Predicting dosing advantages of factor VIIa variants with altered tissue factor-dependent and lipid-dependent activities

BACKGROUND

Recombinant factor VIIa (rFVIIa) is an FX-cleaving coagulation enzyme licensed for the treatment of bleeding episodes in hemophiliacs with inhibitory antibodies. Even though the optimal dosing and comparative dose efficacy of rFVIIa remain poorly understood, genetic or chemical modifications of rFVIIa have been proposed, with the goal of achieving faster and longer hemostatic action. No ongoing trial is currently comparing rFVIIa variants with each other.

OBJECTIVES AND METHODS

We used mathematical modeling to compare the pharmacokinetics, dose-response (pharmacodynamics) and dose-effect duration (pharmacokinetics/pharmacodynamics) of rFVIIa variants to predict their optimal doses. The pharmacodynamic (PD) model of FXa generation by FVIIa in complexes with tissue factor (TF) and procoagulant lipids (PLs) was validated against published ex vivo and in vitro thrombin generation (TG) experiments. To compare variants' safety profiles, the highest non-thrombogenic doses were estimated from the clinical evidence reported for the licensed rFVIIa product.

RESULTS

The PD model correctly described the biphasic TF-dependent and PL-dependent dose response observed in TG experiments in vitro. The pharmacokinetic/PD simulations agreed with published ex vivo TG data for rFVIIa and the BAY 86-6150 variant, and explained the similar efficacies of a single dose of 270 μg kg(-1) (as reported in the literature) and repeated doses of 90 μg kg(-1) of unmodified rFVIIa. The duration of the simulated hemostatic effect after a single optimal dose was prolonged for rFVIIa variants with increased TF affinity or extended half-lives, but not for those with modulated PL activity.

CONCLUSIONS

Some modifications of the rFVIIa molecule may not translate into a prolonged hemostatic effect.

Superior vena cava obstruction (SVCO) in patients with advanced non small cell lung cancer (NSCLC)

INTRODUCTION

To report on prognostic and treatment factors influencing the response of SVCO and related survival outcomes in advanced non small cell lung cancer.

MATERIAL AND METHODS

From November 2008 through December 2011, 18 consecutively diagnosed NSCLC patients with SVCO were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival (OS), Kaplan -Meier survival plots, T-test, Cox Proportional Hazards models were generated by multiple covariates (MVA) and analyzed on SPSS software (version 19.0; SPSS, Inc., Chicago, IL).

RESULTS

Thirteen patients (72%) had presented with SVCO before the pathological diagnosis of underlying lung malignancy, while 5 (28%) progressed to SVCO after initiating treatment with chemotherapy. Twelve (68%) patients achieved subjective relief from the obstruction at the completion of palliative radiation therapy. Treating oncologists preferred 4 Gy per fraction in 11 (62%), while the median biologically equivalent dose delivered was 28 Gy. Six (33%) patients received chemotherapy during the course of treatment. Median OS of the entire cohort was 3±1.85mths and 1-year survival rate of 7%. Univariate analysis confirmed that SVCO patients with good performance score (p=0.02), and partial response to chemotherapy (p= 0.001) have superior OS. However, Cox regression modeling for MVA demonstrated only good performance SVCO patients (p = 0.05) have a better OS.

CONCLUSION

RT effectively relieves SVCO but overall poor survival associated in our clinical scenario needs to be improved with multimodality approach. Adjuvant chemotherapy is to be considered after initial radiation therapy in good performance patients.

KEYWORDS

superior vena cava obstruction (SVCO), radiation therapy, chemotherapy, non small cell lung cancer (NSCLC), BED (biologically equivalent dose).

Hair: an unusual foreign body in airways presenting with haemoptysis in an adult patient

Haemoptysis is defined as expectoration of blood originating from the lungs or tracheo-bronchial tree. It is attributed to various causes like tuberculosis, bronchiectasis, lung cancer, mycetoma, foreign bodies etc. Various types of foreign bodies have been reported in the literature. We report the case of an adult female patient who presented with an episode of haemoptysis (150 mL) in whom flexible fibreoptic bronchoscopy revealed a single long hair at the carina going to left main bronchus. Following successful removal of this hair there were no further episodes of haemoptysis and the patient manifested clinical and radiological improvement.

Application of small-angle neutron scattering to the study of forces between magnetically chained monodisperse ferrofluid emulsion droplets

The optical magnetic chaining technique (MCT) developed by Leal-Calderon, Stora, Mondain-Monval, Poulin & Bibette [Phys. Rev. Lett.(1994),72, 2959–2962] allows precise measurements of force profiles between droplets in monodisperse ferrofluid emulsions. However, the method lacks anin situdetermination of droplet size and, therefore, requires a combination of separately acquired measurements of droplet chain periodicityversusan applied magnetic field from optical Bragg scattering and droplet diameter inferred from dynamic light scattering (DLS) to recover surface force–distance profiles between the colloidal particles. Compound refractive lens (CRL) focused small-angle neutron scattering (SANS) MCT should result in more consistent measurements of droplet size (form factor measurements in the absence of field) and droplet chaining period (from structure factor peaks when the magnetic field is applied), and, with access to shorter length scales, extend force measurements to closer approaches than possible by optical measurements. This article reports on CRL-SANS measurements of monodisperse ferrofluid emulsion droplets aligned in straight chains by an applied field perpendicular to the incident beam direction. Analysis of the scattering from the closely spaced droplets required algorithms that carefully treated resolution and its effect on mean scattering vector magnitudes in order to determine droplet size and chain periods to sufficient accuracy. At lower applied fields, scattering patterns indicate structural correlations transverse to the magnetic field direction owing to the formation of intermediate structures in early chain growth.

Prevalence of hand disorders in type 2 diabetes mellitus and its correlation with microvascular complications

Background:

Physicians have long recognized the association between diabetes mellitus and several pathologic conditions of the hand. The most commonly recognized maladies are limited joint mobility (LJM), Dupuytren's disease (DD), trigger finger (TF), and carpal tunnel syndrome (CTS). Incidence of these hand disorders has increased in the setting of diabetes. Collectively, these are described as diabetic hand syndrome.

Aim:

The aims were to find out the prevalence of hand disorders in diabetic patients, and to study the relation of these hand disorders with microvascular complications.

Subjects and Methods:

This is an observational cross-sectional case-control study done over a period of 1 year Patients of type 2 DM, of age < 65 years, who visited Gandhi Memorial Hospital, Lucknow were enrolled and were described as cases. Age- and sex-matched nondiabetic individuals were taken in the control group. The data were analyzed using software SPSS. SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc. Means and standard deviations were computed; the Student t-test and Chi-square (χ²) test were used as appropriate.

Results:

A total of 400 subjects were studied, 200 each in the case and control groups. Of total 200 diabetic patients, 30% (60/200) patients had neuropathy, 37.5% (75/200) had nephropathy, and 44.5% (89/200) patients had retinopathy. In the study population, 67% patients were having one or more hand disorders, in which LJM was found in 40.5% (81/200) patients, DD was found in 19% (38/200) patients, TF in 16.5% (33/200), and CTS in 14% (28/200) patients.

Conclusions:

This study shows a high prevalence of hand disorders in diabetic patients and also correlates with the duration of type 2 DM, LJM being the most common hand disorder and more common in patients who have microvascular complications.

PANNOTATOR: an automated tool for annotation of pan-genomes

Due to next-generation sequence technologies, sequencing of bacterial genomes is no longer one of the main bottlenecks in bacterial research and the number of new genomes deposited in public databases continues to increase at an accelerating rate. Among these new genomes, several belong to the same species and were generated for pan-genomic studies. A pan-genomic study allows investigation of strain phenotypic differences based on genotypic differences. Along with a need for good assembly quality, it is also fundamental to guarantee good functional genome annotation of the different strains. In order to ensure quality and standards for functional genome annotation among different strains, we developed and made available PANNOTATOR (http://bnet.egr.vcu.edu/iioab/agenote.php), a web-based automated pipeline for the annotation of closely related and well-suited genomes for pan-genome studies, aiming at reducing the manual work to generate reports and corrections of various genome strains. PANNOTATOR achieved 98 and 76% of correctness for gene name and function, respectively, as result of an annotation transfer, with a similarity cut-off of 70%, compared with a gold standard annotation for the same species. These results surpassed the RAST and BASys softwares by 41 and 21% and 66 and 17% for gene name and function annotation, respectively, when there were reliable genome annotations of closely related species. PANNOTATOR provides fast and reliable pan-genome annotation; thereby allowing us to maintain the research focus on the main genotype differences between strains.

Formulation and optimization of mucoadhesive nanodrug delivery system of acyclovir

Acyclovir is an antiviral drug used for the treatment of herpes simplex virus infections, with an oral bioavailability of only 10-20% [limiting absorption in gastrointestinal tract to duodenum and jejunum] and half-life of about 3 h, and is soluble only at acidic pH (pKa 2.27). Mucoadhesive polymeric nanodrug delivery systems of acyclovir have been designed and optimized using 2(3) full factorial design. Poly (lactic-co-glycolic acid) (PLGA) (50:50) was used as the polymer along with polycarbophil (Noveon AA-1) as the mucoadhesive polymer and pluronic F68 as the stabilizer. From the preliminary trials, the constraints for independent variables X(1) (amount of PLGA), X(2) (amount of pluronic F68) and X(3) (amount of polycarbophil) have been fixed. The dependent variables that were selected for study were particle size (Y(1)), % drug entrapment (Y(2)) and % drug release in 12 h (Y(3)). The derived polynomial equations were verified by check point formulation. The application of factorial design gave a statistically systematic approach for the formulation and optimization of nanoparticles with the desired particle size, % drug release and high entrapment efficiency. Drug: Polymer ratio and concentration of stabilizer were found to influence the particle size and entrapment efficiency of acyclovir-loaded PLGA nanoparticles. The release was found to follow Fickian as well as non-Fickian diffusion mechanism with zero-order drug release for all batches. In vitro intestinal mucoadhesion of nanoparticles increased with increasing concentration of polycarbophil. These preliminary results indicate that acyclovir-loaded mucoadhesive PLGA nanoparticles could be effective in sustaining drug release for a prolonged period.

Weight loss for reduction of proteinuria in diabetic nephropathy: Comparison with angiotensin-converting enzyme inhibitor therapy

Reduction of weight in obese type 2 diabetes mellitus (T2DM) individuals is emerging as a significant strategy in the reduction of proteinuria in diabetic nephropathy along with control of hyperglycemia, hypertension, and dyslipidemia. The objective was to evaluate the reduction in 24-h proteinuria in T2DM patients with nephropathy by weight loss, with conventional therapy (angiotensin-converting enzyme [ACE] inhibitors) as the control arm. A prospective, randomized controlled trial was conducted between June 2010 and May 2011. T2DM patients with confirmed nephropathy by 24-h urinary protein estimation with a body mass index (BMI) of >25 kg/m² were studied. Patients who had nondiabetic nephropathy, uncontrolled hypertension (>125/75 mmHg) irrespective of antihypertensive drugs, excess weight due to edema or obesity due to other specific diseases, alcoholics, smokers, and patients who were on hemodialysis were excluded from the study. The patients were divided into three groups, namely, group A, patients on ACE inhibitor therapy; group B, patients on lifestyle modifications for weight loss; and group C, patients on an antiobesity drug (orlistat) and lifestyle modifications. At the end of 6 months, all the three groups were compared. Data were analyzed using software SPSS version 15.0. This study encompassed a total of 88 patients; 12 patients were dropped during the study period and 76 (group A: 22, group B: 23, and group C: 31) patients remained. The mean age of the patients was 58.36 ± 10.87 years (range: 30-70 years). At baseline, age, gender, mean BMI, waist-to-hip ratio (WHR), and 24-h proteinuria did not vary significantly among the three groups. At 6 months, the mean BMI significantly decreased in group C (P < 0.001) compared to that in the other two groups. Among the parameters BMI and WHR, the proportional form of BMI correlated well with the degree of reduction in proteinuria (r = 0.397, P = 0.01). Reduction in weight using lifestyle modifications and antiobesity drugs might improve renal function and proteinuria safely as observed in obese patients with diabetic nephropathy.

Can Metabolic Factors be used Prognostically for Short-Term Mortality in HIV-Infected Patients?

BACKGROUND

Metabolic abnormalities are common throughout the course of human immunodeficiency virus (HIV) infection and may occur either due to HIV infection or as a result of side effects of antiretroviral therapy. It has been established that dyslipidemia and dysglycemia associated with HIV disease reduce the long-term survival of the patients, but their role for predicting prognosis of short-term mortality in HIV patients is unknown.

AIM

To study dyslipidemia and dysglycemia as a prognostic indicator for short-term mortality (<3 months) in HIV patients.

SUBJECTS AND METHODS

An observational, prospective study was conducted at a tertiary care center over a period of 6 months. Consecutive HIV-positive patients hospitalized (both, HIV status known prior to hospitalization and the diagnosis made for the first time at admission) in medical wards from March to May 2010 were studied. All patients had their random blood sugars, fasting blood sugars (if possible), fasting lipid profile, and cluster of differentiation 4 (CD4) counts tested at the time of enrollment. The patients were followed for a period of 3 months, at the end of which they were categorized as survivors and non-survivors, and the demographic, clinical, and investigational parameters were compared between the above groups. Data was analyzed by applying Mann-Whitney U test, two sample t-test, Fisher-Exact test, and stepwise logistic regression analysis of significance, using the computer-based program, Stata, version 11.1.

RESULTS

A total of 82 patients were enrolled for the study of which 64 (78.05%) were males and 18 (21.95%) were females, with a mean (SD) age of 34.00 (7.0) years. The mean CD4 count was 206.23 (129.5) cells/mm(3). The overall mortality within 3 months was 20.7% (17/82). Mycobacterium tuberculosis as opportunistic infection was found in 42 patients, out of which 13 expired (P=0.02). Patients with low high-density lipoprotein (HDL) and hypertriglyceridemia (adjusted OR = 22.92, P value = 0.03, adjusted OR = 3.4, P value = 0.02, respectively) had high likelihood of mortality within 3 months.

CONCLUSIONS

Low HDL and hypertriglyceridemia also appear to be promising short-term mortality markers in HIV patients apart from established factors like low CD4 counts, co-morbid conditions, and opportunistic infections like M. tuberculosis infection. This study warrants further studies with a larger sample size to establish HDL and triglyceride as markers of disease progression and short-term mortality in HIV-infection.

Study on Clinico-Laboratory Profile of Children with Scrub Typhus

Scrub typhus is an acute, febrile, infectious illness caused by Orientia (formerly Rickettsia) tsutsugamushi,an obligate intracellular gram-negative bacterium. Humans are accidental hosts in this zoonotic disease.The present retrospective study describes clinical profile of the children hospitalized in hospital with Scrub Typhus infection during period 2010-2011. 19 hospitalized children with clinical features suggestive of Rickettsial disease (fever, generalized rash) who tested ELISA positive for IgM against Scrub Typhus were included in the present study between the age of 1 years and 15 years. All children presented with fever (100%). 42.10% had lymphadenopathy, 47.36% had eschar and 57.89% patients had cough. 26.31, 21.05%, 10.52%, had hepatomegaly, pain abdomen, and respiratory distress and gastrointestinal bleed respectively. All of the children were investigated and treated with as per protocol. None of them died. We think that Rickettsial infection is not quite common in this region but study showed that it is not an uncommon entity and thus, high degree of suspicion, knowledge of geographical distribution and clinical features of Rickettsial disease helps in its early diagnosis and treatment. J Nepal Paediatr Soc 2012;32(2):187-192 doi: http://dx.doi.org/10.3126/jnps.v32i2.5683

Convergent functional genomics of schizophrenia: from comprehensive understanding to genetic risk prediction

We have used a translational convergent functional genomics (CFG) approach to identify and prioritize genes involved in schizophrenia, by gene-level integration of genome-wide association study data with other genetic and gene expression studies in humans and animal models. Using this polyevidence scoring and pathway analyses, we identify top genes (DISC1, TCF4, MBP, MOBP, NCAM1, NRCAM, NDUFV2, RAB18, as well as ADCYAP1, BDNF, CNR1, COMT, DRD2, DTNBP1, GAD1, GRIA1, GRIN2B, HTR2A, NRG1, RELN, SNAP-25, TNIK), brain development, myelination, cell adhesion, glutamate receptor signaling, G-protein-coupled receptor signaling and cAMP-mediated signaling as key to pathophysiology and as targets for therapeutic intervention. Overall, the data are consistent with a model of disrupted connectivity in schizophrenia, resulting from the effects of neurodevelopmental environmental stress on a background of genetic vulnerability. In addition, we show how the top candidate genes identified by CFG can be used to generate a genetic risk prediction score (GRPS) to aid schizophrenia diagnostics, with predictive ability in independent cohorts. The GRPS also differentiates classic age of onset schizophrenia from early onset and late-onset disease. We also show, in three independent cohorts, two European American and one African American, increasing overlap, reproducibility and consistency of findings from single-nucleotide polymorphisms to genes, then genes prioritized by CFG, and ultimately at the level of biological pathways and mechanisms. Finally, we compared our top candidate genes for schizophrenia from this analysis with top candidate genes for bipolar disorder and anxiety disorders from previous CFG analyses conducted by us, as well as findings from the fields of autism and Alzheimer. Overall, our work maps the genomic and biological landscape for schizophrenia, providing leads towards a better understanding of illness, diagnostics and therapeutics. It also reveals the significant genetic overlap with other major psychiatric disorder domains, suggesting the need for improved nosology.

Diagnosis and inflammatory response of patients with candiduria

Candiduria is common in hospitalised patients, but the clinical relevance is still unclear. This study was done to further our knowledge on detection of and host responses to candiduria. Urines and clinical data from 136 patients in whom presence of yeast was diagnosed by microscopic urinalysis were collected. Diagnosis by standard urine culture methods on blood and MacConkey agar as well as on fungal culture medium (Sabouraud dextrose agar) was compared. Inflammatory parameters (IL-6 and IL-17, Ig) were quantified in the urine and compared with levels in control patients without candiduria. Standard urine culture methods detected only 37% of Candida spp. in urine. Sensitivity was especially low (23%) for C. glabrata and was independent of fungal burden. Candida specific IgG but not IgA was significantly elevated when compared with control patients (P < 0.0001 and 0.07 respectively). In addition, urine levels of IL-6 and IL-17 were significantly higher in candiduric patients when compared with control patients (P < 0.001). Multivariate analysis documented an independent association between an increased IgG (odds ratio (OR) 136.0, 95% confidence interval (CI) 25.7-719.2; P < 0.0001), an increased IL-17 (OR 17.4, 95% CI 5.3-57.0; P < 0.0001) and an increased IL-6 level (OR 4.9, 95% CI 1.9-12.4; P = 0.001) and candiduria. In summary, our data indicate that clinical studies on candiduria should include fungal urine culture and that inflammatory parameters may be helpful to identify patients with clinically relevant candiduria.

Chronic obstructive pulmonary disease: Does gender really matter?

Background:

Limited data is available on the clinical expression of chronic obstructive pulmonary disease (COPD) from India. The impact of gender on expression of COPD has received even less attention. Apart from tobacco smoke, indoor air pollution, especially from biomass fuel may play an important role in development of COPD in women.

Materials and Methods:

Seven hundred and two patients of COPD were studied regarding the etiological and risk factors leading to COPD, gender-related differences in clinical presentation, radiological expression of COPD and the co-morbidities in COPD.

Results:

Tobacco smoke in the form of beedi smoking was the predominant smoke exposure in males, whereas smoke from biofuel burning was the predominant exposure in females. As compared to males, females were younger, reported more dyspnea, more severe bronchial obstruction, more exacerbations, and exhibited higher prevalence of systemic features. Also, females smoked less and had lesser incidence of productive cough, lower body mass index, lesser co-morbidities and less number of hospital admissions as compared to males. Males were more likely than females to have an emphysema-predominant phenotype, while airway-predominant disease was more common among females.

Conclusion:

The current study shows that gender-related differences do exist in COPD patients. Understanding these differences in etiological agent and clinical picture will help early diagnosis of COPD in females.

Cerebrospinal fluid cytology in patients undergoing combined spinal epidural versus spinal anaesthesia without an introducer

The problem of tissue coring exists despite the availability of smaller gauge spinal needles with special tip designs. The aim of the study was to test the hypotheses that a) subarachnoid block given as a part of a combined spinal epidural intervention by needle-through-needle technique introduces a lesser number of epithelial cells into the subarachnoid space compared to isolated subarachnoid block, and b) after lumbar puncture, the initial few drops of cerebrospinal fluid from the spinal needle will have a higher number of epithelial cells than the subsequent sample. One hundred and seven patients of American Society of Anesthesiologists physical status I to III undergoing infra-umbilical surgery were enrolled. Seven patients were excluded from the study and the rest divided into two groups to receive either combined spinal epidural anaesthesia (group A) or isolated subarachnoid anaesthesia, unaided by an introducer (group B). The two groups were compared for the presence of epithelial cells in cerebrospinal fluid. The initial four to six drops of cerebrospinal fluid (sample 1) were collected, the next four to six drops discarded and the following four to six drops (sample 2) collected. The incidence of coring was 96% in group A and 88% in group B (P = 0.142). The median (interquartile range) number of cells in group A, for samples 1 and 2 was 6 (3 to 12.5) and 6 (3 to 10); and in group B, 3.5 (1 to 10) and 4 (1 to 8) respectively. Significant tissue coring was observed with both techniques. Discarding eight to 12 drops of cerebrospinal fluid did not help in reducing the epithelial cell load.

Development and Validation of RP-HPLC Method for Simultaneous Estimation of Atorvastatin Calcium and Fenofibrate in Tablet Dosage Forms

A reverse phase high performance liquid chromatographic method was developed for the simultaneous estimation of atorvastatin calcium and fenofibrate in tablet formulation. The separation was achieved by Luna C18 column and methanol:acetate buffer pH 3.7 (82:18 v/v) as mobile phase, at a flow rate of 1.5 ml/min. Detection was carried out at 248 nm. Retention time of atorvastatin calcium and fenofibrate was found to be 3.02+0.1 and 9.05+0.2 min, respectively. The method has been validated for linearity, accuracy and precision. Linearity for atorvastatin calcium and Fenofibrate were in the range of 1-5 μg/ml and 16-80 μg/ml, respectively. The mean recoveries obtained for Atorvastatin calcium and fenofibrate were 101.76% and 100.06%, respectively. Developed method was found to be accurate, precise, selective and rapid for simultaneous estimation of atorvastatin calcium and fenofibrate in tablets.

Raman scattering of intense, short laser pulses in modulated plasmas

We examine the exponentiation of the Raman forward scattering instability in modulated plasma channels computationally and analytically. An evolution equation for the complex phases of the Raman scattered waves treating the spatial localization and discrete nature of the channel modes is derived. Simulations with WAKE [P. Mora and T. M. Antonsen Jr., Phys. Plasmas 4, 217 (1997)] verify the theory in the linear growth regime and provide insight into the nonlinear stage of the instability when cascading and pump depletion play a role. We find that the exponentiation in modulated channels depends on two factors: the increase in coupling due to the increased plasma wavenumber in the high-density regions of the channel and a decreased coupling due to the reduced longitudinal spatial coherence. For the parameters considered, simulations show that the finite extent of the pump pulse is more significant in determining the exponentiation than phase mixing due to the transverse variation of the channel. Both the theory and simulations confirm that modulated channels allow for the stable guiding of longer pulses than nonmodulated channels.

Inadequate health literacy among paid caregivers of seniors

BACKGROUND

Many seniors rely on paid non-familial caregivers to maintain their independence at home. Caregivers often assist with medication reminding and activities of daily living. No prior studies have examined the health literacy levels among paid non-familial caregivers.

OBJECTIVES

To determine health literacy levels and the health-related responsibilities of paid non-familial caregivers of seniors.

DESIGN

One-on-one face-to-face surveys. The Test for Functional Health Literacy (TOFHLA) was administered to identify health literacy levels. Caregivers were asked to demonstrate their skill in medication use by following directions on pill bottles and sorting medications into pill boxes.

PARTICIPANTS

Ninety-eight paid unrelated caregivers of seniors recruited at physician offices, caregiver agencies, senior shopping areas, and independent living facilities.

RESULTS

Average age of caregivers was 49.5 years, and 86.7% were female. Inadequate health literacy was found in 35.7% of caregivers; 60.2% of all caregivers made errors with the pillbox test medications, showing difficulty in following label directions. Health-related tasks (i.e., medication reminding, sorting, dispensing, and accompanying seniors to physician appointments) were performed by 85.7% of caregivers. The mean age of their seniors was 83.9 years (range 65-99 years), and 82.1% were female.

CONCLUSION

Paid non-familial caregivers are essential for many seniors to remain independent and maintain their health. Many caregivers perform health-related duties, but over 1/3 have inadequate health literacy and have difficulties following medication-related instructions. Educating caregivers and ascertaining their health literacy levels prior to assigning health-related tasks may be an important process in providing optimal care to seniors.

Spectrum of intrabronchial mass lesions and role of flexible bronchoscopy in their diagnosis: a series of 74 cases

BACKGROUND

Variety of benign and malignant lesions of respiratory system presents as intrabronchial mass lesions. Present study was carried out to study the spectrum of intrabronchial lesions and role of flexible flexible bronchoscopy in their diagnosis.

METHODS

Retrospective study of case-records of patients with intrabronchial mass lesions diagnosed by flexible bronchoscopy, bronchial washings and bronchial biopsy between January 2004 and June 2006.

RESULTS

Out of the 696 flexible bronchoscopies done during the study period, intrabronchial mass lesions were evident in 74 patients (10.6%) (age range 21-86 years; 60 males). Fifty (68%) lesions were malignant, eighteen (24%) lesions were benign while six (8%) lesions were inconclusive. Diagnostic yield was about 92%; repeat bronchoscopy for inconclusive results improved the diagnostic yield.

CONCLUSIONS

Though malignant lesions are common, benign lesions remain important causes of intrabronchial mass lesions. Bronchoscopy with adequate sampling is an essential diagnostic modality for confirming the diagnosis of such lesions.

Mediastinal haemangioma with pericardial effusion: a rare entity

Mediastinal haemangioma is a rare benign vascular tumour. A young male presented with complaints of cough and dyspnoea. Serial chest radiographs were suggestive of progressive mediastinal widening and cardiomegaly. Pericardiocentesis revealed haemorrhagic fluid which was negative for microbiology and malignant cells. Patient was unresponsive to antituberculosis treatment and steroids. Computed tomography (CT) of thorax revealed an anterior mediastinal mass lesion with pericardial effusion which on biopsy was found to be a mediastinal haemangioma.

Global warming mitigation potential of biogas plants in India

Biogas technology, besides supplying energy and manure, provides an excellent opportunity for mitigation of greenhouse gas (GHG) emission and reducing global warming through substituting firewood for cooking, kerosene for lighting and cooking and chemical fertilizers. A study was undertaken to calculate (1) global warming mitigation potential (GMP) and thereby earning carbon credit of a family size biogas plant in India, (2) GMP of the existing and target biogas plants in the country and (3) atmospheric pollution reduction by a family size biogas plant. The GMP of a family size biogas plant was 9.7 t CO(2) equiv. year( - 1) and with the current price of US $10 t( - 1) CO(2) equiv., carbon credit of US $97 year( - 1) could be earned from such reduction in greenhouse gas emission under the clean development mechanism (CDM). A family size biogas plant substitutes 316 L of kerosene, 5,535 kg firewood and 4,400 kg cattle dung cake as fuels which will reduce emissions of NOx, SO(2), CO and volatile organic compounds to the atmosphere by 16.4, 11.3, 987.0 and 69.7 kg year( - 1), respectively. Presently 3.83 million biogas plants are operating in the country, which can mitigate global warming by 37 Mt CO(2) equiv. year( - 1). Government of India has a target of installing 12.34 million biogas plants by 2010. This target has a GMP of 120 Mt CO(2) equiv. year( - 1) and US $1,197 million as carbon credit under the CDM. However, if all the collectible cattle dung (225 Mt) produced in the country is used, 51.2 million family size biogas plants can be supported which will have a GMP of 496 Mt of CO(2) equiv. year( - 1) and can earn US $4,968 million as carbon credit. The reduction in global warming should encourage policy makers to promote biogas technology to combat climate change and integration of carbon revenues will help the farmers to develop biogas as a profitable activity.

Non-invasive evaluation of liver cirrhosis using ultrasound

Ultrasound (US) is essential in both assessment of the potentially cirrhotic liver and surveillance of selected patients with chronic hepatitis as liver biopsy can be misleading or inaccurate in up to 25% of cases. Various techniques are already in routine use, such as grey-scale imaging, Doppler US, and contrast-enhanced US (CEUS), while newer techniques such as elastography and hepatic vein transit time (HVTT) have the potential to exclude patients without significant fibrosis or cirrhosis; however, they are operator dependent and require specific software. Grey-scale imaging may demonstrate changes, such as volume redistribution, capsule nodularity, parenchymal nodularity, and echotexture changes. The Doppler findings in the hepatic and portal veins, hepatic artery, and varices allow assessment of liver cirrhosis. However, the operator needs to be aware of limitations of these techniques. Low mechanical index CEUS plays an important role in the assessment of complications of cirrhosis, such as hepatocellular carcinoma and portal vein thrombus. Optimized US technique is crucial for accurate diagnosis of the cirrhotic liver and its complications.

Immune reconstitution inflammatory syndrome in acquired immunodeficiency syndrome

A 33-year-old male presented with a history of fever and cough and was diagnosed to have pulmonary tuberculosis and acquired immunodeficiency syndrome (AIDS). He was started on antituberculosis therapy (ATT) followed by highly active anti-retroviral treatment (HAART) after one week. He developed an immune reconstitution inflammatory syndrome (IRIS) leading to an exacerbation of the tuberculosis disease. After HAART was stopped his condition improved dramatically.