Individualized homeopathic medicines in preventing the progression from pre-diabetes to diabetes: A double-blind, randomized, placebo-controlled, parallel-arm trial

CONTEXT

Pre-diabetes is a significant public health problem worldwide. India has a very high rate of progression from pre-diabetes to diabetes, 75-78 per thousand persons per year.

OBJECTIVE

To study the efficacy of individualized homeopathic medicinal products (HMPs) against placebos in preventing the progression from pre-diabetes to diabetes.

DESIGN

Six-month, double-blind, randomized (1:1), two parallel arms, placebo-controlled trial.

SETTING

Outpatient departments of D. N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India.

PATIENTS

Sixty participants with pre-diabetes.

INTERVENTIONS

Verum: HMPs plus yoga therapy (YT; n = 30); control: identical-looking placebos plus YT (n = 30).

MAIN OUTCOME MEASURES

The primary efficacy endpoint was the proportion of participants progressing from pre-diabetes to diabetes, measured after three and six months. Secondary outcomes comprised of fasting blood glucose (FBS), oral glucose tolerance test (OGTT), glycated hemoglobin percentage (HbA1c%), lipid profile, liver enzymes (alanine transaminase, aspartate transaminase), urea and creatinine, and Measure Yourself Medical Outcome Profile version 2 (MYMOP-2); all measured after 3 and 6 months.

RESULTS

The proportion of participants converted from pre-diabetics to diabetics (n/N; n = diabetics, N = prediabetics) was significantly less in the verum group than control: HbA1C% (month 3: verum - 2/30 versus control - 11/30, p = 0.003; month 6: 3/30 vs. 2/30, p = 0.008), OGTT (month 3: 0/30 vs. 8/30, p = 0.015; month 6: 0/30 vs. 1/30, p = 0.008), but not according to FBS (month 3: 1/30 vs. 1/30, p = 0.779; month 6: 1/30 vs. 3/30, p = 0.469). Several secondary outcomes also revealed significant improvements in the verum group than in placebo: HbA1C% (p < 0.001), OGTT (p = 0.001), serum ALT (p = 0.031), creatinine (p = 0.012), and MYMOP-2 profile scores (p < 0.001). Sulphur, Bryonia alba, and Thuja occidentalis were the most frequently indicated medicines. Thus, HMPs outperformed placebos by successfully preventing the progression of pre-diabetes to diabetes.

TRIAL REGISTRATION

Clinical Trials Registry - India CTRI/2022/04/042,026; UTN: U1111-1277-0021.

Deciphering miRNA-lncRNA-mRNA interaction through experimental validation of miRNAs, lncRNAs, and miRNA targets on mRNAs in Cajanus cajan

Pigeon pea (Cajanus cajan) is widely cultivated for its nutritional and medicinal value yet remains an orphan crop as productivity has not been improved because of a lack of genome and non-coding genome information. Non-coding RNAs, like miRNAs and long non-coding RNAs (lncRNAs), are involved in regulation of growth, metabolism, development, and stress response, and have a critical role in post-transcriptional gene regulation (PTGR). We attempted to elucidate the roles of miRNAs and lncRNAs in pigeon pea through experimental validation of computationally predicted miRNAs and lncRNAs and targets of miRNAs on mRNAs. We experimentally validated 20 miRNAs and 11 lncRNAs. We predicted cleavage sites of three miRNA targets: serine/threonine-protein kinase, polygalacturonase, beta-galactosidase. We identified 469 targets of 265 miRNAs and their functional annotations using computational methods. We built a miRNA-mRNA-lncRNA network model, with the miRNAs targeting both mRNAs and lncRNAs, to obtain information on the interplay of these three molecules. A confirmed interaction through experimental validation was established between miRNA, namely cca-miR1535a targeting the mRNA for beta-galactosidase, as well as the lncRNA cca-lnc-020033. Our findings increase knowledge of the non-coding genome of pigeon pea and their roles in PTGR and in improving agronomic traits of this pulse crop.

Individualized Homeopathic Medicines in the Treatment of Knee Osteoarthritis: Double-Blind, Randomized, Placebo-Controlled Feasibility Trial

INTRODUCTION

 This study aimed at examining the feasibility issues of comparing individualized homeopathic medicines (IHMs) with identical-looking placebos for treating knee osteoarthritis (OA).

METHODS

 Forty eligible patients participated in this double-blind, randomized (1:1), placebo-controlled feasibility trial in the outpatient clinics of a homeopathic hospital in West Bengal, India. Either IHMs or identical-looking placebos were administered, along with mutually agreed-upon concomitant care guidelines. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was the primary outcome measure, and derived Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores from KOOS, EQ-5D-5L questionnaire, and Visual Analog Scale (VAS) were the secondary outcomes; all measured at baseline and after 2 months. Group differences and effect sizes (Cohen's d) were estimated using an intention-to-treat approach. p-Values less than 0.05 (two-tailed) were considered statistically significant.

RESULTS

 Enrolment/screening and trial retention rates were 43% and 85% respectively. Recruitment was difficult owing to the coronavirus disease 2019 (COVID-19) lockdown. Group differences were statistically significant, favoring IHMs against placebos in all the KOOS sub-scales: symptoms (p < 0.001), pain (p = 0.002), activities of daily living (p < 0.001), sports or recreation (p = 0.016), and quality of life (p = 0.002). Derived WOMAC scores from KOOS favored IHMs against placebos: stiffness (p < 0.001) and pain (p < 0.001). The EQ-5D-5L questionnaire score (p < 0.001) and EQ-5D-5L VAS scores (p < 0.001) also yielded significant results, favoring IHMs over placebos. All the effect sizes ranged from moderate to large. Sulphur was the most frequently prescribed homeopathic medication. Neither group reported any harm or serious adverse events.

CONCLUSION

 Although recruitment was sub-optimal due to prevailing COVID-19 conditions during the trial, the action of IHMs was found to be superior to that of placebos in the treatment of knee OA. Larger and more definitive studies, with independent replications, are required to substantiate the findings.

TRIAL REGISTRATION

 CTRI/2021/02/031453.

The use of antivirals in the treatment of human monkeypox outbreaks: a systematic review

OBJECTIVES

Human monkeypox virus (MPXV) infection is a recently declared public health emergency of international concern by the World Health Organization. Besides, there is scant literature available on the use of antivirals in MPXV infection. This systematic review compiles all evidence of various antivirals used on their efficacy and safety and summarizes their mechanisms of action.

METHODS

A review was done of all original studies mentioning individual patient data on the use of antivirals in patients with MPXV infection.

RESULTS

Of the total 487 non-duplicate studies, 18 studies with 71 individuals were included. Tecovirimat was used in 61 individuals, followed by cidofovir in seven and brincidofovir (BCV) in three individuals. Topical trifluridine was used in four ophthalmic cases in addition to tecovirimat. Of the total, 59 (83.1%) were reported to have complete resolution of symptoms; one was experiencing waxing and waning of symptoms, only one (1.8%) had died, and the others were having a resolution of symptoms. The death was thought unrelated to tecovirimat. Elevated hepatic panels were reported among all individuals treated with BCV (leading to treatment discontinuation) and five treated with tecovirimat.

CONCLUSION

Tecovirimat is the most used and has proven beneficial in several aggravating cases. No major safety concerns were detected upon its use. Topical trifluridine was used as an adjuvant treatment option along with tecovirimat. BCV and cidofovir were seldom used, with the latter often being used due to the unavailability of tecovirimat. BCV was associated with treatment discontinuation due to adverse events.

Challenges and Limitations in Distributional Cost-Effectiveness Analysis: A Systematic Literature Review

BACKGROUND

Cost-effectiveness is a tool to maximize health benefits and to improve efficiency in healthcare. However, efficient outcomes are not always the most equitable ones. Distributional cost-effectiveness analysis (DCEA) offers a framework for incorporating equity concerns into cost-effectiveness analysis.

OBJECTIVE

This systematic review aims to outline the challenges and limitations in applying DCEA in healthcare settings.

METHODS

We searched Medline, Scopus, BASE, APA Psych, and JSTOR databases. We also included Google Scholar. We searched for English-language peer-reviewed academic publications, while books, editorials and commentary papers were excluded. Titles and abstract screening, full-text screening, reference list reviews, and data extraction were performed by the main researcher. Another researcher checked every paper for eligibility. Details, such as study population, disease area, intervention and comparators, costs and health effects, cost-effectiveness findings, equity analysis and effects, and modelling technique, were extracted. Thematic analysis was applied, focusing on challenges, obstacles, and gaps in DCEA.

RESULTS

In total, 615 references were identified, of which 18 studies met the inclusion criteria. Most of these studies were published after 2017. DCEA studies were mainly conducted in Europe and Africa and used quality health-adjusted measurements. In the included studies, absolute inequality indices were used more frequently than relative inequality indices. Every stage of the DCEA presented challenges and/or limitations.

CONCLUSION

This review provides an overview of the literature on the DCEA in healthcare as well as the challenges and limitations related to the different steps needed to conduct the analysis. In particular, we found problems with data availability, the relative unfamiliarity of this analysis among policymakers, and challenges in estimating differences among socioeconomic groups.

Search for Subsolar-Mass Binaries in the First Half of Advanced LIGO's and Advanced Virgo's Third Observing Run

We report on a search for compact binary coalescences where at least one binary component has a mass between 0.2  M_{⊙} and 1.0  M_{⊙} in Advanced LIGO and Advanced Virgo data collected between 1 April 2019 1500 UTC and 1 October 2019 1500 UTC. We extend our previous analyses in two main ways: we include data from the Virgo detector and we allow for more unequal mass systems, with mass ratio q≥0.1. We do not report any gravitational-wave candidates. The most significant trigger has a false alarm rate of 0.14  yr^{-1}. This implies an upper limit on the merger rate of subsolar binaries in the range [220-24200]  Gpc^{-3} yr^{-1}, depending on the chirp mass of the binary. We use this upper limit to derive astrophysical constraints on two phenomenological models that could produce subsolar-mass compact objects. One is an isotropic distribution of equal-mass primordial black holes. Using this model, we find that the fraction of dark matter in primordial black holes in the mass range 0.2  M_{⊙}<m_{PBH}<1.0  M_{⊙} is f_{PBH}≡Ω_{PBH}/Ω_{DM}≲6%. This improves existing constraints on primordial black hole abundance by a factor of ∼3. The other is a dissipative dark matter model, in which fermionic dark matter can collapse and form black holes. The upper limit on the fraction of dark matter black holes depends on the minimum mass of the black holes that can be formed: the most constraining result is obtained at M_{min}=1  M_{⊙}, where f_{DBH}≡Ω_{DBH}/Ω_{DM}≲0.003%. These are the first constraints placed on dissipative dark models by subsolar-mass analyses.

Screening of organoids derived from patients with breast cancer implicates the repressor NCOR2 in cytotoxic stress response and antitumor immunity

Resistance to antitumor treatment contributes to patient mortality. Functional proteomic screening of organoids derived from chemotherapy-treated patients with breast cancer identified nuclear receptor corepressor 2 (NCOR2) histone deacetylase as an inhibitor of cytotoxic stress response and antitumor immunity. High NCOR2 in the tumors of patients with breast cancer predicted chemotherapy refractoriness, tumor recurrence and poor prognosis. Molecular studies revealed that NCOR2 inhibits antitumor treatment by regulating histone deacetylase 3 (HDAC3) to repress interferon regulatory factor 1 (IRF-1)-dependent gene expression and interferon (IFN) signaling. Reducing NCOR2 or impeding its epigenetic activity by modifying its interaction with HDAC3 enhanced chemotherapy responsiveness and restored antitumor immunity. An adeno-associated viral NCOR2-HDAC3 competitor potentiated chemotherapy and immune checkpoint therapy in culture and in vivo by permitting transcription of IRF-1-regulated proapoptosis and inflammatory genes to increase IFN-γ signaling. The findings illustrate the utility of patient-derived organoids for drug discovery and suggest that targeting stress and inflammatory-repressor complexes such as NCOR2-HDAC3 could overcome treatment resistance and improve the outcome of patients with cancer.

Magnitude and determinants of inpatient health expenditure among the elderly in India

As India is experiencing both the epidemiological and demographic transition, the grey population is expected to incur huge expenditure on health care, especially hospitalization expenditure, in the coming decades. The present study, thus, examines the magnitude of different types of inpatient health expenditure (medical, non-medical, total and out-of-pocket expenditure) and factors affecting them among the Indian elderly, using a health expenditure model empirically tested by the World Health Organization. Data were drawn from the 75th Round of the Health Survey conducted by the National Sample Survey Office, Government of India. In addition to basic descriptive statistics, the study employs a two-stage least square and a generalized linear model with log-link and gamma distribution to conduct the econometric analysis. The study finds that higher income, education, and household size, diseases like cancer, treatment involving surgery, poor physical mobility, and the elderly opting for packages involve higher inpatient health spending, while both private and social health insurance tends to reduce the same. So, a thrust on insurance-financed health systems may reduce health spending among the elderly. In this context, the study suggests that a disease-specific policy is required for the elderly along with ensuring state-of-the-art treatment facilities for them in public hospitals for critical ailments.

Triangle Singularity as the Origin of the a_{1}(1420)

The COMPASS Collaboration experiment recently discovered a new isovector resonancelike signal with axial-vector quantum numbers, the a_{1}(1420), decaying to f_{0}(980)π. With a mass too close to and a width smaller than the axial-vector ground state a_{1}(1260), it was immediately interpreted as a new light exotic meson, similar to the X, Y, Z states in the hidden-charm sector. We show that a resonancelike signal fully matching the experimental data is produced by the decay of the a_{1}(1260) resonance into K^{*}(→Kπ)K[over ¯] and subsequent rescattering through a triangle singularity into the coupled f_{0}(980)π channel. The amplitude for this process is calculated using a new approach based on dispersion relations. The triangle-singularity model is fitted to the partial-wave data of the COMPASS experiment. Despite having fewer parameters, this fit shows a slightly better quality than the one using a resonance hypothesis and thus eliminates the need for an additional resonance in order to describe the data. We thereby demonstrate for the first time in the light-meson sector that a resonancelike structure in the experimental data can be described by rescattering through a triangle singularity, providing evidence for a genuine three-body effect.

Capturing transformation of flood hazard over a large River Basin under changing climate using a top-down approach

Existing flood modeling studies over coastal catchments involving different combinations of model chain setup imparting complex information fails to entail the needs of policy or decision-makers. Thus, a comprehensive framework that pertains to the requirements of practitioners and provides more perspicuous flood hazard information is required. In this paper, a novel approach translating complex flood hazard information in the form of decision priority maps derived using a rational combination of models (physical and statistical) is elucidated at the finest administrative scale. The proposed methodology is illustrated over a highly flood-prone deltaic region in Mahanadi River Basin, India, to characterize impacts of climate change for a 1:100 years return period flood event under future conditions (2026-2055). The modeled flood events are further analyzed to capture the transformation dynamics of flood hazard classes (FHCs) in near-future, for prioritizing areas with greater hazard potential. Interestingly, the results capture a high transformation characteristic from low to high FHCs in agriculture-dominated areas, which are significantly greater than the areas experiencing flood hazard reduction. The results show a significant increase of 12.5% and 27.35% in areas with high FHCs under RCP4.5 and RCP8.5 scenarios, respectively. Moreover, a notable climate change response is indicated under both climate change scenarios, with approximately 22% (RCP4.5) and 25% (RCP8.5) in villages showing a drastic increment in flood hazard magnitude. The results thus highlight the importance of identifying and prioritizing the areas for flood adaptation where a relative change in flood hazard potential is higher due to climate change. Therefore, we conclude that this study can provide an insight into the implication of new approaches for effective communication of flood information by bridging the gaps between scientific communities and decision-makers in appraisal for better flood adaptation measures.

Health delivery system for older adults in academic campus in India

Purpose

Residential academic campuses generally support a skewed population profile that favours a younger population, mainly the student community, and thereby marginalize the needs of the older people staying within the campus. Health delivery systems are often not in accordance with the needs of staff members co-habiting with their aged parents and relatives as well as older staff members themselves. This poses a serious problem, especially in India, where filial piety is a norm and many employees cohabit with their parents. Moreover, the Government of India has reformulated its retirement policy under which the age for superannuation of teaching staff has been enhanced. This in turn, has raised the older-younger ratio in campuses in recent years. The paper aims to discuss these issues.

Design/methodology/approach

To address these issues, a household survey was carried out on older people staying in a residential academic campus of India followed by a focus group discussion with family caregivers of the older people.

Findings

It was found that older people were a marginalized group in campus, as health delivery system and allied facilities were not consistent with their needs. As a result, they and their family caregivers faced various challenges.

Originality/value

This is the first study exploring the possibility of academic campuses in India to emerge as alternate sites for supporting older care.

Factors affecting the choice of health care utilisation between private and public services among the elderly population in India

India is experiencing rapid population ageing in recent years. One of the most concomitant issues is the choice of health care services among the elderly, leading to its impact on the magnitude of health expenditure. Applying Andersen's Health Behavioural Model, this study identifies the predictors of the choice of inpatient health care services among the Indian elderly between private and public services. It also examines the nature of interregional disparity in the choice of health care services. Using NSSO data, the results suggest that the elderly belonging to upper caste and having higher levels of education, higher incomes, larger family size, and needing surgery are likely to choose private health care, while those experiencing higher economic dependence, chronic diseases, and higher duration of hospitalisation tend to prefer public inpatient services. The magnitude and significance of these factors, however, vary across regions. The findings of the study provide an understanding of the preferences of the India's geriatric population over hospital services, which may help policymakers better understand their health care needs.

First Measurement of Transverse-Spin-Dependent Azimuthal Asymmetries in the Drell-Yan Process

The first measurement of transverse-spin-dependent azimuthal asymmetries in the pion-induced Drell-Yan (DY) process is reported. We use the CERN SPS 190  GeV/c π^{-} beam and a transversely polarized ammonia target. Three azimuthal asymmetries giving access to different transverse-momentum-dependent (TMD) parton distribution functions (PDFs) are extracted using dimuon events with invariant mass between 4.3  GeV/c^{2} and 8.5  GeV/c^{2}. Within the experimental uncertainties, the observed sign of the Sivers asymmetry is found to be consistent with the fundamental prediction of quantum chromodynamics (QCD) that the Sivers TMD PDFs extracted from DY have a sign opposite to the one extracted from semi-inclusive deep-inelastic scattering (SIDIS) data. We present two other asymmetries originating from the pion Boer-Mulders TMD PDFs convoluted with either the nucleon transversity or pretzelosity TMD PDFs. A recent COMPASS SIDIS measurement was obtained at a hard scale comparable to that of these DY results. This opens the way for possible tests of fundamental QCD universality predictions.

Distinct Interaction Modes of the Kinesin-13 Motor Domain with the Microtubule

Kinesins-13s are members of the kinesin superfamily of motor proteins that depolymerize microtubules (MTs) and have no motile activity. Instead of generating unidirectional movement over the MT lattice, like most other kinesins, kinesins-13s undergo one-dimensional diffusion (ODD) and induce depolymerization at the MT ends. To understand the mechanism of ODD and the origin of the distinct kinesin-13 functionality, we used ensemble and single-molecule fluorescence polarization microscopy to analyze the behavior and conformation of Drosophila melanogaster kinesin-13 KLP10A protein constructs bound to the MT lattice. We found that KLP10A interacts with the MT in two coexisting modes: one in which the motor domain binds with a specific orientation to the MT lattice and another where the motor domain is very mobile and able to undergo ODD. By comparing the orientation and dynamic behavior of mutated and deletion constructs we conclude that 1) the Kinesin-13 class specific neck domain and loop-2 help orienting the motor domain relative to the MT. 2) During ODD the KLP10A motor-domain changes orientation rapidly (rocks or tumbles). 3) The motor domain alone is capable of undergoing ODD. 4) A second tubulin binding site in the KLP10A motor domain is not critical for ODD. 5) The neck domain is not the element preventing KLP10A from binding to the MT lattice like motile kinesins.

Rapid Semisynthesis of Acetylated and Sumoylated Histone Analogs

The density and diversity of posttranslational modifications (PTMs) observed in histone proteins typically limit their purification to homogeneity from biological sources. Access to quantities of uniformly modified histones is, however, critical for investigating the downstream effects of histone PTMs on chromatin-templated processes. Therefore, a number of semisynthetic methodologies have been developed to generate histones bearing precisely defined PTMs or close analogs thereof. In this chapter, we present two optimized and rapid strategies for generating functional analogs of site-specifically acetylated and sumoylated histones. First, we describe a convergent strategy to site-specifically attach the small ubiquitin-like modifier-3 (SUMO-3) protein to the site of Lys12 in histone H4 by means of a disulfide linkage. We then describe the generation of thialysine analogs of histone H3 acetylated at Lys14 or Lys56, using thiol-ene coupling chemistry. Both strategies afford multimilligram quantities of uniformly modified histones that are easily incorporated into mononucleosomes and nucleosome arrays for biophysical and biochemical investigations. These methods are readily extendable to any desired sites in the four core nucleosomal histones and their variant forms.

Spatial variability of climate change impacts on yield of rice and wheat in the Indian Ganga Basin

Indian Ganga Basin (IGB), one of the most densely populated areas in the world, is facing a significant threat to food grain production, besides increased yield gap between actual and potential production, due to climate change. We have analyzed the spatial variability of climate change impacts on rice and wheat yields at three different locations representing the upper, middle and lower IGB. The DSSAT model is used to simulate the effects of climate variability and climate change on rice and wheat yields by analyzing: (i) spatial crop yield response to current climate, and (ii) impact of a changing climate as projected by two regional climate models, REMO and HadRM3, based on SRES A1B emission scenarios for the period 2011-2040. Results for current climate demonstrate a significant gap between actual and potential yield for upper, middle and lower IGB stations. The analysis based on RCM projections shows that during 2011-2040, the largest reduction in rice and wheat yields will occur in the upper IGB (reduction of potential rice and wheat yield respectively by 43.2% and 20.9% by REMO, and 24.8% and 17.2% by HadRM3). In the lower IGB, however, contrasting results are obtained, with HadRM3 based projections showing an increase in the potential rice and wheat yields, whereas, REMO based projections show decreased potential yields. We discuss the influence of agro-climatic factors; variation in temperature, length of maturity period and leaf area index which are responsible for modeled spatial variability in crop yield response within the IGB.

Structural model for tubulin recognition and deformation by kinesin-13 microtubule depolymerases

To elucidate the structural basis of the mechanism of microtubule depolymerization by kinesin-13s, we analyzed complexes of tubulin and the Drosophila melanogaster kinesin-13 KLP10A by electron microscopy (EM) and fluorescence polarization microscopy. We report a nanometer-resolution (1.1 nm) cryo-EM three-dimensional structure of the KLP10A head domain (KLP10AHD) bound to curved tubulin. We found that binding of KLP10AHD induces a distinct tubulin configuration with displacement (shear) between tubulin subunits in addition to curvature. In this configuration, the kinesin-binding site differs from that in straight tubulin, providing an explanation for the distinct interaction modes of kinesin-13s with the microtubule lattice or its ends. The KLP10AHD-tubulin interface comprises three areas of interaction, suggesting a crossbow-type tubulin-bending mechanism. These areas include the kinesin-13 family conserved KVD residues, and as predicted from the crossbow model, mutating these residues changes the orientation and mobility of KLP10AHDs interacting with the microtubule.

Screening of hospital patients for HIV: an experience in a tertiary care hospital of West Bengal

The clinical consequences of HIV infection encompass a wide spectrum. Early recognition of persons who have HIV will help in early interventions to halt or slow down the progress of HIV disease and to extend fruitful lives.This cross-sectional study was conducted among patients referred to the voluntary counselling and testing centre (VCTC) from various departments in North Bengal Medical College & Hospital, Darjeeling, West Bengal, to find out the pattern of disease/symptoms, high risk behaviour (HRB) for HIV, and HIV serostatus among the hospital patients. Following the guidelines prescribed by the National AIDS Control Organisation (NACO), anonymous data were collected through interview from 407 individuals. Where specific diagnosis of a disease was obtained, it was analysed as mutually exclusive disease; and where specific diagnosis was not obtained, mutually exclusive symptoms were considered for analysis.The major diseases/symptoms observed among those patients were tuberculosis in 32.19%, STD in 29.97%, prolonged unexplained fever in 19.41% of patients. The overall rate of HIV seroreactivity was 17.44%. The HIV serostatus by disease/symptoms showed that 32.91% of patients with prolonged unexplained fever were HIV seroreactive; the rate was 12.90% among patients with skin diseases, 12.29% in STD and 12.21% in tuberculosis patients. Overall, 270 patients (66.34%) had HRB for HIV/AIDS.The rate of HIV seroreactivity was more among patients who had HRB for HIV/ AIDS and who were referred from indoor departments (23.24%) compared to outdoor departments (13.65%).The patients suffering from prolonged unexplained fever need greater attention for HIV screening. Early detection of HIV positive patients makes Intervention possible at a very early stage and this can slow down/block the progress of HIV disease and, as a result, can extend fruitful life.

Functional Disability and Associated Chronic Conditions among Geriatric Populations in a Rural Community of India

BACKGROUND

Geriatric population and chronic diseases are increasing throughout the world especially in developing countries like India. Because of social change and urbanization, disability is also a problem in India. As the major reasons for geriatric disabilities are chronic diseases, a study was undertaken.

OBJECTIVES

To find out the prevalence of different chronic diseases and disability among the geriatric population in a rural community of India and to determine the association between chronic diseases and disability of the geriatric population.

METHOD

A cross-sectional, observational community based study was conducted in a rural area of West Bengal, India through house to house visit for Clinical examination, observation and interview with a predesigned pre-tested proforma

RESULTS

Out of 495 study population, 80 (16.16%) were found to be functionally disabled as per ADL scale and more than half (56.2%) of them had 3 or more chronic conditions. 92.5% of study populations had one or more chronic conditions

CONCLUSION

Association between different risk factors and disability was found with age, sex, anaemia, Chronic Obstructive Pulmonary Diseases(C.O.P.D), scabies, hypertrophy of prostate, ischaemic heart disease, osteoporosis, osteoarthritis and acid peptic disorder were the risk factors of disability. These data suggest the significant chronic conditions and risk factors associated with disability. Measures to reduce such chronic conditions and impairment would be the useful approach for the prevention of disability.

Assessing cold chain status in a metro city of India: an intervention study

BACKGROUND

Cold chain maintenance is an essential activity to maintain the potency of vaccines and to prevent adverse events following immunization. One baseline study highlighted the unsatisfactory cold chain status in city of Kolkata in India.

OBJECTIVES

To assess the changes which occurred in the cold chain status after the intervention undertaken to improve the status and also to assess the awareness of the cold chain handlers regarding cold chain maintenance.

METHODS

Intervention consisted of reorganization of cold chain points and training of health manpower in Kolkata Municipal area regarding immunization and cold chain following the guidelines as laid by Govt of India. Reevaluation of cold chain status was done at 20 institutions selected by stratified systematic random sampling after the intervention. The results were compared with baseline survey.

RESULTS

Significant improvement had been observed in correct placing of cold chain equipment, maintenance of stock security, orderly placing of ice packs, diluents and vaccines inside the equipment, temperature recording and maintenance. But awareness and skill of cold chain handlers regarding basics of cold chain maintenance was not satisfactory.

CONCLUSIONS

The success of intervention included significant improvement of cold chain status including creation of a designated cold chain handler. The gaps lay in non-availability of non-electrical cold chain equipment and separate cold chain room, policy makers should stress. Cold chain handlers need reorientation training regarding heat & cold sensitive vaccines, preventive maintenance and correct contingency plan.

Expenditure to treat thalassaemia: an experience at a tertiary care hospital in India

BACKGROUND

The medical and economic problem of thalassaemia are considered to be a vast public health problem in the thalassaemia belt countries, emphasizing more on prenatal diagnosis as the solution of the problem.

METHODS

A cross-sectional descriptive study was conducted in the Institute of Haematology & Transfusion Medicine located in Medical College, Kolkata, India to assess the socio-demographic profile, clinical presentation, expenditure for treatment of thalassaemia patients and awareness about cause and prevention of the disease.

RESULTS

Thalassaemia patients attended the Govt. setting were mostly from lower socioeconomic status with low level of literacy. Annual expenditure for treatment of thalassaemia ranged from $ 108 to 432; depending on type of treatment with average cost per transfusion was $ 5.2±2.2. Average 18.5%±14.3 of the total annual income was spent on the treatment for thalassaemia. Average man days or school days lost for the patients was 29.87±18.5 and 19.07±12.7 for the accompanying persons.

CONCLUSION

Blood transfusion and carrier screening facilities should be decentralized to decrease the expenditure for treatment and alleviate the harassment of the families. Folate and calcium tablets, hepatitis B vaccination can be made available at government setting free of cost.

Needle sticks injury among nurses involved in patient care: a study in two medical college hospitals of West Bengal

A hospital-based retrospective study on a sample of 228 nurses involved in patient care, in two medical college hospitals of West Bengal, showed that 61.4% of them sustained at least one Needle Stick Injury (NSI) in last 12 months. The risk of such injuries per 1000 nurses per year was found to be 3,280. Out of the most recent injuries among 140 nurses, 92.9% remained unreported to appropriate authorities; in 52.9% events hand gloves were worn by the nurses; only 5% of those nurses received hepatitis B vaccine, 2.1% hepatitis B immunoglobulin and none of them received post exposure prophylaxis for HIV.

A novel eIF4G homolog, Off-schedule, couples translational control to meiosis and differentiation in Drosophila spermatocytes

During spermatogenesis, cells coordinate differentiation with the meiotic cell cycle to generate functional gametes. We identified a novel gene, which we named off-schedule (ofs), as being essential for this coordinated control. During the meiotic G(2) phase, Drosophila ofs mutant germ cells do not reach their proper size and fail to execute meiosis or significant differentiation. The accumulation of four cell cycle regulators--Cyclin A, Boule, Twine and Roughex--is altered in these mutants, indicating that ofs reveals a novel branch of the pathway controlling meiosis and differentiation. Ofs is homologous to eukaryotic translation initiation factor eIF4G. The level of ofs expression in spermatocytes is much higher than for the known eIF4G ortholog (known as eIF-4G or eIF4G), suggesting that Ofs substitutes for this protein. Consistent with this, assays for association with mRNA cap complexes, as well as RNA-interference and phenotypic-rescue experiments, demonstrate that Ofs has eIF4G activity. Based on these studies, we speculate that spermatocytes monitor G(2) growth as one means to coordinate the initiation of meiotic division and differentiation.

Alteration in uptake and translocation of essential nutrients in cabbage by excess lead

To observe the tolerance limit of lead phytotoxicity in cabbage (Brassica oleracea L.) var. Golden Aker plants were grown in refined sand with complete nutrient solution for 41 days. On 42nd day, pots with plants were separated into six lots. One lot was allowed to grow as such and was treated as control, in rest of the five lots, lead was applied at 0.1, 0.2, 0.4, 0.5 and 1.0 mM as lead nitrate. At d 75 (34 days after metal exposure), the lead toxicity symptoms as restricted growth was observed on plants at 1.0 mM lead supply. Excess lead (0.5 and 1.0 mM) developed interveinal chlorosis along the margins of young leaves. The affected leaves were reduced in size giving plant a rosette like appearance. Head size was markedly reduced at these (0.5 and 1.0 mM) levels of lead. At 0.5 mM the intensity of symptoms was markedly low. With an increase in lead supply, the concentration of lead and zinc was increased whereas that of P, S, Fe, Mn and Cu were decreased in various parts of cabbage. At 1.0 mM Pb, the concentration of lead was highest in roots and lowest in head. In leaves of cabbage the threshold of toxicity and toxicity values were 150 and 320 microg g-1 dry matter, respectively.

The c-MYC oncoprotein is a substrate of the acetyltransferases hGCN5/PCAF and TIP60

The c-MYC oncoprotein functions as a sequence-specific transcription factor. The ability of c-MYC to activate transcription relies in part on the recruitment of cofactor complexes containing the histone acetyltransferases mammalian GCN5 (mGCN5)/PCAF and TIP60. In addition to acetylating histones, these enzymes have been shown to acetylate other proteins involved in transcription, including sequence-specific transcription factors. This study was initiated in order to determine whether c-MYC is a direct substrate of mGCN5 and TIP60. We report here that mGCN5/PCAF and TIP60 acetylate c-MYC in vivo. By using nanoelectrospray tandem mass spectrometry to examine c-MYC purified from human cells, the major mGCN5-induced acetylation sites have been mapped. Acetylation of c-MYC by either mGCN5/PCAF or TIP60 results in a dramatic increase in protein stability. The data reported here suggest a conserved mechanism by which acetyltransferases regulate c-MYC function by altering its rate of degradation.

Autocrine laminin-5 ligates alpha6beta4 integrin and activates RAC and NFkappaB to mediate anchorage-independent survival of mammary tumors

Invasive carcinomas survive and evade apoptosis despite the absence of an exogenous basement membrane. How epithelial tumors acquire anchorage independence for survival remains poorly defined. Epithelial tumors often secrete abundant amounts of the extracellular matrix protein laminin 5 (LM-5) and frequently express alpha6beta4 integrin. Here, we show that autocrine LM-5 mediates anchorage-independent survival in breast tumors through ligation of a wild-type, but not a cytoplasmic tail-truncated alpha6beta4 integrin. alpha6beta4 integrin does not mediate tumor survival through activation of ERK or AKT. Instead, the cytoplasmic tail of beta4 integrin is necessary for basal and epidermal growth factor-induced RAC activity, and RAC mediates tumor survival. Indeed, a constitutively active RAC sustains the viability of mammary tumors lacking functional beta1 and beta4 integrin through activation of NFkappaB, and overexpression of NFkappaB p65 mediates anchorage-independent survival of nonmalignant mammary epithelial cells. Therefore, epithelial tumors could survive in the absence of exogenous basement membrane through autocrine LM-5-alpha6beta4 integrin-RAC-NFkappaB signaling.

Excess chromium alters uptake and translocation of certain nutrients in citrullus

Citrullus plants were grown in refined sand with varying levels of chromium to determine their tolerance limit to excess chromium. The plants were maintained in control nutrient solution for 24 days and on the 25th day chromium as dichromate was added at 0.05, 0.1, 0.2, 0.3 and 0.4 mM. A control set of plants was grown in the same nutrient solution without chromium. At chromium levels >0.2 mM plants showed growth depression, with chlorosis and loss of turgor of middle leaves. Affected leaves had narrow lamina; tendrils were thin, short and did not have coiling property. Later chlorosis became severe and changed to necrosis in patches. Petiole along with lamina became wilted, rugged and hung down due to complete loss of water. At lower chromium concentration, (0.05, 0.1 and 0.2 mM) only depression in growth was observed. With increase in chromium concentration of nutrient solution accumulation of chromium in different parts of Citrullus was increased. Increase in concentrations of phosphorus, manganese and decrease in iron, copper, zinc and sulphur were observed in leaves. Toxicity of chromium was greater at 0.2-0.4 mM, compared to lower concentrations. Threshold of toxicity and toxicity of Cr in old leaves were, respectively, 0.9 and 3.9 microg g(-1) dry matter of citrullus.

Transcriptional regulation of the mdm2 oncogene by p53 requires TRRAP acetyltransferase complexes

The p53 tumor suppressor regulates the cellular response to genetic damage through its function as a sequence-specific transcription factor. Among the most well-characterized transcriptional targets of p53 is the mdm2 oncogene. Activation of mdm2 is critical in the p53 pathway because the mdm2 protein marks p53 for proteosome-mediated degradation, thereby providing a negative-feedback loop. Here we show that the ATM-related TRRAP protein functionally cooperates with p53 to activate mdm2 transcription. TRRAP is a component of several multiprotein acetyltransferase complexes implicated in both transcriptional regulation and DNA repair. In support of a role for these complexes in mdm2 expression, we show that transactivation of the mdm2 gene is augmented by pharmacological inhibition of cellular deacetylases. In vitro analysis demonstrates that p53 directly binds to a TRRAP domain previously shown to be an activator docking site. Furthermore, transfection of cells with antisense TRRAP blocks p53-dependent transcription of mdm2. Finally, using chromatin immunoprecipitation, we demonstrate direct p53-dependent recruitment of TRRAP to the mdm2 promoter, followed by increased histone acetylation. These findings suggest a model in which p53 directly recruits a TRRAP/acetyltransferase complex to the mdm2 gene to activate transcription. In addition, this study defines a novel biochemical mechanism utilized by the p53 tumor suppressor to regulate gene expression.

Fragile X syndrome a case report of a family

Fragile X syndrome is the most common of the inherited disorders causing mental retardation. This disorder results from an abnormal expansion in (CGG)n in repeat found in the coding sequence of the FMRI gene, located at Xq 27.3. Previously it was detected by Karyotyping. With the advent of Molecular Biology PCR, has become the best method in the diagnosis of this disorder. This is a case report of a family with this disorder detected by PCR.

Fragile X syndrome in Calcutta, India

Fragile-X-linked mental retardation usually results from amplification of the CGG repeat in the 5' untranslated region of the FMR1 gene. To assess the extent of variation of the CGG repeat in the population from the eastern region of India we studied 98 mentally retarded individuals living in and around Calcutta and identified 21 distinct alleles ranging in size from 8 to 44 CGG repeats. A repeat size of 28 was the most frequent; this value is different from the most frequent repeat size found in other studies, indicating a racial or ethnic variation. Patients with the clinical features of the syndrome have been found to carry expanded CGG repeats. Thus, it can be inferred that the expansion of CGG repeats may be a frequent cause of the syndrome in our population.

A study on awareness of AIDS among school students and teachers of higher secondary schools in north Calcutta

Higher Secondary School students and their teachers were studied to assess the knowledge about AIDS and attitude towards AIDS patients. Only 13.5% senior school students and 16.2% teachers had clear knowledge regarding AIDS--its general aspects, transmission and prevention. Girls had higher and clear knowledge than boys. 45.8% of girls, 38.8% of boys students and 20.3% of teachers had positive attitudes towards nursing an AIDS case. It is suggested that schools have to device ways to open up more effective communication with students in relation to education on sex and AIDS. Training on AIDS should be emphasized on school teachers who on their turn can teach the students in a correct way about AIDS.

Phytotoxicity of cobalt, chromium and copper in cauliflower

Cauliflower (Brassica oleracea L. var. Botrytis cv. Maghi) was grown in refined sand with complete nutrition (control) and at 0.5 mM each of Co, Cr and Cu. In cauliflower, compared to that of excess Cu or Cr, the visible effects of excess Co appeared first and were most pronounced. Excess of each heavy metal restricted the biomass of cauliflower, concentrations of Fe, chlorophylls a and b, protein and activity of catalase in leaves in the order Co>Cu>Cr. The translocation of Cr from roots to tops was minimum and that of Co was maximum when cauliflower was individually supplied with excess Co, Cu or Cr. In cauliflower each heavy metal inhibited the concentration of most of the macro- and micronutrients. The translocation of P, S, Mn, Zn and Cu from roots to tops of cauliflower were affected most significantly by Co and least by Cr. In contrast to excess Cu or Cr, Co significantly decreased the water potential and transpiration rates and increased diffusive resistance and relative water content in leaves of cauliflower.

Mist deposition onto hairy root cultures: aerosol modeling and experiments

We analyzed the applicability of the standard models for aerosol deposition in randomly packed fibrous filter beds to mist deposition across a bed of hairy roots in the nutrient mist bioreactor. Although the assumptions inherent in the models are met on a local level, the overall structure of the root bed introduces some uncertainty into the correct choice of root packing fraction and gas velocity required by the model. For reasonable parameter values, the minimum in the deposition efficiency curves is close to the peak in the mist number and mass distributions, and good penetration of the root bed is possible. We then measured the deposition of mist across a packed bed of Artemisia annua transformed roots as a function of droplet size, bed length, and gas flow rate at a root packing fraction alpha = 0.5. We compared the experimental measurements with the predictions of the aerosol deposition model and found good agreement between the measured and predicted values for the diameter where the deposition efficiency across the bed is 50%, D0.5. Agreement between the model and the experiments broke down when the flow rate was increased to the point where the creeping flow assumptions were no longer valid.

Self-organizing algorithms for generalized eigen-decomposition

We discuss a new approach to self-organization that leads to novel adaptive algorithms for generalized eigen-decomposition and its variance for a single-layer linear feedforward neural network. First, we derive two novel iterative algorithms for linear discriminant analysis (LDA) and generalized eigen-decomposition by utilizing a constrained least-mean-squared classification error cost function, and the framework of a two-layer linear heteroassociative network performing a one-of-m classification. By using the concept of deflation, we are able to find sequential versions of these algorithms which extract the LDA components and generalized eigenvectors in a decreasing order of significance. Next, two new adaptive algorithms are described to compute the principal generalized eigenvectors of two matrices (as well as LDA) from two sequences of random matrices. We give a rigorous convergence analysis of our adaptive algorithms by using stochastic approximation theory, and prove that our algorithms converge with probability one.