An Economic Analysis of Tank Rehabilitation in Madurai District of Tamil Nadu

There has been a growing realization for rehabilitation and restoration of irrigation tanks with farmers’ participation. The study has presented the costs and benefits of tank rehabilitation and financial feasibility of investment in tank rehabilitation. The total annual income has been found higher in the rehabilitated tanks than the non-rehabilitated tanks and amongst the rehabilitated tanks, panchayat tanks with community well has depicted the highest annual income. The investment analysis has revealed the net present worth to be positive, the B-C ratio to be more than 1.5 and the internal rate of return to be more than the opportunity cost of capital. This shows that all the three investments in tank rehabilitation are economically viable. The study has suggested that rehabilitation work should be undertaken in all the non-rehabilitated tanks also. Besides, efforts should be made to provide supplemental irrigation to crops and to improve the PWD tank management regime.Agricultural and Food Policy,

A comparative study evaluating C-reactive protein, sputum eosinophils and forced expiratory volume in one second in obese and nonobese asthmatics

ntroduction: Asthma and obesity are considered inflammatory disorders. Inflammatory markers — sputum eosinophils, C-reactive protein (CRP) and the forced expiratory volume in one second (FEV1) were analysed to find their association in obese asthmatics and compared with their asthma control test (ACT) to understand these parameters in this phenotype.Material and methods: After completing the asthma control test (ACT), the CRP, FEV1 and sputum eosinophils of sixty asthmatics were compared to find the association of them in obese and nonobese asthmatics and contrasted with their ACT. The data were analysed using IBM SPSS V20.0, Mann-Whitney U test (non-parametric test), Pearson’s correlation coefficient and Fisher’s exact test.Results: We found significant differences for CRP (P = 0.001) and sputum eosinophils (P = 0.001) between obese and nonobese asthmatics, both higher in obese asthmatics and with a significant association with body mass index (BMI) (P < 0.05). The FEV1 levels were independent of the BMI levels of asthmatics. There was a significant correlation between the CRP and sputum eosin-ophils (0.52, P = 0.001) for all asthmatics. There was no significant correlation between FEV1 and sputum eosinophils (nonobese P = 0.120, obese P = 0.388) and between FEV1 and CRP (obese P = 0.423, nonobese P = 0.358) in both obese and nonobese asthmatics. Obesity had an association (P = 0.001) with ACT scores (≤ 19).Conclusions: Sputum eosinophils and CRP were raised in obese asthmatics and had a positive association with BMI. Obese asthmatics had a poorer subjective asthma control than nonobese asthmatics despite FEV1 being independent of the BMI levels. Measuring the systemic inflammatory markers could help in additional interventions in reducing systemic inflammation and thus possibly facilitating better symptom control

Mutant Cbl proteins as oncogenic drivers in myeloproliferative disorders

Casitas B-lineage lymphoma (Cbl) family proteins are evolutionarily-conserved attenuators of protein tyrosine kinase (PTK) signaling. Biochemical analyses over the past two decades have firmly established that the negative regulatory functions of Cbl proteins are mediated through their ability to facilitate ubiquitination and thus promote degradation of PTKs. As aberrant activation of PTKs is frequently associated with oncogenesis, it has long been postulated that loss of normal Cbl functions may lead to unregulated activation of PTKs and cellular transformation. In the last few years, mutations in the CBL gene have been identified in a subset of human patients with myeloid malignancies. Here we discuss insights gained from the analyses of Cbl mutants both in human patients and in animal models and propose potential mechanisms of oncogenesis through this pathway

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

An Economic Analysis of Tank Rehabilitation in Madurai District of Tamil Nadu

There has been a growing realization for rehabilitation and restoration of irrigation tanks with farmers’ participation. The study has presented the costs and benefits of tank rehabilitation and financial feasibility of investment in tank rehabilitation. The total annual income has been found higher in the rehabilitated tanks than the non-rehabilitated tanks and amongst the rehabilitated tanks, panchayat tanks with community well has depicted the highest annual income. The investment analysis has revealed the net present worth to be positive, the B-C ratio to be more than 1.5 and the internal rate of return to be more than the opportunity cost of capital. This shows that all the three investments in tank rehabilitation are economically viable. The study has suggested that rehabilitation work should be undertaken in all the non-rehabilitated tanks also. Besides, efforts should be made to provide supplemental irrigation to crops and to improve the PWD tank management regime

A Comparative Study Evaluating C-Reactive Protein, Sputum Eosinophils and Forced Expiratory Volume in One Second in Obese and Nonobese Asthmatics

Introduction: Asthma and obesity are considered inflammatory disorders. Inflammatory markers—sputum eosinophils, C-reactive protein (CRP) and the forced expiratory volume in one second (FEV1) were analysed to find their association in obese asthmatics and compared with their asthma control test (ACT) to understand these parameters in this phenotype. Material and methods: After completing the asthma control test (ACT), the CRP, FEV1 and sputum eosinophils of sixty asthmatics were compared to find the association of them in obese and nonobese asthmatics and contrasted with their ACT. The data were analysed using IBM SPSS V20.0, Mann-Whitney U test (non-parametric test), Pearson’s correlation coefficient and Fisher’s exact test. Results: We found significant differences for CRP (P = 0.001) and sputum eosinophils (P = 0.001) between obese and nonobese asthmatics, both higher in obese asthmatics and with a significant association with body mass index (BMI) (P &lt; 0.05). The FEV1 levels were independent of the BMI levels of asthmatics. There was a significant correlation between the CRP and sputum eosin-ophils (0.52, P = 0.001) for all asthmatics. There was no significant correlation between FEV1 and sputum eosinophils (nonobese P = 0.120, obese P = 0.388) and between FEV1 and CRP (obese P = 0.423, nonobese P = 0.358) in both obese and nonobese asthmatics. Obesity had an association (P = 0.001) with ACT scores (≤ 19). Conclusions: Sputum eosinophils and CRP were raised in obese asthmatics and had a positive association with BMI. Obese asthmatics had a poorer subjective asthma control than nonobese asthmatics despite FEV1 being independent of the BMI levels. Measuring the systemic inflammatory markers could help in additional interventions in reducing systemic inflammation and thus possibly facilitating better symptom control

Spinoglenoid notch syndrome

Spinoglenoid notch syndrome is due compression of suprascapular nerve, due to a cyst, at the spinoglenoid notch causing pain, which is often mistaken for rotator cuff injury or cervical spondylosis. This patient presented with pain on the back of the right shoulder with weakness of external rotation and abduction. On examination, he had wasting, and weakness of the infraspinatus muscle and rest of the neurological examination was normal. His right shoulder magnetic resonance imaging scan revealed a cystic lesion at the spinoglenoid notch. An ultrasound guided aspiration of the cyst was done. He improved well with physiotherapy. One year later, the bulk and power of his infraspinatus muscle was normal