Serum-ascites albumin gradient in differential diagnosis of ascites

The present study was aimed to find out causes of ascites based on serum-ascites albumin gradient (SAAG) and to compare the diagnostic accuracy of the serum-ascites albumin gradient, proposed as a new biochemical criterion for the differential diagnosis of ascites and to evaluate the value of serum-ascites albumin gradient in differential diagnosis of ascites. This study includes 50 patients with ascites admitted in Medicine wards of Comilla Medical College Hospital, Comilla during the period of July 2010 to June 2011. Blood was drawn from the antecubital vein and ascetic fluid was obtained by paracentesis at the same time. Determination of the concentrations of albumin in both the serum and the ascitic fluid was carried out simultaneously. Considering SAAG value of ≥1.1g/dl is high SAAG and a SAAG value <1.1g/dl is low SAAG. Out of 50 patients, male patients were 36 and female patients were 14. Male and female ratio was 2.5:1. Age range was 21 years to 70 years. Most of the patients fall in age group of 41-50(28%).Among the 50 patients with ascites, cirrhosis of liver accounted for 68%, followed by tubercular peritonitis 12%, nephrotic syndrome 8%, congestive cardiac failure 6%, hepatocellular carcinoma 4% and malignancy related 2%. In this study serum ascites albumin gradient accurately identified the cause of ascites in 97% cases. In contrast the exudate-transudate concept identified only 83% correctly. Serum ascites albumin gradient was found superior to the exudate-transudate concept. So, differential diagnosis of ascites should be based on the serum ascites albumin gradient which is a better distinguishing marker.

Prevalence and genetic variation of salivary gland hypertrophy virus in wild populations of the tsetse fly Glossina pallidipes from southern and eastern Africa

The Glossina pallidipes salivary gland hypertrophy virus (GpSGHV) is a rod-shaped, non-occluded double-stranded DNA virus that causes salivary gland hypertrophy (SGH) and reduced fecundity in the tsetse fly G. pallidipes. High GpSGHV prevalence (up to 80%) makes it impossible to mass-rear G. pallidipes colonies for the sterile insect technique (SIT). To evaluate the feasibility of molecular-based GpSGHV management strategies, we investigated the prevalence and genetic diversity of GpSGHV in wild populations of G. pallidipes collected from ten geographical locations in eastern and southern Africa. Virus diversity was examined using a total sequence of 1497 nucleotides (≈ 1% of the GpSGHV genome) from five putative conserved ORFs, p74, pif1, pif2, pif3 and dnapol. Overall, 34.08% of the analyzed flies (n=1972) tested positive by nested PCR. GpSGHV prevalence varied from 2% to 100% from one location to another but phylogenetic and gene genealogy analyses using concatenated sequences of the five putative ORFs revealed low virus diversity. Although no correlation of the virus diversity to geographical locations was detected, the GpSGHV haplotypes could be assigned to one of two distinct clades. The reference (Tororo) haplotype was the most widely distributed, and was shared by 47 individuals in seven of the 11 locations. The Ethiopian haplotypes were restricted to one clade, and showed the highest divergence (with 14-16 single nucleotide mutation steps) from the reference haplotype. The current study suggests that the proposed molecular-based virus management strategies have a good prospect of working throughout eastern and southern Africa due to the low diversity of the GpSGHV strains.

Determination of some significant batch culture conditions affecting acetyl-xylan esterase production by Penicillium notatum NRRL-1249

Background

Acetyl-xylan esterase (AXE, EC 3.1.1.72) hydrolyses acetate group from the linear chain of xylopyranose residues bound by β-1,4-linkage. The enzyme finds commercial applications in bio-bleaching of wood pulp, treating animal feed to increase digestibility, processing food to increase clarification and converting lignocellulosics to feedstock and fuel. In the present study, we report on the production of an extracellular AXE from Penicillium notatum NRRL-1249 by solid state fermentation (SSF).

Results

Wheat bran at a level of 10 g (with 4 cm bed height) was optimized as the basal substrate for AXE production. An increase in enzyme activity was observed when 7.5 ml of mineral salt solution (MSS) containing 0.1% KH₂PO₄, 0.05% KCl, 0.05% MgSO₄.7H₂O, 0.3% NaNO₃, 0.001% FeSO₄.2H₂O and 0.1% (v/w) Tween-80 as an initial moisture content was used. Various nitrogen sources including ammonium sulphate, urea, peptone and yeast extract were compared for enzyme production. Maximal enzyme activity of 760 U/g was accomplished which was found to be highly significant (p ≤ 0.05). A noticeable enhancement in enzyme activity was observed when the process parameters including incubation period (48 h), initial pH (5), 0.2% (w/w) urea as nitrogen source and 0.5% (v/w) Tween-80 as a stimulator were further optimized using a 2-factorial Plackett-Burman design.

Conclusion

From the results it is clear that an overall improvement of more than 35% in terms of net enzyme activity was achieved compared to previously reported studies. This is perhaps the first report dealing with the use of P. notatum for AXE production under batch culture SSF. The Plackett-Burman model terms were found highly significant (HS), suggesting the potential commercial utility of the culture used (df = 3, LSD = 0.126).

Production of 3,4-dihydroxy L-phenylalanine by a newly isolated Aspergillus niger and parameter significance analysis by Plackett-Burman design

BACKGROUND

The amino acid derivative 3,4-dihydroxy L-phenylalanine (L-dopa) is gaining interest as a drug of choice for Parkinson's disease. Aspergillus oryzae is commonly used for L-dopa production; however, a slower growth rate and relatively lower tyrosinase activity of mycelia have led to an increasing interest in exploiting alternative fungal cultures. In the present investigation, we report on the microbiological transformation of L-tyrosine to L-dopa accomplished by a newly isolated filamentous fungus Aspergillus niger.

RESULTS

The culture A. niger (isolate GCBT-8) was propagated in 500 ml Erlenmeyer flasks and the pre-grown mycelia (48 h old) were used in the reaction mixture as a source of enzyme tyrosinase. Grinded mycelia gave 1.26 fold higher L-dopa production compared to the intact at 6% glucose (pH 5.5). The rate of L-tyrosine consumption was improved from 0.198 to 0.281 mg/ml. Among the various nitrogen sources, 1.5% peptone, 1% yeast extract and 0.2% ammonium chloride were optimized. The maximal L-dopa was produced (0.365 mg/ml) at 0.3% potassium dihydrogen phosphate with L-tyrosine consumption of 0.403 mg/ml.

CONCLUSION

Over ~73% yield was achieved (degree of freedom 3) when the process parameters were identified using 2k-Plackett-Burman experimental design. The results are highly significant (p ≤ 0.05) and mark the commercial utility (LSD 0.016) of the mould culture which is perhaps the first ever report on L-dopa production from A. niger.

Validity of Weech's formulae in detecting undernutrition in children

Primary care physicians in developing countries frequently use Weech's formulae to estimate the expected weight and height of children using age as a variable. The present study was undertaken to assess the validity of Weech's formulae in diagnosing undernutrition. We collected anthropometric information from 294 consecutive children, aged 12-59 months, who visited a health centre. Age was calculated from birth records and was recorded in completed months as well as completed years. Weight and height/length were measured using standard methods. Weight-for-age and height-for-age Z scores were calculated using WHO Anthro. Weech's formulae were used to calculate weight-for-age (%) and height-for-age (%). A cut off of < or =80.0% weight-forage and < or = 95.0% height-for-age were used to evaluate the validity of underweight and stunting respectively; a cut off of < or = 60.0% weight-for-age and <85.0% height-for-age were used for severe underweight and severe stunting respectively. Weech's formulae were found to be 100% sensitive in detecting underweight (weight-for-age Z score<-2) and stunting (height-for-age Z score<-2). When evaluating severe underweight (weight-for-age Z scorc<-3) and severe stunting (height-for-age Z scorc<-3), Weech's formulae were found to be 100% specific but the sensitivity was very low, 25.0% and 15.4% respectively. Based on the findings of our study Weech's formulae appear to be a sensitive tool to detect underweight and stunting in children between 12-59 months of age. Such formulae should however be used with caution when evaluating severe forms of undernutrition.

Application of 2-factorial design on the enhanced production of calcium gluconate by a mutant strain of Aspergillus niger

Sixty-eight isolates of the filamentous fungus Aspergillus niger were examined for calcium gluconate production under submerged culture conditions in 500-ml Erlenmeyer flasks. The isolate Chem-15 was selected for improvement through ultraviolet (UV) light-induced mutagenesis. Among viable mutants, strain 32 exhibited the best gluconate productivity, and it was subjected to N-methyl N-nitro N-nitroso guanidine (NG) treatment. Mutant strain NG-7 gave the highest gluconate production (86.48g/L) which varied significantly (p0.05) from that of the wild type. The mutant was cultured overnight and plated on 5-fluorocytosine-PDA medium. Gluconate productivity was increased by 35% when the process parameters, incubation period (72h), initial pH (6.5), glucose as carbon source (15%), inoculum size (1.875x10(6)CFU/ml) and corn steep liquor (CSL) as nitrogen source (0.5%) were optimized using a 2-factorial Plackett-Burman design. Maximal glucose oxidase activity (28U/ml/min) was achieved at the optimal fermentation conditions with 26.5g/L DCM. The model terms were highly significant thus suggesting the potential commercial utility of the mutant (HS, df=3 approximately 0.0182).

Turning off artistic ability: the influence of left DBS in art production

BACKGROUND

The influence of Parkinson's disease (PD) as well as deep brain stimulation (DBS) on visual-artistic production of people who have been artists is unclear. We systematically assessed the artistic-creative productions of a patient with PD who was referred to us for management of a left subthalamic region (STN) DBS. The patient was an artist before her disease started, permitting us to analyze changes in her artistic-creative production over the course of the illness and during her treatment with DBS.

METHODS

We collected her paintings from four time periods: Time 1 (Early Pre-Presymptomatic), Time 2 (Later Presymptomatic), Time 3 (Symptomatic), and Time 4 (DBS Symptomatic). A total of 59 paintings were submitted to a panel of judges, who rated the paintings on 6 different artistic qualities including: aesthetics, closure, evocative impact, novelty, representation, technique.

RESULTS

Aesthetics and evocative impact significantly declined from Time 2 to Time 4. Representation and technique indicated a curvilinear relationship, with initial improvement from Time 1 to Time 2 followed by a decline from Time 2 to Time 4.

CONCLUSIONS

These results suggest that left STN/SNR-DBS impacted artistic performances in our patient. The reason for these alterations is not known, but it might be that alterations of left hemisphere functions induce a hemispheric bias reducing the influence the right hemisphere which is important for artistic creativity. The left hemisphere itself plays a critical role in artistic creativity and DBS might have altered left hemisphere functions or altered the mesolimbic system which might have also influenced creativity. Future studies will be required to learn how PD and DBS influence creativity.

Cardiovascular risks of COX inhibition: current perspectives

BACKGROUND

NSAIDs are among the most commonly used pharmacotherapeutic agents worldwide. As the long-term use of these drugs is associated with serious gastrointestinal side effects, a new subgroup of COX-2 selective NSAIDs was developed. It was thought that the therapeutic strategy underlying the development of these newer compounds would enable them to provide the same analgesic and anti-inflammatory benefits as those of their traditional counterparts but perhaps offer a much safer gastrointestinal profile. Much scientific data has accumulated over the last few years, however, raising concerns regarding the increased cardiovascular complications associated with the use of COX-2 selective NSAIDs, and perhaps of the traditional NSAIDs as well.

OBJECTIVE

To review current and emerging evidence related to the cardiovascular effects of COX inhibitors and examine the clinical implications.

METHOD

We studied data from basic clinical research, non-randomized analyses, and randomized trials of COX inhibitors that investigated their cardiovascular effects.

CONCLUSION

Both COX-2 selective and traditional NSAIDs are associated with a moderately increased risk of cardiovascular events.

Kinetics of improved extracellular ?-d-fructofuranosidase fructohydrolase production by a derepressed Saccharomyces cerevisiae

AIMS

beta-d-fructofuranosidase fructohydrolase (FFH, EC 3.2.1.26) is an enzyme which hydrolyses the alpha-1,4 glycosidic bonds of sucrose and releases monosaccharides. The present study deals with the kinetics of improved extracellular FFH production by Saccharomyces cerevisiae in batch culture.

MATERIALS AND RESULTS

Strains of S. cerevisiae can show increased FFH activity when grown on chemically defined medium. In the present study, wild-culture S. cerevisiae GCB-IV was mutated by treatment with ethyl methane sulfonate (EMS). Among six yeast mutants, EMS-II was found to be the highest FFH-producing strain (51.46 +/- 2.4 U ml(-1)). Maximum FFH production (78.46 +/- 3.2 U ml(-1)) was obtained 48 h after incubation by this 2-deoxy-d-glucose (2dg)-resistant mutant (76.20 mg ml(-1) protein). The optimal concentration of sucrose, incubation period and initial pH were 30.0 g l(-1), 28 degrees C and 6.5, respectively. The mutant EMS-II showed improvement in FFH production when 5.0 g l(-1) urea was added as a sole nitrogen source into SAPY medium. Values for Q(p) (1.802 +/- 0.2 U ml(-1) h(-1)) and Y(p/s) (3.460 +/- 1.1 U g(-1)) of EMS-II were significantly improved over the other yeast strains.

CONCLUSION

The E(a) value (40.28 +/- 3.5 kJ mol(-1)) of EMS-II was significant (P <or= 0.05) when compared with its wild-culture progenitor GCB-IV. In addition, thermodynamic studies revealed that the cell system exerts protection against thermal inactivation of FFH (33.55 +/- 4.2 kJ mol(-1)).

SIGNIFICANCE AND IMPACT OF THE STUDY

The EMS-II mutant can be exploited for FFH production over a wide range of incubation temperature (26-34 degrees C).

The use of patient partners with back pain to teach undergraduate medical students

OBJECTIVES

To assess the impact of teaching about back pain to medical students using trained patient partners (PP).

METHODS

An initial training programme for four PPs (two with sciatica and two with ankylosing spondylitis) followed by teaching to alternate groups of medical students at the Whittington Campus of the Royal Free and University College Medical School (RFUCMS). A control group of students did not receive the PP teaching. All students received standard Whittington Campus rheumatology teaching. Performance in an end of year objective structured clinical examination (OSCE) was compared between the two groups. Student and PP perceptions of the teaching and training were evaluated using focus groups and questionnaires.

RESULTS

Students receiving the PP teaching performed significantly better in a summative OSCE, but no difference was seen in analysis of a single station assessing history-taking skills in a patient with back pain. Students felt that the PP teaching improved their ability to elicit information from a patient during the consultation. PPs enjoyed the experience of teaching and felt empowered to self-manage their medical conditions, and were better able to seek medical advice when needed.

CONCLUSIONS

Using PPs with back pain to teach medical students has a positive effect on student learning and patient well-being. The feasibility of delivering this programme will depend on faculty resources. The effects on examination performance are small but significant.

Assessing competencies in rheumatology

Assessment of competencies in rheumatology is difficult, but possible, and is an important part of the evaluation of practising clinicians, helping to prevent poor performance. Competencies are currently assessed by the Royal College of Physicians, the General Medical Council, and the National Clinical Assessment Authority.