A novel proposed classification system for rock slope stability assessment

The present study introduces "rock slope instability score (RSIS)" a novel classification system for assessing rock slope stability. It takes into account geological and geotechnical parameters, as well as the impact of human activities and triggering parameters, which have become more frequent due to climate change and few of them have been ignored in existing classifications. The study focuses on rock slopes of various lithologies from the Indian Himalayas. The development of this new classification system is based on the examination of 81 different rock slopes from various states of the Indian Himalayas. Extensive field surveys, rock sampling, geotechnical laboratory tests, and ground measurements have been conducted at the various slope sites to establish a comprehensive scoring system for the stability assessment. The distributions of weightage to each parameter have been considered, corresponding to its degree of impact in causing slope instability. Sensitivity analysis of all defined parameters of RSIS system has revealed that the majority of the parameters exhibit a strong positive correlation, with Pearson correlation coefficients ranging from 0.74 to 0.61. However, two parameters, namely discontinuity dip and the relationship between slope & discontinuity direction, gives moderate relationship with correlation coefficient values of 0.48 and 0.41, respectively. To avoid any designer biasness in the system, several individuals gathered data set at different times. The proposed classification system has demonstrated a strong correlation with the actual slope condition, and it is quite promising. The outcome of RSIS classification for studied 81 slopes classified 2 slopes under stable condition, 21 slopes as partially stable, 44 as unstable, and 14 as completely unstable.

Genetic diversity, morphological traits, quality traits and antioxidants potentiality of Coccinia grandis germplasm under rainfed semi-arid region

The present study was conducted to evaluate the genetic variability for morphological and qualitative traits of Coccinia for development of trait specific lines at ICAR-Central Horticultural Experiment Station (CIAH-RS), Panchmahals (Godhra), Gujarat during 2020-2022. In this study, we evaluated 26 gynoecious accessions to assess the genetic divergence through principal component and cluster analysis. The experiment was carried out in a randomized complete block design with three replications under rainfed semi-arid conditions. High values of PCV and GCV were observed for variables such as NFFP (25.13 and 22.20), PL (23.14 and 20.69), FD (24.01 and 21.46), AFW (22.98 and 20.13), NFPY (26.38 and 24.40), FYP (37.57 and 31.29), FY (35.55 and 33.20), AsC (28.65 and 27.73), Ac (24.32 and 21.06), TSS (37.23 and 35.94), DPPHL (20.71 and 20.38), FRAPL (21.08 and 20.92), TPF(20.81 and 20.45) respectively. High heritability coupled with high genetic advance as per cent of mean was observed for vine length (VL), internodal length (IL), number of female flowers per plant (NFFP), fruit length (FL), peduncle length (PL), fruit diameter (FD), average fruit weight (AFW), number of fruit per plant per year (NFPY), fruit yield per plant (FYP), fruit yield (FY), ascorbic acid (AsC), acidity (Ac), total soluble solids (TSS), total phenols in leaves TPL), total flavonoids in leaves TFL, CUPRAC in leaves (CUPRACL), DPPH in leaves (DPPHL), FRAP in leaves (FRAPL), Total phenols in fruits (TPF), Total flavonoids in fruits (TFF), CUPRAC in fruits (CUPRACF) and DPPH in fruits (DPPHF). The FYP exhibited a significant positive correlation with variables like VL (0.6833), IL (0.2991), NFFP (0.8107), FD (0.5245), AFW (0.6766), NFPY (0.7659), ASC (0.4611), TSS (0.5004) and TPF (0.4281). The estimates of genetic parameters revealed scope for further improvement of fruit yield by selection. Of the eight principal components, PC-I through PC-VIII had eigen values greater than 1 and it accounts 85.02% of the total variation for 26 gynoecious accessions of Ivy gourd. The eigen values of PC-I comprised 5.775% of total variation followed by PC-II (4.250%), PC-III (3.175%), PC-IV (2.588%), PC-V (1.828%), PC-VI (1.447%), PC-VII (1.179%) and PC-VIII (1.013%).The cluster VI and cluster I having highest mean values for most of traits under study. Thus, genotypes from the distinct cluster like cluster VI and I for should be used for selection of parents and varietal improvement for further breeding programme in ivy gourd.

Effects of oral probiotic and lactoferrin interventions on iron-zinc homeostasis, oxidant/antioxidant equilibrium and diarrhoea incidence of neonatal piglets

The objective of this study was to examine the effects of early-life host specific probiotic and lactoferrin (LF) supplementations on diarrhoea incidence, iron (Fe)-zinc (Zn) balance and antioxidant capabilities in serum of neonatal piglets. A total of eight sow litters obtained from parity matched sows were randomly divided into four groups and assigned to one of the four interventions: control (2.0 ml normal saline), bovine lactoferrin (bLF) (100 mg bLF in normal saline), probiotic (Pb) (1×10⁹ cfu of swine origin Pediococcus acidilactici FT28 strain) and bLF+Pb (both 100 mg bLF and 1×10⁹ cfu of P. acidilactici FT28). All the piglets received supplementations once daily orally for first 7 days of life. The incidence of diarrhoea markedly decreased in bLF group compared to control group. Notably, no incidences of diarrhoea were recorded in Pb and bLF+Pb groups. The Zn and Fe concentrations were significantly increased from day 7 to 21 in bLF and on day 21 in bLF+Pb group. No such changes were noted in Pb group. Total antioxidant capacity (TAC) in serum was significantly increased on days 7 and 15 in bLF group and on days 7 and 21 in bLF+Pb group. Malonaldehyde concentration was markedly reduced from day 7 to 21 in bLF and bLF+Pb groups. The concentrations of nitrate on days 15 and 21 and malonaldehyde on day 7 were significantly higher in Pb group, but mean TAC was unaltered from day 0 to 21. Although no correlation between the incidence of diarrhoea and Zn/Fe and oxidant/antioxidant homeostasis was noted in the Pb group, the supplementation of P. acidilactici FT28 alone was sufficient to prevent the incidence of diarrhoea in neonatal piglets. Taken together, it is concluded that strategic supplementation of P. acidilactici FT28 in early life could help in preventing diarrhoea until weaning of piglets.

Abiotic and biotic stress alleviating effects of the medicinal and aromatic plant-derived product on striped catfish Pangasianodonhypophthalmus

Intensification of aquaculture production leads to abiotic and biotic stresses, which are further induced by the impact of climate change. Thus, it is important to explore a combined strategy to alleviate multiple stresses in fish. In the present investigation, the removal of nitrogenous metabolites from aquaponics water was studied using products derived from five different locally available medicinal and aromatic plants (MAPs) namely banana stem (Musa Accuminata), Aloe vera, Mint (Minata sepicata), Indian beech/Pongameoil-tree/Karanj (Pongamia pinnatum), and Coat Button/Mexican daisy/Dagadipala (Tridax procrumbens) in the batch experiment for 24 h. A reduction of 91-94% in the ammonia level and 75-80% removal of nitrite-N in the treatments with products derived from mint, banana stem, and aloe vera has been observed. Mint product was also found to be bactericidal against fish pathogenic bacteria. Based on this dual function of mint, further study was conducted under wet-lab conditions to evaluate the possible protective role of the mint-based product in dry powder form against abiotic stresses caused by nitrogenous toxicants for 24 h and 45 days multiple stresses caused by nitrogenous toxicants in freshwater stocked with eight fingerlings of Pangasianodon hypophthalmus of the initial weight of 8 ± 0.5g for 24 h and 8.82 ± 0.75g for 45 days. The results revealed that mint-derived plant product has better anti-stress properties in terms of their bioremediation effectiveness in lowering ammonia and nitrite. Mint also improved the fish growth performance with better physiological responses and anti-oxidative status and reduced the cellular metabolic stress in fish reared under ammonia, as further indicated by reduced oxidative stress parameters, and tissue biochemical indices. Overall, mint showed its main properties as a growth promoter, and immune enhancer, where this medicinal plant product acts as a bioremediation and antibacterial agent to the host immune system. This has potential applications in the environmental and health management of aquaculture.

Resilience related to novel coronavirus among doctors and undergraduate medical students-A study from India

BACKGROUND

There are no studies pertaining to resilience related to novel coronavirus focusing primarily on doctors and undergraduate medical students in India. The objectives of this survey were to assess the resilience and its various domains that are needed for dealing with novel coronavirus among doctors, interns, and undergraduate students and to see its correlation with various sociodemographic factors.

MATERIALS AND METHOD

An online cross-sectional survey was done among doctors and undergraduate medical students during the first COVID-19 wave from May 19, 2020 to June 8, 2020. A total of 434 responses were recorded during the study period. All the recorded full responses were considered for data analysis. Snowball sampling was used for this study. Resilience was assessed using three items, which were taken from the Brief Resilience Scale (BRS).

RESULT

Out of 434 responses, 51.7% (224/433) of the respondents were non-resilient. The presence of the elderly at home was significantly associated with poor resilience (P = 0.02). Resilience was not significantly associated with other socio-demographic factors. Younger respondents (P = 0.019) and females (P =0.0004) were of the opinion that they recovered late from stressful events. Elderly respondents (P = 0.003) and those with chronic illness (P = 0.008) reported that it is hard for them to snap back if something bad happens (P = 0.003).

CONCLUSIONS

More than half of the doctors and undergraduate medical students were found to be non-resilient, underscoring the urgent need to take steps to improve the resilience of this group of frontline workers.

Differential proteomic profile of X- and Y- sorted Sahiwal bull semen

The identification of differential proteins between X- and Y-sperm may be useful for immunological sexing of sperm. Hence, the present study was aimed to compare the protein profile of X- and Y-sorted Sahiwal bull semen using SDS-PAGE and Liquid Chromatography coupled with Mass Spectrometry (Nano LC-MS). Semen sample (n = 6) were categorized into three groups i.e., group I (X-sorted), group II (Y-sorted) and control group (both X- and Y- sperms). SDS PAGE revealed specific proteins of molecular weight between 18 and 24 kDa and between 30 and 37 kDa were present in X-sorted sperms. Also, band corresponding to 25 kDa was specific to Y-sorted sperms. Data obtained from Nano LC/MS is analysed by search engine database i.e., MASCOT and SEQUEST HT. Total, 241 proteins were identified, out of which 113 were differentially expressed between X- and Y-sorted sperms, in which 54 proteins showed at least two unique peptides. Out of 54 proteins, 27 were upregulated in X-sorted sample, 3 were upregulated in Y-sorted sample and 24 were differentially downregulated. Highly upregulated protein in X-sperm viz. Armadillo repeat containing 12 protein, NDC1 transmembrane nucleoporin, β-nerve growth factor, C-type natriuretic peptide, Nucleobindin-2, Phosphoglycerate mutase 2, Calmodulin along with one uncharacterised protein having accession number F1MN9 may have potential to be used as biomarker for separating X and Y sperm.

Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium

BACKGROUND

Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies.

PATIENTS AND METHODS

Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients).

RESULTS

A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality.

CONCLUSIONS

Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies.

CLINICAL TRIAL IDENTIFIER

NCT04354701.

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

Background

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

Patients and Methods

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

Results

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

Conclusions

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

Over-expression of Caj1, a plasma membrane associated J-domain protein in Saccharomyces cerevisiae, stabilizes amino acid permeases

Hsp70: J-domain protein (JDP) machines, along with the cellular protein degradation systems play a central role in regulating cellular proteostasis. An equally robust surveillance system operates at the plasma membrane too that affects proper sorting, stability as well as the turnover of membrane proteins. Although plausible, a definitive role of the Hsp70: JDP machine in regulating the stability of plasma membrane proteins is not well understood in Saccharomyces cerevisiae. Here we show that a moderate over-expression of Caj1, one of the thirteen JDPs residing in the nucleo-cytosolic compartment of S. cerevisiae reduced the cold sensitivity of tryptophan auxotrophic yeast cells by stabilizing tryptophan permeases, Tat1 and Tat2 in a J-domain dependent manner. Concomitantly, higher Caj1 levels also caused slow growth and increased plasma membrane damage at elevated temperatures possibly due to the stabilization of thermolabile plasma membrane proteins. Finally, we show that although majorly cytosolic, Caj1 also co-localizes with the membrane dye FM4-64 at the cellular periphery suggesting that Caj1 might interact with the plasma membrane. Based on the results presented in this study, we implicate the Hsp70: Caj1 chaperone machine in regulating the stability or turnover of plasma membrane proteins in budding yeast.

Interplay of oxidative stress and antioxidant bio markers in oil adjuvant Brucella melitensis vaccinated and challenged mice

The intracellular nature of Brucella leads to rise in oxidative stress due to bacterial invasion, particularly at the site of predilection spleen and lymph nodes. The present study aimed to evaluate the erythrocytic and tissue specific oxidative stress responses induced during oil adjuvant killed Brucella melitensis vaccination. The results of the study clearly implicated a significant increase in level of catalase, and superoxide dismutase (SOD) activity and lipid peroxidation (LPO), and total protein content in erythrocytes after vaccination. The activity of glutathione-S-transferase (GST) was unaltered during the period of experiment. The catalase activity and GSH content was significantly increased in lung and spleen tissues. The tissues GST levels increased significantly in all tissues, while tissue SOD level increased significantly only in lung tissues. Thus, it can be inferred that oil adjuvant based Brucella vaccine induces negligible signs of inflammatory pathophysiology and supports the development of significant level of protection against virulent Brucella challenge.

Bacillus clausii UBBC-07 reduces severity of diarrhoea in children under 5 years of age: a double blind placebo controlled study

Acute diarrhoea is one of the leading causes of mortality in infants and young children. Evidence suggests that probiotics can reduce diarrhoea duration. As the effects of probiotics are strain specific, the effect of Bacillus clausii UBBC-07, a safe probiotic strain in the treatment of acute diarrhoea in children was studied. The double blind, randomised, placebo-controlled, parallel group multicentric study was conducted at two outpatient facility sites in Lucknow, India. Children aged six months to five years suffering from acute diarrhoea, were randomly assigned to receive either probiotic (B. clausii UBBC-07) spore suspension or placebo suspension twice daily apart from oral rehydration solution (ORS). The duration of treatment was for five days with a follow -up until the 10^th day. Outcomes evaluated were duration and frequency of diarrhoea, consistency of stool, fever and vomiting. The duration of diarrhoea was significantly shorter (P<0.05) in patients who received B. clausii suspension (75.66±13.23 h) than in placebo treated group (81.6±15.43 h). The average daily number of stools (frequency) was 8.67±3.42 at baseline in treatment group receiving B. clausii and 8.53±3.19 in placebo group. By day 4, there was a significant reduction (P<0.01) in frequency of stools in probiotic treated group (3.46±0.66) as compared to placebo group (4.57±1.59). Improvement in stool consistency was also observed in the probiotic treated group as compared to the placebo group. There was no effect on vomiting and duration of fever. B. clausii UBBC-07 significantly decreased the duration and frequency of diarrhoea as compared to placebo indicating effectiveness of strain in the treatment of acute diarrhoea in children and could be a safe alternative to antibiotics.

Purification, developmental expression, and in silico characterization of α-amylase inhibitor from Echinochloa frumentacea

Barnyard (Echinochloa frumentacea) and finger (Eleusine coracana) millet growing at northwestern Himalaya were explored for the α-amylase inhibitor (α-AI). The mature seeds of barnyard millet variety PRJ1 had maximum α-AI activity which increases in different developmental stage. α-AI was purified up to 22.25-fold from barnyard millet variety PRJ1. Semi-quantitative PCR of different developmental stages of barnyard millet seeds showed increased levels of the transcript from 7 to 28 days. Sequence analysis revealed that it contained 315 bp nucleotide which encodes 104 amino acid sequence with molecular weight 10.72 kDa. The predicted 3D structure of α-AI was 86.73% similar to a bifunctional inhibitor of ragi. In silico analysis of 71 α-AI protein sequences were carried out for biochemical features, homology search, multiple sequence alignment, phylogenetic tree construction, motif, and superfamily distribution of protein sequences. Analysis of multiple sequence alignment revealed the existence of conserved regions NPLP[S/G]CRWYVV[S/Q][Q/R]TCG[V/I] throughout sequences. Superfam analysis revealed that α-AI protein sequences were distributed among seven different superfamilies.

Impact of feeding chromium supplemented flaxseed based diet on fatty acid profile, oxidative stability and other functional properties of broiler chicken meat

A total of 240 broiler chicken of same hatch with uniform weight were used in a biological experiment with completely randomized design to investigate the effects of incorporating organic chromium (Cr) in flaxseed meal based diet on the fatty acid profile, oxidative stability and functional properties of broiler chicken meat. Five diets were formulated as per the recommendations of BIS (Nutrient requirements for poultry 13: 9863, Bureau of Indian Standards, New Delhi, 1992) in which flaxseed meal was used to replace 10% of soyabean in basal diet and four levels of Cr (0.0, 0.5, 1.0 and 1.5 mg/kg diet) as Cr-picolinate were used. The results revealed that flaxseed feeding significantly increased the percentage of unsaturated fatty acids, including MUFA, PUFA, ω-3, ω-6 fatty acids and ω-3:ω-6 and PUFA:SFA ratios, whereas, significant decline was seen in saturated fatty acids and no effect of Cr was observed on the fatty acid profile of broiler chicken. Flaxseed feeding significantly reduced the cholesterol and fat percentage of meat, whereas, significant progressive reduction was observed with increasing Cr levels. The combination of 10% flaxseed with 1.0 mg Cr/kg diet increased the final pH of broiler meat. The addition of flaxseed significantly reduced water holding capacity, extract release volume and antioxidant potential of broiler meat, whereas, increasing Cr supplementation progressively increased them. Flaxseed feeding significantly increased the drip loss and lipid peroxidation of broiler meat, whereas, Cr supplementation decreased them. It was concluded that inclusion of 10% flaxseed and 1.5 mg Cr/kg diet results in desirable fatty acid profile, oxidative stability and functional properties of broiler chicken meat.

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

CONTEXT

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

AIMS

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

SETTINGS AND DESIGN

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

SUBJECTS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

This abstract was withdrawn by the authors.

The use of Lactobacillus as an alternative of antibiotic growth promoters in pigs: A review

Antibiotics, often supplemented in feed, used as a growth promoter, may cause their residual effect in animal produce and also trigger antibiotic resistance in bacteria, which is of serious concern among swine farming entrepreneurs. As an alternative, supplementing probiotics gained interest in recent years. Lactobacillus being the most commonly used probiotic agent improves growth performance, feed conversion efficiency, nutrient utilization, intestinal microbiota, gut health and regulates immune system in pigs. The characteristics of Lactobacillus spp. and their probiotic effects in swine production are reviewed here under.

Renal transplantation: Assessment of "at risk" diabetic foot and recommendations for mitigation

We conducted a prospective study (between November 2013 and January 2015) to identify "foot at risk" in the diabetic renal transplant patients at a Tertiary Care Hospital in India. Patients (151) were divided into three groups: diabetic transplant recipients (n = 42), new onset diabetes after transplantation (NODAT) (n = 59), and controls (nondiabetic renal transplant recipients) (n = 50). Foot neuropathy and vasculopathy were assessed by standard methods. Patients with "at risk" feet were given foot care advice. Of the 151 patients, 144 patients were male and seven were female with a male:female ratio of 20:1. Peripheral neuropathy was present among 42.9% of diabetic transplant patients, 35.6% of NODAT patients, and 12% of control patients. Vasculopathy was present in 28.6% of diabetic transplant patients, 23.7% of NODAT patients, and 2% of control patients. On multivariate analysis, patient's age, mean time interval since transplantation, and HbA1c levels were significantly associated with neuropathy, whereas the duration of diabetes and vibration perception threshold was associated with vasculopathy. After undergoing renal transplantation, a significant number of diabetic and NODAT patients has their "feet at risk" who in future may develop full-blown lesions of the diabetic foot. Proper advice to patients and information to the treating doctor helps to mitigate the risk.

Immobilization of β-glucosidase onto silicon oxide nanoparticles and augment of phenolics in sugarcane juice

Purified β-glucosidase was immobilized on SiO₂ nanoparticles with 52 % efficiency and 14.1 % yield. It had a temperature optima at 60 °C and pH optima of 5.0. Immobilized enzyme was fairly stable at 60-70 °C. After immobilization, the K_m value of β-glucosidase for p-nitrophenyl-β-d-glucopyranoside (pNPG) increased from 0.9 to 1.074 mM and V_max decreased from 3.5 to 1.513 U/mg. The immobilized enzyme showed improved storage stability at temperature 4 and 25 °C and was reusable for up to ten cycles with 70 % residual activity in pNPG and 60 % residual activity in sugarcane juice treatment. Sugarcane juice density, viscosity; surface tension etc. changed after treatment with immobilized β-glucosidase. β-Glucosidase treated sugarcane juice showed higher phenolics than untreated sugarcane juice. Caffeic acid which was absent in juice, was detected in β-glucosidase treated juice at a concentration of about 1 mg/L.

Catalytic properties, functional attributes and industrial applications of β-glucosidases

β-Glucosidases are diverse group of enzymes with great functional importance to biological systems. These are grouped in multiple glycoside hydrolase families based on their catalytic and sequence characteristics. Most studies carried out on β-glucosidases are focused on their industrial applications rather than their endogenous function in the target organisms. β-Glucosidases performed many functions in bacteria as they are components of large complexes called cellulosomes and are responsible for the hydrolysis of short chain oligosaccharides and cellobiose. In plants, β-glucosidases are involved in processes like formation of required intermediates for cell wall lignification, degradation of endosperm’s cell wall during germination and in plant defense against biotic stresses. Mammalian β-glucosidases are thought to play roles in metabolism of glycolipids and dietary glucosides, and signaling functions. These enzymes have diverse biotechnological applications in food, surfactant, biofuel, and agricultural industries. The search for novel and improved β-glucosidase is still continued to fulfills demand of an industrially suitable enzyme. In this review, a comprehensive overview on detailed functional roles of β-glucosidases in different organisms, their industrial applications, and recent cloning and expression studies with biochemical characterization of such enzymes is presented for the better understanding and efficient use of diverse β-glucosidases.

Study of short lactation in Sahiwal cattle at organized farm

Aim:

The aim was to study the associated factors and extent of short lactations in Sahiwal cattle maintained under organized herd.

Materials and Methods:

The present study was conducted on Sahiwal cattle (n=530), utilizing 1724 lactation records with respect to lactation length (LL), spread over a period of 15 years (1997-2011), maintained at Livestock Research Center, National Dairy Research Institute, Karnal. Observations of LL were analyzed by descriptive statistical analysis in order to know the extent of short lactation of animals in the herd. Paternal Half sib method was used to estimate the genetic parameters, i.e., heritability, genetic, and phenotypic correlation. The influence of various non-genetic factors (season of calving, the period of calving, parity, type of calving, and season of drying) on LL was studied by least squares analysis of variance technique.

Results:

The least squares means for LL was found to be 215.83±3.08 days. Only 32.48% of total lactation records were fell in the range of 251-350 days of LL, while more than three-fourth (76%) of total observations were failed to reach the standard level of 305 milking days. LL class ranges from 251 to 300 days accommodated maximum number of observations (19.2%). The heritability estimate of LL was 0.22±0.07. Positive correlations were found between LL and service period, LL and 305 or less days milk yield, LL and calving interval; whereas dry period was negatively correlated with the LL. The least squares analysis had shown that LL was significantly (p<0.01) influenced by the period of calving, type of calving, and season of drying. Significantly higher LL (276.50±7.21 days) was found in animals calved in the first period than those calved in other periods. The cows dried during summer season had the shortest LL (188.48±7.68 days) as compared to other seasons.

Conclusion:

Present findings regarding short lactations occurrence may be alarming for the indigenous herd, demanding comprehensive study with the larger data set. Since LL was influenced by various environmental factors suggesting better managerial tools, besides special attention on the milch animals going to dry during the summer season.

P5: SYSTEMIC MASTOCYTOSIS PRESENTING AS CARDIAC TAMPONADE WITH CD25+ PERICARDIAL MAST CELLS

Purpose of Study

Case.

Methods Used

Descriptive.

Summary of Results

A 59 year old man with a history of lymphadenopathy, presented with shortness of breath and pleuritic chest pain since three days. A hyperpigmented maculopapular rash with urticaria was present along with multiple syncopal episodes and chronic diarrhea. CT scan of the abdomen in 2006 revealed lymphadenopathy, hepatosplenomegaly, and osteosclerosis. Inguinal and cervical lymph node biopsies in 2006 and 2012, and two bone marrow biopsies in 2012 were negative for malignancy. In 2009, he was diagnosed with non-ischemic cardiomyopathy with an ejection fraction of 40%. Peripheral blood, lymph node, and bone marrow flow cytometry were also unrevealing. On admission, the eosinophil count on admission was 500/µL. Echocardiography showed a large pericardial effusion with impaired right ventricular filling and significant respiratory variation in transmitral flow velocity. A pericardial window was placed, with drainage of approximately 1 liter of exudative fluid. During the surgery, the patient suffered sudden hypotension requiring epinephrine infusion. Tryptase levels drawn were 115 and 154 ng/ml. Pericardial tissue showed scattered c-Kit+ and CD25+ mast cells and blood PCR showed D816V mutation in the c-KIT gene. Re-stained stomach biopsy specimens from 2006 showed two clusters of c-Kit+ and CD25+ mast cells. A bone marrow biopsy showed aggregates of c-Kit+, tryptase+, CD25+ mast cells consistent with Systemic Mastocytosis. The transient hypotension was likely due to distributive shock from mast cell degranulation. Hyperactive mast cells may have served as mediators of the inflammatory response, contributing to production of the pericardial effusion leading to tamponade.

Conclusions

SM with tamponade.

Abstract P5 Figure 1

Abstract P3-01-06: Sentinel lymph node biopsy after NACT: Results of a validation study in large/locally advanced breast cancer patients

Background:

Sentinel lymph node biopsy (SLNB) is the current standard of care for surgical staging of clinically node negative axilla (N0) early breast cancer patients undergoing primary surgery. SLN- identification rate (IR) of 90% and SLN- false negative rate (FNR) of 10% are considered minimum acceptable indices for SLNB. Its role in staging axillae in patients undergoing post-NACT surgery is somewhat unclear. In India, and most low-and-middle income countries, large operable breast cancers (LOBC) and locally advanced breast cancers (LABC) constitute a large proportion of breast cancer patients treated. These patients are usually are treated with NACT, followed by surgery and radiation therapy. In a prospective validation SLNB study, we investigated the accuracy of SLNB in staging post-NACT N0 axilla in a patient cohort that were LOBC or LABC at the time of initial presentation.

Methods:

Hundred consenting non-inflammatory LOBC/LABC patients (mean age 49.3+8.6; index stage T3,N0-1=21; T4b,N0-1=33; T1-3,N2a=24; T4b,N2a=22) who were N0 after NACT at time of surgery (Breast conservation surgery in 19, Mastectomy in 81) were included. Majority had Infiltrating ductal carcinoma (n=87), and grade II/III tumors (n=93); 45 were hormone receptor positive (+), 29 had HR negative (-) HER2(+); and 26 had triple negative breast cancer on IHC sub-typing. Commonest NACT regimen used was Anthracycline followed by taxanes in 83. SLNB was performed using low-cost methylene-blue and 99mTc-Antimony-colloid, which were produced in-house using well standardized protocols, with clearance of the institutional ethics committee. Irrespective of the SLN histology, a complete axillary dissection (ALND) was carried out in all. SLN-IR and SLN-FNR were calculated, comparing the histological status of the SLN and the ALND specimen. Factors predicting non-identified SLN and false negative SLN were evaluated in uni-variate and multi-variate analysis.

Results:

With a combination of methylene blue dye and radiopharmaceutical, the SLN-IR was 81%. Mean number of SLN removed was 2.4+/-1.02. Mean number of nodes removed at ALND was 13.3+/-2.2. SLN-IR varied significantly (p&lt;0.05) per index stage, and were- 90.4% in T3,N0-1; 84.4% in T4b,N0-1; 83.3% in T1-3,N2a; and 63.6% in T4bN2a. The FNR was 17.3% for the whole cohort. FNR varied significantly (p&lt;0.05) per index stage, and were- 8.3% in T3,N0-1; 14.9% in T4b,N0-1; 22.2% in T1-3,N2a; and 30% in T4bN2a. Factors found predictive of non-identified SLN were tumor stage T4b, nodal stage N2a, extra-nodal spread, and LVI. Factors found predictive of FNR SLN were tumor stage T4b, nodal stage N2a, and extra-nodal spread.

Conclusions:

Considering SLN-IR of 90% and SLN-FNR of 10% as acceptable standards, SLNB in post-NACT N0 patients undergoing surgery was not found robust in staging the axilla, with the exception of patients with index stage T3,N0-1 who had SLN-IR of 90.4% and SLN-FNR of 8.3%. Patients with (pre-NACT) skin involvement(T4b), matted axillary nodes(N2a) and LVI are fraught with high-risk of non-identification and false-negative SLNB.

Citation Format: Agarwal G, Gambhir S, Lal P, Rajan S, Krishnani N, Mishra A, SabaRetnam M, Agarwal A, Chand G, Verma AK, Mishra SK, Kumari N, Agrawal V, Kheruka SC. Sentinel lymph node biopsy after NACT: Results of a validation study in large/locally advanced breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-01-06.

Pulmonary choriostoma in a case of tuberous sclerosis complex

A 52 years old lady was diagnosed to have Tuberous Sclerosis Complex (TSC) on the basis of 2 major and one minor criterion. She had family history of similar complaints in her sister and two sons. There was involvement of kidney in the form of angiomyolipoma, skin in the form of facial angiofibroma and teeth with a dental pit. She had an unusual lung involvement in the form of multiple small choristomas. Choristoma was diagnosed on transbronchial lung biopsy and was present in the form of disorganised striated muscles. The reported pulmonary manifestations of TCS i.e. lymphangioleiomyomatosis (LAM) and multifocal micronodular pneumocyte hyperplasia (MMPH) are types of hamartomas. Hamartomas and choristomas are both types of disorganized tissue. ‘Choristoma’of lung in TSC however is not reported. Clinopathological correlation of pulmonary hamartoma and choristoma, and treatment in TSC has been discussed.

Screening for depressive disorders in outpatients with mild to moderate psoriasis: a study from North India

BACKGROUND

Psoriasis and depressive disorders commonly occur together. Depressive disorders have an impact on the quality of life and the outcome of psoriasis.

AIMS

The aim of this study was to test the feasibility of using a modification of the Hindi translation of the Patient Health Questionnaire-9 (PHQ-9) as a verbal, clinician administered, short screening questionnaire for detecting depressive disorders.

MATERIALS AND METHODS

One hundred and four out-patients with psoriasis were recruited in the study. In the first stage of the study, socio-demographic data, Psoriasis Area Severity Index (PASI) score, and Dermatological Quality of Life (DLQI) score were recorded. The modified questionnaire was administered by the dermatologist. In the second stage, psychiatric diagnoses were confirmed using the Mini International Neuropsychiatric Interview.

RESULTS

The prevalence of depressive disorders was 39.4%. Receiver operating curve (ROC) analysis showed that the questionnaire had a good discriminant ability in detecting depressive disorders (area under curve: 0.81, SE = 0.04, 95% confidence interval = 0.72-0.89).

LIMITATIONS

The sample size is small and more studies are needed with the screening questions in different languages to validate the findings of the study.

CONCLUSION

The questionnaire can be a useful screening instrument for detecting depressive disorders in patients with psoriasis.

Ross River Virus (RRV) infection in horses and humans: a review

A fascinating and important arbovirus is Ross River Virus (RRV) which is endemic and epizootic in nature in certain parts of the world. RRV is a member of the genus Alphavirus within the Semliki Forest complex of the family Togaviridae, which also includes the Getah virus. The virus is responsible for causing disease both in humans as well as horses. Mosquito species (Aedes camptorhynchus and Aedes vigilax; Culex annulirostris) are the most important vector for this virus. In places of low temperature as well as low rainfall or where there is lack of habitat of mosquito there is also limitation in the transmission of the virus. Such probability is higher especially in temperate regions bordering endemic regions having sub-tropical climate. There is involvement of articular as well as non-articular cells in the replication of RRV. Levels of pro-inflammatory factors viz., tumor necrosis factor-alpha (TNF-α); interferon-gamma (IFN-γ); and macrophage chemo-attractant protein-1 (MAC-1) during disease pathogenesis have been found to be reduced. Reverse transcription-polymerase chain reaction (RT-PCR) is the most advanced molecular diagnostic tool along with epitope-blocking enzyme-linked immunosorbent assay (ELISA) for detecting RRV infection. Treatment for RRV infection is only supportive. Vaccination is not a fruitful approach. Precise data collection will help the researchers to understand the RRV disease dynamics and thereby designing effective prevention and control strategy. Advances in diagnosis, vaccine development and emerging/novel therapeutic regimens need to be explored to their full potential to tackle RRV infection and the disease it causes.

Vertebroplasty in Osteoporotic Spine Fractures: A Quality of Life Assessment

Objective:

Our goal was to perform a quantitative evaluation of the improvement in functional capacity, quality of life, mental function, reduction in drug intake and impact on hospital admissions after vertebroplasty in the treatment of osteoporotic compression fractures. The efficacy of vertebroplasty in relief of pain has been addressed in previous publications but the quantitative evaluation of improvement in quality of life has not been addressed before.

Methods:

This is a prospective study of 42 patients with 83 symptomatic vertebral fractures treated by vertebroplasty with a mean follow-up of 9.1 months. The outcome was measured by pre and postoperatively utilizing the Visual Analogue Scale, the Oswestry Disability Index, the Rolland Morris Scale for Back Pain and EuroQol-5D questionnaire (EQ-5D). The postoperative evaluations were performed at one week, one month, three month, and six month intervals thereafter.

Results:

In 34 out of 39 active patients, marked pain relief was noted (87%). The Visual Analogue Scale score improved from a mean preoperative score of 8.2 to a mean postoperative score of 2.9 (p=0.0000003) at one week follow up and 3.9 at the last follow-up. The Rolland Morris Scale for Back Pain showed a drop from a mean preoperative rating of 13 to a mean postoperative rating of 10, showing a 25% improvement (p= 0.0207). The Oswestry Disability Index preoperatively was 64.4 which improved to 43.8 postoperatively, showing a 32% improvement (p= 0.0207). The EQ-5D showed a mean preoperative index value of 0.097 and mean postoperative index value of 0.592 (p = 0.0000003). All p-values were determined by the Willcoxin sign-ranked test.

Conclusion:

Vertebroplasty is a safe and efficacious procedure with a resulting improvement in pain and quality of life.

A study of elderly unnatural deaths in medico-legal autopsies at Lucknow locality

The main aim of this study was to determine the causes and epidemiological aspects of unnatural deaths in the elderly. Data were collected on 4405 male and female victims of unnatural deaths aged 50 years or more from the total number of 21,235 autopsies performed in King George's Medical University, Lucknow, India over a 5-year period, from 2008 to 2012. There were 3165 male victims and 1240 female victims. Unnatural deaths were higher in rural (64%) than in urban (37%) areas. Accidental deaths were the most common manner of unnatural deaths (59%), followed by suicidal deaths (34%) and homicidal deaths (7%). Traumas were the most common cause of unnatural death (77.3%), followed by undetermined causes (16.6%) and toxicological causes (6.1%). The most common causes of traumatic deaths were blunt head injuries (34%) followed by stab in the chest (6%), burn (16%), blunt injuries in abdomen and chest (10%), firearm injuries in the head and trunk (9%), strangulation (3%), stab in the abdomen (4%), smothering (4%), cut throat (3%), throttling (1%) and hanging (10%). Carbamate poisoning was the most common cause of toxicological deaths (44%) followed by organophosphorous poisoning (33%), ethyl alcohol poisoning (12%), barbiturate poisoning (3%) and zinc phosphide poisoning (8%).

Food-borne pathogens of animal origin-diagnosis, prevention, control and their zoonotic significance: a review

The term food borne diseases or food-borne illnesses or more commonly food poisoning are used to denote gastrointestinal complications that occur following recent consumption of a particular food or drink. Millions of people suffer worldwide every year and the situation is quiet grave in developing nations creating social and economic strain. The food borne pathogens include various bacteria viz., Salmonella, Campylobacter, Escherichia coli, Listeria monocytogenes, Yersinia enterocolitica, Staphylococcus, Arcobacter, Clostridium perfringens, Cl. botulinum and Bacillus cereus and helminths viz., Taenia. They also include protozoa viz., Trichinella, Sarcocystis, Toxoplasma gondii and Cryptosporidium parvum. The zoonotic potential and the ability to elaborate toxins by many of the microbes causing fatal intoxication are sufficient to understand the seriousness of the situation. The viral agents being host specific their transmission to humans through food of animal origin is not yet confirmed although these animal viruses are similar to that of viruses infecting human. Food-borne bacteria; protozoa and helminthes have complex distribution pattern in the environment and inside the host system. This along with complexity of the maintenance chain and life cycle (of parasites) has made it difficult for epidemiologist and diagnostician to undertake any immediate safety measures against them. Serological and molecular diagnostic tests viz. ELISA, Latex agglutination test, Lateral flow assays, Immunomagnetic separation assays, molecular assays viz. Polymerase Chain Reaction (PCR), multiplex PCR, immuno-PCR, Realtime PCR, Random Amplified Polymorphic DNA (RAPD)-PCR, DNA microarrays and probes are widely used. Along with these LAMP assays, Capillary Electrophoresis-Single Strand Confirmation polymorphism (CE-SSCP); Flow cytometry, FISH, Biosensors, Direct epifluorescent filter technique, nanotechnology based methods and sophisticated tools (ultrasonography, magnetic resonance imaging and chlonangio-pancreatography) have aided in the diagnosis greatly. Most of the food-borne illnesses are self-limiting but in many instances antibiotics are recommended. With the increased drug resistance however use of chicken immunoglobulin, bacteriophage therapy, probiotics and herbs are gaining much importance these days. Adoption of proper prevention and control measures (including cooking procedures; hygiene, strict adherence to HACCP principles, public awareness and disease surveillance and monitoring) are the need of hour. All these have been discussed vividly in this review to help epidemiologists, diagnosticians, clinicians and above all common people so as to enable them avoid negligence regarding such serious issue.

Molecular and biochemical characteristics of recombinant β-propeller phytase from Bacillus licheniformis strain PB-13 with potential application in aquafeed

Phytic acid is the major storage form of organic phosphorus in nature- and plant-based animal feed. It forms insoluble complexes with nutritionally important metals and proteins that are unavailable for monogastric or agastric animals. Phytases initiate the stepwise hydrolysis of phytic acid and release inorganic orthophosphate. In the present investigation, the phytase gene from a phytase producing Bacillus licheniformis strain PB-13 was successfully expressed in Escherichia coli BL21. Recombinant phytase 'rPhyPB13' was found to be catalytically active, with an activity of 0.97 U/mL and specific activity of 0.77 U/mg. The rPhyPB13 was purified to 14.10-fold using affinity chromatography. Similar to other β-propeller phytases, purified rPhyPB13 exhibited maximal activity at pH 6.0-6.5 and 60 °C in the presence of 1 mM Ca(2+) and was highly active over a wider pH range (pH 4.0-8.0) and high temperature (80 °C). It has shown maximum activity towards Na-phytate as substrate. The observed K m , V max and k cat of purified rPhyPB13 were 1.064 mM, 1.32 μmol/min/mg and 27.46 s(-1), respectively. PhyPB13 was resistant to trypsin inactivation, activated in presence of Ca(2+) and inhibited in presence of EDTA. Crude rPhyPB13 has good digestion efficiency for commercial feed and soybean meal. These results indicate that PhyPB13 is a β-propeller phytase that has application potential in aquaculture feed.

High-resolution chromatin immunoprecipitation (ChIP) sequencing reveals novel binding targets and prognostic role for SOX11 in mantle cell lymphoma

Sex determining region Y-box 11 (SOX11) expression is specific for mantle cell lymphoma (MCL) as compared with other non-Hodgkin's lymphomas. However, the function and direct-binding targets of SOX11 in MCL are largely unknown. We used high-resolution chromatin immunoprecipitation sequencing to identify the direct target genes of SOX11 in a genome-wide, unbiased manner and elucidate its functional significance. Pathway analysis identified WNT, PKA and TGF-beta signaling pathways as significantly enriched by SOX11-target genes. Quantitative chromatin immunoprecipitation sequencing and promoter reporter assays confirmed that SOX11 directly binds to individual genes and modulates their transcription activities in these pathways in MCL. Functional studies using RNA interference demonstrate that SOX11 directly regulates WNT in MCL. We analyzed SOX11 expression in three independent well-annotated tissue microarrays from the University of Wisconsin (UW), Karolinska Institute and British Columbia Cancer Agency. Our findings suggest that high SOX11 expression is associated with improved survival in a subset of MCL patients, particularly those treated with intensive chemotherapy. Transcriptional regulation of WNT and other biological pathways affected by SOX11-target genes may help explain the impact of SOX11 expression on patient outcomes.

Maxillary sinus tuberculosis: various presentations

Tuberculosis (TB) of the maxillary sinus is rare. We describe the clinical presentation, management and outcome in two human immunodeficiency virus (HIV) seronegative patients with histopathologically confirmed maxillary sinus TB. One of the patients who presented earlier in the course of the disease could be managed with antituberculosis treatment alone, while the other who presented late required surgical intervention as well.

Cross sectional study of osteoporosis among women

Osteoporosis is a major public health problem, associated with substantial morbidity and socio-economic burden. An early detection can help in reducing the fracture rates and overall socio-economic burden. The present study was carried out to screen the bone status (osteopenia and osteoporosis) above the age of 35 yrs in the women. A community based cross sectional study was carried out in 158 women by calculating WHO T-scores utilizing calcaneal QUS as diagnostic tool. The prevalence of osteoporosis and osteopenia was found to be 13.3% ± 5.29% and 48.1% ± 7.79% respectively. Statistical association of prevalence of osteopenia and osteoporosis was found to be significant with age group; gravida status; attainment of menopause; body weight and physically active status of the women. The statistical association was not significant in relation to the rank status of their husband, as well as dietary pattern of the women but still it has to be substantiated by conducting larger community based trials in future. The present study found that there was statistically significant relationship between age group and the prevalence of osteopenia and osteoporosis. There was a negative correlation between age of the women and BMD. Besides age, gravida status and menopausal status have negative correlation with BMD while positive correlation with physically active lifestyle. The results were found to be non-significant in relation to rank status of husband and dietary pattern.

Clozapine-induced stuttering: a case report and analysis of similar case reports in the literature

There is limited literature reporting clozapine-associated stuttering. In this case report, we present a case of a young male who developed stuttering with clozapine, which improved with dose reduction. Computer-assisted searches on clozapine-induced stuttering yielded 16 cases, and analysis of these case reports suggests that stuttering may be linked to seizures or movement disorders, but other putative mechanisms may be at work, which need further research.

Factors predicting surgical outcome of thymectomy in myasthenia gravis: A 16-year experience

Aim:

To assess the surgical outcome of myasthenia gravis (MG) following thymectomy and to determine the outcome predictors to such therapeutic approach.

Materials and Methods:

This study is a retrospective review of 80 consecutive thymectomies performed for MG over a 16-year period.

Results:

There were 41 females and 39 males (mean age, 34.32 years) with mean disease duration of 17.45 months prior to surgery. Stagewise distribution of the patients revealed 2.5% in stage I, 48.7% in stage IIA, 33.8% in stage IIB, 8.7% in stage III, and 6.3% in stage IV. The surgical approach was either trans-sternal (n=67) or video-assisted thoracoscopic route (n=13). Follow-up was obtained in 91.2% (n=73) of patients with mean duration of 67.7 months. At their last follow-up, 26.0% were in complete remission, 35.6% were asymptomatic on decreased medications, and 17.8% had clinical improvement on decreased medications. Overall, 79.4% of patients benefited from surgery, 8.2% had unchanged disease status, and 12.3% worsened clinically. Factors influencing favorable outcome include sex, disease stage, gland weight, and preoperative medication with anti-cholinesterase (P<0.05). There was one death in the perioperative period due to septicemia. Two patients died at fourth and seventh month following thymectomy.

Conclusion:

Thymectomy for MG is safe and effective. Certain influencing factors may shape treatment decisions and target higher risk patients.

Prevalence of non-tuberculous mycobacterium in a tertiary care hospital from South India

Tuberculosis is a wide spread infectious disease all over the world as well as in India. Other than tuberculosis complex, more than 30 different non-tuberculous mycobacteria (NTM) are responsible for various diseases, i.e. cervical lymphadelopathy, cutaneous abscess, pulmonary diseases, post-operative infections, etc. These NTMs are resistant to commonly used antimicrobial and anti-tubercular agents, jeopardizing the DOTS and DOTS PLUS program in the country. The accurate diagnosis of mycobacteria upto species level is an urgent need to check/control the increasing incidence of tuberculosis in community. A total of 3456 pulmonary and extra-pulmonary samples were subjected to smear examination and culture. The cultures were done in duplicate using Lowenstein Jensen media and examine weekly upto 8 weeks. A total of 33 positive cultures were identified by growth rate, pigment production, niacin test, nitrate test, heat stable catalase test, semiquantitative catalase test, tellurit reduction test, urease test, tween 80 hydrolysis, growth on McConkey media, growth in 5% sodium chloride and susceptibility to para-nitro benzoic acid. The results showed 33.33% were mycobacterium tuberculosis complex and 66.66% were non-tuberculosis mycobacterium. Among the non-tuberculous group, 11 different species of mycobacteria were identified during this study. Identification of mycobacteria is an utmost necessity in every big hospital as it helps clinicians to treat and stop further spread of the disease tuberculosis. This study reveals that NTM are the major group in culture positive pulmonary and extrapulmonary tuberculosis. The importance of NTM can be further evaluated by conducting more studies and need active participation of reference laboratories.

Clinicopathological profile, airway management, and outcome in huge multinodular goiters: an institutional experience from an endemic goiter region

BACKGROUND

Huge goiters are common in iodine-deficient endemic regions. They are of concern to the surgeons because of the anticipated risk of difficult dissection and increased chances of surgical complications. Similarly, they are of concern to the anesthesiologists because of anticipated intubation-related difficulties and post-thyroidectomy tracheomalacia. In the present study we aimed to present our experience of managing goiters based on their gross weight, highlighting their clinicopathological profile, perioperative airway-related difficulties, and management of surgical morbidity.

METHODS

Retrospective analysis of patients who underwent total thyroidectomy in the primary setting at our institute from 1995 to 2009 was carried out based on the gross gland weight. The patients were thus grouped into group A: ≤200 g; group B: 201 to ≤400 g; group C: 401 to ≤600 g; group D: >600 g.

RESULTS

Group A (660 cases); group B (108 cases); group C (36 cases); and group D (9 cases) were included. As the goiter size increased, the mean duration of goiter, compressive symptoms, retrosternal extension (RSE), airway deformity, intubation difficulty, and tracheomalacia increased. The rate of tracheostomy, sternotomy, hemorrhage, visceral injury, and hospital stay was high with huge goiters. These features were more marked in malignant goiters compared to benign goiters. However, the postoperative complications were comparable in both of those groups.

CONCLUSIONS

Long-standing huge goiters are common in iodine-deficient endemic areas. The majority of patients have symptomatic or clinicoradiological evidence of airway involvement. The incidence of RSE, airway deformity, intubation difficulty, and tracheomalacia is high with huge goiters. The surgery is technically demanding with greater associated chances of injury to native structures. Malignancy influences the presentation and outcome in smaller goiters. In centers with experienced endocrine surgeons and dedicated anesthetists, huge goiters can be successfully managed with minimal short-term and long-term morbidity.

Heat shock protein 60 of filarial parasite Brugia malayi: cDNA cloning, expression, purification and in silico modeling and analysis of its ATP binding site

We report here cloning and expression of full length mitochondrial HSP60 gene of Brugia malayi adult worm (mtHSP60bm), purification of the gene product by affinity chromatography, its in silico 3D structure and the sequence homology of the protein with Escherichia coli GroEL/ES and human HSP60. The ATP binding pocket of human HSP60 and mtHSP60bm were analyzed and compared using in silico models. The distribution of HSP60 in different life-stages of the parasite was determined using antibodies raised against recombinant mtHSP60bm (rmtHSP60bm). mtHSP60bm was present in all life-stages of the parasite except third stage infective larvae, in which it could be induced by heat-shock, and showed high degree of homology with E. coli GroEL/ES. The ATP binding pocket of HSP60 in humans, E. coli and B. malayi were also found structurally conserved. This similarity between human and mtHSP60bm might be useful in understanding the host-parasite interactions. This is the first ever report on distribution, cloning, sequence homology and ATP binding site of mtHSP60bm.

Refractory delirium tremens: a case report and brief review

Delirium tremens is a common presentation in tertiary care hospitals. Severe and/or refractory delirium tremens is not as common, is potentially lethal, and requires intensive management. Usually delirium tremens responds to management with standard doses of benzodiazepines. Limited literature is available, however, for the management of refractory delirium tremens. We describe a case of refractory delirium tremens in which the patient was successfully managed with a combination of high doses of lorazapam, midazolam, and phenytoin.

A pilot study of same day sputum smear examination, its feasibility and usefulness in diagnosis of pulmonary TB

INTRODUCTION

A large number of tuberculosis cases are continuously being reported from India and other developing countries leading to high morbidity and mortality. In spite of many newer tests available for diagnosing a case of tuberculosis, smear microscopy of sputum is still the preferred test under programmatic conditions. The current national and international guidelines recommend two sputum smear examinations in two days for diagnosing cases of tuberculosis, which is time-consuming, tedious, needs multiple visits, leading to high dropout of infectious cases. In the background of existing limitations of smear microscopy, we attempted to complete the diagnosis of tuberculosis on same day by serial collection of the spot sputum specimen and analyze its advantages, feasibility and viability.

MATERIAL & METHODS

The study was undertaken by the Department of Microbiology, Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases during May 2010 to April 2011. Sputum specimens were collected from 330 randomly selected tuberculosis suspects who attended OPD of hospital, patients submitted spot and home collected morning sputum sample in a standard method and spot and additional spot sputum (X- spot) collected one hour after the first spot sample as per the proposed front loading method. All the samples received were stained by acid fast Ziehl-Neelsen (ZN) stain and examined on the same day. The sputum sample was pooled and cultured in Lowenstein Jensen (LJ) media in duplicate set of bottles. The results of two different microscopic methods were compared with the gold standard culture test.

RESULTS

Out of the total 330 TB suspects, 70.60% were males and 29.39% females. The most common complaint was of cough with sputum (88.18%), chest pain (70.21%), fever (55.15%) and loss of appetite (43.03%). Upon examining the total sputum slides, 18.48 % were positive for acid fast bacilli. The smear positivity was 61/330 (18.48%) by standard methods and in proposed new method 43/330 (13.03%). Sensitivity of the standard and proposed new method smear microscopy was 58.25% and 40.07% respectively and specificity was 99.55% in both the methods.

CONCLUSION

Same day smear microscopy for diagnosing tuberculosis by a proposed new method of smear examination in the case of suspected tuberculosis seems not a promising step towards improving the quality of sputum smear examination. The results of sensitivity and specificity of the two approaches were not similar. More than eighty per cent responded in favour of same day sputum delivery system and getting result on same day. This study can be confirmed on larger scale and preference of patients can be examined in peripheral laboratory also before taking it up for consideration in the national tuberculosis programme.

Functional impression technique for an ocular prosthesis

The loss of an eye is the most devastating, psychologically damaging experience for a patient. All hope to bring such patients back to their accustomed and comfortable life-style rests on a cosmetically acceptable prosthesis. An intra-orbital ocular prosthesis serves the purpose in those defects where the orbital margins are intact. Though the stock eye may match the natural eye's iris and sclera in color, the fit of the prosthesis to the tissue bed may not be as good as desired. Herein, a functional ocular impression technique is presented to achieve a better fit of the prosthesis to the defect area. This technique aims to combine cosmetic excellence with comfort for greater benefit to the patient.