Trends of Infectious Disease Markers Among Healthy Blood Donors In Northern India: A Ten Year Study.

OBJECTIVE: Transfusion transmitted infection (TTI) is a major hazard for blood transfusion. The present retrospective chart review was undertaken to study the demographic profile and TTI trends among blood donors to see impact of interventions on blood safety. METHODS: Data of donors and TTI screening results from 2010 to 2019 were analyzed. Degree of significance was determined by Chi square test. RESULTS: Out of 1,68,570 donors, 33,227 (19.7%) were voluntary and 1,35,343 (80.3%) were replacement with 2.8% females and 54% belonging to the age group 18-29 years. Voluntary donation increased by only 3% in ten years and total reactivity rate was 1.6%. The reactive rate for all infections was 0.8% in volunteer donors and 1.95% in replacement donors (p-value < 0.001). The prevalence of HBsAg, HCV, HIV and syphilis showed a significant decline from 2010 to 2014. Of the donors who were reactive for HBV, 8.7% were missed by ELISA but detected by NAT. Donor reactivity for malaria remained the same in this period. CONCLUSION: Newer strategies and effort to increase voluntary donation helping the general public adopt a healthy lifestyle is urgently needed in India. Higher prevalence of TTI among replacement donors is substantiated by this study. Role of counseling of donors cannot be overemphasized. Utility of malaria screening for blood donors needs to be reexamined by evaluating evidences from other blood banks. A rational policy approach, based on a careful assessment of epidemiological data, cost effectiveness analysis, and opinion of stakeholders is necessary for universal adoption of NAT.

Multidisciplinary management of a complex case of renal cell carcinoma arising in a pelvic kidney.

The incidence of ectopic kidney is 1 in 2100-3000 autopsies. Renal cell cancer (RCC) in pelvic kidney is a rare entity with limited case reports available in the literature. Symptoms can vary from abdominal pain to haematuria, or RCC can be detected incidentally. Contrast imaging with computed tomography (CT) angiography is recommended to determine the location of the renal mass and the anatomy of surrounding organs and major vessels feeding it. Treatment of choice is radical nephrectomy. We report a case of RCC in ectopic pelvic kidney managed with radical nephrectomy that was deemed unresectable on CT imaging.

High rising flames: a sign of complex extraperitoneal bladder rupture.

Extraperitoneal bladder rupture is the most common type of bladder injury following pelvic trauma and is seen in 80-90% of cases. Generally, the contrast extravasation seen on computed tomography (CT) cystography is confined to the perivesical space, giving a characteristic flame-shaped appearance. Occasionally contrast extravasation can extend to the scrotum, thigh or anterior abdominal wall, depending on the extent of injury. Here we report an unusual CT cystogram finding of complex extraperitoneal bladder rupture with associated pelvic fracture urethral distraction defect, showing large-volume contrast extravasation extending beyond the perivesical space to the left perinephric region resembling high rising flames.

High rising flames: a sign of complex extraperitoneal bladder rupture.

Extraperitoneal bladder rupture is the most common type of bladder injury following pelvic trauma and is seen in 80-90% of cases. Generally, the contrast extravasation seen on computed tomography (CT) cystography is confined to the perivesical space, giving a characteristic flame-shaped appearance. Occasionally contrast extravasation can extend to the scrotum, thigh or anterior abdominal wall, depending on the extent of injury. Here we report an unusual CT cystogram finding of complex extraperitoneal bladder rupture with associated pelvic fracture urethral distraction defect, showing large-volume contrast extravasation extending beyond the perivesical space to the left perinephric region resembling high rising flames.

Anti-A1Leb: a mind boggler.

The Lewis blood group system is unique because antigens are neither alleles of the same gene nor are they synthesized by red blood cells (RBCs); rather, they are adsorbed onto the RBC membrane from plasma as glycolipids. Antibodies against Lewis antigens are predominantly naturally occurring immunoglobulin (Ig)M type that sometimes react at 37°C and the antihuman globulin phase. Lewis compound antigens, ALeb and BLeb, have been described that were confirmed because of the presence of antibodies against them. These compound antigens are the result of an interaction between ABO, H, SE, and LE genes.The Lewis blood group system is unique because antigens are neither alleles of the same gene nor are they synthesized by red blood cells (RBCs); rather, they are adsorbed onto the RBC membrane from plasma as glycolipids. Antibodies against Lewis antigens are predominantly naturally occurring immunoglobulin (Ig)M type that sometimes react at 37°C and the antihuman globulin phase. Lewis compound antigens, ALeb and BLeb, have been described that were confirmed because of the presence of antibodies against them. These compound antigens are the result of an interaction between ABO, H, SE, and LE genes.

A huge ureteric stone in a functionally, metabolically and anatomically normal kidney: an alliance of rarity.

Urinary stones are a common health problem, necessitating frequent outpatient visits and hospital admissions. Ureteric stones demand special attention, given their propensity for upstream hydroureteronephrosis and loss of renal function. They are usually predisposed by diverse anatomical, functional or metabolic abnormalities of the urinary tract and have an early symptomatic presentation. We report an exceptional clinical presentation of a huge ureteric stone yet functional renal moiety with no obvious anatomical or metabolic predilection for urolithiasis, and its minimally invasive management in a young woman. We emphasise that swift salvaging of the renal function is of utmost importance in these cases. Open exploration can be avoided in favour of laparoscopic ureterolithotomy with better cosmesis and early recovery.

An accurate inner diameter measurement.

The inaccurate deflection behavior of the probing system degrades the performance of the diameter-measuring machines. In this experiment, the probing is improved, applying an autocollimator and an angular positioning datum. We have devised this datum using a liquid wedge. A ring gauge is chosen as a workpiece to evaluate the deflection behavior of the probing system. The improved uncertainty of the probing is found as low as 40 nm. Subsequently, the inner diameter of the ring gauge is measured on this experimental setup. By employing a simulation, we aligned the workpiece. The deflections of the stylus are optimized to achieve zero deflection error at the zenith points. Consequently, the swing of the probe at the zenith points is combined with the rectilinear displacement of the workpiece to estimate the inner diameter. The uncertainty of the measurement of the ring gauge is improved up to 140 nm.

Correlation Between Composition and Electrodynamics Properties in Nanocomposites Based on Hard/Soft Ferrimagnetics with Strong Exchange Coupling.

In this work, Sr0.3Ba0.4Pb0.3Fe12O19/(CuFe2O4)x (x = 2, 3, 4, and 5) as strongly exchange-coupled nanosized ferrites were fabricated using a one-pot sol⁻gel combustion method (citrate sol-gel method). The X-ray diffraction (XRD) powder patterns of the products confirmed the occurrence of pure, exchange-coupled ferrites. Frequency dependencies of the microwave characteristics (MW) were investigated using a co-axial method. The non-linear behavior of the MW with the composition transformation may be due to different degrees of Fe ion oxidation on the spinel/hexaferrite grain boundaries and strong exchange coupling during the hard and soft phases.

Predicting the molecular subtype of breast cancer based on mammography and ultrasound findings.

AIM: To determine the correlation between mammography and ultrasound features of breast cancer with molecular subtypes and to calculate the predictive value of these features. MATERIALS AND METHOD: This is a prospective study of consecutive patients with breast cancer presenting between January 2016 and July 2017, who underwent mammography and/or ultrasound of breast and excision of the breast mass. Patients with contralateral breast mass, metastases, h/o prior cancer treatment, and other malignancies were excluded. On mammography, the presence or absence of microcalcification was noted. On ultrasound examination size, margins, microcalcification, posterior acoustic features, vascularity, and axillary nodes were assessed. Margins were categorized into circumscribed and non-circumscribed. Posterior acoustic features were classified into four categories: shadowing, enhancement, mixed, and no changes. Vascularity was assessed based on Adler's index into grades 0, 1, 2, and 3. Grades 0 and 1 were considered low and 2 and 3 were high. RESULTS: Tumors with non-circumscribed margins and posterior acoustic shadowing were likely to be luminal A or B subtype of breast cancer [odds ratio (OR) 5.78; 95% confidence interval (CI) 3.68-9.80; P < 0.0001]. Tumors with non-circumscribed margins, posterior acoustic shadowing, and high vascularity were more likely to be luminal B subtype (OR 2.88; 95% CI 2-4.14; P- <0.0001). Tumors with microcalcification and posterior mixed acoustic pattern were strongly associated to be HER2-positive (OR 5.48; 95% CI 3.06-9.80; P < 0.0001). Tumors with circumscribed margins and posterior acoustic enhancement were highly suggestive of triple-negative breast cancer (OR 7.06; 95% CI 4.64-10.73; P < 0.0001). CONCLUSION: Microcalcification detected on mammography and certain ultrasound features such as circumscribed or non-circumscribed margins, posterior acoustic features, and vascularity are strongly correlated in predicting the molecular subtypes of breast cancer, and thus may further expand the role of conventional breast imaging.

An essential role of Ffar2 (Gpr43) in dietary fibre-mediated promotion of healthy composition of gut microbiota and suppression of intestinal carcinogenesis.

Composition of the gut microbiota has profound effects on intestinal carcinogenesis. Diet and host genetics play critical roles in shaping the composition of gut microbiota. Whether diet and host genes interact with each other to bring specific changes in gut microbiota that affect intestinal carcinogenesis is unknown. Ability of dietary fibre to specifically increase beneficial gut microbiota at the expense of pathogenic bacteria in vivo via unknown mechanism is an important process that suppresses intestinal inflammation and carcinogenesis. Free fatty acid receptor 2 (FFAR2 or GPR43) is a receptor for short-chain fatty acids (acetate, propionate and butyrate), metabolites of dietary fibre fermentation by gut microbiota. Here, we show FFAR2 is down modulated in human colon cancers than matched adjacent healthy tissue. Consistent with this, Ffar2(-/-) mice are hypersusceptible to development of intestinal carcinogenesis. Dietary fibre suppressed colon carcinogenesis in an Ffar2-dependent manner. Ffar2 played an essential role in dietary fibre-mediated promotion of beneficial gut microbiota, Bifidobacterium species (spp) and suppression of Helicobacter hepaticus and Prevotellaceae. Moreover, numbers of Bifidobacterium is reduced, whereas those of Prevotellaceae are increased in human colon cancers than matched adjacent normal tissue. Administration of Bifidobacterium mitigated intestinal inflammation and carcinogenesis in Ffar2(-/-) mice. Taken together, these findings suggest that interplay between dietary fibre and Ffar2 play a key role in promoting healthy composition of gut microbiota that stimulates intestinal health.

Receptor tyrosine kinase signaling regulates replication of the peste des petits ruminants virus.

In this study, we found out that blocking the receptor tyrosine kinase (RTK) signaling in Vero cells by tryphostin AG879 impairs the in vitro replication of the peste des petits ruminants virus (PPRV). A reduced virus replication in Trk1-knockdown (siRNA) Vero cells confirmed the essential role of RTK in the virus replication, in particular a specific regulation of viral RNA synthesis. These data represent the first evidence that the RTK signaling regulates replication of a morbillivirus.

Tumor homing peptides as molecular probes for cancer therapeutics, diagnostics and theranostics.

Cancer is one of the leading causes of mortality worldwide, with more than 10 million new cases each year. Despite the presence of several anticancer agents, cancer treatment is still not very effective. Main reasons behind this high mortality rate are the lack of screening tests for early diagnosis, and non-availability of tumor specific drug delivery system. Most of the current anticancer drugs are unable to differentiate between cancerous and normal cells, leading to systemic toxicity, and adverse side effects. In order to tackle this problem, a considerable progress has been made over the years to identify peptides, which specifically bind to the tumor cells, and tumor vasculature (tumor homing peptides). With the advances in phage display technology, and combinatorial libraries like one-bead one-compound library, several hundreds of tumor homing peptides, and their derivatives, which have potential to detect tumor in vivo, and deliver anticancer agents specifically to the tumor site, have been discovered. Currently, many tumor homing peptide-based therapies for cancer treatment and diagnosis are being tested in various phases of clinical trials. In this review, we have discussed the progress made so far in the identification of tumor homing peptides, and their applications in cancer therapeutics, diagnosis, and theranostics. In addition, a brief discussion on tumor homing peptide resource, and in silico designing of tumor homing peptides has also been provided.

A prospective, randomized controlled trial comparing the left lateral, modified lateral and sitting positions for spinal block characteristics for Cesarean delivery.

BACKGROUND: Maternal position affects spinal block characteristics. We investigated the effect of lateral, modified lateral and sitting position for spinal anesthesia with 2 mL hyperbaric bupivacaine 0.5% on spinal block characteristics in this prospective, randomized study. METHODS: Seventy-five ASA physical status I parturients were randomly allocated to the left lateral to supine-wedged, modified lateral to supine-wedged with a10°head-up tilt or the sitting to supine-wedged position for induction of spinal anesthesia for Cesarean delivery. Neural block was assessed by pin prick and modified Bromage scale. Data were analyzed using ANOVA, Chi-square test and Wilcoxon rank sum test, where appropriate. P<0.05 was considered significant. RESULTS: Onset time (mean ± SD) for sensory block to T5 dermatome for the lateral, modified lateral and sitting groups was 6.8 ± 2.7, 13.6 ± 6.2 and 9.7 ± 5.5 min, respectively; P<0.001. The median (interquartile range) maximum dermatomal level was significantly lower in the modified lateral group (T5[T3-T5]) compared with the lateral (T3[T2-T4]) and sitting (T3[T3-T4]) groups, respectively; P=0.022 and P=0.030, respectively. Three women in the modified lateral group required general anesthesia compared with none in the other groups; P= 0.044. Apgar scores and cord blood pH, PO2 and PCO2 were similar between groups. CONCLUSION: The modified lateral position with 10 mg of hyperbaric bupivacaine was associated with a slower onset and a lower maximum sensory block necessitating higher requirement for conversion to general anesthesia. It did not offer any advantage over lateral and sitting positions for induction of spinal anesthesia for elective Cesarean delivery and cannot be recommended.

Pathogenesis and management of renovascular hypertension and ischemic nephropathy.

Renovascular disease is an important cause of secondary hypertension and renal impairment. Atherosclerotic renal artery stenosis (ARAS) is the most important cause of renal artery stenosis (RAS), and has been linked to increased cardiovascular risk. The pathogenesis of renovascular hypertension is complex, but is mainly due to the over-activation of Renin-Angiotensin-Aldosterone system. A major consequence of untreated RAS is ischemic nephropathy, which is due to the sustained reduction in renal perfusion leading to derangement of microvascular function, and eventual development of interstitial fibrosis. Diagnosis of these conditions can be complex, sometimes needing invasive testing. Aggressive medical management is key to preventing progression of disease, as the role of revascularization in the management of ARAS is still not well defined.

Estimation of mean ND: Yag laser capsulotomy energy levels for membranous and fibrous posterior capsular opacification.

INTRODUCTION: Posterior capsule opacification (PCO) is a visually-disabling complication of cataract surgery. OBJECTIVE: To estimate energy levels for capsulotomy in various subtypes of PCO (membranous, fibrous and fibro-membranous). MATERIALS AND METHODS: A total of 215 patients with PCO were randomly selected and evaluated for Nd: Yag laser capsulotomy, after a quiet post-operative course of 3 months.The ocular area was arbitrarily divided into three zones: YAG zone (3mm), Optical zone (6mm) and the peripheral zone (12mm). A colour code was assigned to the subtype of PCO in these zones: fibrous green and membranous blue. The type of PCO in each quadrant of YAG zone was estimated in percentage. RESULTS: The statistic mean values of initial energy levels were 1.80 mJ for membranous PCO, 3.17 mJ for fibrous PCO and 2.73 mJ for fibro-membranous PCO. The mean summated energy levels for membranous PCO was 22.80 mJ for membranous PCO, 80.06 mJ for fibrous PCO and 80.48 mJ for fibro-membranous type. CONCLUSION: Colour coding is extremely helpful for quantification of the type of PCO and in deciding the initial energy level necessary to create capsulotomy. Fibro-membranous PCO required more summated energy despite a lower starting energy. Therefore, we recommend firing the initial shot in fibrous portion in case of fibrous-membranous type of PCO.

Cardioprotective effect of a dual acting epoxyeicosatrienoic acid analogue towards ischaemia reperfusion injury.

BACKGROUND AND PURPOSE: Epoxyeicosatrienoic acids (EETs) are cytochrome P450 epoxygenase metabolites of arachidonic acid that are metabolized into dihydroxyepoxyeicosatrienoic acids (DHET) by soluble epoxide hydrolase (sEH). The current investigations were performed to examine the cardioprotective effects of UA-8 (13-(3-propylureido)tridec-8-enoic acid), a synthetic compound that possesses both EET-mimetic and sEH inhibitory properties, against ischaemia-reperfusion injury. EXPERIMENTAL APPROACH: Hearts from C57BL/6 mice were perfused in Langendorff mode and subjected to ischaemia reperfusion. Mechanistic studies involved co-perfusing hearts with either 14,15-EEZE (a putative EET receptor antagonist), wortmannin or PI-103 (class-I PI3K inhibitor). H9c2 cells were utilized to investigate the protective effects against mitochondrial injury following anoxia reoxygenation. KEY RESULTS: Perfusion of UA-8 significantly improved postischaemic left ventricular developed pressure (LVDP) and reduced infarction following ischaemia reperfusion compared with control and 11,12-EET. UA-7 (13-(2-(butylamino)-2-oxoacetamido)tridec-8(Z)-enoic acid), a compound lacking sEH inhibitory properties, also improved postischaemic LVDP, while co-perfusion with 14,15-EEZE, wortmannin or PI-103 attenuated the improved recovery. UA-8 prevented anoxia-reoxygenation induced loss of mitochondrial membrane potential and cell death in H9c2 cells, which was blocked by co-treatment of PI-103. CONCLUSIONS AND IMPLICATIONS: UA-8 provides significant cardioprotection against ischaemia reperfusion injury. The effects are attributed to EETs mimetic properties, which limits mitochondrial dysfunction via class-I PI3K signalling.

Maternal indicators and obstetric outcome in the north Indian population: a hospital-based study.

BACKGROUND: Understanding the effect of maternal parameters on obstetric outcome has public health importance because these indicators are associated with infant health and survival and influence development and health in later life. AIM: To determine the effects of various maternal indicators on pregnancy outcome in north-Indian women. SETTINGS AND DESIGN: A prospective study of all consecutive women with singleton pregnancy, who were registered in the first two months of pregnancy and delivered in the hospital. MATERIALS AND METHODS: Maternal indicators such as age, height, prepregnancy weight, body mass index (BMI), hemoglobin and parity were correlated with pregnancy outcome. The women with a medical disorder or complication that developed during the course of pregnancy were excluded. RESULTS: A total of 2027 women were analyzed. Maternal height, weight, BMI and parity had a positive significant correlation with birth weight of the newborn (r=0.081, P value < 0.001, r=0.148, P value <0.001, r = 0.121, P value < 0.001 and r = 0.099, P value < 0.001, respectively). Maternal height, weight and period of gestation were significant indicators for low birth weight on multivariate logistic regression. The rate of preterm delivery was significantly higher in women with hemoglobin < 7 g% and women with parity >3. The chances of caesarian section increased significantly with increase in maternal height, weight and BMI. CONCLUSIONS: A prepregnancy weight of more than 40 kg, BMI of more than 19.8 and hemoglobin of at least 7 g% or more favor good obstetric outcome.

Overexpression of macrophage inhibitory cytokine-1 induces metastasis of human prostate cancer cells through the FAK-RhoA signaling pathway.

An elevated level of macrophage inhibitory cytokine-1 (MIC-1) is reported in the sera of patients with metastatic prostate cancer compared with that of benign diseases and healthy adults. We investigated the mechanistic role of MIC-1 overexpression in the metastasis of prostate cancer cells. Our study showed a progressive increase in secretory MIC-1 production correlated with the increase in the metastatic potential of PC-3 and LNPCa prostate cancer metastatic variants. Further, the in vitro studies using 'loss-' and 'gain'-of-function approaches showed that ectopic overexpression of MIC-1 (PC-3-MIC-1) and forced downregulation of MIC-1(PC-3M-siMIC-1) enhanced and reduced the motility and invasiveness of these cells, respectively. Supporting our in vitro observations, all the mice orthotopically implanted with PC-3-MIC-1 cells developed metastasis compared with none in the PC-3-vector group. Our results showed that MIC-1 overexpression was associated with apparent changes in actin organization. In addition, an enhanced phosphorylation of focal adhesion kinase (FAK) and guanosine-5'-triphosphate (GTP)-bound RhoA was also seen; however, no significant change was observed in total FAK and RhoA levels in the PC-3-MIC-1 cells. Altogether, our findings show that MIC-1 has a role in prostate cancer metastasis, in part, by promoting the motility of these cells. Activation of the FAK-RhoA signaling pathway is involved in MIC-1-mediated actin reorganization, and thus, leads to an increase in the motility of prostate cancer cells.