Clinical and investigational study for the aetiological evaluation of patients in nontraumatic altered sensorium and its outcome

Background: Apart from head injury many patients present to the tertiary care hospital in unconscious state, the etiology of which is obscure in most of the cases. The present study was conducted with on objective to provide insight into the clinical features and diagnostic methods to know the aetiology of patients with non-traumatic cases of altered sensorium and to study the outcome of these patients.Methods: This is an observational study on 100 patients of altered sensorium of non-traumatic origin during the period from October 2012 to September 2014 conducted in the Department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. All patients were selected for the study based on the inclusion exclusion criteria. Detailed history, clinical evaluation, laboratory investigations like neuroimaging studies etc. were carried out. Statistical data analysis was done using Graph pad Prism 6 and Microsoft Excel. P value <0.0001 was considered statistically extremely significant.Results: Out of 100 patients of altered sensorium, 64 were males and 36 were females. All patients were in the age group of 19 to 89 years. Cerebrovascular accident was the most common aetiology of altered sensorium followed by metabolic encephalopathy and infection. Altered sensorium in patients with CVA carries a high mortality. Metabolic causes and younger age indicated a better prognosis, patients with low (Glasgow Coma Score) GCS score of 3 to 4 had poorer prognosis.Conclusions: The results suggest that clinical assessments yield accurate predictive information about the potential for recovery in cases of altered sensorium. So, this study concludes that empirically based estimates of prognosis in the neurologically severely ill provides great reassurance to those involved in a decision-making process, including patients’ families and physicians

PREVALENCE AND SENSITIVITY PATTERN OF ESBL PRODUCERS IN DIFFERENT CLINICAL ISOLATES FROM A TERTIARY HEALTHCARE CENTER OF EASTERN INDIA, A CROSS-SECTIONAL STUDY.

Background Antimicrobial-resistant organisms have led to increased mortality, morbidity, and economic burden throughout the globe. This study focused on measuring the prevalence of antimicrobial resistance bacteria mostly by extended-spectrum β-lactamase (ESBL) producers from several samples in a facility providing tertiary care in Eastern Odisha.  Methods A cross-sectional study was conducted from February 2021 to January 2022. During that time a total of 2452 culture-positive specimens were processed from different samples. Identification of organisms and antibiotic susceptibility was done manually through Kirby Beuer’s disc diffusion method. Phenotypic detection of ESBL producers was performed by a Double disc synergy test.  Results During the study, E. coli (852) was identified as the most prevalent organism followed by S. aureus (661) and K. pneumoniae (301).  Among them, 1571 isolates were ESBL-producing and E. coli was the most prevalent one followed by S. aureus and K. pneumoniae which were 659, 479, and 172 in number respectively. Most of the ESBL producers were isolated from urine samples and the least number from stool samples. We found in this study that the highest population of P.mirabilis and K. oxytoca were resistant to the fluoroquinolones group of antibiotics, Pseudomonas and K. oxytoca are highly resistant to aminoglycosides group of antibiotics, P.mirabilis, Enterobacter, P. vulgaris and Enterococci were showing high resistance towards penicillin group of antibiotics, P.mirabilis was highly resistant towards β-lactamase inhibitor group of antibiotics.  Conclusion As per the study findings, E. coli is the main producer of ESBLs among members of the Enterobacteriaceae family, and urine is the main source of ESBL-positive isolates. These findings are highly significant from a medical and scientific standpoint and may influence policymakers to better monitor and manage antibiotic resistance

ROLE OF RETICULOCYTE HEMOGLOBIN CONTENT IN DIAGNOSIS OF IRON DEFICIENCY ANEMIA

Objectives: Anaemia is a global problem of immense health significance affecting persons of all ages and economic groups. Iron deficiency anaemia (IDA) is the most common type of anaemia met with in clinical practice. For IDA diagnosis, estimation and treatment, many indices like serum iron (SI), total iron binding capacity (TIBC), serum ferritin (SF), soluble transferrin receptor assay are used. But reticulocyte haemoglobin content (CHr) is called as the gold standard for diagnosing IDA as it is the most valuable screening tool for identifying IDA with a sensitivity of 94% and specificity 80% and differentiates IDA from anaemia of systemic disease (ASD). The present study was undertaken to evaluate CHr as a most efficient marker in diagnosing IDA. Methods: This prospective observational study was carried out in the Department of General Medicine of M.K.C.G. Medical College and hospital, Berhampur, Odisha, India from October 2017 to October 2019. Sixty microcytic hypochromic patients of either sex &gt;18 yrs of age admitted in the medicine ward fulfilling the inclusion and exclusion criteria were included in this study. After taking detailed history and clinical examination, laboratory investigations including complete blood count (CBC), serum iron, serum, ferritin, serum transferrin saturation, TIBC, CHr and bone marrow aspiration with iron stain were done in all patients. Results: In the study group of 60 patients, 10(16.66%) patients had mild anaemia, 17(28.33%) had moderate anaemia and 33(55%) had severe anaemia. Mean haemoglobin of the patients was 6.86g/dL and SD was 1.95g/dL. Nineteen (31.66% patients) had TIBC in the range of 351-400 µg/dl. Mean ± SD of serum TIBC was 333.91 ± 67.26 µg/dL. Thirty-nine patients (65%) had transferrin saturation in the range of 0.1-10%. The Mean ± SD of the study group was 13.68 ± 3.22%. Fifty (83.33%) patients had serum ferritin in the range of 0-100 µg/dL. Twenty-three patients (38.33%) had CHr concentration between 15.1-20pg followed by 19(31.66%) between 20.1-25pg and 18(30%) between 25.1-30pg. The Mean ± SD of this study was 22.14pg ± 3.92. Conclusion: Reticulocyte haemoglobin content is a potential biomarker that can be used to differentiate iron deficiency anaemia from other causes of anaemia

Regional and subregional analyses of macroeconomic policy strategies for growth and equality in Southern Africa

We investigate the relevance of beta (Ø, absolute and conditional) and sigma (&#x03c3;) convergence in the economies of the Common Monetary Area of Southern Africa and in the provinces of the Republic of South Africa using panel data, allowing an understanding of growth and inequality in the region. The region has experienced Ø- and &#x03c3;-convergence; however, growth rates of per capita gross domestic product are low at aggregate and sectoral levels. At sectoral level, the performance of the tertiary sector is better than that of the primary and secondary sectors. The relatively poor performance of the primary and secondary sectors needs policy attention. For the provinces of South Africa, capital expenditure on key sectors such as education and health can enhance growth rate, whereas the overall revenue expenditure retards growth. Therefore, provinces' capital budgets need to be managed well within the limitation of revenue expenditure to avoid fiscal imbalances

Transition metal-free synthesis of &#945;-ketoamides from arylmethyl ketones and alkylphosphoramides

A transition metal-free protocol has been developed for the synthesis of &#945;-ketoamides from aryl methyl ketones and alkylphosphoramides in the presence of oxidant, aqueous Tert-butyl Hydroperoxide (TBHP). A series of aryl methyl ketones having both electron-donating as well as electron-withdrawing groups were successfully employed for the synthesis of their corresponding &#945;-ketoamides using hexamethylphosphoramide and other alkylphosphoramides

Sources of output growth in the countries of the Common Monetary Area and the provinces of South Africa

This paper aims to decompose the sources of growth in economies in the Southern African region's Common Monetary Area and in the provinces of South Africa. Decomposition results for the Common Monetary Area reveal that the growth of aggregate and sectoral gross domestic product is driven by input, without increasing efficiency in production or benefiting from technological progress, which is unsustainable. Negative technical change implies that countries are unable to reap the benefits from shifts in technology. Countries experiencing input-driven growth in the secondary sector, such as Namibia and Eswatini, have the potential to achieve growth through efficiency improvements and by adopting technology. Output growth in the provinces of South Africa is negatively contributed by changes in technical efficiency, which suggests that policy makers should raise growth further by emphasizing improvements in efficiency in these provinces

Historical trends of heavy metal contamination and eutrophication in an aquatic system from Kashmir Himalaya, India

Long-term trends of heavy metal pollution in aquatic systems are significant for assessing the influence of human activities and adopting relevant management strategies. In this study, we present analyses of heavy metals (iron, manganese, copper, zinc, cobalt, nickel, and lead) in 210Pb/137Cs dated sediment cores from Ahansar lake (Kashmir Himalaya, India) covering a time span of the last 200 years. Additionally, the relative water quality analyses and compilation of historical water quality data (since 1983 CE) were performed to understand the long-term eutrophication status of Ahansar lake system. The heavy metal concentrations varied very little in pre-anthropogenic sediments (before 1980 CE) and represent geochemical background concentrations. Since the 1980s, the heavy metals (Pb, Zn and Cu) began to increase gradually corresponding to the population expansion in the region and the beginning of industrialization. Similarly, the ecological risk index (ERI) values for all heavy metals lies below 40, indicating less toxic impact of Pb, Cu, Zn and Ni. However, the increasing trend of ERI observed in Pb and Zn since 1980, indicates deterioration of the lake ecosystem. Further, the water quality parameters revealed deteriorating trend from ∼2000 CE, with an increase of total phosphorus, ammonia, nitrate and a decrease of dissolved oxygen. The present day (∼2020 CE) quantitative assessment of Ahansar lake water quality using trophic level index (TLI) reflected the eutrophic condition of the lake waters. The long-term baseline information from this study will aid policy makers and environmentalists for the development, management and restoration of water resources

Glucose 6‐phosphate dehydrogenase variants increase NADPH pools for yeast isoprenoid production

Isoprenoid biosynthesis has a significant requirement for the co‐factor NADPH. Thus, increasing NADPH levels for enhancing isoprenoid yields in synthetic biology is critical. Previous efforts have focused on diverting flux into the pentose phosphate pathway or overproducing enzymes that generate NADPH. In this study, we instead focused on increasing the efficiency of enzymes that generate NADPH. We first established a robust genetic screen that allowed us to screen improved variants. The pentose phosphate pathway enzyme, glucose 6‐phosphate dehydrogenase (G6PD), was chosen for further improvement. Different gene fusions of G6PD with the downstream enzyme in the pentose phosphate pathway, 6‐phosphogluconolactonase (6PGL), were created. The linker‐less G6PD‐6PGL fusion displayed the highest activity, and although it had slightly lower activity than the WT enzyme, the affinity for G6P was higher and showed higher yields of the diterpenoid sclareol in vivo. A second gene fusion approach was to fuse G6PD to truncated HMG‐CoA reductase, the rate‐limiting step and also the major NADPH consumer in the pathway. Both domains were functional, and the fusion also yielded higher sclareol levels. We simultaneously carried out a rational mutagenesis approach with G6PD, which led to the identification of two mutants of G6PD, N403D and S238QI239F, that showed 15–25% higher activity in vitro. The diterpene sclareol yields were also increased in the strains overexpressing these mutants relative to WT G6PD, and these will be very beneficial in synthetic biology applications

Insights into structure and dynamics of extracellular domain of Toll-like receptor 5 in Cirrhinus mrigala (mrigala): A molecular dynamics simulation approach.

The toll-like receptor 5 (TLR5) is the most conserved important pattern recognition receptors (PRRs) often stimulated by bacterial flagellins and plays a major role in the first-line defense against invading pathogenic bacteria and in immune homeostasis. Experimental crystallographic studies have shown that the extracellular domain (ECD) of TLR5 recognizes flagellin of bacteria and functions as a homodimer in model organism zebrafish. However, no structural information is available on TLR5 functionality in the major carp Cirrhinus mrigala (mrigala) and its interaction with bacterial flagellins. Therefore, the present study was undertaken to unravel the structural basis of TLR5-flagellin recognition in mrigala using structural homodimeric TLR5-flagellin complex of zebrafish as reference. Integrative structural modeling and molecular dynamics simulations were employed to explore the structural and mechanistic details of TLR5 recognition. Results from structural snapshots of MD simulation revealed that TLR5 consistently formed close interactions with the three helices of the D1 domain in flagellin on its lateral side mediated by several conserved amino acids. Results from the intermolecular contact analysis perfectly substantiate with the findings of per residue-free energy decomposition analysis. The differential recognition mediated by flagellin to TLR5 in mrigala involves charged residues at the interface of binding as compared to the zebrafish complex. Overall our results shows TLR5 of mrigala involved in innate immunity specifically recognized a conserved site on flagellin which advocates the scientific community to explore host-specific differences in receptor activation