Prevalence of reproductive tract infection among tribal migrant women living in urban areas: a community-based cross-sectional study.

OBJECTIVES: The current study investigates the reproductive tract infections (RTIs) among tribal migrant women in urban areas of Gujarat, India. These groups of women face multiple challenges, including limited healthcare access, poor living conditions, and inadequate reproductive and child healthcare services. Therefore, the present study was conducted to assess the RTIs of tribal women living in urban areas. STUDY DESIGN: It was a community-based cross-sectional study. METHODS: It was conducted among the four municipal corporation areas in Gujarat. A sample of 592 women, who were in reproductive age (15-45 years) and belonging to tribal community and seasonally migrated to urban areas, were included for the study. RESULT: Almost 64% of the participants married before the legal age of 18, with 29% marrying before the age of 15. Furthermore, early pregnancy (at <18 years) was reported by 29% of the women. Approximately 22% of the women experienced reproductive health issues, with a prevalence of 13% for symptomatic RTIs, 8% for urinary tract infections (UTIs), and 8% for menstrual problems. Almost 58.4% of women with RTIs, 54.1% with UTIs, 48.9% with menstrual problems, and 46.1% with polycystic ovary syndrome were classified as underweight. However, this relationship was not statistically significant. CONCLUSION: The study revealed the 13% of the prevalence of RTIs among the migratory tribal women. It is matching with national-level community-based study of India National Family Health Survey. The current study explored that there is no association of nutrition and RTI. Also, it is required to plan a larger-level community-based study to understand overall reproductive health issues among all different group of women.

Comparing rates of statin therapy in eligible patients living with HIV versus uninfected patients.

OBJECTIVES: Despite an increased risk of atherosclerotic cardiovascular disease (ASCVD) in people living with HIV (PLWH), a gap in statin prescribing practices has been described for statin-eligble PLWH and uninfected patients. Few data have become available characterizing this gap since the publication of the 2013 American College of Cardiology/American Heart Association lipid guidelines. The objective of this study was to characterize statin prescribing rates for eligible PLWH compared to uninfected adults. METHODS: This was a retrospective, comparative analysis of patients seen at two clinics in an urban, academic medical system between February 2017 and September 2017. Patients who qualified for one of the statin benefit groups were included: those with a history of clinical ASCVD, low-density lipoprotein cholesterol ≥ 190 mg/dL, diabetes mellitus, or 10-year ASCVD risk score ≥ 7.5%. Patients < 21 years old or without a lipid panel within 3 years were excluded. The primary outcome was the percentage of PLWH prescribed a statin compared to uninfected patients. Predictors associated with receiving a statin were analysed using a logistic regression model. RESULTS: Nine hundred and eight PLWH and 2239 uninfected patients met the study criteria. A difference in statin prescribing rates was observed between PLWH and uninfected patients (44% versus 56%, respectively; adjusted odds ratio (OR) 0.79; 95% confidence interval (CI) 0.66-0.94). However, only in the 10-year ASCVD risk group were the rates significantly different (24% for PLWH versus 36% for uninfected patients; adjusted OR 0.68; 95% CI 0.5-0.92). PLWH more often received a medium-intensity statin and uninfected patients more often received a high-intensity statin. CONCLUSIONS: PLWH with ASCVD risk were less likely to be prescribed a statin compared to uninfected patients. Additional analyses are needed to investigate reasons for the statin prescribing gap and appropriateness of lipid agent selection in both study populations.

Differential expression of interleukin-12 p35 and p40 subunits in response to Aeromonas hydrophila and Aquareovirus infection in grass carp, Ctenopharyngodon idella.

The grass carp (Ctenopharyngodon idella) aquaculture industry in Asia is prone to bacterial and viral hemorrhagic diseases. Effective adjuvants for vaccine formulation are the need of the hour for control of these diseases and long-term sustainability of grass carp farming. In this study, the involvement of interleukin-12 (IL-12) from grass carp (gcIL­12) in anti-bacterial and anti-viral immune responses was demonstrated via expression profiles of gcIL-12 subunits in immune tissues of the fish, following infection by Aeromonas hydrophila and Aquareovirus. Additionally, cDNA of the gcIL-12 subunits, p35 and p40 was cloned and characterized. We found that most of the structurally and functionally important features of vertebrate orthologues were conserved in gcIL-12 subunits, p35 and p40, with some features specific to grass carp. High levels of gcIL-12 p35 expression in the brain and gills suggest that IL-12 plays an important role in neural and immune systems. High expression levels in the heart, blood, and immune-related tissues suggest an important role in circulation and the immune system as well. Infections by both, A. hydrophila and Aquareovirus stimulated the mRNA expression of gcIL-12 subunits, p35 and p40 in most immune tissues. Significant upregulation or downregulation of gcIL-12 subunits, p35 and p40 by bacterial and viral infection confirms their potential role in anti-bacterial and anti-viral immune responses in fish.

Molecular characterization, expression, and immunological response analysis of the TWEAK and APRIL genes in grass carp, Ctenopharyngodon idella.

TWEAK and APRIL are important members of the TNF superfamily, which play a crucial role in several diseases. Here, we describe the identification of grass carp (Ctenopharyngodon idella) homologs of TWEAK and APRIL (designated gcTWEAK and gcAPRIL, respectively) and their response to Aeromonas hydrophila and Aquareovirus infection. The gcTWEAK cDNA sequence contains 2273 bases with an open reading frame of 753 bases encoding 250-amino acid residues. The gcTWEAK protein contains a predicted transmembrane domain, a putative furin protease cleavage site, 3 conserved cysteine residues, and a typical TNF homology domain. The gcAPRIL cDNA sequence contains 1408 bases with an open reading frame of 747 bases encoding 248-amino acid residues. The gcAPRIL protein contains a predicted transmembrane domain, a putative furin protease cleavage site, 2 conserved cysteine residues, and a typical TNF homology domain corresponding to other, known APRIL homologs. Reverse transcription-polymerase chain reaction analysis shows that both gcTWEAK and gcAPRIL transcripts are predominantly expressed in the skin, spleen, and head kidney, and they are significantly upregulated in most immune tissues by A. hydrophila and Aquareovirus infections. Our results demonstrate that liver is the most responsive tissue against bacterial infection, whereas gill is the most responsive tissue against viral infection. The association of increased gcTWEAK and gcAPRIL expression after bacterial and viral infections suggests that they play a potentially important role in the immune system of fish.

PO-10 - Lung cancer with tumour thrombosis: a poor prognosticator.

INTRODUCTION: Literature has reported tumour thrombus along the inferior vena cava as a result of underlying renal cell carcinoma (RCC) or along the portal vein from hepatocellular carcinoma (HCC). However, tumor thrombus is a rather uncommon complication of a metastatic tumour deposit in the superior vena cava in lung adenocarcinoma. Detection of tumour thrombus at the time of cancer diagnosis is a significant predictor of morbidity and mortality. Unlike RCC with vena caval extension where surgical resection provides meaningful long term survival, lung adenocarcinoma with vena cava involvement has a very dismal outcome. AIM: We discuss a rare case of a tumor thrombus secondary to a lung malignancy, the differentiation between a tumor and a bland thrombus and the rationale behind treatment of the tumor thrombus. MATERIALS AND METHODS: We report a case of a 77 year-old male who presented with right sided chest pain and was subsequently found to have a right upper lobe lung mass. The lung biopsy confirmed the diagnosis of a adenocarcinoma. Computed tomography scans for staging detected focal destruction of the right second rib and tumour thombus in the superior vena cava with partial extension to the left brachiocephalic vein. No other metastases were noted. The patient received chemotherapy with paclitaxel and carboplatin for the stage IV lung adenocarcinoma. He was also started on subcutaneous heparin for tumour thrombus. However, the patient died of pneumonia eight weeks later. RESULTS: A review of literature did not show effective treatment for tumour thrombus. Pathogenesis of tumour thrombus is unclear, however several theories have been postulated for the formation of tumour thrombus; it could result from the direct invasion by tumour resulting in epithelial damage or because of formation of tumour thrombus on top of bland thrombosis, related to cancer hypercoagulability. Irrespective of etiology, tumour thrombus itself being a thrombophilic condition should be treated with anticoagulation, however the mainstay of treatment is treating the underlying cancer. CONCLUSIONS: Adenocarcinoma of the lung with tumour thrombus significantly alter prognosis although the individual's Karnofsky performance scale and response to treatment play a major role in determining life expectancy. Further studies need to be done to address the preferred modality and duration of anticoagulation for tumor thrombus.

Ruptured submitral aneurysm.

Submitral aneurysm is a rare entity, with around few hundred cases reported till date. Presentation can be varied. We describe here a case of submitral aneurysm in a young male with rupture into the left atrium cavity.

Management of bio-medical waste: awareness and practices in a district of Gujarat.

With the objective of assessing the level of awareness about the various aspects of biomedical waste and disposal practices by the medical practitioners this study was conducted. It was a cross sectional study. 30 hospitals with more than 30 beds minimum were randomly selected from Sabarkantha district, Gujarat. The doctors and auxiliary staff of those 30 hospitals were the study population. While all the doctors knew about the existence of the law related to biomedical waste but details were not known. Doctors were aware of risk of HIV and Hepatitis B and C, whereas auxiliary staff (ward boys, ayabens, sweepers) had very poor knowledge about it. There was no effective waste segregation, collection, transportation and disposal system at any hospital in the district. There is an immediate and urgent need to train and educate all doctors and the staff to adopt an effective waste management practices.

Reversible cerebral perfusion abnormalities associated with cyclosporine therapy in orthotopic liver transplantation.

A 60-yr-old woman experienced several episodes of generalized seizures following 2 wk of immunosuppressive therapy with cyclosporine for orthotopic liver transplantation. CT showed low density in the white matter of the parieto-occipital lobes. A 99mTc-HMPAO brain SPECT showed diminished perfusion in the parieto-occipital cortex bilaterally. Although the cyclosporine was discontinued, the patient's neurologic status initially worsened and then improved over the next several days. Repeat perfusion brain SPECT showed resolution of most of the perfusion abnormalities, while repeat CT showed persistent white matter changes in the parieto-occipital lobes. We report the presence of reversible cortical perfusion abnormalities in conjunction with cyclosporine therapy. The findings suggest that perfusion brain SPECT may be a sensitive monitor of cyclosporine-induced neurotoxicity.

Brain perfusion imaging during preoperative temporary balloon occlusion of the internal carotid artery.

UNLABELLED: The main objective of this study was to assess whether 99mTc-HMPAO brain SPECT imaging can identify patients at high risk of developing an infarct following permanent carotid occlusion in the course of brain surgery. METHODS: Test balloon occlusion of the internal carotid artery was performed in 44 patients with a variety of head and neck tumors or aneurysms. Technetium-99m-HMPAO was injected intravenously while the balloon was initiated and a SPECT study was obtained 30 min later. Follow-up CT scans were obtained routinely for all patients at 2 wk and 1 mo following surgery, or earlier when necessary. Thirty patients and five normal volunteers had semiquantitative analysis of cerebral perfusion. RESULTS: Twenty-six patients demonstrated ipsilateral perfusion abnormalities during trial occlusion. Eight patients in this group underwent bypass grafting prior to sacrifice of the artery: two resulting in infarcts. Eighteen patients had symmetric cerebral perfusion during occlusion and four of these patients underwent permanent therapeutic carotid occlusion; three patients had subsequent infarcts and the fourth patient had an impending stroke. CONCLUSION: Patients with symmetric cerebral perfusion measured by 99mTc-HMPAO SPECT may still have a high long-term complication rate following carotid sacrifice. The scan findings in these patients were not predictive of the outcome. Patients with asymmetric cerebral perfusion had alternative therapeutic approach to carotid sacrifice and most of them had good surgical outcomes.

Experimental investigation and mathematical modeling of Pluronic F127 gel dissolution: drug release in stirred systems.

We have examined the dissolution of Pluronic F127 gels in a USP dissolution apparatus under stirred conditions, and simultaneously monitored the release of model drugs from these gels. The drugs selected were propranolol HCl, metronidazole and cephalexin. Our results show that drug release is zero-order and is controlled by the dissolution of the gel for all the drugs, under various conditions of temperature, F127 concentration, drug concentration, and for stirring speeds between 20 and 80 rpm. The addition of inorganic salts has no significant effect on dissolution rate or drug release. Increasing F127 concentration in the gel decreases gel dissolution and drug release rates. We have developed a predictive mathematical model based on the assumption that uptake of water into the gel and subsequent disentanglement of F127 micelles control gel dissolution. There is good agreement between experimental results and model predictions for stirring speeds above 20 rpm. As stirring speed is decreased to 20 rpm and below, there are discrepancies between actual and predicted values, presumably due to a significant diffusion component that contributes to drug release.

Understanding drug release from poly(ethylene oxide)-b-poly(propylene oxide)-b-poly(ethylene oxide) gels.

Experimental and mathematical studies were performed to understand the release mechanism of small molecular weight compounds from poly(ethylene oxide)-b-poly(propylene oxide)-b-poly(ethylene oxide) polymer gels (trademarked Pluronic by BASF Corp.) of various concentrations. Studies of the diffusion coefficient of solutes in the polymer gels were performed using a novel technique to predict movement of drugs within the gel as release occurs. Studies were also performed to determine the diffusion coefficient of water in the polymer gel, as it is this parameter that controls the dissolution rate of the polymer, and in turn, the drug release rate. A model was formulated and solved numerically to determine the controlling release mechanism. By parameter modification, this algorithm for determining the overall mass of drug released from a drug loaded gel can be used for a number of drugs and for a wide range of initial polymer concentrations. Drug release data were obtained with a novel experimental setup and were used to verify the accuracy of the overall solution of the model. The results of the model indicate that although the rate of polymer dissolution ultimately controls the drug release, about 5% of the release is due to diffusion at the gel/liquid interface, giving rise to a slightly non-linear release. It was also found that agitation speed greatly affects the dissolution rates of these polymer gels.

Degradation of chlorthalidone in methanol: kinetics and stabilization.

The reaction of chlorthalidone with methanol to give the corresponding methyl ether was investigated. The kinetics are pseudo-first-order in chlorthalidone, but the observed pseudo-first-order rate constants show an unexpected dependence on the initial chlorthalidone concentration, attributable to the presence of trace catalytic impurities in commercial chlorthalidone. Evidence is presented to show that trace heavy metals are probably responsible for the primary catalytic effect. Trace quantities of acetic acid are also present and show a smaller secondary catalytic effect. Kinetics in the presence of added heavy metals and acetic acid were examined. EDTA and povidone reduce the degradation rate. Stabilization by EDTA is due to its ability to chelate heavy metals. Stabilization by povidone is also primarily due to its ability to complex heavy metals; complexation data of ferric and nickel ions with povidone and with 1-methyl-2-pyrrolidinone as a monomer model are presented. In addition, complexation constants were calculated for the interaction of povidone with chlorthalidone, which may also play a role in stabilization.

Kinetics and mechanism of hydroxy group acetylations catalyzed by N-methylimidazole.

The kinetics of acetylation of alcohols by acetyl chloride and acetic anhydride, with N-methylimidazole as the catalyst, were studied in acetonitrile solution at 25 degrees; some measurements were also made with 4-dimethylaminopyridine as the catalyst. The acetic anhydride-N-methylimidazole system proceeds entirely by a general base catalysis, whereas the acetyl chloride-N-methylimidazole system reacts entirely via a nucleophilic route, with the intermediate formation of the N-acylated catalyst. The reaction of this intermediate with the alcohol is general base catalyzed. The acetyl chloride-4-dimethylaminopyridine system also reacts via the nucleophilic route. In the acetic anhydride-4-dimethylaminopyridine system a small fraction of the intermediate was detected. The acetic anhydride-N-methylimidazole system was studied in n-propanol-acetonitrile solvent mixtures; no spectral evidence for intermediate formation was seen. However, the hydrolysis reaction in acetic anhydride-N-methylimidazole, studied over a wide range of water-acetonitrile mixtures, revealed a change in mechanism from general base in dry acetonitrile to a solely nucleophilic route at high water concentrations.

Effect of pH and temperature on the solubility of a surface active carboxylic acid.

We have examined the effect of pH and temperature on the solubility of 3-(4-heptylbenzoyl) benzoic acid (1), a surface active carboxylic acid with a pKa of 4.83 and a critical micelle concentration (cmc) of 4 X 10(-4) M. Our results show that below a pH of 7.0 and a temperature of 50 degrees C, the solubility of 1 is less than the cmc; under these conditions, 1 behaves like a typical weak acid. Above pH 7.0, the solubility can equal or exceed the cmc, depending on the temperature, and dramatic deviations from typical weak acid solubility behavior are observed. The temperatures at which the solubility becomes equal to the cmc at various pH values were determined; these temperatures are termed apparent Krafft Points (KPapp). The KPapp varies with pH; the higher the pH, the lower the KPapp. For example, the KPapp at pH 7.0 is 49 degrees C, and at pH 8.0 is less than 5 degrees C. We report the pH-temperature-solubility relationship for 1 and use it to construct simple phase diagrams.

Eosinophilic cholecystitis as a possible late manifestation of the eosinophilia-myalgia syndrome.

We describe a case of acute acalculous cholecystitis occurring in a 43-year-old woman with a history of the eosinophilia-myalgia syndrome, associated with the ingestion of 1-tryptophan. The patient underwent a laparoscopic cholecystectomy and subsequent histological examination of the gallbladder revealed an infiltrate predominantly of eosinophils, suggesting a possible relationship to the underlying condition. This may represent a late complication of the eosinophilia-myalgia syndrome--such an association has not previously been reported in the literature. The gastrointestinal and hepatic complications of this syndrome are discussed.

A controlled trial of tiaprofenic acid against indomethacin in patients with rheumatoid arthritis.

A multicentre double-blind crossover study of tiaprofenic acid 600 mg daily against indomethacin 75 mg daily was carried out in 68 patients with rheumatoid arthritis to compare short-term efficacy and tolerance. There were no significant differences in efficacy between the two treatments, but significantly fewer C.N.S. side-effects were associated with tiaprofenic acid treatment. Five patients withdrew during the course of the study due to side-effects and all were receiving indomethacin.

Liposphere based lipoprotein-mimetic delivery system for 6-mercaptopurine.

Long-circulating lipospheres containing 6-mercaptopurine (6-MP) were prepared by solidification of warm microemulsion at low temperature. Palmitoyl PEG was incorporated in the system to confer stealth-type nature. The size of lipospheres was in the range of 60-70 nm and was inversely proportional to sonication time. The size range was attained after 8 h. of sonication. The entrapped 6-MP contained 0.12 mmol/mole of lipid. The coating efficiency of 63-71% was attained. The zeta potential substantially decreased after PEG coating, however, the lipospheres were stable due to steric repulsion and exhibited no aggregation. The release of 6-MP was found to be 18-25% of administered dose in 24 h. and followed a mixed profile for stealth lipospheres. The percent dose remaining in plasma was found to be high even after 24 h as compared to control, indicating an increase in circulation time of lipospheres. Tissue accumulation of drug correlated with the pharmacokinetic behavior of lipospheres. The system seems to be an ideal carrier for anticancer drug delivery.

Electrocardiographic features of atrial depolarization during pacing of right atrial appendage.

Identification of atrial capture during pacing from right atrial appendage is frequently difficult. Electrocardiograms of forty five patients implanted with AAI/DDD pacemakers (thirty unipolar, fifteen bipolar) were analysed to characterize the specific morphology of paced P waves. Compared to sinus P waves, atrial pacing resulted in atrial depolarization of lower amplitude (0.16 +/- 0.05 mv vs 0.11 +/- 0.032 mv, P less than 0.005) but increased duration (0.07 +/- 0.009 sec vs 0.08 +/- 0.017 sec, P less than 0.005). P wave morphology was similar in unipolar and bipolar pacing units. It was positive in lead I (80%), II (71.11%), III (80%) and aVF (75.55%). In lead aVL, paced P waves were usually diphasic with an initial negative deflection (35.55%). Precordial leads showed paced atrial depolarization of small amplitude and did not help in identification of atrial capture. In unipolar pacing P waves were best seen in lead III because of small pacing spike in this lead. Lead II was suitable for identification of paced P waves in bipolar pacing. Thus careful examination of standard ECG leads for paced P waves of low amplitude, prolonged duration and specific morphology can help in confirming atrial capture following pacing stimulus from right atrial appendage.

Acute hemodynamic effects of different atrioventricular intervals in dual chamber pacemakers: is there an optimum atrioventricular delay.

Conflicting data have been reported regarding adjustment of atrioventricular (AV) interval to maximise hemodynamic performance of dual chamber pacemakers. Eleven consecutive patients with complete heart block and dual chamber pacemakers were paced at three AV intervals (150, 200, 250 msec) and free running rates (60-93 bpm, mean 73 +/- 12 bpm) with simultaneous measurements of cardiac output, atrial contribution to left ventricular filling, left ventricular ejection fraction, and peak aortic velocity and acceleration by echo-Doppler techniques to define the optimum AV delay. At all the three AV intervals tested there was no difference in cardiac output (4.7 +/- 0.96, 4.83 +/- 1.12, 4.77 +/- 1.19 litres/min respectively, p = NS), left ventricular ejection fraction (60.2 +/- 10.6%, 61.2 +/- 9.9% and 64 +/- 8.3%, p = NS), atrial contribution to left ventricular filling (0.37 +/- 0.10, 0.38 +/- 0.09, 0.36 +/- 0.16, n = 8, p = NS), peak aortic velocity (104 +/- 8, 105 +/- 12, 104 +/- 13 cm/sec, p = NS) and aortic acceleration (19.68 +/- 4.26, 20.4 +/- 5.58 and 19.0 +/- 4.54 m/sec2, p = NS). Compared to AV delay of 150 msec an increase in cardiac output of 0.5 L/minute was observed in three patients at an AV delay of 200 msec and in one patient at the AV delay of 250 msec. These data suggest that it is difficult to generalize an optimum AV delay in patients with dual chamber pacemakers. With the AV interval in the range of 150-250 msec, only a minority of patients could improve their haemodynamics at rest by adjusting this interval if the baseline cardiac function was normal.