Polysomnographic profile in a sleep laboratory in Kolkata: a retrospective analysis of 714 cases.

In this retrospective analysis, all patients (n=714; male=590; female=124 and female male ratio = 1: 4.76) came to Pulsar, a sleep laboratory of Kolkata, for polysomnography during ten years period were analyzed. More than half (62.46%) cases were between 41-60 years and 14.43% cases between 61-80 years age group. Fifty-two percent cases were referred by pulmonologists, followed by internist (15%), and 7% cases were self referred. Though obstructive sleep apnea was responsible for increased cardiovascular mortality and resistant hypertension, only 4% cases were referred by cardiologists. We observed hypertension as co-morbidity in 52.63% cases and ischemic heart disease in 22.83% cases. Snoring was the presenting complain in 98.88% cases, chocking was present in 48.88% cases and excessive daytime sleepiness was found in 96.64% cases. Females showed comparatively higher frequency of sleep disordered breathing than males with increasing basal metabolic rate. Nocturnal fall of SPO2 below 90% was observed in 86.97% of study population. We found abnormal respiratory disturbance index (> 5/hr of sleep) in 84.59% of our patients, normal respiratory disturbance index (< or = 5/hr of sleep) in 9.94% cases and isolated nocturnal hypoxemia in 5.46% cases (74.36% of the last category having obstructive airway disease). Snoring with respiratory disturbance index (RDI) < or = 5/hr was observed in 102 cases, of them 81.37% had simple snoring without significant arousal whereas 18.63% had multiple sleep fragmentation. We estimated that 84.06% of males, 87.10% of females and 84.59% of study population had obstructive sleep apnea. Split night polysomnography was performed in 362 cases, and of them 15.47% cases could not tolerate continuous positive airway pressure (CPAP) due to local or psychological reasons. In the present one time split-night CPAP titration study, we could not correct OSA in 19.06% subjects. Inadequate correction of hypoxemia due to co-morbid condition like COPD, asthma, obesity, hypothyroidism was the main responsible factor (49.28%). Treatment with CPAP was effective in 68.23% cases in first attempt. More than half of the cases (62.42%) required 10 cm of H20 or less CPAP.

Development of non-agglutination microarray blood grouping.

Microarray technology provides an opportunity to monitor multiple parameters simultaneously. High-throughput applications such as blood donation screening could greatly benefit from performing various tests on a single testing platform. Blood grouping represents one part of the donation testing complementing the screening for blood-borne pathogens. Blood group serology traditionally exploited agglutination as the detection method. In this investigation, we have adapted blood grouping reactions to a solid-phase microarray substrate in a non-agglutination reaction format as an initial step in the development of a combined microarray testing platform. We have investigated immobilization of proprietary antibodies on multiple surfaces and monitored their performance under various reaction conditions. For the first time, highly specific blood grouping has been achieved on a planar microarray using directly labelled erythrocytes or a secondary labelled reagent using fluorescent signal end point readout. We have also complemented microarray data with a label-free, surface plasmon resonance-based Biacore platform data and used the real time quantitative measurement to rank anti-A antibodies according to the strength of reaction with the immobilized synthetic blood group antigen A.

Control of gammaherpesvirus latency by latent antigen-specific CD8(+) T cells.

The contribution of the latent antigen-specific CD8(+) T cell response to the control of gammaherpesvirus latency is currently obscure. Some latent antigens induce potent T cell responses, but little is known about their induction or the role they play during the establishment of latency. Here we used the murine gammaherpesvirus system to examine the expression of the latency-associated M2 gene during latency and the induction of the CD8(+) T cell response to this protein. M2, in contrast to the M3 latency-associated antigen, was expressed at day 14 after infection but was undetectable during long-term latency. The induction of the M2(91-99)/K(d) CD8(+) T cell response was B cell dependent, transient, and apparently induced by the rapid increase in latently infected cells around day 14 after intranasal infection. These kinetics were consistent with a role in controlling the initial "burst" of latently infected cells. In support of this hypothesis, adoptive transfer of an M2-specific CD8(+) T cell line reduced the initial load of latently infected cells, although not the long-term load. These data represent the first description of a latent antigen-specific immune response in this model, and suggest that vaccination with latent antigens such as M2 may be capable of modulating latent gammaherpesvirus infection.

Murine gammaherpesvirus M11 gene product inhibits apoptosis and is expressed during virus persistence.

The murine gammaherpesvirus (MHV-68) M11 gene encodes a protein with BH1 domain homology to Bcl-2. We found that the M11 gene product (MHVBcl-2) protected murine epithelial cells from TNF-alpha induced apoptosis. M11 was transcribed during early lytic infection in vitro. During early infection of mice, M11 message was detected in spleen and lung along with lytic cycle messages. During persistence, lytic cycle gene expression was undetectable but M11 RNA was still present. This suggests that MHVBcl-2 promotes virus survival by protecting not only productively infected but also persistently infected cells from apoptotic death.

Palliative care--past and future--questioning great expectations.

This paper argues that the future of palliative care cannot be divined reliably without considering how a set of basic questions might be answered by health-care professionals, administrators of health care systems, and citizens in countries throughout the world. Seven of the many questions centering on the mission of palliative care are explored here as pathways into the future of how we care for gravely ill and dying people. That future cannot be predicted from the vantage point of some super observatory. It will rather emerge from the responses we give now to a range of questions such as the seven considered in this paper. These questions identify fundamental dimensions of the mission of palliative care, and our responses will determine when, and where that mission will become reality.