Therapeutic metformin concentrations positively regulate proliferation in endometrial epithelial cells via mTOR activation and augmented mitochondrial strength

Metformin, an antidiabetic drug, has recently been repositioned in the treatment of several nondiabetic disorders, including reproductive disorders such as polycystic ovarian syndrome, where it improves endometrial functions. In vitro studies employing supratherapeutic concentrations (5-20 mmol/L) of metformin have reported antiproliferative effects on endometrial epithelial and stromal cells. However, animal and human studies have revealed that therapeutic serum concentrations of metformin range between 20 and 70 µmol/L. In the present study, the effect of therapeutic concentrations of metformin was studied on endometrial epithelial cells (EECs). Therapeutic concentrations of metformin induced proliferation in Ishikawa and HEC-1A cells. The proliferation of EECs was found to be mammalian target of rapamycin (mTOR) dependent. Interestingly, therapeutic metformin concentrations were not able to activate the classical AMP-activated protein kinase (AMPK) signaling. On the contrary, supratherapeutic metformin concentration (10 mmol/L) inhibited mTOR and activated AMPK signaling. Microarray analysis of metformin-treated HEC-1A cells revealed dose-dependent differential effects on biological pathways associated with translation, ribosomal RNA processing, mitochondrial translation, and cell proliferation. Therapeutic concentrations of metformin upregulated mitochondrial number as demonstrated by increased MitoTracker^™ Red staining and enhanced succinate dehydrogenase expression; however, higher concentration (10 mmol/L) abrogated the same. Our results suggest that therapeutic concentrations of metformin augment mitochondrial strength and induce mTOR-dependent endometrial cell proliferation.

Spectrum of coronary angiographic findings in patients with ST Elevation Myocardial Infarction (STEMI) undergoing primary PCI in a tertiary care center of Nepal

BACKGROUND

Even in developing countries like Nepal, prevalence of ST-elevation myocardial infarction has been shown to be increased with rise in prevalence of conventional risk factors like diabetes, Hypertension, smoking, dyslipidemia and obesity. Our aim is to retrospectively analyze for various risk factors and angiographic patterns of coronary artery disease in patients with ST-elevation myocardial infarction undergoing Primary Percutaneous Intervention.

RESULTS

During the period of 1 year (January 2019 to December 2019), 816 patients presented to our ER with acute STEMI, among them 437 (53.6%) patients underwent primary PCI strategy and among them 22 (5.3%) patients were died. Thirty-six (4.4%) patients received thrombolysis, among them 5 (13.9%) patients were died while remaining 343 (42.0%) patients were managed conservatively and among them 20 (5.8%) were died. The mean age of patient who underwent primary PCI was 58.5±12.7 years range from 25 years to 99 years. Among them 55-75 years old 217 (49.6%) were highest in number followed by<55 years old 180 (41.2%). Males 318 (72.8%) were predominant. Among those who underwent primary PCI, hypertension 214 (49%) was the most common risk factor, followed by smoking 198 (45.3%), diabetes mellitus 123 (28.1%), dyslipidemia 53 (12.1%) and family history of premature coronary artery disease 18 (4.1%). Among those patients, 292 patients (66.8%) had single vessel disease, 99 patients (22.7%) had double vessel disease, 41 patients (9.3%) had triple vessel disease and 5 patients (1.1%) had non-significant coronary artery stenosis. Left anterior descending (53.3%) was the most frequently found culprit artery, followed by right coronary artery, left circumflex, ramus intermedius and left main artery.

CONCLUSION

Fifty percent of patients presented with acute ST-elevation myocardial infarction and underwent primary PCI were between 55-75 years of age. Hypertension and smoking were the most common risk factors present in those patients. Single vessel disease was most prevalent with left anterior descending found to be the most commonly involved coronary artery followed by right coronary artery and left circumflex.

Higher rates of early initiation of breastfeeding associated with health facility delivery in Nepal

Background

Initiation of breastfeeding within one hour from birth is one of the five key essential newborn care messages, implemented along with birth preparedness package since 2008. This study aimed to determine the trend of early initiation of breastfeeding (EIBF) and to assess the effect of health facility delivery on EIBF in Nepal.

Methods

We analyzed the data from the last four nationally representative Nepal Demographic and Health Surveys (NDHS) conducted in 2001,2006,2011 and 2016. Data on the early initiation of breastfeeding was obtained from the mothers of infants born within 24 months prior to the survey. The explanatory variable was the place of delivery, dichotomized as either the health facility, or home delivery. Survey year had a significant interaction with the place of delivery. Multivariable logistic regression was conducted separately on pooled samples before (NDHS 2001 and 2006) and after (NDHS 2011 and 2016) the program implementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) for EIBF was calculated after adjusting for predetermined covariates.

Results

The rate of EIBF increased by 26.5% points (from 32.8% in 2001 to 59.3% in 2016) among infants delivered in a health facility, compared to an increase by 17.1% points (from 29.9% to 47.0%) among home born infants. EIBF increased by 32.5% points before, compared to 49.7% points after BPP. Delivery in a health facility was associated with a higher odd of EIBF in later years (AOR2.3, 95% CI 2.0,2.8), but not in earlier years (AOR1.3, 95% CI 0.9,2.0). Delivery by caesarean section, first-born infant, and lack of maternal education were associated with a lower rate of EIBF in both periods.

Conclusions

Higher EIBF was associated with health facility delivery in Nepal, only after programmatic emphasis on essential newborn care messages. This implies the need for explicit focus on EIBF at birth, particularly when mother is less educated, primiparous or undergoing operative delivery.

Key messages

The rate of initiation of breastfeeding within an hour from birth is increasing in Nepal, with higher rates in health facility delivery, as shown by the recent four nationally representative surveys. Programmatic focus on essential newborn care messages may have contributed to significant association of higher rates of early initiation of breastfeeding when delivered in health facility.

Transcriptomic pathway analysis of urokinase receptor silenced breast cancer cells: a microarray study

Urokinase plasminogen activator receptor (PLAUR) has been implicated in a variety of physiological and pathological conditions. The multi-functionality of PLAUR is due to its capacity to interact with many co-receptors to regulate extracellular proteolysis and intracellular signaling. Recent reports are identifying novel functions of PLAUR which were not evident in the past; however, the molecular mechanisms of PLAUR signaling are not completely understood. Here, we have compared the transcriptomes of silencing control (sicon) and PLAUR silenced (PLAURsi) MDA-MB-231 breast cancer cells on treatment with radiation. We isolated RNA from the cells, synthesized cDNA and measured the gene expression changes by microarray. We identified 24 downregulated and 53 upregulated genes, which were significantly (P-value < 0.005) affected by PLAUR silencing. Our analysis revealed 415 canonical pathways and 743 causal disease networks affected on silencing PLAUR. Transcriptomic changes and predicted pathways supported and consolidated some of the earlier understanding in the context of PLAUR signaling; including our recent observations in DNA damage and repair process. In addition, we have identified several novel pathways where PLAUR is implicated.

Fungal Planet description sheets: 558-624

Novel species of fungi described in this study include those from various countries as follows: Australia: Banksiophoma australiensis (incl. Banksiophoma gen. nov.) on Banksia coccinea, Davidiellomycesaustraliensis (incl. Davidiellomyces gen. nov.) on Cyperaceae, Didymocyrtis banksiae on Banksia sessilis var. cygnorum, Disculoides calophyllae on Corymbia calophylla, Harknessia banksiae on Banksia sessilis, Harknessia banksiae-repens on Banksia repens, Harknessia banksiigena on Banksia sessilis var. cygnorum, Harknessia communis on Podocarpus sp., Harknessia platyphyllae on Eucalyptus platyphylla, Myrtacremonium eucalypti (incl. Myrtacremonium gen. nov.) on Eucalyptus globulus, Myrtapenidiella balenae on Eucalyptus sp., Myrtapenidiella eucalyptigena on Eucalyptus sp., Myrtapenidiella pleurocarpae on Eucalyptuspleurocarpa, Paraconiothyrium hakeae on Hakea sp., Paraphaeosphaeria xanthorrhoeae on Xanthorrhoea sp., Parateratosphaeria stirlingiae on Stirlingia sp., Perthomyces podocarpi (incl. Perthomyces gen. nov.) on Podocarpus sp., Readeriella ellipsoidea on Eucalyptus sp., Rosellinia australiensis on Banksia grandis, Tiarosporella corymbiae on Corymbia calophylla, Verrucoconiothyriumeucalyptigenum on Eucalyptus sp., Zasmidium commune on Xanthorrhoea sp., and Zasmidium podocarpi on Podocarpus sp. Brazil: Cyathus aurantogriseocarpus on decaying wood, Perenniporia brasiliensis on decayed wood, Perenniporia paraguyanensis on decayed wood, and Pseudocercospora leandrae-fragilis on Leandrafragilis.Chile: Phialocephala cladophialophoroides on human toe nail. Costa Rica: Psathyrella striatoannulata from soil. Czech Republic: Myotisia cremea (incl. Myotisia gen. nov.) on bat droppings. Ecuador: Humidicutis dictiocephala from soil, Hygrocybe macrosiparia from soil, Hygrocybe sangayensis from soil, and Polycephalomyces onorei on stem of Etlingera sp. France: Westerdykella centenaria from soil. Hungary: Tuber magentipunctatum from soil. India: Ganoderma mizoramense on decaying wood, Hodophilus indicus from soil, Keratinophyton turgidum in soil, and Russula arunii on Pterigota alata.Italy: Rhodocybe matesina from soil. Malaysia: Apoharknessia eucalyptorum, Harknessia malayensis, Harknessia pellitae, and Peyronellaea eucalypti on Eucalyptus pellita, Lectera capsici on Capsicum annuum, and Wallrothiella gmelinae on Gmelina arborea.Morocco: Neocordana musigena on Musa sp. New Zealand: Candida rongomai-pounamu on agaric mushroom surface, Candida vespimorsuum on cup fungus surface, Cylindrocladiella vitis on Vitis vinifera, Foliocryphia eucalyptorum on Eucalyptus sp., Ramularia vacciniicola on Vaccinium sp., and Rhodotorula ngohengohe on bird feather surface. Poland: Tolypocladium fumosum on a caterpillar case of unidentified Lepidoptera.Russia: Pholiotina longistipitata among moss. Spain: Coprinopsis pseudomarcescibilis from soil, Eremiomyces innocentii from soil, Gyroporus pseudocyanescens in humus, Inocybe parvicystis in humus, and Penicillium parvofructum from soil. Unknown origin: Paraphoma rhaphiolepidis on Rhaphiolepsis indica.USA: Acidiella americana from wall of a cooling tower, Neodactylaria obpyriformis (incl. Neodactylaria gen. nov.) from human bronchoalveolar lavage, and Saksenaea loutrophoriformis from human eye. Vietnam: Phytophthora mekongensis from Citrus grandis, and Phytophthora prodigiosa from Citrus grandis. Morphological and culture characteristics along with DNA barcodes are provided.

Determination of Heterodera glycines Virulence Phenotypes Occurring in South Dakota

The soybean cyst nematode (SCN), Heterodera glycines, is the most important yield-limiting pathogen of soybean in the United States. In South Dakota, SCN has been found in 29 counties, as of 2016, and continues to spread. Determining the virulence phenotypes (HG types) of the SCN populations can reveal the diversity of the SCN populations and the sources of resistance that would be most effective for SCN management. To determine the HG types prevalent in South Dakota, 250 soil samples were collected from at least three arbitrarily selected fields in each of the 28 counties with fields previously found to be infested with SCN. SCN was detected in 82 fields (33%), and combined egg and juvenile counts ranged from 200 to 65,200 per 100 cm³ of soil. Eggs and juveniles were extracted from each soil sample and were used to infest seven SCN HG type test indicator soybean lines and 'Williams 82' as the susceptible check. A female index (FI) was calculated based on the number of females found on each indicator line relative to those on the susceptible check. A FI equal to or greater than 10% in any line was assigned as that HG type. Out of 73 SCN populations for which HG type tests were done, 63% had FI ≥10% on PI 548316 (indicator line #7), 25% on PI 88788 (#2), 19% on PI 209332 (#5), 7% on PI 548402 (#1), 4% on PI 90736 (#3), and 4% on PI 89722 (#6). None of the SCN populations had FI ≥10% on PI 437654 (indicator line #4). The most prevalent HG types were 0, 2.5.7, and 7. These accounted for 81% of all the HG types determined for the samples tested. HG types with ≥10% reproduction on indicator lines PI 88788, PI 209332, and PI 548317 were most prevalent in the soil samples tested, suggesting that the use of these sources of resistance for developing SCN resistant cultivars should be avoided. For sustainable SCN management, use of resistant cultivars should be rotated with nonhost crops and cultivars with different sources of resistance.

An Overview of Menopausal Symptoms in A District Hospital of Nepal

INTRODUCTION

Menopause is a universal reproductive phenomenon which confirms the end of fertility of the women. The objectives of this study were to establish the age of natural menopause and to identify the prevalence of menopausal symptoms among the rural women attending district hospital of Nepal.

METHODS

This present study is a hospital based, observational cross-sectional study conducted in Outpatient department of Lamjung District Hospital, Lamjung, Nepal. The study was carried out from January 2014 till June 2014. Fifty four menopausal women were included in the study. A structured questionnaire was used and the data were analyzed using statistical package for social sciences.

RESULTS

There were 54 participants with menopausal symptoms included in the study. Age ranged from 45 to 60 years with mean 51.2 years. Approximately seventy percentages of women were in age group of above 50 years. About two-third of participants had menarche in at 11 to 13 years of age and 32 (59.5%) of females were married before 15 years of age. In the study total 22 different health problems were reported by menopausal women. The most common symptoms were backache, fatigue/tiredness, numbness and tingling of the extremities, mental exhaustion, depressive mood, bladder problems and sexual symptoms.

CONCLUSIONS

The study suggests that rural middle-age and elderly women suffer from variety of health problems related to natural menopause. The health care workers should adopt a holistic approach towards management to improve the quality of life.

Victimization and depression among youth with disabilities in the US child welfare system

AIM

This study aimed to examine the prevalence of victimization among a United States-wide cohort of youth with disabilities (YWD) investigated for maltreatment in the child welfare system (CWS) and their correlation with mental health.

METHODS

Data were drawn from baseline interviews in the second National Survey of Child and Adolescent Well-Being, a national representative survey of youth involved in the CWS. Interviews took place between 2008 and 2009 and included 675 youth, 11-17 years old and residing with biological families across 83 counties nationwide. The sample consisted of 405 females (60.1%) and 270 males (39.9%), mean age = 13.5 years. We identified YWD if they reported one or more physical or neurodevelopmental health condition (n = 247). Reported victimization experiences and Children's Depression Inventory (CDI) scores were analysed using weighted regression analyses.

RESULTS

One-quarter of YWD in the CWS reported three or more victimizations during the prior year compared with 19% of youth without disabilities. The odds of YWD reporting a one-unit increase in level of victimization was 75% higher (P < 0.05) than youth without disabilities. Prevalence of clinical depression was significantly higher among YWD (14 vs. 5.5%; P < 0.05). Unlike youth without disabilities, the odds of clinical depression were 92% higher for every one-unit increase in victimization among YWD, controlling for covariates (P < 0.05). Of CWS-involved youth who reported three or more victimizations, 24.4% of YWD and 2.2% of non-disabled youth had CDI scores in the clinical range.

CONCLUSION

YWDs in the US CWS are at high risk of experiencing victimization and clinical depression. Our findings suggest that health professionals need to screen CWS-involved YWD for multiple forms of victimization, and develop and implement trauma-informed services that target the mental health sequelae that may jeopardize their independence in adulthood.

Fungal Planet description sheets: 281-319

Novel species of fungi described in the present study include the following from South Africa: Alanphillipsia aloeicola from Aloe sp., Arxiella dolichandrae from Dolichandra unguiscati, Ganoderma austroafricanum from Jacaranda mimosifolia, Phacidiella podocarpi and Phaeosphaeria podocarpi from Podocarpus latifolius, Phyllosticta mimusopisicola from Mimusops zeyheri and Sphaerulina pelargonii from Pelargonium sp. Furthermore, Barssia maroccana is described from Cedrus atlantica (Morocco), Codinaea pini from Pinus patula (Uganda), Crucellisporiopsis marquesiae from Marquesia acuminata (Zambia), Dinemasporium ipomoeae from Ipomoea pes-caprae (Vietnam), Diaporthe phragmitis from Phragmites australis (China), Marasmius vladimirii from leaf litter (India), Melanconium hedericola from Hedera helix (Spain), Pluteus albotomentosus and Pluteus extremiorientalis from a mixed forest (Russia), Rachicladosporium eucalypti from Eucalyptus globulus (Ethiopia), Sistotrema epiphyllum from dead leaves of Fagus sylvatica in a forest (The Netherlands), Stagonospora chrysopyla from Scirpus microcarpus (USA) and Trichomerium dioscoreae from Dioscorea sp. (Japan). Novel species from Australia include: Corynespora endiandrae from Endiandra introrsa, Gonatophragmium triuniae from Triunia youngiana, Penicillium coccotrypicola from Archontophoenix cunninghamiana and Phytophthora moyootj from soil. Novelties from Iran include Neocamarosporium chichastianum from soil and Seimatosporium pistaciae from Pistacia vera. Xenosonderhenia eucalypti and Zasmidium eucalyptigenum are newly described from Eucalyptus urophylla in Indonesia. Diaporthe acaciarum and Roussoella acacia are newly described from Acacia tortilis in Tanzania. New species from Italy include Comoclathris spartii from Spartium junceum and Phoma tamaricicola from Tamarix gallica. Novel genera include (Ascomycetes): Acremoniopsis from forest soil and Collarina from water sediments (Spain), Phellinocrescentia from a Phellinus sp. (French Guiana), Neobambusicola from Strelitzia nicolai (South Africa), Neocladophialophora from Quercus robur (Germany), Neophysalospora from Corymbia henryi (Mozambique) and Xenophaeosphaeria from Grewia sp. (Tanzania). Morphological and culture characteristics along with ITS DNA barcodes are provided for all taxa.

Endometrial receptivity: a revisit to functional genomics studies on human endometrium and creation of HGEx-ERdb

BACKGROUND

Endometrium acquires structural and functional competence for embryo implantation only during the receptive phase of menstrual cycle in fertile women. Sizeable data are available to indicate that this ability is acquired by modulation in the expression of several genes/gene products. However, there exists little consensus on the identity, number of expressed/not-detected genes and their pattern of expression (up or down regulation).

METHODS

Literature search was carried out to retrieve the data on endometrial expression of genes/proteins in various conditions. Data were compiled to generate a comprehensive database, Human Gene Expression Endometrial Receptivity database (HGEx-ERdb). The database was used to identify the Receptivity Associated Genes (RAGs) which display the similar pattern of expression across different investigations. Transcript levels of select RAGs encoding cell adhesion proteins were compared between two human endometrial epithelial cell lines; RL95-2 and HEC-1-A by quantitative real time polymerase chain reaction (q-RT-PCR). Further select RAGs were investigated for their expression in pre-receptive (n = 4) and receptive phase (n = 4) human endometrial tissues by immunohistochemical studies. JAr spheroid attachment assays were carried out to assess the functional significance of two RAGs.

RESULTS

HGEx-ERdb (http://resource.ibab.ac.in/HGEx-ERdb/) helped identification of 179 RAGs, of which 151 genes were consistently expressed and upregulated and 28 consistently not-detected and downregulated in receptive phase as compared to pre-receptive phase. q-RT-PCR confirmed significantly higher (p<0.005) expression of Thrombospondin1 (THBS1), CD36 and Mucin 16 transcripts, in RL95-2 as compared to HEC-1-A. Further, the pretreatment with antibodies against CD36 and COMP led to a reduction in the percentage of JAr spheroids attached to RL95-2. Immunohistochemical studies demonstrated significantly higher (p<0.05) expression of endometrial THBS1, Cartilage Oligomeric Matrix Protein (COMP) and CD36 in the receptive phase as compared to pre-receptive phase human endometrial tissues.

CONCLUSION

HGEx-ERdb is a catalogue of 19,285 genes, reported for their expression in human endometrium. Further 179 genes were identified as the RAGs. Expression analysis of some RAGs validated the utility of approach employed in creation of HGEx-ERdb. Studies aimed towards defining the specific functions of RAGs and their potential networks may yield relevant information about the major 'nodes' which regulate endometrial receptivity.

Synthesis, characterization and antimicrobial activity of dextran stabilized silver nanoparticles in aqueous medium

A simple one-step rapid synthetic route is described for the preparation of silver nanoparticles by reduction of silver nitrate (AgNO3) using aqueous dextran solution which acts as both reducing and capping agent. The formation of silver nanoparticles is assured by characterization with UV-vis spectroscopy, atomic force microscopy (AFM), transmission electron microscopy (TEM) and X-ray diffraction (XRD). The absorbance of the silver nanoparticles is observed at 423 nm. The AFM image clearly shows the surface morphology of the well-dispersed silver nanoparticles with size range of 10-60 nm. TEM images show that the nanoparticles are spherical in shape with ∼5-10 nm dimensions. The crystallinity of Ag nanoparticles is assured by XRD analysis. The antimicrobial activity of as synthesized silver nanoparticles is tested against the bacteria, Bacillus subtilis, Bacillus cereus, Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. The bacterial growth is inhibited by gradual reduction of the concentration of the silver nanoparticles.

Site energies of active and inactive pheophytins in the reaction center of Photosystem II from Chlamydomonas reinhardtii

It is widely accepted that the primary electron acceptor in various Photosystem II (PSII) reaction center (RC) preparations is pheophytin a (Pheo a) within the D1 protein (Pheo(D1)), while Pheo(D2) (within the D2 protein) is photochemically inactive. The Pheo site energies, however, have remained elusive, due to inherent spectral congestion. While most researchers over the past two decades placed the Q(y)-states of Pheo(D1) and Pheo(D2) bands near 678-684 and 668-672 nm, respectively, recent modeling [Raszewski et al. Biophys. J. 2005, 88, 986 - 998; Cox et al. J. Phys. Chem. B 2009, 113, 12364 - 12374] of the electronic structure of the PSII RC reversed the assignment of the active and inactive Pheos, suggesting that the mean site energy of Pheo(D1) is near 672 nm, whereas Pheo(D2) (~677.5 nm) and Chl(D1) (~680 nm) have the lowest energies (i.e., the Pheo(D2)-dominated exciton is the lowest excited state). In contrast, chemical pigment exchange experiments on isolated RCs suggested that both pheophytins have their Q(y) absorption maxima at 676-680 nm [Germano et al. Biochemistry 2001, 40, 11472 - 11482; Germano et al. Biophys. J. 2004, 86, 1664 - 1672]. To provide more insight into the site energies of both Pheo(D1) and Pheo(D2) (including the corresponding Q(x) transitions, which are often claimed to be degenerate at 543 nm) and to attest that the above two assignments are most likely incorrect, we studied a large number of isolated RC preparations from spinach and wild-type Chlamydomonas reinhardtii (at different levels of intactness) as well as the Chlamydomonas reinhardtii mutant (D2-L209H), in which the active branch Pheo(D1) is genetically replaced with chlorophyll a (Chl a). We show that the Q(x)-/Q(y)-region site energies of Pheo(D1) and Pheo(D2) are ~545/680 nm and ~541.5/670 nm, respectively, in good agreement with our previous assignment [Jankowiak et al. J. Phys. Chem. B 2002, 106, 8803 - 8814]. The latter values should be used to model excitonic structure and excitation energy transfer dynamics of the PSII RCs.

Endoscopic Grading of Adenoid in Otitis Media with Effusion

INTRODUCTION: Adenoid is thought to be one of the causes of otitis media with effusion, though it is controversial. Grading the adenoid by rigid nasal endoscope in patients with otitis media with effusion may justify adenoidectomy in otitis media with effusion in the future. METHODS: A prospective study was carried out at GMS Memorial Academy of ENT and head neck studies from 15th December 2005-April 2007. Study group comprised of 32 children with otitis media with effusion and control group of 28 children with clinically normal ear and nose. Rigid nasal endoscope was used for grading of adenoid in study and control group. The severity of otitis media with effusion was assessed by preoperative air-bone gap and thickness of the fluid aspirated from middle ear during ventilation tube insertion. RESULTS: In the study group 13 out of 32 had grade 4 adenoid hypertrophy. This grade 4 adenoid hypertrophy was found to be statistically significant in children with otitis media with effusion (P < 0.0002). In control group 15 out of 28 had grade 1 adenoid hypertrophy which was significant in the same group (P < 0.002). Air-bone gap and thickness of fluid did not correlate with the increasing grade of adenoid hypertrophy. CONCLUSIONS: Grade 4 adenoid hypertrophy was statistically found to be significant with otitis media with effusion but severity of hypertrophy were not reflected by hearing loss and thickness of fluid. Keywords: adenoid hypertrophy, myringotomy , otitis media with effusion, ventilaiton tube insertion.

Stratification of persons with diabetes into risk categories for foot ulceration

BACKGROUND

Patients with diabetes mellitus are at a higher risk of lower extremity complications as compared to their non-diabetic counterparts.

OBJECTIVE

To study risk factors for diabetic foot ulcer disease and stratify patients with diabetes into risk categories for foot ulceration.

DESIGN

Cross-sectional descriptive study over five months period.

SETTING

Diabetic outpatient clinic, at the Kenyatta National Hospital.

SUBJECTS

Two hundred and eighteen ambulatory subjects with diabetes mellitus without active foot lesions.

RESULTS

The prevalence of previous foot ulceration was 16% while that of previous amputation was 8%. Neuropathy was present in 42% of the study subjects and was significantly associated with age, male gender, duration of diabetes, random blood sugar, systolic blood pressure and the presence of foot deformity. Peripheral arterial disease was present in 12% and showed significant association with male gender. Foot deformities were observed in 46% of study subjects and were significantly associated with age, male gender, and presence of neuropathy. Subsequently 57% were categorised into IWGDF group 0--no neuropathy, 10% were placed in group 1--neuropathy alone, 16% were put in group 2--neuropathy plus either peripheral arterial disease or foot deformity and 17% were placed in risk group 3--previous foot ulceration/amputation.

CONCLUSION

More than one third (33%) of diabetic patients were found to be at high risk for future foot ulceration (IWGDF groups 2 and 3). Published evidence exists that shows improved outcomes with interventions targeting individual patients with diabetes at high-risk of foot ulceration. Long term prospective studies to determine outcomes for the different risk categories should be carried out locally.

Endoscopic grading of adenoid in otitis media with effusion

INTRODUCTION

Adenoid is thought to be one of the causes of otitis media with effusion, though it is controversial. Grading the adenoid by rigid nasal endoscope in patients with otitis media with effusion may justify adenoidectomy in otitis media with effusion in the future.

METHODS

A prospective study was carried out at GMS Memorial Academy of ENT and head neck studies from 15th December 2005-April 2007. Study group comprised of 32 children with otitis media with effusion and control group of 28 children with clinically normal ear and nose. Rigid nasal endoscope was used for grading of adenoid in study and control group. The severity of otitis media with effusion was assessed by preoperative air-bone gap and thickness of the fluid aspirated from middle ear during ventilation tube insertion.

RESULTS

In the study group 13 out of 32 had grade 4 adenoid hypertrophy. This grade 4 adenoid hypertrophy was found to be statistically significant in children with otitis media with effusion (P < 0.0002). In control group 15 out of 28 had grade 1 adenoid hypertrophy which was significant in the same group (P < 0.002). Air-bone gap and thickness of fluid did not correlate with the increasing grade of adenoid hypertrophy.

CONCLUSIONS

Grade 4 adenoid hypertrophy was statistically found to be significant with otitis media with effusion but severity of hypertrophy were not reflected by hearing loss and thickness of fluid.

Subglottic Chicken Bone in a Five Months old Baby

Foreign body aspiration most commonly affects young children,with respiratory symptoms such as wheeze and cough after a chokingepisode. When the foreign body is fi rst inhaled as per witnessed by the parents or caregiver there is always choking or gaging episode, followed by a coughing spell. The absence of a cough strongly rules out the possibility of foreign body having entered the air passage. Here we report a case of chicken bone inhaled as foreign body in a fi ve months old baby.Key Words: bone, chicken, subglottic

Subglottic chicken bone in a five month old baby

Foreign body aspiration most commonly affects young children, with respiratory symptoms such as wheeze and cough after a choking episode. When the foreign body is first inhaled as per witnessed by the parents or caregiver there is always choking or gaging episode, followed by a coughing spell. The absence of a cough strongly rules out the possibility of foreign body having entered the air passage. Here we report a case of chicken bone inhaled as foreign body in a five months old baby.

A New Report of Cymbidium spp. Pseudobulb Rot Orchestrated by Erwinia carotovora, Fusarium oxysporum, and Mucor hiemalis f. sp. hiemalis

Cymbidium spp. is an orchid of great horticultural value cultivated extensively in Eastern Himalaya, India. Since 1995, growers have experienced huge crop losses in every monsoon month because of pseudobulb rot. Pseudobulbs initially turned soft and pulpy followed by oozing of a dark brown liquid with a foul odor (early phase). With increasing severity, the bulbs and roots lose weight as the internal tissues gradually disintegrate (middle phase). Finally, the bulb becomes hollow, fibrous, and dry causing death of the plant (later phase). Surveys from 2002 to 2005 showed that disease incidence ranged from 60 to 100%. Rotted tissue was plated on nutrient agar and potato dextrose agar media. Three organisms were consistently isolated from 50 samples collected from 30 different localities. They were identified as Erwinia carotovora (2), Fusarium oxysporum (3), and Mucor hiemalis f. sp. hiemalis (1) and were predominant at the earlier, middle, and later stages of disease, respectively. Identifications were further confirmed by the Agricultural Research Institute (ARI), Pune, India. Pseudobulbs were surface sterilized with 0.5% sodium hypochlorite for 1 min, washed by sterile distilled water, and dipped separately into three different spore/cell suspensions (10⁵ CFU/ml) for 1 min. Another set of sterilized bulbs was dipped first into E. carotovora, then into F. oxysporum 12 days later, and then into M. hiemalis f. sp. hiemalis 15 days after the second dip. For the control set, bulbs were dipped into sterile distilled water. Samples were incubated aseptically at 20°C with a relative humidity of 80%, and all inoculated bulbs were evaluated for disease 47 days after the first inoculation. When samples were inoculated separately, E. carotovora exhibited maximum (70%) tissue disintegration followed by F. oxysporum (30%) and M. hiemalis f. sp. hiemalis (10%), but none of the individual pathogens caused 100% tissue disintegration. Complete destruction was observed after 47 days of first inoculation when these three pathogens were inoculated consecutively according to their serial occurrence. It is an interesting report on host-pathogen combination as three pathogens act in sequence toward ultimate demolition of the host. We report this rot as a synergistic activity of three pathogens to cause an uncontrolled epidemic disease of Cymbidium spp. References: (1) J. C. Gilman. Page 37 in: A Manual of Soil Fungi. Iowa State College Press. Ames, IA, 1945. (2) J. G. Holt. Page 469 in: Bergey's Manual of Systematic Bacteriology. Vol. I. Williams and Wilkins. Baltimore/London, 1984, (3) C. V. Subramaniam. Page 657 in: Hyphomycetes. Indian Council of Agricultural Research (ICAR). New Delhi, 1971.

Nitric oxide: the "second messenger" of insulin

Incubation of various tissues, including heart, liver, kidney, muscle, and intestine from mice and erythrocytes or their membrane fractions from humans, with physiologic concentration of insulin resulted in the activation of a membrane-bound nitric oxide synthase (NOS). Activation of NOS and synthesis of NO were stimulated by the binding of insulin to specific receptors on the cell surface. A Lineweaver-Burk plot of the enzymatic activity demonstrated that the stimulation of NOS by insulin was related to the decrease in the Km for L-arginine, the substrate for NOS, with a simultaneous increase of Vmax. Addition of NG-nitro-L-arginine methyl ester (LNAME), a competitive inhibitor of NOS, to the reaction mixture completely inhibited the hormone-stimulated NO synthesis in all tissues. Furthermore, NO had an insulin-like effect in stimulating glucose transport and glucose oxidation in muscle, a major site for insulin action. Addition of NAME to the reaction mixture completely blocked the stimulatory effect of insulin by inhibiting both NO production and glucose metabolism, without affecting the hormone-stimulated tyrosine or phosphatidyl-inositol 3-kinases of the membrane preparation. Injection of NO in alloxan-induced diabetic mice mimicked the effect of insulin in the control of hyperglycemia (i.e., lowered the glucose content in plasma). However, injection of NAME before the administration of insulin to diabetic-induced and nondiabetic mice inhibited not only the insulin-stimulated increase of NO in plasma but also the glucose-lowering effect of insulin.

Stimulation of nitric oxide synthesis and protective role of insulin in acute thrombosis in vivo

Administration of physiologic amounts of insulin in mice (200 microunits/g body weight) resulted in 9 fold increase of basal nitric oxide level from 0.51+/-0.1224 nmol/ml (mean+/-SD, n=12) to 4.45+/-0.645 nmol/ml after 30min of the injection of the hormone. Since NO is a potent inhibitor of platelet aggregation both in vitro and in vivo, we tested the possibility whether the administration of the hormone would result in the in vivo inhibition of thrombosis through the increase of NO level in the circulation. It was found that administration of insulin (200 microunits/g body weight) in mice protected >90%(p<0.00001, n=500) of these animals from death due to thrombosis in the coronary arteries induced by ADP injection in the heart. This effect of insulin in vivo was found to be directly related to the hormone induced increase of NO level in the system. The thromboprotective effect of insulin could not be achieved by using either prostacyclin, a well known antithrombotic agent or its stable probe prostaglandin E1 instead of insulin. The efficacy of insulin was neither related to the blood glucose level nor was the consequence of the hypoglycemic effect of the hormone. In contrast, inhibition of insulin induced increase of NO level resulted in the complete loss of the thromboprotective effect of the hormone. These results suggest that insulin besides being a hypoglycemic hormone could also be a potent antithrombotic humoral factor.