Pelvic Floor Disorders Among Minority Women: Differences in Prevalence, Severity and Health-Related Social Needs

OBJECTIVE

To characterize prevalence and severity of pelvic floor disorders (PFDs) in various health care settings and to examine unmet health-related social needs (HRSN) among minority women.

MATERIALS AND METHODS

Minority women with PFDs were recruited from our academic urogynecology clinic, a general urology clinic at our institution's safety net hospital, and a community outreach mobile clinic. Questions from the Urinary Distress Index-6, Pelvic Organ Prolapse Distress Inventory-6, and Female Genitourinary Pain Index were used to identify patients with stress urinary incontinence, overactive bladder (OAB), and chronic pelvic pain syndrome (CPPS).

RESULTS

Sixty-one (46.6%) women identified as Hispanic, 53 (40.4%) as Black, and 17 (12.9%) as Other. Overall, self-reported PFDs included stress urinary incontinence in 45%, OAB in 74.8%, and CPPS in 24.4% of women. Hispanic women were more likely to report OAB symptoms, compared to Black women (odds ratio (OR) 3.4 [1.2-10.2], P = .03) or Other women (OR = 5.1 [1.3-20.4], P = .02). Participants held a median of 5 unmet HRSN. Minority women facing issues with family and community support, transportation, and utilities were more likely to report CPPS symptoms, compared to those without psychosocial issues (support OR: 4.8 [1.7-13.7], P = .002; transportation OR: 2.0 [1.0-8.2], P = .05; utility OR: 7.0 [1.9-28.1], P = .005).

CONCLUSION

Minority women with PFDs may have several unmet HRSNs which impact their ability to receive appropriate medical care. Our findings may assist in the development of effective strategies to improve health care outcomes for women dealing with PFDs.

Effectiveness and safety of Levofloxacin containing regimen in the treatment of Isoniazid mono-resistant pulmonary Tuberculosis: a systematic review

Background

We aimed to determine the effectiveness and safety of the Levofloxacin-containing regimen that the World Health Organization is currently recommending for the treatment of Isoniazid mono-resistant pulmonary Tuberculosis.

Methods

Our eligible criteria for the studies to be included were; randomized controlled trials or cohort studies that focused on adults with Isoniazid mono-resistant tuberculosis (HrTB) and treated with a Levofloxacin-containing regimen along with first-line anti-tubercular drugs; they should have had a control group treated with first-line without Levofloxacin; should have reported treatment success rate, mortality, recurrence, progression to multidrug-resistant Tuberculosis. We performed the search in MEDLINE, EMBASE, Epistemonikos, Google Scholar, and Clinical trials registry. Two authors independently screened the titles/abstracts and full texts that were retained after the initial screening, and a third author resolved disagreements.

Results

Our search found 4,813 records after excluding duplicates. We excluded 4,768 records after screening the titles and abstracts, retaining 44 records. Subsequently, 36 articles were excluded after the full-text screening, and eight appeared to have partially fulfilled the inclusion criteria. We contacted the respective authors, and none responded positively. Hence, no articles were included in the meta-analysis.

Conclusion

We found no "quality" evidence currently on the effectiveness and safety of Levofloxacin in treating HrTB.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022290333, identifier: CRD42022290333.

HIV, opioid use, and alterations to the gut microbiome: elucidating independent and synergistic effects

Background

The microbiome is essential to immune development, defense against pathogens, and modulation of inflammation. Microbial dysbiosis has been reported in various diseases including human immunodeficiency virus (HIV) and opioid use disorder (OUD). Notably, people living with HIV (PLWH) have been reported to both have higher rates of OUD and use opioids at higher rates than the general public. Thus, studying gut microbial alterations in people living with HIV and with OUD could elucidate mechanisms pertaining to how these conditions both shape and are shaped by the microbiome. However, to date few studies have investigated how HIV and OUD in combination impact the microbiome.

Aim of review

Here, we review previous studies outlining interactions between HIV, opioid use, and microbial dysbiosis and describe attempts to treat this dysbiosis with fecal microbial transplantation, probiotics, and dietary changes.

Key scientific concepts of review

While the limited number of studies prevent overgeneralizations; accumulating data suggest that HIV and opioid use together induce distinct alterations in the gut microbiome. Among the three existing preclinical studies of HIV and opioid use, two studies reported a decrease in Lachnospiraceae and Ruminococcaceae, and one study reported a decrease in Muribaculaceae in the combined HIV and opioid group relative to HIV-alone, opioid-alone, or control groups. These bacteria are known to modulate immune function, decrease colonic inflammation, and maintain gut epithelial barrier integrity in healthy individuals. Accordingly, modulation of the gut microbiome to restore gut homeostasis may be attempted to improve both conditions. While mixed results exist regarding treating dysbiosis with microbial restoration in PLWH or in those with opioid dependency, larger well-defined studies that can improve microbial engraftment in hosts hold much promise and should still be explored.

Re-Evaluating the Association Between Hormonal Contraception and Breast Cancer Risk

This review aims to summarize and assess key studies investigating the relationship between hormonal contraception and breast cancer risk. Approximately two-thirds of breast cancers express the estrogen receptor, and long-term exposure to estrogen is a debated risk factor for breast cancer development. This hypothesis is based on prior studies looking at reproductive risk factors (endogenous estrogen exposure) along with hormone replacement therapy (exogenous hormone exposure). Historically accepted reproductive risk factors include age at menarche, age at first delivery, and parity. Exogenous hormone exposure encompasses both receipt of hormonal contraception and menopausal hormone replacement therapy. This review highlights the reported risks associated with the most common hormonal contraception methods including oral, transdermal, and transvaginal routes. Large observational studies of the past and more recent works are summarized highlighting gaps in knowledge. Several themes emerge: difficulty accounting for well-established risk factors in analyses of epidemiologic studies, challenges determining whether associations between hormonal contraception and breast cancer are due to the exogenous hormones themselves or to increased engagement with the medical system, and discrepancies between statistically significant and clinically significant risk, odds, and hazard ratios. Understanding the strengths and limitations of these studies will help providers in and outside of oncology support women making decisions regarding both cancer risk-reduction and family planning.

Abstract P036: The Association Of CD4:CD8 Ratio With Cardiometabolic Risk Factors In People With HIV

Background: In People with HIV (PWH) with virologic suppression, the CD4:CD8 ratio inversely correlates with immune senescence response. The association between CD4:CD8 ratio and cardiovascular (CV) risk in PWH remains unclear.

Methods: A retrospective chart review was performed of patients who received HIV care at the University of Miami/Jackson Memorial Hospital between 2017-2019 with available CD4: CD8 ratio (n=1,137). We stratified patients according to the CD4:CD8 ratio ≥1 or <1, and compared available data.

Results: The prevalence of CD4:CD8 ratio <1 was 69.5%. A ratio <1 was associated with male gender (57.1% vs 45.8%, p<0.001), lower body mass index (28.29 vs 29.80 kg/m2, p=0.001), lower HDL cholesterol (Chol) (47.57 vs. 53.25 mg/dL, p<0.001), higher total Chol/HDL (4.22 vs. 3.8, p=0.001), higher CRP levels (4.94 vs. 2.61 mg/L, and less statin use (25% vs 35.3%, p<0.001), p=0.02) compared to those with a ratio ≥1. Those with a CD4:CD8 ratio <1 were more likely to have a detectable viral load (35.9% vs. 14.6%. p<0.001), have been on antiretroviral therapy for <6 months (4% vs 1.5%, p=0.27), to be current smokers (27.6% vs. 16.5%, p<0.001), current drug users (9.7% vs 5.5%, p=0.025), and had higher rates of atrial fibrillation/flutter (1.9% vs 0%, p=0.008) than those with a ratio ≥1.

Conclusion: Patients with an inverted CD4:CD8 ratio had higher total Chol/HDL levels, which has been associated with a higher risk of CV disease. Statin use in this high-risk population was lower despite having more CV risk factors and atrial fibrillation/flutter. Further studies are needed to determine the usefulness of the CD4:CD8 ratio as a marker of immune activation and predictor of CV risk in PWH.

Functional connectivity in the dorsal network of the cervical spinal cord is correlated with diffusion tensor imaging indices in relapsing-remitting multiple sclerosis

Focal lesions may affect functional connectivity (FC) of the ventral and dorsal networks in the cervical spinal cord of people with relapsing-remitting multiple sclerosis (RRMS). Resting-state FC can be measured using functional MRI (fMRI) at 3T. This study sought to determine whether alterations in FC may be related to the degree of damage in the normal-appearing tissue. Tissue integrity and FC in the cervical spinal cord were assessed with diffusion tensor imaging (DTI) and resting-state fMRI, respectively, in a group of 26 RRMS participants with high cervical lesion load, low disability, and minimally impaired sensorimotor function, and healthy controls. Lower fractional anisotropy (FA) and higher radial diffusivity (RD) were observed in the normal-appearing white matter in the RRMS group relative to controls. Average FC in ventral and dorsal networks was similar between groups. Significant associations were found between higher FC in the dorsal sensory network and several DTI markers of pathology in the normal-appearing tissue. In the normal-appearing grey matter, dorsal FC was positively correlated with axial diffusivity (AD) (r = 0.46, p = 0.020) and mean diffusivity (MD) (r = 0.43, p = 0.032). In the normal-appearing white matter, dorsal FC was negatively correlated with FA (r = -0.43, p = 0.028) and positively correlated with RD (r = 0.49, p = 0.012), AD (r = 0.42, p = 0.037) and MD (r = 0.53, p = 0.006). These results suggest that increased connectivity, while remaining within the normal range, may represent a compensatory mechanism in response to structural damage in support of preserved sensory function in RRMS.

Antifungal potential of Azotobacter species and its metabolites against Fusarium verticillioides and biodegradation of fumonisin

AIMS

In the study, seven Plant Growth Promoting Rhizobacteria (PGPR) Azotobacter species were screened against three strains of Fusarium verticillioides to test its antifungal activity. Azotobacter strains were tested for the degradation of fumonisin produced by F. verticillioides. Secondary metabolites were isolated and characterized from the Azotobacter strains for the first time.

METHODS AND RESULTS

Potential seven Azotobacter species antifungal activity was tested following the dual culture assay against three starins of Fusarium verticillioides namely FVM-42, FVM-86, MTCC156 estimating the substantial zone of inhibition. Azotobacter species AZT-31 and AZT-50 strains significantly inhibited the growth of F. verticillioides recording drastic growth enhancement of maize under in-vitro conditions by calculating the infection incidence, vigour index and germination percentage. As confirmation, dereplication studies were conducted for the reconfirmation of Azotobacter strains by isolating from rhizoplane. Azotobacter strains played a key role in degradation of fumonisin produced by F. verticillioides reporting 98% degradation at 2hr of incubation with the pathogen. Furthermore, in the study first time we have tried to isolate and characterize the secondary metabolites from the Azotobacter strains exhibiting six compounds from the species AZT-31 (2) and AZT-50 (4). Preliminary in-vitro experiments were carriedout using the compounds extracted to check the reduction of infection incidence (90%) and increase in germination percentage upto 50 to 70% when compared to test pathogen.

CONCLUSION

Azotobacter strains referred as PGPR on influencing the growth of plant by producing certain substances that acts as stimulators on inhibiting the growth of pathogen.

SIGNIFICANCE AND IMPACT OF THE STUDY

Future perspective would be the production of active combination of carboxamide compound and Azotobacter species for preventively controlling the phytopathogenic fungi of plants and crops and also towards the treatment of seeds.

Characterizing genitourinary exam disruptions in women presenting to a sexual health after cancer program

e24048

Background: While treatment-related sexual health sequelae are documented using validated patient-reported outcome measures, the anatomic changes associated with cancer treatment are not well described, which may lead to an underestimation of the severity of these symptoms. To fill this knowledge gap and improve the management of these anatomic disruptions, we sought to objectively report the genitourinary findings of women presenting to a sexual health after cancer program over one year. Methods: At their first visit, patients undergo a thorough history and physical with a focus on the genitourinary exam. Patient demographics, primary symptoms, and treatment history were retrospectively collected and correlated to vaginal assessment scale (VAS) scores of female cancer patients presenting to the MUSIC (Menopause, Urogenital, Sexual Health and Intimacy Clinic) Program at an NCI-designated cancer center. Results: Between 2020-2021, 104 female cis-gender women with a median age of 46 (range 19-75) at diagnosis were seen. 56% identified as Hispanic/Latinx. Mean age was 47 (19-75), and most were treated for breast (80%) or gynecologic (10%) cancer. Primary complaints included vaginal dryness (53%), painful sex (45%), low desire (36%), hot flashes (22%), problems with orgasm (5%), urinary symptoms (10%), chronic pelvic pain (4%), or a need for complex contraceptive counseling (1%). Of those where a VAS was performed (n = 89), patients were found to have mild or moderate/severe loss of rugae (78%), loss of elasticity (84%), loss of vascularity (86%), and/or dryness (88%). Alarmingly, almost half were found to have some element of vaginal stenosis on exam, either vaginal scarring/adhesions (6%), foreshortened vagina (13%), or a narrowed introitus (47%) (Table). Conclusions: In an initial consult of women seeking care for sexual health after cancer treatment, the most common concerns were vaginal dryness, painful sex, and low desire. Despite only approximately half reporting either dryness or painful sex, most were found to have genitourinary disruptions in anatomy at presentation, including vaginal stenosis. The presence of vaginal stenosis in sexual health survivors who did not undergo pelvic radiation deserves future study as these findings often present as a complete inability to have penetrative intercourse.[Table: see text]

More than just “vaginal dryness”: Addressing an unmet need for sexual health intervention in female cancer survivors

e24050

Background: Female sexual dysfunction (FSD) in cancer survivors is underreported and therefore undertreated. This study aims to describe the population of female cancer survivors seeking treatment for sexual dysfunction through a novel sexual health after cancer program. Methods: We conducted a retrospective analysis to characterize patients presenting to the MUSIC (Menopause, Urogenital, Sexual Health and Intimacy Clinic) Program at a NCI-designated cancer center in South Florida. Patients received a baseline Female Sexual Function Index (FSFI) and underwent a physical, including abdominopelvic, exam. The FSFI is a 19-item survey previously validated for use in female cancer survivors. Severity of dysfunction (by presenting symptom, physical exam, and FSFI) was correlated to demographic and cancer characteristics. Sexual dysfunction was defined as ≤26.55. Results: Between 2020-2021, 104 female cis-gender women with a median age of 46 (range 19-75) at diagnosis were seen. 56% identified as Hispanic/Latinx. Most were treated for breast (80%) or gynecologic (10%) cancer. Common presenting symptoms included vaginal dryness (55%), painful sex (45%), low desire (36%) and hot flashes (22%). Patients who disclosed details about pain (n = 62) reported penetration was possible but uncomfortable (16%), possible but painful (66%) or impossible due to pain (18%). Those who disclosed changes with orgasm (n = 43) reported it was more difficult (26%), or impossible (23%). Of those completing the FSFI (n = 66), median Desire Domain score was 1.2 (IQR 1.2-2.4), and median Total Score was 8.1 (IQR 2.9-16.4), with 97% of patients meeting criteria for FSD (Table). Conclusions: The present study highlights a continued unmet need to address severe sexual health concerns in the growing female cancer survivor population. Future work will describe treatment strategies employed and their effectiveness at symptom resolution and quality-of-life improvement.[Table: see text]

Relaxation-Compensated Chemical Exchange Saturation Transfer MRI in the Brain at 7T: Application in Relapsing-Remitting Multiple Sclerosis

Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) can probe tissue biochemistry in vivo with high resolution and sensitivity without requiring exogenous contrast agents. Applying CEST MRI at ultrahigh field provides advantages of increasing spectral resolution and improving sensitivity to metabolites with faster proton exchange rates such as glutamate, a critical neurotransmitter in the brain. Prior magnetic resonance spectroscopy and CEST MRI studies have revealed altered regulation of glutamate in patients with multiple sclerosis (MS). While CEST imaging facilitates new strategies for investigating the pathology underlying this complex and heterogeneous neurological disease, CEST signals are contaminated or diluted by concurrent effects (e.g., semi-solid magnetization transfer (MT) and direct water saturation) and are scaled by the T1 relaxation time of the free water pool which may also be altered in the context of disease. In this study of 20 relapsing-remitting MS patients and age- and sex-matched healthy volunteers, glutamate-weighted CEST data were acquired at 7.0 T. A Lorentzian fitting procedure was used to remove the asymmetric MT contribution from CEST z-spectra, and the apparent exchange-dependent relaxation (AREX) correction was applied using an R1 map derived from an inversion recovery sequence to further isolate glutamate-weighted CEST signals from concurrent effects. Associations between AREX and cognitive function were examined using the Minimal Assessment of Cognitive Function in MS battery. After isolating CEST effects from MT, direct water saturation, and T1 effects, glutamate-weighted AREX contrast remained higher in gray matter than in white matter, though the difference between these tissues decreased. Glutamate-weighted AREX in normal-appearing gray and white matter in MS patients did not differ from healthy gray and white matter but was significantly elevated in white matter lesions. AREX in some cortical regions and in white matter lesions correlated with disability and measures of cognitive function in MS patients. However, further studies with larger sample sizes are needed to confirm these relationships due to potential confounding effects. The application of MT and AREX corrections in this study demonstrates the importance of isolating CEST signals for more specific characterization of the contribution of metabolic changes to tissue pathology and symptoms in MS.

An unusual presentation of posterior reversible encephalopathy syndrome—a case report

Background

Acute neurological emergencies in pregnant and postpartum women presenting as headache, visual disturbances, seizures, and elevated blood pressure are usually attributed to preeclampsia and eclampsia. However cerebral venous sinus thrombosis (CVST) and posterior reversible encephalopathy syndrome (PRES) are two important, rare conditions which should be considered. PRES is a rare neuroradiological syndrome characterised by vasogenic oedema of subcortical white matter, commonly involving posterior cerebral hemispheres. Preeclampsia and eclampsia are the common causes of PRES. However, late postpartum eclampsia concurrent to PRES is rare. Here, we report a rare case of PRES secondary to late postpartum eclampsia with atypical radiological findings.

Case presentation

A 25-year-old married woman with prior history of two spontaneous abortions presented to us on day 5 postpartum, post lower segment caesarean section (LSCS) with complaints of headache followed by one episode of new onset generalised tonic-clonic seizures. There was no history of seizures prior to the pregnancy and no history of hypertension or diabetes during any of her pregnancies. On examination, BP was 140/90 mm Hg and PR 98 bpm. Systemic examination revealed GCS 15/15, no focal neurological deficits, and bilateral flexor plantar response. Fundus examination was normal with no evidence of hypertensive retinopathy. Preliminary haematological and biochemical tests including antiphospholipid antibody (APLA) profile were done in view of prior abortions and were within normal limits. Lumbar puncture was done—normal study. EEG was normal. MRI with MRV was suggestive of atypical posterior encephalopathy. In view of late onset postpartum seizure, the patient was started on injection of magnesium sulphate, anti-hypertensives, and antiepileptics; following which, she improved and was discharged.

Conclusion

Though preeclampsia and eclampsia are usually screened entities, we should also follow women in puerperium for late postpartum eclampsia which is defined as seizures beyond 48 h of delivery up to 4 weeks postpartum. So it is important to follow-up postpartum women for complications like PRES because early detection and treatment can lessen the morbidity and mortality as they are completely reversible. Thus, health care professionals should be educated about the same. Apart from antenatal and intrapartum care, postpartum care should also be given equal importance.

Scientific research publications in dengue: A global and Indian bibliometric analysis from 1997 to 2018

Dengue fever is common in tropical and subtropical countries of the world and its present impact is 30 times more than what it was 50 yr ago. The aim of the study was to analyze the research output/publications on dengue across the world as well as in India, using the Web of Science database. Literature search was done using the keyword 'dengue' in the title field to find global and Indian publications on dengue from 1 June 1997 to 20 July 2018. Bibliometric analysis was done on the basis of the magnitude of research output; year, type and language of publications; citations and h-index, impact factor, keywords, most productive institutes etc. Descriptive analysis was performed using MS Office, Word Cloud Generator and SPSS software. The analysis of the records obtained indicated that globally 11,742 articles were published on dengue during the period of 21 yr of which 1114 were Indian. The country with highest number of publications was United States (3449; 29.37%) while India ranked third (1114; 9.48%). Majority of the published articles where in the American Journal of Tropical Medicine and Hygiene (1366; 11.63%) and the leading journal in India was Indian Journal of Medical Research (56; 5.02%) followed by the Journal of Vector Borne Diseases (42; 3.77%). The most productive Institute at global level was 'Mahidol University, Thailand' while in the Indian context it was 'All India Institute of Medical Sciences, New Delhi'. The elevated metrics of citation, impact factor, and h-index are based on the magnitude of scientific research outputs. Increasing trend in the number of publications over the years both globally as well as in India indicates overall growth in dengue research. Even though it is a good sign of productivity it is still significantly related to the magnitude of occurrence of dengue cases across the globe. Further, it is a good indication that the scientific community is dynamic and responding well in bringing out the regional scenarios to the public for health promotion.

Magnitude and pattern of various cancers from tertiary health care center registry: A study in three southern states of India

Many research studies have looked into the epidemiological aspects including various potential risk factors associated with cancers, namely environmental, dietary, genetic, and hormonal. The present article studies the magnitude and pattern of various cancers registered at tertiary health-care centers in three South Indian states. Data from hospital-based cancer registries compiled by the ICMR-National Centre for Disease Informatics and Research for the time periods 2007-2011 and 2012-2014 for three South Indian states, namely Tamil Nadu, Kerala, and Karnataka, were analyzed using R software. Summarizing the type and proportions of cancers seen at the three registries during the periods 2007-2011 and 2012-2014, it was found that, among men, hypopharyngeal cancer, esophageal cancer, lung cancer, stomach cancer, and oral cancer were the major cancer types prevalent and, among females, cervical cancer, mouth cancer, breast cancer, ovary cancer, and thyroid cancer were the common cancer types. With multidisciplinary approach, cancers can be prevented to a certain extent by insisting behavioural changes through recommendation of increase in physical activities and intake of micro nutrient-rich food items with fiber component.

Addition of biomarker high sensitivity troponin I (hSTROPI) to QRISK3 score in predicting significant coronary artery disease (CAD)

Background

The current models to predict CAD in general population is not universally accepted. Many risk scores do not take into account factors such as south Asian ancestry, type 2 diabetes mellitus or family history of premature CAD. There is still no clarity on the position of biomarkers in addition to traditional risk factors.

Purpose

This study evaluates the role of biomarker hSTROPI in addition to QRISK3 score in predicting significant CAD.

Methods

This observational study included 103 consecutive subjects who had non cardiac pain as per ESC criteria and wanted to assess their future cardiovascular risk and to know the coronary anatomy. None had documented CAD prior. The inclusion criteria consisted of subjects who were &gt;18 years of age asymptomatic or with non-cardiac chest pain and absence of clinical cardiovascular disease. Exclusion criteria were heart failure, chronic kidney disease (CKD) and anemia (hemoglobin &lt;10 gms%). They underwent risk stratification based on QRISK3 score and measurement of hSTROPI. All of them underwent Computerized Tomography coronary angiogram (CTCA). Subjects with more than 50% lesions on CT coronary angiogram were deemed to have significant CAD. We analyzed the impact of hSTROPI in addition to QRISK3 score in picking up significant lesions by CTCA.

Results

The analysis showed sensitivity of QRISK3 &gt;17.5% of 46.43%, specificity of 75.68%, positive predictive value (PPV) of 41.94%, negative predictive value (NPV) of 78.87% and diagnostic accuracy of 67.65%.

hSTROP I &gt;3.5pg/ml showed a sensitivity of 37.93%, specificity of 81.08%, PPV of 44%, NPV of 76.92% and diagnostic accuracy of 68.93%.

When both hSTROPI &gt;3.5pg/ml and QRISK3 &gt;17.5% are combined, the sensitivity was found to be 27.59%, specificity of 91.89%, PPV of 57.14%, NPV of 76.4% and diagnostic accuracy of 73.79%.

In the study population, significant CAD was found in QRISK3 &gt;17.5% in 41.9% and QRISK3&lt;17.5% in 22.2% and (p=0.04).

Significant CAD was found in 44% of population with HSTROPI &gt;3.5 pg/ml and in 23.1% whose HSTROP I &lt;3.5pg/ml (p=0.04).

Significant CAD was found in 57.1% of population with both parameters positive (QRISK3 &gt;17.5% and hSTROPI &gt;3.5 pgm/ml), 23.6% of the population in which both parameters were negative (p=0.009).

Conclusion

Combining QRISK3 score of more than 17.5% and hSTROP I more than 3.5pg/ml have significant association with more than 50% lesion by CTCA with a specificity of 91.89%.

This may be useful in counselling intermediate risk group patients to have aggressive pharmacological primary preventive strategies like high dose statins. This may be a cost effective method of screening south Asian population who have much more risk factors and CAD at much younger age.

Funding Acknowledgement

Type of funding source: None

Cortical activation in generalized seizures

OBJECTIVE

Patients with generalized epilepsy exhibit different epileptiform events including asymptomatic interictal spikes (IS), absence seizures with spike-wave discharges (SWDs), and myoclonic seizures (MS). Our objective was to determine the spatiotemporal patterns of cortical activation in SWDs, IS, and MS in the Gabra1^+/A322D juvenile myoclonic epilepsy mouse.

METHODS

We fabricated affordable, flexible high-density electroencephalography (HdEEG) arrays and recorded spontaneous SWD, IS, and MS with video/HdEEG. We determined differences among the events in amplitude spectral density (ASD) in the δ/θ/α/β/γ frequency bands at baseline (3.5-4.0 seconds before the first spike time, t₀ ) and the prespike period (0.1-0.5 seconds before t₀ ), and we elucidated the spatiotemporal activation during the t₀ spike.

RESULTS

All three events had an increase in ASD between baseline and prespike in at least one frequency band. During prespike, MS had the largest δ-band ASD, but SWD had the greatest α/β/γ band ASD. For all three events, the ASD was largest in the anterior regions. The t₀ spike voltage was also greatest in the anterior regions for all three events and IS and MS had larger voltages than SWD. From 7.5 to 17.5 msec after t₀ , MS had greater voltage than IS and SWD, and maximal voltage was in the posterior parietal region.

SIGNIFICANCE

Changes in spectral density from baseline to prespike indicate that none of these generalized events are instantaneous or entirely unpredictable. Prominent engagement of anterior cortical regions during prespike and at t₀ suggest that common anterior neural circuits participate in each event. Differences in prespike ASD signify that although the events may engage similar brain regions, they may arise from distinct proictal states with different neuronal activity or connectivity. Prolonged activation of the posterior parietal area in MS suggests that posterior circuits contribute to the myoclonic jerk. Together, these findings identify brain regions and processes that could be specifically targeted for further recording and modulation.

Bioconjugated nano-bactericidal complex for potent activity against human and phytopathogens with concern of global drug resistant crisis

The present study emphasizes the need for novel antimicrobial agents to combat the global drug resistant crisis. The development of novel nanomaterials is reported to be of the alternative tool to combat drug resistant pathogens. In present investigation, bioconjugated nano-complex was developed from secondary metabolite secreted from endosymbiont. The endosymbiont capable of secreting antimicrobial metabolite was subjected to fermentation and the culture supernatant was assessed for purification of antimicrobial metabolite via bio-assay guided fraction techniques such as thin layer chromatography (TLC), high performance liquid chromatography (HPLC) and column chromatography. The metabolite was characterized as 2,4-Diacetylphloroglucinol (2,4 DAPG) which was used to develop bioconjugated nano-complex by treating with 1 mM silver nitrate under optimized conditions. The purified metabolite 2,4 DAPG reduced silver nitrate to form bioconjugated nano-complex to form association with silver nanoparticles. The oxidized form of DAPG consists of four hard ligands that can conjugate on to the surface of silver nanoparticles cluster. The bioconjugation was confirmed with UV-visible spectroscopy which displayed the shift and shoulder peak in the absorbance spectra. This biomolecular interaction was further determined by the Fourier-transform spectroscopy (FTIR) and nuclear magnetic resonance (NMR) analyses which displayed different signals ascertaining the molecular binding of 2,4,DAPG with silver nanoparticles. The transmission electron microscopy (TEM) analysis revealed the cluster formation due to bioconjugation. The XRD analysis revealed the crystalline nature of nano-complex with the characteristic peaks indexed to Bragg's reflection occurring at 2θ angle which indicated the (111), (200), (220) and (311) planes. The activity of bioconjugated nano-complex was tested against 12 significant human and phytopathogens. Among all the test pathogens, Shigella flexneri (MTCC 1457) was the most sensitive organisms with 38.33 ± 0.33 zone of inhibition. The results obtained in the present investigation attribute development of nano-complex as one of the effective tools against multi-drug resistant infections across the globe.

Omics based approach for biodiscovery of microbial natural products in antibiotic resistance era

The need for a new antibiotic pipeline to confront threat imposed by resistant pathogens has become a major global concern for human health. To confront the challenge there is a need for discovery and development of new class of antibiotics. Nature which is considered treasure trove, there is re-emerged interest in exploring untapped microbial to yield novel molecules, due to their wide array of negative effects associated with synthetic drugs. Natural product researchers have developed many new techniques over the past few years for developing diverse compounds of biopotential. Taking edge in the advancement of genomics, genetic engineering, in silico drug design, surface modification, scaffolds, pharmacophores and target-based approach is necessary. These techniques have been economically sustainable and also proven efficient in natural product discovery. This review will focus on recent advances in diverse discipline approach from integrated Bioinformatics predictions, genetic engineering and medicinal chemistry for the synthesis of natural products vital for the discovery of novel antibiotics having potential application.

Nanoagroparticles emerging trends and future prospect in modern agriculture system

Increment of technical knowledge has remarkably uplifted logical thinking among scientific communities to shape the theoretical concepts into near product-oriented research. The concept of nanotechnology has overwhelmed almost all forms of lives and has traded its applications in myriad fields. Despite rapid expansion of nanotechnology, sustainable competitions still do exist in the field of agriculture. In current scenario, agriculture is a manifestation demand to provide adequate nutrition for relentless growing global population. It is estimated that nearly one-third of the global crop production is destroyed annually. The loss owes to various stresses such as pest infestation, microbial pathogens, weeds, natural calamities, lack of soil fertility and much more. In order to overcome these limitations, various technological strategies are implemented but a majority of these have their own repercussions. Hence there is a scrawling progress on the evaluation of nanoparticles into agriculture sector which can reform the modern agricultural system. Applications of these nanomaterials can add tremendous value in the current scenario of a global food scarcity. Nanotechnology can address the adverse effects posed by the abundant use of chemical agrochemicals which are reported to cause biomagnification in an ecosystem. Based on these facts and consideration, present review envisages on nanoparticles as nanoherbicides, nanopesticides, onsite detection agro-pathogens and nanoparticles in post harvest management. The review also elucidates on the importance of nanoparticles in soil fertility, irrigation management and its influence on improving crop yield. With scanty reports available on nanotechnology in agriculture system, present review attributes toward developing nanoagroparticles as the future prospect which can give new facelift for existing agriculture system.

Hypercapnic Respiratory Failure in Case of Chiari 1.5 Malformation: Case Report and Review of the Literature

Type 2 respiratory failure is defined as hypercapnia associated with hypoxia. Chiari 1.5 is known as herniation of the cerebellar tonsils along with brain stem and fourth ventricle. We report a 35-year-old male who presented with acute hypercapnic respiratory failure (Type 2), without any preexisting neurological or respiratory abnormality. Analysis of blood gases in emergency revealed a pH of 7.12, pCO₂ of 132 mmHg, and arterial oxygen tension of 118 mm Hg. He was intubated and ventilated. Magnetic resonance imaging brain revealed herniation of the cerebellar tonsils along with brain stem and fourth ventricle. The patient underwent surgery and gradually weaned off. He was mobilized and discharged on day 6. Acute respiratory failure has not been reported with Chiari 1.5 malformation. The lesson to be learned from this case is that craniospinal pathology must be looked for in a patient with hypercapnic respiratory failure.

Extracellular synthesis of silver nanoparticles by novel Pseudomonas veronii AS41G inhabiting Annona squamosa L. and their bactericidal activity

In present investigation extracellular synthesis of silver nanoparticles were synthesized using cell free supernatant of Pseudomonas veronii AS41G isolated from Annona squamosa L. The bacterium significantly reduced silver nitrate to generate silver nanoparticles which was characterized with hyphenated techniques. Synthesis of silver nanoparticles preliminary confirmed by UV-Visible spectrophotometry with the intense peak at 410nm, Further FTIR analysis revealed the possible role of biomolecules in the supernatant responsible for mediating the nanoparticles formation. The XRD spectra exhibited the characteristic Bragg peaks of 100, 111, 200, and 220 facets of the face centred cubic symmetry of nanoparticles suggesting that these nanoparticles were crystalline in nature. TEM microgram showed polydispersity of nanoparticles with size ranging from 5 to 50nm. Synthesized silver nanoparticles showed antibacterial activity against human and environmental pathogens including MRSA. The study enlightens the role of biosynthesized silver nanoparticles as an emerging alternative for drug resistant microorganisms. The obtained results are promising enough to pave the environmentally benign nanoparticle synthesis processes without use of any toxic chemicals and also envision the emerging role of endophytes towards synthesis of nanoparticles. With scanty reports available on P.veronii species, a new role has been reported in this study which will be very valuable for future researchers working on it.

Cross-cultural standardization of the South Texas Assessment of Neurocognition in India

BACKGROUND & OBJECTIVES

Despite the central role of cognition for mental disorders most studies have been conducted in western countries. Similar research from other parts of the world, particularly India, is very limited. As a first step in closing this gap this cross-cultural comparability study of the South Texas Assessment of Neurocognition (STAN) battery was conducted between USA and India.

METHODS

One hundred healthy adults from Kerala, India, were administered six language independent subtests of the Java Neuropsychological Test (JANET) version of the STAN, assessing aspects of general intellectual ability (Matrix Reasoning), attention (Identical Pairs Continuous Performance, 3 Symbol Version Test; IPCPTS), working memory (Spatial Capacity Delayed Response Test; SCAP), response inhibition (Stop Signal Reaction Time; SSRT), Emotional Recognition and Risk taking (Balloon Analogue Risk Task; BART). Test results were compared to a demographically matched US sample.

RESULTS

Overall test performance in the Kerala sample was comparable to that of the US sample and commensurate to that generally described in studies from western countries.

INTERPRETATION & CONCLUSIONS

Our results support the metric equivalence of currently available cognitive test batteries developed in western countries for use in India. However, the sample was restricted to individuals who were literate and had completed basic primary and secondary education.

Recurrent acute renal failure

While acute renal failure secondary to intravascular hemolysis is well described in hemolytic anemias, recurrent acute renal failure as the presenting manifestation of a hemolytic anemia is rare. We report a patient with recurrent acute renal failure who was found to have paroxysmal nocturnal hemoglobinuria (PNH), on evaluation.

Cryptococcal sepsis in small vessel vasculitis

While meningoencephalitis due to cryptococcus is well known in immunocompromised patients, disseminated cryptococcosis and cryptococcemia is rare outside the setting of advanced HIV infection. We report a case of disseminated cryptococcosis occurring in a patient with Wegener's granulomatosis on immunosuppressive medications.

Utility of QuantiFERON TB gold test in a south Indian patient population of ocular inflammation

Aim:

To study the utility of interferon-γ release assays (QuantiFERON TB gold test) in a south Indian patient population of intraocular inflammation.

Design:

Evaluation of a diagnostic test- a pilot study from January 2007 to October 2008.

Materials and Methods:

QuantiFERON TB gold test was performed on the following groups of patients following an informed consent. Group A included healthy volunteers without any exposure to tuberculosis (TB) or past history of TB (n=22). Group B included patients with active systemic TB diagnosed by the demonstration of acid-fast bacilli or by the histopathology finding of caseation with granuloma formation from the sputum, lymph node, skin or intestinal biopsies (n=26). Group C included patients with uveitis of known etiologies other than intraocular TB without any history of exposure to active TB (n=21). Group D included patients with a diagnosis of presumed intraocular TB, who responded to antitubercular therapy by decreased or no recurrences following treatment and with a minimum of nine months follow-up following initiation of antitubercular therapy (n=39).

Results:

The sensitivity and specificity of the QuantiFERON TB gold test to pick up active systemic TB was 58% and 77% respectively. The sensitivity and specificity of the QuantiFERON TB gold test to pickup intraocular TB was 82% and 76% respectively.

Conclusions:

QuantiFERON TB gold test alone may not be specific for intraocular TB. The significance of this test in a case scenario needs to be interpreted with clinical presentation and other evidences for intraocular TB.

Membranoproliferative glomerulonephritis with essential cryoglobulinemia

Cryoglobulinemia is an uncommon cause of renal disease and often occurs in patients with hepatitis C virus (HCV) infection. We report a case of membranoproliferative glomerulonephritis in a patient with cryoglobulinemia, which was not associated with HCV infection or any identifiable etiology.

Altered structure and expression of RB1 gene and increased phosphorylation of pRb in human vestibular schwannomas

Tumor-specific alterations at the RB1 gene locus in 30 human vestibular schwannomas including 10 NF2 and 20 sporadic cases were analysed. Southern blot analysis of DNA from these samples revealed loss of heterozygosity (LOH) at the RB1 locus in 6 of 24 informative cases (25%) compared to normal blood DNAs from the same patients. Northern blot analysis showed normal size RB1 mRNA in all the tumor samples. However, there was a 2-5-fold increase in the level of expression of the RB1 gene in all the tumor samples compared to the WI38 cell line which was used as control. Western blot analysis of the RB1 protein, pRb showed a 2.5-5-fold increase in the level of total pRb as compared to normal WI38 cell line. Sixty five to seventy five percent of the total pRb were in phosphorylated form in most tumors. The LOH at the RB1 gene locus suggests genetic instability in these patients. Further, increased levels of RB1 mRNA, total pRb and the phosphorylated form of pRb suggests that RB1 gene in these tumors may have anti-apoptotic function. These results suggest that the RB1 gene has a major role in the development of human vestibular schwannomas.

Purification of a Class B1 platelet aggregation inhibitor phospholipase A2 from Indian cobra (Naja Naja) venom

A platelet aggregation inhibitor phospholipase A(2) (NND-IV-PLA(2)) was isolated from Naja naja (Eastern India) venom by a combination of cation and anion exchange chromatography. NND-IV-PLA(2) is the most catalytically active enzyme isolated from the Indian cobra venom. The acidic PLA(2) profile of Eastern regional Indian cobra venom is distinctly different from that of the western regional venom. However the acidic PLA(2)s from both the regions follow the pattern of increasing catalytic activity with increase in acidic nature of the PLA(2) isoform. NND-IV-PLA(2) is a Class B1 platelet aggregation inhibitor and inhibits platelet aggregation induced by ADP, collagen and epinephrine. Modification of active site histidine abolishes both catalytic activity and platelet aggregation inhibition activities while aristolochic acid, a phospholipase A(2) inhibitor has only partial effect on the two activities.

Co-occurrence of Wilson's disease and glioblastoma multiforme--is it a chance association?

We report a patient with glioblastoma multiforme who was subsequently diagnosed to have Wilson's disease. Immunohistochemical studies of the tumor revealed high (> 60%) labeling index for p53 and Rb retinoblastoma protein. Whether this association is like the co-occurrence of retinoblastoma and Wilson's disease due to possible somatic mutation in chromosome 13 needs to be explored.

Stress-dependent expression of a polymorphic, charged antigen in the protozoan parasite Entamoeba histolytica

We have identified a novel stress inducible gene, Ehssp1 in Entamoeba histolytica, the causative agent of amebiasis. Ehssp1 belongs to a polymorphic, multigene family and is present on multiple chromosomes. No homologue of this gene was found in the NCBI database. Sequence alignment of the multiple copies, and genomic PCR data restricted the polymorphism to the central region of the gene. This region contains a polypurine stretch that encodes a domain rich in acidic and basic amino acids. Under normal culture conditions only one copy of this multigene family is expressed, as observed by Northern blot and RT-PCR analysis. The size of this copy of the gene is 1,077 nucleotides, encoding a protein of 359 amino acids. The polymorphic domain in this copy is 64 nucleotides long. However, on exposure of cells to stress conditions such as heat shock or oxidative stress, multiple polymorphic copies of the gene are expressed, suggesting a possible role of this gene in adaptation of cells to stress conditions. The gene copy expressed under normal conditions, and the expression profile of cells under heat stress was identical in two different strains of E. histolytica tested. Interestingly, the extent of polymorphism in this gene was very less in E. dispar, a nonpathogenic sibling species of E. histolytica. Ehssp1 was found to be antigenic in invasive amebiasis patients.

Differential use of multiple replication origins in the ribosomal DNA episome of the protozoan parasite Entamoeba histolytica

The factors that control the initiation of eukaryotic DNA replication from defined origins (oris) on the chromosome remain incompletely resolved. Here we show that the circular rDNA episome of the human pathogen Entamoeba histolytica contains multiple potential oris, which are utilized in a differential manner. The primary ori in exponentially growing cells was mapped close to the promoter of rRNA genes in the upstream intergenic spacer (IGS) by two-dimensional gel electrophoresis. Replication initiated predominantly from the upstream IGS and terminated in the downstream IGS. However, when serum-starved cells were allowed to resume growth, the early oris which became activated were located in other parts of the molecule. Later the ori in the upstream IGS became activated, with concomitant silencing of the early oris. When the upstream IGS was located ectopically in an artificial plasmid, it again lost ori activity, while other parts of the rDNA episome could function as oris in this system. Therefore, the activation or silencing of the ori in this episome is context dependent, as is also the case with many eukaryotic replicons. This is the first replication origin to be mapped in this primitive protozoan and will provide an opportunity to define the factors involved in differential ori activity, and their comparison with metazoans.

The Relationship Between Blood Pressure and Mortality in the Oldest Old

OBJECTIVES

To explore the relationship between systolic and diastolic blood pressure and risk of 6-year, all-cause mortality in men and women age 65 to 84 versus those 85 and older.

DESIGN

A population-based longitudinal study.

SETTING

This study was conducted at four different sites: East Boston, Massachusetts; New Haven, Connecticut; two rural counties in Iowa; and Piedmont, North Carolina.

PARTICIPANTS

12,802 community-dwelling persons age 65 and older.

MEASUREMENTS

Baseline measurements collected include demographics, self-reported chronic medical conditions, blood pressure measurements, medications, health habits, and hospitalizations.

RESULTS

Unadjusted actuarial survival analyses show that men age 65 to 84 years with systolic blood pressure < 130 mmHg have significantly lower mortality compared with those with systolic blood pressure > or = 180 mmHg (P < .0001). In contrast, men 85 and older with systolic blood pressure > or = 180 mmHg have significantly lower mortality compared with those with systolic blood pressure < 130 mmHg (P < .0001). In Cox proportional hazards analyses controlling for other predictors of survival, the hazard of death associated with each 10-mmHg increase in systolic blood pressure is positively associated among men age 65 to 84 years and negatively associated among men age 85 and older (Hazard ratio and 95% confidence interval (CI): 1.04 (1.01, 1.07) for younger men vs 0.92 (0.86, 0.99) for older men). Among women age 65 to 84, the hazard of death significantly increased with increase in systolic blood pressure (P < .0001), while there was no relationship between level of systolic blood pressure and survival in women 85 and older. Both men 65 to 84 years old and those 85 and older showed a negative relationship between diastolic blood pressure and all-cause mortality (Hazard ratio 0.93, 95% CI (0.88-0.97) for men age 65-84 years, and Hazard ratio 0.90, 95% CI 0.80-1.02 for men 85 and older).

CONCLUSION

In men age 85 and older, higher systolic blood pressure is associated with better survival.