Digital wrist tomosynthesis (DWT)-based finite element analysis of ultra-distal radius differentiates patients with and without a history of osteoporotic fracture

Despite effective therapies for those at risk of osteoporotic fracture, low adherence to screening guidelines and limited accuracy of bone mineral density (BMD) in predicting fracture risk preclude identification of those at risk. Because of high adherence to routine mammography, bone health screening at the time of mammography using a digital breast tomosynthesis (DBT) scanner has been suggested as a potential solution. BMD and bone microstructure can be measured from the wrist using a DBT scanner. However, the extent to which biomechanical variables can be derived from digital wrist tomosynthesis (DWT) has not been explored. Accordingly, we measured stiffness from a DWT based finite element (DWT-FE) model of the ultra-distal (UD) radius and ulna, and correlate these to reference microcomputed tomography image based FE (μCT-FE) from five cadaveric forearms. Further, this method is implemented to determine in vivo reproducibility of FE derived stiffness of UD radius and demonstrate the in vivo utility of DWT-FE in bone quality assessment by comparing two groups of postmenopausal women with and without a history of an osteoporotic fracture (Fx; n = 15, NFx; n = 51). Stiffness obtained from DWT and μCT had a strong correlation (R2 = 0.87, p < 0.001). In vivo repeatability error was <5 %. The NFx and Fx groups were not significantly different in DXA derived minimum T-scores (p > 0.3), but stiffness of the UD radius was lower for the Fx group (p < 0.007). Logistic regression models of fracture status with stiffness of the nondominant arm as the predictor were significant (p < 0.01). In conclusion this study demonstrates the feasibility of fracture risk assessment in mammography settings using DWT imaging and FE modeling in vivo. Using this approach, bone and breast screening can be performed in a single visit, with the potential to improve both the prevalence of bone health screening and the accuracy of fracture risk assessment.

An Expeditious Route for the Synthesis of Oxazepine Triazolo-β-Lactams through Intramolecular Metal-Free [3+2] Azide–Alkyne Cycloaddition

A copper-free intramolecular azide–alkyne cycloaddition reaction of 4-hydroxymethyl-β-lactam with sodium azide has been described. The present approach involves the incorporation of an alkyne moiety through O-alkynylation of 3-hydroxy β-lactam with various propargylic halides. The generality of the method has been demonstrated by treating the corresponding tosylates or mesylates of the hydroxymethyl functionality of a variety of β-lactam-tethered terminal and internal alkynes with sodium azide in a one-pot three-step reaction to furnish novel oxazepane-β-lactam fused triazole scaffolds of diverse interest in good yield.

Anaemia in Newly Diagnosed Patients of Rheumatoid Arthritis and its Correlation with Disease Activity

AIM

To detect frequency of anemia in patients of Rheumatoid arthritis (RA) and to establish relationship between hemoglobin level and disease activity in RA.

METHOD

Fifty nine patients of RA fulfilling 2010 ACR/EULAR criteria of RA having disease duration less than two years were included in the study. Haemoglobin (Hb) levels were measured. Disease activity was assessed by DAS-28 score.

RESULTS

Among 40/59 (67.80%) anemic cases, 22/40 (55%) patients had anaemia of chronic disease (ACD), 11/40 (27.50%) patients had Iron deficiency anemia (IDA), 3/40 (7.5%) patients had vitamin B(12) deficiency, 1/40 (2.50%) patient had folate deficiency and 3/40 (7.50%) patients had combined IDA and vitamin B(12) deficiency. Duration of disease, rheumatoid factor positivity and occurrence of erosive disease were not significantly different among anaemic and nonanaemic patients (p>0.05 for each). Mean ESR (p>0.02) and DAS-28 (p>0.001) were statistically significantly different among anaemic and nonanaemic patients. Haemoglobin level had significant negative correlation with disease activity (DAS28) in RA cases (r -0.5533, p<0.0001). Conclusion: Anemia was seen in higher frequency in RA patients. Haemoglobin had significantly negative correlation with disease activity (DAS 28) in RA. .

CONCLUSION

Anemia was seen in higher frequency in RA patients. Haemoglobin had significantly negative correlation with disease activity (DAS 28) in RA.

An expeditious green route toward 2-aryl-4-phenyl-1H-imidazoles

Background

Azaheterocycles are an important class of compounds because of their highly potent medicinal activities, and the imidazole subcategory is of special interest in regard to drug discovery research.

Findings

An expeditious synthetic protocol of 2-aryl-4-phenyl-1H-imidazoles has been accomplished by reacting phenylglyoxal monohydrate, ammonium acetate, and aldehyde under sonication. Following this green approach a series of 2-aryl-4-phenyl-1H-imidazoles has been synthesized using diversely substituted aldehydes.

Conclusions

A rapid and simple synthetic procedure to synthesize diversely substituted 2-aryl-4-phenyl-1H-imidazoles has been reported. Other salient features of this protocol include milder conditions, atom-economy, easy extraction, and minimum wastes. The present procedure may find application in the synthesis of biologically active molecules.

Atrial Septal Aneurysm Presenting as Clubbing without Clinically Apparent Cyanosis

Atrial septal aneurysm (ASA) is a localised "saccular" deformity which protrudes to the right or the left atrium or on both sides. It is a rare, but well recognised cardiac abnormality. It is usually an incidental finding or may presents as atrial arrhythmias or arterial embolism. Though it is an acyanotic congenital heart disease but it may result in significant right to left shunt and cyanosis. We describe a patient of ASA with atrial septal defect who presented with clubbing and right to left shunt without clinically apparent cyanosis.

Methaemoglobinaemia as a result of nitrite poisoning

Methaemoglobinaemia due to nitrite poisoning is rare. Awareness of this condition in the cyanosed patient not responding to oxygenation and timely administration of methylene blue may be life saving. We report a case of methaemoglobinaemia as a result of sodium nitrite poisoning.

Estimation of vitamin D levels in rheumatoid arthritis patients and its correlation with the disease activity

AIM

To detect level of serum vitamin D in patients of Rheumatoid arthritis (RA) and to establish relationship between serum vitamin D level and disease activity in RA.

METHOD

Eighty patients of RA fulfilling 1987 revised criteria of the American College of Rheumatology (ACR) of RA classification and eighty healthy controls were included in the study. 25 (OH) vitamin D levels were measured. Disease activity was assessed by DAS-28 score.

RESULTS

Ninety percent of RA patients were either vitamin D deficient or insufficient while only seventy percent of healthy controls were either vitamin D deficient or insufficient(p=0.007). Mean serum vitamin D levels of RA patients was significantly low compared to healthy controls (p=0.009). Thirty-one patients had high disease activity (DAS-28 score >5.1, group A), 32 patients had moderate disease activity (DAS 28 score 3.2-5.1, group B) and 17 patients had low disease activity (DAS-28 score <3.2, group C). Vitamin D levels in high disease activity group was significantly low compared to vitamin D level in patients with low and moderate disease activity (p<.001) and vitamin D level had significant negative correlation with DAS28 score (r=-0.604, p<0.001).

CONCLUSION

Serum vitamin D levels were significantly low in RA patients than in healthy controls. Vitamin D deficiency was seen in significantly higher numbers of patients and vitamin D had negative correlation with disease activity in RA.

Anti-nucleosome antibodies in patients with systemic lupus erythematosus: potential utility as a diagnostic tool and disease activity marker and its comparison with anti-dsDNA antibody

OBJECTIVE

To compare the utility of anti-nucleosome antibodies and anti-dsDNA antibodies in diagnosis of Systemic Lupus Erythematosus (SLE) and as a marker of disease activity.

METHODS

This is a hospital based observational study among 40 (37 females and 3 males) selected cases of SLE (> or = 4 ACR criteria) and 80 control. 40 cases of other systemic autoimmune disease (SAD) [e g. 29 cases of Rheumatoid arthritis, 4 cases of Systemic sclerosis/scleroderma, 4 cases of Sjögren syndrome, 3 cases of MCTD and 40 Healthy blood were taken as control. From each patient venous blood samples were collected and submitted for anti-nucleosome and anti-dsDNA antibodies assay by enzyme linked immunosorbent assay (ELISA).

RESULTS

Anti-nucleosome antibodies were positive in 19 (47.5%) SLE, 02 (05%) other SAD and none of the healthy persons. Anti dsDNA antibodies were positive in 15 (37.5%) SLE patients, 07 (17.5%) other SAD and 01(2.5%) healthy persons. For diagnosis of SLE, sensitivity of anti-ds DNA and anti-nucleosome antibody was found to be 37.5% and 47.50% respectively. The specificity of anti-nucleosome was 100% and that of anti-dsDNA was 97.50%. So, anti-nucleosome antibody test is more specific and more sensitive for diagnosis of SLE than anti-dsDNA. When SLE cases were compared with SAD, sensitivity of anti-dsDNA and anti-nucleosome antibody, for diagnosis of SLE, found to be 37.50% and 47.50% respectively but the specificity of anti-nucleosome was 95% and that of anti-dsDNA was 82.50%. Both antibodies show positive correlation with SLEDAI score .The correlation coefficient was stronger for anti-dsDNA antibodies (r = +0.550, P = < .001) than anti-nucleosome antibodies (r = +0.332, P = < .05) CONCLUSIONS: Anti-nucleosome antibodies show higher positivity than anti-dsDNA antibodies among SLE than other SAD and healthy population. Anti-nucleosome antibodies are more sensitive and specific for the diagnosis of SLE than anti-dsDNA antibodies. Anti-nucleosome and anti-dsDNA both show positive correlation with SLEDAI. But anti-dsDNA antibodies show stronger correlation with SLEDAI than anti-nucleosome. So, anti-nucleosome antibodies can be used as an additional marker for diagnosis of SLE and SLE disease activity.

Aluminum nitrate (Al(NO3)3) as defluoridating agent in drinking water soil pots (vessels of earthenware)

Presence of fluoride in drinking water above (and sometimes even below) permissible limit (1.5 ppm according to WHO) leads to fluorosis. Aluminum salts are commonly used as coagulants in water treatments. Aluminum fluoride is less toxic than other fluorides. The concentration of fluoride was determined by the fluoride ion selective electrode method. In this study, Al (NO3)3 was incorporated in different amounts in soil and prepared soil pots by the mixture. It is observed that these soil pots remarkably decrease the concentration of fluoride in drinking water. Langmuir and Freundlich isotherm studies were also carried out.

Pseudo-aneurysm of left ventricle

A 16 years boy who presented with pain chest, precordial bulging with abnormal chest movement and fever was diagnosed to have pseudo-aneurysm of left ventricle with infective endocarditis.

Partial HPRT deficiency (Kelley-Seegmiller syndrome)

Hypoxanthine-guanine phosphoribosyl transferase (HPRT) deficiency is an X-linked defect of purine metabolism. Clinical manifestations are usually related to the degree of enzyme deficiency; complete HPRT deficiency (Lesh-Nyhan Syndrome) presenting with severe neurological or renal symptoms, or partial HPRT deficiency (Kelley-Seegmiller syndrome) manifesting as a gout-urolithiasis syndrome. We report a case of partial HPRT deficiency presenting as chronic tophaceous gout, mental retardation, nephrolithiasis and family history suggestive of X-linked inheritance, for its rarity.

Isolation and structure elucidation of a new antifungal and antibacterial antibiotic produced by Streptomyces sp. 201

An antibacterial and antifungal antibiotic was isolated from the culture filtrate of Streptomyces sp. 201, and its structure was determined as 2-methyl-heptyl isonicotinate by extensive use of NMR spectroscopy. The compound exhibited marked antimicrobial activity against Bacillus subtilis, Shigella sp., Klebsiella sp., E. coli, Proteus mirabilis, and the pathogenic fungi, Fusarium moniliforme, F. semitectum, F. oxysporum, F. solani and Rhizoctonia solani.

A new cardenolide from the roots of Terminalia arjuna

A new cardenolide, 16,17-dihydroneridienone 3-O-beta-D-glucopyranosyl-(1-->6)-O-beta-D-galactopyranoside (1), was isolated from the roots of Terminalia arjuna.

Immune responses to chloroquine--sensitive and resistant populations of Plasmodium berghei in mice

In order to elucidate the role of the host as a factor in the spread of chloroquine resistance, a study of the host's immune responses in chloroquine resistant (cqr) and chloroquine sensitive (cqs) Plasmodial infections is essential. Course of the infection and the nature of immune responses in mice infected with chloroquine resistant (R) and chloroquine sensitive (S) strains of Plasmodium berghei were compared. Crude parasite antigen activated T cells from both the groups of mice (R and S) and the parasite specific antibodies were detected in the sera of both the groups. The differences in immune responses between the control (uninfected) and infected mice were found to be significant. However, humoral and in vitro cellular responses obtained with T cells from chloroquine resistant P. berghei primed mice was lower in comparison with the responses obtained with T cells from the sensitive infections. Our studies therefore suggest that immunosuppression to parasite antigen is seen in mice primed with chloroquine resistant P. berghei, which may play a role in the development of resistance.

Total serum levels of triiodothyronine (T3) thyroxine (T4) and thyrotropine (TSH) in school going children of Dibrugarh district: an endemic goitre region of Assam

The Thyroid Status was studied by estimating the total serum levels of T3 and T4 by radioimmunoassay (RIA) and TSH by radioimmunometric Assay (IRMA) from 635 school children (8-20 years; male 129, female 506) of the Dibrugarh district: a chronic endemic goitrous region of India. The results were compared with the control group of 147 (male 48, female 99) of healthy medical students of the same geographical area. The average values of T3 and TSH of school children were found higher and T4 lower than the control; the difference were only significant for T3 and TSH. T3/T4 ratio is more in school children than the control. The findings of low T4 and high TSH indicate that the school children (Pubertal stage) from chronic iodine deficients areas suffer from poor thyroid status; the male seemed to have been affected more than the female. As age advances the thyroid status improves in female.

Malaria in Shankargarh PHC, Allahabad District (U.P.): a clinical report

A longitudinal study of malaria incidence recorded at malaria clinic of MRC, Shankargarh, during 1988-1991 showed the immense popularity of the clinic in quarry area. In clinical cases, SPR and SfR gradually increased from 45.6 and 18.2 in 1988 to 52.5 and 34.5 respectively in 1991. Increase in malaria cases during the reporting period was mainly contributed by P. falciparum cases. Peaks of vivax and falciparum malaria were recorded in September and October respectively. Extended transmission in Shankargarh region might be attributed to the influx of quarry labourers after post-monsoon season. SfR for 0 to 1-year age group malaria cases was found to be relatively low as compared to the higher age groups. Only 56 per cent of malaria-positive patients reported in the clinic had fever.

An experimental model of oculorespiratory reflex

An experimental study of the oculorespiratory reflex (ORR) was conducted on 20 albino rabbits using a square wave (SW) type of stimulus. The ORR could be elicited in 100% of animals. The medial rectus was observed to be most reflexogenic for ORR. The frequency and pattern of ORR was not affected by bilateral vagotomy, intravenous atropine or glycopyrrolate, but could be completely abolished by retrobular block.

Isocitrate dehydrogenase activity and its regulation by estradiol in tissues of rats of various ages

The activity and hormonal regulation of NAD- and NADP-linked isocitrate dehydrogenase (EC.1.1.1.41 and EC.1.1.1.42, respectively) in the brain, liver and kidney cortex of female rats of various ages was investigated. The activity of NAD-ICDH of brain was greater than extramitochondrial (-c) or intramitochondrial (-m) NADP-ICDH. In contrast, liver c-NADP-ICDH was much higher than NAD- or m-NADP-ICDH, whereas in kidney cortex the activity of m-NADP-ICDH is dominant over both NAD- and c-NADP-ICDH in all the age group of rats studied. The activity of the NAD-ICDH of brain and all the enzymes of liver and kidney cortex increases until adulthood (33-weeks) and decreases thereafter in old rats (85-weeks). In brain c-NADP-ICDH was much higher in immature (6-weeks) rats and decreases with increasing age of the animal, whereas m-NADP-ICDH showed no significant change with the age of the rats. Bilateral ovariectomy decreases the level of all the three forms of enzyme in all the tissues of 6-, 13- and 33-week rats but failed to show any significant effect in 85-week old rats. Exogenous administration of estradiol induces all the three forms of enzyme in all the tissues of ovariectomized rats. The degree of response is tissue- and age-specific.

Evaluation of serology as a tool for malaria surveillance in East Champaran District of Bihar, India

The indirect immunofluorescence test was evaluated as a tool for malaria surveillance. The population of 12 villages in the East Champaran District of Bihar with a low annual parasitic index and a low annual blood examination rate was surveyed in order to confirm the low endemicity of malaria in these villages. Two specimens of blood, one taken during the pre-transmission season and one taken during the post-transmission season, were collected for parasitological and serological studies. The paired samples showed no parasite positivity in the study population in both surveys. All the villages had very low serological titres. However, the presence of malaria antibodies in the zero to five years age group (the sentinel group) indicated that malaria transmission occurred in the study area at a very low level. The seropositivity and the geometric mean titre were lower in the pre-transmission season than in the post-transmission season, but the overall reduction in geometric mean titre, which was very low throughout the study, was not statistically significant. The study emphasizes the importance of serological tests in malaria surveillance.

Regulation of NAD- and NADP-linked isocitrate dehydrogenase by thyroxine in the brain and liver of female rats of various ages

The specific activity of NAD- and NADP-linked isocitrate dehydrogenase and their regulation by thyroxine in the brain and liver of female rats of various ages were studied with the ultimate goal of better understanding the decreased physiological functioning of the brain and liver during old age. Both thyroidectomy and thyroxine treatment have differential age-dependent effects on the activities of these enzymes in both tissues. The activity of NAD-ICDH decreases whereas both cytoplasmic and mitochondrial NADP-ICDH increase simultaneously following thyroidectomy. Thyroxine administration induces NAD-ICDH and depresses NADP-ICDH. The degree of induction and/or repression is lowest in old rats. These effects of thyroxine are actinomycin D sensitive in both the tissues of rats.

Regulation of NAD- and NADP-linked isocitrate dehydrogenase by hydrocortisone in the brain and liver of male rats of various ages

The activity and hormonal regulation of NAD- and NADP-linked isocitrate dehydrogenase (EC 1.1.1.41 and 1.1.1.42, respectively) in the brain and liver of rats of various ages were investigated. The activity of NAD-linked isocitrate dehydrogenase of the brain was greater than cytoplasmic or mitochondrial NADP-linked isocitrate dehydrogenase. In contrast, the cytoplasmic NADP-isocitrate dehydrogenase of the liver predominates over both NAD- and mitochondrial NADP-isocitrate dehydrogenases at the three ages studied. The activity of NAD-isocitrate dehydrogenase increased in the brain (139%) and liver (17%) of rats up to 33 weeks of age and decreased (57 and 39%, respectively) in old rats (85-week-old). The activity of cytoplasmic NADP-isocitrate dehydrogenase was maximum in immature (6-week-old) rat brain and decreased as the age of the rats increased; whereas, in liver, the activity of this enzyme was found o be maximum in adult rats (33-week-old). Brain mitochondrial NADP-isocitrate dehydrogenase activity increased (64%) in adult rats, but in liver it decreased (45 and 33% in 33- and 85-week-old rats, respectively). In both tissues, adrenalectomy and hydrocortisone treatment showed differential age-dependent response. Hydrocortisone-mediated induction of the level of enzymes was inhibited by actinomycin D.

Philosophic basis of biomedical research. I. Scientific hypotheses

Hypotheses are central in scientific research. This has been so in all the major scientific works of our time. However, the dangers of projecting the desires of hypothesizing individual into his observations and inferences should be avoided and one should consider a hypothesis as a tentative proposition having varifiable consequences. Our present biomedical literature needs more emphasis on well conceived hypotheses. Many of these when subjected to experimentation would be proved wrong, as many have been in the past. But even these would stimulate experimental testing and eventually add to our understanding.

Determination of flucytosine in tablets by differential pulse polarography

A differential pulse polarographic assay was developed for determining flucytosine in tablets. The drug is extracted from the sample with water and hydrochloric acid and, after the pH is adjusted, an aliquot is added to the cell and the solution is polarographed at the dropping mercury electrode versus the saturated calomel electrode with 0.066 M Sørensen phosphate buffer (pH 5.6) as the supporting electrolyte. The polarographic peak height enables precise quantitative determination. The Ep value for flucytosine is--1.54 v versus the saturated calomel electrode. The mean recovery of the drug is 101.5% +/- 1.9 (SD). The method is simple, rapid, and precise.

Determination of fluoxymesterone, norethandrolone, prednisolone, and prednisone in tablets by differential pulse polarography

A differential pulse polarographic method for the determination of fluoxymesterone, norethandrolone, prednisolone, and prednisone in tablets is described. This method is more sensitive than dc polarography, and the measurement of diffusion current is greatly simplified. Sørensen phosphate buffer, pH 5.6, was used as the supporting electrolyte. No apparent interference was observed from tablet excipients; the method is rapid, simple, and relatively precise.