Rare association of Fahr’s disease with multiple myeloma: A case report

Fahr’s disease or Fahr’s syndrome is a rare neurological disorder characterized by abnormal calcified deposits in the basal ganglia and cerebral cortex. 47 years male who presented to us with progressive ataxia and Parkinsonian symptoms was found to have extensive bilateral calcifications including bilateral basal ganglia in CT scan of the brain. The secondary causes of intracranial calcifications were ruled out to make a clinical diagnosis of Fahr’s disease. While investigating for chronic low back pain with anemia and renal failure, high ESR and serum protein electrophoresis showing M band was detected. On further investigation, the bone marrow study confirmed the diagnosis of multiple myeloma. There are only few case reports of association of Fahr’s disease and multiple myeloma in literature. The case is being reported here in view of rarity

A prospective key informant surveillance system to measure maternal mortality – findings from indigenous populations in Jharkhand and Orissa, India

In places with poor vital registration, measurement of maternal mortality and monitoring the impact of interventions on maternal mortality is difficult and seldom undertaken. Mortality ratios are often estimated and policy decisions made without robust evidence. This paper presents a prospective key informant system to measure maternal mortality and the initial findings from the system

Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study

Objectives The study aimed at estimating out-of-pocket (OOP) expenditure, catastrophic health expenditure (CHE) and distress financing due to hospitalisation and outpatient care among industrial workers in Eastern Nepal. Methods We conducted a cross-sectional study involving industrial workers employed in a large-scale industry in Eastern Nepal. Those who were hospitalised in the last 1 year or availed outpatient care within the last 30 days were administered a structured questionnaire to estimate the cost of illness. CHE was defined as expenditure more than 20% of annual household income. Distress financing was defined as borrowing money/loan or selling assets to cope with OOP expenditure on health. Results Of 1824 workers eligible for the study, 1405 (77%) were screened, of which 85 (6%) were hospitalised last year; 223 (16%) attended outpatient department last month. The median (IQR) OOP expenditure from hospitalisation and outpatient care was US$124 (71–282) and US$36 (19–61), respectively. Among those hospitalised, the prevalence of CHE and distress financing was found to be 13% and 42%, respectively, and due to outpatient care was 0.4% and 42%, respectively. Drugs and diagnostics account for a large share of direct costs in both public and private sectors. More than 80% sought hospitalisation and outpatient care in a private sector. Conclusion Industrial workers face significant financial risks due to ill health compared with the general population. Poor utilisation and higher cost of care in public health facilities warrant strengthening of public sector through increased government spending. The labour act 2014 of Nepal should be strictly adhered

Rectal gel application of Withania somnifera root extract expounds anti-inflammatory and muco-restorative activity in TNBS-induced Inflammatory Bowel Disease

<p>Abstract</p> <p>Background</p> <p>Inflammatory Bowel Disease (IBD) is marked with chronic inflammation of intestinal epithelium driven by oxidative stress. Traditional treatments with plant extracts gained renewed interest due to their ability to ameliorate the multi factorial conditions like inflammation. We investigated the beneficial effects of <it>Withania somnifera </it>in Trinitro Benzyl Sulfonic Acid (TNBS) induced experimental IBD through a rectally applicable formulation.</p> <p>Methods</p> <p>The study included (i) preparation of gel formulation from aqueous <it>Withania somnifera </it>root extract (WSRE), (ii) biochemical assays to determine its performance potential, (iii) testing of formulation efficacy in TNBS-induced IBD rat model, and (iv) histo-patholgical studies to assess its healing and muco-regenerative effect in IBD-induced rats. For this purpose, concentration dependant antioxidant activity of the extracts were evaluated using biochemical assays like (a) inhibition of lipid peroxidation, (b) NO scavenging, (c) H₂O₂scavenging, and (d) ferric reducing power assay.</p> <p>Results</p> <p>The extract, at 500 μg/ml, the highest concentration tested, showed 95.6% inhibition of lipid peroxidation, 14.8% NO scavenging, 81.79% H₂O₂scavenging and a reducing capacity of 0.80. The results were comparable with standard antioxidants, ascorbic acid and curcumin. WSRE treatment positively scored on histopathological parameters like necrosis, edema, neutrophil infiltration. The post treatment intestinal features showed restoration at par with the healthy intestine. In view of these results, gel formulation containing an aqueous extract of <it>W. somnifera</it>, prepared for rectal application was tested for its anti-inflammatory activity in TNBS-induced rat models for IBD. Commercially available anti-inflammatory drug Mesalamine was used as the standard in this assay.</p> <p>Conclusions</p> <p>Dose of the rectal gel applied at 1000 mg of WSRE per kg rat weight showed significant muco-restorative efficacy in the IBD-induced rats, validated by histo-pathological studies.</p

Network-Based Prediction and Analysis of HIV Dependency Factors

HIV Dependency Factors (HDFs) are a class of human proteins that are essential for HIV replication, but are not lethal to the host cell when silenced. Three previous genome-wide RNAi experiments identified HDF sets with little overlap. We combine data from these three studies with a human protein interaction network to predict new HDFs, using an intuitive algorithm called SinkSource and four other algorithms published in the literature. Our algorithm achieves high precision and recall upon cross validation, as do the other methods. A number of HDFs that we predict are known to interact with HIV proteins. They belong to multiple protein complexes and biological processes that are known to be manipulated by HIV. We also demonstrate that many predicted HDF genes show significantly different programs of expression in early response to SIV infection in two non-human primate species that differ in AIDS progression. Our results suggest that many HDFs are yet to be discovered and that they have potential value as prognostic markers to determine pathological outcome and the likelihood of AIDS development. More generally, if multiple genome-wide gene-level studies have been performed at independent labs to study the same biological system or phenomenon, our methodology is applicable to interpret these studies simultaneously in the context of molecular interaction networks and to ask if they reinforce or contradict each other

Non-extremal black holes of N=2, d=4 supergravity

We propose a generic recipe for deforming extremal black holes into non-extremal black holes and we use it to find and study the non-extremal black-hole solutions of several N=2,d=4 supergravity models (SL(2,R)/U(1), CPn and STU with four charges). In all the cases considered, the non-extremal family of solutions smoothly interpolates between all the different extremal limits, supersymmetric and not supersymmetric. This fact can be used to find explicitly extremal non-supersymmetric solutions in the cases in which the attractor mechanism does not completely fix the values of the scalars on the event horizon and they still depend on the boundary conditions at spatial infinity. We compare (supersymmetry) Bogomol'nyi bounds with extremality bounds, we find the first-order flow equations for the non-extremal solutions and the corresponding superpotential, which gives in the different extremal limits different superpotentials for extremal black holes. We also compute the "entropies" (areas) of the inner (Cauchy) and outer (event) horizons, finding in all cases that their product gives the square of the moduli-independent entropy of the extremal solution with the same electric and magnetic charges.Comment: Many small, inessential changes. Some misprints corrected and a few references adde

Commercial Nucleic-Acid Amplification Tests for Diagnosis of Pulmonary Tuberculosis in Respiratory Specimens: Meta-Analysis and Meta-Regression

BACKGROUND: Hundreds of studies have evaluated the diagnostic accuracy of nucleic-acid amplification tests (NAATs) for tuberculosis (TB). Commercial tests have been shown to give more consistent results than in-house assays. Previous meta-analyses have found high specificity but low and highly variable estimates of sensitivity. However, reasons for variability in study results have not been adequately explored. We performed a meta-analysis on the accuracy of commercial NAATs to diagnose pulmonary TB and meta-regression to identify factors that are associated with higher accuracy. METHODOLOGY/PRINCIPAL FINDINGS: We identified 2948 citations from searching the literature. We found 402 articles that met our eligibility criteria. In the final analysis, 125 separate studies from 105 articles that reported NAAT results from respiratory specimens were included. The pooled sensitivity was 0.85 (range 0.36-1.00) and the pooled specificity was 0.97 (range 0.54-1.00). However, both measures were significantly heterogeneous (p<.001). We performed subgroup and meta-regression analyses to identify sources of heterogeneity. Even after stratifying by type of commercial test, we could not account for the variability. In the meta-regression, the threshold effect was significant (p = .01) and the use of other respiratory specimens besides sputum was associated with higher accuracy. CONCLUSIONS/SIGNIFICANCE: The sensitivity and specificity estimates for commercial NAATs in respiratory specimens were highly variable, with sensitivity lower and more inconsistent than specificity. Thus, summary measures of diagnostic accuracy are not clinically meaningful. The use of different cut-off values and the use of specimens other than sputum could explain some of the observed heterogeneity. Based on these observations, commercial NAATs alone cannot be recommended to replace conventional tests for diagnosing pulmonary TB. Improvements in diagnostic accuracy, particularly sensitivity, need to be made in order for this expensive technology to be worthwhile and beneficial in low-resource countries

Stiffened composite cylindrical panels�Optimum lay-up for buckling by ranking

Buckling of discretely stiffened composite cylindrical panels made of repeated sublaminate construction is studied using a finite element method. In repeated sublaminate construction, a full laminate is obtained by repeating a basic sublaminate, which has a smaller number of plies. This paper deals with the determination of the optimum lay-up for buckling by ranking of such stiffened (longitudinal and hoop) composite cylindrical panels. For this purpose we use the particularized form of a four-noded, 48 degrees of freedom doubly curved quadrilateral thin shell finite element together with a fully compatible two-noded, 16 degrees of freedom composite stiffener element. The computer program developed has been used, after extensive checking for correctness, to obtain an optimum orientation scheme of the plies in the sublaminate so as to achieve maximum buckling load for a specified thickness of typical stiffened composite cylindrical panels

Optimum design for buckling of plain and stiffened composite axisymmetric shell panels/shells

The buckling of plain and discretely stiffened composite axisymmetric shell panels/shells made of repeated sublaminate construction is studied using the finite element method. In repeated sublaminate construction, a full laminate is obtained by repeating a basic sublaminate, which has a smaller number of plies. The optimum design for buckling is obtained by determining the layup sequence of the plies in the sublaminate by ranking, so as to achieve maximum buckling load for a specified thickness. For this purpose, a four-noded 48-dof quadrilateral composite thin shell element, together with fully compatible two-noded 16-dof composite meridional and parallel circle stiffener elements are used