Pareto frontier analyses based decision making tool for transportation of hazardous waste

Transportation of hazardous wastes through a region poses immense threat on the development along its road network. The risk to the population, exposed to such activities, has been documented in the past. However, a comprehensive framework for routing hazardous wastes has often been overlooked. A regional Hazardous Waste Management scheme should incorporate a comprehensive framework for hazardous waste transportation. This framework would incorporate the various stakeholders involved in decision making. Hence, a multi-objective approach is required to safeguard the interest of all the concerned stakeholders. The objective of this study is to design a methodology for routing of hazardous wastes between the generating units and the disposal facilities through a capacity constrained network. The proposed methodology uses posteriori method with multi-objective approach to find non-dominated solutions for the system consisting of multiple origins and destinations. A case study of transportation of hazardous wastes in Kolkata Metropolitan Area has also been provided to elucidate the methodology.

A comprehensive risk assessment framework for offsite transportation of inflammable hazardous waste

A framework for risk assessment due to offsite transportation of hazardous wastes is designed based on the type of event that can be triggered from an accident of a hazardous waste carrier. The objective of this study is to design a framework for computing the risk to population associated with offsite transportation of inflammable and volatile wastes. The framework is based on traditional definition of risk and is designed for conditions where accident databases are not available. The probability based variable in risk assessment framework is substituted by a composite accident index proposed in this study. The framework computes the impacts due to a volatile cloud explosion based on TNO Multi-energy model. The methodology also estimates the vulnerable population in terms of disability adjusted life years (DALY) which takes into consideration the demographic profile of the population and the degree of injury on mortality and morbidity sustained. The methodology is illustrated using a case study of a pharmaceutical industry in the Kolkata metropolitan area.

Errors during the preparation of drug infusions: a randomized controlled trial

BACKGROUND

We investigated the extent and frequency of dose errors and treatment delays made as a consequence of preparing drug infusions at the bedside, rather than using pre-filled syringes.

METHODS

Forty-eight nurses with critical care experience volunteered to take part in this randomized, blinded, controlled study conducted in the simulation centre of an urban hospital. They assisted in the management of a simulated patient with septic shock. Vasopressor infusions were prepared either by diluting concentrated drugs from ampoules or were provided in syringes pre-filled beforehand by an intensive care unit resident.

RESULTS

The time taken for the infusion to be started and the final concentration of the drugs were measured. We also measured the concentration of infusions prepared by a pharmacist and a pharmaceutical company. Nurses took 156 s to start infusions when using pre-filled syringes compared with 276 s when preparing them de novo, a mean delay of 106 s [95% confidence interval (CI) 73-140 s, P<0.0001]. One infusion prepared from ampoules contained one-fifth of the expected concentration of epinephrine; another contained none at all. Medication errors were 17.0 times less likely when pre-filled syringes were used (95% CI 5.2-55.5), and infusions prepared by pharmacy and industry were significantly more likely to contain the expected concentration (P<0.001 for norepinephrine and P=0.001 for epinephrine).

CONCLUSIONS

Providing drug infusions in syringes pre-filled by pharmacists or pharmaceutical companies would reduce medication errors and treatment delays, and improve patient safety. However, this approach would have substantial financial implications for healthcare providers, especially in less developed countries.

In vivo microdialysis in pharmacological studies of antibacterial agents in the brain

Cerebral microdialysis (MD) has proven to be a valuable clinical and research tool in neuroscience. It allows sampling of endogenous and exogenous molecules of interest from the extracellular fluid (ECF) of the brain. MD has also been successfully used to assess drug delivery to the target tissues in pharmacokinetic (PK) studies. There is a concern that due to the blood-brain barrier (BBB), current regimens of commonly used antibiotics might be inadequate. Although PK/pharmacodynamic (PK/PD) studies play an important role in drug evaluation, PK MD studies of antibacterial agents in cerebral tissue are few in number. These studies demonstrate a significant variation in drug penetration in the presence of intracranial pathology. Antibacterial agents from the same chemical group have significantly different PK profiles due to different affinity to the transport proteins of the BBB. Some studies suggest that commonly used antibiotics do not reach a therapeutic concentration range in brain ECF. Studies reviewed in this article are small and performed in different patient populations (brain tumour, head injury, epilepsy) using different methodological approaches to the drug recovery estimation. Nevertheless, they provide interesting and important data on the variability of antibiotic penetration that could be utilized for PK/PD studies and which may have clinical relevance.

Microsatellite markers based genetic diversity and bottleneck studies in Zanskari pony

Genetic diversity in Zanskari pony breed was evaluated at 48 microsatellite loci using fifty adult, healthy and unrelated animals. Allele frequency data was used to detect genetic diversity and bottleneck. The estimated average number of alleles (±s.e.) was 8.5208±2.5010 with a total of 409 alleles. A high level of genetic diversity within this breed was observed in terms of number of alleles, observed heterozygosity (0.6763±0.1704), expected Leven's heterozygosity (0.7724±0.795), expected Nei's heterozygosity (0.7644±0.0787) and polymorphism information content (>0.5). In-breeding coefficient (F(is)) was 0.115±0.0209, suggesting moderately high in-breeding in Zanskari breed. Although analysis of bottleneck revealed no bottleneck in recent past but population of Zanskari ponies has decreased drastically and only a few thousand pure-bred animals are left. The information is useful for proposing effective population management strategies for future.

Optimization of photocatalytic degradation of methyl blue using silver ion doped titanium dioxide by combination of experimental design and response surface approach

Photocatalytic degradation of methyl blue (MYB) was studied using Ag(+) doped TiO(2) under UV irradiation in a batch reactor. Catalytic dose, initial concentration of dye and pH of the reaction mixture were found to influence the degradation process most. The degradation was found to be effective in the range catalytic dose (0.5-1.5g/L), initial dye concentration (25-100ppm) and pH of reaction mixture (5-9). Using the three factors three levels Box-Behnken design of experiment technique 15 sets of experiments were designed considering the effective ranges of the influential parameters. The results of the experiments were fitted to two quadratic polynomial models developed using response surface methodology (RSM), representing functional relationship between the decolorization and mineralization of MYB and the experimental parameters. Design Expert software version 8.0.6.1 was used to optimize the effects of the experimental parameters on the responses. The optimum values of the parameters were dose of Ag(+) doped TiO(2) 0.99g/L, initial concentration of MYB 57.68ppm and pH of reaction mixture 7.76. Under the optimal condition the predicted decolorization and mineralization rate of MYB were 95.97% and 80.33%, respectively. Regression analysis with R(2) values >0.99 showed goodness of fit of the experimental results with predicted values.

Preparation and characterization of Ni-doped TiO2 materials for photocurrent and photocatalytic applications

Different amounts of Ni-doped TiO(2) (Ni = 0.1 to 10%) powders and thin films were prepared by following a conventional coprecipitation and sol-gel dip coating techniques, respectively, at 400 to 800°C, and were thoroughly characterized by means of XRD, FT-IR, FT-Raman, DRS, UV-visible, BET surface area, zeta potential, flat band potential, and photocurrent measurement techniques. Photocatalytic abilities of Ni-doped TiO(2) powders were evaluated by means of methylene blue (MB) degradation reaction under simulated solar light. Characterization results suggest that as a dopant, Ni stabilizes TiO(2) in the form of anatase phase, reduces its bandgap energy, and adjusts its flat band potentials such that this material can be employed for photoelectrochemical (PEC) oxidation of water reaction. The photocatalytic activity and photocurrent ability of TiO(2) have been enhanced by doping of Ni in TiO(2). The kinetic studies revealed that the MB degradation reaction follows the Langmuir-Hinshelwood first-order reaction relationship.

Vulnerability assessment using hazard potency for regions generating industrial hazardous waste

This study proposes a methodology that would measure the hazardous characteristics of industrial waste based on its physical and chemical properties. A composite hazardous waste index (HWI) is framed using a new aggregation operator proposed in this study. However, HWI alone cannot be used to compare the hazardous characteristics of different wastes. The concept of hazard potency (HP) is introduced in this study in order to address this problem. HP can be calculated not only for a single waste stream but also for multiple industrial processes in an industry. Thus the hazardous wastes generated from two industries can be directly compared using this methodology. The vulnerability arising out of an industrial unit has been evaluated using HP values of the unit and the population residing within its impact area. The industries in a region are prioritized based on the vulnerability of the adjoining population using the non-dominated sorting algorithm. Solutions are ordered into various levels of domination depending on their HP and population values. A case study of Kolkata Metropolitan Area is provided to substantiate the methodology.

Efficacy, safety and tolerability of topical terbinafine nail solution in patients with mild-to-moderate toenail onychomycosis: results from three randomized studies using double-blind vehicle-controlled and open-label active-controlled designs

BACKGROUND

Terbinafine nail solution (TNS) was developed for the treatment of onychomycosis.

OBJECTIVE

To assess the efficacy of TNS vs. vehicle and amorolfine 5% nail lacquer.

METHODS

Subjects with mild-to-moderate toe onychomycosis (25% to ≤75% nail-involvement, matrix uninvolved) were randomized to receive either TNS or vehicle in two double-blind studies, and to TNS or amorolfine in an active-controlled, open-label study. Primary endpoint was complete cure (no residual clinical involvement and negative mycology) at week 52. Secondary endpoints were mycological cure (negative mycology defined as negative KOH microscopy and negative culture) and clinical effectiveness (≤10% residual-involvement and negative mycology) at week 52.

RESULTS

Complete cure was not different between TNS vs. vehicle and amorolfine. Mycological cure was higher with TNS vs. vehicle, as was clinical effectiveness with TNS vs. vehicle, and TNS and amorolfine were not different for secondary efficacy endpoints. Patients achieving mycological cure had a better clinical outcome, and efficacy was improved in subjects with milder disease. Post hoc analysis suggests that nail thickness is an important prognostic factor. Moreover, mycological cure may require 6 months of treatment regimen while complete cure and clinical effectiveness may be achievable only after 10 months. A simulation study suggests that longer treatment duration would have resulted in higher complete cure with TNS vs. vehicle. Study treatments were well-tolerated.

CONCLUSION

Primary efficacy objectives were not met in the studies reported herein. Possible reasons for failure to achieve significant outcomes include insufficient length of treatment; stringency of primary endpoint and severity of nail involvement of study population.

P5-23-07: Treatment Strategy of Locally Advanced Breast Cancer in Sub Group (T3N1M0, T4bN1M0) in Developing Countries

With the recent advances in modern day chemotherapy and hormonal therapy for locally advanced breast cancer [stage III, T3 N1 and T4bN1], most of the oncologist around the globe now prefer to give neoadjuvent chemotherapy and, or hormonal therapy followed by surgery in the treatment of these cases.

Randomized research have also shown that this strategy provides ‘pathological complete resolution’ as compared to surgery and then adjuvant chemotherapy in terms of decreasing in size of tumar, decrease in vascularity of tumor mass and micrometastasis. Some author believes that this improve the overall survival duration of patients.

This protocol is widely accepted but ….

BUT WHAT IF YOU LOSE YOUR PATIENT ON FOLLOWUP …

Especially in the developing countries of south east asian region and African continent, where there is poor socioeconomic status and lack of education among common people. The patient gets frustrated after first few doses of neoadjuvent therapy, due to side effects of chemotherapy and don't consider chemotherapy as a treatment compare to surgery. Thus the patient loses faith in treatment strategy itself and go untraceable after one or two sessions of the therapy. The government of developing countries lack resources in terms of manpower and money for satisfactory completion of treatment making the above condition even worse. In our study we followed 230 patients of locally advanced breast cancer in subgroup of stage III [T3 N1, T4bN1] and divided them into two plans on random basis. In first plan we approached with the surgical management followed by adjuvant chemotherapy & counseled the patients for completion of chemotherapy. This plan was shown to 115 patients, out of which 100 patients provided good acceptance & completed the course of chemotherapy. There were 15 patients who remained untraceable after surgery.

On the other hand in the 2 group the patients were counseled for neoadjuvent chemotherapy and then surgery in next stage. In this group 115 patients were introduced, out of which 60 patients were lost on follow up after 2–3 sessions. The majority of patients complained about the side effects of chemotherapy and financial reasons and did not come back. Rest of the patients completed the whole course. With no doubt about the result of the treatment, the second group has equivocal survival advantages in terms of morbidity and mortality, but we lost more than half of the patients of second group before completion of treatment.

Primarily the acceptance of surgical treatment is more in developing countries, as it is quite more feasible for government and even economical for common people. Thus we prefer the strategy of surgery followed by adjuvant chemo/hormonal therapy in locally advanced breast cancer [stage III T3N1, T4bN1] especially in developing countries like India.

THE MOTTO OF THIS STRATEGY IS TO PROVIDE BENEFIT OF COMPLETE TREATMENT TO THE PATIENT THAN TO LOSE THE PATIENT COMPLETELY BEFORE TREATMENT.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-23-07.

Enhanced protection of mice against Japanese encephalitis virus infection by combinations of monoclonal antibodies to glycoprotein E

In the present study, the protective effect of various combinations of four monoclonal antibodies (MAbs) to glycoprotein E (gpE) of Japanese encephalitis virus (JEV) on the JEV-infected mice was studied. The MAbs were characterized as hemagglutination-inhibition-positive and JEV-specific (Hs). In the protective experiment, mice were first administered single MAbs or their combinations intraperitoneally (i.p.) and 24 hrs later infected with the virus intracerebrally (i.c.). The results showed that single MAbs protected the mice to the extent of 45-65%, while combinations of two or three MAbs gave 85-90% or 100% protection, respectively. The enhanced effect of combinations of several Hs MAbs might be due to the sharing of neutralization epitopes recognized by the Hs MAbs. These results suggested that a combination of at least three epitopes represented by the Hs MAbs should be included in an effective JEV vaccine.

Itraconazole (Sporanox®) for seborrheic dermatitis

Seborrheic dermatitis is a common superficial dermatosis, characterized by red, flaking areas of the skin, which may in some cases be covered with yellowish flakes. The most commonly affected areas are the nasolabial folds, ears, eyebrows, scalp and chest. While seborrheic dermatitis may be easy to recognize clinically, the variability of the lesions in both appearance and location may complicate the diagnosis. Seborrheic dermatitis has been described as resembling psoriasis (in which case, the condition may be called "sebopsoriasis") and, when affecting the eyes or ears, has also been described as blepharitis and otitis, respectively. Seborrheic dermatitis tends to be chronic, though seasonal variation is common, with lesions worsening in the dry, winter months.

Itraconazole (Sporanox®) for vulvovaginal candidiasis

Vulvovaginal candidiasis is a common occurrence among women over 25 years of age. The likelihood of developing infection increases with pregnancy, the use of oral contraceptives or antibiotics, or immune disorders. However, in many cases, the etiology of the disorder is unknown. Sobel1 suggests that some cases of reinfection may actually be cases of relapse, due to either inadequate testing methods, which result in false-negative results after treatment, or to ineffective treatments. Misdiagnosis of the causative organism may also result in ineffective treatment. The most common causal Candida species is C. albicans. However, other, less easily eradicated species may also be involved.

Metabolic syndrome, impaired fasting glucose and obesity, as predictors of incident diabetes in 14 120 hypertensive patients of ASCOT-BPLA: comparison of their relative predictability using a novel approach

AIMS

To evaluate, in hypertensive patients, whether the metabolic syndrome is a better predictor of new-onset diabetes compared with impaired fasting glucose, obesity or its other individual components alone, or collectively.

METHODS

Cox models were developed to assess the risk of new-onset diabetes associated with the metabolic syndrome after adjusting for a priori confounders (age, sex, ethnicity and concomitant use of non-cardiovascular medications), its individual components and other determinants of new-onset diabetes. Area under receiver operator curves using the metabolic syndrome or models of impaired fasting glucose were compared, and the ability of these models to correctly identify those who (after 5-years of follow-up) would or would not develop diabetes was assessed.

RESULTS

The metabolic syndrome adjusted for a priori confounders and its individual components, and further adjusted for other determinants, was associated with significantly increased risk of new-onset diabetes [1.19 (1.00-1.40), P = 0.05 and 1.22 (1.03-1.44), P = 0.02, respectively]. The discriminative ability of the metabolic syndrome model [area under receiver operating curve: 0.764 (0.750-0.778)] was significantly better than the model of impaired fasting glucose [0.742 (0.727-0.757)] (P < 0.001). The metabolic syndrome correctly allocates the risk of new-onset diabetes in a significantly higher proportion of patients (62.3%) than impaired fasting glucose status (37.7%) (P < 0.001). The presence of both the metabolic syndrome and impaired fasting glucose were associated with an approximately 9-fold (7.47-10.45) increased risk of new-onset diabetes. Among normoglycaemic patients, the metabolic syndrome was also associated with significantly increased risk of new-onset diabetes, after adjusting for BMI and a priori confounders [1.66 (1.29-2.13)].

CONCLUSIONS

Both impaired fasting glucose and the metabolic syndrome predict the risk of new-onset diabetes; however, the metabolic syndrome is a better predictor than impaired fasting glucose in assigning the risk of new-onset diabetes in hypertensive patients, and among those with normoglycaemia.

Sinugenic Headache and Nasal Endoscopy

This paper presents an evaluation and results of a study conducted on 62 patients out of 140 cases of chronic headache seen in ENT OPD. 32 patients were taken up for minimal endoscopic surgery. 23 cases (72%) have shown significant relief from headache over a period of 6 months or more. 11 cases showed anatomical / pathological variations at the ethmoidalis infundibulum, the commonest cause being enlarged bulla ethmoidalis followed by minimal polyps/polypoidal mucosa at the frontal recess area. Other causes are hyperplastic sinusitis, high posterior septal deviation, large middle turbinate, paradoxical middle turbinate and concha bullosa.

Effect of short-term Psychiatric Intervention in Cancer Patients

A total of 50 patients undergoing cancer treatment at Malignant Disease Treatment Centre were included in the present study aimed at evaluating the psychological status of cancer patients. All patients filled a specially designed proforma and the following psychological questionnaires : General Health Questionnaire, Carroll Rating Scale for Depression, State-Trait Anxiety Inventory, PGI General Well-being Scale and Quality of Life Scale. Analysis of the results showed that 22 (44%) of the cancer patients had psychiatric disorders and this number had reduced to 12 (24%) after therapy. The difference was statistically significant. Psychiatric treatment also resulted in a statistically significant reduction in level of depression as measured by Carroll Rating Scale for depression. Short term psychiatric treatment was found to be very useful in treating psychiatric morbidity and depression in cancer patients.

Prevalence and associations of hepatitis C viremia in hemodialysis patients at a tertiary care hospital

Hepatitis C virus (HCV) infection in hemodialysis (HD) is a significant problem. We evaluated the prevalence and associations of HCV viremia in our HD patients. All patients undergoing maintenance HD at our center were tested for HCV RNA by PCR after written informed consent. Detailed history regarding age, sex, and duration of dialysis, frequency of dialysis, blood transfusions in one year, number of dialysis centers, dialyzer reuse/fresh use, and recent laboratory data was recorded. A total of 119 patients (77 males and 42 females) were tested for HCV RNA. Thirty three (27.7%) tested positive. Duration of dialysis was significantly longer in HCV RNA positive group (P = 0.001). 45.2% of patients with duration of dialysis more than 16 months were HCV RNA positive while only 7.4% of patients with dialysis duration ≤16 months were HCV RNA positive (P < 0.001). In univariate analysis, in HCV RNA group patients, ALT, AST, and GGTP were significantly elevated and albumin was significantly lower. 39% of patients who had dialysis at more than one center were HCV RNA positive as compared to 20% for patients undergoing dialysis at single center (P = 0.024). Binary logistic regression analysis showed albumin, duration of dialysis, and serum ALT to be significant variables. Sensitivity and specificity of anti-HCV ELISA was 72.7 and 97.7%, respectively. Prevalence of HCV RNA in the HD population is 27.7%. Duration of dialysis, getting dialysis at more than one center, elevated transaminase levels, and low serum albumin are important associations for HCV RNA positivity.

Evaluation of three scales of dyspnea in chronic obstructive pulmonary disease

BACKGROUND:

The Modified Medical Research Council (MMRC) scale, baseline dyspnea index (BDI) and the oxygen cost diagram (OCD) are widely used tools for evaluation of limitation of activities due to dyspnea in patients with chronic obstructive pulmonary disease (COPD). There is, however, limited information on how these relate with each other and with multiple parameters of physiological impairment.

OBJECTIVES:

To study the interrelationships between MMRC, BDI and OCD scales of dyspnea and their correlation with multiple measures of physiological impairment.

MATERIALS AND METHODS:

A retrospective analysis of pooled data of 88 male patients with COPD (GOLD stages II, III and IV) was carried out. Dyspnea was evaluated using the MMRC, BDI and OCD scales. Physiological impairment was assessed by spirometry (FVC % predicted and FEV₁ % predicted), arterial blood gas (ABG) analysis and measurement of the 6-min walk distance (6MWD).

RESULTS:

The interrelationships between MMRC, BDI and OCD scales were moderately strong. The BDI and OCD scores had strong correlations with ABG abnormalities, weak correlations with spirometric parameters but none with 6MWD. MMRC grades were significantly associated with BDI and OCD scores but did not show clear associations with spirometric parameters, ABG abnormalities and 6MWD.

CONCLUSIONS:

The MMRC grades of dyspnea and the BDI and OCD scales are moderately interrelated. While the BDI and OCD scales have significant associations with parameters of physiological impairment, the MMRC scale does not.

Ignatzschineria indica sp. nov. and Ignatzschineria ureiclastica sp. nov., isolated from adult flesh flies (Diptera: Sarcophagidae)

Two Gram-negative-staining, aerobic, non-motile, rod-shaped bacteria, designated strains FFA1T and FFA3T, and belonging to the class Gammaproteobacteria were isolated from the gastrointestinal tract of adult flesh flies (Diptera: Sarcophagidae). Phylogenetic analysis of 16S rRNA gene sequence data placed these two strains within the genus Ignatzschineria with similarities of 98.6 % (FFA1T) and 99.35 % (FFA3T) to Ignatzschineria larvae L1/68T. The level of gene sequence similarity between strains FFA1T and FFA3T was 99 %, 97.15 % and 78.1 % based on the 16S rRNA, 23S rRNA and gyrB gene sequences, respectively. Strains FFA1T and FFA3T shared 24 % DNA–DNA relatedness. DNA–DNA hybridization revealed a very low level of relatedness between the novel strains (22 % for strain FFA1T and 44 % for strain FFA3T) and I. larvae L1/68T genomic DNA. The respiratory quinone was Q-8 in both novel strains. The DNA G+C contents were 41.1 mol% and 40.1 mol% for strains FFA1T and FFA3T, respectively. The cell membrane of both strains consisted of phosphatidylglycerol, phosphatidylethanolamine, phospholipids and aminophospholipid. The major fatty acids for both strains were C16 : 0, summed feature 8 (C18 : 1ω7c and/or C18 : 1ω6c), CyC19 : 0ω8c and C14 : 0. The results of DNA–DNA hybridization between the two new strains and I. larvae L1/68T, in combination with phylogenetic, chemotaxonomic, biochemical and electron microscopic data, demonstrated that strains FFA1T and FFA3T represented two novel species of the genus Ignatzschineria for which the names Ignatzschineria indica sp. nov. (type strain FFA1T = DSM 22309T = KCTC 22643T = NCIM 5325T) and Ignatzschineria ureiclastica sp. nov. (type strain FFA3T = DSM 22310T = KCTC 22644T = NCIM 5326T) are proposed.

Pharmacophore modelling, molecular docking and virtual screening for EGFR (HER 1) tyrosine kinase inhibitors

A pharmacophore model has been developed using diverse classes of epidermal growth factor receptor (EGFR) tyrosine kinase (TK) inhibitors useful in the treatment of human tumours. Among the top 10 generated hypotheses, the second hypothesis, with one hydrogen bond acceptor, one ring aromatic and three hydrophobic features, was found to be the best on the basis of Cat Scramble validation as well as test set prediction (r(training) = 0.89, r(test) = 0.82). The model also maps well to the external test set molecules as well as clinically active molecules and corroborates the docking studies. Finally, 10 hits were identified as potential leads after virtual screening of ZINC database for EGFR TK inhibition. The study may facilitate the designing and discovery of novel EGFR TK inhibitors.

Template to improve glycemic control without reducing adiposity or dietary fat

Drugs that improve chronic hyperglycemia independently of insulin signaling or reduction of adiposity or dietary fat intake may be highly desirable. Ad36, a human adenovirus, promotes glucose uptake in vitro independently of adiposity or proximal insulin signaling. We tested the ability of Ad36 to improve glycemic control in vivo and determined if the natural Ad36 infection in humans is associated with better glycemic control. C57BL/6J mice fed a chow diet or made diabetic with a high-fat (HF) diet were mock infected or infected with Ad36 or adenovirus Ad2 as a control for infection. Postinfection (pi), systemic glycemic control, hepatic lipid content, and cell signaling in tissues pertinent to glucose metabolism were determined. Next, sera of 1,507 adults and children were screened for Ad36 antibodies as an indicator of past natural infection. In chow-fed mice, Ad36 significantly improved glycemic control for 12 wk pi. In HF-fed mice, Ad36 improved glycemic control and hepatic steatosis up to 20 wk pi. In adipose tissue (AT), skeletal muscle (SM), and liver, Ad36 upregulated distal insulin signaling without recruiting the proximal insulin signaling. Cell signaling suggested that Ad36 increases AT and SM glucose uptake and reduces hepatic glucose release. In humans, Ad36 infection predicted better glycemic control and lower hepatic lipid content independently of age, sex, or adiposity. We conclude that Ad36 offers a novel tool to understand the pathways to improve hyperglycemia and hepatic steatosis independently of proximal insulin signaling, and despite a HF diet. This metabolic engineering by Ad36 appears relevant to humans for developing more practical and effective antidiabetic approaches.

Role of phytosterols in lipid-lowering: current perspectives

The cholesterol-lowering effect of plant sterols was first discovered in the early 1950s. However, it is only recently that plant sterols have become clinically important, when advances in food-technology have made it possible to combine sterols with a variety of food products including margarines, yogurts, fruit juices and cereal bars. We review the clinical trial evidence of lipid-lowering efficacy of plant sterols and discuss their implications in routine clinical practice. To generate the evidence we searched the Pubmed database for English language literature, using relevant keywords and medical subject heading (MeSH) terms, and extracted the findings from recently published studies and meta-analyses on this topic. Our findings suggest that the short-term use of food supplements rich in plant sterols is a safe and effective strategy; to maximize the benefits of dietary and lifestyle therapy, either with or without statin therapy, among majority of dyslipidemic patients with need for additional lipid-lowering.

Long-term follow-up of patients with esophageal replacement by reversed gastric tube

PURPOSE

Various surgical procedures are used for esophageal substitution in children. The purpose of this study was to evaluate the long-term outcome in children who underwent esophageal replacement by reversed gastric tube and to assess some aspects of the physiological function and behavior of the reversed gastric tube.

METHODS

This study was a retrospective and prospective review of 16 patients who had undergone reversed gastric tube esophagoplasty between March 1990 and March 2009. Indications for esophageal replacement included esophageal atresia with or without fistula (10) and caustic injury (6). There were 10 boys and 6 girls. Age at the time of this study varied from 1.7-20 years. The interval between operation and follow-up varied; it was more than 3 months in all cases, with an average of 8 months. Follow-up studies included clinical evaluation, anthropometry, barium study (to look for anastomotic leak, stricture, passage of contrast, ulcer, diverticulum, peristalsis and emptying), neoesophagus motility patterns by manometry, 24-h pH monitoring and radionuclide studies (to investigate esophageal transit and gastric emptying times and gastroesophageal reflux). Statistical analysis was carried out using STATA 9.0 and continuous variables were compared between the tests using the Wilcoxon rank sum test.

RESULTS

Of the 16 children, 12 were between the 3 (rd) and 97 (th) percentiles for weight and 10 were between the 3 (rd) and 97 (th) percentiles for height for their respective age group. 14 were eating and swallowing normally. 2 patients had slight swallowing difficulties with lumpy foods but did not require dilatations. None of our patients had respiratory problems. The children with corrosive stricture were almost normal in growth and development compared to esophageal atresia patients. Barium swallow showed normal swallowing in all patients and did not show gastroesophageal reflux. Mass contractions were seen in two-thirds of the patients on manometry. 24-h pH monitoring showed that the intraluminal pH remained consistently low, even long after operative treatment. Scintigraphy and barium swallow showed almost similar results except that scintigraphy was much more sensitive in detecting reflux.

CONCLUSION

Almost all children remained asymptomatic and led a normal life. The function of the neoesophagus was good and growth and nutrition in the majority of patients was satisfactory.

Comparison of the health-promoting orientation of three tertiary care hospitals of India

BACKGROUND

Hospitals have been considered as places for the provision of curative services. Nowadays, services related to health promotion are also sought to be provided through hospitals. We compared the health-promoting hospital (HPH) orientation of the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh with two other tertiary care hospitals in India, which have been declared HPH by WHO.

METHODS

The score obtained by PGIMER as an HPH as per the WHO standards tool was compared with that of two other tertiary care hospitals in India. A short survey was also conducted of patients visiting PGIMER for their treatment through a selfadministered, pretested questionnaire. A statistical test for difference in proportions was applied. A SWOT analysis was done to assess how PGIMER performed as an HPH.

RESULTS

The HPH score of PGIMER was significantly lower (35/80) than that of the other two hospitals. There was no formal HPH policy in PGIMER. One-third of the patients interviewed were not satisfied with the overall preventive and health-promoting services of PGIMER. Apart from the parameters of the HPH standards, PGIMER seemed to satisfy the expectations from it being an apex medical institute.

CONCLUSION

In view of its low score as an HPH, PGIMER should frame an appropriate HPH policy and devise strategies to provide leadership to other hospitals in India.

Aetiology of global developmental delay in young children: experience from a tertiary care centre in India

BACKGROUND

Global developmental delay is a common reason for referral to a paediatrician. We examined the aetiological yield of an extensive diagnostic work-up in young children with developmental delay in a tertiary referral centre.

METHODS

To assess the diagnostic possibilities, we systematically examined 100 consecutive children with global developmental delay (< 5 years of age) who visited the paediatric outpatient department over a period of 18 months. An association between the presence of features at initial contact and aetiology was analysed by the 2-tailed Fisher exact test and chi-square test.

RESULTS

Of the 100 children, 65 were < 2 years of age (mean age 23.6 months) at presentation. The presence of birth asphyxia, sepsis, seizures, abnormal neurological findings, and dysmorphism were significant predictors of aetiology. Four diagnostic categories--chromosomal disorders including Down syndrome, hypoxic-ischaemic encephalopathy, multiple malformation syndromes and cerebral dysgenesis--were the most common causes of global development delay in 20%, 15%, 14% and 11%, respectively. Moderate delay was seen in 42%, severe in 33% and mild in 25% of the patients. The aetiological yield did not differ with the severity of global developmental delay. Additional investigations such as neuroimaging, cytogenetic analysis, metabolic tests and specific molecular tests contributed to a diagnosis in 73% of the children, while in 23% these were the sole means of arriving at a diagnosis. Neuroimaging for a specific indication was almost twice more likely to yield an aetiology when compared with neuroimaging performed as a screening tool (65% v. 35%; p = 0.003).

CONCLUSION

The aetiological yield in this selected cohort with global developmental delay was 73%. A step-wise investigational approach is justified in all children with developmental delay, regardless of the severity of delay or the absence of findings on history and physical examination. This study is an attempt to formulate an investigative approach in a child with global developmental delay, especially in developing countries where advanced molecular and cytogenetic studies are not routinely available.

Effect of ochratoxin A on broiler chicks challenged withSalmonella gallinarum

1. A study was conducted to evaluate the effects of ochratoxin A (OA) on broiler chicks challenged with Salmonella gallinarum. 2. One hundred and seventy-six 1-d-old broiler chicks were divided into two groups of 88 chicks each, with one group fed on a control mash diet and the other given a mash diet containing 2 ppm OA. On d 14, each group was further subdivided into two groups with one group infected with S. gallinarum and the other uninfected. 3. Following S. gallinarum inoculation on d 14, 4 birds from each group were killed at 1, 2, 3, 5, 7, 10, 14 and 21 d post inoculation. 4. S. gallinarum infection caused dullness, depression, weakness, increased thirst, droopy wings, ruffled feathers and greenish-yellow diarrhoea. S. gallinarum infection in the absence of OA caused 11.5% mortality which increased to 28.8% in the presence of OA. 5. Decreased body weight and reduced feed intake were observed in chicks fed on the diet containing OA. S. gallinarum infection also reduced the body weights of chicks, with the effects being more marked in chicks receiving OA. The OA diet led to increased serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, uric acid and creatinine, and decreased levels of total proteins, albumin, globulins, calcium and phosphorus. S. gallinarum infection did not cause significant alteration in any of the serum biochemical parameters. 6. Mortality and the severity of S. gallinarum infection in broiler chicks were increased by the presence of OA in the diet.

Shewanella indica sp. nov., isolated from sediment of the Arabian Sea

A Gram-negative, facultatively anaerobic, rod-shaped, catalase- and oxidase-positive bacterium, motile by means of a single polar flagellum and designated strain KJW27(T), was isolated from the marine sediment of Karwar jetty, west coast of India. The strain was β-haemolytic and grew with 0-10 % (w/v) NaCl, at 10-45 °C and at pH 6.5-10, with optimum growth with 2 % (w/v) NaCl, at 37 °C and at pH 7.5. The major fatty acids were iso-C₁₅:₀ (22.2 %), C₁₇:₁ω8c (21 %), summed feature 3 (comprising C₁₆:₁ω7c and/or C₁₆:₁ω6c; 10.2 %), C₁₆:₀ (7.1 %), iso-C₁₃:₀ (5.6 %) and C₁₇:₀ (4.4 %). The DNA G+C content was 51.2 mol%. Phylogenetic analysis based on 16S rRNA and gyrB gene sequences showed that strain KJW27(T) forms a lineage within the genus Shewanella and is closely related to Shewanella algae ATCC 51192(T) (98.8 %), Shewanella haliotis DW01(T) (98.8 %) and Shewanella chilikensis JC5(T) (98.2 %). Sequence identity with other members of this genus ranges from 92.2 to 96.4 %. The DNA-DNA relatedness of strain KJW27(T) with S. algae ATCC 51192(T), S. haliotis DW01(T) and S. chilikensis JC5(T) was 52, 44 and 33 %, respectively. The phenotypic, genotypic and DNA-DNA relatedness data indicate that strain KJW27(T) should be distinguished from S. algae ATCC 51192(T), S. haliotis DW01(T) and S. chilikensis JC5(T). On the basis of the data presented in this study, strain KJW27(T) represents a novel species, for which the name Shewanella indica sp. nov. is proposed. The type strain is KJW27(T) ( = KCTC 23171(T)  = BCC 41031(T)  = NCIM 5388(T)).

Communicating oesophageal duplication cyst with heterotopic pancreatic tissue - an unusual cause of recurrent pneumonia in an infant

Communicating oesophageal duplication cyst with heterotopic pancreatic tissue is rare congenital anomaly and unusual cause of recurrent pneumonia in children. We report a 10-month-old boy who presented with history, examination and investigations suggestive of aspiration pneumonia since birth. The imaging studies revealed a thin walled cavity communicating with the oesophageal lumen that was excised by surgery. Histopathology showed squamous epithelial lining of cyst with heterotopic pancreatic tissue.

CONCLUSION

Communicating oesophageal cyst causing persistent signs and symptoms can be an unusual cause of recurrent pneumonia in an infant that can be diagnosed by further imaging studies.

Complete 1H, 13C, 19F and 31P NMR data assignment of CWC-related chemicals N,N-dialkyl-P-alkyl phosphonamidic fluorides

The complete multinuclear (1)H, (13)C, (31)P and (19)F NMR data of symmetrically substituted amines containing N,N-dialkyl-P-alkyl phosphonamidic fluorides are presented. Assignment was achieved, using various one-and two-dimensional NMR experiments.

Quality improvement of doctors' shift-change handover in neuro-critical care

BACKGROUND

Clinical handover is a necessary process for the continuation of safe patient care; however, deficiencies in the handover process can introduce error. While the number of handover studies increases, few have validated implemented improvements with repeated audit.

OBJECTIVE

To improve the morning handover round on a busy critical care unit and assess sustainability of improvement through repeated audit.

DESIGN/METHODS

A quality improvement process based on prospective observational assessment of the doctor's shift-change handover was carried out, assessing the content of clinical information and effects of distractions, location and timing. The effect of a training session for the junior doctors with the introduction of a standardised handover protocol was assessed.

RESULTS

The content of clinical information improved after the training session with introduction of a standardised protocol, but returned to baseline with a new cohort of untrained doctors. Distractions were associated with increased handover times for individual patients and for total handover time. Overall, handover time was shortest in the coffee room compared with ward and lecture theatre handovers. Individual patient handover time was positively correlated with clinical content scores. Four indices of critical illness all positively correlated with increased handover time.

CONCLUSIONS

Early specific training is vital for quality clinical handover. Distractions during handover cause inefficiency and can adversely affect information transfer. Changing handover location according to local environment can yield improved efficiency, structure and ease of management. Adequate time must be allocated for clinical handover especially when dealing with very sick and complex patients.

Role of diffusion tensor imaging in differentiating subtypes of meningiomas

PURPOSE

Meningiomas are the most common extraaxial intracranial type of tumor, and their management and prognosis depend on their grade and histology. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are two new imaging techniques that have proved helpful in elucidating the microarchitecture of brain tumors. The aim of the present study was to assess the role of diffusion and diffusion tensor metrics in the identification and classification of meningioma grades and subtypes.

METHODS AND MATERIALS

A total of 21 consecutive patients with meningioma were included in this retrospective study, of whom 16 had benign meningiomas (three fibroblastic, 11 transitional/mixed, two meningothelial) and five had atypical meningiomas. Tumor mean diffusivity (Dav), fractional anisotropy (FA), linear anisotropy (CL), planar anisotropy (CP), spherical anisotropy (CS) and eigenvalues (e1, e2, e3) were measured in all cases, and differences in diffusion tensor metrics between atypical, fibroblastic and other benign (transitional, meningothelial) meningiomas were statistically analyzed using the Mann-Whitney test.

RESULTS

No statistically significant differences were found among the mean Dav values for atypical, fibroblastic and other benign meningiomas. Both atypical and fibroblastic meningiomas showed significantly higher mean FA values and lower mean CS values compared with other meningiomas (P<0.01), but no statistically significant difference in these values between each other. Atypical meningiomas showed higher CL values compared with fibroblastic and other benign meningiomas but, again, the difference was not statistically significant. Both atypical and fibroblastic meningiomas showed statistically significantly higher CP values and lower e3 values compared with transitional meningiomas (P<0.01).

CONCLUSION

These results suggest that diffusion tensor metrics may be helpful in the differentiation of atypical, fibroblastic and other benign meningiomas.

Acute renal failure associated with nonfulminant acute viral hepatitis A

Hepatitis A runs a benign course in children, but may have atypical presentations in adults. Very rarely acute renal failure complicates nonfulminant hepatitis A. We report a patient with nonfulminant acute viral hepatitis A with multiorgan involvement. Patient had biopsy proven acute interstitial nephritis, acute pancreatitis, acute myocarditis and required hemodialysis for 6 weeks.

Early death of Japanese encephalitis virus-infected mice administered a neutralizing cross-reactive monoclonal antibody against glycoprotein E

In the present study, the effect of two haemagglutination-inhibition (HAI)-negative auto-reactive (NHA-1 and NHA-2) monoclonal antibodies (MAbs) against glycoprotein E (gpE) of Japanese encephalitis virus (JEV) administered 1 day before or 2 days after intracerebral (i.c.) inoculation of JEV was studied in mice. Of the two MAbs that cross-reacted with West Nile virus (WNV) and histones, the first one (NHA-1) neutralized JEV, while the second one was non-neutralizing. NHA-1 MAb given intraperitoneally (i.p.) 1 day before virus infection induced early death by about 2 days in comparison to controls, whereas mice administered HAI-positive anti-gpE JEV specific MAbs (Hs-1 or Hs-4) were invariably protected. In contrast, MAb NHA-2 failed to produce any effect in mice. Since the similar virus titers were recorded in the brains of experimental and control infected mice, the present results indicated a modification of the biological activity of JEV by the pre-existing MAb NHA-1 that might be leading to an early death of mice.

KEYWORDS

Japanese encephalitis virus; neutralizing cross-reactive monoclonal antibody.

Indoor resting density pattern of mosquito species in Fingeswar block of Raipur district in Chhattisgarh, central India

Anopheline mosquitoes are vectors of human malaria and hence they are of greatest concern. Around 40% of the world's population resides in malaria affected areas. Malaria affects poor communities and causes enormous economic losses. The deadly disease annually causes clinical illness in 400-600 million people and kills 2-3 millions annually (WHO 2008). Faunistic survey was conducted in Fingeswar block in Raipur district of Chhattisgarh state of India during January 2003 to March 2004 to asses the prevalence of different species of mosquitoes and their seasonal variations.Indoor resting mosquitoes were collected from selected houses in 5 villages using aspirator tube and torch light in the morning between 06:00-08:00. Adult mosquitoes were identified using standard morphological and pictorial keys following Rao (1984), Das et al. (1991) and Reuben et al. (1994) and assessed as person hour density.A total of 13,248 mosquitoes were collected during the study period. Nine species of mosquitoes comprising of 4 genera with 5 Anopheles, two Culex and one each Armigeres and Aedes were recorded. The malaria vectors constituted 14.09% of the total mosquito collections. Anopheles subpictus (25.81%) showed the dominance followed by A. annularis (8.68%), A. barbirostris (6.76%), A. culicifacies (5.41%) and A. pallidus (4.11%). The other genus recorded included Culex quinquefasciatus (38.38%), C. vishnui (3.32%), Armigeres subalbatus (6.92%) and Aedes albopictus (0.29%). The density of all the species were high in months of August, September and October, decreased in month of May and June 2003. There was a significant (p < 0.01) positive correlation between temperature and density of A. culicifacies and A. annularis. The seasonal distribution pattern of A. culicifacies (primary) and A. annularis (secondary) malaria vectors along with other mosquito species was studied which is an important component of epidemiological study of malaria. This information will help in formulating a baseline structure for control program in the study region.

Impact of season on filarial vector density and infection in Raipur City of Chhattisgarh, India

BACKGROUND & OBJECTIVES

Bionomics and transmission dynamics of vector population are profoundly influenced by local climatic conditions. The study monitored variations in density, infection and infectivity rates of Culex quinquefasciatus with respect to season in randomly selected localities of Raipur City of Chhattisgarh state.

METHODS

The indoor resting density of Cx. quinquefasciatus, Wuchereria bancrofti infection and infectivity rates were monitored in Raipur City at regular monthly intervals for over a period of 12 months and the impact of meteorological conditions on transmission indices were assessed. The frequency distribution of different stages of filarial larvae in naturally infected vector population, host efficiency and transmission intensity index of the vector population was also worked out.

RESULTS

The mean vector density of Cx. quinquefasciatus during the study period was 55.22 while the mean vector infection and infectivity rates recorded in Raipur were 4.05 and 0.25% respectively. A gradual increase in Culex infection rate was recorded from June onwards with a maximum (22.14%) in August and minimum (2.38%) in February. No vector with filarial infection was detected during December when the vector density was high. Analysis of frequency distribution of different stages of larvae revealed dominance of microfilarial stage with a mean larval intensity of 5.37. The highest infectivity rate was observed during June (1.15%) and the lowest was in March (0.41%). Both the infection and infectivity rates were at their low during winter season although the density of Cx. quinquefasciatus was at its maximum. Highest mean host efficiency of 0.44 was recorded in February. The annual transmission intensity index (TII) was 32.72. The highest TII was recorded during January and February months.

INTERPRETATION & CONCLUSION

The climate appeared to have profound impact on vector density, infection and infectivity rates. The vector infection and infectivity rates were high in rainy season followed by summer and winter seasons. The highest host efficiency was observed in winter followed by summer and rainy seasons. An apparent negative correlation was observed between vector infection rate and vector density. Lower temperatures (23-25 degree) with low rainfall favoured progression of mf to L3 in Cx. quinquefasciatus in the study region.