Occurrence of Hepatotrophic Viral Infections among patients in Tertiary Care Center.

INTRODUCTION : Hepatic abnormalities are quite common among HIV infected persons. Thousands of people with HIV are also infected, or at risk of being infected with one of the several hepatitis viruses. Some of these viruses can cause chronic infection which may result in cirrhosis, liver failure, and hepatocellular carcinoma in a proportion of patients. Apart from being more prevalent, the natural history of these hepatitis viruses may be modified in patients with HIV infection and hence their significance3. Also it has been claimed that certain hepatitis virus infections may exacerbate the course of HIV infection, with rapid progression to AIDS, although this observation has not yet been confirmed. Viral hepatitis is not so much an opportunistic infection in patients with HIV infection, as it is companion infection. Thus because some forms of hepatitis are acquired through sexual spread, or parenteral contact with blood or blood products in the same way that HIV is, hepatitis and HIV infections often coexist. The enteral forms of hepatitis (HAV and HEV) are not strongly associated with HIV infection, whereas HBV, HDV, HCV and HGV are strongly associated because of shared routes of transmission. So screening of these hepatitis viral infections becomes mandatory in HIV positive patients. AIMS AND OBJECTIVES : • To study the serological status of hepatotrophic viral infections like HBV and HCV among HIV positive and HIV negative patients attending Voluntary Confidential Counselling and Testing Centre (VCCTC), Government General Hospital, Chennai. • To compare the progression of Hepatitis B virus infection among HIV positive and HIV negative study groups. • To compare the levels of anti HBs, among HIV positive and HIV negative study groups with hepatitis B virus infection, during follow up. • To detect the prevalence of HGV RNA using the RT-PCR among HIV positives with coexistent HBsAg and/ or anti HCV. • To study the clinical stage and immunological status of patients with HIV infection at presentation, and their correlation with hepatotrophic viral infections. MATERIALS AND METHODS : This study was conducted in serologically confirmed HIV positive and negative patients attending VCCTC, Government General Hospital, Chennai. Pre and post test counselling were given to the patients attending VCCTC, and informed consent was got from them for testing. Strict confidentiality regarding the results were maintained. For ELISA, blood samples were collected from the patients. Serum was separated, and stored at -20°C in cold storage, until use. For all the ELISAs performed, the manufacturer’s testing protocol instructions were strictly followed and results were interpreted only when the validity criteria were satisfied. RESULTS : In the present study 500 HIV positive and 300 HIV negative patients attending VCCTC, Government General Hospital, Chennai were screened for the coexistence of hepatotrophic virus infections. Majority of the HIV positives were in the sexually active age group of 30 – 39 years ( 52%), with males being more than females in the ratio of 1.9: 1. Prevalence of Hepatitis B surface antigen was more both among HIV positives and negatives, when compared to anti HCV antibodies. The persistence of Hepatitis B surface antigen after 6 months was three times more among the HIV positives, when compared to the HIV negative study group. The presence of HBeAg which indicates active replication was also more among HIV positives when compared to negative study group. HIV negative patients had higher antibody levels, when compared to HIV positive study group. Among the 5 patients who had chronic HBV infection (Table III), 2 had coexistent anti-HBs in their serum. Heterosexual route was the major mode of transmission of HIV. The heterosexuals also included the spouse of infected men. Heterosexual route was the major mode of transmission of HBV. HCV was more prevalent among IVDUs. Among the total 16 IVDUs (Table II), 2 (12.5% ) were positive for both HBsAg and Anti HCV. Majority of the HIV positives without hepatotrophic viral infections were in Clinical Stage II Category B of HIV infection. Majority of the patients who were positive for hepatitis viral markers were in Clinical Stage II Category C of HIV infection CONCLUSION : HGV infection occurs with high frequency in patients with HIV and HCV combined infections (35%), signifying the common modes of transmission of HGV and HCV. Among the HIV positive study group, HBsAg positives with HGV co-infection had higher mean CD4 counts, when compared to HBsAg positives without HGV co-infection. There was no significant difference observed between the HCV positives with or without HGV co-infection. This implies that the presence of HGV RNA is associated with milder HIV status in individuals with HIV and HBV combined infection. Among the HIV positive study group, HGV positive patients with hepatitis B and / or hepatitis C co-infections had higher mean ALT levels, when compared to HGV negative individuals. This implies that, presence of HGV RNA was associated with severe hepatitis in patients with HIV and HBV or HCV combined infections. The present study throws light upon the co existence of HIV with Hepatotrophic viruses in a tertiary care center like ours. Only very few studies have been performed in India analyzing the coexistence of HGV with HIV. Our study can be considered as pioneer study in this context. The results aid the central HIV programme implementing agencies, especially in the field of ART to give importance to hepatitis G virus, along with hepatitis B and hepatitis C viral infections

Impact of spermiogram and sperm function test in idiopathic recurrent pregnancy loss

Aims: To evaluate the role of sperm factors in idiopathic recurrent pregnancy loss cases. Methods: We recruited 100 male subjects where their female partners experienced 2 or more idiopathic pregnancy losses. Recurrent pregnancy loss (RPL) males were grouped into two groups RPL1 (individuals having 2 abortion) and RPL2 (individuals having more than 2 abortions). Fifty volunteers who had fathered child/children prior to the study without the history of recurrent pregnancy loss and unassisted pregnancies were considered as control group. We grouped RPL males into two categories age below 35 years and above 35 years to test whether age plays any role on RPL. Routine semen parameters and sperm function test were performed for all the subjects. Statistical analysis was performed using Independent- Samples T test. Results: Insignificant differences were observed in seminal volume, pH, motility and sperm count but vitality test scores were significantly lesser in both RPL groups when compared to control group. For all three sperm function test both the RPL group showed lesser scores when compare to control. RPL2 group showed more abnormalities when compared to RPL1 group. We did not identify any significant difference for any of the parameters between two age group of RPL males. Conclusion: Our results recommend the screening of both partners simultaneous in RPL cases for the better diagnosis and treatment

Routine screening of antenatal population for thyroid disorders-mandatory

Background: Thyroid dysfunction is commonly seen in pregnant women causing adverse maternal and fetal effects. Routine screening of antenatal population for the same will be helpful for successful pregnancy outcomes. The objective of this study is to detect and treat antenatal women with Thyroid dysfunction to avoid deleterious maternal/ fetal effects.Methods: The present study is a hospital based prospective study conducted in the department of Obstetrics and Gynaecology of Narayana Medical College and Hospital(NMCH), Nellore, Andhra Pradesh, India. 1000 pregnant women were randomly recruited into this study. Apart from routine antenatal investigations, Thyroid function tests (TFT) - Thyroid stimulating hormone (TSH), freeT4 (fT4) and Thyroid peroxidase antibody (TPO Ab) are done for all the recruited women at the first visit of antenatal booking and individual Thyroid tests are repeated as required.Results: Following the TFT the study population is classified into pregnancies with euthyroidism‚ subclinical/ overt hypothyroidism and hyperthyroidism. The prevalence of Thyroid disorders in present study was 12.7% of which hypothyroidism noted in 10.3% (subclinical 6.9% and overt 3.4%) while hyperthyroidism seen in 2.4% (subclinical 1.8% and overt 0.6%). The various pregnancy complications, labour and neonatal outcomes have been analyzed.Conclusions: Thyroid dysfunction in pregnancy affects the health of the mother as well as the baby. Screening for Thyroid dysfunction should be performed as part of the routine antenatal work-up for successful pregnancy outcomes

Successful outcome of a triplet pregnancy following laparoscopic myomectomy for infertility: a unique case report

Infertility is a burning problem affecting 10-15% of the couples globally. The female factors contribute to about 40- 45% among which uterine factor is up to 10%. Presence of uterine myomas also significantly contribute to infertility. A conservative surgical approach like myomectomy is indicated for women in reproductive age both for psychological reasons as well as to preserve their reproductive potential. In recent years laparoscopic myomectomy (LM) has become the procedure of choice. Pregnancy outcome after myomectomy is a more significant concern especially with regard to the obstetric calamity of sudden uterine rupture due to the presence of an operative scar. The intensity of such complication will be considerably high when a triplet pregnancy occurs with a LM scar in the upper uterine segment with history of uterine cavity being opened during the myomectomy surgery. Managing such a case will be a difficult task to the attending clinician posing many unexpected clinical dilemmas. We are reporting a unique case of triplet pregnancy occurred following a LM resulting in successful maternal and fetal outcome. During the course of this pregnancy apart from considerable maternal distress due to uterine over distension many clinical problems like cervical insufficiency, pre eclampsia, polyhydraminos, intrauterine growth restriction (IUGR) and last but not the least severe postpartum haemorrhage (PPH) have been encountered and could be managed efficiently. An elective Caesarean section was performed at 33+4 weeks gestation delivering live triplets. Mother and all the three babies discharged from the hospital in good condition

Prediction of Hybrid Vigour for Yield Attributes among Synthesized Hybrids in Rice (Oryza sativa L.)

Abstract: Five cytoplasmic male sterile lines and ten testers of diverse origin were crossed in Line. Tester fashion to obtain 50 hybrid combinations. The performance of the hybrids was estimated based on relative heterosis, heterobeltiosis and standard heterosis with ASD 16 as check for seed yield and its contributing characters. Many of the hybrids, IR 688886A/ ADT 41, IR 688897A / ADT 41, IR 688886A / ASD 19, IR 68885A / ASD 16 and IR 58025A / ACK 03002 exhibited significantly negative heterobeltiosis as well as standard heterosis for days to flowering and maturity indicating the possibility of exploiting heterosis for earliness. The best hybrid was IR 68885A / White ponni, which showed standard heterosis and heterobeltiosis for panicle length, spikelets per panicle, grains per panicle, straw yield and grain yield. Relative heterosis for grain yield per plant ranged between -69.17 to 243.21 coupled with significant heterobeltiosis from -75.71 to 219.75. The standard heterosis ranged from -73.71 to 129.16 for grain yield per plant. Based on per se performance and standard heterosis the hybrids IR 68885A / White ponni, IR 688886A / White ponni, IR 688886A / ADT 41 and IR 58025A / CO 43 were identified as the superior hybrids for the characters of panicle length, grains per panicle and grain yield. Hence, these rice hybrids may be used for commercial cultivation

Template-Assisted Synthesis and Characterization of Passivated Nickel Nanoparticles

Potential applications of nickel nanoparticles demand the synthesis of self-protected nickel nanoparticles by different synthesis techniques. A novel and simple technique for the synthesis of self-protected nickel nanoparticles is realized by the inter-matrix synthesis of nickel nanoparticles by cation exchange reduction in two types of resins. Two different polymer templates namely strongly acidic cation exchange resins and weakly acidic cation exchange resins provided with cation exchange sites which can anchor metal cations by the ion exchange process are used. The nickel ions which are held at the cation exchange sites by ion fixation can be subsequently reduced to metal nanoparticles by using sodium borohydride as the reducing agent. The composites are cycled repeating the loading reduction cycle involved in the synthesis procedure. X-Ray Diffraction, Scanning Electron Microscopy, Transmission Electron microscopy, Energy Dispersive Spectrum, and Inductively Coupled Plasma Analysis are effectively utilized to investigate the different structural characteristics of the nanocomposites. The hysteresis loop parameters namely saturation magnetization and coercivity are measured using Vibrating Sample Magnetometer. The thermomagnetization study is also conducted to evaluate the Curie temperature values of the composites. The effect of cycling on the structural and magnetic characteristics of the two composites are dealt in detail. A comparison between the different characteristics of the two nanocomposites is also provided

Challenges of Early Years leadership preparation: a comparison between early and experienced Early Years practitioners in England

Leadership has been under-researched in the Early Years (EY) sector of primary schools in England, especially in leading change for professional development. The aim of this paper is to theorise what the leadership culture for EY practitioners looks like, and how Initial Teacher Training providers and schools are preparing practitioners for leadership. Using case studies of EY practitioners in different stages of their career in primary schools, we offer an insight into their preparedness for leadership in EY, the implication being that leadership training requires an understanding and embedding of the EY culture and context. Interviews with both sample groups allowed for deeper insight into the lived world. Interviews were also conducted with the head teachers to gain an overview of the leadership preparation they provided. The main findings suggest that newer EY practitioners are better prepared for leadership from their university training in comparison to more experienced EY practitioners

The Spectrum of Scarring in Craniofacial Wound Repair

Fibrosis is intimately linked to wound healing and is one of the largest causes of wound-related morbidity. While scar formation is the normal and inevitable outcome of adult mammalian cutaneous wound healing, scarring varies widely between different anatomical sites. The spectrum of craniofacial wound healing spans a particularly diverse range of outcomes. While most craniofacial wounds heal by scarring, which can be functionally and aesthetically devastating, healing of the oral mucosa represents a rare example of nearly scarless postnatal healing in humans. In this review, we describe the typical wound healing process in both skin and the oral cavity. We present clinical correlates and current therapies and discuss the current state of research into mechanisms of scarless healing, toward the ultimate goal of achieving scarless adult skin healing