Insights from a Pan India Sero-Epidemiological survey (Phenome-India Cohort) for SARS-CoV2

To understand the spread of SARS-CoV2, in August and September 2020, the Council of Scientific and Industrial Research (India) conducted a serosurvey across its constituent laboratories and centers across India. Of 10,427 volunteers, 1058 (10.14%) tested positive for SARS-CoV2 anti-nucleocapsid (anti-NC) antibodies, 95% of which had surrogate neutralization activity. Three-fourth of these recalled no symptoms. Repeat serology tests at 3 (n = 607) and 6 (n = 175) months showed stable anti-NC antibodies but declining neutralization activity. Local seropositivity was higher in densely populated cities and was inversely correlated with a 30-day change in regional test positivity rates (TPRs). Regional seropositivity above 10% was associated with declining TPR. Personal factors associated with higher odds of seropositivity were high-exposure work (odds ratio, 95% confidence interval, p value: 2.23, 1.92-2.59, <0.0001), use of public transport (1.79, 1.43-2.24, <0.0001), not smoking (1.52, 1.16-1.99, 0.0257), non-vegetarian diet (1.67, 1.41-1.99, <0.0001), and B blood group (1.36, 1.15-1.61, 0.001).

Posttraumatic Carotid Cavernous Fistula–A Rare Case

Carotid cavernous fistula (CCF) is a specific type of dural arteriovenous (AV) fistula characterized by abnormal AV shunting within the cavernous sinus. The authors presented in this article a case of a 17-year-old young male patient who encountered a road traffic accident while driving a car, with a history of flipping of cars multiple times. The patient was unconscious with symmetrical bilateral (B/L) pupils and with Glasgow coma scale (GCS) score of 3. There was no history of seizures or vomiting.

Foldscope as a primary diagnostic tool for oral and urinary tract infections and its effectiveness in oral health education

Due to its speed, accuracy and cost-effectiveness, microscopy has become an integral part of clinical examination for disease diagnosis. However, modern microscopes are very costly and require skilled personnel for their operation and maintenance, and specimen processing and analysis is labour-intensive. Further, lack of such expensive diagnostic tools in remote areas is a serious concern. Affordable point-of-care diagnostic tools are the most useful for timely disease diagnosis and management. The Foldscope is an affordable origami-based microscopy device composed of a series of paper clippings, which, upon assembly, can hold a specimen slide for observation, and this specimen can be viewed via a mobile phone camera attached to it. The present study evaluated the use of the Foldscope in the clinical diagnosis of oral and urinary tract infections and evaluated its efficacy as a motivational tool for improving oral health among school children in India. We qualitatively compared the Foldscope to a clinical microscope by examining five different types of clinical samples. Of the different types of clinical samples, the Foldscope was effective in detecting infection in dental plaque samples and urine samples. Thus, we further analysed 31 dental plaque samples of patients aged 3-13 years and 25 urine samples of patients aged 11-62 years. We also evaluated the use of the Foldscope as an educational tool for motivating oral hygiene among 80 school children aged 12 years and found that students in the Foldscope intervention group had better measures of oral hygiene than did students in the nonintervention group. In summary, our study indicated that the Foldscope is useful in detecting urinary tract infections and kidney stones in urine samples and is a useful motivational tool for oral health education among school-aged children. Furthermore, it may also be useful in oral health monitoring in resource poor settings. LAY DESCRIPTION: Poor and remote population often suffers due to lack of capacity to buy products or avail services which are expensive. In such a society people are not able to afford even the basic detection of diseases. Foldscope may come to rescue here! Foldscope is a paper-based, use-and-throw, affordable microscope. This study explores the use of Foldscope in clinics and diseases diagnosis using patient samples. Preliminary detection of disease associated symptoms in dental and urinary infections and digital record keeping via storage in mobile phone memory and hospital OPD records for monitoring patient's health are some of the advantages of Foldscope for clinical use in resource poor settings. It identifies that Foldscope not only can be used by students or teachers for educational purposes but it can also pave a path for promotion of dental hygiene among young children. The study also suggests that further improvement in design or resolution of Foldscope will broaden the scope of its application, in future.

Tau positron emission tomography imaging in C9orf72 repeat expansion carriers

BACKGROUND AND PURPOSE

AV-1451 (18 F-AV-1451, flortaucipir) positron emission tomography was performed in C9orf72 expansion carriers to assess tau accumulation and disease manifestation.

METHODS

Nine clinically characterized C9orf72 expansion carriers and 18 age- and gender- matched cognitively normal individuals were psychometrically evaluated and underwent tau positron emission tomography imaging. The regional AV-1451 standard uptake value ratios from multiple brain regions were analyzed. Spearman correlation was performed to relate the AV-1451 standard uptake value ratio to clinical, psychometric and cerebrospinal fluid measures.

RESULTS

C9orf72 expansion carriers had increased AV-1451 binding in the entorhinal cortex compared to controls. Primary age-related tauopathy was observed postmortem in one patient. AV-1451 uptake did not correlate with clinical severity, disease duration, psychometric performance or cerebrospinal fluid markers.

CONCLUSION

C9orf72 expansion carriers exhibited increased AV-1451 uptake in entorhinal cortex compared to cognitively normal controls, suggesting a propensity for primary age-related tauopathy. However, AV-1451 accumulation was not associated with psychometric performance in our cohort.

Image Processing to Improve Detection of Mesial Temporal Sclerosis in Adults

In this retrospective case-control study, we investigated whether an image-processing algorithm designed to exaggerate the intensity of diseased hippocampi on FLAIR images can improve the diagnostic accuracy and interobserver reliability of radiologists in detecting mesial temporal sclerosis-related hippocampal signal alteration. Herein, we share the results of this study that showed that the image processing improved the confidence of radiologists in detecting mesial temporal sclerosis-related signal alteration, allowing an improved sensitivity, specificity, and interobserver reliability.

Histone/protein deacetylase inhibitor therapy for enhancement of Foxp3+ T-regulatory cell function posttransplantation

T-regulatory (Treg) cells are like other cells present throughout the body in being subject to biochemical modifications in response to extracellular signals. An important component of these responses involves changes in posttranslational modifications (PTMs) of histones and many nonhistone proteins, including phosphorylation/dephosphorylation, ubiquitination/deubiquitination, and acetylation/deacetylation. Foxp3, the key transcription factor of Tregs, is constantly being rapidly turned over, and a number of these PTMs determine its level of expression and activity. Of interest in the transplant setting, modulation of the acetylation or deacetylation of key lysine residues in Foxp3 can promote the stability and function, leading to increased Treg production and increased Treg suppressive activity. This mini-review focuses on recent data concerning the roles that histone/protein deacetylases (HDACs) play in control of Treg function, and how small molecule HDAC inhibitors can be used to promote Treg-dependent allograft survival in experimental models. These data are discussed in the light of increasing interest in the identification and clinical evaluation of isoform-selective HDAC inhibitors, and their potential application as tools to modulate Foxp3+ Treg cell numbers and function in transplant recipients.

Study of the role of efflux pump in ciprofloxacin resistance in Salmonella enterica serotype Typhi

PURPOSE

There are increasing reports on failure of clinical response to ciprofloxacin in typhoid fever despite the strain being sensitive to drug in in-vitro using standard guidelines and showing mutations in DNA gyrase. But this increased MIC and clinical failures with ciprofloxacin are not always co-related with mutations presently identified in gyrA and parC genes. This shows that there may be other mechanisms such as an active drug efflux pump responsible as has been shown in other Enterobacteriaceae. This study was carried out to determine the role of efflux pump in Salmonella Typhi isolates.

MATERIALS AND METHODS

Total 25 already characterized nalidixic acid sensitive and nalidixic acid resistant S. Typhi strains with different range of ciprofloxacin MIC were included to study the role of efflux pump in the presence of CCCP (efflux pump inhibitor). For genotypic characterization, the entire acrR gene was sequenced to confirm the presence of any mutation in the gene.

RESULTS

The MIC of ciprofloxacin remained same in the presence and absence of CCCP in the studied strains and no significant mutations were found in the acrR gene in any of the isolates studied.

CONCLUSIONS

No role of efflux pump in ciprofloxacin resistance was found in strains studied. There is a need to explore further mechanism of ciprofloxacin resistance in Salmonella Typhi.

A case of protruding eyeballs and diminishing vision

This case report discusses issues related to a 56-year-old man from Bangalore who presented with complaints of a gradual protrusion of his eyeballs along with diminishing vision for the previous month. The approach to diagnosis and management issues around this unusual presentation is dicussed.

User-driven health care: answering multidimensional information needs in individual patients utilizing post-EBM approaches: an operational model

The hypothesis in the conceptual model was that a user-driven innovation in presently available information and communication technology infrastructure would be able to meet patient and health professional users information needs and help them attain better health outcomes. An operational model was created to plan a trial on a sample diabetic population utilizing a randomized control trial design, assigning one randomly selected group of diabetics to receive electronic information intervention and analyse if it would improve their health outcomes in comparison with a matched diabetic population who would only receive regular medical intervention. Diabetes was chosen for this particular trial, as it is a major chronic illness in Malaysia as elsewhere in the world. It is in essence a position paper for how the study concept should be organized to stimulate wider discussion prior to beginning the study.

Influence of amorphous cyclodextrin derivatives on aceclofenac release from directly compressible tablets

An inclusion complex of hydroxypropyl beta-cyclodextrin (HPbetaCD), an amorphous, highly water soluble derivative and aceclofenac (AC), was prepared by the kneading method. The complex was further characterized by differential scanning calorimetry (DSC), X-ray powder diffractometry (XRD), fourier-transform infra red spectroscopy (FT-IR), scanning electron microscopy (SEM) and in vitro dissolution studies. The dissolution of AC from the inclusion complex studied by the dispersed powder technique showed significant dissolution enhancement in case of the kneaded product (KN) compared to pure AC. The complex possessed good compressibility and the tablets so compressed displayed good dissolution profile. The dissolution data were characterized by different model independent parameters such as dissolution efficiency (DE), difference factor (f1) and similarity factor (f2).

Primary osteosarcoma of the skull. A report of 3 cases

Osteosarcomas are malignant bone tumors, which commonly affect the long bones of young adults. Primary osteosarcomas of the skull are exceedingly rare. We herein report 3 cases of primary osteosarcoma of the skull involving the calvaria, diagnosed over a period of 8 years at the Department of Pathology of our Institute.

Nutritional evaluation and shelf life studies of papads prepared from wheat-legume composite flours

The present study was carried out to develop papads from wheat and legume blends and to analyze them for organoleptic acceptability, nutritional quality, and keeping quality. Papad is a dehydrated product prepared from dhals or rice. A firm but pliable dough is made from the flours of dhals or rice with addition of suitable seasoning. It is shaped into balls, rolled out thin, dried and toasted over open fire so as to give a light, crisp product. Mung flour papads were kept as control and wheat flour, chickpea flour, and pea flour were used to supplement mung flour papads. Three different proportions (10, 20, 30%) of each flour were used to supplement Mung flour. Papads with wheat flour (10%), chickpea flour (20%), and pea flour (10%) level of supplementation were found to be most acceptable and these papads were subjected to nutritional evaluation. Protein content significantly increased on supplementation with legume flours at all levels. Fat content was significantly higher in chickpea flour supplemented papads. Ash content varied significantly from 10.17 to 10.78% in papads. Total carbohydrates decreased significantly on supplementation with chickpea flour. Copper content increased significantly on supplementation. A significant decrease in phytic acid and trypsin inhibitor of supplemented papads was found. In vitro protein digestibility significantly increased on supplementation but a significant decrease in in vitro starch digestibility was found in supplemented papads. Storage studies showed that chickpea flour and pea flour supplemented papads can be stored safely for 60 days and wheat flour supplemented papads for 30 days both at room and refrigeration temperatures.

Clear cell odontogenic carcinoma: a diagnostic dilemma

A 26-year-old man presented with a swelling in the right side of face and CT scan revealed a destructive tumor in the right maxilla. Tumor recurred within 5 years of its excision and histopathological examination revealed a clear cell odontogenic carcinoma. The rarity of this tumor, occurrence in maxilla and young age of the patient are some of the rare features which need documentation. The importance of its diagnosis and various differential diagnoses are discussed.

Holoacardius acephalus-myelecephalus

Holoacardius acephalus is a rare anomaly occurring in twin pregnancy. This case was an amorphic monstrous mass with only lower limb buds showing five digits and no definite human form unlike those reported in the Indian literature which either showed the presence of other body parts like thorax, abdomen and head and neck structures or were totally undifferentiated. The other twin had intra uterine growth retardation. This case came to the hospital in labour. As this condition can be recognised in the antenatal period, diagnosis of this anomaly is important for better perinatal outcome.

Acceptability and viscosity of low cost home processed supplementary foods developed for preschool children

Four supplement mixtures using whole wheat, pearl millet, bengal gram, green gram, groundnuts and amaranth leaves were developed employing roasting and malting techniques. Malting used in the formation of the supplements reduced significantly hot paste viscosity of all the four supplements and increased their nutrient density per unit volume. The organoleptic trials conducted on rural mothers revealed that taste, texture, colour, aroma, appearance and overall acceptability of all the four supplements were found to be excellent with mean overall acceptability. Children did not develop any GIT disorders after consuming the products. Trained panelists found all the four supplements acceptable as indicated by a nine point hedonic scale.

Acceptability and viscosity of low cost home processed supplementary foods developed for pre-school children

Four supplement mixtures using whole wheat, pearl millet, bengal gram, green gram, groundnuts and amaranth leaves were developed employing roasting and malting techniques. Malting used in the formation of the supplements reduced significantly hot paste viscosity of all the four supplements and increased their nutrient density per unit volume. The results of organoleptic trials conducted on rural mothers revealed that taste, texture, colour, aroma, appearance and overall acceptability of all the four supplements were excellent with mean scores of overall acceptability (9.77, 9.33, 9.11 and 8.75) for supplements I, II, III and IV, respectively. Children did not develop any GIT disorders after consuming the products. Trained panelists found all the four supplements acceptable as indicated by Nine point hedonic scale.

Development, nutritive content and shelf life of home processed supplementary foods

Four low cost supplements containing whole wheat, pearl millet, bengal gram, green gram grain and amaranth leaves employing roasting and malting methods were developed. Nutritional evaluation showed that chemical composition of developed supplements was within the range prescribed for processed supplements and could meet satisfactorily one third requirements of protein, energy, iron and calcium for young children. Developed supplements were stored in three packings, polythene bags, tins with lids, glass bottle with lids (each 1 kg capacity, under ambient temperature (24-32 degrees C) and RH (70-80%) for a period of 30 days and analysed for moisture, peroxide value, fat acidity and alcoholic acidity. Stored samples were also evaluated organoleptically. The values of moisture, peroxide value, fat acidity and alcoholic acidity of stored samples were within the range of prescribed specifications for processed supplements. Storage of supplements for 30 days resulted in non-significant changes in organoleptic traits except for taste and aroma of bajra based supplements on 20th and 30th day of storage. In spite of these variations, all the supplements were found to be acceptable till 30th day of storage.