Chemical Synthesis of Human Milk Oligosaccharides: para-Lacto-N-hexaose and para-Lacto-N-neohexaose

Human milk oligosaccharides (HMO) have emerged as a very active area of research in glycoscience and nutrition. HMO are involved in the early development of infants and may help to prevent certain diseases. The development of chemical methods for obtaining individual HMO aids the global effort dedicated to understanding the roles of these biomolecules. Reported herein is the chemical synthesis of two common core hexasaccharides found in human milk, i. e. para-lacto-N-hexaose (pLNH) and para-lacto-N-neohexaose (pLNnH). After screening multiple leaving groups and temporary protecting group combinations, a 3+3 convergent coupling strategy was found to work best for obtaining these linear glycans.

Tenofovir diphosphate in dried blood spots and HIV-1 resistance in South Africa

BACKGROUND

Suboptimal antiretroviral (ART) adherence can lead to virologic failure with consequent HIV-1 resistance. Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is a powerful biomarker of cumulative adherence, predictive of future viremia. It has been associated with resistance in Persons With HIV (PWH) in South Africa and the US. We explored the relationship of TFV-DP concentrations with antiretroviral drug resistance at the time of treatment failure in SA.

METHODS

Adult PWH from health clinics in Cape Town, South Africa on efavirenz-based first-line ART containing tenofovir disoproxil fumarate (TDF) with an undetectable (< 50 copies/mL) HIV-1 viral load (VL) were prospectively enrolled in an observational cohort for 12 months. Monthly study visits included blood collection for HIV-1 VL and DBS for TFV-DP. The first confirmed viral breakthrough (VB) > 400 copies/mL triggered HIV-1 genotyping at the subsequent visit. An electronic adherence (EA) device monitored ART adherence in real-time, estimated as a percent for the 30-days prior to VB. Wilcoxon rank sum test was used to compare median [IQR] TFV-DP by genotype outcome.

RESULTS

Of 250 individuals, (n = 195, 78% women), 21 experienced VB, with a median of 5 [4;7] months on study, and a median EA of 33.3 [13.3;53.3]%. Demographic characteristics between those with and without VB were similar. Median VL at VB was 4.0 [3.2;4.5] log copies/mL. TFV-DP concentrations trended down towards the VB visit. Median TFV-DP concentrations were significantly higher in those HIV-1 genotype did not amplify due to being virally suppressed at the subsequent visit (n = 10; 380 [227-661] fmol/punch, p = 0.035; EA 45 [24.9; 59.2]%); than in those who were successfully genotyped with evidence of drug resistance (n = 5, 241 [150-247] fmol/punch, EA 20 [6.7;36.7]%) and in individuals who did not have resistance (n = 3, 39.9 [16.6; 93.9] fmol/punch; EA 33.3 [16-38]%). Three genotype collections were not done. Only non-nucleoside reverse transcriptase inhibitor-associated mutations were identified on resistance testing. (K103N, E138K, Y118H).

CONCLUSION

TFV-DP in DBS showed a step-wise inverse relationship with VB and drug resistance, with evidence of low cumulative ART adherence in PWH who developed antiretroviral resistance. Monitoring TFV-DP concentrations could be a valuable tool for predicting future VB and future resistance.

Feeding silkworm (Bombyx mori L.) oil to growing rabbits improves the fatty acid composition of meat, liver and perirenal fat

Silkworm oil was used in a rabbit diet to evaluate its benefit on the fatty acid (FA) profile of different carcass portions. Two experimental diets were prepared: a control diet (commercial diet with 13 g/kg sunflower oil) and a silkworm oil diet (SWO) (commercial diet with 13 g/kg silkworm oil). Rabbits received the experimental diets the last three weeks before slaughter, which occurred at 10 weeks of age. At slaughter, hind leg meat, liver, and perirenal fat were sampled for FA profile analysis. The SWO diet significantly increased the n-3 FA of all three sampling sites and halved the n-6/n-3 ratio of hind leg meat and perirenal fat. Furthermore, the liver of SWO rabbits was also richer in C22:6 n-3 compared to that of control rabbits. In conclusion, this study demonstrated that the total dietary replacement of sunflower oil with silkworm oil in fattening rabbits positively changed the FA profile of the considered carcass tissues.

ANN-GA based biosorption of As(III) from water through chemo-tailored and iron impregnated fungal biofilter system

The iron impregnated fungal bio-filter (IIFB) discs of luffa sponge containing Phanerochaete chrysosporium mycelia have been used for the removal of As(III) from water. Two different forms of same biomass viz. free fungal biomass (FFB) and modified free fungal biomass (chemically modified and iron impregnated; CFB and IIFB) have been simultaneously investigated to compare the performance of immobilization, chemo-tailoring and iron impregnation for remediation of As(III). IIFB showed highest uptake capacity and percentage removal of As(III), 1.32 mg/g and 92.4% respectively among FFB, CFB and IIFB. Further, the application of RSM and ANN-GA based mathematical model showed a substantial increase in removal i.e. 99.2% of As(III) was filtered out from water at optimised conditions i.e. biomass dose 0.72 g/L, pH 7.31, temperature 42 °C, and initial As(III) concentration 1.1 mg/L. Isotherm, kinetic and thermodynamic studies proved that the process followed monolayer sorption pattern in spontaneous and endothermic way through pseudo-second order kinetic pathway. Continuous mode of As(III) removal in IIFB packed bed bioreactor, revealed increased removal of As(III) from 76.40 to 88.23% with increased column height from 5 to 25 cm whereas the removal decreased from 88.23 to 69.45% while increasing flow rate from 1.66 to 8.30 mL/min. Moreover, the IIFB discs was regenerated by using 10% NaOH as eluting agent and evaluated for As(III) removal for four sorption–desorption cycles, showing slight decrease of their efficiency by 1–2%. SEM–EDX, pHzpc, and FTIR analysis, revealed the involvement of hydroxyl and amino surface groups following a non-electrostatic legend exchange sorption mechanism during removal of As(III).

Synthesis and Glycosidation of Anomeric Halides: Evolution from Early Studies to Modern Methods of the 21st Century

Advances in synthetic carbohydrate chemistry have dramatically improved access to common glycans. However, many novel methods still fail to adequately address challenges associated with chemical glycosylation and glycan synthesis. Since a challenge of glycosylation has remained, scientists have been frequently returning to the traditional glycosyl donors. This review is dedicated to glycosyl halides that have played crucial roles in shaping the field of glycosciences and continue to pave the way toward our understanding of chemical glycosylation.

ONCOCYTIC ADRENOCORTICAL CARCINOMA IN A YOUNG PATIENT

Context

Adrenocortical carcinoma (ACC) is a rare neoplasm with an aggressive course and poor prognosis. The worldwide incidence is about 0.5 to 2 cases per million population per year. Oncocytic adrenocortical carcinoma is a rare histopathological variant of ACC with only a few reported cases in the literature.

Case report

We report a case of an oncocytic variant of adrenocortical carcinoma in a 21-year-old male patient who presented with a left adrenal mass. Imaging studies confirmed a large left adrenal mass with involvement of the left renal vein and inferior vena cava. Endocrine workup showed mildly elevated serum cortisol levels.

Discussion

Oncocytic AAC is a rare histopathological variant of ACC, as well as a rare subgroup of oncocytic adrenal neoplasms Hormonally active or functioning adrenocortical carcinomas most commonly secrete cortisol whereas co-secretion of multiple steroid hormones is a rare phenomenon.

Conclusions

Surgery remains the mainstay of treatment, but most of the patients present late with large masses and eventually become unsuitable for curative resection.

Influence of green tea powder on the performance, nutrient utilisation, caecal microbiota profile and meat quality of broiler chickens

This study assessed the influence of green tea powder diet supplementation on performance, nutrient utilisation, caecal microbiota profile and meat quality in broiler chickens. A total of 144, one-day-old broiler (Ross 308) chicks were allocated to 18 cages (eight broilers/cage) which were randomly assigned to one of three dietary treatments: a wheat-based basal diet or supplemented with one of two types of green tea; normal (N-GT) or selenium-rich (Se-GT) tea, at an inclusion rate of 1%. Bird performance, nitrogen-corrected apparent metabolisable energy (AMEn), and total tract digestibility of fat and starch were measured on d 7, 21 and 35. Effects on microbiota profile on d 7, 21 and 35 were determined in a cohort study. Green tea supplementation reduced (P<0.05) the weight gain and feed intake but improved (P<0.05) feed efficiency. Supplementation with N-GT increased the AMEn on d 7 and 21, and with Se-GT on d 7 (P<0.05). AMEn increased with age for all treatments. Fat digestibility increased (P<0.05) in birds fed N-GT on d 21 and Se-GT on d 7 and 21. Starch digestibility increased (P<0.05) on d 21 with N-GT supplementation and on d 7 with Se-GT supplementation. Carcass and breast meat yields were unaffected (P<0.05) by the dietary treatments. The abdominal fat pad decreased (P<0.05) in the N-GT diet and numerically in the Se- GT diet. Drip loss was less in meat from birds (P<0.05) fed both green tea treatments. Cooking loss was reduced in the Se-GT treatment (P<0.05). Dietary inclusion of green tea powder positively influenced microbiota profile, with increased (P<0.05) numbers of beneficial bacteria (Lactobacillus spp. and Bifidobacterium spp.) and reduced (P<0.05) numbers of pathogenic bacteria (Clostridium spp. and Bacteroides spp.). Differences were observed between the two green tea types, with Se-GT being more beneficial than N-GT in the positive modulation of intestinal microbiota.

Relevance of work-from-home culture in post Covid-19 era: regarding productivity of employees in IT sector

COVID-19 has not just affected the health of citizens. However, the world’s economic wheel stopped. All the import-export activities were sieged, schools, colleges, malls, and any other similar place, where there is a chance of gathering, has been locked down. A major section of the global economy was closed down for a period of two to three months. Still, they are operating with minimum permitted capacity. The service sector is opening up stage-wise, and people have started to work in their respective offices. Before this, most people, right from teachers to CEOs of top companies, worked from home. 100% of IT and ITES based organizations were working from their homes in the recent past; rather, these people were working from home before the COVID-19 situation. This present study will evaluate the interest areas of people working from home and try to evaluate the scenario of working from home even after the pandemic of COVID-19 is over.

N‐Alkylated analogues of indolylthio glycosides as glycosyl donors with enhanced activation profile

While studying indolylthio glycosides, previously we determined their activation profile that required large excess of activators. This drawback was partially addressed in the present study of N-alkylated SInR derivatives. The activation process was studied by NMR and the increased understanding of the mechanism led to a discovery of different activation pathways taking place with SIn versus SInR derivatives. Also investigated was orthogonality of the SInR leaving groups versus thioglycosides and selective activation of thioimidates over SInR glycosides.

Cannabidiol and refractory epilepsy: parental and caregiver perspectives of participation in a compassionate access scheme

Background

The Compassionate Access Scheme (CAS) being delivered through the Queensland Children’s Hospital is designed to allow access to an investigational purified Cannabidiol oral solution to paediatric patients with severe refractory epilepsy. The objectives of this study were to conduct semi-structured interviews to:

1. Understand families’ expectations and attitudes about the use of an investigational cannabinoid product for their child’s seizures;

2. Understand families’ perceptions of Cannabidiol’s efficacy for their child’s seizures; and other aspects of their child’s behaviour, quality of life and/or cognition.

Methods

Children aged 2-18 years had been enrolled in, or were enrolled in a compassionate access scheme for Cannabidiol at the time of the study. Semi-structured interviews (n = 19) with parents or caregivers (n = 23) of children diagnosed with refractory epilepsy were voice-recorded, transcribed and analysed to generate common themes.

Results

Key themes emerged relating to seizure activity, family and school engagement, drug safety and legal access, efficacy, clinical support, social acceptance of the medication and program delivery. The use of Cannabidiol was perceived to have benefits in relation to reducing the severity and frequency of seizure activity for almost a third of patients experiencing refractory epilepsy. Participants described other benefits including improved social engagement, wakefulness and a reduction of side effects related to a reduction of conventional medication dosage.

Conclusion

This study provided unique perspectives of families’ experiences managing untreatable epilepsy, their experiences with conventional and experimental pharmacological treatments and health services. Whilst families’ perceptions showed the use of Cannabidiol did not provide a therapeutic reduction in the seizure activity for all patients diagnosed with refractory epilepsy, it’s use as an additional pharmacological agent was perceived to provide other benefits by some patient families.

Bismuth(iii) triflate as a novel and efficient activator for glycosyl halides

Presented herein is the discovery that bismuth(iii) trifluoromethanesulfonate (Bi(OTf)3) is an effective catalyst for the activation of glycosyl bromides and glycosyl chlorides. The key objective for the development of this methodology is to employ only one promoter in the lowest possible amount and to avoid using any additive/co-catalyst/acid scavenger except molecular sieves. Bi(OTf)3 works well in promoting the glycosidation of differentially protected glucosyl, galactosyl, and mannosyl halides with many classes of glycosyl acceptors. Most reactions complete within 1 h in the presence of only 35% of green and light-stable Bi(OTf)3 catalyst.

Palladium(II)-assisted activation of thioglycosides

Described herein is the first example of glycosidation of thioglycosides in the presence of palladium(ii) bromide. While the activation with PdBr2 alone was proven feasible, higher yields and cleaner reactions were achieved when these glycosylations were performed in the presence of propargyl bromide as an additive. Preliminary mechanistic studies suggest that propargyl bromide assists the reaction by creating an ionizing complex, which accelerates the leaving group departure. A variety of thioglycoside donors in reactions with different glycosyl acceptors were investigated to determine the initial scope of this new reaction. Selective and chemoselective activation of thioglycosides over other leaving groups has also been explored.

Segmental and global longitudinal strain differences between children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 pandemic and Kawasaki disease

Funding Acknowledgements

Type of funding sources: None.

Introduction

 The paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and Kawasaki disease (KD) have overlapping features. This study aimed to describe the strain segmental analysis among both entities.

Methods

Retrospective review of strain segmental analysis within 4 weeks of presentation of symptoms among children diagnosed with PIMS-TS between April and June 2020 and a historic cohort of typical KD from the Royal Brompton Hospital, London.

Results

We included 33 PIMS-TS patients (23 males, 69.7%) at a mean age of 8 ± 4,9 years old and 45 KD patients (31 males, 68,9%) at a mean age of 5,8 ± 4,5 years old. PIMS-TS patients were older at presentation (p = 0.038). Left ventricle ejection fraction (LVEF) was normal in both groups (63,3% vs 63,5%; p= 0,89), 4/33 PIMS-TS children (12,1%) had coronary arteries abnormalities (CAA), whereas 100% of KD cohort had CAA. Both groups had a normal global longitudinal strain (GLS),but in PIMS-TS it was significantly reduced compared to the KD group (-20% vs -22%; p = 0,008). Basal segments were the most affected in PIMS-TS with significant difference in the basal anterior and anterolateral strain compared to KD (respectively -18,2% vs -23,4%; p < 0,001 and - 16,7% vs -22,7%; p < 0,001). PIMS-TS had a greater anterior, anterolateral and posterior segments involvement with a significant reduction in the anterolateral mid-wall longitudinal strain (-18,3% vs -22%; p = 0,002). Apical segments were less involved, with significant difference only in the septal and inferior apical strain (respectively p = 0.001 and p = 0,032).

Conclusions

 These preliminary data showed that after 4 weeks from the onset of symptoms, all PIMS-TS patients had a normal LVEF but they had a significant reduction in GLS and different segmental involvement compared to KD cohort. We hypothesize that these findings may be related to direct myocardial damage in PIMS-TS rather than caused by coronaries perfusion abnormalities.

Effect of a dietary inclusion of full-fat or defatted silkworm pupa meal on the nutrient digestibility and faecal microbiome of fattening quails

Silkworm (Bombyx mori L.) pupae are a by-product derived from silk production, which is often treated as waste and thus discarded: this can cause serious environmental problems and a loss of nutrients. Silkworm pupae are a rich source of protein and lipids, and the resulting protein meal can provide promising outcomes as livestock feed, notably for monogastric species. However, one possible issue that needs to be considered is the possible implication of the 1-Deoxynojirimycin (1-DNJ), a bio-compound of the silkworm that impairs glucose absorption, in poultry nutrition. Therefore, the present study evaluated the effect of the dietary inclusion of full-fat or defatted silkworm pupa meal (SWM) on the apparent digestibility of nutrients, feed choice and faecal microbiome in meat-producing quails. For the digestibility trial, a total of thirty-three 27-day-old Japanese quails (Coturnix coturnix japonica) were individually housed in digestibility cages and received three experimental diets: a control diet (control, commercial feed for fattening quails), and two other diets containing the 12.5% of either a full-fat SWM (SWM-FULL) or a defatted SWM (SWM-DEF). Subsequently, twenty-seven 33-day-old quails were simultaneously provided with Control, SWM-FULL and SWM-DEF diets for a 10-day feed choice trial. The results of the digestibility trial showed that the DM intake and excreta production were higher in both SWM groups than in the Control one (P < 0.001). The apparent digestibility of DM, organic matter, CP, ether extract, starch and energy was lower in both SWM groups than in the control group (P < 0.001), suggesting the possible implication of chitin and 1-DNJ. The feed choice test showed that quails preferred the Control diet (P < 0.001). From the microbiome analysis of the excreta, families such as Streptococcaceae (P < 0.05), Rikenellaceae and Eubacteriaceae (P < 0.01) and taxa at species level such as Lactobacillus delbrueckii (P < 0.05), Aneurinibacillus thermoaerophilus and Bacillus thermoamylovorans (P < 0.01) scored higher in SWM-FULL quails than in SWM-DEF and Control treatments. The present study demonstrated that a successful dietary inclusion of SWM for fattening quails needs to overcome the digestive criticalities caused by the of presence specific bio-compounds, namely chitin and 1-DNJ.

A Streamlined Regenerative Glycosylation Reaction: Direct, Acid-Free Activation of Thioglycosides

Our group has previously reported that 3,3-difluoroxindole (HOFox) is able to mediate glycosylations via intermediacy of OFox imidates. Thioglycoside precursors were first converted into the corresponding glycosyl bromides that were then converted into the OFox imidates in the presence of Ag₂ O followed by the activation with catalytic Lewis acid in a regenerative fashion. Reported herein is a direct conversion of thioglycosides via the regenerative approach that bypasses the intermediacy of bromides and eliminates the need for heavy-metal-based promoters. The direct regenerative activation of thioglycosides is achieved under neutral reaction conditions using only 1 equiv. NIS and catalytic HOFox without the acidic additives.

Indolylthio Glycosides As Effective Building Blocks for Chemical Glycosylation

The S-indolyl (SIn) anomeric moiety was investigated as a new leaving group that can be activated for chemical glycosylation under a variety of conditions including thiophilic and metal-assisted pathways. Understanding of the reaction pathways for the SIn moiety activation was achieved via the extended mechanistic study. Also reported is how the new SIn donors fit into selective activation strategies for oligosaccharide synthesis.

Stereocontrolled α-Galactosylation under Cooperative Catalysis

A recent discovery of a cooperative catalysis comprising a silver salt and an acid led to a dramatic improvement in the way glycosyl halides are glycosidated. Excellent yields have been achieved, but the stereoselectivity achieved with 2-O-benzylated donors was poor. Reported herein is our first attempt to refine the stereoselectivity of the cooperatively catalyzed galactosylation reaction. Careful optimization of the reaction conditions along with studying effects of the remote protecting groups led to excellent stereocontrol of α-galactosylation of a variety of glycosyl acceptors with differentially protected galactosyl donors.

A Highly Efficient Glycosidation of Glycosyl Chlorides by Using Cooperative Silver(I) Oxide-Triflic Acid Catalysis

Following our discovery that silver(I) oxide-promoted glycosylation with glycosyl bromides can be greatly accelerated in the presence of catalytic TMSOTf or TfOH, we report herein a new discovery that glycosyl chlorides are even more effective glycosyl donors under these reaction conditions. The developed reaction conditions work well with a variety of glycosyl chlorides. Both benzoylated and benzylated chlorides have been successfully glycosidated, and these reaction conditions proved to be effective in coupling substrates containing nitrogen and sulfur atoms. Another convenient feature of this glycosylation is that the progress of the reaction can be monitored visually; its completion can be judged by the disappearance of the characteristic dark color of Ag₂ O.

Magneto-elastic properties of a spin crossover membrane deposited on a deformable substrate

Spin-crossover (SCO) solids have been studied for several years due to their fascinating physical properties and their potential applications as optical switches and reversible high-density memories for information storage. Through this article, we will examine in details the effects of substrate's lattice parameters, on a deformable spin crossover membrane, simulated using an electro-elastic model taking into account the volume change at the transition. The molecules of the membrane can be either in the low spin state (LS) or the high spin state (HS), while those of the substrate are electronically neutral. Magnetic properties of the SCO membrane and the pressure distribution as a function of the lattice parameter of the substrate have been investigated. We demonstrated that the thermally induced first-order spin transition is significantly affected by the structural properties of the substrate, where a rise in the lattice parameter of the latter lowers the transition temperature and reduces the width of the thermal hysteresis loop. The investigations on the spatiotemporal aspects of the spin transition in the membrane demonstrates that the nucleation and growth processes are sensitive to the structural properties of the elastic misfit between the substrate and the SCO membrane.

Defining the Scope of the Acid-Catalyzed Glycosidation of Glycosyl Bromides

Following the recent discovery that traditional silver(I) oxide-promoted glycosidations of glycosyl bromides (Koenigs-Knorr reaction) can be greatly accelerated in the presence of catalytic TMSOTf, reported herein is a dedicated study of all major aspects of this reaction. A thorough investigation of numerous silver salts and careful refinement of the reaction conditions led to an improved mechanistic understanding. This, in turn, led to a significant reduction in the amount of silver salt required for these glycosylations. The progress of this reaction can be monitored by naked eye, and the completion of the reaction can be judged by the disappearance of characteristic dark color of Ag2 O. Further evidence on higher reactivity of benzoylated α-bromides in comparison to that of their benzylated counterparts has been acquired.

Defining the Scope of the Acid-Catalyzed Glycosidation of Glycosyl Bromides

Invited for the cover of this issue are Yashapal Singh and Alexei Demchenko from the University of Missouri-St. Louis, USA. The image depicts the Koenigs and Knorr reaction, with the old car illustrating that the reaction is slow in the presence of silver(I) oxide, whereas the fast car shows that the reaction can be significantly accelerated by the addition of catalytic triflic acid. Read the full text of the article at 10.1002/chem.201904185.

Triflic acid-mediated synthesis of thioglycosides

An efficient synthesis of thioglycosides from per-acetates in the presence of triflic acid is described. The developed protocol features high reaction rates and product yields. Some reactive sugar series give high efficiency in the presence of sub-stoichiometric trifluoromethanesulfonic acid (TfOH) in contrast to other known protocols that require multiple equivalents of Lewis acids to reach high conversion rates.

Koenigs-Knorr Glycosylation Reaction Catalyzed by Trimethylsilyl Trifluoromethanesulfonate

The discovery that traditional silver(I)-oxide-promoted glycosidations of glycosyl bromides (Koenigs-Knorr reaction) can be greatly accelerated in the presence of catalytic trimethylsilyl trifluoromethanesulfonate (TMSOTf) is reported. The reaction conditions are very mild that allowed for maintaining a practically neutral pH and, at the same time, providing high rates and excellent glycosylation yields. In addition, unusual reactivity trends among a series of differentially protected glycosyl bromides were documented. In particular, benzoylated α-bromides were much more reactive than their benzylated counterparts under these conditions.

Investigation of Glycosyl Nitrates as Building Blocks for Chemical Glycosylation

Glycosyl nitrates are important synthetic intermediates in the synthesis of 2-amino sugars, 1,2-orthoesters or, more recently, 2-OH glucose. However, glycosyl nitrates have never been glycosidated. Presented herein is our first attempt to use glycosyl nitrates as glycosyl donors for O-glycosylation. Lanthanide triflates showed good affinity to activate the nitrate leaving group.

Regenerative Glycosylation

Previously, we communicated 3,3-difluoroxindole (HOFox)-mediated glycosylations wherein 3,3-difluoro-3H-indol-2-yl (OFox) imidates were found to be key intermediates. Both the in situ synthesis from the corresponding glycosyl bromides and activation of the OFox imidates could be conducted in a regenerative fashion. Herein, we extend this study to the synthesis of various glycosidic linkages using different sugar series. The main outcome of this study relates to enhanced yields and/or reduced reaction times of glycosylations. The effect of HOFox-mediated reactions is particularly pronounced in case of unreactive glycosyl donors and/or glycosyl acceptors. A multistep regenerative synthesis of oligosaccharides is also reported.

Comorbidities and related factors in rheumatoid arthritis patients of south India- Karnataka Rheumatoid Arthritis Comorbidity (KRAC) study

The aim was to study the prevalence of comorbidities in rheumatoid arthritis (RA) patients in everyday clinical practice and their association with disease-specific and demographic factors. The multi-center study recruited 3,247 (at 14 centers, and 265) were excluded due to incomplete data. The number of subjects considered for the analysis was 2982. The mean (±standard deviation) age was 48.98±12.64 years and the male-to-female ratio was 1:5. The data was collected based on a pre-structured pro forma by trained clinical research associates through interview and verification of charts and reports available in the patient records. The following comorbidities were studied: cardiovascular disease, hypertension, diabetes mellitus, hypercholesterolemia, thyroid disease, psychiatric diseases like depression, and pulmonary disease. Hypertension (20.7%), diabetes mellitus (14.4%) and thyroid disease (18.3%) were the most prevalent comorbidities. Hypercholesterolemia (5.3%), pulmonary diseases (2.1%), cardiovascular diseases (0.2%) and depression (0.03%) were prevalent in ≤5% of the study population. The overall presence of comorbidity increased with age and reduced with the duration of illness prior (DOIP). The age, gender, and DOIP differed significantly between groups with and without hypercholesterolemia. Females had a statistically increased prevalence of thyroid disease. The prevalence of comorbidities in RA patients from south India is around 40% and the incidence of comorbidity increased with age. As per the literature evidence, the prevalence in the current study subjects was higher when compared to prevalence of similar diseases occurring in the general south Indian population.

Circulating genotypes of Pneumocystis jirovecii and its clinical correlation in patients from a single tertiary center in India

The present study was carried out with the objectives of genotyping Pneumocystis jirovecii at three distinct loci, to identify the single nucleotide polymorphisms (SNPs), and to study its clinical implications in patients with Pneumocystis pneumonia (PCP). Analysis of genetic diversity in P. jirovecii from immunocompromised patients was carried out by genotyping at three distinct loci encoding mitochondrial large subunit rRNA (mtLSU rRNA), cytochrome b (CYB), and superoxide dismutase (SOD) using polymerase chain reaction (PCR) assays followed by direct DNA sequencing. Of the 300 patients enrolled in the present study, 31 (10.33%) were positive for PCP by a specific mtLSU rRNA nested PCR assay, whereas only 15 P. jirovecii could be amplified at the other two loci (SOD and CYB). These positives were further subjected to sequence typing. Important genotypic combinations between four SNPs (mt85, SOD110, SOD215, and CYB838) and clinical outcomes could be observed in the present study, and mt85A, mt85T, and SOD110C/SOD215T were frequently associated with "negative follow-up". These SNPs were also noted to be relatively more prevalent amongst circulating genotypes in our study population. The present study is the first of its kind from the Indian subcontinent and demonstrated that potential SNPs of P. jirovecii may possibly be attributed to the clinical outcome of PCP episodes in terms of severity or fatality in different susceptible populations likely to develop PCP during their course of illness.