Clinical Manifestations of Nipah Virus-Infected Patients Who Presented to the Emergency Department During an Outbreak in Kerala State in India, May 2018.

BACKGROUND: An outbreak of Nipah virus (NiV) disease occurred in the Kozhikode district of Kerala State in India in May 2018. Several cases were treated at the emergency medicine department (ED) of the Government Medical College, Kozhikode (GMCK). The clinical manifestations and outcome of these cases are described. METHODS: The study included 12 cases treated in the ED of GMCK. Detailed clinical examination, laboratory investigations, and molecular testing for etiological diagnosis were performed. RESULTS: The median age of the patients was 30 years and the male to female ratio was 1.4:1.0. All the cases except the index case contracted the infection from hospitals. The median incubation period was 10 days, and the case fatality ratio was 83.3%. Ten (83.3%) patients had encephalitis and 9 out of 11 patients whose chest X-rays were obtained had bilateral infiltrates. Three patients had bradycardia and intractable hypotension requiring inotropes. Encephalitis, acute respiratory distress syndrome, and myocarditis were the clinical prototypes, but there were large overlaps between these. Ribavirin therapy was given to a subset of the patients. Although there was a 20% reduction in NiV encephalitis cases treated with the drug, the difference was not statistically significant. The outbreak ended soon after the introduction of total isolation of patients and barrier nursing. CONCLUSION: The outbreak of NiV disease in Kozhikode in May 2018 presented as encephalitis, acute respiratory distress and myocarditis or combinations of these. The CFR was high. Ribavirin therapy was tried but no evidence for its benefit could be obtained.

Case Reports of Two Interesting Patients with Sea Snake Envenomation.

Sea Snakes have the most potent venom among snakes known to mankind and a few species are implicated in human fatalities.1 Commonest Sea snake in the Indian Sea is Enhydrina Schistosa.2 Mortality is high in spite of therapy because of multiple complications. This is a Case report of two Fishermen who were bitten by Sea Snake and developed complications.

Nipah Virus Sequences from Humans and Bats during Nipah Outbreak, Kerala, India, 2018.

We retrieved Nipah virus (NiV) sequences from 4 human and 3 fruit bat (Pteropus medius) samples from a 2018 outbreak in Kerala, India. Phylogenetic analysis demonstrated that NiV from humans was 96.15% similar to a Bangladesh strain but 99.7%-100% similar to virus from Pteropus spp. bats, indicating bats were the source of the outbreak.

A sensitive refining of in vitro and in vivo toxicological behavior of green synthesized ZnO nanoparticles from the shells of Jatropha curcas for multifunctional biomaterials development.

ZnO nanoparticles (NPs) possess a wide range of biological functions in pharmaceutical and cosmetic applications due to their excellent antimicrobial, optical and UV protective properties. This study first reports the toxicological assessment of ZnO NPs green synthesized from Jatropha curcas shells for multifunctional biomedical applications. The hot water extract of J.curcas shells is utilized as a chelating agent for the reduction of zinc acetate and then, the prepared ZnO NPs are broadly characterized using X-ray spectroscopic and electron microscopic observations. The prepared ZnO NPs acquire high purity (100%) wurtzite crystal with hexagonal structure with the average particle size of 53 nm. In vitro and in vivo toxicity evaluation against human tumor cell lines and zebrafish embryos have ascertained the purpose of ZnO NPs in clinical research. Toxic effects of ZnO NPs were observed by a dose-dependent reduction of bacterial growth at ≥1   µg ml-1, by teratogenicity and genotoxicity in zebrafish embryos (from 3 to 90 µg ml-1) and by a significant nanoparticle uptake (0.5 ng µl-1) by a fish serum. In contrast, ZnO NPs fail to reduce the proliferation of human bladder tumor cells (UC6) and cell viability of A549 cells in vitro up to 500 µg ml-1. All these observations limit the unobstructed application of ZnO NPs at higher concentrations. Thus, abundantly used metal oxide nanoparticles like ZnO NPs examined in our present study in different animal models under in vitro and in vivo conditions will be the significant screening strategy to determine the nanotoxicity.

Glioma Tumor Grade Identification Using Artificial Intelligent Techniques.

Computer aided diagnosis using artificial intelligent techniques made tremendous improvement in medical applications especially for easy detection of tumor area, tumor type and grades. This paper presents automatic glioma tumor grade identification from magnetic resonant images using Wndchrm tool based classifier (Weighted Neighbour Distance using Compound Heirarchy of Algorithms Representing Morphology) and VGG-19 deep convolutional neural network (DNN). For experimentation, DICOM images are collected from reputed government hospital and the proposed intelligent system categorized the tumor into four grades such as low grade glioma, oligodendroglioma, anaplastic glioma and glioblastoma multiform. After preprocessing, features are extracted, optimized and then classified using Windchrm tool where the most significant features are selected on the basis of Fisher score. In the case of DNN classifier, data augmentation is also performed before applying the images into the deep learning network. The performance of the classifiers are analysed with various measures such as accuracy, precision, sensitivity, specificity and F1-score. The results showed reasonably good performance with a maximum classification accuracy of 92.86% for the Wndchrm classifier and 98.25% for VGG-19 DNN classifier. The results are also compared with similar recent works and the proposed system is found to have better performance.

Pattern Recognition and Size Prediction of Microcalcification Based on Physical Characteristics by Using Digital Mammogram Images.

Breast cancer is one of the life-threatening cancers occurring in women. In recent years, from the surveys provided by various medical organizations, it has become clear that the mortality rate of females is increasing owing to the late detection of breast cancer. Therefore, an automated algorithm is needed to identify the early occurrence of microcalcification, which would assist radiologists and physicians in reducing the false predictions via image processing techniques. In this work, we propose a new algorithm to detect the pattern of a microcalcification by calculating its physical characteristics. The considered physical characteristics are the reflection coefficient and mass density of the binned digital mammogram image. The calculation of physical characteristics doubly confirms the presence of malignant microcalcification. Subsequently, by interpolating the physical characteristics via thresholding and mapping techniques, a three-dimensional (3D) projection of the region of interest (RoI) is obtained in terms of the distance in millimeter. The size of a microcalcification is determined using this 3D-projected view. This algorithm is verified with 100 abnormal mammogram images showing microcalcification and 10 normal mammogram images. In addition to the size calculation, the proposed algorithm acts as a good classifier that is used to classify the considered input image as normal or abnormal with the help of only two physical characteristics. This proposed algorithm exhibits a classification accuracy of 99%.

Synthesis and Characterisation of Nanocomposites of TiO2 and MgAl2O4 for Gas Sensing Applications.

In this study, a conventional mixed oxide method was used to prepare nanocomposites of titanium dioxide and magnesium aluminate samples. The synthesis process of a low concentration of posttransition metal oxide like TiO2 with pre-transition metal oxides like MgO and Al2O3 and its gas sensing behaviour were investigated. The present work focuses on applying different nanocomposite samples of (TiO2) x and MgAl2O4 (at x = 0 magnesium aluminate namely MA; x = 0°25 and 0.75 N namely MAT0.25 and MAT0.75 at 4 and 10 wt% of TiO2 in MgAl2O4 respectively and TiO2 namely T) for gas sensing applications (O2, CO and H2 gases). The composite samples were characterized by their X-ray diffraction pattern, Fourier transform infrared spectroscopy, a particle size analyzer, X-ray fluorescent spectroscopy, scanning electron microscopy, ultraviolet visible spectroscopy, and Brunauer­Emmett­Teller methods. The response to changes in gas pressure (from 0.5 to 2 bar) was quantitatively studied in all samples (MA, MAT0.25, MAT0.75 and T) at different operating temperatures from 300 to 600 K. All samples showed a fast and improved gas response at different operating temperatures. Moreover, it was observed that the gas response of the composite sample, MAT0.75 increased by 11% more than the pure titanium sample at an operating temperature of 360 K, on the passage of O2 gas.

Sensitivity and Response of Polyvinyl Alcohol/Tin Oxide Nanocomposite Multilayer Thin Film Sensors.

Nanocrystalline Tin Oxide (SnO2) is Non-Stoichiometric in Nature with Functional Properties Suitable for gas sensing. In this study, SnO2nanoparticles were prepared by the sol-gel technique, which were then characterised using X-ray diffraction. The nanoparticles showed tetragonal structure with an average crystallite size of 18 nm. The stretching and vibration modes of SnO2were confirmed using Fourier transform infrared spectroscopy. The size of SnO2 nanoparticles was determined using particle size analyser, which was found be 60 ± 10 nm on average. The surface morphology of the nanoparticles was investigated using scanning electron microscope, which showed irregular-sized agglomerated SnO2nanostructures. In addition, primary particle size was evaluated using high-resolution transmission electron microscopy, which was found to be 50 nm on average. The polyvinyl alcohol/SnO2 composite thin film was prepared on a glass substrate using spin-coating method. The values of band gap energy and electrical conductance of 13-layer thin film were found to be 2.96 eV and 0.0505 mho, respectively. Sulfur dioxide (SO2) was suitably tailored to verify the sensor response over a concentration range of 10-70 ppm at room temperature. The performance, response, and recovery time of sensors were increased by increasing the layers of the thin film.

Mg-Doped Hydroxyapatite/Chitosan Composite Coated 316L Stainless Steel Implants for Biomedical Applications.

In this investigation, ultrasonication process was used for the synthesis of magnesium doped nano-hydroxyapatite (MH) (0, 1, 2, and 3 mol% of Mg concentration) particles with controlled size and surface morphology. The size of the prepared MH particles was in the range of 20-100 nm with narrow distribution. Increase in the concentration of Mg reduced the particle size distribution from 60 to 40 nm. On incorporation of Mg in HAp lattice, an increase of 20-66 nm in specific surface area was observed in microporous HAp particles. XRF and XRD patterns reveal that the particles possess stoichiometric composition with reduced crystallinity with respect to the Mg concentration. Surface morphology of MH/chitosan (CTS) coated implant was found to be uniform without any defects. The corrosion rate of the implant decreased with increase in Mg concentration. The in vitro formation of bonelike apatite layer on the surface of the MH/CTS coated implant was observed from simulated body fluid studies. The antimicrobial activity of the MH/CTS composites against gram-positive and gram-negative bacterial strains indicated that increasing Mg concentration enhanced antimicrobial properties. Nanoindentation analysis of apatite coated implant surface reveals that the mechanical property depends on the concentration of magnesium in HAp. From the cytotoxicity analysis against NIH 3T3 fibroblast, it was observed that the Mg incorporated HAp/CTS composite was less toxic than the MHO/CTS composite. From this result, it was concluded that the MH/CTS nanocomposites coated implant is the excellent material for implants.

Atypical Bronchial Carcinoid Masquerading as Bronchial Asthma.

A case study of 35-year-old woman with persistent breathlessness and wheezing that had been unsuccessfully treated with inhaled beta 2-agonists and steroids for about two years. Patient developed dry cough and haemoptysis, so investigated further. Spirometry demonstrated a restrictive pattern. Chest CT demonstrated well defined hyperdense lesion in right middle lobe. Biopsy taken from the mass during bronchoscopy demonstrated the picture of atypical bronchial carcinoid. In this case, due to the lack of awareness, diagnosis of carcinoid was delayed by two years.

A comprehensive evaluation of water, sanitation and hygiene (WASH) in health facilities: a systematic review and meta-analysis.

Despite global recognition, WHO reports reveal significant gaps, with one in four healthcare facilities lacking basic water services, affecting over 1.8 billion people, and 21% lacking sanitation services, impacting 1.5 billion people, especially prevalent in low- and middle-income countries. This study aimed to critically evaluate the current state of water, sanitation and hygiene (WASH) facilities across a diverse range of healthcare settings. This review included various databases such as PubMed, MEDLINE, EMBASE, CINAHL, Scopus and grey literature; eligible studies employing various designs were scrutinized for WASH infrastructure and practices. Methodological quality was rigorously evaluated using the QuADS checklist. Data analysis, performed with R software, involved deriving pooled estimates of WASH intervention effects. Sensitivity analyses were conducted, employing statistical methods such as funnel plots to ensure robustness and mitigate biases. Of the 13,250 articles screened, 18 were included in this review. Meta-analyses revealed significant effect sizes for WASH interventions across domains - water (67.38%), sanitation (53.93%), waste management (40.82%), environment (56.58%), hygiene (66.83%), and management (42.30%). Widespread disparities in WASH persist across healthcare facilities, with rural areas facing notable deficits. Challenges in water quality, sanitation and waste management demand comprehensive, multi-sectoral approaches for improvement.

Enhanced functional properties of ZrO2/SiO2 hybrid nanosol coated cotton fabrics.

In this present investigation, the colloidal silica and nano ZrO2 embedded silica solution were prepared using sol-gel method followed by the sonication process. The particle size was measured for the prepared silica sol with and without ZrO2 nanoparticles. The prepared nanoparticles were coated on the cotton fabric through pad dry method. The phase and functional group analysis of the cotton fabrics after coating reveals the presence of metal oxides on the surface. The surface morphology of the coated fabrics analysed using SEM shows that the nanoparticles were in spherical morphology with slight agglomerations. The element analysis confirms the presence of silica (SiO2) and ZrO2/SiO2 nanoparticles along with cellulose on the surface. The washing durability of the coated fabrics after 5th and 10th wash indicates that the nanoparticles were strongly adhered on the fabric surface. The burning performance of coated fabrics is in the order of ZrO2/SiO2 (19.5 s) > SiO2 (11.3 s) before and after wash; UV resistance of fabric was in the order of ZrO2/SiO2 > SiO2 > uncoated fabric. Cotton fabrics coated with ZrO2/SiO2 particles show better UV and flammability protection for textile applications.

Nipah Virus Outbreak in Kerala State, India Amidst of COVID-19 Pandemic.

We report here a Nipah virus (NiV) outbreak in Kozhikode district of Kerala state, India, which had caused fatal encephalitis in a 12-year-old boy and the outbreak response, which led to the successful containment of the disease and the related investigations. Quantitative real-time reverse transcription (RT)-PCR, ELISA-based antibody detection, and whole genome sequencing (WGS) were performed to confirm the NiV infection. Contacts of the index case were traced and isolated based on risk categorization. Bats from the areas near the epicenter of the outbreak were sampled for throat swabs, rectal swabs, and blood samples for NiV screening by real-time RT-PCR and anti-NiV bat immunoglobulin G (IgG) ELISA. A plaque reduction neutralization test was performed for the detection of neutralizing antibodies. Nipah viral RNA could be detected from blood, bronchial wash, endotracheal (ET) secretion, and cerebrospinal fluid (CSF) and anti-NiV immunoglobulin M (IgM) antibodies from the serum sample of the index case. Rapid establishment of an onsite NiV diagnostic facility and contact tracing helped in quick containment of the outbreak. NiV sequences retrieved from the clinical specimen of the index case formed a sub-cluster with the earlier reported Nipah I genotype sequences from India with more than 95% similarity. Anti-NiV IgG positivity could be detected in 21% of Pteropus medius (P. medius) and 37.73% of Rousettus leschenaultia (R. leschenaultia). Neutralizing antibodies against NiV could be detected in P. medius. Stringent surveillance and awareness campaigns need to be implemented in the area to reduce human-bat interactions and minimize spillover events, which can lead to sporadic outbreaks of NiV.

Tibial osteomyelitis due to Fonsecaea pedrosoi in an immunocompetent patient: case report.

UNLABELLED: Dematiaceous fungi are the etiological agents of phaeohyphomycosis. Diverse presentations of infectious syndromes are seen, ranging from local infections after trauma to widely disseminated infection in immunocompromised patients. Fonsecaea pedrosoi species have been reported to cause an increasing number of infections, particularly in severely immunocompromised patients. Colonization of normal skin has been reported. We present a case of F. pedrosoi osteomyelitis in an immunocompetent patient. A high level of suspicion and routine fungal cultures are required to identify these cases. Tissue culture and pathologic examination are necessary for definitive diagnosis and for distinguishing infection from colonization. Therapy includes antifungal drugs (itraconazole) and aggressive surgical debridement, and, even when these modalities are readily implemented, the outcome may not be optimal because of the angioinvasive character of the organism. LEVEL OF CLINICAL EVIDENCE: 4.

Sodium uptake across basolateral membrane of rat distal colon. Evidence for Na-H exchange and Na-anion cotransport.

This study sought to characterize the mechanism of Na transport across basolateral membrane vesicles of rat distal colon. Both an outward proton gradient and an inward bicarbonate gradient stimulated 22Na uptake. Proton gradient-stimulated 22Na uptake was activated severalfold by the additional presence of an inward bicarbonate gradient, and bicarbonate gradient-stimulated 22Na uptake was significantly enhanced by an imposed intravesicular membrane positive potential. 0.1 mM amiloride inhibited both proton gradient- and bicarbonate gradient-stimulated 22Na uptake by 80 and 95%, respectively, while 1 mM 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (DIDS) inhibited both proton gradient- and bicarbonate gradient-stimulated 22Na uptake by 40 and 80%, respectively. Both proton gradient- and bicarbonate gradient-stimulated 22Na uptake saturated as a function of increasing Na concentration: the apparent kinetic constants (Km) for Na for the DIDS-insensitive component of proton gradient-stimulated 22Na uptake was 46.4 mM, while the DIDS-sensitive component of proton gradient- and bicarbonate gradient-stimulated 22Na uptake had Km for Na of 8.1 and 6.4 mM, respectively. Amiloride inhibited both DIDS-insensitive proton gradient- and bicarbonate gradient-stimulated 22Na uptake with an inhibitory constant (Ki) of approximately 35 and 1 microM, respectively. We conclude from these results that proton gradient-stimulated 22Na uptake represents both DIDS-insensitive Na-H exchange and DIDS-sensitive electrogenic Na-OH cotransport, and that the DIDS-sensitive component of proton gradient-stimulated 22Na uptake and bicarbonate gradient-stimulated 22Na uptake may represent the same electrogenic Na-anion cotransport process.

Functional expression and segmental localization of rat colonic K-adenosine triphosphatase.

A putative cDNA for the colonic K-ATPase has recently been cloned (Crowson, M.S., and G. E. Shull. 1992. J. Biol. Chem. 267:13740-13748). Considerable evidence exists that there are two K-ATPases and active K absorptive processes in the rat distal colon: one that is ouabain sensitive and the other ouabain insensitive. The present study used the baculovirus expression system to express K-ATPase activity in insect Spodoptera frugiperda (Sf 9) cells and a polyclonal antibody (M-1), developed against a fusion protein produced from the 327 nucleotide fragment from 5' coding region of the putative K-ATPase cDNA, to identify the specific localization of the K-ATPase protein. K-ATPase activity (28.7 +/- 1.2 nmol inorganic phosphate/mg protein min) was expressed in plasma membranes isolated from Sf 9 cells infected with baculovirus containing recombinant DNA with the putative K-ATPase cDNA. Km for K for the K-ATPase was 1.2 mM. The expressed K-ATPase activity was not inhibited by ouabain (1 mM); while the Ki for vanadate inhibition was 8.3 microM. Western blot analysis with the M-1 antibody identified a 100-kD protein in apical membranes prepared from distal, but not proximal, rat colon. Immunohistochemical studies with M-1 antibody localized K-ATPase only in the apical membrane of surface cells, while an mAb (c464.6) against Na,K-ATPase localized basolateral membranes of both surface and crypt cells of rat distal colon. In conclusion, the putative K-ATPase cDNA encodes an ouabain-insensitive K-ATPase that is present only in the apical membrane of surface cells of rat distal colon.

Immunohistochemistry in Primary B-cell Lymphoma of Tibia Masquerading as Chronic Osteomyelitis.

The diagnosis between chronic osteomyelitis, Ewing sarcoma and lymphoma often is being confusing in many occasions. As the latter two conditions are malignant, early diagnosis and interventions are crucial. We present a 28 year old male with features of chronic osteomyelitis of right tibia 2 years back then changed through Ewing sarcoma to B-cell lymphoma in the histological diagnosis. This case report highlights the difficulties that arise in diagnosing primary bone lymphomas which may masquerade as chronic osteomyelitis and hence the need for immunohistochemistry in chronic recurrent osteomyelitis.

Transport of carnosine by mouse intestinal brush-border membrane vesicles.

The characteristics of carnosine (beta-alanyl-L-histidine) transport have been studied using purified brush-border membrane vesicles from mouse small intestine. Uptake curves did not exhibit any overshoot phenomena, and were similar under Na+, K+ or choline+ gradient conditions (extravesicular greater than intravesicular). However, uptake of histidine showed an overshoot phenomenon in the presence of a Na+-gradient. There was no detectable hydrolysis of carnosine during 15 min of incubation with membrane vesicles under conditions used for transport experiments. Analysis of intravesicular contents further showed the complete absence of the constituent free amino acids of carnosine, and indicates that intact carnosine is transported. Studies on the effect of concentration on peptide uptake revealed that transport occurred by a saturable process conforming to Michaelis-Menten kinetics with a Km of 9.6 +/- 1.4 mM and a Vmax of 2.9 +/- 0.2 nmol/mg protein per 0.4 min. Uptake of carnosine was inhibited by both di- and tripeptides with a maximum inhibition of 68% by glycyl-L-leucyltyrosine. These results clearly demonstrate that carnosine is transported intact by a carrier-mediated, Na+-independent process.

Transport characteristics of L-glutamate in human jejunal brush-border membrane vesicles.

Previous work using human jejunal brush-border membrane vesicles has demonstrated the existence of a distinct transport system in man for acidic amino acids. This system is energized by an inwardly directed Na+ gradient and an outwardly directed K+ gradient. These studies further characterize the transport of L-glutamate in the human jejunal brush-border membrane vesicles. Efflux studies were performed by loading the brush-border membrane vesicles with radiolabeled L-glutamate and sodium chloride. Extravesicular K+ accelerated the efflux of L-glutamate when compared to extravesicular Na+ or choline, indicating that potassium serves to recycle the carrier. Unlabeled extravesicular L-glutamate (but not D-glutamate) also enhanced the efflux of radiolabeled L-glutamate demonstrating that there is a bidirectional similarity to the transport system. The effect of pH on the transport system was also investigated by varying the intravesicular and extravesicular pH from 5.5 to 9. A pH environment of 6.5 produced the highest initial uptake rates as well as the greatest overshoots for transport of L-glutamate into brush-border membrane vesicles. The imposition of an inwardly directed pH gradient (5.5 outside, 7.5 inside) accelerated both the influx and efflux of L-glutamate. These results demonstrate that the L-glutamate carrier system in human jejunum appears to have similar energizing characteristics in either direction across the brush-border membrane. In addition, the system operates at an optimal pH of 6.5 and protonation of the system may enhance its mobility.

An improved HPLC method for determination of carotenoids in human serum.

An HPLC method was developed to determine the various carotenoids in human serum. A C-30 column and a mobile phase of 100% methanol (A) and 100% methylene chloride (B) with the following gradient elution were used: 90% A and 10% B in the beginning, maintained for 5 min, decreased to 78% A at 15 min, 62% A at 30 min, 52% A at 40 min, 41% A at 50 min, 38% A at 55 min, maintained for 3 min, and returned to 100% A at 65 min. A total of 21 carotenoids, including all-trans forms of lutein, zeaxanthin, alpha-cryptoxanthin, beta-cryptoxanthin, alpha-carotene, beta-carotene and lycopene, as well as their 14 cis-isomers were resolved within 51 min at a flow rate of 1.0 mL/min and detection at 476 nm. all-trans-beta-Carotene was found to be present in highest amount (256.3-864.2 ng/mL), followed by all-trans-lycopene (64.4-569.2 ng/mL), all-trans-lutein (137.9-450.3 ng/mL), all-trans-alpha-cryptoxanthin (55.7-188.2 ng/mL), all-trans-beta-cryptoxanthin (43.1-134.5 ng/mL), all-trans-alpha-carotene (20.0-122.1 ng/mL) and all-trans-zeaxanthin (9.1-21.3 ng/mL). Similar trend was observed for cis-isomers of carotenoids.