Chemical characterization, source identification and potential health effects of PM2.5-bound non-polar organic compounds over a COALESCE network site - Bhopal, India

Year-long (2019) measurements of carbonaceous aerosols were performed at Bhopal, a regionally representative site as a part of the COALESCE (Carbonaceous Aerosol Emissions, Source apportionment and Climate Impacts) campaign. Aerosol-associated non-polar organic compounds (NPOCs) were analysed using thermal desorption (TD) Gas chromatography/Mass spectrometry (TD-GC/MS). The annual average of the total organic carbon (OC), elemental carbon (EC), and analysed PAHs (Polycyclic Aromatic Hydrocarbons), and n-alkanes were, 9.74 ± 9.47 μg m-3, 2.13 ± 3.12 μg m-3, 10.43 ± 5.49 ng m-3, and 114.93 ± 49.24 ng m-3, respectively. PAHs diagnostic ratios suggested emissions from petroleum, grass, wood, and coal combustion. Combustion derived PAHs (CombPAHs) accounted for 72.5 % of the total measured PAHs. During wintertime, based on Pyr/BaP ratio (∼0.6), gasoline exhaust emissions were higher compared to diesel exhaust emissions. The weak correlations between PAHs and meteorological parameters suggested that variations in PAH levels are primarily driven by alterations in emission sources. Total PAHs were correlated moderately with BrC (r2 = 0.60). The estimated lifetime lung cancer risk (LLCR) values on exposure to 16 USEPA priority PAHs (5 × 10-5) demonstrated that PAH levels in this region pose moderate health risks. Given observations from only campaign mode short-term measurements of NPOCs over India, this work provides a more comprehensive understanding of the concentrations, seasonal variations, and sources of n-alkanes and health risk associated with particle bound PAHs over the data-poor central Indian region.

Rete middle cerebral artery presenting with a ruptured aneurysm

ABSTRACT

The developmental anomaly of the middle cerebral artery (MCA) is a rare occurrence. Rete MCA, also known as "unfused," "twig-like," and aplastic MCA, is an even rarer anomaly. These immature rete vessels are prone to flow-related aneurysms which rupture themselves presenting with intraparenchymal hematoma. We here with present a case of rete MCA with a ruptured aneurysm and discuss its pathophysiology and management.

Decoding seasonal changes: soil parameters and microbial communities in tropical dry deciduous forests

In dry deciduous tropical forests, both seasons (winter and summer) offer habitats that are essential ecologically. How these seasonal changes affect soil properties and microbial communities is not yet fully understood. This study aimed to investigate the influence of seasonal fluctuations on soil characteristics and microbial populations. The soil moisture content dramatically increases in the summer. However, the soil pH only gradually shifts from acidic to slightly neutral. During the summer, electrical conductivity (EC) values range from 0.62 to 1.03 ds m-1, in contrast to their decline in the winter. The levels of soil macronutrients and micronutrients increase during the summer, as does the quantity of soil organic carbon (SOC). A two-way ANOVA analysis reveals limited impacts of seasonal fluctuations and specific geographic locations on the amounts of accessible nitrogen (N) and phosphorus (P). Moreover, dehydrogenase, nitrate reductase, and urease activities rise in the summer, while chitinase, protease, and acid phosphatase activities are more pronounced in the winter. The soil microbes were identified in both seasons through 16S rRNA and ITS (Internal Transcribed Spacer) gene sequencing. Results revealed Proteobacteria and Ascomycota as predominant bacterial and fungal phyla. However, Bacillus, Pseudomonas, and Burkholderia are dominant bacterial genera, and Aspergillus, Alternaria, and Trichoderma are dominant fungal genera in the forest soil samples. Dominant bacterial and fungal genera may play a role in essential ecosystem services such as soil health management and nutrient cycling. In both seasons, clear relationships exist between soil properties, including pH, moisture, iron (Fe), zinc (Zn), and microbial diversity. Enzymatic activities and microbial shift relate positively with soil parameters. This study highlights robust soil-microbial interactions that persist mainly in the top layers of tropical dry deciduous forests in the summer and winter seasons. It provides insights into the responses of soil-microbial communities to seasonal changes, advancing our understanding of ecosystem dynamics and biodiversity preservation.

Role of Immunological Cells in Hepatocellular Carcinoma Disease and Associated Pathways

Hepatocellular carcinoma (HCC) remains one of the predominant causes of cancer-related mortality across the globe. It is attributed to obesity, excessive alcohol consumption, smoking, and infection by the hepatitis virus. Early diagnosis of HCC is essential, and local treatments such as surgical excision and percutaneous ablation are effective. Palliative systemic therapy, primarily with the tyrosine kinase inhibitor Sorafenib, is used in advanced cases. However, the prognosis for advanced HCC remains poor. This Review additionally describes the pathophysiological mechanisms of HCC, which include aberrant molecular signaling, genomic instability, persistent inflammation, and the paradoxical position of the immune system in promoting and suppressing HCC. The paper concludes by discussing the growing body of research on the relationship between mitochondria and HCC, suggesting that mitochondrial dysfunction may contribute to the progression of HCC. This Review focuses on immunological interactions between different mechanisms of HCC progression, including obesity, viral infection, and alcohol consumption.

Highly Soluble Ambipolar anti-Perylene-3,4 : 9,10-bis(benzimidazole)s Stabilize a Room-Temperature Columnar Hexagonal Phase

A new series of highly soluble perylene anti-bis(4,5-dialkoxybenzimidazole)s bearing branched flexible chains stabilizing room temperature columnar hexagonal phase and with balanced ambipolar charge carrier mobility is reported for the first time. Only the anti isomer was successfully separated and characterized. These compounds have a high extinction coefficient, small optical band gap and wide absorption range, thus making them a promising class of ambipolar organic semiconductors capable of self-organizing.

PM2.5 carbonaceous components and mineral dust at a COALESCE network site - Bhopal, India: Estimating site-specific optical characteristics

Atmospheric PM_2.5 thermal elemental carbon (EC), optical black carbon (BC), brown carbon (BrC), and mineral dust (MD) were characterized during a field campaign at a regionally representative site (Bhopal, central India) all year-long during 2019. In this study, the optical characteristics of PM_2.5 during 'EC-rich', 'OC-rich', and 'MD-rich' days were used in a three-component model to estimate site-specific Absorption Ångström exponent (AAE) and absorption coefficient (b_abs) of light-absorbing PM_2.5 constituents. The AAE for 'EC-rich', 'OC-rich', and 'MD-rich' days were 1.1 ± 0.2, 2.7 ± 0.3, and 3.0 ± 0.9, respectively. The percentage contribution of calculated b_abs of EC, BrC, and MD to the total b_abs at 405 nm was dominated by EC during the entire study period (EC; 64 % ± 36 %, BrC: 30 % ± 5 %, MD: 10 % ± 1 %). Further, site-specific mass absorption cross-section (MAC) values were calculated to assess the impact of their use over the use of manufacturer-specified MAC values in estimating BC concentrations. The r² between thermal EC and optical BC was higher (r² = 0.67, slope = 1.1) when daily site-specific MAC values were used rather than using the default MAC value (16.6 m² g^-1; r² = 0.54 and slope = 0.6). Overall, had the default MAC₈₈₀ been used instead of the site-specific values, we would have underestimated the BC concentration by 39 % ± 18 % during the study period.

PM2.5 carbonaceous components and mineral dust at a COALESCE network site - Bhopal, India: Assessing the impacts of COVID-19 lockdowns on site-specific optical properties

Thermal elemental carbon (EC), optical black carbon (BC), organic carbon (OC), mineral dust (MD), and 7-wavelength optical attenuation of 24-hour ambient PM_2.5 samples were characterized/estimated at a regionally representative site (Bhopal, central India) during a business-as-usual year (2019) and the COVID-19 lockdowns year (2020). This dataset was used to estimate the influence of emissions source reductions on the optical properties of light-absorbing aerosols. During the lockdown period, the concentration of EC, OC, BC_{880 nm}, and PM_2.5 increased by 70 % ± 25 %, 74 % ± 20 %, 91 % ± 6 %, and 34 % ± 24 %, respectively, while MD concentration decreased by 32 % ± 30 %, compared to the same time period in 2019. Also, during the lockdown period, the estimated absorption coefficient (b_abs) and mass absorption cross-section (MAC) of Brown Carbon (BrC) at 405 nm was higher (42 % ± 20 % and 16 % ± 7 %, respectively), while these quantities for MD, i.e., b_abs-MD and MAC_MD values were lower (19 % ± 9 % and 16 % ± 10 %), compared to the corresponding period during 2019. Also, b_abs-BC-808 (115 % ± 6 %) and MAC_BC-808 (69 % ± 45 %) values increased during lockdown periods compared with the corresponding period during 2019. It is hypothesized that although anthropogenic emissions (chiefly industrial and vehicular) reduced drastically during the lockdown period compared to the business-as-usual period, an increase in the values of optical properties (b_abs and MAC) and concentrations of BC and BrC, were likely due to the increased local and regional biomass burning emissions during this period. This hypothesis is supported by the CBPF (Conditional Bivariate Probability Function) and PSCF (Potential Source Contribution Function) analyses for BC and BrC.

Pollution characteristics and ecological risks of trace elements in PM2.5 over three COALESCE network sites - Bhopal, Mesra, and Mysuru, India

Time-synchronized, 24 h integrated PM_2.5 trace element (TE) measurements made as a part of the COALESCE project (Venkataraman et al., 2020) at Bhopal, Mesra, and Mysore during all of 2019 were analyzed in this study. The concentrations of 15 key elements ranged between 0.05 ng m^-3 and 50 μg m^-3 across the study sites. Pronounced seasonal variation of elements from multiple source classes showed that the crustal origin elements (Al, Si, Fe, Ti, and Ca) peaked during the pre-monsoon season, while the anthropogenic activities driven element (P, S, K, V, Mn, Cu, Zn, and Pb) concentrations increased during the winter and post-monsoon seasons. Spearman correlation coupled with hierarchical clustering separated the matrix of elements into three common clusters at all sites, corresponding to crustal sources, combustion and biomass burning emissions, and industrial/non-exhaust vehicular emissions, respectively. Furthermore, episodes of metal pollution throughout the year were examined using characteristic radar charts of TEs to identify the association between TE sources and poor air quality. For example, maximum metal pollution in Bhopal occurred during the post-monsoon season, attributable to biomass burning, dust storms, industrial and non-exhaust vehicular emissions. Finally, an ecological risk assessment revealed that the risk index was higher than the threshold value of 600 for all heavy metals at all sites. Pb, Cu, and Zn were the top contributors to 'extremely high risk' amongst all heavy metals. Overall, the results show that although TE concentrations at all three locations were much lower than in other urban locations in India, the risk from heavy metals to the ecosystem (and likely to human health) cannot be ignored. The findings warrant a full source apportionment of fine PM to better identify TE-rich source contributions and future studies to examine the atmospheric processing and eco-system uptake of TEs.

First example of ambipolar naphthalene diimide exhibiting a room temperature columnar phase

A self-assembled ambipolar organic semiconductor based on naphthalene diimide with low clearing temperature, solution processability, and high molar extinction coefficient, exhibiting a room temperature columnar hexagonal liquid crystalline phase is reported.

A novel single sensor hemoglobin domain from the thermophilic cyanobacteria Thermosynechococcus elongatus BP-1 exhibits higher pH but lower thermal stability compared to globins from mesophilic organisms

Thermosynechococcus elongatus-BP1 belongs to the class of photoautotrophic cyanobacterial organisms. The presence of chlorophyll a, carotenoids, and phycocyanobilin are the characteristics that categorize T. elongatus as a photosynthetic organism. Here, we report the structural and spectroscopic characteristics of novel hemoglobin (Hb) Synel Hb from T.elongatus, synonymous with Thermosynechococcus vestitus BP-1. The X-ray crystal structure (2.15 Å) of Synel Hb suggests the presence of a globin domain with a pre-A helix similar to the sensor domain (S) family of Hbs. The rich hydrophobic core accommodates heme in a penta-coordinated state and readily binds an extraneous ligand(imidazole). The absorption and circular dichroic spectral analysis of Synel Hb reiteratedthat the heme is in Fe^III+ state with a predominantly α-helical structure similar to myoglobin. Synel Hb displays higher resistance to structural perturbations induced via external stresses like pH and guanidium hydrochloride, which is comparable to Synechocystis Hb. However, Synel Hb exhibited lower thermal stability compared to mesophilic hemoglobins. Overall, the data is suggestive of the structural sturdiness of Synel Hb, which probably corroborates its origin in extreme thermophilic conditions. The stable globin provides scope for further investigation and may lead to new insights with scope for engineering stability in hemoglobin-based oxygen carriers.

Ambipolar Columnar Self-assembled Organic Semiconductors based on Heteroatom bay-Annulated Perylene Bisimides

Highly electron-deficient heteroatom (N, S, Se) bay-annulated PBIs exhibiting ordered columnar phase over a wide mesomorphic range including ambient temperature are reported in this manuscript. These compounds with six peripheral n-decyloxy chains exhibited absorption spectra with high molar extinction coefficients, electron-deficient nature and self-assembling behaviour. A detailed comparison with the PBIs bearing six peripheral n-decyl chains was also carried out to get the valuable insights on the structure-property relations in this important class of organic semiconductors. Both of the PBI series were tested for their charge carrier mobility by space charge limited current method and found that they exhibit ambipolar conductivity. This is in contrary to the vast body of literature, where most of the PBI based semiconductors exhibit electron transport behaviour. In general, PBIs derived from tri-n-alkyl anilines exhibit higher mobility values than the PBIs derived from tri-n-alkoxy anilines. Especially, the ambipolar S-annulated PBI derived from tri-n-alkyl aniline exhibited highest hole (8.39×10^-3  cm² /V.s) and electron (1.5×10^-2  cm² /V.s) mobility values and promising for the application in organic electronics.

Tracing the predominant sources of carbon in PM2.5 using δ13C values together with OC/EC and select inorganic ions over two COALESCE locations

As part of the COALESCE (Carbonaceous Aerosol Emissions, Source apportionment and Climate Impacts) campaign, ambient PM_2.5 was collected at two regional sites (Bhopal and Mysuru) in India during 2019. We utilized organic carbon (OC), elemental carbon (EC) and water-soluble inorganic ions together with δ¹³C values, to better understand total carbon (TC) sources at these locations. The annual average δ¹³C values (-26.2 ± 0.6‰) at Mysuru and Bhopal (-26.6 ± 0.6‰) were comparable. However, at Mysuru, except during winter, day-to-day variability was much lower (narrow range of -26.8 to -26.0‰) than that at Bhopal (range: -28.1 to -24.7‰), suggesting that TC was contributed by few sources, likely dominated by vehicular emissions. Seasonal average δ¹³C values at Bhopal increased slightly (-25.8 ± 0.5‰) during the winter (Jan-Feb) and decreased (-27.0 ± 0.3‰) during the monsoon (Jun-Sep) season compared to the annual average. The decrease in δ¹³C values during the monsoon season was likely driven by enhanced secondary organic aerosol formation. Further, based on MODIS derived fire spots and back trajectories, we infered that the δ¹³C values (-27.5 to -26.0‰) in Bhopal during the post-monsoon season (Oct-Dec) were indicative of dominant biomass burning contributions. The inorganic ions/TC ratio during this season suggested that biomass burning aerosol was aged and may have been transported from crop residue burning in the Indo-Gangetic plains. At Mysuru, like the trend at Bhopal, the δ¹³C values during the monsoon season were lower than those during the winter season. Finally, δ¹³C values were input to a Bayesian model-MixSIAR to demonstrate the usefulness of such models in apportioning TC. In its simplest implementation, the model separated TC sources into fossil fuel emissions and non-fossil fuel sources . Fossil fuel combustion emissions accounted for 47 ± 19% and 62 ± 22% of the TC at Bhopal and Mysuru, respectively.

Impact of atmospheric anthropogenic nitrogen on new production in the northern Indian Ocean: constrained based on satellite aerosol optical depth and particulate nitrogen levels

Aerosols are one of the significant external sources of soluble reactive nitrogen to the surface ocean and their deposition affects the primary productivity. Owing to rapid industrialization over South and Southeast Asia, an increasing trend in atmospheric pollutants was observed over the northern Indian Ocean (NIO). To assess the contribution of the aeolian supply of inorganic nitrogen to the NIO, the available compositional data of marine aerosols collected over this basin between 2001 and 2020 were compiled. Based on the observed relationship of mass load, and particulate nitrate and ammonium concentrations with the corresponding satellite-derived anthropogenic aerosol optical depth (AAOD), the temporal, spatial, and long-term variabilities were derived for the past two decades. In particular, high aerosol mass load, nitrate and ammonium levels were observed in the coastal aerosols of peninsular India during fall and winter and they were low in summer. The atmospheric input of inorganic nitrogen to the Arabian Sea is higher (AS; 1.7 TgN per year) compared to that of the Bay of Bengal (BoB; 0.9 TgN per year) and accounts for ∼30% of the total external sources of nitrogen to the NIO. The new production, supported by external sources of nitrogen, contributes to ∼23 and 53% of export production to the oxygen minimum zone (OMZ) in the AS and BoB respectively. A significant rate of increase in the aerosol mass load (0.05-1.67 μg per m³ per year), and nitrate (0.003-0.04 μg per m³ per year) and ammonium (0.006-0.11 μg per m³ per year) concentrations was observed between 2001 and 2020, likely because of the increased emission of anthropogenic pollutants over South and Southeast Asia and their subsequent long-range atmospheric transport to the NIO. Overall, these results suggest that an enhanced contribution of atmospheric nitrogen may potentially increase (1) the N/P ratio of the surface ocean that impacts phytoplankton composition, (2) export production to the OMZ leads to intensification, and (3) sequestration of atmospheric CO₂. A decrease in primary production due to global warming is reported due to a decrease in vertical nutrient supply; however, the increase in atmospheric deposition of nutrients may compensate for this. Therefore, ocean models must be coupled with atmospheric models to better constrain the oceanic response to climate change in the NIO.

Decadal variations in natural and anthropogenic aerosol optical depth over the Bay of Bengal: the influence of pollutants from Indo-GangeticPlain

Perennial increase in atmospheric pollution over the Bay of Bengal (BoB) and South China Sea is reported due to increase in human population and industrial activity in South and Southeast Asia. Based on total aerosol optical depth (AOD) derived from MODIS (moderate resolution imaging resolution imaging spectroradiometer), natural and anthropogenic fractions were derived. The seasonality and spatial variability in rate of increase in total, natural, and anthropogenic AOD fractions were examined over the BoB using data collected between 2001 and 2019. Both total and anthropogenic AOD displayed statistically significant rate of increase in the northwest BoB (NWB) and western coastal BoB (WCB) regions during 2001 to 2019 whereas the long-term changes are insignificant in the other regions of BoB. Significant increase in AOD in the NWB and WCB regions is mainly contributed by dominant outflow of anthropogenic emissions from Indo-Gangetic Plain (IGP) area of Indian subcontinent. The magnitude of AOD decreased by half from northern BoB to equatorial region due to increase in distance from the source region. The contribution of anthropogenic AOD was >70% to total AOD with higher contribution during winter and lower during summer. The rate of increase in both total and anthropogenic AOD was close to 0.104 and 0.099 per decade in the NWB and 0.069 and 0.059 per decade in the WCB region between 2001 and 2019. The rate of increase in total and anthropogenic AOD decreased from 2001-2009 (0.164 and 0.115 per decade respectively) to 2010-2019 (0.068 and 0.076 per decade respectively) in the NWB region. Significant increase in anthropogenic AOD by 50 and 30% was observed during El Niño and La Niña periods respectively than normal year in both northwest BoB (NWB) and western coastal (WCB) regions due to change in strength and direction of winds. Although some fraction of anthropogenic AOD is found over the entire BoB, significant rate of increase in anthropogenic AOD is found only about 23% of the area of BoB than hitherto reported as entire BoB. The impact of atmospheric deposition of anthropogenic aerosols on biogeochemical processes, such as primary production and ocean acidification, needs further evaluation.

Size-segregated chemical source profiles and potential health impacts of multiple sources of fugitive dust in and around Bhopal, central India

PM_2.5 and PM₁₀ fugitive dust samples from multiple sources (construction, demolition, industrial, agricultural fields, and bare ground) were collected in triplicate for each size bin, from 18 distinct locations in and around Bhopal, central India. The dust samples were dried, sieved, and re-suspended in a chamber fitted with a suitable sampling system, to collect PM_2.5 and PM₁₀ samples onto Teflon and Quartz filters. The filters were subjected to gravimetric and chemical analyses. Trace elements, water-soluble ions, and thermal-optical carbon fractions were quantified using a variety of analyses. These species were then used to develop PM₁₀ and PM_2.5 chemical source profiles of the fugitive dust sources. As expected, crustal species were abundant in all source categories. For industrial dust, Fe contribution to mass in both size fractions was about 11.4% and above the upper continental crustal abundance. Further, the source profiles generated for each source were different from their counterparts in the US EPA SPECIATE database and profiles reported in literature. Thus, it will be useful to utilize profiles generated in this study to enhance receptor model performance for the study region. However, collinearity analysis of the profiles revealed that PM₁₀ agricultural and bare ground dust; and PM_2.5 construction and demolition dust profile pairs may not be separated by receptor models. Finally, a human health risk assessment revealed that construction and industrial dust may pose significant risk to the population. The Incremental Lifetime Cancer Risk (ILCR) metric revealed that adults (2 × 10^-5) and children (1 × 10^-5) were susceptible to cancer risk from exposure to metals in PM_2.5 fugitive dust. Further, children were more vulnerable than adults. This finding merits further investigation of oxidation state and solubility/bioavailability of Cr and Ni in fugitive dusts.

Urine Extracellular Vesicle GATA2 mRNA Discriminates Biopsy Result in Men with Suspicion of Prostate Cancer

PURPOSE

Prostate specific antigen has limited performance in detecting prostate cancer. The transcription factor GATA2 is expressed in aggressive prostate cancer. We analyzed the predictive value of urine extracellular vesicle GATA2 mRNA alone and in combination with a multigene panel to improve detection of prostate cancer and high risk disease.

MATERIALS AND METHODS

GATA2 mRNA was analyzed in matched extracellular vesicles isolated from urines before and after prostatectomy (16) and paired urine and tissue prostatectomy samples (19). Extracellular vesicle GATA2 mRNA performance to distinguish prostate cancer and high grade disease was tested in training (52) and validation (165) cohorts. The predictive value of a multigene score including GATA2, PCA3 and TMPRSS2-ERG (GAPT-E) was tested in both cohorts.

RESULTS

Confirming its prostate origin, urine extracellular vesicle GATA2 mRNA levels decreased significantly after prostatectomy and correlated with prostate cancer tissue GATA2 mRNA levels. In the training and validation cohort GATA2 discriminated prostate cancer (AUC 0.74 and 0.66) and high grade disease (AUC 0.78 and 0.65), respectively. Notably, the GAPT-E score improved discrimination of prostate cancer (AUC 0.84 and 0.72) and high grade cancer (AUC 0.85 and 0.71) in both cohorts when compared with each biomarker alone and PT-E (PCA3 and TMPRSS2-ERG). A GAPT-E score for high grade prostate cancer would avoid 92.1% of unnecessary prostate biopsies, compared to 61.9% when a PT-E score is used.

CONCLUSIONS

Urine extracellular vesicle GATA2 mRNA analysis improves the detection of high risk prostate cancer and may reduce the number of unnecessary biopsies.

Spatial and temporal variability in concentration and characteristics of aerosols at Visakhapatnam (east) and Goa (west) coasts of India

Knowledge on the variability in quantity and compositions of various size groups of aerosols is important to understand their sources and their role in biogeochemical and climate processes. Here, we studied total suspended particles (TSP), PM₁₀ and PM_2.5 for their quantitative and water soluble compositional (F^-, Cl^-, SO₄^2-, NO₃^-, NH₄⁺, Na⁺, K⁺, Ca²⁺, and Mg²⁺) distributions, and to understand their nature and potential sources at Goa and Visakhapatnam on the west and east coasts, respectively, of India. While the mean concentrations of TSP were found to be 117 ± 44 and 85 ± 51 μg/m³ its maximal levels occurred in spring intermonsoon (SIM; 141 ± 52) and winter monsoon (WM; 155 ± 145 μg/m³) seasons at Goa and Visakhapatnam, respectively. PM₁₀ and PM_2.5 exhibited higher ranges at Visakhapatnam than Goa. The increase in PM_2.5 abundance from WM to SIM at Visakhapatnam seems to occur in coincidence with decrease in TSP favored by topography and ambient meteorological conditions. Locally released and seasonally transported (from land and sea) constituents contributed to the observed variability in aerosol compositions. Sulphate dominated the aerosol composition at both Goa (57-64%) and Visakhapatnam (43-55%) followed by NO₃^- (5-16% and 6-18%, respectively) where the former component was higher in PM₁₀ and PM_2.5. The NO₃^- was more in TSP. Relations between SO₄^2- and NH₄⁺ suggested possible presence of NH₄HSO₄. Examination of ionic ratios and balance suggested near neutrality in PM₁₀ and PM_2.5 while TSP was acidic at the both locations. Notable relations between Ca²⁺ and NO₃^-, particularly in PM₁₀ at Goa, indicated their release from mining related activities.

Cost-effective way to reduce stimulant-abuse among gay/bisexual men and transgender women: a randomized clinical trial with a cost comparison

OBJECTIVES

A randomized controlled study was conducted with 422 homeless, stimulant-using gay/bisexual (G/B) men and 29 transgender women (n = 451) to assess two community-based interventions to reduce substance abuse and improve health: (a) a nurse case-managed program combined with contingency management (NCM + CM) versus (b) standard education plus contingency management (SE + CM).

STUDY DESIGN

Hypotheses tested included: a) completion of hepatitis A/B vaccination series; b) reduction in stimulant use; and c) reduction in number of sexual partners.

METHODS

A deconstructive cost analysis approach was utilized to capture direct costs associated with the delivery of both interventions. Based on an analysis of activity logs and staff interviews, specific activities and the time required to complete each were analyzed as follows: a) NCM + CM only; b) SE + CM only; c) time to administer/record vaccines; and d) time to receive and record CM visits. Cost comparison of the interventions included only staffing costs and direct cash expenditures.

RESULTS

The study outcomes showed significant over time reductions in all measures of drug use and multiple sex partners, compared to baseline, although no significant between-group differences were detected. Cost analysis favored the simpler SE + CM intervention over the more labor-intensive NCM + CM approach. Because of the high levels of staffing required for the NCM relative to SE, costs associated with it were significantly higher.

CONCLUSIONS

Findings suggest that while both intervention strategies were equally effective in achieving desired health outcomes, the brief SE + CM appeared less expensive to deliver.

Intrapancreatic Splenule in a Pancreas Allograft: Case Report

A 16-year-old white man was involved in a motor vehicle collision and suffered head, chest, and abdominal trauma. Despite initial resuscitative efforts, he progressed to brain death and was designated to be an organ donor by his family. He had no earlier medical or surgical history and no high-risk behaviors. Blood work revealed normal creatinine, liver function tests, lipase, and amylase. Viral serologies were negative except for cytomegalovirus IgG and Epstein-Barr virus nucleic acid. Imaging revealed a right kidney contusion, a manubrial fracture, and fractures of right first rib and bilateral scapulae. No other abdominal trauma was identified, specifically to the pancreas, duodenum, or spleen. Our transplant center accepted the pancreas from this donor. During back-table inspection of the pancreas, a 1.5 × 1.5 cm dark purple rubbery mass was identified within the parenchyma of the pancreas in the tail. An incisional biopsy of the lesion was sent for frozen section, which yielded a mixed inflammatory infiltrate consisting of neutrophils and lymphocytes and an overlying fibrous capsule. The diagnosis of lymphoma or another neoplasm could not be definitely ruled out. Owing to uncertainty in diagnosis, the entire lesion was excised along with the distal pancreas with the use of a linear stapler. The staple line was oversewn with running 4-0 polypropylene suture, and the pancreas was transplanted. After surgery, the pancreas allograft functioned well with a small pancreatic leak, which had resolved by the first postoperative outpatient visit.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors: Present perspectives and future horizons

AIMS

Our comprehensive review highlights the drug development and pharmacogenomics leading to the recent approval of PCSK9 inhibitors. We also review the anticipated future advances into the uses of PCSK9 inhibition.

BACKGROUND

Despite the present advances in pharmacotherapy, atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality worldwide. Low density lipoprotein-cholesterol (LDL-C) lowering is the primary target for ASCVD risk reduction, showing demonstrable benefits in mortality. However, 70% of events occur even in the presence of statins. This residual risk may be approached with additional LDL-C reduction. Statin intolerance is a common clinical concern affecting adherence and the benefit with statins. There is also significant variation of individual lipid-lowering. Following rapid development, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have progressed from genetic observations, to mechanistic studies, to closer realization of the goal of CVD risk reduction. This review discusses the science behind PCSK9 inhibition, evidence of trials involving efficacy and safety, and reflections of its present and future role in clinical care, especially in high-risk patients with ASCVD, persons with suboptimal responses to statins and familial hyperlipidemia. Monoclonal antibodies have demonstrated LDL-C lowering of up to 57% as monotherapy and up to 73% when added to statins. Statins have limited efficacy in reduction of LDL-C due to an increased number of LDL-receptors. Elevated lipoprotein (a) levels may also be significantly lowered by PCSK9i. The journey from discovery to PSCK9 target validation took less than five years, and development and approval of therapeutic modalities for PCSK9 inhibitors happened over the next seven. This review highlights the drug development and pharmacogenomics leading to the recent approval of two agents, alirocumab and evolocumab, with a third bococizumab, and other novel approaches to the pathway pending.

DATA SYNTHESIS

We searched MEDLINE database via Pubmed for reviews, research publications and relevant trials available on PCSK9 inhibition.

CONCLUSION

Despite decades of medical advances, ASCVD remains one of the major causes of morbidity and mortality worldwide. Statin use has multiplied since the validation of LDL hypothesis, however, it is undeniable a more effective and well-tolerated agent is needed in significant number or patients. With the arrival of the era of unprecedented CV protection with PCSK9 inhibition, this exciting new therapy holds a pivotal promise as the future of lipid management. The data available already indicate safety, tolerability and superb efficacy of these agents, which are already changing contemporary cholesterol management. The rapid translation of innovative basic science research into drug development may lead to CV outcomes reduction and confirm that this pathway will become prominently utilized.

Intricate Assessment and Evaluation of Effect of Bruxism on Long-term Survival and Failure of Dental Implants: A Comparative Study

INTRODUCTION

Dental implants are one of the common lines of treatment used for the treatment of missing tooth. Various risk factors are responsible for the failure of the dental implants and occurrence of postoperative complications. Bruxism is one such factor responsible for the failure of the dental implants. The actual relation between bruxism and dental implants is a subject of long-term controversy. Hence, we carried out this retrospective analysis to assess the complications occurring in dental implants in patients with and without bruxism.

MATERIALS AND METHODS

The present study included 1100 patients which were treated for rehabilitation by dental implant procedure at 21 dental offices of Ghaziabad (India) from 2004 to 2014. Analyzing the clinical records of the patients along with assessing the photographs of the patients was done for confirming the diagnosis of bruxism. Clinical re-evaluation of the patients, who came back for follow-up, was done to confirm the diagnosis of bruxism. Systemic questionnaires as used by previous workers were used to evaluate the patients about the self-conscience of the condition. Estimation of the mechanical complications was done only in those cases which occurred on the surfaces of the restoration of the dental implants. All the results were analyzed by Statistical Package for Social Sciences (SPSS) software. Student's t-test and Pearson's chi-square test were used to evaluate the level of significance.

RESULTS

In both bruxer and non-bruxers, maximum number of dental implants was placed in anterior maxillary region. Significant difference was obtained while comparing the two groups for dimensions of the dental implants used. On comparing the total implant failed cases between bruxers and non-bruxers group, statistically significant result was obtained. Statistically significant difference was obtained while comparing the two study groups based on the health parameters, namely hypertension, diabetes, and smoking habit.

CONCLUSION

Success of dental implant is significantly affected by bruxism. Special attention is required in such patients while doing treatment planning.

CLINICAL SIGNIFICANCE

For the long-term clinical success and survival of dental implants in patients, special emphasis should be given on the patient's deleterious oral habits, such as bruxism as in long run, they influence the stability of dental implants.

Typing of Plasmodium falciparum DNA from 2 years old Giemsa-stained dried blood spots using nested polymerase chain reaction assay

A panel of 129 Giemsa-stained thick blood spots (TBS) confirmed for Plasmodium falciparum infection having different levels of parasite density were collected from a malaria endemic area. DNA was extracted and nested polymerase chain reaction (PCR) assay was performed to amplify P. falciparum DNA. Nested PCR assay successfully amplified P. falciparum DNA at a very low parasitaemia of ~10 parasites/μl of blood. Current PCR assay is very simple and can be used retrospectively to monitor the invasion and prevalence of different Plasmodium species in endemic areas.

Anti-C reactive protein antibodies in Indian patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is characterized by over production of autoantibodies. C-reactive protein (CRP) is a phylogenetically highly conserved plasma protein that participates in the systemic response to inflammation. Anti-CRP antibodies might have biological functions of pathogenetic interest in SLE. We evaluated anti-CRP antibodies in Indian SLE patients and their association with anti-dsDNA antibodies and complement levels (C3 and C4). One hundred SLE patients diagnosed according to the American College of Rheumatology criteria were included. Disease activity was assessed using SLE disease activity index (SLEDAI). Anti-CRP autoantibodies were detected by enzyme linked immunosorbent assay. Anti-dsDNA antibodies were detected by indirect immunofluroscence test (Euroimmun Lubeck, Germany). High sensitivity CRP and complement levels (C3, C4) were detected using a Nephelometer. (BN ProSpec, Dade Behring, Germany). Anti-CRP antibodies were detected in 26% of SLE patients. Mean age of disease onset among anti-CRP positives was 22.4 ± 7.5, and 26.6 ± 9.3 years among anti-CRP negatives (P > 0.05). Anti-dsDNA positivity was significantly higher among anti-CRP positives (32.7%) as compared to anti-CRP negatives (16%) (P = 0.00519). No statistically significant difference was observed in SLEDAI scores of anti-CRP positive group and anti-CRP negative group (P > 0.05). We observed a positive correlation between anti-CRP antibodies and anti-dsDNA antibodies.

Prioritizing areas for malaria control using geographical information system in Sonitpur district, Assam, India

OBJECTIVE

To identify the malaria hot spots at health subcentre level in an endemic district using a geographical information system (GIS). The results will be useful for rapid retrieval of malaria information, and to prioritize malaria control efforts in identified hot spots.

STUDY DESIGN

Extraction, analysis and synthesis of relevant data.

METHODS

Malaria epidemiological data from 2006 to 2009 were analysed to determine the annual parasitic index, slide positivity rate, annual blood examination rate and Plasmodium falciparum percentage for each health subcentre in the district. Maps were produced using GIS, and integrated to identify the malaria hotspots.

RESULTS

Out of 288 health subcentres, GIS identified 10 hot spots at extremely high risk of malaria and 14 hot spots at high risk of malaria. Malaria may flare up in these hot spots whenever favourable transmission conditions arise. Health authorities have been advised to establish control measures in these selected hot spots for timely prevention.

CONCLUSION

There is a need for adequate monitoring and allocation of available resources for better interventions in the malaria hotspots. The GIS model used in this study can be used, even at village or cluster level, to pin point the malaria hot spots, and information can be updated and retrieved easily.

Development and characterization of a cell line TTCF from endangered mahseer Tor tor (Ham.)

Tor tor is an important game and food fish of India with a distribution throughout Asia from the trans-Himalayan region to the Mekong River basin to Malaysia, Pakistan, Bangladesh and Indonesia. A new cell line named TTCF was developed from the caudal fin of T. tor for the first time. The cell line was optimally maintained at 28°C in Leibovitz-15 (L-15) medium supplemented with 20% fetal bovine serum (FBS). The propagation of TTCF cells showed a high plating efficiency of 63.00%. The cytogenetic analysis revealed a diploid count of 100 chromosomes at passage 15, 30, 45 and 60 passages. The viability of the TTCF cell line was found to be 72% after 6 months of cryopreservation in liquid nitrogen (-196°C). The origin of the cell lines was confirmed by the amplification of 578- and 655-bp sequences of 16S rRNA and cytochrome oxidase subunit I (COI) genes of mitochondrial DNA (mtDNA) respectively. TTCF cells were successfully transfected with green fluorescent protein (GFP) reporter plasmids. Further, immunocytochemistry studies confirm its fibroblastic morphology of cells. Genotoxicity assessment of H₂O₂ in TTCF cell line revealed the utility of TTCF cell line as in vitro model for aquatic toxicological studies.

Epidemiology and Risk Analysis of Malaria among Pregnant Women

Malaria remains a complex problem during the pregnancy, which threatens > 35 millions pregnant women every year. Malaria pathogenesis in pregnancy results in accumulation of infected RBCs in the intervillous spaces causing severe alterations leading to the reduced materno-foetal exchanges. In this article we have revisited the current evidences of clinical implications and overall burden of malaria in pregnancy. Many adverse aftermaths including, low birth weight, intrauterine growth retardation, preterm delivery, stillbirth and anemia were found associated with malaria in pregnant women. Despite of worldwide comprehensive control programmes for malaria in pregnancy, the disease control has been a daunting task everywhere. Socio cultural, economical, lack of awareness and various logistic problems compound the disease in developing countries. Thorough evidence based information and estimates, education and awareness and strengthening of prevention programmes are needed urgently to achieve success in malaria control in pregnancy.

Evaluation of POSSUM and P-POSSUM as a tool for prediction of surgical outcomes in the Indian population

BACKGROUND

Increased scrutiny and the need to institute a truly patient centered approach to surgical care has motivated the growing interest in measuring the quality of surgical care through comparative surgical audit. This study aimed to assess the validity of the POSSUM (Physiological and Operative Severity Score for enumeration of Mortality and Morbidity) and P-POSSUM (Portsmouth-POSSUM) score in predicting the risk of morbidity and mortality respectively in general surgical patients presenting with conditions of various operative severities at a tertiary care centre in Haryana, a northern state of India.

METHOD

A prospective study was performed in 100 general surgical patients including an equal number of patients in each of the four groups of operative severity i.e. minor, moderate, major, major plus. The risks of mortality and morbidity were calculated by using the POSSUM equation for morbidity and the P-POSSUM equation for mortality in each patient. The predicted risks were compared with the observed risks of mortality and morbidity and statistically analysed.

RESULTS

The difference in p value of predicted risk of morbidity by POSSUM equation and observed morbidity; calculated by chi square test was 0.756 which was not statistically significant. The difference in p value of predicted mortality by P-POSSUM equation and observed mortality; calculated by chi square test was 0.472 which was also not statistically significant.

CONCLUSION

POSSUM and P-POSSUM appear to be good and valid indices for use in the risk prediction of morbidity and mortality in the north Indian population.

Molecular epidemiology of measles in India, 2005-2010

Measles is a childhood disease that causes great morbidity and mortality in India and worldwide. Because measles surveillance in India is in its infancy, there is a paucity of countrywide data on circulating Measles virus genotypes. This study was conducted in 21 of 28 States and 2 of 7 Union Territories of India by MeaslesNetIndia, a national network of 27 centers and sentinel practitioners. MeaslesNetIndia investigated 52 measles outbreaks in geographically representative areas from 2005 through June 2010. All outbreaks were serologically confirmed by detection of antimeasles virus immunoglobulin M (IgM) antibodies in serum or oral fluid samples. Molecular studies, using World Health Organization (WHO)-recommended protocols obtained 203 N-gene, 40 H-gene, and 4 M-gene sequences during this period. Measles genotypes D4, D7, and D8 were found to be circulating in various parts of India during the study period. Further phylogenetic analysis revealed 4 lineages of Indian D8 genotypes: D8a, D8b, D8c, and D8d. This study generated a large, countrywide sequence database that can form the baseline for future molecular studies on measles virus transmission pathways in India. This study has created support and capabilities for countrywide measles molecular surveillance that must be carried forward.

Changing patterns of diet, physical activity and obesity among urban, rural and slum populations in north India

Rapid urbanization and accompanying lifestyle changes in India lead to transition in non-communicable disease risk factors. A survey was done in urban, urban slum and rural population of Haryana, India, in a sample of 4129 men and 3852 women using WHO STEPS questionnaire. A very high proportion of all the three populations reported inadequate intake of fruits and vegetables. Rural men reported five times physical activity as compared with urban and urban slum men and rural women reported seven times physical activity as compared with women in the other two settings. Mean body mass index (BMI) was highest among urban men (22.8 kg m(-2)) followed by urban slum (21.0 kg m(-2)) and rural men (20.6 kg m(-2)) (P-value < 0.01). Similar trend was seen for women but at a higher level than men. Prevalence of obesity (BMI >/= 30 kg m(-2)) was highest for urban population (male = 5.5%, female = 12.6%) followed by urban slum (male = 1.9%, female = 7.2%) and rural populations (male = 1.6%, female = 3.8%). Urbanization increases the prevalence of the studied non-communicable disease risk factors, with women showing a greater increase as compared with men. Non-communicable disease control strategy needs to address urbanization and warrants gender sensitive strategies specifically targeting women.

Paraesophageal hernia in the neonatal period - another differential diagnosis of esophageal atresia

Two neonates with paraesophageal herniae, both associated with gastric volvulus are reported. The presenting symptoms in both cases were highly suggestive of esophageal atresia. Radiologic examinations enabled the correct diagnosis to be made, and appropriate surgery was then instituted.

Cholinergic stimulation increases thrombin activity and gene expression in cultured mouse muscle

Activity-dependent synapse reduction is a major determinant of neuromuscular innervation. Previous research has shown that nanomolar concentrations of hirudin, a specific thrombin antagonist, significantly attenuates this reduction, and protease nexin 1 (PN1), an endogenous thrombin inhibitor closely localized to the neuromuscular synapse, can inhibit synapse reduction at similar concentrations. Protease inhibitors which do not inhibit thrombin, including cystatin and aprotinin, had no effect on synapse reduction. We present a series of experiments examining whether prothrombin and/or PN1 gene expression, as well as thrombin activity, are regulated in muscle cultures by acetylcholine (ACh) receptor activation. We also studied the effect of exogenous thrombin on synapse elimination in co-cultures of muscle and cholinergic neurons. Cultured muscle cells were electrically blocked with tetrodotoxin (TTX), or co-treated with ACh in order to isolate ACh receptor activation. Electrical blockade resulted in a decrease in thrombin release to about two-thirds of control values. The application of ACh to electrically blocked muscle cultures resulted in a 2.5-fold increase in thrombin activity released into the medium and a 2-fold increase in prothrombin gene expression. In contrast, ACh treatment in the presence of TTX had no effect on PN1 gene expression compared to treatment with TTX alone. In addition, exogenous thrombin significantly increased synapse elimination in unstimulated muscle/cholinergic neuron co-cultures. These results suggest that thrombin or a thrombin-like molecule released from muscle is required for activity-dependent synapse elimination and is regulated by neuromuscular activity.

Congenital segmental dilatation of intestine

We are reporting two cases of segmental dilatation of small intestine presenting as neonatal intestinal obstruction. Clinco-pathological features, etiology and management are discussed in brief.

Endodermal sinus tumour of cervix--case report

Endodermal sinus tumor of Cervix is an extremely rare cause of vaginal bleeding. Because of its rarity and interesting features, it is reported with a brief review of literature.

Transanal and intraperitoneal prolapse in intussusception

An infant with intussusception who developed an unusual complication of transanal and intraperitoneal prolapse is reported. Complete venous occlusion of the intussusceptum for a prolonged period in a patient with congenital anomalous vascular supply of the colon is suggested as a mechanism responsible for rupture of the intussuscepiens.

Successful management of late presentation neonatal oesophageal atresia with distal tracheo-oesophageal fistula and significant pulmonary complications

The successful management of a neonate presenting with oesophageal atresia and a distal tracheo-oesophageal fistula on the twelfth day of life is described. This case is the most delayed diagnosis associated with survival known to have been reported. There were significant pulmonary complications at presentation and initial treatment was by gastrostomy under local anaesthesia, followed by a delayed primary repair.