COVID-19: inflammatory responses, structure-based drug design and potential therapeutics

The COVID-19 pandemic caused by SARS-CoV-2 is responsible for the global health emergency. Here, we explore the diverse mechanisms of SARS-CoV-induced inflammation. We presume that SARS-CoV-2 likely contributes analogous inflammatory responses. Possible therapeutic mechanisms for reducing SARS-CoV-2-mediated inflammatory responses comprise FcR inactivation. Currently, there is no specific remedy available against the SARS-CoV-2. Consequently, recognizing efficacious antiviral leads to combat the virus is crucially desired. The coronavirus (CoV) main protease (Mpro also called 3CLpro), which plays an indispensable role in viral replication and transcription, is an interesting target for drug design. This review compiles the latest advances in biological and structural research, along with development of inhibitors targeting CoV Mpros. It is anticipated that inhibitors targeting CoV Mpros could be advanced into wide-spectrum antiviral drugs in case of COVID-19 and other CoV-related diseases. The crystal structural and docking results have shown that Ebselen, N3, TDZD-8 and α-ketoamide (13b) inhibitors can bind to the substrate-binding pocket of COVID-19 Mpro. α-ketoamide-based inhibitor 13b inhibits the replication of SARS-CoV-2 in human Calu3 lung cells. Quantitative real-time RT-PCR (qRT-PCR) showed that the treatment with Ebselen, TDZD-8 and N3 reduced the amounts of SARS-CoV-2, respectively, 20.3-, 10.19- and 8.4-fold compared to the treatment in the absence of inhibitor. Moreover, repurposing of already present drugs to treat COVID-19 serves as one of the competent and economic therapeutic strategies. Several anti-malarial, anti-HIV and anti-inflammatory drugs as mentioned in Table 2 were found effective for the COVID-19 treatment. Further, hydroxychloroquine (HCQ) was found more potent than chloroquine (CQ) in inhibiting SARS-CoV-2 in vitro. Furthermore, convalescent plasma from patients who have recuperated from viral infections can be employed as a therapy without the appearance of severe adverse events. Hence, it might be valuable to examine the safety and efficacy of convalescent plasma transfusion in SARS-CoV-2-infected patients.

Level of anxiety and depression among health-care professionals amidst of coronavirus disease: A web-based survey from India

BACKGROUND

The spread of novel coronavirus diseases-2019 (COVID-19) across the world and its associated morbidity and mortality confronted the nations by various means. COVID19 pandemic had significant psychological effects not only on the general population but also on health-care workers (HCWs). Hence, we aimed to found the level of anxiety and depression among health-care professionals amidst coronavirus.

MATERIALS AND METHODS

This is a cross-sectional study conducted on 829 participants including doctors and nurses and other medical staff who were posted in the COVID ward and COVID intensive care unit using a well-structured questionnaire through the Google Forms. The two scales used to measure anxiety and depression among the HCWs were the Hamilton anxiety scale (HAM-A) and the Patient Health Questionnaire (PHQ-9), Cronbach's alpha of HAM A is 0.921 and Cronbach's alpha of PHQ 9 is 0.851. Data analysis was done using SPSS 26, Chi-square test and Fisher's exact test were used to establish the association between categorical independent and dependent variables.

RESULTS

The results of this study demonstrate that anxiety and depression were significantly higher in doctors and staff nurses as compared to other medical staff. According to HAM-A, 65.1% of respondents were in the mild category, 22.0% mild to moderate, and 12.9% moderate to severe. The HAM-A (P = 0.022) and PHQ-9 (P = 0.001) for anxiety and depression respectively were significantly higher in females. The means of the scales got increased after postings in the corona wards.

CONCLUSION

Concerning the high occurrence of anxiety and fear among health-care professionals, appropriate psychological/psychiatric intervention necessitates and emphasizes the need to implement urgent measures to prevent further progress to severe mental health disorder.

Short-term Prognostic Value of Admission Cardiac Troponin T, C-Reactive Protein and Echocardiographic Regional Wall Motion Abnormalities in Patients with Acute ST Elevation Myocardial Infarction

Introduction: With increasing burden of Coronary Artery Disease (CAD) and ST-Elevation Myocardial Infarction (STEMI) in India, early risk stratification of patients is as important as making a correct diagnosis. Cardiac Troponin T (cTnT), C-Reactive Protein (CRP) and echocardiographic Regional Wall Motion Abnormalities (RWMA) are used to assess the patients of STEMI at presentation. The short term prognostic importance of these parameters also need to be known. Aim: To study the prognostic values of admission Cardiac Troponin T (cTnT), CRP and echocardiographic RWMA in patients with acute STEMI. Materials and Methods: Fifty patients of STEMI were evaluated from January 2017 to July 2017 by Troponin-T (positive >0.18 ng/mL), CRP (positive >3 mg/l) and echocardiography (positive with presence of RWMA) on day one. The patients were divided into three groups: Group 1: patients with all the three parameters positive, Group 2: patients with all three parameters negative, Group 3: patients with one or two parameters positive. The end points observed were heart failure Left Ventricular Ejection Fraction (LV EF) <40%) assessed by echocardiography at day 28, significant ventricular ectopics (>class II by Lown’s classification) and mortality at day 30 in the groups. Chi-square test for equality of proportions was used to analyse the difference in outcome in the groups. Results: The mean age of patients was 54 years. There were 25 (50%) patients in group 1, 14 (28%) patients in group 2 and 11 (22%) patients in group 3. Twelve (24%) patients had heart failure with 9 (18%) in group 1 and 3 (6%) in group 3 (p<0.05). 9 (18%) patients had significant ventricular ectopics with 8 (16%) patients in group 1 and 1 (2%) patients in group 3 (p<0.05). Mortality was found in 9 (18%) patients with 8 (16%) patients in group 1 and 1 (2%) patients in group 3 (p<0.05). Conclusion: Acute STEMI with high cTnT, CRP and presence of RWMA on echocardiography at admission need more aggressive management and close follow-up.

Enhancing early detection of neurological and developmental disorders and provision of intervention in low-resource settings in Uttar Pradesh, India: study protocol of the G.A.N.E.S.H. programme

INTRODUCTION

Around 9% of India's children under six are diagnosed with neurodevelopmental disorders. Low-resource, rural communities often lack programmes for early identification and intervention. The Prechtl General Movement Assessment (GMA) is regarded as the best clinical tool to predict cerebral palsy in infants <5 months. In addition, children with developmental delay, intellectual disabilities, late detected genetic disorders or autism spectrum disorder show abnormal general movements (GMs) during infancy. General Movement Assessment in Neonates for Early Identification and Intervention, Social Support and Health Awareness (G.A.N.E.S.H.) aims to (1) provide evidence as to whether community health workers can support the identification of infants at high-risk for neurological and developmental disorders and disabilities, (2) monitor further development in those infants and (3) initiate early and targeted intervention procedures.

METHODS

This 3-year observational cohort study will comprise at least 2000 infants born across four districts of Uttar Pradesh, India. Community health workers, certified for GMA, video record and assess the infants' GMs twice, that is, within 2 months after birth and at 3-5 months. In case of abnormal GMs and/or reduced MOSs, infants are further examined by a paediatrician and a neurologist. If necessary, early intervention strategies (treatment as usual) are introduced. After paediatric and neurodevelopmental assessments at 12-24 months, outcomes are categorised as normal or neurological/developmental disorders. Research objective (1): to relate the GMA to the outcome at 12-24 months. Research objective (2): to investigate the impact of predefined exposures. Research objective (3): to evaluate the interscorer agreement of GMA.

ETHICS AND DISSEMINATION

G.A.N.E.S.H. received ethics approval from the Indian Government Chief Medical Officers of Varanasi and Mirzapur and from the Ramakrishna Mission Home of Service in Varanasi. GMA is a worldwide used diagnostic tool, approved by the Ethics Committee of the Medical University of Graz, Austria (27-388 ex 14/15). Apart from peer-reviewed publications, we are planning to deploy G.A.N.E.S.H. in other vulnerable settings.

Profiling peripheral B-cell subtypes most predictive for cardiac allograft rejection

Introduction

B-cells have been strongly implicated in cardiac allograft rejection (CAR). Recently, however, the CTOT-11 trial showed that depleting mature CD20+ B-cells did not reduce rates of rejection in cardiac allograft recipients and unexpectedly increased the severity of allograft vasculopathy. Therefore, it can be hypothesized that differing phenotypic subtypes of B-cells correspond with different biological mechanisms relating to CAR. Though, current applications to quantify these subtypes of immune cells, i.e with immunohistochemistry or flow cytometry, are often restricted by limited cell markers and cost-burden; therefore, we demonstrate a novel deconvolution method, FARDEEP, that has been validated to accurately enumerate peripheral blood mononuclear cell-subtypes (PBMCs) in a quicker and more cost-effective manner.

Purpose

To better understand the association of different B-cell subtypes in CAR by identifying the B-cell subtype most predictive for pathologically defined rejection.

Methods

The machine learning tool, FARDEEP, was trained with the transcriptomic signatures of 29 PBMC subtypes, characterized by previous single-cell RNA experiments. FARDEEP then was used to deconvolute data-mined RNA from 259 blood samples from 98 cardiac allograft recipients enrolled in the CARGO study (GSE2445). Random forest tree (RF) was then used to analyze the levels of deconvoluted subtypes to predict the severity of rejection assessed by endomyocardial biopsy. Finally, RF was used to identify the subtypes of PBMCs most valuable in predicting rejection.

Results

Out of the 259 samples with consensus pathological readings, 140 had a consensus International Society of Heart and Lung Transplant grade of 0, 63 with grade 1a, 31 with grade 1b, and 25 with grade 3a or higher. We grouped biopsy samples with grade 0, 1a, and 1b as “low-risk” rejection (n=234). 3a or higher samples were grouped as “high-risk” (n=25). There were no grade 2s in the dataset. According to the dataset, blood was extracted from patients on average 72.5 days post-transplant. The RF had good performance in predicting rejection severity. (Figure 1a) CD20- plasmablast cells were stronger predictors for differentiating high-risk from low-risk compared to CD20+ B-cell populations (i.e B Naive and B Memory cells). (Figure 1b) Overall, however, dendritic cells (DCs), neutrophils, monocytes, and basophils were the strongest predictors for rejection.

Conclusion

Our findings support the results from the CTOT-11 trial showing that CD20+ B-cells may not contribute to CAR as significantly as seen with other PBMC subtypes. Instead, we showed that among B-cells, CD20- plasmablasts were more likely associated with CAR, possibly explaining why targeting CD20 was ineffective in preventing rejection. Thus, targeting plasmablast-associated markers could potentially be more useful to prevent CAR.

Model Performance with Variables

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): 1) Society of Academic Emergency Medicine Foundation; 2) The Jewish Fund

BA3338, a surface layer homology domain possessing protein augments immune response and protection efficacy of protective antigen against Bacillus anthracis in mouse model

AIM

Category A classified Bacillus anthracis is highly fatal pathogen that causes anthrax and creates challenges for global security and public health. In this study, development of a safe and ideal next-generation subunit anthrax vaccine has been evaluated in mouse model.

METHOD AND RESULTS

Protective antigen (PA) and BA3338, a surface layer homology (SLH) domain possessing protein were cloned, expressed in heterologous system and purified by IMAC. Recombinant PA and BA3338 with alum were administered in mouse alone or in combination. The humoral and cell-mediated immune response was measured by ELISA and vaccinated animals were challenged with B. anthracis spores via intraperitoneal route. The circulating IgG antibody titre of anti-PA and anti-BA3338 was found significantly high in the first and second booster sera. A significant enhanced level of IL-4, IFN-γ and IL-12 was observed in antigens stimulated supernatant of splenocytes of PA + BA3338 vaccinated animals. A combination of PA and BA3338 provided 80% protection against 20 LD₅₀ lethal dose of B. anthracis spores.

CONCLUSION

Both antigens induced admirable humoral and cellular immune response as well as protective efficacy against B. anthracis spores.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study has been evaluated for the first time using BA3338 as a vaccine candidate alone or in combination with well-known anthrax vaccine candidate PA. The findings of this study demonstrated that BA3338 could be a co-vaccine candidate for development of dual subunit vaccine against anthrax.

A Rapid Flow through Membrane Enzyme Linked Immunosorbent Assay for Bacillus anthracis using Surface Array Protein as a Biomarker

Anthrax, caused by Bacillus anthracis is an important disease of biowarfare and public health importance. It is imperative to develop a simple system which can detect and differentiate B. anthracis from other closely related species. The surface array protein (Sap), which is secreted during the early growth phase of bacteria can be an important biomarker for detection of B. anthracis. In the present study, we have developed a rapid flow through membrane ELISA for detection of B. anthracis. Polyclonal antibodies were used to develop a sandwich plate ELISA, which could detect 3.9 ng/ml of recombinant Sap. B. anthracis bacteria grown in culture broth could be detected after 5 h of growth. Finally, a rapid flow through membrane ELISA was developed which can be accomplished just within 2 minutes, instead of 3-4 h as required in sandwich plate ELISA. The results established that the developed flow through membrane ELISA may be used for detection of B. anthracis. The proposed method is rapid, safe and user friendly for detection of B. anthracis culture.

Impact of a peer-review network on the quality of inpatient low secure mental health services: cluster randomised control trial

BACKGROUND

Peer-review networks aim to help services to improve the quality of care they provide, however, there is very little evidence about their impact. We conducted a cluster randomized controlled trial of a peer-review quality network for low-secure mental health services to examine the impact of network membership on the process and outcomes of care over a 12 month period.

METHODS

Thirty-eight low secure units were randomly allocated to either the active intervention (participation in the network n = 18) or the control arm (delayed participation in the network n = 20). A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at 12 month follow up. The primary outcome measure was the quality of the physical environment and facilities of the services. The secondary outcomes included: safety of the ward, patient mental wellbeing and satisfaction with care, staff burnout, training and supervision. We hypothesised that, relative to control wards, the quality of the physical environment and facilities would be higher on wards in the active arm of the trial 12 months after randomization.

RESULTS

The difference in the primary outcome between the groups was not statistically significant (4.1; 95% CI [- 0.2, 8.3] p = 0.06). The median number of untoward incidents rose in control services and remained the same at the member of the network (Difference between members and non-members = 0.55; 95% IC [0.29, 1.07] p = 0.08). At follow up, a higher proportion of staff in the active arm of the trial indicated that they felt safe on the ward relative to those in the control services (p = 0.04), despite reporting more physical assaults (p = 0.04). Staff working in services in the active arm of the trial reported higher levels of burnout relative to those in the control group. No difference was seen in patient outcomes.

CONCLUSIONS

We did not find evidence that participation in a peer-review network led to marked changes in the quality of the physical environment of low secure mental health services at 12 months. Future research should explore the impact of accreditation schemes and examine longer term outcomes of participation in such networks.

TRIAL REGISTRATION

ISRCTN79614916 . Retrospectively registered 28 March 2014.

Excision of innumerable hydatid cysts from the myocardium of the left ventricle via the left thoracotomy along with myoplasty on beating heart

Cardiac hydatid cyst is a rare disease with frequency of less than 2%. The left ventricle is the most common site. Symptoms depend upon site of involvement ranging from asymptomatic to acute coronary syndrome, arrhythmias, valvular lesions, etc. It is a surgical emergency, therefore early diagnosis and surgical treatment is required even in asymptomatic patients. Surgical excision on beating heart along with preparedness with cardiopulmonary bypass and fibrillator via left anterolateral thoracotomy can be done successfully, followed by medical treatment with albendazole. Increased awareness and high degree of suspicion among cardiac physicians in the endemic area is essential for early diagnosis. Echocardiography remains the gold standard for diagnosis and follow-up of patient.

Nationwide Cancer Control Program in India: 3 Decades of Experience With Fundraising Report

Amount raised: In last decade INR 169,708,369 mobilized through sponsored cancer awareness programs. Background and context: With an eagle's eye our vision of eighties resulted in the incorporation of Cancer Aid Society on 8th of December 1987 at Lucknow. Founders of the Cancer Aid Society perceived the threats early and initiated the fight against cancer by developing a self-sustainable model without external financial assistance unfurling series of events internationally. As of now ours is a holistic model on cancer prevention integrated with NCDs, tobacco and palliative care demonstrating replicability within different communities and scalability across the worlds largest democracy having its own network of branches. Aim: Self-sustainable model prevention and control of tobacco, cancer integrated with other NCDs, palliative care and advocacy. Strategy/Tactics: Sponsored cancer awareness programs are organized free of cost in schools and colleges however we accept voluntary donations from the community if any. As schools have contact with the child and their family from kindergarten to senior secondary, they inculcate the spirit of humanitarianism and work for social amelioration improving the overall health of the citizens strengthening the fight against cancer. It covers the need of the current and future generations on cancer control. Program process: Keeping with the ages old adage “Prevention Is Better Than Cure” thousands of community awareness campaigns are organized in educational Institutions every year by mobilizing a million volunteers who generate awareness among twenty million people all over India on health, hygiene, tobacco abuse including passive smoking, carcinogens, balanced diet, regular exercise, obesity, clean drinking water, pollution of air, water and land etc. This plays an integral part in inculcating healthy lifestyle and keeping children away from tobacco at an age when they are vulnerable and tempted the most further grooming our future generation when they are most receptive and in the process of developing habits. They multiply awareness manifold improving the overall health of the community. Costs and returns: As the program follows an integrated and holistic approach on prevention and control of cancer and other NCDs virtually it lacks any administrative costs and offers 100% returns on investments. In last decade INR 144,968,969 spent in sponsored cancer awareness programs. What was learned: With our 30 years of experience of working at grass root community level all across India in spite of regional complexities in terms of multiple languages, cultures, castes, religions etc. ISO 9001 NGO accreditation has given us teeth since 2004 streamlining our functioning through documentation and continuous improvement program through reporting monitoring and feedback. As of now we are ready to share our experiences at international level.

Advocacy for Early Detection and Treatment of Cervix and Breast Cancer

Background and context: According to ICO Information Centre on HPV and Cancer (HPV Information Centre) 2014 in females with 23.8% breast cancer is highest and at 20.2% cervix cancer comes at number 2 in India. India has a population of 432.20 million women aged 15 years and older who are at risk for developing cervical cancer. Current estimates indicate that every year 122,844 women are diagnosed with cervical cancer and 67,477 die of the disease. Cervical cancer in India ranks as the 2nd most frequent cancer among women between 15 and 44 years of age. Aim: Accessibility for the early detection of cervix and breast cancer for the females in Uttar Pradesh. Strategy/Tactics: Lucknow is the capital city of Uttar Pradesh the most populous State of India having 1/6 of population and equivalent burden of cervical cancer. Any action aimed at an effect in Lucknow shall further have impact in the entire state. Advocacy training was organized at Lucknow on the occasion of “World Cancer Day” (4th February) with material for capacity building of organizations working on cervical cancer and female health. We were able to mobilize 10 different organizations working for cervical cancer and female health issue. Presence of Hon'ble Governor and Principal Health Secretary enabled us in making a dent on the issue from the very beginning. His Excellency the Governor of Uttar Pradesh being a cancer survivor was the best advocate, stressing during the lecture on the need to address the issue. Principal Health Secretary, the ultimate deciding authority for developing the policies assured for full cooperation and early action. Program/Policy process: Principal Health Secretary of Government of Uttar Pradesh announced to establish the screening clinics forscreening of cervical cancer in 23 districts of Uttar Pradesh. Treatment facilities would be provided in all the government medical colleges of Uttar Pradesh. The clinic set up shall be monitored by National Health Mission Unit of Uttar Pradesh. Outcomes: Currently Sampoorna clinics are established in 28 districts of Uttar Pradesh which is for females of age group 15 to 60 years for all kind of screening, advice and treatment. What was learned: For advocacy we need ground work to be done before meeting to any policy maker to influence the policy. Different organization working on the same or related issues has to bring together to strengthen the impact.

Impact of peer-led quality improvement networks on quality of inpatient mental health care: study protocol for a cluster randomized controlled trial

BACKGROUND

Quality improvement networks are peer-led programmes in which members of the network assess the quality of care colleagues provide according to agreed standards of practice. These networks aim to help members identify areas of service provision that could be improved and share good practice. Despite the widespread use of peer-led quality improvement networks, there is very little information about their impact. We are conducting a cluster randomized controlled trial of a quality improvement network for low-secure mental health wards to examine the impact of membership on the process and outcomes of care over a 12 month period.

METHODS

Standalone low secure units in England and Wales that expressed an interest in joining the quality improvement network were recruited for the study from 2012 to 2014. Thirty-eight units were randomly allocated to either the active intervention (participation in the network n = 18) or a control arm (delayed participation in the network n = 20). Using a 5 % significance level and 90 % power, it was calculated that a sample size of 60 wards was required taking into account a 10 % drop out. A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at follow up. Researchers masked to the allocation status of the units assessed all study outcomes at baseline and follow-up 12 months later. The primary outcome is the quality of the physical environment and facilities on the wards. The secondary outcomes are: safety of the ward, patient-rated satisfaction with care and mental well-being, staff burnout, training and supervision. Relative to control wards, it is hypothesized that the quality of the physical environment and facilities will be higher on wards in the active arm of the trial 12 months after randomization.

DISCUSSION

To our knowledge, this is the first randomized evaluation of a peer-led quality improvement network that has examined the impact of participation on both patient-level and service-level outcomes. The study has the potential to help shape future efforts to improve the quality of inpatient care.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN79614916 . Retrospectively registered 28 March 2014].

Early demographic and clinical predictors of developing acute kidney injury in snake bite patients: A retrospective controlled study from an Indian tertiary care hospital in North Eastern Uttar Pradesh India

Aims:

This study was conducted retrospectively to define early demographic and clinical predictors for acute kidney injury (AKI) among snake bite patients at the time of hospital admission.

Materials and Methods:

We analyzed 138 cases with a poisonous snake bite. Patients were classified into two groups according to the presence and absence of AKI. The data regarding clinical features and demographic profile of these patients were collected from the hospital records in a prestructured pro forma and statistically compared.

Results:

Of the 138 patients of venomous snake bite, 62 developed AKI (44.92%). Patients who developed AKI were older in age. Moreover, prolonged bite to anti-snake venom (ASV) time had a significant relationship in developing AKI (P < 0.05). Among the clinical features, there was an independent positive association of AKI with abdomen pain, tenderness and vomiting, cellulitis, bleeding tendencies, myalgia, and black or brown urine (P < 0.05). Neurological features were inversely associated with renal involvement.

Conclusion:

We found that marked abdominal pain, tenderness and vomiting, myalgia, black or brown urine, bite site cellulitis, bleeding tendencies, and prolonged (>2 h) bite to ASV time were significantly associated with the development of AKI in snake bite patients.

Early evaluation of voice quality in glottic cancer (T1, T2) following curative radiotherapy

BACKGROUND

This is prospective study analyzing the subjective and objective quality of voice and voice related quality of life in patients of early glottic cancer (T1, T2 disease) before and after receiving curative radiotherapy.

METHODS

Fifteen patients of early glottic carcinoma (T1, T2) underwent voice assessment using multidimensional voice protocol based on recommendation by European Laryngological Society which included Perceptual analysis of voice by speech therapist and otolaryngologist, acoustic analysis; aerodynamic efficiency analysis-Maximum phonation time; patient's self perception of voice analysis--Voice handicap index; and videolaryngostroboscopy. Assessment was done prior to commencement of radiation therapy and at 1 month and 3 months following radio- therapy.

RESULTS

There was significant improvement in majority of the voice parameters post radiotherapy. Perceptual analysis showed significant improvement in GRBAS score following radiotherapy. Perturbation measures (jitter, shimmer, SNR, HNR) showed improvement post radiotherapy though remained inferior compared to controls. Mean fundamental frequency (Mean F0) and habitual frequency (habitual F0) decreased post radiotherapy. Intensity of voice increased following radiotherapy which was statistically significant (p < 0.05). There was significant improvement in the patient's perception of their quality of voice and voice related quality of life post radiotherapy. Maximum phonation time showed statistically significant improvement post-radiotherapy. Perceptual analysis of voice by professional observer correlated well with patients self perception of his own voice.

CONCLUSION

Voice quality improves following radiotherapy but not all the patients regain normal voice. Improvement in voice quality improves quality of life of patients shown by improved voice handicap index.

Ancient science of yogic life for academic excellence in university students

Background:

Academic excellence is essential to provide opportunities for students to work together to improve their understanding of concepts in their academic core. Academic excellence helps students to teach problem-solving and collaborative learning strategies.

Objective:

The objective of this study was to assess Guna (personality traits) in students undergoing Yoga Instructor's Course (YIC).

Materials and Methods:

In all, 68 YIC students with a mean age of 28.03 ± 9.38 years participated in this single group pre–post study. The Personality Inventory data were collected before (pre) and after (post) the YIC.

Statistical Analysis:

Means, standard deviations, Kolmogorov–Smirnov test, and Wilcoxon signed rank test were used for analyzing the data with the help of SPSS 16.

Results:

The data analysis showed 11.33% decrease (P < 0.01) in Tamas Guna (dull personality trait), 0.68% decrease (P =0.819) in Rajas Guna (violent personality trait), and 10.34% increase (P <0.01) in Sattva Guna (balanced personality trait) scores.

Conclusion:

This study suggests that YIC can result in the improvement of Sattva Guna (balance personality trait) among students, thus paving the way for their academic excellence.

Characterization of different road dusts in opencast coal mining areas of India

Dust from haul and transport roads are the major source of air pollution in opencast coal mining areas. Dust generated during mining operations pollutes air which causes different health problems. Various available techniques are implemented in the field to minimize and control dust in mining areas. However, they are not very effective because dust deposited on road surfaces are not removed by these techniques. For effective control of dust in opencast mining areas, it has to be regularly collected from road surfaces and may be converted into solid form, and subsequently can be used as a domestic fuel considering its physicochemical properties. The present paper describes a comparative study of qualitative and quantitative aspects of road dust samples of four coalfields of India. The pH of the dust was found to be in the range of 5.1-7.7. Moisture, ash, volatile matter, fixed carbon, water-holding capacity, bulk density, and specific gravity of dust samples were found to be in the range of 0.5-3.0%, 45-76%, 12.6-20.0%, 10.2-45.3%, 21.17-31.71%, 1.15-1.70, and 1.73-2.30 g cm(-3), respectively. Observing the overall generation and characteristics of coal dust, it is suggested that coal dust from haul and transport roads of mining areas can be effectively collected and used as domestic fuel.

Impact of post-mining subsidence on nitrogen transformation in southern tropical dry deciduous forest, India

The goal of our research was to assess the impact of post-mining land subsidence, caused due to underground coal mining operations, on fine root biomass and root tips count; plant available nutrient status, microbial biomass N (MBN) and N-mineralization rates of a Southern tropical dry deciduous forest of Singareni Coalfields of India. The changes were quantified in all the three (rainy, winter and summer) seasons, in slope and depression microsites of the subsided land and an adjacent undamaged forest microsite. Physico-chemical characteristics were found to be altered after subsidence, showing a positive impact of subsidence on soil moisture, bulk density, water holding capacity, organic carbon content, total N and total P. The increase in all the parameters was found in depression microsites, while in slope microsites, the values were lower. Fine root biomass and root tips count increased in the subsided depression microsites, as demonstrated by increases of 62% and 45%, respectively. Soil nitrate-N and phosphate-P concentrations were also found to be higher in depression microsite, showing an increase of 35.68% and 24.74%, respectively. Depression microsite has also shown the higher MBN value with an increase over control. Net nitrification, net N-mineralization and MBN were increased in depression microsite by 29.77%, 25.72% and 34%, respectively. There was a positive relation of microbial N with organic C, fine root biomass and root tips.

Toxic effects of arsenic (III) on some hematopoietic and central nervous system variables in rats and guinea pigs

OBJECTIVE

To evaluate the effects of arsenic (III) exposure on porphyrin metabolism and the central nervous system supplemented with data on the effect of hepatic and renal tissues of rats and guinea pigs.

METHODS

Rats and guinea pigs were exposed to 10 or 25 ppm arsenic in drinking water for 16 weeks.

RESULTS

Following chronic arsenic (III) exposure, delta-aminolevulinic acid dehydratase activity in blood showed a significant reduction as did the total cell counts (RBC and WBC) and reduced glutathione with increased urinary delta-aminolevulinic acid. Zinc protoporphyrin, a sensitive indicator of iron deficiency and impairment of heme biosynthesis, showed a significant increase in arsenic exposure. The hepatic delta-aminolevulinic acid dehydratase and delta-aminolevulinic acid synthetase activity increased in chronic arsenic (III) exposure in rats and guinea pigs. Significant changes in the steady-state level of three major neurotransmitters, dopamine, norepinephrine, and 5-hydroxytryptamine, and monoamine oxidase were observed following chronic arsenic (III) exposure.

CONCLUSION

At low doses (10 and 25 ppm in drinking water), the effects of arsenic on hematopoietic indices and whole-brain neurotransmitter concentrations were more prominent in guinea pigs than in rats with some variability in the dose response.

Short-term (48 hours) versus long-term (7 days) antibiotic prophylaxis for permanent pacemaker implantation

BACKGROUND

Infection following permanent pacemaker implantation is a dreaded complication. Antibiotic prophylaxis for 1-10 days at the time of implant has been used in the past but there is no consensus regarding its duration. We carried out a prospective, randomized study of two durations of antibiotic prophylaxis to determine which one was more effective.

METHODS AND RESULTS

One hundred and seventy-eight patients undergoing permanent pacemaker implantation for the first time were randomized to receive short duration (group A, n = 8 8) or longer duration (group B, n = 90) antibiotic prophylaxis for 2 days and 7 days, respectively. Patients in both groups received cloxacillin 2 g 2 hours prior to the procedure followed by ampicillin and cloxacillin (50 mg/kg/day in 4 divided doses) and gentamicin (3 mg/kg/day in 2 divided doses) for the respective duration. Patients were followed up for 1-17.3 months (9.3 +/- 1.8 months) in group A and 1-16.5 months (8.9 +/- 2 months) in group B. One patient in group B had an infection at the pacemaker site and two patients in each group had to undergo reimplantation due to pus in the pocket. There was no significant difference in the primary end-point in both groups.

CONCLUSIONS

A short course (48 hours) of antibiotic prophylaxis following permanent pacemaker implantation is as effective as a longer course (7 days).

Left ventricular pacing through coronary sinus tributaries: initial experience

BACKGROUND

Left ventricular pacing is increasingly being used as a part of biventricular pacing in congestive heart failure but data on safety, feasibility, reliability and lead maturation are sparse.

METHODS AND RESULTS

Seventeen patients (13 males and 4 females) with persistent symptomatic degenerative complete heart block underwent temporary left ventricular pacing by a left subclavian puncture through the coronary sinus to its tributaries using a unipolar permanent pacing lead connected to an external pulse generator. The left ventricular pacing was done for two weeks. Permanent right ventricular apical pacing was also done at the same time through a right cephalic vein cut-down or subclavian puncture and the pacing rate was kept below that of the initial left ventricular pacing rate. Pacing parameters of the left and right ventricles were assessed at the time of implantation and at two weeks. Out of 17 patients, left ventricular pacing was successful in 11 (67.7%) patients. The time taken for the total procedure was 56+/-18.1 min. Lead displacement was noted in one patient without loss of pacing. At the time of implant and after two weeks, left ventricular pacing threshold, impedance, R wave height and slew rate were not different as compared to right ventricular pacing. Holter recording for 24 hours revealed regular left ventricular pacing at the end of two weeks in all patients.

CONCLUSIONS

The present study shows that left ventricular pacing through coronary sinus tributaries is feasible and reliable. Acute and subacute maturation of left ventricular pacing are similar to right ventricular apical pacing.

Hepatic and renal metallothionein induction following single oral administration of gallium arsenide in rats

Metallothionein genes (MT) are inducible by a variety of agents, including heavy metals. We report the induction of MT expression by gallium arsenide (GaAs), a superior intermetallic semiconductor material at two time intervals following single oral exposure in rats. The data is also supplemented with two additional groups exposed to gallium (III) as gallium oxide and arsenic (III) as sodium arsenite to determine which of the two moieties in GaAs is responsible for any such possible effects. The results indicate that GaAs administration does significantly induces MT in hepatic tissues accompanied by an increase in cytosolic glutathione, arsenic, zinc and copper concentration. It thus proves that arsenic moiety is chiefly responsible for such an effect.

Effects of thiamin and methionine administration in preventing cadmium-induced biochemical alterations and metal concentration in male rats

Thiamin or methionine supplementation was equally and moderately effective in preventing the accumulation of cadmium in soft organs and alterations in a few selected biochemical indices during concomitant administration. Adequate intake of sulfur amino acid following methionine supplementation might increase the bioavailability of glutathione, facilitating the prevention of the binding of cadmium to different compartments and consequently reversing cadmium-induced biochemical disorders. In the case of thiamine the possibility of formation of a readily excretable complex between cadmium and thiamine or an increase in the body's resistance to cadmium might be the beneficial factor.

Effects of some thiol chelators on enzymatic activities in blood, liver and kidneys of acute arsenic (III) exposed mice

The effects of meso 2, 3-dimercaptosuccinic acid (DMSA), sodium 2, 3-dimercaptopropane 1-sulfonate (DMPS) and S-adenosyl L-methionine (SAM) on the enzymatic activities of mice were studied. The mice were given intraperitoneal (i.p.) injections of these chelating agents (1 mmol/kg) and 3 h later the activity of delta-aminolevulinic acid dehydratase (ALAD) in the blood, and aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyltranspeptidase (gamma-GT), alkaline phosphatase (ALP) in the liver and kidney were determined. The activity of blood ALAD was significantly increased by the administration of DMSA and SAM while DMPS had only a moderate effect. The activities of other hepatic enzymes changed little when the mice were treated with these chelating agents, except for a significant reduction in hepatic ALP activity following DMPS administration. Arsenic (III) administration markedly increased the activities of ALT and ALP in the liver and kidneys. The changes in the enzymatic activities by treatment with arsenic were prevented by injection of DMSA, DMPS and SAM, DMSA being the most effective. These results indicate that DMSA, DMPS and SAM were not toxic to the liver or kidneys of mice and that treatment with DMSA is more effective than DMPS or SAM in protecting mice from acute hepatic or renal toxicity caused by arsenic.

Arsenic-induced changes in certain neurotransmitter levels and their recoveries following chelation in rat whole brain

Arsenic as sodium arsenite (100 ppm in drinking water) was administered to male rats for 16 weeks. Animals were then treated either with meso-2,3-dimercaptosuccinic acid (DMSA), sodium 2,3-dimercaptopropane 1-sulfonate (DMPS), dimethyl DMSA (DmDMSA), or diisopropyl DMSA (DiPDMSA) twice daily (50 mg/kg) intraperitoneally for 5 days. After 5 days of rest period, the animals were again given a second course of chelation therapy. The animals were sacrificed subsequently for the determination of whole brain biogenic amines levels, acetylcholinesterase (AChE), monoamine oxidase (MAO) and delta-aminolevulinic acid dehydratase (ALAD) activities. A number of biochemical parameters and arsenic concentrations in some tissues were also determined. The results suggest a significant increase in brain arsenic concentration accompanied by alterations in neurotransmitters levels following As(III) exposure. Although chelation treatment was effective in reducing As burden, the altered biochemical variables responded less favorably to chelation therapy. The DMSA-diesters, particularly DiPDMSA, produced a more pronounced increase in brain arsenic burden, as well as alterations in a few neurotransmitters. It can be concluded that the lipophilic character of As antidotes may lead to unfavorable results following intraperitoneal administration.

Sequential MTX-5 FU chemotherapy in pallination of advanced cancer cervix

Twenty four patients with advanced cancer of cervix were submitted to sequential chemotherapy 5FU and MTX. The response rate was 85% in stage III and 50% in stage IV. Overall response rate was 75%. Patients who had not received radiotherapy earlier responded better than those who had received it earlier. This easy and economical modality has importance in view of late reporting and advanced stage of disease encountered in our set up.

Peri-operative oxytetracycline in prophylaxis of surgical wound infections

Experience with peri-operative oxytetracycline coverage in prevention of wound infection following elective surgery is presented; of 150 cases included in control group 21 developed infection (14%), whereas only 4 of the study group (170 cases) had infection (2.5%). The importance of peri-operative antibiotic umbrella is emphasised and some of the shortcomings of recommended schedule is highlighted.