A109 TRANEXAMIC ACID TO PREVENT BLEEDING AFTER ENDOSCOPIC RESECTION OF LARGE COLORECTAL POLYPS: A PILOT PROJECT

Background

Colonoscopy and polypectomy reduce colorectal cancer incidence and mortality, but is also associated with adverse events, including bleeding. Postpolypectomy delayed bleeding (PPDB) after EMR of large colorectal polyps (≥2cm) has an incidence of 2.6-9.7%. Tranexamic acid is a member of a class of drugs called antifibrinolytic agents. It reduces fibrinolysis by slowing down the conversion of plasminogen to plasmin, which may prevent bleeding.

Purpose

The goal of this pilot study is to assess the feasibility of using tranexamic acid after EMR of large (≥2 cm) non-pedunculated colorectal polyps (LNPCPs) to prevent PPDB.

Method

This was a single center feasibility study conducted at the Kingston Health Sciences Center from March 2021 to September 2021. Patients referred for removal of a ≥2cm LNPCP and those who were referred for a positive fecal immunochemical test were approached for consideration of inclusion. Patients with INR ≥ 1.5, platelets <50, higher risk of risk of thromboembolic events (atrial fibrillation on anticoagulation, history of stroke, TIA, pulmonary embolism, deep vein thrombosis hypercoagulable state, mechanical heart valve on anticoagulation, myocardial infarction in the last twelve months), pregnancy or undergoing ESD were not included.

Coagulation of submucosal vessels after polypectomy by snare tip coagulation or forceps was performed if thought necessary by the endoscopist. Clipping could be performed only where there was concern for perforation. Intraprocedural bleeding was recorded and managed at the discretion of the endoscopist.

After the procedure was completed, 1 gram of TXA in 100mL of normal saline (NS) was infused over a 10-minute interval. The participants received tranexamic acid 1 gram PO TID to be taken for 5 days after the procedure. A post procedure day 5, 14 and 30 phone call was conducted with participants to monitor study drug compliance and adverse events.

Result(s)

A total of 25 patients were enrolled with a mean polyp size of 3 cm. Baseline patient and polyp characteristics are presented in table 1. 90% of eligible patients approached consented to be in the study. Procedure details are presented in table 2. Intraprocedural bleeding occurred in 7 patients (28%) and all of these were treated with soft coagulation. 2 patients had clipping for muscle injury. All 25 patients received IV TXA post procedure. 16 patients (64%) took every dose of the prescribed pills. 21 patients (84%) took at least 80% of the prescribed TXA pills. 1 patient presented with post polypectomy bleeding. All patients completed the day 30 follow up phone call. There were no adverse events.

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Conclusion(s)

TXA to prevent postpolypectomy delayed bleeding (PPDB) was feasible to use with no adverse events reported. All patients received IV TXA post procedure and completed 30 day follow up. However, only 64% of patients took every scheduled dose of medication. A randomized controlled study will be needed to see if TXA can significantly reduce PPDB.

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Queen's University DOM Research Award – Clinical Innovation

Disclosure of Interest

None Declared

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

A259 ASSESSING SYSTEM BASED QUALITY MEASURES IN THE CARE OF ACUTE PANCREATITIS AT A TERTIARY CARE HOSPITAL

Background

Acute pancreatitis (AP) is an acute condition associated with significant morbidity and mortality. There has been a >75% increase in incidence since 1990 associated with annual Canadian healthcare costs greater than $200 million. Despite established guidelines for clinical management and quality indicators at the individual patient level, system-based performance measures are novel. Thus, hospital-based quality measures have recently been released by the American Gastroenterology Association (AGA) and are yet to be evaluated in a clinical setting.

Aims

To assess rates of compliance to the AGA quality and performance measures in the care of acute pancreatitis.

Methods

Retrospective chart review identified adult patients admitted with AP from June 2019 to May 2020 at Kingston Health Sciences Centre to review clinical profile. Data was collected, assessed, and stratified based on compliance with AGA performance measures of (1) cholecystectomy on index presentation of gallstone pancreatitis (GP), (2) initiation of early oral feeding within 24 hours, and (3) inappropriate parenteral nutrition (PN) use. Additional data collected included length of stay (LOS), presence of complications, and etiology of AP to assess for trends in associations. Descriptive and bivariate analysis was conducted.

Results

There were 130 admissions of AP during the study period, of which the most common aetiologies were GP (52.3%) and alcohol (16.9%). Unknown/idiopathic AP had an incidence rate of 22.3%. The most likely etiology of having a prior presentation of AP was unknown/idiopathic AP (34.5%), closely followed by alcoholic AP (32%). The incidence of complications was 13.1% and median LOS was 4 days. 63% of eligible GP patients underwent cholecystectomy on index admission, whereas 20% proceeded with cholecystectomy at a later date. 88% of admissions had a diet ordered within 24 hours of admission. The median LOS was 4 days in the early feeding group, in contrast to 7.5 days in admissions which did not have diet ordered within 24 hours. A total of 3 patients received parenteral nutrition, however only one of these patients was eligible for enteral feeding.

Conclusions

This study demonstrates that increasing cholecystectomy rates during index admission is an area to improve upon. Early diet orders were associated with a shorter hospital LOS; however additional evidence of direct correlation is required. Further studies are warranted to identify system level factors affecting quality of care as well as the development of targeted interventions in AP.

Funding Agencies

None

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Recent advances on mycotic keratitis caused by dematiaceous hyphomycetes

Dematiaceous hyphomycetes (DH) are darkly pigmented fungi ubiquitously found all over the world as plant pathogens and saprophytes, and many of the members of this group have emerged as opportunistic pathogens. These fungi are responsible for a wide variety of infections including mycotic keratitis, which is considered as one of the major causes of corneal blindness, particularly in tropical and subtropical countries with an annual global burden of about 1 000 000 patients. The infection is more common in workers working in an outdoor environment. Moreover, trauma is found to be the most important predisposing cause of mycotic keratitis. Considerable delay in diagnosis and scarcity of effective pharmacological drugs are the major factors responsible for increased morbidity and visual impairment. Considering the crucial role of DH in mycotic keratitis, in the present review, we have focused on major DH with special emphasis on their pathogenicity, diagnosis and treatment strategies.

A195 THE CANADIAN POEM EXPERIENCE. THE FIRST 50 PATIENTS

Background

Achalasia is a disorder of esophageal motility characterized by a loss of enteric neurons resulting in impaired relaxation of the lower esophageal sphincter and absence of esophageal peristalsis. There are no current treatments that allow for regeneration of the enteric neurons. Interventions focus primarily on lowering the LES pressure to provide symptom relief and improve quality of life. Peroral endoscopic myotomy (POEM) has emerged as a less invasive technique for performing myotomy in patients with achalasia.

Aims

This study aims to assess the safety and efficacy of POEM in a Canadian tertiary care center.

Methods

All consecutive patients who underwent POEM between March 2016 and May 2018 at a tertiary center were included. The primary outcome of the study was clinical success rate of POEM defined as a post-POEM Eckardt score ≤ 3 at ≥ 3 months. Adverse events were recorded according to the Clavien-Dindo grading system.

Results

A total of 50 consecutive patients underwent 51 POEM procedures with a mean procedure length of 85.6±29.6 minutes. Post-POEM Eckardt scores of ≤ 3 at ≥ 3 months was achieved in 98% of patients. The incidence of pathologic reflux post-poem was 23%. The median length of hospital stay was 1 day (range 1–2 days). No major adverse events occurred.

Conclusions

POEM is a safe and effective procedure for the treatment of achalasia. At a median follow up of 19.5 months, 98% of patients had sustained clinical response (Eckardt score ≤ 3).

Funding Agencies

None

Thenar lumps: a review of differentials

Most soft-tissue lumps in the hand are benign, with ganglions being the commonest, but in the thenar region, solid soft-tissue masses are more common than a ganglion. In this review, we focus on soft-tissue lesions (neoplastic and non-neoplastic) presenting as a palpable lump in this region. A specific diagnosis can often be reached using ultrasonography and/or magnetic resonance imaging. Most of these lesions are managed in local hospitals or primary care, whereas some are referred to specialist centres. This review article will help both general and musculoskeletal radiologists to diagnose and characterise these lesions, provide a guide for further imaging, and provide an insight into imaging features that may need specific investigations such as core biopsy, tertiary referral, and further review at multidisciplinary meetings.

Antimicrobial and cytotoxic activity of silver nanoparticles synthesized from two haloalkaliphilic actinobacterial strains alone and in combination with antibiotics

AIMS

Presently, the effective antimicrobial agents have been limited by the emergence of microbial strains with multidrug resistance and biofilm formation potential. In the present study, we report remarkable antimicrobial activity of silver nanoparticles (AgNPs) synthesized from Streptomyces calidiresistens IF11 and IF17 strains, including inhibition of biofilm formation and synergistic effect of AgNPs and antibiotics against selected bacteria and yeasts. Cytotoxic effect of AgNPs on mammalian cell lines was also evaluated.

METHODS AND RESULTS

Analysis of biosynthesized AgNPs by Fourier Transform Infrared Spectroscopy and transmission electron microscopy revealed their spherical shape, small size in the range of 5-50 and 5-20 nm, respectively, as well as the presence of capping agents. Study of antimicrobial activity of AgNPs against Bacillus subtilis, Staphylococcus aureus, Escherichia coli, Candida albicans and Malassezia furfur evaluated by minimum inhibitory concentration (MIC) and minimum biocidal concentration (MBC) assays revealed that MICs of AgNPs from IF11 and IF17 strains against bacteria and yeasts were found to be in the range of 16-128 and 8-256 μg ml^-1 , while MBCs were in the range of 48-192 and 32-256 μg ml^-1 respectively. AgNPs inhibited biofilm formation of microbial strains, which was tested by using crystal violet stain. The highest synergistic effect determined by fractional inhibitory index of AgNPs with antibiotic (kanamycin or tetracycline) was found against Staph. aureus; while in case of yeasts, M. furfur showed highest sensitivity to AgNPs-ketoconazole combination (FIC = 0·12). The cytotoxic activity of AgNPs towards HeLa and 3T3 cell lines was studied by MTT assay. The IC₅₀ of AgNPs estimated against mouse fibroblasts was found to be 8·3 and 28·3 μg ml^-1 and, against HeLa cell line, 28·5 and 53·8 μg ml^-1 respectively.

CONCLUSIONS

It can be concluded that AgNPs synthesized from S. calidiresistens IF11 and IF17 strains have potential as an effective antimicrobial and cytotoxic agent, especially when used in combination with antibiotics/antifungal agents.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study indicates potential application of biogenic silver nanoparticles as an antimicrobial agent in nanomedicine.

A177 BIRTH COHORT SCREENING FOR HEPATITIS C IN AN OUTPATIENT ENDOSCOPY UNIT: A PILOT STUDY

Background

Chronic hepatitis C (HCV) is a curable asymptomatic infection that can progress to liver failure and hepatocellular carcinoma if left untreated. The Canadian Liver Foundation (CLF) recommends one-time HCV screening in all Canadians born from 1945–1975. A large proportion of outpatient endoscopic procedures are for colon cancer screening in this birth cohort providing an opportunity for HCV screening and linkage to HCV care.

Aims

We aimed to assess the feasibility of developing a targeted birth-cohort HCV screening program in the outpatient endoscopy setting.

Methods

This is a cross-sectional study of patients born from 1945–1975 presenting to the outpatient endoscopy unit at Hotel Dieu Hospital in Kingston, Ontario in September, 2016. Patients were scheduled for upper endoscopy, colonoscopy, and/or sigmoidoscopy. All patients were given written information on HCV and the CLF recommendation of birth-cohort screening. Patients were then asked to complete a short survey regarding previous HCV screening and acceptance of being screened during their endoscopy visit.

Results

During a 30 day period, 95% (223/235) of eligible patients completed the survey. The cohort was 53% female with a median age of 59 years (IQR 52–66 years). 83% had either never been screened or were unaware of their HCV status. Overall, 87% of participants would be accepting of HCV screening during their endoscopy visit, 9% would not accept screening and 4% stated they were unsure. These results suggest that almost 2,000 patients could be targeted for HCV screening in the endoscopy unit annually.

Conclusions

Most patients born from 1945–1975 presenting for outpatient endoscopy have not been screened for HCV but are accepting of screening during their procedural visit. This identifies a target population for the development of an HCV screening program to increase HCV identification and facilitate linkage to HCV care.

Funding Agencies

None

Evaluation of cytotoxicity, immune compatibility and antibacterial activity of biogenic silver nanoparticles

The study was focused on assessment of antibacterial activity, cytotoxicity and immune compatibility of biogenic silver nanoparticles (AgNPs) synthesized from Streptomyces sp. NH28 strain. Nanoparticles were biosynthesized and characterized by UV-Vis spectroscopy, transmission electron microscopy, Fourier transform infrared spectroscopy, nanoparticle tracking analysis system and zeta potential. Antibacterial activity was tested against Gram-positive and Gram-negative bacteria; minimal inhibitory concentration was recorded. Cytotoxicity was estimated using L929 mouse fibroblasts via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide test. Biocompatibility of AgNPs was performed using THP1-XBlue™ cells. Biogenic AgNPs presented high antibacterial activity against all tested bacteria. Minimum inhibitory concentration of AgNPs against bacterial cells was found to be in range of 1.25-10 μg/mL. Silver nanoparticles did not show any harmful interaction to mouse fibroblast cell line, and no activation of nuclear factor kappa-light-chain-enhancer of activated B (NF-κB) cells was observed at concentration below 10 µg/mL. The half-maximal inhibitory concentration (IC₅₀) value was established at 64.5 μg/mL. Biological synthesis of silver can be used as an effective system for formation of metal nanoparticles. Biosynthesized AgNPs can be used as an antibacterial agent, which can be safe for eukaryotic cells.

Laser-induced excited-state crossover and spectral variation of Cr3+ in the high-crystal-field environment of CaGa2O4

We have studied a wide-bandgap oxide semiconductor, CaGa_1.99Cr_0.01O₄, which possesses high crystal field strength and develops deep traps. These traps efficiently store electric charges after excitation with ultraviolet light. Stimulation of trap charges using infrared radiation (both coherent and incoherent) gives wideband emission of Cr³⁺ in the red-infrared region, which is similar to the photon upconversion process in lanthanides. Under laser excitation, high photon density and local heating pronounce the coupling of E2 and T₂4 states and causes an excited state crossover of the population from the E2 to T₂4 state. This expands the emission band-width of Cr³⁺ up to 900 nm.

From QTL to variety-harnessing the benefits of QTLs for drought, flood and salt tolerance in mega rice varieties of India through a multi-institutional network

Rice is a staple cereal of India cultivated in about 43.5Mha area but with relatively low average productivity. Abiotic factors like drought, flood and salinity affect rice production adversely in more than 50% of this area. Breeding rice varieties with inbuilt tolerance to these stresses offers an economically viable and sustainable option to improve rice productivity. Availability of high quality reference genome sequence of rice, knowledge of exact position of genes/QTLs governing tolerance to abiotic stresses and availability of DNA markers linked to these traits has opened up opportunities for breeders to transfer the favorable alleles into widely grown rice varieties through marker-assisted backcross breeding (MABB). A large multi-institutional project, "From QTL to variety: marker-assisted breeding of abiotic stress tolerant rice varieties with major QTLs for drought, submergence and salt tolerance" was initiated in 2010 with funding support from Department of Biotechnology, Government of India, in collaboration with International Rice Research Institute, Philippines. The main focus of this project is to improve rice productivity in the fragile ecosystems of eastern, northeastern and southern part of the country, which bear the brunt of one or the other abiotic stresses frequently. Seven consistent QTLs for grain yield under drought, namely, qDTY1.1, qDTY2.1, qDTY2.2, qDTY3.1, qDTY3.2, qDTY9.1 and qDTY12.1 are being transferred into submergence tolerant versions of three high yielding mega rice varieties, Swarna-Sub1, Samba Mahsuri-Sub1 and IR 64-Sub1. To address the problem of complete submergence due to flash floods in the major river basins, the Sub1 gene is being transferred into ten highly popular locally adapted rice varieties namely, ADT 39, ADT 46, Bahadur, HUR 105, MTU 1075, Pooja, Pratikshya, Rajendra Mahsuri, Ranjit, and Sarjoo 52. Further, to address the problem of soil salinity, Saltol, a major QTL for salt tolerance is being transferred into seven popular locally adapted rice varieties, namely, ADT 45, CR 1009, Gayatri, MTU 1010, PR 114, Pusa 44 and Sarjoo 52. Genotypic background selection is being done after BC2F2 stage using an in-house designed 50K SNP chip on a set of twenty lines for each combination, identified with phenotypic similarity in the field to the recipient parent. Near-isogenic lines with more than 90% similarity to the recipient parent are now in advanced generation field trials. These climate smart varieties are expected to improve rice productivity in the adverse ecologies and contribute to the farmer's livelihood.

Controlled synthesis, bioimaging and toxicity assessments in strong red emitting Mn2+ doped NaYF4:Yb3+/Ho3+ nanophosphors

Rare earth, Yb³⁺/Ho³⁺ doped NaYF₄ nanophosphors co-doped with Mn²⁺ showed enhanced red emission under NIR irradiation and were successfully used for cancer cell imaging.

Probing a new approach for warm white light generation in lanthanide doped nanophosphors

Warm white light generation through modification of CCT by incorporation of the defect level induced emission of ZnO in Y_1.993Dy_0.001Tm_0.006O₃ nano-phosphors.

Regulatory and effector T cells changes in remission and resistant state of childhood nephrotic syndrome

Idiopathic minimal change disease is a disorder of T-cell dysfunction. The relative predominance of regulatory T cells (Tregs), Th1, and Th2 cells in nephrotic syndrome (NS) remains controversial. Imbalance in peripheral blood regulatory and effector T cells (Teff) are linked to cell mediated immune response and may be associated with steroid response in NS. Peripheral blood CD4 + CD25 + FoxP3 + (Tregs), CD4 + IFN-γ⁺ (Th1), and CD4 + IL-4 + (Th2) lymphocytes were analyzed in 22 steroid-sensitive NS (SSNS) patients in sustained remission, 21 steroid-resistant NS (SRNS) and 14 healthy controls. The absolute percentage values and ratio of Th1/Tregs, Th2/Tregs, and Th1/Th2 were compared between SSNS, SRNS and control subjects. The percentage of Tregs was lower in SRNS patients (P = 0.001) compared with that of SSNS and healthy control. The percentage of Th1 cells was higher in SRNS (P = 0.001) compared to that of SSNS patients; however, it was similar to healthy controls (P = 1.00). The percentage of Th2 cells in SRNS (P = 0.001) was higher as compared to SSNS and controls. The ratio of Th1/Treg cells in SRNS (P = 0.001) was higher as compared to SSNS patients and controls. The ratio of Th2/Treg was also higher in SRNS as compared to SSNS and controls. The ratio of Th1/Th2 cells in SSNS, SRNS, and healthy controls were similar. The cytokines secretion complemented the change in different T-cell subtypes in SSNS, SRNS and healthy controls. However, the IFN-γ secretion in healthy controles was low inspite of similar percentage of Th1 cells among SRNS cases. We conclude that greater ratio of Tregs compared to that Th1 and Th2 favor steroid sensitivity and reverse ratio results in to SRNS. The difference in ratio is related to pathogenesis or it can be used as marker to predict steroid responsiveness needs further evaluation.

Educational attainment and obesity: a systematic review

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.

Clinical profile and response to first-line ARV in HIV patients from Eastern UP and Bihar: a retrospective study

BACKGROUND AND OBJECTIVES

Spectrum of infections in Human Immunodeficiency Virus (HIV) infected patient from Eastern UP and Bihar has not been systemically evaluated. This study was conducted with the following objectives; a) explore the spectrum of clinical conditions associated with HIV disease, b)the difference between clinical and investigatory parameters in those patients who presented with infection from those who present without infection and c) to evaluate the effect of anti-retroviral (ARV) therapy.

METHODS

1248 subjects who fulfilled the inclusion criteria were enrolled for the study from May 2007 to November 2008. Patients were evaluated for their baseline characteristics along with CD4 count and followed up for at least for 6 months after initiation of ARV (6-24 months).

RESULT AND INTERPRETATION

In this retrospective study, tuberculosis (58.96%) was the commonest infection followed by chronic diarrhoea (26.56%) and various skin infections. Males had significantly higher incidence (p value < .001) of infection as compared to females. There was a significant difference between the patients who presented with infection from those who presented without infection for their baseline weight (42.3 vs 45.42), haemoglobin (9.06 vs 9.91), mean CD4 count at baseline (107.38 vs 128.38/microL) and CD4 count after 6 month of therapy (298.09 vs 322.98/microL). Mortality was also significantly high (p value < 0.05) in those who presented with infection (19.95% vs 15.1%), although there was no difference between these two groups on their improvement in CD4 count from baseline after 6 months of therapy.

CONCLUSION

Among the spectrum of infection in HIV patient from North East part of India, tuberculosis was commonest, followed by skin infections and chronic diarrhoea. Patients who presented with infection at the time of initial presentation had a low haemoglobin, body weight and CD4 count and had high initial mortality but if they survived they show similar response to ARV therapy as patients who presented without infection.

Depression, insomnia and sleep apnea in patients on maintenance hemodialysis

Depression and sleep disorders are more frequent in patients on maintenance hemodialysis (HD) than the general population, and are associated with reduced quality of life and increased mortality risk. The purpose of this study was to assess the prevalence of depression, sleep apnea, insomnia in patients on HD as well as depression in their primary caregiver and to correlate these with the demographic profile. A cross-sectional study was conducted among 69 patients on maintenance HD for more than 3 months. There was high p revalence of depression (47.8%), insomnia (60.9%), increased risk of sleep apnea (24.6%) and depression in caregiver (31.9%). Depression was significantly more in patients with low monthly income (P=0.03), those on dialysis for more than 1 year (P=0.001) and the unemployed (P=0.009). High-risk patients for sleep apnea tended to be males with low monthly income (P=0.02). Insomnia was significantly higher in patients who were on dialysis for more than 1 year (P=0.003).

Endocrine changes in male HIV patients

AIMS AND OBJECTIVES

To determine the frequency of adrenal, thyroid and gonadal dysfunction in HIV positive male patients and to evaluate the endocrine function at different level of CD4 cell counts.

MATERIAL AND METHODS

A total of 150 male HIV positive subjects were included in study. The patients were divided in three groups on the basis of CD4 cell counts. "Group A": HIV positive with CD4 count<200/mm "Group B": HIV positive with CD4 count 200-350/mm3 and "Group C": HIV positive with CD4 count>350/mm3.

RESULTS

In "group A" (n=50) 2 patients had basal cortisol<5 microg/dl while 23 patients had basal cortisol>25 microg/ dl. 15 patients had subclinical hypothyroidism while 11 patients had overt hypothyroidism. 25 patients in this group had gonadal dysfunction: majority of them (24) had primary gonadal dysfunction (elevated LH). None of the patients in "group B" (n=50) had hypocortisolism while 11 patients had elevated cortisol; 18 had subclinical hypothyroidism while 4 had overt hypothyroidism while 17 patients were hypogonad, all having elevated LH. In "group C" (n=50) 2 patients had hypocortisolism and 5 had elevated cortisol; 12 patients had subclinical and one had overt hypothyroidism; 7 patients had primary hypogonadism and one had secondary hypogonadism. Overall 4(2.66%) had hypocortisolism while 39 (26%) had elevated cortisol; 45 (30%) had subclinical hypothyroidism while 16(10.66%) had overt hypothyroidism. Gonadal dysfunction was observed in 50 patients (33%) majority of them (48) had primary hypogonadism. On analysis of Pearson's correlation coefficient CD4 count has strong inverse correlation with basal cortisol (r=-0.301, p<0.0001), TSH (r=-0.257, p=0.002) and LH (r=-0.228, p=0.006), while there was a direct correlation with serum testosterone (r=0.175, p=0.037).

CONCLUSION

This pilot study has demonstrated a high incidence of endocrine dysfunction in HIV infected patient in this part of country. High incidence of thyroid and gonadal dysfunction may contribute to morbidity of the patients and have a bearing on quality of life of the HIV infected patients. Hypocortisolism was not that common but high level of cortisol may be a marker of stress due to HIV per se or due to associated infection. Many of these dysfunctions might be transient and a large longitudinal study should be undertaken to substantiate the finding of the present study.

Molecular Characterization of Tomato leaf curl Palampur virus and Pepper leaf curl betasatellite Naturally Infecting Pumpkin (Cucurbita moschata) in India

Pumpkin cultivation in India is affected by severe incidence of a yellow vein mosaic disease. Tomato leaf curl New Delhi virus and Squash leaf curl China virus are known to be associated with this disease in India. We were able to identify a third begomovirus-Tomato leaf curl Palampur virus (ToLCPMV), from pumpkin showing typical symptoms of the disease at Varanasi based on the sequence of complete DNA-A genome of the virus. The complete DNA-A sequence of the virus shared more than 99% sequence identity with other ToLCPMV isolates available in the GenBank and clustered with them in the phylogenetic analysis. This betasatellite amplified from the same infected sample has been identified as Pepper leaf curl betasatellite (PepLCB) which also infects chilli in India. There was 92% sequence identity between the two isolates. This is the first report of natural infection of ToLCPMV on pumpkin and association of PepLCB with yellow vein mosaic disease of pumpkin in India.

The definition of exertion-related cardiac events

Vigorous physical activity increases the risk of sudden cardiac death (SCD) and acute myocardial infarction (AMI) but there is no standard definition as to what constitutes an exertion-related cardiac event, specifically the time interval between physical exertion and cardiac event. A systematic review of studies related to exertion-related cardiac events was performed and the time interval between exertion and the event or the symptoms leading to the event was looked for in all the articles selected for inclusion. A total of 12 of 26 articles "suggested" or "defined" exertion-related events as those events whose symptoms started during or within 1 h of exertion. Others used definitions of 0.5 h, 2 h, "during exertion", "during or immediately post exertion" and "during or within several hours after exertion". It is suggested, therefore, that the definition of an exertion-related cardiac event be established as a cardiac event in which symptoms started during or within 1 h of physical exertion.