Study to determine the distribution pattern of agglutinating antibodies to Salmonella enterica serotype: typhi, paratyphi A and paratyphi B antigens in normal healthy individuals and individuals with afebrile illness in pediatric population

Background: Enteric fever continues to be a major health problem in developing countries including India. The serological test, Widal test, is a well known test, used as an indirect test to detect the serological evidences of presence of Salmonella groups. The following study was undertaken to determine the baseline Widal titre (the titre of the antibodies to the O and the H antigens of S. typhi and to the H antigens of S. paratyphi A and B) in normal healthy individuals and individuals with afebrile illness in paediatric population coming to our hospital (both IPD and OPD). Materials & Methods: The Widal test was performed with serial serum dilutions: 1:20, 1:40, 1:80, 1:160 and 1:320 by using isotonic normal saline. 0.5ml of each of the antigen suspension was added to corresponding tubes, mixed well and incubated at 37C for 24 hours. The tubes were then examined visually for agglutination. A 50% agglutination is considered and recorded as the titre of antibodies present in the individual against Salmonella. Results: Positive agglutination in Widal test was observed to be lowest among under-fives as compared to older children (46% vs 62%), but the results were not significant (p=0.06). No significant association was observed between Positive agglutination in Widal test and gender (p=0.31). Conclusion: It is clear that Salmonella agglutinins are common among apparently healthy people and as endemicity of typhoid in an area may change over time, more studies should be carried out to determine Salmonella agglutinin titre in apparently healthy populations, so that a better judgment which is based on the prevailing agglutinin titres can be made. Keywords: Agglutination, Salmonellosis, Typhoid fever, Salmonella typhi, Paratyphi A,  Paratyphi

The effect of 0.25% levobupivacaine and 0.25% ropivacaine in fascia iliaca block in elderly patients with fracture femur given before positioning for subarachnoid block

Background: Positioning of elderly patients with fracture femur for subarachnoid block (SAB) is a challenging task, both for the patient and anesthesiologist. Severe pain not only adds to the morbidity but also alters the success rate of SAB as appropriate positioning becomes difficult. Fascia iliaca compartment block (FICB) is a simple, rapid, effective and safe method for achieving excellent pain relief. The purpose of this study is to compare the efficacy of 0 .25% of levobupivacaine and 0.25% ropivacaine in FICB on reducing preoperative and postoperative pain and analgesic consumption in lower limb surgery.Methods: 60 elderly patients of ASA class I-III scheduled for elective fracture femur surgery were enrolled in the study and randomly divided into two groups. Group L received 30ml 0.25% levobupivacaine in FICB while Group R received 0.25% ropivacaine in FICB 15min before SAB. Parameters recorded were blood pressure, heart rate, visual analogous scale (VAS), quality of positioning and time to first rescue analgesia. VAS was noted before and after performing FICB and at the time of positioning for subarachnoid block (SAB).Results: The VAS score at different time interval and time to first rescue analgesia were comparable (P >0.05). Quality of positioning was also similar in both the groups (P >0.05).Conclusions: The study demonstrates that levobupivacaine and ropivacaine produce comparable preoperative and postoperative analgesia when used for FICB

Protein Profile of Human Lung Epithelial Cells (A549) Revealing Deviation in Cytoskeleton Proteins in Response to Zinc Oxide Nanoparticles Exposure

Zinc oxide nanoparticles (ZnO NPs) are widely used in biomedicine and scientific research because of their high dissolution property and bioavailability. On the contrary, this property also increases the intracellular reactivity, accessibility and cytotoxicity. These nano-bio interactions could induce undesirable changes in the proteome of the interacting cells, especially in the lung cells as these are the primary contact site. However, the potential effects of ZnO NPs exposure on proteome remain unclear. Proteomics data will substantiate the detailed mechanism of cellular interactions and modulatory effects of ZnO NPs on cells. Quantitative proteomic profiling was done using MALDI-TOF/TOF and MS/MS to identify differential protein expression on exposure to NPs among non exposed and exposed cells. Twenty-two proteins, with approximately 1.5 fold differential expression in cells exposed to ZnO NPs as compared to control cells were identified. Differentially expressed proteins were further classified using PANTHER software on the basis of functional gene ontology term: molecular function, biological process and cellular component. ToppGene suite was used to study protein-protein interaction and network was enriched with STRING. This study is a systematic analysis of protein modulation of the A549 cells exposed to ZnO NPs indicating alterations in the cytoskeleton

Cardioembolic but Not Other Stroke Subtypes Predict Mortality Independent of Stroke Severity at Presentation

Introduction. Etiology of acute ischemic stroke (AIS) is known to significantly influence management, prognosis, and risk of recurrence. Objective. To determine if ischemic stroke subtype based on TOAST criteria influences mortality. Methods. We conducted an observational study of a consecutive cohort of patients presenting with AIS to a single tertiary academic center. Results. The study population consisted of 500 patients who resided in the local county or the surrounding nine-county area. No patients were lost to followup. Two hundred and sixty one (52.2%) were male, and the mean age at presentation was 73.7 years (standard deviation, SD = 14.3). Subtypes were as follows: large artery atherosclerosis 97 (19.4%), cardioembolic 144 (28.8%), small vessel disease 75 (15%), other causes 19 (3.8%), and unknown 165 (33%). One hundred and sixty patients died: 69 within the first 30 days, 27 within 31–90 days, 29 within 91–365 days, and 35 after 1 year. Low 90-, 180-, and 360-day survival was seen in cardioembolic strokes (67.1%, 65.5%, and 58.2%, resp.), followed for cryptogenic strokes (78.0%, 75.3%, and 71.1%). Interestingly, when looking into the cryptogenic category, those with insufficient information to assign a stroke subtype had the lowest survival estimate (57.7% at 90 days, 56.1% at 180 days, and 51.2% at 1 year). Conclusion. Cardioembolic ischemic stroke subtype determined by TOAST criteria predicts long-term mortality, even after adjusting for age and stroke severity

Assessment of cognitive impairment in hypertensive individuals attending a tertiary health-care center in metropolitan city: An analytical study

Background: Cognitive impairment is a physiological consequence of ageing. Mostly, after 65 years of age, impairment in the memory and dexterity is common. The various factors for such decline are yet under evaluation. The “Montreal Cognitive Assessment Scale” scoring system is been used in this study. This scale is based on seven domains of cognition. It is developed to improve the chances of early detection of cognitive impairment and it claims to diagnose dementia more efficiently compared to the standard MMSE scale. Aims and Objectives: The present study was conducted to compare the cognition status in hypertensive and normotensive individuals of similar age groups. Materials and Methods: The study participants were the selected patients attending the hypertension (HTN) OPD in Seth GS Medical college and KEM HOSPITAL Parel, Mumbai and among the staff working. Patients with age 30–40 years and blood pressure (BP) <140/90 mm Hg supine position without taking any anti-hypertensive medication. After selection of study subjects, the cognition status was assessed in both groups using the MoCA instrument. The BP was measured in supine posture, after interval of 10 min between each measurement, with the help of Sphygmomanometer. Unpaired “t”-test was applied to test the significance of difference of mean values of MoCA scale. Results: We observed that among hypertensive subjects, comparatively lower MoCA score (mean value: 25.97) was reported. Thirteen (28.88%) study subjects had low MoCA score, whereas 32 (71.11%) hypertensive study subjects had normal MoCA score. Conclusion: Thus, if the HTN is of a longer duration, it may show the poor cognitive performance. However, more such studies are required to know the exact mechanism and to know the critical level of BP which can cause cognitive impairment in long standing cases

A high LDH to absolute lymphocyte count ratio in patients with DLBCL predicts for a poor intratumoral immune response and inferior survival

Purpose: To test the utility of the circulating Lactate Dehydrogenase (LDH) to absolute lymphocyte count (ALC) ratio (LAR) to predict outcome to conventional first-line chemo-immunotherapy in Diffuse Large B-cell Lymphoma (DLBCL), and investigate its correlation to the tumour immune microenvironment (TME). Experimental Design: A population based cohort of 210 patients (median age: 64, range 18-90 years) with median follow up 3.8 years was analysed. All patients were treated with R-CHOP, and no immunosuppression related cases were included. Tissue for nanoString gene expression was available in 141. Results: High (i.e. adverse) LAR was associated with inferior progression free and overall survival (PFS 45% vs. 78%; OS 56% vs 86%, both p < 0.001) at 5-years. Patients with a high LAR had a strikingly different TME compared to patients with a low ratio. Low LAR was associated with a good-risk TME immune gene signature (p < 0.0001), including high CD8 and lower M2 macrophage infiltration. COO classification was not significantly different between high and low LAR patients. LAR was predictive of outcome independent of cell of origin and the international prognostic index (IPI). In particular, LAR discriminated patients with high IPI (3- 5), showing 5-year PFS and OS of 32% vs. 74% (p=0.0006), and 43% vs. 81% (p=0.0003). A combined nanoString based immune score and the LAR allowed better prediction of outcome than either prognosticator alone (p < 0.0001). Conclusions: The LAR reflects the TME within DLBCL, and is a strong predictor of outcome in DLBCL treated with conventional first-line therapy that is independent of and additive to the IPI. Further studies are required to determine if this easily applicable blood assay can determine patients that might benefit from immune checkpoint blockade

A high LDH to absolute lymphocyte count ratio in patients with DLBCL predicts for a poor intratumoral immune response and inferior survival

Purpose: To test the utility of the circulating Lactate Dehydrogenase (LDH) to absolute lymphocyte count (ALC) ratio (LAR) to predict outcome to conventional first-line chemo-immunotherapy in Diffuse Large B-cell Lymphoma (DLBCL), and investigate its correlation to the tumour immune microenvironment (TME). Experimental Design: A population based cohort of 210 patients (median age: 64, range 18-90 years) with median follow up 3.8 years was analysed. All patients were treated with R-CHOP, and no immunosuppression related cases were included. Tissue for nanoString gene expression was available in 141. Results: High (i.e. adverse) LAR was associated with inferior progression free and overall survival (PFS 45% vs. 78%; OS 56% vs 86%, both p < 0.001) at 5-years. Patients with a high LAR had a strikingly different TME compared to patients with a low ratio. Low LAR was associated with a good-risk TME immune gene signature (p < 0.0001), including high CD8 and lower M2 macrophage infiltration. COO classification was not significantly different between high and low LAR patients. LAR was predictive of outcome independent of cell of origin and the international prognostic index (IPI). In particular, LAR discriminated patients with high IPI (3- 5), showing 5-year PFS and OS of 32% vs. 74% (p=0.0006), and 43% vs. 81% (p=0.0003). A combined nanoString based immune score and the LAR allowed better prediction of outcome than either prognosticator alone (p < 0.0001). Conclusions: The LAR reflects the TME within DLBCL, and is a strong predictor of outcome in DLBCL treated with conventional first-line therapy that is independent of and additive to the IPI. Further studies are required to determine if this easily applicable blood assay can determine patients that might benefit from immune checkpoint blockade

An epidemiological study to estimate the baseline titres of Widal test in apparently healthy children

Background: Enteric fever is one of the common infectious diseases of humans.&nbsp;It is a major health problem in developing countries and its diagnosis on clinical ground is difficult. Diagnosis in developing countries is still mostly done by Widal test. However, the value of the test has been debated.&nbsp;The following study was undertaken to determine the baseline Widal titre (the titre of the antibodies to the O and the H antigens of S.&nbsp;typhi&nbsp;and to the H antigens of&nbsp;S. paratyphi&nbsp;A and B) in normal healthy children.Materials &amp; Methods: A total of 300 children satisfying the eligibility criteria were taken in the study after informed consent from their parents. &nbsp;­­­­­A detailed history was taken from each participant with special reference to source of water and method used for purification. Participants were classified into various socio-economic classes as per modified Kuppuswami classification. Widal titres were done with tube agglutination method for all the patients. A Widal antigen kit (antigen suspension of salmonella enterica serotype typhi, paratyphi A and B) was used. Venous blood sample was collected from each participant; left to clot for 15 minutes in the room temperature then sera was separated by using micropipette. The separated sera was properly labeled and stored in -20C for further study. Results: Most of the study subjects were between 6- 10 years of age with mean age of 7.8 +/- 3.2 years.&nbsp; More males were observed among study subjects with male to female ratio of 2:1 (67% males vs 33% females).&nbsp; Over half of the subjects (58.7%) were from middle socio-economic class as per modified kuppuswami classification. About one third were from lower class while only 7% were from upper class. Out of the total 300 subjects, 37% of the subjects were not using any purification method for water and were directly consuming water supplied from municipal sources.&nbsp;&nbsp; Positive agglutination in Widal test i.e titre ≥ 1:20 was seen in 59% of the healthy subjects.&nbsp; Positive agglutination in Widal test was observed to be lowest among under-fives as compared to older children (46% vs 62%), but the results were not significant (p-0.06). No significant association was observed between positive agglutination in Widal test and gender (p-0.31). Conclusion: It is clear that&nbsp;Salmonella&nbsp;agglutinins are common among apparently healthy people and as endemicity of typhoid in an area may change over time, more studies should be carried out to determine&nbsp;Salmonella&nbsp;agglutinin titre in apparently healthy populations, so that a better judgment which is based on the prevailing agglutinin titres can be made