Study of febrile thrombocytopenia in Malwa region of India

Background: Febrile thrombocytopenia is the thrombocytopenia associated with fever. Diseases which commonly present with fever and thrombocytopenia are malaria, leptospirosis, septicemia, typhoid, arbovirus diseases such as dengue.Aims and Objectives: The study was intended to know the underlying etiology of febrile thrombocytopenia in Malwa region and its various presentations.Materials and Methods: This study was conducted at Department of General Medicine of a tertiary care centre for two years. Five-hundred adult patients (age >18 years) of febrile thrombocytopenia were evaluated for possible inclusion in this study. Routine investigations including complete blood counts, peripheral smear examination, kidney function tests, liver function tests, ultrasound of abdomen were done in all subjects. The specific investigations were done as and when indicated.Results: Out of 500 patients of febrile thrombocytopenia, 298 were male, while 202 were female. Commonest symptom after fever was malaise (83%) followed by nausea-vomiting (76%), headache (63.4%), jaundice (26.8%), easy fatigability (22.4%), bleeding manifestations (7.8%), cough (6.8%), dyspnea (5.8%), rash (2.4%) and delirium (1.4%). Dengue was found in 178 patients. Malaria was found in 122 patients. Other causes of febrile thrombocytopenia were septicemia (22 cases), leptospirosis (12 cases), chikungunya fever (10 cases), viral hepatitis (9 cases), enteric fever (9 cases), acute lymphoblastic leukemia (2 cases), non-hodgkin lymphoma (one case), disseminated tuberculosis (one case).Conclusion: Febrile thrombocytopenia is an important clinical condition commonly caused by infections, particularly viruses and malaria. Such studies will help in finding changing trends of locally prevalent infectious diseases and finding some new emerging diseases not prevalent in the particular region.Asian Journal of Medical Sciences Vol.8(5) 2017 83-86

Evaluation of therapeutic potential of VB-001, a leave-on formulation, for the treatment of moderate adherent dandruff

Background

Dandruff is a common scalp condition characterized by excessive scaling and itch. Aberrant colonization of the scalp by commensal Malassezia spp. is a major contributor in the multifactorial etiology of dandruff. Literature based understanding of Malassezia linked pathophysiology of dandruff allowed us to comprehend a strategy to potentiate the efficacy of a known antifungal agent used in dandruff therapy.

The aim of this study was to determine the efficacy and skin safety of VB-001 antidandruff leave-on formulation in comparison with marketed antidandruff ZPTO shampoo in patients with moderate adherent dandruff of the scalp.

Methods

Healthy males or females aged ≥ 15 years and ≤ 65 with a clinical diagnosis of moderate adherent dandruff of the scalp were recruited for the study to monitor the effects of topical VB-001 versus those of marketed antidandruff ZPTO shampoo.

Results

168 subjects were randomized to the treatment (VB-001, n = 84) and control (ZPTO shampoo, n = 84) groups. The efficacy of each product was evaluated by comparing proportion of subjects who have shown reduction in flaking by ASFS (adherent scalp flaking score) and pruritus by IGA (investigator global assessment) score. VB-001 imparted consistently better reduction in ASFS and enabled early reduction of pruritus in comparison to marketed ZPTO shampoo.

Conclusion

VB-001, a leave-on formulation with ingredients chosen to selectively disturb the Malassezia niche on dandruff scalp by denying extra nutritional benefits to the microbe, provides unique advantages over existing best in class ZPTO shampoo therapy. It has the potential to emerge as an attractive novel treatment for moderate adherent dandruff.

Trial registration

CTRI Registration number: CTRI/2013/01/003283. Registered on: 02/01/2013

Study of Parental Perceptions on Health & Social Needs of Children with Neuro-Developmental Disability and It's Impact on the Family

INTRODUCTION

The term Neuro Developmental Disorder (NDD) is used for conditions caused by a dysfunction in any part of the brain or nervous system, resulting in physical and/or psychological symptoms as a child develops. Family of children with NDD face many problems. It is very important to find them and create awareness so that gaps in essential services and supports can be decreased.

AIM

To explore parental perceptions on health & social needs of children with NDD, to understand the impact of disability on the families having children with disability, and to find out the parental perceptions on availability of services for children with NDD and its utilization by families.

MATERIALS AND METHODS

The parents of 30 children with NDD were interviewed using a questionnaire and data elicited in these interviews were analysed. The questionnaire had preliminary information about parents and child with NDDs, socio-demographic profile of the family and the parental perceptions on health and social needs of their child having NDDs.

RESULTS

There were total 30 patients 17 were males and 13 were females. Most of the patients suffered from Cerebral Palsy (13 cases) and were diagnosed by General Practitioner (22 cases) while Developmental Neurologist/paediatrician had diagnosed remaining cases of NDD (8 cases). Most common disability for which parents were worried was inability to walk (17 cases). Common difficulties countered in daily care by parents were feeding and bathing (10 cases). Only 2 children were given assistance with tuition & psychologist (cases of ADHD). Most of the parents knew about special schools but didn't know which place such facilities were available and none of the children were attending special schools. Twenty two parents said they have no plans for the future studies but wish that at least child learns to read & write. With help of spiritual power (doing prayers and pooja) 25 parents got courage to face the difficulties and discrimination. Two parents required antidepressants. Six Mothers had to quit their jobs so as to concentrate and give more time to their children. Experience with services provided was satisfactory in 17 cases, while 13 parents reported problem of arranging money, adjusting time for long travelling and regular follow-up.

CONCLUSION

The findings can be utilized in developing supportive activities for families with disabled children. It addresses the need for new prospective of stigma reduction in our society. The study has found that the care givers of child with NDDs suffer from significant physical and mental stress, and their health should be taken into consideration. The study has found need of "care givers' support group". The professionals can help parents in establishing positive thinking towards care giving. There is need of provision of comprehensive and latest rehabilitation/ support resources & information.

Development of Crystalline Cellulosic Fibres for Sustained Release of Drug

Natural quinoline alkaloid camptothecin (CPT) is used for the treatment of colon, lung, breast and ovarian cancers still facing challenges due to low solubility in aqueous and biological fluids. Its lactone form easily converts into a toxic carboxylic form at slightly basic pH, typical in blood and tissue fluid has rapid clearance from systemic administration. We report a new approach based on micro crystalline cellulose (MCC) and nano crystalline cellulose (NCC) isolated from natural sources such as Cymbopogan flexuosus to stabilize and regulate the release kinetics of CPT in physiological solution. Langmuir and Freundlich isotherm studies approve that degree of crystallinity i.e. ratio of amorphous and crystalline cellulose regulate the adsorption of CPT. The freeze dried celluloses of Cymbopogan flexuosus origin (MCC and NCC) further were optimized for drug delivery with a mimicked physiologically relevant solution. Both carriers can significantly extend the release of drug as compared to reported values, however, NCC showed better results. Not only the crystallinity but crystal size and hydrogen bonding play critical role in drug release. Free diffusion of drug into physiological solution follows the Ritger- Peppes kinetic model. The coefficient of the model signifies the Fickian diffusion mechanism of release. The investigation indicates that NCC cellulosic matrix can act as a better carrier of CPT for its sustained release formulation.

Ligand controlled switchable selectivity in ruthenium catalyzed aerobic oxidation of primary amines

A ligand controlled catalytic system for the aerobic oxidation of 1° amines to nitriles and imines has been developed where the varying π-acidic feature of BIAN versus phen in the frameworks of ruthenium catalysts facilitates switchable selectivity.

Transabdominal color doppler ultrasonography: A relevant approach for assessment of effects of uterine torsion in buffaloes

AIM

The present study was conducted on advanced pregnant buffaloes suffering from uterine torsion to assess the status of fetus and uterus by transabdominal ultrasonography, and the findings were compared with normal advanced pregnant buffaloes.

MATERIALS AND METHODS

The study was conducted on 20 clinical cases of uterine torsion and 20 normal advanced pregnant buffaloes (control group). The lower ventral area just lateral to linea alba (on both sides of the udder) in standing animals was scanned transabdominally by the two-dimensional convex transducer for various ultrasonographic findings. The data collected were statistically analyzed by "one-way ANOVA" and "independent sample t-test" using computerized SPSS 16.0 software program.

RESULTS

Transabdominal ultrasonography revealed dead fetus in 95% uterine torsion cases and proved useful in imaging internal structures of fetuses while no dead fetus was reported in the control group. Size of umbilicus was found significantly decreased (p<0.05) in uterine torsion group in comparison to control animals, but the decrease in placentomal area was marginal (p>0.05) in uterine torsion group. Average thickness of the uterine wall and mean pixel values of fetal fluids (echogenicity) were found significantly increased (p<0.05) in uterine torsion affected buffaloes in comparison to control group.

CONCLUSION

Status of fetus (whether live or dead), internal status of uterus, and its contents could be determined by transabdominal ultrasonography in uterine torsion cases and thus determining the prognosis of the uterine torsion cases before going for further manipulations. This will also help in taking all the precautions to avoid death of the fetus.

Demographic and health-related factors associated with complementary and alternative medicine (CAM) use in multiple sclerosis

Complementary and alternative medicine (CAM) use is high among people with multiple sclerosis (MS), yet there are no reports on the association between CAM use and health-related quality of life (HRQL) in MS. To examine this relationship, a cross-sectional survey and SF-12 was used to collect demographic and HRQL data from 1667 survey respondents. Factors examined for their association with CAM use included, age, gender, race, self-reported disease severity, disease-modifying drug (DMT) use, MS duration, MS type, education level, physical and mental well-being. Multiple regression analysis revealed that female gender, high education level, longer MS duration, lower physical well-being and not using DMT were independent factors associated with both ‘ever’ and ‘current’ CAM use. The finding that a drop in physical component score (PCS) of the SF-12 is independently associated with an increased odds of ‘ever’ CAM use, ‘current’ CAM use, and ‘past’ CAM reflect an association of CAM use with PCS regardless of time of use. Although, temporality of this relationship cannot be established, as this was a cross-sectional study, a longitudinal study is warranted so that we can establish if HRQL is predictive for CAM use in MS.

A highly immunogenic trivalent T cell receptor peptide vaccine for multiple sclerosis

Background: T cell receptor (TCR) peptide vaccination is a novel approach to treating multiple sclerosis (MS). The low immunogenicity of previous vaccines has hindered the development of TCR peptide vaccination for MS. Objective: To compare the immunogenicity of intramuscular injections of TCR BV5S2, BV6S5 and BV13S1 CDR2 peptides in incomplete Freund’s adjuvant (IFA) with intradermal injections of the same peptides without IFA. Methods: MS subjects were randomized to receive TCR peptides/IFA, TCR peptides/saline or IFA alone. Subjects were on study for 24 weeks. Results: The TCR peptides/IFA vaccine induced vigorous T cell responses in 100% of subjects completing the 24-week study (9/9) compared with only 20% (2/10) of those receiving the TCR peptides/saline vaccine (P =0.001). IFA alone induced a weak response in only one of five subjects. Aside from injection site reactions, there were no significant adverse events attributable to the treatment. Conclusions: The trivalent TCR peptide in IFA vaccine represents a significant improvement in immunogenicity over previous TCR peptide vaccines and warrants investigation of its ability to treat MS.

Functional outcome of intraarticular distal humerus fracture fixation using triceps-sparing paratricipital approach

BACKGROUND

Displaced intraarticular distal humerus fracture has been conventionally treated operatively with various triceps disrupting approaches. These approaches are associated with several complications, such as triceps weakness, nonunion or delayed union of osteotomy, implant prominence, and delayed mobilization of the elbow. We present the functional outcome of intraarticular distal humerus fracture fixation using a triceps-sparing paratricipital approach which allows early elbow mobilization and preserving triceps strength.

MATERIALS AND METHODS

Twenty five patients with intraarticular distal humerus fracture were operated using triceps-sparing paratricipital approach with orthogonal plate construct. There were 16 male and 9 female patients and average age was 42.16 years (range 23-65 years). The mechanism of injury was fall from height (n = 8), road traffic accident (n = 13) and ground level fall (n = 4). Clinical, radiological, and functional assessment with Mayo Elbow Performance Index (MEPI) were obtained at follow up period.

RESULTS

All fractures united primarily. At the mean follow up of 13.58 months (range 6-22 months), mean elbow flexion was 121.08° (range 94°-142°) and mean motion arc was 114.92°(range 65°-140°). The mean MEPI score was 94.40 points (range 70-100) with 17 excellent, five good, and three fair results. The mean flexion deformity or extension loss was 6.16° (range 5°-15°).

CONCLUSION

Open reduction and internal fixation of intraarticular distal humerus fractures with triceps-sparing paratricipital approach provide adequate exposure with no adverse effect on triceps muscle strength and allows early initiation of elbow motion. We analyzed, age and injury to surgical interval with relation to functional range of elbow using Z-test which is insignificant.

Calcineurin upregulates local Ca(2+) signaling through ryanodine receptor-1 in airway smooth muscle cells

Local Ca(2+) signals (Ca(2+) sparks) play an important role in multiple cellular functions in airway smooth muscle cells (ASMCs). Protein kinase Cϵ is known to downregulate ASMC Ca(2+) sparks and contraction; however, no complementary phosphatase has been shown to produce opposite effects. Here, we for the first time report that treatment with a specific calcineurin (CaN) autoinhibitory peptide (CAIP) to block CaN activity decreases, whereas application of nickel to activate CaN increases, Ca(2+) sparks in both the presence and absence of extracellular Ca(2+). Treatment with xestospogin-C to eliminate functional inositol 1,4,5-trisphosphate receptors does not prevent CAIP from inhibiting local Ca(2+) signaling. However, high ryanodine treatment almost completely blocks spark formation and prevents the nickel-mediated increase in sparks. Unlike CAIP, the protein phosphatase 2A inhibitor endothall has no effect. Local Ca(2+) signaling is lower in CaN catalytic subunit Aα gene knockout (CaN-Aα(-/-)) mouse ASMCs. The effects of CAIP and nickel are completely lost in CaN-Aα(-/-) ASMCs. Neither CAIP nor nickel produces an effect on Ca(2+) sparks in type 1 ryanodine receptor heterozygous knockout (RyR1(-/+)) mouse ASMCs. However, their effects are not altered in RyR2(-/+) or RyR3(-/-) mouse ASMCs. CaN inhibition decreases methacholine-induced contraction in isolated RyR1(+/+) but not RyR1(-/+) mouse tracheal rings. Supportively, muscarinic contractile responses are also reduced in CaN-Aα(-/+) mouse tracheal rings. Taken together, these results provide novel evidence that CaN regulates ASMC Ca(2+) sparks specifically through RyR1, which plays an important role in the control of Ca(2+) signaling and contraction in ASMCs.

Handedness can be explained by a serial hybrid control scheme

Our previous studies on healthy individuals and stroke patients led us to propose that the dominant and nondominant arms are specialized for distinct motor control processes. We hypothesize that the dominant arm is specialized for predictive control of limb dynamics, and the nondominant arm is specialized for impedance control. We previously introduced a hybrid control scheme to explain lateralization of single-joint elbow movements. In this paper we apply a similar computational framework to explore interlimb differences in multi-joint reaching movements: the movements of both arms are initiated using predictive control mechanisms, and terminated using impedance mechanisms. Four parameters characterize predictive mechanisms, four parameters characterize impedance mechanisms, and the ninth parameter describes the instant of switch between the two modes of control. Based on our hypothesis of motor lateralization, we predict an early switch to impedance control for the nondominant arm, but a late switch, near the end of motion, for the dominant arm. We fit our model to multi-joint reaching movements of each arm, made in the horizontal plane. Our results reveal that the more curved trajectories of the nondominant arm are characterized by an early switch to impedance mechanisms, in the initial phase of motion near peak velocity. In contrast, the trajectories of the dominant arm were best fit, when the switch to impedance mechanisms occurred late in the deceleration phase of motion. These results support a model of motor lateralization in which the dominant controller is specialized for predictive control of task dynamics, while the nondominant arm is specialized for impedance control mechanisms. For the first time, we are able to operationally define handedness expressed during multi-joint movements by applying a computational control model.

Detection of subclinical peste des petits ruminants virus infection in experimental cattle

The present study was undertaken to investigate the possible involvement of cattle in the epidemiology of peste des petits ruminants (PPR) as subclinical carriers. Cattle were exposed experimentally to PPR virus (PPRV) infection or placed in contact with PPR infected goats. Clinical samples including heparinized/EDTA blood, plasma, peripheral blood monocyte cells (PBMCs) and clotted blood (for serum) were collected periodically from 21 days post infection (dpi) to 397 dpi (21, 45, 50, 57, 65, 95, 111, 119, 148, 190, 203 and 397 dpi) and tested for PPRV antigen, nucleic acid and antibody. Exposed cattle seroconverted and maintained PPRV specific haemagglutinin antibodies and detectable PPRV antigen/nucleic acid in blood, plasma and PBMCs from 21 to 397 dpi. PPRV was recovered from blood and PBMC collected from experimental animals at 21 dpi, initially in B95a cells and then adapted to Vero cells. The study indicated that PPRV can infect cattle subclinically and PPRV antigen/nucleic acid persist in cattle for at least 397 days.

Loss of guide wire: a lesson learnt review of literature

Catheterization of central veins is a routine technique which is widely used in emergency department and medical intensive care units. Seldinger's technique is widely used to place central venous and arterial catheters and is generally considered safe. The technique does have multiple potential risks. Guide wire-related complications are rare but potentially serious. We describe a case of a lost guide wire during central venous catheter (CVC) insertion followed by a review of the literature of this topic. Measures which can be taken to prevent such complications are explained in detail as well as recommended steps to remedy errors should they occur.

Variability in radiative properties of major aerosol types: a year-long study over Delhi--an urban station in Indo-Gangetic Basin

Aerosol measurements over an urban site at Delhi in the western Ganga basin, northern India, were carried out during 2009 using a ground-based automatic sun/sky radiometer to identify their different types and to understand their possible radiative implications. Differentiation of aerosol types over the station was made using the appropriate thresholds for size-distribution of aerosols (i.e. fine-mode fraction, FMF at 500 nm) and radiation absorptivity (i.e. single scattering albedo, SSA at 440 nm). Four different aerosol types were identified, viz., polluted dust (PD), polluted continent (PC), mostly black carbon (MBC) and mostly organic carbon (MOC), which contributed ~48%, 32%, 11% and 9%, respectively to the total aerosols. Interestingly, the optical properties for these aerosol types differed considerably, which were further used, for the first time, to quantify their radiative implications over this station. The highest atmospheric forcing was observed for PC aerosol type (about +40 W m(-2), along with the corresponding atmospheric heating rate of 1.10 K day(-1)); whereas the lowest was for MBC aerosol type (about +25 W m(-2), along with the corresponding atmospheric heating rate of 0.69 K day(-1)).