Journey of technological advancements in the detection of antimicrobial resistance

Increased uses rather an extensive misuse of antibiotics due to easy availability and easy access have resulted in antibiotic resistance as a global crisis. The speed of discovery of new antibiotics has slowed down recently. Therefore, there is a need to reduce the rate of increase in resistance against the presently available antibiotics, or else many infections may be left untreatable or difficult to be treated due to the high prevalence of resistance. The judicious use of broad-spectrum antibiotics can control the increase in resistance profile. Various techniques are presently being used for the detection of antibiotic resistance. Conventional phenotypic methods are preferred that are highly reliable but are much more time-consuming. The patients cannot spare more time as the infection keeps increasing. The results with genotypic methods are obtained within 24 h as compared to phenotypic methods. Hence, recent molecular methods like qPCR can be used for detection. In this review, we present an overview of various methods useful for the detection of antibiotic resistance, with emphasis on their advantages and limitations. The review also emphasizes qPCR to be the most preferred method out of all because of various advantageous factors.

Association of Viral and Host Genetic Architecture with the Status of Neurocognitive Disorder in HIV-Infected Individuals

The polymorphisms in host genes such as CCR5, CCR2, stromal derived factor (SDF), and MBL (mannose-binding lectin) as well as the viral nef gene have been shown to influence human immunodeficiency virus (HIV) infection, followed by the development of HIV-associated neurocognitive disorder (HAND). In this preliminary study with a limited number of samples, we have tried to associate the genetic polymorphism from the host and viral genetic factors with the neurocognitive status along with immuno-virological parameters. The total RNA was isolated from 10 unlinked plasma samples containing 5 samples from each group with and without HAND based on the International HIV Dementia Scale (IHDS) score <9.5 and >9.5, respectively. The CCR5, CCR2, SDF, MBL, and HIV nef genes were amplified and digested with restriction enzymes, except for the nef gene amplicon. Restrictions fragment length polymorphism (RFLP) was used to determine whether allelic variations were present in the digested host gene products, while sequencing was done for HIV nef amplicons without digestion. CCR5 delta 32 heterozygous variants were present in two samples from the HAND group. Three samples with HAND showed SDF-1 3' heterozygous allelic variant, while the MBL-2 gene presented with a homozygous mutant allele (D/D) in codon 52, heterozygous mutant allele (A/B) in codon 54, and codon 57 (A/C) for all samples except IHDS-2 irrespective of dementia status. Furthermore, amino acid alignment of Nef sequences confirmed the heterogeneity, while prediction of the human leukocyte antigen binding epitopes further explored its effect on functional motifs with variable binding efficiency such as epitopes GAFDLSFFL (aa 83) and LTFGWCFKL (aa 138) binding with HLA molecules at 60% and 80%, respectively. Thus, host genetics evidently influence predisposition to HIV infection and HAND. The genetic variability in the nef gene from both groups resulted in altering the functionality of specific domains and showing its impact on the progression of the disease, which needs to be explored.

The role of thioredoxin proteins in Mycobacterium tuberculosis probed by proteome-wide target profiling

Mycobacterium tuberculosis encounters diverse microenvironments, including oxidative assault (ROS and RNS), when it attempts to establish itself within its human host. Therefore, redox sensory and regulation processes are assumed significant importance, as these are essential processes for M. tuberculosis to survive under these hostile conditions. M. tuberculosis contains thioredoxin system to maintain redox homeostasis, which establish a balance between the thiol/dithiol couple. Still very less is known about it. In the present study, we attempted to capture the targets of all the M. tuberculosis thioredoxin proteins (viz., TrxB and TrxC) and a thioredoxin-like protein, NrdH, under aerobic and hypoxic conditions by performing thioredoxin trapping chromatography followed by mass spectrometry. We found that TrxC captured the maximum number of targets in both the physiological conditions and most of the targets of TrxB and NrdH showing overlap with targets of TrxC, indicating that TrxC acts as main thioredoxin. Further the PANTHER classification system provides involvement of targets in various metabolic processes and Gene Ontology analysis suggests that glutamine biosynthetic process and Fe-S cluster biosynthesis are the most enriched processes in the target list of TrxC and TrxB respectively. Also, we suggest that the thioredoxin system might play an important role under hypoxia by targeting those proteins which are responsible to sense and maintain hypoxic conditions. Furthermore, our studies establish a link between TrxB and iron-sulfur cluster biogenesis in M. tuberculosis. Ultimately, these findings open a new direction to target the thioredoxin system for screening new anti-mycobacterial drug targets.

APOBEC3, TRIM5α, and BST2 polymorphisms in healthy individuals of various populations with special references to its impact on HIV transmission

AIDS restriction genes (ARGs) like APOBEC3, TRIM5α, and BST2 can act as immunological detectors of the innate protective mechanism of the body. ARGs influence the course of viral pathogenesis and progression of the disease. The infection caused by different viruses including HIV activates the innate immune receptors leading to production of proinflammatory cytokines, interferons and signals that recruit and activate cells involved in the process of inflammation following induction of adaptive immunity. Differential expression of genes involved in viral infection decide the fate and subsequent susceptibility to infection and its clinical outcome. Nevertheless, comprehensive reports on the incidence of genetic polymorphism of APOBEC3s, TRIM5α, and BST-2 in the general population and its association with pathological conditions have not been described well. Therefore, the occurrence of APOBEC3, TRIM5α, and BST2 polymorphism in healthy individuals and its impact on HIV transmission was analyzed. We conducted an extensive search using the several databases including, EMBASE, PubMed (Medline), and Google Scholar. APOBEC3-D, -F, -G, and -H out of the seven human APOBEC3s, help in the control of viral infection. Amongst various restriction factors, TRIM5α and BST-2 also restrict the viral infection followed by the development of the disease. In the current review, a brief account of the polymorphism in the APOBEC3G, TRIM5α, and BST2 genes are explored among different populations along with the interaction of APOBEC3G with Vif protein. Furthermore, this review specifically focus on ARGs polymorphism (APOBEC3G, TRIM5α, and BST2) associated with HIV transmission.

SIGNIFICANCE OF DETECTION OF FREE/TOTAL PSA RATIO AND OTHER BIOCHEMICAL PARAMETERS IN PATIENTS WITH BPH, CARCINOMA PROSTATE AND ITS CLINICOPATHOLOGIC CORRELATION

Background. Benign prostatic hyperplasia (BPH) can raise prostate-specific antigen (PSA) levels two to three times higher than the normal level. An increased PSA level does not indicate Prostate Cancer (PCa), but the higher the PSA level, the higher the chance of having PCa. Detection and treatment have been profoundly affected by the advent of Free/Total PSA ratio testing. Objectives. The aim of the study was to estimate free, total PSA levels and its ratio for serum levels of calcium, acid phosphatase and alkaline phosphatase in patients with BPH and PCa; to correlate clinical, biochemical and histopathological findings in the above patients. Methods. PSA levels were detected by Chemiluminescent assay; serum calcium – by Modified Arsenazo method; serum acid phosphatase – by Doumas et al method; and Alkaline phosphatase – by Lowry et al method. Results. Present study found high levels of total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa rate. Free/Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were considerably higher in PCa as compared to BPH. Serum calcium levels did not show significant difference in control and study groups. Conclusions. It was established that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in those without PCa. Therefore, in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary. Objectives: The study was carried out with the following objectives: to estimate free, total PSA levels and calculate Free/Total PSA ratio in patients with BPH and Carcinoma Prostate, to study the serum levels of calcium, acid phosphates, and alkaline phosphatase in patients with BPH and PCa. and to correlate clinical, biochemical and histopathological findings in the above patients. Methods. Free and total PSA levels were detected by  Chemiluminescent assay; Serum Calcium was detected by Modified Arsenazo method. Serum  acid phosphatase was detected by Doumas et al method and Alkaline phosphatase were detected by Lowry et al  method Results: Present study found high levels of Total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa ate. Free /Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were slightly raised in PCa as compared to BPH. Serum calcium levels did not show a significant difference in control and study groups. Conclusion: We concluded that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in men without PCa. There was a negative correlation found between the free/total PSA ratio and the histopathologic findings. The lower the ratio higher is the grade of malignancy. Therefore in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary

The impact of the COVID-19 pandemic on transcatheter aortic valve implantation (TAVI) service: a United Kingdom tertiary centre experience

Background/Introduction

Untreated, symptomatic, severe aortic stenosis carries significant mortality and morbidity. Timely intervention is pivotal to ensure patient safety. The COVID-19 pandemic created unprecedented challenges to the UK's National Health Service (NHS), resulting in the deferral of all elective work, including TAVI services from March 2020.

Purpose

To evaluate clinical outcomes and time delays in patients undergoing TAVI during the pandemic period compared to an age and risk factor-matched cohort of patients prior to COVID-19. We hypothesized that there were significant time delays, more emergency procedures and related adverse outcomes in patients who underwent TAVI during the pandemic period.

Methods

We analysed prospectively collected data (patient characteristics, procedural details, complications and in-hospital outcomes) of 210 consecutive patients who underwent TAVI between March 2019 and February 2021 in a tertiary centre in the UK (The centre serves for a population of 2.5 million and provided in-patient treatment for 5590 COVID-positive patients over a 12 month period). We compared time-lags from an initial referral to outpatient review, CT aortograms, valve implantation and 30-day mortality between patients who underwent TAVI between March 2019 and Feburary 2020 (N=134) and those who underwent TAVI between March 2020 and February 2021 (COVID Group=76).

Results

The mean age of the cohort was 81.4±6.6 years and majority were females (51%) and were in moderate risk category (EuroSCORE II=4.55±5.5). Of the total cohort, 4 (5.3%) patients acquired COVID-19 pneumonia during the hospital stay. The age, cardiovascular comorbidities and risk scores were comparable between the control group and the COVID cohort. (Table 1). There were no significant differences in procedural complications in the control group compared to the COVID-19 group (Table 1). The median waiting time from referral to TAVI clinic was significantly shorter in the COVID-19 group (33 (8–66) vs. 51 (17–89) days (P=0.04)) and there was no significant difference in time delays for CT aortogram, MDT or TAVI procedure between the two groups. The median length of stay (2 (2–4) vs 2.5 (2–9) days) and 30 day mortality (1.4% vs 5.3%) was comparable between the two groups (Table 1).

Conclusion

Contrary to our hypothesis, our analysis demonstrated that there were no significant time delays, excess complications or mortality in TAVI procedures during the COVID-19 pandemic period despite the excess burden imposed on our local health services. More importantly, very few TAVI patients acquired COVID-19 infection during in-hospital stay. This is likely due to prompt identification of innovative ways of re-configuring an existing local patient pathway, by the TAVI team, to deliver safe and uninterrupted TAVI services during this unprecedented pandemic setting.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Referral times

The Burden of Respiratory Viruses and Their Prevalence in Different Geographical Regions of India: 1970-2020

As per the 2019 report of the National Health Portal of India, 41,996,260 cases and 3,740 deaths from respiratory infections were recorded across India in 2018. India contributes to 18% of the global population, with severe acute respiratory infection (SARI) as one of the prominent causes of mortality in children >5 years of age. Measures in terms of the diagnosis and surveillance of respiratory infections are taken up globally to discover their circulating types, detect outbreaks, and estimate the disease burden. Similarly, the purpose of this review was to determine the prevalence of respiratory infections in various regions of India through published reports. Understanding the pattern and prevalence of various viral entities responsible for infections and outbreaks can help in designing better strategies to combat the problem. The associated pathogens comprise respiratory syncytial virus (RSV), rhinovirus, influenza virus, parainfluenza virus, adenovirus, etc. Identification of these respiratory viruses was not given high priority until now, but the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has sensitized our system to be alert about the burden of existing infections and to have proper checks for emerging ones. Most of the studies reported to date have worked on the influenza virus as a priority. However, the data describing the prevalence of other respiratory viruses with their seasonal pattern have significant epidemiological value. A comprehensive literature search was done to gather data from all geographical regions of India comprising all states of India from 1970 to 2020. The same has been compared with the global scenario and is being presented here.

Development of a position-sensitive fast scintillator (LaBr3(Ce)) detector setup for gamma-ray imaging application

We have characterized a Cerium doped Lanthanum Bromide (LaBr3(Ce) ) crystal coupled with the position-sensitive photo-multiplier system for the gamma-ray imaging application. One can use this detector set-up for the scanning of high purity germanium detectors for pulse shape analysis in gamma-ray spectroscopy experiments and the image formation of an object by Compton back-scattering . The sensor has been tested for energy, timing and position information of the gamma-rays interacting within the detector crystal. The GEANT4 simulation results are consistent with the experimental results. We have reconstructed the image of irradiation spots in different positions throughout the detector crystal. Position resolution is found to be around 3.5 mm with the 2 mm collimated gamma-rays. The 2-d image of hexagonal Bismuth Germanate (BGO) crystal and a cylindrical LaBr3(Ce) crystal have been reconstructed in coincidence technique. The performance of the detector for imaging application has been investigated by coincidence technique in GEANT4 simulation and compared with the experimental data. We have reconstructed the 2-d images of objects with various geometrical shapes by Compton back-scattered events of the gamma-rays. This position-sensitive detector can be used as an absorber of a Compton camera for the image reconstruction of an extended radioactive source. One can also use this kind of set-up as in radiation imaging and many other applications where the energy and source position of the gamma-ray is the main interest.

Notes on Ptilomera agriodes (Hemiptera: Heteroptera: Gerridae) from Eastern Ghats, India

The present study reports an aquatic hemipteran species Ptilomera agriodes (Schmidt, 1926) distributed in different streams and waterfalls of Eastern Ghats of Andhra Pradesh and Telangana for the first time.  

Drops That Change Their Mind: Spontaneous Reversal from Spreading to Retraction

A liquid drop may spread faster on surfaces when surfactants are added. Here we show that after some time the spreading in such systems can, under certain conditions, spontaneously reverse to retraction and the droplet pulls itself back, receding from areas it has just recently wetted, elevating its center of mass in a jerklike motion. The duration from drop placement to the onset of retraction ranges from hours to less than a second primarily as a function of surfactant concentration. When the retraction is asymmetric, it results in drop motion, and when it is symmetric, the mass of the drop collects itself on its spot. This phenomenon, which was predicted theoretically in 2014, is apparently a general one for drops with surfactants; however, other factors, such as evaporation and contamination, prevented its observance so far.

Iron catalysis of lipid peroxidation in ferroptosis: Regulated enzymatic or random free radical reaction?

Duality of iron as an essential cofactor of many enzymatic metabolic processes and as a catalyst of poorly controlled redox-cycling reactions defines its possible biological beneficial and hazardous role in the body. In this review, we discuss these two "faces" of iron in a newly conceptualized program of regulated cell death, ferroptosis. Ferroptosis is a genetically programmed iron-dependent form of regulated cell death driven by enhanced lipid peroxidation and insufficient capacity of thiol-dependent mechanisms (glutathione peroxidase 4, GPX4) to eliminate hydroperoxy-lipids. We present arguments favoring the enzymatic mechanisms of ferroptotically engaged non-heme iron of 15-lipoxygenases (15-LOX) in complexes with phosphatidylethanolamine binding protein 1 (PEBP1) as a catalyst of highly selective and specific oxidation reactions of arachidonoyl- (AA) and adrenoyl-phosphatidylethanolamines (PE). We discuss possible role of iron chaperons as control mechanisms for guided iron delivery directly to their "protein clients" thus limiting non-enzymatic redox-cycling reactions. We also consider opportunities of loosely-bound iron to contribute to the production of pro-ferroptotic lipid oxidation products. Finally, we propose a two-stage iron-dependent mechanism for iron in ferroptosis by combining its catalytic role in the 15-LOX-driven production of 15-hydroperoxy-AA-PE (HOO-AA-PE) as well as possible involvement of loosely-bound iron in oxidative cleavage of HOO-AA-PE to oxidatively truncated electrophiles capable of attacking nucleophilic targets in yet to be identified proteins leading to cell demise.

Alternative hypotheses related to Alzheimer's disease

Alzheimer's disease represents the most common form of dementia and belongs to the group of neurodegenerative disorders characterized by progressive loss of neurons in the central nervous system. In the pathogenesis of Alzheimer's disease several etiologic and pathogenic factors exist, which lead to the dysfunction of neurotransmitter systems and consequent cognitive decline. Last three decades have delivered a crucial progress leading to better understanding of Alzheimer's disease, however, the exact mechanisms of pathology remain unclear. In this review, we summarize some hypotheses such as amyloid and tau hypotheses, inflammatory processes, prion-like hypothesis, the hypothesis of oxidative stress, vascular and cholesterol hypothesis, the hypothesis of metal accumulation in the brain, cell cycle hypothesis, the hypothesis of impaired insulin signalization and another, which were proposed to explain the pathogenesis of this severe disorder (Ref. 115).

Miscellanea Dependent generalized functional linear models

This paper considers testing for no effect of functional covariates on response variables in multivariate regression. We use generalized estimating equations to determine the underlying parameters and establish their joint asymptotic normality. This is then used to test the significance of the effect of predictors on the vector of response variables. Simulations demonstrate the importance of considering existing correlation structures in the data. To explore the effect of treating genetic data as a function, we perform a simulation study using gene sequencing data and find that the performance of our test is comparable to that of another popular method used in sequencing studies. We present simulations to explore the behaviour of our test under varying sample size, cluster size and dimension of the parameter to be estimated, and an application where we are able to confirm known associations between nicotine dependence and neuronal nicotinic acetylcholine receptor subunit genes.

GeneXpert HIV-1 quant assay, a new tool for scale up of viral load monitoring in the success of ART programme in India

BACKGROUND

Recent WHO guidelines identify virologic monitoring for diagnosing and confirming ART failure. In view of this, validation and scale up of point of care viral load technologies is essential in resource limited settings.

METHODS

A systematic validation of the GeneXpert® HIV-1 Quant assay (a point-of-care technology) in view of scaling up HIV-1 viral load in India to monitor the success of national ART programme was carried out. Two hundred nineteen plasma specimens falling in nine viral load ranges (<40 to >5 L copies/ml) were tested by the Abbott m2000rt Real Time and GeneXpert HIV-1 Quant assays. Additionally, 20 seronegative; 16 stored specimens and 10 spiked controls were also tested. Statistical analysis was done using Stata/IC and sensitivity, specificity, PPV, NPV and %misclassification rates were calculated as per DHSs/AISs, WHO, NACO cut-offs for virological failure.

RESULTS

The GeneXpert assay compared well with the Abbott assay with a higher sensitivity (97%), specificity (97-100%) and concordance (91.32%). The correlation between two assays (r = 0.886) was statistically significant (p < 0.01), the linear regression showed a moderate fit (R² = 0.784) and differences were within limits of agreement. Reproducibility showed an average variation of 4.15 and 3.52% while Lower limit of detection (LLD) and Upper limit of detection (ULD) were 42 and 1,740,000 copies/ml respectively. The misclassification rates for three viral load cut offs were not statistically different (p = 0.736). All seronegative samples were negative and viral loads of the stored samples showed a good fit (R² = 0.896 to 0.982).

CONCLUSION

The viral load results of GeneXpert HIV-1 Quant assay compared well with Abbott HIV-1 m2000 Real Time PCR; suggesting its use as a Point of care assay for viral load estimation in resource limited settings. Its ease of performance and rapidity will aid in timely diagnosis of ART failures, integrated HIV-TB management and will facilitate the UNAIDS 90-90-90 target.

Next generation tau models in Alzheimer's disease research - virus based gene delivery systems

Alzheimer's disease (AD) the most common form of dementia is characterized by cognitive decline and progressive loss of neurons in the central nervous system. Despite huge scientific progress, there are only few animal models that recapitulate at least majority of the AD pathology and related symptomatology. Therefore, alternative methods to develop animal models for neurodegenerative diseases are constantly explored. Recently, recombinant adeno-associated viruses (AAVs) are widely used viral vectors in development of novel models for neurodegenerative diseases. AAV vectors expressing full length, mutant or truncated forms of tau demonstrate early and robust pathology characterized by AT8 positivity, NFT formation, motor and cognitive deficits. Furthermore, AAVs have been used in expression of tau in amyloid rodent models thus developing both lesions of amyloid and tau therefore recapitulating AD like features. Major advantage of AAV as a delivery system is the site specific expression of tau, mostly in hippocampus and cortex, and thus elimination of unwanted ectopic transgene expression. These novel models may help in better understanding of AD etiopathogenesis and provide a platform for development and testing of disease modifying drugs in preclinical efficacy studies.

Evaluation of 4-thiazolidinone derivatives as potential reverse transcriptase inhibitors against HIV-1 drug resistant strains

Rapid emergence of drug resistance is crucial in management of HIV infection limiting implementation of efficacious drugs in the ART regimen. Designing new molecules against HIV drug resistant strains is utmost essential. Based on the anti-HIV-1 activity, we selected four 4-thiazolidinone derivatives (S009-1908, S009-1909, S009-1911, S009-1912) and studied their interaction with reverse transcriptase (RT) from a panel of 10 clinical isolates (8 nevirapine resistant and two susceptible) using in silico methods, and inhibition pattern using in vitro cell based assays. On the basis of binding affinity observed in in silico analysis, 2-(2-chloro-6-nitrophenyl)-3-(4, 6-dimethylpyridin-2-yl) thiazolidin-4-one (S009-1912) was identified as the lead molecule followed by S009-1908, S009-1909 and S009-1911. The in vitro activity against the same panel was assessed using TZM-bl assay (IC50: 0.4-11.44µg/ml, TI: 4-126) and subsequently in PBMC assay against a nevirapine resistant clinical isolate (IC50: 0.8-6.65µg/ml, TI: 8.31-11.43) and standard strain from NIH ARRRP (IC50: 0.95-3.6µg/ml, TI: 9-26). The study shows analogue with pyrimidin-2-yl amino substitution at N-3 position of thiazolidin-4-one ring (S009-1908, S009-1909, S009-1911) exhibited enhanced activity as compared to pyridin-2-yl substituted derivatives (S009-1912), suggesting the use 4-thiazolidinones for developing potent inhibitors against HIV-1 drug resistant strains.

Pethia sanjaymoluri, a new species of barb (Teleostei: Cyprinidae) from the northern Western Ghats, India

Pethia sanjaymoluri, a new cyprinid, is described from the Pavana and Nira tributaries of Bhima River, Krishna drainage, Maharashtra, India. It can be distinguished from congeners by a combination of characteristics that includes an incomplete lateral line, absence of barbels, upper lip thick and fleshy, 23-25 lateral series scales, 7-12 lateral-line pored scales, 10 predorsal scales, 11-14 prepelvic scales, 17-20 pre-anal scales, 4½ scales between dorsal-fin origin and lateral line, four scales between lateral line and pelvic-fin origin, 8-15 pairs of serrae on distal half of dorsal-fin spine, 12-14 branched pectoral-fin rays, 4 + 26 total vertebrae, 4 + 5 predorsal vertebrae, 4 + 13 abdominal vertebrae, 13 caudal vertebrae and a unique colour pattern comprising a humeral spot positioned below the lateral line and encompassing the third and fourth lateral-line scales and one scale below, one caudal spot on 17th-21st lateral-line scales with a yellow hue on its anterior side and apical half of dorsal fin studded with melanophores making the fin tip appear black. Genetic analysis based on the mitochondrial cytochrome b gene sequence suggests that the species is distinct from other known species of Pethia for which data are available.

Non-cancer mortality in workers in the meat and delicatessen departments of supermarkets (1950-2006)

We studied non-cancer mortality in 10,701 workers in the meat and delicatessen departments of supermarkets because they have increased exposure to a variety of microorganisms that infect and cause disease in food animals such as cattle, pigs, sheep, and poultry, to which subjects in the general population are also exposed, albeit to a lesser degree. These workers were also exposed to fumes from the wrapping machine. Standardized mortality ratios were estimated in the cohort as a whole and in race/sex subgroups, using the US population for comparison. Study subjects were followed up from January 1950 to December 2006. Significantly increased deaths from diabetes, ischemic heart disease, pulmonary embolism, chronic bronchitis, peritonitis, intracranial and intraspinal abscess, other bacterial diseases, and significantly decreased deaths from diffuse diseases of connective tissue, functional diseases of the heart, intracerebral hemorrhage, occlusion/stenosis of the precerebral and cerebral arteries, and various types of accidents were observed in certain race/sex subgroups or in the cohort as a whole. The observed increased risks of several infectious conditions suggest that the increased occupational exposure to microorganisms may be responsible for at least some of the observed excess deaths, while exposure to fumes may also contribute to the excess of chronic bronchitis. The findings are important not only for supermarket workers and other workers in the meat and poultry industries, but also because the general population is exposed to these microorganisms found in food animals and their products. Nested case-control studies within cohorts that include both workers in supermarkets and other sectors of the meat and poultry industries, are now needed to examine specific risks from occupational exposures while adequately controlling for confounding factors, so that the role of these infectious agents in the occurrence of these diseases in workers and in general population subjects can be adequately assessed.

Cancer mortality in the meat and delicatessen departments of supermarkets (1950-2006)

Meat cutters and meat wrappers in the meat department of supermarkets are exposed to oncogenic viruses present in raw meat from cattle, pigs, sheep, and poultry, and their products (unpasteurized milk and raw eggs). Up to the mid 1970s, meat wrappers were also exposed to carcinogens present in fumes emitted from the machine used to wrap meat. Because of this we studied cancer mortality in a cohort of 10,701 workers in the meat and delicatessen departments of supermarkets, and we report here the findings after the third follow-up. Standardized mortality ratios (SMR) were estimated in the cohort as a whole and in race/sex subgroups, using the US population for comparison. Study subjects were followed up from January 1950 to December 2006. Significantly increased SMRs of 1.3 (95% CI, 1.2-1.5), and 2.7 (95% CI, 1.2-5.3) were recorded for cancers of the lung, and tonsils/oropharynx, respectively, in the entire cohort, affecting nearly all race/sex subgroups. SMRs of 4.6 (95% CI, 1.0-13.6) for cancer of the floor of the mouth, and 2.8 (95% CI, 1.3-5.3) for cancer of the gall bladder and biliary tract were recorded only in White male meatcutters. Significantly decreased SMRs were observed for a few cancers. It is not known if the observed excess of cancers is a result of occupational exposures. However, substantial evidence points to fumes from the wrapping machine as a possible candidate for explaining the excess in female meat wrappers. Nested case-control studies that can examine risks from occupational exposures in greater detail, and adequately control for confounding factors are now needed, to permit specifically investigate the role of the oncogenic viruses, fumes and non-occupational risk factors in the occurrence of these cancers. The findings are important, not only occupationally but also because the general population may also experience these exposures, albeit to a lesser degree.

Role of vaccine manufacturers in developing countries towards global healthcare by providing quality vaccines at affordable prices

Vaccines represent one of the greatest achievements of science and medicine in the fight against infectious diseases. Vaccination is one of the most cost-effective public health tools to prevent infectious diseases. Significant progress has been made in expanding the coverage of vaccines globally, resulting in the prevention of more than two million deaths annually. In 2010, nearly 200 countries endorsed a shared vision to extend the benefits of vaccines to every person by 2020, known as the Decade of Vaccine Initiative (DoV). Vaccine manufacturers in developing countries, as represented by the Developing Countries Vaccine Manufacturers Network (DCVMN), make a significant contribution to DoV by supplying quality vaccines at affordable prices to the people who need them most. About 70% of the global Expanded Program on Immunization (EPI) vaccine supplies are met by DCVMN. Besides EPI vaccine supplies, DCVMN is also targeting vaccines against rotavirus, Japanese encephalitis, pneumonia, human papillomavirus, meningitis and neglected tropical diseases. This article reviews the roles and contributions of DCVMN in making the vaccines accessible and affordable to all.

N-aryl piperazine metabotropic glutamate receptor 5 positive allosteric modulators possess efficacy in preclinical models of NMDA hypofunction and cognitive enhancement

Impaired transmission through glutamatergic circuits has been postulated to play a role in the underlying pathophysiology of schizophrenia. Furthermore, inhibition of the N-methyl-d-aspartate (NMDA) subtype of ionotropic glutamate receptors (NMDAR) induces a syndrome that recapitulates many of the symptoms observed in patients with schizophrenia. Selective activation of metabotropic glutamate receptor subtype 5 (mGlu5) may provide a novel therapeutic approach for treatment of symptoms associated with schizophrenia through facilitation of transmission through central glutamatergic circuits. Here, we describe the characterization of two novel N-aryl piperazine mGlu5 positive allosteric modulators (PAMs): 2-(4-(2-(benzyloxy)acetyl)piperazin-1-yl)benzonitrile (VU0364289) and 1-(4-(2,4-difluorophenyl)piperazin-1-yl)-2-((4-fluorobenzyl)oxy)ethanone (DPFE). VU0364289 and DPFE induced robust leftward shifts in the glutamate concentration-response curves for Ca(2+) mobilization and extracellular signal-regulated kinases 1 and 2 phosphorylation. Both PAMs displayed micromolar affinity for the common mGlu5 allosteric binding site and high selectivity for mGlu5. VU0364289 and DPFE possessed suitable pharmacokinetic properties for dosing in vivo and produced robust dose-related effects in reversing amphetamine-induced hyperlocomotion, a preclinical model predictive of antipsychotic-like activity. In addition, DPFE enhanced acquisition of contextual fear conditioning in rats and reversed behavioral deficits in a mouse model of NMDAR hypofunction. In contrast, DPFE had no effect on reversing apomorphine-induced disruptions of prepulse inhibition of the acoustic startle reflex. These mGlu5 PAMs also increased monoamine levels in the prefrontal cortex, enhanced performance in a hippocampal-mediated memory task, and elicited changes in electroencephalogram dynamics commensurate with procognitive effects. Collectively, these data support and extend the role for the development of novel mGlu5 PAMs for the treatment of psychosis and cognitive deficits observed in individuals with schizophrenia.

Promise and pitfalls of molecular markers of thyroid nodules

Thyroid nodules are common in the general population with a prevalence of 5-7% The initial evaluation of thyroid nodules commonly involves thyroid function tests, an ultrasound (USG) and fine needle aspiration biopsy (FNAB). The optimal management of patients with thyroid nodules with indeterminate cytology is plagued by the lack of highly sensitive and specific diagnostic modalities In this article we attempt to review the available literature on the molecular markers which are increasingly being studied for their diagnostic utility in assessing thyroid nodules. The various molecular markers consist of gene mutations, gene re arrangements, RNA based assays and immunohistochemical markers. The molecular markers definitely would help to optimise the management of such patients.

Laparoscopic sleeve gastrectomy in partial situs inversus

Laparoscopic surgery in a patient with Partial Situs Inversus may pose interesting challenges to the surgeon. Here we report a case of a morbidly obese young female with partial situs inversus who underwent Laparoscopic Vertical Sleeve Gastrectomy (LSG). The peri-operative challenges very many and these have been enumerated. The mirror image approach is recommended in such cases for a successful surgery which was not employed in this case. Postoperative barium swallow was normal and the patient has been on regular follow up.

Anterior abdominal wall abscess with epididymo-orchitis: an unusual presentation of acute pancreatitis

Pancreatitis indicates inflammation of the pancreas. Clinically acute pancreatitis typically presents as upper abdominal pain mostly in epigastric region, nausea, vomiting and elevated levels of amylase and lipase. Depending upon severity of acute pancreatitis patient may presents with minimal symptoms to more severe signs of acute abdomen like generalized guarding and rigidity. Inspite of absence of disease-specific signs and symptoms for acute pancreatitis, diagnosis is usually not difficult using a combination of clinical, laboratory and radiological findings. Sometimes pancreatitis may presents atypically, which may be misleading in the management especially when typical presentation of pancreatitis as described above is absent. We have described a case of pancreatitis where patient presented with anterior abdominal wall abscess with epididymo-orchitis because of tracking of pancreatic fluid into the retroperitoneum till scrotum. Patients presentation may be different depending upon complication occurred during the course of pancreatitis. After reviewing the literature we found very few cases in which you may not get a clue to diagnose pancreatitis because of atypical presentation. In the described case, patient managed conservatively with percutaneous drainage of the abscess by pigtail catheter placement and scrotal support for epididymoorchitis. This avoided unnecessary exploration in above patient.

Genetic Conservation in gp36 Transmembrane Sequences of Indian HIV Type 2 Isolates

HIV-2 group A is predominant in different parts of the world, especially Africa, Portugal, Spain, France, the United Kingdom, the United States, Korea, and India. Among the Asian countries, India accounts for about 95% of all HIV-2 infections. The prevalence of HIV-2 has been reported from various states of India such as Maharashtra, Goa, Tamil Nadu, West Bengal, and Uttar Pradesh. In the present study, we analyzed transmembrane region (gp36) sequences of 10 HIV-2 group A Indian strains, isolated from Indian HIV-2-seropositive individuals. HIV Blast analysis for the 1.0-Kb region of the gp36 transmembrane region has shown that all these sequences belong to HIV-2 group A. Phylogenetic analysis indicated that the sequences cluster with HIV-2 group A sequences of Cameroon and Senegal. The epitope found at position 645-656 (YELQKLNSWDVF), previously reported as a broadly neutralizing determinant, was very well conserved in all 10 study sequences. The percentage similarity between Indian and South African HIV-2 group A gp36 sequences was 90% (range 86-100, SD 2.8) and with other nonsubtype A clades was 84% (range 77-100, SD 6.06) indicating overall less variability among the reported HIV-2 sequences. Similarly, the consensus amino acid sequences of the envelope transmembrane region of HIV-1 (gp41) and HIV-2 (gp36) is quite synonymous, indicating 87% similarity; however, limited information is available about the gp36 transmembrane region of the prevalent HIV 2 group A Indian strain. The rate of synonymous substitutions reported in the gp105 region was significantly higher, suggesting lower virulence of HIV-2, which does translate into a lower rate of evolution, while the dN/dS ratio for the gp36 transmembrane region was less than one, indicating its conservation and significance (p<0.05) in structural and functional constraints.

Molecular phylogenetics of nearly full-length HIV type 2 envelope gene sequences from West India

Abstract While infection with HIV-1 has become a pandemic, the presence of HIV-2 is also of concern in certain regions of the world. We have characterized the gp105 region of the envelope gene of HIV-2 isolates from Western India. Phylogenetic analysis of all 18 sequences revealed that these sequences were closely related to each other as well as to published African and European HIV-2 group A sequences, with an overall genetic divergence of 10.9% (range 2-14%). Our study sequences showed close relatedness with West African HIV-2 group A (CAM group) sequences from Guinea Bissau with 89% homology. This was further confirmed by SimPlot as well as RIP analysis. Accordingly, the sequences presented here demonstrate the predominance of HIV-2 group A infection and show no evidence of HIV-2 recombination in Western India.

Murine monoclonal anti-H as typing reagent

BACKGROUND & OBJECTIVE

The antigen H present on the surface of red cells in varying concentration, is maximum in O group red cells, but absent in Bombay phenotype individuals. This differentiation is generally detected by seed extracts of Ulex europaeus. The titre of such an extract is usually low and is subjected to batch variation. Hence, we carried out this study to raise potent murine monoclonal antibody against H antigen.

METHODS

Spleen cells of female BALB/c mice immunized with O group red cells were fused in presence of polyethylene glycol (PEG) 1500 with a mouse myeloma cell line Sp2/0 Ag14 in hypoxanthine aminopterine thymidine (HAT) selective medium and incubated at 37 degrees, 5 per cent CO(2) and 95 per cent humidity for a week.

RESULTS

The culture supernatants showing anti-H activity, were further subcloned and two clones 3E8A10 and 3E8A11 generated which showed a good potency, avidity and specificity.

INTERPRETATION & CONCLUSION

The anti-H clones thus produced indigenously provided a potent reagent in distinguishing normal O group from Bombay phenotype individuals. The unlimited availability makes this reagent cost-effective to ensure a constant supply of hybrid clones with the similar specificities.

Studies on the ABH-Iso-Agglutinins in serum, saliva and milk from mothers with "Bombay" (Oh) phenotype

Background:

ABO blood group iso-antibodies are naturally occurring antibodies found in serum and other body fluids.

Methods:

Serum, saliva and milk samples from 5 mothers identified as “Bombay” phenotype were tested for ABH-iso-antibodies by routine serological techniques.

Results:

All the five mothers showed presence of iso-antibodies in the samples tested. Higher titer values in milk than their serum were observed on subjects whose samples were collected in immediate post-partum phase as compared to those whose samples were collected after a lapse of a few months.

Conclusion:

High titer iso-agglutinins against ABH antigens were detected in milk samples besides their presence in saliva as well as serum.

Neutralizing antibody responses in recent seroconverters with HIV-1 subtype C infections in India

The longitudinal heterologous neutralization response against two HIV-1 subtype C isolates was studied in 33 ART-naive individuals recently infected with HIV-1 subtype C from India. Seven of 33 (21%) seroconverters demonstrated a consistent response against both isolates (65-100% neutralization), whereas the remaining 26 (79%) were nonresponders. Four of the seven responders demonstrated a neutralization response (>75% neutralization) within 2-3 months of infection and in the remaining three, the response was demonstrated between 22 and 38 months after infection. In the past, HIV vaccines targeted the V3 region for the development of neutralizing antibodies. However, recent studies have shown that anti-V3 antibodies are generated after HIV-1 infection, but are not effective in neutralizing virus. In this study, the V3 sequences of HIV-1 from seven responders were analyzed and compared with those from nonresponders. The V3 region sequences from early and late responders did show certain mutations that were not found in the nonresponders; however none of these mutations could explain the neutralization responses. This suggested that HIV-1 envelope regions other than the V3 domain may be involved in generating a neutralization response. This is the first report that describes the pattern of emergence and persistence of the heterologous neutralization response in recently HIV-1 subtype C-infected individuals from India and studies its association with sequence variation in the V3 region.

Prolonged behavioral stress enhances synaptic connectivity in the basolateral amygdala

Recently identified cellular and molecular correlates of stress-induced plasticity suggest a putative link between neuronal remodeling in the amygdala and the development of anxiety-like behavior. Rodent models of immobilization stress, applied for 10 consecutive days, have been reported to enhance anxiety, and also cause dendritic elongation and spine formation in the basolateral amygdala (BLA). Paradoxically, longer exposure to stress, which is also anxiogenic, fails to affect key molecular markers of neuronal remodeling in the BLA. This has raised the possibility of homeostatic mechanisms being triggered by more prolonged stress that could potentially dampen the morphological effects of stress in the BLA. Therefore, we examined the cellular and behavioral impact of increasing the duration of stress in rats. We find that prolonged immobilization stress (PIS), spanning 21 days, caused significant enhancement in dendritic arborization of spiny BLA neurons. Spine density was also enhanced along these elongated dendrites in response to PIS. Finally, this striking increase in synaptic connectivity was accompanied by enhanced anxiety-like behavior in the elevated plus-maze. Thus, we did not detect any obvious morphological correlate of adaptive changes within the BLA that may have been activated by prolonged and repeated application of the same stressor for 21 days. These findings add to accumulating evidence that structural encoding of aversive experiences, through enhanced availability of postsynaptic dendritic surface and synaptic inputs on principal neurons of the BLA, may contribute to the affective symptoms of stress disorders.

Production of murine monoclonal anti-B

BACKGROUND & OBJECTIVE

Monoclonal antibodies against red blood cell antigens used in research and as diagnostics in India are commercially procured from western countries. Indigenously generated potent clones are not available in India. Hence, the objective of the present study was to raise potent murine monoclonal antibodies against A, B and H blood group antigens indigenously and establish a stable clone of anti-B secreting cells.

METHODS

Spleen cells of female BALB/c mice immunized with B group red blood cells were fused in presence of polyethylene glycol (PEG) 1500 with a mouse myeloma cell line Sp 2/0 Ag. 14 in hypoxanthine aminopterine thymidine (HAT) selective medium and incubated at 37 degrees C, 5 per cent CO(2) and 95 per cent humidity for a week.

RESULTS

The culture supernatant of the wells showing anti-B activity, were further subcloned and a clone 2C4D5F10 was generated which showed a good potency, avidity and specificity.

INTERPRETATION & CONCLUSION

The anti-B clones thus produced indigenously provided a useful reagent in blood group typing. The unlimited availability unlike polyclonal antisera makes this reagent more cost-effective. It also ensures a regular supply with the similar specificity.

Familial hypercholesterolemia presenting as intracranial xanthoma

A 22 years female who was diagnosed as having cholestseatoma of right ear was referred to us for medical fitness. On examination she incidentally had evidence of tuberous and tendon xanthomas. She was found to have hypercholesterolemia. On mastoid exploration a yellowish groomous mass was seen which was surrounded by foamy macrophages, suggestive of 'mastoid xanthoma'. The purpose of this case presentation is to report occurrence of such rare case and importance of early detection that will warrant treatment with proper diet and medical management. This will stabilize lesions and delay complications.

Indian primary HIV-2 isolates and relationship between V3 genotype, biological phenotype and coreceptor usage

The chemokine coreceptors play a significant role in HIV entry and pathogenesis. The V3 region of HIV envelope glycoprotein is considered as a principal determinant for viral phenotype and tropism. The present study describes lack of association between the V3 genotype and viral phenotype of 18 Indian HIV-2 isolates. The viruses were isolated, confirmed by PCR and the HIV subtypes were determined by sequencing V3 region of the env gene. The coreceptor usage and syncytium inducing (SI) capacity of isolates was determined. Our study indicated that CCR5 coreceptor usage and NSI phenotype is predominant among Indian HIV-2 isolates obtained from patients in the early stage of infection. Two of the four HIV-2 isolates obtained from the late stage patients were SI and dual tropic. Phylogenetic analysis of these isolates revealed close relatedness to the isolates from western and southern India.

Insulin resistance as a contributor to myocardial ischaemia independent of obstructive coronary atheroma: a role for insulin sensitisation?

There is good evidence to suggest that insulin resistance and its surrogate markers are at least modest independent cardiovascular risk factors. However, as well as long term effects on atheromatous coronary disease, there is a well described correlation between markers of insulin resistance and endothelial dysfunction. In this review, the evidence for a relation between endothelial dysfunction and myocardial ischaemia is summarised. The evidence for a correlation between insulin resistance and endothelial dysfunction and the proposed cellular mechanisms are also examined. Finally, the potential role for insulin sensitising strategies is looked at and recent data examining their effects on both endothelial function and clinical symptoms is examined. In conclusion, it was found that insulin sensitising modalities have a potential role in the amelioration of angina and that randomised controlled studies are therefore warranted.

Full-length gag sequences of HIV type 1 subtype C recent seroconverters from Pune, India

Although HIV-1 subtype C is the most prevalent subtype worldwide, data on subtype C viruses are rather limited. Very little information is available on the complete HIV-1 subtype C gag sequences from India. We report full-length gag (p55) sequences from six Indian early seroconverters. The samples were collected within few weeks of seroconversion and may represent immunologically naive viruses. The comparison of p55 sequences with other Indian and non-Indian subtype C sequences as well as with nonsubtype C sequences obtained from the Los Alamos database revealed gag as a well-conserved region of the HIV genome (range: 84-95%). The phylogenetic tree indicated that the sequences compared here cluster together within clade C. Two epitopes in the p24 region of the gag gene were subtype C specific while many epitopes in the same region were also present in other clades. The data on HIV-1 subtype C full-length gag sequences would be useful in the design and evaluation of effective subtype C-based HIV vaccines.

Genetic analysis of Indian HIV-1 nef: subtyping, variability and implications

HIV-1 subtype C is predominant in India and globally. In the present study, we analyze HIV-1 subtype C regulatory protein Nef sequences from five recent Indian seroconverters and five long-term survivors (LTSs) for variability at crucial functional domains. Sequence analysis suggested the possibility of using regulatory gene sequences for viral subtyping and evolutionary studies apart from structural genes. In the phylogenetic tree, Indian nef sequences segregated away from other reported subtype C sequences, forming an Indian subclade within subtype C. Our studies also suggested no evidence for the association of truncated Nef with slow progression of disease, as all LTSs had intact Nef. We could identify some variations in juxtapositions to crucial functional domains, especially in seroconverter sequences, when comparing them with others. In phylogenetic analysis, specifically for the base-pair regions 411-428 and 478-525, our seroconverter sequences segregated away from those reported earlier in the literature, indicating specific evolutionary changes in these conserved regions of nef in currently circulating viruses. But the dN/dS ratio for our samples was less than one on comparing them with reported subtype C and representative sequences of different clades, strongly emphasizing the necessity of sequence conservation at different disease stages and even across clades. HLA-I binding epitope predictions for common Indian HLAs indicated that specific mutations in seroconverter Nef may alter the intensity of epitope binding, which may alter the outcome of the immune response. Hence these data would be useful in designing Nef epitopes to be included in multi-epitope HIV-1 vaccine for the Indian population and would also be of immense help in HIV-1 evolutionary studies.

A bicarbonate anion-dependent anti-'N' MoAb

While studying the serologic characteristics of certain monoclonal blood group antibodies, we observed a hybridoma clone (5A-11E10) with anti-N-like serologic specificity that was dependent on the presence of the bicarbonate anion. The diluted cell culture supernatant preferentially agglutinated M-N+ RBCs by immediate spin. This supernatant also agglutinated M-N+ RBCs that had been treated with trypsin or sialidase (to remove N-reactivity), suggesting anti-'N' activity. Anti-'N' specificity was confirmed by the supernatant's non-reactivity with N+ RBCs treated with papain (to remove 'N' reactivity) or with ('N'-negative) M+N-U- RBCs. The requirement for bicarbonate in the MoAb's formulation was not a function of pH. Both sodium and ammonium bicarbonate supported agglutination, but neither sulfate nor carbonate was effective.