Simultaneous conversion of chromium and malachite green coexists in halophilic bacterium Halomonas xianhensis SUR308 isolated from a solar saltern

Many industries are known to use heavy metals like chromium (Cr) to fix dyes in the fabrication processes and malachite green (MG) as colorant. Alkalinity, elevated temperature, or salinity of the industrial effluents makes conventional physicochemical removal of MG and hexavalent chromium [Cr(VI)] more difficult to apply and demands to perceive potential cost-effective and environment-friendly treatment methods to eliminate or convert them into less toxic compounds. Here, we report simultaneous removal and bioconversion of MG and Cr(VI) by a halophilic biofilm-forming bacterium Halomonas xianhensis SUR308. It can efficiently produce exopolysaccharides as extracellular polymeric substances (EPS) and form biofilm under oxygen limiting condition. The reduction of hexavalent chromium [Cr(VI)] to trivalent chromium [Cr(III)] is about 100%, and 95% after 84 h of growth in shaken and stagnant culture, respectively. The strain completely decolorizes MG after 48 h of growth in shaken culture. Furthermore, we found that strain SUR308 can efficiently detoxify chromium by reduction and degrades MG via producing various intermediate products simultaneously. Most interestingly, such conversions can also take place in alkaline environment and in environment where substantial amount of salt is present. These unique features of strain SUR308 make it suitable for the simultaneous remediation of toxic heavy metals and hazardous dye even from the environment having higher pH and salinity. The detail molecular mechanism of the bioconversion with its application in open environment would be the future research focus for bioprospecting strain SUR308.

Prediction of Preterm Delivery among Low-risk Indian Pregnant Women: Discriminatory Power of Cervical Length, Serum Ferritin, and Serum Alpha-fetoprotein

Background

Around 80% of preterm births (PTBs) occur spontaneously. Various biomarkers are being evaluated to assess the possible role of chorioamniotic inflammation in PTBs.

Aim

The aim of this study was to establish the accuracy of serum bio-markers( cut off values of ferritin and alpha-fetoprotein [AFP] at midtrimester) along with cervical length [CL] assessment to predict preterm delivery among low-risk women.

Methods

Three hundred low-risk pregnant women attending the antenatal clinic of a tertiary health care facility were included and underwent CL measurement during mid-trimester by transvaginal ultrasonography and their serum levels of ferritin and AFP were recorded. All were followed up till delivery.

Results

Receptor-operated characteristic curves for ferritin, AFP, and CL were constructed. Area under curves and Youden Index calculated for each marker were very low (<0.5) which is statistically considered very poor for a screening test.

Conclusion

Serum ferritin and AFP together with CL measurement in the second trimester of pregnancy had poor discriminatory value in predicting preterm delivery among low-risk asymptomatic pregnant women.

Optic nerve sheath diameter measurements using ultrasonography to diagnose raised intracranial pressure in preeclampsia: an observational study

Objective

To estimate the incidence of raised intracranial pressure (ICP) as evident by enlarged optic nerve sheath diameter (ONSD) by ocular ultrasound among patients with preeclampsia and its relationship to severity of disease.

Material and Methods

Sixty pregnant mothers with preeclampsia were compared to 30 normotensive, uncomplicated pregnant controls. For ONSD measurement, a 7-MHZ linear probe was used and three values from each optic nerve were taken and the mean of six values of both eyes was recorded. All study subjects were followed until seven days after delivery.

Results

Two cut off values (5.8 mm and 4.6 mm) were used to compare ONSD in severe and non-severe preeclampsia with that of healthy pregnant individuals. The incidence of raised ICP among severe preeclampsia above 5.8 mm and 4.6 mm cut-off were 43.3% and 90%, respectively, before delivery. ONSD was significantly elevated among preeclampsia subjects at both cut-off values at pre-delivery (p=0.004 for ONSD >5.8 mm and p<0.001 for ONSD >4.6 mm) compared to controls. There a significant association between presence of neurological manifestations and enlarged ONSD (p<0.001 for ONSD >5.8 mm and p=0.04 for ONSD >4.6 mm) before delivery.

Conclusion

Severe preeclampsia with neurological features was associated with increased ONSD, reflecting raised ICP. Further studies are needed to compare ONSD values with invasive ICP monitoring for better understanding of this relationship.

Biotechnological impacts of Halomonas: a promising cell factory for industrially relevant biomolecules

Extremophiles are the most fascinating life forms for their special adaptations and ability to offer unique extremozymes or bioactive molecules. Halophiles, the natural inhabitants of hypersaline environments, are one among them. Halomonas are the common genus of halophilic bacteria. To support growth in unusual environments, Halomonas produces various hydrolytic enzymes, compatible solutes, biopolymers like extracellular polysaccharides (EPS) and polyhydroxy alkaloates (PHA), antibiotics, biosurfactants, pigments, etc. Many of such molecules are being produced in large-scale bioreactors for commercial use. However, the prospect of the remaining bioactive molecules with industrial relevance is far from their application. Furthermore, the genetic engineering of the respective gene clusters could open up a new path to bio-prospect these molecules by overproducing their products through heterologous expression. The present survey on Halomonas highlights their ecological diversity, application potential of the their various industrially relevant biomolecules and impact of these biomolecules on respective fields.

Effect of single-dose methotrexate injection to prevent neoplastic changes in high risk complete hydatidiform mole: A randomised control trial

Background

Complete hydatidiform mole affects women in their reproductive age. About 15-20% develops persistent molar gestational trophoblastic neoplasia (GTN), which is linked with delayed (beyond 56 days) normalization of serum βHCG after surgical evacuation.

Objective

The objective of the article is to shorten the duration of normalization time of βHCG with single-dose methotrexate injection in women with high risk complete hydatidiform mole (CHM) after suction evacuation.

Methods

Total 76 women with CHM were randomized into intervention and control groups. In the intervention arm (n = 34) women received single dose 100 mg intramuscular methotrexate injection post evacuation and the control group (n = 42) had standard care. Surveillance was done in both groups at two weeks intervals for next six months and duration of normalization of βHCG level was recorded.

Results

Total 94.7% women completed follow-up. Mean of normalization time was significantly lower in the intervention group compared to controls (9.7 weeks versus 14.7 week; P < 0.01). Time to event curve showed significantly earlier cumulative normalization time for the intervention group.

Conclusion

Single-dose 100 mg methotrexate injection is a low-cost, simple intervention to help one out of three women with CHM with high-risk features to achieve normalization of βHCG within 56 days. This might be helpful for people in resource-poor countries where adherence to prolonged surveillance is poor.

A prospective cohort study of adverse fetomaternal outcomes among overweight, obese, and normal weight pregnant women with term singleton pregnancy in a tertiary care hospital

Background: Globally, overweight and obesity are the common risk factors with increasing frequency for adverse fetomaternal outcomes. In resource-poor countries, it is emerging as a threat for favorable pregnancy outcome even with the prevalence of high hunger index. Aims and Objectives: This study aims to determine the impact of obesity and overweight in pregnancy on fetomaternal outcomes in comparison to normal weight mothers. Materials and Methods: A prospective cohort study was conducted in a tertiary care center for 1½ years with singleton term pregnancies and 64 mothers with body mass index (BMI) ≥25 kg/m2 (cases) were compared with 64 normal weight mothers with BMI 18.5–24.9 kg/m2 (controls). Maternal and perinatal outcome was analyzed during antenatal, intranatal periods and after delivery along with the follow-up of newborns up to early neonatal period. Results: After optimizing the two groups in different sociodemographic status, the result shows significantly higher weight gain (P<0.001), incidence of gestational diabetes mellitus (P<0.001), hypertensive disorders of pregnancy (P<0.001), and macrosomia (P<0.001) in overweight and obese pregnant women than their normal weight counterparts. Increased cesarean section rate (P<0.001), postpartum hemorrhage (P<0.005), neonatal low Apgar score at 5 min (P<0.05), neonatal intensive care unit admission (P<0.05), and higher rate of early neonatal death were also observed in cases group than controls group. Conclusion: Pre-pregnancy intervention for optimization of maternal weight with proper surveillance of every pregnant mother of this subset and vigilant neonatal care may improve the obstetric and perinatal outcome.

Long lifetime of bialkali photocathodes operating in high gradient superconducting radio frequency gun

High brightness, high charge electron beams are critical for a number of advanced accelerator applications. The initial emittance of the electron beam, which is determined by the mean transverse energy (MTE) and laser spot size, is one of the most important parameters determining the beam quality. The bialkali photocathodes illuminated by a visible laser have the advantages of high quantum efficiency (QE) and low MTE. Furthermore, Superconducting Radio Frequency (SRF) guns can operate in the continuous wave (CW) mode at high accelerating gradients, e.g. with significant reduction of the laser spot size at the photocathode. Combining the bialkali photocathode with the SRF gun enables generation of high charge, high brightness, and possibly high average current electron beams. However, integrating the high QE semiconductor photocathode into the SRF guns has been challenging. In this article, we report on the development of bialkali photocathodes for successful operation in the SRF gun with months-long lifetime while delivering CW beams with nano-coulomb charge per bunch. This achievement opens a new era for high charge, high brightness CW electron beams.

Production and characterization of a bioactive extracellular homopolysaccharide produced by Haloferax sp. BKW301

The production of extracellular polysaccharides (EPS) by haloarchaeal members, with novel and unusual physicochemical properties, is of special importance and has the potential for extensive biotechnological exploitation. An extremely halophilic archaeon, Haloferax sp. BKW301 (GenBank Accession No. KT240044) isolated from a solar saltern of Baksal, West Bengal, India has been optimized for the production of EPS under batch culture. It produced a considerable amount (5.95 g/L) of EPS in the medium for halophiles with 15% NaCl, 3% glucose, 0.5% yeast extract, and 6% inoculum under shake flask culture at 120 rpm. The purified EPS, a homopolymer of galactose as revealed by chromatographic methods and Fourier-transform infrared spectroscopy, is noncrystalline (CI_xrd , 0.82), amorphous, and could emulsify hydrocarbons like kerosene, petrol, xylene, and so forth. Moreover, the polymer is highly thermostable (up to 420°C) and displayed pseudoplastic rheology. Biologically, the EPS was able to scavenge DPPH (2,2-diphenyl-1-picrylhydrazyl) radical efficiently and inhibit the proliferation of the Huh-7 cell line at an IC₅₀ value of 6.25 µg/ml with a Hill coefficient of 0.844. Large-scale production of this thermostable, pseudoplastic homopolysaccharide, therefore, could find suitable applications in industry and biotechnology.

Biological agent in prevention of ocular recurrence in Behçets disease: a case report

INTRODUCTION

Ocular involvement in Behçets disease (BD) is characterized by recurrent inflammatory attacks leading to poor long-term visual prognosis. The development of biologic agents has heralded a new era in the management of BD uveitis enabling more targeted immune modulation with greater efficacy and has now become the first line agents.

OBJECTIVE

To report a case of young gentleman with Behçets disease whose ocular recurrence was controlled with injection Adalimumab.

CASE

A 31-year-old male with recurrent oral and genital ulcers with bilateral recurrent uveitis was diagnosed as bilateral ocular Behçet's disease based on positive HLA B51typing and ferning pattern in FFA. He was on oral Prednisolone and Cyclosporine and was advised for biological agents. On presentation to us, he had anterior uveitis with pseudophakia and secondary open angle glaucoma in right eye and posterior sub capsular cataract in left eye. After starting Inj Adalimumab with oral Methotrexate, he ocular inflammation was under control and patient underwent uneventful cataract surgery in left eye. Over 1-year follow-up, the patient is on remission, on injection Adalimumab with the steroid tapered off.

CONCLUSION

Biological agents like Adalimumab is effective in controlling recurrences in Behçet's disease.

Analysis of Neonatal Outcome with Supplemental Oxygen to Mother during Elective Cesarean Section under Spinal Anesthesia: A Prospective Randomized Controlled Trial

Background:

Many questions have arisen on benefits of routine use of supplemental oxygen during elective cesarean section (CS) under spinal anesthesia.

Aims:

The aim of this randomized controlled study was to evaluate neonatal outcome in immediate postpartum period with or without supplemental oxygen to mother, undergoing elective CS under spinal anesthesia.

Materials and Methods:

One hundred and thirty-four nonlaboring term pregnant women were allocated randomly into two groups to breathe room air (air group) or oxygen (oxygen group). Times from starting oxygen supplementation to delivery interval, skin incision to delivery (I-D) interval, and uterine incision to delivery (U-D) interval were recorded. APGAR scores were assessed at 1 min and 5 min after delivery. Umbilical cord blood gas analysis was done immediately to measure pH, oxygen partial pressure, carbon dioxide partial pressure (PCO₂), and bicarbonate.

Statistical Analysis:

Statistical comparisons were performed using either Student's t-test or Mann–Whitney U-test.

Results:

For oxygen group versus air group, In Oxygen group, proportion of fetal acidosis was significantly less; umbilical arterial (UA) blood pH (7.22 ± 0.05 vs. 7.19 ± 0.05, P = 0.001) as well as umbilical venous (UV) blood pH (7.26 ± 0.05 vs. 7.22 ± 0.06, P < 0.001) were significantly higher and UA PCO2 (55.4 ± 9.9 vs. 62.9 ± 6.9, P = 0.001) and UV PCO2 (51.4 ± 8.2 vs. 54.3 ± 7.2, P = 0.036) were significantly lower compared to air group. APGAR scores were similar between the groups.

Conclusions:

Supplemental oxygen has potential benefits as demonstrated by less proportion of FA in mothers receiving supplemental oxygen.

Enablers and Barriers of Follow-Up Care: An Experience From an HPV DNA Detection–Based Cervical Cancer Screening Program in Rural India

Background: Success of a cervical cancer screening program is intrinsically linked with appropriate management of women detected positive on screening tests. While routine screening can be done in any setting, the follow-up care of screen positive women is linked with settings that are equipped with diagnostic and treatment facilities, and trained medical providers. In low resource settings, the major obstacles to deliver follow-up care are lack of adequate healthcare infrastructure and trained service providers at district or subdistrict levels. Aim: To assess feasibility of implementing community based interventions to increase uptake of follow-up care of screen positive women in a HPV detection based screening program conducted by Chittaranjan National Cancer Institute (CNCI), Kolkata. Strategy: A network of key stakeholders including government authorities and civil society organizations was developed to deliver continuum of care at the doorsteps of screen positive women. The infrastructure of government's primary health care delivery system was used to set up temporary clinics at district and subdistrict levels. The clinics were organized on prescheduled dates and times that were convenient to the women. Community health workers (CHWs) were trained in community mobilization strategies to increase uptake of follow-up services. All instruments, equipment and consumables required for providing follow-up services were carried to the clinics in a vehicle. Program: The CHWs played a key role in counseling and recalling the screen positive women. The temporary clinics were arranged in the government primary health centers. A team of trained doctors and paramedics provided the diagnostic and treatment services. Colposcopy was performed on all screen positive women using portable colposcopes and guided biopsies were taken as indicated. Women who were eligible for ablative treatment were counseled and treated in the same sitting. All women were advised yearly follow-up. Outcomes: A total of 43,325 women were screened by HC2 test during July 2010 to March 2015, and 2045 (4.7%) women were detected to be high-risk HPV positive. Compliance to first recall was good with 78.6% (1608/2045) of women undergoing diagnostic evaluation at field clinics. But overall compliance to at least one follow-up visit after 1 year was poor (23.2%). Follow-up compliance rate was higher in women who were diagnosed with CIN1 as compared with those with normal diagnosis ( P < 0.001). What was learned: Diagnostic and treatment services could be effectively organized in the community in convergence with existing healthcare delivery system. High compliance to initial diagnostic evaluation and treatment was achieved by making the services available close to the doorsteps of the women. The reasons for low compliance to yearly follow-up were lack of understanding of future cancer risk, unwilling to undergo speculum examination again, and lack of cooperation of spouse/family.

INFLUENCE OF CULTURAL CONDITIONS FOR EXTRACELLULAR LIPASE PRODUCTION BY A HALOTOLERANT BACTERIUM, BACILLUS sp. ORS4

During the course of survey of halotolerant bacteria from saline environments, 17 bacterial cultures were isolated in pure form from the multi-pond solar salterns of Odisha and West Bengal, India. The isolates were screened for their lipase production capability on basal MH-Tween 80 agar medium containing 10% NaCl and the isolate ORS4 having potential for high lipase production, the most potent lipolytic isolate ORS4 was selected for further detailed studies. The ORS4 isolate showed most similarity to Bacillus vallismortis from genus Bacillus on behalf of the morphological, physiological and biochemical characteristics along with 16S rRNA gene sequence analysis. Time course of growth and lipase production by the isolate ORS4 showed maximum enzyme activity (35.79 U/ml) during the stationary phase of growth. Moreover, the optimum conditions for lipase production by the isolate in basal MH medium involved 1% Tween 80, 5% NaCl, 1% glucose, 1% tryptone with an inoculum density of 1012 cells/ml. The partially purified extracellular lipase of Bacillus sp. ORS4 showed tolerance to alkaline pH along with high salinity and temperature suggesting its potential for biotechnological applications in saline environments.

Ocular distribution of antioxidant enzyme paraoxonase & its alteration in cataractous lens & diabetic retina

Background & objectives:

The enzyme paraoxonase (PON), an antioxidant enzyme that has both arylesterase and thiolactonase activity, is well studied in cardiovascular diseases. Although a few studies have shown altered PON activity in ocular diseases such as age-related macular degeneration and diabetic retinopathy, but the tissue-wise expression of PON in its three gene forms has not been studied. This study was conducted to see the ocular distribution of PON for any altered expression in ocular pathologies such as in cataract and diabetes mellitus.

Methods:

Immunohistochemistry (IHC) of the ocular tissues was done for localizing all three forms of the PON in the human donor eyeballs. The PON arylesterase (PON-AREase) and thiolactonase (PON-HCTLase) activities were determined by spectrophotometry in kinetic mode, and the mRNA expression of the PON genes (PON1-3) was determined by reverse transcription-polymerase chain reaction.

Results:

IHC showed the presence of both PON1 and 2 in all the ocular tissues and PON3 was seen only in retina. The mRNA expression analysis showed that PON2 and PON3 were present in all the tissues, whereas PON1 was seen only in ciliary and retina. Both the PON-AREase and PON-HCTLase activities were detected in all ocular tissues and was in the order of lens>retina>choroid>ciliary body>iris. The expression and activity were studied in cataractous lens and in diabetic retina of the donor eyes. A significant decrease in PON-AREase activity was seen in cataractous lens (P<0.05) but not in diabetic retina, and there was an increase in PON- HCTLase activity (P<0.05) only in diabetic retina. Bioinformatic studies and in vitro experiments indicated that advanced glycation end products (AGE) such as carboxymethyl -lysine might decrease the PON- AREase activity of the PON.

Interpretation & conclusions:

Distribution of PON enzyme and its activity in ocular tissues is reported here. The study revealed maximal PON activity in lens and retina, which are prone to higher oxidative stress. Differential activities of PON were observed in the lens and retinal tissues from cataractous and diabetic patients, respectively.

Optimization of factors influencing exopolysaccharide production by Halomonas xianhensis SUR308 under batch culture

A moderately halophilic bacterium, Halomonas xianhensis SUR308 (GenBank Accession No. KJ933394) was isolated from multi-pond solar salterns of Odisha, India. Exopolysaccharide (EPS) production by this strain in malt extract yeast extract (MY) medium has been optimized under batch culture system. Among the different media tested, MY medium showed an EPS production of 2.55 g/L, which increased to 2.85 g/L under optimized aeration. An initial pH of 7.5 and incubation temperature of 32 °C were found to be most suitable for EPS production by the isolate under aerobic condition. An EPS production of 3.85 g/L was achieved when the growth medium was supplemented with 2.5% NaCl. Glucose was the most favourable carbon source for EPS production and maximum production (5.70 g/L) was recorded with 3% glucose. However, growth as well as production of EPS was remarkably affected when the growth medium was supplemented with hydrocarbons as sole source of carbon. Among different nitrogen sources, casein hydrolysate at 0.5% level was proved to be the best for EPS production and an initial inoculum dose of 7% (v/v) enhanced the EPS production to 7.78 g/L, while the divalent metal ions were in general toxic to growth and EPS production, EPS synthesis by SUR308 was enhanced with Cr (VI) supplementation.

Comparative Study on Antenatal and Perinatal Outcome of Vivax and Falciparum Malaria in a Tertiary Care Hospital of Kolkata, India

INTRODUCTION

Malaria occurring in pregnancy is associated with considerable maternal and perinatal morbidity. In India, the problem is compounded by dual parasitological aetiology of Plasmodiumvivax (P.vivax) and Plasmodium falciparum (P.falciparum).

AIM

To compare the outcome of infections by P. vivax and P.falciparum species among pregnant women in a hospital setting.

MATERIALS AND METHODS

Pregnant women who tested positive for malaria either by microscopy of peripheral blood smear or ELISA test for double antigen were enrolled in the study. They were followed up till their delivery and discharge from hospital. Demographic, clinical and laboratory data was collected at enrolment, on event of complication and at delivery. Data was analyzed for univariate and multivariate associations.

RESULTS

There were 64 pregnant women diagnosed with malaria. A total of 76.6% study subjects had vivax infection rest were infected with p. falciparum. Anaemia (84%) was the commonest complication. A total of 60.9% women had pathological placenta. Preterm delivery, low birth weight and Apgar score <7 were the adverse pregnancy outcomes which were more frequent with falciparum infection. There were three perinatal deaths. Multigravidas were at significantly higher risk for low birth weight and low Apgar score of newborn. Infection in later trimester was associated with low Apgar score.

CONCLUSION

Both types of malaria cause considerable morbidity in pregnant women. More cases occurred among primigravida but multigravida and later trimester of pregnancy had more severe disease.

Diclofenac is more effective for post-operative analgesia in patients undergoing lower abdominal gynecological surgeries: A comparative study

Aim:

The present study aimed to compare the efficacy of injectable diclofenac intramuscularly (IM), injection paracetamol intravenously (IV), or a combination of both to provide post-operative analgesia in patients undergoing lower abdominal gynecological surgeries.

Materials and Methods:

A total of 90 female patients (American Society of Anesthesiologists I and II), aged 20-50 years, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomized to receive 75 mg diclofenac IM 8 hourly (Group D) or 1 g paracetamol IV 8 hourly (Group P) or a combination of both 8 hourly (Group PD) for 24 h post-operative period from the start of surgery. The primary outcome measured was the requirement of rescue analgesic (tramadol), the secondary outcomes measured included visual analog score (VAS) for pain, time until first rescue analgesic administration, patient satisfaction score and any side effects.

Results:

The requirement of rescue analgesic was significantly lower in Groups D and PD compared to Group P. Mean (standard deviation) tramadol requirement during 24 h was 56.67 (62.60) mg, 20.00 (40.68) mg and 20.00 (40.68) mg in the Groups P, D and PD respectively. Less number of patients in Groups D and PD (20% in both the groups) required rescue analgesic compared to Group P (50%). The VAS showed a significant decrease in Groups D and PD compared to Group P between 4 and 12 h post-operatively. However, Group PD showed no significant difference when compared to Group D alone.

Conclusion:

Injection diclofenac IM is more effective than paracetamol IV in terms of rescue analgesic requirement, but the combination of diclofenac IM and paracetamol IV provides no added advantage over diclofenac IM alone.

Do pencil-point spinal needles decrease the incidence of postdural puncture headache in reality? A comparative study between pencil-point 25G Whitacre and cutting-beveled 25G Quincke spinal needles in 320 obstetric patients

Background:

Postdural puncture headache (PDPH) is a distressing complication of the subarachnoid block. The previous studies conducted, including the recent ones, do not conclusively prove that pencil-point spinal needles decrease the incidence of PDPH. In this study, we have tried to find out whether a pencil-point Whitacre needle is a better alternative than the classic cutting beveled, commonly used, Quincke spinal needle, in patients at risk of PDPH.

Materials and Methods:

Three hundred and twenty obstetric patients, 20-36 years of age, ASA I and II, posted for Cesarean section under subarachnoid block, were randomly assigned into two groups W and Q, where 25G Whitacre and 25G Quincke spinal needles were used, respectively. The primary objective of the study was to find out the difference in incidence of PDPH, if any, between the two groups, by using the t test and Chi square test.

Results:

The incidence of PDPH was 5% in group W and 28.12% in group Q, and the difference in incidence was statistically significant (P<0.001).

Conclusion:

The pencil-point 25G Whitacre spinal needle causes less incidence of PDPH compared to the classic 25G Quincke needle, and is recommended for use in patients at risk of PDPH.

Partial characterization of an extracellular polysaccharide produced by the moderately halophilic bacterium Halomonas xianhensis SUR308

A moderately halophilic bacterium, Halomonas xianhensis SUR308 (Genbank Accession No. KJ933394) was isolated from a multi-pond solar saltern at Surala, Ganjam district, Odisha, India. The isolate produced a significant amount (7.87 g l(-1)) of extracellular polysaccharides (EPS) when grown in malt extract-yeast extract medium supplemented with 2.5% NaCl, 0.5% casein hydrolysate and 3% glucose. The EPS was isolated and purified following the conventional method of precipitation and dialysis. Chromatographic analysis (paper, GC and GC-MS) of the hydrolyzed EPS confirmed its heteropolymeric nature and showed that it is composed mainly of glucose (45.74 mol%), galactose (33.67 mol %) and mannose (17.83 mol%). Fourier-transform infrared spectroscopy indicated the presence of methylene and carboxyl groups as characteristic functional groups. In addition, its proton nuclear magnetic resonance spectrum revealed functional groups specific for extracellular polysaccharides. X-ray diffraction analysis revealed the amorphous nature (CIxrd, 0.56) of the EPS. It was thermostable up to 250 °C and displayed pseudoplastic rheology and remarkable stability against pH and salts. These unique properties of the EPS produced by H. xianhensis indicate its potential to act as an agent for detoxification, emulsification and diverse biological activities.

Collision tumors in the gastrointestinal tract: a rare case series

A collision tumor is one where histology shows the presence of two distinct primaries involving the same organ without intermixture of individual cell types, ie, a side by side pattern. Here we present three rare cases of collision tumors involving the stomach and transverse colon. There were two cases of collision tumors involving the stomach, one of which was a combination of adenocarcinoma and low-grade non-Hodgkin’s (mucosa-associated lymphoid tissue) lymphoma, and the other showed the presence of non-Hodgkin’s lymphoma involving the entire stomach wall along with adenocarcinoma infiltrating the muscle layer. The third case comprised a mucinous adenocarcinoma and carcinoid tumor in the large gut.

New trends to support independence in persons with mild dementia: a mini-review

Our research was motivated by the growing aging population worldwide and the need to concentrate research efforts on a specific target group; it focuses on elderly persons with physical and cognitive deficiencies. The primary goal is to enable persons with mild dementia to maximize their physical and mental functions through assistive technologies in order to be able to continue to participate in social networks and lead independent and purposeful lives. Persons with mild dementia usually have problems in performing activities of daily living due to episodic memory decline. These can include simple activities, such as bathing, changing clothes and preparing meals. Through extended field test trials involving end users, we have demonstrated that assistive technology that provides timely prompts, alarms and reminders can enable them to preserve their abilities and improve their quality of life. Understanding the user context, especially when targeting demented individuals, and providing the required personalized assistive services is the objective of our research work. Finding the appropriate user interface to interact with the provided services is often a barrier. Thus, we have adopted the approach of a multimodal interactive system with the living environment including a TV set, iPad-like tablets, sensors/actuators, and wireless speakers connected to a reasoning engine that is able to consider the complexity of the users' profile defined by his/her cognitive abilities. In this paper we will mainly focus on the interaction level with the system as well as on the validation stages performed to meet the users' requirements. This is the result of several years' work since 2006 in the frame of two projects (IST-FP6 COGKNOW European completed project and AMUPADH ongoing project in Singapore).

BRCA1 protein expression and its correlation with ER/PR status in sporadic and familial breast cancer in Eastern Indian patients--a hospital based study

BRCA1 gene expression in familial breast cancer is mainly focused on mutational analysis. However in sporadic cancers BRCA1 protein expression is the main area of interest because somatic inactivation of one allele of the gene is likely to occur during the oestrogen mediated proliferation at puberty and subsequent tumourigenic events take place in the same cell. Standard immunohistochemical analysis was used to assess BRCA1 and oestrogen/progesterone receptor (ER/PR) status in familial and sporadic breast cancer patients and correlation of BRCA1 protein expression with histopathological features ER/PR status was studied in these tumours. One hundred and seventy-seven sporadic tumours (group A) and 28 familial tumours (patients with history of breast cancer in first or second degree relative ie, group B) were studied. In group A, 61 tumours had absent/reduced BRCA 1 protein expression; 30 (49%) out of these were negative for ER/PR receptors. In group B, 18 patients had absent/reduced BRCA1 protein expression, and 10 (55.6%) out of these, were ER/PR negative. Overall in 2 groups, 82 tumours were of grade 1, 61 tumours of grade 2 and 62 tumours were of grade 3 differentiation. Test of proportion showed that percentage of ER/PR negativity is significantly higher than ER/PR positivity in sporadic as well as in familial tumours with absent/ reduced BRCA 1 protein expression (p < 0.05). Sporadic tumours with deranged BRCA1 protein expression like familial tumours have more unfavourable histopathological characteristics and are likely to be of higher grade and oestrogen receptor negative

Panuveitis as a manifestation of ocular syphilis leading to HIV diagnosis

Syphilis is a rare cause of panuveitis. We present the case of a 33-year-old man who presented with diminution of vision of three months duration in his left eye (OS), without any other systemic illness. Ophthalmic examination showed features of pauveitis with dense vitreous exudates, disc pallor and sheathing of vessels on fundoscopy. A diagnosis of probable endogenous endophthalmitis was made and vitreous tap performed. Vitreous biopsy showed no growth of fungus or bacteria. Rapid plasma reagin (RPR) and Treponema pallidum hemagglutination (TPHA) test were positive. Enzyme-Linked Immuno Sorbent Assay (ELISA) and Western Blot test were then performed, which revealed concurrent HIV infection. The patient improved dramatically with intravenous penicillin therapy. HIV positive patients may present with panuveitis secondary to ocular syphilis, as the only presenting feature in HIV positive patient in absence of any other systemic features.

Neoadjuvant and adjuvant therapy with imatinib for locally advanced gastrointestinal stromal tumors in eastern Indian patients

BACKGROUND

Imatinib mesylate is able to at least modify the course of gastrointestinal stromal tumours (GISTs). Neoadjuvant use for locally advanced lesions is evolving as a new treatment paradigm in this hitherto universally fatal disease.

METHODS AND RESULTS

The study patients with locally advanced GIST received neoadjuvant and adjuvant imatinib mesylate. Response was noted as per the RECIST protocol and overall progression free survival was reported. Of 19 patients (mean age 38.5 years, range 26 yrs to 64 yrs) studied, 13 achieved partial response (PR) and 6 a stationary disease (SD) on preoperative imatinib. Histopathological evaluation and grading of responses revealed only moderate and low grade pathological response after imatinib. R0 resection was possible in 13/19 and R1 in 6/19. Imatinib was well tolerated and adverse reactions were minimal. Post operative complications of surgery were not out of the ordinary for a surgical series featuring extensive abdominal surgery.

CONCLUSION

Preoperative imatinib in locally advanced GIST seems to be a reasonable option for locally advanced GIST patients and enough downstaging to allow a resection with microscopically negative margins can be expected in a fairly good proportion of patients.

A study in awareness about eye health care and eye donation among secondary level students of North Kolkata, India

BACKGROUND

Corneal blindness is one of the important types of blindness that can be prevented by proper health care education and conventionally cured by corneal transplantation for which awareness regarding eye donation is essential.

OBJECTIVES

The aim of the study is to assess the awareness of eye health care and eye donation among secondary level school students of North Kolkata.

METHODS

It was a cross-sectional study.

SETTINGS

Eight Government aided schools of North Kolkata, West Bengal, India. A total of 1525 students of standard VIII, IX and X of Government aided schools of North Kolkata participated in this study. A pre-tested, semi-structured questionnaire was administered on eye health care and eye donation.

RESULTS

1284 (84.2%) participants opined that awareness on eye health care can prevent most of the blindness and 1206 (79.1%) students knew that Vitamin A has important role in prevention of childhood blindness. Majority, 1235 (81.0%) students were aware of eye donation after death while only 489 (32.1%) participants knew that the ideal time for eye donation is within 6 hours of death. 802 (52.6%) participants mentioned printed and electronic media (like newspaper and television) as the major source of information on eye donation.

CONCLUSIONS

Media publicity to increase awareness of eye donation and eye health care is not enough. Strategies have to be developed to educate the students, so that they can act as motivators for enhancing eye donation and increasing eye health care awareness in the community.

Analysis and comparison of sleeping posture classification methods using pressure sensitive bed system

Pressure ulcers are common problems for bedridden patients. Caregivers need to reposition the sleeping posture of a patient every two hours in order to reduce the risk of getting ulcers. This study presents the use of Kurtosis and skewness estimation, principal component analysis (PCA) and support vector machines (SVMs) for sleeping posture classification using cost-effective pressure sensitive mattress that can help caregivers to make correct sleeping posture changes for the prevention of pressure ulcers.

Results of Treatment of Squamous Cell Carcinoma of Maxillary Sinus: A 26-Year Experience

BACKGROUND

Five-year survival in squamous cell carcinoma of maxillary antrum is low. This article examines the results of various approaches to treatment as given in our hospital in past 26 years.

METHODS

From 1979 to 2005, 379 patients with squamous cell carcinoma of maxillary antrum managed with curative intent were studied. Twenty-eight patients had T2, 237 patients had T3, and 114 had T4 tumors. The N classification was N0 in 316 patients, N1 in 21 patients, N2a in 28 patients and N2b in 14 patients. Treatment to the primary site comprised of surgery (Sx) and radiation therapy (RT) in 284 patients, RT alone in 57 patients and chemotherapy (CTx) with radiotherapy in 38 patients.

RESULTS

There was a difference in survival between patients who underwent Sx with RT compared with patients who received RT alone or CTx with RT. The most common pattern of recurrence was in the primary site, 187 (49.3%) patients. Local control at 3 and 5 years was 71% and 63.8% respectively in Sx with RT, 31.6% and 28% respectively in RT, and 28.9% and 26% in CTx with RT group.

CONCLUSIONS

The type of treatment to the primary site is an important determinant of survival and local control. Surgery with radiation is a better treatment option.

Ellis van Creveld syndrome with unusual association of essential infantile esotropia

Ellis-van Creveld syndrome is a rare short-limbed disproportionate dwarfism characterized by postaxial polydactyly, several skeletal, oral mucosal and dental anomalies, nail dysplasia and in 50-60% cases of congenital cardiac defects. It is an autosomal recessive disorder with mutations of the EVC1 and EVC2 genes located on chromosome 4p16. Patients with this syndrome usually have a high mortality in early life due to cardiorespiratory problems. We present the case of a six- month-old female infant with Ellis-van Creveld syndrome - essential infantile esotropia, which has been infrequently documented in the literature.

Tamoxifen use in Indian women--adverse effects revisited

BACKGROUND

Tamoxifen is generally considered a safe drug for Indian women with breast cancer. Indian women seem to tolerate tamoxifen therapy better than western women, but there are no data regarding safety and local adverse effect profiles in typical Indian populations.

METHODS AND RESULTS

A total of 3,000 case records of patients who had received tamoxifen daily for any period of time, between January 1988 and December 2007, were identified for study. Hot flashes were reported by 800 (26%), mild vaginal dryness by 450 (15%) and vaginal discharge by 300 (10%), with vaginal bleeding experienced by 40 (1.3%) patients. A total of 1,100 (36.6%) asymptomatic patients had a thickened endometrium(defined as >8mm in thickness) on ultrasonography. Endometrial curettage was performed in all of these. None of the patients developed endometrial carcinoma. Fatty infiltration of liver was found in 1,440 (48%) patients with a mean time interval for development of 7 months (range 6-30 months).

CONCLUSIONS

Fatty infiltration of liver is found in almost half of the Eastern Indian women who receive tamoxifen. Increased endometrial thickness, which remains asymptomatic, was documented in more than one third of patients on ultrasound examination. Tamoxifen seems to have a negligible potential for causation of uterine malignancies in eastern Indian women. Rates of hysterectomies in Indian patients on tamoxifen are substantially lower than those of western patients on tamoxifen.

Study of 'patterns of care' of ovarian cancer patients in a specialized cancer institute in Kolkata, eastern India

BACKGROUND

Ovarian cancer is one of the leading cancers in Indian women. The current standard of care is a combination of surgical staging, maximal surgical effort to achieve cytoreduction, and judicious use of chemotherapy. Multimodality therapy can reduce mortality, but the practice and uptake of such therapy in Indian Institutions are not up to the desired level.

OBJECTIVES

To study the protocol adherence for ovarian cancer management along with patient compliance and evaluate their effects on survival.

MATERIALS AND METHODS

The retrospective study obtained and analyzed data from records of patients operated for ovarian cancer at a Regional Cancer Center in eastern India between January 2002 and December 2006.

RESULTS

The records of 202 patients were evaluable. None of the patients who had primary surgery outside the institute had staging information. A substantial number of patients operated at the institute had incomplete surgical staging, inadequate information on residual disease after surgery, and incomplete histology report. Only 20.3% patients could have optimal cytoreduction after surgery. Compliance to chemotherapy was poor. The median overall survival time and disease-free survival time were 24 months and 5 months, respectively. The residual disease after surgery significantly affected the overall survival, but not the disease-free survival. Incomplete chemotherapy was found to adversely affect survival after adjusting for advanced stage and bulky residual disease.

CONCLUSION

Management of ovarian cancer is suboptimal even in the specialized cancer institute. Poor patient compliance to chemotherapy is one of the major factors adversely affecting survival from advanced ovarian cancer.

A prospective observational clinical study involving an alternative cancer treatment, psorinum therapy, in treating stomach, gallbladder, pancreas, and liver cancers

3050

Background: The prospective observational clinical study was conducted to know the efficacy of an alternative cancer treatment, ‘psorinum therapy,‘ in treating liver, gall bladder, pancreatic, and stomach cancers. The primary outcome measures of the study were (1) to assess the radiological tumor response; (2) to assess how many participants survived at least 1 year, 2 years, 3 years, 4 years, and finally, 5 years after the beginning of the study. The secondary outcome measure of the study was to assess the side effects of the investigational anti-cancer drug (psorinum) if any. Methods: The drug psorinum (an alcoholic extract of scabies, scrub, slough, and pus cells) was administered orally at 0.01ml-0.02 ml/Kg body weight as a single dose in empty stomach per day and ongoing to all the participants along with allopathic and homeopathic supportive cares. Results: 158 histopathology or cytopathology proved participants (42 of stomach, 40 of gallbladder, 44 of pancreas, and 32 of liver cancers) were included in the final analysis at the end of the study. According to the AJCC/UICC TNM staging system, 7 (4.43%) of them diagnosed at stage II, 39 (24.68%) of them diagnosed at late stage II or early stage III and 112 (70.87%) of them diagnosed at late stage III or stage IV. According to the RECIST criteria, complete tumor response occurred in 28 (17.72%) cases and partial tumor response occurred in 56 (35.44%) cases. 126 (79.75%) of them survived at least 1 year, 99 (62.66%) of them survived at least 2 years, 87 (55.06%) of them survived at least 3 years, 76 (48.10%) of them survived at least 4 years, and 62 (39.24%) of them survived at least 5 years. These participants did not receive any other conventional or investigational cancer treatments. The participants report no side effects from the drug psorinum. Conclusions: Psorinum therapy is effective in treating stomach, gallbladder, pancreas, and liver cancers. Double-blinded randomized controlled clinical trial should be done for further investigation of this alternative cancer treatment.

No significant financial relationships to disclose.