Comparative evaluation of DTT treated ABO isoagglutinin titres performed by two methods with solid phase red cell adhesion (SPRCA) titres

BACKGROUND AND AIMS

Measurement of actual concentration of IgG requires methods like treatment of serum with dithiothreitol (DTT). This study was aimed at comparing of DTT treated ABO titres performed by conventional test tube technique (CTT) and column agglutination technique (CAT) with HA/SPRCA.

MATERIALS AND METHODS

This was a prospective, observational study conducted from October 2019 to March 2020. All consecutive A, B and O group donors who gave consent for participation were included. All samples were tested by CTT and CAT before and after DTT treatment (pCTT, pCAT) and with HA/SPRCA.

RESULTS

A total of 300 donors were included; 100 each from A, B and O blood group donors. Group O titres were higher than group A/B titres. Group O titres were highest when performed by pCAT, followed by pCTT and lowest by HA/SPRCA. Group A/B titres were highest when performed by HA/SPRCA, followed by pCAT and pCTT for anti-A and highest when performed by pCAT, followed by HA/SPRCA and lowest by pCTT for anti-B.

CONCLUSION

Results obtained by pCAT were closer to results obtained by pCTT, whereas those obtained by HA/SPRCA were variable. SPRCA offers the advantage of automation, no inter-observer variation and less time consumption because IgM interference is not observed with SPRCA, thus providing an alternative to pCTT. However, these methods cannot be used interchangeably and to discern the most suitable method, a clinical impact of these results needs to be studied.

Practical consensus recommendations on management of HR + ve early breast cancer with specific reference to genomic profiling

Breast cancer is a heterogeneous disease and patients are managed clinically based on ER, PR, HER2 expression, and key risk factors. The use of gene expression assays for early stage disease is already common practice. These tests have found a place in risk stratifying the heterogeneous group of stage I–II breast cancers for recurrence, for predicting chemotherapy response, and for predicting breast cancer-related mortality. Most guidelines for hormone receptor (HR)–positive early breast cancer recommend addition of adjuvant chemotherapy for most women, leading to overtreatment, which causes considerable morbidity and cost. Expert oncologist discussed about strategies of gene expression assays and aid in chemotherapy recommendations for treatment of HR + ve EBC and the expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.

The perspective of our future doctors towards organ donation: a national representative study from India

Introduction Timely donation of organs has helped many get a new life. But in India, the pace of Organ Donation and Transplant (ODT) has been disturbingly sluggish. There is a wide gap between patients who need transplants and the organs that are available in India. Doctors can play a pertinent role in decreasing this gap. Therefore, the present study was done to assess the knowledge, attitude, and perception of the medical students in India regarding Organ Donation (OD). Material and Methods A cross-sectional study was carried out among the undergraduate students (n=1463) in 10 different medical colleges across the country. Data were collected electronically through Google forms by using a pre-designed, semi-structured, self-administered questionnaire. Results About 65% of students had a positive attitude regarding ODT. Most of the students acknowledged that Internet sources (57.7%) and print media (46.5%) played a significant role in their awareness. 83% of the students felt that there is a need for effective laws to regulate the process of ODT. It was encouraging that most of the students (69.6%) were not biased for the type of recipients for the organ. Conclusion In the face of acute shortage of donated organs in India, the medical students can be the torchbearers of a positive change. Topics on ODT should be stressed in the initial years and during the early clinical exposure through rapid implementation of the revised Medical curriculum. They can motivate the general public and patients during their routine interactions to make this idea more accessible and acceptable.

Practical consensus recommendation on when to do BRCA testing

BRCA-mutation associated breast cancer and to future cancer risks and sensitivity to systemic therapies. Now that rapid genetic testing for BRCA1 and BRCA2 mutations is available, BRCA mutation status can be considered when making treatment and prevention decisions for BRCA testing, BRCA mutation carriers with breast cancer. Expert group used data from published literature, practical experience, and opinion of a large group of academic oncologists, to arrive at practical consensus recommendations for use by the community oncologists.

Place and type of delivery along with assistance during delivery among women residing in a village in South Delhi: Low performance pocket within a high performing state

Background: Various initiatives have been taken under the National Health Mission to improve coverage of institutional deliveries. Yet there are disparities in the proportion of institutional deliveries between states. A high proportion of non-institutional deliveries was noted in a village under PHC Fatehpur Beri in South Delhi. Aims and Objectives: To study the place, assistance and type of deliveries in this village during the years 2007 to 2016 which is the period when several initiatives were taken up to promote institutional deliveries. Material & Methods: A community based cross-sectional study was conducted in Kharak village under PHC, Fatehpur Beri in which data on place and year of delivery, assistance during delivery, type and outcome of deliveries in the period 2007 to 2016 were collected. In analysis, the data for two five year periods were compared using Fishers exact test and odds ratio was calculated with 95% confidence intervals. Trends were assessed by using Mantel-Haenszel test. Changes in the delivery characteristics of two consecutive deliveries were assessed. Results: Of the 312 deliveries, 106 (34%) were institutional deliveries out of which 98 (92%) were in public hospitals. A total of 113 (36%) were assisted by doctors and nurses 44 (14%) were caesarean section deliveries. The proportion of institutional deliveries had increased significantly from 23% in the years 2007-2012 to 42 % in the period 2012 to 2016. [X2=11.76, df=1, p=0.001, OR=2.37(1.44-3.91)]. The proportion of women assisted by trained health professionals during the deliveries also showed a significant rise from 26% to 44% between these time periods. [X2=11.39, df =1, p=0.001, OR=2.3(1.41-3.75)] There was no significant difference in the proportion of caesarean section deliveries between the two study periods. [X2=0.167, df=1, p=0.683, OR=0.87(0.46-1.66)]. There was a significant increase in the proportion of institutional deliveries over the ten year period from 23% to 56% [X2=17.84, df=1, p=0.00]. Conclusion: There are pockets of poor performance on institutional deliveries within high performing states. There is increasing trend in institutional deliveries and assistance by trained health professional in the village but there is huge scope to improve the coverage to match the state and national figures. There is a need to identify the challenges and customize interventions to address them in such pockets

Thrombomodulin-dependent protein C activation is required for mitochondrial function and myelination in the central nervous system

Essentials The role of protein C (PC) activation in experimental autoimmune encephalitis (EAE) is unknown. PC activation is required for mitochondrial function in the central nervous system. Impaired PC activation aggravates EAE, which can be compensated for by soluble thrombomodulin. Protection of myelin by activated PC or solulin is partially independent of immune-modulation.

SUMMARY

Background Studies with human samples and in rodents established a function of coagulation proteases in neuro-inflammatory demyelinating diseases (e.g. in multiple sclerosis [MS] and experimental autoimmune encephalitis [EAE]). Surprisingly, approaches to increase activated protein C (aPC) plasma levels as well as antibody-mediated inhibition of PC/aPC ameliorated EAE in mice. Hence, the role of aPC generation in demyelinating diseases and potential mechanisms involved remain controversial. Furthermore, it is not known whether loss of aPC has pathological consequences at baseline (e.g. in the absence of disease). Objective To explore the role of thrombomodulin (TM)-dependent aPC generation at baseline and in immunological and non-immunological demyelinating disease models. Methods Myelination and reactive oxygen species (ROS) generation were evaluated in mice with genetically reduced TM-mediated protein C activation (TMPro/Pro ) and in wild-type (WT) mice under control conditions or following induction of EAE. Non-immunological demyelination was analyzed in the cuprizone-diet model. Results Impaired TM-dependent aPC generation already disturbs myelination and mitochondrial function at baseline. This basal phenotype is linked with increased mitochondrial ROS and aggravates EAE. Reducing mitochondrial ROS (p66Shc deficiency), restoring aPC plasma levels or injecting soluble TM (solulin) ameliorates EAE in TMPro/Pro mice. Soluble TM additionally conveyed protection in WT-EAE mice. Furthermore, soluble TM dampened demyelination in the cuprizone-diet model, demonstrating that its myelin-protective effect is partially independent of an immune-driven process. Conclusion These results uncover a novel physiological function of TM-dependent aPC generation within the CNS. Loss of TM-dependent aPC generation causes a neurological defect in healthy mice and aggravates EAE, which can be therapeutically corrected.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Ocular myocysticercosis: an unusual case of ptosis

BACKGROUND

Cysticercosis is common in endemic countries like India. It can have various clinical manifestations depending on the tissue involved. It refers to a parasitic infestation by Cysticercus cellulosae, the larval form of the pork tapeworm or Taenia solium.

OBJECTIVE

To report an unusual case of ocular cysticercosis involving the levator palpebrae superioris and superior rectus muscle of the right eye.

CASE DESCRIPTION

A young, male adult was diagnosed by Magnetic Resonance Imaging (MRI) scan of the skull and orbit to have right-sided ocular cysticercosis. The patient was treated with oral prednisolone and albendazole, to which he showed a significant improvement.

CONCLUSION

Ocular myocysticercosis can be diagnosed by MRI and be treated medically with steroid and albendazole.

Small-incision cataract surgery in patients with Fuch's heterochromic iridocyclitis

INTRODUCTION

Fuch's heterochromic iridocyclitis (FHI) is often complicated by cataract formation.

OBJECTIVE

To assess the results of small-incision cataract surgery (SICS) in FHI and to study the effect of preoperative factors on postoperative vision.

MATERIALS AND METHODS

Sixty-three eyes of 59 patients with Fuchs heterochromic iridocyclitis who had SICS with in-the-bag implantation of intraocular lens (IOL) were evaluated retrospectively; and the primary and secondary outcome measures evaluated were the postoperative vision and complication rate.

RESULTS

The mean age was 39.22±4.95 years. The mean pre-operative vision was 0.75±0.24 Log MAR units. The mean final vision was 0.27±0.10 Log MAR units (P=less than 0.001). At the final follow-up, 84.1% of the patients had a final Snellen's vision of 6/12 or better. The mean follow-up period was 12.06±2.06 months. The causes of corrected distance visual acuity (CDVA) worse than 6/60 were vitreous opacities, posterior keratic precipitates (KPs), glaucoma, persistent uveitis and cystoid macular edema (CME). Preoperative factors like iris atrophy (P=0.973), heterochromia (P=0.10) and vessels in angle (P=0.074) did not have a significant effect on the final vision. On the contrary, vitreous opacities (P=0.002) and posterior KPs (P=0.009) had a significant effect on the final visual outcome.

CONCLUSION

SICS with in-the-bag implantation of IOL in patients with Fuch's heterochromic iridocyclitis resulted in good visual outcomes. SICS in complicated cataracts can be performed in rural settings and eye camps with minimal instrumentation, obviating the need for referral to tertiary care centers. Pre-operative factors like vitreous opacities and posterior KPs have a significant effect on the final vision.

Clostridium difficile infections in HIV-positive patients with diarrhoea

BACKGROUND

Patients with HIV/AIDS are at a high risk of being infected with toxin-producing strains of Clostridium difficile (C. difficile) because of frequent hospitalization, exposure to antibiotics and antibiotic prophylaxis for opportunistic infections. There are little data from India on the prevalence of C. difficile infection in such patients.

METHODS

We assessed the occurrence of C. difficile infections in HIV-positive patients with diarrhoea by looking for the presence of its toxin as well as by culturing. Enzyme immunoassay (EIA, Premier toxins A and B; Meridian Diagnostic Inc.) was used to detect toxin from 237 fresh stool samples collected from HIV-positive patients with diarrhoea. Culture was done on cycloserine-cefoxitin-fructose agar and brain- heart infusion agar.

RESULTS

C. difficile was found in 12 of 237 (5.1%, 95% CI 2.64%-8.68%) HIV-positive patients with diarrhoea (9 patients were positive by EIA and 3 by culture). The presence of C. difficile in patients who had received antiretroviral therapy (7/66 [10.6%]) was significantly higher (p < 0.016) compared with those who had not (5/171 [3%]). Of the 12 patients positive for C. difficile, 7 were on antiretroviral therapy for a mean (SD) of 34.4 months with mean CD4+ count of 186 (98.81) cells/cmm and 5 patients were anti-retroviral-naïve with mean CD4+ count of 181 (68.7) cells/cmm. All the 12 patients were on antibiotics for previous 2 months and 4 of 12 had been hospitalized in the previous 30 days.

CONCLUSION

C. difficile infections occurred more frequently in patients who had received antiretroviral therapy. Our study population had a lower frequency of C. difficile infections compared to previous studies.

Prevalence of depression among elderly people living in old age home in the capital city Kathmandu

Background: There has been a considerable increase in the numbers of older people in the world population of both developed and developing countries. These populations are thought to be at greater risk for depression. Many researches are conducted on physical wellbeing of elderly but studies regarding depression among elderly, especially in old age home is lesser in the developing countries. Objectives: To assess depression among elderly residing in an old age home in Kathmandu and its association with some of the socio-demographic variables. Methods: One hundred fifty elderly people residing in social welfare centre elderly home, Pashupatinath, Gaushala, Kathmandu, Nepal were selected randomly. Geriatric depression scale (GDS) was applied in all the individuals to assess the prevalence and degree of depression. Results: This study showed that, 47.33% of population had depression. Among the depressed population, 70.42% had mild depression and 29.58% had severe depression. There was significant association between the prevalence of depression and history of physical illness. Conclusion: Depressive disorder is highly prevalent among the elderly population residing in the old age home in Kathmandu with history of physical illness. DOI: http://dx.doi.org/10.3126/hren.v11i3.9634 Health Renaissance 2013;11(3):213-218

Progressive multifocal leucoencephalopathy in HIV/AIDS: observational study from a tertiary care centre in northern India

BACKGROUND & OBJECTIVES

Progressive multifocal leucoencephalopathy (PML) is seen mostly in advanced human immunodeficiency virus (HIV) infection. Little is known about the epidemiology and disease course of these patients from India. This study was aimed to determine the frequency of PML in patients with HIV/AIDS, and the clinical features and survival of these patients.

METHODS

The charts of HIV/AIDS patients with PML seen over a period of five years (2006-2011) at the Antiretroviral treatment (ART) centre at a tertiary care centre in New Delhi, India, were retrospectively reviewed.

RESULTS

Of 1465 patients with HIV/AIDS, 18 (1.2%) were diagnosed with PML; four were laboratory confirmed and 14 had consistent clinical and radiological features. PML was the initial presentation of HIV infection in 10 (56%) patients, and 16 (89%) patients had CD4 count less than 200/μl. Insidious onset focal limb weakness (78%) and visual disturbance (28%) were common symptoms. Magnetic resonance imaging (MRI) of the brain revealed characteristic white matter lesions in all the patients. The estimated median survival was 7.6 months (95% CI, 0-20 months).

INTERPRETATION & CONCLUSIONS

Our results show that the patients present late to access treatment with advanced immunosuppression at presentation. PML is associated with high morbidity and mortality despite institution of highly active antiretroviral therapy (HAART). There is a need to address the lacuna in diagnostic and management services for these patients in India.

Challenges of setting up psychiatric services in Nepal: Lessons from the first year of Janakpur Project

In Nepal psychiatric services outside big cities are virtually non-existent. This paper reports the observations and findings of a mental health project jointly run by private and voluntary sector organisations at Janakpur in southeast Nepal. The services included monthly outpatient clinics, day care, home visits and psychiatric training for medical students. At the monthly clinic, altogether 396 patients attended the service in 2009: a high proportion had psychoses (30% schizophrenia and 25% bipolar disorder); most (54%) were young; they came mainly from rural areas. Medical students also benefited from the clinical exposure, but the intake of the day care service was poor. The overall success of the innovative project shows how low-cost basic psychiatric services can be delivered in Nepal by private and voluntary sectors in the absence of state health care system.

Design of a new invertible polymer coating on a solid surface and its effect on dispersion colloidal stability

This article presents a new approach to building up self-adjustable invertible polymer coatings at solid surfaces. The approach is based on a two-step process. In the first step, the surface of dispersed TiO2 or silicon wafers was functionalized with the aid of a reactive copolymer, viz., poly(styrene-alt-maleic anhydride) (PSM), to which, in the second step, the chains of amphiphilic oligoester have been tethered. The latter contains both hydrophilic poly(ethylene glycol) and hydrophobic aliphatic dibasic acid moieties being alternately distributed along the oligomer chains. It is shown that the titania modified in this way can form stable suspensions in both polar (water) and nonpolar (toluene) media. Moreover, multiple drying/redispersion cycles demonstrate the ability of the modified titania particles, after their removal from one type of dispersion and consequent drying, to be redispersed in dispersing media strongly differing by polarity from that of the previous medium. An environmentally induced switching of the surface properties has been observed via the measurement of the wetting contact angles and scanning force microscopy (SFM) of silicon wafers covered by PSM with tethered oligoester chains. These experiments give strong support for the predicted capability of such polymer coatings to switch their environmental appearance (i.e., to behave as a self-adjustable invertible interface because of the ability of the tethered amphiphilic oligoester chains to change their conformations in response to environmental changes in such a manner so as to adapt and enhance their compatibility with the surrounding media).

Therapeutic and persistent efficacy of moxidectin 1% nonaqueous injectable formulation against natural and experimentally induced lung and gastrointestinal nematodes in cattle

Four controlled trials were conducted to evaluate the therapeutic and persistent efficacy of a new moxidectin formulation (moxidectin 1% nonaqueous injectable) against nematode parasites in cattle. This injectable moxidectin formulation, given as a single subcutaneous injection at a dose rate of 0.02 ml/kg BW to provide 0.2 mg moxidectin/kg BW, was highly efficacious (>90-100%) against larval and/or adult stages of many species of nematodes in cattle including, Dictyocaulus viviparus, Ostertagia spp., Trichostrongylus axei, Haemonchus placei, Trichostrongylus colubriformis, Cooperia spp., Nematodirus helvetianus, Strongyloides papillosus, Oesophagostomum radiatum and Trichuris spp. This formulation had persistent efficacy of >90% against D. viviparus for at least 6 weeks post-treatment, H. placei and Oe. radiatum for 5 weeks post-treatment, and Ostertagia spp. and T. axei for 2 weeks post-treatment.

Susceptibility to IVM in a field strain of Haemonchus contortus subjected to four treatments in a closed sheep-goat flock in Kenya

Susceptibility to IVM (IVM) of "strain A" Haemonchus contortus which had been exposed to IVM four times over a 2-year period was compared to IVM susceptibility of "strain C" H. contortus which had no prior field exposure to IVM, by in vivo and in vitro methods. In vivo, the percentage reduction in faecal egg counts (FEC) and the total worm counts (TWC) were compared between control animals (lambs and kids) and animals treated with low dose IVM (20 microg/kg). In vitro susceptibility to IVM was evaluated by larval migration inhibition (LMI) after the two strains of H. contortus were exposed to different concentrations of IVM. The dose response, measured as the proportion of larvae inhibited from migrating, was used to estimate LD(50). Although differences in response to IVM in the in vivo determinations were not significant, "strain A" H. contortus had a significantly higher LD(50) than "strain C" in the LMI assay. Coincident with the conduct of the in vivo experiment, it was observed that "strain A" H. contortus established and survived better than "strain C" in the control lambs.

Selection for resistance to macrocyclic lactones by Haemonchus contortus in sheep

An anthelmintic-sensitive Haemonchus contortus strain was selected for moxidectin and ivermectin resistance concurrently for 22 generations. Treatment with 0.002 mg moxidectin/kg BW or 0.02 mg ivermectin/kg BW produced >99% efficacy against the susceptible parent strain passaged for 22 generations without any anthelmintic exposure. However, to obtain similar efficacy the moxidectin-selected and the ivermectin-selected strains of H. contortus required 0.05 mg moxidectin/kg BW or 0.4 mg ivermectin/kg BW. These results indicate that development of resistance to one macrocyclic lactone, simultaneously results in resistance to another macrocyclic lactone. However, rates of resistance development differ between compounds and occurs more slowly with moxidectin than with ivermectin.

Hypobiosis of Haemonchus contortus in natural infections of sheep and goats in a semi-arid area of Kenya

A total of 42 lambs, 42 kids, 21 ewes and 21 does were necropsied during an investigation of the epidemiology of Haemonchus contortus infection of sheep (Red Maasai) and goats (Small East African Goat) in a semi-arid area of Kenya. Availability and establishment of the infective stages were monitored by the necropsy of 21 tracer lambs and 21 tracer kids. Prevalence of H. contortus was over 90% in both sheep and goats and this species contributed to about 80% of the total worm burden. Only about 10% of the hypobiotic larvae were recovered from the mucosal digest whereas about 90% were recovered from the abomasal contents and washings, thereby suggesting that hypobiotic larvae may be loosely attached to the abomasal mucosa from which they may be dislodged during the processing of the abomasa for examination. Throughout the study, both adult worms and hypobiotic larvae were found in proportions that varied with seasons. Statistically, a higher proportion of hypobiotic larvae was found during the dry months than during the wet months, an indication that hypobiosis was an important feature in the survival of H. contortus during the dry months. Negligible worm burdens were acquired by the tracers during the short rains, suggesting that few H. contortus larvae survived on pasture in this season. The effectiveness of strategic control using ivermectin varied according to the timing in relation to the wet season. Treatment did not influence the seasonal pattern of hypobiosis but the treatment administered before the onset of the rains significantly reduced the numbers of both hypobiotic larvae and the adult worms. Treatment during the rains conferred a temporary relief of adult worm burden but had no impact on hypobiotic larvae.

Nematode reinfection following treatment of cattle with doramectin and ivermectin

A study was conducted to investigate reinfection with nematodes in calves following treatment with doramectin or ivermectin administered subcutaneously at a dose rate of 200 micrograms kg-1 of body weight under conditions of natural challenge. Thirty calves were allocated to three groups of 10 calves each based on body weight, sex, breed and pre-treatment faecal egg counts (FEC) after grazing together on a common pasture for three months. Treatments were doramectin, ivermectin and no treatment. Calves were returned to the same pasture for 56 days, placed on dry lot from days 56 to 63 and then necropsied over days 64-66. Faecal egg counts were done at days -1 and 0, then bi-weekly from day 14 to 56 and day 63. Mean FEC in control calves continued to rise throughout the grazing period. Trichostrongyle FEC were significantly (P < 0.05) greater in the control group compared to either treated group at each sample time following treatment. At necropsy, a total geometric mean of 19,847 nematodes per calf was recovered from untreated controls, of which eight genera were identified. The predominant nematode genera were Ostertagia (8749), Nematodirus (3702) and Cooperia (1927). In the ivermectin-treated calves, geometric mean worm burden was similar to that of the untreated controls: A total of 20,349 nematodes per calf was present including the genera Nematodirus (8633), Ostertagia (4700) and Cooperia (1740). In contrast, the geometric mean worm burden in doramectin-treated calves was 12,173, including Ostertagia (4310), Cooperia (1141) and Nematodirus (1667). Doramectin was more effective than ivermectin in protecting calves from reinfection over a 56-day post-treatment grazing period under conditions of natural challenge as measured by accumulated mean worm burdens.

Effects of three nematode anthelmintic treatment regimes on flock performance of sheep and goats under extensive management in semi-arid Kenya

A study was undertaken in a semi-arid area of Kenya between August 1991 and June 1993 to evaluate the effects of anthelmintic treatment using ivermectin before or during the rains, on performance of mixed sheep and goat flocks, in comparison with an untreated flock. Performance parameters measured included age and weight of dams at first parturition, parturition intervals, body weights of dams and offspring, and birth weights, growth rates, and mortality rates of offspring. Among these parameters, birth weights and growth rates of offspring were found to be significantly improved by the treatment administered before the rains compared with the other two treatments. Mortality was lower in lambs and kids with high birth weights. Treatment, either before or during the rains, significantly reduced the faecal egg output and improved body weight, packed cell volume and flock fertility. Liveweight was confirmed to be a better measure of sexual maturity than age. It was further shown that lambs and kids, born of dams at their first lambing or kidding, experienced higher mortality rates than lambs and kids born of dams in their second and subsequent parturitions. Overall, treatment with ivermectin before the onset of rains was equal to or better, in terms of the performance parameters measured, than treatment during the rains, whilst treatment compared with no treatment increased performance in almost all of the parameters measured.