Enhancing the shelf life of chevon Seekh Kabab using chitosan edible film and Cinnamomum zeylanicum essential oil.

Chevon Seekh Kabab is a popular meat product of India. However, due to high protein and moisture content it undergoes quick microbial spoilage and oxidative reactions leading to lower shelf life. The combination of chitosan edible film and cinnamon essential oil (CEO) was chosen to remediate this problem because of its antimicrobial and antioxidative effect. Control and chitosan edible film with CEO coated chevon Seekh Kabab samples were stored at 4 °C. The physicochemical (pH, TBARS, TVBN, moisture, colour), microbiological (APC, psychrophilic, coliform and Staphylococcal count) and sensory attributes were evaluated over a 30 days period. The maximum shelf life of 27 days was observed when 2% chitosan edible film with 0.3% CEO was coated over samples. A reduction in moisture, L* value, a* value and sensory scores along with an increase in pH, TVBN, TBARS, b* value and microbiological parameters were observed during the storage period. Reaction kinetics for the physicochemical and microbiological parameters was also established. The physicochemical, microbiological and sensory parameters were within prescribed limits till spoilage in the treated sample. This investigation may aid researchers working on scaling up of processing and preservation of Seekh Kabab.

Triploid genetic algorithm for convolutional neural network-based diagnosis of mild cognitive impairment.

The diagnosis of mild cognitive impairment (MCI), which is deemed a formative phase of dementia, may greatly assist clinicians in delaying its headway toward dementia. This article proposes a deep learning approach based on a triploid genetic algorithm, a proposed variant of genetic algorithms, for classifying MCI converts and non-converts using structural magnetic resonance imaging data. It also explores the effect of the choice of activation functions and that of the selection of hyper-parameters on the performance of the model. The proposed work is a step toward automated convolutional neural networks. The performance of the proposed method is measured in terms of accuracy and empirical studies exhibit the preeminence of our proposed method over the existing ones. The proposed model results in a maximum accuracy of 0.97961. Thus, it may contribute to the effective diagnosis of MCI and may prove important in clinical settings.

Association between Long Term Exposure to Air Pollution, Impaired Fasting Glucose, Impaired Glucose Tolerance and Prevalence of Diabetes.

Air pollution exposure have been shown to adversely impact health through a number of biological pathways, and is also associated with glucose metabolism. There are few studies that evaluated the associations between air pollution and fasting blood sugar and HbA1C levels. But no such study occurred in Indian population. Hence to address this knowledge gap, we investigated the associations between air borne fine particulate matter (PM10, PM2.5), nitrogen di-oxide and glucose metabolism in a tertiary care center in north western rajasthan. MATERIAL: We performed cross-sectional analysis in 3457 participants between 30 to 70 years of age group from five different urban and rural areas of Bikaner district. Air pollution concentration of multiple air pollutants (PM10, PM2.5andNitogen dioxide) were estimated by ambient air quality standard method by respiratory dust sampler. Diabetes was defined based on self reported diagnosis, medication prescription, oral glucose tolerance test and HbA1C. We adjusted for potential confounders including socio-economic status, smoking habits, alcohol consumtion, physical activity and Body Mass Index (BMI) by using logistic regression method. OBSERVATION: After adjustment for potential confounders, air pollutants PM10, NO2, except PM2.5 were associated with diabetes prevalence. The prevalence of diabetes was 8.93% and the mean HbA1C was 8.67±1.16, where as the concentration of PM10 was 156.12 mcg/m3, NO2 was 5.43 mcg/m3 and PM2.5 was 25.36 mcg/m3. The prevalence of IFG, IGT and diabetes increases with increased concentration of air pollutants. By applying Pearson's co-relation for air pollutants the 'r' value of PM10was 0.163, p value < 0.001, for PM2.5 'r' value was 0.001 and p value 0.965, for NO2 'r' value was 0.149 and p value was 0.001 respectively. By applying step wise logistic regression analysis, air pollutants PM10 (Odd Ratio 0.002, 95% CI 0.002;0.003) and by adding duration of exposure to air pollutants (Odd ratio 0.003,95%CI 0.001,0.005) by adding PM2.5 air pollutant (odd ratio 0.028,95%CI -0.042,-0.015) and by adding NO2 (odd ratio 0.140,95% CI 0.104,0.175). CONCLUSION: long term air pollution exposure was associated with impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and prevalence of diabetes mellitus (DM). This study can be used as a good evidence that air pollution is an important and manageable risk factor for diabetes hence awareness about air pollution in the society and at government level is much needed.

Comparison of Effect of Yoga versus Aerobic Exercise on Waist Circumference, Waist-Hip Ratio and Body Mass Index in Overweight and Obese Adult Individuals.

Background Obesity is becoming serious global public health issue due to sedentary lifestyle and bad eating habits. Dietary and lifestyle practices are directly related to obesity, which can cause serious health problems like cardiac ailments, diabetes, and hypertension etc. Vast varieties of options are available for weight reduction including physical exercises, various diet plans and also the pharmacological agents. Physical activity improves the fitness of the individual and helps in reducing the ill effects of the obesity. Objective To compare the effects of Yoga and Aerobic Exercise on weight circumference, waisthip ratio (WHR) and body mass index (BMI) in overweight and obese individuals. Method An experimental study was started with purposive sampling. Sixty overweight and obese individuals from the community were divided equally into two groups, one group was given supervised yoga asana and the other group was given supervised aerobic exercise for 6 weeks. Waist circumference, waist hip ratio and body mass index were taken pre and post intervention. Result Statistically significant difference was seen in pre and post intervention value of waist circumference, waist hip ratio and body mass index in both the groups with the p value < 0.05. However there was no statistical significant difference noted in waist hip ratio in individuals performing aerobic exercises as p value was > 0.05. Conclusion Both the interventions showed significant reduction in waist circumference, waist hip ratio and body mass index, while better results were noted in the individuals performing yoga asanas.

Development and application of a triplex-PCR assay for rapid detection of methicillin-resistant Staphylococcus aureus from pigs.

A triplex-PCR assay was developed and evaluated for rapid detection of methicillin-resistant Staphylococcus aureus (MRSA) recovered from various biological samples of pig. Three sets of primers were designed to target mecA, 16S rRNA and nuc genes of MRSA. The specific amplification generated three bands on agarose gel, with sizes 280 bp for mecA, 654 bp for 16S rRNA and 481 bp for nuc, respectively. A potential advantage of the PCR assay is its sensitivity with a detection limit of 102  CFU per ml of bacteria. In all, 79 MRSA isolates recovered from various samples of pigs were subjected to the amplification by the triplex-PCR assay and all the isolates yielded three bands corresponding to the three genes under this study. No false-positive amplification was observed, indicating the high specificity of the developed triplex-PCR assay. This assay will be a useful and powerful method for differentiation of MRSA from methicillin-sensitive S. aureus, coagulase-negative methicillin-resistant staphylococci and coagulase-negative methicillin-sensitive staphylococci.

Battling COVID-19: critical care and peri-operative healthcare resource management strategies in a tertiary academic medical centre in Singapore.

In December 2019, a cluster of atypical pneumonia cases were reported in Wuhan, China, and a novel coronavirus elucidated as the aetiologic agent. Although most initial cases occurred in China, the disease, termed coronavirus disease 2019, has become a pandemic and continues to spread rapidly with human-to-human transmission in many countries. This is the third novel coronavirus outbreak in the last two decades and presents an ensuing healthcare resource burden that threatens to overwhelm available healthcare resources. A study of the initial Chinese response has shown that there is a significant positive association between coronavirus disease 2019 mortality and healthcare resource burden. Based on the Chinese experience, some 19% of coronavirus disease 2019 cases develop severe or critical disease. This results in a need for adequate preparation and mobilisation of critical care resources to anticipate and adapt to a surge in coronavirus disease 2019 case-load in order to mitigate morbidity and mortality. In this article, we discuss some of the peri-operative and critical care resource planning considerations and management strategies employed in a tertiary academic medical centre in Singapore in response to the coronavirus disease 2019 outbreak.

Jamun fruit (Syzgium cumini) skin extract based indicator for monitoring chicken patties quality during storage.

Natural plant pigment, anthocyanins have the capability to change its color with the change of its structure influenced by changing pH. This feature of anthocyanin has been harnessed to design a meat products quality indicator. In the present experiment anthocyanin rich Jamun fruit (Syzgium cumini) skin extract was used to develop quality indicator by immobilizing on filter paper strips with the purpose of application in chicken patties packets stored at refrigeration temperature (4 ± 1 °C). The indicator changed its color from violet to yellow due to changed pH in it when it was attached inside packet of chicken patties during storage, due to reaction with volatile basic compounds generated from meat. During storage for 21 days, various changes in quality attributes of chicken patties viz., pH, Total volatile basic nitrogen (TVBN), ammonia level, color value, sensory attributes and microbial evaluation were estimated. The pH decreased (P < 0.5) from 6.22 to 6.04. TVBN and ammonia and level increased significantly (P < 0.5) throughout storage. Redness, yellowness, hue and chroma value gradually changed during storage. Sensory scores also decreased significantly (P < 0.5). Microbial count also increased (P < 0.5) during this time. The experiment showed that, during storage, the color changing pattern of quality indicator was well correlated with the changes in quality attributes of chicken meat patties. Therefore, it is expected that the developed quality indicator can provide a convenient, non destructive, visual mean to monitor the meat products quality during refrigerated storage.

Experimental bovine rotavirus-A (RV-A)infection causes intestinal and extra-intestinal pathology in suckling mice.

We describe here the intestinal and extra-intestinal spread of the species A rotavirus (RV-A) and associated lesions thereof in Swiss albino suckling mice pups, inoculated with a bovine-origin RV-A strain. In total, 35 suckling pups were used, wherein 20 pups received cell culture isolated RV-A @ 160 µL (TCID50/ml, 5 × 106.5) per pup [oral 80 µL and intra peritoneal (IP) 80 µL] and served as an infected group, while 15 pups were kept in the control group and inoculated the same volume of phosphate buffered saline (PBS) of neutral pH orally and IP. Four pups from the infected group and 3 from control group were sacrificed at 3, 5, 7, 9 and 12 day post infection (DPI). Of note, infected pups exhibited signs of dullness and restlessness till 5DPI, but none showed diarrhea at any point of time. No appreciable gross lesions were evident in any of the organs, except for mild congestion of the small intestine and yellowish catarrhal smearing over the luminal surface. However, light microscopic lesions in hematoxylin and eosin (H&E) stained sections of jejunum and ileum revealed vacuolation and pyknosis of nuclei of the mature enterocytes, their lysis and detachment, constriction and detachment of villi, mild mononuclear cells (MNCs) infiltration in the lamina propria and mildcell depletion of Peyer's patches and mesenteric lymph nodes (MLN). The extra-intestinal lesions of the cellular degeneration and mild MNCs infiltration were identified in the liver and kidneys from 3 to 7 DPI, but no lesion was seen in the brain. Interstitial thickening with MNCs of lung parenchyma was visible from 3 to 7 DPI. The lesions in the intestine, lymphoid tissues and lungs resolved after 7 DPI. The presence of viral nucleic acid was seen in the intestinal contents from 3 to 5 DPI by using a RV-A specific reverse-transcription polymerase chain reaction (RT-PCR), while in the MLNs and the lungs it could be detected till 5 DPI by both the RT-PCR and direct fluorescent antigen test (dFAT). However, liver, spleen and brain were tested negative for the presence of RV-A by any of these tests. Nonetheless, the persistence of the RV-A was seen in the MLNs even after the absence of virus from the small intestines. Findings here conclusively indicates that heterologous host origin RV-A has an affinity not only to the intestine but also to extra-intestinal tissues like MLNs and lung tissues.

Rapid visual isothermal nucleic acid-based detection assay of Brucella species by polymerase spiral reaction.

AIM: The aim of this study was to develop polymerase spiral reaction (PSR) for rapid, sensitive and specific detection of Brucella sp. METHODS AND RESULTS: Polymerase spiral reaction assay was developed using specifically designed primers targeting the conserved multicopy IS711 gene of Brucella sp. The assay could be performed within 60 min at an isothermal temperature of 64°C. The lower limit of detection of PSR was 11·8 fg and conventional PCR was 1·18 pg of Brucella abortus genomic DNA. Thus, PSR was found to be 100-fold more sensitive than conventional PCR and was comparable to real-time PCR. The specificity of PSR was tested with other non-Brucella bacteria and also with some bacterial and viral pathogens causing abortions. The assay was found to be specific as it did not detect any putative pathogens other than Brucella sp. Fifty-six clinical samples suspected for brucellosis (aborted fetal stomach content) were screened with PSR to validate the applicability of the test to detect Brucella DNA. The same samples were also screened with conventional PCR and real-time PCR. Of 56 samples, 25 samples were found to be positive with both PSR as well as real-time PCR, whereas only 20 samples were found positive with conventional PCR. CONCLUSIONS: The results of this study indicated that the PSR assay is a simple, rapid, sensitive and specific method for the detection of Brucella sp. that may improve diagnostic potential in clinical laboratories or can be used at diagnostic laboratories with minimal infrastructure. SIGNIFICANCE AND IMPACT OF THE STUDY: The PSR assay, because of its simplicity and low cost, can be preferred to other molecular methods in the diagnosis of infectious diseases.

Relevant Feature Selection from a Combination of Spectral-Temporal and Spatial Features for Classification of Motor Imagery EEG.

This paper presents a novel algorithm (CVSTSCSP) for determining discriminative features from an optimal combination of temporal, spectral and spatial information for motor imagery brain computer interfaces. The proposed method involves four phases. In the first phase, EEG signal is segmented into overlapping time segments and bandpass filtered through frequency filter bank of variable size subbands. In the next phase, features are extracted from the segmented and filtered data using stationary common spatial pattern technique (SCSP) that can handle the non- stationarity and artifacts of EEG signal. The univariate feature selection method is used to obtain a relevant subset of features in the third phase. In the final phase, the classifier is used to build adecision model. In this paper, four univariate feature selection methods such as Euclidean distance, correlation, mutual information and Fisher discriminant ratio and two well-known classifiers (LDA and SVM) are investigated. The proposed method has been validated using the publicly available BCI competition IV dataset Ia and BCI Competition III dataset IVa. Experimental results demonstrate that the proposed method significantly outperforms the existing methods in terms of classification error. A reduction of 76.98%, 75.65%, 73.90% and 72.21% in classification error over both datasets and both classifiers can be observed using the proposed CVSTSCSP method in comparison to CSP, SBCSP, FBCSP and CVSCSP respectively.

The Influence of Metformin on Serum Carbohydrate Antigen 19-9 (CA 19-9) Levels in Type 2 Diabetes Mellitus Patients.

Objective: Diabetes mellitus has been claimed to be a risk factor for the development of pancreatic carcinoma. CA 19-9 has a great sensitivity in detection of pancreatic adenocarcinoma. Metformin exhibits a strong and consistent antiproliferative action on several cancer cell lines including pancreatic cancer. We aim to determine the influence of metformin on CA 19-9 levels in type 2 diabetes mellitus patients. Methods: Total 193 patients with type 2 diabetes mellitus were registered for a single centre, cross-sectional study. On the basis of treatment modalities, patients were divided into metformin group (93 patients) and non-metformin group (100 patients). Detailed history, clinical examination, anthropometric measurements, serum CA 19-9 level, glucose and lipid metabolic profiles were determined. Results were presented as mean±SD. Association between CA 19-9 level and other variables were assessed with Pearson correlation and multiple stepwise regression analysis. Results: Mean CA 19-9 level was 18.99±4.30 U/ml in the metformin group as compared to 30.49±5.61 U/ml in non-metformin group (p<0.001). Mean value of CA 19-9 was found highest among all i.e. 37.05±4.94 U/ml in patients taking insulin. Patients having lifestyle modification for the management of diabetes had their mean CA 19-9 level of 21.39±5.62 U/ml. CA 19-9 level is positively correlated with age, duration of diabetes, BMI, 2-hour Plasma Glucose level, HbA1C, VLDL cholesterol, triglyceride, total cholesterol, LDL cholesterol (p<0.005) and negatively correlated with HDL cholesterol (p<0.001). Conclusion: Metformin is associated with lower level of CA 19-9 in type 2 diabetes mellitus patients. It may have a protective role in preventing pancreatic damage and pancreatic cancer in diabetic individuals. CA 19-9 level could be an effective indicator of glycemic control, disease progression and lipid metabolism in patients with type 2 diabetes mellitus.

Clinical and Etiological Profile of Fever with Thrombocytopenia - A Tertiary Care Hospital Based Study.

Objectives: Febrile thrombocytopenia is a condition commonly caused by infections. The present study is intended to know the underlying etiology of fever with thrombocytopenia, the various presentations and complications in our community. Material and Methods: A cross-sectional epidemiological study was conducted including 1217 patients aged more than 14 years with fever and thrombocytopenia admitted in the medical wards from October 2013 to September 2014. Detailed clinical examination and routine investigations were done; specific investigations like blood culture, widal test, antigen test for malaria, IgM ELISA leptospira, IgM ELISA dengue, bone marrow aspiration/biopsy etc. were done as and when indicated. The data are presented as percentage and numbers. Rates and ratios are computed. Results: Infection was the commonest cause of thrombocytopenia and dengue was the commonest of the infections followed by malaria. Bleeding manifestations were seen in 42.7% of patients. 91.40% of patients with bleeding tendencies had petechiae/purpura as the commonest bleeding manifestation, followed by spontaneous bleeding in 57%. Spontaneous bleeding was noted when platelet counts were less than 20,000. Petechiae/Purpura were seen more commonly when platelet count was in the range of less than or equal to 50,000. Good recovery was noted in 95%, while 5% had mortality. Septicemia accounted for 85.24% of deaths followed by malaria (6.55%) and dengue (5%). Conclusion: Fever with thrombocytopenia is an important clinical condition commonly caused by infections, particularly dengue and malaria. In majority of patients thrombocytopenia was transient and asymptomatic, but in significant number of cases there were bleeding manifestations. On treating the specific cause drastic improvement in platelet count was noted. Mortality in febrile thrombocytopenia is not directly associated with degree of thrombocytopenia but with concomitant involvement of other organs leading to multiorgan dysfunction.

SNP in KCNQ1 Gene is Associated with Susceptibility to Diabetic Nephropathy in Subjects with Type 2 Diabetes in India.

OBJECTIVE: Diabetic nephropathy (DN) remains the most common cause of end stage renal disease (ESRD) as the burden of diabetes increases worldwide. Only 25 to 40% of patients with type 2 diabetes mellitus (T2DM) develop diabetic nephropathy irrespective of glycemic control so there should be a specific genetic basis for the development of diabetic nephropathy. METHODS: We have collected venous blood samples from 50 cases (Diabetic nephropathy) and 20 controls (T2DM without nephropathy) diagnosed by spot urine albumin creatinine ratio (ACR). DNA was isolated from processed samples. PCR study and sequencing was done to detect polymorphism of rs2237897 in KCNQ1 gene. RESULTS: Statistically significant difference was found when the allelic frequencies between the two groups were compared (p=0.03), with the C allele having a 2.4 fold higher risk of having diabetic nephropathy (risk ratio, RR )= 1.16, 95%CI of RR = 1.01 to 1.3, Odds Ratio (OR) =2.4; 95% CI of OR =1.06 to 4.6). Chi-square analysis showed a significant difference in genotype frequency of rs2237897 (χ2 = 4.63, p=0.03) in Diabetic nephropathy subjects, compared with that of controls. CONCLUSIONS: This study suggested that, KCNQ1 being an established type 2 diabetes gene, genetic variation in this gene may contribute to susceptibility to diabetic nephropathy and the C allele is the risk allele for diabetic nephropathy, which is different from Japanese population where the T allele was the risk allele.

Association of Serum Prolactin Level with Impaired Glucose Regulation and Diabetes.

BACKGROUND: Increase in prolactin during pregnancy has been identified as a major stimulus for ß cells. These effects have been demonstrated in both in-vitro and in-vivo non-pregnant animal models. Recently, bromocriptine has also been approved for the therapy of type 2 diabetes, regardless of the baseline prolactin level, with its mechanism of action poorly understood. Hence, this study was planned to assess whether prolactin levels within normal range associates with prediabetes and diabetes. METHODS: A total of 300 participants, 180 males and 120 females, with equal number of subjects in the prediabetes, diabetes and normal group were analyzed. The participants were categorized into sex-specific quartiles of serum prolactin, with the first quartile representing subjects with the lowest prolactin levels and the fourth quartile having the highest levels. In addition, multinomial logit analyses were performed to evaluate the odds ratio and 95% confidence interval of having prediabetes & diabetes for each quartile. RESULTS: Prolactin levels in the normal group were 10.99 ± 3.65 ng/ml for the males and 12.25 ± 3.67 ng/ml for the post-menopausal females. The prolactin levels for the males in prediabetes group were 9.46 ± 3.43 ng/ml and for diabetes group were 8.98 ± 3.43 ng/ml (p value = 0.005). In females, the prolactin levels were 10.20 ± 3.99 ng/ml for the prediabetes group and 9.60 ± 3.85 ng/ml for the diabetes group (p value = 0.007). The mean fasting plasma glucose for the four male quartiles in their numerical order were 135 mg/dl, 128 mg/dl, 120 mg/dl and 110 mg/dl (p value = 0.04) and the mean HbA1c in the same order for the quartiles were 7%, 6.4%, 6.1% and 5.9% (p value = 0.01). Similarly, the mean fasting plasma glucose for the four female quartiles in their numerical order were 138 mg/dl, 131 mg/dl, 124 mg/dl and 107 mg/dl (p value = 0.03) and the mean HbA1c in the same order for the quartiles were 7.2%, 6.7%, 6.3% and 5.8% (p value = 0.01). The age adjusted odds ratio for 2nd, 3rd and 4th quartiles as compared to the 1st quartile for prediabetes in men were 0.82, 0.72 and 0.61 and for diabetes were 0.84, 0.65 and 0.55, respectively. Risk for diabetes in females ranged from 0.04 to 0.72 for the 3rd quartile and 0.03 to 0.56 for the 4th quartile as compared to 1st quartile. The risk for prediabetes in females ranged from 0.06 to 0.95 for 3rd quartile and 0.04 to 0.74 for the 4th quartile as compared to 1st quartile. CONCLUSIONS: Mean prolactin levels in both males and females were lower in prediabetics and lowest in diabetics. Prolactin, on quartile based analysis, associated with better HbA1c and fasting plasma glucose. Decreasing relative risk trends for both prediabetes and diabetes were found with increasing serum prolactin concentrations. No association was found with obesity and dyslipidemia.

Vitamin D: A Critical Micronutrient for Vascular Health in Type 2 Diabetes Mellitus.

OBJECTIVE: Vitamin D deficiency may be responsible for endothelial dysfunction which in turn affects the onset and progression of vascular disease including coronary artery disease and its risk factor, directly or indirectly through various mechanisms. This study was undertaken to find out association between vitamin D and endothelial dilatation of brachial artery, which may help to suggest possible underlying mechanisms and may be of clinical importance in planning preventive and therapeutic strategies. MATERIAL AND METHODS: 50 cases of type 2 diabetes mellitus aged 40-60 years were taken. 50 cases without type 2 diabetes mellitus matched for confounding factors were taken as controls. Venous blood samples were collected for the investigations including vitamin D levels. Then Participants were subjected to ultrasound examination for measurement of flow mediated dilatation (FMD) and endothelial independent dilatation after ingestion of glyceryl tri-nitrate (GTN). Unpaired student T test and correlation coefficient analysis were used to find out association between different variables. RESULTS: The mean values of FMD were 18.85 ± 5.39% and 10.29 ± 4.91% in controls and cases respectively (p<0.001). The dilatation after GTN was observed to be 26.16 ± 4.25% and 18.74 ± 5.72% in controls and cases respectively (p<0.001). The mean levels of vitamin D among controls and cases were 25.41 ± 12.18 and 14.52 ± 8.28 ng/ml respectively. The correlation between endothelial dependent dilatation (FMD), endothelial independent dilatation (after GTN) and vitamin D was found to be more positive in cases (r=0.870, r=0.798) than controls (r=0.079, r=0.158). CONCLUSIONS: Vitamin D deficiency state is higher among cases of type 2 DM. Endothelial dependent dilatation (FMD) was found to be lower among the patients of type 2 DM. The study gives us an insight to identify the diabetics with vitamin D deficiency which may be at higher risk of vascular complications including coronary artery disease.

Effect of Carica papaya Leaf Extract Capsule on Platelet Count in Patients of Dengue Fever with Thrombocytopenia.

OBJECTIVE: Thrombocytopenia in dengue fever is a common and serious complication. However, no specific treatment is available for dengue fever induced thrombocytopenia. In few countries (Pakistan, Malaysia, Sri Lanka and other Asian countries) the leaf extract of Carica papaya has been effectively used for thrombocytopenia. So, the study is planned to access effect of Carica papaya leaf extract on platelet count in dengue fever patients. METHODS: All participants were randomised into two groups, study group and control group; the study group was given papaya leaf extract capsule of 500 mg once daily and routine supportive treatment for consecutive five days. The controls were given only routine supportive treatment. Daily complete blood counts, platelet counts and haematocrit level, liver function test, renal function test of both groups were observed. RESULTS: On the first day platelet count of study group and control group was (59.82±18.63, 61.06±20.03 thousands, p value 0.36). On the 2nd day platelet count of both study and control groups was not significantly different (61.67±19.46 and 59.93±19.52 thousands, p value 0.20) but on 3rd day platelet count of study group was significantly higher than control group (82.96±16.72, 66.45±17.36 thousands, p value < 0.01). On 4th and 5th day platelet count of study group (122.43±19.36 and 112.47±17.49 thousands respectively) was also significantly higher than the control group (88.75±21.65 and 102.59±19.35 thousands) (p value < 0.01). On 7th day platelet count of study group and control group were not significantly different (124.47±12.35 and 122.46±19.76 thousands respectively, p value 0.08). Average hospitalization period of study group v/s control group was 3.65±0.97 v/s 5.42±0.98 days (p value < 0.01). Average platelet transfusion requirement in study group was significantly less than control group (0.685 units per patient v/s 1.19 units per patient) (p value <0.01). CONCLUSIONS: It is concluded that Carica papaya leaf extract increases the platelet count in dengue fever without any side effect and prevents the complication of thrombocytopenia. So, it can be used in dengue fever with thrombocytopenia patients.

Ratio of Waist-To-Calf Circumference and Carotid Atherosclerosis in Patients of Type 2 Diabetes Mellitus.

AIM: Diabetes is a well known risk factor for carotid atherosclerosis. However, screening of all diabetics by carotid ultrasonography is cumbersome and cost-effective. Search for anthropometric measures related to severity of disease has been relentless. It's a proposal for waist-calf ratio as a better marker of carotid atherosclerosis than traditional measurements as it is cost-effective and non-invasive. METHODS: This was a cross-sectional observational study. 100 patients were included. Detailed history, clinical examination, biochemical indices and anthropometric measurements were recorded. Carotid atherosclerosis was measured using a high resolution USG system with 10 MHz linear transducer. The carotid intima-media thickness (CIMT) was measured at 3 points on far wall of mid and distal CCA and 1 cm proximal to dilation of carotid bulb. Mean value of six measurements from right and left CCA was used. CIMT → Distance between media-adventitia interface and lumen intima interface. Carotid Plaque → distinct area of hyperechogenicity and or protrusion into the lumen of vessel with at least 50% greater thickness than the surrounding area. Carotid atherosclerosis → Focal plaque or CIMT > 1.1 mm. RESULTS: Mean CIMT in quartiles of WCR in females and males are 1st (0.740, 0.674); 2nd (0.833, 0.726); 3rd (0.902, 0.814); 4th (1.005, 0.910) as well as mean WCR in quartiles of CIMT in males and females are 1st (2.292, 2.302); 2nd (2.473,2.443 ); 3rd (2.641, 2.671); 4th (3.177, 2.967). All the quartiles are statistically highly significant with p<0.001. Out of 100 patients 17 patients with carotid plaques, 12 had CIMT >1 and 14 had WCR >2.5. The difference was statistically significant with p<0.01. CONCLUSIONS: waist-calf ratio is a stronger anthropometric marker of carotid atherosclerosis and can be used in screening of high risk patients in diabetic population.

Laparoscopic Transplantation Following Transvaginal Insertion of the Kidney: Description of Technique and Outcome.

Laparoscopic kidney transplantation (LKT) is well accepted modality of treatment for ESRD patients at our center. Usually, the kidney is inserted through small Pfannenstiel incision. With the permission of the Internal Review Board, we carried out LKT in eight female recipients following insertion of the kidney through the vagina. The kidney was procured by the retroperitoneoscopic approach. Antibiotic prophylaxis was given. All cases were carried out successfully with immediate graft function and 100% graft and patient survival at 1 year of follow-up. Estimated glomerular filtration rate at 1 month and 1 year was similar to eight randomly selected female recipients who underwent open kidney transplantation (OKT). No analgesia was required in seven out of eight patients after the 3rd postoperative day. In summary, vaginal insertion of kidney and LKT is safe and feasible in a selected group of patients. It is associated with better analgesia and has similar allograft function as compare to OKT.

Analysis of cytokine production by peanut-reactive T cells identifies residual Th2 effectors in highly allergic children who received peanut oral immunotherapy.

BACKGROUND: Only limited evidence is available regarding the cytokine repertoire of effector T cells associated with peanut allergy, and how these responses relate to IgE antibodies to peanut components. OBJECTIVE: To interrogate T cell effector cytokine populations induced by Ara h 1 and Ara h 2 among peanut allergic (PA) children in the context of IgE and to evaluate their modulation during oral immunotherapy (OIT). METHODS: Peanut-reactive effector T cells were analysed in conjunction with specific IgE profiles in PA children using intracellular staining and multiplex assay. Cytokine-expressing T cell subpopulations were visualized using SPICE. RESULTS: Ara h 2 dominated the antibody response to peanut as judged by prevalence and quantity among a cohort of children with IgE to peanut. High IgE (> 15 kU(A)/L) was almost exclusively associated with dual sensitization to Ara h 1 and Ara h 2 and was age independent. Among PA children, IL-4-biased responses to both major allergens were induced, regardless of whether IgE antibodies to Ara h 1 were present. Among subjects receiving OIT in whom high IgE was maintained, Th2 reactivity to peanut components persisted despite clinical desensitization and modulation of allergen-specific immune parameters including augmented specific IgG4 antibodies, Th1 skewing and enhanced IL-10. The complexity of cytokine-positive subpopulations within peanut-reactive IL-4(+) and IFN-γ(+) T cells was similar to that observed in those who received no OIT, but was modified with extended therapy. Nonetheless, high Foxp3 expression was a distinguishing feature of peanut-reactive IL-4(+) T cells irrespective of OIT, and a correlate of their ability to secrete type 2 cytokines. CONCLUSION: Although total numbers of peanut-reactive IL-4(+) and IFN-γ(+) T cells are modulated by OIT in highly allergic children, complex T cell populations with pathogenic potential persist in the presence of recognized immune markers of successful immunotherapy.