A proposed methodology of health education for inherited genetic disorders: Bag and Ball technique.

The life-threatening genetic blood disorder, thalassaemia, which causes decreased haemoglobin production, is preventable. Sociocultural determinants and the level of public health awareness must be used to adopt control measures of prevention. Identifying information gaps and educating the community about screening should be a priority, especially in areas with high disease burdens. A relevant health education technique, with which the audience can identify, can effectively bring understanding necessary effectively to sensitise the community. We propose the 'Bag and Ball' method, which includes role-play for health education specifically concerning inherited genetic disorders.

Production, characterization, and bio-ethanologenic potential of a novel tripartite raw starch-digesting amylase from Priestia flexa UCCM 00132.

The biological conversion of agro-waste biomass into value-added metabolites is one of the trendy biotechnological research areas in recent times. One of the major drawbacks of the bioprocess is the saccharification potential of the amylolytic enzyme that releases reducing sugar from complex biomass to serve as substrate for fermentation. The present study reports the production of a novel tripartite raw starch-digesting amylase (RSDA) by an indigenous Priestia flexa strain with α-, ß-, and gluco-amylolytic activities and its potential for bioethanol production. Response surface statistics was employed to develop a suitable medium for improved production of the tripartite enzyme by submerged fermentation. The bioprocess selected raw starch (4.36%) Ca2+(2.71 g/L) and Zn2+ (0.0177 g/L) as significant variables which demonstrated a total RSDA activity of 7208.23 U/mL in a 5-L batch bioreactor. SDS/Native-PAGE determined the molecular weights of the 27-fold purified product as 25.2 kDa, 57.3 kDa, and 90.1 kDa for α-, ß-, and gluco-amylases, respectively. Optimum temperature and pH for enzyme activity were respectively broad at 30-70 °C and 4-11. The enzyme mixture demonstrated digestibility above 90% against a variety of raw starches and simultaneous fermentation of digestate with Saccharomyces cerevisiae generated 71.69 g/L of bioethanol within 24 h suggesting great potential for bioethanologenesis.

Common Iliac Node-Positive Prostate Cancer Treated With Curative Radiation Therapy: N1 or M1a?

PURPOSE: Common iliac (CI) nodes are staged as (oligo)metastatic M1a for prostate cancer. Whether outcomes of pelvic node-positive (cN1) differ from CI node-positive (CI-M1a) prostate cancer after curative treatment is unclear. The present study compares outcomes in patients treated with radical whole pelvic radiation therapy (RT) and long-term androgen deprivation therapy (ADT). METHODS AND MATERIALS: Patients with a node-positive adenocarcinoma prostate were identified, either CI-M1a or cN1, from a prospectively maintained database. More than 75% of patients were staged with Gallium (Ga) 68 prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) at the time of diagnosis. All patients received long-term ADT and moderately or extremely hypofractionated RT to the prostate and pelvis, including the CI region. At the time of biochemical failure (BCF), restaging was done with Ga68-PSMA-PET/CT to establish the patterns of failure. The CI-M1a cohort was classified as proximal or distal CI nodal location, and studied for outcomes. RESULTS: Of the 130 patients analyzed, 87 had cN1 and 43 had CI-M1a stage disease. The median duration of ADT before RT was 7 months, and total duration was at least 24 months. The majority of patients (65%) had Gleason grade group IV to V, and 75% had ≥T3 disease. After a median follow up of 61 months, BCF in the 2 groups was similar (cN1: n = 21 of 87; 24.1%; CI-M1a: n = 11 of 43; 25.6%; P = .86). At the time of BCF, restaging Ga68-PSMA-PET/CT located distant metastases in 20 of 32 patients (63%; 57% in cN1 and 73% in CI-M1a; P = .47). In addition, the 5-year biochemical failure-free (cN1: 77.4%; CI-M1a: 70.4%; P = .43), distant metastasis-free (cN1: 86.9%; CI-M1a: 79.4%; P = .23), and overall (cN1: 92.6%; CI-M1a 90.1%; P = .80) survival were similar in the 2 groups. Outcomes within CI-M1a were similar for proximal versus distal CI nodal location and 5-year biochemical failure-free survival (73.6% vs 58.6%; P = .81). CONCLUSIONS: Patients with oligometastatic CI-M1a and cN1 prostate cancer showed similar outcomes when treated with curative whole pelvic RT and long-term ADT. The treatment for these oligometastatic patients should be prospectively evaluated.

Hazardous use of alcohol among men in the tribal population of Jawadhi Hills, Tamil Nadu: Nature, prevalence, and risk factors.

BACKGROUND: Worldwide, hazardous use of alcohol is common among many cultures and societies and adversely impacts families and communities, with significant morbidity and mortality. Scheduled Tribes (STs) who are socially deprived and marginalised have higher rates of alcohol use. AIM: We attempted to determine the nature, prevalence, and risk factors associated with hazardous consumption of alcohol in the tribal community. METHODOLOGY: A cross-sectional study was conducted among adult male and permanent residents of Jawadhi hills. A total of 1200 men were interviewed. Study participants were chosen by Probability Proportionate to Size (PPS) sampling method. The questionnaire that documented socio-demographic characteristics and patterns of alcohol use was used. AUDIT tool was used to assess the hazardous use of Alcohol. Data were analysed using SPSS. RESULTS: Majority of the men were middle-aged, married, and were from lower socio-economic strata. A large proportion of men (65%) had a history of alcohol consumption in the last one year using one-year, of whom a quarter showed hazardous use (29%) and another quarter exhibited alcohol dependency (24%). Tobacco use, higher income and local alcohol production were found to be significant risk factors for Hazardous alcohol use. CONCLUSION: Alcohol consumption needs to be treated as a social problem and has to be tackled at the policy level. Population-based interventions, legislation, taxation, policies regarding the manufacture and sale of alcohol, are some of the ways to address this problem.

Predictors of recovery in children aged 6-59 months with uncomplicated severe acute malnutrition: a multicentre study.

OBJECTIVE: To identify predictors of recovery in children with uncomplicated severe acute malnutrition (SAM). DESIGN: This is a secondary data analysis from an individual randomised controlled trial, where children with uncomplicated SAM were randomised to three feeding regimens, namely ready-to-use therapeutic food (RUTF) sourced from Compact India, locally prepared RUTF or augmented home-prepared foods, under two age strata (6-17 months and 18-59 months) for 16 weeks or until recovery. Three sets of predictors that could influence recovery, namely child, family and nutritional predictors, were analysed. SETTING: Rural and urban slum areas of three states of India, namely Rajasthan, Delhi and Tamil Nadu. PARTICIPANTS: In total, 906 children (age: 6-59 months) were analysed to estimate the adjusted hazard ratio (AHR) using the Cox proportional hazard ratio model to identify various predictors. RESULTS: Being a female child (AHR: 1·269 (1·016, 1·584)), better employment status of the child's father (AHR: 1·53 (1·197, 1·95)) and residence in a rental house (AHR: 1·485 (1·137, 1·94)) increased the chances of recovery. No hospitalisation (AHR: 1·778 (1·055, 2·997)), no fever, (AHR: 2·748 (2·161, 3·494)) and ≤ 2 episodes of diarrhoea (AHR: 1·579 (1·035, 2·412)) during the treatment phase; availability of community-based peer support to mothers for feeding (AHR: 1·61 (1·237, 2·097)) and a better weight-for-height Z-score (WHZ) at enrolment (AHR: 1·811 (1·297, 2·529)) predicted higher chances of recovery from SAM. CONCLUSION: The probability of recovery increases in children with better WHZ and with the initiation of treatment for acute illnesses to avoid hospitalisation, availability of peer support and better employment status of the father.

Outcomes of external cephalic version for antenatal women with breech presentation in a secondary hospital in Vellore, Tamil Nadu - a retrospective review

Objective: Breech presentation is the most common fetal malpresentation at term, with an incidence of 3-4%. External cephalic version (ECV) is a procedure that can be offered to women with breech presentation beyond 36 weeks of gestation to convert it to cephalic presentation, reducing the risks of a vaginal breech delivery and the morbidities associated with caesarean section. Material and Methods: We retrospectively reviewed the records of women who underwent ECV between October 2012 and June 2020 with the objectives of determining the success rate of the procedure, the mode of delivery, the maternal and neonatal outcomes, periprocedural complications and their management. Results: Among the 200 women who underwent the procedure with a 64% success rate (128 women), there were 110 vaginal deliveries (56.7%) including five vaginal breech deliveries, and 84 women (43.2%) underwent caesarean section, which included 24 women who had successful ECV but needed emergency caesarean for other indications. There was no significant difference in the neonatal APGAR scores in those who had a successful ECV and those who did not. Only three women (1.5%) experienced any significant periprocedural complication. Conclusion: These results suggest that ECV improves the possibility of a vaginal delivery with an overall low complication rate, reducing the neonatal risks associated with vaginal breech delivery and the maternal morbidity of a caesarean section. It may thus contribute to reducing the primary caesarean section rate, making it a useful intervention, especially in limited resource settings.

Risk factors for severe acute malnutrition among children aged 6-59 months: A community-based case-control study from Vellore, Southern India.

BACKGROUND: Malnutrition plays an important role in the economic burden of society as well as the country. This study aimed to identify the various risk factors and determinants of severe acute malnutrition (SAM) as defined by WHO growth reference standards in children aged 6 months to 59 months living in Vellore. METHODS: A community-based case-control study matched for age (±2months), gender and location was done among the children of the age group 6- 59 months residing in both rural and urban Vellore. Children of age group 6-59 months with SAM according to WHO definition, i.e., weight for height of less than -3SD with or without nutritional oedema were classified as cases. Children with weight-for-height z-score more than -1 SD and MUAC ≥13.5cms were classified as controls. With 2 controls per case, the required sample size was 54 cases and 108 controls. A questionnaire used to identify the risk factors including dietary intake. Uni-variate and multivariate analysis was done to generate an odds ratio and 95% confidence interval for the risk factors. RESULTS: Majority of the cases 64.8% and 50% of the controls belonged to low SES. After adjusting all confounders, Severe Acute Malnutrition was significantly associated with birth weight <2.499kg [AOR- 8.95 (95% CI: 2.98-26.85)], not exclusively breastfed for 6 months [AOR 4.67 (95% CI: 1.72-12.65)], inadequate calorie intake [AOR 8.09 (95% CI: 3.15-20.82)] and mother being underweight [AOR 6.87 (95% CI: 1.92-24.55)]. CONCLUSION: Programs should be implemented to reduce the poor nutritional status of young girls and women in the reproductive age group. The importance of exclusive breastfeeding for the first six months, the time of weaning and appropriate feeding practice for the child should be emphasized to postnatal mothers during their hospital visits.

The methionase chain reaction: an enzyme-based autocatalytic amplification system for the detection of thiols.

We present an autocatalytic system for the detection and amplification of thiols termed the Methionase Chain Reaction (MCR). MCR is based on the reversible modification of the thiol producing enzyme Methionine Gamma-Lyase (MGL). MCR was able to amplify the concentration of thiols by a factor of 560 and was able to visually detect thiols at concentrations as low as 50 nM.

Immune cell regulation of glia during CNS injury and disease.

Glial cells are abundant in the CNS and are essential for brain development and homeostasis. These cells also regulate tissue recovery after injury and their dysfunction is a possible contributing factor to neurodegenerative and psychiatric disease. Recent evidence suggests that microglia, which are also the brain's major resident immune cells, provide disease-modifying regulation of the other major glial populations, namely astrocytes and oligodendrocytes. In addition, peripheral immune cells entering the CNS after injury and in disease may directly affect microglial, astrocyte and oligodendrocyte function, suggesting an integrated network of immune cell-glial cell communication.

Avoiding the Need for Bowel Anastomosis during Pelvic Exenteration-Urinary Sigmoid or Descending Colon Conduit-Short and Long Term Complications.

OBJECTIVE: To educate surgeons of distal colon urinary diversion as an alternative to ileal conduit. To assess perioperative outcomes of distal colon conduit in pelvic exenteration including conduit-related, gastrointestinal, infectious, metabolic, and wound complications within 30 days, 31-89 days, and greater than 90 days from the time of surgery. MATERIALS AND METHODS: Forty-one patients who underwent distal colon urinary diversion for malignancy, fistula, or neurogenic bladder were identified in our IRB approved database from 1/2007 to 7/2017. RESULTS: Twenty-six (63.4%) were male with mean age of 54.1 years. Complications were stratified by early (≤30 days), intermediate (31-89 days), and late (≥90 days). Within 30 days, 2 (4.9%) had partial small bowel obstructions requiring nasogastric tube (NGT) placement and total parenteral nutrition (TPN); 8 (19.5%) prolonged ileus with 6 (14.6%) requiring TPN and 5 (12.2%) requiring NGT placement; 1 (2.4%) enterocutaneous fistula; 1 (2.4%) conduit hemorrhage, 10 (24.4%) treated urinary tract infections (UTIs). Between 31 and 89 days, 1 patient (2.4%) had urinary conduit leak and 3 (7.3%) treated UTIs. At ≥90 days, 2 (4.9%) had partial small bowel obstructions requiring NGT placement, 4 (9.8%) ureterocolonic strictures and 1 (2.4%) parastomal hernia, 3 (7.3%) treated UTIs. Readmission rate in ≤30 days was 10 (24.4%), 31-89 days was 13 (31.7%), and 90+ days was 16 (39%). Long-term metabolic complications at ≥90 days included 16 (39%) with hypokalemia, 10 (24.4%) with hyperchloremia, and 14 (34.1%) with metabolic acidosis. CONCLUSION: Distal colon urinary conduit is a relatively safe and feasible option and obviates the need for small bowel anastomosis and possible associated complications.

Human rights: a new language for aging advocacy.

PURPOSE: The purpose of this study was to consider how human rights concepts developed by the international human rights movement could contribute to advocacy efforts on behalf of the aging in an era of population aging. DESIGN AND METHODS: This study evaluated changes in popular perceptions of aging, the concomitant need for a reformulation of aging advocacy, and the role that human rights concepts could play in protecting older persons. It then considered human rights concepts as they are related to the issues of work, retirement security, health care, and long-term care. RESULTS: Human rights apply to all aspects of the life spectrum and can be a powerful force in defending and protecting older persons by operating as a baseline for establishing the underlying values for aging policies and by linking older persons' concerns with the other segments of society. IMPLICATIONS: The study's conclusion suggests that seniors' groups should use human rights principles as a new foundation on which to develop new approaches to their public education and advocacy efforts.

Rapid and dynamic regulation of TGF-beta receptors on blood vessels and fibroblasts during ischemia-reperfusion injury.

The pathophysiological mechanisms involved in ischemia-reperfusion injury are poorly understood. Although transforming growth factor (TGF)-beta has been shown to provide protection against ischemia-reperfusion injury in different organ systems, little is known about the regulation of TGF-beta action during this process. Here we analyzed the effect of ischemia and reperfusion on the expression of TGF-beta and its receptors in vivo with a pig skin flap model. Analysis of unoperated skin, nonischemic control flap, ischemic flap, and reperfused flap by immunohistochemistry indicates that ischemia and reperfusion result in rapid and dynamic regulation of type I, II, and III TGF-beta receptors and TGF-beta1 in a cell type-specific manner. Furthermore, hypoxia upregulates type II TGF-beta receptor mRNA in skin fibroblasts in culture. Together, our results reveal that TGF-beta receptors and TGF-beta1 are markedly increased under acute ischemic conditions in the blood vessels and fibroblasts of the skin. We conclude that TGF-beta action is enhanced under ischemic conditions and that it may represent an adaptive response to ischemic injury. The augmented TGF-beta responsiveness may be a critical determinant of the protective effect of TGF-beta during ischemia-reperfusion injury.