Effect of Biological Rhythm on Cognitive Performance

Biological rhythm has contributed in evolution process of humankind and has created certain distinct capabilities and preferences in shaping his phycho-psychological reactions. On the basis of behavioural activities, reactions, preferences and performances during the day-night cycle, individuals are classified in chronotype as morning type (M type) and evening type (E type). Such a differentiation has been hypothesised to contributing to individual differences at the cognitive, affective and conative levels. The present study was an attempt to further study such differentiation in terms of neuro cognitive performance by using the most advanced psycho-physiological measures. The participants of both chronotypes, morning and evening were classified and later subjected to cognitive testing by using the Cambridge Neuropsychological Test Automated Battery in the morning and the evening session under repeated measure design. The study revealed that performance on neuro cognitive functions; Planning and working memory, Decision-making and response control, and Motor skills get effected differently by their biological rhythm cycle and thus under performance in these functions can be attributed to maladaptation of biological rhythm termed as biological dysrhythmia. The study also highlights the role of this behavioural maladaptation in moderating operational efficiency of soldier in combat situation

BIOLOGICS (BIOLOGICAL AGENTS): A NEW APPROACH IN THE TREATMENT OF PSORIASIS

ABSTRACTPsoriasis is a chronic inflammatory and multifactorial systemic disorder with predominant manifestation over the skin and/or joints resulting frominteractions between genetic pre-disposition and triggering environmental factors. Due to its systemic nature, patients exhibit a broad spectrum ofsymptoms that vary in severity. Although many patients, particularly those with the limited form of the disease, may be treated with topical therapy,those with extensive (moderate to severe) psoriasis eventually require phototherapy, systemic, or biologic therapy to adequately suppress the systemic,immunopathogenic process. Biological agents (biologics or biologicals) are a set of different engineered proteins. These are immunosuppressiveagents, designed to selectively interfere with the immune mechanisms that induce psoriasis. Their use is restricted to the treatment of moderateto severe psoriasis, which has failed to respond to systemic therapies (and/or phototherapy) or where such treatments are contra-indicated ornot tolerated. Biologics are becoming increasingly useful for the treatment of many skin diseases including psoriasis, particularly as alternativesfor patients who have failed to tolerate or respond to conventional systemic therapies or where non-biologic systemic agents are unsuitable due tothe presence of comorbidities. Biological therapies provide a targeted approach to treatment through interaction with specific components of theunderlying immune and inflammatory disease processes.Keywords: Immunopathogenesis, Biologicals, Psoriasis, Quality of life, Psoriasis area and severity index, Dermatology life quality index

Evaluation of CD4 count and correlation with development of opportunistic infection among HIV seropositives

Background: Opportunistic infections have been the important indicators to suspect and diagnose the HIV seropositives. CD4 count has been used an important tool to monitor the treatment and progression of disease. Methods: This study was done to study the pattern or common presentations of opportunistic infections among HIV seropositive patients and their relationship with CD4 counts. Results: Tuberculosis and candidiasis were the most common opportunistic infections in HIV infected patients followed by herpes, diarrhoea, acute respiratory infection, papular pruritic eruptions, seborrhoeic dermatitis, cryptococcal meningitis, and hepatitis B and C co-infection. Decrease in CD4 count is an important predictor to progression of the disease. Conclusions: This gives a representation of opportunistic infections in HIV seropositive patients in low prevalence state like Jharkhand

Therapeutic effect of hydroethanolic extract of Trianthema portulacastrum L. against N-Nitroso-N-Methylurea-induced mammary tumors in Wistar rats

406-415This study evaluated the therapeutic action of hydroethanolic extract of Trianthema portulacastrum L. (TPE) on N-nitroso-N-methylurea (NMU)-induced mammary tumors in Wistar rats. A hydroethanolic was prepared and subjected to qualitative and quantitative phytochemical screening. After acclimatization, Wistar rats were divided into 4 groups of 6 rats each: Group A (vehicle control), Group B (TPE control), Group C (TPE treatment) and group D (NMU control). NMU (50 mg/kg body weight) was injected intraperitoneally at 50, 80 and 110 days of age. After the induction of palpable tumors, the rats were administered 200 mg/kg bw of TPE by oral gavage for 2 months. The treatment with TPE significantly (pin vivo therapeutic action of TPE extract on NMU-induced mammary tumors. TPE exhibited antitumor activity through its antiproliferative, antiangiogenic, pro-apoptotic, and estrogen receptor-modulatory properties

Contralateral Fracture of the Penis with Concomitant Urethral Injury – Report of a Rare Case

Penile refracture is a rare urological emergency, more so on the side contralateral to the previous fracture. A 55-year-old male was referred 70 hours after sudden detumescence during sexual intercourse, with a history of blood at the urethral meatus. The patient had had a fracture of the penis four years previously. Examination revealed ecchymosis and swelling of the proximal shaft and purulent discharge from a laceration in the penile skin over the proximal corpora. Ultrasonography revealed laceration of the right tunica albuginea and corpus cavernosum. Exploration revealed scar tissue at the site of the previous operation on the left side and a fresh laceration, 1cm in size, in the right corpus cavernosum in the mid shaft, and a urethral defect of 0.5 cm. The patient had normal erections post-operatively and no complications at 6 months followup. On literature review, anecdotal cases of contralateral refracture of the penis were found. High suspicion, prompt diagnosis and expedient surgical management are essential for a good outcome with minimal complication

SEISMIC BRIDGE PIER ANALYSIS FOR PILE FOUNDATION BY FORCE AND DISPLACEMENT BASED APPROACHES

Seismic analysis of bridge pier supported on pile foundation requires consideration of soil-pile-structure (kinematic and inertial) interactions. This paper presents the design forces generated for bridge piers with varying height and constant diameter for medium and soft soils in earthquake probability zones considering contribution of soil-pile-structure interactions by developed analytical approaches. The results have shown that the difference in base shear demand between force based and displacement based approach and that between capacity spectrum and displacement based method in general decreases with the increase in slenderness ratio of the pier. The base shear demand by non-linear time history analysis has been found to be much higher compared to that by other methods. The relationship between height and pier cross-section has been developed for different soils and seismic zones such that the base shear demands by force based and displacement based method are of the same order. The overall value of the slenderness ratio works out to be such that failure of the pile shall be as a short column for both medium and soft soil

Do Quality Improvement Initiatives Improve Outcomes for Patients in Antiretroviral Programs in Low- and Middle-Income Countries? A Systematic Review.

BACKGROUND: There have been a range of quality improvement (QI) and quality assurance initiatives in low- and middle-income countries to improve antiretroviral therapy (ART) treatment outcomes for people living with HIV. To date, these initiatives have not been systematically assessed and little is known about how effective, cost-effective, or sustainable these strategies are in improving clinical outcomes. METHODS: We conducted a systematic review adhering to PRISMA guidelines (PROSPERO ID: CRD42017071848), searching PubMed, MEDLINE, Embase, Web of Science, and the Cochrane database of controlled trials for articles reporting on the effectiveness of QI and quality assurance initiatives in HIV programs in low- and middle-income countries in relation to ART uptake, retention in care, adherence, viral load suppression, mortality, and other outcomes including cost-effectiveness and long-term sustainability. RESULTS: One thousand eight hundred sixty articles were found, of which 29 were included. QI approaches were categorized as follows: (1) health system approaches using QI methods; (2) QI learning networks including collaboratives; (3) standard-based methods that use QI tools to improve performance gaps; and (4) campaigns using QI methods. The greatest improvements were seen in ART uptake [median increase of 14.0%; interquartile range (IQR) -9.0 to 29.3], adherence [median increase of 22.0% (IQR -7.0 to 25.0)], and viral load suppression [median increase 26.0% (IQR -8.0 to 26.0)]. CONCLUSIONS: QI interventions can be effective in improving clinical outcomes; however, there was significant variability, making it challenging to identify which aspects of interventions lead to clinical improvements. Standardizing reporting and assessment of QI initiatives is needed, supported by national quality policies and directorates, and robust research

Aplastic Crisis as Primary Manifestation of Systemic Lupus Erythematosus

Aplastic crisis is an unusual feature of systemic lupus erythematosus (SLE). We report the case of a 54-year-old woman presenting with both (extravascular) Coombs-positive hemolytic anemia and laboratory findings of bone marrow hyporegeneration with concomitant severe neutropenia. A bone marrow biopsy confirmed aplastic crisis. Diagnostic work-up revealed soaring titers of autoantibodies (anti-nuclear, anti-double-stranded DNA, anti-cardiolipin-IgM, and anti-beta 2-glykoprotein-IgM antibodies), indicating a connective tissue disease as the most plausible reason for bone marrow insufficiency. As the criteria for SLE were fulfilled, we initiated an immunosuppressive therapy by steroids, which led to a rapid complete hematologic and clinical remission in our patient. In this case, we could report on one of the rare cases of SLE-induced aplastic crisis showing that this condition can be entirely reversed by immunosuppressive treatment and that SLE-induced aplastic crisis yields a good prognosis. In conclusion, in a case of aplastic crisis, physicians should be aware that SLE can be a rare cause that is accessible to specific treatment

Activation of Aryl Hydrocarbon Receptor (AhR) Leads to Reciprocal Epigenetic Regulation of FoxP3 and IL-17 Expression and Amelioration of Experimental Colitis

Aryl hydrocarbon receptor (AhR), a transcription factor of the bHLH/PAS family, is well characterized to regulate the biochemical and toxic effects of environmental chemicals. More recently, AhR activation has been shown to regulate the differentiation of Foxp3(+) Tregs as well as Th17 cells. However, the precise mechanisms are unclear. In the current study, we investigated the effect of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), a potent AhR ligand, on epigenetic regulation leading to altered Treg/Th17 differentiation, and consequent suppression of colitis.Dextran sodium sulphate (DSS) administration induced acute colitis in C57BL/6 mice, as shown by significant weight loss, shortening of colon, mucosal ulceration, and increased presence of CXCR3(+) T cells as well as inflammatory cytokines. Interestingly, a single dose of TCDD (25 µg/kg body weight) was able to attenuate all of the clinical and inflammatory markers of colitis. Analysis of T cells in the lamina propria (LP) and mesenteric lymph nodes (MLN), during colitis, revealed decreased presence of Tregs and increased induction of Th17 cells, which was reversed following TCDD treatment. Activation of T cells from AhR(+/+) but not AhR (-/-) mice, in the presence of TCDD, promoted increased differentiation of Tregs while inhibiting Th17 cells. Analysis of MLN or LP cells during colitis revealed increased methylation of CpG islands of Foxp3 and demethylation of IL-17 promoters, which was reversed following TCDD treatment.These studies demonstrate for the first time that AhR activation promotes epigenetic regulation thereby influencing reciprocal differentiation of Tregs and Th17 cells, and amelioration of inflammation