Is CRISPR/Cas9-based multi-trait enhancement of wheat forthcoming?

Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) technologies have been implemented in recent years in the genome editing of eukaryotes, including plants. The original system of knocking out a single gene by causing a double-strand break (DSB), followed by non-homologous end joining (NHEJ) or Homology-directed repair (HDR) has undergone many adaptations. These adaptations include employing CRISPR/Cas9 to upregulate gene expression or to cause specific small changes to the DNA sequence of the gene-of-interest. In plants, multiplexing, i.e., inducing multiple changes by CRISPR/Cas9, is extremely relevant due to the redundancy of many plant genes, and the time- and labor-consuming generation of stable transgenic plant lines via crossing. Here we discuss relevant examples of various traits, such as yield, biofortification, gluten content, abiotic stress tolerance, and biotic stress resistance, which have been successfully manipulated using CRISPR/Cas9 in plants. While existing studies have primarily focused on proving the impact of CRISPR/Cas9 on a single trait, there is a growing interest among researchers in creating a multi-stress tolerant wheat cultivar 'super wheat', to commercially and sustainably enhance wheat yields under climate change. Due to the complexity of the technical difficulties in generating multi-target CRISPR/Cas9 lines and of the interactions between stress responses, we propose enhancing already commercial local landraces with higher yield traits along with stress tolerances specific to the respective localities, instead of generating a general 'super wheat'. We hope this will serve as the sustainable solution to commercially enhancing crop yields under both stable and challenging environmental conditions.

A novel fuzzy programming approach for piece selection problem in P2P content distribution network.

Piece selection policy in dynamic P2P networks play crucial role and avoid the last piece problem. BitTorrent uses rarest-first piece selection mechanism to deal with this problem, but its efficacy is limited because each peer only has a local view of piece rareness. The problem of piece section is multiple objectives. A novel fuzzy programming approach is introduced in this article to solve the multiple objectives piece selection problem in P2P network, in which some of the factors are fuzzy in nature. Piece selection problem has been prepared as a fuzzy mixed integer goal programming piece selection problem that includes three primary goals such as minimizing the download cost, time, maximizing speed and useful information transmission subject to realistic constraints regarding peer's demand, capacity and dynamicity. The proposed approach has the ability to handle practical situations in a fuzzy environment and offers a better decision tool to each peer to select optimal pieces to download from other peers in dynamic P2P network. Extensive simulations are carried out to demonstrate the effectiveness of the proposed model. It is proved that proposed system outperforms existing with respect to download cost, time and meaningful exchange of useful information.

Synergistic antibacterial and mosquitocidal effect of Passiflora foetida synthesized silver nanoparticles.

Silver nanoparticles are opted to have various applications in different fields ranging from traditional medicines to culinary items. It is toxic and most effective against bacteria, fungi viruses, parasites, parasite carrying vectors such as mosquitoes and their larvae and other eukaryotic microorganisms at low concentration without any side effects and toxicity to humans. In view of these data, the present research has been investigated by synthesizing silver nanoparticles using 1mM silver nitrate and aqueous extract of Passiflora foetida. The variation of nanoparticles in size and shape concerning the concentration of extract prepared were analysed. The formation of silver nanoparticles was confirmed by colour changing from yellowish green to reddish-brown implicating the surface plasmon resonance. Further, it was concluded by obtaining an absorbance peak at 420 nm using UV-Visible spectrophotometer analysis. FTIR analysis was used to identify the capping ligands, which included alkanes, aromatic groups and nitro compounds. The average grain size of ~12 nm to 14 nm with crystalline phase was revealed by X-ray Diffraction studies. The SEM images depicted the surface morphology with agglomeration; TEM studies showed the shape of nanoparticles as spherical and hexagonal with sizes ranging from 40 nm to 100 nm and EDAX analysis confirmed the presence of elemental silver as the principal constituent. The characterized silver nanoparticles were then tested for synergistic antibacterial effects with tetracycline, and the results show that they are more active against E. coli and S. aureus, but moderately effective against B. cereus and K. pneumoniae . It also had a strong larval and pupal toxic effects on the dengue vector, Aedes aegypti with the highest mortality. As a result, silver nanoparticles could be a viable alternative for a variety of applications.

Low yield but high levels of multidrug resistance in urinary tract infections in a tertiary hospital, Nepal.

SETTING: There are concerns about the occurrence of multidrug resistance (MDR) in patients with urine tract infections (UTI) in Nepal. OBJECTIVE: To determine culture positivity, trends in MDR among Escherichia coli and Klebsiella pneumoniae infections and seasonal changes in culture-positive UTI specimens isolated from 2014 to 2018 at the B P Koirala Institute of Health Sciences, Dharan, Eastern Nepal. DESIGN: This was a cross-sectional study using secondary laboratory data. RESULTS: Among 116,417 urine samples tested, 19,671 (16.9%) were culture-positive, with an increasing trend in the number of samples tested and culture positivity. E. coli was the most common bacteria (54.3%), followed by K. pneumoniae (8.8%). Among E. coli and K. pneumoniae isolates, MDR was found in respectively 42.5% and 36.0%. MDR was higher in males and people aged >55 years, but showed a decreasing trend over the years. The numbers of isolates increased over the years, with a peak always observed from July to August. CONCLUSION: Low culture positivity is worrying and requires further work into improving diagnostic protocols. Decreasing trends in MDR are a welcome sign. Information on seasonal changes that peak in July-August can help laboratories better prepare for this time with adequate buffer stocks to ensure culture and antibiotic susceptibility testing.

CONTEXTE: La résistance à plusieurs médicaments (MDR) chez les patients atteints d'infections urinaires (UTI) au Népal est un sujet de préoccupations. OBJECTIF: Déterminer le taux de positivité des cultures, les tendances de MDR parmi les infections à Escherichia coli et Klebsiella pneumoniae et les variations saisonnières dans les échantillons d'UTI positifs par culture de 2014 à 2018 au BP Koirala Institute of Health Sciences, Dharan, Népal oriental. MÉTHODE: Il s'agissait d'une étude transversale réalisée en utilisant des données de laboratoire secondaires. RÉSULTATS: Parmi les 116 417 échantillons urinaires testés, 19 671 (16,9%) étaient positifs par culture, avec une tendance à la hausse du nombre d'échantillons testés et du taux de positivité par culture. E. coli était la bactérie la plus fréquente (54,3%), suivie de K. pneumoniae (8,8%). Une MDR a été observée chez respectivement 42,5% et 36,0% des isolats de E. coli et de K. pneumoniae. La MDR était plus élevée chez les hommes et les personnes âgées >55 ans, mais une tendance à la baisse a été observée au fil des ans. Le nombre d'isolats a augmenté au fil des ans, avec un pic toujours observé de juillet à août. CONCLUSION: Le faible taux de positivité par culture est préoccupant et d'autres études sont nécessaires pour améliorer les protocoles diagnostiques. Les tendances à la baisse en matière de MDR sont un signe encourageant. Les informations relatives aux variations saisonnières avec un pic en juillet-août peuvent aider les laboratoires à mieux se préparer en prévision de cette période, en renouvelant les stocks de solutions tampons afin de pouvoir réaliser les cultures et les tests de sensibilité aux médicaments.

Polymer-based or polymer-free stents in patients at high bleeding risk

BACKGROUND Polymer-free drug-coated stents provide superior clinical outcomes to bare-metal stents in patients at high bleeding risk who undergo percutaneous coronary intervention (PCI) and are treated with 1 month of dual antiplatelet therapy. Data on the use of polymer-based drug-eluting stents, as compared with polymer-free drug-coated stents, in such patients are limited. METHODS In an international, randomized, single-blind trial, we compared polymer-based zotarolimus-eluting stents with polymer-free umirolimus­coated stents in patients at high bleeding risk. After PCI, patients were treated with 1 month of dual antiplatelet therapy, followed by single antiplatelet therapy. The primary outcome was a safety composite of death from cardiac causes, myocardial infarction, or stent thrombosis at 1 year. The principal secondary outcome was target-lesion failure, an effectiveness composite of death from cardiac causes, target-vessel myocardial infarction, or clinically indicated target-lesion revascularization. Both outcomes were powered for noninferiority. RESULTS A total of 1996 patients at high bleeding risk were randomly assigned in a 1:1 ratio to receive zotarolimus-eluting stents (1003 patients) or polymer-free drugcoated stents (993 patients). At 1 year, the primary outcome was observed in 169 of 988 patients (17.1%) in the zotarolimus-eluting stent group and in 164 of 969 (16.9%) in the polymer-free drug-coated stent group (risk difference, 0.2 percentage points; upper boundary of the one-sided 97.5% confidence interval [CI], 3.5; noninferiority margin, 4.1; P=0.01 for noninferiority). The principal secondary outcome was observed in 174 patients (17.6%) in the zotarolimus-eluting stent group and in 169 (17.4%) in the polymer-free drug-coated stent group (risk difference, 0.2 percentage points; upper boundary of the one-sided 97.5% CI, 3.5; noninferiority margin, 4.4; P=0.007 for noninferiority). CONCLUSIONS Among patients at high bleeding risk who received 1 month of dual antiplatelet therapy after PCI, use of polymer-based zotarolimus-eluting stents was noninferior to use of polymer-free drug-coated stents with regard to safety and effectiveness composite outcomes. (Funded by Medtronic; ONYX ONE ClinicalTrials.gov number, NCT03344653.). (AU)

Clinical and equipment-related factors associated with the adequate peripheral blood stem cell collection in autologous transplant at a tertiary cancer center in Kerala - A retrospective cohort study.

BACKGROUND: PBSC collection using apheresis is the preferred source of hematopoietic stem cells transplantation. However, apheresis procedures fail to harvest adequate CD34 yield in 5 to 40% of patients during the first collection. Therefore, this study aimed to study both the clinical- and equipmentrelated factors influencing CD34 yield among the autologous patients and to compare the collection efficiency of two apheresis equipments(Haemonetics MCS+ and Terumo Spectra Optia). METHODS: Retrospective analysis of 69 patients underwent PBSC collection from 2015 to 2018. Frequency, clinical- and equipment-related factors responsible for adequate CD34+ cells (≥2 x106 cells/kg) yield during the first collection was studied. Factors such as collection efficiency, percentage platelet loss and percentage hemoglobin loss were considered to compare the two apheresis system. RESULTS: Two-third (72%) patients of the study population had adequate CD34 stem cells yield during the first collection. Factors such as exposure to lenalidomide-based pretreatment regimen, peripheral blood WBC count and CD34 count are associated with the adequate CD34 yield. Optia had a slightly better collection efficiency than MCS+ (50 and 44; p=0.37). Optia had lower product volume (237 vs 298 ml) and lesser procedure duration (277 vs 360 min), whereas the median Hb loss (3.0% and 2.3%) and mean platelet loss (49% and 34%) were higher with MCS. CONCLUSION: This study infers that the collection efficiency of both the equipments in collecting CD34 stem cells was similar. However, during PBSC collection, procedures using Optia can be preferred to MCS+ on the patients with risk of anemia and thrombocytopenia.

Diabetes and pre-diabetes among household contacts of tuberculosis patients in India: is it time to screen them all?

SETTING: Pre-diabetes mellitus (pre-DM) and DM increase the risk of developing tuberculosis (TB). Screening contacts of TB patients for pre-DM/DM and linking them to care may mitigate the risk of developing TB and improve DM management. OBJECTIVE: To measure the prevalence of pre-DM/DM and associated factors among the adult household contacts (HHCs) of pulmonary TB patients. METHODS: Between August 2014 and May 2017, adult HHCs of newly diagnosed adult PTB patients in Pune and Chennai, India, had single blood samples tested for glycosylated haemoglobin (HbA1c) at enrolment. DM was defined as previously diagnosed, self-reported DM or HbA1c 6.5%, and pre-DM as HbA1c between 5.7% and 6.4%. Latent tuberculous infection (LTBI) was defined as a positive tuberculin skin test (5 mm induration) or QuantiFERON® Gold In-Tube (0.35 international units/ml). RESULTS: Of 652 adult HHCs, 175 (27%) had pre-DM and 64 (10%) had DM. Forty (64%) HHCs were newly diagnosed with DM and 48 (75%) had poor glycaemic control (HbA1c 7.0%). Sixty-eight (22%) pre-DM cases were aged 18-34 years. Age 35 years, body mass index 25 kg/m2, chronic disease and current tobacco smoking were significantly associated with DM among HHCs. CONCLUSIONS: Adult HHCs of TB patients in India have a high prevalence of undiagnosed DM, pre-DM and LTBI, putting them at high risk for developing TB. Routine DM screening should be considered among all adult HHCs of TB.

Dysfunction among Families of Children with Intellectual Disability in India Using Systems Model: Prevalence, Pattern, and Severity of Impairment.

OBJECTIVES: Family dysfunction is observed in families with children with intellectual disability (ID). We study the prevalence, pattern of dysfunction, and severity of impairment in these special families using Systems approach. METHODS: Sixty-two special families (a child with ID) and 62 typical families (all children with typical development) were included in the present study. The presence of ID was confirmed and quantified with the Binet-Kamat Scale of intelligence or Gesell's Developmental Schedule and Vineland Social Maturity Scales among the special families. In the typical families, brief ID scale was used to rule out ID. Prevalence, pattern, and severity of family dysfunction were assessed using Family Apgar Scale, Chicago Youth Development Study Family Assessment Scale and Global Assessment of Relational Functioning Scale, respectively. Appropriate bivariate analyses were used. RESULTS: About 53% of special families and 19% of typical families had family dysfunction. About 21% of special families and 71% of typical families had the satisfactory relational unit. Areas of adaptability, partnership, growth, affection, resolve, beliefs about family, beliefs about development, beliefs about purpose, cohesion, deviant beliefs, support, organization, and communication were significantly different between special and typical families. The functional impairment was significantly more in the special families. CONCLUSION: Family dysfunction is more prevalent among special families in India using systems approach. These families should be screened for dysfunction, and family therapy be prescribed when required.

Tuberculosis retreatment outcomes and associated factors: a mixed-methods study from Puducherry, India.

Setting: Four Tuberculosis (TB) Units in the Union Territory of Puducherry in India. Objectives: To identify factors associated with unfavourable outcomes among retreatment TB cases in Puducherry. Design: The study had a mixed-methods design in which routinely reported TB data from retreatment TB cases registered during 2014 and 2015 were used for the quantitative part; the qualitative phase comprised interviews and focus group discussions with health care providers. Results: Among the 392 retreatment cases, 297 (75.8%) had favourable outcomes. Outcome for previous treatment such as loss to follow-up (LTFU) (adjusted relative risk [aRR] 1.6, 95%CI 1.1-2.4, P = 0.001), treatment failure (aRR 1.7, 95%CI 1.04-2.8, P = 0.03) and pre-treatment weight <40 kg (aRR 1.8, 95%CI 1.3-2.5, P = 0.001) had increased risk for unfavourable outcomes. Health care providers reported that alcoholism, lack of family support, job-related issues and lack of access to trained staff for injections were some of the reasons for unfavourable outcomes. Providing incentives, nutritional supplements and early retrieval of the LTFU cases were some of the suggestions to reduce unfavourable outcomes. Conclusion: Outcome of previous treatment and low pre-treatment weight of the patient affected retreatment outcomes. Health professionals and workers highlighted social and health system-related factors. Commitment at all levels on the part of health care providers and addressing their concerns can improve retreatment outcomes.

Contexte : Quatre unités tuberculose (TB) dans le territoire de Puducherry en Inde.Objectif : Identifier les facteurs associés à des résultats défavorables parmi les cas de retraitement de TB à Puducherry.Schéma : Schéma à méthodes mixtes dans lequel les données TB recueillies en routine relatives aux cas de retraitement de TB enregistrés en 2014 et 2015 ont été utilisés de manière quantitative. L'aspect qualitatif a été basé sur des entretiens et des discussions en groupe focal avec les prestataires de soins de santé.Résultats : Parmi les 392 cas de retraitement, 297 (75,8%) ont eu un résultat défavorable. Les résultats du traitement précédent comme les pertes de vue (LTFU) (risque relative ajusté [RRa] 1,6 ; IC95% 1,1­2,4 ; P = 0,001), un échec du traitement (RRa 1,7 ; IC95% 1,04­2,8 ; P = 0,03) et un poids avant traitement <40 kg (RRa 1,8 ; IC95% 1,3­2,5 ; P = 0,001) ont majoré le risque de nouveau résultat défavorable. Les prestataires de soins de santé ont rapporté que l'alcoolisme, l'absence de soutien familial, des problèmes professionnels et l'absence d'accès à du personnel formé pour les injections ont été parmi les causes de résultats défavorables. On a suggéré de réduire ces problèmes, notamment en fournissant des incitations et des suppléments nutritionnels et en recherchant rapidement les LTFU.Conclusion : Les résultats du traitement précédent et un faible poids avant le traitement ont affecté les résultats du retraitement. Le personnel de santé a attribué ce fait à des facteurs sociaux et liés au système de santé. L'engagement à tous les niveaux des prestataires de soins de santé et le fait de répondre à leurs préoccupations peuvent améliorer les résultats du retraitement.

Marco de Referencia: Cuatro unidades de tuberculosis (TB) en Puducherry, que es un Territorio de la Unión en la India.Objetivos: Reconocer los factores que se asocian con los desenlaces desfavorables en los casos de retratamiento de la TB en Puducherry.Método: Fue este un estudio con diseño de método mixtos; en el análisis cuantitativo se utilizaron los datos corrientes de notificación de los casos de retratamiento de la TB registrados en el 2014 y el 2015 y en la fase cualitativa se realizaron entrevistas y sesiones en grupos de opinión con los proveedores de atención de salud.Resultados: De los 392 casos en retratamiento, 297 (75,8%) alcanzaron desenlaces favorables. Se observó que el riesgo aumentado de desenlaces desfavorables se asociaba con el desenlace del tratamiento anterior como la pérdida durante el seguimiento (LTFU) (riesgo relativo ajustado [RRa] 1,6; 95%CI 1,1­2,4; P = 0,001), el fracaso terapéutico (RRa 1,7; 95%CI 1,04­2,8; P = 0,03) y con un peso <40 kg antes de iniciar el tratamiento (RRa 1,8; 95%CI 1,3­2,5; P = 0,001). Los profesionales de salud refirieron el alcoholismo, la falta de apoyo familiar, los problemas relacionados con el trabajo y la falta de acceso a personal capacitado para las inyecciones como algunas de las razones de los desenlaces desfavorables y sugirieron la provisión de incentivos, los suplementos nutricionales y la recuperación rápida de los casos LTFU como estrategias para corregirlos.Conclusión: El desenlace de un tratamiento anterior y el bajo peso del paciente antes de iniciar el tratamiento afectan el desenlace de los casos de retratamiento de la TB. Los profesionales y los trabajadores de salud atribuyeron estos resultados a factores sociales y factores relacionados con el sistema de salud. La participación de los proveedores de atención de salud a todos los niveles y la respuesta a sus inquietudes contribuirán a mejorar los desenlaces del retratamiento de la TB.

Are partners of HIV-infected people being tested for HIV? A mixed-methods research from Gujarat, India.

Setting: Four selected antiretroviral therapy (ART) centres of Gujarat State, India, which accounts for 8% of the human immunodeficiency virus (HIV) burden in India. Objectives: 1) To assess the proportion of people living with HIV (PLHIV) whose partners were not tested for HIV; 2) to assess sociodemographic and clinical characteristics of index cases associated with partner testing; and 3) to understand perceived facilitators and barriers to partner testing and make suggestions on how to improve testing from the perspective of the health-care provider. Design: A mixed-method design with a quantitative phase that involved reviewing the programme records of married PLHIV enrolled during 2011-2015, followed by a qualitative phase of key informant interviews. Results: Of 3884 married PLHIV, 1279 (33%) did not have their partners tested for HIV. Factors including index cases being male, illiterate, aged >25 years, belonging to key populations, substance use and being in advanced clinical stages were more likely to be associated with partner non-testing. Non-disclosure of HIV status (due to fear of marital discord) and lack of awareness and risk perception were the key barriers to testing. Conclusion: One third of PLHIV did not have their partners tested for HIV. Several factors were identified as being associated with the non-testing of partners, and solutions were explored that need to be implemented urgently if we are to achieve the 90-90-90 targets and end HIV.

Contexte : Quatre centres du traitement antirétroviral (TAR) sélectionnés de l'état de Gujarat, qui compte pour 8% du poids du virus de l'immunodéficience humaine (VIH) en Inde.Objective : Nous avons voulu 1) évaluer la proportion de personnes vivant avec le VIH (PVVIH) dont les partenaires n'ont pas été testés pour le VIH ; 2) évaluer les caractéristiques sociodémographiques et cliniques du cas index associées au test du partenaire ; et 3) comprendre les facilitateurs et les contraintes perçus au test du partenaire et faire des suggestions pour améliorer les tests du point de vue des prestataires de soins de santé.Schéma à plusieurs methods: La phase quantitative a impliqué de retrouver dans les archives du programme les PVVIH mariés enrôlés entre 2011 et 2015 ; la phase qualitative a ensuite consisté en entretiens avec des informateurs clés.Résultats: Sur 3884 PVVIH mariés, 1279 (33%) n'ont pas fait tester leurs partenaires pour le VIH. Les facteurs comme le fait que le cas index soit un homme, illettré, d'âge >25 ans, appartenant à des populations clés, utilisant des drogues, étant à un stade avancé de la maladie, ont été plus susceptibles d'être associés à l'absence de test du partenaire. Le non divulgation du statut VIH (due à la peur d'une discorde maritale) et le manque de connaissances et de perception des risques ont été les obstacles majeurs au test.Conclusion : Un tiers des PVVIH n'ont pas fait tester leurs partenaires pour le VIH. Plusieurs facteurs associés à l'absence de test des partenaires ont été identifiés et des solutions ont été recherchées. Elles doivent être mises en œuvre d'urgence si nous voulons atteindre les cibles de 90­90­90 et mettre fin au VIH.

Marco de referencia: Cuatro centros de tratamiento antirretrovírico (TAR) en el estado de Guyarat, que representa el 8% de la carga de morbilidad por el virus de la inmunodeficiencia humana (VIH) de la India.Objetivos: 1) Examinar la proporción de personas positivas frente al VIH cuyas parejas no cuentan con la prueba diagnóstica del VIH; 2) analizar las características socioeconómicas y clínicas del caso inicial que se relacionan con la práctica de la prueba diagnóstica en la pareja; y 3) comprender los elementos facilitadores y los obstáculos percibidos a la prueba del VIH en las parejas y las propuestas encaminadas a mejorar su utilización, desde el punto de vista de los profesionales de salud.Métodos: Se aplicó un modelo de métodos mixtos con una etapa inicial cuantitativa, que comportó el examen de los registros del programa de las personas positivas frente al VIH casadas inscritas del 2011 al 2015, seguida por una etapa cualitativa durante la cual se realizaron entrevistas a informantes clave.Resultados: De las 3884 personas positivas frente al VIH casadas, 1279 parejas no contaban con la prueba del VIH (33%). Las características del caso inicial que se asociaron con mayor frecuencia a la falta de prueba diagnóstica de la pareja fueron el sexo masculino, el analfabetismo, la edad más de 25 años, el hecho de pertenecer a una población clave, el consumo de sustancias psicoactivas y un estadio clínico avanzado de la enfermedad. Los principales obstáculos a la práctica de las pruebas fueron la negativa a divulgar su situación frente al VIH (por temor a una discordia conyugal) y la falta de sensibilización y percepción de los riesgos.Conclusión: En un tercio de las personas positivas frente al VIH, no se había practicado a su pareja la prueba diagnóstica de la infección. Se reconocieron diversos factores vinculados con esta situación y se analizaron las soluciones. La aplicación de estas medidas es urgente con el fin de cumplir con las metas 90­90­90 y eliminar la infección por el VIH.

Alarming rates of attrition among tuberculosis patients in public-private facilities in Lahore, Pakistan.

Setting: All public-private mix (PPM) facilities caring for tuberculosis (TB) patients in Lahore city, Pakistan, under four models: PPM1 (general practitioners), PPM2 (non-governmental organisations), PPM3 (private hospitals) and PPM4 (others). Objective: To assess the pre-treatment loss to follow-up (LTFU), defined as patients documented in the laboratory registers but not in the treatment registers of any PPM facility, among sputum smear-positive TB patients diagnosed during January-March 2015, and unfavourable treatment outcomes among patients registered for treatment and associated factors. Design: This was a retrospective cohort study reviewing existing programme records. Poisson regression was used to identify factors associated with outcomes. Results: Of 2473 patients diagnosed, 1590 (64%) were lost to follow-up before treatment. This was higher among males (68%) and the elderly (79%), and lower among 'high positives' (smear grading 2+ or 3+, 53%) and in the PPM1 model (34%). Of 883 patients started on treatment, 165 (19%) had unfavourable outcomes: 8% LTFU, 5% treatment failure, 3% died and 3% not evaluated. Previously treated patients (34%) and children (44%) had the worst outcomes. Conclusion: Pre-treatment LTFU was alarmingly high and requires urgent attention, including the development and institution of mechanisms for patient tracking using information and mobile phone technology, and making TB notification mandatory in the private sector.

Contexte: Toutes les structures mixtes public-privé (PPM) prenant en charge les patients tuberculeux (TB) à Lahore, Pakistan, dans quatre modalités : PPM1 (médecins généralistes), PPM2 (organisations non gouvernementales), PPM3 (hôpitaux privés), PPM4 (autres).Objectif: Evaluer les pertes de vue avant traitement (LTFU), définies comme des patients figurant dans le registre du laboratoire mais pas dans le registre de l'une quelconque des PPM pour leur traitement, parmi les patients ayant eu un diagnostic de TB à frottis positif de janvier à mars 2015 et un résultat défavorable du traitement parmi les patients enregistrés pour leur traitement, ainsi que les facteurs associés.Schéma: Une étude rétrospective de cohorte par revue des dossiers de programme existants. La régression de Poisson a été utilisée pour identifier les facteurs associés aux résultats.Résultats: Sur 2473 patients diagnostiqués, 1590 (64%) ont été perdus de vue avant le traitement. Ce résultat a été plus élevé parmi les hommes (68%) et les patients plus âgés (79%), et plus faible parmi les patients « hautement positifs ¼ (frottis grade 2+ ou 3+, 5%) et dans le modèle de PPM1 (34%). Sur 883 patients ayant mis en route leur traitement, 165 (19%) ont eu un résultat défavorable (8% LTFU, 5% d'échecs du traitement, 3% décédés, 3% non évalués). Les patients déjà traités (34%) et les enfants (44%) ont eu des résultats plus mauvais.Conclusion: Les LTFU avant le traitement ont été élevées de manière alarmante et demandent une attention urgente. Ceci inclut le développement et la mise en œuvre de mécanismes de recherche des patients grâce aux techniques d'information et de téléphonie mobile, et l'obligation de notification de la TB par le secteur privé.

Marco de referencia: Todos los establecimientos de la colaboración público privada (PPM, por public-private mix) que atienden pacientes con tuberculosis (TB) en la ciudad de Lahore, en Pakistán, según cuatro modelos, a saber: PPM1 (médicos generalistas), PPM2 (organizaciones no gubernamentales), PPM3 (hospitales privados) y PPM4 (otros).Objetivo: Examinar las pérdidas durante el seguimiento antes del tratamiento (LTFU), definidas como los pacientes que aparecen en los registros de laboratorio, pero no se encuentran en los registros de tratamiento en ningún establecimiento PPM, de los pacientes con baciloscopia positiva del esputo, diagnosticados de enero a marzo del 2015, evaluar los desenlaces terapéuticos desfavorables en los pacientes registrados en tratamiento y determinar los factores asociados con estos desenlaces.Método: Un estudio retrospectivo de cohortes con análisis de los registros del programa. Mediante una regresión de Poisson se definieron los factores asociados con los criterios de valoración.Resultados: De los 2473 pacientes diagnosticados, 1590 se perdieron durante el seguimiento antes de comenzar el tratamiento (64%). Esta proporción fue más alta en los hombres (68%) y los ancianos (79%) y más baja en los casos con baciloscopia de alta positividad (53%, frotis calificado como 2+ o 3+) y en el modelo PPM1 (34%). De los 883 pacientes que iniciaron tratamiento, 165 (19%) presentaron desenlaces desfavorables (8% LTFU, 5% fracaso terapéutico, 3% fallecieron, 3% no se evaluaron). Los desenlaces más desfavorables se observaron en los pacientes con antecedente de tratamiento antituberculoso (3%) y en los niños (44%).Conclusión: La proporción de LTFU durante el seguimiento antes de iniciar el tratamiento antituberculoso fue muy alarmante y exige una atención urgente. La respuesta puede consistir en la elaboración y aplicación de mecanismos de localización de los pacientes mediante las tecnologías de la información y los teléfonos celulares y la introducción de la notificación obligatoria de la TB en el sector privado.

Toxicity and bioefficacy of individual and combination of diversified insecticides against jute hairy caterpillar, Spilarctia obliqua.

Toxicity of conventional (profenofos 50 EC and λ-cyhalothrin 5 EC) and non-conventional (flubendiamide 480 SC, chlorantraniliprole 18.5 SC, emamectin benzoate 5 SG) insecticides was determined on the basis of median lethal concentration (LC50) values on third instar larvae of jute hairy caterpillar, Spilarctia obliqua under laboratory conditions. Further, the promising binary insecticides combinations with lesser LC50 values and adequate synergistic activity were evaluated under field conditions. The LC50 values calculated for insecticides viz., chlorantraniliprole, flubendiamide emamectin benzoate, λ-cyhalothrin and profenophos were 0.212, 0.232, 0.511, 0.985 and 3.263 ppm, respectively. Likewise, the LC50 values for flubendiamide with λ-cyhalothrin in 3:1 proportion was most toxic (0.103 ppm) amongst all the other binary combinations with λ-cyhalothrin. Chlorantraniliprole in combination with λ-cyhalothrin at 1:1 proportion (0.209 ppm) was most toxic followed by 3:1 proportion (0.345 ppm). Similarly, emamectin benzoate in combination with λ-cyhalothrin at 1:1 proportion was more toxic (0.271 ppm) than 3:1 ratio (0.333 ppm). Toxicity index of flubendiamide + λ-cyhalothrin (3:1 ratio) was highest (970.87). Bioefficacy of synergistic binary combinations along with individual insecticides established the superiority of profenophos + λ-cyhalothrin (3:1) with 89.12% reduction in infestation and recorded maximum fibre yield 38.67qha' under field condition. Moreover, combination of diverse insecticides group might sustain toxicity against the target insect for longer period with least probability of resistance development.

An Efficient Framework for Large Scale Multimedia Content Distribution in P2P Network: I2NC.

Network coding (NC) makes content distribution more effective and easier in P2P content distribution network and reduces the burden of the original seeder. It generalizes traditional network routing by allowing the intermediate nodes to generate new coded packet by combining the received packets. The randomization introduced by network coding makes all packets equally important and resolves the problem of locating the rarest block. Further, it reduces traffic in the network. In this paper, we analyze the performance of traditional network coding in P2P content distribution network by using a mathematical model and it is proved that traffic reduction has not been fully achieved in P2P network using traditional network coding. It happens due to the redundant transmission of noninnovative information block among the peers in the network. Hence, we propose a new framework, called I2NC (intelligent-peer selection and incremental-network coding), to eliminate the unnecessary flooding of noninnovative coded packets and thereby to improve the performance of network coding in P2P content distribution further. A comparative study and analysis of the proposed system is made through various related implementations and the results show that 10-15% of traffic reduced and improved the average and maximum download time by reducing original seeder's workload.

"Hyperfrontality" as seen on FDG PET in unmedicated schizophrenia patients with positive symptoms.

INTRODUCTION: Decreased frontal activity has been reported widely in unmedicated schizophrenic patients with predominantly negative symptoms. Not many studies have assessed the frontal lobe status in unmedicated patients with positive symptoms. PATIENTS AND METHODS: Fifty-one patients with schizophrenia (all unmedicated, 38 never medicated) and 12 healthy age-matched controls were evaluated with FDG PET CT. The patients met ICD-10 and DSM-IV criteria for schizophrenia, and all reported psychotic, "positive" symptoms when tested. RESULTS: Schizophrenic patients with positive symptoms had a hypermetabolic frontal metabolic pattern on quantification by region to occipital ratio comparison. Associated statistically significant differences were also found when comparing ratios of occipital to thalamic, striatal and temporal cortex in schizophrenic patients. CONCLUSION: The finding of a hyperfrontality in unmedicated and never medicated psychotic schizophrenic patients is observed when there is a predominance of positive symptoms. There could be a possible disruption of cortico-striato-thalamic feedback loops causing hyperfrontality as seen in experimentally induced models of psychosis .

Identification of defense-related genes newly-associated with tomato flower abscission.

The current abscission model suggests the formation of a post-abscission trans-differentiation of a protective layer as the last step of the process. The present report expands the repertoire of genes activated in the tomato flower abscission zone (AZ), which are likely to be involved in defense responses. We identified four different defense-related genes, including: Cysteine-type endopeptidase, α-Dioxygenase 1 (α-DOX1), HopW-1-1-Interacting protein2 (WIN2), and Stomatal-derived factor-2 (SDF2), that are newly-associated with the late stage of the abscission process. The late expression of these genes, induced at 8-14 h after flower removal when pedicel abscission was already in progress, was AZ-specific, and was inhibited by treatments that prevented pedicel abscission, including 1-methylcyclopropene pretreatment or IAA application. This information supports the activation of different defense responses and strategies at the late abscission stages, which may enable efficient protection of the exposed tissue toward different environmental stresses.

Congenital rubella syndrome and rubella in Vellore, South India.

Rubella, a mild, vaccine-preventable disease, can manifest as congenital rubella syndrome (CRS), a devastating disease of the fetus. To emphasize the inadequacy of the existing rubella vaccination programme in India, we evaluated epidemiological evidence of rubella virus activity with data available from a tertiary-care centre. The proportion of suspected CRS cases that were laboratory confirmed increased from 4% in 2000 to 11% in 2008. During the same period, 329 clinically suspected postnatal rubella cases were tested of which 65 (20%) were laboratory confirmed. Of women (n=770) of childbearing age, 12·5% were susceptible to rubella.

Microarray analysis of the abscission-related transcriptome in the tomato flower abscission zone in response to auxin depletion.

The abscission process is initiated by changes in the auxin gradient across the abscission zone (AZ) and is triggered by ethylene. Although changes in gene expression have been correlated with the ethylene-mediated execution of abscission, there is almost no information on the molecular and biochemical basis of the increased AZ sensitivity to ethylene. We examined transcriptome changes in the tomato (Solanum lycopersicum 'Shiran 1335') flower AZ during the rapid acquisition of ethylene sensitivity following flower removal, which depletes the AZ from auxin, with or without preexposure to 1-methylcyclopropene or application of indole-3-acetic acid after flower removal. Microarray analysis using the Affymetrix Tomato GeneChip revealed changes in expression, occurring prior to and during pedicel abscission, of many genes with possible regulatory functions. They included a range of auxin- and ethylene-related transcription factors, other transcription factors and regulatory genes that are transiently induced early, 2 h after flower removal, and a set of novel AZ-specific genes. All gene expressions initiated by flower removal and leading to pedicel abscission were inhibited by indole-3-acetic acid application, while 1-methylcyclopropene pretreatment inhibited only the ethylene-induced expressions, including those induced by wound-associated ethylene signals. These results confirm our hypothesis that acquisition of ethylene sensitivity in the AZ is associated with altered expression of auxin-regulated genes resulting from auxin depletion. Our results shed light on the regulatory control of abscission at the molecular level and further expand our knowledge of auxin-ethylene cross talk during the initial controlling stages of the process.

Evaluation of a rapid immunochromatographic device for the detection of IgM & IgG antibodies to dengue viruses (DENV) in a tertiary care hospital in south India.

This study has evaluated the performance of a rapid immunochromatographic test (ICT) device in detecting antibodies to Dengue virus (DENV) in a tertiary hospital in South India. Sera from hospital attendees, with requests for DENV antibody testing, were tested with the Panbio Dengue Duo Cassette and a reference antibody capture assay for the detection of IgM (Dengue IgM capture ELISA-National Institute of Virology, India) and IgG (Dengue IgG capture ELISA-Panbio Diagnostics Inc., Australia) antibodies. The ICT results were compared with results of antibody capture tests for the detection of the IgM and IgG antibodies, respectively. Accuracy indices for IgM and IgG detection, respectively were -- sensitivity 81.8% and 87.5%, specificity 75.0%, and 66.6%, positive predictive value (PPV) 61.0% and 72.9% and negative predictive value (NPV) 89.6% and 83.9%. The device performs poorly in detection of IgM and IgG antibodies to DENVs and is not recommended for use as a stand-alone diagnostic test.

Structure and microbial synthesis of sub-10 nm Bi2O3 nanocrystals.

After the advent of novel chemical and microbial techniques, providing control over grain size and shape of the nanomaterials, several binary-oxide materials have been explored in size less than 10 nm for their tunable physical properties. Bi2O3 nanoparticles have also redrawn attention due to their excellent properties, mostly as optoelectronic material. Here, we report the room-temperature biosynthesis of Bi2O3 nanoparticles in a size range of 5-8 nm by extra-cellularly challenging the plant pathogenic fungus--Fusarium oxysporum with the bismuth nitrate as precursor. The as-synthesized particle-surfaces are inherently functionalized by a robust layer of proteins which provides them very good stability in the aqueous medium. Structural investigation using selected area electron diffraction, high resolution transmission electron microscopy and powder XRD shows that particles are almost perfectly single crystalline and primarily crystallize in alpha-phase with monoclinic structure.