Isolated Acute Cerebrovascular Involvement in COVID-19 without Fever and Respiratory Symptoms: An Indian Perspective

BACKGROUND

Stroke in COVID-19 has been reported in critically ill patients globally. Stroke as a singular manifestation of COVID-19 in absence of typical symptoms (fever, cough and dyspnea) is under- recognized.

OBJECTIVE

Comparative study of clinical and laboratory parameters of COVID-19 stroke patients without typical symptoms at onset with stroke cases without COVID-19 infection.

METHODS

28consecutive stroke patients, eight with coronavirus infection and twenty without COVID-19 admitted to neurology department of a tertiary care centre of North West India between 20 June,2020 and 19 July,2020 were enrolled in this retrospective study.

RESULTS

COVID-19 patients had higher frequency of seizures (4[50%]) vs 2[10%];p= 0.03)and altered mental status(6[75%] vs 6[30%] p= 0.04). Severity of ischemic stroke(NIHSS >20, 3[75 %] vs 2[18%])and mortality(p=0.04)despite comparable vascular risk factors for stroke between the two groups was higher in COVID-19 patients. Three out of four COVID-19 young strokes died. Two females with COVID-19 did not develop any typical symptoms, six males(75%) developed fever with dyspnea after a mean delay of 2.7 days(Standard deviation 1.7) from stroke onset. All six patients who developed fever subsequently expired. Inflammatory markers (neutrophil to lymphocyte ratio;p<0.001and ESR: p<0.001), transaminases(p=0.038) and creatinine (p=0.009) were significantly elevated in COVID-19 patients.

CONCLUSION

Isolated cerebrovascular involvement can be a presentation of COVID-19.Stroke severity and mortality is higher in COVID-19 with young strokes being no exemption. Development of fever was associated with clinical worsening. COVID-19 pandemic is far from over in India, such atypical presentations need to be recognized early and warrant stringent diagnostic protocols.

Prices of combination medicines and single-molecule antihypertensive medicines in India's private health care sector

More than half of patients with hypertension require two or more medicines to control blood pressure. Combinations of anti‐hypertensive medicines are available as Single Pill Combinations (SPCs) or Single Agent Pills (SAPs). SPCs of two or more anti‐hypertensive medicines facilitate simpler dosing schedules, decrease pill burden, increase adherence to medicine, and simplify procurement and distribution. Despite this, equivalent combinations of separate pills (SAPs) are often prescribed instead of SPCs under the assumption that SAPs are priced lower. This study compared prices of anti‐hypertensive SPCs and equivalent SAPs in the private health care sector of India. High sales volume anti‐hypertensive SPCs and SAPs were selected from 2018 private sector pharmaceutical sales data. SPCs and SAPs price information was collected from online pharmacy websites between November 2019 and January 2020. Anti‐hypertensive SPCs represent approximately 39.1% of India's private sector anti‐hypertensive drug market. Multiple manufacturers produce the same top‐selling SPCs, suggesting a viable and competitive market. A comparison of SPCs and SAPs across different manufacturers showed that the lowest prices of both SPCs and the sum of component SAPs were nearly identical across different manufacturers. An analysis of dual‐drug SPCs and SAPs by the same manufacturer showed that most manufacturers (five of six) had priced their SPCs higher than SAPs. These observations suggest that the price of SPCs could be lowered to match the combined price of the component SAPs, and manufacturing costs and market forces do not present a barrier to the implementation of anti‐hypertensive SPCs.

Investigating role of Mycobacterium tuberculosis secretory antigens in altering activation of T cell signaling events in Jurkat T cells

Background

Mycobacterium tuberculosis is able to survive and persist as an intracellular pathogen by modulating its own metabolism and host immunity. The molecules and mechanisms utilized to accomplish this modulation are not fully understood. The present study elucidates the effects of M. tuberculosis secretory antigens on T-cell-receptor (TCR)/CD28-triggered signaling in Jurkat T-cells.

Method

In the present study, intracellular calcium mobilization was investigated in CD3-activated cells in response to M. tuberculosis antigens, Ag85A, early secretory antigenic target-6 (ESAT-6), and H₃₇Rv. The activation of mitogen-activated protein kinases, extracellular signal-regulated kinases 1 and 2 (ERK1/2), and p-38 was also analyzed in CD3- and CD28-activated cells by western blotting.

Results

Our results showed CD3-triggered modulations in free intracellular calcium levels in Jurkat T-cells in response to M. tuberculosis antigens. In addition, we also noted M. tuberculosis antigens induced downregulation in phosphorylation of ERK1/2 and p-38. Overall, our results proposed that M. tuberculosis secretory antigens, particularly ESAT-6, impede TCR/CD28-induced signaling events which could be responsible for T-cell unresponsiveness, implicated in the progression of disease.

Conclusion

The present study demonstrated M. tuberculosis secretory antigens induced alteration of T-cell signaling pathways in unsensitized Jurkat T-cell line which might be implied in T-cell dysfunctioning during the progression of the disease.

A review on neuropharmacological role of erucic acid: an omega-9 fatty acid from edible oils

Neurodegenerative diseases (ND) are characterised by loss of neurons in the brain and spinal cord. For the normal functioning of the brain, divers group of fatty acids in the form of glycerophospholipids, glycerol ether lipids, cerebrosides, sulfatides, and gangliosides are essential. They are present abundantly in the nervous system and are actively involved in both the development and maintenance of the nervous system. A dietary deficiency of essential fatty acid during development results in hypomyelination state which affects various neuronal functions. Several studies suggested that age remains the primary risk factor for almost all neurodegenerative disorders. The potential contribution of these fatty acids in the progression of neurodegenerative disorders is indispensable. Erucic acid an omega 9 fatty acid, which is obtained from edible oils has proven to cause myocardial lipidosis, heart lesions and hepatic steatosis in animals therefore, its content in edible oils is restricted to certain levels by regulatory agencies. However, erucic acid in the form of a mixture with oleic acid is often used as a dietary treatment for the management of adrenoleukodystrophy without any cardiotoxicity. Our literature search revealed that, erucic acid reported to enhance cognitive function, interact with peroxisome proliferator activated receptors (PPARs), inhibit elastase and thrombin. In this review first we have attempted to describe the relationship between fatty acids and neurodegeneration followed by a description on the pharmacology of erucic acid. The overall purpose of this review is to analyse toxic and beneficial neuropharmacological effects of erucic acid.

Comprehensive assessment of 2G bioethanol production

The advancements in second-generation bioethanol produced from lignocellulosic biomass, such as crops residues, woody crops or energy grasses are gaining momentum. Though, they are still representing less than 3% of total bioethanol production, the GHG reduction potential is higher than for 1G-bioethanol. The environmental impacts of bioethanol production are totally dependent on feedstock availability and conversion technology. The biochemical conversion route must overcome several technological and economical challenges such as pre-treatment, fermentation, hydrolysis process and separation. A completely mature technology is still to be developed and must adapted to the nature of the feedstock. Nevertheless, using process simulation software, Life Cycle Assessment and integrating the different steps of bioresource harvesting and treatment processes, including the energy balances and the water requirements, it is shown that 2G bioethanol production will reduce environmental impacts provided the evaluation addresses a long-time perspective, including all conversion steps and the regeneration of the bioresource.

Abstract P170: Validation Of A Practical Approach To Blood Pressure Measurement: Secondary Analysis Of Data From A Nationally Representative Household Survey In India

Background: Various clinical guidelines differ on the required number of blood pressure (BP) measurements during clinic visits. The research standard approach is measuring BP three times and using the mean of the last two readings. India’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) recommends measuring twice and averaging the two readings. We hypothesized that a selective, practical approach to BP measurement in public health settings would be simpler, avoid calculating the mean, but not substantially erode measurement accuracy.

Method: We used the data of adults (aged 30-54 years) from the National Family Health Survey (2015-16), with three seated BP measurements for each participant (N= 372,110). In the practical BP measurement approach, if the first reading is <140/90 mm Hg, the first BP was used. If first BP is ≥140/90 mm Hg, the second BP was used. If the difference between the two systolic or diastolic BP readings was ≥5 mm Hg, then third BP was used. We compared the accuracy of practical and NPCDCS approaches in stratifying high BP (≥140/90 mm Hg), each referencing against research standard.

Results: The prevalence of high BP was 15.5% (95% CI: 15.5%, 15.7%), 14.9% (14.9%, 15.1%), and 19.3% (19.3%,19.5%), when used the standard, practical, and NPCDCS approaches, respectively. Referencing the research standard, the sensitivity, specificity, false positive and false negative rates of the practical approach were 85.4%, 98.0%, 11.3% and 2.7%; rates of the NPCDCS approach were 94.3%, 93.4%, 25.1% and 1.3%, respectively. For categorizing the stages of high BP, the agreement and kappa statistics for practical vs. standard were 94.7% and 0.80 at p <0.0001 and NPCDCS vs. standard were 92% and 0.742 at p <0.0001. The mean number of BP measurements required per person was 1.4 for the practical approach compared with 2.0 for the NPCDCS approach.

Conclusions: Both the practical and NPCDCS approaches to BP measurement had high validity and agreement with the research standard. The practical approach is simpler and involves a lower measurement burden on health care professionals; this approach could improve the utility of BP measurement and hypertension diagnosis in public health settings.

Microwave-Assisted Rapid Synthesis of Reduced Graphene Oxide-Based Gum Tragacanth Hydrogel Nanocomposite for Heavy Metal Ions Adsorption

Reduced graphene oxide (RGO) was synthesized in this research via Tour's method for the use of filler in the hydrogel matrix. The copolymerization of N,N-dimethylacrylamide (DMA) onto the gum tragacanth (GT) was carried out to develop gum tragacanth-cl-N,N-dimethylacrylamide (GT-cl-poly(DMA)) hydrogel using N,N'-methylenebisacrylamide (NMBA) and potassium persulfate (KPS) as cross-linker and initiator correspondingly. The various GT-cl-poly(DMA) hydrogel synthesis parameters were optimized to achieve maximum swelling of GT-cl-poly(DMA) hydrogel. The optimized GT-cl-poly(DMA) hydrogel was then filled with RGO to form reduced graphene oxide incorporated gum tragacanth-cl-N,N-dimethylacrylamide (GT-cl-poly(DMA)/RGO) hydrogel composite. The synthesized samples were used for competent adsorption of Hg²⁺ and Cr⁶⁺ ions. Fourier transform infrared, X-ray powder diffraction, field emission scanning electron microscopy, energy-dispersive X-ray spectroscopy were used to characterize the gum tragacanth-cl-N,N-dimethylacrylamide hydrogel and reduced graphene oxide incorporated gum tragacanth-cl-N,N-dimethylacrylamide hydrogel composite. The experiments of adsorption-desorption cycles for Hg²⁺ and Cr⁶⁺ ions were carried out to perform the reusability of gum tragacanth-cl-N,N-dimethylacrylamide hydrogel and reduced graphene oxide incorporated gum tragacanth-cl-N,N-dimethylacrylamide hydrogel composite. From these two samples, reduced graphene oxide incorporated gum tragacanth-cl-N,N-dimethylacrylamide exhibited high adsorption ability. The Hg²⁺ and Cr⁶⁺ ions adsorption by gum tragacanth-cl-N,N-dimethylacrylamide and reduced graphene oxide incorporated gum tragacanth-cl-N,N-dimethylacrylamide were best suited for pseudo-second-order kinetics and Langmuir isotherm. The reported maximum Hg²⁺ and Cr⁶⁺ ions adsorption capacities were 666.6 mg g^-1 and 473.9 mg g^-1 respectively.

Heartworm control in Grenada, West Indies: Results of a field study using imidacloprid 10% + moxidectin 2.5% and doxycycline for naturally-acquired Dirofilaria immitis infections

Canine heartworm disease (CHD) results from infection with Dirofilaria immitis and while it is of global concern, it is most prevalent in tropical climates where conditions support the parasite and vector life cycles. Melarsomine dihydrochloride is the sole treatment for CHD recommended by the American Heartworm Society. However, in cases where cost or access to melarsomine precludes treatment of an infected dog, therapeutic alternatives are warranted. This randomized, controlled field study evaluated the adulticidal efficacy of a combination therapeutic protocol using 10 % imidacloprid + 2.5 % moxidectin spot-on and a single 28-day course of doxycycline and compared with that of a 2-dose melarsomine dihydrochloride protocol. Of 37 naturally-infected domestic dogs with class 1, 2 or early class 3 CHD enrolled in the study, 30 were evaluated for a minimum of 12 months. Seven dogs were withdrawn due to canine ehrlichiosis, non-compliance, or wrongful inclusion. Dogs were randomly assigned to a control (CP, n = 15) or investigational (IVP, n = 15) treatment group. CP dogs received two injections of melarsomine dihydrochloride (2.5 mg/kg) 24 -hs apart and maintained on monthly ivermectin/pyrantel. IVP dogs were treated with oral doxycycline (10 mg/kg twice daily for 28 days) and topical 10 % imidacloprid + 2.5 % moxidectin once monthly for 9 months. Dogs were evaluated up to 18 months - monthly for the first 9 months, then every 3 months. Parasiticidal efficacy was based on antigen status using the IDEXX PetChek® 34 Heartworm-PF Antigen test. By month 18, antigen was not detected in any study dog except one from the IVP group. One other IVP dog was persistently antigenemic and treated with melarsomine at month 12 according to the initial study protocol. Mean antigen concentration (based on optical density) decreased more rapidly in the CP group and by month 15 was 0.11 for the IVP and 0.07 for CP groups, with equivalent median concentrations (0.04) in both groups. Conversion following heat-treatment of antigen-negative samples occurred frequently and at similar rates in both treatment groups. Based on the bias of diagnostic tests towards detection of female worms, we conclude that monthly application of 10 % imidacloprid + 2.5 % moxidectin for 9 months combined with a course of doxycycline twice daily for 28 days resulted in effective therapy against female adults in CHD. This therapeutic option may be particularly useful in cases where financial constraint or access to melarsomine precludes treatment of an infected individual. This study was supported by Bayer Animal Health.

A perspective of private health care providers in the state of Madhya Pradesh on adopting key strategies of the India hypertension control initiative

The India Hypertension Control Initiative (IHCI) has been implemented in public health facilities. This study assessed the perspective of private physicians (PPs) on adopting the core strategies of the IHCI in Bhopal district of Madhya Pradesh. A semi-structured interview was purposely applied to 30 PPs to obtain their opinions on standardized hypertension treatment protocols, patient-centered services, and easy-to-use information system in their private practices. Verbatim data were recorded and analyzed thematically. Only 11 PPs followed the state hypertension treatment protocol. Among the remaining 19 PPs, the major reasons for not adopting protocol were (1) limited availability of single component hypertension drugs, (2) preferences for fixed dose combinations (FDCs), and (3) fear of either losing patients due to a lack of immediate blood pressure control or causing drug-related adverse effects. None of the interviewed doctors had resources to provide patient-centered care and use a digital health information system. Overall, the interviewed doctors identified that free supply of hypertension treatment protocol drugs, inclusion of FDCs in treatment protocol, increasing number of staff for follow-up visits, and patient education, IT-based solutions for patient records, employee incentives, and need for national data sharing policies are the key actions to accelerate the adoption of IHCI strategies in the private sector. This exploratory qualitative study suggests that engagement of private sector in the IHCI is feasible. Plans to expand the IHCI to the private sector should consider ensuring the wider availability of hypertension treatment protocol drugs and developing a simple user-friendly digital platform for patient monitoring.

Biogenic Silver Nanoparticles: Evaluation of Their Biological and Catalytic Potential

The biogenic tailoring of silver nanoparticles using plant extract is becoming an attractive approach in the current scenario. Manilkara zapota (MZ) is well known for its antibacterial, hepato-protective, anti-inflammatory, anti-tussive, anti-fungal, anti-tumour, and free radical scavenging potential. Its plants extract is a rich source of secondary metabolites. Nowadays, silver nanoparticles (AgNPs) have been advocated for a variety of biomedical applications. In present work, silver nanoparticles have been synthesized using an aqueous extract of MZ, physicochemically characterized and finally evaluated for antimicrobial effects, catalytic reduction/degradation of organic dyes and cytotoxicity. The nanosized AgNPs (~ 84 nm) were found to possess prominent antibacterial potential against gram positive and gram negative pathogens (MIC 50 μg/ml) in comparison to native plant extract. Moreover, these particles were found to be non-toxic and efficient eradicators of environmental toxicants via rapid catalytic reduction of toxic chemicals and dyes. Altogether, these results suggest promising potential of these nanoparticles that can be used as multifunctional agents for future biomedical applications.

Critical methodological considerations in recruiting and engaging non-native English speaking workers with a head injury: a Canadian perspective

OBJECTIVE

Non-native English speaking workers with a mild work-related traumatic brain and/or head injury are a vulnerable and underrepresented population in research studies. The researchers present their experiences with recruiting and performing qualitative interviews with non-native English speaking individuals with a work-related mild traumatic brain injury, and provide recommendations on how to better include this vulnerable population in future research studies. This paper presents considerations regarding ethics, recruitment challenges, interview preparation and debriefing, sex & gender and language and cultural issues must be made when working with this vulnerable population.

RESULTS

The researchers discuss critical issues and provide recommendations in recruiting and engaging with non-native English language workers including ethics, recruitment challenges, interview preparation and debriefing, sex & gender and language, and cultural considerations that must be made when working with this population. The study recommendations advise investigators to spend more time to learn about the non-native English participants in the mild wrTBI context, to be familiar with the vulnerabilities and specific circumstances that these workers experience. By increasing their awareness of the challenging facing this vulnerable population, the intention is to provide better care and treatment options through evidence-based research and practice.

Coinfection with Hymenolepis nana and Hymenolepis diminuta infection in a child from North India: A rare case report

Hymenolepiasis is considered the most common tapeworm infection throughout the world infecting 50-75 million people. Hymenolepis diminuta infection is not commonly reported in human beings as compared to Hymenolepis nana because it is primarily a parasite of rats and mice. There are few case reports of H. diminuta in the Indian population. To the best of our knowledge, not a single case of coinfection with H. nana and H. diminuta has been reported from India. We present here a rare case report of coinfection of H. nana and H. diminuta in a 4-year-old male child from a semirural area of India who presented with acute and severe colitis.

IL-17-CXC Chemokine Receptor 2 Axis Facilitates Breast Cancer Progression by Up-Regulating Neutrophil Recruitment

Recent evidence suggests that interactions among proinflammatory cytokines, chemokines, and cancer cell-recruited neutrophils result in enhanced metastasis and chemotherapy resistance. Nonetheless, the detailed mechanism remains unclear. Our aim was to discover the role of IL-17, CXC chemokine receptor 2 (CXCR2) ligands, and cancer-associated neutrophils in chemotherapy resistance and metastasis in breast cancer. Mice were injected with Cl66 murine mammary tumor cells, Cl66 cells resistant to doxorubicin (Cl66-Dox), or Cl66 cells resistant to paclitaxel (Cl66-Pac). Higher levels of IL-17 receptor, CXCR2 chemokines, and CXCR2 were observed in tumors generated from Cl66-Dox and Cl66-Pac cells in comparison with tumors generated from Cl66 cells. Tumors generated from Cl66-Dox and Cl66-Pac cells had higher infiltration of neutrophils and T helper 17 cells. In comparison with primary tumor sites, there were increased levels of CXCR2, CXCR2 ligands, and IL-17 receptor within the metastatic lesions. Moreover, IL-17 increased the expression of CXCR2 ligands and cell proliferation of Cl66 cells. The supernatant of Cl66-Dox and Cl66-Pac cells enhanced neutrophil chemotaxis. In addition, IL-17-induced neutrophil chemotaxis was dependent on CXCR2 signaling. Collectively, these data demonstrate that the IL-17-CXCR2 axis facilitates the recruitment of neutrophils to the tumor sites, thus allowing them to play a cancer-promoting role in cancer progression.

Aetiology and trends of rates of stillbirth in a tertiary care hospital in the north of India over 10 years: a retrospective study

OBJECTIVE

To analyse the aetiology of stillbirth and its changing trends in a single tertiary care referral institute of northern India over a 10-year period (2007-2016).

DESIGN

Retrospective study.

SETTING

Tertiary care hospital in the north of India.

SAMPLE

Medical records of all mothers who delivered a stillborn at the institute.

METHODS

Data was collected from monthly and annual perinatal audits and causes of stillbirths were classified using Simplified CODAC classification. Annual reduction rate was calculated by linear regression analysis and Cusick test for the changing trends over 9 years.

MAIN OUTCOME MEASURES

Of 54 160 births, 3678 babies were stillborn. Over 9 years, the annual stillbirth rate has reduced significantly from 73.6 to 62.0 per 1000 total births with an average annual reduction rate of 1%. The most common causes of stillbirths were hypertensive disorders of pregnancy (27.6%), antepartum haemorrhage (19.5%), and congenital anomalies (9.3%).

CONCLUSION

The annual reduction rate (1%) of stillbirth remains low. The aetiology of stillbirths remains unchanged over a 10-year period and hypertensive disorder of pregnancy remains the single most preventable cause of stillbirth.

TWEETABLE ABSTRACT

Analysis of stillbirths over a 10-year period in an Indian institute showed a high but declining trend with annual reduction rate of 1%.

Abstract 4554: IL-17-CXCR2 axis promotes breast cancer metastasis and therapy resistance through facilitating recruitment of neutrophils

Breast cancer is one of the most common cancer types that happens to global females. The major challenges for breast cancer include therapy resistance and metastasis. Various factors and cancer-related immune cells are involved in tumor chemotherapy resistance process, including pro-inflammatory cytokine, interleukin (IL) 17, CXCR2 ligands (pro-inflammatory chemokines) and neutrophils. They are the key players for promoting cancer progression, and numerous reports indicated them as a potential therapeutic target for various cancer types including breast cancer. However, the detailed mechanism(s) remains unclear. In the present study, we investigate the role of neutrophils in chemotherapy resistance and metastasis in breast cancer.

In our previous study, we have observed increased levels of CXCR2 ligands in chemotherapy-resistant cells comparing with Cl66 parent cells. In this study, we observed upregulated IL17, IL17 receptor (IL-17R), granulocyte colony stimulating factor (GCSF) by qRT- PCR in resistant cells compared with parent cells. We further evaluated the protein levels of CXCR2 and its ligands, IL17 and its receptor, frequencies of neutrophils and T-helper 17 (Th17) cells in primary and metastatic tumors through using immunohistochemistry method. There were higher levels of IL17R, CXCR2, and CXCR2 ligands in metastatic tumor sites in comparison to the primary tumor sites. Moreover, we observed increased levels of IL17R, CXCR2, CXCR2 ligands together with the higher frequencies of neutrophils and Th17 cells in resistant tumors than Cl66 tumors. At the same time, tumor cells treated with IL-17 increased its proliferation rate and its expression of CXCL1 & CXCL5; and the increase was all in a concentration-dependent manner. In addition, the increase of CXCR2 ligands by IL17 was inhibited when we treated the tumor cells with ERK and NF-KB signaling inhibitors, indicating both pathways are involved in the regulation of IL17-induced CXCR2 ligands secretion.

Together, our data demonstrate an IL17-CXCR2 ligands axis plays protumorigenic inflammation, facilitating therapy resistance and metastasis through recruited neutrophils.

Citation Format: Lingyun Wu, Sugandha Saxena, Mohammad Awaji, Bhawna Sharma, Rakesh Singh. IL-17-CXCR2 axis promotes breast cancer metastasis and therapy resistance through facilitating recruitment of neutrophils [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4554.

A comparison of decontamination methods of tried-in preformed metal crowns: an in-vivo study

AIM

To compare the effectiveness of different decontamination methods on tried-in preformed metal crowns (PMCs).

METHODS

Sixty unused PMCs and 90 tried-in PMCs from patients were assessed for contamination after culturing for 24 h on liquid media, solid media and differential media for identification of Streptococcus mutans, Staphylococcus aureus, and Escherichia coli. Subsequently, these PMCs were divided equally into the following six groups: autoclave (121 °C, 15 psi for 15 min), 5% sodium hypochlorite (5 min), 5% glutaraldehyde (5 min), 70% isopropyl alcohol (1 min) and normal saline (5 min). The contamination was reassessed, and the Log₁₀ counts were compared to the pre-decontamination levels using one way ANOVA and paired t-test at a significance level of p < 0.05.

RESULTS

The mean percentage reduction in colony counts was significantly more in the autoclave group compared to glutaraldehyde or sodium hypochlorite groups, glass bead, isopropyl alcohol, and normal saline in this decreasing order.

CONCLUSIONS

PMCs supplied by the manufacturer were found to be sterile and can be used directly on patients. The autoclave was the best method of sterilisation, although it did not eliminate the microbes 100%; followed by 5% glutaraldehyde and 5% sodium hypochlorite.

CXCR2: A Novel Mediator of Mammary Tumor Bone Metastasis

Most breast cancer patients die due to bone metastasis. Although metastasis accounts for 5% of the breast cancer cases, it is responsible for most of the deaths. Sometimes even before the detection of a primary tumor, most of the patients have bone and lymph node metastasis. Moreover, at the time of death, breast cancer patients have the bulk of the tumor burden in their bones. Therapy options are available for the treatment of primary tumors, but there are minimal options for treating breast cancer patients who have bone metastasis. C-X-C motif chemokine receptor type 2 (CXCR2) receptor-mediated signaling has been shown to play a critical role during bone-related inflammations and its ligands C-X-C motif chemokine ligand 6 (CXCL6) and 8 (CXCL8) aid in the resorption of bone during bone metastasis. In this study, we tested the hypothesis that CXCR2 contributes to mammary tumor-induced osteolysis and bone metastasis. In the present study, we examined the role of both tumor cell-derived and host-derived CXCR2 in influencing mammary tumor cell bone metastasis. For understanding the role of tumor cell-derived CXCR2, we utilized Cl66 CXCR2 knockdown (Cl66-shCXCR2) and Cl66-Control cells (Cl66-Control) and observed a significant decrease in tumor growth and tumor-induced osteolysis in Cl66-shCXCR2 cells in comparison with the Cl66-Control cells. Next, for understanding the role of host-derived CXCR2, we utilized mice with genomic knockdown of CXCR2 (Cxcr2^-/-) and injected Cl66-Luciferase (Cl66-Luc) or 4T1-Luciferase (4T1-Luc) cells. We observed decreased bone destruction and metastasis in the bone of Cxcr2^-/- mice. Our data suggest the importance of both tumor cell- and host-derived CXCR2 signaling in the bone metastasis of breast cancer cells.

Allergic Bronchopulmonary Mycosis due to fungi other than Aspergillus

Summary

Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi that colonize the airways. Early diagnosis and treatment with systemic corticosteroids is the key in preventing the progression of the disease to irreversible lung fibrosis. Although Aspergillus has progressively gained recognition as a causative agent in past few decades, other fungi, that have been reported to cause ABPM, are not yet widely evaluated. We studied hundred and two patients with asthma for occurrence of ABPM. Patients were tested for cutaneous hypersensitivity and serum precipitin to 12 common fungal antigens. The positive cases were further evaluated for ABPM using standard criteria. Out of 102 asthma patients screened, 18 patients had either skin prick test (SPT) and/or serum precipitin positive. While 14 patients were SPT positive for one or more fungal antigen, two patients were serum precipitin positive for one or more fungi. Two patients had both serum precipitin positive as well as SPT positive. Six (5.8%) patients were diagnosed as ABPM as they fulfilled the criteria. Three of these were because of Aspergillus sp. Two were because of fungi other than Aspergillus namely Schizophyllum and Curvularia. One patient had ABPM because of both Aspergillus and Curvularia. In our study absolute eosinophil count (AEC), total IgE, serum precipitin and SPT had sensitivity of 100%, 100% 50% and 83.3% respectively for diagnosing ABPM. The specificity of these tests was 44.79%, 64.58% 98.96% and 88.54% respectively. Specfic IgE was positive in 50% of patients with either serum precipitin or SPT positivity. SPT or serum precipitin followed by specific IgE had sensitivity of 100% and specificity of 96.88% for diagnosing ABPM. SPT alone followed by Specific IgE had a sensitivity of 83.33% and specificity of 96.88% for diagnosing ABPM. We found that fungi other than Aspergillus such as schizophyllum, and curvularia, can be implicated in ABPM. Multiple fungal agents may be responsible for ABPM in an individual. There is a subset of patients of BA who have fungal sensitization but do not fulfil the criteria for ABPM. SPT was the single most sensitive and specific test, AEC >350 and total IgE more than 417IU were most sensitive tests and SPT followed by specific IgE was most effective strategy for diagnosing ABPM.

Thrombocytopenia in Septic Shock Patients—A Prospective Observational Study of Incidence, Risk Factors and Correlation with Clinical Outcome

The objectives of the study were to study the incidence of various degrees of severity of thrombocytopenia in septic shock, the risk factors for its development and the correlation with clinical outcome. Complete blood counts, chemistry panel, arterial lactate, serum cortisol, APACHE II score, logistic organ dysfunction score and SOFA score were determined in 69 septic shock patients within 24 hours of admission or onset of septic shock. We followed the patients until they died or for six months to determine the mortality rate. The incidence of thrombocytopenia in our study group was 55%. Patients with thrombocytopenia had significantly higher serum creatinine, SOFA score, vasopressor requirement, lower PaO2/FiO2 ratio and higher mortality than those without thrombocytopenia (P <0.05). Higher SOFA score, low PaO2/FiO2 ratio and high vasopressor dose were independent risk factors for development of thrombocytopenia. The presence of thrombocytopenia had significant correlation with SOFA score (P=0.008). On receiver-operator characteristic curve analysis, platelet count was found to be predictive of increased mortality (area under curve=0.56). Thrombocytopenic patients had 1.4 times the risk of mortality and lower survival probability at six months (log rank test P=0.03). In conclusion, thrombocytopenia is common in septic shock and is associated with worse clinical outcome. Higher SOFA score, low PaO2/FiO2 ratio and high vasopressor dose are independent risk factors for development of thrombocytopenia in septic shock.

Transcription factors STAT-4, STAT-6 and CREB regulate Th1/Th2 response in leprosy patients: effect of M. leprae antigens

Background

Leprosy is an ideal human disease to study T cell regulation as patients show correlation between cytokine skewed Th1-Th2 responses and clinical forms of the disease. The Role of transcription factors on the modulation of Th1 and Th2 responses by M. leprae antigens has not been adequately studied. In the present study, we studied the effect of M. leprae antigens on transcription factors STAT-4, STAT-6 and CREB and their correlation with Th1/Th2 cell mediated immune responses in leprosy.

Methods

Leprosy patients of both categories of tuberculoid leprosy (BT/TT) and lepromatous leprosy (BL/LL) were selected from the OPD of NJ1L & OMD, (ICMR), Agra and healthy individuals (H) were chosen from the staff and students working in the institute. Peripheral blood mononuclear cells (PBMCs) of the study subjects were stimulated with M. leprae antigens (WCL, MLSA, and PGL-1). Sandwich ELISA was done in the culture supernatants of healthy and leprosy patients to detect IL-4, IL-10 and IFN-γ. Further, expression of IFN-γ and IL-4 and activation of STAT4, STAT6 and CREB transcription factors in CD4⁺ T cell with or without stimulation of M. leprae antigens was investigated by flow cytometry.

Results

Lepromatous leprosy patients showed significantly lower IFN-γ and higher IL-4 levels in culture supernatant and significantly low expression of IFN-γ and higher expression of IL-4 by CD4⁺ T cells than healthy individuals with or without antigenic stimulation. Antigenic stimulation significantly increased IL-10 in BL/LL patients but not in BT/TT patients or healthy individuals. PGL-1 stimulation led to significantly higher activation of STAT-6 in BT/TT and BL/LL patients in comparison to healthy individuals. All the three antigens led to activation of CREB in healthy and BT/TT patients but not in BL/LL patients.

Conclusion

Our findings show that M. leprae antigens differentially modulate activation of T cell transcription factors STAT-4/STAT-6 and CREB. These transcription factors are well known to regulate Th1 and Th2 mediated immune response which in turn could play vital role in the clinical manifestations of leprosy. These observations may help to determine how these T cell transcription factors affect the development of immune dysfunction and whether these new pathways have a role in immunomodulation in intracellular diseases like leprosy and TB.

Erratum: Observation of D^{0} Meson Nuclear Modifications in Au+Au Collisions at sqrt[s_{NN}]=200 GeV [Phys. Rev. Lett. 113, 142301 (2014)]

This corrects the article DOI: 10.1103/PhysRevLett.113.142301.