A real-world exploration into clinical outcomes of direct oral anticoagulant therapy in people with chronic kidney disease: a large hospital-based study

BACKGROUND

There is limited evidence to support definite clinical outcomes of direct oral anticoagulant (DOAC) therapy in chronic kidney disease (CKD). By identifying the important variables associated with clinical outcomes following DOAC administration in patients in different stages of CKD, this study aims to assess this evidence gap.

METHODS

An anonymised dataset comprising 97,413 patients receiving DOAC therapy in a tertiary health setting was systematically extracted from the multidimensional electronic health records and prepared for analysis. Machine learning classifiers were applied to the prepared dataset to select the important features which informed covariate selection in multivariate logistic regression analysis.

RESULTS

For both CKD and non-CKD DOAC users, features such as length of stay, treatment days, and age were ranked highest for relevance to adverse outcomes like death and stroke. Patients with Stage 3a CKD had significantly higher odds of ischaemic stroke (OR 2.45, 95% Cl: 2.10-2.86; p = 0.001) and lower odds of all-cause mortality (OR 0.87, 95% Cl: 0.79-0.95; p = 0.001) on apixaban therapy. In patients with CKD (Stage 5) receiving apixaban, the odds of death were significantly lowered (OR 0.28, 95% Cl: 0.14-0.58; p = 0.001), while the effect on ischaemic stroke was insignificant.

CONCLUSIONS

A positive effect of DOAC therapy was observed in advanced CKD. Key factors influencing clinical outcomes following DOAC administration in patients in different stages of CKD were identified. These are crucial for designing more advanced studies to explore safer and more effective DOAC therapy for the population.

Blood-based microRNA profiling unveils complex molecular dynamics in breast cancer

BACKGROUND

Breast cancer, a genetically intricate disease with diverse subtypes, exhibits heightened incidence globally. In this study, we aimed to investigate blood-based microRNAs (miRNAs) as potential biomarkers for breast cancer. The primary objectives were to explore the role of miRNAs in cancer-related processes, assess their differential expression between breast cancer patients and healthy individuals, and contribute to a deeper understanding of the molecular underpinnings of breast cancer.

METHODS

MiRNA extraction was performed on 40 breast cancer patients and adjacent normal tissues using a commercial RNA isolation kit. Total RNA quantification and quality assessment were conducted with advanced technologies. MiRNA profiling involved reverse transcription, labeling, and hybridization on Agilent human miRNA arrays (V2). Bioinformatics analysis utilized the DIANA system for target gene prediction and the DIANA-mirPath tool for pathway enrichment analysis. Selected miRNAs underwent validation through quantitative real-time PCR.

RESULTS

Principal component analysis revealed overlapping miRNA expression patterns in primary and malignant breast tumors, underscoring the genetic complexity involved. Statistical analysis identified 54 downregulated miRNAs in malignant tumors and 38 in primary tumors compared to controls. Bioinformatics analysis implicated several pathways, including Wnt, TGF-b, ErbB, and MAPK signaling. Validation through qRT-PCR confirmed altered expression of hsa-miR-130a, hsa-miR-21, hsa-miR-223, and hsa-let-7c key miRNAs, highlighting their significance in breast cancer. The results from microarray were further validated by qPCR and the expression of which are downregulated in breast cancer was detected.

CONCLUSION

This study provides significant insights into distinct miRNA expression patterns in normal and malignant breast tissues. The overlapping miRNA profiles in primary and malignant tumors underscore the complexity of genetic regulation in breast cancer. The identification of deregulated miRNAs and affected pathways contributes to our understanding of breast cancer pathogenesis. The validated miRNAs hold potential as diagnostic and prognostic markers, offering avenues for further clinical exploration in breast cancer research.

Computational ensemble expert system classification for the recognition of bruxism using physiological signals

This study aimed to develop an automatic diagnostic scheme for bruxism, a sleep-related disorder characterized by teeth grinding and clenching. The aim was to improve on existing methods, which have been proven to be inefficient and challenging. We utilized a novel hybrid machine learning classifier, facilitated by the Weka tool, to diagnose bruxism from biological signals. The study processed and examined these biological signals by calculating the power spectral density. Data were categorized into normal or bruxism categories based on the EEG channel (C4-A1), and the sleeping phases were classified into wake (w) and rapid eye movement (REM) stages using the ECG channel (ECG1-ECG2). The classification resulted in a maximum specificity of 93% and an accuracy of 95% for the EEG-based diagnosis. The ECG-based classification yielded a supreme specificity of 87% and an accuracy of 96%. Furthermore, combining these phases using the EMG channel (EMG1-EMG2) achieved the highest specificity of 95% and accuracy of 98%. The ensemble Weka tool combined all three physiological signals EMG, ECG, and EEG, to classify the sleep stages and subjects. This integration increased the specificity and accuracy to 97% and 99%, respectively. This indicates that a more precise bruxism diagnosis can be obtained by including all three biological signals. The proposed method significantly improves bruxism diagnosis accuracy, potentially enhancing automatic home monitoring systems for this disorder. Future studies may expand this work by applying it to patients for practical use.

Correlation between serum galanin and neuron-specific enolase levels with EEG abnormalities in pediatric convulsive status epilepticus and the efficacy of triple drug therapy

OBJECTIVE

This study aimed to investigate the association between serum galanin (GAL) and neuron-specific enolase (NSE) levels in children with convulsive status epilepticus (CSE) and their relationship with abnormal electroencephalogram (EEG) patterns. Additionally, the study assessed the effectiveness of a combination therapy involving midazolam, diazepam, and phenobarbital in treating CSE.

PATIENTS AND METHODS

The research involved 100 children diagnosed with CSE and included a control group of 50 healthy children. Serum GAL and NSE levels were measured, and EEGs were analyzed for abnormalities in the CSE group. Comparisons were made between the healthy control group and the CSE group, particularly within the first 24 hours after persistent seizures. The severity of EEG abnormalities was correlated with GAL and NSE levels. The treatment consisted of an observation group that received the triple therapy of midazolam, diazepam, and phenobarbital, while a control group received diazepam and phenobarbital. Clinical efficacy, symptom improvement, Status Epilepticus Severity Score (STESS), and adverse reactions were evaluated.

RESULTS

The results indicated elevated levels of GAL and NSE in the CSE group, with higher levels noted within 24 hours after persistent seizures. Furthermore, a positive correlation was observed between the severity of EEG abnormalities and GAL and NSE levels. The group receiving the triple therapy demonstrated superior efficacy, faster resolution of seizures and fever, reduced STESS scores, and fewer adverse reactions than the control group. In conclusion, this study highlights the positive correlation between serum GAL and NSE levels and the severity of EEG abnormalities in pediatric CSE. The triple therapy approach is effective in treating CSE, leading to improved clinical symptoms, reduced brain damage, and enhanced safety.

CONCLUSIONS

The study concludes that serum GAL and NSE levels in children with convulsive status epilepticus are positively correlated with the degree of EEG abnormalities. The combination therapy involving midazolam, diazepam, and phenobarbital is effective in treating children with convulsive status epilepticus, significantly improving clinical symptoms, reducing brain damage, and ensuring safety.

Direct oral anticoagulants and the risk of adverse clinical outcomes among patients with different body weight categories: a large hospital-based study

OBJECTIVE

Through predictable pharmacokinetics-including a convenient fixed-dose regimen, direct oral anticoagulants (DOACs) are preferred over previous treatments in anticoagulation for various indications. However, the association between higher body weight and the risk of adverse consequences is not well studied among DOAC users. We aim to explore the association of body weight and adverse clinical outcomes in DOAC users.

METHODS

A total of 97,413 anonymised DOAC users in a tertiary care setting were identified following structured queries on the electronic health records (EHRs) to extract the feature-rich anonymised dataset. The prepared dataset was analysed, and the features identified with machine learning (ML) informed the adjustments of covariates in the multivariate regression analysis to examine the association. Kaplan-Meier analysis was performed to evaluate the mortality benefits of DOACs.

RESULTS

Among DOAC users, the odds of adverse clinical outcomes, such as clinically relevant non-major bleeding (CRNMB), ischaemic stroke, all-cause mortality, and prolonged hospital stay, were lower in patients with overweight, obesity, or morbid obesity than in patients with normal body weight. The odds of ischaemic stroke (OR 0.42, 95% CI: 0.36-0.88, p = 0.001) and all-cause mortality (OR 0.87, 95% CI: 0.81-0.95, p = 0.001) were lower in patients with morbid obesity than in patients with normal body weight. In the Kaplan-Meier analysis, apixaban was associated with a significantly lower rate of mortality overall and in obesity and overweight subgroups than other DOACs (p < 0.001). However, rivaroxaban performed better than apixaban in the morbid obesity subgroup (p < 0.001).

CONCLUSION

This study shows the positive effects of DOAC therapy on clinical outcomes, particularly in patients with high body weight. However, this still needs validation by further studies particularly among patients with morbid obesity.

The small molecule Erk1/2 signaling pathway inhibitor PD98059 improves DNA repair in an experimental autoimmune encephalomyelitis SJL/J mouse model of multiple sclerosis

Multiple sclerosis (MS) is a demyelinating disorder in which the myelin sheath covering the central nervous system axons is damaged or lost, disrupting action potential conduction and leading to various neurological complications. The pathogenesis of MS remains unclear, and no effective therapies are currently available. MS is triggered by environmental factors in genetically susceptible individuals. DNA damage and DNA repair failure have been proposed as MS genetic risk factors; however, inconsistent evidence has been found in multiple studies. Therefore, more investigations are needed to ascertain whether DNA damage/repair is altered in this disorder. In this context, therapies that prevent DNA damage or enhance DNA repair could be effective strategies for MS treatment. The overactivation of the extracellular-signal-related kinase 1 and 2 (Erk1/2) pathway can lead to DNA damage and has been linked to MS pathogenesis. In our study, we observed substantially elevated oxidative DNA damage and slower DNA repair rates in an experimentally autoimmune encephalomyelitis animal model of MS (EAE). Moreover, statistical decreases in oxidative DNA strand breaks and faster repair rates were observed in EAE animals injected with the Erk1/2 inhibitor PD98059 (PD). Moreover, the expression of several genes associated with DNA strand breaks and repair changed in EAE mice at both the mRNA and protein levels, as revealed by the RT² Profiler PCR array and verified by RT-PCR and protein analyses. The treatment with PD mitigated these changes and improved DNA repair gene expression. Our results demonstrate clear associations between Erk1/2 activation, DNA damage/repair, and MS pathology, and further suggest that PD therapy may be a promising adjuvant therapeutic strategy.

A Real-World Exploration into Clinical Outcomes of Direct Oral Anticoagulant Dosing Regimens in Morbidly Obese Patients Using Data-Driven Approaches

INTRODUCTION

The clinical outcomes of direct oral anticoagulant (DOAC) dosage regimens in morbid obesity are uncertain due to limited clinical evidence. This study seeks to bridge this evidence gap by identifying the factors associated with clinical outcomes following the dosing of DOACs in morbidly obese patients.

METHOD

A data-driven observational study was carried out using supervised machine learning (ML) models with a dataset extracted from electronic health records and preprocessed. Following 70%:30% partitioning of the overall dataset via stratified sampling, the selected ML classifiers (e.g., random forest, decision trees, bootstrap aggregation) were applied to the training dataset (70%). The outcomes of the models were evaluated against the test dataset (30%). Multivariate regression analysis explored the association between DOAC regimens and clinical outcomes.

RESULTS

A sample of 4,275 morbidly obese patients was extracted and analysed. The decision trees, random forest, and bootstrap aggregation classifiers achieved acceptable (excellent) values of precision, recall, and F1 scores in terms of their contribution to clinical outcomes. The length of stay, treatment days, and age were ranked highest for relevance to mortality and stroke. Among DOAC regimens, apixaban 2.5 mg twice daily ranked highest for its association with mortality, increasing the mortality risk by 43% (odds ratio [OR] 1.430, 95% confidence interval [CI] 1.181-1.732, p = 0.001). On the other hand, apixaban 5 mg twice daily reduced the odds of mortality by 25% (OR 0.751, 95% CI 0.632-0.905, p = 0.003) but increased the odds of stroke events. No clinically relevant non-major bleeding events occurred in this group.

CONCLUSION

Data-driven approaches can identify key factors associated with clinical outcomes following the dosing of DOACs in morbidly obese patients. This will help design further studies to explore well tolerated and effective DOAC doses for morbidly obese patients.

Ossification of Superior Transverse Scapular Ligament - Incidence, Embryology and Association with Suprascapular Neuropathy

Introduction

Suprascapular notch is present at superior border of scapula just medial to coracoid process. This is covered by superior transverse scapular ligament (STSL). Suprascapular nerve passes below this ligament while suprascapular vessels pass above it. STSL ossification is a rare finding with variable incidences in different population groups.

Materials and Methods

We observed 60 dry bony scapulae, 30 prosected formalin fixed upper limbs with scapula and 10 embalmed cadavers for the presence of ossified STSL.

Results

There were complete ossification of STSL in two dried bony specimens of sacpula.

Conclusion

Ossified STSL may be the causative factor for suprascapular neuropathy. The mainstay of management in cases of neuropathy or compression of suprascapular nerve is release of suprascapular ligament by either open or arthroscopic surgical approach. So, it is extremely important to know this type of variation to minimize any damage to related structure and plan the management accordingly.

Bioclimatic modeling and FACE study forecast a bleak future for wheat production in India

Since the impact of future climate change on wheat productivity is inconsistent, we studied geographic distribution and yield of wheat using two global General Circulation Models (GCMs) and Free Air CO_2/O₃ Enrichment (FACE) experiments. The GCMs (IPSL-CM5A-LR and NIMR-HADGEM2-AO) with four Representative Concentration Pathways (RCPs) and 19 bioclimatic variables were used for distribution/ecological niche modeling (ENM). Currently cultivated eight wheat cultivars were exposed to individual treatment of (i) ambient CO₂, temperature, and ozone (ACO + AO + AT) representing the present climate scenario, and (ii) elevated CO₂ (550 ppm) (ECO), (iii) elevated temperature (+ 2 °C) (ET), (iv) elevated O₃ (ambient + 20 ppb) (EO), (v) elevated CO₂ + elevated O₃ (ECO + EO), and (vi) elevated CO₂ + elevated temperature + elevated O₃ (ECO + EO + ET) under FACE facility simulating the future climate change scenarios in 2050. The niche models predicted a reduction in climatically suitable areas for wheat, and identified "maximum temperature" as the most influencing factor for area reduction. The elevated CO₂, O₃, and temperature individually and in combinations had differential impacts on the yield of wheat cultivars. Only two cultivars, viz., DBW 184 and DBW 187 did not exhibit yield decline suggesting their suitability in the future climate change scenario. Since the performance of six out of eight cultivars significantly declined under simulated FACE experiment, and ENM predicted reduction in wheat cultivation area under RCP 8.5 in 2050, it was concluded that future of wheat cultivation in India is bleak. The study further indicates that coupling of bioclimatic modeling and FACE experiment can effectively predict the impact of climate change on different crops.

A Layer-Wise Surface Deformation Defect Detection by Convolutional Neural Networks in Laser Powder-Bed Fusion Images

Surface deformation is a multi-factor, laser powder-bed fusion (LPBF) defect that cannot be avoided entirely using current monitoring systems. Distortion and warping, if left unchecked, can compromise the mechanical and physical properties resulting in a build with an undesired geometry. Increasing dwell time, pre-heating the substrate, and selecting appropriate values for the printing parameters are common ways to combat surface deformation. However, the absence of real-time detection and correction of surface deformation is a crucial LPBF problem. In this work, we propose a novel approach to identifying surface deformation problems from powder-bed images in real time by employing a convolutional neural network-based solution. Identifying surface deformation from powder-bed images is a significant step toward real-time monitoring of LPBF. Thirteen bars, with overhangs, were printed to simulate surface deformation defects naturally. The carefully chosen geometric design overcomes problems relating to unlabelled data by providing both normal and defective examples for the model to train. To improve the quality and robustness of the model, we employed several deep learning techniques such as data augmentation and various model evaluation criteria. Our model is 99% accurate in identifying the surface distortion from powder-bed images.

Multiple exposure to methylmercury aggravates DNA damage in the BTBR T + Itpr3 tf/J autistic mouse model: the role of DNA repair efficiency

Environmental and genetic factors have been recognized to play major roles in the pathogenesis of autism. Here we examined the BTBR T⁺Itpr3^tf/J (BTBR) mice's susceptibility, an autistic model, to the genotoxic effects and DNA repair dysregulation of methylmercury. Micronuclei formation and oxidative DNA damage were analyzed using the micronucleus/fluorescence in situ hybridization test and modified comet assay, respectively. The results showed higher centromeric-positive micronuclei and oxidative DNA damage in BTBR mice exposed to methylmercury than the unexposed mice, which indicates that mutagenesis aggravated in BTBR mice after methylmercury exposure. Lipid peroxides in BTBR mice were significantly elevated, with a decrease in reduced/oxidized glutathione ratio after methylmercury exposure, indicating an augmenting oxidant-antioxidant imbalance. The expression of several genes involved in DNA repair was markedly altered in BTBR mice after methylmercury exposure as evaluated via PCR array and RT-PCR analyses. Declining of the antioxidant defense and dysregulation in DNA repair process after methylmercury exposure may explain the aggravated genotoxic susceptibility of BTBR mice. Thus, autistic individuals exposed to methylmercury must be under regular medical follow-up through standard timetabled medical laboratory inquiry to allow for early recognition of any mutagenic changes. Additionally, strategies that elevate cellular antioxidants/DNA repair efficiency may counteract methylmercury-induced genotoxicity.

Correlation between Sonoelastography and Histopathological Findings in Evaluation of Chronic Renal Allograft Disease

Background Non-invasive evaluation tool for allograft kidney is important to predict chronic allograft dysfunction as it can be alternative to the invasive biopsy which is prone to so many complications. Sonoelastography can assess the stiffness of the allograft renal parenchyma, which is prone to undergo interstitial fibrosis. Objective To correlate sonoelastography with histopathology findings in the renal allografts. Method Sonoelastography was done in 60 renal allograft recipients prior to their biopsy for various indications. Estimated glomerular filtration rate (eGFR) of the patient were also obtained. Histopathology reports were collected to determine Banff score of interstitial fibrosis. Descriptive measurements (Mean ± standard deviation, Frequencies, Proportions) were calculated. Correlations among the variables were measured using Pearson's correlation, independent sample t-test, and ANOVA. Result The mean strain index (SI) was lower in higher grades of fibrosis. There was significant difference in mean SI (F=18.264; df= 2,57; p < 0.001) among the histological grades of fibrosis. Also a significant difference in SI among mild and moderate (S.E. 0.27, p value < 0.001), mild and severe (S.E. 0.213, p value < 0.001) as well as moderate and severe fibrosis (S.E. 0.244, p value < 0.001) was seen. Significant correlation of eGFR with SI (p < 0.001) was also seen. Conclusion Strain index, measured with sonoelastography, significantly correlated with different grades of tissue fibrosis. Thus it can be used as alternative method for evaluation of renal allograft patients to avoid complications of biopsy.

Energy and carbon budgeting of traditional land use change with groundnut based cropping system for environmental quality, resilient soil health and farmers income in eastern Indian Himalayas

Energy intensive traditional cereals based monoculture often lead to high greenhouse gas emissions and degradation of land and environmental quality. Present study aimed at evaluating the energy and carbon budget of diversified groundnut (Arachis hypogea L) based cropping system with over existing traditional practice towards the development of a sustainable production technology through restoration of soil and environmental quality and enhancement of farming resiliency by stabilizing farmers' income. The trials comprised of three introduced groundnut based systems viz. groundnut- pea (Pisum sativum), groundnut-lentil (Lens esculenta) and groundnut-toria (Brasssica campestris var. Toria) replacing three existing systems viz. maize (Zea mays L) - fallow, maize - toria, and rice (Oryza sativa L)-fallow systems. Four years study revealed that adoption of groundnut based systems reduced non-renewable energy input use (fertilizers, chemical, machinery and fossil fuels) by 25.5%, consequently that reduced the cost of production. Repeated analysis of variance measurement also affirmed that groundnut based systems (groundnut-pea>groundnut-lentil> groundnut-toria) increased the energy use efficiency, energy productivity, carbon use efficiency, net returns and decreased the specific energy and energy intensiveness. Groundnut based systems increased the mean system productivity and water productivity in terms of groundnut equivalent yield by 3.7 and 3.1 folds over existing practice. The savings of fossil fuel reduced greenhouse gas emissions owing to reduced use of farm machinery and synthetic fertilizers. Groundnut based systems significantly (p < 0.05) enhanced the soil carbon concentration (8.7-18.1%) and enzymatic activities (27.1-51.8%) over existing practice. Consequently, estimated soil quality index values were 35.9-77.3% higher under groundnut based systems than existing practice. Thus, the study indicated the resilient nature of groundnut based systems as an environmentally safe and sustainable production technology for enhancing resource use efficiency, reduce carbon emission, energy intensiveness and cost of production in the Eastern Himalaya region of India and similar ecosystems.

Progress in Detection of Insomnia Sleep Disorder: A Comprehensive Review

Lack of adequate sleep is a major source of many harmful diseases related to heart, brain, psychological changes, high blood pressure, diabetes, weight gain, etc. 40 to 50% of the world's population is suffering from poor or inadequate sleep. Insomnia is a sleep disorder in which an individual complaint of difficulties in starting/continuing sleep at least four weeks regularly. It is estimated that 70% of heart diseases are generated during insomnia sleep disorder. The main objective of this study is to determine all work conducted on insomnia detection and to make a database. We used two procedures including network visualization techniques on two databases including PubMed and Web of Science to complete this study. We found 169 and 36 previous publications of insomnia detection in the PubMed and the Web of Science databases, respectively. We analyzed 10 datasets, 2 databases, 21 genes, and 23 publications with 30105 subjects of insomnia detection. This work has revealed the future way and gap so far directed on insomnia detection and has also tried to provide objectives for the future work to be proficient in a scientific and significant manner.

Sonographic Quantification of Ovarian Volume in Adults Attending General Health Checkup and General Out Patient Department in Tribhuvan University Teaching Hospital

Background Ultrasonography is the easily available, cheap and reliable method for evaluation of ovaries. Ovarian volume is the major factor in the diagnosis of various ovarian pathologies and confusing discrepancies are found in the literature. Objective To determine the ovarian volume among individuals attending outpatient department in tertiary level hospital. Method Descriptive cross sectional study design was used; 305 patients of 16-60 years attending general outpatient department in the Tribhuvan University Teaching Hospital, Kathmandu, Nepal were included. Ovarian volume was calculated by using transabdominal ultrasonography. Data was collected in the predesigned proforma and analyzed using statistical package for the social sciences software. Result The study showed mean total ovarian volume 5.95 ± 2.44 cc (centimeter cube) with mean right ovarian volume 5.94 ± 2.70 cc and mean left ovarian volume 6.05 ± 2.79 cc. Significant decrease in ovarian volume with age was observed. Height and weight did not show significant correlation with ovarian volumes and no significant variation seen in the volumes of right and left ovaries. Periovulatory ovaries show significantly higher volumes on right side than luteal phase. Similarly, significantly higher volume of left ovary seen in mixed ethnic group than mongoloid group. Conclusion Measurement of ovarian volume is important for evaluation and management of ovarian disorders. Ultrasonography which is readily available, simple and cost effective is better suited for our environment than other imaging modality. Values of ovarian volume from this study may provide a baseline of normal ovarian volume in our community.

Synthesis, characterization and evaluation of visible light active cadmium sulfide-graphitic carbon nitride nanocomposite: A prospective solar light harvesting photo-catalyst for the deactivation of waterborne pathogen

Cadmium sulfide-graphitic carbon nitride nanocomposite was synthesized by pulsed laser ablation in liquid, and it was found from the results of optical and morphological characterizations that the proper anchoring of nanostructured cadmium sulfide on the nano-sheets of graphitic carbon nitride took place, which brought about the positive attributes such as enhanced visible light absorption and reduced photo-generated charge recombination, the key features required for an efficient photo-catalyst by solar light harvesting. The pulsed laser ablation in liquid method adopted for the synthesis of cadmium sulfide-graphitic carbon nitride has the following advantages: the shape and size of the synthesized particles can be controlled by altering the experimental parameters such as laser wavelength, pulse laser duration, the pH of the solution, the surfactants and the temperature of the solution, pulsed laser ablation in liquid method neither requires cumbersome equipment nor does it require intermediate chemicals and catalysts nor does it necessitate the post synthesis purification. The enhancement of photo-catalytic activity of cadmium sulfide-graphitic carbon nitride nanocomposite was tested for the photo-catalytic deactivation of Escherichia coli bacteria in water under visible light radiation. As anticipated, a significant improvement of photo-catalytic deactivation was observed, which is attributed to the enhanced and extended light absorption in the visible spectral region, and the formation of herterojunction between the semiconductors, which is instrumental in inhibiting the undesired recombination of photo-generated charge carriers. Quantitatively, the presence of cadmium sulfide on the graphitic carbon nitride surface contributed to a remarkable 129% increase of photo-catalytic degradation constant compared to pure graphitic carbon nitride, which resulted in the decrease of total depletion time of Escherichia coli from 156 min to 67 min with the cadmium sulfide-graphitic carbon nitride nanocomposite synthesized by pulsed laser ablation in liquid method. Our results on the efficient photo-catalytic deactivation of Escherichia coli under visible light assures that cadmium sulfide-graphitic carbon nitride nanocomposite can very well be used for photo-catalytic water purification by harvesting the abundant solar light.

Electrochemical Sensing for Examining Vitamin D3 based on MIP using NOVA 1.7 and Autolab PGSTAT 302N

Introduction: An electrochemical sensor has the ability to transform the associated data containing electrochemical reactions into a reliable representative signal. The electrochemical sensors can be classified into potentiometric, conductometric, and ampere-metric or Volta-metric. Although, there are various electrochemical techniques for the detection of Vitamin D3, there is still a need for a simplified and cost-effective method. An electrochemical sensor provides great sensitivity towards the detection of the analyte. Aim: To fabricate an electrochemical sensor for the detection of Vitamin D3. The sensor used Molecular Imprinted Polymer (MIP) based Screen Printed Carbon Electrode (SPCE). Materials and Methods: The SPCE used was a three-electrode system consisting of silver working electrode, silver reference electrode and a counter carbon electrode. The reagents used in the experiment was p-Phenylenediamine, resorcinol and Vitamin D3 that were applied in a particular amount onto the SPCE. The process of electropolymerisation was carried out in order to form a non-conductive layer. Cavities were gradually formed on the surface of SPCE. A mediator was used to obtain reliable results for the detection of Vitamin D3. It is evident from the existing literature that the number of scans of electropolymerisation holds a significant role in this process. The procedure was applied for the formation of non-imprinted electrode in the absence of the analyte. Results: The presence of the template i.e., Vitamin D3 was recorded using the developed electrochemical sensor. The current decreased on rebinding of Vitamin D3 which resulted in the change of redox peak of ferricyanide. This signified the sudden increase in concentration of Vitamin D3 specifying its presence. Conclusion: The results obtained specifies the great sensitivity of the electrochemical sensor towards the template i.e., vitamin D3. The clinical relevance of such electrochemical sensors is that they produce simple, accurate and reproducible results which can be used to optimise the care of patients.

Investigation of belinostat-induced genomic instability by molecular cytogenetic analysis and pathway-focused gene expression profiling

Histone deacetylases (HDACs), which regulate transcription and specific functions such as tumor suppression by p53, are frequently altered in tumors and have a contentious role in carcinogenesis. HDAC inhibitors, which have a long history of use in psychiatry and neurology, have recently been tested as possible treatments for tumors. Belinostat received regulatory approval in the USA on July 3, 2014, for use against peripheral T-cell lymphoma. However, the unavailability of information on belinostat genotoxicity in normal cells and the molecular mechanisms involved in the genetic instability after exposure to belinostat encouraged us to conduct this study. Our data showed that the exposure of mice to belinostat at the recommended human doses induced chromosome breakage, whole-chromosome lagging, and oxidative DNA damage in bone marrow cells in a dose-dependent manner. The expression levels of 84 genes involved in the DNA damage signaling pathway were evaluated by using an RT² Profiler PCR array. Belinostat exposure altered the expression of 25 genes, with statistically significant changes observed in 17 genes. The array results were supported by RT-PCR and western blotting experiments. Collectively, our results showed that belinostat exposure caused oxidative DNA damage and downregulated the expression of genes involved in DNA damage repair, which may be responsible for belinostat-induced genomic instability. Thus, the clinical usage of this drug should be weighed against the hazards of carcinogenesis, and the observed genotoxicity profile of belinostat may support further development of efficient HDAC inhibitors with weaker genotoxicity.

Challenges in culture-negative cases of Madurella mycetomatis: A case report re-accentuating PCR as an essential diagnostic tool

Identification of dematiaceous fungi responsible for black-grain mycetoma has remained cumbersome and time consuming for years leading to delayed diagnosis and thereby increased agony to patients. Moreover, difficult morphology of some of these fungi demanding enough expertise for species identification in addition to culture-negativity has often led to misdiagnosis and hence inapt treatment to the patients. We report the identification of Madurella mycetomatis from culture-negative black granules discharged from foot nodular lesions of a 27 years old male using PCR followed by sequencing of the internal transcribed spacer region. The patient's lesions were successfully treated using a combination of itraconazole (200mg) and terbinafine (250mg), confirming our diagnosis. Our case study proves the clinical value of PCR as the best, rapid and accurate diagnostic method for the identification of Madurella mycetomatis and related fungi, particularly in culture-negative cases.

Fetal Ductus Venosus Pulsatility Index and Diameter during Second and Third Trimester of Gestation

INTRODUCTION

The ductus venosus is a small funnel shaped vessel found posterior to the fetal liver connecting the intra-abdominal umbilical vein and the inferior vena cava. It is one of the three physiological shunts in the fetus. The main objective of this study is to construct the reference table and normogram for fetal ductus venosus Pulsatility Index and diameter with gestational age.

METHODS

This was a prospective cross sectional study conducted during August 2011 to July 2012 taking 294 uncomplicated pregnancies using systemic random sampling method. Three measurements were made for ductus venosus diameter and Pulsatility Index in each fetus during period of fetal quiescence.

RESULTS

The ductus venosus diameter at <20weeks, 20-25 weeks, 25-30 weeks, >30 weeks were 1.16, 1.31, 1.62, 1.81 and Pulsatility Index at <20weeks, 20-25 weeks, 25-30 weeks, >30 weeks were 0.41, 0.44, 0.41 and 0.41 respectively.

CONCLUSIONS

The mean diameter of the ductus venosus was linear across gestational age. The Pulsatility Index shows a scattered distribution across the gestational age.

Foot Infections

Infections of the foot are very variable, some being complex in nature, causing pain, morbidity, and even mortality. In patients with diabetes mellitus, foot infections are common, ranging from chronic bacterial or fungal infections to serious limb-threatening ones. To manage infections, a sound knowledge of anatomy is essential. This article reviews the problems with respect to recent evidence and provides pathways to management and suggestions of changes with potential to wound healing.

Morphological Changes in Degenerative Disc Disease on Magnetic Resonance Imaging: Comparison Between Young and Elderly

BACKGROUND

Morphological changes implicated in low back are complicated by additional age related degenerative changes in spine, which increases with aging. This study aims to compare the morphological MRI findings in young and elderly patients with low back pain and also correlate them with the clinical symptoms.

METHODS

The study was a retrospective hospital record based comparative study carried out in a Teaching Hospital. MRI performed for patients with low back pain during May 2012 to October 2012 were reviewed. The MRI findings were compared between below 60 years and at and above 60 years and were also correlated with symptoms.

RESULTS

A total of 301 MRI met the inclusion criteria out of which 228(75.74%) were young adults and 73(24.25%) were elderly adults. Degenerative changes and disc bulge was more common in elderly. Disc herniations including disc prolapse was more common in young adults. Disc protrusion involving L4-L5 was most common in the elderly while L5-S1 was most common in young adults. Nerve root compression was noted more commonly in the young adults. Radiculopathy was associated with grade III nerve root compression and paramedian disc protrusion in young adults while no such association was noted in elderly. No association of radiculopathy with presence of degenerative changes, spinal stenosis was noted in both groups.

CONCLUSIONS

Degenerative changes are more common in elderly while disc herniations are more common in young adults. Morphologic changes do correlate with symptoms in young adults to some extent while they do not correlate in elderly.

Indigenous traditional knowledge and usage of folk bio-medicines among Rongmei tribe of Tamenglong district of Manipur, India

BACKGROUND

Rongmei tribe (Kooki), are inhabitant of the Charoi Chagotlong village, Tupul, Tamenglong district of Manipur have the traditional knowledge of folk bio-medicine based on diverse plant species for the prevention and cure of certain chronic diseases. The aim of this study was to document and preserve the indigenous knowledge of the Rongmei tribe on folk medicines.

MATERIAL AND METHODS

The present work was based on methodical field survey conducted between 2010, to 2013. Local people of within 30-70 age groups of both sexes were interviewed and a group discussion (using a structured interview schedule), was held to know about the type of plant parts used in folk bio-medicines, and their mode of use. The interviewers were drawn from a wide array of disciplines (Vendors, Farmers club, NGO's, scientific societies, etc.), to obtain maximum information in relation to folk bio-medicine.

RESULTS

A total of 60 species belonging to 36 different families (ranging from gymnosperm to angiosperm with medicinal benefits), were discussed briefly with significant emphasis on their local name, scientific name, family, parts used; they claimed to cure various ailments from these plants in this mode of folk bio-medicine. The different plant parts used were leaves, fruits, bulbs, bark, roots, seeds, tuber, trunk, flower, shoot, whole plant, rhizome, stem, wood and berries. Based on a life form of the reported plants comprise herbs, shrubs, trees, grasses, bulb, vine, climber, tuber and succulent.

CONCLUSION

Efforts should be made to promote the use of traditional biomedicines within rural communities to preserve the traditional knowledge.

Inclusion of Three-Vessel View in Routine Fetal Cardiac Screening

Aims: The purpose of this study was to study the feasibility of inclusion of 3-vessel view (3-VV) of the fetal upper mediastinum in routine fetal anomaly screening; and to study the size relationship of these vessels namely, main pulmonary artery (MPA), ascending aorta (AA) and the superior venacava (SVC) in fetuses between 17 and 24 weeks of pregnancy by antenatal ultrasound. Methods: This was a prospective cross sectional study involving 106 pregnant ladies between 17 and 24 weeks of gestation. The time burden to the examination due to addition of 3-VV in routine anomaly screening was recorded. The relationships of the three great vessels of the fetal upper mediastinum were studied and their diameters were obtained. Regression equations were used to construct the reference ranges for all the parameters of statistical significance. Results: The 3-VV could be easily obtained in all but eight patients within five minutes (the difficulty in these eight patients was due to fetal position). The MPA, AA and SVC were aligned in a straight line from left to right respectively, the MPA being the largest vessel, the SVC being the smallest vessel and the AA having an intermediate diameter. All of these three vessels showed significant correlation of size with advancing gestational age. Conclusions: 3-VV is easily obtained in fetuses at the time of routine anomaly screening. This should be routinely included in the screening ultrasound of fetal heart along with the four-chamber view to detect the anomalies of the outflow tract. DOI: http://dx.doi.org/10.3126/njog.v9i1.11197 NJOG 2014 Jan-Jun; 2(1):82-86

Subcutaneous mycoses caused by Rhytidhysteron species in an immunocompetent patient

Subcutaneous mycoses are chronic fungal infections of the skin and subcutaneous tissues caused by variety of fungal agents and usually occur following trauma with vegetative matter. We report a case of subcutaneous mycoses caused by rare fungus belonging to the genus Rhytidhysteron, in an immunocompetent male who presented with a subcutaneous nodule on left foot. This unusual species was identified and confirmed by molecular methods.

Texture-based medical image retrieval in compressed domain using compressive sensing

Content-based image retrieval has gained considerable attention in today's scenario as a useful tool in many applications; texture is one of them. In this paper, we focus on texture-based image retrieval in compressed domain using compressive sensing with the help of DC coefficients. Medical imaging is one of the fields which have been affected most, as there had been huge size of image database and getting out the concerned image had been a daunting task. Considering this, in this paper we propose a new model of image retrieval process using compressive sampling, since it allows accurate recovery of image from far fewer samples of unknowns and it does not require a close relation of matching between sampling pattern and characteristic image structure with increase acquisition speed and enhanced image quality.

Interaction of Al(2)O(3) nanoparticles with Escherichia coli and their cell envelope biomolecules

AIMS

The aim of this study is to investigate the antibacterial activity of aluminium oxide nanoparticles (Al2 O3 NPs) against multidrug-resistant clinical isolates of Escherichia coli and their interaction with cell envelope biomolecules.

METHODS AND RESULTS

Al2 O3 NPs were characterized by scanning electron microscope (SEM), high-resolution transmission electron microscope (HR-TEM) and X-ray diffraction (XRD) analyses. Antibacterial activity and interaction of Al2 O3 NPs with E. coli and its surface biomolecules were assessed by spectrophotometry, SEM, HR-TEM and attenuated total reflectance/Fourier transform infrared (ATR-FTIR). Of the 80 isolates tested, about 64 (80%) were found to be extended spectrum β-lactamase (ESBL) positive and 16 (20%) were non-ESBL producers. Al2 O3 NPs at 1000 μg ml(-1) significantly inhibited the bacterial growth. SEM and HR-TEM analyses revealed the attachment of NPs to the surface of cell membrane and also their presence inside the cells due to formation of irregular-shaped pits and perforation on the surfaces of bacterial cells. The intracellular Al2 O3 NPs might have interacted with cellular biomolecules and caused adverse effects eventually triggering the cell death. ATR-FTIR studies suggested the interaction of lipopolysaccharide (LPS) and L-α-Phosphatidyl-ethanolamine (PE) with Al2 O3 NPs. Infrared (IR) spectral changes revealed that the LPS could bind to Al2 O3 NPs through hydrogen binding and ligand exchange. The Al2 O3 NPs-induced structural changes in phospholipids may lead to the loss of amphiphilic properties, destruction of the membrane and cell leaking.

CONCLUSIONS

The penetration and accumulation of NPs inside the bacterial cell cause pit formation, perforation and disorganization and thus drastically disturb its proper function. The cell surface biomolecular changes revealed by ATR-FTIR spectra provide a better understanding of the cytotoxicity of Al2 O3 NPs.

SIGNIFICANCE AND IMPACT OF THE STUDY

Al2 O3 NPs may serve as broad-spectrum bactericidal agents to control the emergent pathogens regardless of their drug-resistance mechanisms.

Knowledge and attitude of basic health workers (BHWs) toward HIV/AIDS

BACKGROUND

The incidence of HIV infection and AIDS is rising in Nepal. The Basic Health Workers (BHWs) are front-line services providers in rural community. The aim of this study was to ascertain BHWs concerns regarding risk awareness, knowledge and attitude toward HIV/AIDS.

METHODS

A stratified random sample was used to select the BHWs from two districts. Data were collected using well-structured self-administrated questionnaire. It was consists of knowledge and attitude related question. Knowledge was assessed by asking several questions concerning issues on HIV/AIDS. Attitude was measured on a five-point Likert scale. Collected data were analyzed using the Epi-Info Software.

RESULTS

A total of 100 BHWs were participated in this study. The mean age of Basic Health Workers were 39 years. Out of all the participants 69 (69%) were male and 31 (31%) were female. The present study revealed that only 46 (46%) had good knowledge and 59 (59%) differentiate between HIV and AIDS. Only 22 (22%) BHWs had accurate knowledge of Universal Precaution. Only 38 (38%) participants showed positive and rationalized feeling towards HIV/AIDS patients and 51 (51%) BHWs agreed that HIV/AIDS patients have right to live as we do. 41 (41%) were uncertain that universal precaution can prevent transmission of HIV.

CONCLUSIONS

This study suggested that the Basic Health workers who participated in this study study possess basic knowledge but inadequate, although majority of them have poor attitudes toward persons with HIV/AIDS. Most incorrect answers were related to universal precaution. Ministry of Health Services, Nepal should consider the potential benefits to be gained from improving knowledge, attitude and practice of Basic Health Workers in prevention and control of rapidly increasing health problem of HIV/AIDS.

Partial role of multiple pathways in infarct size limiting effect of quercetin and rutin against cerebral ischemia-reperfusion injury in rats

BACKGROUND

Reperfusion therapy used in the treatment of cerebral ischemia often causes reperfusion neurological injury. Multiple pathological processes are involved in this injury including oxidative stress and components of the inflammatory response appear to play key roles in these deleterious effects. Thus new therapeutic strategies aimed at neutralization of OS-induced neurotoxicity support the application of natural antioxidant bioflavonoids. Both experimental and epidemiological evidence demonstrate that bioflavonoid such as quercetin and rutin are neuroprotective in models of cerebral ischemia reperfusion injury. However, recent studies indicate that the radical scavenger property of quercetin and rutin is unlikely to be the only reason for their cerebroprotective actions and in fact, a wide spectrum of cellular signaling events may well account for their biological actions.

AIM

In this study we attempted to establish the various mechanisms involved in the cerebroprotective activity of quercetin and rutin.

METHODS

Adult Sprague Dawely rats were anesthetized with thiopentone and subjected to global cerebral ischemia by occlusion of bicommon carotid arteries. Infarct size (TTC staining), SOD, MDA, CAT and MPO levels was assessed 4 h after the onset of ischemia.

RESULTS

Quercetin (50 mg/kg) and rutin (10 mg/kg) administered 10 min before reperfusion resulted in significant reduction of infarct size, MDA, and MPO levels and significant increase in SOD and CAT levels. Administration of L-NAME prior to administration of quercetin and rutin, significantly reduced the cerebroprotection offered by quercetin and rutin.

CONCLUSIONS

Possible partial role of antioxidant, anti-inflammatory and involvement of NO in the beneficial effects of bioflavonoids quercetin and rutin against cerebral ischemia reperfusion injury was observed.

Neuroprotective effect of allopurinol and nimesulide against cerebral ischemic reperfusion injury in diabetic rats

OBJECTIVES

The main objective of the study was to determine the neuroprotective effect of allopurinol and nimesulide against the cerebral ischemic reperfusion injury in diabetic and nondiabetic rats.

MATERIALS AND METHODS

In this study, Wistar albino rats of either sex weighing 150-250 g were procured from authorized suppliers. Rats were anesthetized by giving thiopentone sodium (45 mg/kg) by i.p. Under anesthesia, midline incision was given. Common carotid arteries were identified and isolated carefully from vago-sympathetic nerve. Rats were made ischemic by occluding bicommon carotid arteries with thread for 30 min, followed by reperfusion for 4 h by removing the occlusion. The drugs allopurinol (15, 30 mg/kg) and nimesulide (20, 40 mg/kg) were administered 10 min before reperfusion. Then after 4 h reperfusion, animals were sacrificed and immediately brain was removed, homogenized, centrifuged and supernatant was collected, various enzyme estimations were done and same procedure was followed in streptozotocin (STZ: 45 mg/kg; i.p.) induced diabetic rats.

RESULTS

Ischemia reperfusion (I/R) group showed significant increase in malondialdehyde (MDA), myeloperoxidase (MPO) and depletion in catalase (CAT) and superoxide dismutase (SOD) levels. Treatment with allopurinol and nimesulide significantly decreased the MDA and MPO levels whereas increased the SOD and CAT levels when compared I/R group in both non-diabetic and diabetic rats.

CONCLUSIONS

These findings suggest the cerebral injury due to over production of free radicals was inhibited by allopurinol and nimesulide that exert a neuroprotective effect probably by radical scavenging and antioxidant activities.

Influence of iron metabolism indices on HbA1c in non-diabetic pregnant women with and without iron-deficiency anemia: effect of iron supplementation

AIMS

Condition that influence erythrocyte turnover also affect HbA1c. Although many forms of anemia are associated with lowering of HbA1c, iron-deficiency anemia (IDA) tends to increase HbA1c. In this study, we examined the relationship between HbA1c and erythrocyte indices in non-diabetic pregnancy and assessed the effect of iron supplementation on HbA1c.

MATERIALS AND METHODS

150 women were studied (30 non-diabetic), non-pregnant, non-anemic women in child bearing women with varying parity as controls (Gp 1); 30 non-diabetic, non-anemic pregnant women in first trimester of pregnancy (Gp 2a); 30 non-diabetic, non-anemic pregnant women in second trimester of pregnancy (Gp 2b); 30 non-diabetic, non-anemic pregnant women in third trimester of pregnancy (Gp 2c) and 30 non-diabetic pregnant women with IDA (Gp 2d). HbA1c, OGTT, erythrocyte indices and iron metabolic indices were determined in Gp 2d subjects not supplemented with iron and repeated these indices after 3 months of iron-supplementation.

RESULTS

The mean fasting and postprandial blood glucose levels (79.9±8.0mg/dl, 108.1±14.1mg/dl) in Gp 1 were found to be significantly lower in first trimester among Gp 2a (74.4±5.3mg/dl and 97.2±11.1mg/dl), in second trimester among Gp 2b (76.2±5.2mg/dl and 103.4±7.9mg/dl) followed by increase in IIIrd trimester among Gp 2c (82.3±5.7mg/dl and 112.5±8.5mg/dl) subjects. A significant difference in HbA1c was also observed among the groups (HbA1c 4.7±0.3% in Gp 1; 4.6±0.4% in Gp 2a; 4.5±0.3 in Gp 2b; 4.7±0.3 in Gp 2c). Among Gp 2d subjects, HbA1c was 5.2±0.3% and the level decreased after iron supplementation to 5.1±0.3%. Significant correlation between erythrocyte indices, iron metabolic indices and HbA1c was also observed.

CONCLUSION

We conclude that consideration should be given for performing glucose testing in patients with IDA to ascertain the reliability of HbA1c in the diagnosis of diabetes. HbA1c concentrations in diabetic patients with IDA should be interpreted with caution.

Validity of Weech's formulae in detecting undernutrition in children

Primary care physicians in developing countries frequently use Weech's formulae to estimate the expected weight and height of children using age as a variable. The present study was undertaken to assess the validity of Weech's formulae in diagnosing undernutrition. We collected anthropometric information from 294 consecutive children, aged 12-59 months, who visited a health centre. Age was calculated from birth records and was recorded in completed months as well as completed years. Weight and height/length were measured using standard methods. Weight-for-age and height-for-age Z scores were calculated using WHO Anthro. Weech's formulae were used to calculate weight-for-age (%) and height-for-age (%). A cut off of < or =80.0% weight-forage and < or = 95.0% height-for-age were used to evaluate the validity of underweight and stunting respectively; a cut off of < or = 60.0% weight-for-age and <85.0% height-for-age were used for severe underweight and severe stunting respectively. Weech's formulae were found to be 100% sensitive in detecting underweight (weight-for-age Z score<-2) and stunting (height-for-age Z score<-2). When evaluating severe underweight (weight-for-age Z scorc<-3) and severe stunting (height-for-age Z scorc<-3), Weech's formulae were found to be 100% specific but the sensitivity was very low, 25.0% and 15.4% respectively. Based on the findings of our study Weech's formulae appear to be a sensitive tool to detect underweight and stunting in children between 12-59 months of age. Such formulae should however be used with caution when evaluating severe forms of undernutrition.

HCV-genotypes: a review on their origin, global status, assay system, pathogenecity and response to treatment

The present report is a review article on various aspects of Hepatitis C virus (HCV) genotypes and their subtypes. HCV has six genotypes and several subtypes showing important epidemiological and clinical implications. The information based on previous studies and presented through this article highlight the origin, classification and causes of genetic diversity, global status, detection assays, pathogenicity and response to treatment of HCV-genotypes. The six genotypes differ in 30-35% of nucleotide sites over the complete genome. The difference in genomic composition of sub-types of genotype is usually found to be 20-25%. The variability remains more frequent in structural genes as compared to non-structural or untranslated genes. Both genotypes and their sub-types show a varied prevalence globally and raise several issues related to their transmission and treatment of HCV-infection. All this information has a great significance while planning future strategies for eradication and therapeutic management of HCV. In addition, these reports produce a further scope for more studies to unravel the mystery behind HCV-genotypes and formulate guidelines to resolve this public health problem noted worldwide.

Global developmental delay and its determinants among urban infants and toddlers: a cross sectional study

OBJECTIVE

To estimate the prevalence of global developmental delay among children under 3 years of age and study the determinant factors.

METHODS

Cross sectional descriptive study was conducted in field practice areas of the Department of Community Medicine, JN Medical College, Aligarh, India. A total of 468 (243 boys and 225 girls) children aged 0-3 years were included. Developmental screening was performed for each child. A multitude of biological and environmental factors were analysed.

RESULTS

As many as 7.1% of the children screened positive for global developmental delay. Maximum delay was observed in the 0-12 months age group (7.0%). Undernutrition and prematurity were the two most prevalent etiological diagnoses (21% each). Stunting and maternal illiteracy were the microenvironmental predictors on stepwise binary logistic regression while prematurity and a history of seizures emerged significant biological predictors.

CONCLUSIONS

Developmental delay can be predicted by specific biological and environmental factors which would help in initiating appropriate interventions.

Cervical Rib causing Thrombosis of Subclavian Atery

We describe here an unusual case of thrombosis of left subclavian artery in a patient with cervical rib. The patient presented with features of ischaemia of left upper limb. X-ray chest revealed bilateral cervical ribs, longer on the left side. Color Doppler studies showed echogenic thrombus within the left subclavian artery. Angiography revealed complete occlusion of left subclavian artery. Embolectomy was done. She was planned for excision of rib. KEYWORDS:  cervical rib, thrombosis of subclavian artery.

Cervical rib causing thrombosis of subclavian artery

We describe here an unusual case of thrombosis of left subclavian artery in a patient with cervical rib. The patient presented with features of ischaemia of left upper limb. X-ray chest revealed bilateral cervical ribs, longer on the left side. Color Doppler studies showed echogenic thrombus within the left subclavian artery. Angiography revealed complete occlusion of left subclavian artery. Embolectomy was done. She was planned for excision of rib.

Cancer Diagnosis by Discrimination between Normal and Malignant Human Blood Samples Using Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy

FTIR spectroscopy is a common technique for cancer diagnosis. Applied tissue samples are heterogeneous and may be damaged in preparation procedures. Easier sampling, more available samples and also easier process with assured results would be interesting. Whole blood samples include all of these qualifications and our hypothesis was the bio-molecular changes in blood which manifest themselves in different optical signatures, detectable by FTIR spectroscopy. Noncancerous blood samples were differentiated from cancerous ones using ATR-FTIR spectroscopy and LDA classification method. Procedure was 100 percent and 90 percent accurate in prediction of cancerous or noncancerous situation for 33 known and 10 unknown samples, respectively.

Impact of etofenprox (Vectron 20 WP) indoor residual spray on malaria transmission

BACKGROUND & OBJECTIVE

A longitudinal study was carried out to assess the impact of indoor residual spray with Vectron 20 WP (etofenprox) against Anopheles culicifacies and on malaria transmission in a selected village of Dadri primary health centre (PHC), District Gautam Budh Nagar, Uttar Pradesh, India.

METHODS

Two villages, namely Patadi and Anandpur in District Gautam Budh Nagar, Uttar Pradesh, with similar malaria incidence and vector prevalence were selected for the present evaluation. In one village two rounds of indoor spraying of etofenprox (0.1 g/m(2)) were done at an interval of 12 wk and the other village was kept as control where no intervention except intensive active surveillance for early detection and prompt treatment (EDPT) was undertaken during the study period. Entomological and epidemiological data were collected using standard procedures.

RESULTS

Persistence of the effectiveness of etofenprox against An. culicifacies was observed up to 12 wk. Spraying of etofenprox significantly reduced the density (P<0.001) and proportion of parous An. culicifacies mosquitoes (P<0.05) in the experimental village. There was a significant reduction in malaria cases in the experimental village during the post-spray period when compared to the control village (P<0.05). No adverse effect was reported by the spraymen and inhabitants during and after the spray.

INTERPRETATION & CONCLUSION

Indoor residual spray of etofenprox (0.1 g/m(2)) with an interval of three months in between two rounds of spray produced the desired impact in reducing the indoor resting density of vector mosquitoes and also in curtailing malaria transmission in the sprayed village when compared with the control village without spray.

Accuracy of ultrasonography in the diagnosis of acute appendicitis

AIMS AND OBJECTIVES

To assess the accuracy of ultrasonography in the diagnosis of acute appendicitis.

METHODOLOGY

A prospective randomized study was carried in the Dept. of Radiology and Imaging, Tribhuvan University, Teaching Hospital, Maharajgunj, Kathmandu, Nepal. A total of 120 patients, who were clinically diagnosed as acute appendicitis were subjected to ultrasonography of the abdomen. A detailed ultrasonography was performed and the findings were recorded. Twenty one cases had alternate diagnosis. Ninety nine cases ultimately underwent laparotomy and the retrieved appendices were sent for histopathological examination. Intra-operative, histopathological and ultrasonographic diagnoses were then statistically analyzed.

RESULTS

Ultrasonographic, intra-operative and histopathological findings were statistically insignificant (P0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy percentage of ultrasonography in the diagnosis of acute appendicitis was 85.7%, 100%, 100%, 6.7% and 85.9% respectively.

CONCLUSION

Ultrasonography has a high degree of accuracy in the diagnosis of acute appendicitis. However, the diagnosis should be considered with the diameter of appendix over 6 mm. Therefore acute appendicitis with diameter of appendix having less than 6 mm should be evaluated with other diagnostic parameters.

Efficacy of PermaNet 2.0 against Anopheles culicifacies and Anopheles stephensi, malaria vectors in India

Bioefficacy of PermaNet was evaluated in both the laboratory and field against Anopheles culicifacies and An. stephensi, major malaria vectors in India. Contact bioassays were carried out after repeated washings and ring net bioassays to determine the median knockdown time of mosquitoes. Three villages were selected for the field trial: in the 1st village PermaNets were distributed, in the 2nd village untreated nets were distributed, and the 3rd village was a control. Entomological data were collected using standard procedures. The PermaNet contact bioassays showed high mortality (>80%) even after 20 washes against both the vector species. The median knockdown time of An. culicifacies and An. stephensi was 392 and 480 sec when exposed to fresh PermaNets and 472 and 986 sec when exposed to PermaNets that had been washed 20 times, respectively. PermaNets showed high efficacy in reducing the person-vector contact as evidenced by reduced person-hour density in the PermaNet village. Long-term field trials are indicated to test the impact of use of PermaNets in controlling malaria.

Impact of Olyset nets on malaria transmission in India

BACKGROUND & OBJECTIVES

Efficacy of Olyset nets, long-lasting insecticidal nets were tested from August 2003 to August 2006 against Anopheles culicifacies, the vector which transmits 60% of all malaria cases in rural India.

METHODS

Three villages in District Gautam Budh Nagar (Uttar Pradesh), India were selected for the trial and Olyset nets were distributed in one village, in another village untreated nets were distributed and the third village was kept as control where nets were not used. Entomological, and epidemiological data were collected using standard methods.

RESULTS

The use of Olyset nets reduced the indoor resting density of An. culicifacies and also reduced mosquito entry into the structures where Olyset nets were used. No mosquitoes were caught landing on the Olyset nets. There was a reduction in the parity rate of An. culicifacies in the Olyset net village as compared with untreated net and no net villages. The impact of Olyset nets was observed on malaria incidence and only one case of Plasmodiumfalciparum malaria was reported in the Olyset net village but these continued to be found in the village with untreated nets and the control.

CONCLUSION

Results of the present study confirmed that Olyset nets are highly effective in reducing the indoor resting density of mosquitoes, man-vector contact and malaria incidence.

Wash resistance and bioefficacy of Olyset net--a long-lasting insecticide-treated mosquito net against malaria vectors and nontarget household pests

During recent years, long-lasting insecticide-treated nets (LLINs) have been developed to overcome the problems of low retreatment rates, washing, and erratic dose of the insecticide resulting in the dilution of efficacy of the conventional insecticide-treated mosquito nets. These nets are treated at factory level with insecticide either incorporated into or coated around fibers. Olyset net, a polyethylene net with 2% permethrin incorporated within fibers, is one type of LLIN. Therefore, these nets were evaluated for their wash resistance and bioefficacy against malaria vectors Anopheles culicifacies Giles and Anopheles fluviatilis James (Diptera: Culicidae) and other nontarget species. Cone bioassay tests produced 100% mortality in these two vector species with 3-min exposure. Results of the bioassays on washed nets showed 100% mortality in An. fluviatilis even after 20 washings, whereas in An. culicifacies 100% mortality up to 11 washings and 80% mortality up to 20 washings were observed. Cone bioassay tests also were performed on nontarget mosquito species Culex quinquefasciatus Say; house fly, Musca domestica L.; American cockroach, Periplaneta americana (L.); head louse, Pediculus humanus capitis De Geer; and bed bug, Cimex lectularius L. with 30-min exposure. Except for bed bugs, 100% mortality was observed in these nontarget species after 24-h recovery period. In bed bugs, only 25% mortality was observed. The density of An. culicifacies and An. fluviatilis was significantly reduced in houses with Olyset nets compared with those with untreated nets or no nets. Thus, it may be concluded that Olyset nets are highly effective against malaria vectors and moderately against other nontarget household insects.

Bioefficacy of Olyset nets against mosquitoes in India

Olyset nets are highly effective in killing anopheline mosquitoes within 3 min of exposure, as evidenced in cone bioassay tests. These nets also showed their efficacy on other vector mosquitoes (Aedes aegypti and Cx. quinquefasciatus) at higher exposure periods. The efficacy remained at approximately 90% even after 20 washings at an interval of 24 h against Anopheles culicifacies and Cx. quinquefasciatus. Use of the nets inside the house also resulted in drastic reduction of daytime resting density of mosquitoes because of high repellency, excitorepellency, and killing action of the nets. Pilot studies are indicated to evaluate the impact of use of Olyset nets on vector-borne diseases, particularly malaria, and its cost-effectiveness in comparison to conventional indoor residual spraying.

Diversity in pathogenicity of Steinernema carpocapsae and its symbiotic bacterium for Spodoptera spp

Pathogenicity of five isolates of Steinernema carpocapsae (GER: Germany, BUW: Becker Underwood, KOP: Koppert, CZ: Czech Republic, BEL: Belgium) were tested against the fourth instar larvae of the cotton leaf worm, Spodoptera littoralis and the beet armyworm, Spodoptera exigua (Lepidoptera: Noctuidae) at different concentrations (0, 5, 10, 25, and 50 infective juveniles/cm2) in Petri dishes (9 cm dia.) lined with filter paper. Results obtained after 48 h exposure indicated that the pathogenicity varied in time, dose of application and host species. On S. littoralis, KOP, BUW, CZ and GER were more virulent than BEL, whereas all isolates showed 100% control of S. exigua after 72 h. The LC50 values of all five isolates were lower for S. exigua than for S. littoralis. Among the isolates tested, KOP showed the lowest LC50 value in both S. exigua (3.84) and S. littoralis (4.44 infective juveniles). To further check the pathogenicity, the symbiotic bacterium of S. carpocapsae, Xenorhabdus nematophilus, was isolated from Galleria mellonella 30 h after its infection with the nematode. Ten microlitres of 50 mM phosphate buffer containing 0, 10, 100, 1000, or 10,000 cfu were injected into the haemocel of fifth instar larvae of S. exigua. Significant differences in mortality of S. exigua larvae were observed 96 h post-injection with different bacterial doses. Cell-free filtrates of X. nematophilus were isolated from a bacterial suspension; 10 microlitres of filtrates were injected into fifth instars of S. exigua. All larvae had died 72 h post-injection. To check the insecticidal capability of X. nematophilus via oral uptake, suspensions of bacteria at concentrations of 0, 1010, 109, and 108 cfu/ml were sprayed onto tomato leaves cv. Moneymaker infected with fourth instar larvae of S. exigua. None of the larvae were killed after 24 h. Finally, we tested the virulence of selected isolates of S. carpocapsae (KOP, BUW, and BEL) in the glass-house on tomato plants infested with S. exigua or S. littoralis larvae. Nematodes were sprayed at a concentration of 2.5 billion/ha. After 48 h isolate KOP caused higher mortality (99% and 85% on S. exigua and S. littoralis, respectively), than other tested isolates. S. carpocapsae isolates BUW and BEL caused 61-65% mortality on S. exigua and S. littoralis, respectively. As most of the isolates had the same origin, viz. the ALL strain, these results demonstrate differences in pathogenicity of the production.

Laboratory and field evaluation of Hilmilin against mosquitoes

Hilmilin (diflubenzuron), an insect growth regulator, was tested for efficacy against Anopheles stephensi, Anopheles culicifacies, Aedes aegypti, and Culex quinquefasciatus in the laboratory and in field conditions. Fifty percent and 90% lethal concentrations (LC50 and LC90) of Hilmilin formulations were determined by exposing early 4th-stage larvae to serial dilutions of the formulation, and data were subjected to log probit analysis. Two doses (0.004 and 0.008 g/m2) were applied in different breeding habitats of mosquitoes with the help of stirrup pumps. Percent inhibition of adult emergence was compared according to a previously described procedure. Laboratory results revealed that both 25WP (wettable powder) and 22SL (semiliquid) formulations showed more or less the same degree of efficacy against tested mosquito species (P < 0.05). Of 4 species tested, An. stephensi was more susceptible, followed by An. culicifacies, Ae. aegypti, and Cx. quinquefasciatus. One hundred percent inhibition of adult emergence was observed at a dose of 0.0125 ppm (25WP and 22SL) against all mosquitoes tested in the laboratory. Both formulations showed almost similar effect when applied in the field at doses of 0.004 and 0.008 g/m2 in their respective preferential breeding habitats. However, the effect was more pronounced at a higher concentration (0.008 g/m2) against all species of mosquitoes. Hilmilin at a dose of 0.008 g/m2 can be used to contain mosquito breeding in stone quarries, pools, cement tanks, unused wells, unused coolers, and irrigation channels.

Larvicidal and mosquito repellent activities of Pine (Pinus longifolia, family: Pinaceae) oil

BACKGROUND AND OBJECTIVES

Various plant-based products are safe and biodegradable alternatives to synthetic chemicals for use against mosquitoes. Oil of Pinus longifolia is traditionally used for protection against mosquitoes in some rural areas but there is no documented report of its use against mosquitoes. The present study was undertaken to scientifically evaluate the activity of Pine oil against mosquitoes.

METHODS

The oil was procured from the market and its contents were chemically analysed. Larvicidal activity of oil was tested in laboratory bioassays, while repellent action was studied during whole night bait collections in field by direct application on the skin and after its impregnation on mats.

RESULTS

Results showed varying degree of larvicidal activity of Pine oil against mosquitoes with LC50 values ranging between 82 and 112 ppm. The Pine oil had strong repellent action against mosquitoes as it provided 100% protection against Anopheles culicifacies for 11 h and 97% protection against Culex quinquefasciatus for nine hours respectively. Electrically heated mats prepared from Pine oil provided, 94 and 88% protection against An. culicifacies and Cx. quinquefasciatus for 10 and seven hours respectively. INTERPRETAION AND CONCLUSION: Pine oil is effective against mosquito larvae at very higher doses which are not of any practical utility. However, Pine oil showed strong repellent action against An. culicifacies (malaria vector) and Cx. quinquefasciatus (pest mosquito). Thus its use could be popularised as mosquito repellent.