Absolute Neutrophil Count in Cases of Pancytopenia.

Pancytopenia is a common cause of hematological consultation. Common underlying causes include vitamin deficiency (vitamin B12, folic acid), drugs (hydroxyurea, phenytoin, methotrexate), and bone marrow failure syndrome. Aplastic anemia is one of the rarest hematological diseases and presents as pancytopenia. However, it is the most sinister one and is a hematological emergency that needs urgent medical attention. Absolute neutrophil count (ANC) is a measure of disease severity and is expected to be low in patients with pancytopenia of any cause. Aim & Objective: We aimed to analyze the absolute neutrophil count (ANC) level in patients presenting with pancytopenia. Material & Method: This prospective, observational study was conducted at a tertiary care hospital in northern India. We included patients with pancytopenia diagnosed at our center or reported to our center for therapy. ANC was measured before starting therapy. Observation: One hundred twenty-seven patients were included in this study. After evaluation, megaloblastic anemia was the commonest underlying cause in 42 (33%) patients followed by myelodysplastic syndrome in 31 (24.4%) patients. Twenty-three (18.1%) patients having pancytopenia were diagnosed with aplastic anemia. Other causes included leukemia, paroxysmal nocturnal hemoglobinuria and drugs. The median age was 37 years (range 18-75 years), and 67 (52.75%) were male. The mean hemoglobin was 5.5 g/dL (95% CI ±1.9). The median WBC was 2570/cmm (300-3130) and the median platelet was 36000/cmm (2000-92000). The median ANC in patients with aplastic anemia was 594/cmm (range 25- 3850). When compared, the ANC level was significantly lower in aplastic anemia than other causes of pancytopenia (p<0.001). Conclusion: On univariate and multivariate analysis ANC was significantly lower at baseline in patients of aplastic anemia. A longer follow-up of the patients will be required to assess the value of ANC in predicting response to therapy.

Pulse electrodeposition of CuSbS2 thin films: Role of Cu/Sb precursor ratio on the phase formation and its performance as photocathode for hydrogen evolution§.

In this paper, we outline the development of stoichiometric chalcostibite, CuSbS2 thin films, from a single bath by pulse electrodeposition for its application as a photocathode in photoelectrochemical cells (PEC). The Cu/Sb precursor molar ratio of the deposition bath was varied to obtain stoichiometric CuSbS2 thin films. The optimized deposition and dissolution potentials were -0.72 V and -0.1 V vs saturated calomel electrode, respectively. The formation of CuSbS2 was analyzed using different characterization tools. X-ray diffraction and Raman results showed the formation of the pure chalcostibite phase from a precursor bath with molar ratio Cu/Sb = 0.41. The heterostructure CuSbS2/CdS/Pt was tested as a photocathode in the PEC. The energy positions of the conduction and valence bands were estimated from the Mott Schottky plots. The conduction band and valence band offset of CuSbS2/CdS heterojunction were 0.1 eV and 1.04 eV, respectively. The electric field created in the junction reduced the recombination of the electron/hole pairs and improved charge transfer in the interface. The heterostructure CuSbS2/CdS/Pt demonstrated an improved photocurrent density of 3.4 mA cm-2 at 0 V vs reversible hydrogen electrode. The PEC efficiency obtained from the CuSbS2/CdS heterojunction was 0.56 %. Therefore, we demonstrated the feasibility of an inexpensive technique like electrodeposition for the development of an efficient earth-abundant photocathode.

Fertility Awareness and Perceptions among Procreant Age Group in Western India: An Exploration with Mixed Methodology.

BACKGROUND: In India, fertility rate demonstrates a descending trend whereas there is upsurge in infertility rate. In addition, a knowledge gap concerning fertility has been identified among the current generation. AIM: To quantify the fertility awareness and in-depth exploration of perceptions about fertility among procreant age group. MATERIALS AND METHODS: Explanatory mixed method design with sequential data collection, nested sampling technique was assumed. Purposive sampling was incorporated to recruit 1000 participants into the prospective cohort study. Awareness was measured using fertility knowledge questionnaire, while qualitative data were collected by in-depth interview of 28 participants until data saturation. The study was intact in terms of ethical compliance. RESULTS: Sociodemographic data revealed that the mean age of the respondents was 31.33 ± 6.4 years, 59.6% were female, 78.3% were married, 61.5% completed their university education, 76.0% were working. The mean of overall fertility awareness score was 50.2 ± 13.5. There was no statistical difference in responses of the subgroups (P > 0.05) and only educational status was significantly associated (P = 0.001*) with awareness scores. Perceptions pertinent to fertility were evidently varying amongst the general group and couples accessing fertility treatment, which subsequently was elucidated with the qualitative thematic analysis. CONCLUSION: Procreant age group of western India demonstrated low to average fertility awareness. Assertive recommendations were proposed for fertility awareness initiatives across both genders, irrespective of educational status.

Impact of Vertical Inhomogeneity on the Charge Extraction in Perovskite Solar Cells: A Study by Depth-Dependent Photoluminescence.

In perovskite solar cells (PSCs), the vertical inhomogeneities which include uneven grains, voids, and grain boundaries are closely linked to the underlying charge transport layer which controls the nucleation and grain growth in the perovskite film. Herein, the vertical inhomogeneity of perovskite films in the device structure is analyzed by depth-dependent photoluminescence (PL) achieved with different excitation wavelengths. An analytical representation between vertical inhomogeneity and depth-dependent PL, parametrized with a factor, b, is introduced to understand the relation between inhomogeneity and charge recombination. Lower values of b correlate to lower vertical inhomogeneity and hence reduced recombination. The analytical representation is validated in two sets of devices that show remarkable differences in perovskite film morphology, device based on mesoporous TiO2 and planar SnO2. By exploring the morphological properties and the PL emission from different depths across the device structures, we show that the lower vertical inhomogeneity leads to more efficient charge carrier extraction in planar SnO2-based devices. Moreover, the SnO2-based devices exhibit lower Urbach energy, which concurs with the slow transient photovoltage decay, suggesting less defects and recombination losses. This work provides a broader understanding of the impact of vertical inhomogeneity on the charge extraction efficiency and presents a methodology to study quantitatively the inhomogeneity of perovskite films in device structures.

Contrast-Enhanced 3D-FLAIR Imaging of the Optic Nerve and Optic Nerve Head: Novel Neuroimaging Findings of Idiopathic Intracranial Hypertension.

BACKGROUND AND PURPOSE: The sensitivity of contrast-enhanced 3D-FLAIR has not been assessed in patients with idiopathic intracranial hypertension. The purpose of this study was to evaluate whether hyperintensity of the optic nerve/optic nerve head on contrast-enhanced 3D-FLAIR imaging is associated with papilledema in patients with idiopathic intracranial hypertension. MATERIALS AND METHODS: A retrospective review was conducted from 2012 to 2015 of patients with clinically diagnosed idiopathic intracranial hypertension and age- and sex-matched controls who had MR imaging with contrast-enhanced 3D-FLAIR. Two neuroradiologists graded each optic nerve/optic nerve head on a scale of 0-3. This grade was then correlated with the Frisén Scale, an ophthalmologic scale used for grading papilledema from 0 (normal) to 5 (severe edema). To estimate the correlation between the MR imaging and Frisén scores, we calculated the Kendall τ coefficient. RESULTS: Forty-six patients (3 men, 43 women) with idiopathic intracranial hypertension and 61 controls (5 men, 56 women) with normal findings on MR imaging were included in this study. For both eyes, there was moderate correlation between the 2 scales (right eye: τ = 0.47; 95% CI, 0.31-0.57; left eye: τ = 0.38; 95% CI, 0.24-0.49). Interreader reliability for MR imaging scores showed high interreader reliability (right eye: κ = 0.76; 95% CI, 0.55-0.88; left eye: κ = 0.87; 95% CI, 0.78-0.94). Contrast-enhanced 3D-FLAIR imaging correlates with the Frisén Scale for moderate-to-severe papilledema and less so for mild papilledema. CONCLUSIONS: Hyperintensity of the optic nerve/optic nerve head on contrast-enhanced 3D-FLAIR is sensitive for the detection of papilledema in patients with idiopathic intracranial hypertension, which may be useful when prompt diagnosis is crucial.

Molecular, serological and epidemiological observations after a suspected outbreak of plague in Nyimba, eastern Zambia.

Plague is a re-emerging zoonotic disease caused by the bacterium Yersinia pestis. The disease has caused periodic global devastation since the first outbreak in the 6th century. Two months after a suspected plague outbreak in Nyimba district, samples were collected from 94 livestock (goats and pigs), 25 rodents, 6 shrews and 33 fleas. Enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) techniques were used to investigate the presence of Y. pestis, which showed that 16.0% (4/25) of rodents, 16.7% (1/6) of shrews (Crocidura spp) and 6.0% (5/83) of goats were positive for IgG antibodies against Fraction 1 antigen of Y. pestis. Plasminogen activator (Pla) gene (DNA) of Y. pestis was detected in five pools containing 36.4% (12/33) fleas collected from pigs (n = 4), goats (n = 5) and rodents (n = 3). The detection of Pla gene in fleas and IgG antibodies against Fraction1 antigen in rodents, shrews and goats suggest that Y. pestis had been present in the study area in the recent past.

A comparative study of bio degradation of various orthodontic arch wires: an in vitro study.

BACKGROUND: Orthodontic wires are the corner stones of the science and art of orthodontics and they remain in the patient's mouth for a prolonged period of 18-24 months. It is but natural to expect that they will undergo some biodegradation when in the oral environment during that period. This study aims to compare the biodegradation characteristics of four different orthodontic wires, stainless steel, nickel titanium (NiTi), titanium molybdenum alloy (TMA), and copper NiTi and to assess whether these biodegradation products, are within acceptable limits. MATERIALS AND METHODS: This study involved the incubation of four different wires in artificial saliva and analyzing the amount of metal released from them at the end of a 28 days study period. The metals analyzed for where nickel, chromium, copper, cobalt, manganese, iron, molybdenum, and titanium. The artificial saliva was changed on days 7, 14, and 21 to prevent the saturation of metals in the artificial saliva. At the end of 28 days, these four samples of artificial saliva of each wire were mixed together and analyzed for the eight metals using an inductively coupled plasma spectroscope. RESULTS: The results showed only the release of nickel, chromium, and iron from stainless steel wire, nickel from NiTi wire, nickel, and chromium from copper NiTi and none from TMA wire. CONCLUSION: The metals released from arch wires are of such minute quantities to be of any biologic hazard. The amount of metals released is well within acceptable biocompatible limits. Though this study has analyzed the biodegradation of various orthodontic wires, orthodontic wires are never used alone in mechanotherapy. Orthodontic wires along with multiband appliance system with which it is always used and in combination with accessories like face bows may release more metals.

A novel series of 2,5-substituted tryptamine derivatives as vascular 5HT1B/1D receptor antagonists.

The design, synthesis, and activity of a novel series of 2,5-substituted tryptamine derivatives at vascular 5HT1B-like receptors is described. Several important auxiliary binding sites of the 5HT1B-like receptor have been proposed following various modifications to the 2-substituent and especially to the methylene- or ethylene-linked 5-side chain. Careful design of new molecules based on a proposed pharmacophoric model of the 5HT1B-like receptor has resulted in the discovery of ethyl 3-[2-(dimethylamino)ethyl]-5-[2-(2, 5-dioxo-1-imidazolidinyl)ethyl]-1H-indole-2-carboxylate (40), a highly potent, silent, competitive, and selective antagonist which shows affinity at the vascular 5HT1B-like receptors only. Changes to the size of the 2-ester substituent have a significant effect on affinity at the 5HT1B-like receptor and other receptors. Prudent placement of the carbonyl substituent in the heterocycle of the 5-side chain is crucial for good affinity and selectivity over the 5HT2A and other receptors. Several key structural and electronic features were identified which are crucial for producing antagonism within a tryptamine-based series. An electron deficient indole ring system appears essential in order to achieve antagonism, and this is achieved by the inclusion of electron-withdrawing groups at the 2-position of the indole ring. The molecule displacement within the receptor resulting from the inclusion of the bulky 2-substituents also enhances antagonism as this results in the removal of the pi electron density of the indole ring from the region of the receptor normally occupied by the indole ring of 5HT. There also appears to be a structural requirement on the side chain incorporating the protonatable nitrogen, and this is achieved by the inclusion of the bulky 2-ester group which neighbors the 3-ethylamine side chain.

Synthesis and serotonergic activity of substituted 2, N-benzylcarboxamido-5-(2-ethyl-1-dioxoimidazolidinyl)-N, N-dimethyltryptamine derivatives: novel antagonists for the vascular 5-HT(1B)-like receptor.

The synthesis and vascular 5-HT(1B)-like receptor activity of a novel series of substituted 2, N-benzylcarboxamido-5-(2-ethyl-1-dioxoimidazolidinyl)-N, N-dimethyltryptamine derivatives are described. Modifications to the 5-ethylene-linked heterocycle and to substituents on the 2-benzylamide side chain have been explored. Several compounds were identified which exhibited affinity at the vascular 5-HT(1B)-like receptor of pK(B) > 7.0, up to 100-fold selectivity over alpha(1)-adrenoceptor affinity and 5-HT(2A) receptor affinity, and which exhibited a favorable pharmacokinetic profile. N-Benzyl-3-[2-(dimethylamino)ethyl]-5-[2-(4,4-dimethyl-2, 5-dioxo-1-imidazolidinyl)ethyl]-1H-indole-2-carboxamide (23) was identified as a highly potent, silent (as judged by the inability of angiotensin II to unmask 5-HT(1B)-like receptor-mediated agonist activity in the rabbit femoral artery), and competitive vascular 5-HT(1B)-like receptor antagonist with a plasma elimination half-life of approximately 4 h in dog plasma and with good oral bioavailability. The selectivity of compounds from this series for the vascular 5-HT(1B)-like receptors over other receptor subtypes is discussed as well as a proposed mode of binding to the receptor pharmacophore. It has been proposed that the aromatic ring of the 2, N-benzylcarboxamide group can occupy an aromatic binding site rather than the indole ring. The resulting conformation allows an amine-binding site to be occupied by the ethylamine nitrogen and a hydrogen-bonding site to be occupied by one of the hydantoin carbonyls. The electronic nature of the 2,N-benzylcarboxamide aromatic group as well as the size of substituents on this aromatic group is crucial for producing potent and selective antagonists. The structural requirement on the 3-ethylamine side chain incorporating the protonatable nitrogen is achieved by the bulky 2, N-benzylcarboxamide group and its close proximity to the 3-side chain.

Testing Compounds for Antiviral Activity in Cell Cultures Infected with HIV.

This chapter describes the procedures that can be used to determine compounds that have antiviral activity against HIV. These include: maintenance of lymphoblastoid cell lines, preparation of peripheral blood mononuclear cells (PMMCs), and determination of the infectivity of the HIV stock-supernatant and antiviral assays. The assays described use both acutely and chronically infected cells. Toxicity of compounds is assessed by measuring (14)C uptake. These protocols are used for the evaluation of compounds that can be carried out by a single individual in a Category 3 containment laboratory. The number of compounds analyzed would be about 10, which is a convenient number to fill a single 96-well p24 enzyme-linked immunosorbent assay (ELISA) plate.

Acute arsenic toxication of a free-ranging white-tailed deer in New York.

An adult, female white-tailed deer (Odocoileus virginianus) died due to acute arsenic intoxication in an intensively managed northern hardwood forest in northern New York. We hypothesize that the deer licked trees injected with Silvisar 550, which contains monosodium methanearsonate. We believe this is the first report of death of a free-ranging white-tailed deer, due to ingestion of monosodium methanearsonate.

The escalating cesarean section rate: a 25 year experience at the University of Nebraska Medical Center.

The cesarean section rate at our medical center has increased gradually from 9.1% in 1965 to 21.9% in 1989, which is lower but similar to national trends. This upward trend was reversed in 1990 by more strongly encouraging vaginal births after cesarean section, attempting more vaginal deliveries in select cases of breech presentations, and complying with national guidelines for defining fetal distress and dystocia. Recommendations are offered for the development of statewide guidelines for peer review and quality assurance.

Fascicular premature beats with narrow QRS in the presence of bundle-branch block.

The electrocardiogram of a sixty-two-year-old male revealed right bundle-branch block, left anterior superior fascicular block, and right precordial Q waves consistent with anteroseptal myocardial infarction. Premature beats with narrow QRS (100 ms) occurred intermittently; coupling intervals varied between 560-600 ms. His bundle electrogram confirmed the fascicular origin of the premature beats. During atrial prematuring studies, it was shown that an appropriately timed premature beat could prolong infra-His conduction time, but QRS normalization was not achieved. The possible electrophysiologic mechanisms that could result in a normal QRS complex with fascicular premature beats in this patient are discussed; a new mechanism is suggested.

Hyperimmunoglobulin E syndrome: treatment with isotretinoin.

A patient with hyperimmunoglobulin E syndrome is described. Recurrent cutaneous staphylococcal abscesses were a prominent feature and had been resistant to treatment with antibiotics and surgical drainage. Following a 4-month course of treatment with isotretinoin, he developed no further abscesses over a 6-month follow-up period. Detailed immunological investigations were undertaken before and after treatment and no change was found to account for his improvement. We consider that the beneficial effects of isotretinoin in this situation are likely to be due to a reduction in sebaceous gland size and activity, rather than to any effect on the underlying disorder.

Effects of differentiation inducing chemicals on in vivo malignancy and NK susceptibility of metastatic lymphoma cells.

In the present investigation we have determined the effects of the differentiation-inducing chemicals dimethyl sulfoxide (DMSO) and sodium butyrate on the growth and tumorigenicity of a highly malignant/metastatic cell line (RAW117-H10) and its less tumorigenic parental lymphoma cell line (RAW117-P). Both of these agents at doses shown to be nontoxic slowed the growth of these cells in suspension culture and significantly lengthened the doubling time while reducing colony formation in the agar tumor stem cell assay. Corresponding to these observations, the in vivo tumorigenicity of the highly malignant RAW117-H10 line was reduced by both chemicals but particularly by butyrate treatment. In addition, both agents increased the expression of some glycoproteins and the glycolipid asialo GM1. There was also a corresponding increase in the NK susceptibility of the normally NK resistant RAW117-H10 cells. To determine if the decreased malignancy of the highly malignant cells following treatment with the chemical agents was primarily due to the alteration in cell surface glycoconjugates or merely due to concomitant decreased growth potential, we transplanted highly glycosylated membrane fragments from normal syngeneic thymocytes to both RAW117-P and RAW117-H10 cells using a Sendai virus mediated membrane fusion technique. The in vivo tumorigenicity of the membrane altered RAW117-H10 cells was significantly decreased. These results strongly suggest that the decreased in vivo malignancy of RAW117-H10 cells resulting from treatment with chemical differentiation agents is caused by their increased susceptibility to NK cell mediated lysis which in turn results from cell surface changes involving altered, primarily increased, expression of certain glycosylated surface molecules. The cell surface glycoconjugates, such as receptors for certain lectins and glycolipid asialo GM1, can be used as markers for malignant potential and NK sensitivity of malignant lymphoid cells.

Thrombosis of Björk-Shiley aortic valve prostheses.

Though thromboembolic complications are reportedly minimal in patients with Björk-Shiley aortic valve prostheses, massive thrombosis remains a major and often fatal problem. The authors observed massive thrombosis in 3 patients, only one of whom survived. In all three instances, the disk of the prosthesis was relatively radiolucent. With valves manufactured after late 1975, which contain a tantalum foil hoop, cineradiography is the most rapid and accurate method of showing the disk. A simple method of calculating the valve opening angle from the cineradiograph is described. It is suggested that serial cineradiographs might be useful in detecting lesser degrees of thrombosis and partial immobilization of the disk.