Evaluation of total Lymphocyte Count and Absolute Lymphocyte Count as a Surrogate Marker for CD4 Count to Initiate ART

INTRODUCTION: The burden of HIV remains high for patients and their families especially in resource limited settings. It is estimated that 40 million people with human immunodeficiency virus (HIV) reside in resource limited settings. Among them it is reported that 6 million require highly active anti retroviral therapy (HAART). Ideally the WHO recommends regular combined immunological and virological monitoring for all HIV infected patients. Analysis for viral loads and CD4 counts require not only sophisticated equipment, but in addition, highly skilled laboratory personnel. The initiation of antiretroviral therapy is based on CD4 counts of less than 350 cells/mm3 according to the World Health Organization (WHO) and National AIDS Control Organisation (NACO). The determination of CD4 count however in resource-limited localities is difficult. A total lymphocyte count (TLC) of <1200 cells/mm3 has been recommended in addition to WHO staging (stage II) of the disease, for the initiation of antiretroviral therapy in such localities. The use of absolute lymphocyte count as a marker for HIV progression has been argued in many quarters over the years . Studies have suggested that when the absolute lymphocyte count is used in conjunction with blood hemoglobin, gives a more sensitive marker for HIV progression. Also studies have demonstrated the usefulness of absolute lymphocyte count (ALC) or total lymphocyte count (TLC), in identifying patients who would benefit from initiating prophylaxis for acquired immunodeficiency syndrome (AIDS)-related opportunistic infections. This study is being conducted to evaluate the correlation of TLC and ALC to CD4 count for initiating HAART in HIV-infected patients, as there are fewer published studies on this subject, from resource-limited settings. AIMS AND OBJECTIVES: 1. To evaluate the correlation of CD4 counts with the TLC and ALC to suggest that these can be used as a surrogate for CD4 count to initiate ART in resource limited settings. 2. To determine a range of TLC and ALC cut-offs for predicting CD4 count <350 cells/μl, which is important for the initiation of ART and for CD4 count 200CELLS/μL. MATERIALS & METHOD: The present study was conducted on HIV seropositive patients admitted in any wards or attending outpatient departments of Government Rajaji Hospital, Madurai during the period of Jan 2016 to June 2016. The study included 100 cases of newly detected HIV positive patients. All subjects fulfilled eligibility criteria, and none of the exclusion criteria were included in the study. METHODOLOGY: A previously designed proforma is used to collect the demographic and clinical details of the patients. All the patients underwent detailed clinical evaluation, appropriate investigations. History was taken on details of unprotected sexual intercourse, blood transfusion ,IV drug abuse, repeated respiratory infections, fever, recurrent diarrhoea and unexplained weight loss. Presence of lymphadenopathy, oral ulcers, splenomegaly and peripheral neuropathy will be noted. Hemoglobin, complete blood count including total WBC count and differential count, blood urea, serum creatinine, blood glucose, liver function tests including serum bilirubin, serum transaminases, will be estimated. CD4 count, Total lymphocyte count and absolute lymphocyte count are also estimated .The study group was divided on the basis of CD4 count into >350 cells / cu.mm, 200 to 350 cells/cu.mm 100 to 200 cells/cu.mm and <100 cells/cu.mm amd mean for absolute lymphocyte count and total lymphocyte count and haemoglobin was studied in these groups. RESULTS: In our study 100 patients were randomly selected of which 67% were males and 33% were females. Majority of patients in our study were in reproductive age group (21 to 50 years). This indicates a trend of young and productive generation being affected; a reflection of the devastating effects India will face as the younger generation work force is affected. Most common mode of HIV transmission was heterosexual. Also there is a rise in transmission through male to male sexual contact. In our study TLC<1100 cells/cu.mm correlates with CD4 count <200 cells/μL and TLC < 1300 cells/ cu.mm correlates with CD4 count <350 cells /μL. In our study using WHO clinical staging 4 when correlated with CD4 count < 200 cells/μL we get a significant statistical p value. Patients with stage 4 had mean CD4 count 155.86 cells/μL and patients with CD4 count < 200 cells/μL were in stage 3 or stage 4(93%).The mean Hemoglobin for CD4 count <350 cells/μL is 6.26 gm% and the mean haemoglobin for CD4 count <200 cells/μL is 5.6 gm%. The mean ALC for CD4 count <350 cells/μL is 1066.56 cells/cu.mm. and the mean ALC for CD4 count <200 cells/μL is 978.75 cells/cu.mm. CONCLUSION: In all the patients various clinical and inexpensive laboratory measures such as WHO clinical staging, Total lymphocyte count, Hemoglobin, Absolute lymphocyte count were done and correlated with CD4 count. It was analysed that these parameters can used as a surrogate marker for CD4 count to initiate HAART

MODIFIED ELECTROSPUN CHITOSAN GUIDED BONE REGENERATION MEMBRANES FOR STIMULATING OSTEOGENESIS AND ANGIOGENESIS

Guided bone regeneration (GBR) membranes are commonly used to maximize bone healing/regeneration by protecting bone grafted sites from invasion by soft tissues. Electrospun chitosan membranes modified by short chain fatty acids (Acetic anhydride (AA), butyric anhydride (BA) and hexanoic anhydride (HA)) or with tBOC (tert-Butyloxycarbonyl group) have many characteristics including retention of nanofiber structure, occlusive to soft tissues and osteoconductive properties in vivo that are important for GBR applications. The high surface area of the nanofiber structure of the membranes provides opportunity for the local delivery of osteogenic or angiogenic agents for enhancing their healing and bone regeneration properties. The objective of this research was to fabricate modified electrospun chitosan membranes capable of controlling the release of an osteogenic (Simvastatin, SMV) and angiogenic (magnesium) agent and evaluate their bioactivity for GBR applications in a series of in vitro and in vivo experiments. Electrospun chitosan membranes with different modifications were fabricated that enabled the controlled release of loaded/incorporated agents. SMV was released faster by AA and tBOC modified membranes than BA and HA modified membranes. SMV loaded membranes prevented soft tissue infiltration into the defect site and promoted better bone healing than non-loaded membranes in a rat calvarial defect model. A slow release of high SMV dose showed better bone healing than fast release of high or low dose. Membranes incorporated with magnesium were capable of stimulating angiogenesis in vitro. The AA modified membranes released more magnesium and thereby showed better angiogenesis than HA modified membranes. Osteogenic and angiogenic potential of our drug loaded chitosan membranes was successfully demonstrated. Since angiogenesis plays an important role in the bone healing process, future studies with dual loading of SMV and magnesium might prove useful in enhancing the ability of these membranes to stimulate better/faster bone regeneration

Nanoscale Solutions to Tailor Fiber Architectures for Realizing Composites with Triumvirate Properties

The paramount need for the development of multifunctional, smart and adaptive material systems for application in industries like automobile, aeronautical and aerospace is undeniable. Polymer composites are fast becoming the primary material options to this demand in light of their superior mechanical properties, low density, high corrosion resistance and easy manufacturability. The design flexibility offered in terms of achieving higher specific properties and light weighting is the key reason behind their success. Among all the properties that composites possess, it is the stiffness, strength and toughness that most applications mandate. These properties however, provide complimentary and contrasting characteristics for composites thereby limiting them for wide variety of applications. Hence it is critical to design composites with these triumvirate properties, which are capable of producing superior performance over their conventional counterparts. This research aims at providing solutions to this problem by altering the constituent material architectures. ‘Roding’ architecture, innovated via this study, is an integration between ‘Rod’ and ‘Dampening’ elements. This is an ingenious design capable of realizing the above mentioned triumvirate properties, comprising of ‘Rod’ elements that are capable of improving the strength and stiffness and ‘Dampening’ elements that can enhance the toughness. This overarching goal of realizing these triumvirate properties in a composite material system can be achieved through various methods like iterating the combinations and modifications of the nanofiller’s shape, size, topology, chemical composition and even the surface charge. In this thesis however, this concept was proven via realizing the ‘Roding’ architecture at a nanoscale by covalently coupling ‘Rod’ like single walled carbon nanotubes and ‘Damper’ like hyperbranched polymers. This concept can potentially be translated into micro and macro scales to suit the mass production needs of the transportation industry. The catch here is not to restrict ourselves to a particular morphology but to explore the possibilities of customizing the composite material’s morphology, as per application needs. Nanofillers with ‘Roding’ architecture were synthesized by optimizing the interplay between the individual nanoparticle’s shape, dimension, composition and interface. Integrating the triumvirate properties of strength, stiffness and toughness into the matrix by controlling the architecture of these nanofillers is the essence of this attempt. Once nanofillers with ‘Roding’ structure have been successfully synthesized, they were embedded into a thermoset matrix called ‘Diglycidyl ether of bisphenol-A’ (DGEBA). Techniques like FTIR, Raman, XPS, XRD, TGA, Gel Fraction, ATR and FE-SEM, have been used to characterize the physical, chemical and structural aspects of the hybrid ‘Roding Nanofillers’. This composite material then was also tested for its performance using standard tensile tests in order to analyze the properties of the material and the optimum loading ratios of the nanofillers. As expected the material exhibited increased strength and stiffness as well as mechanical toughness. A comprehensive study of potential applications of ‘Roding’ nanofillers into the more processable thermoplastic resins is presented. ‘Roding’ Nanofillers are but an example of the materials that can be custom made by engineering their morphology, to suit customer needs. In a gist, advanced nanocomposites with higher order smart architectures that have the potential to exhibit triumvirate properties of strength, stiffness and toughness have been synthesized and tested for performance

IN VITRO FREE RADICAL SCAVENGING ACTIVITY OF TEA TREE OIL AND CLOVE OIL

ABSTRACTObjective: To investigate the in vitro free radical scavenging activity of tea tree oil and the clove oil.Methods: Both tea tree oil and clove oil were tested by using phytochemical test, estimation of total phenolic content as well as various antioxidantsassays such as nitric oxide radical inhibition assay, hydrogen peroxide scavenging assay and 1-diphenyl 2-picrylhyorazyl (DPPH) assayResults: Both tea tree oil and clove oil possess antioxidants activity and in vitro free radical scavenging activity.Keywords: Scavenging activity, Tea tree oil, Clove oil, Antioxidant

Developing Communicative Competence of Engineering Students

This paper titled “Developing Communicative Competence in English of Engineering Students – Some Strategies” begins with an introduction on the importance of communicative competence for students of engineering courses to have a rosy future in the world of competitions and challenges. The paper, besides defining the terms ‘Communication’ and ‘Competence’ in an appropriate manner, moves with a detailed discussion on the text materials in English prescribed in technical institutes, and pinpoints the inclusion of essential components in the curriculum for the benefit of the students. The wrong notions about the process of communication are listed out and discussed in detail. The irregular approach in the system and the teaching-learning process is discussed with appropriate illustrations. It further underscores the importance of communication skills in terms of prosperity in both academic and professional life of students of engineering courses. The objectives of teaching and learning English both as a subject and as a language are highlighted in this paper. The paper stresses the role of teachers in enhancing the communicative competence of students and also shows some surveys recently taken in favour of engineers with communicative competence. The efforts on the part of the learners in the process of developing their communicative competence are also highlighted. The paper ends with some innovative and down-to-earth strategies for developing the communicative competence of students in the best possible ways.       Keywords: Communicative Competence, Engineering students, Teaching and Learnin