Genome-Wide Association Study of Fungicide Sensitivity in a Fusarium graminearum Population Collected from North Dakota

Fusarium head blight is a destructive disease of small grains. The disease is predominantly caused by the haploid ascomycete fungus Fusarium graminearum in North America. To understand the genetics of quantitative traits for sensitivity to fungicides in this fungal pathogen, we conducted a genome-wide association study of sensitivity to two demethylation inhibition class fungicides, tebuconazole and prothioconazole, using an F. graminearum population of 183 isolates collected between 1981 and 2013 from North Dakota. Baseline sensitivity to tebuconazole and prothioconazole was established using 21 isolates collected between 1981 and 1994. Most fungal isolates were sensitive to both tebuconazole and prothioconazole; however, five isolates showed significantly reduced sensitivity to prothioconazole. The genome-wide association study identified one significant marker-trait association on chromosome 3 for tebuconazole resistance, whereas six significant marker-trait associations, one on chromosome 1, three on chromosome 2, and two on chromosome 4, were detected for prothioconazole resistance. Functional annotation of the marker-trait association for tebuconazole revealed a candidate gene encoding a basic helix-loop-helix domain-containing protein that reinforces sterol in the fungal membrane. Putative genes for prothioconazole resistance were also identified, which are involved in RNA interference, the detoxification by ubiquitin-proteasome pathway, and membrane integrity reinforcement. Considering the potential of the pathogen toward overcoming chemical control, continued monitoring of fungal sensitivities to commercially applied fungicides, especially those containing prothioconazole, is warranted to reduce risks of fungicide resistance in the pathogen populations.

Investigating rate-limited sorption, sorption to air-water interfaces, and colloid-facilitated transport during PFAS leaching

Various sorption processes affect leaching of per- and polyfluoroalkyl substances (PFAS) such as PFOA and PFOS. The objectives of this study are to (1) compare rate-limited leaching in column and lysimeter experiments, (2) investigate the relevance of sorption to air-water interfaces (AWI), and (3) examine colloid-facilitated transport as a process explaining early experimental breakthrough. A continuum model (CM) with two-domain sorption is used to simulate equilibrium and rate-limited sorption. A random walk particle tracking (PT) model was developed and applied to analyze complex leaching characteristics. Results show that sorption parameters derived from column experiments underestimate long-term PFOA leaching in lysimeter experiments due to early depletion, suggesting that transformation of precursors contributes to the observed long-term leaching in the lysimeters (approximately 0.003 µg/kg/d PFOA). Both models demonstrate that sorption to AWI is the dominant retention mechanism for PFOS in lysimeter experiments, with retardation due to AWI being 3 (CM) to 3.7 (PT) times higher than retardation due to solid phase sorption. Notably, despite a simplified conception of AWI sorption, the PT results are closer to the observations. The PT simulations demonstrate possible colloid-facilitated transport at early time; however, results using substance-specific varying transport parameters align better with the observations, which should be equal if colloid-facilitated transport without additional kinetics is the sole mechanism affecting early breakthrough. Possibly, rate-limited sorption to AWI is relevant during the early stages of the lysimeter experiment. Our findings demonstrate that rate-limited sorption is less relevant for long-term leaching under field conditions compared to transformation of precursors and that sorption to AWI can be the dominant retention mechanism on contaminated sites. Moreover, they highlight the potential of random walk particle tracking as a practical alternative to continuum models for estimating the relative contributions of various retention mechanisms.

Community Perceptions of Facilitators and Barriers to Post Natal Care access in Rural Laos

Background

The quality of Maternal, Neonatal and Child Health (MNCH) services delivered varies widely in Lao People Democratic Republic. Swiss Red Cross (SRC) provides support to the country to improve the quality of reproductive health services, enhance access, and positively change health behavior through the MNCH2 project. This implementation research was then undertaken aiming to identify factors affecting decision-making of women relative to accessing postnatal care (PNC) and explore opportunities for improving SRC programming.

Methods

From August 2020 to January 2021, 33 in-depth interviews and 6 focus group discussion (FGD) with 54 women were conducted. Women who had given birth in the last six months were purposively selected from several ethnic groups residing in Chomphet and Phonexay Districts in Luang Prabang province. Socio-cultural and behavioral factors affecting women's decision to access PNC were assessed during the interviews and FGD. Additional perceptions were gathered though interviews with the partners, health service providers, village heads, and external project stakeholders.

Results

Traditional practices such as smoking ritual, strict practice of keeping the baby in the house within the first three days, and the treatment and disposal of placenta were identified as the main barrier for women to access PNC. Perceived importance of these traditional practices, however, are affected by family hierarchy especially with older family members insisting on its practice. Economic, road conditions, and transport challenges were also identified as significant barriers.

Conclusions

Traditional practices and family hierarchy, together with physical and economic access limit women's capacity to engage with facility-based postnatal care. Thus, quality outreach with home visits are critical. Gender inclusive health education given not only to pregnant women but to all family members was also identified as critical and is recommended to improve PNC access.

Key messages

Molecular Mapping of Quantitative Trait Loci for Fusarium Head Blight Resistance in the Brazilian Spring Wheat Cultivar "Surpresa"

Fusarium head blight (FHB) is a devastating disease in wheat. The use of resistant germplasm from diverse sources can significantly improve resistance to the disease. "Surpresa" is a Brazilian spring wheat cultivar with moderate FHB resistance, different from currently used sources. In this study, we aimed to identify and map the genetic loci for FHB resistance in Surpresa. A mapping population consisting of 187 recombinant inbred lines (RILs) was developed from a cross between Surpresa and a susceptible spring wheat cultivar, "Wheaton." The population was evaluated for FHB by the point-inoculation method in three greenhouse experiments and four field trials between 2016 and 2018. Mean disease severity for Surpresa and Wheaton was 41.2 and 84.9% across the 3 years of experiments, ranging from 30.3 to 59.1% and 74.3 to 91.4%, respectively. The mean FHB severity of the NILs was 57%, with an overall range from 7 to 100%, suggesting transgressive segregation in the population. The population was genotyped using a two-enzyme genotyping-by-sequencing approach, and a genetic map was constructed with 5,431 single nucleotide polymorphism (SNP) markers. Four QTL for type II resistance were detected on chromosomes 3A, 5A, 6A, and 7A, explaining 10.4-14.4% of the total phenotypic variation. The largest effect QTL was mapped on chromosome 7A and explained 14.4% of the phenotypic variation; however, it co-localized with a QTL governing the days to anthesis trait. A QTL for mycotoxin accumulation was also detected on chromosome 1B, explaining 18.8% of the total phenotypic variation. The QTL for FHB resistance identified in the study may diversify the FHB resistance gene pool and increase overall resistance to the disease in wheat.

Investigating Small Modular Reactor's Design Limits for Its Flexible Operation With Photovoltaic Generation in Microcommunities

Use of flexible and dispatchable generation from the small modular reactors (SMRs) in combination with the nondispatchable generation from renewable energy systems (RES) can be an effective alternative to pursue the mandate of replacing the fossil-fuel based electricity with the carbon-neutral energy systems in the remote microcommunities. This paper evaluates the feasibility of SMRs' flexible operations in microcommunities with the photovoltaic (PV) generation as a case study. Considering the design limits of SMRs for (a) the range of net change in electrical power output and (b) the ramp rates of net change in turbine power, a power system study is conducted to cover the three aspects of flexible operations, namely: (1) Planned load-following, (2) Unplanned load-following, and (3) Frequency regulation. A generic governor model in power system simulator for engineering (PSS/E), a power system transmission and planning software, is adapted to incorporate the operating limits of the reactor for the dynamic simulation. The multitimescale approach, combining (a) steady-state time-series power flow analysis and (b) dynamic simulations with high-resolution solar irradiation datasets, is proposed to assess the implications of SMR's design limits. The results obtained on an existing remote feeder with three sets of operating limits—namely, the conventional, advanced and extreme limits of ramp rates juxtapose the SMRs' performance, given the challenging operating conditions with PV generation in remote locations. The results indicate that the SMR under study can accommodate the highest permissible PV penetration obtained by the hosting capacity analysis of the feeder under the clear sky conditions. However, dynamic simulations with the extreme PV variabilities show that the PV penetration level should be further limited so that the maximum deviations in SMR power levels stay within 40% of its rated capacity. SMR provides adequate frequency support for the PV penetration of up to 50% of the feeder maximum demand in this study.

Sex differences in the rates of incident and recurrent coronary heart disease and all-cause mortality

Background

Women have lower age-specific rates of incident coronary heart disease (CHD) than men. However, it remains unclear whether women maintain the same advantage once they have had a cardiac event.

Purpose

To assess whether sex differences in the rates of cardiac events and all-cause mortality among individuals without a history of CHD persist following a myocardial infarction (MI).

Methods

We identified 171,897 women and 167,993 men <65 years of age with commercial health insurance and ≥66 years of age with government health insurance through Medicare who had a MI hospitalization between 2015 and 2016 in the US. These beneficiaries were matched to 687,588 women and 671,972 men without a history of CHD based on age and calendar year. Beneficiaries were followed until December 2017 for the occurrence of MI, CHD, heart failure, and all-cause mortality (Medicare only).

Results

The age-standardized rates of MI per 1,000 person-years were 4.5 in women and 5.7 in men without a history of CHD (multivariable-adjusted hazard ratio [HR] [95% confidence interval] of female sex: 0.64 [0.62; 0.67]) and 60.2 in women and 59.8 in men with a history of MI (HR: 0.94 [0.92, 0.96]) (Figure 1). Rates of CHD events in women vs. men were 6.3 vs. 10.7 among those without CHD (HR: 0.53 [0.51, 0.54]) and 84.5 vs. 99.3 among those with MI (HR: 0.87 [0.85, 0.89]). Heart failure hospitalization rates in women vs. men were 9.3 vs. 6.6 for those without CHD (HR: 0.93 [0.90, 0.96]) and 114.9 vs. 97.9 among those with MI (HR: 1.02 [1.00, 1.04]). All-cause mortality rates in women vs. men were 63.7 vs. 59.0 among those without CHD (HR: 0.72 [0.71; 0.73]) and 311.6 vs. 284.5 among those with a MI (HR: 0.90 [0.89, 0.92]).

Conclusion

The women advantage against MI, CHD, heart failure and all-cause mortality is considerably attenuated following a MI, suggesting that a prior MI puts women at almost the same high-risk of subsequent events as men.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): This work was funded by an industry/academic collaboration between Amgen Inc. and University of Alabama at Birmingham.

Exploring Synergy Among New Generation Technologies—Small Modular Reactor, Energy Storage, and Distributed Generation: A Strong Case for Remote Communities

With a steady rise in power demand in the remote communities in Canada, utilities are looking for new options to provide a reliable supply of electricity. While distributed generation is a promising option, scaling and firming up the capacity of distributed generators is essential. Alternatively, small modular reactors (SMRs) can be used as a prime local source of electricity for remote feeders provided they are flexible enough to respond to the fluctuations in demand. Electrical energy storage (EES) can be used as a buffer to absorb fluctuations in demand and generation, and as a critical back-up for the SMR on-site power supply system by replacing the diesel-generator sets. The synergy of SMR-EES-distributed generation can be an all-inclusive alternative with win-win situation for both the utility and remote communities. This paper discusses the technical feasibility of the proposed synergy using an example of an existing remote feeder in Saskatchewan, Canada. The integral pressurized water reactor is considered along with the photovoltaic (PV) generation in an existing remote feeder in Northwest Saskatchewan to estimate the plant load factor (LF) of the SMR with and without the PV generation and EES. The results quantify the benefit of having EES to support the SMR in hosting more PV generation in remote communities. EES when used in support of the SMR to host 60% PV penetration, the plant load factor improves by as much as 5%.

5191Recurrent coronary heart disease in the year following myocardial infarction among US men and women between 2008 and 2015

Background

Although the risk of recurrent events among adults with coronary heart disease (CHD) has declined considerably from the 1970's in the US and many Western countries, studies from the 2000's show that rates remain high. Women have lower rates of incident CHD but little is known about sex differences in recurrent events in adults with CHD.

Purpose

To examine trends in rates of recurrent myocardial infarction (MI), recurrent CHD, and all-cause mortality following a MI hospitalization between 2008 and 2015 among US men and women. Also, we compared sex differences in event rates among individuals with a MI hospitalization versus their counterparts without a history of CHD.

Methods

Data were used from 1,232,024 (53% women) US adults <65 years of age with commercial health insurance in the MarketScan database and US adults ≥66 years of age with government health insurance through Medicare who had a MI hospitalization between January 1, 2008 and December 31, 2015. For each calendar year, age-standardized sex-specific rates of recurrent MI, recurrent CHD (i.e., recurrent MI or coronary revascularization), and all-cause mortality (in Medicare only) were calculated through 365 days following the hospital discharge date for MI. In a secondary analyses, we assessed the rate of recurrent MI, CHD events and all-cause mortality among women versus men with a history of MI (n=324,283) and without a history of CHD (n=1,297,132) in 2014–2015. For these analyses, adjusted hazard ratios (95% confidence intervals) were calculated using follow-up through December 31, 2016.

Results

From 2008 to 2015, age-standardized rates over 365 days of follow-up for recurrent MI declined by 15%, from 94 to 80 per 1000 person-years, in men and by 14%, from 89 to 77 per 1000 person-years, in women. Age-standardized recurrent CHD rates decreased by 16%, from 163 to 138 per 1000 person-years, in men and by 17%, from 142 to 118 per 1000 person-years, in women. In the Medicare population, age-standardized all-cause mortality rates following MI decreased by 6%, from 446 to 421 per 1000 person-years, in men and by 3%, from 412 to 398 per 1000 person-years, in women. In the secondary analyses, the women-to-men hazard ratios for those with a history of MI and those without prior CHD were 0.97 (0.94–0.99) and 0.67 (0.65–0.69), respectively, for MI, 0.89 (0.87–0.91) and 0.52 (0.51–0.54), respectively, for CHD, and 0.84 (0.83–0.85) and 0.74 (0.73–0.75) respectively, for all-cause mortality.

Conclusion

Reductions in rates of recurrent MI, recurrent CHD, and all-cause mortality within 365 days after hospitalization for MI have been similar for US women and men. The lower risk for events comparing women versus men without prior CHD is attenuated after a MI.

Acknowledgement/Funding

The design and conduct of the study was supported through a research grant from Amgen, Inc.

P6206Death, debility, and destitution following recurrent myocardial infarction in older adults

Background

Most prior research on outcomes among older adults with established cardiovascular diseases focuses on recurrent events and hospitalizations. However, older adults value financial security and functional independence in addition to these disease-focused metrics. Recurrent cardiovascular events may increase risk of long-term nursing home residence and financial strain.

Purpose

To compare the risk for death, debility (long-term residence in a nursing home), and destitution (eligibility for health insurance programs for impoverished individuals) among older adults with recurrent myocardial infarction (MI) and controls.

Methods

We conducted a retrospective cohort study using administrative data from the United States Medicare program, a health insurance program for older adults. Among all patients who experienced a first overnight hospitalization with a discharge diagnosis of MI between 1 January 2007 and 30 June 2016, we identified patients with a recurrent MI hospitalization. Additionally, we selected controls from the same population of patients with MI, matched on calendar year of the initial MI and days since the initial MI. We included 194,481 patients aged 66 years and older with recurrent MI hospitalizations and 777,924 controls. Patients were followed for death, debility, and destitution until 31 December 2016. We used Kaplan-Meier curves and Cox proportional hazards models adjusted for sociodemographic factors, comorbidities, and healthcare utilization to compare patients with recurrent MI and matched controls.

Results

The average age of the population was 80.0 (standard deviation 8.3) years and 56.7% were women. Patients with recurrent MI were more likely to have a history of diabetes, chronic kidney disease, heart failure and peripheral artery disease than controls. The cumulative incidence of death, debility, and destitution were all higher among patients with recurrent MI than their matched controls (Figure). Comparing patients with recurrent MI to controls, the hazard ratios (95% confidence intervals) were 2.11 (2.09–2.13) for death, 0.92 (0.89–0.94) for debility, and 1.34 (1.29–1.39) for destitution after multivariable adjustment.

Death, debility, and destitution

Conclusion

Preventing recurrent MIs has the potential to reduce not only mortality but also destitution.

Acknowledgement/Funding

Amgen, Inc

Handwashing Practices in Neonatal Intensive Care Unit, Paediatric Intensive Care Unit and Neonatal Nurseries in Patan Hospital

BACKGROUND

Hand hygiene has been identified as the single most important factor in minimising hospital acquired infections. However, compliance of handwashing guidelines has remained low. The aim of this study was to study the handwashing practices in the Paediatric and Neonatal intensive care units and Neonatal nurseries in Patan Hospital, and secondly to re-evaluate the improvement on compliance of handwashing guidelines after intervention.

METHODS

Pre-intervention study was conducted by covertly observing the handwashing practices by the healthcare workers. The healthcare workers were then shown the video demonstrating correct methods of handwashing as recommended by World health organization. The cycle was completed by discretely re-observing the handwashing practices following intervention.

RESULTS

Sixty five samples were collected initially. Only 6 (9.2%) had completed all steps of handwashing correctly. Post- intervention, 51 samples were collected, out of which 35 (68.6%) had correctly completed all the steps. Following audio-visual demonstration, 100% correctly completed 8/10 steps of handwashing with soap and water. 8 (16%) failed to dry hands using a single use towel and 14 (28%) failed to turn off the tap using elbow. Post- intervention, 100% correctly completed 4/7 steps of handwashing using chlorhexidine. Four (15%) still failed to rub backs of fingers to opposite palm, eight (30%) failed to palm to palm with fingers interlaced, and rub thumb to opposite palm.

CONCLUSIONS

Compliance in hand hygiene is low despite the known fact that it reduces nosocomial infections. However, a simple intervention like video demonstration can improve the compliance among healthcare workers.

Surgical Results of Non-small Cell Lung Cancer in Nepal

INTRODUCTION

Surgery remains the only curative modality for early stage of Non small cell lung caner (NSCLC). We reviewed overall scenario of lung cancer and surgical results in Nepal.

METHODS

1000 patients with the pathological diagnosis of lung cancer were analyzed to summarize the overall scenario of lung cancer. 157 NSCLC patients underwent pulmonary resection. cIA, IB, IIA, IIB, IIIA (N1) underwent surgery as initial modality of treatment. cIIIA (N2) patients were taken for surgery after neoadjuvant chemo/ chemoradiation.

RESULTS

Analysis of 1000 patients showed squamous cell carcinoma in 41.3%, incurable stage (IIIB/ IV) in 66.8% and rate of curative resection in 6.7% cases. Surgery as a single modality of treatment was used in 38%. Neoadjuvant Chemo/ chemoradiation/ radiation followed by surgery and surgery followed by chemo/ chemoradiation/ radiation was done in 12% and 50%, respectively. In-hospital mortality was 2% (post pneumonectomy: 5.5%; post lobectomy: 1.5%; post sublobar resection: 0%). R0 resction was achieved in 91% cases. Median survival and 5-year overall survival were 36 months and 18%, respectively. Better survival was achieved in pI-II vs pIII/ IV, pN0-1 vs pN2 and pR0 vs pR+ (p <0.05).

CONCLUSIONS

Earlier stage (pI-II), R0 resection and pathological pNo-1 has the best five year overall survival in Nepalese patients with NSCLC as well.

Prevalence of metabolic syndrome in chronic kidney disease: a hospital based cross-sectional study

BACKGROUND

The components of metabolic syndrome (MetS) are the established risk factors of chronic kidney disease (CKD). Therefore, MetS and interplay of its various components, have deleterious effects on patients with chronic kidney disease. The aims of our study was to find out the prevalence of MetS in chronic kidney disease patients and to find out the association of each component of MetS with chronic kidney disease.

METHODS

A Hospital based cross-sectional study was carried out from February 2008 to August 2009. One hundred and sixty confirmed chronic kidney disease diagnosed patients were included in this study. Chronic kidney disease was defined from national kidney foundation guidelines. Anthropometric measurements of subjects were noted in a semi-structured pro-forma. Fasting blood sample was collected for the estimation of fasting blood glucose, triglyceride and HDL-cholesterol. Chronic kidney disease patients were diagnosed as having the metabolic syndrome by using the modified National Cholesterol Education Program Adult Treatment Program III criteria. Data were assessed by the t-test and Chi Square Test.

RESULTS

Sixty (37.5%) of the chronic kidney disease patients had MetS according to modified National Cholesterol Education Program Adult Treatment Program III criteria. The prevalence of hypertension, high fasting blood glucose, high triglyceride, low HDL Cholesterol and high waist circumference in chronic kidney disease patients was 112 (70.0%), 36 (22.5%), 74(46.25%), 98 (61.25%) and 30 (18.75%) respectively. Among the five components of the metabolic syndrome, waist circumference has the highest positive predictive value (73.34%) for chronic kidney disease.

CONCLUSIONS

MetS occurs in more than one-third of chronic kidney disease patients. The prevalence of individual components of MetS is higher in chronic kidney disease patients.

Spectrum of thyroid dysfunction in patients visiting Kantipur Hospital, Kathmandu, Nepal

Thyroid disorder is most common endocrine abnormality in the general population and its prevalence increases with age. The screening of thyroid disorder is advised in high risk population. This hospital based cross-sectional study was conducted in Department of Biochemistry, Kantipur Hospital, Kathmandu, Nepal. Patients having complains of thyroid disease from February 2010 to January 2011 were enrolled in this study. Thyroid parameters such as FT3, FT4 and TSH were measured by ELISA technique. Among total 472 subjects 393(83.27%) were female whereas 79(16.73%) were male. The prevalence of thyroid dysfunction was 36.0% (n=170). The different patterns of thyroid dysfunction in Kathmandu valley were: hypothyroid (11.6%), subclinical hypothyroid (16.9%), hyperthyroid (4.0%), and subclinical hyperthyroid (3.6%) respectively. Subjects having all thyroid parameters normal i.e. euthyroid were 63.9%. In conclusion, this study reveals a higher prevalence of thyroid dysfunction in Kathmandu region. This study recommends community based nationwide epidemiological studies on a regular basis to monitor thyroid dysfunction in Nepalese populations.

Dyslipidaemia in chronic kidney disease in Nepalese population

Patients having chronic kidney disease (CKD) are at higher risk for cardiovascular disease (CVD). Dyslipidaemia is a potential risk factor for CVD in CKD cases. In this study our aim was to find out the dyslipidaemia in patients with different stages of CKD. This hospital based cross-sectional study was conducted in department of biochemistry, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Total of 163 CKD cases and 163 non-CKD healthy controls were enrolled. CKD was defined and classified as per national kidney foundation guidelines. We analyzed fasting lipid profile including total cholesterol, HDL-C, LDL-C and TG. Significant difference in mean value of serum total cholesterol, HDL-C, LDL-C and TG were found in different stage of CKD and non-CKD groups (p value <0.05). CKD cases 33.75% and 21.47% of non-CKD controls had hypercholesterolemia (Odds ratio 1.86, p value 0.013). CKD cases 32.5% and 17.18% of non-CKD controls had low HDL-C (Odds ratio 2.32, P-value 0.001). CKD cases 38.03% and 33.13% of non-CKD controls had high LDL-C (Odds ratio 1.24, p value 0.297). CKD cases 35.58% and 19.01% of non-CKD controls had hypertriglyceridemia (Odds ratio 2.35, P-value 0.001). CKD had a higher prevalence of dyslipidaemia compared to non-CKD controls. Dyslipidaemia was also found in early stages of CKD.

Adenosine deaminase in CSF and pleural fluid for diagnosis of tubercular meningitis and pulmonary tuberculosis

Tuberculosis (TB) is one of the most common infectious diseases in developing countries including Nepal. Delay in diagnosis and treatment of tuberculosis results in poor prognosis of the disease. This study was conducted to estimate diagnostic cut off values of Adenosine Deaminase (ADA) in cerebrospinal fluid (CSF) and pleural fluid and to evaluate the sensitivity, specificity, positive and negative predictive values ofADA in pleural fluid and CSF from patients with tuberculous and non-tuberculous disease. A total of 98 body fluid (CSF: 24, Pleural fluid: 74) specimens were received for the estimation of ADA. ADA activity was measured at 37 degrees C by spectrophotometric method of Guisti and Galanti, 1984 at 625nm wavelength. Among the patients enrolled for the study subjects for which CSF were received (n = 24) included 8 tuberculous meningitis (TBM), and 16 non-tubercular meningitis (NTM). Pleural fluid samples (n = 74) were received from 19 pulmonary TB with pleural effusion, 17 PTB without pleural effusion and 37 of non-tuberculous disease patients. CSF ADA activity were (11. 1 +/- 2.03 IU/L) and (5.3 +/- +1.89 IU/L) (p <00001) in TM and non-NTM groups and Pleural fluid ADA activity were (10 +/- 22.18 IU/L) and (23.79 +/- 11.62 IU/L) (p < 0.001) in PTB and non-TB groups respectively. ADA test in body fluids, which is simple, cost-effective and sensitive, specific for the tubercular disease is recommended to perform before forwarding the cumbersome and expensive procedures like culture and PCR for TB diagnosis.

Pure red cell aplasia caused by Parvo B19 virus in a kidney transplant recipient

Parvo B19 is a single stranded DNA virus, which typically has affi nity for erythroid progenitor cells in the bone marrow and produces a severe form of anemia known as pure red cell aplasia. This condition is particularly worse in immunocompromised individuals. We herein report a young Nepali male who developed severe and persistent anaemia after kidney transplantation while being on immunosuppressive therapy. His bone marrow examination revealed morphological changes of pure red cell aplasia, caused by parvovirus B19. The IgM antibody against the virus was positive and the virus was detected by polymerase chain reaction in the blood. He was managed with intravenous immunoglobulin. He responded well to the treatment and has normal hemoglobin levels three months post treatment. To the best of our knowledge, this is the fi rst such case report from Nepal. Keywords: Intravenous immunoglobulin, kidney transplant recipient, Parvovirus B19, pure red cell aplasia.

Pure red cell aplasia caused by Parvo B19 virus in a kidney transplant recipient

Parvo B19 is a single stranded DNA virus, which typically has affinity for erythroid progenitor cells in the bone marrow and produces a severe form of anemia known as pure red cell aplasia. This condition is particularly worse in immunocompromised individuals. We herein report a young Nepali male who developed severe and persistent anaemia after kidney transplantation while being on immunosuppressive therapy. His bone marrow examination revealed morphological changes of pure red cell aplasia, caused by parvovirus B19. The IgM antibody against the virus was positive and the virus was detected by polymerase chain reaction in the blood. He was managed with intravenous immunoglobulin. He responded well to the treatment and has normal hemoglobin levels three months post treatment. To the best of our knowledge, this is the first such case report from Nepal.

Assessment of chronic kidney disease in Nepalese people with hypertension

Hypertension is one of the leading causes to develop chronic kidney disease (CKD) and could be a risk factor for progression of CKD to end stage renal disease (ESRD).Uncontrolled hypertension worsens CKD. Hypertension control may contribute to prevent CKD in early stages and retards the progression of CKD stages to ESRD. Prevalence of CKD in people with diagnosed and chronic hypertension is known to be high, but little is known about the prevalence of CKD in those with newly diagnosed Hypertension. Present work was undertaken to see the prevalence of CKD among people with newly diagnosed hypertension. In this cross-sectional study, we accessed the CKD in newly diagnosed hypertensive patients and determined the association between hypertension and CKD. CKD was defined as either kidney dysfunction or kidney damage or both as per National Kidney Foundation Guidelines. 106 of newly diagnosed patients and 106 of normotensive controls were recruited in the study. 51.9% of newly diagnosed hypertensive patients and 23.6% of normotensive controls had CKD which was statistically significant (p-value <0.001). Difference in the mean value in eGFR and spot urine ACR (mg/mmol) between hypertensive patients and normotensive controls was statistically significant (p-Value <0.001). Both systolic BP and diastolic BP negative significantly correlated with eGFR (p-Value < 0.001 and 0.024 respectively) and positive significantly correlated with ACR (p-Value 0.003 and 0.003 respectively). The prevalence of CKD is high among people with newly diagnosed hypertension. Those, people might benefit from interventions aimed at preventing development and/or progression of both CKD and hypertension.

In-vitro assessment of cell-mediated immunity by demonstrating effector-t cells for diagnosis of tuberculosis in Nepalese subjects

The immune response against mycobacterium tuberculosis (MTB) is cell mediated. T-cells become sensitized when they encounter MTB antigens and subsequently activated effector T-cells produce a number of cytokines including interferon- gamma (INF-gamma) to fight the infecting organisms. Demonstration of either production of INF-gamma or presence of effector T-cells sensitized to MTB specific antigens in vitro can be diagnostic for TB infection. Aim of this study was to determine the efficacy of commercially available T-SPOT.TB kit which is used for the in vitro diagnosis of TB infection and to determine if this test has any cross reactivity in leprosy patients. Blood sample was taken from 30 sputum AFB positive, 30 sputum AFB negative healthy controls and 10 cases of paucibacillary leprosy patients. The blood samples were processed to separate peripheral blood mononuclear cells. The final cell suspensions were cultured along with MTB specific antigens namely- Early Secretory Antigenic Target (ESAT-6) and Culture Filtrate Protein (CFP 10) along with negative and positive controls. The production of INF-gamma was demonstrated by enzyme linked immunospot (ELISPOT) assay technique. All AFB positive samples produced INF-gamma after exposure to MTB specific antigens. 4 (16.6%) of healthy controls were also found reactive for INF-gamma. The sensitivity and "specificity" for active disease of the ELISPOT (T-SPOT.TB) in respect to AFB microscopy was 100% and 85.7% respectively. Assessment of CMI against tuberculosis, by demonstrating effector T-cell sensitized to MTB antigens can be use to aid the diagnosis of tuberculosis. T-SPOT.TB has no cross reactivity with leprosy patients.

First Report of Cucumber mosaic virus Infecting Blephilia hirsuta in North America

Blephilia hirsuta (Pursh) Benth. var. hirsuta, an ornamental plant known as hairy pagoda or hairy wood mint (Lamiaceae), is native to eastern North America and is listed as an endangered species or a species of special concern in several northeastern states ( http://www.ct.gov/dep/cwp/view.asp?a=2702&q=323482&depNav_GID=1628 and http://www.mass.gov/dfwele/dfw/nhesp/species_info/mesa_list/mesa_list.htm ). B. hirsuta, grown as an ornamental on the University of Arkansas campus in Fayetteville, exhibited mottling symptoms indicative of viral infection. Double-stranded RNA extractions (3) yielded four bands of approximately 3.2, 2.9, 2.2, and 0.9 kb, a pattern identical to that of Cucumber mosaic virus (CMV [2]). Nicotiana benthamiana and Chenopodium quinoa seedlings were mechanically inoculated with sap from symptomatic tissue. N. benthamiana inoculated plants were stunted and developed systemic mosaic and C. quinoa inoculated plants developed local lesions, whereas mock inoculated plants remained symptomless. Dot-blot and indirect ELISA using antisera against CMV (developed by H. A Scott) gave strong reactions when testing symptomatic tissue from B. hirusta, N. benthamiana, and C. quinoa compared with no reaction for symptomless plants. Total nucleic acid extractions (4) from symptomatic tissue was subjected to reverse transcription-PCR using Cucumovirus degenerate primers (1). An amplicon of approximately 940 bases was obtained and sequenced. The sequence, deposited in GenBank under Accession No. GU453918, confirmed the results of the immunological assays that B. hirsuta was infected with CMV. The nucleotide identities between the B. hirsuta isolate and those of the Fny CMV group exceeded 98%. To our knowledge, this is the first report of CMV infecting B. hirsuta, not only in North America, but globally. This finding has major implications for the ornamental industry and the viability of the endangered species. Given the wide range of CMV, B. hirsuta may act as a reservoir for the virus and facilitate transmission to ornamentals and other plants. In addition, the virus may reduce host fitness and undermine the efforts to preserve the species in areas that is threatened. References: (1) S. K. Choi et al. J. Virol. Methods 83:67, 1999. (2) I. E. Tzanetakis. Plant Dis. 93:431, 2009. (3) I. E. Tzanetakis and R. R. Martin. J. Virol. Methods 149:167, 2008. (4) I. E. Tzanetakis et al. Virus Res. 127:26, 2007.

Use of protein: creatinine ratio in a random spot urine sample for predicting significant proteinuria in diabetes mellitus

Present study was undertaken during a period of 6 months (September 2008-February 2009) to see an correlation of 24 hours urine protein estimation with random spot protein-creatinine (P:C) ratio among a diabetic patients. The study comprised of 144 patients aged 30-70 years, recruited from Kantipur hospital, Kathmandu. The 24-hr urine sample was collected, followed by spot random urine sample. Both samples were analyzed for protein and creatinine excretion. An informed consent was taken from all participants. Sixteen inadequately collected urine samples as defined by (predicted creatinine--measured creatinine)/predicted creatinine > 0.2 were excluded from analysis. The Spearman's rank correlation between the spot urine P:C ratio and 24-hr total protein were performed by the Statistical Package for Social Service. At the P:C ratio cutoff of 0.15 and reference method (24-hr urine protein) cutoff of 150 mg/day, the correlation coefficient was found to be 0.892 (p < 0.001). The area under ROC curve at different cutoffs was 0.88 at 95.0% CI. The sensitivity and specificity of the P:C ratio to detect significant proteinuria at the cutoff of 0.15 are 96.6% and 74.4%. So the P:C ratio can predict significant proteinuria in diabetic subjects, avoiding the inconvenient 24-hr urine collection but the cutoff should be carefully selected for different patients group under different laboratory procedures and settings.

Sarcoidosis - Three Clinical Vignettes with a Short Review

abstract

Shape evolution of lead telluride and selenide nanostructures under different hydrothermal synthesis conditions

Face-open nanoboxes of lead telluride and selenide have been synthesized by a simple hydrothermal method. Nano- and microcrystals of various morphologies, including microflowers, semi-microflowers, cubic nanoparticles, etc., have also been observed at different synthesis conditions. Temperature, time, and concentrations of various reactants play a major role in controlling the morphology and shape evolution of the product. This simple synthesis technique for the growth of various nano- and microstructures opens a new route to prepare hierarchical structures of a variety of binary semiconducting materials in a large quantity. A possible growth mechanism of such nano- and microstructures has been proposed.