Employing barcoding markers to authenticate selected endangered medicinal plants traded in Indian markets.

The high demand of medicinal plants and their unrestricted collection have rendered many of these as rare or endangered. The restrictions imposed on their collection and trade are difficult to implement because of the inability to identify them in fragmented form. The rarity of these plants in nature and lack of their cultivation raise doubt about the authenticity of the herbals sold in markets. Therefore, in the present investigation, ITS/ITS2, matK, rbcL and rpoC1 sequences of fourteen species of important medicinal plants, some of which are endangered, were generated and checked for their species-specificity (sequences having maximum similarity only with their own) by BLAST1 and/or BOLD identifications. ITS sequences of 12 species were species-specific. However, ITS2 of only 10 of these 12 species were species-specific. As for the chloroplast loci, rbcL and rpoC1 sequences of all 14 species could be obtained, while matK sequences of only 10 of these could be generated. Of the retrieved sequences, rbcL, rpoC1 and matK sequences of 7, 11 and 7 species, respectively, were species-specific. The sequences of the targeted loci from the herbal samples of these species were difficult to retrieve because of failure in the amplification or sequencing. Nevertheless, based on ITS2 and/or one or more of the chloroplast loci targeted, the botanical identities of 22 herbal market samples were checked by phylogenetic tree, BLAST1 and BOLD identification methods. Of these 22 samples, only one of each of Rauvolfia serpentina and Picrorhiza kurroa were found to be authentic.

Evaluating five different loci (rbcL, rpoB, rpoC1, matK, and ITS) for DNA barcoding of Indian orchids.

Orchidaceae, one of the largest families of angiosperms, is represented in India by 1600 species distributed in diverse habitats. Orchids are in high demand owing to their beautiful flowers and therapeutic properties. Overexploitation and habitat destruction have made many orchid species endangered. In the absence of effective identification methods, illicit trade of orchids continues unabated. Considering DNA barcoding as a potential identification tool, species discrimination capability of five loci, ITS, matK, rbcL, rpoB, and rpoC1, was tested in 393 accessions of 94 Indian orchid species belonging to 47 genera, including one listed in Appendix I of CITES and 26 medicinal species. ITS provided the highest species discrimination rate of 94.9%. While, among the chloroplast loci, matK provided the highest species discrimination rate of 85.7%. None of the tested loci individually discriminated 100% of the species. Therefore, multi-locus combinations of up to five loci were tested for their species resolution capability. Among two-locus combinations, the maximum species resolution (86.7%) was provided by ITS+matK. ITS and matK sequences of the medicinal orchids were species specific, thus providing unique molecular identification tags for their identification and detection. These observations emphasize the need for the inclusion of ITS in the core barcode for plants, whenever required and available.

Emergency Department Use in the Perinatal Period: An Opportunity for Early Intervention.

STUDY OBJECTIVE: We characterize emergency department (ED) utilization among perinatal women and identify differences in risk factors and outcomes between women who use versus do not use the ED during the perinatal period. METHODS: This is a retrospective cross-sectional study comparing patients who used the ED versus did not use the ED during the perinatal period. Patient data were collected from medical chart review and postpartum interviews. RESULTS: Of the 678 participants, 218 (33%) had at least 1 perinatal ED visit. Women who used the ED were more likely than those who did not to be adolescent (relative risk [RR] 2.23; 95% confidence interval [CI] 1.38 to 3.63), of minority race (RR 1.94; 95% CI 1.46 to 2.57), and Medicaid insured (RR 2.14; 95% CI 1.71 to 2.67). They were more likely to smoke prenatally (RR 3.42; 95% CI 2.34 to 4.99), to use recreational drugs prenatally (RR 3.53; 95% CI 1.78 to 7.03), and to have experienced domestic abuse (RR 1.78; 95% CI 1.12 to 2.83). They were more likely to have delayed entry to prenatal care (RR 2.01; 95% CI 1.46 to 2.77) and to experience postpartum depression (RR 2.97; 95% CI 1.90 to 4.64). Their infants were nearly twice as likely to be born prematurely (RR 1.92; 95% CI 1.07 to 3.47). CONCLUSION: Results highlight that pregnant patients using the ED are a high-risk, vulnerable population. Routine ED screening and linkage of this vulnerable population to early prenatal care and psychosocial interventions should be considered as a public health strategy worth investigating.

Outcomes in pediatric hepatitis C transplant recipients: analysis of the UNOS database.

HCV may lead to the development of ESLD in late childhood and, consequently, contributes to the need for liver transplantation. The aim of this study was to examine post-transplant outcomes in HCV-positive pediatric patients with ESLD from any cause and to determine the impact of the PELD scoring system, introduced in February 2002, on post-transplant patient and graft survival. A retrospective analysis of the UNOS database from 1994 to 2010 was performed to assess graft and patient survival in pediatric HCV-seropositive liver transplant recipients. Graft survival and patient survival comparing subjects in the pre-PELD era and post-PELD era were analyzed using Kaplan-Meier statistics. Factors associated with survival were identified using Cox regression analysis. Of 120 pediatric HCV transplant recipients, 80 were transplanted in the pre-PELD era and 40 were transplanted post-PELD. Median serum total bilirubin, INR, and creatinine were 4.8 mg/dL, 1.6, and 0.7 mg/dL in the pre-PELD era vs. 5.5 mg/dL, 1.7, and 0.6 mg/mL, respectively, in the post-PELD era (p NS). One-yr graft survival in the pre-PELD vs. post-PELD era was 65.0% and 89.7%, respectively (p < 0.01); corresponding three-yr graft survival was 57.3% vs. 76.2% (p = 0.04). One-yr patient survival in the pre-PELD vs. post-PELD era was 79.0% and 97.5%, respectively (p < 0.01); corresponding three-yr survival was 79.0% vs. 89.4% (p = 0.17). Twenty-eight patients (23.3%) were retransplanted: 24 (30%) in the pre-PELD era (median time to retransplant 272 days) and four (10%) in the post-PELD era (median time to retransplant 586 days). Early follow-up demonstrates a trend toward improved pediatric HCV liver transplant graft and patient survival in the post-PELD era. Superior outcomes may be attributed to pretransplant factors, improved surgical technique and better treatment options for HCV infection.

Liver transplantation and cirrhotomimetic hepatocellular carcinoma: classification and outcomes.

Liver transplantation has become the standard-of-care treatment for hepatocellular carcinoma (HCC) that falls within certain size and numerical criteria for patients with cirrhosis. Cirrhotomimetic (CMM) HCC is an uncommon growth pattern that infiltrates cirrhotic parenchyma, can become extensive in size, and can evade detection via radiological studies. Liver transplant outcomes for this type of HCC are not well reported but generally are considered to be poor. We wished to better describe this variant of HCC in explanted livers, derive a classification system for this tumor type, and assess the outcomes of liver transplantation for this tumor variant. All patients undergoing transplantation for HCC at a single center in 1996-2009 (358 patients) were retrospectively analyzed, and 26 patients exhibiting a CMM growth pattern were identified. We developed a classification system for this tumor growth pattern variant and determined patient and tumor-specific outcomes. We derived a classification schema for CMM HCC based on the tumor extent and cellular histopathology, with a clear cell pathology being associated with favorable outcomes. We noted 100.0% 3-year recurrence-free survival and 58.3% 5-year recurrence-free survival after transplantation for those patients with tumors confined to 1 lobe that had a clear cell pathology and 16.2% 3- and 5-year recurrence-free survival for those patients who did not meet these criteria. In conclusion, CMM HCC features were noted in 7% of the patients undergoing transplantation for HCC at our center, with favorable outcomes observed for inpatients with clear cell histology and growth involving less than or equal to 50% of the liver.

Liver transplantation in a child with multifocal hepatocellular carcinoma hepatitis C and management of post-transplant viral recurrence using boceprevir.

HCV infection is the leading cause of liver transplantation in the adult population in the United States. HCV infection occurs in 0.2-0.4% of the pediatric population and progression to HCC is uncommon. Liver transplantation for HCV in children is rare. In this report, we present a case of pediatric patient with HCV and multifocal HCC at the age of 13 who underwent successful liver transplantation. While good graft function was initially observed, at one month after transplant, he experienced significant hepatitis C recurrence. He was treated with low-accelerating dose regimen antiviral therapy of PEG-IFN and RBV, followed by addition of a protease inhibitor, boceprevir, which led to viral clearance. To our knowledge, this is the first case report describing the post-transplant course of a child transplanted for HCV and HCC, and the first pediatric case report on using the triple therapy for management of post-liver transplant recurrence of HCV. This case report demonstrates the need for increased vigilance of surveillance for HCC during childhood.

Lab on chip for testing of repurposed drugs.

The lab-on-chip technique broadly comprises of microfluidics and aims to progress multidimensionally by changing the outlook of medicine and pharmaceuticals as it finds it roots in miniaturization. Moreover, microfluidics facilitates precise physiological simulation and possesses biological system-mimicking capabilities for drug development and repurposing. Thus, organs on chip could pave a revolutionary pathway in the field of drug development and repurposing by reducing animal testing and improving drug repurposing.

Effectiveness of Telemedicine Interventions in Chronic Obstructive Pulmonary Disease (COPD) Management: A Randomized Controlled Trial Comparing Yoga Therapy and Pulmonary Rehabilitation Over Three Months.

Background Pulmonary rehabilitation (PR) is an integral part of non-pharmacological therapy in chronic obstructive pulmonary disease (COPD). Yoga therapy (YT) has been shown to be beneficial in COPD, but the lack of large well-designed trials and standardized modules restricts its acceptability. This randomized control trial compares these two modalities in COPD patients via supervised tele-intervention. Objectives The primary objective of the study is to compare a 45-minute, five-days-per-week series of tele-YT (T-YT) with tele-PR (T-PR) for three months in terms of exercise capacity (6-Minute Walk Distance (6MWD)) in COPD patients. Methods COPD patients were randomly assigned (1:1) to T-YT or T-PR groups in a parallel-arm single-blinded controlled trial. The primary outcome is 6MWD recorded at baseline and after three months and secondary outcomes were symptom scores, Forced expiratory volume in the first second (FEV1), health-related quality of life (HrQoL), and depression and anxiety scores. Assessments were conducted at baseline and at the end of the three-month study period with a sample size of 75 in each group. Results A total of 150 consecutive patients with COPD were randomly assigned to either the T-YT (n = 75) or T-PR (n = 75) group. Their mean ± SD ages was 62.5 ± 7.0 years. The T-YT group had 55.5% males and 34.47% females, whereas the T-PR group had 44.5% males and 61.53% females. The trial was completed by 123 patients; 88% in the T-YT group and 76% in the T-PR group. Pre-intervention, the median (range) of 6MWD in T-YT and T-PR groups was 240 (120-600) m and 240 (120-660) m, respectively. There was statistically significant improvement in both groups respectively (p<0.001) post intervention from baseline but no significant intergroup difference (p = 0.486). A similar trend was seen in secondary outcomes with significant intragroup improvements and non-significant inter-group differences except FEV1%, which showed neither intragroup nor intergroup significant improvement. Conclusion Using a validated module, a three-month T-YT improves exercise capacity, symptom scores, HrQoL, and depression and anxiety scores similar to T-PR. T-YT is an acceptable alternative to T-PR in the management of COPD.

Biliary complications adversely affect patient and graft survival after liver retransplantation.

Inferior outcomes are consistently observed for recipients of liver retransplantation (re-LT) versus recipients of primary transplants. Few studies have examined the incidence and impact of biliary complications (BCs) on outcomes after re-LT. The aim of this study was to compare patient and graft survival for re-LT recipients with BCs (BC(+) ) and re-LT recipients without BCs (BC(-) ). Additional aims were to determine the impact of biliary reconstruction on the incidence of BCs and to identify risk factors for BCs after re-LT. A single-center, retrospective analysis of all re-LT recipients over a decade was performed. Univariate analyses were performed, and survival was compared with the log-rank method. A multivariate Cox regression analysis was performed to determine independent predictors of death and graft failure. The BC rate was 20.9% (n = 23) for 110 re-LT cases. The average follow-up was 55 months. The survival rates for BC(-) recipients at 3 months and 1, 3, and 5 years were 95.3%, 91.7%, 85.4%, and 80.9%, respectively, whereas BC(+) patients had survival rates of 64.3%, 49.7%, 34.8%, and 29.8%, respectively (P < 0.001, log-rank). The graft survival rates at 3 months and 1, 3, and 5 years were 92.0%, 88.5%, 82.4%, and 78.0%, respectively, for the BC(-) group and 60.9%, 43.5%, 30.4%, and 26.1%, respectively, for the BC(+) group (P < 0.001, log-rank). BCs, a length of stay ≥ 12 days, and donor age were strongly associated with death and graft failure in a regression analysis, whereas retransplant indications other than chronic rejection and recurrent disease also affected graft failure. In conclusion, BCs significantly affected both patient and graft survival, with an increased risk of death and graft loss among BC(+) recipients. Early recognition, appropriate interventions, and preventative measures for BCs are critical in the clinical management of re-LT recipients.

The Role of Yoga in Hospitalized COVID-19 Patients: An Exploratory Randomized Controlled Trial.

Introduction The unpredictable course and sheer magnitude of coronavirus disease 2019 (COVID-19) have sparked a search for novel and repurposed pharmacological interventions. Non-pharmacological interventions may also play a role in the management of this multifaceted disease. This study aimed to evaluate the safety, feasibility, and effect of yoga in hospitalized patients with moderate COVID-19. Methods Twenty patients satisfying the inclusion criterion were randomized (1:1 ratio) into Intervention and Control groups. Patients in the intervention arm performed a one-hour yoga session that included pranayama and Gayatri mantra (GM) chant for up to 14 days. Sessions were fully supervised by a trained yoga trainer via an online platform. Patients in both groups received the normal treatment as per national guidelines. Outcome parameters were recorded on the 14th day/end of the hospital stay. Results Yoga is safe and feasible in hospitalized patients with COVID-19. The decline of high-sensitivity C-reactive protein (hs-CRP) levels was significantly greater in the Intervention Group. Quality of life (QOL), depression, anxiety, and fatigue severity scale (FSS) showed a decline in both groups with a significant decline observed in FSS scores of the Intervention Group. Median chest X-ray score values, duration of hospital stay, and reverse transcription-polymerase chain reaction (RT-PCR) conversion days were observed to be lower in the Intervention Group but were not significant (p>0.05). Conclusion The study found that incorporating pranayama and GM practices in hospitalized patients with moderate COVID-19 pneumonia was safe and feasible. It showed a notable reduction in hs-CRP levels and FSS scores in the Intervention Group, but the study was not powered to detect statistically significant results. Further research with larger sample sizes is needed for conclusive findings.

Exercise Capacity in Patients With Chronic Obstructive Pulmonary Disease Treated With Tele-Yoga Versus Tele-Pulmonary Rehabilitation: A Pilot Validation Study.

Background In chronic obstructive pulmonary disease (COPD), pulmonary rehabilitation (PR) is an integral component of the non-pharmacological management of COPD. Yoga has proven to be beneficial in COPD, although well-designed comparative studies between the two modalities are lacking. This pilot study aims to compare these two modalities delivered as supervised tele-intervention. Methods The outpatient department (OPD) of a tertiary hospital recruited consenting, consecutive, inclusion-eligible COPD participants who were randomly assigned to intervention and control arms of 30 patients each. The intervention arm received a 45-minute tele-yoga therapy module (T-YT) validated by content validity ratio (CVR), computed using Lawshe's methodology and responses from 24 yoga specialists. The control arm received a 45-minute standardized tele-pulmonary rehabilitation session (T-PR). T-YT and T-PR were both managed through an online portal. Exercise capacity as measured by the six-minute walk distance (6MWD), symptom score (COPD assessment test [CAT], modified medical research council [mMRC]), forced expiratory volume in one second (FEV1%), quality of life (QoL) scores, St. George respiratory questionnaire (SGRQ), depression and anxiety scores (patient health questionnaire [PHQ-9] and generalized anxiety disorder scale [GAD-7] scores), were recorded at baseline and at the end of three months. Results 6MWD, symptom scores, SGRQ, PHQ-9, and GAD-7 all improved significantly from baseline within each group, but there was no statistically significant difference between the groups. FEV1% did not differ significantly between or among groups. This study shows T-YT module can be a reasonable substitute for T-PR in patients with COPD. Conclusions T-YT is beneficial in patients of COPD in terms of exercise capacity, symptom scores, and depression and anxiety scores and can be a reasonable alternative to T-PR.

A Case Report of a Novel Harm Reduction Intervention Used to Detect Opioid Overdose in the Emergency Department.

INTRODUCTION: As over 130 people die daily from opioid overdose in the United States, harm reduction strategies have become increasingly important. Because public restrooms are a common site for opioid overdose, emergency department waiting room restrooms (EDWRR) should be considered especially high-risk areas. CASE REPORT: We present the case of a patient found after a presumed opioid overdose in our EDWRR. Staff were alerted to his condition by a reverse motion detector (RMD), and rapidly treated him with naloxone. CONCLUSION: The RMD is a novel intervention that can save lives and should be considered in EDs with a high incidence of opioid overdose.

Reduced ß-Cell Secretory Capacity in Pancreatic-Insufficient, but Not Pancreatic-Sufficient, Cystic Fibrosis Despite Normal Glucose Tolerance.

Patients with pancreatic-insufficient cystic fibrosis (PI-CF) are at increased risk for developing diabetes. We determined ß-cell secretory capacity and insulin secretory rates from glucose-potentiated arginine and mixed-meal tolerance tests (MMTTs), respectively, in pancreatic-sufficient cystic fibrosis (PS-CF), PI-CF, and normal control subjects, all with normal glucose tolerance, in order to identify early pathophysiologic defects. Acute islet cell secretory responses were determined under fasting, 230 mg/dL, and 340 mg/dL hyperglycemia clamp conditions. PI-CF subjects had lower acute insulin, C-peptide, and glucagon responses compared with PS-CF and normal control subjects, indicating reduced ß-cell secretory capacity and α-cell function. Fasting proinsulin-to-C-peptide and proinsulin secretory ratios during glucose potentiation were higher in PI-CF, suggesting impaired proinsulin processing. In the first 30 min of the MMTT, insulin secretion was lower in PI-CF compared with PS-CF and normal control subjects, and glucagon-like peptide 1 and gastric inhibitory polypeptide were lower compared with PS-CF, and after 180 min, glucose was higher in PI-CF compared with normal control subjects. These findings indicate that despite "normal" glucose tolerance, adolescents and adults with PI-CF have impairments in functional islet mass and associated early-phase insulin secretion, which with decreased incretin responses likely leads to the early development of postprandial hyperglycemia in CF.