Bacteriology of endotracheal tube biofilms and antibiotic resistance: a systematic review

Bacteria commonly adhere to surfaces and produce polymeric material to encase the attached cells to form communities called biofilms. Within these biofilms, bacteria can appear to be many times more resistant to antibiotics or disinfectants. This systematic review explores the prevalence and microbial profile associated with biofilm production of bacteria isolated from endotracheal tubes and its associations with antimicrobial resistance. A comprehensive search was performed on databases PubMed, Embase, and Google Scholar for relevant articles published between 1st January 2000 and 31st December 2022. The relevant articles were exported to Mendeley Desktop 1.19.8 and screened by title and abstract, followed by full text screening based on the eligibility criteria of the study. Quality assessment of the studies was performed using the Newcastle-Ottawa Scale (NOS) customized for cross-sectional studies. Furthermore, the prevalence of antimicrobial resistance in biofilm-producers isolated from endotracheal tube specimens was investigated. Twenty studies encompassing 981 endotracheal tubes met the eligibility criteria. Pseudomonas spp. and Acinetobacter spp. were predominant isolates among the biofilm producers. These biofilms provided strong resistance against commonly used antibiotics. The highest resistance rate observed in Pseudomonas spp. was against fluoroquinolones whereas the least resistance was seen against piperacillin-tazobactam. A similar trend of susceptibility was observed in Acinetobacter spp. with a very high resistance rate against fluoroquinolones, third-generation cephalosporins and carbapenems. In conclusion, endotracheal tubes were associated with colonization by biofilm forming bacteria with varying levels of antimicrobial resistance. Biofilms may promote the occurrence of recalcitrant infections in endotracheal tubes which need to be managed with appropriate protocols and antimicrobial stewardship. Research focus should shift towards meticulous exploration of biofilm-associated infections to improve detection and management.

Sediment modeling using laboratory-scale rainfall simulator and laser precipitation monitor

The characterization of a rainfall simulator provides an excellent opportunity to study the potential of soil erosivity without waiting for natural rain. But, precise instrumentation is required to estimate the parameters, which is seldom available. To overcome this problem, the empirical and conceptual relationships obtained through physically-based modeling help to correlate the rain parameters contributing to soil erosion. The present laboratory study used five pressurized nozzles of different capacities and a Laser Precipitation Monitor (LPM) to generate different rain intensities (21.0-79.0 mm h-1) and to register drop size distribution, respectively. The sediment transportation induced by rain and runoff was measured with an erosion flume of 2.50 × 1.25 × 0.56 m with an adjustable longitudinal slope. The spatial uniformity, drop size distribution, drop velocity, and kinetic energy were used to evaluate the simulator's performance. The different rain erosivity parameters were correlated and tested statistically using linear and non-linear regression analysis. The rain simulation experiments of different intensities at different pressure ranges were performed on flat, 5, 10, and 15% slopes of the erosion flume to evaluate rain characteristics and record the surface runoff and sediment yield. The median drop sizes produced during the simulator ranged from 0.38 to 2.11 mm, coinciding with natural rain. The empirical relationships were developed to correlate surface discharge and sediment yield with rain intensity by optimizing the parameters for further study of experimental field plots of different slopes. The observed and estimated rain erosivity parameters showed a significant relationship (R2 = 0.75 to 0.93; P < 0.001) in multiple regression analysis, and the metrics used to test the developed regression equations showed lower MAE, MSE, and RMSE errors indicating the adequacy of the relationships. The results indicated that the simulator helps to understand the complex task of soil erosion with hydrologic and geomorphic processes in laboratory experimentation with sufficient accuracy in measuring sediment transport events.

Supplementation of nano-selenium (SeNPs) improved growth, immunity, antioxidant enzyme activity, and selenium retention in broiler chicken during summer season

The present experiment was aimed at finding the optimal supplemental dose of nano-selenium in broiler chicken during the summer season for better performance in terms of growth, blood metabolites, immune response, antioxidant status, and selenium concentration in vital organs. Three-hundred-day-old Vencobb broiler chicks were randomly distributed into five dietary treatment groups with six replicates of 10 chicks each. The dietary treatments were as follows: T1 (control group), basal diet; T2, basal diet with 0.0375 ppm of nano-Se; T3, basal diet with 0.075 ppm of nano-Se; T4, basal diet with 0.15 ppm of nano-Se; T5, basal diet with 0.3 ppm of nano-Se. The experiment was carried out for 35 days. The average gain and feed conversion ratio were best observed in T4 and T5. The antibody titres were significantly higher (P < 0.05) in the treated birds. At the 5th week, erythrocytic glutathione peroxidase, catalase, and superoxide dismutase activities were significantly (P < 0.05) higher and lipid peroxidation values were significantly (P < 0.05) lower in all the nano-Se-treated groups. The Se levels in the liver, breast muscle, kidney, brain, and gizzard were significantly (P < 0.05) increased with increased dietary nano-Se. Histological studies of the liver and kidney in the highest nano-Se-treated groups (T4 and T5) did not show any abnormal changes. It is concluded that supplementation of nano-selenium at 0.15 ppm over and above the basal level improved the performance and protect the birds from summer stress without any adverse effect on the vital organs of chicken.

Mapping and visualizing the research contribution of India on telemedicine: A scientometric study

Background

The term "Telemedicine" is being used in the medical and health sector to treat patients and to provide medical guidance remotely. The intellectual output from India in terms of publications was harvested from Scopus^® with the keyword "Telemedicine" and analyzed by using bibliometric techniques.

Methods

The source data was downloaded from the Scopus^® database. All the publications on telemedicine and indexed in the database up to the year 2021 were considered for scientometric analysis. The software tools VOSviewer^® version 1.6.18 to visualize bibliometric networks, statistical software R Studio^® version 3.6.1 with the Bibliometrix package Biblioshiny^® were used for analysis and data visualization, and EdrawMind^® was used for mind mapping.

Result

India contributed 2,391 (4.32%) publications on telemedicine to a total of 55,304 publications worldwide until 2021. There were 886 (37.05%) papers that appeared in open access mode. The analysis revealed that the first paper was published in the year 1995 from India. Steep growth in the number of publications was observed in 2020 with 458 publications. The highest, 54 research publications, appeared in the "Journal of Medical Systems." The All India Institute of Medical Sciences (AIIMS), New Delhi, contributed the highest number of publications (n = 134). A considerable overseas collaboration was observed (USA: 11%; UK: 5.85%).

Conclusions

This is the first such attempt to address the intellectual output of India in the emerging medical discipline of telemedicine and has yielded useful information such as leading authors, institutions, their impact, and year-wise topic trends.

Identification of novel allelic patterns and evolutionary lineage of BoLA MHC class II DQA locus in indicine and taurine cattle

Among different cattle types, Bos indicus are known for their ability to better resist the tropical microbial infections comparatively, wherein MHC molecules play a significant role. In this study allelic diversity at MHC locus, DQA of Bos indicus, Bos taurus and crossbred of taurine-indicus has been explored to understand the possible role of MHC region in differential immune response. Thirty nine different DQA alleles were identified, out of which 14 were novel, along with documentation of duplication of DQA alleles. Indicus cattle population presented diverse types of DQA alleles compared to crossbred and exotic. Translated amino acid sequence analysis indicated, codon 64 and 50 of peptide binding sites being highly polymorphic and most of the indicus cattle presented alanine and arginine amino acid at position 64 and 50. Within breed genetic variation found to be higher than between breeds. Because of their ability to bind and subsequently respond to a wide array of antigens, the newly identified DQA alleles with high diversity present in the form of duplicated haplotypes in different combinations in cattle populations provided significant insights into probable role of this MHC locus in better tropical disease combating ability and genetic fitness of indicus cattle.

Feasibility and impact of a one-stop thyroid clinic in a low- and middle-income country

BACKGROUND

The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting.

METHODS

This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n = 118) - OSTC protocol, and control group (CG, n = 108) - routine protocol.

RESULTS

Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14).

CONCLUSION

OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system.

Historical Perspective and Medical Maladies of Alexander the Great

Alexander the Great (356 BC - 323 BC) was only 20 years old when he was named the next King of Macedonia after his father was assassinated. The following 11 years witnessed the evolution of an outstanding leader who expanded his empire from Egypt to the Indian frontier. Despite successfully conquering much of the world, he was afflicted with a febrile illness at the age of 32, which he battled for a mere 11 days before perishing. It has been almost 2,400 years since his death, but the exact cause remains a mystery. Did he die of natural causes or at the hands of conspirators? Numerous papers have been written about the illnesses suffered by Alexander, with the current evidence revealing a healthy 32-year-old man who developed fever and acute abdominal pain with rapid deterioration of his general condition leading to death within a short duration. We analyze various theories and discuss possible etiologies that may have contributed to his tragic death. Information was gathered from primary and secondary sources found through searching multiple online academic databases and the University of Southern California (USC), University of California Los Angeles (UCLA), and Harvard libraries. Unreliable sources and the unavailability of Alexander's body for autopsy make reaching a definitive diagnosis an impossible task; however, based on existing information, we presume that he most probably died of a neurological cause due to acute necrotizing pancreatitis and encephalopathy secondary to peritonitis. Other potential causes include fulminant hepatic failure, acute demyelinating neuropathy or Guillain Barre Syndrome, and arsenic poisoning.

Particle composition and morphology over urban environment (New Delhi): Plausible effects on wheat leaves

Particulate matter (PM) deposition on leaves adversely affects physical, chemical and biological nature of agricultural crops resulting in their loss of productivity and yield. Wheat being a staple food in major parts of Northern India and around the World, has been selected for research purpose by designing a study to explore the probable effects of PM deposition on wheat leaves and wheat crops to ensure the food security. PM₅ (Particulate matter with aerodynamic diameter <5 μm) and Dry Deposited Particulate Matter (DDPM) on wheat leaves (Leaf_DDPM) were collected from the wheat crop field in Indian Agriculture Research Institute (IARI), New Delhi for growing and harvesting season of wheat crops (i.e. December 2014 to April 2015). The EDS (Energy Dispersive Spectroscopy) analysis was used for this study and the individual particle analysis revealed the presence of both acidic and alkaline components like C, Al, Si, Fe, Ca, K, S and Mg. The offline characterization tool i.e. SEM (Scanning Electron Microscope) was utilized for obtaining the micrographs which clearly showed the presence of some angular, sharp-edged and spherical particles consisting of both smooth and rough texture. Apart from that, prevalence of slightly non-spherical particles with aspect ratio of range (>1.20-1.40) and CIR (>0.70-0.80) for both PM₅ and leaf_DDPM were observed. The size distribution of individual particles for both PM₅(#194 particles) and Leaf_DDPM(#657 particles) revealed that Surface Equivalent Radius (SER) and Volume Equivalent Radius (VER) of particles observed to be 0.40-0.80 μm while surface area to be 0-1 μm². These particles may easily block stomatal openings (with typical diameter range: 42-51 μm) of wheat leaves and damage internal leaf tissues while particle VER determines the interaction of incoming solar radiation with leaf surfaces. Average PM₅ concentrations ± Standard deviations (μg/m³) were reported to be 231.05 ± 113.03. The XRF (X-Ray Fluorescence) spectrometer analysis of bulk PM₅ revealed the concentrations of non-carbonaceous elements (μg/m³) as N (67.34 ± 16.09), Si (27.44 ± 11.01), Al (7.79 ± 3.37), S (3.88 ± 2.24), Na (2.29 ± 0.94), Mg (1.65 ± 0.62), K (0.51 ± 0.26), Ca (0.60 ± 0.26), Fe (0.54 ± 0.26), Cr (1.10 ± 0.70), Zn (0.05 ± 0.03), P (0.10 ± 0.03), Cu (0.07 ± 0.06). The dominant elemental oxides were calculated as SiO₂, Al₂O₃, SO₄^2-, Na₂O, MgO, K₂O, CaO, Fe₂O₃, Cr₂O₃, ZnO, P₂O₅, Cu₂O with variable concentrations. In high humid conditions, with relative humidity (~85%) during the vegetative and flowering growth stages of wheat crops, presence of C and S rich acidic and hygroscopic particles may cause the corrosion of wheat leaves that ultimately affect the wheat crops.

Role of postoperative intact serum PTH as an early predictor of severe post-thyroidectomy hypocalcemia: a prospective study

BACKGROUND

Post thyroidectomy hypocalcemia is a major sequel of thyroidectomy and continues to trouble the endocrinologists and the endocrine surgeons as there is no ideal predictive marker of hypocalcemia which has the potential to develop into a life-threatening complication. The role of early serum intact parathormone (iPTH) to predict post thyroidectomy hypocalcemia is becoming useful but the literature is still unclear regarding the optimal time of testing and the optimal cut-off value of serum iPTH.

PATIENTS AND METHODS

This is a prospective cohort study of 111 patients who underwent total thyroidectomy in a tertiary care endocrine surgery referral unit. Serum iPTH was measured after 20 min and 4 h of surgery. Receiver-Operator characteristic Curve (ROC) was used to find out of the best cut-off value of S. iPTH 20 min and 4 h after surgery in predicting hypocalcemia.

RESULTS

Hypocalcemia was noted in 60 (54%) out of 111 subjects who underwent total thyroidectomy. The best cut-off values of Serum iPTH to predict hypocalcemia was found to be 4.28 pmol/l at 20 min post total thyroidectomy with a sensitivity and specificity of 81.7% and 51%, respectively. In addition, patients with malignancy or central lymph nodal dissection were significantly over-represented in the hypocalcemia group with serum iPTH above the threshold level of 4.28 pmol/l. Below the cut off level, parenteral calcium supplementation was required in 23% (17/74) subjects while the rate was only 5.4% (2/37) patients when serum iPTH was above the cut-off level.

CONCLUSIONS

The decline of serum iPTH below a specific level after surgery has predictive value together with other factors strictly related to patient, the thyroid disease itself and surgery. The risk of development of hypocalcemia and consequent need for calcium supplementation should be evaluated by clinical assessment along with serum PTH measurement.

Spin-up conversion, exchange-interactions, and tailored magnetic properties in core-shell La2NiMnO6of small crystallites

La₂NiMnO₆-a ferromagnetic (FM) insulator offers tunable charge carriers and spins useful to devise its multiple properties and applications. In this view, we studied a core-shell La₂NiMnO₆(2-3 nm shell on 65 - 80 nm core) of a Ni²⁺/Ni³⁺(d⁷) to Mn⁴⁺/Mn³⁺(d⁴) spin-up conversion- revived a new FM phase-2, raising a spin-densityσ_s = 0.7 s a^-1over the Ni^2+/Mn⁴⁺species (phase-1),σ_s = 0.5 s a^-1, i.e. 2.12μ_B/f.u. larger spin moment. HRTEM images studied with x-ray diffraction characterizing core-shell structure that plays a crucial role in tuning the high spin FM phase-2 of profound properties. Below 110 K, the dc magnetization and ac magnetic susceptibilityχ(ω,T) reveal a metastable magnetic behavior on an antiferromagnetic canting of a spin-glass nature. The results follow a Vogel-Fulcher type relaxation with a relaxation timeτ₀∼ 10^-13s, confirming a spin-glass freezing behavior. Uniquely, FM field of phase-1 controls magnetics of phase 2 of a coupled magnet, modulating joint features with small thermal magnetic hysteresis on heating-cooling cycles.

Spin reorientation behaviour and dielectric properties of Fe-dopedh-HoMnO3

We have studied the magnetic structure, spin reorientation behaviour and dielectric properties of polycrystalline HoMn_1-xFe_xO₃(0.0 ⩽x⩽ 0.25) compounds using magnetization, neutron diffraction and dielectric measurements. These compounds crystallize predominantly in the hexagonal phase (P6₃cm) with a small phase fraction of the orthorhombic phase (Pnma) which increases with increase in dopant concentration and a total suppression of the hexagonal phase is observed atx= 0.25. Doping Fe at the Mn site leads to an increase in the spin reorientation temperature (T_SR) from 33 K (x= 0) to 55 K (x= 0.1) while theT_Nremains nearly constant at 72 K. The magnetic structure of the hexagonal phase was found to be Γ₄(P6₃'c'm) belowT_Nand Γ₃(P6₃'cm') belowT_SR. The magnetic ordering temperature of Ho³⁺ions at 2(a) site appears to coincide with theT_SRonly in the case ofx= 0 sample. The Ho ions at 4(b) site are found to magnetically order below 8 K. TheT_Nof the Ho ions at both 4(b) and 2(a) sites do not appear to be affected by doping at the Mn site. The temperature variation of the Mn and Ho moments follow the Brillioun function dependence albeit with differing values of the molecular field constantλ₀andλ₁. Short range magnetic order alone was found for the completely orthorhombic sample (x= 0.25). An anomalous suppression of the dielectric constant (ε) atT_Nis observed in the case of hexagonal samples. Further, a linear correlation between Δε(=ε(T) -ε(0)) and the square of the antiferromagnetic momentM, is observed in these compounds.

Comparative retrospective analysis of locoregional recurrence in unselected breast cancer patients treated with conventional versus hypofractionated radiotherapy at a tertiary cancer center?

Background

Role of hypofractionated radiotherapy (HFRT) in early breast cancer is established; comparatively, there are limited data for HFRT in locally advanced breast cancer (LABC). We report the impact of HFRT in unselected breast cancer patients in comparison with historically treated patients with conventional fractionated radiotherapy (CFRT).

Patients and Methods

Records of 463 breast cancer patients treated between January 09 and July 13 with CFRT (50 Gy/25 fr) or HFRT (42.4 Gy in 16 fractions or 40 Gy in 15 fractions) in two sequential periods were retrospectively reviewed. The analysis was done in August 2018. The primary endpoint was to compare the differences in locoregional recurrence rate.

Results

Of the 463 patients, 209 received CFRT and 254 received HFRT. The median age was 48 years (interquartile range: 40-56), premenopausal (CFRT: 23% vs. HFRT 39%, P = 0.005). The most common pathology was infiltrating ductal carcinoma (81%) with Grade III tumors (45%), estrogen receptor (+) was seen in 44%, triple-negative breast cancer in 34%, and Her2Neu (3+) were seen in 27%. Two hundred and fifty-four patients (54.5%) had undergone breast-conserving surgery (BCS) and 209 patients (45%) modified radical mastectomy (MRM). Nodal radiotherapy was delivered in 76% versus 64% in patients receiving CFRT versus HFRT, respectively (P = 0.005). With a median follow-up of 46 months in CFRT and 57 months in HFRT, 9/209 (4.3%) patients in CFRT and 7/254 (2.7%) in HFRT had locoregional relapse (LRR). The 4 years#39; actuarial local recurrence-free survival (LRFS) in CFRT versus HFRT was 95% versus 97% (P = 0.37). The mean estimated LRFS (local relapse-free survival) for CFRT is 113.4 months and for HFRT 94.2 months (P = 0.3).

Conclusions

The risk of local recurrence among patients of breast cancer treated with HFRT after BCS or MRM was not worse when compared to CFRT.

Low-dose ACTH test for evaluation of hypothalamus-pituitary-adrenal axis preoperatively and 3-month follow-up in non-functioning pituitary adenomas

BACKGROUND

Peri-operative glucocorticoids are routinely administered to patients undergoing trans-sphenoidal surgery for non-functional pituitary adenomas (NFPA) irrespective of hypothalamus-pituitary-adrenal (HPA) axis status.

PURPOSE

Evaluation of HPA axis before and 12 weeks after endoscopic trans-sphenoidal adenomectomy (E-TSA) utilizing low-dose (1 μg) ACTH stimulation test (LDACTH) to determine the need for glucocorticoid administration in patients with NFPA. We also determined the factors that can predict occurrence of hypocortisolism at 12 weeks after surgery.

METHODS

Sixty-three consecutive patients with NFPA requiring surgical excision were enrolled in this study. Glucocorticoids were administered to patients with demonstrable hypocortisolism [preoperative peak cortisol < 16 μg/dL during LDACTH test, postoperative day 3 (POD-3) 0800 hrs Cortisol < 8 μg/dL or stimulated cortisol (LDACTH) < 16 μg/dL at 12 weeks].

RESULTS

Hypocortisolism was present in 43 patients (68.2%) pre-operatively and persisted in 33 patients (52.4%) on POD-3. Thirty-three patients (52.4%) had hypocortisolism at 12 weeks after surgery. Eleven patients (17.4%) did not require glucocorticoids during the entire study period and 30 patients (47.6%) did not require glucocorticoids after 3 months. None of the patients developed adrenal crisis during the study. Hypocortisolism on the third post-operative day was the single significant predictor of hypocortisolism at 12 weeks after the surgery. There was a significant correlation between POD-3 0800 hrs cortisol ≥ 8μg/dL and stimulated cortisol (LDACTH) ≥16μg/dL at 12 weeks (r = 0.62, p < 0.0001). POD-3 0800 hrs cortisol ≥ 8 μg/dL had 73% sensitivity and 79% specificity in predicting eucortisolism at 12 weeks.

CONCLUSIONS

HPA function is preserved in significant proportion of NFPA patients undergoing E-TSA. Perioperative glucocorticoids should be given only in patients with demonstrable preoperative hypocortisolism on 1 μg ACTH test. Postoperative day 3 0800 hrs cortisol is a reasonable predictor of HPA axis status at 12 weeks after surgery.

Novel NUDT2 variant causes intellectual disability and polyneuropathy

Exome or genome sequencing was performed to identify the genetic etiology for the clinical presentation of global developmental delay, intellectual disability, and sensorimotor neuropathy with associated distal weakness in two unrelated families. A homozygous frameshift variant c.186delA (p.A63Qfs*3) in the NUDT2 gene was identified in cases 1 and 2 from one family and a third case from another family. Variants in NUDT2 were previously shown to cause intellectual disability, but here we expand the phenotype by demonstrating its association with distal upper and lower extremity weakness due to a sensorimotor polyneuropathy with demyelinating and/or axonal features.

Whole-genome resequencing of Dulong Chicken reveal signatures of selection

1. Dulong Chickens (DLCs) live at high altitude (~3000 m) and humidity (~90%), are endemic to the Yunnan province, and have gradually developed unique physiological characteristics, but their genetic basis is still unclear. Using the fixation index (F_ST ) approach, based on whole-genome resequencing, DLCs were analysed to uncover the genomic architecture of the population and candidate genes involved in selection during domestication. 2. A total of 469 candidate genes were obtained to be putatively under selection in DLCs. Further investigations revealed the genic footprint for local adaptation (high-altitude and high-humidity) as the genic signatures that are involved in economic traits (related to egg production). 3. Candidate genes were identified that may be associated with disease resistance, aggressiveness, small body size and positive selection of vision in DLCs. 4. These data revealed loci of selective signals that operate during selection for production at high altitude and humidity.

An Overview of Neuromuscular Junction Aging Findings in Human and Animal Studies

Background:

Aging is a complex irreversible process that is not only related to an individual’s genetic make-up but also to lifestyle choices and environmental exposures. Like every other structure in human body, the Neuromuscular Junction (NMJ) is not averse to aging.

Objectives:

The prime objective is to analyse the microscopic and macroscopic changes at the NMJs with aging.

Methods:

For the purpose of review we evaluated data from resources like Pubmed, Ovid, UCLA libraries and USC libraries.

Results:

We review various morphological, physiological, immunological, and biochemical changes in NMJs with aging and their management.

Conclusion:

The alterations in NMJs secondary to aging are inevitable. It is vital that neurologists clearly understand the pathophysiology of NMJ aging and differentiate between physiological and pathological effects of aging. With the current knowledge of science, the changes in NMJ aging can be better prevented rather than cured.

A Rare Case of Charcot-Marie-Tooth Disease Type 1C With an Unusual Presentation

Charcot-Marie-Tooth neuropathy type 1 (CMT1) is an inherited demyelinating neuropathy characterized by distal muscle weakness and atrophy. Charcot-Marie-Tooth disease type 1C (CMT1C) is a rare form of CMT1 caused by mutations in the lipopolysaccharide-induced tumor necrosis factor (LITAF) or small integral membrane protein of the lysosome/late endosome (SIMPLE) gene. Phenotypically, CMT1C is characterized by sensory loss and slow conduction velocity, and is typically slowly progressive and often associated with pes cavus foot deformity and bilateral foot drop. A 42-year-old female presented with a 10-year history of slowly progressive bilateral calf pain and cramps. After multiple electromyography/nerve conduction studies (EMG/NCS) and genetic testing, the patient was revealed to have CMT1C with a heterozygous pathogenic variant, c.334G>A (p.Gly112Ser). However, the presentation of the patient's CMT1C phenotype was unusual compared to patients with similar diagnosis in a previous study, including a normal sensory exam with the exception of high arches and mildly reduced vibratory sense. Additionally, the patient's teenage son already started showing symptoms of CMT1C despite the fact that the onset of the disease typically occurs at an older age. This particular case further highlights the idea that the phenotype related to CMT1C may have a wide spectrum of disease severity.

Mitochondrial sequence-based evolutionary analysis of riverine-swamp hybrid buffaloes of India indicates novel maternal differentiation and domestication patterns

In this study, mitochondrial D-loop sequence data on riverine, swamp and hybrid buffaloes from India have been generated and compared with other reported Indian riverine, Chinese and Bangladeshi swamp buffalo populations. Sequence analysis revealed the presence of 132 haplotypes, with a haplotype diversity of 0.9611 ± 0.0045 and a nucleotide diversity of 0.04801 ± 0.00126. For the first time, the existence of riverine-swamp hybrids among the Indian Chilika buffalo population has been recorded, having 49 chromosomes, which was also confirmed by mitochondrial haplotype sharing between Chilika and Indian swamp as well as Chinese swamp buffalo populations in the network analysis. Phylogenetic analysis documents the sharing of reported pre-domestication haplogroups 'SA1', 'SA2', 'SA3' and 'SB1' between the Chilika and swamp buffalo populations of India, China and Bangladesh, an indication of the migration of swamp buffaloes towards Bangladesh and adjoining lower parts of India and north towards Chinese domestication sites. The results have also been supplemented by multidimension scaling, grouping Indian and Chinese swamp buffaloes more closely together with Bangladeshi buffaloes, but into a separate quadrant, whereas Chilika grouped away from other riverine as well as swamp buffaloes. These findings thus confirm the previous reports that the northeast region of India, close to the Indo-China border, is the point of evolution of swamp buffaloes with multiple sites of domestication.

Patient, thyroid, and surgeon related factors that make thyroidectomy difficult-cohort study

Introduction

When thyroidectomy is performed under optimal conditions within a milieu of sound anatomical and physiological knowledge combined with meticulous surgical skills, complications are minimal. However, thyroidectomy can be difficult, and its complications can be life-threatening. The factors that predict difficult thyroidectomy can be patient-, thyroid-, or surgeon-related, and we aimed to study these three factors. .

Materials and methods

This prospective study was performed in a tertiary care center between September 2016 and March 2017. We developed and validated modified thyroidectomy difficulty scale (TDS), with 11 items. Preoperatively, height, weight, neck length, and other parameters were recorded. Postoperatively, the modified TDS form was filled out by the surgeon and assistant, blinded to each other's responses. The minimum score was 19 and maximum was 54. The surgeon's baseline pulse rate was monitored throughout the procedure using a pulse oximeter probe that was On-The-Go (OTG) compatible. The probe was placed over the ear lobule/pinna of the surgeon and connected to an Android phone that was comfortably placed in the surgeon's pocket inside the gown. An application USB SPO₂, was used in recording the pulse rate.

Results

A total of 52 patients undergoing hemi- or total thyroidectomy were included in this study. All had benign cytology on fine needle aspiration cytology (colloid, 71.42%). A total of 104 modified TDS questionnaires filled by the operating surgeon and assistant were analyzed. The pulse rate of the operating surgeon, as measured by the novel pulse oximeter, was recorded in 52 surgeries. The minimum score was 20, maximum score was 35.50, and mean score was 26.85 ± 2.80. There was an interobserver agreement in most domains of the modified TDS except mobility. The surgeon was found to have the maximum heart rate when performing recurrent laryngeal nerve (RLN) dissection in 38 patients (73.07%).

Discussion

We found that majority of the trainees found thyroidectomy to be a vigorously intense activity. Thyroidectomy is a demanding surgery, which requires meticulous identification and dissection of the RLN and parathyroid glands for optimum outcome.

Comparative modeling and mutual docking of structurally uncharacterized heat shock protein 70 and heat shock factor-1 proteins in water buffalo

Aim:

In this study, a wide range of in silico investigation of Bubalus bubalis (BB) heat shock protein 70 (HSP70) and heat shock factor-1 (HSF1) has been performed, ranging from sequence evaluation among species to homology modeling along with their docking studies to decipher the interacting residues of both molecules.

Materials and Methods:

Protein sequences of BB HSP70 and HSF1 were retrieved from NCBI database in FASTA format. Primary and secondary structure prediction were computed using Expasy ProtParam server and Phyre2 server, respectively. TMHMM server was used to identify the transmembrane regions in HSP70. Multiple sequence alignment and comparative analysis of the protein was carried out using MAFFT and visualization was created using ESPript 3.0. Phylogenetic analysis was accomplished by COBALT. Interactions of HSP70 with other proteins were studied using STRING database. Modeller 9.18, RaptorX, Swiss-Modeller, Phyre2, and I-TASSER were utilized to design the three-dimensional structure of these proteins followed by refinement; energy minimization was accomplished using ModRefiner and SPDBV program. Stereochemical quality along with the accuracy of the predicted models and their visualization was observed by PROCHECK program of PDBsum and UCSF Chimera, respectively. ClusPro 2.0 server was accessed for the docking of the receptor protein with the ligand.

Results:

The lower value of Grand Average of Hydropathy indicates the more hydrophilic nature of HSP70 protein. Value of the instability index (II) classified the protein as stable. No transmembrane region was reported for HSP70 by TMHMM server. Phylogenetic analysis based on multiple sequence alignments (MSAs) by COBALT indicated more evolutionarily closeness of Bos indicus (BI) with Bos taurus as compared to BI and BB. STRING database clearly indicates the HSF1 as one of the interacting molecules among 10 interacting partners with HSP 70. The best hit of 3D model of HSP70 protein and HSF1 was retrieved from I-TASSER and Phyre2, respectively. Interacting residues and type of bonding between both the molecules which were docked by ClusPro 2.0 were decoded by PIC server. Hydrophobic interactions, protein-protein main-chain-side-chain hydrogen bonds, and protein-protein side-chain-side-chain hydrogen bonds were delineated in this study.

Conclusion:

This is the first-ever study on in silico interaction of HSP70 and HSF1 proteins in BB. Several bioinformatics web tools were utilized to study secondary structure along with comparative modeling, physicochemical properties, and protein-protein interaction. The various interacting amino acid residues of both proteins have been indicated in this study.

Performance evaluation of light weight gas sensor system suitable for airborne applications against co-location gas analysers over Delhi

In the present work, we discuss the light-weight gas sensor system (LWGSS) [350 g, 7″ ∗ 3″] originally developed at CSIR-National Physical Laboratory. This instrument is equipped with low-cost electrolytic gas sensors for quantifying major gaseous pollutants present in the atmosphere. Alphasense electrochemical gas sensors were used to measure gas pollutant species such as CO, SO₂, NO₂, O₃ and H₂S. In our experiment, we focus on the observation of CO, SO₂, NO₂, O₃ using this system. LWGSS has been designed for vertical observations using balloons or unmanned aerial vehicles (UAVs) to study the gaseous concentration in the atmospheric boundary layer (ABL). But, before using such instruments in field campaigns, there is a strong need for the inter-comparison of these instruments with that of the collocated high-end gas analysers. Thus, the inter-comparisons were performed between LWGSS and other high-end analysers during 6-7, March 2017 and 26-27, April 2017. The LWGSS system comprising all the sensors was compared against high-end analyser present at CSIR-NPL for ozone and other gas analysers present at IMD, New Delhi. The ozone sensor deployed in LWGSS showed good correlation (i.e. R² = 0.83, slope = 0.93) against the high-end ozone gas analyser, which was calibrated with primary ozone facility (SRP43) available at CSIR-NPL. Inter-comparisons performed for NO₂, SO₂ and CO showed different results. While the NO₂ gas sensor showed medium correlation (R² = 0.75; slope = 0.49), the SO₂ and CO gas sensor showed a poor correlation (and R² = 0.44; slope = 0.98; R² = 0.28, slope = 0.79) respectively, when compared with co-location gas analysers present at IMD, New Delhi. Comparisons were performed for LWGSS data during 1-28 February 2018 with data collected at CPCB station (Shadipur, Delhi) and IMD station (Pusa, Delhi). The comparison results showed variations in LWGSS CO and SO₂ data whereas LWGSS O₃ and NO₂ results were in accordance with data collected at aforementioned monitoring stations.

Superior Photo-thermionic electron Emission from Illuminated Phosphorene Surface

This work demonstrates that black phosphorene, a two dimensional allotrope of phosphorus, has the potential to be an efficient photo-thermionic emitter. To investigate and understand the novel aspects we use a combined approach in which ab initio quantum simulation tools are utilized along with semiclassical description for the emission process. First by using density functional theory based formalism, we study the band structure of phosphorene. From the locations of electronic bands, and band edges, we estimate the Fermi level and work function. This leads us to define a valid material specific parameter space and establish a formalism for estimating thermionic electron emission current from phosphorene. Finally we demonstrate how the emission current can be enhanced substantially under the effect of photon irradiation. We observe that photoemission flux to strongly dominate over its coexisting counterpart thermionic emission flux. Anisotropy in phosphorene structure plays important role in enhancing the flux. The approach which is valid over a much wider range of parameters is successfully tested against recently performed experiments in a different context. The results open up a new possibility for application of phosphorene based thermionic and photo-thermionic energy converters.

Identification of novel polymorphism in buffalo stanniocalcin-1 gene and its expression analysis in mammary gland under different stages of lactation

Stanniocalcin-1 (STC1) is secreted by the variety of tissues having a major role in the regulation of calcium ions in the involuting mammary gland. The present work aims to sequence and structural characterization as well as expression profiling of STC1 gene in buffalo. Polymorphism identified in the 3-untranslated region (UTR) was analysed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) genotyping in riverine and swamp buffaloes. Expression profiling of STC1 was performed in different lactation stages of mammary gland and peripheral blood mononuclear cells to study the impact of 3'-UTR polymorphism on its expression. Different polymorphic sites were detected in the entire coding and noncoding regions of riverine and swamp buffaloes, including two INDELs. An identified polymorphic nucleotide locus A324G, having target sites for two miRNAs, namely bta-miR-2382 and bta-miR-1343, reported in cattle, was genotyped by PCR-RFLP to reveal variable allelic distribution among swamp and riverine buffaloes. Gene expression profiling across buffalo mammary tissues representing different lactation stages showed maximum expression of the STC1 gene in the involuting mammary gland. Ruminants' specific genetic variation has been observed in STC1 and its implication in buffalo mammary gland involution as well as coregulation of gene expression through miRNA binding in the 3'-UTR is suggested.

A Case of Tuberculosis-related Leukocytoclastic Vasculitis Presenting With Peripheral Neuropathy

Tuberculous granulomatous vasculitis is commonly associated with meningitis and retinitis. We describe a 39-year-old male, with a history of pulmonary tuberculosis (TB) who presented with progressive weakness, pain, tingling and numbness in the bilateral lower extremities. Significant atrophy and weakness of the lower extremities were evident along with absent reflexes. Nerve conduction studies and electromyography showed severe axonal polyneuropathy and denervation on the lower extremities. Nerve biopsy demonstrated small vessel leukocytoclastic vasculitis without any granuloma formation. Muscle biopsy was consistent with denervation and atrophy with target fiber changes. Tuberculosis-related vasculitis causing peripheral neuropathy is extremely rare and our case is unique in manifesting this presentation.

Hydroxychloroquine-induced autophagic vacuolar myopathy with mitochondrial abnormalities

Hydroxychloroquine (HCQ) and chloroquine are used worldwide for malaria as well as connective and rheumatological disorders. They have been reported to be linked to myopathy in patients. We report four patients who were receiving HCQ as part of treatment for connective tissue disorder and who presented with myopathy. The muscle biopsy in these patients was consistent with findings of HCQ toxicity. HCQ muscle toxicity is usually self-limiting after discontinuation of the drug. It also usually tends to be under-reported due to presence of various confounding factors. This warrants close monitoring and consideration of muscle biopsy as part of initial work up of patients who present with myopathy while receiving HCQ.

TRPV4 activation in rat carotid artery in DOCA hypertension involves eNOS and endothelium-derived contractile factor (EDCF)

Aim: Role of TRPV4 channel in regulation of endothelial function in the carotid artery in deoxycorticosterone acetate (DOCA) model of hypertension in rat was studied. Methods: 8-10 weeks old albino Wistar rats divided into three groups namely Control, UNX and hypertensive animals. Vascular smooth muscle response was studied in isolated carotid artery of rat with acetylcholine, sodium nitroprusside, GSK1016790A (GSK) in presence and absence of L-NAME and indomethacin. Results: At the end of the 6th week, the mean systolic blood pressure was increased in DOCA-treated hypertensive rats (166 ± 8 mm Hg) compared to Control and UNX (125 ± 5 mm Hg). ACh (10-9 to 10-5 M) produced almost 100% relaxation in Control (Emax = 97.48 ± 1.06 %) and UNX animals (Emax = 93.16 ± 2.33 %) which was attenuated in DOCA-treated hypertensive animals (Emax = 70.85 ± 1.65 %). No significant changes seen in SNP (10-12 to 10-5 M) induced relaxation. GSK1016790A (10-12 to 10-7 M)-mediated relaxation was significantly attenuated in DOCA-treated hypertensive animals (Emax = 25.58 ± 13.60%) compared to the control (Emax = 80.59 ± 6.86%) and UNX (Emax = 87.32 ± 2.01%) animals. L-NAME (10-4 M) potently blocked GSK-induced relaxation, and a contractile response to GSK was observed in presence of L-NAME in all the three groups of animals which was sensitive to indomethacin (10-5 M). Conclusion: TRPV4 may regulate the vascular tone of rat carotid artery through an attenuated NO pathway and stimulation of the release of contractile prostanoids in the DOCA hypertensive rats.

Concentration of rare earth elements during high temperature pyrolysis of waste printed circuit boards

An in-depth investigation was carried out on the recovery of rare earth elements (REEs) from a variety of waste printed circuit boards (PCBs). High temperature pyrolysis was carried out at 850 °C for 15 min using horizontal resistance and thermal plasma furnaces with different levels of turbulence. The concentration of REEs in key pyrolysis residues, namely, copper rich red metallic fraction, lead/tin rich white metallic fraction and slag rich carbonaceous residues, were determined using ICP analysis. Most of the REEs were found concentrated in the carbonaceous residue with negligible levels of REEs recovered in the two metallic fractions. Most of the recovered REEs showed a high affinity towards to refractory oxides silica and alumina, and little affinity towards metals Cu, Pb and Sn. The yield of REEs was significantly higher from the plasma furnace indicating the important role of turbulence in the dissociation & subsequent diffusion of REEs during pyrolysis. While La, Pr, Sm and Y required turbulent conditions for their recovery, Nd, Gd, Ce and Dy were relatively easy to dissociate and extract from the waste. Significant amounts of REEs could thus be recovered from waste PCBs as concentrated recyclates for further processing and extraction of individual rare earths. This study has shown that PCBs could prove to be a valuable urban mining resource of REEs. The recovery of REEs, in addition to precious and other metals, could play an important role towards enhancing the economic and environmental sustainability of e-waste recycling.

Teaching learning based optimization-functional link artificial neural network filter for mixed noise reduction from magnetic resonance image

BACKGROUND

The clinical magnetic resonance imaging (MRI) images may get corrupted due to the presence of the mixture of different types of noises such as Rician, Gaussian, impulse, etc. Most of the available filtering algorithms are noise specific, linear, and non-adaptive.

OBJECTIVE

There is a need to develop a nonlinear adaptive filter that adapts itself according to the requirement and effectively applied for suppression of mixed noise from different MRI images.

METHODS

In view of this, a novel nonlinear neural network based adaptive filter i.e. functional link artificial neural network (FLANN) whose weights are trained by a recently developed derivative free meta-heuristic technique i.e. teaching learning based optimization (TLBO) is proposed and implemented.

RESULTS

The performance of the proposed filter is compared with five other adaptive filters and analyzed by considering quantitative metrics and evaluating the nonparametric statistical test. The convergence curve and computational time are also included for investigating the efficiency of the proposed as well as competitive filters.

CONCLUSION

The simulation outcomes of proposed filter outperform the other adaptive filters. The proposed filter can be hybridized with other evolutionary technique and utilized for removing different noise and artifacts from others medical images more competently.

Importance of aerosol non-sphericity in estimating aerosol radiative forcing in Indo-Gangetic Basin

Aerosols are usually presumed spherical in shape while estimating the direct radiative forcing (DRF) using observations or in the models. In the Indo-Gangetic Basin (IGB), a regional aerosol hotspot where dust is a major aerosol species and has been observed to be non-spherical in shape, it is important to test the validity of this assumption. We address this issue using measured chemical composition at megacity Delhi, a representative site of the western IGB. Based on the observation, we choose three non-spherical shapes - spheroid, cylinder and chebyshev, and compute their optical properties. Non-spherical dust enhances aerosol extinction coefficient (β_ext) and single scattering albedo (SSA) at visible wavelengths by >0.05km^-1 and >0.04 respectively, while it decreases asymmetry parameter (g) by ~0.1. Accounting non-sphericity leads top-of-the-atmosphere (TOA) dust DRF to more cooling due to enhanced backscattering and increases surface dimming due to enhanced β_ext. Outgoing shortwave flux at TOA increases by up to 3.3% for composite aerosols with non-spherical dust externally mixed with other spherical species. Our results show that while non-sphericity needs to be accounted for, choice of shape may not be important in estimating aerosol DRF in the IGB.

Ischemic Stroke in a Patient with Parry-Romberg Syndrome

OBJECTIVE

This study aimed to discuss a case of a patient with a known diagnosis of Parry-Romberg syndrome (PRS) presenting with ischemic stroke, the second such reported case.

BACKGROUND

PRS is a rare genetic disorder with progressive hemifacial atrophy, which usually presents within the first 2 decades of life. Neurologic manifestations include trigeminal neuralgia with associated deafness, hemifacial pain with associated migraine headaches, seizures, movement disorders, and neuropsychiatric symptoms. Many patients have elevated antinuclear antibody (ANA) titers. However, stroke is uncommon.

CASE DESCRIPTION

A 34-year-old right-handed woman, diagnosed with PRS at age 15, presented with right-sided weakness on waking up. Brain magnetic resonance imaging revealed a small infarct of the posterior limb of the left internal capsule. Vessel imaging revealed an aberrant right subclavian artery. Atrophy of the right-sided muscles of mastication is consistent with her known diagnosis of right-sided PRS. Stroke workup revealed a patent foramen ovale; however, no evidence of deep venous thrombosis was found. Hypercoagulability workup revealed an elevated ANA. The cause of stroke in this patient with PRS remains unclear, as she has no known risk factors.

CONCLUSION

It is possible that elevated inflammatory markers associated with PRS may cause a proinflammatory state and predispose patients to small-vessel vasculopathy. It is important to note the association between PRS and ischemic stroke.

Spirituality and Religiosity and Its Role in Health and Diseases

Religiosity is a factor involved in the management of health and diseases/patient longevity. This review article uses comprehensive, evidence-based studies to evaluate the nature of religiosity that can be used in clinical studies, thus avoiding contradictory reports which arise from misinterpretation of religiosity. We conclude that religiosity is multidimensional in nature and ultimately associated with inherent protection against diseases and overall better quality of life. However, a number of untouched aspects of religiosity need to be investigated further before we can introduce religiosity in its fully functional form to the realm of health care.

PCR-SSCP analysis of MDGI gene and its association with milk production traits in river buffalo (Bubalus bubalis)

In this study, we investigated the genetic variation within 3'UTR of Mammary-Derived Growth Inhibitor (MDGI) gene of buffalo using PCR-SSCP and sequencing; and also analyzed association of polymorphism with the milk production traits. The study revealed two conformational patterns, 'A' and 'B' among 234 Mehsana buffaloes maintained with their records in the field and at farm. The frequency of SSCP variant 'A' was found to be invariably high in the buffalo population under study. Further, association analysis of SSCP variants with various milk production and milk quality traits indicated no significant effect on any of the traits investigated. Sequencing of SSCP variant 'A' showed homozygous G/G and A/A and 'B' had heterozygous G/C and A/G at positions +124 and +140 respectively, in the 3'UTR of buffalo MDGI. The preliminary results showed the substantial variations in the distribution of SSCP variants' frequencies within Mehsana buffaloes, however these variants had non-significant association with milk yield, fat yield and fat percentage in Mehsana buffaloes.

Reflection of few cycle laser pulses from an inhomogeneous overdense plasma

The use of a plasma mirror to improve the temporal contrast of few cycle laser pulses has been considered. Pre-plasma features, prior to the main pulse, have been evaluated using an analytical model that has been verified using hydrodynamic code. The temporal/ spectral profile, reflectivity, and broadening of the reflected pulse have been parametrically analysed using an analytical formulation that describes the reflection of broadband ultra-short pulses from the plasma gradient. The analytical estimate for the pulse reflectivity is in good agreement with experimental measurements. The consistency of the analytical expressions for the collisionless case has been validated via comparison with a 1D particle in cell simulations.

Adrenocortical carcinoma in children and adults: Two decades experience in a single institution

CONTEXT

Adrenocortical carcinoma (ACC) occurring in children and adults show distinct characteristics. However, due to rarity of the disease no large series addressing this issue has been published.

AIMS

The aim of this study was to study clinico-pathologic profile and outcome of ACC in children and adults.

SETTINGS AND DESIGN

Tertiary referral center. Retrospective study (January 1990-June 2011).

SUBJECTS AND METHODS

Forty-five patients with ACC were included; 16children (aged < 18 years) and 29 adults. Clinical details, hormonal profile, operation records, pathology reports and follow-up findings were noted and compared. Survival analysis was performed using Kaplan-Meier method. Log rank test and Cox regressionan alysis were performed.

RESULTS

Mean age was 8 ± 5.7 (M: F = 1:2.1) in children and 44.4 ± 15 years (M: F = 1:1.1) in adult groups. Prevalence of functioning tumors was significantly high in children (87.5 vs. 31% P = 0.001), while prevalence of incidentalomas was high in adults (6.3 vs. 51.7% P = 0.05). Tumor stage distribution at presentation, mean diameter (10.9 vs. 13.7 cm), and weight (392.9 vs. 892.9 g) didn't differ significantly in two groups. Adults had better albeit non-significant 5 year overall survival (OS) than children (0 vs. 13%). On univariate analysis stage of disease (P = 0.008), surgical intervention (P = 0.004), Weiss score (P = 0.04) and hormonal secretion (P = 0.04) were significantly associated with OS in adults but not in children. No factor was found significant on multivariate analysis.

CONCLUSIONS

Except for high prevalence of functioning tumors in children, clinico-pathologic attributes and outcome of ACC in the two groups didn't differ significantly.

Abstract P1-11-07: Frozen section histology evaluation of surgical margins helps perform single step oncologically safe and cost-effective breast conservation surgery

This abstract was withdrawn by the authors.

Cardiac Abnormalities in Congenital and Childhood Myotonic Muscular Dystrophy Type 1

Myotonic dystrophy often presents with cardiac abnormalities, particularly conduction defects, that factor into an increased risk of sudden cardiac death. Myotonic dystrophy has two forms, myotonic dystrophy type 1 (DM1) and DM2, and is a multisystemic disorder that presents in a wide, clinical spectrum and age range. A distinguishing feature of DM1 is the existence of a congenital form. Though research on cardiac involvement has been conducted on patients with the adult form of myotonic dystrophy, there have been few studies focused on cardiac involvement in pediatric patients with congenital myotonic dystrophy type 1 (CDM1). In this study, a survey was conducted to determine the prevalence and variations of cardiac abnormalities in pediatric patients with CDM1. This preliminary study found a prevalence of 25.8% CDM1 pediatric patients with cardiac abnormalities in a sample size of 31 patients.

Identification of genetic variation in NOD-like receptor 2 gene and influence of polymorphism on gene structure and function in buffalo (Bubalus bubalis)

Nucleotide-binding oligomerization domain (NOD)-like receptor 2 is one of the important mediators of innate as well as adaptive immune response to microbial infections. In this study, NOD-like receptor-2 was characterized by determining the full gene sequence and analyzing genetic diversity in Indian buffaloes. Sequence analysis of buffalo NOD2 revealed 3042 nucleotides long ORF, encoding 1013 amino acids from 12 exons. Domain structure analysis indicated existence of 8 leucine-rich repeat (LRR) domains in buffalo, cattle, sheep and mouse, along with central NACHT/NOD domain and two N-terminal CARD domains. Comparative sequence analysis among different buffalo breeds identified 46 polymorphic sites in NOD2 gene. Among coding region SNPs, 10 were non-synonymous, 7 synonymous and 3 were present in 5'UTR. Genotyping of two nsSNPs, revealed significant differences in the allele frequencies, distinguishing swamp and riverine buffaloes, having different utilities. Association analysis with mastitis in dairy buffaloes indicated significant variation in allelic frequencies at G1135A locus, between mastitis affected and non-affected animals. Further, NOD2 gene expression was quantified in different riverine buffalo tissues, using real-time PCR and lymph node displayed highest expression, compared to others organs included in the study. Overall, the study revealed buffalo NOD2 gene attributes, important to understand species specific immune response in ruminants.

Outcome of early surgery in infantile esotropia: Our experience in tertiary care hospital

BACKGROUND

Infantile esotropia is a convergent strabismus presenting before 6 months of age and is the most common strabismus disorder presenting in the ophthalmology OPD. The dilemma of whether to go for early surgery and how early has been a matter of research for the last 50 years. We describe our results of surgery in infantile esotropia at variable age groups, as well as with different reoperation rates and compare with the results in western literature.

METHODS

A prospective study was carried out through a review of 113 cases operated for infantile esotropia between February 2013 and August 2014. The variables studied were: age at surgery, type of fixation, refractive error, associated nystagmus, inferior oblique overaction or dissociated vertical deviation (DVD), type of surgery performed and pre- and postoperative deviation angles.

RESULTS

There were 67 male and 46 female cases of infantile esotropia. The age group of patients varied from 6 months to 12 years. Latent nystagmus was seen in 22 cases, inferior oblique overaction in 49 cases and DVD (mild) in 14 cases. Bimedial rectus recession was done in 78 cases and recession-resection in non-dominant eye in remaining 35 cases. The postoperative residual deviation was <10 PD in 102 cases, between 10 and 16 PD in 5 cases and more than 16 PD in 6 cases. Only 6 cases (5.3%) required reoperation for correction of residual deviation.

CONCLUSION

The authors recommend surgery before 12 months in all cases of infantile esotropia. The reoperation rates in the current study were considerably low.

Changes in functional magnetic resonance imaging with Yogic meditation: A pilot study

Background:

The neural substrates of Yogic meditation are not well understood. Meditation is theorized to be a conscious mental process that induces a set of complex physiological changes within the areas of the brain termed as the “relaxation response.”

Aims and objective:

Pilot data of a functional magnetic resonance imaging (fMRI) study is presented to observe and understand the selective activations of designated brain regions during meditation.

Material and methods:

Four trained healthy Patanjali Yoga practitioners in their mid-60s participated in this prototype interventional study. A three-part 1-min block design alternating between meditation (test) and relaxation (control) phase with an imaginary visual fixation and auditory stimulation was used.

Result and observation:

The fMRI images revealed strong activation in the right prefrontal regions during the visual and auditory fixation meditation phases compared to no activations during the relaxation phase. A comparison between the visual and auditory fixations revealed shifts within the prefrontal and temporal regions. In addition, activation in occipital and temporal regions was observed during the meditation phase. Occipital lobe activation was more apparent during visual meditation phase.

Conclusion:

It is concluded that specific fMRI brain activations are observed during different forms of Yogic meditation (visual and auditory phases). Occipital and prefrontal activation could be modulating the known neurophysiological and biological effects of meditation.

Urinary B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL): potential biomarkers of active lupus nephritis

B cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) help in B cell activation, maintenance and plasma cell survival. B cell infiltration has been demonstrated in kidneys of patients with lupus nephritis (LN). Serum levels of BAFF and APRIL have shown inconsistent relationships with lupus disease activity. We evaluated urinary levels of BAFF and APRIL as biomarker for LN. Thirty-six patients with proliferative lupus nephritis (AN), 10 with active lupus without nephritis (AL) and 15 healthy controls (HC) were studied. APRIL and BAFF levels were measured in both serum and urine using enzyme-linked immunosorbent assay (ELISA). Urine levels were normalized for urinary creatinine excretion. Urine levels were correlated with conventional disease activity markers and histology. Levels were reassessed in 20 AN patients at 6 months after treatment with cyclophosphamide. Urinary APRIL (uAPRIL) and BAFF (uBAFF) levels were raised significantly in AN. uAPRIL, but not uBAFF, correlated moderately with renal Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in AN (r = 0·36, P < 0·05). On receiver operator curve (ROC) analysis, uBAFF and uAPRIL showed an area under the curve (AUC) of 0·825 and 0·781, respectively, in differentiating between nephritis and non-nephritis, which performed better than low C3, C4 and raised anti-dsDNA antibodies. There was no correlation of serum levels with uBAFF (r = 0·187, P = 0·261) and uAPRIL (r = 0·114, P = 0·494). uAPRIL levels reduced after treatment (mean 125 pg/mg to 36 pg/mg, P < 0·05). uBAFF levels reduced in 16 responders while two of four non-responders had increase in levels. Thus, uBAFF and uAPRIL are potential biomarkers of proliferative lupus nephritis.

Comparative evaluation of hormonal protocol on the performance of crossbred cattle

A total of 60 animals (38 cows, 22 heifers) were selected and were divided into three groups of 20 animals each (containing both anoestrus and repeat breeder) in which treatment was performed for 60 days. Group I: control (farmer practice), T₁ group: group I + hormone (double synch), and T₂ group: group I + hormone (Estra double synch). The growth performances were measured in terms of body weight and average daily gain (ADG). Blood collection was done at the start and end of the experiment for assessment of blood biochemical, hematological, and reproductive status of the animals. Results revealed significant improvement in growth and reproductive performances in treatment group as compared to control group. Higher percentage of conception was achieved in group III (60%) followed by group II (55%). The least percentage was in group I (15%), i.e., in control group. So it was found that the effect of treating the reproductive-disordered animals with Estra double synch gave comparatively better result than double synch hormonal application.