Patient Reported Financial Distress and its Association with Quality of Life and Symptom Burden in Cancer Patients Reporting to a Public Facility in LMIC

PURPOSE/OBJECTIVE(S)

Financial distress (FD) associates with worse quality of life (QoL) and there is paucity of literature from low middle income setting (LMIC). We investigated the prevalence & impact of subjective FD on QoL & symptom burden in advanced cancer patients, reporting to a public facility.

MATERIALS/METHODS

Patients aged ≥18yrs with a diagnosis of cancer within 3months and without prior treatment were accrued. Subjective FD was assessed by EORTC QLQ-C30 and symptoms were assessed by ESAS-R at baseline and 3 months. Patients were classified as experiencing FD if they answered ≥2 on a Likert scale question (1-4 points) asking about FD and dichotomized as Grp 1: No FD and Grp 2: FD. Mean change in score was calculated by subtracting the baseline from the 3-month score for each subscale, minimal important difference (MID) was defined using an anchor of ≥ 10-point compared to baseline for Global Qol and compared between groups. We used Mann Whitney, independent sample t test and Fisher's exact test for determining the association between FD and QoL and symptom burden. A p-value < 0.05 was considered statistically significant.

RESULTS

Of the 100 patients participating in the study, 69% reported subjective financial distress at baseline, 10% had insurance coverage, 27% used distressed financing (borrowing :21%; sold off assets:6%) and debt accumulation was seen in 34% patients. Cost reduction strategies were adopted by 98% patients. Mean Global Health (GH), physical (PF), emotional function (EF) was significantly worse at all time-points in FD patients. Physical (pain, tiredness) and psychological symptom scores (anxiety, depression) were significantly higher at all time points for FD patients. Mean change score for subscales of QoL and symptom burden was not significantly different between groups from baseline to 3 months (Table1).MID for deterioration of Global Qol was Grp 1 vs 2; 21.1% vs 32.7%, p = 0.504.

CONCLUSION

Two-thirds of patients have FD at presentation and report worse quality of life and symptom burden at all time-points. Presence of FD is not associated with significant change in QoL scores or symptom burden over 3 months. Measures are warranted to screen and reduce FD.

Aerosol Loading and Radiation Budget Perturbations in Densely Populated and Highly Polluted Indo-Gangetic Plain by COVID-19: Influences on Cloud Properties and Air Temperature

Aerosols emitted in densely populated and industrialized Indo-Gangetic Plain, one of the most polluted regions in the world, modulate regional climate, monsoon, and Himalayan glacier retreat. Thus, this region is important for understanding aerosol perturbations and their resulting impacts on atmospheric changes during COVID-19 lockdown period, a natural experimental condition created by the pandemic. By analyzing 5 years (2016-2020) data of aerosols and performing a radiative transfer calculation, we found that columnar and near-surface aerosol loadings decreased, leading to reductions in radiative cooling at the surface and top of the atmosphere and atmospheric warming during lockdown period. Further, satellite data analyses showed increases in cloud optical thickness and cloud-particle effective radius and decrease in lower tropospheric air temperature during lockdown period. These results indicate critical influences of COVID-19 lockdown on regional climate and water cycle over Indo-Gangetic Plain, emphasizing need for further studies from modeling perspectives.

Relationship between body mass index and percentage of body fat, estimated by bio-electrical impedance among adult females in a rural community of North India: A cross-sectional study

Introduction:

Body adiposity measured by percentage of body fat (BF%) is found to be better predictor of cardiovascular morbidity and mortality than body mass index (BMI). Limited information exists showing relationship between BMI and BF% in North Indian population.

Objectives:

To study the relationship between BMI and BF% among North Indian adult females across various age strata and level of BMI.

Materials and Methods:

This was a cross-sectional study conducted at Ballabgarh Health and Demographic Surveillance Site (HDSS) among randomly selected females. BMI using standard techniques and BF% using bioelectrical impedance analysis was estimated. Linear regression was performed using general linear model with BF% as dependent variable and BMI as main independent variable.

Results:

Mean (±2 SD) age of participants was 41.3 ± 15.7 years. Mean BMI (±SD) was 23.3 (±4.6) kg/m², whereas mean fat mass (±2 SD) and BF% (±95% CI) was 19.2 (±7.9) kg and 33.6 (±6.9) %. BMI and BF% were highly correlated among obese (r = 0.77), whereas least correlated (r = 0.32) in underweight females. Across age strata, correlation between BMI and BF% was maximum in 18–35 years age group (r = 0.95), whereas least in females ≥56 years (r = 0.67). Age and BMI together predicted 73% of variability in BF% in hierarchical linear regression model.

Conclusions:

In this population, we have found strong correlation between BMI and BF% particularly at higher level of BMI and in younger females. There is need to conduct more robust prospective longitudinal studies to assess BF%, which is a better predictor of cardiovascular morbidity and mortality.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

T cell suppression in the bone marrow of visceral leishmaniasis patients: impact of parasite load

Visceral leishmaniasis (VL) is a disseminated and lethal disease of reticulo-endothelial system caused by protozoan parasites Leishmania donovani and L. infantum, which are known to induce host T cell suppression. To understand the impact of parasite load on T cell function, the present was focused on parasite load with T cell function in bone marrow of 26 VL patients. We observed significant enrichment of forkhead box protein 3 (FoxP3)⁺ (P = 0·0003) and interleukin (IL)-10⁺ FoxP3⁺ regulatory T cells (T_reg ) (P = 0·004) in the bone marrow (BM) of patients with high parasite load (HPL) compared with low parasite load (LPL). Concordantly, T effector cells producing interferon (IFN)-γ (P = 0·005) and IL-17A (P = 0·002) were reduced in the BM of HPL. Blocking of T_reg -cell derived suppressive cytokines [(IL-10 and transforming growth factor (TGF)-β] rescued the effector T cells and their functions. However, it was observed that TGF-β levels were dominant, favouring T_reg cell differentiation. Furthermore, the low ratio of IL-6/TGF-β favours the suppressive milieu in HPL patients. Here we show the change in levels of various cytokines with the parasitic load during active VL, which could be helpful in devising newer immunotherapeutic strategies against this disease.

Influence of alcohol on condom use pattern during non-spousal sexual encounter in male migrant workers in north India

CONTEXT

Migrant workers constitute an important risk group for Human Immunodeficiency Virus/Acquired Immuno-Deficiency Syndrome transmission in India. Alcohol consumption before sexual intercourse has been postulated to influence condom use practices. This study aimed to assess this association with regard to non-spousal sexual encounters among male migrant workers in northern India.

MATERIALS AND METHODS

A cross-sectional facility-based survey was conducted in 2011. Male migrant workers aged ≥18 years, who were born outside Haryana, who had moved to the current location after 15 years of age,had worked in the current factory for at least 1 year, who were willing to participate and were able to give written, informed consent were included in the study. A consecutive sampling was performed. Descriptive, bivariate and multiple logistic regression analyses were carried out.

RESULTS

A total of 162 participants reported having experienced non-spousal sexual encounters in the last 1 year. The proportion of men who reported not having used a condom at their last non-spousal sexual encounter was 59.3%, and 78.4% of the men reported having consumed alcohol in the last 1 year. About 48.1% of men reported having consumed alcohol before their last non-spousal sexual encounter. Men who consumed alcohol were three times more likely to not use a condom at their last non-spousal sexual encounter (OR = 3.1, 95% CI: 1.5-6.4). This association persisted even after adjusting for relevant confounders.

CONCLUSION

Alcohol consumption had a negative influence on condom use during non-spousal sexual encounter among male migrant workers. An integrated approach to promote condom use and reduce alcohol consumption among migrant men needs to be undertaken through targeted intervention strategies.

Immunostimulatory potential and proteome profiling of Leishmania donovani soluble exogenous antigens

Isolation of the soluble exogenous antigens (SEAgs), its immune response study and proteome profiling is an essential prerequisite for understanding the molecular pathogenesis of Leishmania donovani. The immunostimulatory potential of L. donovani SEAgs, purified from culture of L. donovani clinical isolate, was evaluated for their ability to induce cellular responses in treated/cured hamsters. SEAgs induced significant proliferative responses in lymphocytes (SI 5.6 ± 2.3; P < 0.01) isolated from cured hamster. In addition, significant NO production in response to SEAgs was also noticed in macrophages of hamsters, mouse and human cell lines (J774A-1 and THP1). Western blot analyses with antibodies against proteophosphoglycan (PPG; surface-expressed and secreted molecule) of L. donovani revealed that PPG molecules are also present in L. donovani SEAgs. Mass spectrometry (MS)-based proteome analysis of 12 protein bands of SEAgs through MALDI-TOF/TOF endorsed the identification of some Th1-stimulatory immunogenic proteins. These immunogenic proteins may offer increased hope for the discovery of new promising vaccine candidates against visceral leishmaniasis (VL). The overall results suggest that immunostimulatory molecules are present in the SEAgs, which may be further exploited, for developing a subunit vaccine against VL a fatal human disease.

Band offset at TiO2/MDMO PPV and TiO2/PEDOT PSS interfaces studied using photoelectron spectroscopy

We report band alignment and band offset studies across the interfaces of hetero-structures of TiO₂ with MDMO PPV and PEDOT PSS using photoelectron spectroscopy.

Coating doxorubicin-loaded nanocapsules with alginate enhances therapeutic efficacy against Leishmania in hamsters by inducing Th1-type immune responses

BACKGROUND AND PURPOSE

The aim of the present study was to evaluate the immunomodulatory and chemotherapeutic potential of alginate-(SA) coated nanocapsule (NCs) loaded with doxorubicin (SA-NCs-DOX) against visceral leishmaniasis in comparison with nano-emulsions containing doxorubicin (NE-DOX).

EXPERIMENTAL APPROACH

NE-DOX was prepared using low-energy emulsification methods. Stepwise addition of protamine sulphate and SA in a layer-by-layer manner was used to form SA-NCs-DOX. SA-NCs-DOX, NE-DOX and Free DOX were compared for their cytotoxicity against Leishmania donovani-infected macrophages in vitro and generation of T-cell responses in infected hamsters in vivo.

KEY RESULTS

Size and ζ potential of the NE-DOX and SA-NCs-DOX formulations were 310 ± 2.1 nm and (-)32.6 ± 2.1 mV, 342 ± 4.1 nm and (-)29.3 ± 1.2 mV respectively. SA-NCs-DOX was better (1.5 times) taken up by J774A.1 macrophages compared with NE-DOX. SA-NCs -DOX showed greater efficacy than NE-DOX against intramacrophagic amastigotes. SA-NCs-DOX treatment exhibited enhanced apoptotic efficiency than NE-DOX and free DOX as evident by cell cycle analysis, decrease in mitochondrial membrane potential, ROS and NO production. T-cell responses, when assessed through lymphoproliferative responses, NO production along with enhanced levels of iNOS, TNF-α, IFN-γ and IL-12 were found to be up-regulated after SA-NCs-DOX, compared with responses to NE-DOX in vivo. Parasitic burden was decreased in Leishmania-infected hamsters treated with SA-NCs-DOX, compared with NE-DOX.

CONCLUSIONS AND IMPLICATIONS

Our results provide insights into the development of an alternative approach to improved management of leishmaniasis through a combination of chemotherapy with stimulation of the innate immune system.

Teaching community medicine to medical undergraduates-learning by doing: our experience of rural posting at All India Institute of Medical Sciences, New Delhi, India

BACKGROUND

The goal of medical education is to ensure that the medical graduate has acquired broad public health competencies needed to solve the health problems of the community. We present the current teaching of community medicine to medical students of the All India Institute of Medical Sciences (AIIMS), New Delhi during their 5-week posting at the rural centre at Ballabgarh, Haryana.

METHODS

The teaching activities consist of field visits to different levels of health facilities and meeting with health workers, epidemiological exercises, a community-based exercise, posting in inpatient and outpatient departments of a secondary hospital, and domiciliary visits to families of patients. These are spread over 80 sessions of about 200 hours. There is very little didactic teaching and the assessment is broad-based. The evaluation of the posting was based on comparison of blinded pre- and post-posting assessments as well as anonymous feedback of the posting by the students.

RESULTS

There was a significant increase in the mean scores of all components of the posting-epidemiology (5.1 to 8.4), health systems (6.8 to 9.3) and clinical (8.0 to 10.8). The posting did not result in a better understanding of a public health approach as compared to a clinical approach. The feedback provided by students was generally positive for all activities with 94% of them rating it as good or very good.

CONCLUSION

The teaching of community medicine can be made more practical and interesting without compromising on learning. However, despite such a programme, getting medical students to develop a public health approach is a daunting task.

A highly efficient and compact long pulse Nd:YAG rod laser with 540 J of pulse energy for welding application

We have developed an efficient and high average power flash lamp pumped long pulse Nd:YAG laser capable of generating 1 kW of average output power with maximum 540 J of single pulse energy and 20 kW of peak power. The laser pulse duration can be varied from 1 to 40 ms and repetition rate from 1 to 100 Hz. A compact and robust laser pump chamber and resonator was designed to achieve this high average and peak power. It was found that this laser system provides highest single pulse energy as compared to other long pulsed Nd:YAG laser systems of similar rating. A slope efficiency of 5.4% has been achieved, which is on higher side for typical lamp pumped solid-state lasers. This system will be highly useful in laser welding of materials such as aluminium and titanium. We have achieved 4 mm deep penetration welding of these metals under optimized conditions of output power, pulse energy, and pulse duration. The laser resonator was optimized to provide stable operation from single shot to 100 Hz of repetition rate. The beam quality factor was measured to be M(2) ~ 91 and pulse-to-pulse stability of ±3% for the multimode operation. The laser beam was efficiently coupled through an optical fiber of 600 μm core diameter and 0.22 numerical aperture with power transmission of 90%.

Prevalence of chronic kidney diseases and its determinants among perimenopausal women in a rural area of North India: A community-based study

The burden of noncommunicable diseases is rising in India. A high prevalence of lifestyle-related diseases in perimenopausal women in the community makes them vulnerable to chronic kidney diseases (CKD). A cross-sectional community-based study was carried out among women >35 years of age in the village of Ballabgarh, Haryana (north India). Eligible women were selected by the probability proportionate to size sampling method. Estimation of glomerular filtration rate (GFR) was carried out by using the age- and body surface area (BSA)-adjusted Cockcroft–Gault (CG) and modification of diet in renal disease (MDRD) equations. Association of risk factors such as obesity, hyperlipidemia, hypertension, and diabetes mellitus with CKD was also assessed using multivariate logistic regression analysis. A total of 455 women were studied. The prevalence of low GFR (<60 mL/min/1.73 m²) by the CG/BSA equations and MDRD equation was found to be 18.2% (95% confidence interval 14.6, 21.8) and 5.9% (95% confidence interval 3.7, 8.1), respectively. Obesity (odds ratio 15.5) (P = 0.002), hyperlipidemia (odds ratio: 2.5) (P = 0.017), and age (P < 0.001) were significantly associated with reduced GFR on multivariate logistic regression analysis. This study observed a high prevalence of CKD and its risk factors among perimenopausal women in a rural community in north India. The study highlights the need of a multipronged, community-based intervention strategy that includes a high-risk screening approach and awareness generation about CKD and its risk factors in the community.

Nerve injuries sustained during warfare: part II: Outcomes

The outcomes of 261 nerve injuries in 100 patients were graded good in 173 cases (66%), fair in 70 (26.8%) and poor in 18 (6.9%) at the final review (median 28.4 months (1.3 to 64.2)). The initial grades for the 42 sutures and graft were 11 good, 14 fair and 17 poor. After subsequent revision repairs in seven, neurolyses in 11 and free vascularised fasciocutaneous flaps in 11, the final grades were 15 good, 18 fair and nine poor. Pain was relieved in 30 of 36 patients by nerve repair, revision of repair or neurolysis, and flaps when indicated. The difference in outcome between penetrating missile wounds and those caused by explosions was not statistically significant; in the latter group the onset of recovery from focal conduction block was delayed (mean 4.7 months (2.5 to 10.2) vs 3.8 months (0.6 to 6); p = 0.0001). A total of 42 patients (47 lower limbs) presented with an insensate foot. By final review (mean 27.4 months (20 to 36)) plantar sensation was good in 26 limbs (55%), fair in 16 (34%) and poor in five (11%). Nine patients returned to full military duties, 18 to restricted duties, 30 to sedentary work, and 43 were discharged from military service. Effective rehabilitation must be early, integrated and vigorous. The responsible surgeons must be firmly embedded in the process, at times exerting leadership.

Nerve injuries sustained during warfare: part I--Epidemiology

We describe 261 peripheral nerve injuries sustained in war by 100 consecutive service men and women injured in Iraq and Afghanistan. Their mean age was 26.5 years (18.1 to 42.6), the median interval between injury and first review was 4.2 months (mean 8.4 months (0.36 to 48.49)) and median follow-up was 28.4 months (mean 20.5 months (1.3 to 64.2)). The nerve lesions were predominantly focal prolonged conduction block/neurapraxia in 116 (45%), axonotmesis in 92 (35%) and neurotmesis in 53 (20%) and were evenly distributed between the upper and the lower limbs. Explosions accounted for 164 (63%): 213 (82%) nerve injuries were associated with open wounds. Two or more main nerves were injured in 70 patients. The ulnar, common peroneal and tibial nerves were most commonly injured. In 69 patients there was a vascular injury, fracture, or both at the level of the nerve lesion. Major tissue loss was present in 50 patients: amputation of at least one limb was needed in 18. A total of 36 patients continued in severe neuropathic pain. This paper outlines the methods used in the assessment of these injuries and provides information about the depth and distribution of the nerve lesions, their associated injuries and neuropathic pain syndromes.

High prevalence and low awareness, treatment and control of hypertension in Asian Indian women

Hypertension is an important public health problem in India. To determine its prevalence, awareness, treatment and control among women, we performed a nationwide study. Population-based studies among women aged 35-70 years were performed in four urban and five rural locations. Stratified sampling was performed and we enrolled 4608 (rural 2604 and urban 2004) of the targeted 8000 (57%). Demographic details, medical history, diet, physical activity, anthropometry and blood pressure (BP) were recorded. Descriptive statistics are reported. Logistic regression was performed to determine the association of hypertension and its awareness, treatment and control with socioeconomic factors. Age-adjusted prevalence of hypertension (known or BP≥140/≥90 mm Hg) was observed in 1672 women (39.2%) (rural 746, 31.5%; urban 926, 48.2%). Significant determinants of hypertension were urban location, greater literacy, high dietary fat, low fibre intake, obesity and truncal obesity (P<0.01). Hypertension awareness was noted in 727 women (42.8%), more in urban (529, 56.8%) than in rural (198, 24.6%). Of these, 38.6% of the women were on treatment (urban 35.7, rural 46.5) and of those treated, controlled blood pressure (<140 and <90 mm Hg) was observed in 21.5% (urban 28.3 vs 10.2). Among hypertensive subjects, treatment was noted in 18.3% (rural 13.1, urban 22.5) and control in 3.9% (rural 1.3, urban 5.9). A significant determinant of low awareness, treatment and control was rural location (multivariate-adjusted P<0.05). There is a high prevalence of hypertension in middle-aged Asian Indian women. Very low awareness, treatment and control status are observed.

A review of the epidemiology of diabetes in rural India

OBJECTIVE

To describe the extent of problem of diabetes in rural India based on review of available literature and examine the secular trends over a period of 15 years i.e. from 1994 to 2009.

METHODS

A systematic search was performed using electronic as well as manual methods. Studies providing details of sample size, age group of participants, criteria used for diagnosis, along with the prevalence of any of the three outcomes of interest i.e. diabetes mellitus, impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), were included.

RESULTS

Analysis of secular trends reveals an increase in diabetes prevalence among rural population at a rate of 2.02 per 1000 population per year. The rate of increase was high in males (3.33 per 1000 per year) as compared to females (0.88 per 1000 per year). High prevalence of IFG and IGT has been observed in southern and northern parts of the country.

CONCLUSION

The prevalence of diabetes is rising in rural India. There is a large pool of subjects with IFG and IGT at high risk of conversion to overt diabetes. Population-level and individual-level measures are needed to combat this increasing burden of diabetes.

Development and performance evaluation of amphotericin B transfersomes against resistant and sensitive clinical isolates of visceral leishmaniasis

The present study was aimed to assess the efficacy of developed transfersome (TF-3) formulation bearing amphotericin B (AmB) against sensitive and resistant clinical isolates of L donovani and compared with conventional liposomal formulation (F-2) and free AmB (F-1). The skin permeation of AmB from TF-3 was performed using Franz diffusion cell using rat skin which showed fickian diffusion across the skin. When tested against L. donovani (intramacrophagic amastigotes), it has been observed that TF was more effective than F-1 and F-2 formulation in sensitive and resistant clinical isolates. The data provides evidences that the TF formulation owing to its fluidized behaviour imparted by sodium deoxycholate, enables to penetrate well in the infected cells and thus provide enhanced activity. The permeation study also supports this data as the flux value of AmB through TF formulation was 1.5 fold higher compared to conventional liposomes suggesting improved penetration and better partitioning in skin layers. Implicit to this preliminary data it is evident that the AmB loaded TF formulation has potential as alternate chemotherapeutic approach to control of VL. Potential utilities of novel formulation as a transdermal delivery of AmB for leishmaniasis necessitates further elaborated investigations which is underway in our laboratory.

Simulation and modeling of laser-tissue interactions based on a liposome-dye system

This work presents an overview of the use of liposomes for targeted delivery of photosensitizers to tumors for Photodynamic Therapy (PDT). It assesses the results of a quantitative model to explain the interaction of short-pulsed lasers (in the nanosecond and picosecond domains) with a liposome-dye complex in terms of a localized photo-induced thermal mechanism. Incorporation of an organic dye (sulforhodamine) within lipid vesicles has been investigated in conjunction with the effect of laser irradiation on the integrity of the liposome-dye complex. The variation of the absorption coefficient as a function of wavelength for dye-encapsulated liposomes before and after laser-induced release of dye was studied and modeled. The commercial software Mathematica was used to develop a Gaussian model for the energy absorption by the liposome-dye complex. Dye release from 3 microm - liposome encapsulating 25 mM aqueous solution of sulforhodamine dye was studied using 8 ns laser pulses at the second harmonic of the Nd:YAG laser (at 532 nm) and compared with dye release employing 25 ps - laser pulses. In addition, the temperature-dependence of the dye release has been included in the photo-thermal model.

Differential transcriptional expression following thidiazuron-induced callus differentiation developmental shifts in rice

Very little is known about molecular events associated with callus differentiation in indica rice. The genes expressed differentially during shoot meristem initiation were identified on genomic arrays applied to efficiently regenerating rice calli. A thidiazuron (TDZ; N-phenyl-N-thiadiazol-1,2,3-5,ylurea)-dependent regeneration protocol was developed for efficient embryogenesis in indica rice. The regenerating embryogenic calli induced by TDZ for 10 days showed transcriptional modulation of a number of genes associated with photosynthesis, hormone metabolism, plant development, signal transduction, light response, and plant defense. Eighteen candidate miRNAs were predicted to target the genes expressed differentially in the embryogenic calli grown in TDZ-containing medium. The majority of the photosynthesis-related genes up-regulated in differentiating calli were not expressed or were down-regulated in developing seeds and inflorescences. Most of the genes down-regulated in differentiating calli were up-regulated in developing seeds. The transcriptome of differentiating callus most closely resembled that of the germinating whole seed.

Nano-engineering by implanting Al2O3 nano particle as sandwiched scattering centers in between the Lao.5Pr0.2Sr0.3MnO3 thin film layers

We report the use of non-magnetic Al2O3 nano particles deposited between two ferromagnetic La0.5Pr0.2Sr0.3MnO3 (LPSMO) manganite layers with an aim to improve the electronic and magnetotransport properties of the layered supper lattice grown on single crystal STO(100) substrate using Pulsed Laser Deposition (PLD) technique. We studied the electronic-transport and magnetotransport properties of this system wherein Al2O3 particles are expected to act as insulating scattering centers between two ferromagnetic LPSMO layers. The scattering due to additional scattering centers (insulating Al2O3 nano particles) could be controlled by application of external field, resulting in high magnetoresistance (MR) approximately 72% as compared to pristine LPSMO film (MR approximately 51%) at temperature close to their T(M) values. In addition, incorporation of nanostructured Al2O3 barrier between the two ferromagnetic LPSMO layers results in a 2-3 fold increase in the values of temperature coefficient of resistance (TCR) and the field coefficient of resistance (FCR) as compared to pristine LPSMO film, suggesting the use of such nanoengineered manganite layered structure for better device application.

Sero-prevalence of Bovine Johne's disease in buffaloes and cattle population of North India using indigenous ELISA kit based on native Mycobacterium avium subspecies paratuberculosis ‘Bison type’ genotype of goat origin

Present pilot study is the first attempt in the country to estimate sero-prevalence of Bovine Johne's disease (BJD) by screening cattle and buffaloes representing large population belonging to farmer's and farm herds in the home tracts (Uttar Pradesh (UP) and Punjab) of Hariana cattle and Murrah buffaloes in North India. Indigenous and in-house plate ELISA kit (using protoplasmic antigen from native Mycobacterium avium subsp. paratuberculosis 'Bison type' strain of goat origin), originally developed for goats and sheep was standardized in bovines and used for screening. For this study, 33 villages of south and west UP were randomly selected and surveyed from 2001 to 2003. There were 7943 farmer's families having 38,251 livestock, including cattle, buffaloes, goats and sheep (per family 4.8% livestock). Numerically, buffaloes and cattle were 54.7% and 22.1%, respectively. Serum samples were collected from 726 animals (4.2% of 16, 981 livestock with 4375 farmer's families) located in 33 randomly surveyed villages. Serum samples (699), submitted to Epidemiology Department of Veterinary College (Punjab Agricultural University, Ludhiana), in the year 2004 by farmer's and organized farm herds (Buffaloes, 372, Cattle, 327), were screened by this ELISA kit. Soluble protoplasmic antigen was prepared from Map (S 5) 'Bison type' strain isolated from a terminally sick goat with Johne's disease. Of the total 1425 bovine (Buffaloes and cattle) serum samples screened using indigenous ELISA kit, sero-prevalence of Johne's disease was 29.0% (28.6% in buffalo and 29.8% in cattle) in Northern India. State-wise sero-prevalence was 31.9% and 23.3% in UP and Punjab, respectively. In UP, of the 601 randomly sampled buffaloes, sero-prevalence was 40.3% (16.6% in young and 40.9% adults) and 25.5% (10.5% in young and 26.3% adults) in south and west UP, respectively. Of the 125 cattle screened, sero-prevalence was 42.6% (nil in young and 44.4% adults) and 30.0% (nil in young and 30.6% adults) in south and west UP, respectively. Of the 699 serum samples screened from Ludhiana, Punjab, sero-prevalence of BJD was 23.0%. Sero-prevalence was 23.3% (12.1% in young and 24.4% in adults) and 26.9% (27.2% in young and 26.8% in adults) in buffaloes and cattle, respectively. High prevalence of BJD in buffaloes in native tract of Murrah breed, and Hariana breed of cattle correlated with poor per-animal productivity and BJD may be the major cause. Indigenous ELISA kit was rapid, economic and sensitive test for large-scale screening of buffaloes and cattle population against incurable BJD.

Linking undergraduate medical education to primary health care

Under graduate medical education aims at producing doctors who are competent in preventive, promotive and curative knowledge and skills. The community medicine curriculum in All India Institute of Medical Sciences, New Delhi has been designed with this objective in view. Students are given community oriented training in urban and rural settings whereby students are taught to carry out various activities under the guidance of faculty members. This curriculum has evolved over many years and provides ample exposure to the students to understand the health problems, and health system of the country especially at the primary and secondary level. There is a sequential teaching of community medicine, which starts from fourth semester through internship. Successful training in community medicine lies outside the walls of the department and the involvement of other partners like the community, health systems etc contribute largely.

Zero kinetic energy spectroscopy of hydroquinone-water (1:1) complex: A probe for conformer assignment

Zero kinetic energy (ZEKE) photoelectron spectroscopy of the hydroquinone-water (HQW) complex was carried out to characterize its S(1)-S(0) resonantly enhanced multiphoton ionization (REMPI) spectrum in terms of the cis and trans conformers. The ZEKE spectra of the hydroquinone isomers show differences in the Franck-Condon (FC) activity of a few ring modes, viz., modes 15, 9b, and 6b, due to the different symmetries of the two isomers. These modes were used as a "diagnostic tool" to carry out the categorical assignment of the REMPI spectrum of the HQW complex. It was found that the FC activity of these diagnostic modes in the cationic ground state (D(0)) of the water complex is similar as that of the monomer. The two lowest energy transitions in the REMPI spectrum of the water complex, 33,175 and 33,209 cm(-1), were reassigned as the band origins of the cis and trans hydroquinone-water complexes, which is opposite of the previous assignment. The intermolecular stretching mode (sigma) of the complex shows a long progression, up to v(')=4, in the cationic ground state and is strongly coupled to other observed ring modes. The Franck-Condon factors for different members in the progression were calculated using the potential energy surfaces computed ab initio. These agree well with the observed intensity patterns in the progression. The ionization potential of the trans and cis complexes was determined to be 60,071+/-4 and 60,024+/-4 cm(-1), respectively.

Quality assurance of annual HIV sentinel surveillance 2006: experience of regional institute, central zone

National AIDS Control Organisation (NACO) identified five regional institutes (RIs) to monitor and supervise the 2006 round of annual HIV sentinel surveillance. The task mandated was quality control of both epidemiological data collection and HIV testing. The team at RI consisted of epidemiologist and microbiologist. We describe here the process of quality control and the quality of surveillance in the states of Uttar Pradesh, Uttarakhand, Bihar, Jharkand, and Delhi. The supervisors visited almost 90% of the sentinel sites. Performance of vast majority of the sentinel sites (92%) was satisfactory. The testing laboratories were found to be adhering to standard operating procedures. Concordance rate of test results between testing laboratory and the designated reference laboratory was high. Overall, the quality of sentinel surveillance was good. The lacunae found during the visit have been enumerated along with the recommendations for future surveillance round.

Interaction between warfarin and tamoxifen: a case report

Warfarin is a commonly used anticoagulant with documented reports of drug interactions. Tamoxifen is used in the adjuvant hormonal treatment of women with oestrogen-receptor- positive breast cancer. Warfarin and tamoxifen are known to interact with each other with a resultant increase in the bleeding tendency. These reports are mainly from the white population. We report a case of drug interaction between warfarin and tamoxifen with an acute onset. This report suggests that when these drugs are co administered, careful monitoring of the coagulation profile is needed.

Pain phenomena and sensory recovery following brachial plexus avulsion injury and surgical repairs

Seventy-six patients with severe brachial plexus avulsion injuries were studied using pain questionnaires and quantitative sensory testing. There was significant correlation between pain intensity and the number of roots avulsed prior to surgery (P=0.0004) and surgical repairs were associated with pain relief. Sensory recovery to thermal stimuli was observed, mainly in the C5 dermatome. Allodynia to mechanical and thermal stimuli was observed in the border zone of affected and unaffected dermatomes in 18% of patients assessed early (<6 months) and 37% patients at later stages. Pain and sensations referred to the original source of afferents occurred at a later stage (>6 months) in 12% of patients and were related to nerve regeneration. By contrast, "wrong-way" referred sensations (e.g. down the affected arm while shaving or drinking cold fluids) were reported by 44% of patients and often occurred early, suggesting CNS plasticity. Understanding sensory mechanisms will help develop new treatments for severe brachial plexus injuries.