Examining engagement in care of women living with HIV in South India.

HIV seropositive adherence-challenged women, who reported being on ART for at least four months were interviewed. Data on healthcare history, anti-retroviral therapy, clinic visits, doctor communication, disclosure and fear of stigma were collected. Better engagement in care was significantly more likely among older women, ≥ 10 years of education, higher income, HIV status disclosure to family, with higher community stigma fears and fewer healthcare access barriers. To promote retention, women may be encouraged to consider disclosing their HIV serostatus to supportive household members. A variety of possible interventions to overcome the prevalent barriers to care are provided.

Potassium hydroxide mount with cellophane adhesive tape: a method for direct diagnosis of dermatophyte skin infections.

BACKGROUND: Potassium hydroxide (KOH) mount is a simple and rapid procedure that can be performed with minimal resources and provides results within 1-2 h. AIM: To further optimize KOH mount using transparent cellophane tape to ascertain fungal elements, even by inexperienced personnel. METHODS: A split-body study was conducted on 100 patients with tinea cruris. Conventional scrape method was performed on the right side and the cellophane tape method on the left. Microscopy was performed 1-2 h after collection, and on the next morning and days 3 and 7. RESULTS: Of the 100 samples, positive results were seen in 91 (91%) with the standard method and 94 (94%) with the cellophane tape method. Clumping of the fungi and presence of artefacts were more marked with the scrape than with the tape method. CONCLUSION: In view of its merits over the conventional scrape method, the cellophane tape method is a prudent alternative for the detection of superficial fungal infections.

Intralesional Vitamin D3 Injection in the Treatment of Recalcitrant Warts: A Novel Proposition.

BACKGROUND: Verruca vulgaris (viral warts) is a fairly common condition with a plethora of treatment options having variable success rates. Recalcitrant warts are refractory to treatment with often disappointing response and high recurrence rates. Lately, treatment with intralesional injections has gained momentum due to its effectiveness in clearing warts by stimulating the cell-mediated immunity. Vitamin D, when applied topically, regulates epidermal cell proliferation and is involved in the formation of antimicrobial peptides. We have attempted to use vitamin D3 to exploit its reported action as an immunotherapeutic molecule in addition to its topical effects. To our knowledge, there are no reports of intralesional vitamin D3 injections used in the treatment of extragenital recalcitrant warts. METHODS: Sixty-four patients with recalcitrant warts of varying sizes and duration were included in the study. About 0.2- to 0.5-mL vitamin D3 solution (600,000 IU, 15 mg/mL) was injected to the base of the wart. A maximum of 5 warts were injected per session at 3-week intervals until resolution or for a maximum of 4 treatments. Patients were followed up for 6 months after the last injection to detect any recurrence. RESULTS: Sixty patients completed the study. Complete response was seen in 54 of 60 (90%), partial response in 4 of 60 (6.66%), and no response in 2 of 60 (3.33%). The average number of injections required to achieve a complete resolution was 3.66. Complete resolution of distant warts was noticed in all patients. CONCLUSIONS: Intralesional vitamin D3 is a safe, effective, and an inexpensive treatment option for recalcitrant warts.

Status of Vitamin B12 and Folate among the Urban Adult Population in South India.

BACKGROUND: Deficiency of vitamin B12 (B12) and folate (FA) leads to a wide spectrum of disorders that affect all age groups. However, reports on B12 and FA status in healthy adults in India are limited. Hence, we determined the plasma levels and dietary intake of B12 and FA in the adult population. METHODS: We conducted a community-based cross-sectional study in an urban setup among 630 apparently healthy adults distributed into 3 age groups: 21-40, 41-60 and >60 years. Plasma concentrations of B12 and FA were analyzed by radio immunoassay and dietary intake by 24-hour recall method. RESULTS: The overall prevalence of FA deficiency was 12%, but there was no significant difference in plasma FA concentrations among the groups. While the overall prevalence of B12 deficiency was 35%, it was significantly higher in the 21-40 (44%) and 41-60 age groups (40%) when compared with the >60 group (30%). B12 deficiency was higher in vegetarians (54%) compared to those consuming mixed diet (31%), and the reverse was the case with FA. However, the dietary intakes of FA and B12 were not significantly different among the groups. CONCLUSIONS: These results indicate a higher prevalence of B12 deficiency in apparently healthy adults in an urban setup.

A comparative study of ascending urethrogram and sono-urethrogram in the evaluation of stricture urethra.

UNLABELLED: To compare the efficacy of sono-urethrogram and ascending urethrogram in the evaluation of stricture urethra. MATERIALS AND METHODS: In this prospective study 40 patients with obstructive lower urinary tract symptoms and suspected to be having stricture urethra were subjected to ascending urethrogram and sonourethrogram. The radiologist was blinded to the findings of ascending urethrogram. All the sonourethrograms were done by the same radiologist. The findings of sonourethrogram & ascending urethrogram were compared with the findings of cystoscopy and intra-operative findings. The specificity, sensitivity,positive predictive value and negative predictive value of each modality in the diagnosis of various urethral anomalies were estimated. RESULTS: The sonourethrogram identified stricture disease in all the patients who had abnormal ascending urethrogram. In addition, other abnormalities like spongiofibrosis, diverticula and stones which were not picked up in ascending urethrogram were diagnosed by sonourethrogram. The cystoscopic and intra-operative findings with respect to stricture length, diameter and spongiofibrosis correlated well with sono-urethrogram findings. 5 patients who had stricture in the ascending urethrogram were found to be having the normal urethra in sonourethrogram and confirmed by cystoscopy. CONCLUSION: sonourethrogram is an effective alternative to ascending urethrogram in the evaluation of stricture urethra. It is more sensitive in the diagnosis of anterior urethral strictures than posterior urethral strictures. It is superior to ascending urethrogram in the identification of spongiofibrosis, diameter and length of the stricture. The complications were lower in sonourethrogram group compared to ascending urethrogram.

Progressive multifocal leukoencephalopathy (PML) associated with HIV Clade C--is not uncommon.

Progressive multifocal leukoencephalopathy (PML) is a rare, subacute, demyelinating disease of the central nervous system caused by JC virus. Studies of PML from HIV Clade C prevalent countries are scarce. We sought to study the clinical, neuroimaging, and pathological features of PML in HIV Clade C patients from India. This is a prospective cum retrospective study, conducted in a tertiary care Neurological referral center in India from Jan 2001 to May 2012. Diagnosis was considered "definite" (confirmed by histopathology or JCV PCR in CSF) or "probable" (confirmed by MRI brain). Fifty-five patients of PML were diagnosed between January 2001 and May 2012. Complete data was available in 38 patients [mean age 39 ± 8.9 years; duration of illness-82.1 ± 74.7 days). PML was prevalent in 2.8 % of the HIV cohort seen in our Institute. Hemiparesis was the commonest symptom (44.7 %), followed by ataxia (36.8 %). Definitive diagnosis was possible in 20 cases. Eighteen remained "probable" wherein MRI revealed multifocal, symmetric lesions, hypointense on T1, and hyperintense on T2/FLAIR. Stereotactic biopsy (n = 11) revealed demyelination, enlarged oligodendrocytes with intranuclear inclusions and astrocytosis. Immunohistochemistry revelaed the presence of JC viral antigen within oligodendroglial nuclei and astrocytic cytoplasm. No differences in clinical, radiological, or pathological features were evident from PML associated with HIV Clade B. Clinical suspicion of PML was entertained in only half of the patients. Hence, a high index of suspicion is essential for diagnosis. There are no significant differences between clinical, radiological, and pathological picture of PML between Indian and Western countries.

Terpenoids of plant origin inhibit morphogenesis, adhesion, and biofilm formation by Candida albicans.

Biofilm-related infections caused by Candida albicans and associated drug resistant micro-organisms are serious problems for immunocompromised populations. Molecules which can prevent or remove biofilms are needed. Twenty-eight terpenoids of plant origin were analysed for their activity against growth, virulence attributes, and biofilms of C. albicans. Eighteen molecules exhibited minimum inhibitory concentrations of <2 mg ml(-1) for planktonic growth. Selected molecules inhibited yeast to hyphal dimorphism at low concentrations (0.031-0.5 mg ml(-1)), while adhesion to a solid surface was prevented at 0.5-2 mg ml(-1). Treatment with 14 terpenoids resulted in significant (p < 0.05) inhibition of biofilm formation, and of these, linalool, nerol, isopulegol, menthol, carvone, α-thujone, and farnesol exhibited biofilm-specific activity. Eight terpenoids were identified as inhibitors of mature biofilms. This study demonstrated the antibiofilm potential of terpenoids, which need to be further explored as therapeutic strategy against biofilm associated infections of C. albicans.

Bis(4-sulfamoylanilinium) sulfate.

In the title salt, 2C6H9N2O2S(+)·SO4 (2-), the sulfate S atom is situated on a crystallographic twofold axis (the symmetry of the anion is 2). The anion exerts intense libration, which is manifested by shortening of the observed sulfate S-O bonds, as well as by features in the electron-density map. The crystal structure is stabilized through a three-dimensional hydrogen-bonding network formed by strong N-H⋯O hydrogen bonds.

Linking D-Dimer and haematological parameters among Indian COVID 19 patients.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak continues to place a significant strain on healthcare systems, economies, and patient management. Therefore, it is of interest to evaluate the role of D-Dimer and haematological parameters to identify severity and outcome of COVID 19 patients. Total 100 cases diagnosed with COVID 19 were recruited in the study and followed up for 6 months. The subjects were grouped into 2, Group 1: Newly Diagnosed COVID 19 Patients and Group 2: After 6 months of follow up COVID 19 Patients. We analyzed Hb, RBCs, WBCs, PT, APTT and D-Dimer and also, we taken CT values of the study subjects. A statistical analysis was done by using SPSS version 20.0. The WBCs and haemoglobin mean values are shown significant values between the study subjects, respectively with p-values < 0.001**. The PT and APTT significantly increased in newly diagnosed COVID 19 patients when compared to after 6 months of follow up at p-value < 0.001**. There was a positive correlation of WBCs, PT, APTT (r= 0.458, 526, 509) with D-Dimer and negatively correlated RBCS, Hb, CT (-0.056, 321, 526, 353), respectively at p < 0.001**. Thus, low platelet, high d-dimer, and fibrinogen may serve as risk markers for the progression of COVID-19 severity. Hence, COVID-19 patients may experience anaemia-related consequences as hypoxia, coronary and pulmonary failure due to low Hb concentration. Further, patients with COVID-19 also experience bleeding issues due to thrombocytopenia.

Interaction of physico-chemical parameters with Shannon-Weaver Diversity Index based on phytoplankton diversity in coastal water of Diu, India.

Phytoplankton acts as carbon sinks due to photosynthetic efficacy and their diversity is expressed by SWDI (Shannon-Weaver Diversity Index), which depends on water quality parameters. The coastal water of Diu was studied for three seasons, and the relationship between different parameters and SWDI was established. Subsequently, an attempt was made to build up a prediction model of SWDI based on multilayer perceptron Artificial neural network (ANN) using the R programme. Analysis shows interrelationship between the water quality parameters and phytoplankton diversity is same in linear principal component analysis (PCA) and neural network model. Variations of different parameters depend on seasonal changes. The ANN model shows that ammonia and phosphate are key parameters that influence the SWDI of phytoplankton. Seasonal variation in SWDI is related to variation in water quality parameters, as explained by both ANN and PCA. Hence, the ANN model can be an important tool for coastal environmental interaction study.

Prevalence of anti-basal ganglia antibodies in adult obsessive-compulsive disorder: cross-sectional study.

BACKGROUND: Symptoms of obsessive-compulsive disorder (OCD) have been described in neuropsychiatric syndromes associated with streptococcal infections. It is proposed that antibodies raised against streptococcal proteins cross-react with neuronal proteins (antigens) in the brain, particularly in the basal ganglia, which is a brain region implicated in OCD pathogenesis. AIMS: To test the hypothesis that post-streptococcal autoimmunity, directed against neuronal antigens, may contribute to the pathogenesis of OCD in adults. METHOD: Ninety-six participants with OCD were tested for the presence of anti-streptolysin-O titres (ASOT) and the presence of anti-basal ganglia antibodies (ABGA) in a cross-sectional study. The ABGA were tested for with western blots using three recombinant antigens; aldolase C, enolase and pyruvate kinase. The findings were compared with those in a control group of individuals with depression (n = 33) and schizophrenia (n = 17). RESULTS: Positivity for ABGA was observed in 19/96 (19.8%) participants with OCD compared with 2/50 (4%) of controls (Fisher's exact test P = 0.012). The majority of positive OCD sera (13/19) had antibodies against the enolase antigen. No clinical variables were associated with ABGA positivity. Positivity for ASOT was not associated with ABGA positivity nor found at an increased incidence in participants with OCD compared with controls. CONCLUSIONS: These findings support the hypothesis that central nervous system autoimmunity may have an aetiological role in some adults with OCD. Further study is required to examine whether the antibodies concerned are pathogenic and whether exposure to streptococcal infection in vulnerable individuals is a risk factor for the development of OCD.

Sensitization of Candida albicans biofilms to various antifungal drugs by cyclosporine A.

BACKGROUND: Biofilms formed by Candida albicans are resistant towards most of the available antifungal drugs. Therefore, infections associated with Candida biofilms are considered as a threat to immunocompromised patients. Combinatorial drug therapy may be a good strategy to combat C. albicans biofilms. METHODS: Combinations of five antifungal drugs- fluconazole (FLC), voriconazole (VOR), caspofungin (CSP), amphotericin B (AmB) and nystatin (NYT) with cyclosporine A (CSA) were tested in vitro against planktonic and biofilm growth of C. albicans. Standard broth micro dilution method was used to study planktonic growth, while biofilms were studied in an in vitro biofilm model. A chequerboard format was used to determine fractional inhibitory concentration indices (FICI) of combination effects. Biofilm growth was analyzed using XTT-metabolic assay. RESULTS: MICs of various antifungal drugs for planktonic growth of C. albicans were lowered in combination with CSA by 2 to 16 fold. Activity against biofilm development with FIC indices of 0.26, 0.28, 0.31 and 0.25 indicated synergistic interactions between FLC-CSA, VOR-CSA, CSP-CSA and AmB-CSA, respectively. Increase in efficacy of the drugs FLC, VOR and CSP against mature biofilms after addition of 62.5 µg/ml of CSA was evident with FIC indices 0.06, 0.14 and 0.37, respectively. CONCLUSIONS: The combinations with CSA resulted in increased susceptibility of biofilms to antifungal drugs. Combination of antifungal drugs with CSA would be an effective prophylactic and therapeutic strategy against biofilm associated C. albicans infections.

4-Sulfamoylanilinium nitrate.

In the crystal structure of the title compound, C(6)H(9)N(2)O(2)S(+)·NO(3) (-), the cations and anions are connected by N-H⋯O hydrogen bonds into a three-dimensional network.

Shear Stress Alterations Activate BMP4/pSMAD5 Signaling and Induce Endothelial Mesenchymal Transition in Varicose Veins.

Chronic venous diseases, including varicose veins, are characterized by hemodynamic disturbances due to valve defects, venous insufficiency, and orthostatism. Veins are physiologically low shear stress systems, and how altered hemodynamics drives focal endothelial dysfunction and causes venous remodeling is unknown. Here we demonstrate the occurrence of endothelial to mesenchymal transition (EndMT) in human varicose veins. Moreover, the BMP4-pSMAD5 pathway was robustly upregulated in varicose veins. In vitro flow-based assays using human vein, endothelial cells cultured in microfluidic chambers show that even minimal disturbances in shear stress as may occur in early stages of venous insufficiency induce BMP4-pSMAD5-based phenotype switching. Furthermore, low shear stress at uniform laminar pattern does not induce EndMT in venous endothelial cells. Targeting the BMP4-pSMAD5 pathway with small molecule inhibitor LDN193189 reduced SNAI1/2 expression in venous endothelial cells exposed to disturbed flow. TGFß inhibitor SB505124 was less efficient in inhibiting EndMT in venous endothelial cells exposed to disturbed flow. We conclude that disturbed shear stress, even in the absence of any oscillatory flow, induces EndMT in varicose veins via activation of BMP4/pSMAD5-SNAI1/2 signaling. The present findings serve as a rationale for the possible use of small molecular mechanotherapeutics in the management of varicose veins.

State-of-Art Bio-Assay Systems and Electrochemical Approaches for Nanotoxicity Assessment.

Innovations in the field of nanotechnology, material science and engineering has rendered fruitful utilities in energy, environment and healthcare. Particularly, emergence of surface engineered nanomaterials offered novel varieties in the daily consumables and healthcare products including therapeutics and diagnostics. However, the nanotoxicity and bioactivity of the nanomaterials upon interaction with biological system has raised critical concerns to individual as well as to the environment. Several biological models including plant and animal sources have been identified to study the toxicity of novel nanomaterials, correlating the physio-chemical properties. Biological interaction of nanomaterials and its mediated physiological functions are studied using conventional cell/molecular biological assays to understand the expression levels of genetic information specific to intra/extra cellular enzymes, cell viability, proliferation and function. However, modern research still demands advanced bioassay methods to screen the acute and chronic effects of nanomaterials at the real-time. In this regard, bioelectrochemical techniques, with the recent advancements in the microelectronics, proved to be capable of providing non-invasive measurement of the nanotoxicity effects (in vivo and in vitro) both at single cellular and multicellular levels. This review attempted to provide a detailed information on the recent advancements made in development of bioassay models and systems for assessing the nanotoxicology. With a short background information on engineered nanomaterials and physiochemical properties specific to consumer application, present review highlights the multiple bioassay models evolved for toxicological studies. Emphasize on multiple mechanisms involved in the cell toxicity and electrochemical probing of the biological interactions, revealing the cytotoxicity were also provided. Limitations in the existing electrochemical techniques and opportunities for the future research focusing the advancement in single molecular and whole cell bioassay has been discussed.

Development and evaluation of a rapid IgM capture ELISA (JEV-Chex) for the diagnosis of Japanese encephalitis.

BACKGROUND: The IgM capture ELISA has been the most widely used diagnostic method for Japanese encephalitis. However, the lack of availability of validated commercial kits as well as the short shelf life of the kit reagents has limited the use of this technique to very few centres in Asia. OBJECTIVES: Development and evaluation of a rapid IgM capture ELISA (JEV Chex) in comparison to the conventional IgM capture ELISA. Produce key reagents such as cell culture derived JEV antigen and biotinylated monoclonal antibody which are stable at room temperature. STUDY DESIGN: The conventional IgM capture ELISA was modified to reduce the total assay time and two key reagents used in the assay JEV antigen and biotinylated anti-JEV monoclonal antibodies were rendered stable at room temperature using a special procedure. A multi-centric evaluation of this rapid ELISA was carried out using well characterized stored CSF and serum samples. Long term stability of the key reagents was also assessed over a period of 6 months. RESULTS: The rapid IgM capture ELISA developed by us showed complete concordance with the results obtained using the conventional ELISA at all the three centres where it was evaluated. In addition, the stability studies carried out with the inactivated cell culture antigen and the biotinylated monoclonal antibodies stored at room temperature for a period of 180 days revealed that both these reagents yielded consistent optical density values in the ELISA. CONCLUSIONS: The rapid ELISA format of the IgM capture ELISA (JEV-Chex) developed by us as well as the stability of reagents achieved by us in this study is what renders this rapid IgM capture ELISA very robust and user friendly since reagents can be stored at 4 degrees C by peripheral labs.

Clinical, electrophysiological, imaging, pathological and therapeutic observations among 18 patients with Rasmussen's encephalitis.

We studied the clinical, electrophysiological, imaging and pathological features of 18 patients with Rasmussen's encephalitis (RE). This descriptive study included 18 patients (six males, 12 females) with RE who were evaluated for demographic and phenotypic details, electroencephalogram (EEG) results, MRI results, pathological features, virological markers and outcome. Radiological staging as per Bien et al. and pathological staging in accordance with Robitaille et al. were performed. Simple partial seizures were the most common initial manifestation. During the disease course, epilepsia partialis continua (EPC) developed in 15/18 (83.3%) and hemiparesis in 17/18 (94.4%) patients. EEG revealed hemispheric slowing (100%), interictal epileptiform discharges (100%) and ictal pattern (44.4%). Brain MRI revealed unihemispheric focal cortical atrophy (100%), white matter changes (88.2%), basal ganglia-ipsilateral caudate and putamen involvement (50.0%) and progression of atrophy on serial MRI (100%). Unusual presentations in this series included late onset (n=1), and isolated lingual EPC (n=1). Diagnostic biopsies in two patients revealed Robitaille stage 3 disease. The six hemispherotomy specimens showed stage 2 disease in one, stage 3 in three and stage 4 in two cases. Heterogeneity in disease stage in the different neuroanatomical regions and within the same cortical segment reflected progression of immune-mediated damage. Immunomodulation provided only temporary benefit. Patients who underwent functional hemispherotomy had reduction in seizure frequency and improved quality of life. The clinical, EEG and MRI findings are in accordance with the established literature. MRI staging was concordant with Robitaille pathological staging. Immunomodulation did result in transient reduction in seizure frequency while surgery in six produced reasonable benefit.

Calotropis procera mediated combustion synthesis of ZnAl2O4:Cr(3+) nanophosphors: structural and luminescence studies.

ZnAl2O4:Cr(3+) nanophosphors were synthesized for the first time by a simple and environment friendly route using Calotropis procera milk latex as fuel. The structural and surface morphological studies were carried out using powder X-ray diffraction (PXRD), scanning electron microscopy and transmission electron microscopy techniques. The photoluminescence (PL) properties of ZnAl2O4:Cr(3+) as a function of dopant concentration and calcination temperature was studied in detail. The PXRD patterns and Rietveld confinement confirmed the cubic crystal system with space group Fd-3m. The crystallite size estimated from Scherrer's and W-H plots was found to be in the range of 16-26 nm. The PL spectrum shows an intense peak at ∼688 and ∼699 nm assigned to spin-forbidden (2)Eg→(4)A2g transition of Cr(3+) ions. The PL measurements for two excitations (∼410 and 527 nm) and with respect to calcination temperature indicated no significant change in the shape and position of emission peak except PL intensity. The CIE chromaticity coordinates lies well within the white region. Thermoluminescence (TL) studies revealed well resolved glow peak at ∼212°C with a small shoulder at 188 and 233°C. The glow peak intensity at ∼212°C increases linearly with γ-dose which suggest ZnAl2O4:Cr(3+) is suitable candidate for radiation dosimetric applications. The activation energy (E in eV), order of kinetics (b) and Frequency factor (s) were estimated using glow peak shape method.

Antiepileptic Drugs Inhibit Growth, Dimorphism, and Biofilm Mode of Growth in Human Pathogen Candida albicans.

Exploring the potential of existing drugs for their unknown properties may offer advantages over conventional drug development by saving time and money. Candida albicans, an important human opportunist, shares many genetic properties with humans. This has encouraged us to study drugs that are not originally antifungals against C. albicans. In the present study, we have tested six antiepileptic drugs for their activities against C. albicans. Their effects on growth, time-dependent killing, yeast-to-hyphal form switching, and biofilms formation by C. albicans were studied. Out of the drugs studied, four drugs, which are γ-aminobutyric acid (GABA) receptor agonists in humans, inhibited growth, yeast-to-hyphal form switching, and biofilm formation in C. albicans. Lorazepam inhibited growth of C. albicans at 25 µg/ml, followed by midazolam and diazepam (minimum inhibitory concentrations 100 and 400 µg/ml, respectively). Members from other group voltage-gated sodium channel blockers failed to inhibit C. albicans. Our study has identified GABA receptor agonists used in epileptic therapy as potential candidates for antifungal drug development against the human pathogen C. albicans.

MR defecography for obstructed defecation syndrome.

Patients with obstructed defecation syndrome (ODS) form an important subset of patients with chronic constipation. Evaluation and treatment of these patients has traditionally been difficult. Magnetic resonance defecography (MRD) is a very useful tool for the evaluation of these patients. We evaluated the scans and records of 192 consecutive patients who underwent MRD at our center between January 2011 and January 2012. Abnormal descent, rectoceles, rectorectal intussusceptions, enteroceles, and spastic perineum were observed in a large number of these patients, usually in various combinations. We discuss the technique, its advantages and limitations, and the normal findings and various pathologies.