Revolutionizing transdermal drug delivery: unveiling the potential of cubosomes and ethosomes

The area of drug delivery systems has witnessed significant advancements in recent years, with a particular focus on improving efficacy, stability, and patient compliance. Transdermal drug delivery offers numerous benefits compared to conventional methods of drug administration through the skin. It helps in avoiding gastric irritation, hepatic first-pass metabolism, and gastric degradation of the drug. It bypasses the gastrointestinal tract, eliminating the risk of first-pass metabolism and allowing drugs to be administered without being affected by pH, enzymes, or intestinal bacteria. Additionally, it allows for sustained release of the drug, is noninvasive, and enhances patient adherence to the treatment regimen. The transdermal drug delivery system (TDDS) can serve as an alternative route for drug administration in individuals who cannot tolerate oral medications, experience nausea, or are unconscious. When compared to intravenous, hypodermic, and other parenteral routes, TDDS stands out due to its ability to eliminate pain, reduce the risk of infection, and prevent disease transmission associated with needle reuse. Consequently, the overall patient compliance is significantly improved with the utilization of TDDS. Among the noteworthy developments are cubosomes and ethosomes, two distinct yet promising carriers that have garnered attention for their unique properties. In conclusion, this review synthesizes the current knowledge on cubosomes and ethosomes, shedding light on their individual strengths and potential synergies. The exploration of their application in various therapeutic areas underscores their versatility and establishes them as key players in the evolving landscape of drug delivery systems.

A Tête-à-tête with ChatGPT on the impact of artificial intelligence in medical education

Chat Generative Pre-Trained Transformer (ChatGPT) is an artificial intelligence (AI) language model developed by OpenAI. It is trained to process vast amounts of text and engage in human-like conversational interaction with users. Being accessible by all, it is widely used and its capabilities range from language translation, summarising long texts and creative writing. This article explores the potential role of ChatGPT in medical education and the possible concerns about the misuse of this technology through a conversation with ChatGPT itself via text prompts. The implications of this technology in medical education as told by ChatGPT are interesting and seemingly helpful for both the students and the tutors. However, this could be a double-edged sword considering the risks of compromised students' integrity and concerns of over-reliance. This also calls for counter strategies and policies in place to mitigate these risks.

Perception and use of reversible contraceptive methods in Germany: A social listening analysis

BACKGROUND

With an increasing array of contraceptives in the market, it is important to understand how users perceive them and how their interests evolve over time.

OBJECTIVES

In this analysis, we aimed to examine the contraceptive interests of women and couples in Germany using data derived from social media posts.

STUDY DESIGN

Social listening analysis.

METHODS

Posts from Urbia-a German Internet community-mentioning at least one reversible contraceptive method between April 2006 and April 2021 were carefully selected by searching for a defined set of keywords and phrases. The frequency of mention of each method was studied and their trend over the last 5 years was analyzed. The significance of trends was evaluated using Mann-Kendall test. Additionally, 656 random posts were individually assessed for method transitions and problems associated with specific contraceptives.

RESULTS

The contraceptive pill was the most frequently mentioned method of contraception followed by natural family planning methods, condom, hormonal coil, and copper/gold coil. Although general interest in hormonal contraception was higher compared to non-hormonal, interest in the pill decreased and interest in natural family planning and copper/gold coil increased. Most women switched from the pill to non-hormonal methods, almost half of them using a condom. Almost all migrations to natural family planning were from the pill and most migrations to non-hormonal intrauterine devices such as the coil were from hormonal methods. The common problem associated with most contraceptives was side effects.

CONCLUSION

Social media provides valuable information about contraceptive experiences that can be used to monitor contraceptive prevalence patterns and attitudes within a large population in a very short span of time. A good understanding of how various contraceptives are currently perceived helps in identifying strategies for improving existing family planning policies.

PLAIN LANGUAGE SUMMARY

Currently, there are a variety of contraceptive products available in the market. To understand how users perceive them and how their interest evolves over time, we analyzed social media posts from Urbia, a German Internet platform. We scraped posts between 2016 and 2021 from the "child-desire" and "contraception" forums and analyzed the relative frequency of mentions of different contraceptive methods. We also looked at 1000 individual posts from 1000 different users, analyzed method switches and the problems associated with individual methods of use. The oral pill was the most frequently mentioned method of contraception followed by natural family planning methods, condom, hormonal coil, and copper/gold coil. Over the last 5 years however, the mention of the pill dropped, whereas the mentions of natural family planning and copper or gold coil increased. Further analysis of individual posts showed most women migrating from the pill to other non-hormonal methods such as natural family planning and condom. Almost all migrations to natural family planning were from the pill and most migrations to non-hormonal intrauterine devices such as the coil were from hormonal methods. The most common problem associated with the pill and non-hormonal intrauterine devices was side effects. Through this analysis we show that social media serves as a useful tool to monitor contraceptive prevalence and attitudes within a large population in a very short span of time. Our findings give policy makers an idea on the topics where more counseling and education may be required to help women and couples find their best suited method of contraception.

Correlation and differences of patient-reported outcomes vs. Likert-Rating of MS symptoms in a real-world cohort using a digital patient app

Background

Multiple Sclerosis (MS) is a chronic and progressive neurological autoimmune disease currently affecting 250,000 individuals in Germany. Patients suffering from the disease can be severely impaired in their day-to-day activities. BRISA is a digital app specifically designed to help MS patients monitor their disease by regularly tracking symptoms. Lengthy and time-consuming questionnaires for patient-reported outcomes (PRO) are the standard method to assess the patients' current condition. Here, we examine whether simplified versions of these questionnaires can provide comparable information regarding individual symptom presentations in BRISA users.

Methods

828 users were included in the analysis. Patients who provided onboarding information and answered at least one questionnaire and the corresponding simplified smiley symptoms assessment were included. Correlation of questionnaire and symptom scores was calculated using Pearson's correlation.

Results

Our analysis cohort predominantly consisted of female, 26-55-year-olds. Relapsing-remitting MS (RRMS) was the most common MS type recorded. Most patients were diagnosed 2-5 years ago. Questionnaires regarding fatigue and vision impairment were among the most answered, those regarding bowel movement and sexual satisfaction received fewest responses. Overall, the scores from questionnaires and symptoms correlated positively. Scoring correlation could also be shown across the subgroups divided by gender, age groups, type of MS, and time since diagnosis of the disease.

Conclusion

Scores recorded from traditional PRO questionnaires can be reflected more easily as a trend in a simplified scale using smileys. Nevertheless, traditional questionnaires are needed to also maintain a more objective assessment. In conclusion, the patient will benefit most from an adaptive combination of regular traditional PRO questionnaire assessments and simplified symptom recording.

Highly efficient microencapsulation of phytonutrients by fractioned cellulose using biopolymer complexation technology

A poorly water soluble polar and non-polar bioactive complexes encapsulated in a nanocellulose-based polymeric network are the focus of this research. Ascorbic acid, resveratrol, holy basil extract, pomegranate extract, and niacin are all microencapsulated bioactive complexes that make up Zetalife^®, a nutritional ingredient. It uses an interpenetrating polymeric network (IPN) with more dispersed nanocellulose and phospholipids to increase Zetalife^® s bioavailability. Field Emission Scanning Electron Microscopic (FESEM) images were used in studying the morphology of encapsulated bioactive molecules. The average microbead size was determined to be 244.2 nm. After each month of storage, the sample's microbial content was measured to assess stability. In vitro release followed a first-order kinetic model with high R².

Demographic Patterns of MS Patients Using BRISA: An MS-Specific App in Germany

Background: Multiple sclerosis (MS) is a chronic, progressive neurological autoimmune disease impacting quality of life. BRISA is an app designed to help MS patients in Germany track their disease course by symptom-monitoring. This study aimed to understand demographic and health-related characteristics of BRISA users. Methods: Demographic data provided by 2095 users were analyzed to describe characteristics such as sex, age, type of MS, and medication. The distribution of tracked symptoms based on age and time since diagnosis were studied. Furthermore, the covariance of specific symptom pairs was analyzed. Results: BRISA users are predominantly female and between 26 and 55 years old. Relapsing–remitting MS was the most prevalent form of MS. First-line category 1 drugs were most frequently used, followed by high-efficacy category 3 drugs (e.g., monoclonal antibodies). The relative frequencies of use of category 1 and category 2 drugs (e.g., spingosine-1-phosphate-receptor modulators) significantly altered with time since diagnosis. Fatigue, concentration disorders, tingling, forgetfulness, and pain were the top five symptoms affecting users. Conclusion: The results highlight the diversity among MS patients and the need for extensive cohort characterization in the real-world scenario. In-depth analysis could help in identifying novel insights that could aid in disease management.

Lung Cancer Detection and Improving Accuracy Using Linear Subspace Image Classification Algorithm

The ability to identify lung cancer at an early stage is critical, because it can help patients live longer. However, predicting the affected area while diagnosing cancer is a huge challenge. An intelligent computer-aided diagnostic system can be utilized to detect and diagnose lung cancer by detecting the damaged region. The suggested Linear Subspace Image Classification Algorithm (LSICA) approach classifies images in a linear subspace. This methodology is used to accurately identify the damaged region, and it involves three steps: image enhancement, segmentation, and classification. The spatial image clustering technique is used to quickly segment and identify the impacted area in the image. LSICA is utilized to determine the accuracy value of the affected region for classification purposes. Therefore, a lung cancer detection system with classification-dependent image processing is used for lung cancer CT imaging. Therefore, a new method to overcome these deficiencies of the process for detection using LSICA is proposed in this work on lung cancer. MATLAB has been used in all programs. A proposed system designed to easily identify the affected region with help of the classification technique to enhance and get more accurate results.

User-centric framework to facilitate trust worthy cloud service provider selection based on fuzzy inference system

The widespread adoption of cloud computing by several companies across diverse verticals of different sizes has led to an exponential growth of Cloud Service Providers (CSP). Multiple CSPs offer homogeneous services with a vast array of options and different pricing policies, making the suitable service selection process complex. Our proposed model simplifies the IaaS selection process that can be used by all users including clients from the non-IT background. In the first phase, requirements are gathered using a simple questionnaire and are mapped with the compute services among different alternatives.In the second phase, we have implemented the Sugeno Fuzzy inference system to rank the service providers based on the QoS attributes to ascertain the appropriate selection. In the third phase, we have applied the cost model to identify the optimal CSP. This framework is validated by applying it for a gaming application use case and it has outperformed the online tools thus making it an exemplary model.

Treatment of triclosan through enhanced microbial biodegradation

Triclosan (TCS) is extensively used in healthcare and personal care products as an antibacterial agent. Due to the persistent and toxic nature of TCS, it is not completely degraded in the biological wastewater treatment process. In this research work, identification of TCS degrading bacteria from municipal wastewater sludge and applying the same as bioaugmentation treatment for wastewater have been reported. Based on the 16S rRNA analysis of wastewater sludge, it was found that Providencia rettgeri MB-IIT strain was active and able to grow in higher TCS concentration. The identified bacterial strain was able to use TCS as carbon and energy source for its growth. The biodegradation experiment was optimized for the operational parameters viz. pH (5-10), inoculum size (1-5% (v/v)) and different initial concentration (2, 5, and 10 mg/L) of TCS. During the TCS degradation process, manganese peroxidase (MnP) and laccase (LAC) enzyme activity and specific growth rate of P. rettgeri strain were maximum at pH=7% and 2% (v/v) inoculum size, resulting in 98% of TCS removal efficiency. A total of six intermediate products were identified from the Liquid chromatography-high-resolution mass spectrometry (LC-HRMS) analysis, and the two mechanisms responsible for the degradation of TCS have been elucidated. The study highlights that P. rettgeri MB-IIT strain could be advantageously used to degrade triclosan present in the wastewater.

Echocardiographic Indicators Associated with Adverse Clinical Course and Cardiac Sequelae in Multisystem Inflammatory Syndrome in Children with Coronavirus Disease 2019

Background

Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 causes significant cardiovascular involvement, which can be a determinant of clinical course and outcome. The aim of this study was to investigate whether echocardiographic measures of ventricular function were independently associated with adverse clinical course and cardiac sequelae in patients with MIS-C.

Methods

In a longitudinal observational study of 54 patients with MIS-C (mean age, 6.8 ± 4.4 years; 46% male; 56% African American), measures of ventricular function and morphometry at initial presentation, predischarge, and at a median of 3- and 10-week follow-up were retrospectively analyzed and were compared with those in 108 age- and gender-matched normal control subjects. The magnitude of strain is expressed as an absolute value. Risk stratification for adverse clinical course and outcomes were analyzed among the tertiles of clinical and echocardiographic data using analysis of variance and univariate and multivariate regression.

Results

Median left ventricular apical four-chamber peak longitudinal strain (LVA4LS) and left ventricular global longitudinal strain (LVGLS) at initial presentation were significantly decreased in patients with MIS-C compared with the normal cohort (16.2% and 15.1% vs 22.3% and 22.0%, respectively, P < .01). Patients in the lowest LVA4LS tertile (<13%) had significantly higher C-reactive protein and high-sensitivity troponin, need for intensive care, and need for mechanical life support as well as longer hospital length of stay compared with those in the highest tertile (>18.5%; P < .01). Initial LVA4LS and LVGLS were normal in 13 of 54 and 10 of 39 patients, respectively. There was no mortality. In multivariate regression, only LVA4LS was associated with both the need for intensive care and length of stay. At median 10-week follow-up to date, seven of 36 patients (19%) and six of 25 patients (24%) had abnormal LVA4LS and LVGLS, respectively. Initial LVA4LS < 16.2% indicated abnormal LVA4LS at follow-up with 100% sensitivity.

Conclusion

Impaired LVGLS and LVA4LS at initial presentation independently indicate a higher risk for adverse acute clinical course and persistent subclinical left ventricular dysfunction at 10-week follow-up, suggesting that they could be applied to identify higher risk children with MIS-C.

Does Premature Ventricular Contractions Affect Exercise Capacity in Teenagers with Normal Hearts?

Premature ventricular contractions (PVCs) are common in teenagers even in the absence of structural heart disease or channelopathy. The suppression of PVCs with exercise is a favorable prognostic indicator. There is a paucity of data regarding the relationship between exercise capacity and PVC burden in this population. Our objective was to evaluate the association between various exercise stress parameters and PVC burden ascertained with a 24 h Holter in children without structural heart disease and/or channelopathy. In this retrospective study, 447 patient's charts with a diagnosis of PVC were reviewed at a single tertiary center. The study cohort consisted of ninety one patients with no structural heart disease or channelopathy who underwent an echocardiogram, maximal stress test, and 24 h Holter monitor. The cohort was divided into two groups based on PVC burden by 24-h Holter monitoring: < 10% and ≥ 10%. Peak oxygen uptake (VO₂ in ml/kg/min), an indicator of maximal aerobic capacity, was collected. Other exercise parameters included a) percentage of predicted VO₂ (%VO₂) based on age, weight, height, and gender b) percent oxygen pulse, c) Anaerobic threshold (AT), and d) Metabolic equivalents. Demographic and exercise stress test-derived parameters were compared between the two groups using student t test and a p value < 0.05 was considered significant. In our cohort of 91 patients, the mean (SD) age at exercise was 14.5 (3.2) years with 56 (62%) males. Left ventricle shortening fraction (LVFS) was ≥ 28% in all enrolled patients. PVCs were monomorphic in 72(80%) patients. The mean (SD) PVC burden was 14.43% (12.3) ranging from 0.1 to 49.8%. PVC burden was ≥ 10% in 48 (53%) patients. Eighty eight (97%) patients in the study cohort had suppression of PVCs with exercise. There were no significant differences between the two groups (< 10% vs. ≥ 10% PVC burden) with respect to demographic or exercise test-derived parameters. Univariate regression between PVC burden and %VO₂ did not show significant correlation (r = - 0.04, p = 0.75). Children even with ≥ 10% PVC burden did not demonstrate any objective decrease in their exercise capacity. A plausible reason for no difference in exercise capacity in our cohort may be due to lower PVC load or shorter duration of PVCs compared to adults.

Evaluation and clinical comparison studies on liposomal and non-liposomal ascorbic acid (vitamin C) and their enhanced bioavailability

The aim of this study was to evaluate the oral bioavailability of liposomal vitamin C and non-liposomal vitamin C in healthy, adult, human subjects under fasting conditions through an open label, randomized, single-dose, two-treatment, two-sequence, two-period, two-way crossover, study. The vitamin C loaded liposome was well characterized using transmission electron microscopy (TEM), dynamic light scattering (DLS) and zeta potential measurements for evaluating morphology, particle size and stabilities, respectively. Microscopic image shows the core-type structure that confirms the characteristic pattern of liposome. The encapsulation efficiency (EE%) and the particle size were 65.85 ± 1.84% and below 100 nm, respectively. The results of the clinical studies of liposomal vitamin C by oral delivery to be 1.77 times more bioavailable than non-liposomal vitamin C. The liposomal vitamin C demonstrated higher values of C_max, AUC_0-t and AUC_0-∞ related to non-liposomal vitamin C due to liposomal encapsulation. No adverse events were reported. It could be concluded that liposomal encapsulated ascorbic acid (vitamin C) shows well-organized morphological pattern, uniform particle size and highly efficient, which leads to have enhanced bioavailability.

Extraction of Nanochitin from Marine Resources and Fabrication of Polymer Nanocomposites: Recent Advances

Industrial sea food residues, mainly crab and shrimp shells, are considered to be the most promising and abundant source of chitin. In-depth understanding of the biological properties of chitin and scientific advancements in the field of nanotechnology have enabled the development of high-performance chitin nanomaterials. Nanoscale chitin is of great economic value as an efficient functional and reinforcement material for a wide range of applications ranging from water purification to tissue engineering. The use of polymers and nanochitin to produce (bio) nanocomposites offers a good opportunity to prepare bioplastic materials with enhanced functional and structural properties. Most processes for nanochitin isolation rely on the use of chemical, physical or mechanical methods. Chitin-based nanocomposites are fabricated by various methods, involving electrospinning, freeze drying, etc. This review discusses the progress and new developments in the isolation and physico-chemical characterization of chitin; it also highlights the processing of nanochitin in various composite and functional materials.

Diversity of hepatitis C virus infection among HIV-infected people who inject drugs in India

The availability of generic direct acting antivirals (DAAs) for hepatitis C virus (HCV) treatment has prompted many low-and-middle-income countries to launch HCV elimination programs. Because the efficacy of some of these generic DAAs varies by HCV viral subtype, information on subtype distribution can contribute important information to these elimination programs. We conducted a cross-sectional serosurvey to characterize HCV subtype diversity among HIV positive people who inject drugs (PWID) across 14 cities in India. Of 801 HIV positive PWID sampled, 639 tested HCV antibody positive (78.9%). Among 105 samples sequenced, genotype 3 (58.1%) was the most commonly observed followed by genotype 1 (36.2%) and genotype 6 (5.7%). Of the genotype 3 infections, 65% were subtype 3a and 35% were subtype 3b. Of the genotype 1 infections, 94% were subtype 1a and 6% were subtype 1b. All genotype 6 samples were subtype 6n. There was some variability in genotype diversity depending on geographic region and PWID epidemic stage with greater diversity observed in older PWID epidemics. One sequence, HY018, did not cluster with any known reference sequences in phylogenetic analysis. Nearly 80% of HIV infected PWID across India are co-infected with HCV, and subtype prevalence and genetic diversity varied by region and PWID epidemic stage. HCV elimination programs in India will need to consider HCV subtype.

Occult HBV infection in HIV-infected adults and evaluation of pooled NAT for HBV

The study aimed to determine the prevalence of occult hepatitis B virus infection among HIV-infected persons and to evaluate the use of a pooling strategy to detect occult HBV infection in the setting of HIV infection. Five hundred and two HIV-positive individuals were tested for HBV, occult HBV and hepatitis C and D with serologic and nucleic acid testing (NAT). We also evaluated a pooled NAT strategy for screening occult HBV infection among the HIV-positive individuals. The prevalence of HBV infection among HIV-positive individuals was 32 (6.4%), and occult HBV prevalence was 10%. The pooling HBV NAT had a sensitivity of 66.7% and specificity of 100%, compared to HBV DNA NAT of individual samples. In conclusion, this study found a high prevalence of occult HBV infection among our HIV-infected population. We also demonstrated that pooled HBV NAT is highly specific, moderately sensitive and cost-effective. As conventional HBV viral load assays are expensive in resource-limited settings such as India, pooled HBV DNA NAT might be a good way for detecting occult HBV infection and will reduce HBV-associated complications.

Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India

Syndemic theory describes the clustering and synergistic interaction of disease driven by contextual and social factors, which worsen health outcomes for a population, and has been applied to men who have sex with men (MSM) and their risk for HIV and other sexually transmitted infections. Recent reviews, however, have critiqued prevailing approaches in syndemic studies that assess only additive associations without evaluation of synergy. Following these suggestions, we compared the traditional additive approach with a test for synergistic association of 5 syndemic conditions (alcohol dependence, illicit drug use, depression, intimate partner violence (IPV), and childhood sexual abuse (CSA)) with unprotected anal intercourse (UAI) and active syphilis infection among 11,771 MSM recruited through respondent driven sampling from 12 cities in India. UAI was assessed via self-report and active syphilis infection was diagnosed by RPR and THPA tests. An additive association was explored using a condition count (range 0-5), and synergy was tested using relative excess risk due to interactions (RERIs) calculated from all 2-way and common 3-way interactions between conditions in adjusted regression models. There was a significant dose response associated with the syndemic count and UAI, and a similar pattern for syphilis, though not statistically significant. RERIs showed synergy for only one pair of conditions for UAI and syphilis, respectively: IPV + depression and alcohol dependence + illicit drug use. In this study, we found an additive association between syndemic conditions and UAI with evidence of synergistic interaction between a pair of psychosocial conditions, and no significant additive association, but a synergistic interaction between another pair of psychosocial conditions for syphilis. Our results lend further support to a critical reassessment of syndemic analyses. Closer attention to the cumulative development, underlying causal pathways, and possible synergistic interaction of co-occurring epidemics through combined qualitative and quantitative methodologies may yield more effective interventions for vulnerable, marginalized populations.

Chitin nanowhisker (ChNW)-functionalized electrospun PVDF membrane for enhanced removal of Indigo carmine

In this study, an active functional adsorbent membrane developed by combining both hydrophilic bio polymer filler such as chitin nanowhiskers (ChNW) which contains two functional groups and a hydrophobic polymer matrix such as polyvinylidene fluoride (PVDF) using electrospinning technique. Here ChNW were successfully extracted by excluding proteins and mineral and well characterized using FTIR, XRD, SEM and TEM. The optimized combination of PVDF/ChNW (15%:1%) membrane was fabricated and well characterized using SEM, water contact angle and FTIR spectroscopy. There was a remarkable difference in contact angle observed for PVDF/ChNW (22.72°) compared to neat PVDF (93.1°) membrane. Ultimately the membrane used for indigo carmine (IC) adsorption and an enhanced removal efficiency (88.9%) and adsorption capacity (72.6mgg^-1) were observed compared to neat PVDF. In the future, the overall idea can make leads to various applications such as proteins, virus and hormones adsorption from the contaminated sources.

Facile synthesis of chitin nanocrystals decorated on 3D cellulose aerogels as a new multi-functional material for waste water treatment with enhanced anti-bacterial and anti-oxidant properties

We report the fabrication and application of multi-functional hybrid bio-aerogels based on cellulose nanofibers (CNFs) and chitin nanocrystals (CNCs).

GCKR and PPP1R3B identified as genome-wide significant loci for plasma lactate: the Atherosclerosis Risk in Communities (ARIC) study

AIM

To investigate the genetic influence of circulating lactate level, a marker of oxidative capacity associated with diabetes.

METHODS

We conducted a genome-wide association study of log-transformed plasma lactate levels in 6901 European-American participants in the Atherosclerosis Risk in Communities study. For regions that achieved genome-wide significance in European-American participants, we conducted candidate region analysis in African-American subjects and tested for interaction between metformin use and the index single nucleotide polymorphisms for plasma lactate in European-American subjects.

RESULTS

The genome-wide association study in European-American subjects identified two genome-wide significant loci, GCKR (rs1260326, T allele β=0.08; P=1.8×10(-47) ) and PPP1R3B/LOC157273 (rs9987289, A allele β=0.06; P=1.6×10(-9) ). The index single nucleotide polymorphisms in these two loci explain 3.3% of the variance in log-transformed plasma lactate levels among the European-American subjects. In the African-American subjects, based on a region-significant threshold, the index single nucleotide polymorphism at GCKR was associated with plasma lactate but that at PPP1R3B/LOC157273 was not. Metformin use appeared to strengthen the association between the index single nucleotide polymorphism at PPP1R3B/LOC157273 and plasma lactate in European-American subjects (P for interaction=0.01).

CONCLUSIONS

We identified GCKR and PPP1R3B/LOC157273 as two genome-wide significant loci of plasma lactate. Both loci are associated with other diabetes-related phenotypes. These findings increase our understanding of the genetic control of lactate metabolism.

Chlamydia trachomatis genital infection in apparently healthy adult population of Tamil Nadu, India: a population-based study

Since the epidemiology of Chlamydia trachomatis infection in apparently healthy population has not been studied in India, a population-based study was conducted in the state of Tamil Nadu, India in order to analyse the prevalence of genital chlamydial infections in the community and to implement control programmes. A representative sample was taken from three randomly selected districts by using the 'probability proportional to size' cluster survey method. Households were the basic units of clusters. Adults aged 15-45 years, pre-identified from the selected households were enrolled during the medical camps conducted for a major study on community prevalence of sexually transmitted diseases in Tamil Nadu. Blood and urine samples collected from the study subjects were tested by enzyme-linked immunosorbent assay (ELISA) for anti-chlamydial IgM antibodies and by the commercial Amplicor polymerase chain reaction (PCR) test for chlamydial DNA. The prevalence of anti- C. trachomatis antibodies determined by IgM-ELISA was 2.4% (95% CI 1.6%-3.2%). The prevalence of genital chlamydial infection determined by PCR was 1.1% (95% CI 0.5%-1.7%). Majority of the detected infections (68.8%) were asymptomatic. This is the first Indian report on the prevalence of genital chlamydial infections in the general population. It is concluded that this study provides evidence for a substantial burden of approximately 10 million asymptomatic genital chlamydial infection cases in the sexually active age groups in the general population of India.