Role of Immunohistochemistry and serology in subclassifying the Inflammatory Bowel Disease cases diagnosed as Inflammatory Bowel Diseases---unclassified on colonic biopsies

BACKGROUND

Inflammatory bowel diseases (IBDs) mainly consist of Crohn's Disease (CD) and Ulcerative Colitis (UC). These two categories have overlapping histopathological features and sometimes it is difficult to diagnose them into distinct category and such biopsies are categorised as Inflammatory Bowel Disease (IBD-U). Recently, there has been an increase in interest to discover new biomarkers of IBD to differentiate UC and CD and predict their prognosis.

METHOD

In the present study, 273 non-neoplastic colonic biopsies with clinicoendoscopic features of IBD were studied and categorized into UC (88; 32.3%) and CD (03; 1.1%) but a major chunk remained in category of IBD-U (182; 66.6%). 161 (58.9%) of these biopsies were then subjected to IHC for RB protein and β-catenin and Serology for pANCA and ASCA was done in only 85 (31.13%) of these selected cases for identification of UC and CD on colonic biopsies.

RESULT

161 biopsies that were subjected to IHC analysis included 57 cases of UC, 03 cases of CD, and rest 101 cases of IBD-U. Out of 101 cases of IBD-U, 87 (86.13%) cases were reclassified as UC (61; 60.3%) and CD (14; 13.86%) on the basis of results of IHC and Serology.

CONCLUSION

The two major tools IHC for β-catenin and RB protein and the assay of serum ASCA and p-ANCA along with proper history and clinical presentation can act as a good adjunct to conventional H and E in subclassifying cases of IBD-U into UC and CD.

Prevalence of precursor lesions (P53 signature, SCOUT, STIL, STIC) in fallopian tubes resected for non-neoplastic causes

BACKGROUND

High-grade pelvic serous carcinoma is a common cause of death in women worldwide and India. Recent evidence has clearly implicated the changes in the mucosa of the fimbrial end of the fallopian tube in its pathogenesis.

OBJECTIVE

1) To study histopathology features of surgically resected specimens of fallopian tubes received with non-neoplastic lesions of the uterus and ovary for the presence of any precursor lesions [secretory cell outgrowth (SCOUT), serous tubal intraepithelial lesion (STIL), p53 signatures, and serous tubal intraepithelial carcinoma (STIC)]. 2) To confirm the findings with immunohistochemistry. 3) To correlate the prevalence of precursor lesions with clinical parameters and benign lesions of the uterus and ovaries.

MATERIALS AND METHODS

Assessment of histopathological changes in 100 specimens of distal fallopian tubes was done using the sectioning and extensive examination of the fimbrial end (SEE-FIM) protocol. H and E stain followed by immunohistochemistry for Bcl-2, p53, and Ki-67. The statistical significance of the difference in the mean values of precursor areas was evaluated by an unpaired t-test.

RESULTS

Among 100 specimens taken on H and E, precursor lesions were suspected in 49% of the cases. SCOUT, suspicious for STIC, suspicious for STIC with areas of SCOUT, and unequivocal for STIC with areas of SCOUT were seen in 8%, 4%, 33%, and 4% of the cases, respectively. However, on IHC, SCOUTS were confirmed in 45% of the cases, p53 signature in 2%, STIL in 9%, and STIC in 4% of the cases.

CONCLUSION

Sectioning and extensive examination of the fimbrial end (SEE-FIM) should be routinely done as it provides the opportunity to detect the early malignant changes. It may help in evolving the strategies for early detection, management, and reducing mortality.

Randomized comparison of proximal and distal radial access for coronary angiography and interventions

Funding Acknowledgements

Type of funding sources: None.

Introduction

Vascular access for coronary procedures is of paramount important not only for successful procedure but also to prevent complications. In comparison to femoral access, proximal radial artery (PRA) access at wrist is associated with decreased bleeding complications and mortality.  The most important complication of PRA access is radial artery occlusion Use of the proximal radial artery (PRA) approach at wrist has several limitations:  the need to supinate the hand, which can exacerbate chronic joint pain, the depth of the radial artery in large arms, which could make arterial puncture challenging even under ultrasound guidance, the risk of sporadic bleeding in the forearm, and the risk of radial artery occlusion. All above limitations can be overcome by distal radial artery (DRA) access in anatomical snuff box.  Randomized Studies are lacking for the comparison between DRA and PRA approach in coronary procedures.

Aims and objective

To compare safety, efficacy and feasibility between PRA and DRA approach in randomized fashion.

Material and methods

This was single center randomized controlled trial. 320 patients were randomized in PRA and DRA groups. PRA approach was in wrist and DRA approach was in anatomical snuff box. Primary endpoint was cannulation failure (failure to achieve radial access) and transradial failure (failure to complete procedure after successful access). Secondary safety outcome includes major (compartment syndrome, need for vascular surgery, hand dysfunction, nerve palsy ,arteriovenous fistula, hematoma requiring blood transfusion, proximal radial artery occlusion) and minor (radial artery spasm, hematoma not requiring transfusion or causing compartment syndrome, ecchymosis, local edema, paresthesia, pseudoaneurysm) complications; secondary efficacy outcome were puncture attempts, cannulation time, procedure time, radiation dose, hemostasis time  and quality of life endpoint  was pain score .

Results

 Each group was having 160 patients. In DRA group 73.9 % were CAG and 26.1 % were PCI; in PRA group and 75.7 were CAG and 24.3 were PCI. Cannulation failure was more in DRA group (7.5 % vs 2.5 %, P < 0.001) without difference in transradial failure (n = 3 vs 4, p =0.764). There were no major complications in both groups except PRAO which was significantly less in DRA group (0 % vs 5.2 %, p= 0.007). Puncture attempts, cannulation time, pain score were more in DRA (1.65 vs 1.29, P < 0.001;3.23 vs 2.62 minutes, p < 0.001;25.5 vs 21.6 minutes, p = 0.039 respectively). There was no significant difference for minor complications in both groups.

Conclusion

DRA approach is as safe and feasible as PRA approach and causes significantly less PRAO. DRA approach may be advocated as default approach where radial access is chosen for coronary procedures. Abstract Figure. primary outcome  Abstract Figure. Procedural characteristic

Clinical significance of epicardial fat in suspected angina pectoris: an observational study

Funding Acknowledgements

Type of funding sources: None.

Background

Epicardial adipose tissue (EAT) is the visceral fat between pericardium and visceral epicardium and is the source of several endocrine and inflammatory mediators. It also has paracrine affects in the neighboring coronary arteries.

Objective

 To evaluate the association of EAT with subclinical atherosclerosis (carotid intima media thickness & flow mediated vasodilation), ultrasonic and anthropometric measures of abdominal fat, metabolic syndrome and coronary artery disease (CAD) concurrently.

Material and methods

Patients who underwent computed tomography (CT) coronary angiography for suspected CAD were prospectively included. All underwent anthropometric measurements, laboratory investigations, ultrasonic measurement of liver fat grade & B-mode hepatorenal ratio, carotid intima media thickness (CIMT), flow mediated vasodilation (FMD), CT measurement of epicardial fat thickness (EFT) & epicardial fat volume (EFV) along with CT coronary angiography. Study population was divided into 2 groups on the basis of presence or absence of CAD and were compared. The relationship between risk factors and presence of CAD was assessed by logistic regression analysis. To define EFT and EFV value predictive of the presence of significant CAD, the area under (AUC) the receiver operating characteristic (ROC) curve was calculated. Correlation between EFT as well as EFV with anthropometric and laboratory parameters, CIMT and FMD were assessed by Pearson correlation coefficient.

Results

Total 54 patients were included in study. Mean age was 54 years, 66% were diabetic and 33% were hypertensive. Mean CIMT, FMD, EFT and EFV were 0.70 + 0.27 cm; 5.64 + 2.64%; 5.51 + 2.50 mm and 60.6 + 28.6 cc, respectively. Total 34 (62.96%) patients were detected to have CAD. EFT as well as EFV were significantly higher in CAD group (3.31 + 2.34 vs 6.24 + 1.91mm; p= <0.001, 72.5 + 22.3 vs 40.4 + 27.1cc; p= <0.001); in patients with metabolic syndrome (83.3 + 18.4 vs 49.2 + 26.1cc; p < 0.001, 7.13 + 1.49 vs 4.16 + 2.32mm; p < 0.001). Both, EFV & EFT were significantly correlated with the abdominal fat, CIMT and FMD. Smoking, age and EFV were the independent predictors for CAD.  EFV >31.65cc predicted the presence of CAD (sensitivity 91.25%, specificity 60%, AUC = 0.798, 95% CI = 0.665-0.930) and EFT >2.85mm predicted the presence of CAD (sensitivity 94.1%, specificity 65%, AUC= 0.820, 95% CI= 0.687-0.953).

Conclusions

Epicardial fat is significantly associated with presence of CAD, metabolic syndrome, visceral fat, CIMT and FMD. CT measured epicardial fat may be included with CT based CAD lesion assessment and CT coronary calcium score to screen the patients of suspected angina pectoris. Abstract Figure. Epicardial adipose tissue  Abstract Figure. EFV and CAD

Distal radial access in the right anatomical snuffbox for coronary angiography and interventions: a prospective observational study

Background

Distal radial access in the anatomical snuffbox is a novel technique for vascular access. However, limited clinical data is available, mainly limited to the left distal radial access. In view of the paucity of data on right distal radial access; this study was conducted to assess the feasibility, efficacy and safety of the right distal radial approach as a default access route for transradial catheterization.

Methods

We enrolled 159 consecutive patients with a palpable right distal radial pulse prospectively at a single center. A detailed clinical evaluation, laboratory tests and echocardiographic examination was done. Doppler examination of distal radial artery for its patency and size was done before puncture attempt. The right distal radial artery was punctured using the back wall technique. Primary outcome was successful puncture of distal right radial artery. Secondary outcomes were number of puncture attempts, pain score, radial artery spasm, forearm and distal radial hematoma, proximal and distal radial artery occlusion, bleeding and other vascular complications, access site crossover due to distal radial access failure, contrast volume used, and radiation dose.

Results

Distal radial puncture was successful in 144/159 (90.1%) patients. The mean distal radial artery diameter was 2.2±0.25 mm. Mean pain score by visual analogue scale was 2.36±1.9. There were no bleeding events. Snuffbox hematoma was seen in 11 (7.6%) patients and forearm hematoma occurred in 5 (3.5%) patients. There were 9 (6.3%) cases of radial spasm, 4 (2.8%) cases of radial occlusion at distal access site and 1 (0.7%) forearm radial artery occlusion.

Conclusions

The right distal radial access is a feasible, safe and efficacious alternative approach for coronary angiogram and interventions.

Funding Acknowledgement

Type of funding sources: None.

925 Is Routine Bloods Group and Save Required for Emergency Appendicectomy?

Introduction

Appendicectomy is commonly a safe and low bleeding risk procedure. However, some hospital guidelines stipulate a requirement for routine pre-operative blood group and save (G&S).We aim to determine if pre-operative G&S is required for appendicectomies by looking at the number of tests vs transfusion conducted.The cost of G&S is £4.14 per sample in our trust.

Method

A retrospective review was conducted over a 3-month period. Patient data and demographics were identified using the hospital coding, theatre records and transfusion departments.

Results

118 consecutive appendicectomies were identified. Of which, 99 laparoscopic vs 19 open (13 started open vs 6 converted to open) operations were performed. No patients required a blood transfusion during their admission. There was a total of 219 G&S conducted. Cross matching tests for these procedures cost a total of £906. We estimate a cost projection of £3624 for G&S tests over a year and £18120 over 3 years.

Conclusions

Bleeding complications requiring transfusion following appendicectomies are very uncommon. In our unit, 0% of patients identified required a transfusion during their admission. We suggest stopping routine pre-operative G&S for these patients would be clinically safe and would lead to financial savings and reduce pre-operative waiting time.

902 Too Hot to Handle? Acute Cholecystitis (‘Hot Gallbladder’) Management and Compliance with NICE Guidelines in A District General Hospital

Introduction

Current NICE guidelines recommend that patients with acute cholecystitis should be offered laparoscopic cholecystectomy within 1 week of diagnosis. However, the recommendation is often not met within our trust. We aim to investigate our compliance with these guidelines while outlining the complications and cost effects associated with delayed operation.

Method

A retrospective study identifying emergency patients presenting with image proven uncomplicated acute cholecystitis was performed. Hospital coding and finance departments were used to obtain this information.

Results

166 patients were identified within a 3-month period. Of which, 85 patients were diagnosed with acute uncomplicated cholecystitis and fulfilled the inclusion criteria. On average, patients waited 108 days for their cholecystectomies (range 14-281). No patients received a cholecystectomy within 1 week of diagnosis. 33 patients re-presented to hospital at least once and the total number of repeated admissions was 51. The average length of stay during readmissions was 6 days (range 1-27). The total cost incurred for those readmissions was £117,118.

Conclusion

Combined pancreatic and gastric heterotopia in small intestine presenting as intussusception-A rare congenital anomaly

Pancreatic and gastric heterotopias are rare congenital anomalies which have been reported throughout the length of the gastrointestinal tract. Combined gastric and pancreatic heterotopias, although very rare, have been described mainly in the duodenum followed by jejunum with ileum being a rare site. The reported incidence of this combined heterotopias is low, ranging from <1% to 13%. Extensive literature search has revealed that only Four cases of combined pancreatic and gastric heterotopias have been reported in the small intestine till date. Hence, we report this case for its rarity and unusual presentation as intussusception in a young male.

Cardiological Society of India: Document on acute MI care during COVID-19

The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.

P41 Correlation of doppler ultrasound assessment of carotid femoral pulse wave velocity with coronary artery disease

Funding Acknowledgements

self

Background

Arterial stiffness is an important cardiovascular risk factor. Carotid femoral pulse wave velocity (cfPWV) is simple noninvasive  method to determine aortic stiffness. Arterial stiffness measures, cfPWV in particular,  have been found to be correlate with stroke and peripheral artery disease. Usually SphygmoCor or Complior are used to calculate cfPWV. Doppler ultrasound can serve as an alternative to these methods. 

Purpose

To assess cfPWV using doppler ultrasound and study its correlation with coronary artery disease and its severity. 

Methods

cfPWV was assessed by ultrasound Doppler in patient aged 20-70 years undergoing coronary angiography.  cfPWV was measured by sequential recordings of arterial pressure waveform at the carotid and femoral arteries with a Doppler ultrasound with ECG gating and calculated as the distance between the carotid and the femoral sampling site divided by the time interval. 

Result

Of the 358 subjects studied, 243 had coronary artery disease(CAD) (&gt;50% diameter stenosis) and were further divided into single, double or triple vessel disease groups. 115 patients  had mild CAD (&lt; 50% stenosis) or no CAD and served as controls. Baseline characteristics were similar except diabetes (more common in CAD group)(39.09% v/s 27.82%). cfPWV was found to increase with age in all groups. cfPWV was not significantly affected  by sex, diabetes, dyslipidemia, BMI, smoking or hypothyroidism. Mean cfPWV was significantly higher in patients with CAD (8.99 v/s 6.51 m/s, p &lt; 0.001) and hypertensives (8.71 v/s 7.83 m/s, p &lt; 0.001). Patients with triple vessel disease(TVD) had significantly higher cfPWV (10.12 m/s) than those with double(DVD)(8.84 m/s) or single vessel disease(SVD)(8.28m/s)(p &lt; 0.001). Multinomial logistic regression revealed an odds ratio of 2.00, 2.375 and 3.368 respectively for SVD, DVD and TVD groups in comparison to controls (p &lt; 0.001). cfPWV value &gt; 7.25 m/s predicted CAD with sensitivity 78.6 % and specificity 74.8% (AUC =0.848, P &lt; 0.001). 

Conclusion

Carotid femoral pulse wave velocity can be measured noninvasively by ultrasound Doppler. cfPWV increases with age and hypertension and has strong correlation with coronary artery disease and its severity. The cfPWV can be an independent risk factor and may be utilized for cardiovascular risk prediction.

Abstract P41 Figure. cfPWV in various subgroups.

The effect of an intraorifice barrier and base under coronal restorations on the healing of apical periodontitis: a randomized controlled trial

AIM

To evaluate the effect of intraorifice barriers and bases on the healing of apical periodontitis following root canal treatment in mandibular molars.

METHODOLOGY

A total of 120 permanent mandibular molars with necrotic pulps and periapical radiolucencies (PAI score ≥ 3) were recruited. Root canal treatment was performed in all teeth using a standard protocol, following which they were randomly allocated to one of the three treatment groups: intraorifice barrier group: coronal 3-mm gutta-percha was removed and replaced with glass-ionomer cement (GIC) barrier. The floor of the pulp chamber was then sealed with 2-mm-thick GIC base followed by final composite resin restoration; base group: received 2-mm-thick GIC base before placement of composite resin restoration; and control group: had pulp chamber entirely filled with composite resin only. Follow-up was done at 3, 6, 9 and 12 months. Combination of clinical and radiographic parameters were used to assess treatment outcome. The data were analysed using Kruskal-Wallis, chi-square and Wilcoxon signed-rank tests and logistic regression analysis.

RESULTS

At the end of 12 months, the base group had the most favourable healing (97.1%), whilst the control group had the least favourable healing (83.8%). The intraorifice barrier group had healing of 92.1%. However, there was no significant difference in healing between groups at the end of the follow-up period (P > 0.05). Additional subgroup analysis revealed a nonsignificant effect of periodontal status and root filling level on periapical healing.

CONCLUSION

The use of an additional barrier under permanent restorations did not significantly improve the outcome of primary root canal treatment in posterior teeth after 12 months. However, its influence in the long term requires further evaluation.

P1496Use of strain, strain rate, tissue velocity imaging and endothelial function for early detection of cardiovascular involvement in young diabetics

Background

Subtle structural and functional changes may precede the onset of overt global left ventricular dysfunction and obvious reduction of ejection fraction (EF), especially in young diabetics. Data pertaining to tissue velocity indices (TVI) and strain imaging to assess regional myocardial function and flow mediated vasodilatation is limited in young patients with diabetes.

Purpose

To evaluate conventional echocardiography parameters, tissue doppler indices, global and regional strain, carotid intimal medial thickness (CIMT), endothelial dependent (FMD) and independent function (NMD) of brachial artery in young patients (age <18 years) with type 1 diabetes and compare them with matched controls.

Methods

Conventional echocardiography parameters, tissue velocity indices (TVI) parameters along with strain (S), and strain rate (SR) in basal and mid left ventricular (LV) lateral wall, right ventricular (RV) lateral wall and septum were measured in 50 young diabetics (age 15.16±2.95 years, mean HBA1c 8.15±1.37 gm %) and 25 controls (age 15.60±2.51 years). Flow-mediated dilatation (FMD), nitrate mediated dilatation and carotid intimal media thickness (CIMT) were also estimated.

Results

Conventional echocardiography parameters were similar in patients and controls however deceleration time of the mitral inflow velocity (EDT) was significantly shorter in patients when compared with controls (149.06±31.66 vs. 184.56±19.27 ms, p<0.05). Lateral early diastolic myocardial velocity (LV-Em) was significantly lower (10.30±0.99 vs. 11.67±3.21, p<0.05) whereas lateral late diastolic myocardial velocity (LV-Am) was significantly higher than controls (11.73±1.44 vs. 8.82±1.69, p<0.05), thus a significantly lower ratio of early/late diastolic velocity at the basal segment of lateral LV (LV-Em/Am). Lower strain values at the basal lateral LV (21.39±4.12 vs. 23.78±2.02; p<0.05), mid lateral LV (21.43±4.27 vs. 23.17±1.92; p<0.05), basal septum (20.59±5.28 vs. 22.91±2.00; p<0.05), and mid septum (22.06±4.75 vs. 24.10±1.99; p<0.05) as compared to controls. SR at the basal and mid segments of the lateral LV wall and at the basal septum were also significantly lower in diabetic subjects. Strain rate (SR) in mid septal, basal and mid RV were lower than controls although not statistically significant. Patients also had significantly lower flow mediated dilatation (FMD) (8.36±4.27 vs. 10.57±4.12, p<0.05) implying endothelial dysfunction.

Strain rate in diabetic patient

Conclusion

Left ventricular strain indices are impaired in asymptomatic children and adolescents with type 1 DM despite absence of overt heart failure and normal ejection fraction. Early detection of subclinical regional myocardial dysfunction by deformation analysis including strain and strain rate may be useful in the asymptomatic diabetic population. In addition, evidence of endothelial dysfunction in the form of impaired flow mediated vasodilatation was observed in the diabetic children.

Acknowledgement/Funding

None

Clinical Effectiveness of a Resin-modified Glass Ionomer Cement and a Mild One-step Self-etch Adhesive Applied Actively and Passively in Noncarious Cervical Lesions: An 18-Month Clinical Trial

OBJECTIVES:

To evaluate the clinical effectiveness of two methods of application of a mild one-step self-etch adhesive and composite resin as compared with a resin-modified glass ionomer cement (RMGIC) control restoration in noncarious cervical lesions (NCCLs).

METHODS:

A total of 294 restorations were placed in 56 patients, 98 in each one of the following groups: 1) G-Bond active application combined with Solare-X composite resin (A-1SEA), 2) G-Bond passive application combined with Solare-X composite resin (P-1SEA), and 3) GC II LC RMGIC. The restorations were evaluated at baseline and after six, 12, and 18 months according to the FDI criteria for fractures/retention, marginal adaptation, marginal staining, postoperative sensitivity, and secondary caries. Cumulative failure rates were calculated for each criterion at each recall period. The effect of adhesive, method of application, and recall period were assessed. The Kruskal-Wallis test for intergroup comparison and Friedman and Wilcoxon signed ranks tests for intragroup comparison were used for each criterion ( α=0.05).

RESULTS:

The retention rates at 18 months were 93.26% for the A-1SEA group, 86.21% for the P-1SEA group, and 90.91% for the RMGIC group. The active application improved the retention rates compared with the passive application of mild one-step self-etch adhesive; however, no statistically significant difference was observed between the groups. Marginal staining was observed in 13 restorations (1 in A-1SEA, 4 in P-1SEA, and 8 in RMGIC) with no significant difference between the groups. The RMGIC group showed a significant increase in marginal staining at 12 and 18 months from the baseline. There was no significant difference between the groups for marginal adaptation, secondary caries, or postoperative sensitivity.

CONCLUSION:

Within the limitations of the study, we can conclude that mild one-step self-etch adhesive followed by a resin composite restoration can be an alternative to RMGIC with similar retention and improved esthetics in restoration of NCCLs. Agitation could possibly benefit the clinical performance of mild one-step self-etch adhesives, but this study did not confirm that the observed benefit was statistically significant.

World Health Organization

The World Health Organization, situated in Geneva, Switzerland, since its establishment on 7 April 1948, is working for the betterment of health and sanitary conditions across the globe through its six regional offices spanning the different continents. It has a well-laid network of trained personnel working in a transparent fashion for its various committees and projects for the eradication of epidemics such as malaria, cholera, and smallpox while providing both quantitative and qualitative data for the preparation of documents on technological, procedural, statistical, and developmental fronts on various health-related issues. It has extended help to the UN in achieving the Millennium Development Goals target and has shown prompt and efficient action against Ebola outbreak in West Africa in 2014 and is also involved in establishing food security and safety in African and South Asian subcontinent.

Attention Mediates the Effect of Context-Relevant Social

In everyday life we perceive events as having durations. Recent research suggests that the labeling of a stimulus influences the experience of its duration. Plausibly, the social meaning attributed to a stimulus impacts upon the amount of attention allocated to it, with greater attention resulting in better encoding and longer reproduction times. However, direct evidence for the role of attention in this effect of social meaning on duration reproduction is lacking. The present study addresses this issue directly. Eighty-four male Hindu pilgrims attending theKumbh Melain India listened to an ambiguous sound clip and reproduced its duration in a prospective timing task. The context-relevant social meaning of this sound clip was manipulated through attributing the sound to either the religious festival or busy city streets. Attentional load was manipulated by asking half the participants to perform a concurrent task. Reproduced durations were longer in the Mela compared to the City condition but only when participants completed a single task. The finding that mere labeling of the stimulus impacts duration judgments in a prospective paradigm in the single-task but not the dual-task conditions suggests that the effect of social meaning is indeed mediated through the deployment of attentional resources.

Cation Homeostasis in Red Cells From Patients With Sickle Cell Disease Heterologous for HbS and HbC (HbSC Genotype)

Sickle cell disease (SCD) in patients of HbSC genotype is considered similar, albeit milder, to that in homozygous HbSS individuals--but with little justification. In SCD, elevated red cell cation permeability is critical as increased solute loss causes dehydration and encourages sickling. Recently, we showed that the KCl cotransporter (KCC) activity in red cells from HbSC patients correlated significantly with disease severity, but that in HbSS patients did not. Two transporters involved in red cell dehydration, the conductive channels Psickle and the Gardos channel, behaved similarly in red cells from the two genotypes, but were significantly less active in HbSC patients. By contrast, KCC activity was quantitatively greater in HbSC red cells. Results suggest that KCC is likely to have greater involvement in red cell dehydration in HbSC patients, which could explain its association with disease severity in this genotype. This work supports the hypothesis that SCD in HbSC patients is a distinct disease entity to that in HbSS patients. Results suggest the possibility of designing specific treatments of particular benefit to HbSC patients and a rationale for the development of prognostic markers, to inform early treatment of children likely to develop more severe complications of the disease.

Effect of maintaining apical patency on endodontic pain in posterior teeth with pulp necrosis and apical periodontitis: a randomized controlled trial

AIM

To evaluate the association between apical patency and post-operative pain in posterior teeth with pulp necrosis and apical periodontitis.

METHODOLOGY

Sixty-eight patients requiring primary root canal treatment in mandibular first molars with necrotic pulps and apical periodontitis were included. The patients were randomly allocated to one of two groups: patency (n = 34) and nonpatency (n = 34). After administering local anaesthesia, root canal preparation was completed using ProTaper rotary instruments. A size 10 K-file was used as a patency file and carried 1 mm beyond the working length (WL) between each instrument change in the patency group, while it was carried up to WL in the nonpatency group. Patients were asked to record their pain experience on a pain chart daily for 7 days. Three patients (two in the patency group, one in the nonpatency group) did not return with completed pain charts on the subsequent visit, resulting in a total of 65 patients for the final analysis (patency, n = 32; nonpatency, n = 33). Data was analysed using Chi Square test, t-test, Mann-Whitney test and Wilcoxon Signed Ranks test.

RESULTS

Overall, 43% of the patients experienced post-operative pain. The patency group had less incidence of pain (34%) as compared to the nonpatency group (52%), but the difference was not significant (P = 0.163).

CONCLUSION

Maintenance of apical patency during chemomechanical preparation had no significant influence on post-operative pain in posterior teeth with necrotic pulps and apical periodontitis.

Majorana fermions in ferromagnetic chains on the surface of bulk spin-orbit coupled s-wave superconductors

Majorana fermion (MF) excitations in solid state system have non-Abelian statistics which is essential for topological quantum computation. Previous proposals to realize MF, however, generally requires fine-tuning of parameters. Here we explore a platform which avoids the fine-tuning problem, namely a ferromagnetic chain deposited on the surface of a spin-orbit coupled s-wave superconductor. We show that it generically supports zero-energy topological MF excitations near the two ends of the chain with minimal fine-tuning. Depending on the strength of the ferromagnetic moment in the chain, the number of MFs at each end, n, can be either one or two, and should be revealed by a robust zero-bias peak (ZBP) of height 2 ne²/h in scanning tunneling microscopy (STM) measurements which would show strong (weak) signals at the ends (middle) of the chain. The role of an approximate chiral symmetry which gives an integer topological invariant to the system is discussed.

Talc based exopolysaccharides formulation enhancing growth and production of Hellianthus annuus under saline conditions

Stress tolerating strain of Pseudomonas aeruginosa PF07 possessing plant growth promoting activity was screened for the production of exopolysaccharides (EPS). EPS production was monitored in the cell free culture supernatant (CFCS) and extracted EPS was further purified by thin layer chromatography. EPS producing cells were taken to design talc based formulation and its efficacy was checked on oilseed crop sunflower (Hellianthus annuus), under in vivo saline conditions (soil irrigated with 125 mM of saline water). Application of bioformulation significantly enhanced the yield and growth attributes of the plant in comparison to control (untreated seeds) under stress and non&mdash;stress conditions. Germination rate, plant length, dry weight and seed weight increased remarkably. The above findings suggest the application and benefits of utilizing EPS formulation in boosting early seedling emergence, enhancing plant growth parameters, increasing seed weight and mitigating stress in saline affected regions. Such bioformulation may enhance RAS/RT (Root Adhering Soil to Root Tissue ratio), texture of the soil, increase porosity, improve uptake of nutrients, and hence may be considered as commercially important formulation for renovation of stressed sites and enhancing plant growth.

Effects of o-vanillin on K⁺ transport of red blood cells from patients with sickle cell disease

Aromatic aldehydes like o-vanillin were designed to reduce the complications of sickle cell disease (SCD) by interaction with HbS, to reduce polymerisation and RBC sickling. Present results show that o-vanillin also directly affects RBC membrane permeability. Both the K(+)-Cl(-) cotransporter (KCC) and the Ca(2+)-activated K(+) channel (or Gardos channel) were inhibited with IC50 of about 0.3 and 1 mM, respectively, with activities almost completely abolished by 5 mM. Similar effects were observed in RBCs treated with the thiol reacting reagent N-ethylmaleimide or with the Ca(2+) ionophore A23187, to circumvent any action via HbS polymerisation. The deoxygenation-induced cation conductance (sometimes termed P(sickle)) was partially inhibited, whilst deoxygenation-induced exposure of phosphatidylserine was completely abrogated. Na(+)/K(+) pump activity was also reduced. Notwithstanding, o-vanillin stimulated K(+) efflux through an unidentified pathway and resulted in reduction in cell volume (as measured by wet weight-dry weight). These actions are relevant to understanding how aromatic aldehydes may affect RBC membrane permeability per se as well as HbS polymerisation and thereby inform design of compounds most efficacious in ameliorating the complications of SCD.

Physiological integration plays key role in cranberry (Ericales: Ericaceae) for tolerance of damage by Dasineura oxycoccana (Diptera: Cecidomyiidae)

Understanding the mechanisms by which plants tolerate herbivory is important in the study of insect-plant interactions. In cranberry, current season growth has been identified as the main source of photosynthate for the developing fruits. Feeding injury by larvae of cranberry tipworm, Dasineura oxycoccana Johnson, disrupts the apical growth of cranberry shoots or uprights, but does not impact fruit output. To study the effects of experimentally depleting photosynthate available from sources other than the current season growth on fruit output, we girdled tipworm-injured uprights. This technique enabled us to estimate the contribution of current season growth in supplying photosynthate to developing fruits in tipworm-injured uprights. The mean fruit weight declined by >55% in those tipworm-injured uprights that were limited to photosynthate from only the current season growth (girdled uprights). The result was consistent between two phenologically different cultivars of cranberry, one a native selection from wild cranberry stands ('Howes') and the other a hybrid ('Stevens'). In addition, fruit weight was positively correlated to current season leaf area in the girdled uprights only. These results strongly suggest that physiological integration among the different sources of photosynthate plays a key role in the tolerance of tipworm feeding injury for fruit output in cranberry.

Bilateral axillary masses mimicking as accessory breast with multiple fibroadenoma and bilateral gigantomastia in HIV-positive patient

Accessory breast is a rare entity that can present as asymptomatic masses or can cause symptoms like heaviness, pain, restriction of arm movement and limitation in daily pursuits with allied apprehension and anxiety for the patient. We present a case of bilateral axillary masses mimicking as accessory breast with multiple fibroadenoma in a 28 years, nulliparous, Indian woman who is HIV positive, which proves to be a diagnostic dilemma. Excisional biopsy was diagnostic. The rarity of such cases imposes challenges on the management in terms of diagnosis, prognosis and therapeutic options.

Majorana fermions in semiconductor nanowires: fundamentals, modeling, and experiment

After a recent series of rapid and exciting developments, the long search for the Majorana fermion-the elusive quantum entity at the border between particles and antiparticles-has produced the first positive experimental results, but is not over yet. Originally proposed by E Majorana in the context of particle physics, Majorana fermions have a condensed matter analogue in the zero-energy bound states emerging in topological superconductors. A promising route to engineering topological superconductors capable of hosting Majorana zero modes consists of proximity coupling semiconductor thin films or nanowires with strong spin-orbit interaction to conventional s-wave superconductors in the presence of an external Zeeman field. The Majorana zero mode is predicted to emerge above a certain critical Zeeman field as a zero-energy state localized near the order parameter defects, namely, vortices for thin films and wire ends for the nanowire. These Majorana bound states are expected to manifest non-Abelian quantum statistics, which makes them ideal building blocks for fault-tolerant topological quantum computation. This review provides an update on the current status of the search for Majorana fermions in semiconductor nanowires by focusing on the recent developments, in particular the period following the first reports of experimental signatures consistent with the realization of Majorana bound states in semiconductor nanowire-superconductor hybrid structures. We start with a discussion of the fundamental aspects of the subject, followed by considerations on the realistic modeling, which is a critical bridge between theoretical predictions based on idealized conditions and the real world, as probed experimentally. The last part is dedicated to a few intriguing issues that were brought to the fore by the recent encouraging experimental advances.

Impact of early season apical meristem injury by gall inducing tipworm (Diptera: Cecidomyiidae) on reproductive and vegetative growth of cranberry

Larvae of cranberry tipworm, Dasineura oxycoccana Johnson, disrupt early season growth of cranberry (Vaccinium macrocarpon Aiton) uprights or shoots by feeding on apical meristem tissue. A 2-yr field study was carried out at three different locations to determine the impact of tipworm feeding injury on the reproductive and vegetative growth of two cranberry cultivars ('Howes' and 'Stevens') in Massachusetts. In addition to tipworm-injured and intact control uprights, an artificial injury treatment simulating tipworm feeding was also included. Individual uprights of cranberry exhibited tolerance to natural (tipworm) and simulated apical meristem injury in the current growing season (fruit production) and results were corroborated by a greenhouse study. In the field study, weight of fruit was higher in tipworm-injured uprights as compared with intact control uprights at the sites with Howes. However, majority of injured uprights (tipworm and simulated) did not produce new growth from lateral buds (side-shoots) before the onset of dormancy. In the next growing season, fewer injured uprights resumed growth and produced flowers as compared with intact uprights at two of the three sites. We suggest that multiple-year studies focusing on whole plant response to tipworm herbivory will be required to determine the costs of chronic feeding injury over time.

Major pharmaceutical residues in wastewater treatment plants and receiving waters in Bangkok, Thailand, and associated ecological risks

Pharmaceuticals have been frequently detected in aquatic environment worldwide and suspected for potential ecological consequences. However, occurrences, sources and potential risks of pharmaceutical residues have rarely been investigated in Bangkok, Thailand, one of most densely populated cities in the world. We collected water samples from five wastewater treatment plants (WWTPs), six canals, and in mainstream Chao Phraya River of Bangkok, in three sampling events representing different seasonal flow conditions, i.e., June and September 2011 and January 2012. Fourteen major pharmaceuticals including acetaminophen, acetylsalicylic acid, atenolol, caffeine, ciprofloxacin, diclofenac, ibuprofen, mefenamic acid, naproxen, roxithromycin, sulfamethazine, sulfamethoxazole, sulfathiazole and trimethoprim were analyzed. Levels of pharmaceutical residues in WWTP influents on average were the highest for acetylsalicylic acid (4700 ng L(-1)), followed by caffeine (2250 ng L(-1)) and ibuprofen (702 ng L(-1)). In effluents, the concentration of caffeine was the highest (307 ng L(-1)), followed by acetylsalicylic acid (261 ng L(-1)) and mefenamic acid (251 ng L(-1)). In surface water, acetylsalicylic acid showed the highest levels (on average 1360 ng L(-1) in canals and 313 ng L(-1) in the river). Removal efficiencies of WWTPs for roxithromycin, sulfamethoxazole and sulfamethazine were determined negligible. For several compounds, the concentrations in ambient water were higher than those detected in the effluents, implying contribution of the WWTPs to be negligible. Hazard quotients estimated for acetylsalicylic acid, ciprofloxacin, diclofenac and mefenamic acid in most of the canals and that of ciprofloxacin in the river, were greater than or close to 1, suggesting potential ecological risks. Ecological implications of the pharmaceutical residues in Bangkok waterway warrant further investigation.

Comparative evaluation of antimicrobial efficacy of Syzygium aromaticum, Ocimum sanctum and Cinnamomum zeylanicum plant extracts against Enterococcus faecalis: a preliminary study

AIM

To evaluate the antimicrobial efficacy of Ocimum sanctum, Cinnamomum zeylanicum, Syzygium aromaticum and 3% sodium hypochlorite (NaOCl) against Enterococcus faecalis in planktonic suspension and biofilm phenotypes.

METHODOLOGY

The antibacterial efficacy of different concentrations of aqueous ethanolic extracts of O. sanctum, C. zeylanicum and S. aromaticum against E. faecalis at various time intervals was assessed using the agar well diffusion test, microdilution test and biofilm susceptibility assay (BSA) on cellulose nitrate membrane as well as in a tooth model. NaOCl was used as the positive control. Distilled water was used as negative control for agar diffusion and microdilution tests and phosphate-buffered saline for the BSA. The results of the agar diffusion test were analysed statistically using anova and Tukey's tests.

RESULTS

Cinnamomum zeylanicum, S. aromaticum and O. sanctum exhibited minimum bactericidal concentration at 10%, 10% and 40%, respectively. Cinnamomum zeylanicum, S. aromaticum, O. sanctum and NaOCl showed complete bacterial inhibition in planktonic form after exposure of 30, 15, 35 and 1 min, respectively. In BSA on cellulose nitrate membrane, NaOCl was associated with complete bacterial inhibition after contact of 2 min, whilst 10% C. zeylanicum, 10% S. aromaticum and 40% O. sanctum showed cessation of growth after 12, 12 and 24 h, respectively. The results of BSA on tooth model were similar except for O. sanctum, which was not included in the model.

CONCLUSION

Cinnamomum zeylanicum, S. aromaticum and O. sanctum demonstrated antimicrobial activity against planktonic and biofilm forms of E. faecalis with C. zeylanicum and S. aromaticum having better antimicrobial efficacy than O. sanctum. NaOCl had superior antimicrobial efficacy amongst all the groups.

Safety and efficacy of oral ivabradine as a heart rate-reducing agent in patients undergoing CT coronary angiography

OBJECTIVE

To investigate the role of oral ivabradine as a heart rate reducing agent in patients undergoing CT coronary angiography (CTCA). Despite the routine use of β-blockers prior to CTCA studies, it is not uncommon to have patients with heart rates persistently above the target range of 65 bpm. Ivabradine is a selective inhibitor of the I(f) current, which primarily contributes to sinus node pacemaker activity, and has no significant direct cardiovascular effects such as reduction of blood pressure, cardiac contractility or impairment of cardiac conduction.

METHODS

We investigated 100 consecutive patients who had been referred for CTCA for the evaluation of suspected coronary artery disease (CAD). Patients were randomised to receive either of the following two pre-medication protocols: oral metorprolol or oral ivabradine.

RESULTS

Ivabradine was significantly more effective than metorprolol in lowering the heart rate; the mean percentage reduction in heart rate with ivabradine vs metorpolol was 23.89+6.95% vs 15.20+4.50%, respectively (p=0.0001). Metoprolol significantly lowered both systolic and diastolic blood pressure while ivabradine did not. The requirement of additional doses to achieve a target heart rate of <65 beats per min was also significantly more frequent with metoprolol.

CONCLUSION

Ivabradine is a potentially attractive alternative to currently used drugs for reduction of heart rate in patients undergoing CTCA.