Clinical and Immunological Profile in Newly Diagnosed HIV Patients

INTRODUCTION: Simian immunodeficiency virus (SIV) was prevalent among chimpanzees for several thousands of years. For unknown reasons it had remained silent without harming humans. During the middle of twentieth century, it had transformed into Human Immunodeficiency virus. Numerous hypotheses have been forwarded for explaining this phenomenon. In most of the theories, colonisation of African nations, rapid urbanisation, unprotected sex and travel were being attributed for the sudden transformation and spread. After transformation it had taken only few years for the pandemic to get established. Today the virus has spread worldwide and has become a biggest public health challenge for low income countries. As it primarily affects working population of a nation, it has resulted in a great economic burden. Infections which were previously uncommon and sporadic, are being frequently reported. Several countries are witnessing resurgence of tuberculosis. HIV is one of the most extensively studied virus. Thousands of articles are being published each year about HIV/AIDS. This has led to immense knowledge about the virus as well as the disease. Epidemiological data, statistics and guidelines are regularly updated by international bodies. Mandatory screening with effective testing methods have effectively brought down blood products related transmission to a negligible rate. Active campaigns about HIV have resulted in increased awareness among public. Global annual new HIV infection rate have started to decline. Treatment regimens have been changed to improve the drug compliance as well to minimise adverse effects. Now patients are able to lead a normal life like any other person with the help of effective therapeutic regimens. In developed nations like United States, many patients who are under treatment remain asymptomatic for more than two decades. AIM: 1. To study about the clinical profile of HIV at the time of diagnosis. 2. To study about the mean CD4 count among newly diagnosed HIV patients. 3. To study about the correlation between CD4 count and the various clinical parameters. MATERIALS AND METHODS: Design of study : Cross sectional study. Period of study : July 2011 – September 2012. Study population : 151 cases. Settings : Study was conducted in ART Centre, Government Rajaji Hospital, Madurai. Selection of study subjects: Inclusion criteria: Patients who were diagnosed as HIV for the first time. Exclusion criteria: • Patients who were already diagnosed as HIV positive. • Patients who were previously on ART and discontinued. • Children < 13 years. SUMMARY: 1. Mean age of the study group was 36.73. 2. Males are predominantly involved. 3. Most of the females were married and have HIV positive partners. 4. Most of the males present in either stage 3 or stage 4 5. Heterosexual route was the predominant mode of transmission. 6. Oral candidiasis and tuberculosis were the commonest opportunistic infections. 7. Weight loss, chronic diarrhea and fever of unknown origin were commonest non specific symptoms. 8. Tuberculous meningitis was the commonest extrapulmonary tuberculosis. 9. Mean age of Stage 1 was low when compared to other stages. 10. Mean CD4 count in our study was 278.5. For males: 259.1. For females: 312.4. 11. CD4 count of stage 4 was statistically lower than other stages. 12. Oral candidiasis, tuberculosis and PCP pneumonia correlate significantly with CD4 count less than 200. CONCLUSION: Proportion of late presenters are very high worldwide. Early diagnosis in these patients would have helped them to survive for longer periods. Recommendations must be made to integrate HIV testing along with basic investigations during routine health visits in high risk individuals. Awareness must be created among serodiscordant couples and HIV infected partner may be advised to start on ART to reduce the transmission to HIV negative partner. Awareness about the availability of voluntary testing must be created among high risk individuals as well as general population. The immense knowledge and scientific advances in the field of HIV/AIDS would become meaningless if the available valuable resources underutilized by the community. So the special focus should be made to diagnose the HIV patients at early stages to achieve WHOs ambitious target of zero “AIDS related death”

Efficient microwave synthesis of novel aromatic esters catalyzed by zirconia and its modified forms: a kinetic study

A series of solid acids such as ZrO2, 5% Mo(VI)/ZrO2, 10% Mo(VI)/ZrO2, 20% Mo(VI)/ZrO2 and SO42-/ZrO2 were prepared. These solid acids were characterized by BET, NH3-TPD/n-butylamine back titration, powder-XRD, FT-IR spectroscopy, scanning electron microscopy (SEM), transmission electron microscopy (TEM) and ICP-OES techniques. The catalytic performance of these solid acids was evaluated in the synthesis of novel aromatic esters by the assistance of microwave irradiation and the catalytic activity of these solid acids was compared with pTsOH. The results clearly indicated that the zirconia based solid acids are efficient green catalysts for esterification reactions, which gave a maximum yield of the ester in a shorter reaction time and comparable catalytic activity of the pTsOH Bronsted acid. Kinetic studies were carried out to calculate the temperature coefficients (1.66 and 1.56) and energy of activation (66.82 kJ mol(-1) and 58.93 kJ mol(-1)) for SO42-/ZrO2 and pTsOH respectively. Pre-adsorption studies revealed that the reaction follows the Langmuir-Hinshelwood mechanism. The SO42-/ZrO2 solid acid catalyst was found to be reactivable and reusable

Pulmonary tuberculosis in HIV individuals: Preliminary report on clinical features and response to treatment

Objectives: To study the clinical, radiological and immunological profile of pulmonary tuberculosis in HIV infected patients and assess the response to short-course chemotherapy regimens. Methods: Seventy eight patients (68 males and 10 females) with HIV infection and having symptoms suggestive of tuberculosis attending the Government Hospital for Thoracic Medicine, Tambaram or the Tuberculosis Research Centre, Chennai were studied. The diagnosis of tuberculosis was based on clinical evaluation, bacteriological examination including sputum smear and culture and chest skiagram. HIV diagnosis was based on two tests (rapid/ELISA), detecting different antigens. CD4+ T cell counts were done on all patients initially and at the end of treatment. Blood tests and skiagrams were repeated at 2 months and at the end of treatment. All the patients were treated with standard (RNTCP) short course regimens. Patients were given all the doses under supervision during the initial intensive phase and through community DOTS providers in the continuation phase. Results: Sixty five patients had culture confirmed pulmonary tuberculosis, of whom 54 had smear positive disease, initially. The radiological manifestations were varied, with 11 subjects having miliary tuberculosis, 54 with non-homogeneous opacities and 10 with cavitation. The mean CD4 cell count at intake was 192 ± 172 cells/cumm. Patients showed good initial response to treatment with significant weight gain. At the end of 2 months of treatment, 91% of patients had sputum cultures negative for Mycobacterium tuberculosis. However, the CD4 % fell significantly by the sixth month. The study is being continued to assess the long-term response to SCC of patients with HIV and tuberculosis. Conclusions: Tuberculosis has a varied clinical presentation in patients with HIV infection. The spectrum of radiographic features ranges from normal to a miliary pattern. Inspite of clinical and bacteriological improvement during treatment, immunologic deterioration may continue

Parental psychosocial aspects and stressors involved in the management of inborn errors of metabolism.

Parents of children with inborn errors of metabolism (IEM) face numerous psychosocial challenges. An increased understanding and awareness of these stressors can ensure better overall outcomes for the entire family. We conducted semi-structured, in-person interviews with ten parents to identify psychosocial stressors, strategies, and supports they utilized to overcome their challenges. Our interview guide was designed to elicit familial experiences during the pre- and post-diagnosis periods. The themes and sub-themes were identified through qualitative descriptive textual analysis of audio-recorded transcripts. Major themes identified include ambiguity of illness, changing family and spousal dynamics, and navigating the healthcare system. Sub-themes revolved around disease effects, psychological stressors, health systems, support, and facing the disease. Healthcare professionals have an opportunity to minimize the impact of negative emotional outcomes by assisting families as they navigate the experience of having a child with an IEM. Our findings can be used to develop and continue a more well-rounded, family-oriented framework for IEM management

Investigating genome wide DNA methylation in bronchial and lung fibroblasts from healthy individuals and individuals with COPD

Rationale: Lung fibroblasts are implicated in respiratory disease pathology including chronic obstructive pulmonary disease (COPD). Phenotypic differences between fibroblasts isolated from the bronchi versus the lung parenchyma have been described but no studies have compared the cell types on a genome wide scale. DNA methylation is a reversible modification of the DNA structure with the ability to affect cell function via the alteration of gene expression. Here we compared genome wide DNA methylation profiles from bronchial and lung fibroblasts and assessed modification to these profiles in cells isolated from individuals with COPD. Methods: DNA was isolated from lung (LgF) and bronchial fibroblasts (BrF) at passage 4 and bisulphite treated. Site specific, quantitative genome wide methylation was determined using the Illumina 450K Infinium Methylation BeadChip array. Linear modelling and DMRcate functions identified differentially methylated sites and regions respectively between BrF and LgF and from cells isolated from healthy individuals versus those with COPD. Results: 3980 CpG (methylation) sites significantly differed, following Bonferroni correction, between BrF and LgF isolated from healthy individuals. These sites had a broad distribution of effect size, with 240 CpG sites displaying a difference in methylation of >50%. 78 of these sites were validated in a second cohort of matched BrF and LgF isolated from the same individuals. There was genomic proximity to these sites and DMRcate was used to refine the individual CpG sites to 5 regions of interest associated with 5 genes; HLX, TWIST1, CREB5, SKAP2 and PRDM16. Differences in methylation were less pronounced when comparing cells isolated from healthy individuals to those with COPD. In BrF 47 DMRcate regions were identified with a maximum difference in methylation of at least 20%. In LgF 3 DMRcate regions were identified with a maximum difference in methylation of at least 20%. Conclusions: DNA methylation profiles are significantly different between BrF and LgF but only small modifications are associated with COPD. Future work will focus on validating a methylation based marker of lung versus bronchial fibroblasts to differentiate cell types by validating our differential DNA methylation observations with gene/protein expression

Mesocorticolimbic monoamine correlates of methamphetamine sensitization and motivation.

Methamphetamine (MA) is a highly addictive psychomotor stimulant, with life-time prevalence rates of abuse ranging from 5-10% world-wide. Yet, a paucity of research exists regarding MA addiction vulnerability/resiliency and neurobiological mediators of the transition to addiction that might occur upon repeated low-dose MA exposure, more characteristic of early drug use. As stimulant-elicited neuroplasticity within dopamine neurons innervating the nucleus accumbens (NAC) and prefrontal cortex (PFC) is theorized as central for addiction-related behavioral anomalies, we used a multi-disciplinary research approach in mice to examine the interactions between sub-toxic MA dosing, motivation for MA and mesocorticolimbic monoamines. Biochemical studies of C57BL/6J (B6) mice revealed short- (1 day), as well as longer-term (21 days), changes in extracellular dopamine, DAT and/or D2 receptors during withdrawal from 10, once daily, 2 mg/kg MA injections. Follow-up biochemical studies conducted in mice selectively bred for high vs. low MA drinking (respectively, MAHDR vs. MALDR mice), provided novel support for anomalies in mesocorticolimbic dopamine as a correlate of genetic vulnerability to high MA intake. Finally, neuropharmacological targeting of NAC dopamine in MA-treated B6 mice demonstrated a bi-directional regulation of MA-induced place-conditioning. These results extend extant literature for MA neurotoxicity by demonstrating that even subchronic exposure to relatively low MA doses are sufficient to elicit relatively long-lasting changes in mesocorticolimbic dopamine and that drug-induced or idiopathic anomalies in mesocorticolimbic dopamine may underpin vulnerability/resiliency to MA addiction

Comparison of Interactive Teaching in Online and Offline Platforms among Dental Undergraduates

In recent years, the educational system has focused more on the holistic development of an individual. Modern technology has changed the educational environment to provide students with better academic opportunities. Along with the education system, teaching techniques and learning tools have also changed with digital evolution. This research was undertaken to assess the academic performance of interactive teaching methods in offline and online platforms in Periodontics among BDS undergraduates at a dental college in India. This prospective study was conducted among 49 students: Group I (n = 24, online class through Zoom) and Group II (n = 25, offline classes). The subject was divided into three modules and was covered in one week. The topics covered, teaching methods, lectures, and activities were similar for both groups. A formative assessment mark was obtained from written tests during the module, whereas the summative assessment mark was recorded from exams conducted towards the end of the module. In the results, a statistically significant difference was not observed in terms of formative assessment between Group I (77.88 ± 12.89) and Group II (77.80 ± 16.09) (p = 0.98). In addition, a statistically significant difference was not observed in terms of summative assessment between Group I (80.54 ± 8.39) and Group II (80.28 ± 11.57) (p = 0.93). Overall, this study suggests that interactive teaching methods in both offline and online platforms in Periodontics showed equivalent performance by the undergraduate dental students

Bifurcations, Chaos, Controlling and Synchronization of Certain Nonlinear Oscillators

In this set of lectures, we review briefly some of the recent developments in the study of the chaotic dynamics of nonlinear oscillators, particularly of damped and driven type. By taking a representative set of examples such as the Duffing, Bonhoeffer-van der Pol and MLC circuit oscillators, we briefly explain the various bifurcations and chaos phenomena associated with these systems. We use numerical and analytical as well as analogue simulation methods to study these systems. Then we point out how controlling of chaotic motions can be effected by algorithmic procedures requiring minimal perturbations. Finally we briefly discuss how synchronization of identically evolving chaotic systems can be achieved and how they can be used in secure communications.Comment: 31 pages (24 figures) LaTeX. To appear Springer Lecture Notes in Physics Please Lakshmanan for figures (e-mail: [email protected]