An efficient and convenient protocol for the synthesis of tetracyclic isoindolo[1,2-a]quinazoline derivatives

A convenient and one-pot synthesis of tetracyclic isoindolo [1,2-a]quinazoline derivatives via Lewis acid mediated sequential C–N bond formation reactions is reported.

Verbal autopsy of neonatal deaths in Khatauli Block of District Muzaffarnagar, Uttar Pradesh, India

BackgroundVerbal autopsy is a method of inquiry to ascertain the likely cause of death in populations where vital registration of deaths is incomplete and unreliable. Over 75% of deaths in India occur at homes; more than half of these do not have a certified cause. Further, most of the deaths in the rural areas of India occur at home and that is why a medical certification by a qualified practitioner is not possible. Keeping these facts in mind, this study was designed having objectives as to find out the causes of neonatal deaths through verbal autopsy and its feasibility to be used by health workers.Material & Methods:This cross-sectional epidemiological study was conducted in randomly selected rural areas of Khatauli Block of District Muzaffarnagar, Uttar Pradesh, India. Verbal autopsy data was collected by a team of health workers adequately trained for the same well in advance. Data related to reported neonatal deaths in the study area in the specified period of time was collected on structured & pre-tested questionnaire used as study tool by interviewing the parents, relatives or neighbours of the deceased. Data thus collected was verified twice by the coordinator and principal investigator respectively and analyzed by using Epi info statistical package.Results:A total of 24 perinatal deaths were reported, out of which 7 (29.2%) were stillbirth and 17 (70.8%) were neonatal deaths. ANC was received by 14 mothers (58.3%). Half of the deliveries were conducted by untrained Dai. About 20 deliveries (83.3%) were at home and 10 (58.8%) of the deceased were early neonates. The cause of deaths found by means of verbal autopsies were mainly: pneumonia - 4 (23.5%), diarrhoea - 2 (11.8%) neonatal jaundice - 03 (17.6%) etc.Conclusion:Pneumonia, diarrhoea & neonatal jaundice alone constitute about 53% of the total neonatal deaths. The use of the verbal autopsy tool by health workers to find out the cause of neonatal deaths is very much feasible.DOI: http://dx.doi.org/10.3126/nje.v4i5.12019 Nepal Journal of Epidemiology 2014; 4(5):423-27

Pancreatic beta cells are highly susceptible to oxidative and ER stresses during the development of diabetes

The complex interplay of many cell types and the temporal heterogeneity of pancreatic islet composition obscure the direct role of resident alpha and beta cells in the development of Type 1 diabetes. Therefore, in addition to studying islets isolated from non-obese diabetic mice, we analyzed homogeneous cell populations of murine alpha (αTC-1) and beta (NIT-1) cell lines to understand the role and differential survival of these two predominant islet cell populations. A total of 56 proteins in NIT-1 cells and 50 in αTC-1 cells were differentially expressed when exposed to proinflammatory cytokines. The major difference in the protein expression between cytokine-treated NIT-1 and αTC-1 cells was free radical scavenging enzymes. A similar observation was made in cytokine-treated whole islets, where a comprehensive analysis of subcellular fractions revealed that 438 unique proteins were differentially expressed under inflammatory conditions. Our data indicate that beta cells are relatively susceptible to ER and oxidative stress and reveal key pathways that are dysregulated in beta cells during cytokine exposure. Additionally, in the islets, inflammation also leads to enhanced antigen presentation, which completes a three-way insult on beta cells, rendering them targets of infiltrating T lymphocytes.

Stable algebraic spin liquid in a Hubbard model

We show the existence of a stable algebraic spin liquid (ASL) phase in a Hubbard model defined on a honeycomb lattice with spin-dependent hopping that breaks time-reversal symmetry. The effective spin model is the Kitaev model for large on-site repulsion. The gaplessness of the emergent Majorana fermions is protected by the time-reversal invariance of this model. We prove that the effective spin model is time-reversal invariant in the entire Mott phase, thus ensuring the stability of the ASL. The model can be physically realized in cold atom systems, and we propose experimental signals of the ASL.

Microscopic model of quasiparticle wave packets in superfluids, superconductors, and paired Hall states

We study the structure of Bogoliubov quasiparticles, bogolons, the fermionic excitations of paired superfluids that arise from fermion (BCS) pairing, including neutral superfluids, superconductors, and paired quantum Hall states. The naive construction of a stationary quasiparticle in which the deformation of the pair field is neglected leads to a contradiction: it carries a net electrical current even though it does not move. However, treating the pair field self-consistently resolves this problem: in a neutral superfluid, a dipolar current pattern is associated with the quasiparticle for which the total current vanishes. When Maxwell electrodynamics is included, as appropriate to a superconductor, this pattern is confined over a penetration depth. For paired quantum Hall states of composite fermions, the Maxwell term is replaced by a Chern-Simons term, which leads to a dipolar charge distribution and consequently to a dipolar current pattern.

Managing diabetic ketoacidosis in non-intensive care unit setting: Role of insulin analogs

Aim:

To compare the efficacy and safety of rapid acting insulin analog lispro given subcutaneously with that of standard low-dose intravenous regular insulin infusion protocolin patients with mild to moderate diabetic ketoacidosis.

Materials and Methods:

In this prospective, randomized and open trial, 50 consecutive patients of mild to moderate diabetic ketoacidosis were randomly assigned to two groups. The patients in group 1 were treated with intravenous regular insulin infusion and admitted in intensive care unit. The patients in group 2 were treated with subcutaneous insulin lispro 2 hourly and managed in the emergency medical ward. Response to therapy was assessed by duration of treatment and amount of insulin administered until resolution of hyperglycemia and ketoacidosis, total length of hospital stay, and number of hypoglycemic events in the two study groups.

Results:

The baseline clinical and biochemical parameters were similar between the two groups. There were no differences in the mean duration of treatment and amount of insulin required for correction of hyperglycemia and ketoacidosis. There was no mortality and no difference in the length of hospital stay between the two groups. The length of stay and amount of insulin required for correction of hyperglycemia was greater in patients who had infection as the precipitating cause than those with poor compliance. The hypoglycemic events were higher in the regular insulin group (2 vs1) than in the lispro group.

Conclusion:

Patients with uncomplicated diabetic ketoacidosis can be managed in the medical wards with appropriate supervision and careful monitoring. Rapid acting insulin analog lispro is a safe and effective alternative to intravenous regular insulin for this subset of patients.

Our experience of application of Autologous Bone Marrow Stem Cells in critical limb ischemia in six diabetic patients - A five-year follow-up

BACKGROUND

Numerous Clinical studies have reported the safety and efficacy of injection of one Marrow and Peripheral Blood Mononuclear cells in patients with lower limb ischemia. Earlier we have reported the six months follow-up of successful application of autologous bone marrow mononuclear cells in patients with Fontaine Stage IV critical limb ischemia due to diabetes. As a continuation of the previous study, herein we report the long term results of the six patients after a follow-up for five years.

MATERIALS & METHODS

Six Diabetic patients with Fontaine Stage IV critical limb ischemia with ulcers were given intra-lesional injections of their autologous bone marrow mononuclear cells (BMMNC), isolated following the cGMP protocols. The patients have been followed up at regular intervals for five years after the treatment with all relevant clinical investigations.

RESULTS

Six months follow-up results revealed that all the patients showed improvements with appearance of healthy granulation tissue and uniform revascularization. Complete healing was reported at a mean duration of nine months in five patients and one patient died due to a complication of renal failure, peritoneal dialysis and cardiac failure, which were unrelated to the BMMNC injection. Five year continuous follow-up revealed that the healed tissue with or without skin grafting remained healthy in all the five patients and two of the patients are able to walk without support with a pain free walking distance of greater than 100m.There were no adverse effects in any of the patients..

CONCLUSION

Autologous bone marrow stem cell therapy has been found to be salvaging the affected limb in patients with Fontaine Stage IV Critical Limb ischemia patients where revascularization was not feasible. Hence with our experience of six patients we recommend that the same should be considered in patients of similar clinical parameters before considering an amputation.

Equality of bulk wave functions and edge correlations in some topological superconductors: a spacetime derivation

For certain systems, the N-particle ground-state wave functions of the bulk happen to be exactly equal to the N-point spacetime correlation functions at the edge, in the infrared limit. We show why this had to be so for a class of topological superconductors, beginning with the p+ip state in D=2+1. Varying the chemical potential as a function of Euclidean time between weak and strong pairing states is shown to extract the wave function. Then a Euclidean rotation that exchanges time and space and approximate Lorentz invariance lead to the edge connection. This framework readily generalizes to other dimensions. We illustrate it with a D=3+1 example, superfluid 3He- B, and a p-wave superfluid in D=1+1. Our method works only when the particle number is not conserved, as in superconductors.

Change in medical students' readiness for self-directed learning after a partially problem-based learning first year curriculum at the KIST medical college in Lalitpur, Nepal

INTRODUCTION

Modern medical education and the requirement for lifelong learning place increasing emphasis on self-directed learning. Studies have not been done on readiness for self-directed learning (SDL) among medical students in Nepal. The present study was carried out to (1) measure and compare readiness for SDL among medical students, and (2) note differences in readiness for SDL according to students' personal characteristics at the beginning and end of the first year of the MBBS course for medical students at the KIST Medical College in Nepal.

METHODS

The study was done using the Self-directed Learning Readiness Scale. Respondents' agreement with each of forty statements pertinent to self-directed learning readiness using a modified Likert-type scale was noted. The mean total and scores on the subcategories 'self-management', 'desire for learning' and 'self-control' were calculated and compared across subgroups of respondents and in January and August 2010 using appropriate parametric and non-parametric tests (p<0.05).

RESULTS

All 100 students participated in January while 90 participated in August. The mean scores varied with certain demographic and background characteristics. The mean total score increased from 152.7 to 157.3 while the self-management score increased significantly from 48.6 to 50.2 from January to August. There were small increases in the mean desire for learning scores from 46.9 to 47.7 and in the self-control scores from 58 to 59 from January to August, but not in other scores.

CONCLUSIONS

Self-directed learning scores were lower among these Nepalese students than reported elsewhere in the literature. Total scores and self-management scores improved at the end of the first year, but not scores on desire for learning and self-control.

Renormalization group for non-relativistic fermions

A brief introduction is given to the renormalization group for non-relativistic fermions at finite density. It is shown that Landau's theory of the Fermi liquid arises as a fixed point (with the Landau parameters as marginal couplings) and its instabilities as relevant perturbations. Applications to related areas, nuclear matter, quark matter and quantum dots, are briefly discussed. The focus will be on explaining the main ideas to people in related fields, rather than addressing the experts.

Monitoring drug effectiveness in kala-azar in Bihar, India: cost and feasibility of periodic random surveys vs. a health service-based reporting system

OBJECTIVE

In 2009, a random survey was conducted in Muzaffarpur district to document the clinical outcomes of visceral leishmaniasis patients (VL) treated by the public health care system in 2008, to assess the effectiveness of miltefosine against VL. We analysed the operational feasibility and cost of such periodic random surveys as compared with health facility-based routine monitoring.

METHODS

A random sample of 150 patients was drawn from registers kept at Primary Health Care centres. Patient records were examined, and the patients were located at their residence. Patients and physicians were interviewed with the help of two specifically designed questionnaires by a team of one supervisor, one physician and one field worker. Costs incurred during this survey were properly documented, and vehicle log books maintained for analysis.

RESULTS

Hundred and 39 (76.7%) of the patients could be located. Eleven patients were not traceable. Per patient, follow-up cost was US$ 15.51 and on average 2.27 patients could be visited per team-day. Human resource involvement constituted 75% of the total cost whereas involvement of physician costs 51% of the total cost.

CONCLUSION

A random survey to document clinical outcomes is costly and labour intensive but gives probably the most accurate information on drug effectiveness. A health service-based retrospective cohort reporting system modelled on the monitoring system developed by tuberculosis programmes could be a better alternative. Involvement of community health workers in such monitoring would offer the additional advantage of treatment supervision and support.