Overlap Syndrome of Autoimmune Hepatitis and Primary Biliary Cirrhosis: A Clinical Enigma

“Overlap syndrome” is a term used to describe variant forms of autoimmune hepatitis (AIH) which present with characteristics of AIH and primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). Patients with overlap syndrome present with both hepatitic and cholestatic serum liver test and the clinical, biochemical, and histological features of these autoimmune diseases are overlapped. Thus, it is difficult to appreciate overlap syndrome as an actual diagnostic entity. AIH-PBC is the most common form of overlap syndrome, affecting almost 10% of adults with AIH or PBC. Transitions from PBC to AIH-PBC overlap syndrome have also been reported. Ursodeoxycholic acid is usually combined with immunosuppressive therapy but end-stage disease requires liver transplantation. We present a case of Overlap Syndrome (AIHPBC)in a 16 year old girl who presented to us with features of obstructive jaundice. She had six months history of generalised itching, yellow discoloration of skin and urine, decreased appetite and intermittent abdominal pain. Liver function test revealed conjugated hyperbilirubinemia, with moderate elevationof liver enzymes. Antinuclear, anti-muscle M2 and anti-glycoprotein 210 antibodies were positive. Liver biopsy showed features of primary biliary cirrhosis. The patient responded to ursodeoxycholic acid and immunosuppression

Metabolic Profile of Young Onset Type 2 Diabetes Mellitus Patients and Their First Degree Relatives

Objective: There is a paucity of data on the metabolic profile of the first degree relatives of young onset type 2 diabetes mellitus especially from India. Therefore, this study was done to evaluate the metabolic profile of young- onset type 2 diabetic patients and their first degree relatives. Material and method: Thirty young- onset type 2 diabetic patients of age < 30 yrs and 89 first degree relatives (28 parents and 61 siblings) were assessed for anthropometric parameters such as BMI, waist circumference, waist hip ratio and body mass index. Various biochemical tests were done which included fasting and 2 hours post 75 gm glucose load, glycated haemoglobin (HbA1c), lipid profile and renal function test. Metabolic syndrome was diagnosed as per National Cholesterol Education Program- Third Adult Treatment Panel III (NCEP- ATP III) criteria and IDF criteria.Results: Mean age of the patients was 27.53 years whereas mean age of the first degree relatives was 36.53 years. Mean BMI of the patients and first degree relatives were 26.46 and 25.46 kg/m2 respectively. 60% of patients and their first degree relatives separately fulfilled the IDF criteria for central obesity. 51 (57.3%) first degree relatives fulfilled the WHO criteria for abdominal obesity. Family history of diabetes was seen in 60% of these young diabetics. Out of 89 first degree relatives, 32 relatives (35.9%) were found to have diabetes and additional 13(14.6%) relatives had either impaired fasting glucose or impaired glucose tolerance test results. 18 (60%) patients and 48 (54%) first degree relatives fulfilled the IDF criteria for metabolic syndrome. According to NCEP ATP III criteria, 73.3% of these young onset diabetic patients and 50% of their first degree relatives fulfilled the criteria for metabolic syndrome.Conclusion: More than 50% of the first degree relatives of the young onset type 2 DM patients fulfill the criteria of metabolic syndrome and 50% of these FDRs have diabetes or prediabetes. Hence, our study clearly reinforces the importance of screening the first degree relatives for metabolic parameters, as it will detect metabolic syndrome or diabetes early in this high risk group so that appropriate treatment can be started in time to prevent the complications

RE-MOVE: An Adaptive Policy Design Approach for Dynamic Environments via Language-Based Feedback

Reinforcement learning-based policies for continuous control robotic navigation tasks often fail to adapt to changes in the environment during real-time deployment, which may result in catastrophic failures. To address this limitation, we propose a novel approach called RE-MOVE (\textbf{RE}quest help and \textbf{MOVE} on), which uses language-based feedback to adjust trained policies to real-time changes in the environment. In this work, we enable the trained policy to decide \emph{when to ask for feedback} and \emph{how to incorporate feedback into trained policies}. RE-MOVE incorporates epistemic uncertainty to determine the optimal time to request feedback from humans and uses language-based feedback for real-time adaptation. We perform extensive synthetic and real-world evaluations to demonstrate the benefits of our proposed approach in several test-time dynamic navigation scenarios. Our approach enable robots to learn from human feedback and adapt to previously unseen adversarial situations

Transcriptome analysis of Bipolaris sorokiniana - Hordeum vulgare provides insights into mechanisms of host-pathogen interaction

Spot blotch disease incited by Bipolaris sorokiniana severely affects the cultivation of barley. The resistance to B. sorokiniana is quantitative in nature and its interaction with the host is highly complex which necessitates in-depth molecular analysis. Thus, the study aimed to conduct the transcriptome analysis to decipher the mechanisms and pathways involved in interactions between barley and B. sorokiniana in both the resistant (EC0328964) and susceptible (EC0578292) genotypes using the RNA Seq approach. In the resistant genotype, 6,283 genes of Hordeum vulgare were differentially expressed out of which 5,567 genes were upregulated and 716 genes were downregulated. 1,158 genes of Hordeum vulgare were differentially expressed in the susceptible genotype, out of which 654 genes were upregulated and 504 genes were downregulated. Several defense-related genes like resistant gene analogs (RGAs), disease resistance protein RPM1, pathogenesis-related protein PRB1-2-like, pathogenesis-related protein 1, thaumatin-like protein PWIR2 and defensin Tm-AMP-D1.2 were highly expressed exclusively in resistant genotype only. The pathways involved in the metabolism and biosynthesis of secondary metabolites were the most prominently represented pathways in both the resistant and susceptible genotypes. However, pathways involved in MAPK signaling, plant-pathogen interaction, and plant hormone signal transduction were highly enriched in resistant genotype. Further, a higher number of pathogenicity genes of B. sorokiniana was found in response to the susceptible genotype. The pathways encoding for metabolism, biosynthesis of secondary metabolites, ABC transporters, and ubiquitin-mediated proteolysis were highly expressed in susceptible genotype in response to the pathogen. 14 and 11 genes of B. sorokiniana were identified as candidate effectors from susceptible and resistant host backgrounds, respectively. This investigation will offer valuable insights in unraveling the complex mechanisms involved in barley- B. sorokiniana interaction

Crystal structure and Hirshfeld surface analysis of tris(2,2′-bipyridine)nickel(II) bis(1,1,3,3-tetracyano-2-ethoxypropenide) dihydrate

International audienceThe title compound, [Ni(C10H8N2)3](C9H5N4O)2·2H2O, crystallizes as a racemic mixture in the monoclinic space group C2/c. In the crystal, the 1,1,3,3-tetracyano-2-ethoxypropenide anions and the water molecules are linked by O—H...N hydrogen bonds, forming chains running along the [010] direction. The bpy ligands of the cation are linked to the chain via C—H...π(cation) inter­actions involving the CH3 group. The inter­molecular inter­actions were investigated by Hirshfeld surface analysis and two-dimensional fingerprint plots

Engineering room-temperature multiferroicity in Bi and Fe codoped BaTiO3

Fe doping into BaTiO3, stabilizes the paraelectric hexagonal phase in place of the ferroelectric tetragonal one [P. Pal et al. Phys. Rev. B, 101, 064409 (2020)]. We show that simultaneous doping of Bi along with Fe into BaTiO3 effectively enhances the magnetoelectric (ME) multiferroic response (both ferromagnetism and ferroelectricity) at room-temperature, through careful tuning of Fe valency along with the controlled-recovery of ferroelectric-tetragonal phase. We also report systematic increase in large dielectric constant values as well as reduction in loss tangent values with relatively moderate temperature variation of dielectric constant around room-temperature with increasing Bi doping content in Ba1-xBixTi0.9Fe0.1O3 (0<x<0.1), which makes the higher Bi-Fe codoped sample (x=0.08) promising for the use as room-temperature high-k dielectric material. Interestingly, x=0.08 (Bi-Fe codoped) sample is not only found to be ferroelectrically (~20 times) and ferromagnetically (~6 times) stronger than x=0 (only Fe-doped) at room temperature, but also observed to be better insulating (larger bandgap) with indirect signatures of larger ME coupling as indicated from anomalous reduction of magnetic coercive field with decreasing temperature. Thus, room-temperature ME multiferroicity has been engineered in Bi and Fe codoped BTO (BaTiO3) compounds.Comment: 16 pages, 17 figure

Visceral Leishmaniasis in Muzaffarpur District, Bihar, India from 1990 to 2008

BACKGROUND: Visceral Leishmaniasis (VL) is a vector-borne disease transmitted by Phlebotomus argentipes. To understand the VL seasonality, annual and monthly variations of VL incidence and its relationship to meteorological variables, the numbers of VL cases reported in Muzaffarpur district, Bihar, India from 1990 to 2008 were studied. METHODS: Annual VL incidence per 10,000 and the total number of annual VL cases reported at block Community Health Centres (CHC), Public Hospitals or Non-Governmental Organisations (NGO) and the number of VL cases per month from 2000 to 2008 as well as the monthly average of cases for 2000-08, 2000-04 and 2005-08 periods along with the monthly averages of temperature, rainfall and relative humidity were plotted. VL Standardised Incidence Ratios per block were computed for the periods of 1990-1993, 1994-1998, 1999-2004 and 2005-2008 and month wise from 2002 to 2008. A negative binomial regression model was used to evaluate the association between meteorological variables and the number of VL cases per month from 2000 to 2008. RESULTS: A total of 68,358 VL cases were reported in Muzaffarpur district from 1990 to 2008, ranging from 1,2481 in 1992 to 1,161 in 2001. The blocks with the highest number of cases shifted from East (1990-98) to West (1999-2008). Monthly averages of cases ranged from 149 to 309, highest peak in March-April and another one in July. Monthly VL incidence was associated positively to rainfall and negatively to relative humidity and the numbers of VL cases in the previous month. INTERPRETATION: The number of cases reported to the public health sector allowed the describing of the spatial distribution and temporal variations in the Muzaffarpur from 1990 to 2008. However, to assess the actual VL burden, as well as the efficacy of the control measures applied in the district, reporting from private practices and NGOs should be encouraged