Fetal hemoglobin and alpha thalassemia modulate the phenotypic expression of HbSD-Punjab

INTRODUCTION

HbSD-Punjab (HbSD) is a less common form of sickle cell disease (SCD) and discrimination between HbSD and HbSS is not possible on alkaline electrophoresis because the two variants overlap in the compound heterozygous state. There are only a few publications consisting mostly of case reports. Thus, the phenotypic expression of HbSD and its modifiers has not been studied.

METHODS

We studied the phenotypic expression of 42 cases of HbSD (the largest number of subjects ever included in this kind of study) and compared them with 84 HbSS cases matched for age, sex, and caste. Further, we evaluated the influence of HbF concentration and alpha thalassemia on the phenotypic expressions of HbSD, namely the frequency of VOC and degree of hemolysis.

RESULTS

The frequencies of VOC were similar in both the groups. The markers of hemolysis such as total bilirubin, unconjugated bilirubin, and LDH were higher where as HbF concentration was significantly low in HbSD. There was a negative correlation between HbF concentration and risk of VOC in the HbSD. The total hemoglobin level and hematocrit were significantly high, and the MCV and MCH were significantly low in HbSD with alpha thalassemia. Alpha thalassemia had no influence on the frequency of VOC and severity of hemolysis in HbSD.

CONCLUSION

HbF reduced the frequency of VOC but had no influence on the hemolytic markers in HbSD. HbSD with alpha thalassemia was associated with hypohromic and microcytic features of red blood cells.

Unilateral Hypoplastic Kidney in a Case of Holt-Oram Syndrome

Holt-Oram syndrome (HOS) is characterised by skeletal abnormalities of the upper limb & congenital cardiac defects. Here we report a case of one day old male baby with skeletal abnormalities of forearms and hands, atrial septal defect of ostium secundum type and unilateral hypoplastic kidney. Till date, other associated anomalies like extra-hepatic portal hypertension, renal artery malformations etc have been reported with Holt-Oram syndrome, but it is the first case to be reported in association with hypoplastic kidney. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7127 J Nepal Paediatr Soc. 2013;33(1):77-79

Blood biomarkers in metal scrap workers accidentally exposed to ionizing radiation

The detrimental effect of nuclear accidents due to localized or whole body radiation exposure results in severe cellular damage. The current study was carried out to evaluate radiation-mediated variability in blood components of metal scrap workers exposed accidently to cobalt-60 source. Blood samples collected initially from five hospitalized patients, coded P1–P5, were processed for total leukocyte counts (TLC), platelet (PLT) counts, haemoglobin, estimation of DNA double strand breaks by measuring phosphorylated form of H2AX (γ-H2AX) and chromosomal aberrations (dicentrics). Blood cells count (TLC), in all the patients except P2, was found decreased. Dicentrics increased in all the five patients. γ-H2AX was found significantly elevated in patients P2 and P4. After 3 days, 21 subjects working in close vicinity of accident site were evaluated for the above-mentioned markers to confirm their possibility of radiation exposure; however, all the parameters in these subjects were found within normal limits. Blood from patients P1–P5 was collected again after 11 days. Studies revealed exorbitant increase in γ-H2AX in lymphocytes and monocytes of patients P1, P4 and P5. TLC and PLT count in these patients had fallen further. Dicentrics declined with time in all the five patients. Based on the studied blood biomarkers, we conclude that the five subjects showed signs of radiation exposure. Measurement on radiation dose could not be performed in the current study; however, the generated data particularly on dicentrics provide ample evidence of radiation exposure.

Preliminary evaluation of effect of Engineered Safety Features on source term for AHWR containment

The proposed Advanced Heavy Water Reactor (AHWR) employs double containment envelope along with many Engineered Safety Features (ESFs) to mitigate the consequences of Loss-of-Coolant Accidents (LOCA) with safety system failure, during which high enthalpy steam and radioactive fission products will be discharged into the containment. In such conditions, the pressurized containment will be the source of activity release to the environment by way of leakage. It is required to study the effect of ESFs on the source term from the AHWR containment. An analysis was performed to evaluate the release rate from the AHWR containment during a postulated accident with the in-house containment code CONTRAN and the aerosol behavior code NAUA5-M in a coupled way. Modules for simulating the engineered safety features were incorporated in the CONTRAN code and the aerosol transport behaviour was evaluated using NAUA5-M separately. The AHWR containment is divided into three nodal volumes interconnected by junctions. The blow down mass, energy discharge data and activity released into the containment from the reactor core, for a postulated LOCA case of 200% RIH break with failure of shutdown systems (1 & 2), are inputs to the CONTRAN code. Thermodynamic parameters like containment gas temperature, partial pressure of steam, air in the subdivided volumes along with the flow rates through junctions obtained from CONTRAN were supplied to NAUA5-M. An analysis was carried out for a number of cases, postulated based on availability/unavailability of ESFs. Pressure, temperature and activity concentration transients were evaluated, for 72 h, in the subdivided volumes along with the activity released out of the containment through leakages and stack discharges for all the cases. This paper highlights the importance of operation of ESF in reducing the activity release to the environment.

Simulation model of a nuclear power plant turbine

A computer code “TURDYN” has been developed for prediction of high pressure and low pressure turbine torque under thermodynamic transient conditions. The model is based on the conservation laws of mass and energy. All the important components of turbine systems, e. g. high pressure turbine, low pressure turbine, feed heaters, reheater, moisture separator have been considered. The dynamic equations are solved simultaneously to obtain the stage pressure at various load conditions. The details of the mathematical formulation of the model and open loop responses for specific disturbances are presented.

Regulation of several androgen-induced genes through the repression of the miR-99a/let-7c/miR-125b-2 miRNA cluster in prostate cancer cells

The androgen receptor (AR) stimulates and represses gene expression to promote the initiation and progression of prostate cancer. Here, we report that androgen represses the miR-99a/let7c/125b-2 cluster through AR and anti-androgen drugs block the androgen-repression of the miRNA cluster. AR directly binds to the host gene of the miR-99a/let7c/125b-2 cluster, LINC00478. Expression of the cluster is repressed or activated by chromatin remodelers EZH2 or JMJD3 in the presence or absence of androgen, respectively. Bioinformatics analysis reveals a significant enrichment of targets of miR-99a, let-7c and miR-125b in androgen-induced gene sets, suggesting that downregulation of the miR-99a/let7c/125b-2 cluster by androgen protects many of their target mRNAs from degradation and indirectly assists in the gene induction. We validated the hypothesis with 12 potential targets of the miR-99a/let7c/125b-2 cluster induced by androgen: 9 out of the 12 mRNAs are downregulated by the microRNA cluster. To ascertain the biological significance of this hypothesis, we focused on IGF1R, a known prostate cancer growth factor that is induced by androgen and directly targeted by the miR-99a/let7c/125b-2 cluster. The androgen-induced cell proliferation is ameliorated to a similar extent as anti-androgen drugs by preventing the repression of the microRNAs or induction of IGF1R in androgen-dependent prostate cancer cells. Expression of a microRNA-resistant form of IGF1R protects these cells from inhibition by the miR-99a/let7c/125b-2 cluster. These results indicate that a thorough understanding of how androgen stimulates prostate cancer growth requires not only an understanding of genes directly induced/repressed by AR, but also of genes indirectly induced by AR through the repression of key microRNAs.

Initial experience with lingual mucosal graft urethroplasty for anterior urethral strictures

BACKGROUND

To present the feasibility of lingual mucosal graft urethroplasty in anterior urethral strictures and appraisal of donor site morbidity.

METHODS

From November 2007 to December 2010, 14 patients underwent dorsal onlay lingual mucosal graft urethroplasty for anterior urethral strictures. Lingual mucosal graft was harvested from the lateral and undersurface of the tongue. Check micturating cystourethrograms were done 2 weeks after catheter removal and uroflowmetry after 3 months. Success was defined as normal uroflowmetry rates at 3 months in the absence of any postoperative instrumentation. Tongue was assessed for any residual pain, taste disturbances or restricted movement at 3 months.

RESULTS

Four patients had submucosal fibrosis of the oral cavity and their buccal mucosa was unfit for grafting. Mean (range) stricture length was 5 (3-16) cm and the operation time 170 (140-210) min. Graft width averaged 1.6 cm. Average length of harvested graft was 6.5 cm. Mean duration of follow-up was 12.8 months. Two patients developed stricture at the proximal anastomotic site. There were no donor site complications.

CONCLUSIONS

Lingual mucosal graft harvesting is simple, gives graft lengths comparable to buccal mucosa and is associated with negligible donor site morbidity.

Study of the effects of chemotherapy on auditory function

Chemotherapeutic agents are known to cause multiple toxicities such as myelotoxicity, nephrotoxicity and ototoxicity. A prospective study was carried out on 60 patients receiving Cisplatin based chemotherapy in a tertiary care centre. The effects of Cisplatin on auditory function were studied using metabolic, biochemical and audiological parameters. The auditory effects were correlated with the dose and duration of chemotherapy. The study concluded that a significant percentage (15%) of patients who were subjected to chemotherapy based on Cisplatin developed high frequency sensorineural hearing loss which was permanent and irreversible in nature.

Bioavailability, antioxidant and non toxic properties of a radioprotective formulation prepared from isolated compounds of Podophyllum hexandrum: a study in mouse model

The current study was aimed to determine the stability, serum protein binding ability, biodistribution, antioxidant potential and tissue toxicity status of a novel radioprotective formulation (G-002M) from Podophyllum hexandrum. G-002M is the combination of a flavonoid, a lignan and its glucoside isolated from P. hexandrum rhizome that exhibit high radioprotective potential. Stability of G-002M tagged with 99mTc was observed in vitro and with mice serum till 24 hr of incubation. The formulation was investigated for its antioxidant status and its bioavailability and toxicity in different organs of mice. Biodistribution study of 99mTc-G-002M revealed its uptake by all the vital organs of mice. Higher absorbed dose was observed in lungs, liver, jejunum and kidney. Maximum retention of G-002M in kidney revealed that G-002M was excreted predominantly through renal route. G-002M was also observed to have high free radical scavenging and total reducing properties. Histopathological observations showed no significant alterations in tissue morphology of lungs, liver, jejunum and kidney by G-002M administration. The data conclusively demonstrate that high stability, multi organ availability, longer retention and non-toxic behavior of G-002M might help in exhibiting strong protective potential against lethal radiation.

CFD analysis of a hydraulic valve for cavitating flow

A successful design of high pressure hydraulic valves requires a thorough analysis of both velocity and pressure fields, with the aim of improving the geometry to avoid cavitation. Cavitation behavior prediction of hydraulic valves and its associated performance drop is of high interest for the manufacturers and for the users. The paper presents a CFD analysis of the flow inside a high pressure hydraulic valve. First, the analysis was carried out without using cavitation model (single phase). It was observed that absolute pressure was going below the vapor pressure. Hence, it was required to turn on the cavitation model. This model enables formation of vapor from liquid when the pressure drops below the vaporization pressure. Since the cavitation bubble grows in a liquid at low temperature, the latent heat of evaporation can be neglected and the system can be considered isothermal. Under these conditions the pressure inside the bubble remains practically constant and the growth of the bubble radius can be approximated by the simplified Rayleigh equation. For typical poppet valve geometry, ½ of computational domain is assumed, with pressure inlet and outlet boundary conditions, and a steady flow solution is computed. Because of the highly complex geometry of the hydraulic valve, the computational domain was meshed using unstructured grids using tetrahedral cells only. The paper presents a numerical investigation of the flow inside a hydraulic valve using commercial CFD code CFD-ACE. The aim of the study is to provide a good basis for future designing of the hydraulic valve. The result indicated the cavitation zones which in turn suggest needs of modification of present geometry.

Clinical effectiveness and safety of gemifloxacin versus cefpodoxime in acute exacerbation of chronic bronchitis: A randomized, controlled trial

Objective:

Acute exacerbation of chronic bronchitis (AECB) is a commonly encountered problem and those suspected to be due to bacterial infections require antibiotic therapy. This randomized, controlled trial was designed to evaluate the effectiveness and safety of gemifloxacin, a new fluoroquinolone, versus cefpodoxime, an oral third-generation cephalosporin, for the treatment of mild to moderately severe cases of AECB.

Materials and Methods:

Adult subjects diagnosed with chronic bronchitis with clinical symptoms suggestive of an Anthonisen type II acute exacerbation (any two of the following criteria – increased dyspnea, cough, sputum purulence) were eligible and those fulfilling the subject selection criteria were randomized to receive either gemifloxacin 320 mg once daily or cefpodoxime 200 mg twice daily orally for 7 days. The primary outcome measure was clinical success rate at day 14 visit and the secondary outcome measures were changes in Clinical Global impression (CGI) scales and incidence of adverse events (AEs). Fifty-two subjects were enrolled: 26 in gemifloxacin group and 24 in the other and 2 were lost to follow-up.

Results:

The clinical success rates were comparable (84.6% in gemifloxacin group versus 83.3% in cefpodoxime group) and no statistically significant difference was observed between the groups. AEs were mild, self-limiting and few (two in gemifloxacin and three in cefpodoxime arm) and tolerability was also good.

Conclusion:

The results of this randomized, single-blind trial demonstrated that a 7-day course of gemifloxacin is therapeutically comparable to cefpodoxime in terms of both clinical effectiveness and safety for the treatment of type II Anthonisen category AECB patients.

Calculation of moderator circulation in IPHWR using a porosity approach

In the present configuration of the calandria for the 700 MWe Kakrapara Nuclear Power Plant, moderator inlet diffusers are directed upwards and the outlet is from the bottom of the calandria. Moderator circulation patterns and temperature distribution needs to be predicted to ensure adequate cooling margin for all channels. This study consists of two steps: at first, an optimized calculation scheme is obtained by comparison of the predicted results with the experimental data and by evaluating the fluid flow and temperature distribution. Then, in the second step, the analysis for the real 700 MWe IPHWR moderator under normal operating conditions has been performed with the optimized scheme. The present paper describes the methodology used for predicting the circulation pattern and temperature distribution in the moderator during normal operation using CFD code CFD-ACE+. The matrix of the calandria tubes in the core region is simplified to a porous media in which the momentum resistance model is used for pressure loss. The buoyancy effects due to internal heating and jet momentum effects through inlet nozzles have been considered in the analysis. The results show that the maximum temperature observed in the calandria is within the design limits during normal operation.

Hypertension with elevated levels of oxidized low-density lipoprotein and anticardiolipin antibody in the circulation of premenopausal Indian women chronically exposed to biomass smoke during cooking

This study aims to investigate whether indoor air pollution (IAP) from biomass fuel use was associated with hypertension, platelet hyperactivity, and elevated levels of oxidized low-density lipoprotein (oxLDL) and anticardiolipin antibody (aCL). We enrolled 244 biomass fuel-using (median age 34 year) and 236 age-matched control women who cooked with liquefied petroleum gas (LPG). Enzyme-linked immunosorbent assay was used to measure oxLDL in plasma and aCL in serum, flow cytometry for P-selectin expression on platelet and reactive oxygen species (ROS) generation by leukocytes, aggregometry for platelet aggregation, spectrophotometry for superoxide dismutase (SOD) in erythrocytes, and laser photometer for particulate matter <10 and 2.5 μm in diameter (PM(10) and PM(2.5), respectively) in cooking areas. Biomass users had three times more particulate pollution in kitchen, had higher prevalence of hypertension (29.5 vs. 11.0% in control, P < 0.05), elevated oxLDL (170.6 vs. 45.9 U/l; P < 0.001), platelet P-selectin expression (9.1% vs. 2.4%), platelet aggregation (23.2 vs. 15.9 Ohm), raised aCL IgG (28.7% vs. 2.1%), IgM (8.6% of vs. 0.4%), and ROS (44%) but depleted (13%) SOD. After controlling potential confounders, the changes were positively associated with PM(10) and PM(2.5) in indoor air, suggesting a positive association between IAP and increased cardiovascular risk.

PRACTICAL IMPLICATIONS

The study showing high risk of developing cardiovascular diseases (CVD) among poor, underprivileged women in their reproductive ages in rural India is important from public health perspectives. It may motivate the government and the regulatory agencies of the country to take a serious note of the indoor air pollution (IAP) from biomass fuel use as it threatens the health of millions of women, children, and the elderly who mostly stay indoor. We hope the findings will strengthen the demand for setting up a standard for indoor air quality in the country in the line of national ambient air quality standard. The findings may also inspire the authorities to take measures for the reduction in IAP by improving housing, kitchen ventilation, and cook stoves. Moreover, the parameters used in this study can be utilized for large, population-based studies to identify women at a higher risk of developing CVD so that medical intervention can be taken at the formative stage of a disease.