Crystal structures of GCN2 C-terminal domain: Insight into GCN2 regulation

General control non-derepressible 2 kinase (GCN2) is a serine threonine kinase that curtails translation in response to diverse stress stimuli [1]. It is a primary sensor of amino acid starvation and mediates translation repression by phosphorylating eIF2 [2]. In addition to the kinase domain, GCN2 contains two regulatory regions; a histidyl-tRNA synthetase-like domain (HisRS) and a C-terminal domain (CTD), which function together to sense nutrient depletion. Both domains have been proposed to bind uncharged tRNA's that accumulate during amino acid starvation followed by dimerization of the kinase domain facilitating activation of GCN2 [3]. Thus, while the CTD plays an important regulatory role in activating GCN2, information on how the CTD facilitates dimerization and whether the CTD plays a similar role in murine GCN2 is limited. Moreover, the sequences of vertebrate CTDs share less than 10% sequence identity with their yeast counterpart; therefore, it is not known whether regulatory mechanisms in GCN2 are conserved across different species. We present here the experimentally phased crystal structures of murine CTD at 1.9 Å and yeast CTD at 1.95 Å. Both murine and yeast CTDs share a novel interdigitated dimeric organization, although the dimeric structures differ somewhat in overall shape and size. Additional biochemical analysis of the murine CTD confirms an important role for dimerization in its activation. Moreover, functional studies reveal that both yeast and murine GCN2 have similar nucleic acid binding properties, but mGCN2 does not appear to exhibit ribosomal association, a key feature in the model for regulation of yeast GCN2, suggesting that there are regulatory differences between the murine GCN2 and its yeast counterpart. Our data provides a basis for understanding the role of the CTD in regulation of GCN2 in both yeast and mammals.

Identification of pregnancy-associated glycoproteins by peptide mass fingerprinting in water buffalo (Bubalus bubalis)

Ruminant placentas synthesize pregnancy-associated glycoproteins (PAGs) during pregnancy, which serve as biomarkers of pregnancy. The present study was conducted to verify, whether PAGs are expressed in buffalo placenta by using lectin-based affinity chromatography and peptide mass finger printing (PMF). Fetal cotyledonary tissues were collected from gravid uteri procured from slaughtered house. Proteins were extracted and subjected to wheat germ agglutinin (WGA) lectin affinity chromatography to isolate the PAGs. The isolated glycoproteins were separated by one-dimensional SDS-PAGE. PMF results of the 75 kDa protein revealed presence of two PAGs (PAG-7 and -11). The PAG-7 consisted of about 170 mass signals, of which 16 were assigned to corresponding/translated cDNA sequences of buffalo PAG-7, leading to sequence coverage of 40%. PMF result of PAG-11 showed 170 mass signals, of which 15 were assigned to buffalo PAG-11, leading to sequence coverage of 34%. In conclusion, the glycoprotein isolated from placental extract corresponding to 75 kDa band on SDS PAGE gel was a mixture of PAG-7 and -11, which may help in development of suitable diagnostics for pregnancy in buffalo.

Crystal structures of GCN2 protein kinase C-terminal domains suggest regulatory differences in yeast and mammals

In response to amino acid starvation, GCN2 phosphorylation of eIF2 leads to repression of general translation and initiation of gene reprogramming that facilitates adaptation to nutrient stress. GCN2 is a multidomain protein with key regulatory domains that directly monitor uncharged tRNAs which accumulate during nutrient limitation, leading to activation of this eIF2 kinase and translational control. A critical feature of regulation of this stress response kinase is its C-terminal domain (CTD). Here, we present high resolution crystal structures of murine and yeast CTDs, which guide a functional analysis of the mammalian GCN2. Despite low sequence identity, both yeast and mammalian CTDs share a core subunit structure and an unusual interdigitated dimeric form, albeit with significant differences. Disruption of the dimeric form of murine CTD led to loss of translational control by GCN2, suggesting that dimerization is critical for function as is true for yeast GCN2. However, although both CTDs bind single- and double-stranded RNA, murine GCN2 does not appear to stably associate with the ribosome, whereas yeast GCN2 does. This finding suggests that there are key regulatory differences between yeast and mammalian CTDs, which is consistent with structural differences.

The structure of an authentic spore photoproduct lesion in DNA suggests a basis for recognition. Corrigendum

A correction is made to the article by Singh et al. [(2014). Acta Cryst. D70, 752–759].

The article by Singh et al. [ (2014). Acta Cryst. D70, 752–759] is corrected.

The structure of an authentic spore photoproduct lesion in DNA suggests a basis for recognition

The spore photoproduct lesion (SP; 5-thymine-5,6-dihydrothymine) is the dominant photoproduct found in UV-irradiated spores of some bacteria such as Bacillus subtilis. Upon spore germination, this lesion is repaired in a light-independent manner by a specific repair enzyme: the spore photoproduct lyase (SP lyase). In this work, a host-guest approach in which the N-terminal fragment of Moloney murine leukemia virus reverse transcriptase (MMLV RT) serves as the host and DNA as the guest was used to determine the crystal structures of complexes including 16 bp oligonucleotides with and without the SP lesion at 2.14 and 1.72 Å resolution, respectively. In contrast to other types of thymine-thymine lesions, the SP lesion retains normal Watson-Crick hydrogen bonding to the adenine bases of the complementary strand, with shorter hydrogen bonds than found in the structure of the undamaged DNA. However, the lesion induces structural changes in the local conformation of what is otherwise B-form DNA. The region surrounding the lesion differs significantly in helical form from B-DNA, and the minor groove is widened by almost 3 Å compared with that of the undamaged DNA. Thus, these unusual structural features associated with SP lesions may provide a basis for recognition by the SP lyase.

Drug utilisation study in a tertiary care center: recommendations for improving hospital drug dispensing policies

Drug therapy accounts for a major portion of health expenditure. A useful strategy for achieving cost efficient healthcare is drug utilisation research as it forms the basis for making amendments in drug policies and helps in rational drug use. The present observational study was conducted to generate data on drug utilization in inpatients of our tertiary care hospital to identify potential targets for improving drug prescribing patterns. Data was collected retrospectively from randomly selected 231 medical records of patients admitted in various wards of the hospital. WHO Anatomical Therapeutic Chemical/Defined Daily Dose methodology was used to assess drug utilisation data and drug prescriptions were analysed by WHO core drug indicators. Antibiotics were prescribed most frequently and also accounted for majority of drug costs. The prescribed daily dose for most of the antibiotics corresponded to defined daily dose reflecting adherence to international recommendations. Brand name prescribing and polypharmacy was very common.78% of the total drugs prescribed were from the National List of Essential Medicines 2003. Restricting the use of newer and costlier antibiotics, branded drugs and number of drugs per prescription could be considered as targets to cut down the cost of drug therapysignificantly.

A review of the mechanisms and effectiveness of dietary polyphenols in reducing oxidative stress and thrombotic risk

Dietary sources of polyphenols, which are derivatives and/or isomers of flavones, isoflavones, flavonols, catechins and phenolic acids, possess antioxidant properties and therefore might be important in preventing oxidative-stress-induced platelet activation and attenuating adverse haemostatic function. Free radicals, including reactive oxygen and nitrogen species, promote oxidative stress, leading to platelet hyperactivation and the risk of thrombosis. The consumption of antioxidant/polyphenol rich foods might therefore impart anti-thrombotic and cardiovascular protective effects via their inhibition of platelet hyperactivation or aggregation. Most commonly-used anti-platelet drugs such as aspirin block the cyclooxygenase (COX)-1 pathway of platelet activation, similar to the action of antioxidants with respect to neutralising hydrogen peroxide (H2 O2 ), with a similar effect on thromboxane production via the COX-1 pathway. Polyphenols also target various additional platelet activation pathways (e.g. by blocking platelet-ADP, collagen receptors); thus alleviating fibrinogen binding to platelet surface (GPIIb-IIIa) receptors, reducing further platelet recruitment for aggregation and inhibiting platelet degranulation. As a result of the ability of polyphenols to target additional pathways of platelet activation, they may have the potential to substitute or complement currently used anti-platelet drugs in sedentary, obese, pre-diabetic or diabetic populations who can be resistant or sensitive to pharmacological anti-platelet therapy.

Cortisol and proinflammatory cytokine profiles in type 1 (reversal) reactions of leprosy

PURPOSE

Cortisol levels in the circulation and at the sites of peripheral inflammation regulate type 1 (Reversal) reactions in leprosy akin to delayed type hypersensitivity reactions (DTH). In this study we determine the extent to which the differential mRNA expression of genes encoding cortisone-cortisol shuttle enzymes (11 β hydroxysteriod dehydrogenase I & II (11 β HSD I & II)), circulatory levels of proinflammatory cytokines (IL-6, IL-7, IP-10, IL-17F, IL-23, TNF-α, IL-1β, PDGF BB and CRP) and cortisol are associated with development of type 1 reactions in leprosy.

METHODS

Urine, blood and incisional skin biopsy samples from site of lesions were collected from 49 newly diagnosed untreated leprosy cases in T1R and 51 cases not in reaction (NR). mRNA expression levels of genes encoding 11 β HSD I & II in skin biopsy samples were determined by realtime PCR. Cortisol levels from the lesional skin biopsies, serum and urine samples and serum proinflammatory cytokine levels were measured using ELISA.

RESULTS

The mean expression ratios of 11 β HSD I & II are significantly lower in leprosy cases with T1R when compared to the NR leprosy cases. Cortisol levels in lesional skin biopsies and in urine are significantly lower (p=0.001) in leprosy cases with T1R. Serum cytokine levels of IP-10, IL-17F, IL-IL-6 and TNF-α are significantly higher (p<0.05) in leprosy cases with T1R when compared the NR leprosy cases.

CONCLUSION

Our study indicated an association of urinary and lesional skin cortisol levels with the manifestation of T1R in leprosy. IP-10, IL-17F, IL-6 and TNF-α can be potential prognostic serological markers and gene expression markers for early detection of type 1 reactions in leprosy.

Addressing Antimicrobial Resistance in Dentistry

Background

Antimicrobial agents are life saving drugs which are used in management of various life threatening infections but irrational use of antibiotics have led to resurgence of multidrug resistant bacteria which are associated with global increase in mortality due to various infections. Dentists are one among important health care personnel who prescribe antibiotics routinely to treat various oral infections.

Objectives

To summarise the evidence of antimicrobial resistance (AMR) encountered in dental practice, discuss factors associated with it and suggest measures to prevent antimicrobial resistance in dentistry.

Methodology

Articles were identified by searching in electronic data bases such as PubMed, Medline, Embase, Google Scholar and Cochrane data bases using key words like antibiotics, antimicrobial resistance, and antibiotic resistance in dentistry. The articles fulfilling the objectives were included.

Results and Conclusions

Dentists also contribute significantly to the global burden of antimicrobial resistance due to irrational use of antibiotics. Antibiotic stewardship is essential to prevent antimicrobial resistance in dental practice and hence there is an urgent need to educate not only dentists but general public as well. The article describes the gravity of the AMR and the importance of prudent use of antibiotics is discussed.

Nasal mucous ciliary clearance and olfaction in atrophic rhinitis

Nasal mucocilliary Clearacne (NMCC) was studied in 75 cases of atrophic rhinitis and results were compared with 35 healthy controls using Anderson's method. Olfaction in atrophic rhinitis decreases but its extent has not been studied earlier. We have tried to quantify olfaction. This was normal in 10.6%, mild hyposmia was seen in 30%, severe in 23.33% and anosmia was present in 36%.

Study of histopathological changes in atrophic rhinitis

A punch biopsy from the inferior turbinate was taken in 71 consecutive cases of atrophic rhinitis and studied for histopahtological changes. Squamous metaplasia was seen in 85 percent of cases. Tunica propria showed granulation tissue (41 percent) and chronic inflammatory cellular infiltrate (32 percent). Mucosal glands were decreased in 42 percent of cases and absent in 28 percent. Areas of dilated vessels were observed in 35 percent and decreased vascularity in 59 percent of cases. These observations are similar to those reported by others. Total squamous metaplasia with keratinisation and hypertrophy was seen by us in one case. This has not been reported earlier.

The overweight: obesity and plasma lipids in adults with intellectual disability and mental illness

BACKGROUND

Previous studies in adults with intellectual disabilities (ID) have reported a higher prevalence of obesity than in the general population, and a trend to an increase in the prevalence of excess weight. However, little information is available on body weight status and lipids levels of adults with ID and co-existing mental illness. The aim of this study was to address this information gap, by conducting a stepwise multiple regression analysis to predict BMI, thereby allowing the investigation of (semi-)partial correlations, which assess the extent to which a particular predictor variable is associated with BMI over and above the other predictors.

METHODS

A study of the patients with ID and psychiatric illness registered in the service. Collected data included body mass index (BMI), age, gender, the presence of additional physical conditions, residential status, mental illness and use the psychotropic medication. We analysed the lipid profile including serum cholesterol together with low-density lipoprotein, high-density lipoprotein (HDL), triglycerides and the serum cholesterol/HDL ratio. Data for these variables were entered into a stepwise multiple linear regression to predict BMI.

RESULTS

28% of the participants were overweight and 41% obese. Most of the obese patients were men with mild ID (P = 0.039). Level of ID (P = 0.003), gender (P = 0.001) and serum triglycerides (P = 0.026) had significant predictive value in the regression model. There were no significant differences in either the mean serum cholesterol levels or the mean triglyceride levels between those taking and those not taking first-generation antipsychotics, second-generation antipsychotics or anti-epileptic medication.

CONCLUSIONS

The rate of obesity in our sample was higher than in previous studies. The most predictive combination of predictors to predict BMI was ID level, gender and serum triglyceride levels. Serum triglyceride and cholesterol levels did not appear to be unduly affected by first- or second-generation antipsychotic medication or by antiepileptic medication.

228 DOMINANT FOLLICLE ABLATION IMPROVES SUPEROVULATORY RESPONSE AND EMBRYO YIELD IN BUFFALOES SUBJECTED TO INTEGRATED SINGLE-OVULATION EMBRYO TRANSFER - MULTIPLE-OVULATION EMBRYO TRANSFER PROGRAM

Effect of the removal of inhibitory consequences of a dominant follicle (DF) on the recruitment, growth and ovulation of follicles in cyclic buffaloes induced to superovulate, was evaluated. Eight elite, multiparous, donor Murrah buffaloes, 80 to 120 days postpartum, were included in an integrated single-ovulation embryo transfer–multiple-ovulation embryo transfer (SOET-MOET) schedule. Superovulation with FSH (Folltropin® NIH-FSH-P1, Bioniche Animal Health, Belleville, ON, Canada) was preceded by nonsurgical single embryo (SOET) recovery on Day 5 or 6 after prostaglandin F2α (Lutalyse®, Pfizer, Madison, NJ, USA)-induced oestrus and AI (Day 0). For MOET, Folltropin was administered from Day 9 p.m. through to Day 13 p.m. in a twice-daily descending dose schedule (0–5, 5–4, 4–3, 3–2, 2–1 mL; total dose of 580 mg of NIH-FSH-P1). A dose of 25 mg of Lutalyse was administered on Day 12 a.m. and p.m. Donors were inseminated with proven semen on Day 14 a.m. and p.m. and Day 15 a.m. Nonsurgical embryo collection was carried out on Day 19 or 20 followed by administration of Lutalyse on Day 25. Following sexual rest for one complete oestrous cycle, Day 5 or 6 SOET was repeated. On Day 9, ultrasound-guided follicle aspiration was used to ablate the DF and the second MOET treatment was initiated at the same time. Mean diameter of DF at the start of superovulation treatment on Day 9 was similar between the first (12.5 ± 0.66 mm) and second (12.2 ± 0.33 mm) MOET cycles. At AI, mean number (9.6 ± 1.43 vs 13.4 ± 1.87) of follicles >9 mm were higher (P < 0.05) in the second (ablation) MOET cycle, though their mean diameters were similar (11.7 ± 0.21 vs 12.3 ± 0.21 mm; P = 0.17). On the day of ova/embryo collection, almost similar numbers of large follicles (4.1 ± 0.93 and 4.4 ± 0.84), with mean diameters of 12.9 ± 0.74 and 13.4 ± 0.83 mm, were observed for the first and second MOET, respectively. Mean (± SEM) numbers of corpora lutea (3.9 ± 0.81 and 4.9 ± 0.61; P = 0.19) and transferable quality embryos (0.6 ± 0.37 and 1.6 ± 0.37; P = 0.077) were counted in the first and second (ablation) MOET cycles, respectively. These preliminary findings suggest that ablation of DF before start of superovulatory treatment may be beneficial in improving the yield of transferable embryos in a buffalo MOET program. Director, CIRB, is acknowledged for the experimental facilities.

Age, breed, sex distribution and nutrition of a population of working farm dogs in New Zealand: results of a cross-sectional study of members of the New Zealand Sheep Dog Trial Association

AIM

To establish baseline information about age, breed, sex distribution and feeding practices for a population of working farm dogs owned by members of the New Zealand Sheep Dog Trial Association (NZSDTA) throughout New Zealand.

METHODS

Questionnaires were sent to members of the NZSDTA in August 2007, requesting information on the size and terrain of the farms where they worked, as well as the breed, weight, age and sex of each working dog they owned, feeding regime employed, diet fed, work levels, and general health of their dogs.

RESULTS

The survey was completed by 542/676 (81%) of the eligible sample population, and provided information on 2,861 dogs, excluding those <1 year old. All of the dog owners surveyed worked on sheep and beef-cattle farms. The median farm size was 440 [Inter-quartile range (IQR) 132-1,200] ha and varied with region. The majority of farms were situated on either hill country (184/542; 34%) or a mixture of hilly and flat terrain (260/542; 48%), and had a median of six (IQR 5-8) working dogs per farm. The median age of dogs was 3.0 (IQR 2.0-6.0) years. Heading dogs were the most common type of working dog (1,510/2,861; 52.8%), followed by Huntaways (1,161/2,861; 40.6%). The gender distribution of all dogs was biased towards males (57%), but this decreased with age. There was a positive association between the number of dogs on a farm and perceived level of tiredness of dogs (p<0.001), but there were no differences in levels of tiredness between farms of different terrain. Most owners (526/542; 97%) fed their dogs once a day. The most common diet fed was a combination of dry food and homekill, which was fed by 328/542 (61%) owners during peak and 313/542 (58%) during off-peak periods of work.

CONCLUSIONS AND CLINICAL RELEVANCE

This study has established baseline information on the age, breed, gender and nutrition of a large population of working farm dogs in New Zealand. Current feeding practices employed by owners include offering a substantial amount of homekill to their animals. Homekill may be deficient or marginal in vitamins and minerals, therefore opportunities could exist to improve the diets and therefore the longevity and performance of these dogs.

Trace metal concentration in different Indian tobacco products and related health implications

Concentrations of seven heavy metals, viz. Cd, Ni, Pb, Cr, Cu, Fe and Zn were determined in 30 samples of various brands of five different tobacco product types easily available in Indian markets. Three product types cigarettes, cigars and biri (tobacco rolled in dry leaf and smoked without filter) are consumed by smoking while chewing tobacco and snuff are consumed by chewing and sniffing, respectively. The metal content showed smoking and non-smoking type, brand and element specific variations. In the non-smoking type, chewing tobacco samples contained more heavy metals compared to snuff samples. Biri showed minimum metal content compared to cigarettes and cigars among the smoking types. This could be due to the metal enrichment during both chemical and physical processing in finished product; biri being the most raw and cheap product. The intra brand variations also indicate the same as the processing technologies are exclusive and different for each brand. The results are nearly comparable to the existing data with limited exceptions. We suggest that the smoke and ash produced could be significant contributor to metal load in the soil, air and water systems in addition to the adverse human health effects via direct tobacco consumption.

Dermatophytes, related keratinophilic and opportunistic fungi in indoor dust of houses and hospitals

Dermatophytes, related keratinophilic and opportunistic fungi were isolated from indoor dust samples of 46 hospitals and 47 houses in Kanpur. A total of 19 fungi represented by 11 genera were isolated by the hair-baiting technique from 230 and 235 samples from hospitals and houses respectively. The isolated fungi are Acremonium implicatum (Indian Type Culture Collection) ITCC 5266, A. strictum (Germplasm Centre for Keratinophilic Fungi) GPCK 1137, Aphanoascus fulvescens GPCK 1081, Arthroderma simii GPCK 1275, Chrysosporium queenslandicum ITCC 5270, C. indicum ITCC 5269, C. pannicola GPCK 1022, C. tropicum GPCK 1269, Ctenomyces serratus ITCC 5267, Gymnoascus reessii ITCC 5265, Malbranchea fulva GPCK 1075, Malbranchea pulchella ITCC 5268, Micosporum gypseum GPCK 1038 , Microsporum cookei GPCK 2001, M. fulvum GPCK 2002, Paecilomyces lilacinum GPCK 1080, Penicillium expansum GPCK 1082, Trichophyton mentagrophytes GPCK 2003 and T. terrestre GPCK 2004. In hospitals, the minimum frequency was of Ctenomyces serratus ITCC 5267 while the maximum frequency was of Arthroderma simii GPCK 1275. In houses, Chrysosporium queenslandicum ITCC 5270 and C. tropicum GPCK 1269 were with minimum and maximum frequencies respectively. This makes the first report of these fungi with keratinolytic ability in the indoor dust of hospitals and houses.

The effect of exercise and training status on platelet activation: Do cocoa polyphenols play a role?

Sedentary and trained men respond differently to the same intensity of exercise, this is probably related to their platelet reactivity and antioxidant capacity. There is growing interest in the utilization of antioxidant-rich plant extracts as dietary food supplements. The aim of this study was to investigate the effect of an acute bout of sub maximal exercise on platelet count and differential response of platelet activation in trained and sedentary subjects and to observe if cocoa polyphenols reverse the effect of exercise on platelet function. The practical significance of this study was that many sedentary people engage in occasional strenuous exercise that may predispose them to risk of heart disease. Fasting blood samples were collected from 16 male subjects, pre and post 1-h cycling exercise at 70% of maximal aerobic power (VO2max) before and after consumption of cocoa or placebo. Agonist stimulated citrated whole blood was utilized for measuring platelet aggregation, adenosine triphosphate (ATP) release and platelet activation. Baseline platelet count (221 +/- 33 x 10(9)/L) and ATP release (1.4 +/- 0.6 nmol) increased significantly (P < 0.05) after exercise in all subjects. Baseline platelet numbers in the trained were higher (P < 0.05) than in the sedentary (235 +/- 37 vs. 208 +/- 34 x 10(9)/L), where as platelet activation in trained was lower (P < 0.05) than sedentary (51 +/- 6 vs. 59 +/- 5%). Seven days of cocoa polyphenol supplementation had little effect on any of the parameters measured. We conclude that trained subjects show decreased activation of stimulated platelets when compared to the sedentary subjects and short-term cocoa polyphenol supplementation did not decrease platelet activity in response to exercise independent of prior training status.

Rickettsial diseases in Haryana: not an uncommon entity

Rickettsioses have not been reported from the plains of North India and Haryana in particular. Here we are reporting three cases of scrub typhus and one cases of Indian tick typhus in the state of Haryana, all of which presented with fever and multi organ dysfunction, rash and without eschar. All were successfully treated with doxycycline.

Dendrimers and their pharmaceutical applications--a review

Dendrimers are hyperbranched macromolecules having tree like structure, consisting of a core molecule and alternating layers of monomers. They can be synthesized by divergent and convergent growth methods. During synthesis, properties like dendrimer size, molecular mass, surface group can be controlled and configured to the desired need. The ability of dendrimers to encapsulate and bind the guest molecule can be used for solubility enhancement, sustained release and drug delivery applications. In this review we tried to delineate the properties, synthesis methods and expound potential pharmaceutical applications along with toxicological considerations of dendrimers.

Medullary carcinoma in a lingual thyroid

Total ectopia of thyroid is a rare phenomenon and malignant change in an ectopic thyroid is even rarer. We report a case of medullary carcinoma in a total ectopic lingual thyroid occurring in a 45-year-old woman who presented with dysphagia, plummy voice and a round sessile mass at the base of the tongue. The mass was extirpated using Trotter's midline approach. Upon examination, it was found to be medullary carcinoma in an ectopic thyroid. Permanent substitution therapy with thyroxine secured the euthyroid status of the patient. The embrylogical basis and a review of literature regarding carcinomatous change in an ectopic thyroid are also discussed. There is a need to investigate for an ectopic thyroid, or even total ectopia, in the case of any smooth mass found at the base of the tongue.

The morphology of central tympanic membrane perforations

The objective of this study was to assess the extent of conductive hearing loss in relation to different sizes and sites of simple central tympanic membrane perforations. Total 100 cases attending ENT OPD, BPKIHS during period of April 2003 to Mar 2004 without any discrimination of sex, race and religion were taken for the cross sectional prospective study. Dry, clean central tympanic membrane perforations due to various causes like chronic suppurative otitis media-tubotympanic, post acute suppurative otitis media residual perforations or simple traumatic perforations with conductive hearing loss and without preexisting hearing loss were clinicoaudiologically evaluated and analyzed. Hearing loss was found to be directly proportional to the size of perforation irrespective of their cause, which was statistically significant. Hearing loss in the study was found to range from negligible to 53dB. Overall, perforations involving posterioinferior quadrant were found to have maximum hearing loss.

Why are we waiting? A study of the patients' perspectives about their protracted stays in an emergency department

The overcrowding of Emergency Departments compromises their critical function and the safety of patients and staff. This study asked the patients how the wait in overcrowded conditions impacted on them and the care they received and what they believed the reasons for the overcrowding were. A prospective questionnaire based structured interview study was performed. Over half (57.7%) of patients felt that the lack of inpatient beds and wards was the main reason that they experienced delays. An overwhelming 85.9% felt that the Health Authorities were not doing enough to address the overcrowding issue. Overcrowding of Emergency Departments has been identified as a major problem the solution is to be found in increasing the capacity of the acute hospital system according to the majority of our study population.

Influence of water soluble polymers on hydroxypropyl-beta-cyclodextrin complexation of rofecoxib

Rofecoxib (Rb) is a nonsteroidal anti-inflammatory drug (NSAID) with poor aqueous solubility. The present study was undertaken to investigate the influence of water-soluble polymers namely sodium carboxymethyl cellulose (Na CMC), polyvinylpyrrolidine (PVP) and polyethylene glycol (PEG-6000) on hydroxypropyl beta-cyclodextrin (HP beta-CD) complexation of Rb. The complexes were prepared by kneading, autoclaving and precipitation techniques in 1:1 and 1:2 molar ratios. The aqueous solubility enhancement of Rb by these polymers is found to be of the following order: Na CMC > PVP > PEG-6000. Complexes were characterized by Fourier transform infrared (FTIR) spectroscopy, Nuclear magnetic resonance (NMR) and X-ray diffractometry (XRD) techniques. In vitro dissolution studies were carried out on tablets formulated from molar ratios of the complexes prepared by different techniques.