Effect of the timing of insertion of postpartum intrauterine contraceptive device (PPIUCD) copper T380A on expulsion rates.

Background & objectives: Postpartum intrauterine contraceptive device (PPIUCD) is well accepted and recommended for contraception. However, anxiety at the time of delivery may restrict the acceptance of a PPIUCD for its immediate insertion. So far there is limited evidence to conclude anything concrete on the association between the expulsion rates and the timing of insertion following a vaginal delivery. Thus, this study was undertaken to compare the expulsion rates in immediate and early insertions and their safety and complications. Methods: This prospective comparative study was carried out over 17 months on women delivering vaginally in a tertiary care teaching hospital in South India. A copper device (CuT380A) was inserted using Kelly's placental forceps either within 10 min of placental delivery (immediate group, n=160) or between 10 min upto 48 h postpartum (early group, n=160). Ultrasound was done before discharge from the hospital. The expulsion rates and any other complications at six-week and three-month follow up were studied. Chi-square test was used to compare the difference in expulsion rates. Results: The expulsion rate was five per cent in the immediate compared to 3.7 per cent in the early group (no significant difference). In ten cases, the device was found to be in the lower uterus upon ultrasound before discharge. These were repositioned. There was no case with perforation, irregular bleeding or infection up to the three-month follow up. Higher age, higher parity, lack of satisfaction and motivation to continue were predictors of expulsion. Interpretation & conclusions: In the present study PPIUCD was found to be safe with overall expulsion in 4.3 per cent. It was marginally, though not significantly, higher in the immediate group.

Modified Technique of Pectoralis Major Myocutaneous Flap Inset for Buccal Mucosa Reconstruction.

BACKGROUND: Conventional technique of flap inset in buccal mucosa reconstruction is by direct suturing of cutaneous margin of Pectoralis Major Myocutaneous (PMMC) flap to hard and soft palate mucosa and margin of floor of mouth with simple interrupted sutures. We have done a prospective study of the efficacy of anchoring the upper margin of PMMC flap to the hard palate by a modified method in reconstruction of buccal mucosa defects following tumour excision. This is to prevent disruption of suture line from the mucoperiosteum of hard palate and resultant oro-cutaneous fistula. METHODS: This hospital-based prospective study was carried out in the Department of Plastic Surgery at Bangalore, India for a period of 18 months (2015-2017). Patients (N=48) with buccal mucosa defects requiring reconstruction with PMMC flap either with conventional (n=24) or modified method (n=24) following tumour excision were included. Clinico-demographic profile of the patients including age, gender, size of defect, staging of illness, site and type of reconstruction, disruption of suture margin in the hard palate, development of oro-cutaneous fistula (OCF), day of starting oral feeds, removal of Ryle's tube and post-operative average length of stay in the hospital were recorded. RESULTS: Disruption of suture line in hard palate and Oro-cutaneous fistula were statistically significant in study group in both the variables (P-0.033, P-0.033). The median days on which patients were started with oral clear liquids and removal of Ryle's tube were also statistically significant between study and control groups. Post-operative average length of hospital stay which is the outcome of favourable results in the study group was found to be statistically significant (P-0.021) between the groups. CONCLUSION: Overall, modified technique of anchorage of PMMC flap can be considered as a reliable technique in buccal mucosa reconstruction because of its stability, lower complication rates and shorter length of hospital stay.

16S rRNA Methyltransferases as Novel Drug Targets Against Tuberculosis.

Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis (M.tb) whose natural history traces back to 70,000 years. TB remains a major global health burden. Methylation is a type of post-replication, post-transcriptional and post-translational epi-genetic modification involved in transcription, translation, replication, tissue specific expression, embryonic development, genomic imprinting, genome stability and chromatin structure, protein protein interactions and signal transduction indicating its indispensable role in survival of a pathogen like M.tb. The pathogens use this epigenetic mechanism to develop resistance against certain drug molecules and survive the lethality. Drug resistance has become a major challenge to tackle and also a major concern raised by WHO. Methyltransferases are enzymes that catalyze the methylation of various substrates. None of the current TB targets belong to methyltransferases which provides therapeutic opportunities to develop novel drugs through studying methyltransferases as potential novel targets against TB. Targeting 16S rRNA methyltransferases serves two purposes simultaneously: a) translation inhibition and b) simultaneous elimination of the ability to methylate its substrates hence stopping the emergence of drug resistance strains. There are ~ 40 different rRNA methyltransferases and 13 different 16S rRNA specific methyltransferases which are unexplored and provide a huge opportunity for treatment of TB.

Polymorphisms in vitamin B12 and folate metabolising genes and their association with adverse pregnancy outcome: secondary analysis of a population based case control study.

Vitamin B12 and folate deficiency leads to accumulation of homocysteine that increases the risk of adverse pregnancy outcomes like preterm birth and low birth weight (LBW) of the neonate. We explored the association of genetic variants of key vitamin B12 and folate metabolising enzymes (MTHFR C677T and A1298C, MTR A2756G, TCN-2 C776G) with preterm birth and LBW in South Indian women. MTHFR A1298C heterozygotes (AC) were at higher risk for preterm delivery, whereas TCN-2 C776G heterozygotes (CG) were at higher risk for both preterm delivery and LBW. MTHFR C677T, A1298C and MTR A2756G haplotype CAG was protective for preterm delivery (p=.036, OR = 0.475; 95% CI: 0.233-0.97), whereas, haplotype CCG increasing the risk of preterm birth by 1.8 folds (p=.018, OR = 1.81; 95% CI: 1.09-2.98). These results underscore the significance of vitamin B12 and folate in the pathophysiology of preterm birth and LBW.Impact StatementWhat is already known on this subject? Polymorphisms of vitamin B12 and folate metabolising genes have been reported to influence preterm birth and LBW, but the reports are not consistent.What do the results of this study add? We observed a relationship of MTHFR A1298C and TCN-2 C776G with preterm birth, and significant association of TCN-2 C776G with LBW in infants.What are the implications of these findings for clinical practice and/or further research? Identification of women carrying these polymorphic risk alleles may benefit from early nutritional modifications.

Cross-sectional association between vitamin B12 status and probable postpartum depression in Indian women.

BACKGROUND: Vitamin B12 is an essential micronutrient for neurological function, as it leads to the regeneration of methionine from homocysteine, which is precursor of biologically active molecule S-Adenosyl Methionine (SAM). Pregnancy is a state of increased demand and delayed postpartum repletion of nutrients may predispose women to depression. METHODS: We included women who visited the hospital at 6-weeks postpartum for a regular checkup. Inclusion criteria were age (18-50 years), and willingness to donate venous sample for analysis. Exclusion criteria included previous history of mood disorders or antidepressant medication use, and any systemic illness like hypothyroidism, epilepsy, diabetes, and hypertension. Based on EPDS score of 10 as a cutoff, 217 women with probable postpartum depression (PPD) and equal number of age and BMI matched controls were included. Plasma total vitamin B12, holotranscobalamin (holotc), homocysteine (hcy), methyl malonic acid (MMA), 5-methyl tetrahydrofolate (THF), SAM and serotonin levels were estimated using commercially available ELISA kits. Combined B12 (cB12) score was calculated from study parameters. Multivariate analysis was performed to assess the risk of probable postpartum depression. RESULTS: Total vitamin B12 and combined B12 score were found to be significantly lower (p = 0.001) and MMA (p = 0.002) and 5-methyl THF (p < 0.001) levels were higher in women with probable depression than women without probable PPD. Women in the lowest vitamin B12 quartile had 4.53 times higher likelihood of probable postpartum depression (p < 0.001). Multivariate analysis demonstrated that decreasing vitamin B12 (OR = 0.394; 95% CI: 0.189-0.822) and cB12 (OR = 0.293; 95% CI: 0182-0.470) and increasing MMA (OR = 2.14; 95% CI: 1.63-2.83) and 5-methyl THF levels (OR = 3.29; 95% CI: 1.59-6.83) were significantly associated with the risk of probable PPD. CONCLUSION: Low vitamin B12 may contribute to depressive symptoms in vulnerable postpartum period.

Moriarty's sign - predictor of skin graft take.

BACKGROUND: Resurfacing wound beds with split skin graft is the most common procedure in plastic surgery. Association of more pain in the donor site than in the recipient site has been used as a predictor of successful graft take by Stark in 1962 who termed it Moriartys sign. PURPOSE: The aim of the study was: 1) to predict the successful take of skin graft by eliciting Moriartys sign; 2) to decide the day of first graft inspection based on Moriartys sign. METHODS: The authors hereby present a prospective study in 100 patients who underwent wound resurfacing with split thickness skin graft at the Department of Plastic Surgery in a tertiary care center between January 2014 and June 2015. The area with more pain, absence of pain or equivocal response at the graft donor site was recorded on the visual analog scale for 10 days. RESULTS: In this study, 80 patients had positive Moriartys sign, 12 patients had equivocal responses and 8 patients showed a negative sign. Patients with positive Moriartys sign underwent their first graft inspection on 10th postoperative day and showed 100% graft take. Twelve patients with equivocal response underwent first graft inspection on 5th day and had 70-80% graft take.  In 8 patients, with negative Moriartys sign first graft inspection done on 3rd day, the graft take was < 50%. CONCLUSION: The study demonstrates that Moriartys sign is a reliable clinical predictor of split thickness skin graft take and may be useful as a guide to determine the day of first graft inspection. It is an effective method even for junior members of the surgical and nursing team to monitor parameters in relation to this sign. It can be practiced in a smaller group of hospitals, too. Hence, the authors recommend to integrate this clinical assessment in routine practice.

Clinical efficacy and pharmacokinetics of colistimethate sodium and colistin in critically ill patients in an Indian hospital with high endemic rates of multidrug-resistant Gram-negative bacterial infections: A prospective observational study.

BACKGROUND: Safe and effective use of colistin requires robust pharmacokinetic (PK) and pharmacodynamic (PD) data to guide dosing. AIM: To evaluate the pharmacokinetics of colistimethate sodium and colistin in critically ill patients and correlate with clinical efficacy and renal function. MATERIALS AND METHODS: Twenty critically ill adult patients with colistin-susceptible multidrug-resistant (MDR) infections and normal renal function treated with intravenous colistimethate sodium - at a 9 million units (270 mg CBA) loading dose followed by maintenance (MD) of 3 million units t.i.d, 24 hours later - were evaluated for clinical cure (CC) at the end of therapy. Patient characteristics and plasma colistin levels at 0, 0.5, 1, 2, 4, 8 and 12 hours after the loading dose and at 1, 2 and 8 hours after the eighth and ninth infusion of MD were evaluated. Colistimethate sodium and colistin levels were measured by high-performance liquid chromatography and tandem mass spectrometry (HPLC-MS/MS). RESULTS: Among the 20 patients who were evaluated, 60% had pneumonia. Predominant pathogens were Klebsiella pneumoniae and Acinetobacter spp. Clinical cure was 50% (10/20). Mean peak loading dose concentrations were 3 ± 1.1 mg/L (1.75-5.14) and 2.37 ± 1.2 mg/L (1.52-5.54) for 'cure' and 'failure' groups, respectively (p = 0.13), while mean steady-state (Cssavg) concentrations were 2.25 ± 1.3 mg/L and 1.78 ± 1.1 mg/L in 'cure' and 'failure' groups, respectively (p = 0.19). Nephrotoxicity was 5% on day 7 of therapy. However, bacteriological cure could not be correlated with PK/PD. CONCLUSIONS: Subtherapeutic Cssavg with clinical failure and lower efficacy without significant nephrotoxicity highlights the need for therapeutic drug monitoring to guide colistin dosing.

One-step synthesis of eco-friendly boiled rice starch blended polyvinyl alcohol bionanocomposite films decorated with in situ generated silver nanoparticles for food packaging purpose.

The study reports a one-step preparation of polyvinyl alcohol/boiled rice starch blend film fabricated with in situ generated silver nanoparticles (PVA/BRS/sAgNPs) formed in the presence of sunlight irradiation. The bionanocomposite appeared to have dark brown color with a characteristic surface plasmon resonance peak at 439 nm. Further characterization has confirmed the presence of physical interactions among the components PVA, BRS and sAgNPs. Compared to the control PVA, the nanocomposites showed improved mechanical and optical properties with decreased water sensitivity. Presence of boiled rice starch and sAgNPs were also found to influence the light transmittance of composite film. Moreover, PVA/BRS/sAgNPs film was found to have superior barrier property against environmental microorganisms. Biodegradation of the composite films was studied by indoor soil burial test and was assessed by visual appearance, weight loss and FTIR analysis. Interestingly, both the PVA/BRS and PVA/BRS/sAgNPs films proved to be biodegradable and hence have promising application as cost effective food packaging material with the latter having marked antimicrobial property.

A Study on Omentin-1 and Prostate Specific Antigen in Women on Treatment for Polycystic Ovary Syndrome.

Omentin-1 and prostate specific antigen (PSA) are known to be markers of insulin resistance and hyperandrogenism respectively in polycystic ovary syndrome (PCOS). This study aimed to assess the changes in serum omentin-1 and PSA levels in PCOS patients while on treatment. Serum omentin-1, PSA, BMI and Ferriman gallwey score (FG score) were measured in 80 women with PCOS. The subjects were treated depending on their presenting complaints. The parameters were analysed at baseline and after 3 months of treatment viz. lifestyle modification (Group I), oral contraceptive pills (OCP) (Group II), clomiphene citrate (Group III), medroxy progesterone acetate (Group IV) or metformin (Group V) and was compared using paired-t test. Group II showed significant increase in serum omentin-1 (271.7 ± 112.2 vs 378.1 ± 242 ng/ml; P = 0.025) and decrease in serum PSA (0.014 ± 0.02 vs 0.005 ± 0.008 ng/ml; P = 0.027) after 3 cycles of OCP. Group I and IV also showed a decrease in serum PSA while FG score decreased in group II and group III. There was a negative correlation observed between serum omentin-1 and BMI. To conclude, PCOS women showed increase in serum omentin-1 levels after 3 cycles of OCP while serum PSA decreased after 3 months of lifestyle modification or on treatment with OCP or medroxy progesterone acetate.

Dengue virus transmission from live donor liver graft.

Arboviral transmission through transplanted organs is rare. We report a highly probable case of dengue viral transmission during live donor liver transplantation. Fever with severe thrombocytopenia was observed in the donor and recipient within 6 and 9 days after transplantation, respectively. Dengue diagnosis was confirmed by testing blood and explant tissue from the donor and recipient using dengue-specific NAT (nucleic acid testing) and serology. Serology indicated the donor had secondary dengue infection that ran a mild course. However, the dengue illness in the recipient was severe and deteriorated rapidly, eventually proving fatal. The recipient's explant liver tissue tested negative for viral RNA indicative of a pretransplant naïve status. The prM-Envelope gene sequence analysis of the donor and recipient viral RNA identified a similar serotype (DENV1) with almost 100% sequence identity in the envelope region. Molecular phylogenetic analysis of donor and recipient viral envelope sequences with regional and local dengue strains further confirmed their molecular similarity, suggesting a probable donor-to-recipient transmission via organ transplantation. Screening of living donors for dengue virus may be considered in endemic regions.

Influence of anaesthetic technique on maternal and foetal outcome in category 1 caesarean sections - A prospective single-centre observational study.

BACKGROUND AND AIMS: In category 1 caesarean section (CS), there is limited evidence regarding superior anaesthetic technique. Hence, this study was designed to study the influence of anaesthetic technique on the maternal and foetal outcome. METHODS: Patient characteristics, indication for CS, decision-to-delivery interval (DDI), uterine incision-to-delivery time (UIDT), cord blood pH, Apgar scores and neonatal and maternal outcome were noted. Composite endpoint (Apgar score <7, umbilical cord blood pH <7.2, neonatal intensive care unit admission or death) was created for adverse neonatal outcome. Logistic regression was done to assess the influence of confounding factors on the occurrence of adverse neonatal outcome. RESULTS: Of 123 patients who underwent category 1 cesarean section, 114 patients were included for analysis. The DDI and UIDT were comparable. One and 5-min Apgar scores were significantly lower in the group general anaesthesia (GA) than in the group spinal anaesthesia (SA). The umbilical cord blood pH was comparable (7.21 ± 0.15 vs 7.25 ± 0.11 in groups GA and SA, respectively). Neonatal intensive care admission and maternal outcome were comparable in both the groups. Subgroup analysis of patients with foetal heart rate of less than 100 showed that group GA had significantly lower 1-min Apgar scores and umbilical cord blood pH and significantly more neonatal admission and mortality. Binominal logistic regression showed that group GA (odds ratio 2.9, 95% confidence intervals 1.27-6.41) and gestational age were independently associated with adverse neonatal outcome. CONCLUSION: GA for category 1 CS was associated with increased incidence of adverse neonatal outcome.

Addition of power Doppler to grey scale transvaginal ultrasonography for improving the prediction of endometrial pathology in perimenopausal women with abnormal uterine bleeding.

BACKGROUND & OBJECTIVES: Transvaginal ultrasonography (TVS) is a non-invasive procedure and can be used as a screening tool among women with abnormal uterine bleeding (AUB). Power Doppler is useful in depicting the vascular architecture better than the conventional Doppler. Hence, this study was conducted to evaluate whether addition of power Doppler to grey scale TVS can replace invasive hysteroscopy for the prediction of endometrial pathology in perimenopausal women with AUB. METHODS: One hundred women (>45 yr) with perimenopausal AUB underwent evaluation with TVS, power Doppler and hysteroscopy-guided biopsy after a detailed history and examination. Histopathology was considered as gold standard and other tools such as grey scale TVS with power Doppler and hysteroscopy were compared with it. RESULTS: Fifty six per cent women had no vascularity on power Doppler. Among those who had vascularity, the vascular patterns noted were single-vessel in 18 per cent, scattered-vessel in 15 per cent and multiple-vessel in 11 per cent. The sensitivity, specificity, positive predictive value and negative predictive value of TVS-endometrial thickness with power Doppler in detecting hyperplasia were 50, 86.5, 13.3 and 97.6 per cent, respectively, whereas the same for hysteroscopy were 100, 97.6, 88.1 and 100 per cent, respectively. INTERPRETATION & CONCLUSIONS: Addition of power Doppler to grey scale TVS improved the specificity and negative predictive value almost comparable to hysteroscopy for evaluation of AUB, but sensitivity and positive predictive value remained poor.

Wilson's disease presenting during pregnancy: A diagnostic and therapeutic dilemma.

Wilson's disease is an autosomal recessive genetic disorder affecting copper transport leading to hepatic and/or neuropsychiatric manifestations. Changes in pregnancy can mimic certain clinical features of chronic liver disease such as spider naevi, and constraints for the use of various investigation for diagnosis pose a challenge to physicians. A high index of suspicion, multi-disciplinary team approach, use of correct non-invasive testing including viral serology, autoantibodies and copper studies and ultrasonography help to diagnose most of the pre-existing, de novo or pregnancy-specific hepatological conditions. We report a case of Wilson's disease diagnosed during pregnancy and discuss the challenges in diagnosis and treatment in pregnancy.

Shared Authentic Leadership in Research Teams: Testing a Multiple Mediation Model.

Research teams face complex leadership and coordination challenges. We propose shared authentic leadership (SAL) as a timely approach to addressing these challenges. Drawing from authentic and functional leadership theories, we posit a multiple mediation model that suggests three mechanisms whereby SAL influences team effectiveness: shared mental models (SMM), team trust, and team coordination. To test our hypotheses, we collected survey data on leadership and teamwork within 142 research teams that recently published an article in a peer-reviewed management journal. The results indicate team coordination represents the primary mediating mechanism accounting for the relationship between SAL and research team effectiveness. While teams with high trust and SMM felt more successful and were more satisfied, they were less successful in publishing in high-impact journals. We also found the four SAL dimensions (i.e., self-awareness, relational transparency, balanced processing, and internalized moral perspective) to associate differently with team effectiveness.

Palate Mucoperosteum: An Usefull Adjunct in Buccal Mucosa Reconstruction.

BACKGROUND: Palate is a complex structure separating oro- and nasopharynx. However, reconstruction of the defects of palate is much simpler because of the versatile mucoperiosteal flaps. Here, we present our experience of palatal mucoperiosteal flap used in different situations. METHODS: Fifteen patients of palatal as well as buccal mucosa defects were reconstructed using either free or pedicled mucoperiosteum. RESULTS: All patients recovered well. No flap loss or secondary procedure were required. CONCLUSION: Success in Reconstruction of the palatal defects depends on creation of good nasal as well as buccal mucosal lining. The rich vascular macronet in the palatal mucosa makes it an ideal donor site for local reconstruction. The mucoperiosteum harvested either as a free graft or as pedicled flap serves the purpose well leaving no donor site deformity.

Maternal ascites an independent prognostic factor in severe preeclampsia: a matched cohort study.

BACKGROUND: Preeclampsia is a multi-systemic, multi-organ dysfunction associated with increased maternal and perinatal complications. The presence of maternal ascites, a manifestation of endothelial dysfunction and increased capillary permeability, is shown to be associated with adverse outcomes. We aim to investigate the impact of maternal ascites on pregnancy outcome in women with severe preeclampsia. METHODS: A matched cohort study was conducted in a tertiary care teaching hospital in South India between March 2014 and March 2015. One hundred and twenty-one severe preeclamptic women with ascites formed the study cohort while age-, parity-, and gestational age-matched group of 121 severe preeclamptic women without ascites formed the control. Primary outcome was the composite maternal adverse outcome defined as the development of any of eclampsia, pulmonary edema, renal failure, or disseminated intravascular coagulation (DIC). Secondary outcome was the composite perinatal outcome defined as the occurrence of any of still birth, hypoxic ischemic encephalopathy or early neonatal death. RESULTS: Four maternal deaths occurred in the study group. The rates of pregnancies with composite maternal adverse outcome [42 vs 9% RR 4.6 (95% CI 2.5-8.4)] and composite perinatal adverse outcome [36 vs 17% RR 2.1, (95% CI 1.3-3.3)] were significantly more in ascites group than in control group. After adjusting for other confounding variables, ascites was independently associated with adverse maternal events [adjusted OR 16.40 (95% CI 2.88-93.31)] but not adverse perinatal outcome. CONCLUSION: In women with severe preeclampsia, maternal ascites is an independent risk factor for adverse maternal outcome.

Furosemide in postpartum management of severe preeclampsia: A randomized controlled trial.

BACKGROUND: Hypertension in the postpartum period is a common phenomenon and is often a cause for concern. Following delivery, fluid that has been sequestered in the extravascular space is mobilized, producing a large auto-infusion of fluid from the extravascular to the intravascular compartment. As a result of this fluid mobilization process, there is an increase in central venous pressure and pulmonary capillary wedge pressure, which might favor the development of pulmonary edema. Thus, diuretics logically might be a better choice as antihypertensive medication in such a scenario. METHODS: A total of 108 antenatal women diagnosed with having severe preeclampsia, with two high blood pressure recordings of ≥150/100 mm of Hg in the postpartum period within the first 24 hours of delivery, were enrolled in the study. These patients were randomly divided into two groups (Group A: furosemide 20 mg OD + nifedipine & Group B: nifedipine alone). Main outcome measures studied were reduction in systolic, diastolic, and mean arterial blood pressures, requirement of additional antihypertensive drugs to control blood pressure, duration of hospital stay, and antihypertensive requirement at discharge. RESULTS: Both groups were comparable for distribution of age and parity and presence of imminent symptoms and eclampsia. There was no significant difference in mean systolic, diastolic, and mean arterial pressures (MAPs) between both the groups at admission. Mean gestational age at delivery was 36 weeks in both the groups. Requirement of additional antihypertensive was significantly higher in women in group B (26.0% vs. 8.0%, p = 0.017). Duration of hospital and postpartum stay and the use of antihypertensive at discharge were similar in both the groups Conclusion: In conclusion, the use of a short course of furosemide along with nifedipine significantly reduces the need of additional antihypertensive in severe preeclamptic women with postpartum hypertension when compared to women who received nifedipine alone.

A map of mobile DNA insertions in the NCI-60 human cancer cell panel.

BACKGROUND: The National Cancer Institute-60 (NCI-60) cell lines are among the most widely used models of human cancer. They provide a platform to integrate DNA sequence information, epigenetic data, RNA and protein expression, and pharmacologic susceptibilities in studies of cancer cell biology. Genome-wide studies of the complete panel have included exome sequencing, karyotyping, and copy number analyses but have not targeted repetitive sequences. Interspersed repeats derived from mobile DNAs are a significant source of heritable genetic variation, and insertions of active elements can occur somatically in malignancy. METHOD: We used Transposon Insertion Profiling by microarray (TIP-chip) to map Long INterspersed Element-1 (LINE-1, L1) and Alu Short INterspersed Element (SINE) insertions in cancer genes in NCI-60 cells. We focused this discovery effort on annotated Cancer Gene Index loci. RESULTS: We catalogued a total of 749 and 2,100 loci corresponding to candidate LINE-1 and Alu insertion sites, respectively. As expected, these numbers encompass previously known insertions, polymorphisms shared in unrelated tumor cell lines, as well as unique, potentially tumor-specific insertions. We also conducted association analyses relating individual insertions to a variety of cellular phenotypes. CONCLUSIONS: These data provide a resource for investigators with interests in specific cancer gene loci or mobile element insertion effects more broadly. Our data underscore that significant genetic variation in cancer genomes is owed to LINE-1 and Alu retrotransposons. Our findings also indicate that as large numbers of cancer genomes become available, it will be possible to associate individual transposable element insertion variants with molecular and phenotypic features of these malignancies.

A randomized controlled trial of sublingual misoprostol and intramuscular oxytocin for prevention of postpartum hemorrhage.

PURPOSE: In India, two third of maternal deaths occur in rural areas where there is lack of transportation facilities, lack of refrigeration to store the injectable uterotonic drug such as oxytocin, lack of skilled personnel to administer them and lack of sterile syringes and needles. Hence, this study was conceived to evaluate misoprostol as a safe, effective, easily administered non-parenteral drug in the prevention of postpartum hemorrhage. METHODS: This study was conducted during the period from August 2012 to July 2014. Low risk women with singleton pregnancy at term admitted for vaginal delivery were eligible for the study. A total of 500 women were randomized to two groups, 250 in each group, either to receive 400 mcg misoprostol sublingually or 10 units oxytocin intramuscularly at the delivery of anterior shoulder. Patient factors, labor parameters, blood loss and side effects were noted. RESULTS: The women in both the groups were well matched with respect to age, parity, gestational age and labor parameters. There was statistical significance in the blood loss (p = 0.04) between the two groups. The average blood loss was 70 ml in misoprostol group and 75 ml in oxytocin group. Shivering was the statistically significant side effect (p = 0.004) in the misoprostol group and nausea was the statistically significant side effect (p = 0.003) in the oxytocin group. CONCLUSIONS: Sublingual misoprostol is as effective as intramuscular oxytocin as a prophylactic oxytocic in the active management of third stage of labor for prevention of postpartum hemorrhage.

Fungal beta glucan protects radiation induced DNA damage in human lymphocytes.

BACKGROUND: Ganoderma lucidum (Ling Zhi), a basidiomycete white rot macrofungus has been used extensively for therapeutic use in China, Japan, Korea and other Asian countries for 2,000 years. The present study is an attempt to investigate its DNA protecting property in human lymphocytes. MATERIALS AND METHODS: Beta glucan (BG) was isolated by standard procedure and the structure and composition were studied by infrared radiation (IR) and nuclear magnetic resonance (NMR) spectroscopy, gel filtration chromatography and paper chromatography. The radioprotective properties of BG isolated from the macro fungi Ganoderma lucidum was assessed by single cell gel electrophoresis (comet assay). Human lymphocytes were exposed to 0, 1, 2 and 4 Gy gamma radiation in the presence and absence of BG. RESULTS: The comet parameters were reduced by BG. The results indicate that the BG of G. lucidum possessed significant radioprotective activity with DNA repairing ability and antioxidant activity as the suggestive mechanism. CONCLUSIONS: The findings suggest the potential use of this mushroom for the prevention of radiation induced cellular damages.