®) prior to laser ablation of a recurrent transitional cell carcinoma of the bladder, resulting in anaphylaxis. Subsequent investigation confirmed allergy to chlorhexidine. Although there are previous reports in the literature, this is the first report of intraurethral chlorhexidine resulting in anaphylaxis in a patient who had had repeated, uneventful previous exposures. As such, this case illustrates the phenomenon of chlorhexidine sensitisation and that previous uneventful exposures do not exclude the diagnosis of anaphylaxis in the context of sudden, unexpected deterioration.

Effect of spinach powder on physico-chemical, rheological, nutritional and sensory characteristics of chapati premixes

Effect of spinach powder on the physico-chemical, rheological, nutritional and sensory characteristics on chapati premixes was studied by incorporating spinach powder at different concentrations from 1 % to 10 % based on wheat flour. Addition of 5 % of spinach powder to wheat flour was found to be optimum for chapati preparation. Effect of incorporation of spinach powder on the alveo-consistographic, mixographic and pasting characteristics were studied. It was observed that peak viscosity, breakdown viscosity significantly decreases whereas, peak time, tenacity increases with the increase in the concentration of spinach powder from 1 % to 10 % in chapati premixes. Addition of spinach powder also significantly affects the textural qualities of the chapaties. Premixes and prepared chapaties were also studied for chlorophyll content, total carotenoids,vitamins and minerals.

The UK military experience of thoracic injury in the wars in Iraq and Afghanistan

INTRODUCTION

Thoracic injury during warfare is associated with a high incidence of morbidity and mortality. This study examines the pattern and mortality of thoracic wounding in the counter-insurgency conflicts of Iraq and Afghanistan, and outlines the operative and decision making skills required by the modern military surgeon in the deployed hospital setting to manage these injuries.

METHODS

The UK Joint Theatre Trauma Registry was searched between 2003 and 2011 to identify all patients who sustained battle-related thoracic injuries admitted to a UK Field Hospital (Role 3). All UK soldiers, coalition forces and local civilians were included.

RESULTS

During the study period 7856 patients were admitted because of trauma, 826 (10.5%) of whom had thoracic injury. Thoracic injury-related mortality was 118/826 (14.3%). There were no differences in gender, age, coalition status and mechanism of injury between survivors and non-survivors. Survivors had a significantly higher GCS, Revised Trauma Score and systolic blood pressure on admission to a Role 3 facility. Multivariable regression analysis identified admission systolic blood pressure less than 90, severe head or abdominal injury and cardiac arrest as independent predictors of mortality.

CONCLUSIONS

Blast is the main mechanism of thoracic wounding in the recent conflicts in Iraq and Afghanistan. Thoracic trauma in association with severe head or abdominal injuries are predictors of mortality, rather than thoracic injury alone. Deploying surgeons require training in thoracic surgery in order to be able to manage patients appropriately at Role 3.

Integrating biophysical and socioeconomic information for prioritizing watersheds in a Kashmir Himalayan lake: a remote sensing and GIS approach

Dal Lake, a cradle of Kashmiri civilization has strong linkage with socioeconomics of the state of Jammu and Kashmir. During last few decades, anthropogenic pressures in Dal Lake Catchment have caused environmental deterioration impairing, inter-alia, sustained biotic communities and water quality. The present research was an integrated impact analysis of socioeconomic and biophysical processes at the watershed level on the current status of Dal Lake using multi-sensor and multi-temporal satellite data, simulation modelling together with field data verification. Thirteen watersheds (designated as 'W1-W13') were identified and investigated for land use/land cover change detection, quantification of erosion and sediment loads and socioeconomic analysis (total population, total households, literacy rate and economic development status). All the data for the respective watersheds was integrated into the GIS environment based upon multi-criteria analysis and knowledge-based weightage system was adopted for watershed prioritization based on its factors and after carefully observing the field situation. The land use/land cover change detection revealed significant changes with a uniform trend of decreased vegetation and increased impervious surface cover. Increased erosion and sediment loadings were recorded for the watersheds corresponding to their changing land systems, with bare and agriculture lands being the major contributors. The prioritization analysis revealed that W5 > W2 > W6 > W8 > W1 ranked highest in priority and W13 > W3 > W4 > W11 > W7 under medium priority. W12 > W9 > W10 belonged to low-priority category. The integration of the biophysical and the socioeconomic environment at the watershed level using modern geospatial tools would be of vital importance for the conservation and management strategies of Dal Lake ecosystem.

Responses ofMastomys coucha, that have been infected withBrugia malayiand treated with diethylcarbamazine or albendazole, to re-exposure to infection

The responses of Mastomys coucha to re-exposure to infection with homologous infective larvae (L(3)) of Brugia malayi were investigated, after initial infections with the nematode had been treated subcutaneously for 5 days with diethylcarbamazine (DEC; 150 mg citrate/kg. day) or albendazole (ALB; 50 mg/kg. day). The parasite burdens, serum concentrations of IgG reacting with a soluble somatic extract of adult B. malayi (BmAS), and cytokine and lymphocyte-proliferative responses to filarial antigen (BmAS) or mitogen (concanavilin A or lipopolysaccharide) were studied. The results demonstrated, for the first time, that re-infection with L(3) was only successful in the DEC-treated animals, not the ALB-treated ones. When the ALB-treated animals were re-exposed, interferon-gamma production decreased, lymphocyte-proliferative responses either remained the same (with concanavilin A) or decreased (with BmAS), and concentrations of specific IgG decreased. When the DEC-treated animals were re-exposed, microfilaraemias re-appeared and, although production of interferon-gamma decreased, there were no detectable lymphocyte proliferative responses, and concentrations of specific IgG remained unchanged. Taken together, the results indicate that, at least in the M. coucha model of human filariasis, ALB but not DEC treatment may help to prevent the development of re-infections.