Impact assessment of nutritional education and motivation of mothers in food supplementation of malnourished 2-5 years old in an urban slum of Ludhiana: A field trial

Background: Malnutrition in all its forms remains a major public health problem throughout the developing world and is an underlying factor in child mortality. India is home to 40 percent of the world’s malnourished children. 2 million children die in India, accounting for one in five child deaths in the world. More than half of these deaths could be prevented if children were well nourished.  Objectives: To assess the impact of maternal education and motivation in the nutritional supplementation of malnourished 2-5 years olds in an urban slum area of Ludhiana. Methodology: A community-based interventional study was carried out in 101 eligible children in an urban slum of Ludhiana. The mothers were given nutritional and health education and were also taught how to prepare different types of low cost energy-dense supplementary foodstuffs for the children. The results were seen in terms of continuation of the practice after educating and motivating the mothers of malnourished under-fives to provide the supplementary nutrition. The data was analyzed using Epi-Info version-6 software and SPSS version 16. Result: Post intervention showed that number of days in a month the mother gave nutritional supplement declined from mean 17.5 days to 10.5 days from first to sixth month follow up. Conclusion: Nutritional status of the children improves with continued nutrition and health education of the mothers

Pattern of prescription and drug use in psychiatry out patient department of private practitioners of Central India

Background: Psychotropic drugs have had a remarkable impact in psychiatric practice. The continuous monitoring of prescription and drug utilization studies may help to identify the problem involved in therapeutic decision and promote rational prescribing. Very few studies from India have evaluated the prescription pattern of Psychiatrists. Present study was undertaken to analyze the prescription pattern and drug used in psychiatric Out Patients of private practitioners of Central India.Methods: One thousand prescriptions were collected by undergraduate students from chemist and analysed. Study parameter like demographic profile of patients viz. age, sex, diagnosis were recorded. Basic drug indicators, the prescribing pattern of antipsychotics and other categories of drugs were also recorded. The most common and, top brands of anti psychotics were analyzed .Inappropriate prescription if any were recorded and analyzed further.Result: The most common psychotropic drugs were anti-anxiety in 361(36.1%) and antidepressants 130 (13%) prescribed for various psychiatric disorder. Usage of Sedative Hypnotics 104(10.4%), anti-psychotics 90(9%) and anticonvulsants 80 (8%) drugs in prescriptions. The incidence of polypharmacy (22%) was common occurrence in prescriptions. The commonest combination prescribed was of tricyclic antidepressant with benzodiazepines. Central anti-cholinergic was commonly prescribed with anti psychotics.Conclusions: Anti-anxiety drug (benzodiazepines) was the most frequently prescribed class of psychotropic drugs in various psychiatry disorders. The prescribing prevalence of Alprazolam with different brand names was more than that of other benzodiazepines. The combination of different psychotropic drugs were also prescribed

Ultrasound guided fine needle aspiration cytology in deep seated lesions: an effective diagnostic tool

Background: Fine needle aspiration cytology (FNAC) is a diagnostic method used to assess various masses in the body with minimal invasion. FNAC alone has a lower yield as compared to biopsy for diagnosing deep-seated lesions. Radiological guidance improves the yield of FNAC. The aim of the study was to evaluate the diagnostic efficacy of Ultrasound (USG) guided FNAC in various deep-seated lesions in the body. We conducted a cross-sectional analytical study at the cytology section of pathology department of our hospital for indoor patients.Methods: It was a retrospective study done over a period of five years, which included 334 aspirates suspected to be of inflammatory or neoplastic origin obtained from deep-seated lesions. After a thorough clinical and radiological evaluation, USG guided FNACs were performed. Experienced pathologists processed the smears, prepared thereby, for cytological evaluation and diagnosis.Results: A total of 334 samples were collected using USG-guided FNAC. The most common site was lungs (36.5%) followed by liver (13.77%). The most common type were malignant lesions (57.19%) which were either primary malignancies or metastatic carcinomas. 29 samples were found to be acellular or had inadequate material, thus a diagnosis couldn’t be made. Out of the various lung masses, non-small cell carcinoma was the most common (66.39%). The most common liver mass was metastatic carcinoma (54.35%).Conclusions: USG guided FNAC is a relatively simple, safe, fast, minimally invasive and cost effective procedure, which provides quite a high rate of adequacy and diagnostic efficacy. It is useful for making a pre-operative diagnosis and guiding the choice of treatment.

Development of a continuous-flow anaerobic co-digestion process of olive mill wastewater and municipal sewage sludge

BACKGROUND: Olive mill wastewater (OMW) represents an environmental problem due to its high organic load and relevant concentration of phenolic compounds (PCs). OMW treatment and disposal represents a relevant challenge and cost for olive mills and multi-utilities in charge of waste management in Mediterranean countries. The goal of this study was to develop an anaerobic co-digestion (co-AD) process of OMW and sewage sludge (SwS) from municipal wastewater treatment. RESULTS: Different volumetric OMW:SwS ratios up to 100% OMW were fed in continuous 1.7-L bioreactors. The reactors fed with raw OMW (rOMW) performed better than those fed with OMW dephenolized by adsorption (dOMW). At a 23-day hydraulic retention time, the best performances were obtained in the reactor fed with 25% rOMW, with a 105% increase in methane yield in comparison to the 100% SwS test. At a 40-day hydraulic retention time, the reactor fed with 40% rOMW attained a 268 NLCH4/kgvolatile solids methane yield. The conversion of phenolic compoundsreached 70% when the hydraulic retention time was increased from 23 to 40 days. A cost\u2013benefit analysis indicated that both rOMW co-AD in existing digesters and phenolic compounds recovery from OMW followed by co-AD of dOMW can lead to relevant additional revenues for the multi-utilities in charge of wastewater management. CONCLUSION: This work proves that, using the existing network of SwS anaerobic digesters, it is feasible to co-digest the entire OMW production in regions characterized by intense olive oil production, thus attaining a relevant increase in methane production yield (a 144% increase in comparison to 100% SwS)

Potential Mechanisms Underlying TGF-β-mediated Complement Activation in Lung Fibrosis

While our previous studies suggest that limiting bleomycin-induced complement activation suppresses TGF-β signaling, the specific hierarchical interactions between TGF-β and complement in lung fibrosis are unclear. Herein, we investigated the mechanisms underlying TGF-β-induced complement activation in the pathogenesis of lung fibrosis. C57-BL6 mice were given intratracheal instillations of adenoviral vectors overexpressing TGF-β (Ad-TGFβ) or the firefly gene-luciferase (Ad-Luc; control). Two weeks later, mice with fibrotic lungs were instilled RNAi specific to receptors for C3a or C5a-C3ar or C5ar, and sacrificed at day 28. Histopathological analyses revealed that genetic silencing of C3ar or C5ar arrested the progression of TGF-β-induced lung fibrosis, collagen deposition and content (hydroxyproline, col1a1/2); and significantly suppressed local complement activation. With genetic silencing of either C3ar or C5ar, in Ad-TGFβ-injured lungs: we detected the recovery of Smad7 (TGF-β inhibitor) and diminished local release of DAF (membrane-bound complement inhibitor); in vitro: TGF-β-mediated loss of DAF was prevented. Conversely, blockade of the TGF-β receptor prevented C3a-mediated loss of DAF in both normal primary human alveolar and small airway epithelial cells. Of the 52 miRNAs analyzed as part of the Affymetrix array, normal primary human SAECs exposed to C3a, C5a or TGF-β caused discrete and overlapping miRNA regulation related to epithelial proliferation or apoptosis (miR-891A, miR-4442, miR-548, miR-4633), cellular contractility (miR-1197) and lung fibrosis (miR-21, miR-200C, miR-31HG, miR-503). Our studies present potential mechanisms by which TGF-β activates complement and promotes lung fibrosis

IL‐17A deficiency mitigates bleomycin‐induced complement activation during lung fibrosis

Interleukin 17A (IL‐17A) and complement (C′) activation have each been implicated in the pathogenesis of idiopathic pulmonary fibrosis (IPF). We have reported that IL‐17A induces epithelial injury via TGF‐β in murine bronchiolitis obliterans; that TGF‐β and the C′ cascade present signaling interactions in mediating epithelial injury; and that the blockade of C′ receptors mitigates lung fibrosis. In the present study, we investigated the role of IL‐17A in regulating C′ in lung fibrosis. Microarray analyses of mRNA isolated from primary normal human small airway epithelial cells indicated that IL‐17A (100 ng/ml; 24 h; n = 5 donor lungs) induces C′ components (C′ factor B, C3, and GPCR kinase isoform 5), cytokines (IL8, ‐6, and ‐1B), and cytokine ligands (CXCL1, ‐2, ‐3, ‐5, ‐6, and ‐16). IL‐17A induces protein and mRNA regulation of C′ components and the synthesis of active C′ 3a (C3a) in normal primary human alveolar type II epithelial cells (AECs). Wild‐type mice subjected to IL‐17A neutralization and IL‐17A knockout (i717a−/−) mice were protected against bleomycin (BLEO)‐induced fibrosis and collagen deposition. Further, BLEO‐injured i17a−/− mice had diminished levels of circulating Krebs Von Den Lungen 6 (alveolar epithelial injury marker), local caspase‐3/7, and local endoplasmic reticular stress‐related genes. BLEO‐induced local C′ activation [C3a, C5a, and terminal C′ complex (C5b‐9)] was attenuated in il17a−/− mice, and IL‐17A neutralization prevented the loss of epithelial C′ inhibitors (C′ receptor‐1 related isoform Y and decay accelerating factor), and an increase in local TUNEL levels. RNAi‐mediated gene silencing of il17a in fibrotic mice arrested the progression of lung fibrosis, attenuated cellular apoptosis (caspase‐3/7) and lung deposition of collagen and C′ (C5b‐9). Compared to normals, plasma from IPF patients showed significantly higher hemolytic activity. Our findings demonstrate that limiting complement activation by neutralizing IL‐17A is a potential mechanism in ameliorating lung fibrosis.—Cipolla, E., Fisher, A. J., Gu, H., Mickler, E. A., Agarwal, M., Wilke, C. A., Kim, K. K., Moore, B. B., Vittal, R. IL‐17A deficiency mitigates bleomycin‐induced complement activation during lung fibrosis. FASEB J. 31, 5543–5556 (2017). www.fasebj.orgPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154482/1/fsb2fj201700289r-sup-0001.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154482/2/fsb2fj201700289r.pd

Crosstalk between TGF-β1 and complement activation augments epithelial injury in pulmonary fibrosis

The epithelial complement inhibitory proteins (CIPs) cluster of differentiation 46 and 55 (CD46 and CD55) regulate circulating immune complex-mediated complement activation in idiopathic pulmonary fibrosis (IPF). Our previous studies demonstrated that IL-17A mediates epithelial injury via transforming growth factor β1 (TGF-β1) and down-regulates CIPs. In the current study, we examined the mechanistic role of TGF-β1 in complement activation-mediated airway epithelial injury in IPF pathogenesis. We observed lower epithelial CIP expression in IPF lungs compared to normal lungs, associated with elevated levels of complement component 3a and 5a (C3a and C5a), locally and systemically. In normal primary human small airway epithelial cells (SAECs) treated with TGF-β1 (10 ng/ml), C3a, or C5a (100 nM), we observed loss of CIPs and increased poly(ADP-ribose) polymerase (PARP) activation [also observed with RNA interference (RNAi) of CD46/CD55]. TGF-β1-mediated loss of CIPs and Snail induction [SNAI1; a transcriptional repressor of E-cadherin (E-CAD)] was blocked by inhibiting mitogen-activated protein kinase (p38MAPK; SB203580) and RNAi silencing of SNAI1. C3a- and C5a-mediated loss of CIPs was also blocked by p38MAPK inhibition. While C3a upregulated TGFb transcripts, both C3a and C5a down-regulated SMAD7 (negative regulator of TGF-β), and whereas TGF-β1 induced C3a/C5a receptor (C3aR/C5aR) expression, pharmacologic C3aR/C5aR inhibition protected against C3a-/C5a-mediated loss of CIPs. Taken together, our results suggest that epithelial injury in IPF can be collectively amplified as a result of TGF-β1-induced loss of CIPs leading to complement activation that down-regulates CIPs and induces TGF-β1 expressio

High pressure phases in highly piezoelectric Pb(Zr0.52Ti0.48)O3

Two novel room-temperature phase transitions are observed, via synchrotron x-ray diffraction and Raman spectroscopy, in the Pb(Zr0.52Ti0.48)O3 alloy under hydrostatic pressures up to 16 GPa. A monoclinic (M)-to-rhombohedral (R1) phase transition takes place around 2-3 GPa, while this R1 phase transforms into another rhombohedral phase, R2, at about 6-7 GPa. First-principles calculations assign the R3m and R3c symmetry to R1 and R2, respectively, and reveal that R2 acts as a pressure-induced structural bridge between the polar R3m and a predicted antiferrodistortive R-3c phase.Comment: REVTeX, 4 pages with 3 figures embedded. Figs 1 and 3 in colo

Ipilimumab administration for advanced melanoma in patients with pre-existing Hepatitis B or C infection: a multicenter, retrospective case series

Ipilimumab is a fully human, monoclonal antibody directed against Cytotoxic T Lymphocyte Antigen-4 (CTLA-4) that has demonstrated a survival benefit and durable disease control in patients with advanced melanoma. Ipilimumab is associated with potentially serious immune-related adverse events, including autoimmune hepatitis. Because clinical trials of ipilimumab excluded patients with pre-existing hepatitis B or C infection, there is a paucity of data on the safety of ipilimumab administration to that patient population. Here, we report the largest case series to date of patients with hepatitis B or C who received ipilimumab for advanced melanoma. Two of the nine patients described in this case series experienced fluctuations in their liver function tests (LFTs) and were subsequently treated with corticosteroids. Although this is a small series, the rate of hepatotoxicity appears similar to what has been seen in the general population treated with ipilimumab, and the ability to administer ipilimumab did not appear to be affected by concomitant hepatitis B or C infection. The use of ipilimumab in patients with metastatic melanoma who have pre-existing hepatitis can be considered among other therapeutic options

Elective Total Knee Replacement in a Patient With a Left Ventricular Assist Device-Navigating the Challenges With Spinal Anesthesia.

Elective joint surgery in a patient with a left ventricular assist device (LVAD) may become increasingly common as these devices become entrenched in the management of patients with heart failure. Furthermore, regional techniques may be reasonable anesthetic options in this challenging population. This case conference discusses a spinal anesthetic for an elderly female with an LVAD who presented for an elective left total knee arthroplasty. The expert case commentaries that follow the case discussion further explore the anesthetic issues in light of the existing literature