First report of Candidatus Phytoplasma australasia (16SrII- subgroup D) associated with virescence of Chia (Salvia hispanica L.) from India

Chia (Salvia hispanica L., Lamiaceae) is an important commercial and medicinal crop recently popularized in India and widely cultivated in Karnataka (Joy et al., 2022). During the field survey of chia crop diseases, characteristic virescence like symptoms were observed at Main Agricultural Research Station, UAS, Raichur as well as at Mysuru and HD Kote region. The incidence was ranged from 2 - 4 per cent in an area of 30 hectares. Typical symptoms associated with chia are malformed shoot and/or inflorescence axis with reduced floral parts with greenish florets. The stem axis become thick, flattened, leaves are reduced towards terminal region. A total of five phytoplasma suspected samples and five suspected healthy samples were used for identification purpose. The Plant Genomic DNA Miniprep Kit (Sigma Aldrich, USA) was used to extract the DNA from five symptomatic and five asymptomatic samples and the DNA was used as template to amplify the phytoplasma-specific 16S rDNA gene using P1/P7 primers (Deng and Hiruki, 1991; Schneider et al., 1995) followed by nested PCR using R16F2n/R16R2 primers (Gundersen and Lee 1996). The expected 1.25-kb amplicon was detected from the suspected symptomatic samples. Nested PCR products were purified and sequenced from both the directions using ABIX370 Genetic Analyzer (Applied Biosystems, Waltham, MA). The analysis revealed that all five sequences shared 100 per cent identity with Candidatus Phytoplasma aurantifolia (OM649850, ON975012) and Tomato big bud phytoplasma (EF193359). The in-silico RFLP pattern of F2n/R2 primed region of 16S rDNA gene analyzed by using iPhyClassifier (Zhao et al. 2009) revealed that the sequence shared 98.72 per cent nucleotide sequence similarity with coefficient value of 1.00 to the reference strain RFLP pattern of 16Sr group II, subgroup D (witches'-broom disease of lime; U15442). Based on 16SrDNA sequences and in-silico RFLP analysis, the phytoplasma associated with the chia virescence was identified as a member of 16SrII-D group. Further, SecA gene was also amplified from the samples using SecAfor1/SecArev3 primer pair (Hodgetts et al., 2008). All samples produced ~400 bp products and sequenced as detailed above. Sequence analysis by nBLAST revealed 100 per cent similarity to Ca. P. australasia (MW020545) and Ca. P. aurantifolia isolate Idukki Kerala 1 (MK726369) both representing 16SrII-D group phytoplasma. The representative sequence (16Sr: PP359693, PP359694; secA:PP386558, PP386559) were deposited in GenBank. Chia virescence phytoplasma belonging to Ca. phytoplasma australasia has not been reported anywhere. The phytopathological studies associated with chia crop are very limited. Joy et al. (2022) reported the occurrence of foot rot disease caused by Athelia rolfsii. Several hosts are recorded to be associated with 16SrII D phytoplasma which includes china aster, eggplant and crotalaria (Mahadevakumar et al., 2017, Yadav et al., 2016a, b). Now the wide occurrence of the phytoplasma in the area might have transmitted by vectors. The occurrence of virescence is of great importance as it affects the overall yield which reduces the market value. To our knowledge, this is the first report of a group 16SrII-D phytoplasma associated with chia virescence in India.

A Nonlinear Three-Dimensional Finite Element Analysis of Stress Distribution and Microstrain Evaluation in Short Dental Implants with Three Different Implant-Abutment Connections in Single and Splinted Conditions in the Posterior Mandible

Background

Stress distribution plays a vital role in the longevity and success of implant-supported prosthesis. This study evaluated the von Mises stress and microstrain in the peri-implant bone and the implant-abutment junction of short dental implants with three different implant-abutment connections in splinted and unsplinted conditions using finite element analysis (FEA).

Materials and Methods

In this experimental study, nine transversely isotropic finite element models were developed, and randomly divided into three equal groups (n = 3): control, (Group AC) single-standard 4.3 × 10 mm bone level implant-supported restorations with external hexagonal (EH) connection, internal conical (IC) and internal trichannel (ITC) connection, single short implant-supported restorations (Group AT), and splinted short implant-supported restorations (Group B) for each of the three implant-abutment connections, respectively. A 200 N load was applied along the long axis of the implants and a 100 N (45°) oblique load was applied and von Mises stress and microstrain values were evaluated.

Results

Single standard implants demonstrated the highest von Mises stress and microstrain values followed by single short implants and splinted short implants, respectively. Among the implant-abutment connections, the IC connection showed the highest values and the ITC connection showed the least values.

Conclusion

Within the limitations of this study, it was concluded that splinting of short dental implants demonstrated lesser and more homogeneous stress and microstrain, especially on oblique loading. The microstrain values for all connections evaluated were within the physiological loading limit (200-2,500 N) and were hence considered safe for clinical use.

First report of Athelia rolfsii (=Sclerotium rolfsii) associated with foot rot disease of Chrysanthemum morifolium in India

Chrysanthemum morifolium L. is an important flower crop grown in different parts of Karnataka for its striking cut flowers and international market value. During a field survey (Mysore district, Karnataka, February, 2022), chrysanthemum fields were found infected with foot rot disease. The presence of white mycelial structures with sclerotia were recorded near the stem-soil interface. The disease incidence ranged 10-12% measured in an area of approximately 10 hectares. The infected plants showed quick wilt, yellowing and toppling of the entire plant. Infected plants from Doddamaragowdanahally and Rayanahally (n=15) were collected and associated fungal pathogen isolated after surface sterilization with NaOCl (1%) on potato dextrose agar (PDA) amended with chloramphenicol (50 mg/L). Fungal mycelia developed from the infected tissues were inoculated on to fresh PDA plates to obtained pure cultures for further identification. Fungal colonies with dense, aerial whitish-cottony mycelia with uniformly globoid sclerotia (0.284.2 mm) were observed after 15 days of incubation (28 ± 2°C). Sclerotia were white in the beginning and turned brown at maturity. The average number of sclerotia produced per plate ranged from 240 to >480 (n = 10). To further to confirm the identity of the isolates, two representative isolates (CmSr1 and CmSr2) was subjected to molecular identification based on ITS-rDNA sequences. Briefly, genomic DNA was isolated from 12 day old cultures using the CTAB method and ITS-rDNA was amplified using ITS1-ITS4 primers (White et al., 1990). An expected amplicon of >650 bp (ITS) was obtained and later sequenced from both the directions. The consensus sequences were analysed through nBLAST search which revealed that 100% sequence similarity with reference sequences of Athelia rolfsii (S. rolfsii) from GenBank database (MT127465, MN974137, KC292637; identity 656/656; 0 gaps). A phylogenetic tree obtained by the neighbor-joining method using MEGAX shared a common clade with the reference sequences retrieved and computed, thus confirming the identification based on sequence analysis and molecular phylogeny. The representative sequence of A. rolfsii isolates CmSr1 and CmSr2 isolates deposited in GenBank with Accession nos. ON456153 and ON456154, respectively. Based on etiology, morphological, cultural and molecular data the pathogen was identified as Athelia rolfsii (Curzi) Tu & Kimbrough (Syn: Sclerotium rolfsii Sacc.) (Mordue, 1974; Mahadevakumar et al., 2016, 2018). Plants (n=60) were inoculated with sclerotial bodies (2 sclerotia/plant) near stem soil interface under green house and covered with polythene bags (at 27 ± 2°C and 80% RH). Non-inoculated plants (n=20) served as controls. The development of foot rot disease was observed eight days after inoculation. A total of 48 plants showed the foot rot symptoms and 12 inoculated plants and control plants remained healthy. The identity of the fungus was confirmed by morphological and cultural characters after re-isolation. C. morifolium is an important flower crop in Karnataka. S. rolfsii is known to be associated with blight and collar rot of Chrysanthemum spp. from Kerala (Beena et al., 2002) but no species (host) identity provided. Therefore, to the best of our knowledge, this is the first report of foot rot disease caused by Athelia rolfsii on C. morifolium in India. Early diagnosis of this disease will help the farmers to adopt suitable management practices to avoid loss.

Expression of p53 and Ki-67 proteins in patients with increasing severity and duration of pterygium

Purpose:

Pterygium is a triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over the cornea. It is now considered to be a result of uncontrolled cellular proliferation as overexpression of p53 protein and Ki-67 nuclear protein was found in the epithelium. This study was done to find the expression of p53 and Ki-67 with the severity and duration of the pterygium to explain the etiopathogenesis.

Methods:

Data were analyzed from 43 Indian participants of all age groups. All patients were divided according to the severity of pterygium (mild, moderate, and severe groups) and according to the duration of pterygium (<4 years and >4 years). The samples were studied by immunohistochemistry by using antibodies against p53 and Ki-67 proteins considering >5% expression as significant.

Results:

Of 43 cases, p53 and Ki-67 expression were positive in 33 cases. In mild, moderate, and severe cases p53 positivity was 33.3%, 78.4%, 100%, respectively. P53 expression increased with duration, 79.3% positive in <4 years, and 92.9% positive in >4 years. With increasing severity of pterygium, mild, moderate, and severe cases, Ki-67 positivity was 66.7%, 78.37%, 66.7%, respectively. Ki-67 expression with duration, 79.3% positive in <4 years, and 85.7% positive in >4 years of the duration of pterygium with no statistical significance.

Conclusion:

Our study revealed that with increasing duration and severity of pterygium, p53 expression was observed to be increasing. Ki-67 expression increased with the duration of pterygium but not with the severity.

Clinical Efficacy and Safety Profile of Lurasidone Comparing with Risperidone: Randomized, Open Label, Clinical Study

There are diverse studies which afford evidences that risperidone is as effective as second generation antipsychotics in treating positive symptoms and more effective in treatment of negative symptoms. This study is intended to find the clinical efficacy and safety profile of lurasidone comparing with risperidone, a drug in common use nowadays. Patients aged between 18 to 60yrs, Patients with new onset of symptoms who fulfil the ICD-10 criteria for a primary diagnosis of schizophrenia and Patients having a total PANSS score of ≥80 including a score ≥4 (moderate) on two or more of positive subscale at baseline. Patients with acute exacerbation of schizophrenia who remained drug free for at least last 6 months also included. Demographic data of the patients were collected. Baseline investigations like BP, complete blood count, lipid profile, blood sugar, renal function test and liver function test were done. Severity of schizophrenia at baseline was assessed using positive and negative symptoms scale (PANSS). Patients were randomized by using computer generated random table in 1:1 ratio as group A and group B, with 25 patients in each group. The efficacy of group A and group B was analysed by applying rating scale Positive and negative syndrome scale (PANSS) at the end of 4 and 6 weeks. Adverse drug reactions were recorded and monitored by interviewing with patients, by physical examination and also by necessary lab investigations at the end of 6 weeks. Patients were insisted to maintain a diary to note any new occurrence of adverse drug reactions in between the follow up period. Suspected adverse drug reactions were documented in predesigned reporting form. In PANSS positive scale both groups had significant decrease in PANSS score both at week 4 and week 6 (p<0.05). Lurasidone is as equally efficacious as risperidone in reducing PANSS score, but produces less metabolic syndrome and other adverse effects than risperidone.

An in vitro study of comparative evaluation of efficacy of electrochemically activated water as a root canal irrigant in smear layer removal

Aim:

The aim was to compare and evaluate the efficacy of electrochemically activated water (ECA) against maleic acid, Mixture of tetracycline, acid and detergent. ie; 3% doxycycline, 4.25% citric acid, and 0.5% Tween 80 detergent (MTAD), Sodium hypochlorite (NaOCl), and saline as root canal irrigants in removing the smear layer.

Materials and Methods:

Twenty single canal mandibular premolars were randomly divided into five groups (n = 4), decoronated, prepared to working length, and instrumented till F3 using protaper gold rotary files. Each group was assigned a different irrigant. Saline-negative control and NaOCl-positive control. Teeth were sectioned and subjected to Scanning Electron Microscopic analysis. ECA was prepared using a custom-made apparatus having two chambers of capacity 50 ml each separated by a polymer membrane. About 40 ml of tap water was collected in each chamber. Two graphite electrodes were connected to the top of the compartments, linked to a power supply which initiates electrolysis, and the solutions obtained in anodic and cathodic compartments were collected. Statistical analysis was done using one-way ANOVA and Post hoc Tukey analysis.

Results:

NaOCl, maleic acid, and ECA had similar smear layer removal efficacy. MTAD was less efficient than the other irrigants tested. Saline did not remove the smear layer.

Conclusion:

Electrochemically activated water has promising smear layer removal efficacy and is comparable with conventional root canal irrigants.

Diagnosis of Spinal Tuberculosis in Retrovirus Negative Cases: A Case Series

Spinal Tuberculosis (TB) is the most common destructive form of extrapulmonary TB. The diagnosis of spinal TB is challenging involving combined approach of clinical diagnosis, imaging techniques, detection of acid-fast bacilli in microscopy, histopathology, and culture. This case series reports four patients of spinal TB diagnosed clinically, radiologically and microbiologically that were treated appropriately with standard anti-TB treatment according to Category I daily regimen.

Evaluation of chemical disinfection and microwave irradiation on denture base materials: An in vitro study

Objective

This study evaluated the effect of chemical disinfection and microwave irradiation on the surface hardness and roughness of two commercially available hard relining materials (Ufi Gel hard, GC Kooliner) and one denture base resin (Trevalon).

Materials and Methods

A total of 72 specimens (n = 24) were divided into four groups. C: Not disinfected, Cl: disinfected with 4% chlorhexidine solution, Gl: disinfected with 2% glutaraldehyde solution, Mw: disinfected with microwave irradiation (650 W; 6 min). Hardness and roughness measurements were made after polymerisation, 1^st day, 14^th day and 28^th day.

Results

Ufi Gel hard showed an increased roughness after 1^st day (P = 0.021) following chemical disinfection and GC Kooliner showed similar results after 14^th day (P < 0.05). Microwave irradiation showed a significant increase in surface roughness value after 1^st day (P < 0.05) for both Ufi Gel hard and GC Kooliner. Hardness of both Ufi Gel (12.131 to 7.333 VHN) and Kooliner (9.133 to 5.276 VHN) was significantly reduced by chemical disinfection, while microwave irradiation resulted in an increased surface hardness of Kooliner (from 9.126 to 12.713 VHN) and Ufi Gel hard (from 11.698 to 14.940VHN). Results for Trevalon were not significant for both the disinfection methods.

Conclusions

Microwave irradiation increased the surface roughness and hardness of Ufi Gel hard and Kooliner, while chemical disinfection resulted in a decreased hardness and increased roughness of both hard relining materials. There was no effect of either of the disinfection methods on Trevalon.

Rieger’s Anomaly without Posterior Embryotoxon: A Rare Presentation

Rieger’s anomaly is a rare congenital ocular defect with autosomal dominant inheritance, characterised by dysgenesis of the anterior segment. Ocular features of typical Reiger’s anomaly include a prominent anteriorly displaced Schwalbe's line (posterior embryotoxon), iris stromal hypoplasia, corectopia, and glaucoma. An atypical presentation of Rieger’s anomaly is described in the current case report. A 26-year-old female presented with diminution of vision in right eye and mild photophobia in both eyes, since childhood. On examination, it was recognised as an atypical isolated case of Rieger’s anomaly with several classical features including segmental full thickness iris defect and ectropion uveae. This was associated with total cataract in right eye and persistent pupillary membrane in left eye, without posterior embryotoxon and glaucoma. There were no other associated ocular or systemic anomalies. Patient was operated for cataract surgery in right eye under guarded visual prognosis. The postoperative visual acuity was 3/60, signifying pre-existing amblyopia. The patient was kept on close follow-up for the development of glaucoma. This is a rare case of Anterior Segment Dysgenesis (ASD) manifesting as atypical Rieger’s anomaly without posterior embryotoxon and any systemic association, signifying the fact that posterior embryotoxon is not an essential diagnostic criterion.

Intraocular pressure and tear production changes in pregnant women at term pregnancy and immediate post-partum: A pilot study

Aim:

To study the intraocular pressure (IOP) and tear production changes in uncomplicated pregnant women at term pregnancy and immediate postpartum.

Materials and methods:

The patients admitted in the Department of Obstetrics and Gynaecology for delivery were included in the study. A total of 106 participants who were at term uncomplicated pregnancy were selected according to the inclusion and exclusion criteria. They were subjected to type 1 Schirmer's testing and intraocular pressure measurement by Perkin's tonometer before and after delivery.

Result:

There was no significant pre- and postdelivery IOP difference between the different age groups (<30 and ≥30 years), mode of delivery, and parity. There was a statistically significant (P < 0.001) increase in mean tear production (Schirmer's test) after delivery, irrespective of age group, mode of delivery, and gravida status. However, no significant intergroup difference was observed.

Conclusion:

There was no significant change in IOP before and after delivery in uncomplicated pregnancies. However, a statistically significant increase in tear production was observed in the immediate postpartum period.

An unusual association of Morning Glory Syndrome with chronic myeloid leukemia-Philadelphia chromosome

Morning glory disc anomaly (MGDA) is a rare congenital malformation that results from the incomplete formation of the optic nerve in utero. The majority of the patients have unilateral involvement and poor vision leading to sensory strabismus. Morning Glory Syndrome (MGS) may be a part of other syndromes and systemic abnormalities like transsphenoidal basal encephalocele, midfacial malformations, absent optic chiasma, MoyaMoya syndrome, and renal agenesis. In the present report, we describe a patient with a large disc with an excavated posterior scleral opening with a white glial tuft at the centre. The blood vessels were increased in number and arranged radially from the disc with peripapillary hyperpigmentation in clumps. Funnel-shaped excavation of the posterior globe was also noted on MRI. Associated ocular features were microcornea, nystagmus, esotropia, and systemic features included chronic myeloid leukemia- Philadelphia chromosome (CML-PC) and empty sella turcica. We report an unusual association of MGS with CML-PC.

Biosynthesis of selenium nanoparticles from Bacillus species and its applications

Selenium nanoparticles have been widely used in the various areas especially in medical field for its anticancer and immune modulatory properties. To reduce the toxic chemicals released by chemical process, the present work was aimed at synthesis of selenium nanoparticles by microbes. In this study, microbes were isolated from soil samples from different areas of Bangalore and screened for the antioxidant activity by DPPH assay. The organism with highest antioxidant activity (IC50 value = 11.6µg/mL) was identified as Bacillus species. Under experimental conditions, this microbe along with sodium selenite synthesised selenium nanoparticle indicated by the colour change of the medium to reddish orange. The synthesised selenium nanoparticles were further characterised. From UV-Vis spectrophotometry, the maximum peak was obtained at 266.5nm. The FT-IR analysis showed peaks at different wavelengths with the maximum of 3200cm-1 showing the presence of alcoholic group. The shape and size of the selenium nanoparticles was also calibrated by SEM analysis as oval and 209nm-748nm respectively. The nanoparticles were further analysed for antimicrobial assays by well diffusion method against E. coli, S. aureus, P. aeruginosa, St. mutans and antifungal assay against the strains of C. albicans, A. niger and A. flavus. The highest zone of inhibition was observed against E.coli (1.7 cm) at a concentration of 400µg and maximum for C. albicans (2.5cm) at a concentration of 400µg. Microbial synthesized nanoparticles emerges as a promising medicine in curing different disorders because of its potent antioxidant and antimicrobial activity.  

Total external ophthalmoplegia: First clinical manifestation of Sjögren's syndrome

Sjögren's syndrome (SS) is an autoimmune disease causing destruction of the exocrine glands secondary to lymphocytic infiltration. Common clinical symptoms of SS are xerostomia, xerophthalmia, myalgia, arthritis, and vasculitis. Neurological symptoms may precede the diagnosis of SS by up to 2 years in about 80% of patients. A 28-year-old female presented to us with complaints of horizontal and vertical diplopia along with inability to move the right eye and sudden drooping of the right upper eyelid. She was a recently diagnosed case of type 2 diabetes mellitus and had a history of foreign body sensation in both eyes for 4 months. Schirmers I test revealed less than 5 mm of wetting in both eyes after 5 min, suggesting dry eyes. On immunological blood investigations, serum c-peptide was normal, rheumatoid factor was negative, antinuclear antibodies were positive, and proliferating cell nuclear antigens were positive. Extractable Nuclear Ag profile RO 52 was strongly positive suggestive of primary SS. Lip biopsy revealed mild-to-moderate chronic inflammation showing irregular acanthotic epidermis, and dermis had perivascular lymphocytic infiltrate. Thus, the possible diagnosis of primary SS with type 2 diabetes mellitus and right-sided total external ophthalmoplegia was made. Patient was prescribed subcutaneous insulin, multivitamins, tear substitutes and alternate patching. Later on insulin was replaced by oral hypoglycemics. The external ophthalmoplegia completely resolved within 6 weeks. So, total external ophthalmoplegia can be added to the spectrum of central nervous system involvement in SS.

Antioxidant and antimicrobial activity of bioactive prodigiosin produces from Serratia marcescens using agricultural waste as a substrate

The objective of this investigation was to explore the antioxidant and antimicrobial property of bioactive prodigiosin produced from Serratia marcescens using rice bran. The antioxidant potential of prodigiosin was examined by 2, 2-diphenyl-1-picrylhydrazyl (DPPH) and 2, 2'-azino-bis 3-ethylbenzthiazoline-6-sulfonic acid (ABTS) radical scavenging method via UV-visible, electron spin resonance spectrum (ESR), cyclic voltammetry and excitation emission spectrum. The antimicrobial activity of prodigiosin was examined against foodborne pathogens. The shelf life extending capacity of prodigiosin was evaluated with meat extract powder (MEP) as a model food material. The DPPH and ABTS radicals were completely scavenged by prodigiosin at the concentration of 10 mg/L. The food spoilage was inhibited by the addition of prodigiosin with MEP and it was compared with conventional preservative. The prodigiosin has prohibited the growth of foodborne pathogens effectively and the shelf life of the food was also extended significantly. The antimicrobial edible preservative developed in this study inhibited the growth of the microbial populations that produced through storage of the MEP and free radical scavenging activity. The results reveal that the bioactive prodigiosin effectively scavenged the free radical and inhibited the bacterial growth in food stuff.

Anaerobic digestion of sulphate-rich post-tanning wastewater at different COD/sulphate and F/M ratios

Anaerobic digestion of post-tanning wastewater was performed in batch anaerobic digester to evaluate the effect of COD/sulphate ratio [0.62, 0.69, and 1.20 (w/w) %] and F/M ratio [0.2, 0.3, 0.5, 0.7, 0.9, 1.1, 1.3, and 1.5 (w/w) %)] on the removal efficiency of COD. The F/M ratio of 0.3 was found to be the optimum ratio for the removal of COD by 53, 57, and 65%, respectively at COD/sulphate ratio of 0.62, 0.69, and 1.20. The maximum sulphate removal was observed at F/M ratio of 0.2 and the removal efficiency was 48, 50, and 58% at COD/sulphate ratio of 0.62, 0.69, and 1.20, respectively. The removal efficiency of COD and sulphate was increased with increase in COD/sulphate ratio from 0.62 to 1.20 and decreased with increase in F/M ratio from 0.2 to 1.5 in anaerobic digestion of post-tanning wastewater. The maximum concentration of sulphide formation was 784 mg/L at COD/sulphate ratio of 0.62 in anaerobic digestion process and the process was inhibited at this sulphide concentration. The microbial activity in the sludge was evaluated through live and dead cell assay using fluorescent microscopy. The maximum amount of dead microbes was observed in the anaerobic digester, which was operated at COD/sulphate ratio of 0.62 than other studied ratio.

Exploring the Binding Affinity of Novel Syringic Acid Analogues and Critical Determinants of Selectivity as Potent Proteasome Inhibitors

Syringic acid, a known plant phenolic compound and its analogues are known to possess high proteasome inhibitory activity. In the current work, we describe synthesis, characterization, DFT, docking of syringic acid (SA) and analogues (SAA1 and SAA2) and biological effects were studied. Syringic acid and its analogues were docked for the first time with the crystal structures of β5 proteasome of diverse eukaryotic organisms. Among all proteasomes, the humanoid proteasome showed the highest degree of docking conformation and low inhibition constant (Ki). SAA2 specifically displayed binding to the N-terminal Thr1 residue in the S1 pocket of Mus musculus β5 proteasome along with threonine, lysine and arginine; conventionally involved major amino acid residues in ligand binding. The geometrical properties (B3LYP/6- 31g (d, p)) and electrostatic potentials of molecules were computed using DFT calculations. A detailed molecular picture of the compounds and its interactions was obtained from NBO analysis. SA-analogues elucidated potent antioxidant activities and good antibacterial activity. In-vitro DNA binding studies revealed that all molecules had strong binding at the major groove of dsDNA. In the view of medical applicability, proteasome inhibition is an important therapeutic strategy for various types of cancers. Therefore, current discoveries may encourage the rational design and development of new chemical entities of syringic acid based chemotherapeutics.

Occurrence of Diabetes Mellitus in Obese Nondiabetic Patients, with Correlative Analysis of Visceral Fat, Fasting Insulin, and Insulin Resistance: A 3-year Follow-up Study (Mysore Visceral Adiposity in Diabetes Follow-up Study)

OBJECTIVE

To assess the occurrence of diabetes in obese nondiabetic patients over a 3-year follow-up period with a correlative analysis of visceral fat (VF), fasting insulin levels, (FILs) and insulin resistance (IR).

MATERIAL AND METHODS

Thirty-seven obese and nineteen nonobese nondiabetics of our previous study, Mysore Visceral Adiposity in Diabetes were followed for the next 3 years. Their blood pressure, body mass index, waist circumference (WC), fasting blood sugar (FBS), FIL, lipid profile and subcutaneous fat (SCF), and VF measurement by US method were repeated every 6 months for the next 3 years. The findings were analyzed with appropriate statistical methods.

RESULTS

Twenty-three obese and 18 nonobese nondiabetics completed the study. There were 17 dropouts. The changes in the physical and biochemical characteristics of the two groups before and after the study were not significant. SCF had no correlation with IR whereas VF correlated with FIL and IR. There were three diabetics in the obese group and two from the control group at the end of the study. There were 12 impaired glucose tolerance (IGT) in the test group and 2 in the control group. Those who developed diabetes had higher VF, WC, FBS, FIL, and IR. Those who showed IGT also had these at higher levels compared to others. There was no change in the VF at the end of the study.

CONCLUSIONS

This follow-up study on South Indians has shown that VF is a significant risk factor for the development of IR. IR can develop without any increase in the volume of the VF, is the essential finding of this study. SCF has not shown any significant relationship with IR. We recommend FBS and FIL in all the obese nondiabetics to calculate IR, which has given much insight in the development of IGT and diabetes. Large multicentric, longitudinal studies are required to establish the cause of IR.

Benchmarking Lumbar Puncture Fluoroscopy Time during Fellowship Training

We sought to establish a guide for identifying fellowship competency in performing fluoroscopically guided lumbar punctures. With a linear mixed-effects model, we compared the fluoroscopy time between the first and last 3 months of neuroradiology training. During 7 years, 55 fellows performed 1142 and 861 lumbar punctures in the first and last quarters of training. A target fluoroscopy time of 0.26 minutes, the upper 95% confidence interval, can serve as a fellowship benchmark for successfully achieving competence in fluoroscopically guided lumbar punctures.

Unintended and accidental medical radiation exposures in radiology: guidelines on investigation and prevention

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived from an International Atomic Energy Agency Technical Meeting. More serious overexposures can result in skin doses high enough to produce tissue reactions, in interventional procedures and computed tomography, most notably from perfusion studies. A major factor involved has been deficiencies in training of staff in operation of equipment and optimization techniques. The use of checklists and time outs before procedures commence, and dose alerts when critical levels are reached during procedures, can provide safeguards to reduce the risks of these effects occurring. However, unintended and accidental overexposures resulting in relatively small additional doses can take place in any diagnostic or interventional x-ray procedure and it is important to learn from errors that occur, as these may lead to increased risks of stochastic effects. Such events may involve the wrong examinations, procedural errors, or equipment faults. Guidance is given on prevention, investigation, and dose calculation for radiology exposure incidents within healthcare facilities. Responsibilities should be clearly set out in formal policies, and procedures should be in place to ensure that root causes are identified and deficiencies addressed. When an overexposure of a patient or an unintended exposure of a foetus occurs, the foetal, organ, skin, and/or effective dose may be estimated from exposure data. When doses are very low, generic values for the examination may be sufficient, but a full assessment of doses to all exposed organs and tissues may sometimes be required. The use of general terminology to describe risks from stochastic effects is recommended rather than the calculation of numerical values, as these are misleading when applied to individuals.

Male mice are susceptible to high fat diet-induced hyperglycaemia and display increased circulatory retinol binding protein 4 (RBP4) levels and its expression in visceral adipose depots

Vitamin A and its metabolites are known to modulate adipose tissue development and its associated complications. Here, we assessed the vitamin A status and its metabolic pathway gene expression in relation to sexual dimorphism by employing 35 days old C57BL/6J male and female mice, which were fed either stock or high fat (HF) diet for 26 weeks. HF diet feeding increased body weight/weight gain and white adipose tissue (WAT) of visceral and subcutaneous regions, however, increase in vitamin A levels observed only in subcutaneous WAT. Further, the expression of most of the vitamin A metabolic pathway genes showed no sexual dimorphism. The observed HF diet-induced hyperglycaemia in male corroborates with increased retinol binding protein 4 (RBP4) levels in plasma and its expression in visceral adipose depots. In conclusion, the male mice are susceptible to high fat diet-induced hyperglycaemia and display higher plasma RBP4 levels, possibly due to its over-expression in visceral adipose depots.

Chronic sub-clinical inflammation in the abdominal adipose tissue - Evaluation of inflammatory cytokines and their link with insulin resistance in metabolically obese South Indians: A cross-sectional observational study

OBJECTIVE

To measure the levels of proinflammatory cytokines tumor necrosis factor-alpha (TNF-α), interleukin-6(IL-6), and high-sensitive C-reactive protein (hs-CRP) and the anti-inflammatory cytokine adiponectin (AN) in obese South Indian subjects and to ascertain whether or not a causal role could be ascribed to these cytokines in the development of insulin resistance (IR).

MATERIALS AND METHODS

Forty obese and forty nonobese volunteers of both genders were recruited. Parameters such as body mass index (BMI), waist circumference (WC), and blood pressure were evaluated. Fasting blood sugar (FBS), fasting insulin level, hemoglobin A1c (HbA1C), lipid profile, TNF-α, IL-6, hs-CRP, and AN levels were measured. IR was evaluated by homeostatic model assessment-IR method. Abdominal adiposity was measured by ultrasonography. The results were statistically evaluated by appropriate tests.

RESULTS

BMI, WC, and visceral fat were high in the obese group. Females had higher subcutaneous fat in both groups. HbA1C was marginally high in the obese group (P = 0.014). IR was high in all the groups, obese males showing higher values (not significant[NS]). Total cholesterol and low-density lipoprotein were high in the obese group (P = 0.028, P = 0.003). TNF-α was high in obese males (NS), IL-6 was high in both groups, higher in nonobese females (NS), hs-CRP was high in both groups, higher in females of both groups (NS). AN was high in females of both groups (P = 0.002).

CONCLUSIONS

In this study on South Indian subjects, proinflammatory cytokines such as IL-6 and hs-CRP, despite being high, did not show any causal correlation either with abdominal obesity or with IR. TNF-α being normal showed some correlation which was inconsistent. Even the anti-inflammatory adipokine, AN did not show any correlation with IR. Cytokines had an inconsistent correlation with the components of metabolic syndrome hence were not useful.

Determination of the Dexlansoprazole in Bulk and Spiked Human Plasma by Extraction Spectrophotometry

This paper describes a simple extraction spectrophotometric method for the quantification of dexlansoprazole in bulk and spiked human plasma. This method involves formation of stable yellow colored chloroform extractable ion-pair complex of the amino derivative of dexlansoprazole with acid dye, namely methyl orange in acidic medium. The ion-pair complexes exhibit absorption maxima at 425 nm. Dexlansoprazole can be determined up to 4-40 μg/mL by the proposed method. The effect of optimum reagent concentration was studied. The relative standard deviations (≤1. 246%) obtained in the intra-day and inter-day analyses were found to be satisfactory. The accuracy results exhibited the mean recovery and percentage error in the range of 99.137%–100.574% and 0.012%–0.863%. When applied for the assay of the dexlansoprazole in spiked human plasma sample, recovery mean values ranged from 96.495–98.960%. The proposed method is useful for the estimation of the dexlansoprazole in bulk and human plasma samples.

Correlation of abdominal adiposity with components of metabolic syndrome, anthropometric parameters and Insulin resistance, in obese and non obese, diabetics and non diabetics: A cross sectional observational study. (Mysore Visceral Adiposity in Diabetes Study)

OBJECTIVES

To measure Visceral Fat (VF) and Subcutaneous Fat (SCF) by ultrasound, in obese and non-obese diabetics and obese and non-obese non diabetics, in a South Indian (Asian Indian) Population and correlate them with Body Mass Index (BMI), Waist Circumference (WC), components of metabolic syndrome and Insulin Resistance (IR).

RESEARCH DESIGN AND METHODS

This was a prospective observational study, 80 diabetics (40 obese and 40 non obese) and 80 non diabetics (40 obese and 40 non obese) a total of 160 subjects were enrolled, out of whom 153 completed the study. The subjects were evaluated with respect to BMI, WC, Blood Pressure (BP); Fasting Blood Sugar (FBS) Fasting Insulin levels (FIL), HbA1C and Lipid profile. The SCF and VF were measured by Ultrasonography.The results were statistically analyzed.

RESULTS

WC correlated significantly with VF in all the groups. Diabetics had more VF compared to non-diabetics. Insulin resistance was significant in all the groups; however diabetics had greater levels of IR, BMI, WC, VF and SCF had no correlation with IR and had no significant correlation with metabolic parameters.

CONCLUSIONS

In this study population, WC was found to be a useful surrogate measure of VF conforming to its well established applicability in other populations. Contrary to other studies elsewhere, SCF and VF were found to be poor indicators of Insulin Resistance. BMI, WC, VF and SCF were not useful in the prediction of metabolic syndrome. Ultrasound was found to be an easier and economic method of measuring abdominal adiposity and actual measurement of abdominal fat was more informative than anthropometric measurements.

Efficacy and safety of hydroxychloroquine in the treatment of type 2 diabetes mellitus: a double blind, randomized comparison with pioglitazone

OBJECTIVE

To compare efficacy and safety of hydroxychloroquine with pioglitazone in type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

This double-blind study randomized 267 uncontrolled type 2 diabetes patients (HbA1c ≥7.5% and ≤11.5%), post 3 months' treatment with glimepiride/gliclazide and metformin, to additionally receive hydroxychloroquine 400 mg/day (n = 135) or pioglitazone 15 mg/day (n = 132) for 24 weeks. Efficacy was assessed by changes in HbA1c, fasting (FBG) and post-prandial (PPG) blood glucose at Week 12 and Week 24.

RESULTS

At Week 12 and Week 24, HbA1c, FBG and PPG significantly reduced from baseline in both groups. Mean reduction in glycemic parameters at Week 12 (HbA1c: -0.56% vs -0.72%, p = 0.394; FBG: -0.99 mmol/L vs -1.05 mmol/L, p = 0.878; PPG: -1.93 mmol/L vs -1.52 mmol/L, p = 0.423) and Week 24 (HbA1c: -0.87% vs -0.90%, p = 0.909; FBG: -0.79 mmol/L vs -1.02 mmol/L, p = 0.648; PPG: -1.77 mmol/L vs -1.36 mmol/L, p = 0.415) was not significantly different between the hydroxychloroquine and pioglitazone groups. Change in total cholesterol (TC) and LDL-C was significant in favor of hydroxychloroquine (TC: -0.37 mmol/L vs 0.03 mmol/L, p = 0.002; LDL-C: -0.23 mmol/L vs 0.09 mmol/L, p = 0.003). Triglycerides significantly reduced in both groups at Week 24. Mean HDL-C remained unchanged. Study treatments were well tolerated.

CONCLUSION

With favorable effects on glycemic parameters and lipids, hydroxychloroquine may emerge as well tolerated therapeutic option for T2DM.

LIMITATIONS

The sample size for this study was small. However, based on the encouraging results of this proof-of-concept study, longer duration studies in larger population can be conducted to further confirm these findings. TRIAL REGISTRATION DETAILS: Clinical Trial Registry-India URL: http://ctri.nic.in, Registration Number: CTRI/2009/091/001036.

A case of acute on chronic uterine inversion with fibroid polyp

Chronic nonpuerperal inversion of the uterus is uncommon and is usually associated with a fundal submucous myoma extrusion. We report herewith the case of a young lady with hitherto asymptomatic long standing mass per vagina presenting acutely with vaginal bleeding and shock. The mass was a uterine myoma. She underwent hysterectomy in view of extensive necrosis.

Helicobacter pylori associated vitamin B12 deficiency, pernicious anaemia and subacute combined degeneration of the spinal cord

A 23-year-old man presented with weakness in the lower limbs, numbness in hands and feet over past 6 months. Examination revealed a combination of absent ankle jerk, extensor plantar response and reduced sensations in a glove and stocking distribution. MRI of the spinal cord was distinctive of subacute combined degeneration (SACD) of the spinal cord. Serum vitamin B12 was low and anti-intrinsic factor antibodies were positive. A biopsy of the stomach revealed intense inflammatory infiltrates in lamina propria with grade III Helicobacter pylori infection. Other work-up for the cause of vitamin B12 deficiency was unremarkable. H pylori infection triggers autoantibodies by a mechanism of molecular mimicry. This case report highlights H pylori as a causative agent in vitamin B12 deficiency and culminating in SACD of the spinal cord. H pylori treatment reverses the underlying pathogenesis and corrects vitamin B12 deficient state in selected individuals.

Bilateral ptosis due to a rare cause-pachydermoperiostosis

Pachydermoperiostosis is a rare hereditary disorder that is characterised by pachydermia (thickening of the facial skin and/or scalp), and periostosis (swelling of the periarticular tissue and a subperiosteal new bone formation). Other associated features are arthralgia, polyarthritis, clubbing, seborrhoea, hyperhidrosis, hypertrophic gastropathy, peptic ulcer and gyanecomastia. Eyelid ptosis which is caused by thickened eyelids (blepharoptosis) is a less common association. We are hereby reporting a patient with a complete form of Pachydermoperiostosis, wherein the presenting feature was bilateral ptosis.