Parametric optimization of hexavalent chromium removal by electrocoagulation technology with vertical rotating cylindrical aluminum electrodes using Taguchi and ANN model

This study aims to evaluate the performance of rotating aluminum electrodes in the electrocoagulation reactor for removing hexavalent chromium (Cr6+) from synthetic tannery wastewater. Taguchi and Artificial Neural Network (ANN) based models were developed to obtain the optimum condition for maximum Cr6+ removal. The optimum working condition obtained by Taguchi approach for the maximum Cr6+ removal (94%) was: Initial Cr6+ concentration (Cr6+ i) = 15 mg/L; Current Density (CD) = 14.25 mA/cm2; Intial pH = 5; Rotational Speed of Electrode (RSE) = 70 rpm. In contrast, the optimal condition for maximum Cr6+ ions removal (98.83%) obtained from the BR-ANN model was: Cr6+ i = 15 mg/L; CD = 14.36 mA/cm2; pHi = 5.2; RSE = 73 rpm. Compared to the Taguchi model, the BR-ANN model outperformed in terms of providing higher Cr6+ removal (+ 4.83%); reduced energy demand (-0.035 KWh/gm Cr6+ remove); lower error function value (χ2 = -7.9674 and RMSE = -3.5414); and highest R2 value (0.9991). The data for the conditions 91,007 < Re < 227,517 and Sc = 102.834 were found to fit the equation for the initial Cr6+ concentration of 15 mg/l; Sh = 3.143Re0.125 Sc0.33. The Cr6+ removal kinetics was best described by Pseudo 2nd Order model, as validated by high R2 and lower error functions value. The SEM and XRF analysis confirmed that Cr6+ was adsorbed and precipitated along with metal hydroxide sludge. The rotating electrode led to lower SEEC (10.25 kWh/m3), as well as maximum Cr6+ removal (98.83%), compared to EC process with stationary electrodes.

Laboratory parameters associated with prolonged hospital length of stay in COVID-19 patients in Johannesburg, South Africa

BACKGROUND

Coronavirus disease (COVID-19) has imposed unprecedented stressors on South Africa (SA)'s healthcare system. Superimposed on the country's quadruple burden of disease, pandemic-related care further exposes existing inequities. Some of these inequities are specific to hospital-based inpatient services, such as the geographical maldistribution of hospital beds, lack of oxygen supplies and assisted ventilation, and scarcity of trained healthcare workers. Certain high-risk groups, such as individuals with cardiometabolic comorbidity, are likely to develop severe COVID-19 disease requiring hospitalisation with potential for a prolonged length of stay (LoS). It may be helpful for health authorities to identify those at risk for prolonged LoS to facilitate appropriate health systems planning.

OBJECTIVES

To identify hospital admission laboratory parameters associated with a hospital stay &gt;14 days in patients with COVID-19 pneumonia.

METHODS

A retrospective observational study design was used. Laboratory data were obtained from an SA private laboratory for 642 inpatients with suspected or confirmed COVID-19 pneumonia, comprising 7 months of admission laboratory data from six private hospitals in Johannesburg, Gauteng Province.

RESULTS

Of 642 hospital admissions for pneumonia, 497 were confirmed to have COVID-19 infection (reverse transcription-polymerase chain reaction test positive). In the COVID-19-positive group, hospital LoS was prolonged in 35.4% of admissions. Univariate analysis demonstrated an association with the following risk factors for prolonged LoS: older age; male sex; high serum creatinine, sodium (Na), chloride, potassium and urea levels and low estimated glomerular filtration rate; raised white blood cell count, lymphopenia, neutrophilia and an elevated neutrophil-to-lymphocyte ratio (NLR); and elevated levels of D-dimers, interleukin-6 (IL-6), and procalcitonin (PCT). The strongest univariate associations (relative risk (RR) ≥2.0) with a hospital stay &gt;14 days were high Na levels, NRL &gt;18, high PCT levels and IL-6 &gt;40 pg/mL. On multivariable analysis, the following factors remained significantly associated with prolonged LoS: older age (RR 1.015 per year of age; 95% confidence interval (CI) 1.005 - 1.024); hypernatraemia (RR 1.80; 95% CI 1.25 - 2.60); hyperkalaemia (RR 1.61; 95% CI 1.18 - 2.20); and neutrophilia (RR 1.47; 95% CI 1.15 - 1.88).

CONCLUSIONS

COVID-19 pandemic preparedness requires hospital-based inpatient care to be prioritised in resource-limited settings, and availability of beds and prompt admissions are essential to ensure good clinical outcomes. In this study of COVID-19 patients admitted with pneumonia, multivariable analysis showed older age, hypernatraemia, hyperkalaemia and neutrophilia to be associated with LoS &gt;14 days. This may assist with healthcare systems planning.

Decreased severity of disease during the first global omicron variant covid-19 outbreak in a large hospital in tshwane, south africa

INTRODUCTION

The coronavirus disease 2019 (COVID-19) first reported in Wuhan China in December 2019 is a global pandemic that is threatening the health and wellbeing of people worldwide. To date there have been more than 274 million reported cases and 5.3 million deaths. The Omicron variant first documented in the City of Tshwane, Gauteng Province, South Africa on 9 November 2021 led to exponential increases in cases and a sharp rise in hospital admissions. The clinical profile of patients admitted at a large hospital in Tshwane is compared with previous waves.

METHODS

The methods should describe what study design you employed for the study and what your sample size was, as it is this is mainly results. 466 hospital COVID-19 admissions since 14 November 2021 were compared to 3976 prior admissions since 4 May 2020. Ninety-eight patient records at peak bed occupancy during the outbreak were reviewed for primary indication for admission, clinical severity, oxygen supplementation level, vaccination and prior COVID-19 infection. Provincial and city-wide daily cases and reported deaths hospitalizations and excess deaths data were sourced from the NICD, the National Department of Health and the South African Medical Research Council.

RESULTS

Deaths and ICU admissions were 4.5% vs 21.3% (p<0.00001), and 1% vs 4.3% (p<0.00001); length of stay was 4.0 days vs 8.8 days; and mean age was 39 years vs 49 years for the Omicron and previous waves respectively. Admissions peaked and declined rapidly with peak bed occupancy at 51% of highest previous peak. Sixty two (63%) patients in COVID-19 wards had incidental COVID-19 following a positive SARS-CoV-2 PCR test . Only one third (36) had COVID-19 pneumonia, of which 72% had mild to moderate disease. The remaining 38% required high care or ICU admission. Fewer than half (45%) of patients in COVID-19 wards compared to 99.5% in the first wave required oxygen supplementation. City and provincial rates show decoupling of cases, hospitalisations and deaths compared to previous waves, corroborating the clinical findings of milder omicron disease in the hospital.

CONCLUSION

There was decreased severity of disease in the Omicron driven fourth wave in the City of Tshwane, its first global epicentre.

Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort

BACKGROUND

Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such as substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse.

METHODS

Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in India was used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse Childhood Experiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smoking and Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysis explained the associations between ACEs and substance misuse with adjustments for confounders such as sex and family structure.

RESULTS

1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, males report more of every individual childhood adversity and are more likely to report misusing substances compared with females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5-11.7) and collective level ACEs (adj OR 6.6, 95% CI 1.4-31.1) show associations with substance misuse whilst in young adults, child level ACEs such as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1-3.5).

CONCLUSION

ACEs such as abuse and domestic violence are strongly associated with substance misuse, most commonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACE resilience programmes and 'trauma-informed' approaches to tackling longer-term impact of ACEs in India.

FUNDING

Newton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and the Indian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).

DNA polymerase λ promotes error-free replication through Watson-Crick impairing N1-methyl-deoxyadenosine adduct in conjunction with DNA polymerase ζ

In a previous study, we showed that replication through the N1-methyl-deoxyadenosine (1-MeA) adduct in human cells is mediated via three different Polι/Polθ, Polη, and Polζ-dependent pathways. Based on biochemical studies with these Pols, in the Polι/Polθ pathway, we inferred a role for Polι in the insertion of a nucleotide (nt) opposite 1-MeA and of Polθ in extension of synthesis from the inserted nt; in the Polη pathway, we inferred that this Pol alone would replicate through 1-MeA; in the Polζ pathway, however, the Pol required for inserting an nt opposite 1-MeA had remained unidentified. In this study, we provide biochemical and genetic evidence for a role for Polλ in inserting the correct nt T opposite 1-MeA, from which Polζ would extend synthesis. The high proficiency of purified Polλ for inserting a T opposite 1-MeA implicates a role for Polλ—which normally uses W-C base pairing for DNA synthesis—in accommodating 1-MeA in a syn confirmation and forming a Hoogsteen base pair with T. The potential of Polλ to replicate through DNA lesions by Hoogsteen base pairing adds another novel aspect to Polλ’s role in translesion synthesis in addition to its role as a scaffolding component of Polζ. We discuss how the action mechanisms of Polλ and Polζ could be restrained to inserting a T opposite 1-MeA and extending synthesis thereafter, respectively.

Bi-allelic MCM10 variants associated with immune dysfunction and cardiomyopathy cause telomere shortening

Minichromosome maintenance protein 10 (MCM10) is essential for eukaryotic DNA replication. Here, we describe compound heterozygous MCM10 variants in patients with distinctive, but overlapping, clinical phenotypes: natural killer (NK) cell deficiency (NKD) and restrictive cardiomyopathy (RCM) with hypoplasia of the spleen and thymus. To understand the mechanism of MCM10-associated disease, we modeled these variants in human cell lines. MCM10 deficiency causes chronic replication stress that reduces cell viability due to increased genomic instability and telomere erosion. Our data suggest that loss of MCM10 function constrains telomerase activity by accumulating abnormal replication fork structures enriched with single-stranded DNA. Terminally-arrested replication forks in MCM10-deficient cells require endonucleolytic processing by MUS81, as MCM10:MUS81 double mutants display decreased viability and accelerated telomere shortening. We propose that these bi-allelic variants in MCM10 predispose specific cardiac and immune cell lineages to prematurely arrest during differentiation, causing the clinical phenotypes observed in both NKD and RCM patients.

A novel role of DNA polymerase λ in translesion synthesis in conjunction with DNA polymerase ζ

As an integral scaffolding component of DNA polymerase (Pol) zeta, Pol lambda adapts Pol zeta–dependent translesion synthesis to operate in a predominantly error-free manner in human cells.

By extending synthesis opposite from a diverse array of DNA lesions, DNA polymerase (Pol) ζ performs a crucial role in translesion synthesis (TLS). In yeast and cancer cells, Rev1 functions as an indispensable scaffolding component of Polζ and it imposes highly error-prone TLS upon Polζ. However, for TLS that occurs during replication in normal human cells, Rev1 functions instead as a scaffolding component of Pols η, ι, and κ and Rev1-dependent TLS by these Pols operates in a predominantly error-free manner. The lack of Rev1 requirement for Polζ function in TLS in normal cells suggested that some other protein substitutes for this Rev1 role. Here, we identify a novel role of Polλ as an indispensable scaffolding component of Polζ. TLS studies opposite a number of DNA lesions support the conclusion that as an integral component, Polλ adapts Polζ-dependent TLS to operate in a predominantly error-free manner in human cells, essential for genome integrity and cellular homeostasis.

Error-Prone Replication through UV Lesions by DNA Polymerase θ Protects against Skin Cancers

Cancers from sun-exposed skin accumulate "driver" mutations, causally implicated in oncogenesis. Because errors incorporated during translesion synthesis (TLS) opposite UV lesions would generate these mutations, TLS mechanisms are presumed to underlie cancer development. To address the role of TLS in skin cancer formation, we determined which DNA polymerase is responsible for generating UV mutations, analyzed the relative contributions of error-free TLS by Polη and error-prone TLS by Polθ to the replication of UV-damaged DNA and to genome stability, and examined the incidence of UV-induced skin cancers in Polθ-/-, Polη-/-, and Polθ-/- Polη-/- mice. Our findings that the incidence of skin cancers rises in Polθ-/- mice and is further exacerbated in Polθ-/- Polη-/- mice compared with Polη-/- mice support the conclusion that error-prone TLS by Polθ provides a safeguard against tumorigenesis and suggest that cancer formation can ensue in the absence of somatic point mutations.

Clinical and laboratory profile of anti-M

Anti-M is a frequently detected naturally occurring antibody that has been reported in various clinical settings and also in voluntary donors. We describe here the clinical and laboratory findings of 11 cases with anti-M detected at our center. This report is a retrospective study in which we reviewed our immunohematology laboratory records for cases involving anti-M. Both donor and patient data from a 28-month period (September 2014 to December 2016) were reviewed. During this period, 11 examples of anti-M were detected (8 patients, 1 voluntary whole blood donor, and 1 hematopoietic stem cell donor. Anti-M was also detected in one external quality assessment scheme sample received during this period. In conclusion, anti-M can be detected in various clinical settings. This antibody can be clinically significant; in the laboratory, it can present as a serologic problem such as an ABO group discrepancy or an incompatible crossmatch. After detection, management and course of action is determined by both the antibody characteristics and the clinical setting. Anti-M is a frequently detected naturally occurring antibody that has been reported in various clinical settings and also in voluntary donors. We describe here the clinical and laboratory findings of 11 cases with anti-M detected at our center. This report is a retrospective study in which we reviewed our immunohematology laboratory records for cases involving anti-M. Both donor and patient data from a 28-month period (September 2014 to December 2016) were reviewed. During this period, 11 examples of anti-M were detected (8 patients, 1 voluntary whole blood donor, and 1 hematopoietic stem cell donor. Anti-M was also detected in one external quality assessment scheme sample received during this period. In conclusion, anti-M can be detected in various clinical settings. This antibody can be clinically significant; in the laboratory, it can present as a serologic problem such as an ABO group discrepancy or an incompatible crossmatch. After detection, management and course of action is determined by both the antibody characteristics and the clinical setting.

Effects of Thrombolytic Therapy on Hemorrhage from Post-operative Wounds

Hemorrhage from post-operative wounds in different organs and structures during thrombolytic therapy was investigated in relation to the time after surgical trauma and to the results of laboratory tests of coagulation and fibrinolysis. Streptokinase was given to rabbits at different times following the production of standardized wounds in different organs. Bleeding was frequent and severe when streptokinase was given between one and five days after surgery and was most marked from artery, followed in order by kidney, vein, liver, muscle, gut and skin. Bleeding appeared to be associated with the in vitro demonstration of an active systemic fibrinolytic state together with elevated levels of fibrin degradation products.

Barriers to tuberculosis care delivery among miners and their families in South Africa: an ethnographic study

SETTING

South African miners suffer the highest tuberculosis (TB) rates in the world. Current efforts to stem the epidemic are insufficient. Historical legacies and persistent disease burden demand innovative approaches to reshape health care delivery to better serve this population.

OBJECTIVE

To characterize social and behavioral health determinants for successful TB care delivery and treatment from the perspective of miners/ex-miners, health care workers and policy makers/managers.

DESIGN

We conducted applied ethnography with 30 miners/ex-miners, 13 family/community members, 14 health care providers, and 47 local policy makers/managers in South Africa.

RESULTS

Miners/ex-miners felt health care delivery systems failed to meet their needs. Many had experienced unnecessary physical and psychological harm due to limited health education about TB, minimal engagement in their own care, lack of trust in providers, and a system that did not value their experience. Stigma and fear associated with TB result in denial of symptoms and delays in care seeking. Health care providers and policy makers/managers felt discouraged by system constraints in providing optimal care.

CONCLUSION

Our findings describe long-term effects of perpetual TB misinformation and stigma resulting from fear and disempowerment among miners and their families/communities. To reduce the TB burden, there is an urgent need to co-design a care delivery system with miners to better meet their needs.

An efficient protocol for in vitro direct shoot organogenesis of Sesamum indicum L. using cotyledon as explant

Establishment of a suitable regeneration protocol is a pre-requisite to carry out transformation study in Sesamum indicum L. (sesame). In this paper, different parameters of regeneration were standardised to develop an efficient protocol for in vitro plant regeneration via direct adventitious shoot organogenesis using de-embryonated cotyledons of sesame as explants. Among the various treatments of MS medium supplemented with 6-benzylaminopurine, thidiazuron and indole-3-acetic acid, maximum regeneration frequency (25.93  ±  2.21%) was obtained in BTI 4 medium (MS supplemented with 33.33 µM BAP with 2.85 µM IAA) within 6 weeks of culture. Regeneration frequency increased further (50.37 ± 2.49%) by fortifying BTI 4 with 29.43 µM silver nitrate (AG 3 medium). Pre-culture of cotyledon explants in AB 3 medium (AG 3 supplemented with 3.78 µM abscisic acid) for 14 days followed by sub-culture in AG 3 medium further improved the regeneration frequency (68.15 ± 2.68%). The highest rate of shoot regeneration (94.82 ± 1.34%) was obtained by pre-culturing 4-day-old cotyledon in a vertical position in AB 3 medium for 14 days and sub-culturing in AG 3 medium for 4 weeks. Regenerated shoots proliferated in MS medium supplemented with 4.44 μM BAP and 1.44 μM gibberelic acid (GA₃). The highest frequency (65.33 ± 3.78%) of root induction was achieved by culturing the elongated shoots in MS medium supplemented with 2.69 μM α-naphthalene acetic acid (NAA) for 6 weeks. Rooted plants were acclimatised in soilrite and transferred to soil after 6-8 weeks. The rate of acclimatisation of plants was 76%.

A prospective comparative clinical study of peripheral blood counts and indices in patients with primary brain tumors

BACKGROUND

Elevation of the neutrophil to lymphocyte ratio (NLR) has been shown to be an indicator of poor prognosis in many malignancies including recurrent glioblastoma multiforme.

OBJECTIVES

This study was aimed at assessing if the NLR and other leukocyte counts and indices were deranged in treatment-naïve patients with primary brain tumors when compared with an age-matched healthy control group.

MATERIALS AND METHODS

This was a prospective comparative clinical observational study by design. A healthy control population was compared with treatment-naïve patients diagnosed with intra- and extraaxial brain tumors. Leukocyte counts (neutrophil, lymphocyte, monocyte, eosinophil, and basophil counts) as well as leukocyte ratios such as the NLR and the monocyte to lymphocyte ratio (MLR) were calculated. We also evaluated if the counts and indices were related to the tumor volume.

RESULTS

In all patients with tumors, the platelet and neutrophil counts were elevated when compared to the controls. In contrast, monocyte counts and the MLR were found to be decreased in patients with tumors when compared to the controls. The subset of patients with glioblastoma showed a significant increase in NLR when compared to the controls.

CONCLUSIONS

Significant changes in the neutrophil, monocyte, and platelet counts as well as NLR and MLR were observed. Prospective longitudinal studies are required to determine the prognostic and therapeutic implications of these findings.

A randomized study of very low-dose factor VIII prophylaxis in severe haemophilia - A success story from a resource limited country

INTRODUCTION

Current factor prophylaxis strategy practised in developed countries is not feasible in resource constraint developing countries like India.

AIM

The aim of this study was to investigate the efficacy and safety of very low-dose factor prophylaxis in India.

METHODS

Children of 1-10 years of age with severe haemophilia were randomized to Prophylaxis group and Episodic (On demand) group. Children in prophylaxis group received very low-dose factor VIII (FVIII) concentrate, i.e. 10 units kg(-1) body weights on 2 days a week. Episodic group received factor concentrate in standard recommended doses. The study period was 11.5 months.

RESULTS

In total 21 children were enrolled in this study, 11 assigned to prophylaxis and 10 to episodic group. Children on prophylaxis had 11 joint bleeds in comparison to 57 joint bleeds in episodic group. Mean number of haemarthrosis per patient per month were 0.08 (0.08 ± 0.13) in prophylaxis group compared to 0.48 (0.48 ± 0.34) in episodic group (P < 0.05). Total FVIII consumption was 87.51 and 56.32 units kg(-1) month(-1) in prophylaxis and episodic group respectively (P = ns). Overall median hospital emergency visits were 1 day in prophylaxis group and 9 days in episodic group (P ≤ 0.05). Median days of absenteeism from school were 25 days in episodic group and 3 days in prophylaxis group (P < 0.05). No significant complications were noted in prophylaxis group and compliance was 98%.

CONCLUSION

To conclude, low-dose FVIII prophylaxis is cost effective, efficacious and a safe method of preventing joint bleeds and consequent joint damages.

Non-haematopoietic malignancies metastasing to the bone marrow: a 5 year record-based descriptive study from a tertiary care centre in South India

INTRODUCTION

Bone marrow involvement by a non-haematological malignancy gives an opportunity to identify the lodgement, invasion of metastatic cells and the response of the host to the tumor cells. The study was undertaken to assess the involvement of bone marrow with non-haematopoietic malignancies and its significance in establishing primary diagnosis in clinically unsuspected cases.

MATERIALS AND METHODS

This was a descriptive study which included record review of the departmental archives for the last five years (January 2007 to December 2011). Eighty four cases were studied; which included clinically diagnosed non-haematological malignancy for staging or symptomatic cytopenias/bony lesions (group 1, n = 63), clinically suspected bone marrow metastasis of unknown primary malignancy due to symptomatic cytopenias/bony lesions (group 2, n = 07) and clinically unsuspected malignancy with incidentally detected bone marrow metastasis (group 3, n = 14).

RESULTS

Bone marrow metastases of solid tumors were identified in 23 cases (27.3%) which included 9 cases from group 1, 14 cases from group 3 and nil in group 2. Of the 14 cases in group 3, in 12 cases a definitive diagnosis could be made by correlating clinicoradiological findings with morphology and immunohistochemistry. The most common tumor in pediatric cases were neuroblastoma and Ewing's sarcoma (40%) and in adult's adenocarcinoma of gastrointestinal tract (30.7%) was the commonest.

CONCLUSION

Bone marrow metastasis can masquerade as a primary haematopoietic disorder; however its detection has both therapeutic and prognostic significance. Immunohistochemistry is a useful adjunct to morphology in reaching a definitive diagnosis.

A case of pediatric acute lymphoblastic leukemia with invasive candidiasis: short review

Mortality rate associated with invasive fungal infections is very high. Early suspicion for fungal infections is important during intensive chemotherapy for acute leukemia. Empirical treatment with antifungals amphotericin B or caspofungin should be started if patient is not responding to broad spectrum antibiotics and if expected duration of neutropenia is prolonged. We are reporting a 3 years old girl child with diagnosis of pre-B acute lymphoblastic leukemia who developed invasive candidiasis with typical clinical and radiological findings during induction chemotherapy. Candida non-albicans was isolated and she was treated with amphotericin B followed by caspofungin. Patient deteriorated after initial response and succumbed to death. Species identification and sensitivity pattern of fungus can help in selecting appropriate antifungal drug.

Thoracic cord compression by extramedullary hematopoiesis in thalassemia

Extramedullary hematopoiesis (EMH) refers to hematopoiesis occurring outside the medulla of bone. It may be physiologic or due to pathological conditions like hematopoietic disorders. EMH can involve liver, spleen, thorax, and lymph nodes. It can involve paraspinal tissues with extension and involvement of spinal canal. In our case, the diagnosis was confirmed by the history of the patient stating underlying hematological condition and by magnetic resonance imaging (MRI) findings showing large soft tissue masses in paraspinal areas with involvement of spinal canal and leading to cord compression.

Identification of two functional PCNA-binding domains in human DNA polymerase κ

Previously, we have shown that human DNA polymerase (Pol) η has two functional PCNA-binding motifs, PIP1 and PIP2, and that a C-terminal deletion of Polη that lacks the ubiquitin-binding UBZ domain and the PIP2 domain but retains the PIP1 domain promotes normal levels of translesion synthesis (TLS) opposite a cis-syn TT dimer in human cells. Here, we identify two PIP domains in Polκ and show that TLS occurs normally in human fibroblast cells in which the pip1 or pip2 mutant Polκ is expressed, but mutational inactivation of both PIP domains renders Polκ nonfunctional in TLS opposite the thymine glycol lesion. Thus, the two PIP domains of Polκ function redundantly in TLS opposite this DNA lesion in human cells. However, and surprisingly, whereas mutational inactivation of the PIP1 domain completely inhibits the stimulation of DNA synthesis by Polκ in the presence of proliferating cell nuclear antigen (PCNA), replication factor C, and replication protein A, mutations in PIP2 have no adverse effect on PCNA-dependent DNA synthesis. This raises the possibility that activation of Polκ PIP2 as a PCNA-binding domain occurs during TLS in human cells and that protein-protein interactions and post-transcriptional modifications are involved in such activation.

Are nurse-conducted brief interventions (NCBIs) efficacious for hazardous or harmful alcohol use? A systematic review

AIM

The aim of this study was to compare the efficacy of nurse-conducted brief interventions in reducing alcohol consumption, by looking at with treatment as usual compared with other treatments and general physician-delivered brief interventions within the literature.

BACKGROUND

Globally, the consumption of alcohol is at a worrying level and has significant effects on health when consumed to excess. Numerous studies have reported that brief intervention is effective in reducing excessive drinking. However, evidence on the efficacy of such interventions by nurses is still inconclusive.

METHODS

We included randomized controlled trials of brief interventions in which nurses were primarily involved as therapists, and were designed to achieve a reduction in alcohol consumption and related problems. We used online searches to locate randomized controlled trials in this area published from 1995 till 2012.

FINDINGS

Eleven trials were found meeting inclusion criteria, comparing nurse-conducted brief interventions with a control group or with other treatments. Five trials reported a statistically significant reduction in alcohol consumption in the intervention group with 6-12-month follow-up period and two trials concluded that brief interventions delivered by nurses was as efficacious as by physicians.

IMPLICATIONS FOR NURSING POLICY

The findings of the review have important policy implications for the preparation of nurses as therapists for brief interventions to reduce excessive drinking in a broad range of settings such as primary healthcare and hospital settings. The adoption of this intervention into contemporary nursing practice should be considered by the International Council of Nurses and nurses around the world as, according to the literature, it provides an evidence base for the independent functioning of nurses within the realms of nursing profession and addiction medicine.

CONCLUSION

The results of the review suggest that nurse-conducted brief interventions are an effective strategy for reducing alcohol consumption. We advocate more rigorous randomized controlled trials to underpin its efficacy in both research and real life scenario.

Morbidity from unsafe termination of pregnancy in South Africa

The Termination of Pregnancy (TOP) Act in South Africa (SA) allows women to request TOP for social reasons. A retrospective record review was done on all (85) women who were admitted with complications arising from TOP over a 1-year period in 2008, at the Charlottee Maxeke Johannesburg Academic (CMJA) Hospital, SA. The demography, methods and place of TOP, presenting complications and final management was discussed. Morbidity such as severe blood loss (39%), sepsis (26%), multiple organ dysfunctions (4%) and organ injuries (5%) were observed. A correct guideline for TOP was followed in only 33% of women. Self-induced TOP remained common practice. There is a need for accelerated training among healthcare workers providing TOP in SA to prevent this costly and preventable maternal morbidity.

Substance-induced psychotic disorders: 13-year data from a de-addiction centre and their clinical implications

The relationship between substance use and psychotic disorder has been complex. Alcohol, cannabis, amphetamines, hallucinogens, and phencyclidine have been implicated as a causative factor for psychotic disorders. It is important to differentiate substance induced psychotic disorders (SIPDs) from primary psychotic disorders as management of the two conditions is different. There is paucity of research in the area of SIPD particularly from Asia. The present study was a retrospective study and it determines retrospectively the incidence rate and clinical characteristics of the SIPDs over a period of 13 years. The incidence of SIPDs was found to be 1.4% and all the subjects were males. In the present study, only alcohol and cannabis were implicated as causative agents for SIPDs. The most common type of psychosis was schizophrenia like psychosis, being more common in the cannabis group. The other forms of psychosis included delusional type, hallucinatory type and affective psychosis. 20% of the subjects had a change in diagnosis to either schizophrenia or affective psychosis on follow-up. The present study showed that the presentation of SIPDs is similar to the primary psychotic disorder and this has management implication.

Demographic and clinical variables influencing gestational age at booking among South African pregnant women

A retrospective record review was made of 758 women who delivered over a 2-month period at the Charlottee Maxeke Johannesburg Academic Hospital. Women booking early (up to 14 weeks) were compared with women booking late (from 15 weeks onwards). A total of 45 (6%) and 713 (94%) women booked in the early and late groups, respectively. Women of white ethnicity and women who experienced previous fetal loss booked significantly early. Primigravidae booked significantly late.

Comparison of bioactive glass coated and hydroxyapatite coated titanium dental implants in the human jaw bone

BACKGROUND

Current trends in clinical dental implant therapy include modification of titanium surfaces for the purpose of improving osseointegration by different additive (bioactive coatings) and subtractive processes (acid etching, grit-blasting). The aim of this study was to evaluate and compare the behaviour of hydroxyapatite and the newly developed bioactive glass coated implants (62 implants) in osseous tissue following implantation in 31 patients.

METHODS

Bioactive glass and hydroxyapatite was suitably coated on titanium alloy. Hydroxyapatite coating was applied on the implant surface by air microplasma spray technique and bioactive glass coating was applied by vitreous enamelling technique. The outcome was assessed up to 12 months after prosthetic loading using different clinical and radiological parameters.

RESULTS

Hydroxyapatite and bioactive glass coating materials were non-toxic and biocompatible. Overall results showed that bioactive glass coated implants were as equally successful as hydroxyapatite in achieving osseointegration and supporting final restorations.

CONCLUSIONS

The newly developed bioactive glass is a good alternative coating material for dental implants.

Development of porous HAp and β-TCP scaffolds by starch consolidation with foaming method and drug-chitosan bilayered scaffold based drug delivery system

The inability to maintain high concentrations of antibiotic at the site of infection for an extended period of time along with dead space management is still the driving challenge in treatment of osteomyelitis. Porous bioactive ceramics such as hydroxyapatite (HAp) and beta-tri calcium phosphate (β-TCP) were some of the alternatives to be used as local drug delivery system. However, high porosity and high interconnectivity of pores in the scaffolds play a pivotal role in the drug release and bone resorption. Ceftriaxone is a cephalosporin that has lost its clinical popularity. But has recently been reported to exhibit better bactericidal activity in vitro and reduced probability of resistance development, in combination with sulbactam, a β-lactamase inhibitor. In this article, a novel approach of forming HAp and pure β-TCP based porous scaffolds by applying together starch consolidation with foaming method was used. For the purpose, pure HAp and β-TCP were prepared in the laboratory and after thorough characterization (including XRD, FTIR, particle size distribution, etc.) the powders were used for scaffold fabrication. The ability of these scaffolds to release drugs suitably for osteomyelitis was studied in vitro. The results of the study indicated that HAp exhibited better drug release profile than β-TCP when drug was used alone indicating the high influence of the carrier material. However, this restriction got relaxed when a bilayered scaffold was formed using chitosan along with the drug. SEM studies along with EDAX on the drug-chitosan bilayered scaffold showed closest apposition of this combination to the calcium phosphate surface.

DNA clasping by mycobacterial HU: the C-terminal region of HupB mediates increased specificity of DNA binding

BACKGROUND

HU a small, basic, histone like protein is a major component of the bacterial nucleoid. E. coli has two subunits of HU coded by hupA and hupB genes whereas Mycobacterium tuberculosis (Mtb) has only one subunit of HU coded by ORF Rv2986c (hupB gene). One noticeable feature regarding Mtb HupB, based on sequence alignment of HU orthologs from different bacteria, was that HupB(Mtb) bears at its C-terminal end, a highly basic extension and this prompted an examination of its role in Mtb HupB function.

METHODOLOGY/PRINCIPAL FINDINGS

With this objective two clones of Mtb HupB were generated; one expressing full length HupB protein (HupB(Mtb)) and another which expresses only the N terminal region (first 95 amino acid) of hupB (HupB(MtbN)). Gel retardation assays revealed that HupB(MtbN) is almost like E. coli HU (heat stable nucleoid protein) in terms of its DNA binding, with a binding constant (K(d)) for linear dsDNA greater than 1000 nM, a value comparable to that obtained for the HUalphaalpha and HUalphabeta forms. However CTR (C-terminal Region) of HupB(Mtb) imparts greater specificity in DNA binding. HupB(Mtb) protein binds more strongly to supercoiled plasmid DNA than to linear DNA, also this binding is very stable as it provides DNase I protection even up to 5 minutes. Similar results were obtained when the abilities of both proteins to mediate protection against DNA strand cleavage by hydroxyl radicals generated by the Fenton's reaction, were compared. It was also observed that both the proteins have DNA binding preference for A:T rich DNA which may occur at the regulatory regions of ORFs and the oriC region of Mtb.

CONCLUSIONS/SIGNIFICANCE

These data thus point that HupB(Mtb) may participate in chromosome organization in-vivo, it may also play a passive, possibly an architectural role.

Internet addiction: consensus, controversies, and the way ahead

OBJECTIVES

To review the fast-growing literature on Internet addiction.

METHODS

Descriptive review, using electronic databases as well as hand-search of relevant publications or cross-references from 1970 to 2010.

RESULTS

There are no universally accepted definitions for the captioned condition, but investigators seem to agree that it involves problematic computer usage that is time-consuming and causes distress or impairs functioning in important life domains. Several aetiological models have been proposed, from the diverse perspectives of learning theory, cognitive behavioural theory, social learning, reward deficiency, culture, genetics and neurobiology. Controversies abound, ranging from conceptual (whether behavioural addictions are true addictions), technical (which component of Internet use is a person 'addicted' to), and practical (how should Internet addiction be diagnosed, if it exists at all). However, using various instruments and populations, Internet addiction has been suggested as having a prevalence of 0.3 to 38%, with a young male preponderance. Several screening, diagnostic, and severity assessment instruments are now available, but few have been subjected to rigorous psychometric testing. Psychiatric co-morbidity is common. Treatment modalities lack a firm evidence base, but antidepressants, mood stabilisers, and cognitive behavioural therapy and other psychotherapies have been used.

CONCLUSIONS

Recently, the American Psychiatric Association recommended including Internet addiction in its forthcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, but only as an appendix and not in the main body of the addictive disorders. This appears to be a fairly balanced and cautious approach, which can hopefully give rise to more meaningful research in this important but controversial area.

Orthopaedic applications of bone graft & graft substitutes: a review

Treatment of delayed union, malunion, and nonunion is a challenge to the orthopaedic surgeons in veterinary and human fields. Apart from restoration of alignment and stable fixation, in many cases adjunctive measures such as bone-grafting or use of bone-graft substitutes are of paramount importance. Bone-graft materials usually have one or more components: an osteoconductive matrix, which acts as scaffold to new bone growth; osteoinductive proteins, which support mitogenesis of undifferentiated cells; and osteogenic cells, which are capable of forming bone in the appropriate environment. Autologous bone remains the "gold standard" for stimulating bone repair and regeneration, but its availability may be limited and the procedure to harvest the material is associated with complications. Bone-graft substitutes can either substitute autologous bone graft or expand an existing amount of autologous bone graft. We review the currently available bone graft and graft substitutes for the novel therapeutic approaches in clinical setting of orthopaedic surgery.

Non-healing ulcer on the great toe due to cellular schwannoma

Cellular schwannoma (CS) occurring in the foot is uncommon, and when it does occur, it usually presents as a slowly growing tumour. Ulceration of CS on the foot is rare. We report a 20-year-old woman who presented with a painful and non-healing ulcer on the lateral area of the right great toe, which failed to heal despite treatment. Six months after onset of the ulcer, a small swelling appeared below it. Histological examination of a biopsy taken from the edge of the ulcer established the diagnosis of CS. Preoperative magnetic resonance imaging delineated the mass on the lateral area of the right great toe. The mass was surgically excised, which led to resolution of the symptoms. This case highlights the fact that chronic ulcers in the foot can be due to CS. Correct diagnosis and management depend on a histopathological diagnosis.

YAP insertion signature in South Asia

A total of 2169 samples from 21 tribal populations from different regions of India were scanned for the Y-chromosome Alu polymorphism. This study reports, for the first time, high frequencies (8-65%) of Y Alu polymorphic (YAP) insertion in northeast Indian tribes. All seven Jarawa samples from the Andaman and Nicobar islands had the YAP insertion, in conformity with an earlier study of Andaman Islanders. One isolated case with haplotype E* was found in Dungri Bhill, a western Indian population, while YAP insertion in northeast India and Andaman tribes was found in association with haplotype D* (M168, M174). YAP insertion frequencies reported in the mainland Indian populations are negligible, according to previous studies. Genetic drift may be the causative factor for the variable frequency of the YAP insertion in the mainland populations, while the founder effect may have resulted in the highest incidence of haplotype D among the Andaman Islanders. The results of YAP insertion and the evidence of previous mtDNA studies indicate an early out of Africa migration to the Andaman and Nicobar Islands. The findings of YAP insertion in northeast Indian tribes are very significant for understanding the evolutionary history of the region.