Strategic administration of antioxidant multiminerals and vitamins to transitional buffaloes augments antioxidant and udder defense mechanisms in early lactation.

The aim of the study was to examine the effects of repeated administrations of antioxidant multiminerals and vitamins in transition buffaloes on udder defense mechanism, antioxidant activity and occurrence of intramammary infection (IMI) in early lactation period. Forty clinically healthy pregnant buffaloes were enrolled 45 days before expected date of calving and randomly allocated into five different supplementation groups (n = 8): only basal ration (control), vitamin E and selenium (VES), multiminerals (MM), ascorbic acid (AA) and chromium (Cr) picolinate in basal diet. The udder defense mechanism was monitored by measuring phagocytic activity (PA), myeloperoxidase (MPO) and nitric oxide (NO) productions in milk leukocytes, antioxidant activity was evaluated by measuring total antioxidant capacity (TAC) in plasma and occurrence of IMI was assessed by milk cytology, bacterial count in milk and visible clinical signs of udder until day 28 post-calving. The results showed that the VES and MM supplementations exhibited significantly higher PA, MPO and NO productions of milk leukocytes till first week of lactation whereas, elevated mean TAC in plasma was maintained from day -7 to 1 of calving in MM supplementation group as compared to control group. Statistically, no significant difference in occurrences of subclinical or clinical IMI was noted across the groups until four weeks of lactation. Taken together, it is concluded that repeated administrations of VES and MM to transition buffaloes could be an effective strategy to maintain good udder health by augmenting milk leukocyte functions and antioxidant status and preventing incidence of IMI in early lactation.

An assessment of the quality of antenatal care and pregnancy outcomes in a tertiary hospital in Ghana.

BACKGROUND: Antenatal care (ANC) is imperative to decreasing adverse pregnancy outcomes and their related maternal mortality. However, in sub-Saharan Africa, increases in ANC coverage have not correlated well with improved maternal and fetal outcomes suggesting the quality of ANC received could be the missing link. This study assessed ANC quality and its effect on adverse pregnancy outcomes among women who delivered at Komfo Anokye Teaching Hospital. METHODS: A cross-sectional study was conducted among women who delivered at Komfo Anokye Teaching Hospital within the study period. Women were selected through systematic sampling and interviewed using a pretested structured questionnaire as well as review of their medical records. Data were collected on their sociodemographic and reproductive characteristics, care provided during ANC and delivery outcomes. Categorical variables were compared using the χ2 test. Factors associated with quality of ANC and adverse pregnancy outcomes were assessed using univariate and multivariate logistic regression to generate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Statistical analyses were performed using SPSS and GraphPad Prism. P-values of < 0.05 were considered statistically significant. RESULTS: 950 women were recruited into the study with mean age of 30.39±5.57 years. Less than one-tenth (7.6%) of the women received good quality ANC, 63.4% had average quality ANC, and 29.0% received poor quality ANC. Increasing educational level and initiating ANC in the first trimester [aOR 0.2; 95%CI 0.08-0.68; p<0.001] increased the odds of receiving good quality ANC while being unemployed decreased the odds of receiving good quality ANC [aOR 0.3; 95% CI 0.12-0.65; p = 0.003]. Receiving poor and average quality of ANC were significantly associated with increased likelihood of developing anaemia during pregnancy, preeclampsia with severe features or delivering a low birth weight baby. CONCLUSION: Most women did not receive good quality ANC. High quality ANC should be provided while the women are encouraged to comply with the recommendations during ANC.

Porcine sapelovirus among diarrhoeic piglets in India.

Porcine sapelovirus (PSV) A belongs to the genus Sapelovirus, family Picornaviridae. PSV infections in pigs have been reported from European countries, United States, Japan, China, Korea and Brazil. The virus has been isolated/detected from faeces of healthy pigs as well as those affected with diarrhoea, respiratory signs, encephalitis, skin lesions and fertility disorders. This study was planned to investigate whether PSV is prevalent among pigs in India and to characterize PSV encountered in the study population. The study revealed that five of 70 (7.14%) faecal samples were found positive for PSV using RT-PCR. Three viruses were successfully isolated from faecal samples using IB-RS-2 cell line. Complete genome sequencing and analysis of one Indian PSV isolate revealed highest homology (88%) with V13 strain from England. Phylogenetic analysis of the complete polyprotein nucleotide sequences of 14 strains of PSV classified the viruses into four distinct clades. This first report from India adds to our knowledge on genetic diversity of PSV detected so far among pigs in different countries. A large-scale surveillance of the virus is required to understand its genomic diversity and economic impact.

Tumor volume and uterine body invasion assessed by MRI for prediction of outcome in cervical carcinoma treated with concurrent chemotherapy and radiotherapy.

OBJECTIVE: The aim of this study was to evaluate the prognostic significance of primary tumor volume and uterine body invasion assessed by pre-treatment MRI for uterine cervical cancer patient treated with concurrent chemotherapy and radiotherapy. METHODS: A retrospective analysis of 106 patients with IB-IIIB cervical carcinoma was performed. Potential prognostic factors were stage, clinical tumor diameter, histology, age, pelvic lymph node, vaginal extension, parametrial invasion, tumor volume and uterine body invasion status. Multivariate analyses were performed to identify the prognostic factor for overall survival (OS) and disease-free survival (DFS). RESULTS: The 5-year OS, DFS rate were 59.7 and 56.6%. Using multivariate analyses, a large tumor volume (>/=30 ml; P = 0.012) and uterine body invasion (P = 0.020) and positive pelvic lymph node (LN) enlargement (P = 0.040) showed a significantly unfavorable influence on OS. Using these three factors, patients were divided into four subgroups: the OS rates of patients with risk 0 (volume <30 ml, no uterine body invasion, and negative LN), risk 1 (one of these three factors), risk 2 (two of these three factors) and risk 3 (volume >/=30 ml, uterine body invasion, and positive LN) were 96.3, 77.5, 53.0 and 14.8%, respectively (P < 0.0001). CONCLUSIONS: Tumor volume and uterine body invasion determined by MRI were significant prognostic factors for patients with cervical carcinoma. Pelvic lymph node enlargement diagnosed by CT also proved to be a significant prognostic factor in OS. Using these three parameters, we devised a practical and effective model to predict OS.

Rectum dose analysis employing a multi-purpose brachytherapy phantom.

PURPOSE: It is difficult to reproduce a brachytherapy measurement because of changes in the rectal shape during inter-fraction. We constructed a multi-purpose brachytherapy phantom (MPBP) and reproduced the same conditions found in actual therapy. We further attempted to apply the measured optimal dose to reduce rectal complications. METHODS: A measured dose was administered at rectal reference point R1 using a diode detector in four patients who used a tandem and ovoid in brachytherapy for carcinoma of the cervix. A total number of 20 rectal dose measurements were performed five times per patient. In addition, discrepancies in the set-up of the diode detector were analyzed with each repetitive measurement. After reproducing the same conditions as found in actual therapy using a multi-function applicator (MFA) in the multi-purpose brachytherapy phantom constructed for this study, the dose was measured at reference points in the rectum using a thermoluminescence dosimeter (TLD). RESULTS: According to the discrepancies measured in the set-up using a diode detector, Patient 1 showed a maximum value of 11.25 +/- 0.95 mm in the Y direction, Patients 2 and 3 exhibited 9.90 +/- 2.40 mm and 20.85 +/- 4.50 mm in the Z direction, respectively. Patient 4 showed 19.15 +/- 3.33 mm in the Z direction. In addition, values of the mean dose according to the position of the diode detector were recorded as 122.82 +/- 7.96-323.78 +/- 11.16 cGy. In the measured results for TLD in an MPBP, relative error for Patients 1 and 4 at the rectal reference point R2 were a maximum of 8.6 and 7.7%, respectively. For Patients 2 and 3 they were 1.7 and 1.2%, respectively. Furthermore, the dose measured at point R1 and R2 exhibited values approximately 1.7-8.6% higher than the dose calculated in advance, excluding point R1 in Patient 2. The discrepancies in the set-up owing to repetitive measurements and alterations in dosage according to these changes were not analyzed. It was evident that the relative error between the calculated and measured value was within 15%, which was allowable according to the recommendations by the American Association of Physicists in Medicine (AAPM). CONCLUSIONS: The multi-purpose brachytherapy phantom constructed for this study successfully reproduced an optimal dose measured under the same conditions found in actual therapy in which the dose was precisely analyzed at a rectal reference point. In addition, these results were considered reliable and applicable for dose optimization before applying therapy using the measured data from the phantom in order to reduce rectal complications.

Consensus recommendations for the diagnosis and treatment of multiple sclerosis in Kuwait.

OBJECTIVES: We aim to develop consensus recommendations to guide neurologists in the community for the diagnosis and treatment of Multiple Sclerosis (MS). METHODS: After reviewing the available literature, a group of neurologists with expertise in MS met to discuss the evidence and develop consensus recommendations for the diagnosis and treatment of MS. RESULTS: The revised 2010 McDonald criteria is the established diagnostic criteria for MS and has wide international acceptance among international MS experts. Several red flags in the history and examination, along with certain laboratory tests were pointed out to exclude MS mimickers in the diagnostic phase. The available approved disease modifying therapies (DMTs) were listed in an algorithmic fashion based on initial assessment of disease severity and subsequent disease breakthrough while on DMTs. Risk stratification based on the benefit versus risk ratio was used to help choosing the appropriate therapy to MS patients using an "individualized therapy" approach. The requirements for initiation and monitoring of treated MS patients were highlighted with emphasis on early identification of disease breakthrough, adverse events, and safety concerns. The role of multi-disciplinary MS clinics was discussed and a guide for referral to specialized MS clinics was developed. CONCLUSIONS: Consensus recommendations have been developed to guide local neurologists on the diagnosis and treatment of patients with MS. Implementation of the revised 2010 McDonald diagnostic criteria was advised while a personalized treatment approach was recommended using a treatment algorithm based on risk stratification and patient-centered outcomes.

Development of potent non-carbohydrate imidazole-based small molecule selectin inhibitors with antiinflammatory activity.

A novel series of non-carbohydrate imidazole-based selectin inhibitors has been discovered via high-throughput screening using a P-selectin ELISA-based assay system. The initial lead 1 had an IC(50) of 17 microM in the P-selectin ELISA; this potency was significantly improved via an extensive SAR exploration. One of the current lead compounds (29) has an IC(50) of 300 nM in a P-selectin ELISA; it also has good activity in P- and E-selectin cell adhesion assays and shows efficacy in vivo. These compounds represent a novel series of sLe(X) mimetics with antiinflammatory activity. Their unique profile supports our interest in their further evaluation as drug candidates for the treatment of inflammation. Herein we describe the syntheses, optimization, and SAR of this series of novel potent selectin antagonists.

Psychiatric morbidity in HIV infected individuals.

Forty six subjects infected with the human immunodeficiency virus (HIV) were followed up, for recording psychiatric morbidity if any, before and after the information regarding their HIV status was revealed to them. Among these, four patients had the AIDS syndrome, while 42 individuals were HIV carriers. The pre-information morbidity in the AIDS group included two individuals who presented with delirium and one with an adjustment disorder. The psychiatric diagnosis among the HIV carriers revealed one patient with major depression, four with adjustment disorders and four with alcohol dependence syndrome. The additional morbidity after the diagnoses was revealed included major depression and adjustment disorders which could be managed by psychological intervention and counselling in most cases. The individual who developed major depression later, committed suicide. The study though preliminary in nature, suggests that it may be beneficial to include psychiatric management as part of the general care of individuals with HIV infection.

PIP: 46 subjects infected with human immunodeficiency virus (HIV) were followed up to determine psychiatric morbidity, both prior to and after information regarding their HIV status was revealed to them. Among these patients, 4 had AIDS syndrome while 42 individuals were HIV carriers. The preinformation morbidity in the AIDS group included 2 individuals who presented with delirium and 1 with an adjustment disorder. The psychiatric diagnosis among the HIV carriers revealed 1 patient with major depression, 4 with adjustment disorders, and 4 with alcohol dependence syndrome. The additional morbidity after the diagnosis was revealed and included major depression and adjustment disorders which could be managed by psychological intervention and counseling in most instance. The individual who later developed major depression committed suicide. The study, though preliminary in nature, suggests that it may be beneficial to include psychiatric management as past of the general care of individuals with HIV infection.

Reconstruction of mandible and surrounding soft tissues in patient with necrotizing fasciitis.

Necrotizing fasciitis is rare in the orofacial region, with fewer than 20 cases reported in the literature. Extension of the disease process to involve the underlying bone has not been previously reported. A patient is presented in whom destruction of superficial skin and fascia, necrosis of a portion of the mandible, and involvement of the parotid gland complicated reconstruction.

Development of a hybrid artificial pancreas with a dense polyurethane membrane.

We have synthesized a series of strong, elastomeric polyurethaneureas and have used them to fabricate non-porous film and hollow fiber membranes. The solvent cast membranes are non cytotoxic, angiogenic, and permeable to gases, nutrients, secretagogues, and cell products via purely concentration driven transport. Permeability to water, glucose, and protein increases monotonically with membrane water absorption above a threshold value. Water absorption increases with soft segment hydrophilicity, soft segment molecular weight, and soft segment volume fraction of the (dry) segmented polyurethanes. Cell lines (RAJI and MOPC-31C) and primary cells (porcine islets) contained within our membranes have been maintained in culture for up to 6 months with nutrients supplied only by the external media. Cells within membrane devices were protected from immune rejection when implanted into murine hosts. Simple, compact devices containing porcine islets restored normoglycemia and near normal response to glucose tolerance tests in diabetic mice for at least 2 months. Explants had a high degree of vascularization adjacent to the membrane, with little or no fibrous tissue. These properties, and the material's ability to support cell function and protect xenogeneic cells from immunologic rejection, suggest that it would be useful in the construction of hybrid artificial organs and in in vitro cell culture.

Psychiatric morbidity among dermatology inpatients.

BACKGROUND: Research on psychiatric morbidity among patients with dermatological diseases generally focuses on outpatients and questionnaire-based surveys. The aim of this study was to determine the prevalence and nature of psychiatric morbidity among dermatological inpatients with diagnosis being made by psychiatric interview, and ascertain whether demographic and clinical details in dermatological inpatients with psychiatric morbidity differed from those without it. METHODS: Charts of all inpatients admitted by the dermatology department between 1 January 1991 and 31 July 1995 were analysed for socio-demographic data, clinical features, treatment and course in hospital. For those patients who were referred to a psychiatrist, all records of the psychiatric consultation were obtained and analysed. RESULTS: A total of 1073 patients were admitted during the study period. Ninety-eight patients (9%) were diagnosed to have a psychiatric illness. Patients with psychiatric illness were likely to have had more admissions and longer duration of hospital stay. The most common psychiatric diagnoses were depressive episodes (34%) and adjustment disorders (29%). The highest rates of psychiatric morbidity were found among patients with chronic urticaria, exfoliative dermatitis and sexually transmitted diseases, including human immunodeficiency virus infection. The prevalence of psychiatric disorders was significantly higher in those who had received long term (more than six weeks) treatment with high-dose steroids (more than 1 mg/kg body weight of prednisolone). CONCLUSION: Some dermatology inpatients have psychiatric morbidity, which affects the course of the dermatological condition as well as the duration of hospitalization. The availability of psychiatric consultation at dermatology clinics and regular liaison between psychiatrists and dermatologists are essential for appropriate management.

Country watch: India.

PIP: This article describes the role played by barbers, trained by the Christian Medical College in Vallore, India, in discussing AIDS among their clients. Barbers were trained in a number of sessions about AIDS transmission, prevention, care, and risk factors such as genital lesions. Barbers were pleased with their new roles as health educators, but barbers did not want the reputation of being condom salesmen. Condoms were made available for sale through barber shops, with the intention of giving the barbers the small profit as an incentive to continue the health role. Barbers were taught the importance of medical intervention, and some referred clients to the College for more information or testing. Follow-up visits were made by the College at least once every three months in order to exchange information on the difficulties encountered and to give additional booklets and stickers. Barbers advised clients to purchase condoms from local small "cigarette and beedi" shops. A formal evaluation of client satisfaction was not conducted, however some feedback indicated clients were interested in the conversations. One warden of a local boys hostel even invited a barber to give a talk on AIDS to his wards.^ieng

Flow cytometric analysis of lymphocyte activation in the mixed lymphocyte response.

Interleukin 2 receptor (IL2R) expression may be a useful parameter for assessing lymphocyte activation in the mixed lymphocyte response (MLR). However, the contribution of irradiated stimulator (S*) cells to the levels of IL2R+ cells recovered must first be defined. We have used a flow cytometric parameter termed the sip count to assess this potential contribution of S* cells. This parameter, which is the number of cells within a defined cell gate, is a reflection of the viable cell number per culture well, since (a) a constant number of cells were plated per well on day 0, (b) cells recovered from a well were resuspended in a constant volume, (c) the flow cytometer aspirated (sipped) a constant volume of cell suspension, and (d) nonviable cells were not included in the gate. Sip count assessment showed that only 5% of S* cells were recoverable by day 4 of culture; in contrast, 70% or more of unstimulated responder cells were recoverable. Sip counts of MLR cultures identified an increase in cell number beginning on day 5, reflecting DNA synthesis and cell division. We then used the sip count to assess changes in the levels of IL2R+ cells in MLR cultures. The number of IL2R+ cells continued to increase up to day 7, even though maximal DNA synthesis occurred on day 5. Further, dual color analysis revealed that the proportion of CD4 cells expressing IL2R was maximal on day 5, whereas the proportion of CD8 cells expressing IL2R continued to increase until day 9. These findings show that flow cytometry can be used to study lymphocyte activation by alloantigens.

ATP-dependent activation of glucocorticoid receptor from rat liver cytosol.

The glucocorticoid--receptor complex from freshly prepared rat liver cytosol is in a non-activated form, with very little affinity to bind to isolated nuclei. When such preparations were incubated with 5--10 mM-ATP at 4 degrees C, the receptor complex acquired the properties of an 'activated' transformed form, which readily bound to nuclei, ATP--Sepharose, phosphocellulose and DNA--cellulose. This transformation was comparable with the activation achieved by warming the steroid--receptor complex at 23 degrees C. The effect of ATP was specific, as it was more effective than ADP, whereas AMP had no such effect on activation. The process of receptor activation was sensitive to the presence of 10 mM-sodium molybdate; the latter blocked activation by both ATP and heat. Bivalent cations had no observable effect on the receptor activation at low temperature, but they decreased the extent of activation by ATP. The steroid-binding properties of glucocorticoid receptor remained intact under the above conditions. However, a significant increase in steroid binding occurred when ATP was preincubated with cytosol receptor before the addition of [3H]triamcinolone acetonide. ATP also stabilized the glucocorticoid--receptor complexes at 23 degrees C. These results suggest a role for ATP in receptor function and offer a convenient method of studying the activation process of glucocorticoid receptor under mild assay conditions.

Interaction of rat liver glucocorticoid receptor with adenosine 5'-triphosphate. Characterization of interaction by use of ATP-sepharose affinity chromatography.

An interaction between rat liver glucocorticoid--receptor complex and immobilized ATP was identified. Rat liver cytosol preparations were incubated with [3H]triamcinolone acetonide for 4 h at 4 degrees C and partially purified by precipitation with (NH4)2SO4 before use. The resulting glucocorticoid--receptor complex could be selectively adsorbed on to columns of ATP--Sepharose. The freshly prepared cytosol [3H]triamcinolone acetonide--receptor complex had very little affinity for binding to the ATP--Sepharose column, but acquired this ability on temperature- or salt-activation. The presence of 10 mM-sodium molybdate during this salt- or temperature-dependent activation blocked the binding of the receptor complex to ATP--Sepharose. The interaction is reversible, since it can be disrupted by high-salt conditions. A competitive binding assay, using free nucleotides in samples to be chromatographed, revealed a preferential interaction between ATP and the glucocorticoid--receptor complex. Buffer containing ATP was also used to elute the glucocorticoid--receptor complex from ATP--Sepharose columns successfully. When ATP was added to the preparations containing [3H]triamcinolone acetonide--receptor complexes, the steroid specificity or sedimentation properties of the complex remained unaltered. Our results demonstrate an interaction between rat liver glucocorticoid--receptor complex and immobilized ATP and suggest a role of this nucleotide in receptor function.