Contribution of infection and vaccination to population-level seroprevalence through two COVID waves in Tamil Nadu, India

This study employs repeated, large panels of serological surveys to document rapid and substantial waning of SARS-CoV-2 antibodies at the population level and to calculate the extent to which infection and vaccination separately contribute to seroprevalence estimates. Four rounds of serological surveys were conducted, spanning two COVID waves (October 2020 and April-May 2021), in Tamil Nadu (population 72 million) state in India. Each round included representative populations in each district of the state, totaling ≥ 20,000 persons per round. State-level seroprevalence was 31.5% in round 1 (October-November 2020), after India's first COVID wave. Seroprevalence fell to 22.9% in round 2 (April 2021), a roughly one-third decline in 6 months, consistent with dramatic waning of SARS-Cov-2 antibodies from natural infection. Seroprevalence rose to 67.1% by round 3 (June-July 2021), with infections from the Delta-variant induced second COVID wave accounting for 74% of the increase. Seroprevalence rose to 93.1% by round 4 (December 2021-January 2022), with vaccinations accounting for 63% of the increase. Antibodies also appear to wane after vaccination. Seroprevalence in urban areas was higher than in rural areas, but the gap shrunk over time (35.7 v. 25.7% in round 1, 89.8% v. 91.4% in round 4) as the epidemic spread even in low-density rural areas.

SNAC for Enhanced Oral Bioavailability: An Updated Review

The delivery of proteins and peptides via an oral route poses numerous challenges to improve the oral bioavailability and patient compliance. To overcome these challenges, as well as to improve the permeation of proteins and peptides via intestinal mucosa, several chemicals have been studied such as surfactants, fatty acids, bile salts, pH modifiers, and chelating agents, amongst these medium chain fatty acid like C10 (sodium caprate) and Sodium N-[8-(2-hydroxybenzoyl) amino] caprylate (SNAC) and its derivatives that have been well studied from a clinical perspective. This current review enumerates the challenges involved in protein and peptide delivery via the oral route, i.e., non-invasive routes of protein and peptide administration. This review also covers the chemistry behind SNAC and toxicity as well as mechanisms to enhance the oral delivery of clinically proven molecules like simaglutide and other small molecules under clinical development, as well as other permeation enhancers for efficient delivery of proteins and peptides.

Unraveling the Complexity of Nano-Dispersoids in the Oxide Dispersion Strengthened Alloy 617

Nanocrystalline oxides are mainly responsible for Ni-base oxide dispersion strengthened (ODS) superalloys excellent thermo-mechanical properties. To establish the microstructural correlations between the metallic matrix and various oxide dispersoids, we report here the atomic-scale structure and chemistry of the complex nano-oxide dispersoids. Ultrahigh-resolution Cs-aberration-corrected scanning transmission electron microscopy (STEM) based techniques have been used to resolve nano-dispersoids in the Alloy 617 ODS. These nano-oxides, interestingly, possess a variety of high-angle annular dark-field (HAADF) contrasts, that is, bright, dark, and bi-phases. Both the light and heavy atoms have been found to be present in Y–Al–O complex-oxide nanostructures in varying quantities and forming a characteristic interface with the metallic matrix. In overcoming the limitation of conventional STEM-HAADF imaging, the integrated differential phase-contrast imaging technique was employed to investigate the oxygen atoms along with other elements in the dispersoids and its interface with the matrix. The most intriguing aspect of the study is the discovery of a few atoms thick Al2O3 interlayer (shell) around a monoclinic Y–Al–O core in the Ni-matrix. On the other hand, when the dispersoid is a hexagonal type Y–Al–O complex, the interface energy is already low, maintaining a semi-coherent interface and it was devoid of a shell.

Dimensions of the paediatric femur: anatomical limitations of flexible intramedullary nailing

PURPOSE

Although spica casting remains the benchmark for treating diaphyseal femur fractures in preschool children, some authors advocate using flexible intramedullary nails in certain situations. The aim of the current study was to evaluate the anatomic feasibility of flexible nailing in young children.

METHODS

Consecutive patients between the ages of zero and ten years with normal femurs who received femur radiographs at a tertiary paediatric hospital over a two-year period were included. Anteroposterior femur radiographs were evaluated for length and isthmus width measurements. Each femur was templated for flexible nail size. The proportions of each age group capable of accommodating two flexible nails up to 4.0 mm in size were determined and compared.

RESULTS

A total of 381 full-length femur radiographs were reviewed. There was a strong, direct linear relationship between age and femoral length (R² = 0.896) and a moderate correlation between age and femoral isthmus width (R² = 0.417). Although the percentage of femurs able to accommodate flexible nails continued to increase with age, this increase did not represent a significant difference when comparing preschool-aged children with older age groups.

CONCLUSIONS

Age and femoral length demonstrated a strong, positive correlation while age and isthmus width had weaker correlation. The ability of femurs to accommodate flexible nails increased with age with most children age two years and older able to accommodate two flexible nails of at least 2.5 mm in size.

LEVEL OF EVIDENCE

III.

Coronary Angiography Profile at the Time of Hemodialysis Initiation in End-Stage Renal Disease Population: A Retrospective Analysis

Cardiovascular disease is associated with increased mortality in dialysis population. However, there are very few studies that assessed the prevalence of coronary artery disease (CAD) at the time of initiation of hemodialysis (HD). The present study was aimed to assess the prevalence of CAD in end-stage renal disease (ESRD) patients at the time of initiation of HD and the risk factors for CAD in this population. This was a single-center retrospective study and included ESRD patients who underwent coronary angiography (CAG) at the time of initiation of HD. Inclusion criteria were age >18 years and those who were subjected to CAG within 2 weeks of initiation of HD. According to the findings on CAG, patients were divided into no CAD and CAD groups. CAD was diagnosed if there was >50% stenosis of vessel. Clinical and laboratory parameters between these two groups were analyzed. Ninety-seven patients were included in the study based on the inclusion criteria. Forty-four (45%) patients were diagnosed with CAD. Patients who had CAD were younger compared to no CAD group (50.7 + 10 vs. 55.8 + 9.3 years; P = 0.01). Majority of them were males. Diabetic nephropathy (DN) was associated with increased risk of CAD (60% vs. 40%, P = 0.007). History of smoking, high high-sensitivity C-reactive protein (hs-CRP), low total cholesterol, and low high-density lipoprotein (HDL) were associated with significantly increased risk of CAD. Gender, symptoms of CAD, serum low-density lipoprotein (LDL), very LDL, and triglycerides were not associated with increased risk of CAD. Neither calcium (Ca), phosphorus (PO₄), nor Ca × PO₄products were associated with an increased risk of CAD. Resting electrocardiogram abnormalities had no significance in predicting CAD (32% in CAD and 19% in no CAD group). Echocardiography showed regional wall motion abnormalities/global hypokinesia in 18% patients of CAD group and 3.8% patients of no CAD group (P = 0.03). Single-, double-, and triple-vessel disease was documented in 17 (38%), 13 (29.5%), and 14 (32.5%) patients, respectively, and the most common vessel involved was the left anterior descending artery. At the initiation of HD in ESRD patients, CAD was seen in almost half of the patients. DN was a significant risk factor for CAD. Other risk factors for CAD include smoking, low cholesterol, low HDL, and high hs-CRP levels.

Clinical Profile and Outcome of Posterior Reversible Encephalopathy Syndrome in Hemodialysis Patients

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic entity characterized by headache, altered level of consciousness, seizures, visual disturbances, and reversible vasogenic subcortical edema. Hypertension and renal failure are well known principal risk factors for the development of PRES. However, risk factors and outcome of PRES has not been studied in patients on maintenance hemodialysis (MHD). The objective of this study is to characterize the factors predisposing to the development of PRES in patients on MHD. We performed a retrospective analysis in patients of MHD who were diagnosed with PRES between August 1, 2013, and July 31, 2015. Those with a history of cerebrovascular accidents/stroke, and epilepsy were excluded. We analyzed the clinical details, course, and laboratory data. One year follow-up data were noted in recurrence of PRES and mortality. A total of 18 patients were included for the final analysis. Of these, 13 (72%) patients were males. Majority of these patients were young and mean age was 21.1 years (6–50 years). Most of the PRES episodes developed shortly after initiation of MHD with mean duration of 2 months after initiation of MHD (1 month–3 years). All 18 patients had resistant hypertension. Eight (45%) patients had infection at the time of PRES episodes. Four patients had catheter-related bloodstream infection, 1 had pneumonia and 3 patients were recently diagnosed with pulmonary tuberculosis. Four (22%) patients developed recurrence of PRES and all these episodes developed within 2 months of index event. Seven (39%) patients underwent renal transplantation, and all received triple immune suppression and had uncontrolled hypertension in the perioperative period. However, none of these patients developed PRES after transplantation. All these patients had been maintaining stable graft function in the follow-up. All episodes of PRES were of generalized tonic–clonic seizure type and 6 of them presented as status epilepticus. None of them had any neurological sequel and no mortality at the end of 1 year. PRES is not uncommon in patients on MHD. Uncontrolled hypertension and infection are common predisposing factors. Renal transplantation is safe and not adversely affected by prior episodes of PRES in MHD.

Minimally invasive repair of a pseudomeningocele caused by a sheared intrathecal catheter following implantation of a drug delivery system

Background:

Shearing of an intrathecal catheter during implantation of a drug delivery system is an underreported complication that can be challenging to manage.

Case Description:

A 53-year-old man with refractory cancer pain had an intrathecal pump system implanted. The procedure was complicated with catheter shear and retention in the intrathecal space. A second catheter was successfully placed but formation of a painful pseudomeningocele and ineffective pain relief complicated the outcome. A minimally invasive approach through a tubular retractor was employed to access the spinal canal via a laminotomy, the sheared catheter was removed and the dural defect repaired. Complete resolution of the pseudomeningocele and efficient pain control were observed at follow-up.

Conclusion:

Minimally invasive approach to the spine is demonstrated as a safe and effective alternative in this case of retained catheter induced cerebrospinal fluid (CSF) leak.

Idiopathic nodular glomerulosclerosis: Report of two cases and review of literature

Nodular glomerulosclerosis, a pathological finding characterized by areas of marked mesangial expansion with accentuated glomerular nodularity can be seen in a number of conditions including diabetic nephropathy, amyloidosis, light chain deposition disease, fibrillary and immunotactoid glomerulopathy, collagen type III disease, nodular membranoproliferative glomerulonephritis, and Takayasu's arteritis. Idiopathic nodular glomerulosclerosis is a diagnosis of exclusion and is reported in patients with hypertension, smoking, chronic obstructive pulmonary disease, obesity, metabolic syndrome, etc. We report two cases of idiopathic nodular glomerulosclerosis, one in obese hypertensive male and the other in nonhypertensive, nonobese female patient.

Antimicrobial prescription and usage in the neonatal intensive care units of a Caribbean country: a prospective observational study

OBJECTIVE

To study the prescribing patterns and usage of antimicrobials in the Neonatal Intensive Care Units (NICU) of Trinidad & Tobago.

METHODS

A 3-month prospective observational study was conducted at the three NICUs at the major public hospitals. Data included antimicrobials prescribed, route of administration, culture and sensitivity reports, leukocyte count, length of stay and outcome of patients.

RESULTS

353 patients were studied, 57.5% of the patients were males. Mean birth weight was 2.96 ± 0.94 (Standard Deviation) kg. Admission diagnoses included meconium stained liquor, preterm, respiratory distress, sepsis, etc. Length of stay ranged between 1 to 76 days, (median 4, Interquartile Range 1-8). The mean leukocyte count was 15.7 ± 8.5 × 103 per μL. Overall, 645 culture specimens were sent; umbilical swab (27.6%), throat swab (27.0%) and blood (16.4%) being the most common specimens. 310 (48.1%) showed no bacterial growth. Overall, 16 different antimicrobials were used. First line antibiotic of choice was a combination of ampicillin and gentamicin (85.8 %). Second line antibiotic of choice was cefotaxime. The overall mortality was 7.6%.

CONCLUSION

The choice of antimicrobials in the NICUs of major public hospitals is mostly empirical and not primarily dictated by the culture and sensitivity reports, emphasizing the need for antibiotic stewardship programme in Trinidad & Tobago.

Postural and ambulatory changes in regional flow and skin perfusion

BACKGROUND

Studies of orthostatic changes in cutaneous micro-perfusion have yielded conflicting results, likely from imprecision of legacy equipment.

METHODS

Postural flow changes in the femoral vessels and cervical carotids were measured in healthy normal adults using duplex equipment. Nutrient skin flow was measured using Hyperspectral imager (OxyVu-2™), a newer non-touch measurement technology.

RESULTS

There are regional variations in cutaneous capillary density, sparse in the abdomen but richer in the forehead and ankle. Orthostatic microvascular congestion displays regional variations reflective of the non-linear pressure-volume relationship in thin walled vessels. There is profound cutaneous deoxygenation (≈40% reduction) in the lower body starting at the level of the umbilicus and involving all levels below, in the erect posture; upper body is unaffected. Quantitative regional flow is preserved however, with an increase in pulse rate despite a velocity decrease in the femoral vessels. Increasing the arterio-venous gradient by calf-emptying maneuvers resulted in little improvement in cutaneous oxygenation unable to overcome the powerful orthostatic vasoconstriction.

CONCLUSION

There is intense orthostatic vasoconstriction and cutaneous deoxygenation of the lower limbs to a degree not previously suspected. This powerful mechanism may be relevant to an understanding of dysvascular syndromes, particularly those with strong orthostatic features.

Multi-component synthesis and in vitro and in vivo anticancer activity of novel arylmethylene bis-isoxazolo[4,5-b]pyridine-N-oxides

A three component one-pot protocol has been investigated for the synthesis of arylmethylene bis-isoxazolo[4,5-b]pyridine-N-oxides 1 from the commercially available materials. The title compounds 1 were also synthesized by a step-wise method and found to be identical with one-pot synthesis by spectral and analytical data. The newly synthesized compounds were evaluated for their in vitro anticancer activity against human cancer cell lines and in vivo anticancer activity on EAC-bearing mice. Compound 1a was found to be the most active both in in vitro and in vivo cytotoxic studies.

Floral extract of Tecoma stans: a potent inhibitor of gentamicin-induced nephrotoxicity in vivo

OBJECTIVE

To highlight the nephroprotective activity of ethyl acetate extract of dried flowers of Tecoma stans for its protective effects on gentamicin-induced nephrotoxicity in albino rats.

METHODS

For studying acute toxicity study, single oral dose of 5,000 mg ethyl acetate floral extract/kg body weight was administered to albino rats (five females, five males). Nephrotoxicity was induced in albino rats by intraperitoneal administration of gentamicin 80 mg/kg/day for eight days. Effect of concurrent administration of ethyl acetate floral extract of Tecoma stans at a dose of 100, 200 and 300 mg/kg/day given by oral route was determined using serum creatinine, serum uric acid, blood urea nitrogen and serum urea as indicators of kidney damage. The study groups contained six rats in each group. As nephrotoxicity of gentamicin is known to involve induction of oxidative stress, in vitro antioxidant activity and free radical-scavenging activity of this extract was also evaluated.

RESULTS

For acute toxicity testing both female and male rats administered with the extract at a dose of 5,000 mg/kg. The results showed no toxicity in terms of general behavior change, mortality, or change in gross appearance of internal organs (LD(50) > 5 000 mg/kg). It was observed that the ethyl acetate floral extract of Tecoma stans significantly protected rat kidneys from gentamicin-induced histopathological changes. Gentamicin-induced glomerular congestion, peritubular and blood vessel congestion, epithelial desquamation, accumulation of inflammatory cells and necrosis of the kidney cells were found to be reduced in the groups receiving the ethyl acetate floral extract of Tecoma stans along with gentamicin in a dose dependent manner. The floral extract also reduced the gentamicin-induced increase in serum creatinine, serum uric acid, blood urea nitrogen and serum urea levels (P >0.01).

CONCLUSIONS

The present study indicates a very important role of reactive oxygen species (ROS) and the relation to renal dysfunction and point to the therapeutic potential of Tecoma stans in gentamicin induced nephrotoxicity.

Synthesis, antimicrobial, and mosquito larvicidal activity of 1-aryl-4-methyl-3,6-bis-(5-methylisoxazol-3-yl)-2-thioxo-2,3,6,10b-tetrahydro-1H-pyrimido[5,4-c]quinolin-5-ones

A series of 1-aryl-4-methyl-3,6-bis-(5-methylisoxazol-3-yl)-2-thioxo-2,3,6,10b-tetrahydro-1H-pyrimido[5,4-c]quinolin-5-ones (6a-h) have been synthesized by cyclization of ethyl-3-aryl-4-(2-chlorophenyl)-6-methyl-1-(5-methylisoxazol-3-yl)-2-thioxo-1,2,3,4-tetrahydropyrimidine-5-carboxylates 4a-h with 3-amino-5-methylisoxazole 5. Compounds 4a-h were obtained by Biginelli reaction, by condensation of aromatic aldehyde 1, ethyl acetoacetate 2, and isoxazolyl thioureas 3 in a one-pot reaction catalyzed by ceric ammonium nitrite (CAN). Compounds 6a-h were tested for their antibacterial and antifungal activities against various bacterial and fungal strains. The results showed that these compounds exhibited good antibacterial and antifungal activity compared with that of standard antibiotics. Mosquito larvicidal activity of the newly synthesized compounds 6a-h is also studied against fourth instar larvae Culex quinquefasciatus. Some of the compounds are proved to be lethal for mosquito larvae.

Invasive treatment of deep venous disease. A UIP consensus

Deep venous disease includes primary and/or secondary pathological changes in the deep venous system. These may consist of valve insufficiency, complete or incomplete vein obliteration and/or functional impairment.

Abstract 4653: Role of serum HE4 in studying ovarian cancer progression and response to therapy with ARCHITECT HE4 assay

Human epididymis protein 4 (HE4) is a whey acidic four-disulfide core protein. Serum HE4 has been shown to be a promising biomarker for epithelial ovarian cancer (EOC) with manual HE4 EIA assays. The ARCHITECT system is one of the major automated formats for cancer immunodiagnostics. This abstract describes the clinical performance of an investigational ARCHITECT HE4 assay in the measurement of serum HE4 from longitudinal samples of subjects with EOC and single-point samples from healthy subjects, and subjects with malignancy, benign diseases, EOC or other malignant diseases.

PROCEDURES: The ARCHITECT HE4 Assay is a paramagnetic microparticle chemiluminescent assay adopting the sensitive CHEMIFLEX® technology. Single-point and longitudinal serum samples were tested with an investigational ARCHITECT HE4 Assay reagent lot on the ARCHITECT i2000SR. Single-point sera were collected from healthy subjects (N = 400), subjects with pregnancy (N = 50) and benign disease (N = 612), and subjects which were diagnosed with EOC (N = 314) and other cancers (N = 250) including endometrial, breast, gastrointestinal, lung, and bladder cancer. Longitudinal sera (N = 506), including initial time point and follow-up visits (average = 5.7 per subject), were collected from subjects (N = 76) which were diagnosed with EOC. All of the single-point and longitudinal samples were handled in accordance with IRB-approved and GCP-compliant protocols.

RESULTS: Using an ARCHITECT HE4 cut-off value of >140 pmol/L, the percent distributions of ARCHITECT HE4 by cohort are: 3% of healthy subjects, 0% with pregnancy, 7.2% of subjects with benign diseases, 53.5% with EOC and 28.4% with other cancers. Using the upper 95% point of the distribution of the HE4 ratio at 14% to categorize the successive HE4 readings into those that were and were not significantly elevated for the longitudinal samples, the sensitivity, specificity and positive predictive value of HE4 elevation versus disease progression were 53.4% (95% CI: 44.1%-62.5%), 78.8% (95% CI: 74.7% - 82.4%) and 43.2% (95% CI: 32.9% - 54.1%) respectively. The total concordance between HE4 elevation and disease progression was 73%. Receiver Operator Characteristic analysis showed an area under the curve of 0.685 (SE = 0.033) for the diagnosis of progression from the ratio of successive HE4 readings. When comparing the change of the HE4 ratio with the diagnostic response to therapy, a decrease in HE4 reflected response to therapy with a sensitivity of 82% and a specificity of 53%.

CONCLUSIONS: The study with single-point samples has shown the utility of ARCHITECT HE4 values as a serum biomarker for EOC. The longitudinal increase of ARCHITECT HE4 values in sera seemed to be effective in recognizing the progression of EOC. The longitudinal decrease of ARCHITECT HE4 values in sera seemed to correlate with the response of EOC subjects to therapy.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4653.

Host factor Ebp1 inhibits rinderpest virus transcription in vivo

ErbB3 binding protein Ebp1 has been shown to downregulate ErbB3 receptor-mediated signaling to inhibit cell proliferation. Rinderpest virus belongs to the family Paramyxoviridae and is characterized by the presence of a non-segmented negative-sense RNA genome. In this work, we show that rinderpest virus infection of Vero cells leads to the down-regulation of the host factor Ebp1, at both the mRNA and protein levels. Ebp1 protein has been shown to co-localize with viral inclusion bodies in infected cells, and it is packaged into virions, presumably through its interaction with the N protein or the N-RNA itself. Overexpression of Ebp1 inhibits viral transcription and multiplication in infected cells, suggesting that a mutual antagonism operates between host factor Ebp1 and the virus.

Presumed Ocular Histoplasmosis Syndrome in India

The authors report a case series of presumed ocular histoplasmosis syndrome (POHS) from India. Patients with progressive diminution of vision and having subretinal neovascularisation (SRNVM) were evaluated thoroughly to look for signs of POHS. Three patients had features suggestive of POHS, which to the best of the authors' knowledge is the first case series reported from India. This study shows that patients with clinical features suggestive of POHS do exist in India. A thorough fundus examination of young adults with supposedly idiopathic SRNVM may help to uncover more cases of POHS in India.

Aminoglycoside-resistance mechanisms in multidrug-resistant Staphylococcus aureus clinical isolates

Aminoglycoside resistance in six clinically isolated Staphylococcus aureus was evaluated. Genotypical examination revealed that three isolates (HLGR-10, HLGR-12, and MSSA-21) have aminoglycoside-modifying enzyme (AME) coding genes and another three (GRSA-2, GRSA-4, and GRSA-6) lacked these genes in their genome. Whereas isolates HLGR-10 and HLGR-14 possessed bifunctional AME coding gene aac(6')-aph(2''), and aph(3')-III and showed high-level resistance to gentamycin and streptomycin, MSSA-21 possessed aph(3')-III and exhibited low resistance to gentamycin, streptomycin, and kanamycin. The remaining three isolates (GRSA-2, GRSA-4, and GRSA-6) exhibited low resistance to all the aminoglycosides because they lack aminoglycoside-modifying enzyme coding genes in their genome. The transmission electron microscopy of the three isolates revealed changes in cell size, shape, and septa formation, supporting the view that the phenomenon of adaptive resistance is operative in these isolates.

Endovenous treatment of patients with iliac-caval venous obstruction

Liberal use of intravascular ultrasound in symptomatic chronic venous disease (CVD) patients and the advent of venous stent technology have introduced a new paradigm of treatment for these conditions that often required open surgery in the past. Iliac outflow obstruction is present in >90% of limbs with CVD symptoms including in ''primary'' cases. In the latter, the obstructive lesion appears to function as a permissive lesion, provoking symptoms when additional secondary pathology is added. Like other known permissive lesions in human disease, symptom relief occurs after correction of the permissive lesion with a stent even when the secondary pathology is left uncorrected. Long-term stent patency is astonishingly high in ''primary'' disease and only slightly less in post-thrombotic subsets. Totally occluded veins, including those involving long segments of the ilio-femoral vein and vena cava, can be successfully recanalized with stent technology. The technique is minimally invasive and is carried out on an outpatient basis. Morbidity and mortality are minimal. Clinical results are excellent, including rather unexpected sustained healing of stasis ulceration in about 60% of patients. Later open surgery of the traditional types is not precluded should the stent were to fail. These attributes hold the promise of wider application of stent technology to a class of symptomatic CVD patients than was possible with open surgical techniques.

Additional flexor muscles of the forearm: case report and clinical significance

Anomalous muscles usually do not cause symptoms but are of academic interest. They become a surgical problem when they produce symptoms or are difficult to differentiate from soft tissue tumours. During routine cadaveric dissection for the undergraduate students at the Kasturba Medical College, Mangalore, we came across two additional muscles in the deep flexor compartment of the right forearm of a 69-year-old woman. The anomalous muscles were located on the ventral aspect of the proximal forearm, in a plane deep to the flexor digitorum superficialis (FDS). Both the muscles originated from the deep surface of the FDS. The muscle on the radial side was a Gantzer's muscle as it was inserted into the tendon of the flexor pollicis longus. The muscle on the ulnar side formed an independent tendon for the middle finger, 14 cm above the proximal edge of the flexor retinaculum and passed through the carpal tunnel; surprisingly the tendon of the additional muscle and flexor digitorum profundus tendon for the middle finger gave origin to the second lumbrical in the carpal tunnel. The passive traction on the tendon of the additional muscle resulted in flexion of the distal and medial phalanges. The presence of such an additional tendon and origin of lumbrical muscle in the carpal tunnel should be considered in the aetiology of carpal tunnel syndrome.

Performance Analysis of Various Techniques Applied in Human Identification Using Dental X-Rays

This paper proposes a novel approach for automating the analysis of identifying the person based on their ante mortem and postmortem reports. This approach involves three techniques (i.e.) morphological contour detector, Gaussian filtering and an existing semi-automatic contour extraction method. Forensic dentistry involves the identification of people based on their dental records, mainly available as radiograph images. Our goal is to automate this process using image processing and pattern recognition techniques. Given a postmortem radiograph, we search a database of antemortem radiographs in order to retrieve the closest match with respect to some salient features. In this paper, we use the contours of the teeth as the feature for matching. The algorithm completes the task in three steps: radiograph segmentation, pixel classification and contour matching. In this paper a hit rate of 0.7 is achieved by the Morphological contour detectors which are comparable with the other two methods.

High-level oxacillin and gentamycin resistance with reduced susceptibility to vancomycin in Staphylococcus aureus-carrying mecA and femA gene complex

Staphylococcus aureus oxiva 10 and oxiva 14 strains clinically isolated from diabetic patients were resistant to gentamycin and oxacillin The minimal inhibitory concentrations (MICs) of oxacillin and gentamycin were 720 and >2048 microg/mL, respectively, for oxiva 10 and 680 and 400 microg/mL. respectively, for oxiva 14; both strains carry mecA and femA genetic determinants in their genomes. In addition, both are vancomycin-intermediate Staphylococcus aureus (VISA) isolates. The addition of vancomycin led to significant decreases in oxacillin resistance of both oxiva 10 and oxiva 14 strains, whereas the addition of vancomycin to gentamycin plates showed a decrease in gentamycin resistance of non-high-level gentamycin-resistant (non-HLGR) oxiva 14 and indifference in gentamycin resistance in HLGR oxiva 10. Transmission electron microscopy of representative strains unveils a remarkable increase in the thickness of the cell wall, indicating that thickening of the cell wall is a common phenotype associated with vancomycin resistance in VISA isolates. The present study reports that the rate of synergism and synergistic effect in the combination vancomycin-gentamycin vary according to the MICs of gentamycin.

Bacteriological analysis of water samples from tsunami hit coastal areas of Kanyakumari district, Tamil Nadu

Water borne diseases such as cholera, enteric fever and dysentery were expected after the tsunami, which hit the coastal areas of Kanyakumari district, Tamil Nadu. In the present study 151 drinking water sources were collected from the tsunami affected villages and relief shelters and tested for coliforms and pathogens. Nine well water samples were also collected for specific bacteriological analysis. Presence of coliforms was detected in 56 (37%) water samples. One isolate each of Salmonella Paratyphi B and NAG Vibrio were isolated from two well water samples. There was no report of acute diarrhoeal diseases or typhoid illness during the post tsunami period monitored by a field microbiology laboratory for a month.

Plasma beta-amyloid and white matter lesions in AD, MCI, and cerebral amyloid angiopathy

BACKGROUND

Microvascular brain injury, typically measured by extent of white matter hyperintensity (WMH) on MRI, is an important contributor to cognitive impairment in the elderly. Recent studies suggest a role for circulating beta-amyloid peptide in microvascular dysfunction and white matter disease.

METHODS

The authors performed a cross-sectional study of clinical, biochemical, and genetic factors associated with WMH in 54 subjects with Alzheimer disease (AD) or mild cognitive impairment (AD/MCI) and an independent group of 42 subjects with cerebral amyloid angiopathy (CAA). Extent of WMH was determined by computer-assisted volumetric measurement normalized to intracranial size (nWMH). Biochemical measurements included plasma concentrations of the 40- and 42-amino acid species of beta-amyloid (Abeta40 and Abeta42) detected by specific enzyme-linked immunosorbent assays.

RESULTS

Plasma Abeta40 concentrations were associated with nWMH in both groups (correlation coefficient = 0.48 in AD/MCI, 0.42 in CAA, p < or = 0.005). Plasma Abeta40 remained independently associated with nWMH after adjustment for potential confounders among age, hypertension, diabetes, homocysteine, creatinine, folate, vitamin B12, and APOE genotype. The presence of lacunar infarctions was also associated with increased Abeta40 in both groups. nWMH was greater in CAA (19.8 cm3) than AD (11.1 cm3) or MCI (10.0 cm3; p < 0.05 for both comparisons).

CONCLUSIONS

Plasma beta-amyloid 40 concentration is independently associated with extent of white matter hyperintensity in subjects with Alzheimer disease, mild cognitive impairment, or cerebral amyloid angiopathy. If confirmed in longitudinal studies, these data would suggest circulating beta-amyloid peptide as a novel biomarker or risk factor for microvascular damage in these common diseases of the elderly.