Long-Term Outcomes in Patients With Spontaneous Cerebellar Hemorrhage: An International Cohort Study

BACKGROUND

Spontaneous intracerebral hemorrhage (ICH) in the cerebellum has a poor short-term prognosis, whereas data on the long-term case fatality and recurrent vascular events are sparse. Herewith, we aimed to assess the long-term case fatality and recurrence rate of vascular events after a first cerebellar ICH.

METHODS

In this international cohort study, we included patients from 10 hospitals (the United States and Europe from 1997 to 2017) aged ≥18 years with a first spontaneous cerebellar ICH who were discharged alive. Data on long-term case fatality and recurrence of vascular events (recurrent ICH [supratentoria or infratentorial], ischemic stroke, myocardial infarction, or major vascular surgery) were collected for survival analysis and absolute event rate calculation.

RESULTS

We included 405 patients with cerebellar ICH (mean age [SD], 72 [13] years, 49% female). The median survival time was 67 months (interquartile range, 23-100 months), with a cumulative survival rate of 34% at 10-year follow-up (median follow-up time per center ranged: 15-80 months). In the 347 patients with data on vascular events 92 events occurred in 78 patients, after initial cerebellar ICH: 31 (8.9%) patients had a recurrent ICH (absolute event rate, 1.8 per 100 patient-years [95% CI, 1.2-2.6]), 39 (11%) had an ischemic stroke (absolute event rate, 2.3 [95% CI, 1.6-3.2]), 13 (3.7%) had a myocardial infarction (absolute event rate, 0.8 [95% CI, 0.4-1.3]), and 5 (1.4%) underwent major vascular surgery (absolute event rate, 0.3 [95% CI, 0.1-0.7]). The median time to a first vascular event during follow-up was 27 months (interquartile range, 8.7-50 months), with a cumulative hazard of 47% at 10 years.

CONCLUSIONS

The long-term prognosis of patients who survive a first spontaneous cerebellar ICH is poor and comparable to that of patients who survive a first supratentorial ICH. Further identification of patients at high risk of vascular events following the initial cerebellar ICH is needed. Including patients with cerebellar ICH in randomized controlled trials on secondary prevention of patients with ICH is warranted.

Treating Hypertension: Important for Heart Health, Fundamental for Brain Health

The Brain Health crisis stands as one of humankind's most pressing threats, with age-related noncommunicable brain diseases, particularly stroke, and dementia, affecting hundreds of millions annually and jeopardizing the economic well-being of populations worldwide. Epidemiological studies indicate that ≈40% of dementia and 60% of stroke cases are attributable to modifiable risk factors. In this Comments and Opinions article, we underscore the pivotal role of blood pressure (BP) control in reducing suffering, enhancing economic well-being, and promoting healthy longevity for populations worldwide. Emphasizing that BP control is crucial for both brain and heart health, it advocates for heightened awareness, positioning hypertension as a primary focus for preventing dementia and stroke with potential global impact. Despite its significance, BP control encounters global challenges, with proportions of the population maintaining adequately controlled hypertension ranging from 23% to 90%. The World Health Organization estimated that 46% of the 1.28 billion people with hypertension are unaware of their elevated BP. Given the notable disparities in BP management, addressing BP management also contributes to combating significant health inequalities. The next time you are faced with a patient anxious about the prospect of experiencing a fate similar to a parent with dementia or a sister with a stroke, we suggest a straightforward answer for health care providers: start ensuring BP control. BP is a matter of brain health, and it is a matter of our economic future.

Predicting post-stroke cognitive impairment using electronic health record data

BACKGROUND

Secondary prevention interventions to reduce post-stroke cognitive impairment (PSCI) can be aided by the early identification of high-risk individuals who would benefit from risk factor modification.

AIMS

To develop and evaluate a predictive model to identify patients at increased risk of PSCI over 5 years using data easily accessible from electronic health records.

METHODS

Cohort study that included primary care patients from two academic medical centers. Patients were aged 45 years or older, without prior stroke or prevalent cognitive impairment, with primary care visits and an incident ischemic stroke between 2003 and 2016 (development/internal validation cohort) or 2010 and 2022 (external validation cohort). Predictors of PSCI were ascertained from the electronic health record. The outcome was incident dementia/cognitive impairment within 5 years and beginning 3 months following stroke, ascertained using International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) codes. For model variable selection, we considered potential predictors of PSCI and constructed 400 bootstrap samples with two-thirds of the model derivation sample. We ran 10-fold cross-validated Cox proportional hazards models using a least absolute shrinkage and selection operator (LASSO) penalty. Variables selected in >25% of samples were included.

RESULTS

The analysis included 332 incident diagnoses of PSCI in the development cohort (n = 3741), and 161 and 128 incident diagnoses in the internal (n = 1925) and external (n = 2237) validation cohorts, respectively. The C-statistic for predicting PSCI was 0.731 (95% confidence interval (CI): 0.694-0.768) in the internal validation cohort, and 0.724 (95% CI: 0.681-0.766) in the external validation cohort. A risk score based on the beta coefficients of predictors from the development cohort stratified patients into low (0-7 points), intermediate (8-11 points), and high (12-23 points) risk groups. The hazard ratios (HRs) for incident PSCI were significantly different by risk categories in internal (high, HR: 6.2, 95% CI: 4.1-9.3; Intermediate, HR: 2.7, 95% CI: 1.8-4.1) and external (high, HR: 6.1, 95% CI: 3.9-9.6; Intermediate, HR: 2.8, 95% CI: 1.9-4.3) validation cohorts.

CONCLUSION

Five-year risk of PSCI can be accurately predicted using routinely collected data. Model output can be used to risk stratify and identify individuals at increased risk for PSCI for preventive efforts.

DATA ACCESS STATEMENT

Mass General Brigham data contain protected health information and cannot be shared publicly. The data processing scripts used to perform analyses will be made available to interested researchers upon reasonable request to the corresponding author.

Predicting post-stroke cognitive impairment using electronic health record data

Importance

Secondary prevention interventions to reduce post-stroke cognitive impairment (PSCI) can be aided by the early identification of high-risk individuals who would benefit from risk factor modification.

Objective

To develop and evaluate a predictive model to identify patients at increased risk of PSCI over 5 years using data easily accessible from electronic health records.

Design

Cohort study with patients enrolled between 2003-2016 with follow-up through 2022.

Setting

Primary care practices affiliated with two academic medical centers.

Participants

Individuals 45 years or older, without prior stroke or prevalent cognitive impairment, with primary care visits and an incident ischemic stroke between 2003-2016 (development/internal validation cohort) or 2010-2022 (external validation cohort).

Exposures

Predictors of PSCI were ascertained from the electronic health record.

Main Outcome

The outcome was incident dementia/cognitive impairment within 5 years and beginning 3 months following stroke, ascertained using ICD-9/10 codes. For model variable selection, we considered potential predictors of PSCI and constructed 400 bootstrap samples with two-thirds of the model derivation sample. We ran 10-fold cross-validated Cox proportional hazards models using a least absolute shrinkage and selection operator (LASSO) penalty. Variables selected in >25% of samples were included.

Results

The analysis included 332 incident diagnoses of PSCI in the development cohort (n=3,741), and 161 and 128 incident diagnoses in the internal (n=1,925) and external (n=2,237) validation cohorts. The c-statistic for predicting PSCI was 0.731 (95% CI: 0.694-0.768) in the internal validation cohort, and 0.724 (95% CI: 0.681-0.766) in the external validation cohort. A risk score based on the beta coefficients of predictors from the development cohort stratified patients into low (0-7 points), intermediate (8-11 points), and high (12-35 points) risk groups. The hazard ratios for incident PSCI were significantly different by risk categories in internal (High, HR: 6.2, 95% CI 4.1-9.3; Intermediate, HR 2.7, 95% CI: 1.8-4.1) and external (High, HR: 6.1, 95% CI: 3.9-9.6; Intermediate, HR 2.8, 95% CI: 1.9-4.3) validation cohorts.

Conclusions and Relevance

Five-year risk of PSCI can be accurately predicted using routinely collected data. Model output can be used to risk stratify and identify individuals at increased risk for PSCI for preventive efforts.

The predictive validity of a Brain Care Score for dementia and stroke: data from the UK Biobank cohort

Introduction

The 21-point Brain Care Score (BCS) was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke. We aimed to assess the associations of the BCS with risk of incident dementia and stroke.

Methods

The BCS was derived from the United Kingdom Biobank (UKB) baseline evaluation for participants aged 40-69 years, recruited between 2006-2010. Associations of BCS and risk of subsequent incident dementia and stroke were estimated using Cox proportional hazard regressions, adjusted for sex assigned at birth and stratified by age groups at baseline.

Results

The BCS (median: 12; IQR:11-14) was derived for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incident cases of dementia and 7,259 incident cases of stroke recorded during a median follow-up of 12.5 years. A five-point higher BCS at baseline was associated with a 59% (95%CI: 40-72%) lower risk of dementia among participants aged <50. Among those aged 50-59, the figure was 32% (95%CI: 20-42%) and 8% (95%CI: 2-14%) for those aged >59 years. A five-point higher BCS was associated with a 48% (95%CI: 39-56%) lower risk of stroke among participants aged <50, 52% (95%CI, 47-56%) among those aged 50-59, and 33% (95%CI, 29-37%) among those aged >59.

Discussion

The BCS has clinically relevant and statistically significant associations with risk of dementia and stroke in approximately 0.4 million UK people. Future research includes investigating the feasibility, adaptability and implementation of the BCS for patients and providers worldwide.

Computed Tomography Angiography Spot Sign, Hematoma Expansion, and Functional Outcome in Spontaneous Cerebellar Intracerebral Hemorrhage

[Figure: see text].

Secondary Hematoma Evacuation and Outcome After Initial Conservative Approach for Patients with Cerebellar Hematoma Larger than 3 cm

Background

In patients with spontaneous cerebellar intracerebral hemorrhage (ICH) guidelines advocate evacuation when the hematoma diameter is > 3 cm. We studied outcome in patients with cerebellar ICH > 3 cm who did not undergo immediate hematoma evacuation.

Methods

We included consecutive patients with cerebellar ICH > 3 cm at two academic hospitals between 2008 and 2017. Patients who died < 24 h (h) were excluded because of probable confounding by indication. We determined patient characteristics, hematoma volumes, EVD placement, secondary hematoma evacuation, in-hospital and 3-month case-fatality, and functional outcome.

Results

Of 130 patients with cerebellar ICH, 98 (77%) had a hematoma > 3 cm of whom 22 (23%) died < 24 h and 28 (29%) underwent hematoma evacuation < 24 h. Thus, 48 patients were initially treated conservatively (mean age 70 ± 13, 24 (50%) female). Of these 48 patients, 7 (15%) underwent secondary hematoma evacuation > 24 h, of whom 1 (14%) had received an EVD < 24 h. Five others also received an EVD < 24 h without subsequent hematoma evacuation. Of the 41 patients without secondary hematoma evacuation, 11 (28%) died and 20 (51%) had a favorable outcome (mRS of 0–3) at 3 months. The 7 patients who underwent secondary hematoma evacuation had a decrease in GCS score of at least two points prior to surgery; two (29%) had deceased at 3 months; and 5 (71%) had a good functional outcome (mRS 0–3).

Conclusions

While cerebellar ICH > 3 cm is often considered an indication for immediate hematoma evacuation, there may be a subgroup of patients in whom surgery can be safely deferred. Further data are needed to assess the optimal timing and indications of surgical treatment in these patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12028-021-01203-6.

Structural, optical and electronic properties of Ni1-x Co x O in the complete composition range

Crystallographic and electronic structures of phase pure ternary solid solutions of Ni_1−xCo_xO (x = 0 to 1) have been studied using XRD, EXAFS and XAS measurements. The lattice parameter of the cubic rock-salt (RS) Ni_1−xCo_xO solid solutions increases linearly with increasing Co content and follows Vegard's law, in the complete composition range. A linear increase in the bond lengths (Ni/Co–O, Ni–Ni and Ni–Co) with “x”, closely following the bond lengths determined from virtual crystal approximation (VCA), is observed, which implies that there is only a minimal local distortion of the lattice in the mixed crystal. The optical gap of the ternary solid solution determined from diffuse reflectivity measurements shows neither a linear variation with Co composition nor bowing, as observed in many ternary semiconductors. This trend in the variation of optical gaps is explained by probing the conduction band using XAS at the O K-edge. We have observed that the variation in the onset energy of the conduction band edge with “x” is very similar to the variation in the optical gap with “x”, thus clearly indicating the dominant role played by the conduction band position in determining the optical gap. The variation in the intensities of the pre-edge peak in the XANES spectra measured at Ni and Co K-edges, and the L_1/2 peak in XAS spectra measured at Ni and Co L-edges, is found to depend on the unoccupied O 2p-metal-(Ni/Co) 3d hybridized states and the bond lengths.

The optical gap of Ni_1−xCo_xO solid solutions neither varies linearly with Co composition nor shows any bowing in the complete composition range. The nature of this variation of the gap is governed by the position of conduction band edge.

Co-infection of Newcastle disease virus genotype XIII with low pathogenic avian influenza exacerbates clinical outcome of Newcastle disease in vaccinated layer poultry flocks

Newcastle disease (ND) and avian influenza (AI) are economically important infectious diseases of poultry. Sometime, concomitant secondary viral/or bacterial infections significantly alters the pathobiology of ND and AI in poultry. As of now, the disease patterns and dynamics of co-infections caused by ND virus (NDV, genotype XIII) and Low Pathogenic AI viruses (LPAI, H9N2) are explicitly elusive. Thus, we examined the clinicopathological disease conditions due to these two economically important viruses to understand the complex disease outcomes by virus-virus interactions in vaccinated flocks. The findings of clinicopathological and molecular investigations carried on 37 commercial ND vaccinated poultry flocks revealed simultaneous circulation of NDV and AIV in same flock/bird. Further, molecular characterization of hemagglutinin (HA) and neuraminidase (NA) genes confirmed that all the identified AIVs were of low pathogenicity H9N2 subtype and fusion (F) gene analysis of detected NDVs belong to NDV class II, genotype XIII, a virulent type. The NDV and H9N2 alone or co-infected flocks (NDV + LPAI) exhibit clinical signs and lesions similar to that of virulent NDV except the degree of severity, which was higher in H9N2-NDV co-infected flocks. Additionally, avian pathogenic E. coli and mycoplasma infections were detected in majority of the ailing/dead birds from the co-infected flocks during progression of the clinical disease. Overall, the findings highlight the multi-factorial disease complexity in commercial poultry and suggest the importance of NDV genotype XIII in intensifying the clinical disease in vaccinated birds.

Cerebellar Microbleed Distribution Patterns and Cerebral Amyloid Angiopathy

Background and Purpose- Hematoma location within the cerebellum may help identify the dominant small vessel disease type (cerebral amyloid angiopathy [CAA] versus nonamyloid small vessel disease). However, it is unknown whether this holds true for cerebral microbleeds (CMBs) within the cerebellum. We tested the hypothesis that cerebellar CMBs restricted to the cortex and vermis (defined as superficial regions) are associated with clinically diagnosed and pathology-verified CAA. Methods- Three hundred and seven consecutive spontaneous intracerebral hemorrhage (ICH) patients with a baseline magnetic resonance imaging that included susceptibility-weighted imaging or angiography were enrolled. Using a topographical template, cerebellar CMB patterns were defined as strictly superficial versus deep (cerebellar gray nuclei and white matter) or mixed (both regions involved). Thirty-six ICH patients with cerebellar CMBs and neuropathology data available were evaluated for the presence of CAA. Results- One hundred and thirty-five (44%) ICH patients had CMBs in the cerebellum. In the patient group with cerebellar CMBs, 85 (63%) showed a superficial pattern, and 50 (37%) had a deep/mixed pattern. Strictly superficial cerebellar CMBs were independently associated with a supratentorial pattern of probable CAA-ICH according to the Boston criteria (odds ratio, 1.6; CI, 1.03-2.5) and deep/mixed cerebellar CMBs with a pattern of deep/mixed ICH (odds ratio, 1.8; CI, 1.2-2.7). Pathologically verified CAA was present in 23 of 24 (96%) patients with superficial cerebellar CMBs versus 3 of 12 (25%) patients with deep/mixed cerebellar CMBs ( P<0.001). Conclusions- In ICH patients, cerebellar CMBs are relatively common and often restricted to superficial regions. A strictly superficial distribution of cerebellar CMBs is associated with clinically diagnosed and pathologically verified CAA.

Interplay of phosphorus doses, cyanobacterial inoculation, and elevated carbon dioxide on yield and phosphorus dynamics in cowpea

Phosphorus (P) demand is likely to increase especially in legumes to harness greater benefits of nitrogen fixation under elevated CO₂ condition. In the following study, seed yield and seed P uptake in cowpea increased by 26.8% and 20.9%, respectively, under elevated CO₂ level. With an increase in phosphorus dose up to 12 mg kg^-1, seed yield enhanced from 2.6 to 5.4 g plant^-1. P application and cyanobacterial inoculation increased the microbial activity of soil, leading to increased availability of P. Under elevated CO₂ condition, microbial activity, measured as dehydrogenase, acid phosphatase, and alkaline phosphatase activities showed stimulation. Soil available P also increased under elevated CO₂ condition and was stimulated by both P application and cyanobacterial inoculation. Higher P uptake in elevated CO₂ condition led to lower values of inorganic P in soil. Stepwise regression analysis showed that aboveground P uptake, soil available P, and alkaline phosphatase activity of soil influenced the yield while available P, and organic and inorganic P influenced the aboveground P uptake of the crop. This study revealed that under elevated CO₂ condition, P application and cyanobacterial inoculation facilitated P uptake and yield, mediated through enhanced availability of nutrients, in cowpea crop.

Effect of elevated carbon dioxide on soil hydrothermal regimes and growth of maize crop (Zea mays L.) in semi-arid tropics of Indo-Gangetic Plains

To see the effect of climate change on the variation of soil hydrothermal regimes and growth of maize crop, an experiment was conducted in free-air carbon dioxide enrichment (FACE) facility during the kharif season of 2015 at Climate Change Facility of Indian Agricultural Research Institute, New Delhi, India. Under elevated CO₂ and ambient condition, surface bulk density (BD) were 1.38 Mgm^-3 and 1.44 Mgm^-3, respectively but BD were not significantly different. During different days after sowing (DAS), in 0 to 10-cm soil depth, soil water content (SWC) in FACE varied between 14.58-20.70%, whereas in ambient condition, SWC variations were in between 19.33-22.94%. In 10 to 20-cm soil depth, SWC ranged in between 20.47-27.14% in FACE and 23.57-25.42% in ambient condition for different DAS. It is also observed that the arrival of peak surface ST was 1 h early in elevated CO₂ condition. Photosynthetic rate increased by 5.7% on 44 DAS and 18.1% on 70 DAS under elevated carbon dioxide condition. Elevated carbon dioxide had reduced the stomatal conductance but the reduction was not significant. Like variation in air temperature for climate change, more intensive study is required to see the effect of climate change on soil temperature and its effect on crop growth.

Cytological and immunocytological detection and differentiation of Marek's disease and lymphoid leucosis in poultry

Marek's disease (MD) and lymphoid leucosis (LL) are the major diseases causing lymphoid tumors in chickens accounting for high economical losses. Gross examination could not yield definite diagnosis owing to their similar presentation of lesions. Thus present work was aimed for diagnosis and differentiation of MD and LL by utilizing simple cytology and novel immunocytology techniques. Cytological examination was carried out on slides with tumor touch imprints stained by simple Giemsa staining. The diagnosis was mainly achieved based on morphology of cell population. In the present study, out of a total of 595 cases examined, 502 cases had pleomorphic lymphocytic cell population suggestive of MD and 53 cases had uniform lymphocytic/lymphoblast cell population suggestive of LL, while the rest 40 cases remained inconclusive. A definitive diagnosis was achieved after performing immunocytology using specific antibodies that revealed 518 cases had reactivity for Meq oncoprotein specific for MD and 77 cases showed immunoreactivity for IgM in transformed B-cells confirming LL. The technique of immunocytology which has been useful for detecting human viral pathogens and MD in poultry has been applied for the first time as a novel, simple, rapid and inexpensive technique that could be used as an alternate test to effectively detect and differentiate MD and LL in poultry.

Augmentation of Water Resources Potential and Cropping Intensification Through Watershed Programs

  This paper presents the biophysical impact of various interventions made under watershed development programs, in terms of the creation of additional water resources, and resultant changes in land use and cropping patterns in the Bundelkhand region of Madhya Pradesh State, India. Both primary and secondary data gathered from randomly selected watersheds and their corresponding control villages were used in this study. Analysis revealed that emphasis was given primarily to the creation of water resources potential during implementation of the programs, which led to augmentation of surface and groundwater availability for both irrigation and non-agricultural purposes. In addition, other land based interventions for soil and moisture conservation, plantation activities, and so forth, were taken up on both arable and nonarable land, which helped to improve land slope and land use, cropping pattern, agricultural productivity, and vegetation cover.

Associated Factors and Outcome of Babies Born Through Meconium Stained Amniotic Fluid

Background Neonates born through meconium stained amniotic fluid (MSAF) are associated with significant morbidity and mortality. Objective To study the incidence, associated factors and outcome of meconium stained amniotic fluid babies born in Dhulikhel hospital. Method Prospective, cross-sectional study conducted in Obstetric ward and Neonatal Intensive Care Unit (NICU) from 15 December 2015 to 15 December 2016. All the babies born through meconium stained amniotic fluid during the period were included. Result Incidence of meconium stained amniotic fluid was 6.5%(167/2581). Meconium aspiration syndrome (MAS) developed in 9(5.4%) among all meconium stained amniotic fluid cases. Primigravidity and postdatism were observed more in Meconium aspiration syndrome group than meconium stained amniotic fluid group (77.8% VS 73.4%; 33.3% VS 26.3%). Babies delivered by caesarian section were more in meconium stained amniotic fluid group than Meconium aspiration syndrome group (47.5% VS 33.3%). All the babies with meconium stained amniotic fluid improved except one baby with Meconium aspiration syndrome who expired. Neonatal sepsis was a significant co-morbidity in Meconium aspiration syndrome group (P value= 0.008). There was increased incidence of operative delivery in thick meconium stained amniotic fluid than thin meconium stained amniotic fluid (52.6% VS 38.9%). Similarly, Neonatal Intensive Care Unit admission and neonatal complications like Meconium aspiration syndrome, perinatal asphyxia and sepsis were more commonly observed in thick meconium stained amniotic fluid group than thin meconium stained amniotic fluid group. Conclusion The progression to meconium aspiration syndrome in babies with meconium stained amniotic fluid is not associated with any maternal and neonatal factors studied. MAS babies are 10 times more likely to require NICU admission and sepsis is a significant co-morbidity. Thick meconium stained amniotic fluid is worrisome. There is increased chance of operative delivery and neonatal complications if associated with thick meconium stained amniotic fluid.

Analysis of Thermoluminescence Glow Curves using Derivatives of different Orders

The suitability of the second derivative method for locating component peaks in complex thermoluminescence (TL) glow curves has been investigated in this work by considering both numerically simulated and experimental TL peaks. This technique is useful to acquire knowledge of the number of component peaks in a complex TL curve which in turn serves as a basic information before applying the deconvolution technique to the glow curve. To check the consistency of the results so obtained, we have also applied the first derivative technique to TL glow curves. It is well-known that kinetic order formalism fails for saturated TL peaks with heavy retrapping. Such peaks are usually broad and, to the best of our knowledge, have not yet been observed experimentally. The present derivative technique has been used to detect whether such broad peaks are truly single or not by considering a number of numerically simulated saturated glow curves with heavy retrapping where the conventional peak shape method fails. In all the cases considered here, the second derivative technique proves to be a potential candidate for estimating the number of peaks and their respective locations in a complex TL glow curve.

Immunomodulatory and prophylactic efficacy of herbal extracts against experimentally induced chicken infectious anaemia in chicks: assessing the viral load and cell mediated immunity

Chicken infectious anaemia virus (CIAV) is an economically important and a highly immunosuppressive virus affecting poultry industry worldwide. In this study we assessed the immunomodulatory effects of four herbal preparations namely Withania somnifera, Tinospora cordifolia, Azadirachta indica and E Care Se Herbal in resisting the viral multiplication and immunosuppression inflicted by CIAV in chicks. Day-old chicks (n = 90) were randomly and equally divided into six groups (Groups A-F). Groups A-D were administered with purified extracts of W. somnifera, T. cordifolia, A. indica and E Care Se Herbal, respectively followed by the evaluation of viral load in lymphoid organs by quantitative real-time PCR and cell mediated immune response by flow cytometric analysis of CD4⁺ and CD8⁺ T cells. Groups A-D were found to resist CIAV multiplication and pathogenesis with significant reduction of viral load compared with the infected control (P < 0.05). Group A-C chicks showed significantly higher (P < 0.05) CD4⁺ and CD8⁺ T cell counts compared to control birds while of E Care Se Herb had minimal effect on T cell count. The findings suggested that the herbal preparations used during the study were effective as both prophylactic and immunomodulatory agents and thus have potential of being used against CIAV induced immunosuppression in poultry.

Phylogenetic analysis of Newcastle disease virus isolates occurring in India during 1989-2013

The study details characterization of Newcastle disease virus (NDV) isolates recovered from commercial poultry flocks (chicken) and wild birds (crane) of India during the time period from 1989 to 2013. Phylogenetic analysis revealed that most of the NDV isolates belongs to class II, genotype XIIIa and a chicken isolate (108/BAREILLY/AD-IVRI/91) was of genotype VI, where it showed diversity of 3 % from the other viruses belonging to same genotype. Another chicken isolate (75/RAMPUR/AD-IVRI/89) grouped in genotype III and showed 4 % diversity with viruses of genotype III. The crane origin NDV identified as of genotype II corresponding to the vaccine virus. This appears to be the first report about existence of genotype XIIIa and its ancestral viruses are circulating in India for the last two decades in different species of birds. Furthermore, genetically distinct viruses belonging to genotypes II, III and VI are also circulating in India.

Aortic flow patterns before and after personalised external aortic root support implantation in Marfan patients

Implantation of a personalised external aortic root support (PEARS) in the Marfan aorta is a new procedure that has emerged recently, but its haemodynamic implication has not been investigated. The objective of this study was to compare the flow characteristics and hemodynamic indices in the aorta before and after insertion of PEARS, using combined cardiovascular magnetic resonance imaging (CMR) and computational fluid dynamics (CFD). Pre- and post-PEARS MR images were acquired from 3 patients and used to build patient-specific models and upstream flow conditions, which were incorporated into the CFD simulations. The results revealed that while the qualitative patterns of the haemodynamics were similar before and after PEARS implantation, the post-PEARS aortas had slightly less disturbed flow at the sinuses, as a result of reduced diameters in the post-PEARS aortic roots. Quantitative differences were observed between the pre- and post-PEARS aortas, in that the mean values of helicity flow index (HFI) varied by -10%, 35% and 20% in post-PEARS aortas of Patients 1, 2 and 3, respectively, but all values were within the range reported for normal aortas. Comparisons with MR measured velocities in the descending aorta of Patient 2 demonstrated that the computational models were able to reproduce the important flow features observed in vivo.

Plant Pathogenic Microbial Communication Affected by Elevated Temperature in Pectobacterium carotovorum subsp. carotovorum

Gram-negative plant pathogenic bacteria regulate specific gene expression in a population density-dependent manner by sensing level of Acyl-Homoserine Lactone (HSL) molecules which they produce and liberate to the environment, called Quorum Sensing (QS). The production of virulence factors (extracellular enzyme viz. cellulase, pectinase, etc.) in Pectobacterium carotovorum subsp. carotovorum (Pcc) is under strong regulation of QS. The QS signal molecule, N-(3-oxohexanoyl)-L-Homoserine Lactone (OHHL) was found as the central regulatory system for the virulence factor production in Pcc and is also under strict regulation of external environmental temperature. Under seven different incubation temperatures (24, 26, 28, 30, 33, 35, and 37 °C) in laboratory condition, highest amount of OHHL (804 violacein unit) and highest (79 %) Disease Severity Index (DSI) were measured at 33 °C. The OHHL production kinetics showed accumulation of highest concentration of OHHL at late log phase of the growth but diminution in the concentration occurred during stationary phase onwards to death phase. At higher temperature (35 and 37 °C) exposure, OHHL was not at detectable range. The effect of temperature on virulence factor production is the concomitant effect of HSL production and degradation which justifies less disease severity index in cross-inoculated tomato fruits incubated at 35 and 37 °C. The nondetection of the OHHL in the elevated temperature may because of degradation as these signal molecules are quite sensitive and prone to get degraded under different physical factors. This result provides the rationale behind the highest disease severity up to certain elevated temperature and leaves opportunities for investigation on mutation, co-evolution of superior plant pathogen with more stable HSL signals-mediated pathogenesis under global warming context.

Biomechanical properties of the Marfan's aortic root and ascending aorta before and after personalised external aortic root support surgery

Marfan syndrome is an inherited systemic connective tissue disease which may lead to aortic root disease causing dilatation, dissection and rupture of the aorta. The standard treatment is a major operation involving either an artificial valve and aorta or a complex valve repair. More recently, a personalised external aortic root support (PEARS) has been used to strengthen the aorta at an earlier stage of the disease avoiding risk of both rupture and major surgery. The aim of this study was to compare the stress and strain fields of the Marfan aortic root and ascending aorta before and after insertion of PEARS in order to understand its biomechanical implications. Finite element (FE) models were developed using patient-specific aortic geometries reconstructed from pre and post-PEARS magnetic resonance images in three Marfan patients. For the post-PEARS model, two scenarios were investigated-a bilayer model where PEARS and the aortic wall were treated as separate layers, and a single-layer model where PEARS was incorporated into the aortic wall. The wall and PEARS materials were assumed to be isotropic, incompressible and linearly elastic. A static load on the inner wall corresponding to the patients' pulse pressure was applied. Results from our FE models with patient-specific geometries show that peak aortic stresses and displacements before PEARS were located at the sinuses of Valsalva but following PEARS surgery, these peak values were shifted to the aortic arch, particularly at the interface between the supported and unsupported aorta. Further studies are required to assess the statistical significance of these findings and how PEARS compares with the standard treatment.

Clinical profile and antibiotics sensitivity in childhood urinary tract infection at Dhulikhel Hospital

BACKGROUND

Urinary Tract Infection implies presence of actively multiplying organisms in the urinary tract. Although it is infrequently associated with mortality, it is still a significant cause of morbidity. Early diagnosis is critical to preserve renal function of growing kidney.

OBJECTIVE

Our purpose was to determine the clinical, microbiologic profile and antibiotic sensitivity of such infections in pediatric Urinary Tract Infection (UTI) patients at Dhulikhel Hospital.

METHODS

A hospital based prospective descriptive study of 135 children from 2 months to 16 years, with clinical diagnosis of urinary tract infection who visited the pediatric department of Dhulikhel Hospital over the period of 15 months were enrolled in the study. All patients underwent routine urine analysis and culture. Children with recurrent UTI underwent micturating cystourethrogram (MCUG). Children with recurrent UTI of more than two years and with feature of pyelonephritis underwent USG abdomen as well. Complications and response of the treatment was observed in all cases of UTI. All data were entered in Epidata and data analysis was done using spss 16 version.

RESULTS

Among 135 children, 32.5% were male and 67.4% were female. Fever was the most common presenting symptom in 74.80% of patients followed by dysuria in 54.1%. Among these children 95.6% had significant pyuria and 45% had culture positive infection. Children who showed positive for bacteriuria, Escherichia coli (78.7%) was the most common organism and are more than 80% sensitive to Amikacin, Gentamicin, Ceftriaxone, Ofloxacin, Nalidixic acid, Imipenem and Vancomycin. Co-trimoxazole was the most common drug used for treatment with a mean drug respond time of (mean+/-S.D) of 2.21+/-.78 days. 2+/-. Children who had recurrent UTI were more prone to develop culture positive UTI (p=0.0001).

CONCLUSION

Urinary Tract Infection in female was almost twice more common than in male. Cotrimoxazole was the most common drug used for treatment, sensitivity of this drug was less than 50% for all organisms.

Molecular analysis of dinucleotide microsatellite in growth hormone gene of Asian seabass (Lates calcarifer) from Mumbal, India

In the present study, out of four alleles amplified from seabass (Lates calcarifer) genome inhabiting Mumbai water by PCR using growth hormone (GH) gene-specific primers, two DNA fragments (SGMS1, 233 bp and SGMS2, 239 bp) were eluted from gel, cloned using pTZ57R (2.886 kb) vector into E. coli DH5α, characterized by restriction endonuclease analysis and sequenced by automated DNA sequencer. After blasting and multiple alignment of the above sequences, SGMS1 showed 97% and SGMS2 93.3% homology with promoter region of GH gene containing microsatellite of Australian seabass and 94.6% homology between both the fragments. These sequences SGMS1 and SGMS2 were submitted to NCBI GenBank. On blasting, these sequences with gene databases, SGMS1 and SGMS2 showed partial homologies with Seriola quinqueradiata (26.9%, 12.9%), flounder (15.8%, 15.8%), Oreochromis nilotica (23%, 7.9%), Oreochromis mossambicus (23%, 7.9%) and Danio rerio (8.2%, 7.5%). Critical analysis showed the presence of microsatellite (CA)16 and (CA)19 repeats in fragments SGMS1 and SGMS2, respectively in seabass from Mumbai water in comparison to (CA)14 repeats from the Australian seabass. Further, on sequence comparison, single nucleotide mismatches detected at their several positions in relation to seabass GH gene of Australia. These nucleotide variations detected in SGMS1 and SGMS2 in comparison to those of the Australian seabass may be due to mutations owing to environmental or habitat changes that seem to have definite potentials for development of genetic markers, which would be useful for identification and selection of superior germplasm with desirable commercial traits such as high growth rate.

A rapid method of accurate detection and differentiation of Newcastle disease virus pathotypes by demonstrating multiple bands in degenerate primer based nested RT-PCR

A rapid and accurate method of detection and differentiation of virulent and avirulent Newcastle disease virus (NDV) pathotypes was developed. The NDV detection was carried out for different domestic avian field isolates and pigeon paramyxo virus-1 (25 field isolates and 9 vaccine strains) by using APMV-I "fusion" (F) gene Class II specific external primer A and B (535bp), internal primer C and D (238bp) based reverses transcriptase PCR (RT-PCR). The internal degenerative reverse primer D is specific for F gene cleavage position of virulent strain of NDV. The nested RT-PCR products of avirulent strains showed two bands (535bp and 424bp) while virulent strains showed four bands (535bp, 424bp, 349bp and 238bp) on agar gel electrophoresis. This is the first report regarding development and use of degenerate primer based nested RT-PCR for accurate detection and differentiation of NDV pathotypes by demonstrating multiple PCR band patterns. Being a rapid, simple, and economical test, the developed method could serve as a valuable alternate diagnostic tool for characterizing NDV isolates and carrying out molecular epidemiological surveillance studies for this important pathogen of poultry.

Development of slide ELISA (SELISA) for detection of four poultry viral pathogens by direct heat fixation of viruses on glass slides

The development of an easy and simpler method of slide enzyme-linked immunosorbent assay (SELISA) for the diagnosis of four economically important poultry viruses viz., Newcastle disease virus (NDV), infectious bronchitis virus (IBV), infectious bursal disease virus (IBDV) and egg drop syndrome 76 virus (EDS 76) and the use of SELISA for semi quantitation of NDV are described. The positive signals for viral aggregates were detected under light microscope. This is the first report regarding the development of SELISA based on heat fixation for the diagnosis of viral pathogens.

Synergistic action of tropospheric ozone and carbon dioxide on yield and nutritional quality of Indian mustard (Brassica juncea (L.) Czern.)

Field experiments were conducted in open top chamber during rabi seasons of 2009-10 and 2010-11 at the research farm of the Indian Agricultural Research Institute, New Delhi to study the effect of tropospheric ozone (O3) and carbon dioxide (CO2) interaction on yield and nutritional quality of Indian mustard (Brassica juncea (L.) Czern.). Mustard plants were grown from emergence to maturity under different treatments: charcoal-filtered air (CF, 80-85 % less O3 than ambient O3 and ambient CO2), nonfiltered air (NF, 5-10 % less O3 than ambient O3 and ambient CO2 ), nonfiltered air with elevated carbon dioxide (NF + CO2, NF air and 550 ± 50 ppm CO2), elevated ozone (EO, NF air and 25-35 ppb elevated O3), elevated ozone along with elevated carbon dioxide (EO + CO2, NF air, 25-35 ppb O3 and 550 ± 50 ppm CO2), and ambient chamber less control (AC, ambient O3 and CO2). Elevated O3 exposure led to reduced photosynthesis and leaf area index resulting in decreased seed yield of mustard. Elevated ozone significantly decreased the oil and micronutrient content in mustard. Thirteen to 17 ppm hour O3 exposure (accumulated over threshold of 40 ppm, AOT 40) reduced the oil content by 18-20 %. Elevated CO2 (500 ± 50 ppm) along with EO was able to counter the decline in oil content in the seed, and it increased by 11 to 13 % over EO alone. Elevated CO2, however, decreased protein, calcium, zinc, iron, magnesium, and sulfur content in seed as compared to the nonfiltered control, whereas removal of O3 from air in the charcoal-filtered treatment resulted in a significant increase in the same.

Fowl adenovirus (FAdV) in India: evidence for emerging role as primary respiratory pathogen in chickens

Adenoviruses have been isolated from both clinically healthy and diseased birds worldwide. The pathogenic role of most of the FAdVs is still questionable. They can quickly take on the role of opportunistic pathogens when additional factors, particularly concurrent infections, adversely affect the health of the avian host. Immnosuppressing agents especially chicken infectious anemia and infectious bursal disease viruses are known to enhance the pathogenicity of FAdVs upon coinfection. The aim of the present study was to screen for the involvement of FAdV in poultry flocks affected with respiratory disease complex by RT-PCR. The samples were also screened by RT-PCR/PCR for other respiratory pathogens. Thirty two commercial poultry flocks with the history of respiratory disease complex from various parts of India. FAdV nucleic acid could be detected in tissue samples of 13 out of 34 farms investigated. Out of 13 FAdV positive farms, FAdV and CIAV were alone detected in 4/13 (31%) whereas, in other farms more than two respiratory pathogens were detected together. CIAV was detected in all the farms (34/34) investigated. Eosinophilic intranuclear inclusion bodies were noticed in FAdV infected laryngeal and tracheal epithelium under light microscopy. The findings of the study assert that FAdV can play the role of primary respiratory pathogen in immunocompromised birds and also in the presence of other respiratory pathogens.

Increased T-regulatory cells within lymphocyte follicles in moderate COPD

Lymphoid follicles in the lung parenchyma are a characteristic feature of chronic obstructive pulmonary disease (COPD). There are reports of altered CD4 T-regulatory cell numbers in COPD lungs, but the location of these cells within COPD lung tissue specific follicles has not been investigated. The presence of CD4(+)FOXP3(+) T-regulatory cells was assessed in surgically resected lung tissue from 12 COPD patients, 11 smokers with normal lung function and seven nonsmokers by combined immunofluorescence and immunohistochemistry. Organised lymphoid follicles were observed in all three groups of patients, as well as lymphoid clusters lacking organisation. The percentage of CD4 cells that were T-regulatory cells were significantly increased (p = 0.02) within COPD (16%) follicles compared with smokers (10%) and nonsmokers (8%). In contrast, there was no change (p>0.05) in the percentage of T-regulatory cells in clusters or the subepithelium between groups. Lymphoid follicles in COPD patients have increased T-regulatory cells. Therefore, T-regulatory activity may be altered within COPD lymphoid follicles.

Bronchoprotective and bronchodilator effects of an HFA pMDI vs. a CFC pMDI and a DPI containing formoterol in asthma patients

In this double-blind, placebo-controlled, crossover study we compared the bronchoprotective effects of formoterol 12 microg inhaled via an HFA-134a inhaler (Modulite HFA) versus a CFC and a DPI device in 38 patients with mild-to-moderate persistent asthma. All three formoterol preparations significantly increased methacholine PD20 and FEV1 and improved small airway function parameters compared with placebo (p < 0.001). No significant differences were observed between formoterol formulations. In conclusion, Modulite HFA formoterol was found to be an effective and well tolerated treatment in patients with asthma, with comparable efficacy to current formoterol preparations.

Comparison of bronchoprotective and bronchodilator effects of a single dose of formoterol delivered by hydrofluoroalkane and chlorofluorocarbon aerosols and dry powder in a double blind, placebo-controlled, crossover study

BACKGROUND

In response to the phasing out of chlorofluorocarbon (CFC) inhalers, a metered dose hydrofluoroalkane (HFA) formulation, Modulite (Chiesi Farmaceutici S.p.A, Parma, Italy), to be delivered with a pressurized metered dose inhaler (pMDI), has been developed. Modulite is a HFA formulation technology that has been designed to provide stable and uniform dose delivery of HFA-based formulations to enable an easy transition from CFC to HFA inhalers.

OBJECTIVES

The aim of this study was to compare the bronchoprotective and bronchodilator effects of a single dose of 12 microg of formoterol from the HFA Modulite inhaler with the Foradil Aerolizer (dry powder inhaler, DPI) and the Foradil CFC inhalers (Novartis Health Consumer, Basel, Switzerland).

METHODS

This was a double blind, double dummy, randomized, placebo-controlled, crossover study conducted in 38 subjects with mild to moderate asthma (mean forced expiratory volume in 1 s [FEV1] 87.5% predicted). The primary endpoint was methacholine challenge provocative dose required for 20% fall in the FEV1 (PD20) 90 min post dose. Bronchodilation was assessed with spirometry (FEV1, FVC, FEF25-75) and impulse oscillometry (resistance at 5 and 20 Hz, reactance at 5 Hz and resonant frequency) over the 90 min post dose. In a subset of 12 subjects formoterol plasma levels, serum potassium and glucose were determined up to 480 min post dose.

RESULTS

The three formoterol formulations demonstrated significant (P < or = 0.05) improvements in bronchoprotection compared to placebo and non-inferiority of the HFA preparation compared to the CFC and DPI preparations was demonstrated. Geometric mean PD20 values were 0.51 mg with HFA, 0.62 mg with DPI, 0.62 mg with CFC and 0.2 mg with placebo. The log transformed mean differences in PD20 doubling dose between HFA and (a) DPI was -0.28 (95% CI -0.84-0.29, P = 0.57) (b) CFC was -0.28 (95% CI -0.84-0.28, P = 0.57) and (c) placebo was 1.38 (95% CI 0.82-1.94, P < 0.001). Serum potassium, glucose and formoterol plasma profiles were comparable for the CFC, HFA and DPI devices.

CONCLUSION

Our findings of similar efficacy, pharmacokinetics and systemic effects of the HFA formoterol inhaler compared to the CFC and DPI preparations supports the potential use of this novel formulation in the treatment of asthma.

Pharmacokinetics and systemic effects of inhaled fluticasone propionate in chronic obstructive pulmonary disease

AIMS

We have previously shown that the systemic exposure to inhaled fluticasone propionate (FP) is reduced in asthmatics compared with healthy subjects. We have now compared its pharmacokinetics in patients suffering from chronic obstructive pulmonary disease (COPD, n = 10) and matched healthy subjects (n = 13).

METHODS

A double-blind, randomized, cross-over study design was used. Plasma FP and serum cortisol were measured for 12 h after subjects received hydrofluoroalkane FP 1000 microg day-1 inhaled (via an MDI and spacer) for 7 days and following a single 1000- microg intravenous dose.

RESULTS

The pharmacokinetics differed in the two groups. After inhalation, geometric least square means were significantly lower in the COPD group for the plasma AUC (1961 vs 2996 pg ml-1 h-1 for COPD and controls, respectively; P = 0.03) and the Cmax (235 vs 421 pg ml-1 for COPD and controls, respectively; P = 0.03). Suppression of serum cortisol concentration over 12 h was greater in healthy controls. Weighted mean serum cortisol concentration (nmol l-1) in healthy subjects and COPD was 93 and 170, respectively (P = 0.03). The intravenous pharmacokinetic parameters for FP were comparable in the two groups, resulting in similar suppression of serum cortisol.

CONCLUSIONS

We conclude that the altered pharmacokinetics of inhaled fluticasone propionate in COPD caused less hypothalamic-pituitary-adrenal suppression than in healthy controls. This is further evidence that the systemic effects of inhaled corticosteroids should be assessed in patients and not healthy subjects.

Genetic variability of Fusarium wilt pathogen isolates of chickpea (Cicer arietinum L.) assessed by molecular markers

Genetic variability among 43 isolates of Fusarium oxysporum f.sp. ciceri, the chickpea wilt pathogen, collected from nine states of India including the four well-characterized races of the pathogen were assessed using the molecular markers, RAPDs and AFLP. Principal coordinate analysis of the similarity index data generated from the molecular marker studies mostly gave three different clusters: Of these two clusters represented race-1 and race-2, and the third cluster consisted of race-3 and race-4 pathogen isolates. In RAPDs a fourth cluster was seen which did not go with any of the four races of the pathogen. The molecular markers established the distinctness of race-1 and race-2 pathogen isolates and the close similarity of pathogen isolates of race-3 with that of race-4. AFLP was found to be more informative as it differentiated more number of the pathogen isolates with the known races with minimum of outliers. The high levels of DNA polymorphism observed with the molecular markers suggest the rapid evolution of new recombinants of the pathogen in the chickpea growing fields.

Immunosuppression in broiler chicks fed aflatoxin and inoculated with fowl adenovirus serotype-4 (FAV-4) associated with hydropericardium syndrome

A total of 240 unvaccinated day-old broiler chicks, which had been found to be negative for antibodies against FAV-4, were divided into four groups of 60 chicks each. Group A was fed aflatoxin at 1 ppm from 7 days to 7 weeks of age. Group V was infected intra-abdominally at 14 days of age with 0.2 ml of FAV-4, having a titre of 10(5.5) TCID50 per 0.2 ml. The combined group AV was given the aflatoxin and infected with FAV-4. The fourth group C served as the control. More pronounced clinical signs, a higher mortality rate (56.7%), and reductions in body weight gain and in the organ to body weight ratios of the bursa and spleen were recorded in group AV. A significant (p < 0.01) reduction in the HI antibody titre following vaccination against Newcastle disease, and of skin thickness in the delayed hypersensitivity test following sensitization with DNCB, indicated an additive immunosuppressive effect from aflatoxin and FAV-4 on the humoral and cell-mediated immune responses in group AV compared to groups A and V. Microscopically, marked depletion and degeneration of lymphocytes in the thymus, bursa, spleen and caecal tonsils were observed in group AV up to 5 weeks PI.

Tuberculin-induced lymphocyte proliferation in whole blood: an antigen specific method for assessing immunosuppressive agents

Antigen-stimulated whole blood cultures have not been used to study the effects of immunosuppressive drugs. The aim of this study was to assess the potential usefulness of tuberculin purified protein derivative (PPD)-stimulated lymphocyte proliferation in whole blood for studying the effects of T cell inhibitory agents. We have investigated whether PPD causes antigen specific T cell proliferation, and the role of the major histocompatibility complex class II (MHC class II), co-stimulation and IL-2 in the development of this response. We have also studied the effects of prednisolone and cyclosporin on lymphocyte proliferation. Heparinised blood from healthy volunteers was diluted in culture medium and incubated with PPD. Cell proliferation, measured by liquid scintillation counting, was maximal using 1000 units/ml PPD incubated in 10% whole blood for 6-7 days. A population of large CD4+ lymphocytes appeared in cultures incubated with PPD, suggesting that the major responding population was composed of T lymphocytes. There was no significant response to the negative control antigen KLH, indicating that proliferation was antigen specific. Monoclonal antibodies (mAbs) against MHC, CD2, CD26, CD28 and IL-2 inhibited proliferation. Prednisolone was more potent than cyclosporin in this assay (IC50 values; prednisolone 20 nmol, cyclosporin 278 nmol). For the first time, this report shows that the PPD causes antigen specific lymphocyte proliferation in whole blood, which is dependent on antigen presentation via MHC class II, co-stimulation and IL-2 production. Because the proliferative response is dependent on the major interactions that lead to T cell activation, this simple assay can be used to assess the effects of novel immunomodulators.

Effect of fever on pharmacokinetics and dosage regimen of intramuscularly administered amikacin in goats

A comparative pharmacokinetic study of amikacin (10 mg/kg intramuscular) by microbiological assay method in normal and experimentally induced febrile goats revealed that the plasma drug concentrations were significantly higher in febrile condition at most of the time intervals. Various pharmacokinetic parameters like t(1/2), AUC, AUMC, MRT and Vd(area) were significantly higher whereas total body clearance (Cl(B)) was significantly lower in febrile goats as compared to normal goats. Absorption half-life (t(1/2) ka) value differed non-significantly. For maintaining mean therapeutic level of 2 mg/ml, a priming dose (D*) of 14.73+/-2.28 mg/kg, followed by maintenance dose (D(o)) of 13.95+/-2.28 mg/kg at shorter dosage interval (t) of 8 hr may be useful in case of normal goats whereas lower doses (D* of 13.58+/-1.61 mg/kg followed by D(o) of 12.65+/-1.60 mg/kg) at longer tau of 12 hr may be advised in case of febrile goats.

The prevalence and incidence of medical conditions in healthy pharmaceutical company employees who volunteer to participate in medical research

AIMS

Although clinical research in healthy volunteers is commonly performed there have been few studies of the value of the medical screening of subjects. The aim of this study was to investigate the prevalence and incidence of medical conditions found during the medical screening of 'healthy' subjects employed in a pharmaceutical company who volunteered to participate in medical research.

METHODS

This was a retrospective study of the medical notes of all the subjects who volunteered for membership of the Zeneca Clinical Pharmacology Unit's healthy volunteer panel over a 4 year period from 1990 to 1994. The prevalence of medical conditions found at presentation was determined. The incidence of medical conditions during the 4 year observation period was also ascertained. Medical screening included a full medical history and examination, clinical chemistry, haematology and urinalysis screens, pulmonary function tests, ECGs, 24 h ambulatory cardiac monitoring and a request for information from the volunteer's General Practitioner.

RESULTS

Prevalence-1293 subjects volunteered to join the panel of which 156 subjects (12%) were not accepted at presentation including 141 (10. 9%) for medical reasons. The most medical common reasons were; previously diagnosed medical conditions (3.3%), cardiovascular abnormalities (1.9%), abnormal liver function tests (1.9%), anaemia (1.2%), hyperlipidaemia (1.1%), excess alcohol intake (0.6%) and thyroid disease (0.5%). Incidence-36 of the 1137 volunteers (0.8% per year) accepted onto the panel subsequently developed medical conditions of which the most common were; anaemia (0.29% per year), cardiovascular abnormalities (0.13% per year) and vasovagal syncope (0.13% per year).

CONCLUSIONS

This study demonstrates the importance of medical screening before healthy volunteers participate in clinical research.

Neem (Azadirachta indica) kernel meal in the diet of White Leghorn layers

1. Neem kernel meal (NKM) was incorporated into a standard layer diet at 0, 100, 150 and 200 g/kg, replacing parts of the soyabean meal and deoiled rice bran. Each diet was offered to 18 White Leghorn layers (25 weeks, 50% egg production) in individual cages for a period of 12 weeks. 2. Results indicated significantly lower food intakes (P < 0.01), rates of egg production and egg weights in birds fed on the diets with NKM at 150 and 200 g/kg. Fertility and hatchability were also adversely affected by the higher inclusion rates of NKM. 3. Except for lower egg shell weight and shell thickness (P < 0.05) in hens fed NKM at 150 and 200 g/kg, the internal egg quality characteristics were comparable in all groups. 4. Feeding NKM beyond 100 g/kg to laying hens significantly (P < 0.01) reduced the content of haemoglobin, erythrocyte count, packed cell volume, serum calcium and uric acid concentrations. However, the leucocyte count, plasma glucose concentration and serum glutamate oxaloacetate transaminase activity were unaltered. Serum glutamate pyruvate transaminase activity was significantly (P < 0.05) reduced in birds fed NKM at 200 g/kg. 5. Thus NKM at 100 g/kg in a layer diet would appear to be safe and cost-effective.

Inheritance of Complete Resistance to Pearl Millet Downy Mildew

Inheritance of downy mildew (Sclerospora graminicola) resistance in pearl millet (Pennisetum glaucum) was studied in a cross involving DMRP (downy mildew resistant Pennisetum) 292 and DMSP (downy mildew susceptible Pennisetum) 23. DMRP 292, derived from IP 18292, and DMSP 23, derived from Tift 23DB, were made homozygous for downy mildew resistance-susceptibility by three generations of single plant selection followinginoculations with homogenized sporangial population of S. graminicola from the ICRISAT Asia Center. Potted seedlings of parental lines, F₁, F₂, and BC progenies were evaluated for their reactions to downy mildew following inoculation. The results show that complete resistance to downy mildew in DMRP 292 is controlled by a single dominant gene. Because of the simple mode of inheritance, resistance utilization from DMRP 292 is simple and straightforward. We designate this gene as Rsg₁.

Recognition of facial expressions of emotion by children with attention-deficit hyperactivity disorder

Fifty children and adolescents were tested for their ability to recognize the 6 basic facial expressions of emotion depicted in Ekman and Friesen's normed photographs. Subjects were presented with sets of 6 photographs of faces, each portraying a different basic emotion, and stories portraying those emotions were read to them. After each story, the subject was asked to point to the photograph in the set that depicted the emotion described. Overall, the children correctly identified the emotions on 74% of the presentations. The highest level of accuracy in recognition was for happiness, followed by sadness, with fear being the emotional expression that was mistaken most often. When compared to studies of children in the general population, children with ADHD have deficits in their ability to accurately recognize facial expressions of emotion. These findings have important implications for the remediation of social skill deficits commonly seen in children with ADHD.

Familial cardiac myxoma--a comprehensive review of reported cases

BACKGROUND

Cardiac myxoma with familial involvement is a rare manifestation of an uncommon tumor, which nevertheless has been reported with increasing frequency in the past two decades. As a feature of the hereditary Carney syndrome, cardiac myxoma occurs at a much younger age, often has multicentric origins, and tends to recur. We report the case of a family in which three members had cardiac myxoma and two had other characteristics of the Carney syndrome.

METHODS

We have made a comprehensive review of the international literature from 1971-1992 to determine the incidence and clinical presentation of cardiac myxoma when diagnosed in more than one family member or first-degree relative.

RESULTS

Twenty-six cases of familial cardiac myxoma, involving 68 family members, have now been reported in the United States, Europe, and Australia. One-fourth of these reports have appeared in the past 4 years alone. The rate of diagnosis at autopsy has declined from 40% in early reports to a current 17%. Seventeen episodes of recurrence (25%) at the same or different intracardiac sites have been documented, approximately twice the rate of recurrence in isolated cases.

CONCLUSIONS

The diagnostician should be alert for evidence of cutaneous, endocrine, or testicular features of the hereditary Carney syndrome in young patients who have cardiac myxoma. In the families of these patients, all first-degree relatives should be examined regularly for evidence of cardiac myxoma.

The use of ventilation tubes and the incidence of cholesteatoma surgery in the paediatric population of Liverpool

Many surgeons believe that grommet insertion has reduced the incidence of cholesteatoma and thus radical mastoidectomy. Several causes for this trend have been postulated, including the increased use of ventilation tubes to treat otitis media with effusion. We have studied the number of operations for cholesteatoma, together with the number of ventilation tube insertions in the paediatric population of Liverpool, over a 28-year period between 1963 and 1990. There was a decline in the number of operations for cholesteatoma and an increase in the use of ventilation tubes, but there was no significant correlation between the two. This suggests that other factors are responsible for the decline in surgery for cholesteatoma.

The effect of ractopamine hydrochloride on the carcass cutting yields of finishing swine

This study was designed to evaluate growth performance, carcass cutting yield, and processing characteristics of boneless hams and bellies from finishing pigs fed diets containing 0, 5, 10, or 20 ppm of the phenethanolamine ractopamine hydrochloride (RAC). Sixty pigs were blocked by starting weight and randomly assigned to pens (four pigs/pen) within each of three blocks. Treatments were then randomly assigned to the pens to total six pens of the 0-ppm level and three pens each at the 5-, 10-, and 20-ppm RAC levels. Weight gain and feed consumption were monitored and animals were slaughtered by weight block after approximately 48 d on trial. Slaughter weight, ADG, and feed/gain were improved (P less than .05) for RAC treatments. Dressing percentage was higher and increased linearly (P less than .05) for RAC treatments. Carcass weight, length, leaf fat weight, backfat thickness, loin eye area, and color, marbling, and firmness of the longissimus were evaluated. The RAC-treated carcasses were heavier (P less than .05) and loin eye area increased linearly (P less than .05). One side of each carcass was fabricated using National Association of Meat Purveyors specifications. Trimmed hams and loins from the RAC treatments were heavier (P less than .05) than those from control animals. No differences (P greater than .05) in carcass cutting yield (percentage of trimmed primal cuts) were observed between treatments. However, trimmed hams and loins from the 20-ppm RAC treatment represented a greater (P less than .05) percentage of carcass weight than did those from control animals. Ractopamine did not affect raw belly or bacon characteristics (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)