Prototyping a wearable and stretchable graphene-on-PDMS sensor for strain detection on human body physiological and joint movements

In the era of wearable electronic devices, which are quite popular nowadays, our research is focused on flexible as well as stretchable strain sensors, which are gaining humongous popularity because of recent advances in nanocomposites and their microstructures. Sensors that are stretchable and flexible based on graphene can be a prospective 'gateway' over the considerable biomedical speciality. The scientific community still faces a great problem in developing versatile and user-friendly graphene-based wearable strain sensors that satisfy the prerequisites of susceptible, ample range of sensing, and recoverable structural deformations. In this paper, we report the fabrication, development, detailed experimental analysis and electronic interfacing of a robust but simple PDMS/graphene/PDMS (PGP) multilayer strain sensor by drop casting conductive graphene ink as the sensing material onto a PDMS substrate. Electrochemical exfoliation of graphite leads to the production of abundant, fast and economical graphene. The PGP sensor selective to strain has a broad strain range of ⁓60%, with a maximum gauge factor of 850, detection of human physiological motion and personalized health monitoring, and the versatility to detect stretching with great sensitivity, recovery and repeatability. Additionally, recoverable structural deformation is demonstrated by the PGP strain sensors, and the sensor response is quite rapid for various ranges of frequency disturbances. The structural designation of graphene's overlap and crack structure is responsible for the resistance variations that give rise to the remarkable strain detection properties of this sensor. The comprehensive detection of resistance change resulting from different human body joints and physiological movements demonstrates that the PGP strain sensor is an effective choice for advanced biomedical and therapeutic electronic device utility.

Clinical Diagnosis and Therapeutic Management of Trypanosoma theileri Infection Associated with Peritonitis in Crossbred Cow: A Rare Case Report

PURPOSE

The present study reports a very rare case of Trypanosoma theileri like infection in the peritoneal fluid of a 6-year-old female Holstein Friesian (HF) cattle brought to Veterinary Clinical Complex, Lala Lajpat Rai University of Veterinary and Animal Sciences (LUVAS), Hisar. The aim of the clinical study was to report an unusual case of T. theileri-like infection associated with peritonitis and its therapeutic management.

METHODS

For confirmatory diagnosis, peritoneal fluid and blood sample was collected from animal for haemato-biochemical examination, buffy coat examination and detection of Trypanosoma antigen by monoclonal antibody-based latex agglutination test.

RESULTS

Animal had history of anorexia, high fever, oedematous swelling on the abdominal area and decrease in milk yield since 1 week. Clinical examination revealed high fever, congested conjunctival mucus membrane and oedematous inflammatory swelling on the abdominal region. Haematological examination on Day 1 revealed relative neutrophilia and eosinophilia, whereas other parameters measured were on the lower side of normal range. Thin blood smear examination did not reveal any parasite on first attempt. However, after confirmation of Trypanosoma species in peritoneal fluid collected by FNAC, buffy coat examination of blood sample was also found positive for Trypanosoma species. On Day 2, haematological examination revealed neutrophilic leucocytosis, eosinophilia and anaemia. Blood sample was also found serologically positive for Trypanosoma antigen by monoclonal antibody based latex agglutination test. Biochemical examination revealed increased blood urea nitrogen (BUN), gamma glutamyl transferase (GGT) levels, hyperglycemia, hyperprotienemia and decreased levels of sodium and chloride ions. Animal was primarily treated with isometamidium chloride (Nyzom^®) @ 0.5 mg/kg body weight (IM, single dose) along with supportive therapy.

CONCLUSION

Animal showed clinical recovery after 10 days of treatment. Post-recovery, blood sample of the animal was re-examined for parasite and other blood parameters and it was found negative for presence of Trypanosoma infection along with restoration of haematological values. Hence, the present study concludes the confirmatory diagnosis and therapeutic use of isometamidium hydrochloride along with anti-inflammatory drugs to Trypanosoma infection.

Bone stress injuries in the presence of tarsal coalition as a cause of hindfoot pain in adolescents: case series of 6 patients with literature review

OBJECTIVE

To highlight causal relationship between stress fracture in the presence of tarsal coalition and hindfoot pain in adolescents on magnetic resonance imaging (MRI).

MATERIAL AND METHODS

A retrospective review was performed of the clinical and MRI imaging findings of 6 adolescents referred for MRI to evaluate symptoms of hindfoot pain with possible tarsal coalition. MRI studies were systematically assessed for cause of hindfoot pain, types of tarsal coalition, patterns of stress fractures, bone marrow oedema and any other associated features.

RESULTS

All the 6 patients (4 male: 2 female) aged between 12 and 19 years developed insidious onset of hindfoot or midfoot pain over a period of weeks to months. On MRI, all 6 cases had features of fibrous tarsal coalition predominantly in the calcaneonavicular articulation (5 out of 6 patients). Associated stress fractures/response were in the posterior facet/body of the calcaneus (3), talar head (2), cuboid (1) and third metatarsal bone in one patient.

CONCLUSION

Stress fractures/response adjacent to tarsal coalition could be because of altered biomechanics and can be an unusual cause of hindfoot pain in adolescents. A high index of suspicion and complementary MRI findings is crucial to interpret this condition to direct appropriate patient management.

Development of tBu-phenyl Acetamide Appended Thiacalix[4]arene as "Turn-ON" Fluorescent Probe for Selective Recognition of Hg(II) Ions

Herein, a novel N-(4-(tert-butyl)-phenyl)-2-chloroacetamide functionalized thiacalix[4]arene architecture, viz TCAN2PA has been synthesized and the sensing behaviour towards metal ions were explored. The probe, TCAN2PA displayed "turn-on" fluorescence response towards Hg(II) ions in acetonitrile over a series of competing common metal ions. A bathochromic shift in absorption band along with a significant "Turn-On" fluorescence behaviour of TCAN2PA was observed upon interaction with Hg(II) ions. The lower rim modification of thiacalixarene with N-(4-(tert-butyl)-phenyl)-2-chloroacetamide actively contributes toward the fluorescence property due to the presence of strong electron-donating aryl amido substituent. Fluorescence titration experiments were conducted to find out the limit of detection and to understand binding stoichiometry as well. The electron transfer interactions between the electron rich TCAN2PA host with Hg(II) ions have been postulated which is also supported by computational modelling insights.

Cadmium Sulfide (CdS) Thin Films with Improved Morphology for Humidity Sensing by Chemical Bath Deposition at Lower pH

Cadmium sulfide (CdS), an II-VI group semiconductor material, is one of the most investigated semiconductors in thin film form. In this work, we synthesized CdS thin films with improved film morphology in the presence of ethylene diamine (EA) as the complexing agent by chemical bath deposition (CD) at lower pH. Detailed characterization reveals the presence of cubic phase CdS with a band gap of 2.39 eV with the resultant morphology significantly influenced by the composition of the growth solution. The resultant CdS films finds prospective application as a humidity sensor with a high sensor response of 2.61 corresponding to 80% relative humidity.

Comparison of Virosome vs. Liposome as drug delivery vehicle using HepG2 and CaCo2 cell lines

AIM

The present work involves encapsulation of herbal drug nanocurcumin into the virosomes and compared with a liposome in terms of their in vitro anti-proliferative, anti-inflammatory, and anti-migratory efficacy.

METHODS

The anti-proliferative, anti-inflammatory, and anti-migratory efficacy of virosome and liposome were compared in HepG2 and CaCo2 cells by using MTT, Nitric oxide scavenging, and Wound healing assay, respectively.

RESULTS

Size of the optimised NC-Virosome and NC-Liposome was 70.06 ± 1.63 and 265.80 ± 1.64 nm, respectively. The prepared NC-Virosome can be stored at -4 °C up to six months. The drug encapsulation efficiency of NC-Virosome and NC-Liposome was found to be 84.66 ± 1.67 and 62.15 ± 1.75% (w/w). The evaluated minimum inhibitory concentration (IC50 value) for NC-Virosome was 102.7 μg/ml and 108.1 μg/ml, while NC-Liposome showed 129.2 μg/ml and 160.1 μg/ml for HepG2 and CaCo2 cells, respectively. Morphological examination depicts detachment of the cells from substratum after exposure to NC-Virosome for 48 h.

CONCLUSION

The prepared NC-Virosome provides remarkable in vitro efficacy in both the cell lines with site-specific drug-targeting potential as compared to the liposome, results proved its potential as a drug delivery vehicle for future therapy with reduced toxicity.

Impact of COVID-19 on Clinical Practices during Lockdown: A pan India Survey of Orthopaedic Surgeons

Introduction:

The social lockdown measures imposed to contain the COVID-19 pandemic, have had profound effects on the healthcare systems across the world and India has been no exception to it. The study was aimed to evaluate the impact of COVID-19 on orthopaedic practice in India during the lockdown period and assess the preparedness of orthopaedic surgeons for resuming clinical practice after the initial lockdown was lifted.

Materials and Methods:

An online survey of 35 questions was conducted to evaluate impact on (i) general orthopaedic practice (ii) hospital protocols (iii) out-patient practice (iv) surgical practice (v) personal protective equipment (PPE) use and (vi) post-lockdown preparedness.

Results:

A total number of 588 practising orthopaedic surgeons from India completed the survey. Majority (88.3%) found severe impact (>50%) on trauma surgery and non-trauma surgery with significant reduction in out -patient attendance compared to corresponding time in 2019. There were significant changes made in individual hospital protocols (91.7 %). Appropriate required PPE was available in majority of the hospitals (74.3%). No remodelling or upgrading of the existing operating theatre infrastructure was done by most surgeons (89.5%).

Conclusion:

This pan India survey of orthopaedic surgeons has indicated that COVID-19 has had a profound impact on their outpatient and surgical trauma and non-trauma practice, due to the lockdown and resulted in significant changes to hospital protocols. Preparedness to resume clinical and surgical practice was associated with anxiety in two-thirds of the respondents. Majority of the orthopaedic practitioners felt that they would continue to conduct pre-operative COVID-19 screening and use PPE even after the lockdown is over.

Preparation and characterization of nanocurcumin based hybrid virosomes as a drug delivery vehicle with enhanced anticancerous activity and reduced toxicity

The present study represents a formulation of nanocurcumin based hybrid virosomes (NC-virosome) to deliver drugs at targeted sites. Curcumin is a bioactive component derived from Curcuma longa and well-known for its medicinal property, but it exhibits poor solubility and rapid metabolism, which led to low bioavailability and hence limits its applications. Nanocurcumin was prepared to increase the aqueous solubility and to overcome all the limitations associated with curcumin. Influenza virosomes were prepared by solubilization of the viral membrane with 1,2-distearoyl-sn-glycerol-3-phosphocholine (DSPC). During membrane reconstitution, the hydrophilic nanocurcumin was added to the solvent system, followed by overnight dialysis to obtain NC-virosomes. The same was characterized using a transmission electron microscope (TEM) and scanning electron microscope (SEM), MTT assay was used to evaluate it's in vitro-cytotoxicity using MDA-MB231 and Mesenchyme stem cells (MSCs). The results showed NC-virosomes has spherical morphology with size ranging between 60 and 90 nm. It showed 82.6% drug encapsulation efficiency. The viability of MDA-MB231 cells was significantly inhibited by NC-virosome in a concentration-dependent manner at a specific time. The IC50 for nanocurcumin and NC-virosome was 79.49 and 54.23 µg/ml, respectively. The site-specific drug-targeting, high efficacy and non- toxicity of NC-virosomes proves its future potential as drug delivery vehicles.

Microporous polymer membrane assisted water induced electricity generation based on triboelectrification and electrostatic induction

Water in its various forms has been found to be one of the most abundant sources of energy on the planet after solar energy, and hydroelectric power plays a key role in renewable-energy supplies. Traditionally, harvesting tremendous amounts of hydrodynamic energy requires the deployment of complex, bulky, and expensive electromagnetic generators, which become inefficient at lower volumes of flowing or falling water, and then the energy is stored when there is an excess, but these techniques remain largely unperfected. Regardless of the diversity of development strategies, adopted methodologies, and working mechanisms, there are a wide range of energy scavengers, to effectively harness environmental friendly alternative energy sources. Robust, sustainable and technologically effective water energy harvesting devices, especially hydroelectric nanogenerators, are in the research spotlight globally, due to their numerous benefits to society, including cost effectiveness, clean and continuous electricity generation, and environmental applicability. Here the design and working mechanism involved in the development of a microporous polymer membrane assisted unique hydroelectric generator (MPA-HEG) based on triboelectrification and electrostatic induction phenomena is reported, which scavenges energy from continuously dripping water droplets sliding onto the surface of a hydrophobic microporous polymer membrane. MPA-HEG utilizes a very simple architecture that consists of a hydrophobic microporous polymer, poly(tetrafluoroethylene) (PTFE), membrane on a single-sided copper-clad laminate as a substrate and an aluminium electrode. Unlike other reported water energy harvesting devices with similar functionalities, the rational design of MPA-HEG does not necessitate any technologically complex structures to be embedded in the substrate. It has also been revealed that the interaction of water droplets on the smooth, water-resistant solid polymer surface in MPA-HEG switches ‘ON’ and connects the originally disconnected equivalent electrical components at the solid–liquid–solid interfaces, giving an uninterrupted electrical circuit, and transmuting the conservative interfacial effects into a bulk mechanism. Consequently, the instantaneous power output shows a vast increase over equivalent devices that are constrained either to triboelectric interfacial effects or moisture-induced electricity generation. This could serve the purpose of validating the inherent advantages of developing self-powered electronic devices, and this approach can also be effectively exploited for boosted power generation with realistic future applications.

Water in its various forms has been found to be one of the most abundant sources of energy on the planet after solar energy, and hydroelectric power plays a key role in renewable-energy supplies.

Clinical practice guidelines 2019: Indian consensus-based recommendations on influenza vaccination in adults

Influenza, a common cause of acute respiratory infections, is an important health problem worldwide, including in India. Influenza is associated with several complications; people with comorbidities and the elderly are at a higher risk for such complications. Moreover, the influenza virus constantly changes genetically, thereby worsening therapeutic outcomes. Vaccination is an effective measure for the prevention of influenza. Despite the availability of global guidelines on influenza vaccination in adults, country-specific guidelines based on regional variation in disease burden are required for better disease management in India. With this aim, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The discussion was aimed at delineating evidence-based recommendations on adult influenza vaccination in India. The present article discusses expert recommendations on clinical practice guidelines to be followed in India for adult influenza vaccination, for better management of the disease burden.

Clinical practice guidelines 2019: Indian consensus-based recommendations on pneumococcal vaccination for adults

Similar to the global scenario, pneumococcal diseases are a significant health concern in India. Pneumococcal diseases occur frequently among adults and are largely preventable through vaccines. Globally, several guidelines and recommendations are available for pneumococcal vaccination in adults. However, owing to wide variations in the disease burden, regulatory landscape, and health-care system in India, such global guidelines cannot be unconditionally implemented throughout the country. To address these gaps, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The aim of the discussion was to lay down specific evidence-based recommendations on adult pneumococcal vaccination for the country, with a view to further ameliorate the disease burden in the country. This article presents an overview of the closed-door discussion by the expert members on clinical practice guidelines to be followed for adult pneumococcal vaccination in India.

Oral administration of 3,3'-diselenodipropionic acid prevents thoracic radiation induced pneumonitis in mice by suppressing NF-kB/IL-17/G-CSF/neutrophil axis

The incidence of symptomatic radiation induced lung pneumonitis (RILP), a major dose limiting side effect of thoracic radiotherapy, is in the range of 15-40%. Therapeutic options for the prevention and treatment of RILP are limited. Hence there is a need for developing novel radioprotectors to prevent RILP which can be patient compliant. This study sought to evaluate the efficacy of oral 3,3'-diselenodipropionic acid (DSePA), a novel selenocystine derivative to prevent RILP. C3H/HeJ (pneumonitis responding) mice received a single dose of 18 Gy, whole thorax irradiation and a subset were treated with DSePA orally (2.5 mg/kg), three times per week beginning 2 h post irradiation and continued till 6 months. DSePA delayed onset of grade ≥ 2 RILP by 45 days compared to radiation control (~105 versus ~60 days). It also reversed the severity of pneumonitis in 3/10 radiation treated mice leading to significant improvement in asymptomatic survival compared to radiation control (~180 versus ~102 days). DSePA significantly (p < 0.05) reduced the radiation-mediated infiltration of polymorphonuclear neutrophils (PMN) and elevation in levels of cytokines such as IL1-β, ICAM-1, E-selectin, IL-17 and TGF-β in the bronchoalveolar lavage fluid. Moreover DSePA lowered PMN-induced oxidants, maintained glutathione peroxidase activity and suppressed NF-kB/IL-17/G-CSF/neutrophil axis in the lung of irradiated mice. Additionally, this compound did not protect A549 (lung cancer) derived xenograft tumor from radiation exposure in SCID mice. DSePA offers protection to normal lung against RILP without affecting radiation sensitivity of tumors. It has the potential to be developed as an oral agent for preventing RILP.

Anamnestic Immune Response and Safety of an Inactivated Quadrivalent Influenza Vaccine in Primed Versus Vaccine-Naïve Children

BACKGROUND

It has not yet been demonstrated whether 2 doses of inactivated quadrivalent influenza vaccine (IIV4) prime a booster response in infants. We evaluated the anamnestic immune response to an IIV4 in children 17-48 months of age.

METHODS

Children were randomized to 2 doses of IIV4 or control in the primary phase III study (NCT01439360). One year later, in an open-label revaccination extension study (NCT01702454), a subset of children who received IIV4 in the primary study (primed group) received 1 IIV4 dose and children who received control in the primary study (unprimed) received 2 IIV4 doses 28 days apart. The primary objective was to evaluate hemagglutination inhibition (HI) antibody titers 7 days after first IIV4 vaccination in the per-protocol cohort (N = 224 primed; N = 209 unprimed). Neutralizing and antineuraminidase antibodies were also measured. Safety was analyzed in the total vaccinated cohort (N = 241 primed; N = 229 unprimed).

RESULTS

An anamnestic response was observed in primed children relative to unprimed controls, measured by age-adjusted geometric mean HI titer ratios against strains homologous (A/H1N1: 9.0; B/Victoria: 3.9) and heterologous (A/H3N2: 2.7; B/Yamagata: 6.7) to those in the primary vaccination series. The anamnestic response in primed children included increases in neutralizing antibodies (mean geometric increase: 5.0-10.6) and antineuraminidase antibodies (4.9-8.8). No serious adverse events related to vaccination were reported.

CONCLUSIONS

In this study, 2-dose priming with IIV4 induced immune memory that was recalled with 1-dose IIV4 the following year to boost HI, antineuraminidase and neutralizing antibodies, even though the IIV4 strain composition partially changed.

Assessment of an optimized manufacturing process for inactivated quadrivalent influenza vaccine: a phase III, randomized, double-blind, safety and immunogenicity study in children and adults

BACKGROUND

GSK has modified the licensed monovalent bulk manufacturing process for its split-virion inactivated quadrivalent influenza vaccine (IIV4) to harmonize the process among different strains, resulting in an increased number of finished vaccine doses, while compensating for the change from inactivated trivalent influenza vaccine (IIV3) to IIV4. To confirm the manufacturing changes do not alter the profile of the vaccine, a clinical trial was conducted to compare IIV4 made by the currently licensed process with a vaccine made by the new (investigational) process (IIV4-I). The main objectives were to compare the reactogenicity and safety of IIV4-I versus IIV4 in all age groups, and to demonstrate the non-inferiority of the hemagglutination-inhibition (HI) antibody responses based on the geometric mean titer ratio of IIV4-I versus IIV4 in children.

METHODS

The Phase III, randomized, double-blind, multinational study included three cohorts: adults (18-49 years; N = 120), children (3-17 years; N = 821), and infants (6-35 months; N = 940). Eligible subjects in each cohort were randomized 1:1 to receive IIV4-I or IIV4. Both vaccines contained 15 μg of hemagglutinin antigen for each of the four seasonal virus strains. Adults and vaccine-primed children received one dose of vaccine, and vaccine-unprimed children received two doses of vaccine 28 days apart. All children aged ≥9 years were considered to be vaccine-primed and received one dose of vaccine.

RESULTS

The primary immunogenicity objective of the study was met in demonstrating immunogenic non-inferiority of IIV4-I versus IIV4 in children. The IIV4-I was immunogenic against all four vaccine strains in each age cohort. The reactogenicity and safety profile of IIV4-I was similar to IIV4 in each age cohort, and there was no increase in the relative risk of fever (≥38 °C) with IIV4-I versus IIV4 within the 7-day post-vaccination period in infants (1.06; 95% Confidence Interval: 0.75, 1.50; p = 0.786).

CONCLUSIONS

The study demonstrated that in adults, children, and infants, the IIV4-I made using an investigational manufacturing process was immunogenic with a reactogenicity and safety profile that was similar to licensed IIV4. These results support that the investigational process used to manufacture IIV4-I is suitable to replace the current licensed process.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02207413 ; trial registration date: August 4, 2014.

Prevention of vaccine-matched and mismatched influenza in children aged 6-35 months: a multinational randomised trial across five influenza seasons

BACKGROUND

Despite the importance of vaccinating children younger than 5 years, few studies evaluating vaccine prevention of influenza have been reported in this age group. We evaluated efficacy of an inactivated quadrivalent influenza vaccine (IIV4) in children aged 6-35 months.

METHODS

In this phase 3, observer-blinded, multinational trial, healthy children from 13 countries in Europe, Central America, and Asia were recruited in five independent cohorts, each in a different influenza season. Participants were randomly assigned (1:1) to either IIV4 (15 μg haemagglutinin antigen per strain per 0·5 mL dose; a single dose on day 0 for vaccine-primed children, and two doses, on days 0 and 28, for vaccine-unprimed children) or to one or two doses of a non-influenza control vaccine. Primary endpoints were moderate-to-severe influenza or all influenza (irrespective of disease severity) confirmed by RT-PCR on nasal swabs. Cultured isolates were further characterised as antigenically matched or mismatched to vaccine strains. Efficacy was assessed in the per-protocol cohort and total vaccinated cohort (time-to-event analysis), and safety was assessed in the total vaccinated cohort.

FINDINGS

Between Oct 1, 2011, and Dec 31, 2014, 12 018 children were recruited into the total vaccinated cohort (6006 children in the IIV4 group and 6012 children in the control group). 356 (6%) children in the IIV4 group and 693 (12%) children in the control group had at least one case of RT-PCR-confirmed influenza. Of these 1049 influenza strains, 138 (13%) were A/H1N1, 529 (50%) were A/H3N2, 69 (7%) were B/Victoria, and 316 (30%) were B/Yamagata. Overall, 539 (64%) of 848 antigenically characterised isolates were vaccine-mismatched (16 [15%] of 105 for A/H1N1; 368 [97%] of 378 for A/H3N2; 54 [86%] of 63 for B/Victoria; 101 [33%] of 302 for B/Yamagata). Vaccine efficacy was 63% (97·5% CI 52-72) against moderate-to-severe influenza and 50% (42-57) against all influenza in the per-protocol cohort, and 64% (53-73) against moderate-to-severe influenza and 50% (42-57) against all influenza in the total vaccinated cohort. There were no clinically meaningful safety differences between IIV4 and control.

INTERPRETATION

IIV4 prevented influenza A and B in children aged 6-35 months despite high levels of vaccine mismatch. Vaccine efficacy was highest against moderate-to-severe disease, which is the most clinically important endpoint associated with greatest burden.

FUNDING

GlaxoSmithKline Biologicals SA.

Nevus comedonicus on scalp: An unusual presentation

Nevus comedonicus (NC) is a rare developmental anomaly of follicular infundibulum plugged with keratinous material that resembles comedo-like lesions. Frequently affected sites are face, neck, trunk, and upper arm. Few cases have been described on palms, soles, scalp, and genitalia. We hereby report a rare case of NC on scalp in a 14-year-old boy.

Immunogenicity and safety of an inactivated quadrivalent influenza vaccine co-administered with a 23-valent pneumococcal polysaccharide vaccine versus separate administration, in adults ≥50years of age: Results from a phase III, randomized, non-inferiority trial

INTRODUCTION

We compared co-administration versus separate administration of an inactivated quadrivalent influenza vaccine (IIV4) with a 23-valent pneumococcal polysaccharide vaccine (PPV23) in adults at high risk of complications of influenza and pneumococcal infection.

METHODS

This phase III, placebo-controlled, observer-blind trial (NCT02218697) was conducted in France and Belgium during the 2014-2015 influenza season. Adults≥50years of age meeting their country's vaccination recommendations were randomized 1:1 to co-administration or separate administration. Immunogenicity was assessed by hemagglutination inhibition (HI) titers for IIV4 and 22F-inhibition ELISA for PPV23. Co-primary objectives were to demonstrate non-inferiority of co-administration versus separate administration in terms of geometric mean titer (GMT) ratio for each influenza strain in the IIV4 and geometric mean concentration (GMC) ratio for six pneumococcal serotypes (1, 3, 4, 7F, 14, 19A) in the PPV23 in the per-protocol cohort (N=334).

RESULTS

The study met its co-primary objectives, with the upper limit of the 95% confidence interval of the GMT and GMC ratios (separate administration over co-administration) being ≤2.0 for all four antigens of the IIV4 and the six pre-selected serotypes of the PPV23, respectively. Immunogenicity of the IIV4 and PPV23 was similar regardless of administration schedule. In a post hoc analysis pooling participants ≥60years of age from the co-administration and separate administration groups, IIV4 immunogenicity was similar in higher risk adults with comorbidities (diabetes; respiratory, heart, kidney, liver, or neurological diseases; morbid obesity) versus those without. Both vaccines had an acceptable safety and reactogenicity profile; pain was the most common symptom, occurring more often with co-administration than separate administration.

CONCLUSION

The IIV4 and PPV23 can be co-administered without reducing antibody responses reflecting protection against influenza or pneumococcal disease. Co-administration of PPV23 at the annual influenza vaccination visit may improve uptake. Comorbidities had no impact on IIV4 immunogenicity, supporting its value in older adults with chronic medical conditions. Clinical Trial Registry Number: NCT02218697.

Clinical Efficacy and Safety on Combining 20% Trichloroacetic Acid Peel with Topical 5% Ascorbic Acid for Melasma

Introduction

Trichloroacetic Acid (TCA) is a versatile peeling agent for treatment of melasma. However, Post-Inflammatory Hyperpigmentation (PIH) is reported to be the most common side-effect associated with TCA peel. Topical Ascorbic Acid (AA) due to its effect as antioxidant and tyrosinase inhibitor helps to prevent PIH and maintains the response.

Aim

To assess the clinical efficacy, safety and reduction in Melasma Quality of Life (MELASQOL) on combining 20% TCA peel with 5% ascorbic acid cream in epidermal melasma.

Materials and Methods

This study was conducted in the Department of Dermatology, Pt. Bhagwat Dayal Sharma University of Health Sciences, Rohtak. This was an open labelled prospective randomized study in which 60 patients of epidermal melasma were enrolled for 12 weeks. Patients were divided into two groups: Combination group received 20% TCA peel every two weeks with once daily 5% ascorbic acid cream and Control group received only 20% TCA peel. Melasma Area Severity Index (MASI) was used for evaluating clinical improvement of melasma. Improvement in Quality Of Life (QoL) was assessed by MELASQOL scale in both groups. Adverse effects were evaluated at each visit. All statistical analysis was carried out with SPSS 20^th version. The difference in change in mean MASI scoring and MELASQOL scores between the two groups were analysed using Mann-Whitney test. The side effects between the two groups were compared using Chi-square test.

Results

The combination group demonstrated a statistically significant improvement in MASI, percentage decrease in MASI and quality of life as compared to control group after treatment. At the baseline there was no statistically significant difference in MASI between the two groups (i.e., MASI in combination group and control group were 23.55±4.61 and 23.613±4.088 respectively). However, it was statistically significant at the end of therapy (i.e., MASI in combination group was 9.50±5.31 and in control group was 15.10±4.44). When the results were analysed in terms of percentage decrease in MASI from baseline, there was statistically significant difference in combination group (i.e., 10.87±4.11) as compared to control group (i.e., 6.3±1.97) after 2^nd week of therapy. When the mean MELASQOL scores were compared between the two groups at the end of therapy (i.e., 12 weeks), it was found to be statistically significantly lower in combination group (16.60±8.03) as compared to control group (25.90±8.17). Minor adverse effects like post peel erythema, pruritus, burning and stinging sensation were observed in some of the patients, which didn't necessitate termination of the therapy.

Conclusion

Combination of 20% TCA peel with topical 5% ascorbic acid is a highly effective, safe and promising therapeutic option in treatment of melasma which significantly improves the QoL.

Time to Change Dosing of Inactivated Quadrivalent Influenza Vaccine in Young Children: Evidence From a Phase III, Randomized, Controlled Trial

BACKGROUND.

Children under 3 years of age may benefit from a double-dose of inactivated quadrivalent influenza vaccine (IIV4) instead of the standard-dose.

METHODS.

We compared the only United States-licensed standard-dose IIV4 (0.25 mL, 7.5 µg hemagglutinin per influenza strain) versus double-dose IIV4 manufactured by a different process (0.5 mL, 15 µg per strain) in a phase III, randomized, observer-blind trial in children 6-35 months of age (NCT02242643). The primary objective was to demonstrate immunogenic noninferiority of the double-dose for all vaccine strains 28 days after last vaccination. Immunogenic superiority of the double-dose was evaluated post hoc. Immunogenicity was assessed in the per-protocol cohort (N = 2041), and safety was assessed in the intent-to-treat cohort (N = 2424).

RESULTS.

Immunogenic noninferiority of double-dose versus standard-dose IIV4 was demonstrated in terms of geometric mean titer (GMT) ratio and seroconversion rate difference. Superior immunogenicity against both vaccine B strains was observed with double-dose IIV4 in children 6-17 months of age (GMT ratio = 1.89, 95% confidence interval [CI] = 1.64-2.17, B/Yamagata; GMT ratio = 2.13, 95% CI = 1.82-2.50, B/Victoria) and in unprimed children of any age (GMT ratio = 1.85, 95% CI = 1.59-2.13, B/Yamagata; GMT ratio = 2.04, 95% CI = 1.79-2.33, B/Victoria). Safety and reactogenicity, including fever, were similar despite the higher antigen content and volume of the double-dose IIV4. There were no attributable serious adverse events.

CONCLUSIONS.

Double-dose IIV4 may improve protection against influenza B in some young children and simplifies annual influenza vaccination by allowing the same vaccine dose to be used for all eligible children and adults.

Association of NKG2D gene variants with susceptibility and severity of rheumatoid arthritis

NKG2D (KLRK1) is a C-type lectin receptor present on natural killer (NK) cells, γδ, CD8⁺ and CD4⁺ T cells. Upon ligand binding, NKG2D mediates activatory and co-stimulatory signals to NK cells and activated CD4⁺ T cells, respectively. Polymorphisms in NKG2D predispose to infectious diseases, cancer, transplantation and autoimmune disorders. We studied the influence of this NK receptor polymorphism on predisposition to and modification of the disease phenotype in patients with rheumatoid arthritis (RA). Eight different single nucleotide polymorphisms (SNP) in the NKG2 gene were genotyped in 236 patients with RA and 187 controls using Taqman 5' nuclease assays. NKG2D genotype/allele frequency did not differ between patients and controls. Subgroup analysis showed that the frequency of A allele of NKG2D9 and T allele of NKG2D10 was significantly higher in patients with deformities (a marker of severe disease) [11 versus 5%, Pc = 0·03, odds ratio (OR) = 2·44, 95% confidence interval (CI) = 1·09-5·98 and 10 versus 4%, Pc = 0·04, OR = 2·45, 95% CI = 1·05-6·39, respectively], while the frequency of alleles G of NKG2D9 and A of NKG2D10 was greater in patients without deformities (Pc = 0·03, OR = 0·41, 95% CI = 0·17-0·91 and Pc = 0·04, OR = 0·41, 95% CI = 0·16-0·96). Similar trends of association were observed with deforming phenotype of RA in female patients and deforming young onset RA subgroups. Haplotype analysis revealed that the frequency of haplotype G-C-A-G-A-T-C-C was higher in patients than in controls (12 versus 8%, P = 0·04, OR = 1·61, 95% CI = 1·01-2·55), suggesting that it may predispose to RA. Our study suggests that the NKG2D gene polymorphisms may modify the risk of development and severity of RA.

Immunogenicity and safety of Southern Hemisphere inactivated quadrivalent influenza vaccine: a Phase III, open-label study of adults in Brazil

The World Health Organization influenza forecast now includes an influenza B strain from each of the influenza B lineages (B/Yamagata and B/Victoria) for inclusion in seasonal influenza vaccines. Traditional trivalent influenza vaccines include an influenza B strain from one lineage, but because two influenza B lineages frequently co-circulate, the effectiveness of trivalent vaccines may be reduced in seasons of influenza B vaccine-mismatch. Thus, quadrivalent vaccines may potentially reduce the burden of influenza compared with trivalent vaccines.

In this Phase III, open-label study, we assessed the immunogenicity and safety of Southern Hemisphere inactivated quadrivalent influenza vaccine (Fluarix™ Tetra) in Brazilian adults (NCT02369341). The primary objective was to assess hemagglutination-inhibition antibody responses against each vaccine strain 21 days after vaccination in adults (aged ≥18–60 years) and older adults (aged >60 years). Solicited adverse events for four days post-vaccination, and unsolicited adverse events and serious adverse events for 21 days post-vaccination were also assessed.

A total of 63 adults and 57 older adults received one dose of inactivated quadrivalent influenza vaccine at the beginning of the 2015 Southern Hemisphere influenza season. After vaccination, in adults and older adults, the hemagglutination-inhibition titers fulfilled the European licensure criteria for immunogenicity. In adults, the seroprotection rates with HI titer ≥1:40 were 100% (A/H1N1), 98.4% (A/H3N2), 100% (B/Yamagata), and 100% (B/Victoria); in older adults were 94.7% (A/H1N1), 96.5% (A/H3N2), 100% (B/Yamagata), and 100% (B/Victoria). Pain was the most common solicited local adverse events in adults (27/62) and in older adults (13/57), and the most common solicited general adverse events in adults was myalgia (9/62), and in older adults were myalgia and arthralgia (both 2/57). Unsolicited adverse events were reported by 11/63 adults and 10/57 older adults.

The study showed that inactivated quadrivalent influenza vaccine was immunogenic and well-tolerated in Brazilian adults and older adults.

Alopecia universalis as a side effect of pegylated interferon α-ribavirin combination therapy for hepatitis C: a rare case report

Pegylated interferon α and ribavirin therapy is associated with increased incidence of various systemic and cutaneous side effects. Among the side effects of this therapy, alopecia universalis is a rarely reported side effect which causes significant cosmetic concern to the patient. We report a rare case of alopecia universalis which developed eight weeks after discontinuation of this antiviral combination therapy. This gains importance because it is essential to sensitize the treating gastroenterologist and the dermatologist regarding this rare side effect.

Embolization of cranial/spinal tumours and vascular malformations with hydrogel microspheres: An experience of 69 cases

Objective: To evaluate polymethyl methacrylate hydrogel microspheres (HMs) as an embolization material in the management of hypervascular craniofacial and spinal lesions.

Material and Methods: Sixty-nine patients with vascular lesions of the craniofacial and spinal regions underwent embolization with HM. The pathologies included craniofacial tumours (n=38), cranial arteriovenous malformations (AVMs) (n=7), dural AVM (n=1), cavernous carotid fistula (n=1), spinal tumours (n=7), spinal AVMs (n=6), orbital lesions (n=4) and scalp AVMs (n=5). Surgery was done in 56 patients. The blood loss at surgery, tumour shrinkage, surgical cleavage and ease of removal of tumour was noted from the records. Histopathology was available in 39 patients. A follow-up of 3 months to 6 years was available in 13 patients in whom embolization was the sole treatment. Surgical and histopathological findings were correlated with angio-embolization findings.

Results: HMs were easy to inject through the microcatheter with good control. Good devascularization was obtained in 61 patients and partial in 8 patients. Two patients developed complications due to presence of anastomoses between intra- and extracranial circulation and 1 patient due to tumor swelling. Histopathology showed presence of HMs in all the lesions, with minimal inflammatory reaction in 2 patients. Patients with spinal lesions treated with embolization only stabilised in neurologic deficits.

Conclusion: HMs are highly suitable as embolization agents in the management of craniofacial and spinal hypervascular lesions.

Immunogenicity and Safety of an Inactivated Quadrivalent Influenza Vaccine in US Children 6-35 Months of Age During 2013-2014: Results From A Phase II Randomized Trial

BACKGROUND

Viruses from 2 influenza B lineages co-circulate, leading to suboptimal protection with trivalent influenza vaccines (TIV). Quadrivalent influenza vaccines (QIV) containing both lineages offer broader protection.

METHODS

We compared inactivated seasonal QIV versus TIV (15 and 7.5 μg hemagglutinin [HA] for each influenza strain, respectively) in a phase II randomized (1 : 1), observer-blind trial in US children 6-35 months of age (identifier NCT01974895). The primary objective was to evaluate immune responses induced by QIV for the 4 vaccine strains 28 days after completion of vaccination. A secondary objective was to demonstrate superiority of QIV versus TIV for the B/Victoria strain contained in QIV but not TIV. Immunogenicity was evaluated in the per-protocol cohort (N = 280), and safety was evaluated in the intent-to-treat cohort (N = 314).

RESULTS

Seroconversion rates (SCRs) for QIV were 80.4% (95% confidence interval [CI], 73.0%-86.6%), 72.0% (95% CI, 63.9%-79.2%), 86.0% (95% CI, 79.2%-91.2%), and 66.4% (95% CI, 58.1%-74.1%) for A/H1N1, A/H3N2, B/Yamagata, and B/Victoria, respectively. Quadrivalent influenza vaccines demonstrated immunogenic superiority over TIV for B/Victoria with a geometric mean titer ratio of 4.73 (95% CI, 3.73%-5.99%) and SCR difference of 54.02% (95% CI, 43.88%-62.87%). Safety was similar between the vaccine groups despite the QIV's higher antigen content. No serious adverse events were reported related to vaccination.

CONCLUSIONS

Quadrivalent influenza vaccine (15 µg HA/strain) was immunogenic with an acceptable safety profile. The next phase of its development in children 6-35 months of age is a phase III trial in countries where it is not yet licensed. In countries where it is already licensed, a switch from TIV to QIV would provide broader protection in this vulnerable group.

Tacalcitol: A useful adjunct to narrow band ultraviolet B phototherapy in psoriasis

BACKGROUND

A combination of calcipotriol and narrow-band ultraviolet B (NBUVB) has been shown to have a superior efficacy as compared to NBUVB alone in psoriasis. Very few studies have been performed using the combination of NBUVB with tacalcitol, a comparatively newer Vitamin D analogue.

OBJECTIVE

Comparison of the efficacy and safety of topical tacalcitol in combination with NBUVB versus NBUVB alone in psoriasis.

METHODS

Thirty patients with plaque psoriasis were taken up for a 12 week, open-label, right-left intra-individual clinical trial. NBUVB phototherapy was given thrice weekly. The target lesions on one side were treated topically with tacalcitol ointment once daily, while no topical treatment was given on the other side. Efficacy was assessed by target plaque scoring.

RESULTS

Better improvement in plaques was seen with combination therapy as compared to NBUVB monotherapy, with a statistically significant difference from 2 to 8 weeks. The combination led to an earlier clearance of plaques and a better maintenance of the response than NBUVB alone. The number of treatment sessions and cumulative NBUVB doses were significantly lower in the tacalcitol-treated group.

CONCLUSION

Topical tacalcitol enhances the therapeutic effects of NBUVB therapy and exerts a UVB-sparing effect, without increasing the incidence of adverse effects.

Incidence and clinical vital parameters in primary ketosis of Murrah buffaloes

AIM

The present study was undertaken to ascertain the incidence and clinical vital parameters in cases of primary ketosis in Murrah buffaloes brought to teaching veterinary clinical complex, Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar and from adjoining villages of the district Hisar, Haryana, India.

MATERIALS AND METHODS

The investigation was conducted on 24 clinical cases (out of total 145 screened) of primary ketosis. The diagnosis was confirmed on the basis of clinical signs and significantly positive two tests for ketone bodies in urine (Rothera's and Keto-Diastix strip test). Data collected were statistically analyzed using independent Student's t-test.

RESULTS

Overall incidence of disease in these areas was found to be 16.55% and all the animals were recently parturited (mean: 1.42±0.14 month), on an average in their third lactation (mean: 2.38±0.30) and exhibited clinical signs such as selective anorexia (refusal to feed on concentrate diet), drastic reduction in milk yield (mean: 64.4±5.35%), ketotic odor from urine, breath, and milk and rapid loss of body condition. All the clinical vital parameters in ketotic buffaloes (body temperature, heart rate, respiration rate, and rumen movements) were within normal range.

CONCLUSION

Primary ketosis in Murrah buffaloes was the most common seen in the third lactation, within the first 2 months after parturition with characteristics clinical signs and no variability in vital parameters. The disease has severe effect on the production status of affected animal.

Clinical and hemato-biochemical studies on fever of unknown origin in buffaloes

Aim:

The present study was undertaken to ascertain the clinical observation and haemato-biochemical studies on fever of unknown origin (FUO) in buffaloes which were presented for treatment at the Teaching Veterinary Clinical Complex (TVCC), Lala Lajpat Rai University of Veterinary and Animal Sciences (LUVAS), Hisar.

Materials and Methods:

The investigation was conducted on total 106 clinical cases presented at “TVCC, LUVAS, Hisar.” Diseased animals having history of fever and increased rectal temperature were considered for the current study. Diagnosis of FUO was done on the basis of negative parasitological examination, culture examination, fecal and urine test. The cases in which etiology could not be established (such as pneumonia, metritis, traumatic reticuloperitonitis, urinary tract infection, trypanosomosis, diaphragmatic hernia, Brucellosis, and foreign body) were considered as true cases of FUO.

Results:

Out of 106 clinical cases different etiologies were identified in 76 (71.70%) cases including pneumonia, traumatic pericarditis, trypanosomosis, bacteremia, etc. and 30 cases (28.30%) remained undiagnosed even after detailed investigation. The mean rectal temperature (104.43±0.16°F), respiration rate (56.57±1.51/min) and pulse rate (83.40±1.77/min) of animals (n=30) suffering from FUO were significantly higher, whereas ruminal movement (1.00±0.23) was significantly lower compared to healthy control group. The mean value of hemoglobin, lymphocytes, and packed cell volume were significantly lower, whereas mean value of neutrophils was significantly higher compared to that of healthy control animals. Mean value of serum levels of glucose, phosphorus, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine phosphokinase (CPK), blood urea nitrogen (BUN), and creatinine were found to be significantly higher, whereas mean value of calcium value was significantly lower in all clinically affected animals compared to the healthy control group.

Conclusion:

About 28.30% cases of fever in buffaloes were found to be of unknown origin. Haemato-biochemical findings in cases of FUO in buffaloes revealed relative neutrophilia with lymphopenia, hyperglycemia, hypocalcemia, hyperphosphatemia, significantly increased AST, ALT, and CPK along with adversely altered kidney function indicators (elevated BUN and serum creatinine).

Sino-Nasal Status in Patients with Chronic Obstructive Pulmonary Disease

Background. Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease with serious impact on quality of life (QoL). There are limited studies available supporting coexistence of sino-nasal involvement in COPD. Methods. A prospective study was conducted to evaluate sino-nasal status in patients with COPD (n=100) presenting to the Department of Respiratory Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur from July 2011 to October 2012. COPD was diagnosed based on the Global initiative on Obstructive Lung Disease (GOLD) guidelines. Sino-nasal status was assessed by detailed history, radiograph of the para-nasal sinuses (PNS), nasal endoscopy and mucociliary clearance time. Results. Sino-nasal symptoms were present in 74 patients with COPD; nasal discharge (75.7%) being the most common. Tobacco smokers with COPD had a higher occurrence of sino-nasal symptoms (76.8%). Radiograph of para-nasal sinuses showed that maxillary sinus was most commonly involved. Nasal endoscopy revealed discharge in 63.5% cases. Nasal mucociliary clearance time was delayed (>11 to >40 min) in 98% cases. Nasal mucociliary clearance time was significantly delayed (>20 min) in COPD patients who were tobacco smokers as compared to non-smokers (53.7% versus 16.7%) and also related with increasing severity of COPD. Conclusions. Our observations suggest that sino-nasal involvement and delayed mucociliary clearance are common in patients with COPD, especially in tobacco smokers. Assessment of upper airway involvement in all the patients with COPD can help better therapeutic intervention and improvement in QoL.

Nonfamilial Multiple Trichoepithelioma: Few and Far Between

Trichoepithelioma is a rare benign adnexal tumor which may be of solitary nonfamilial type or multiple familial trichoepitheliomas. Here, we describe a rare presentation of nonfamilial case of trichoepithelioma in a 50-year-old female with multiple skin colored facial papules and nodules over the face, upper back, and extremities.

Efficiently functionalized oxacalix[4]arenes: Synthesis, characterization and exploration of their biological profile as novel HDAC inhibitors

A series of novel substituted oxacalix[4]arene has been synthesized and explored for their biological profile by evaluating anticancer, antifungal and antibacterial properties. The derivatives have been characterized by various spectroscopic techniques such as IR, (1)H NMR, (13)C NMR and Mass spectrometry. Many compounds showed strong inhibition (MIC) in the range of ∼0-50 μM with interesting cytotoxic activities against Hela cells in particular. The compounds were theoretically evaluated by docking studies as potential histone deacetylase inhibitors (HDACi). The study indicates that compounds bound adequately with HDAC, and hence complemented the experimental findings.

Evidence update: GlaxoSmithKline's inactivated quadrivalent influenza vaccines

Inactivated trivalent influenza vaccines (IIV3s) are designed to protect against illness caused by two influenza A virus subtypes and one influenza B virus lineage. They may provide inadequate protection due to the co-circulation of viruses from two antigenically distinct influenza B lineages. Incorporating strains from both B lineages as in inactivated quadrivalent influenza vaccines (IIV4s) reduces this risk. We summarize the evidence supporting two IIV4s manufactured by GSK Vaccines. Compared to IIV3s, these two IIV4s demonstrated noninferior immunogenicity against the shared influenza strains and superior immunogenicity for the strain of the additional B lineage, particularly in subjects who were seronegative for that B strain. One IIV4's efficacy in children aged 3-8 years was 55.4% against influenza of any severity and 73.1% against moderate-to-severe influenza. Both IIV4s were well-tolerated with a similar safety profile to IIV3s. These IIV4s are more likely than IIV3s to protect against the added influenza B strain.

Supramolecular Macrocyclic Pd(II) and Pt(II) Squares and Rectangles with Aryldithiolate Ligands and their Excellent Catalytic Activity in Suzuki C-C Coupling Reaction

Addition of 1,4-benezenedithiol and 4,4'-biphenyldithiol to M(OTf)2 (M = cis-[Pt(PEt3)2](2+) or cis-[Pd(dppe)](2+)) (dppe = 1,2-bis(diphenylphosphino)ethane) gave self-assembled tetranuclear complexes [M2{S(C6H4)nS}]2(OTf)4 (n = 1, 2). The same reaction with 1,4-benezenedimethanethiol yielded octanuclear supramolecular coordination complexes (SCC) [M2{SCH2C6H4CH2S}]4(OTf)8. These complexes were characterized by NMR, mass, and UV-vis spectroscopies, cyclic voltammetry, as well as density functional theory studies and represent the first examples of SCCs constructed by thiolate groups and square-planar metal ions. The rectangular shape of tetranuclear complexes and square shape of octanuclear complex are confirmed by single-crystal structures and computational studies. The palladium complexes showed excellent catalytic activity in Suzuki C-C cross-coupling reactions with high turnover numbers (2 × 10(7)), even with low catalyst loading.

Immunogenicity and Reactogenicity of an Inactivated Quadrivalent Influenza Vaccine Administered Intramuscularly to Children 6 to 35 Months of Age in 2012-2013: A Randomized, Double-Blind, Controlled, Multicenter, Multicountry, Clinical Trial

BACKGROUND

Influenza attack rates are high in 6- to 35-month-old children; vaccines containing both lineages of influenza B (Yamagata and Victoria), in addition to the H3N2 and H1N1 antigens, may improve protection rates.

METHODS

In a randomized double-blind controlled trial, the immunogenicity and reactogenicity of an inactivated quadrivalent influenza vaccine (QIV) and a trivalent control vaccine (TIV) were assessed.

RESULTS

Six hundred one children (QIV, n = 299; TIV, n = 302) were enrolled at 8 sites in 3 countries. The primary immunogenicity objective was met: the lower limit (LL) of the 2-sided 95% confidence interval (CI) for the seroconversion rate in QIV recipients ranged from 66.6% to 81.3%, which was ≥40% against all 4 strains. The immunogenic superiority of the additional B/Victoria strain in the QIV compared to that in the TIV was confirmed: the LL of the 2-sided 95% CI of the geometric mean titer ratio (QIV/TIV) (6.28 [95% CI, 5.32-7.41]) was greater than 1.5, and the LL of the 2-sided 95% CI for the difference in the seroconversion rate (QIV - TIV) (64.19% [95% CI, 57.65%-69.95%]) was greater than 10%. Injection-site pain and irritability/fussiness were the most commonly reported solicited injection-site and general adverse events, respectively, from days 0 to 6 and were similar in frequency between the groups.

CONCLUSIONS

In children aged 6 to 35 months, a QIV has superior immunogenicity for the added B strain and acceptable immunogenicity for shared strains, with no notable difference in reactogenicity and safety when compared to a TIV.

Source identification and metallic profiles of size-segregated particulate matters at various sites in Delhi

A study of elemental composition in the ambient air of Delhi was carried out in the monsoon, winter and summer seasons at four different sites from August 2012 to April 2013 in the size ranges <1, 1-2.5, 2.5-10 and >10 μm using "Dekati PM10" impactor. At each site, three samples were collected and were analyzed by energy-dispersive X-ray fluorescence (EDXRF). The presence of elements was found to be very common and highly concentrated in aerosol particles at all the sites, which are Na, Al, Si, K, Ca, Zn and Ba. Total suspended particulate matters (TSPMs) of fine particles were found high in comparison to coarse particles at all seasons. The TSPM of fine particles was found to be varied in the range from 303.6 to 416.2 μg/m(3). Similarly, the range of coarse TSPM was observed from 162.9 to 262.8 μg/m(3). Correlation matrices were observed between fine (size ranges <1 and 1-2.5 μm) and coarse (size ranges 2.5-10 and >10 μm) size particles for all elements with seasons. Source apportionments of elements were carried out using MS Excel 2010 through XLSTAT software. The source apportionments between fine and coarse particles were carried out through factor analysis and dominated sources found to be crustal re-suspension and industrial activities.

Blue rubber bleb nevus syndrome: a rare multisystem affliction

About 200 cases of blue rubber bleb nevus syndrome (BRBNS) have been reported in the literature. The disorder affects both sexes equally and the occurrence is mostly sporadic except for a few reports of cases with autosomal dominant inheritance pattern. Herein we report an 11-year-old girl with progressive BRBNS and onset at 5 years of age.

Fruit and food eponyms in dermatology

Dermatology world is brimming with myriad of interesting clinical conditions, signs and syndromes. It is infinite, which has systemic clinical connotations too. Complicated pronunciations of diagnosis have always placed residents in an intricate state. Each one is trying his best to make this cumbersome subject comparatively more acceptable and convenient. The present paper is an attempt to further simplify the subject by correlating difficult conditions with commonly used and seen things such as fruit and food. A total of 45 dermatological conditions were found to be based on fruit and food eponyms. For example, strawberries can remind us of strawberry gums of Wegener's granulomatosis and strawberry nevus.

A novel reusable nanocomposite for complete removal of dyes, heavy metals and microbial load from water based on nanocellulose and silver nano-embedded pebbles

The present work proposed a nanocellulose (NC)-silver nanoparticles (AgNPs) embedded pebbles-based composite material as a novel reusable cost-effective water purification device for complete removal of dyes, heavy metals and microbes. NC was prepared using acid hydrolysis of cellulose. The AgNPs were generated in situ using glucose and embedded within the porous concrete pebbles by the technique of inter-diffusion of ion, providing a very strong binding of nanoparticles within the porous pebbles and thus preventing any nanomaterials leaching. Fabrication of a continual running water purifier was achieved by making different layering of NC and Ag nano-embedded pebbles in a glass column. The water purifier exhibited not only excellent dye and heavy metal adsorption capacity, but also long-term antibacterial activity against pathogenic and non-pathogenic bacterial strains. The adsorption mainly occurred through electrostatic interaction and pore diffusion also contributed to the process. The bed column purifier has shown 99.48% Pb(II) and 98.30% Cr(III) removal efficiency along with 99% decontamination of microbial load at an optimum working pH of 6.0. The high adsorption capacity and reusability, with complete removal of dyes, heavy metals and Escherichia coli from the simulated contaminated water of composite material, will provide new opportunities to develop a cost-effective and eco-friendly water purifier for commercial application.

Guidelines for Diagnosis and Management of Bronchial Asthma: Joint Recommendations of National College of Chest Physicians (India) and Indian Chest Society

Bronchial asthma is an important public health problem in India with significant morbidity. Several international guidelines for diagnosis and management of asthma are available, however there is a need for country-specific guidelines due to vast differences in availability and affordability of health-care facilities across the globe. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have collaborated to develop evidence-based guidelines with an aim to assist physicians at all levels of health-care in diagnosis and management of asthma in a scientific manner. Besides a systematic review of the literature, Indian studies were specifically analysed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (1) definitions, epidemiology and impact, (2) diagnosis, (3) pharmacologic management of stable disease, (4) management of acute exacerbations, and (5) non-pharmacologic management and special situations. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.

In vitro toxicity assessment of chitosan oligosaccharide coated iron oxide nanoparticles

Iron oxide nanoparticles (INPs) have potential biological, biomedical and environmental applications. These applications require surface modification of the iron oxide nanoparticles, which makes it non-toxic, biocompatible, stable and non-agglomerative in natural and biological surroundings. In the present study, iron oxide nanoparticles (INPs) and chitosan oligosaccharide coated iron oxide nanoparticles (CSO-INPs) were synthesized to evaluate the effect of surface coating on the stability and toxicity of nanoparticles. Comparative in vitro cytotoxicity of nanoparticles was evaluated in HeLa (human cervix carcinoma), A549 (human lung carcinoma) and Hek293 (human embryonic kidney) cells by using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay along with flow cytometry study for cell viability, membrane integrity, mitochondrial membrane potential (MMP) and reactive oxygen species (ROS) production. Morphological alteration in nanoparticles treated cells was analyzed by Acridine orange/ethidium bromide double staining and electron microscopy. Synthesized nanoparticles were found to be spherical in shape, well dispersed and stable at various pH values, making them suitable for biomedical and environmental applications. The present study also indicates that the chitosan oligosaccharide coating on iron oxide nanoparticles results in the decrease in cellular damage and moderate ROS production, thereby, significantly decreasing the cytotoxic impact of bare iron oxide nanoparticles.

Determination of volatile organic compounds and associated health risk assessment in residential homes and hostels within an academic institute, New Delhi

The purpose of this study was to investigate the concentrations of volatile organic compounds (VOCs) in different indoor microenvironments of residential homes and hostels in an academic institute, in New Delhi, during March-May 2011. Eleven VOCs (aromatic and halogenated) were assessed. Sampling and analytical procedure were based on National Institute for Occupational Safety and Health (NIOSH) standard method. The lifetime cancer and non-cancer risk were calculated for targeted VOCs using US Environmental Protection Agency guidelines. The mean concentrations of ∑ VOCs (sum of monitored VOCs) and individual VOC were found to be higher indoors as compared to outdoors at both types of premises. Indoor to outdoor (I/O) ratios of the targeted VOCs exceeded 1.0, suggesting the significant presence of indoor sources. Strong correlations between I/O concentrations of VOCs in the current study suggest the presence of common sources. Factor analysis (FA) was used for source evaluation separately at two premise types. The estimated lifetime cancer risks in the current study for all occupants at both premises exceeded 10(-6) .

A historically-controlled Phase III study in adults to characterize the acceptability of a process change for manufacturing inactivated quadrivalent influenza vaccine

BACKGROUND

An inactivated quadrivalent influenza vaccine (QIV) was recently licenced in the US as a thimerosal-free formulation presented in a pre-filled syringe. A multidose presentation is preferred in some settings due to reduced acquisition and cold storage costs. We assessed the immunogenicity and safety of a thimerosal-containing QIV formulated using a new manufacturing process for presentation in multidose vials.

METHODS

Two Phase III non-randomized studies separately evaluated inactivated trivalent influenza vaccine (TIV; 2010-2011; historical control) and a QIV (2011-2012). The QIV contained the same strains as the TIV plus an additional B strain. Both vaccines contained thimerosal to allow multidose presentation: this preservative was added to the QIV during the final formulation step using a new process, whereas it was added to the TIV early in the manufacturing process using an established method. The TIV study included 50 and 70 subjects aged 18-60 and >60 years, respectively; the QIV study included 56 subjects in each age stratum. Immunogenicity was assessed using hemagglutination-inhibition (HI) assays. Reactogenicity was assessed during the 4-day post-vaccination periods and unsolicited adverse events (AEs) were assessed during the 21-day post-vaccination periods.

RESULTS

The TIV and QIV were immunogenic in both age strata. With the QIV and TIV respectively, the seroconversion rates were 48.2-62.7% and 71.4-83.7% for influenza A, and 33.9-62.5% and 67.3-72.9% for influenza B. With the QIV and TIV respectively, the seroprotection rates were 92.9-98.2% and 98.2-100% for influenza A, and 88.6-100% and 95.9-98.6% for influenza B. Pre-vaccination titers were higher in the QIV versus TIV study which confounds a direct comparison and likely explains the lower seroconversion rates observed in the QIV study. There were no safety concerns raised with TIV or QIV.

CONCLUSIONS

The thimerosal-containing QIV formulated using a new process was immunogenic, conforming to regulatory acceptance criteria, with a reactogenicity and safety profile in line with the TIV manufactured using a licensed process. These results support acceptability of a manufacturing process change in which the thimerosal preservative is added at the point at which batches are filled into multidose vials.

TRIAL REGISTRATION

These trials were registered at ClinicalTrials.gov: NCT01440387; NCT01153685.