A randomized double-blind, placebo-controlled trial to evaluate the safety and efficacy of live Bifidobacterium longum CECT 7347 (ES1) and heat-treated Bifidobacterium longum CECT 7347 (HT-ES1) in participants with diarrhea-predominant irritable bowel syndrome

To determine the efficacy of the probiotic Bifidobacterium longum CECT 7347 (ES1) and postbiotic heat-treated Bifidobacterium longum CECT 7347 (HT-ES1) in improving symptom severity in adults with diarrhea-predominant irritable bowel syndrome (IBS-D), a randomised, double-blind, placebo-controlled trial with 200 participants split into three groups was carried out. Two capsules of either ES1, HT-ES1 or placebo were administered orally, once daily, for 84 days (12 weeks). The primary outcome was change in total IBS-Symptom Severity Scale (IBS-SSS) score from baseline, compared to placebo. Secondary outcome measures were stool consistency, quality of life, abdominal pain severity and anxiety scores. Safety parameters and adverse events were also monitored. The change in IBS-SSS scores from baseline compared to placebo, reached significance in the ES1 and HT-ES1 group, on Days 28, 56 and 84. The decrease in mean IBS-SSS score from baseline to Day 84 was: ES1 (-173.70 [±75.60]) vs placebo (-60.44 [±65.5]) (p < .0001) and HT-ES1 (-177.60 [±79.32]) vs placebo (-60.44 [±65.5]) (p < .0001). Secondary outcomes included changes in IBS-QoL, APS-NRS, stool consistency and STAI-S and STAI-T scores, with changes from baseline to Day 84 being significant in ES1 and HT-ES1 groups, compared to the placebo group. Both ES1 and HT-ES1 were effective in reducing IBS-D symptom severity, as evaluated by measures such as IBS-SSS, IBS-QoL, APS-NRS, stool consistency, and STAI, in comparison to the placebo. These results are both statistically significant and clinically meaningful, representing, to the best of the authors' knowledge, the first positive results observed for either a probiotic or postbiotic from the same strain, in this particular population.

Intriguing role of novel ionic liquids in stochastic degradation of chitosan

Green technique for hydrolysis of chitosan was developed using novel Brønsted Acidic Ionic Liquids (BAILs) as homogenous reusable catalysts. Efficiency of BAILs in controlling stochastic and irregular breakdown of chitosan was compared with that of mineral acids. Structural elucidation of the novel BAILs was performed using H¹-NMR evaluation and supplemented using mass spectroscopy. Additionally, thermal characterization was conducted using TGA-DTA analysis, while acidity was estimated by deriving the Hammet acidity function. BAILs investigated in this work enabled consistent production of LMWCS variants, with minimum formation of residual impurities. Around 80 % reduction in molecular weight was noted as compared to original under extreme conditions employed. Further, Box-Behnken Design (BBD) was implemented to optimize effect of processing parameters for conversion of chitosan to low molecular weight congeners.

The role of altered glycosylation in human nucleus pulposus cells in inflammation and degeneration

Intervertebral disc (IVD) degeneration causes low-back pain through disc compression, prolapse and herniation. Inflammation of the IVD and subsequent degeneration produce altered glycosylation profiles in several animal models of IVD injury and ageing, although the function of this altered glycosylation pattern in a human is unknown. Altered N-glycome, specifically sialylated and fucosylated N-glycosylation motif expression, might play a role in inflammation and disease progression. Healthy (foetal and adolescent idiopathic scoliosis) and degenerated (lumbar degeneration) human IVD glycosylation patterns were studied using lectin histochemistry. Small-molecule fluorinated sugar analogues (3Fax-Peracetyl Neu5Ac; 2F-Peracetyl-Fucose) were used to inhibit sialylation and fucosylation in an in vitro model of inflammation, to investigate their effects on the glycosignature, cell metabolism, extracellular matrix synthesis and cell migration. The effects of interleukin (IL)-1β, tumour necrosis factor (TNF)-α and IL-6 on glycosylation in human nucleus pulposus cells were investigated by lectin histochemistry, PCR and enzyme-linked immunosorbent assay (ELISA). In the in vitro model of IVD degeneration, cytokine-induced inflammation-induced hypersialylation was observed, as indicated by Sambucus nigra I binding. However, this modification was inhibited by the sialyltransferase inhibitor. Inhibition of sialylation and fucosylation modulates cell migration and protein translation of catabolic enzymes in response to inflammation. The altered patterns of glycosylation in human tissue in degeneration was consistent with previous IVD studies in murine, bovine and ovine models. The present study was the first functional investigation of glycosylation in human degenerated IVD, elucidating the role of the glycome in disease progression and identified potential therapeutic targets for future regenerative therapies.

Poststudy Point-of-Care Oral Fluid Testing in Human Immunodeficiency Virus-1 Vaccinees

Background

Experimental human immunodeficiency virus (HIV)-1 vaccines frequently elicit antibodies against HIV-1 that may react with commonly used HIV diagnostic tests, a phenomenon known as vaccine-induced seropositivity/seroreactivity (VISP/VISR). We sought to determine, under clinic conditions, whether a patient-controlled HIV test, OraQuick ADVANCE Rapid HIV-1/2 Antibody Test, detected HIV-1 vaccine-induced antibodies.

Methods

Plasma assessment of HIV-1 cross-reactivity was examined in end-of-study samples from 57 healthy, HIV-uninfected participants who received a candidate vaccine that has entered Phase 2B and 3 testing. We also screened 120 healthy, HIV-uninfected, unblinded HIV-1 vaccine participants with VISP/VISR for an assessment using saliva. These participants came from 21 different parent vaccine protocols representing 17 different vaccine regimens, all of which contained an HIV-1 envelope immunogen. OraQuick ADVANCE was compared with results from concurrent blood samples using a series of commercial HIV screening immunoassays.

Results

Fifty-seven unique participant plasma samples were assayed in vitro, and only 1 (1.8%) was reactive by OraQuick ADVANCE. None of the 120 clinic participants (0%; 95% confidence interval, 0% to 3.7%) tested positive by OraQuick ADVANCE, and all were confirmed to be uninfected by HIV-1 viral ribonucleic acid testing. One hundred eighteen of the 120 (98.3%) participants had a reactive HIV test for VISP/VISR: 77 (64%) had at least 1 reactive fourth-generation HIV-1 diagnostic test (P < .0001 vs no reactive OraQuick ADVANCE results), and 41 (34%) only had a reactive test by the less specific third-generation Abbott Prism assay.

Conclusions

These data suggest that this widely available patient-controlled test has limited reactivity to HIV-1 antibodies elicited by these candidate HIV-1 vaccines.

Longitudinal analysis of T-cell receptor repertoires reveals persistence of antigen-driven CD4+ and CD8+ T-cell clusters in systemic sclerosis

The T-cell receptor (TCR) is a highly polymorphic surface receptor that allows T-cells to recognize antigenic peptides presented on the major histocompatibility complex (MHC). Changes in the TCR repertoire have been observed in several autoimmune conditions, and these changes are suggested to predispose autoimmunity. Multiple lines of evidence have implied an important role for T-cells in the pathogenesis of Systemic Sclerosis (SSc), a complex autoimmune disease. One of the major questions regarding the roles of T-cells is whether expansion and activation of T-cells observed in the diseases pathogenesis is antigen driven. To investigate the temporal TCR repertoire dynamics in SSc, we performed high-throughput sequencing of CD4⁺ and CD8⁺ TCRβ chains on longitudinal samples obtained from four SSc patients collected over a minimum of two years. Repertoire overlap analysis revealed that samples taken from the same individual over time shared a high number of TCRβ sequences, indicating a clear temporal persistence of the TCRβ repertoire in CD4⁺ as well as CD8⁺ T-cells. Moreover, the TCRβs that were found with a high frequency at one time point were also found with a high frequency at the other time points (even after almost four years), showing that frequencies of dominant TCRβs are largely consistent over time. We also show that TCRβ generation probability and observed TCR frequency are not related in SSc samples, showing that clonal expansion and persistence of TCRβs is caused by antigenic selection rather than convergent recombination. Moreover, we demonstrate that TCRβ diversity is lower in CD4⁺ and CD8⁺ T-cells from SSc patients compared with memory T-cells from healthy individuals, as SSc TCRβ repertoires are largely dominated by clonally expanded persistent TCRβ sequences. Lastly, using "Grouping of Lymphocyte Interactions by Paratope Hotspots" (GLIPH2), we identify clusters of TCRβ sequences with homologous sequences that potentially recognize the same antigens and contain TCRβs that are persist in SSc patients. In conclusion, our results show that CD4⁺ and CD8⁺ T-cells are highly persistent in SSc patients over time, and this persistence is likely a result from antigenic selection. Moreover, persistent TCRs form high similarity clusters with other (non-)persistent sequences that potentially recognize the same epitopes. These data provide evidence for an antigen driven expansion of CD4⁺/CD8⁺ T-cells in SSc.

The Relationship Between Cerebral Reperfusion And Regional Expression Of Matrix Metalloproteinase-9 In Rat Brain Following Focal Cerebral Ischemia

We investigated the effect of full and partial mechanical reperfusion on MMP-9 expression in rat brain following middle cerebral artery occlusion, mimicking mechanical thrombectomy. Using percentage hemispheric lesion volume and oedema as measures, partial reperfusion reduced extent of brain damage caused by MCA occlusion, but the protective effect was less pronounced than with complete reperfusion. Using ELISA quantification in fresh frozen tissue, confirmed by immunofluorescence in perfusion fixed tissue, increased MMP-9 expression was observed in infarcted tissue. MMP-9 was increased in lesioned tissue of the anterior and posterior temporal cortex and underlying striatal tissue, but also the normal appearing frontal cortex. No significant increase in MMP-9 in the hippocampus was observed, nor in the unlesioned contralateral hemisphere. Both partial reperfusion and full reperfusion reduced the regional MMP expression significantly. The highest levels of MMP-9 were observed in lesioned brain regions in the non-reperfused group. MMP-9 expression was evident in microvessels and in neuronal cell bodies of affected tissue. This study shows that MMP-9 brain levels are reduced relative to the extent of reperfusion. These observations suggest targeting early increases in MMP-9 expression as a possible neuroprotective therapeutic strategy and highlight the rat MCA occlusion model as an ideal model in which to study candidate therapeutics.

Which long line do we use in very low birth weight neonates; umbilical venous catheter or peripherally inserted central catheter?

BACKGROUND

Umbilical venous catheters (UVC) and peripherally inserted central catheters (PICC) are commonly used in preterms. UVC is cheap, easy to insert but has shorter dwell time. UVC is replaced after 7 days due to the risk of complications. This is associated with increased cost, work, and risk of nosocomial infections. The aim of this study was to determine the antenatal and postnatal factors that predict the need for a central line for more than 7 days, thus helping select between UVC or PICC on day 1 of life in babies ≤1500 grams.

METHODS

We retrospectively collected antenatal and postnatal data of VLBW neonates over a period of 1 year who needed CL during their NICU stay. We then divided them into two cohorts. Group 1: CL ≤7 days. Group 2: CL > 7 days.

RESULTS

Sepsis and catheter complications were lower with use of a single CL or duration being ≤7 days. Birth weight, incomplete/no antenatal steroids, need for resuscitation, low Apgar's, RDS, hs-PDA, and initiation of feeds beyond 24 hours of birth were significant. The score was devised based on factors found significant that had an acceptable AUC of 0.767 on ROC analysis with a score of 1 or above having 74.8% sensitivity and 67.7% specificity for prediction of need for CL > 7 days.

CONCLUSIONS

Birth weight ≤1000 grams, incomplete steroids and need for resuscitation at birth were predictive of the need of CL beyond seven days, on day one of life.

Probing synergistic interplay between bio-inspired peptidomimetic chitosan-copper complexes and doxorubicin

The current investigation reports a novel and facile method for modification of low molecular weight chitosan (Cs) with guanidine moieties, aimed at enhancing its cellular interaction and thus augmenting its cellular internalization. Guadinylated chitosan-copper (Cs-Gn-Cu) chelates, based on copper-nitrogen co-ordination, were established. Characterization of chelates was conducted using ¹H NMR, ¹³C NMR, XPS, XRD, TGA-DTA, and GPC techniques. Anticancer activity of formed chelates was confirmed against A549 cells using MTT assay. Experimental outcomes, for the first time, have provided an empirical evidence for synergistic interaction between the chelated polymer (Cs-Gn-Cu) and the established anti-cancer agent, Doxorubicin (Dox), based on analysis by the Chou Talalay method and estimation of their combination indices. ROS induction was demonstrated as the mechanism of action of the chelated polymer, which supplemented rapid destruction of cancerous cells by Dox. These findings strongly advocate the need for harnessing unexplored potential of these innovative metal polymer chelates in cases of Dox resistant lung cancer, wherein the polymeric system itself would serve as an anti-cancer agent.

Microbial biofilms in nature: unlocking their potential for agricultural applications

Soil environments are dynamic and the plant rhizosphere harbours a phenomenal diversity of micro-organisms which exchange signals and beneficial nutrients. Bipartite beneficial or symbiotic interactions with host roots, such as mycorrhizae and various bacteria, are relatively well characterized. In addition, a tripartite interaction also exists between plant roots, arbuscular mycorrhizal fungi (AMF) and associated bacteria. Bacterial biofilms exist as a sheet of bacterial cells in association with AMF structures, embedded within a self-produced exopolysaccharide matrix. Such biofilms may play important functional roles within these tripartite interactions. However, the details about such interactions in the rhizosphere and their relevant functional relationships have not been elucidated. This review explores the current understanding of naturally occurring microbial biofilms, and their interaction with biotic surfaces, especially AMF. The possible roles played by bacterial biofilms and the potential for their application for a more productive and sustainable agriculture is discussed in this review.

The role of innate immune cells in systemic sclerosis in the context of autologous hematopoietic stem cell transplantation

Systemic sclerosis (SSc) is a complex, heterogeneous autoimmune connective tissue disease. Autologous hematopoietic stem‐cell transplantation (AHSCT) has emerged as a valuable treatment option for rapidly progressive diffuse cutaneous SSc (dcSSc) patients, and thus far is the only treatment that has been shown to have a long‐term clinical benefit. AHSCT is thought to reintroduce immune homeostasis through elimination of pathogenic self‐reactive immune cells and reconstitution of a new, tolerant immune system. However, the mechanism of action underlying this reset to tolerance remains largely unknown. In this study we review the immune mechanisms underlying AHSCT for SSc, with a focus on the role of the innate immune cells, including monocytes and natural killer (NK) cells, in restoring immune balance after AHSCT.

Mechanistic insights into controlled depolymerization of Chitosan using H-Mordenite

Kinetics of chitosan depolymerization were studied in dilute acetic acid solution, in presence of H-Mordenite (H-MOR). Rate constants for chitosan depolymerization were determined by measurement of molecular weight, using Gel permeation Chromatography (GPC). Depolymerization rate of chitosan was altered in presence of an acidic, porous material like H-MOR. Maximum concentration of H-MOR studied during process led to minimal increase in energy of activation, from 20.54 kJ/moL to 23.25 kJ/moL. Infra-red spectroscopy, adsorption studies and rheological assessment indicated adsorption /grafting of chitosan onto porous H-MOR surface as the possible mechanism for facilitation of the depolymerization process. Under extreme conditions investigated during process optimization, H-MOR resulted in a three-fold reduction in 5-Hydroxy Methyl Furfural (5-HMF) formation and over ten times decrease in glucosamine content, as compared to reactions conducted without H-MOR. Therefore, presence of H-MOR is imperative to cleave chitosan in controlled manner and obtain products of desired molecular weight, with fewer impurities.

Use of triazoles for the treatment of invasive aspergillosis: A three-year cohort analysis

In a 3-year cohort study of adult patients with proven or probable IA, fewer patients initially treated with isavuconazole experienced adverse events compared with voriconazole, but more patients required a change in therapy due to lack of clinical efficacy.

2453. Prolonged Local Epidemic of an XDR P. aeruginosa Subclade of High-Risk Clonal Complex 298

Background

Antimicrobial resistance (AMR) poses an increasing challenge to the treatment of the nosocomial pathogen Pseudomonas aeruginosa, with the majority of highly resistant infections caused by relatively few high-risk clones. We investigated the role of clonal complex 298 (CC298: ST298 and ST446) in multidrug-resistant (MDR) and extensively drug-resistant (XDR) infections at Northwestern Memorial Hospital (NMH).

Methods

We determined the AMR of 40 whole-genome sequenced CC298 isolates, including 30 from patients at NMH in Chicago (2000–2017), 7 from hospital environments (e.g., sinks) in Chicago (2017–2018), and 3 from patients at Brigham and Women’s Hospital (BWH) in Boston (2015–2016). We used phylogenetics to assess the population structure of these isolates and 38 additional publicly available CC298 genomes. We interrogated the genomes of NMH CC298 isolates to uncover drivers of AMR.

Results

NMH CC298 isolates showed high rates of AMR, with 76.7% (23/30) MDR and 46.7% (14/30) XDR. Phylogenetic analysis revealed that 21/23 MDR (13/14 XDR) isolates from NMH formed a subclade of ST298, termed ST298*, as of yet not seen elsewhere. A time-scaled phylogeny of ST298* indicates a last common ancestor in 1980 (mean 1980.8, 95% HPD interval 1973.3–1987.4), with XDR ST298* isolates seen between 2001 and 2017. Many ST298* isolates, including all XDR isolates, harbored a large plasmid with an AMR class 1 integron. This plasmid is part of a family of large Pseudomonas genus plasmids. By comparing a plasmid-cured strain to its parent, we show that the plasmid imparts resistance to gentamicin and piperacillin–tazobactam. In the parental strain we detect T83I GyrA and S87L ParC substitutions known to cause fluoroquinolone resistance, showing that mutational resistance also contributes to the high AMR of ST298*. Publicly available genomes and previous reports indicate that CC298 has caused infections worldwide with multiple instances of significant AMR.

Conclusion

The repeated isolation of XDR ST298* P. aeruginosa at NMH over 16 years raises concern for the ability of this strain to persist in the healthcare environment. With this local epidemic and additional reports of MDR CC298 isolates around the world, we argue that CC298 should be considered a high-risk clone.

Disclosures

All authors: No reported disclosures.

Long-term Persistence of an Extensively Drug-Resistant Subclade of Globally Distributed Pseudomonas aeruginosa Clonal Complex 446 in an Academic Medical Center

BACKGROUND

Antimicrobial resistance (AMR) is a major challenge in the treatment of infections caused by Pseudomonas aeruginosa. Highly drug-resistant infections are disproportionally caused by a small subset of globally distributed P. aeruginosa sequence types (STs), termed "high-risk clones." We noted that clonal complex (CC) 446 (which includes STs 298 and 446) isolates were repeatedly cultured at 1 medical center and asked whether this lineage might constitute an emerging high-risk clone.

METHODS

We searched P. aeruginosa genomes from collections available from several institutions and from a public database for the presence of CC446 isolates. We determined antibacterial susceptibility using microbroth dilution and examined genome sequences to characterize the population structure of CC446 and investigate the genetic basis of AMR.

RESULTS

CC446 was globally distributed over 5 continents. CC446 isolates demonstrated high rates of AMR, with 51.9% (28/54) being multidrug-resistant (MDR) and 53.6% of these (15/28) being extensively drug-resistant (XDR). Phylogenetic analysis revealed that most MDR/XDR isolates belonged to a subclade of ST298 (designated ST298*) of which 100% (21/21) were MDR and 61.9% (13/21) were XDR. XDR ST298* was identified repeatedly and consistently at a single academic medical center from 2001 through 2017. These isolates harbored a large plasmid that carries a novel antibiotic resistance integron.

CONCLUSIONS

CC446 isolates are globally distributed with multiple occurrences of high AMR. The subclade ST298* is responsible for a prolonged epidemic (≥16 years) of XDR infections at an academic medical center. These findings indicate that CC446 is an emerging high-risk clone deserving further surveillance.

Anthropometric measures as biomarkers of neurodevelopmental outcomes of newborns with moderate to severe hypoxic ischemic encephalopathy

BACKGROUND

Perinatal asphyxia is a prominent cause of neonatal mortality in the developing world. Growth in head circumference is associated with improved neurodevelopment. Previous studies found a positive correlation between additional dietary supplementation and growth in head circumference among newborns with perinatal brain injury. This study aims to evaluate the association between anthropometric parameters and developmental outcomes in newborns with hypoxic ischemic encephalopathy (HIE).

METHODS

Newborns at ≥36 weeks gestation with moderate to severe HIE were included in the study and growth parameters were monitored. Newborns with life-threatening anomalies were excluded. None of the study participants received therapeutic hypothermia (TH). Developmental Assessment Scale for Indian Infants (DASII) was used to evaluate neurodevelopmental outcomes at 1 year of age.

RESULTS

Of 76 study participants, 46 were followed for 12 months, 28 died, and 2 were lost to follow-up. HIE stage III, Apgar score <5 at 5 minutes of age, pH ≤ 7.1 on first blood gas and base deficit > - 16 was associated with death or disability at 1 year of age. All anthropometric parameters were significantly lower in presence of death or disability. pH ≤ 7.1 at birth (odds ratio: 11.835, 95% CI 2.273-61.629, p = 0.003) and weight gain at one year (odds ratio 1.001, 95% CI 1.000-1.002, p = 0.03) were significantly associated with death and disability.

CONCLUSION

pH > 7.1 at birth, and weight gain were associated with better neurodevelopmental outcomes at 1 year of age. Thus, in addition to TH, nutritional interventions may potentially improve outcomes among newborns with HIE.

1557. Acyclovir-Resistant (ACV-R) Herpes Simplex Virus (HSV) Disease in Patients with Hematologic Malignancies (HM) and Hematopoietic-Cell Transplant (HCT) Recipients

Background

HSV reactivation is a challenging complication of HM and HCT. ACV prophylaxis effectively decreases the incidence of symptomatic HSV episodes, but may contribute to development of ACV-R HSV disease in this population. Outcomes in patients with ACV-R HSV disease remain poorly characterized.

Methods

We identified adult HM patients and HCT recipients treated at Dana-Farber Cancer Institute who developed clinically significant ACV-R HSV disease between January 1, 2006 and March 1, 2018. HCT recipients typically receive 1 year of ACV prophylaxis after HCT, or longer in those with graft-vs. host disease. Clinical, microbiological and treatment details were collected.

Results

Nineteen patients had 27 episodes of ACV-R HSV disease during the study. Median age was 50 years (range 31–77); 15 (79%) were men. Fifteen (79%) were allogeneic HCT recipients and 4 (21%) had HM (3 CLL, 1 NHL). Thirteen (68%) had oral ulcers (HSV1), four (21%) had perineal ulcers (3 HSV2, 1 HSV1), one had HSV1 vesicles on the trunk and one had concurrent oral HSV1 and perineal HSV2 ulcers. Three patients had recurrent ACV-R HSV: two had one recurrence each and one had six recurrences. Of 19 first episodes of ACV-R HSV, 15 (79%) were confirmed by culture-based phenotypic resistance testing.

Most episodes (20/27, 74%) were treated with foscarnet at clinical diagnosis or after failure of high-dose val-ACV; four of these episodes were also treated with topical cidofovir without success before foscarnet. Three episodes resolved on high-dose val-ACV or IV ACV alone and three were treated with cidofovir or brincidofovir initially. Coinfection was present in 19 episodes (70%), most often bacterial pneumonia or blood stream infection. Twenty-two episodes (81%) resolved completely after a median of 36 days (range 10–88) of treatment. No patient died of HSV disease but five (26%) died before resolution of ACV-R HSV, a median of 25 days (range 1–117) after treatment started. Eight patients died after ACV-R HSV resolved, a median of 111 days (range 27–382) after treatment started. Among HCT recipients, six (37%) died within 12 weeks of diagnosis.

Conclusion

ACV-R HSV disease is an uncommon complication of HM and allogeneic HCT. While ACV-resistant HSV did not cause death in this cohort, death within 12 weeks of infection was common.

Disclosures

N. C. Issa, GSK: Investigator, Research grant; Merck: Investigator, Research grant; Akros Pharma: Consultant, Consulting fee. F. M. Marty, Chimerix: Consultant and Investigator, Consulting fee and Research support. S. P. Hammond, Merck: Investigator, Research support.

In Vitro Enzymatic Degradation of Tissue Grafts and Collagen Biomaterials by Matrix Metalloproteinases: Improving the Collagenase Assay

Matrix metalloproteinase-1 and -8 are active during the wound healing and remodelling processes, degrading native extracellular matrix and implantable devices. However, traditional in vitro assays utilize primarily matrix metalloproteinase-1 to mimic the in vivo degradation microenvironment. Herein, we assessed the influence of various concentrations of matrix metalloproteinase- 1 and 8 (50, 100, and 200 U/mL) as a function of pH (5.5 and 7.4) and time (3, 6, 9, 12, and 24 h) on the degradation profile of three tissue grafts (chemically cross-linked Permacol, nonchemically cross-linked Permacol and nonchemically cross-linked Strattice) and a collagen biomaterial (nonchemically cross-linked collagen sponge). Chemically cross-linked and nonchemically cross-linked Permacol samples exhibited the highest resistance to enzymatic degradation, while nonchemically cross-linked collagen sponges exhibited the least resistance to enzymatic degradation. Qualitative and quantitative degradation analysis of all samples revealed a similar degradation profile over time, independently of the matrix metalloproteinase used and its respective concentration and pH. These data indicate that matrix metalloproteinase-1 and matrix metalloproteinase-8 exhibit similar degradation profile in vitro, suggesting that matrix metalloproteinase-8 should be used for collagenase assay.

Surveillance of Quality of Medicines Available in the Nepalese Market: A Study from Kathmandu Valley

BACKGROUND

Many countries are having problem of substandard and counterfeit drugs which results in life threatening issues, financial loss of consumers and loss in trust on health system. This study is concerned with the assessment of drugs quality available in the Nepalese market.

METHODS

A cross sectional survey was carried out in Kathmandu valley. Five different brands from each eight molecules of drugs (Paracetamol tablet, Cloxacillin capsule, Amlodipine tablet, Metformin tablet, Losartan tablet, Cefixime tablet, Ofloxacin tablet, Carbamazepine tablet) were purposively selected. Registration compliance was verified from Department of Drug Administration (DDA) and laboratorial analysis was done in two different laboratories.

RESULTS

Out of 40 drug samples, 90% did not comply with the existing regulatory requirement on labeling and 42.5% brands did not mention about the pharmacopoeial standard. There was no uniformity in mentioning the selflife. Similarly, large variation was seen on price of same generic drugs. Laboratory analysis showed that 40% samples failed to meet the standard among domestic companies and 28% among imported brands. Altogether 32.5% samples were found to be of substandard quality. Only the result of one sample matched with both laboratories. This indicates that there was variation in the selected two laboratories.

CONCLUSIONS

The result of this survey indicates that, substandard medicines are available in Nepalese market. Moreover, there is weak regulation and no uniformity in similar pharmaceutical products. A larger study is required to access the quality of pharmaceutical products in the Nepalese market with testing of products in more than two independent laboratories.

The past, present and future in scaffold-based tendon treatments

Tendon injuries represent a significant clinical burden on healthcare systems worldwide. As the human population ages and the life expectancy increases, tendon injuries will become more prevalent, especially among young individuals with long life ahead of them. Advancements in engineering, chemistry and biology have made available an array of three-dimensional scaffold-based intervention strategies, natural or synthetic in origin. Further, functionalisation strategies, based on biophysical, biochemical and biological cues, offer control over cellular functions; localisation and sustained release of therapeutics/biologics; and the ability to positively interact with the host to promote repair and regeneration. Herein, we critically discuss current therapies and emerging technologies that aim to transform tendon treatments in the years to come.

An antibody fragment functionalized dendritic PEGylated poly(2-(dimethylamino)ethyl diacrylate) as a vehicle of exogenous microRNA

The translation of interfering RNA to the clinic requires more effective delivery agents to enable safe and efficient delivery. The aim of this work was to create a multi-functional delivery agent using deactivation enhanced ATRP synthesis of poly(dimethylamino)ethyl methacrylate (pDMAEMA)-co-PEGMEA/PEGDA (pD-b-P/DA) with linear pDMAEMA as a macro-initiator. The pD-b-P/DA was characterized for its potential to bind synthetic microRNA mimics to form structures and reacted with antibody-derived fragments (Fabs) using Michael-type addition. Conjugation of antibody fragments was verified using SDS-PAGE. Functional delivery of these interfering RNA complexes was proven using a dual luciferase reporter assay. Functional silencing of a reporter gene was improved by complexation of microRNA mimics with pD-b-P/DA alone and with Fab-decorated pD-b-P/DA. The improved silencing with Fab-decorated pD-b-P/DA was evident at 48 h but disappeared at 96 h. The resultant agent enables complexation of nucleic acid (microRNA mimic) and facile conjugation of antibody fragments via a Michael-type addition. In conclusion, this platform is effective at silencing in this reporter system and has potential as an effective delivery system of interfering RNA.

Socio-demographic Predictors of Tobacco Use among Women of Nepal: Evidence from Non Communicable Disease Risk Factors STEPS Survey Nepal 2013

BACKGROUND

Globally, tobacco use is most common public health problem. Similar is the situation of Nepal where thousands of lives are lost annually. Both sexes are affected by tobacco use but women share different and unique problems. Hence, in this paper we made an attempt to understand socio-demographic predictors of tobacco use among women of Nepal.

METHODS

A cross-sectional study was carried out with a sample of 2797 women (15-69 years) recruited through multistage cluster sampling technique. This study used sub-set of data of non-Communicable diseases risk factors survey 2013 of Nepal. Bivariate and multivariable regression analyses were carried out to determine predictors of tobacco use among women of Nepal.

RESULTS

Among total women, 14% were having at least one form and pattern of tobacco use. Furthermore, 10 % were smoker and 4 percent were using any form of chewing tobacco user. As compared to 15-29 years women, 45-69 years age group were 5 times (OR=4.7, 95% CI =2.7-8.0) more likely to be tobacco user. Similarly, urban women were 40% (OR=0.6, 95% CI=0.38-0.95) less vulnerable than rural women. In addition, higher educated women were found to be at 1% (OR=0.01, 95% CI=0.01-0.01) less risk of being tobacco user.

CONCLUSIONS

Age, area of residence, and education level were found to be significant socio-demographic predictors for tobacco use among women in Nepal. Therefore, tobacco control programme should target these groups for interventions.

Alcohol Use by Nepalese Women: Evidence from Non Communicable Disease Risk Factors STEPS Survey Nepal 2013

BACKGROUND

Over the centuries, the world has witnessed alcohol use as a common phenomenon among the male population. Owing to the vulnerability of women towards alcohol and its possible consequences on women as well as children when pregnant or lactating mothers drink alcohol, there is utmost need to know the alcohol use among this population. The study sought to assess alcohol use among the Nepalese women aged 15-69 years.

METHODS

It was a sub-set analysis of 2807 women aged 15-69 years, extracted from a data of national cross-sectional study, NCD Risk Factors: STEPS Survey Nepal 2013 carried out among 4200 adults in 2013 using a multistage cluster sampling. Data collected in personal digital assistants using WHO NCD STEPS instrument version 2.2 were transferred to Microsoft Excel, cleaned in SPSS 16.0, and analyzed in STATA 13.0.

RESULTS

We reported 11.7% (95% CI: 9.5-14.3) ever users of alcohol, 9.4% (95% CI: 7.4-11.7) last 12 months alcohol users, 7.1% (95% CI: 5.2-9.0) current drinkers, and 0.9% (95% CI: 0.5-1.6) with harmful use of alcohol. As compared to 15-29 years women, 30-44 and 45-69 years women were 1.61 (95% CI: 1.02-2.55) and 1.58 (95% CI: 1.03-2.43) times more likely to be drinkers in the last 12 months, respectively. Likewise, 45-69 years women were 2.84 (95% CI: 1.05-7.63) times more likely to indulge into harmful use of alcohol than their younger counterparts (15-29 years). Women from the Terai belt had lower odds of any drinking pattern than the women from hills: ever use (0.43, 95% CI: 0.27-0.70), alcohol use in the last 12 months (0.44, 95% CI: 0.26-0.75), current drinking (0.38, 95% CI: 0.22-0.65), and harmful use of alcohol (0.11, 95% CI: 0.03-0.37). Primary education holders were found to have 0.64 times (95% CI: 0.43-0.95) chances of current drinking than those without formal education.

CONCLUSIONS

Women from upper age groups, hills, and with no formal education were found likely to be consuming alcohol. Contextual and culture friendly anti alcohol behaviour change communication interventions on community settings of hills and mountains, promoting active participation of relatively older women (45-69 years) and illiterate women are of great importance.

Oral Health Condition of School Children in Nawalparasi District, Nepal

BACKGROUND

Oral diseases and feeding habits are inextricably linked. Significance of assessing oral health conditions among the school children therefore exists. The current study investigated the oral health condition among 5-6 years and 12-13 years children in Nawalparasi district, Nepal.

METHODS

Recruiting 1,000 school children aged (5-6) and (12-13) years in Nawalparasi district, a cross-sectional study was carried out from November to December, 2014. Data assembled from standard instrument was entered in Epi-Data 3.1, cleaned in SPSS version 16.0, and analyzed in Epi Info 3.5.4.

RESULTS

Of 12-13 years children, three out of ten (32.0%, 95% CI: 27.8-36.4) suffered from occasional dental discomfort and pain, and 8.1% (95% CI: 5.9-11.0) often experienced dental discomfort and pain during the last 12 months. It was 73.6% (95% CI: 69.3-77.4) who brushed teeth at least once a day, while another 20.7% (95% CI: 17.2-24.7) brushed twice a day. Among all children, 86.1% (95% CI: 82.6-89.1) used toothpaste to brush the teeth. A three-fourth (73.8%, 95% CI: 69.5-77.7) drank tea with sugar daily. Dental caries was visible on 42.2% (95% CI: 37.7-46.8) (mean DMFT score 2.3 ± 1.5). Likewise, a quarter (24.1%, 95% CI: 20.3-28.3) had gingival bleeding, 10.9% (95% CI: 8.3-14.1) questionable enamel fluorosis, 4.5% (95% CI: 2.9-6.9) dental trauma, and 1.7% (95% CI: 0.8-3.5) oral mucosal lesion. Referral for preventive/routine treatment was observed in 40.5% (95% CI: 36.145.1). Among 5-6 years old children, a remarkable proportion of dental caries (64.4%, 95% CI: 59.2-69.4 and mean DMFT score 4.4 ± 3.0) was noted. Statistics of enamel fluorosis, dental trauma, and oral mucosal lesions in this age group were: 3.1% (95% CI: 1.6-5.6), 1.7% (95% CI: 0.7-3.8), and 1.1% (95% CI: 0.4-3.0) respectively. About 40.1% (95% CI: 35.0-45.4) were referred for preventive treatment, and the rest for prompt treatment.

CONCLUSIONS

Oral health of the children was poor, chiefly dental carries remained widespread. Dental hygiene awareness should be promoted in schools in active coordination and collaboration with education authorities.

Group forum counselling for vasectomy: A consistent and cost-effective improvement in patient care

Objective:

The objective of this article is to improve patient care pathways for vasectomy referrals by offering a group forum pre-operative education and consent process. This should prove more consistent and efficient than traditional outpatient appointments, resulting in a high standard of information provision, reduction in waiting times and cost savings.

Subjects/patients and methods:

All vasectomy referrals were offered a group counselling seminar with subsequent individual examination instead of a routine outpatient appointment. Patient satisfaction questionnaires were completed and analysed at the forum conclusion.

Results:

During the pilot, 38/40 patients opted for group-based counselling. Subsequent forums had provision to counsel, examine and consent 45 patients within one hour. Patient satisfaction survey scores were consistently high and 100% gave scores >8/10 in overall satisfaction. The wait from GP referral to consultation dropped by 61% from 23 to 9 weeks.

Conclusions:

There has been a significant reduction in waiting times to consultation and improved efficiency of care provision. Standardised quality information should minimise dissatisfaction and litigation based on poor pre-operative counselling. Satisfaction surveys indicate that there have been no detrimental effects to patient care. One-hour group clinical sessions are adaptable to flexible working hours which may feature increasingly within the NHS.

Synthesis of polymer-silica hybrid microparticles with defined geometry using surface initiated atom transfer radical polymerization

In vivo functionalization of the diatom with an initiator site allows grafting from the surface via SI-ATRP.

Prevalence and Determinants of Comorbid Diabetes and Hypertension in Nepal: Evidence from Non Communicable Disease Risk Factors STEPS Survey Nepal 2013

BACKGROUND

Despite being preventable disease, diabetes and hypertension fall among top 10 leading causes of death globally. Diabetes and hypertension are independent risk factor for cardiovascular disease, and the risk is markedly increased by their co-occurrence.This study attempted to find out the prevalence of comorbid diabetes and hypertension in Nepal.

METHODS

A cross-sectional survey was conducted among 4,200 Nepalese adults selected through multistage cluster sampling.Out of 4,200 respondents of larger study, this article includes the analysis of 3,772respondents who granted permission for physical and biochemical measurement. Nepali version of WHO NCD STEPS instrument version 2.2 was used for data collection. In order to obtain national estimates sample weight was used. Chi-square test and multivariable binary logistic regression were used to assess the association of socio-economic predictors with comorbid conditions after adjusting effect of clusters and strata.

RESULTS

The overall prevalence of comorbid diabetes and hypertension was found to be 2% in Nepal.Considering age group 15 to 29 years as reference, people in age group 45-69 and 30 to 44 years were found to have 33 folds (AOR=33.06, 95%CI=5.90-185.35) and 6 folds(AOR=6.36, 95%CI=1.08-37.43) higher odds of developing comorbid condition of diabetes and hypertension.

CONCLUSIONS

Prevalence of comorbid diabetes and hypertension seem to be high in people of 45-69 years of age. Age and level of education seem to be associated with comorbid diabetes and hypertension.

A prospective study on the risk of glove fingertip contamination during draping in joint replacement surgery

INTRODUCTION

The aim of this prospective study was to investigate the risk of contamination of surgical gloves during preparation and draping in joint replacement surgery.

METHODS

During 46 hip and knee replacement procedures, the gloves of orthopaedic consultants (n=5) and registrars (n=3) were assessed for contamination immediately after draping by impression of gloved fingers on blood agar. Contamination was evaluated by the surgeon's grade, the type of procedure, the role of the assistant and the dominance of the hand.

RESULTS

A total of 125 pairs of top gloves were examined (79 pairs from registrars and 46 pairs from consultants). Bacterial contamination was isolated on 19 pairs (15.2%) (16 pairs from registrars and 3 pairs from consultants, p=0.04). Coagulase negative staphylococci were the main isolates and contamination was considered low in all cases (1-5 colonies). Contamination was seen more on the dominant hand (16 gloves from dominant hands and 6 from non-dominant hands, p=0.04), on the index finger and thumb. More contaminated gloves were seen in hip arthroplasty procedures (16 pairs from total hip replacements vs 3 pairs from total knee replacements, p=0.02).

CONCLUSIONS

Contamination of glove fingertips during draping in joint replacement procedures is more likely to occur among junior surgeons, in hip rather than knee arthroplasty procedures and on the dominant hand. It is therefore essential that surgeons of different grades replace gloves used in draping to avoid exposing patients to the risk of infection.

Untying a nanoscale knotted polymer structure to linear chains for efficient gene delivery in vitro and to the brain

The purpose of this study was to develop a platform transfection technology, for applications in the brain, which could transfect astrocytes without requiring cell specific functionalization and without the common cause of toxicity through high charge density. Here we show that a simple and scalable preparation technique can be used to produce a "knot" structured cationic polymer, where single growing chains can crosslink together via disulphide intramolecular crosslinks (internal cyclizations). This well-defined knot structure can thus "untie" under reducing conditions, showing a more favorable transfection profile for astrocytes compared to 25 kDa-PEI (48-fold), SuperFect® (39-fold) and Lipofectamine®2000 (18-fold) whilst maintaining neural cell viability at over 80% after four days of culture. The high transfection/lack of toxicity of this knot structured polymer in vitro, combined with its ability to mediate luciferase transgene expression in the adult rat brain, demonstrates its use as a platform transfection technology which should be investigated further for neurodegenerative disease therapies.

Imbalance of folic acid and vitamin B12 is associated with birth outcome: an Indian pregnant women study

BACKGROUND/OBJECTIVES

Maternal nutrient supplementation in developing countries is generally restricted to provision of iron and folic acid. Along with folic acid, vitamin B12 is also an important determinant of fetal growth and development. During pregnancy, the increased requirement of folic acid is met with supplementation, while vitamin B12 remains untreated and possibly deficient. The objective of our study was to study the combined effect of maternal plasma folate and vitamin B12, and their ratio on birth anthropometrics.

SUBJECTS/METHODS

We carried out an observational study on 49 full-term pregnant women at KEM Hospital, Pune, India, during 2006-2008, and measured plasma folate, vitamin B12 and homocysteine in venous blood at 36 weeks of gestation. Neonatal anthropometrics (birth weight, length, head circumference, abdominal circumference, mid arm circumference, chest circumference, triceps skinfold and subscapular skinfold thickness) were measured within 24 h of birth.

RESULTS

Maternal plasma folate and vitamin B12 were not correlated to neonatal anthropometrics. The combined association of folate and vitamin B12 expressed as folate to vitamin B12 ratio was correlated to the neonatal anthropometrics. Imbalance in the maternal micronutrients with increasing ratio of folate to vitamin B12 was associated with an increase in plasma homocysteine (P=0.014), lowering of neonatal birth weight (P=0.009), birth length (P=0.034), head circumference (P=0.018) and chest circumference (P=0.009), while no significant association to other anthropometrics was observed.

CONCLUSIONS

Supplementation of vitamin B12 in addition to supplementation of folic acid in pregnancy may be important for improving birth weight, birth length, head circumference and chest circumference.

Multi-modal delivery of therapeutics using biomaterial scaffolds

Functionalisation of biomaterials with therapeutic moieties (proteins, drugs, genes) is a pre-requisite to tissue regeneration and restoration of function following injury or disease.

Use of a fibrin-based system for enhancing angiogenesis and modulating inflammation in the treatment of hyperglycemic wounds

The complex pathophysiology of chronic ulceration in diabetic patients is poorly understood; diabetes-related lower limb amputation is a major health issue, which has limited effective treatment regimes in the clinic. This study attempted to understand the complex pathology of hyperglycemic wound healing by showing profound changes in gene expression profiles in wounded human keratinocytes in hyperglycemic conditions compared to normal glucose conditions. In the hyper-secretory wound microenvironment of hyperglycemia, Rab18, a secretory control molecule, was found to be significantly downregulated. Using a biomaterial platform for dual therapy targeting the two distinct pathways, this study aimed to resolve the major dysregulated pathways in hyperglycemic wound healing. To complement Rab18, and promote angiogenesis eNOS was also targeted, and this novel Rab18-eNOS therapy via a dynamically controlled 'fibrin-in-fibrin' delivery system, demonstrated enhanced wound closure, by increasing functional angiogenesis and reducing inflammation, in an alloxan-induced hyperglycemic preclinical ear ulcer model of compromised wound healing.

Assessment of sub-clinical mastitis and its associated risk factors in dairy livestock of Lamjung, Nepal

INTRODUCTION: Mastitis is one among the top three threats faced by dairy farmers. The study was carried out to assess sub-clinical mastitis, management practices and associated risk factors for mastitis. MATERIALS AND METHODS: A cross sectional study was conducted in Chandreshwor and Archalbot VDCs of Lamjung district taking 63 dairy livestock randomly each from a herd along with questionnaire survey to respective owner. Tem ml of milk sample from each quarter was taken in a sterilized syringe for further laboratory investigation. California Mastitis Test (CMT) was performed at farmer’s shed. Organisms were identified based on colony characteristics, Gram's staining and various biochemical tests. RESULTS: On CMT, subclinical mastitis was 46.1% (n=29) and 30.15% (n=76) on animal and quarter basis respectively, however, culture showed, 28.6% and 24.2%. Streptococcal mastitis was the commonest (11.1%) followed by coliform (9.5%) and staphylococcal (7.9%). Mastitis was highest in left fore quarter (34.92%) followed by left hind (31.76%), right hind (28.57%) and right fore (25.39%). Coliform & Staphylococcal mastitis was highest in left fore and right hind quarter respectively. Most of dairy animals (86%) were on zero grazing, 30% (n=19) of the farmers had forage trees and only 29% (n=18) had known about subclinical mastitis. The average milk production was 3.5 ±1.47 liters. Subclinical mastitis was associated significantly (p<0.01) with livestock yielding more than 3 lt per lactation. CONCLUSIONS: There was high prevalence of subclinical mastitis in dairy livestock at Lamjung due to poor management, unhygienic shed, and little knowledge on subclinical mastitis.  DOI: http://dx.doi.org/10.3126/ijim.v2i2.8322 Int J Infect Microbiol 2013;2(2):49-54  

GDNF gene delivery via a 2-(dimethylamino)ethyl methacrylate based cyclized knot polymer for neuronal cell applications

Nonviral genetic therapeutic intervention strategies for neurological disorders hold great promise, but a lack of vector efficacy, coupled with vector toxicity, continue to hinder progress. Here we report the application of a newly developed class of polymer, distinctly different from conventional branched polymers, as a transfection agent for the delivery of glial cell line derived neurotrophic factor (GDNF) encoding gene. This new 2-(dimethylamino)ethyl methacrylate (DMAEMA) based cyclized knot polymer was studied for neuronal cell transfection applications, in comparison to branched polyethyleneimine (PEI). While showing a similar transfection profile over multiple cell types, the cyclized knot polymer showed far lower toxicity. In addition, transfection of Neu7 astrocytes with the GDNF encoding gene was able to cause neurite outgrowth when cocultured with dorsal root ganglia (DRGs). The cyclized knot polymer assessed here (PD-E 8%PEG), synthesized via a simple one-pot reaction, was shown to have great potential for neuronal gene therapy applications.