Nanoparticle-based therapeutic strategies for mitochondrial dysfunction in cardiovascular disease

Although cardiovascular diseases (CVD) are the leading cause of global mortality, there is a lack of therapies that target and revert underlying pathological processes. Mitochondrial dysfunction is involved in the pathophysiology of CVD, and thus is a potential target for therapeutic development. To target the mitochondria and improve therapeutic efficacy, nanoparticle-based delivery systems have been proposed as promising strategies for the delivery of therapeutic agents to the mitochondria. This review will first discuss how mitochondrial dysfunction is related to the progression of several CVD and then delineate recent progress in mitochondrial targeting using nanoparticle-based delivery systems including peptide-based nanosystems, polymeric nanoparticles, liposomes, and lipid nanoparticles. In addition, we summarize the advantages of these nanocarriers and remaining challenges in targeting the mitochondria as a therapeutic strategy for CVD treatment.

Spotlight on Genetic Kidney Diseases: A Call for Drug Delivery and Nanomedicine Solutions

Nanoparticles as drug delivery carriers have benefited diseases, including cancer, since the 1990s, and more recently, their promise to quickly and efficiently be mobilized to fight against global diseases such as in the COVID-19 pandemic have been proven. Despite these success stories, there are limited nanomedicine efforts for chronic kidney diseases (CKDs), which affect 844 million people worldwide and can be linked to a variety of genetic kidney diseases. In this Perspective, we provide a brief overview of the clinical status of genetic kidney diseases, background on kidney physiology and a summary of nanoparticle design that enable kidney access and targeting, and emerging technological strategies that can be applied for genetic kidney diseases, including rare and congenital kidney diseases. Finally, we conclude by discussing gaps in knowledge remaining in both genetic kidney diseases and kidney nanomedicine and collective efforts that are needed to bring together stakeholders from diverse expertise and industries to enable the development of the most relevant drug delivery strategies that can make an impact in the clinic.

Inequality of handwashing practice using antimicrobial agents in Bangladesh: a household level analyses

OBJECTIVES

About 2.3 billion individuals worldwide are still deprived of the amenity of handwashing with antimicrobial agents. The progress of handwashing with antimicrobial agents in Bangladesh is relatively slower than in many developing countries. The objective of this study was to capture the inequality of the prevalence of handwashing with antimicrobial agents and to identify the factors that are potentially contributing to socio-economic inequalities of handwashing practice in Bangladesh.

STUDY DESIGN

Cross-sectional study.

METHODS

The present study used the nationally representative cross-sectional data from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18. A total of 19,457 households were included in the analysis of this study. A regression-based decomposition method was applied to assess the socio-economic contributors of inequality.

RESULTS

This study showed that only 38% of Bangladeshi households wash their hands with antimicrobial agents while a pro-rich socio-economic inequality was observed. Household's wealth index was responsible for about 46% of the overall inequality of handwashing with antimicrobial agents while the type of place for handwashing variable contributed 38% of total inequalities. Hygienic toilet facilities (12%) and exposure to mass media (7.4%) are other determinants of total inequalities of handwashing with antimicrobial agents.

CONCLUSIONS

Despite recent declines in attributable mortality, handwashing with antimicrobial agents remains an important determinant of public health problems in many developing countries like Bangladesh. The regular programs aimed at promoting best hand hygiene practices and ensuring the availability of the necessary infrastructure at the community level will be important measures to eliminate this inequality at the population level.

Occurrence of GI parasites in ruminants of Kashmir and Ladakh

The study was conducted in Kashmir and Ladakh Divisions of the erstwhile state of Jammu and Kashmir to work out the occurrence of gastrointestinal parasites in ruminants. The qualitative faecal examination of 476 samples revealed an overall prevalence of GI parasites to the tune of 80.04% comprising of 80.61% in cattle, 96.70% in sheep and 66.27% in goats. In Kashmir overall prevalence of GI parasites was 88.33% comprising of 80.61% in cattle, 98.41% in sheep and 100% in goats. Highest prevalence was observed for strongyles (84.00%) followed by Eimeria spp. (31.67%), Moniezia spp. (20.00%), Ascaris spp. (5.33%) and Strongyloides spp. (1.67%). Mixed infection was observed in 37.67% samples. In cattle, the parasites observed were strongyles (68.37%) and Eimeria spp. (13.27%) with mixed infection in 1.02% samples. In sheep highest prevalence was observed for strongylid eggs (97.88%) followed by Eimeria spp. (43.38%), Moniezia spp. (31.74%), Ascaris spp. (8.47%) and Strongyloides spp. (2.64%) with mixed infection in 59.26% samples. Amongst goats, only strongylid eggs (100%) were observed. In Ladakh region overall prevalence of GI parasites was 65.91% with 82.61% in sheep and 63.40% in pashmina goats. Highest prevalence was observed for Eimeria spp. (63.64%) followed by strongyles (9.09%) Moniezia spp. (5.11%) and Thysanosoma spp. (1.14%). Mixed infection was observed in 13.07% samples. In sheep, highest prevalence was observed for Eimeria spp. (73.91%) followed by strongyles (17.39%) and Thysanosoma spp. (8.70%) with mixed infection in 17.39% samples. In pashmina goats, the prevalence of Eimeria spp. (62.09%) was observed highest followed by strongylid eggs (7.84%) and Moniezia spp. (5.88%) with mixed infection in 12.42% samples.

989 Sustained and Further Improvements in Management of Open Fractures at a UK Major Trauma Centre

Aim

To re-audit pre-operative hospital management of open fractures following further interventions (junior doctor education and awareness, editing of trauma clerking form), after the initial audit and interventions led to improvements in all parameters.

Method

Pre-operative hospital management of open fractures was audited by reviewing patient notes using standards from the NICE (NG37) and BOAST/BAPRAS open fracture management guidelines. Patients included were treated by doctors with full exposure to the further interventions (due to junior doctor changeover the third cycle included fewer patients).

Results

All parameters remained improved in the third audit cycle compared to the first (before interventions were implemented). The following results compare the second (n = 30) and third audit (n = 14) cycles. Patients receiving correct antibiotics (96%vs100%) and in a timely manner (<2 hours) where not given pre-hospital (46%vs60%) improved. Initial neurovascular assessment (93%vs100%), specifying nerves assessed (60%vs71%), assessing all relevant arteries (60%vs71%) and nerves (63%vs71%) and using Medical Research Council (MRC) grading in nerve assessment (3%vs71%) improved, while specifying arteries assessed was similar (87%vs86%). Post-manipulation, neurovascular assessment (93%vs75%) and appropriate nerve examination (90%vs50%) deteriorated, however appropriate vascular assessment (60%vs75%) and use of MRC grading in nerve assessment (0%vs50%) improved. Documentation where neurovascular assessment was not possible, initially (50%vs93%) and post-manipulation (40%vs50%) improved. Photo availability deteriorated (70%vs64%). Tetanus cover (87%vs100%) and appropriate dressing use (47%vs71%) improved.

Conclusions

Most parameters showed sustained and further improvements. The haemodynamic stability variation of these patients may create difficulties in fully adhering to the management standard; in some cases, other acute concerns may take priority.

Retreatment of previously treated intracranial aneurysm: Procedural complications and risk factors for complications

OBJECTIVE

Intracranial aneurysm (IA) is a frequent vascular malformation that can be managed by endovascular treatment (EVT) or microsurgery. A previously treated IA can recanalize, which may require further treatment. The aim of our study was to evaluate procedural complications related to IA retreatment and their risk factors.

METHODS

All patients retreated for IA between 2007 and 2017 in 4 hospitals were included. We retrospectively reviewed the frequency of procedural complications of IA retreatment, defined as death or≥1-point increase in modified Rankin score 24h after the procedure. We then screened for risk factors of procedural complications by comparing the characteristics of patients with and without complications.

RESULTS

During the inclusion period, 4,997 IAs were treated in our 4 institutions. Of these, 237 (4.7%) were retreated. 29 (12.2%) had≥1 procedural complication. However, severe complications, defined as death or dependency at 1 month, occurred only in 3 patients (1.3%). The only risk factor for complications was microsurgical clipping as retreatment.

CONCLUSIONS

Procedural complications during IA retreatment were frequent but, in most cases, retreatment did not lead to death or severe disability. The only risk factor for complications of IA retreatment was clipping as retreatment. However, the design of the study did not allow any conclusion to be drawn as to the optimal means of aneurysm retreatment, and further studies are needed.

Mitigation of cisplatin induced nephrotoxicity by casticin in male albino rats

Cisplatin (CP) is a commonly used, powerful antineoplastic drug, having numerous side effects. Casticin (CAS) is considered as a free radical scavenger and a potent antioxidant. The present research was planned to assess the curative potential of CAS on CP persuaded renal injury in male albino rats. Twenty four male albino rats were distributed into four equal groups. Group-1 was considered as a control group. Animals of Group-2 were injected with 5mg/kg of CP intraperitoneally. Group-3 was co-treated with CAS (50mg/kg) orally and injection of CP (5mg/kg). Group-4 was treated with CAS (50mg/kg) orally throughout the experiment. CP administration substantially reduced the activities of catalase (CAT), superoxide dismutase (SOD), peroxidase (POD), glutathione S-transferase (GST), glutathione reductase (GSR), glutathione (GSH) content while increased thiobarbituric acid reactive substances (TBARS), and hydrogen peroxide (H2O2) levels. Urea, urinary creatinine, urobilinogen, urinary proteins, kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) levels were substantially increased. In contrast, albumin and creatinine clearance was significantly reduced in CP treated group. The results demonstrated that CP significantly increased the inflammation indicators including nuclear factor kappa-B (NF-κB), tumor necrosis factor-α (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6) levels and cyclooxygenase-2 (COX-2) activity and histopathological damages. However, the administration of CAS displayed a palliative effect against CP-generated renal toxicity and recovered all parameters by bringing them to a normal level. These results revealed that the CAS is an effective compound having the curative potential to counter the CP-induced renal damage.

Chromium supplemented carbohydrate diets for Cirrhinus mrigala: effects on body composition, gut enzyme activity and hematological parameters

A ninety days nutritional trial was directed to explore the effects of dietary chromium on body composition, gut enzyme activity and physiological status of Cirrhinus mrigala by using G & NG corn. Six experimental diets were prepared by using different levels of chromium chloride hexahydrate (0, 0.2, 0.4 mg/kg, each with G & NG corn). For this experimental trial, 480 fingerlings, irrespective of sex were distributed in six aquariums each with replicate. Results revealed that gelatinized corn along with increasing level of Cr2Cl3.6H2O have a positive impact upon body composition of fish. Hematology was positively correlated with chromium chloride hexahydrate supplementation in gelatinized corn. Amylase gut enzyme also showed significant (P<0.05) increase in group fed with chromium chloride hexahydrate supplemented diet (G corn). However, corn with chromium chloride hexahydrate supplementation did not revealed any significant impact on gut protease enzyme activity. From these results it can be concluded that both chromium chloride hexahydrate and gelatinized corn in fish feed are very beneficial to improve body composition, enzymes activity and physiological health status of fish.

Portrayal of Punica granatum L. peel extract through High Performance Liquid Chromatography and antimicrobial activity evaluation

Increasing trend in antimicrobial resistance and failure of chemically synthesized antibiotics lead to discover alternative methods for the treatment of bacterial infections. Various medicinal plants are in use traditionally and their active compounds can be further applied for treatment of bacterial diseases. This study was designed to determine the antibacterial activity of Punica granatum (P. granatum L.) (pomegranate) peel extract against Enterobacteriaceae [Escherichia coli (E. coli), Salmonella Typhimurium (S. Typhimurium) and Shigella Dysenteriae (S. Dysenteriae)] and gram-positive bacterium [Staphylococcus aureus (Staph aureus)]. Methanolic extract of P. granatum L. peel was prepared by Soxhlet apparatus method. Total flavonoid and phenolic contents from the extract were determined by High Performance Liquid Chromatography (HPLC). The antibacterial activity of P. granatum L. peel extract was evaluated through agar well diffusion method. HPLC showed the range of phenolics (gallic acid, caffeic acid, benzoic acid, cinnamic acid) and flavonoid compounds. The chemical structures of flavonoid and phenolics found in the methanolic extract of P. granatum L. peel have been reported for the first time. The methanolic peel extract (50 ul) of yellow P. granatum L. showed 26, 10, 10 and 9mm zones of inhibition (ZOI) against S. aureus, S. Typhimurium, S. Dysenteriae and E. coli, respectively. The methanolic extract of red P. granatum L. (100 ul) showed 27, 8, 12 and 15 mm ZOI against Staph. aureus, S. Typhimurium, S. Dysenteriae and E. coli, respectively. Highest ZOI was observed against Staph. aureus. Many of the bacteria studied in the present work may cause serious gastrointestinal infections, which can lead to hemorrhagic diarrhea in children. These infections can be life-threatening to young children and the elderly. There is an incentive to find alternative control measures, such as plant and herbal extracts, especially in lesser-developed countries where traditional antibiotics may not be readily available.

Assessment of zinc solubilization potential of zinc-resistant Pseudomonas oleovorans strain ZSB13 isolated from contaminated soil

Zinc is an essential micronutrient that is required for optimum plant growth. It is present in soil in insoluble forms. Bacterial solubilization of soil unavailable form of Zn into available form, is an emerging approach to alleviate the Zn deficiency for plants and human beings. Zinc solubilizing bacteria (ZSB) could be a substitute for chemical Zn fertilizer. The present study aimed to isolate and characterize bacterial species from the contaminated soil and evaluate their Zn solubilizing potential. Zn resistant bacteria were isolated and evaluated for their MIC against Zn. Among the 13 isolated bacterial strains ZSB13 showed maximum MIC value upto 30mM/L. The bacterial strain with the highest resistance against Zn was selected for further analysis. Molecular characterization of ZSB13 was performed by 16S rRNA gene amplification which confirmed it as Pseudomonas oleovorans. Zn solubilization was determined through plate assay and broth medium. Four insoluble salts (zinc oxide (ZnO), zinc carbonate (ZnCO3), zinc sulphite (ZnS) and zinc phosphate (Zn3(PO4)2) were used for solubilization assay. Our results shows 11 mm clear halo zone on agar plates amended with ZnO. Likewise, ZSB13 showed significant release of Zn in broth amended with ZnCO3 (17 and 16.8 ppm) and ZnO (18.2 ppm). Furthermore, Zn resistance genes czcD was also enriched in ZSB13. In our study, bacterial strain comprising Zn solubilization potential has been isolated that could be further used for the growth enhancement of crops.

POS0310 EXPOSURE TO MAJOR PSYCHOLOGICAL TRAUMA OR STRESS IN THE PRECEDING ONE YEAR SIGNIFICANTLY CONTRIBUTES TO POOR DISEASE CONTROL IN PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT

Background:

Stress response is considered to involve the activation of both the hypothalamus-pituitary-adrenal axis and the autonomic nervous system, along with its communication with the immune system. Because many rheumatic diseases are characterized by immune-mediated joint inflammation, stressful events might contribute to the aetiology, maintenance and exacerbation of rheumatic diseases.

Objectives:

We aimed to examine whether real-life major stressful events lead to poor disease control among patients with Rheumatoid arthritis (RA). We addressed this question using real-world data from the PRIME registry.

Methods:

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. We assessed the registry data for RA patients. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, comorbidities (using Charlson Comorbidity Index). Education status was stratified by whether participants completed secondary (high) school education. Evaluation of disease activity and severity was made as per internationally agreed definitions, such as: swollen joint counts (SJC), tender joint counts (TJC), deformed joint counts, and DAS-28. Major psychological trauma or stress was defined if the patient has experienced any of the following in the past year: a) major personal injury or illness; b) death/major illness of a close relative; c) marital separation/divorce; d) loss of job; e) major financial loss; f) mass casualty incident loss.

Results:

The data of consecutive 507 RA patients (mean age 42.3±12.6 years, 73.6% female, disease duration of 80±22 months) was reviewed. Thirty-six percent of the cohort reported to have major psychological stress and trauma in the preceding one year. No statistical association of age, gender, and marital status was noted, but statistical association of low education status (p=0.042), longer disease duration (p=0.044), higher DAS-28 values (p<0.001) and other markers of RA disease activity (SJC, TJC, ESR, patient global health) was found. On multiple logistic regression analysis, a significant association of major psychological stress and trauma in the preceding one year was noted with active disease (DAS-28; OR 1.67, CI 1.17-2.4, p=0.005). Following variables were included in the full regression model, disease duration, gender, age, marital status, education status, and DAS-28 value (also used models with SJC, TJC, deformed joint counts, ESR, patient global health, but the results remained unchanged).

Conclusion:

Major psychological stress and trauma in the preceding one year is associated with high disease activity among patients with RA. Therapies that focus on stress management may be important adjuncts to traditional pharmacotherapy in the treatment of inflammatory rheumatic diseases.

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Sadia Asif: None declared, Shabnam Batool: None declared, Farzana Hashmi: None declared, Saadat Ullah: None declared, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared

POS0663 SAFETY AND EFFICACY OF COMBINING METHOTREXATE AND LEFLUNOMIDE AMONG PATIENTS WITH INFLAMMATORY ARTHROPATHIES: FINDINGS FROM THE PRIME REGISTRY

Background:

Currently, conventional synthetic DMARDs (csDMARDs) are the most commonly prescribed drugs as first-line treatment for peripheral arthritis. In resource-constrained settings where biologic agents are not widely available, there are limited therapeutic options for patients with rheumatoid arthritis (RA) and seronegative inflammatory arthropathies refractory to other csDMARD therapies. Hence, in our practice, we are inclined to use combination of potent DMARDs after MTX failure, prior to considering biologic therapies. We believe that combination of DMARDs, especially combining MTX and Leflunomide (LEF) provides a potent and valuable low-cost treatment option. Efficacy of MTX and LEF is very well established, but there have been lot of concern as regards their combination use due to potential risk of hepatotoxicity.

Objectives:

We aimed to review our inflammatory arthropathies cohort data especially examining the safety, efficacy and drug retention of the combination usage of MTX and Leflunomide. We addressed this question using real-world data from the PRIME registry.

Methods:

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. A number of clinical variables were recorded. Detailed history was gathered from every patient regarding their present and past medications usage. Questions were asked directly about the usage or otherwise of all available DMARDs and biologics. The duration of usage, any adverse events, or the reasons for discontinuation were recorded. Evaluation of disease activity and severity was made as per internationally agreed definitions.

Results:

The data of 766 inflammatory arthritis patients (RA=663, PsA=103) was reviewed. Among them, 241 patients (RA=196, PsA=45) were using combination therapy of MTX and LEF (combo MTX+LEF) with mean age 42.3±6 years; 42% male]. These patients had failed MTX or LEF monotherapy. Among these 241 patients, 49 patients were also on concomitant hydroxychloroquine therapy. It was noted that median drug retention of combo MTX+LEF therapy has been 9.5 months (IQR 6-16). Regarding any adverse events of combo MTX+LEF therapy, hepatotoxicity (ALT ≤3 times the upper limit of normal) was noted among 15 (6.2%) patients, hepatotoxicity (ALT ≥3 times the upper limit of normal) was noted among 8 (3.3%) patients, and troublesome gastrointestinal upset (nausea, or vomiting, or diarrhoea) in 3 (1.2%). Overall, only 13 (5.4%) patients had to discontinue this combo MTX+LEF therapy due to adverse events. Disease activity among combo MTX+LEF users was as follows: 64% (n=29) of PsA patients had achieved MDA; 42% (n=83) of RA cohort were in DAS28 remission, 46% (n=91) of RA patients were having DAS low disease activity.

Conclusion:

Combination of MTX and LEF was well tolerated and had good drug retention time, with 94.6% of patients having ongoing treatment to date. In low-income countries, where bDMARD availability is limited, financial arguments significantly influence decision making process, and our data provides initial evidence that MTX and LEF combination therapy could be an effective treatment option.

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared, Sadia Asif: None declared, Shabnam Batool: None declared, Farzana Hashmi: None declared, Saadat Ullah: None declared

POS0589 PREVALENCE AND SEVERITY OF STRESS AT HOME AMONG PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT

Background:

In chronic inflammatory diseases like rheumatoid arthritis (RA), psychological stress is widely recognised as an important risk factor to negatively affect the disease course. Stress activates the hypothalamic-pituitary adrenal axis and the autonomic nervous system, which associate with the release of neurotransmitters (i.e. norepinephrine), hormones (i.e. cortisol) and activation of immune cells. Perceived stress can potentially induce the disease exacerbation, but on the other hand, the disease itself might produce significant stress to patients thus the vicious circle is formed and maintained.

Objectives:

We aimed to examine the prevalence of mental/emotional stress at home and its associations among patients with Rheumatoid arthritis. We addressed this question using real-world data from the PRIME registry.

Methods:

This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. We assessed the data for RA patients. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, comorbidities (using Charlson Comorbidity Index). Education status was stratified by whether participants completed secondary (high) school education. Evaluation of disease activity and severity was made as per internationally agreed definitions, such as: swollen joint counts, tender joint counts, deformed joint counts, and DAS-28. All participants were directly inquired at the interview during the time of patient enrolment about the presence or otherwise of mental/emotional stress at home, and to rate it from 1-3 (mild, moderate, severe). For better understanding and ease of statistical analysis, dichotomous variable was made with moderate-to-severe stress patients were categorised into one group and none-to-mild stress patients into second group.

Results:

The data of consecutive 507 RA patients (mean age 42.3±12.6 years, 73.6% female, disease duration of 80±22 months) was reviewed. Forty-eight percent of patients accepted to have moderate-severe stress at home (moderate stress=29.9%, severe stress=18.3%). On univariate analysis, significant association of moderate-severe stress at home was noted with deformed joint counts (p=0.036), higher DAS-28 scores (p<0.001), and being married (p=0.001). Weak statistical association of age (p=0.11), disease duration (p=0.13), low education status (p=0.14), female gender (p=0.24) was noted. On multiple logistic regression analysis, a significant association of moderate-severe stress at home was observed with higher DAS-28 scores (OR 1.76, CI 1.29-2.41, p<0.001) and deformed joint counts (OR 1.15, CI 1.00-1.31, p=0.040). Following variables were included in multiple stepwise regression analysis: age, disease duration, low education status, married, Das-28 scores, and deformed joint counts. However, when gender was included in the regression analysis, a significant association of moderate-severe stress at home was observed with female gender (OR 3.99, CI 1.47-10.83, p=0.007), higher DAS-28 scores (OR 1.8, CI 1.31-2.51, p<0.001), with marginal association with deformed joint counts (OR 1.13, CI 0.99-1.30, p=0.061).

Conclusion:

Stress at home is common among patients with RA, and nearly half of the cohort was noted to have moderate-severe level of stress at home. Ongoing stress at home has significant association with higher RA disease activity and deformities suggesting a bidirectional relationship. These findings demonstrate an important need for integration of rheumatologic, social workers and mental health services

Disclosure of Interests:

Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Farzana Hashmi: None declared, Saadat Ullah: None declared, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared, Sadia Asif: None declared, Shabnam Batool: None declared

Biological screening and docking studies of unique hybrids synthesized by conventional versus microwave assisted techniques

Purpose: To carry out the synthesis of various hybrids of 1,2,4-triazole in search of potential therapeutic enzyme inhibitory agents, and carry out docking and bovine serum albumin (BSA) binding studies on docking and bovine serum albumin (BSA) binding studies on the hybrids. Methods: The target compounds were synthesized by following a multistep protocol. Compound 1 was synthesized from 4-methoxybenzenesulfonyl chloride (a) and ethyl isonipecotate (b). Compound 1 was refluxed with hydrazine to synthesize compound 2, which was converted to compound 3 through two consecutive steps. Compound 4 and different amines (5a-5i), were utilized to synthesize an array of electrophiles (6a-6i). A series of 1,2,4-triazole hybrids (7a-7i) were synthesized at room temperature by stirring together 3 and 6a-6i. The final structures of 7a-7i were elucidated through 1H-NMR, 13C-NMR and EI-MS spectroscopy. The BSA binding studies were performed by fluorometric titration. Furthermore, antioxidant and enzyme inhibition activities were determined colorimetrically. Results: Compound 7d was the most active antioxidant agent, compared to butylated hydroxyanisole (BHA), while compounds 7d, 7e, 7f, 7g and 7i proved to be potent urease inhibitors with half-maximal inhibitory concentration (IC50) values of 19.5 ± 0.12, 21.1 ± 0.68, 18.2 ± 0.78, 19.9 ± 0.77 and 17.9 ± 0.10 µM, respectively, compared to thiourea with an IC50 of 24.3 ± 0.24 µM. Compounds 7a, 7b, 7d, and 7e exhibited high butyrylcholinesterase inhibition potential, compared to eserine. Conclusion: The synthesized compounds require studies further as potential therapeutic enzyme inhibitory agents in view of their urease inhibition as well as antioxidant activity.

180 Management of Open Fractures at Oxford University Hospitals NHS Trust Major Trauma Centre

Introduction

This audit was developed after noticing patients with open fractures had poor neurovascular assessment documentation (non-specific, none post-manipulation), and to check these patients received appropriate antibiotics. Review of open fracture management guidelines identified areas to be improved.

Method

Pre-operative hospital management of open fractures was audited using the NICE (NG37) and joint BOAST/BAPRAS guidelines on open fracture management. Interventions were awareness and education of junior doctors and editing the Trauma Clerking Form to prompt appropriate management and documentation, followed by re-audit.

Results

30 patients were assessed pre- and post-intervention. Correct antibiotic administration rate (93%vs97%) and speed (50% &lt;2 hours where not given pre-hospital - in both groups) were similar. The initial neurovascular assessment frequency was identical (93%), however documentation of assessment of specific arteries (86%vs30%) and nerves (60%vs23%) and assessing all appropriate arteries (60%vs13%) and nerves (60%vs20%) improved. There were increased frequencies of documenting manipulation in A&E (90%vs47%) and neurovascular assessment post-manipulation (90%vs16%). Tetanus cover (87%vs77%), photo availability (70%vs40%), and appropriate dressing use (47%vs27%) improved.

Conclusions

Antibiotic management was consistent and appropriate. There were improvements in frequency and quality of neurovascular assessment, tetanus cover, availability of photographs of injuries and appropriate dressings used. Overall, pre-operative hospital management of open fractures improved.

Masculinization in common carp (Cyprinus carpio) by androgen immersion: The interaction effect of hormone concentration and immersion time

Synthetic androgens (male hormones) administered to fish nursery are being used in aquaculture to avoid sexual differentiation and unwanted spawning at the eggs or the first feeding fry stage of fish. Present trial was conducted with the aim to produce male common carp (Cyprinus carpio) by egg immersion technique. Through this little insight, the effect of different hormone concentrations (17α-methyltestosterone @ HC:150, 300, 450 and 600 µgl-1) with immersion times (IT: 24, 48 and 72 hrs) and their interaction effect (HC x IT) on the hatching percentage of Cyprinus carpio eggs, percent survival and percent of male's production was evaluated specifically. Results showed that egg hatching percentage decreased with increased IT likewise, survival of treated fry was affected by increasing the IT (P<0.001). The main interaction effect of HC x IT showed that the highest percent of male individuals (95%) was obtained at 450-600 µgl-1 HC for 72 hrs IT, followed by 88-92.50% at 150-300 µgl-1 HC for 72-hrsof IT, 87.50% at 48-hrs of IT for rest of the hormone treatments, and lowest 47.50% was recorded in control (P<0.05). Increased percent male of Cyprinus carpio was obtained with increasing HC across all ITs. It was observed that the immersion treatment at 600µgl-1 for 72 hours was more effective to change the sex ratio of pre hatch Cyprinus carpio. A comparative outlook made from this experimental trial that sex induction of Cyprinus carpio by eggs immersion using synthetic male steroid hormone is an alternative safe technique of fish sex reversal in contrast to oral administration of hormone in fish feed.

Assessment of cadmium tolerance and biosorptive potential of Bacillus Cereus GCFSD01 isolated from cadmium contaminated soil

Continuous occurrence of heavy metals is a major cause of environmental pollution due to its toxic effects. At minimum concentrations, these metals are highly reactive and can gather in the food chains and food web, causing major dangers to public health concerns. Soil samples were collected from Paharang drain, Faisalabad. Cadmium tolerant bacteria were isolated and evaluated for their MIC against Cd. The isolated bacterial strain GCFSD01 showed MIC value upto 30 mM/L. The bacterial strain with the highest resistance against Cd was selected for further study. Molecular characterization of bacterial isolate GCFSD01 was performed by 16S rRNA which confirmed it as Bacillus cereus. Optimum growth conditions of bacterial strain were also evaluated. Strain GCFSD01 showed optimum growth at pH 7 and 37 °C temperature. Our result revealed that B. cereus strain GCFSD01 reduced 61.3% Cd after 48 hrs. Multiple metal tolerance and Cd reduction by B. cereus indicate its potential for further use for decontamination of polluted soil.

Cortical thickness following electroconvulsive therapy in patients with depression: a longitudinal MRI study

OBJECTIVE

Several studies have found an increase in hippocampal volume following electroconvulsive therapy (ECT), but the effect on cortical thickness has been less investigated. We aimed to examine the effects of ECT on cortical thickness and their associations with clinical outcome.

METHOD

Using 3 Tesla MRI scanner, we obtained T1-weighted brain images of 18 severely depressed patients at three time points: before, right after and 6 months after a series of ECT. The thickness of 68 cortical regions was extracted using Free Surfer, and Linear Mixed Model was used to analyze the longitudinal changes.

RESULTS

We found significant increases in cortical thickness of 26 regions right after a series of ECT, mainly within the frontal, temporal and insular cortex. The thickness returned to the baseline values at 6-month follow-up. We detected no significant decreases in cortical thickness. The increase in the thickness of the right lateral orbitofrontal cortex was associated with a greater antidepressant effect, r = 0.75, P = 0.0005. None of the cortical regions showed any associations with cognitive side effects.

CONCLUSION

The increases in cortical thickness induced by ECT are transient. Further multimodal MRI studies should examine the neural correlates of these increases and their relationship with the antidepressant effect.

Status updates of Newcastle disease and amelioration effects of medicinal plants against Newcastle disease virus: A review

Recently, medicinal plants are achieving great interest because of their use in ethno medicine treatment of different common diseases and also other medicinal assertions are now reinforced by comprehensive scientific evidence. Almost 82 research articles and abstracts published, so far, were screened for evaluating antiviral efficiency of various plant samples and 23 different plants were found to be traditionally used against Newcastle disease (ND). ND is a most transmissible viral disease of avian species caused by virulent strain of Avula virus from the Paramyxoviridae family. The first epidemic of ND was perceived in Java, Indonesia and England in year 1926. ND causes great economic loses to the commercial poultry farmers around the world. Medicinal plants are traditionally used in the control of viral or other diseases and infections. Plants have been found useful in treating many microbial diseases in man and animals caused by bacteria and viruses. The ability to synthesize compounds retaining antiviral potential by secondary metabolism makes plants a vital source of pharmaceutical and therapeutic products, which can reduce chemotherapeutic load in birds. Current studies signify that the natural products posses a rich potential source of new antiviral compounds. Further ethnobotanical studies and laboratory investigations are established to identify species having potential to improve ND control.

Pain in severe dementia: A comparison of a fine-grained assessment approach to an observational checklist designed for clinical settings

Background

Fine‐grained observational approaches to pain assessment (e.g. the Facial Action Coding System; FACS) are used to evaluate pain in individuals with and without dementia. These approaches are difficult to utilize in clinical settings as they require specialized training and equipment. Easy‐to‐use observational approaches (e.g. the Pain Assessment Checklist for Limited Ability to Communicate‐II; PACSLAC‐II) have been developed for clinical settings. Our goal was to compare a FACS‐based fine‐grained system to the PACSLAC‐II in differentiating painful from non‐painful states in older adults with and without dementia.

Method

We video‐recorded older long‐term care residents with dementia and older adult outpatients without dementia, during a quiet baseline condition and while they took part in a physiotherapy examination designed to identify painful areas. Videos were coded using pain‐related behaviours from the FACS and the PACSLAC‐II.

Results

Both tools differentiated between painful and non‐painful states, but the PACSLAC‐II accounted for more variance than the FACS‐based approach. Participants with dementia scored higher on the PACSLAC‐II than participants without dementia.

Conclusion

The results suggest that easy‐to‐use observational approaches for clinical settings are valid and that there may not be any clinically important advantages to using more resource‐intensive coding approaches based on FACS. We acknowledge, as a limitation of our study, that we used as baseline a quiet condition that did not involve significant patient movement. In contrast, our pain condition involved systematic patient movement. Future research should be aimed at replicating our results using a baseline condition that involves non‐painful movements.

Significance

Examining older adults with and without dementia, a brief observational clinical approach was found to be valid and accounted for more variance in differentiating pain‐related and non‐pain‐related states than did a detailed time‐consuming fine‐grained approach.

Fowl adenovirus: history, emergence, biology and development of a vaccine against hydropericardium syndrome

The poultry industry has emerged as one of the largest and fastest growing public sectors in the developed and developing countries. Unfortunately, this industry is under a major threat from diseases that are viral (Newcastle disease, infectious bursal disease, influenza, hydropericardium syndrome), bacterial (colibacillosis, pasteurellosis, salmonellosis, mycoplasmosis), parasitic (coccidiosis, histoplasmosis) or nutritional (dyschondroplasia, osteoporosis). Among these diseases, hydropericardium syndrome (HPS) is one of the important emerging diseases occurring in the specific areas of the world where broilers (chickens) are reared under intensive conditions. HPS was first observed in 1987 at Angara Goth, an area near Karachi, Pakistan, where broilers are raised. Since then, HPS has been reported in many countries of the world. From these reported cases, an adenovirus that was either isolated from or visualized electron microscopically in the liver of affected broilers has been implicated in the syndrome. The syndrome has been reproduced by inoculation of isolated fowl adenovirus (FAdV) strains, and hence, the syndrome is also called infectious hydropericardium syndrome. To our knowledge, HPS has not been observed in humans, so it is not considered a zoonotic disease, but it is of economic importance and causes huge losses to the poultry industry. Efforts have been made to develop conventional vaccines against this disease, which were formulated from infected liver homogenate. Formalin-inactivated liver organ vaccines have failed to protect the poultry industry. Hence, there is a dire need to develop a suitable vaccine to combat this disease. Currently, recombinant vaccine candidates are being developed by using molecular biology and biotechnological approaches for the prevention and control of infectious diseases, including HPS. Therefore, it is suggested that the immunogenicity of these recombinant proteins should be evaluated for their use as subunit vaccines.

Factors affecting outcome after the use of the Ponseti method for the management of idiopathic clubfoot, a retrospective study in an orthopaedic referral institute

TIn the last few decades Ponseti method has replaced soft tissue releases as the gold standard in the management of idiopathic clubfoot. However, the recurrence of the deformity is common without post tenotomy bracing. The purpose of this study was to retrospectively see various attributes of the patients associated with poor outcome after use of Ponseti method in idiopathic clubfoot management. Seventy nine consecutive patients with one hundred and twenty three idiopathic clubfeet treated with Ponseti method by single orthopaedic surgeon were followed for a period of two years and recurrence of the deformity was studied in relation to age of patient at presentation (< 3 months or more), sex of the patient, severity of the deformity ( moderate to severe verses (Vs.) very severe), compliance to post tenotomy bracing (compliant Vs. non compliant), educational level of parents (high school or less) and access of parents to internet (Yes or No) and odds ratio for recurrence and level of significance determined for each using Fisher's exact t-test. Non compliance in seventeen patients (17.7%) with post tenotomy bracing was the most important factor related to the recurrence, with an odds ratio of 6.22 (P =0.0059). Educational level (less than high school) of parents (36.7%) was the second most important factor with odds ratio of 5.5 (P=0.0073). Fifteen patients with severe Demiglio scoring feet had an odds ratio of 5.3 (P= 0.0097) for the recurrence of the deformity. Inaccess of the parents to the internet had an odds ratio of 6.33 (P =0.011) for the recurrence of the deformity. Age and sex of the patients was not found to have a significant effect on the recurrence of the deformity. In conclusion, the risk factors associated with recurrence of the idiopathic clubfoot deformity except severity of the deformity are modifiable and extra minutes can be spent with risk group parents during follow up visits to prevent a recurrence by making them understand natural history of the corrected foot without post tenotomy bracing, encouraging them for regular follow up visits, arranging interactive sessions with other patients who are regular in their follow up and compliant with bracing, and encouraging the literate parents to update their information about clubfoot from internet.

ID: 76: AVOIDING TRANSTHORACIC ECHOCARDIOGRAPHY (TTE) AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) FOR PATIENTS WITH VARIABLE BODY MASS INDEXES (BMI) IN INFECTIVE ENDOCARDITIS

Background

Echocardiography has been a popular modality used to aid in the diagnosis of infective endocarditis (IE) with the modified Dukes' criteria. We evaluated the necessity between the uses of either a transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) in patients with a body mass index (BMI) greater than or equal to 25 kg/m2 and less than 25.

Methods

A single-centered, retrospective study of 198 patients between the years of 2005 and 2012 diagnosed with IE based on modified Dukes' criteria. Patients were required to be above the age of 18, undergone an echocardiogram study and had blood cultures to be included in the study.

This study was conducted at a major hospital in one of the most diverse communities in the United States, providing a cultural and epidemiologically significant advantage. An approved chart analysis using QuadraMed Computerized Patient Record (QCPR) was retrospectively accessed with data-input and calculations formulated in computerized software.

Results

Among 198 patients, two echocardiographic groups were evaluated as 158 patients obtained a TTE, 143 obtained a TEE, and 103 overlapped with TEE and TTE. 167 patients were included in the study as 109 (65%) were discovered to have native valve vegetations on TEE and 58 (35%) with TTE. TTE findings were compared to TEE results for true negative and positives to isolate valvular vegetations Overall sensitivity of TTE was calculated to be 67% with a specificity of 93%. Patients were further divided into two groups with the first group having a BMI less than or equal to 25 kg/m2 and the subsequent group with a BMI<25. Patients with a BMI less than or equal to 25 that underwent a TTE study had a sensitivity and specificity of 54% and 92, respectively. On the contrary, patients with a BMI<25 had a TTE sensitivity and specificity of 78% and 95, respectively. Furthermore, we obtained the sensitivities of specific valves diseased from vegetations, visualized by TTE (figure 1). Lastly, we were able to demonstrate a correlation between the different modalities of echocardiography used to the specific organism identified on blood cultures (figure 2).

Conclusion

Calculating a BMI in patients with suspicion for IE may provide benefit in reducing further diagnostic imaging. Our study demonstrated that patients having a BMI <25 kg/m2 with a negative TTE should refrain from further diagnostic studies with TEE, given the findings of increased sensitivities (figure 3). Patients with a BMI less than or equal to 25 may proceed directly to a TEE, possibly avoiding an additional study with a TTE given the low sensitivities identified in this population. Clinicians should be aware that this study has several limitations, one of which a small sample size that may be increased with a multi-centered study. Further investigations with a larger population may improve and possibly provide similar findings, reinforcing the study.

ID: 99: PREVELNACE, MORBIDTY AND MORTALITY OF INFECTIVE ENDOCARDITIS IN THE MOST DIVESE AREA OF USA IN NEW YORK CITY

Background

Infective endocarditis (IE) is a serious illness associated with significant morbidity and mortality. The primary purpose of this study was to evaluate the mortality and morbidity of IE in a community public hospital of the most diverse area in New York.

Methods

An analysis of 209 patients that were admitted to hospital from 2000 to 2012, found to have IE based on Duke's criteria.

Results

The incidence rate of IE is trending down since 2000 (figure 1A).

Among our study population, the overall mortality rate of IE was 20.1% (95% CI: 9.84–19.56%), readmission rate within 30 days after discharge was 21.5% (95% CI: 16.22–27.58%) with an average age of 59 years (95% CI: 57.63–60.37%). The most common causative organisms were staphylococcus aureus (43.7%), followed by streptococcus viridians (17%) and Group D enterococcus (14.7%). We divided the patients into two groups; male (n=107) versus female (n=102). And the same aspects were identified and studied in each gender group.

The incidence of IE has a slight female predominance, except two age groups with male significant predominance; 40–49 and 50–59 years. (figure 1-B).

The mortality rate in males was 17% vs 23% in females (p=0.09) and Readmission rate within 30 days after discharge from the hospital was 20% in males vs 22% in females (p=0.1).

Of the 209 patients, 188 patients were with native hearts and 21 patients had non-native heart valves. Of the 188 native heart valves, 114 had risk factors such as: CABG surgeries, were active drugs users, had pacemakers, valves disease or CHF. Mortality rate in non-native hearts and/or patients with risk factors were 27.7% compared to patients with native heart without risk factors of 8.11%(OR:3, P<0.0001).

The causative organism of IE was evaluated in our study and we found that S. aureus is the most common cause in males and females among all age groups. The only exception to that is a slightly higher prevalence of S. viridians in males between the ages of 30–39 (figure1-C). Similarly, the prevalence of group D enterococcus appeared higher in females aged 70–79 years. (figure 1-D).

Approximately 71% of males' patient with S. aureus IE between ages 50–49 had DM. Also, 80% of female patients with IE between ages 60–69 had DM which could explain the high prevalence of IE with S. aureus in this age groups as DM may complicated with skin infections which is mostly Staphylococcus infection that led to IE.

The highest incidences of IE in our study were in Hispanic ethnicity group (38%) follow by white (29%). However, the lowest incidences were observed in South Asia population (5%).

Conclusion

Despite appropriate prophylaxis and treatment of IE patients, high rates of incidences, morbidity and mortality remained especially in population >50 years. Risk factors for developing IE such as Diabetes Mellitus which might complicated with skin infection and lead to IE, raising the importance of controlling and monitoring risk factors for IE in patients older than 50 years of age.

Abstract ID: 99 Figure 1

ID: 53: SEVER SYMPTOMATIC BABESIOSIS CO-INFECTION WITH LYME DISEASE

Case Presentation

A 70-year-old male with known history of controlled hypertension, presented with sudden onset of headaches, fevers, vomiting and low urine output for the past 4 days. The patient had recently emigrated from Bangladesh 6 months ago and had been staying in Eastern Long Island, NY. On admission, the patient found to have anemia, thrombocytopenia and acute kidney injury. Significant labs include hemoglobin of 10.2 g/dl, platelets of 39 109/L, BUN of 87 mg/dl, creatinine of 4.48 mg/dl, prothrombin time of 14.8, AST 55 U/l and ALT 65 U/l, LDH of 359 U/l, fibrinogen of 637 mg/dl, CRP of 17.8 mg/l and ESR of 92 mm/h. Haptoglobin was within normal limits. Peripheral blood smear revealed intracellular ovoid rings resembling both Plasmodium sp. and B. microti rings. The patient was started on a 7-day treatment with doxycycline and quinine to cover either infection. Later on, PCR test for B. microtii came back positive. He showed improvement in both symptoms and laboratory findings. On the day of planned discharge, the patient began to complain of right-sided numbness and difficulty closing the mouth and right eye. The diagnosis of Bell palsy had been established. Borrelia burgdorferi serology then sent and it turned out to be positive. Doxycycline had been restarted for another 2 weeks and the patient was symptoms-free after the new course.

Discussion

Humans are opportunistic hosts to Babesia when bitten by nymph or adult ticks; the most known ticks are Ixodes. Babesiosis should be considered in patients who have a malaria-like illness in areas endemic for Babesia infection. The symptoms usually begin 2–4 weeks after a tick bite. The presentation includes constitutional symptoms, abdominal pain and dark urine. Labs finding include hemolytic anemia and elevated liver enzymes. Urinalysis reveals hemoglobinuria without red blood cells. The diagnosis of Babesiosis is usually established by microscopic examination of Giems or Wright-stained blood smears, indirect immunofluorescent antibody tests and PCR. In healthy individuals with intact spleens, the symptoms resolve spontaneously without treatment. For mild to moderate babesiosis, combination therapy with atovaquone and azithromycin for 7 days. However, in patients who are asplenic or immunocompromized, babesiosis is quite severe and is associated with higher mortality, the preferred treatment is intravenous clindamycin and oral quinine. In patients who are refractory to pharmacological treatment, red blood cells exchange transfusion has been shown to improve mortality. It is very important to consider other tick-borne agents that may be co-transmitted with Babesia such as B. burgdorferi; the agent of Lyme disease. Co-infection should be considered in patients with a poor response to conventional antimicrobial therapy or atypical clinical presentations. When co-infection is suspected, as in our patient, physicians should consider treating Lyme disease empirically for 2–3 weeks.

Abstract ID: 53 Figure 1

ID: 50: PERFORATED DIVERTICULOSIS COMPLICATED WITH ACTINOMYCOSIS INFECTION AND PRESENTED AS PELVIC MALIGNANCY

Case Presentation

A 48-year-old female with no significant past medical history who presented with fatigue, and lower abdominal pain, unintentionally weight lost and yellowish vaginal discharge. Physical examination was remarkable for a palpable mass extending from supra-pubic to supra-umbilical area and vaginal examination remarkable for foul-smelling vaginal discharge. Initial laboratory studies indicated Hemoglobin 5.8 mg/dl and white blood counts 15,000/µL. Computerized tomography of Abdomen/Pelvis CT with contrast which demonstrating an infiltrative process or mass like structure involving the pelvis measuring 10×12×6 cm. The initial impression was Gynecological cancer which could be uterine/cervix/ovarian cancer. However, Pap-smear was negative. Biopsy was obtained which showed acute inflammatory exudates fragments of benign appearing smooth muscle proliferation and fibro-adipose tissue infiltrated with histiocytes. The decision for exploratory laparotomy was made which revealed a large pelvic abscess. The surgery resulted in modified radical hysterectomy, resection of left and right tubo-ovarian abscess complexes, recto-sigmoid resection with end-sigmoid colostomy and Hartmann's pouch, and ileo-colic resection with a primary anastomosis. Pathology examination revealed a segment of colon with perforated diverticulosis and a tubo-ovarian complex with acute and chronic inflammations, granulation tissue formation and bacterial colonies morphologically suggestive of Actinomyces. Patient started on Intra-venous Penicillin-G. After 4 weeks, CT abdomen/Pelvic repeated which showed post-surgical changes and decreased in size of abscess/fluid collections.

Discussion

Actinomycosis is a rare and insidious disease. The most common etiologic organism is the anaerobic, Gram-positive bacterium, Actinomyces israelii. Actinomycetes are prominent among the normal flora of the oral cavity but less prominent in the lower gastrointestinal and female genital tract. Because these microorganisms are not virulent, they require a break in the integrity of the mucous membranes and the presence of devitalized tissue to invade deeper body structures and to cause human illness.

Cervicofacial actinomycosis is the most common type of the infections followed by Thoracic actinomycosis and less common in abdomen and pelvis. The most common cause of abdominal/pelvic actinomycosis is acute perforated appendicitis. Also, most of Abdomen/Pelvis cases have a history of recent or remote bowel surgery (e.g.perforated appendicitis, perforate colonic diverticulitis). Pelvic actinomycosis has become more common in females who use an Intra-Uterine Devices, which may increase the risk of infection through injury to the normal uterine mucosa. Diagnosis of Abdomen/Pelvic actinomycosis is usually established postoperatively, following exploratory laparotomy for a suspected malignancy. Involvement of any abdominal organ, including the abdominal wall, can occur by direct spread, with eventual formation of draining sinuses.

Abstract ID: 50 Figure 1

Molecular cloning, expression and characterization of 100K gene of fowl adenovirus-4 for prevention and control of hydropericardium syndrome

Fowl adenovirus-4 is an infectious agent causing Hydropericardium syndrome in chickens. Adenovirus are non-enveloped virions having linear, double stranded DNA. Viral genome codes for few structural and non structural proteins. 100K is an important non-structural viral protein. Open reading frame for coding sequence of 100K protein was cloned with oligo histidine tag and expressed in Escherichia coli as a fusion protein. Nucleotide sequence of the gene revealed that 100K gene of FAdV-4 has high homology (98%) with the respective gene of FAdV-10. Recombinant 100K protein was expressed in E. coli and purified by nickel affinity chromatography. Immunization of chickens with recombinant 100K protein elicited significant serum antibody titers. However challenge protection test revealed that 100K protein conferred little protection (40%) to the immunized chicken against pathogenic viral challenge. So it was concluded that 100K gene has 2397 bp length and recombinant 100K protein has molecular weight of 95 kDa. It was also found that the recombinant protein has little capacity to affect the immune response because in-spite of having an important role in intracellular transport & folding of viral capsid proteins during viral replication, it is not exposed on the surface of the virus at any stage.

A study of changing trends of prevalence and genotypic distribution of hepatitis C virus among high risk groups in North India

PURPOSE

Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. There is a great variability in HCV's geographical presence, transmission routes, genotypic distribution etc., in studied populations. We undertook this study in a North Indian hospital on patients of chronic liver disease to observe any emerging trend in risk groups, transmission patterns, genotypic distribution of the virus in this geographical region and its correlation with viral load.

MATERIALS AND METHODS

There were 54 anti-HCV positive patients including 31 HCV Ribonucleic acid (RNA) positive patients were included in the study. HCV genotyping was carried out by restriction fragment length polymorphism (RFLP) followed by direct sequencing of the core region. Viral load estimation was carried out by Taqman real time polymerase chain reaction system.

RESULTS

In 45/54 (83.3%) anti-HCV positive patients, iatrogenic procedures were responsible for transmission with blood transfusion alone responsible in 36/54 (67%). Genotype 3 was observed to be the commonest type found in all risk groups followed by type 1 and 2. Subtype 3b (35.5%) was found more prevalent than subtype 3a. A higher frequency of subtype 1b (19.4%) was also seen. Genotype 1 was associated with a significantly higher viral load compared to genotypes 3 and 2. No significant difference was observed in the biochemical profile among the three genotypes except for the levels of the enzyme, aspartate aminotransferase (AST).

CONCLUSIONS

Iatrogenic procedures, especially contaminated blood transfusion etc., still contributes significantly to the pool of HCV infection. Genotype 3 is the predominant genotype in North India, though the subtype distribution within genotype 3 may be changing. The association of severe liver disease is significantly more with genotype 1 as evidenced by higher viral load and deranged AST levels.

162 CAN CHLAMYDIA ABORTUS BE TRANSMITTED BY EMBRYO TRANSFER IN GOATS?

Chlamydia abortus is a gram-negative obligate intracellular bacterium. Its lifecycle includes a resistant infectious form and a metabolically active non-infectious form. Chlamydia abortus infection results in abortion in goats; in nonpregnant animals the infection is usually subclinical. Chlamydia abortus presents a major zoonotic risk for pregnant women. The aim of this study was to investigate whether the embryonic zona pellucida (ZP) protects early embryo cells from infection and to test the efficacy of the washing protocol recommended by the IETS for bovine embryos. The study was performed in triple replicate: 14 donor goats, certified negative by ELISA and PCR to C. abortus, were synchronized, superovulated, and subsequently inseminated by males controlled negative for C. abortus. Fifty-two ZP-intact embryos (8–16 cells) were collected 4 days later, by laparotomy. The embryos were randomly divided into 12 batches. Nine batches of 5 embryos were incubated in a medium containing 4 × 107 Chlamydia mL–1, AB7 strain. After incubation for 18 h at 37°C in an atmosphere of 5% CO2, the embryos were washed in batches in 10 successive baths of PBS and 5% FCS solution in accordance with IETS guidelines for bovine embryos. In parallel, 3 batches of ZP-intact embryos (2, 2, and 3 embryos in the first, second, and third batches, respectively) were used as controls by being subjected to similar procedures, but without exposure to C. abortus. The 10 wash baths were collected separately and centrifuged for 1 h at 13 000 × g. The washed embryos and the pellets of the 10 centrifuged wash baths were frozen at –20°C before examination for evidence of C. abortus using RT-PCR. Chlamydia abortus DNA was found in all batches of infected ZP-intact embryos (9/9) after 10 successive washes. It was also detected in the tenth wash fluid for 4 batches (4/9) of infected embryos. As expected, none of the embryos or their washing fluids in the control batches were DNA positive. These results demonstrate that C. abortus adheres to and/or penetrates the ZP of in vivo caprine embryos after in vitro infection, and that the standard washing protocol recommended by the IETS for bovine embryos failed to remove it. The persistence of these bacteria after washing makes the embryo a potential means of transmission of the bacterium during embryo transfer from infected donor goat to healthy recipients and/or their offspring. Further studies are required to investigate whether enzymatic and/or antibiotic treatment of infected caprine embryos can eliminate C. abortus from the ZP.

The effect of confinement on the crystalline microstructure of polymer : fullerene bulk heterojunctions

We investigate the effect of confinement on the crystalline microstructure of the polymer component of polymer : fullerene bulk heterojunction thin films using grazing incidence wide angle X-ray scattering.

A subunit vaccine against hydropericardium syndrome using adenovirus penton capsid protein

Hydropericardium syndrome (HPS) is a disease of poultry that is caused by fowl adenovirus-4. Inactivated liver homogenate from diseased birds is still the choice of vaccine in some countries which disseminates numerous pathogens along with inactivated virus. Moreover incomplete attenuation or inactivation, reversion to virulence and the oncogenic potential/genetic instability of the adenoviruses have prevented their use in routine vaccines. To address this problem an effort is made to develop a subunit vaccine. For this purpose penton base protein of HPS virus was expressed in Escherichia coli and used as subunit vaccine in broilers. Immunogenicity of the recombinant penton base protein and challenge protection test against pathogenic virus demonstrated the ability of recombinant penton base protein to confer (90%) protection. Results suggest that the recombinant penton base protein is a candidate for subunit vaccine against HPS.

Calcium homeostasis may influence resting energy expenditure with effects most apparent in early pubertal girls

AIM

Perturbations in dietary and hormonal components of the calciotropic network may be mediated through the influence of calcium homoeostasis on resting energy expenditure (REE). We investigated the association of dietary and hormonal factors involved in the regulation of calcium homoeostasis with REE in girls.

METHODS

Thirty-six girls aged 7-11 years participated. REE was assessed by indirect calorimetry, and body composition, dietary intake (calcium, vitamins D and K, phosphorus) and serum hormones (PTH, osteocalcin, 25OHD) were evaluated by DXA, 24 h recall and serum assay, respectively.

RESULTS

  A positive association between vitamin K and REE and an inverse association of parathyroid hormone (PTH) with REE (p = 0.05) were observed. PTH and REE were positively related in those having normal adiposity (p = 0.03) and inversely related in those with excess adiposity (p = 0.01). The association of REE with vitamin K intake was evident in lean individuals (p = 0.001), but was null in those with excess adiposity.

CONCLUSION

Decreased calciotropic hormone levels along with increased related nutrient intakes were associated with greater REE, although these relationships differed according to adiposity. The physiologic response to the diet and subsequent energy partitioning needs to be considered in the context of puberty. In particular, regulation and signalling of the calciotropic network during pubertal maturation warrant investigation.

Automatic Segmentation of Breast Carcinomas from DCE-MRI using a Statistical Learning Algorithm

Segmenting regions of high angiogenic activity corresponding to malignant tumors from DCE-MRI is a time-consuming task requiring processing of data in 4 dimensions. Quantitative analyses developed thus far are highly sensitive to external factors and are valid only under certain operating assumptions, which need not be valid for breast carcinomas. In this paper, we have developed a novel Statistical Learning Algorithm for Tumor Segmentation (SLATS) for automatically segmenting cancer from a region selected by the user on DCE-MRI. In this preliminary study, SLATS appears to demonstrate high accuracy (78%) and sensitivity (100%) in segmenting cancers from DCE-MRI when compared to segmentations performed by an expert radiologist. This may be a useful tool for delineating tumors for image-guided interventions.

AIDS-associated Kaposi's sarcoma of the conjunctiva in a woman

Conjunctival involvement by AIDS-associated Kaposi's sarcoma (KS) is rare, more so in women. We present a case of a 34-year-old African-American woman with AIDS, who was admitted to our hospital and diagnosed with KS of the conjunctiva. To date there are only a few reported cases of AIDS-associated conjunctival KS in the literature. This case is the first case of AIDS-associated conjunctival KS in an African-American woman and emphasizes the importance of considering KS as a differential diagnosis of the conjunctival mass in HIV-positive patients.

A comparative analysis on factors affecting calf mortality of buffalo in a breeding farm

Study of calf mortality was carried out on three breeds of buffalo in a buffalo breeding and development farm. There were three types of buffalo such as Nili-Ravi, Indigenous and their crosses were reared here. Data for this study had been taken from record registrar books maintained in the farm. One hundred thirty one dead calves were studied for mortality. Pure Nili-Ravi showed higher mortality rate. The highest life span of dead calves was found as 717 days in Nili-Ravi and lowest 1 day in all breeds. The effect of breed on the life span of dead calves was insignificant (p>0.05). Furthermore, female calves are more prone to death as compared to male counterpart.