Evaluation of anti-inflammatory potential of ayurvedic formulation Rheumacure in animal model of rheumatoid arthritis

Background: Rheumacure (RC) is a herbomineral preparation recommended by Ayurvedic medical practitioners for treatment of rheumatoid arthritis. The present study was designed to evaluate the effect of oral treatment with the herbomineral formulation in animal model of Freund's adjuvant induced arthritis to develop scientific evidence to the efficacious claim of the use of ayurvedic proprietary medicine in the management of rheumatoid arthritis in folklore medicine.Methods: Arthritis was induced by sub plantar injection of 0.1ml of complete Freund’s adjuvant. Treatment with RC 100 mg/kg and dexamethasone 2 mg/kg was given to rats orally once a day from day 1 to day 21 and after which estimation of physical, biochemical, and haematological parameters were carried out.Results: Treatment of RC to arthritic animal showed statistically significant (p<0.05) improvement in physical parameters like arthritic index, paw edema, paw thickness, splenomegaly and thymus index of the animal. The treatment also showed significantly (p <0.05) reduction in inflammatory markers like C-reactive protein, serum rheumatoid factor, erythrocyte sedimentation rate and increase in % haemoglobin. The histopathological examination showed protective effect against hyperplasia of synovium, pannus formation and destruction of the joint space.Conclusions: The results obtained in experiments indicated significant anti-inflammatory effect comparable to dexamethasone and without significant side effect. Thus the RC may be a potential preventive or therapeutic candidate for the treatment of chronic inflammation and arthritis

Prevalence and determinants of hypertension in apparently healthy schoolchildren in India: a multi-center study

Background: Hypertension in children is often under recognized, especially in developing countries. Data from rural areas of developing countries is particularly lacking. Objectives: To study prevalence of hypertension and its determinants in apparently health school children from predominantly rural populations of India. Methods: Apparently healthy schoolchildren (n = 14,957) aged 5–15 years (mean (standard deviation) age 10.8 (2.8) years; 55.5% boys) at four predominantly rural sites in separate states of India were studied. Systolic and diastolic blood pressures were recorded by trained staff in addition to age, gender, height, weight, type of school and season. Waist circumference was also recorded in 12,068 children. Geographic location and type of school (government, government-aided or private) were used to determine socio-economic status. Results: Systolic and/or diastolic hypertension was present in 3443 (23%) children. Systolic hypertension was present in 13.6%, diastolic hypertension in 15.3% and both in 5.9%. Isolated systolic hypertension was present in 7.7% while isolated diastolic hypertension was present in 9.4%. On univariate analysis, age, gender, geographical location, socio-economic status, season and anthropometric parameters (z-scores of height, weight and waist circumference, waist/height ratio and body mass index) were all significantly related to risk of hypertension (p &lt; 0.0001 for each). Similar association was observed with weight group (normal, overweight and obese). Multiple regression analysis showed lower age, female gender, richer socio-economic status, certain geographical locations, higher weight and larger waist circumference to be independently associated with a greater risk of hypertension. Conclusion: There is a high prevalence of hypertension in apparently healthy schoolchildren even in predominantly rural areas of India. Screening and management programs targeted to high risk groups identified may prove cost-effective

Natural Killer Cell Degranulation Defect: A Cause for Impaired NK-Cell Cytotoxicity and Hyperinflammation in Fanconi Anemia Patients

Fanconi anemia (FA) is a rare inherited syndrome characterized by progressive bone marrow failure (BMF), abnormal skin pigmentation, short stature, and increased cancer risk. BMF in FA is multifactorial and largely results from the death of hematopoietic stem cells due to genomic instability. Also, inflammatory pathology in FA has been previously reported, however the mechanism is still not clear. In literature, decreased NK-cell count and/or impaired NK-cell activity, along with other immunological abnormalities have been described in FA-patients (1). However, to the best of our knowledge, this is the first report showing a defective degranulation mechanism leading to abnormal NK-cell cytotoxicity in FA-patients, which may explain the development of a hyperinflammatory response in these patients. This may predispose some patients to develop Hemophagocytic lymphohistiocytosis (HLH) which manifests with prolonged fever, progressive cytopenias and organomegaly. Early diagnosis and initiation of immunosuppressive therapy in these patients will help to better manage these patients. We also propose FA genes to be listed as a cause of familial HLH

Clinical, Immunological, and Molecular Findings in 57 Patients With Severe Combined Immunodeficiency (SCID) From India

Severe combined immunodeficiency (SCID) represents one of the most severe forms of primary immunodeficiency (PID) disorders characterized by impaired cellular and humoral immune responses. Here, we report the clinical, immunological, and molecular findings in 57 patients diagnosed with SCID from India. Majority of our patients (89%) presented within 6 months of age. The most common clinical manifestations observed were recurrent pneumonia (66%), failure to thrive (60%), chronic diarrhea (35%), gastrointestinal infection (21%), and oral candidiasis (21%). Hematopoietic Stem Cell Transplantation (HSCT) is the only curative therapy available for treating these patients. Four patients underwent HSCT in our cohort but had a poor survival outcome. Lymphopenia (absolute lymphocyte counts/μL &lt;2,500) was noted in 63% of the patients. Based on immunophenotypic pattern, majority of the cases were T−B− SCID (39%) followed by T−B+ SCID (28%). MHC class II deficiency accounted for 10.5% of our patient group. A total of 49 patients were molecularly characterized in this study and 32 novel variants were identified in our cohort. The spectrum of genetic defects in our cohort revealed a wide genetic heterogeneity with the major genetic cause being RAG1/2 gene defect (n = 12) followed by IL2RG (n = 9) and JAK3 defects (n = 9). Rare forms of SCID like Purine nucleoside phosphorylase (PNP) deficiency, reticular dysgenesis, DNA-Protein Kinase (DNA-PKcs) deficiency, six cases of MHC class II deficiency and two ZAP70 deficiency were also identified in our cohort. Fourteen percent of the defects still remained uncharacterized despite the application of next generation sequencing. With the exception of MHC class II deficiency and ZAP70 deficiency, all SCID patients had extremely low T cell receptor excision (TRECs) (&lt;18 copies/μL)

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

Smile for the Camera: The Revenge Pornography Dilemma, California\u27s Approach, and Its Constitutionality

Revenge pornography is an increasingly prevalent form of cyberharassment, in which embarrassing and sexually explicit pictures and videos are posted on the internet without the consent of the depicted individual. Due to the First Amendment\u27s protection of speech and expression, victims have had little legal recourse against their cyber-harassers. Many states have started to pass laws prohibiting revenge pornography, which have fortunately created some protections for victims. However, the recent passage of such statutes has also led to the debate about their constitutionality. This Note first examines revenge pornography from various First Amendment perspectives, concluding that courts should carve out a new category of unprotected speech under New York v. Ferber. This Note next analyzes and posits changes for California\u27s revenge pornography law. Namely, California should expand its law to protect victims who take selfies, punish webmasters profiting from revenge pornography postings, and increase the severity of punishment for violations of the law

INVESTIGATION OF EPIDEMIOLOGY AND ETIOLOGY OF LIVER DISEASES AND CHARACTERIZATION OF ITS ASSOCIATION WITH VARIOUS FACTORS

 Objective: The population of Gujarat is at higher risk of facing non-alcoholic liver diseases therefore it becomes important to examine etiology andepidemiology of liver diseases and to characterize its association to various risk factors.Methods: Patient details such as socioeconomic background, demography, family history, medical history were collected at tertiary care trust hospitalin Vadodara district, Gujarat. Causes of disease and various complications associated with the disease were investigated. The reports of various liverfunction tests were clinically co-related with patient conditions.Results: Out of 137 patients of liver diseases, prevalence of alcoholic patients was 25%. Prevalence of viral infection was found to be 20%. Amongall 78% were male and 22% were female and 80% patients were above 40 years of age. Urban population were found to be more susceptible to liverdiseases. It was observed that 33% patients were of liver cirrhosis. Diabetes and cardiovascular disorders were most prevalent co-morbidities with24% and 19.3% respectively. Gamma glutamyl transferase levels were significantly high (p&lt;0.001) in alcoholics while alkaline phosphatase levelswere significantly high (p&lt;0.001) in viral manifestations. Hematocrit values also correlate well with the severity of liver diseases.Conclusion: Thus, the present study concludes that gender, age, urbanization, comorbid conditions are risk factors associated with high prevalenceof liver disease.Keywords: Alcoholic liver disease, Fatty liver disease, Hepatitis, Liver disease, Non-alcoholic fatty liver disease

The relative cost-effectiveness of PCNL and ESWL for medium sized (2 cms) renal calculi in a tertiary care urological referral centre

There is a paucity of cost-effectiveness studies in India comparing PCNL and ESWL in the treatment of renal cal-culi. We are dependent on costing studies from western literature, although the nature of expenses in developed countries is quite different from those in India. This study compares the two procedures with regards to cost-effec-tiveness & efficacy in clearing medium-sized renal calculi (2.0 cms) at our institute. All costs borne by the patient & the institute were taken into account, including equip-ment costs, stay charges & cost of travel incurred, for re-peat visits to the institute. The groups compared had similar stone characteristics & were from our early experience with the two methods. All costing was done at 1998 rates by submitting case sheets to a fresh billing. PCNL, was significantly more efficient at clearing calculi (94% vs 69%) than ESWL, but patients needed hospitalization. The re-quirement of ancillary procedures was significantly less with PCNL than ESWL (1 vs 35) and ESWL was more expensive although the difference was not statistically sig-nificant. High initial cost of a lithotripter along with the need for repeated visits to the hospital for clearance of the calculus contribute to the increased cost of ESWL. PCNL ensures clearance of calculi at a single hospital admission with minimal morbidity