A comparative study to determine the clinical efficacy of Ramipril versus combination of Ramipril and Telmisartan in reducing microalbuminuria associated with grade 2 hypertension

Inhibition of the renin-angiotensin system causes a reduction in urinary protein excretion. It is uncertain whether Angiotensin receptor blockers (ARBs) are equally effective antiproteinuric agents as Angiotensin converting Enzyme (ACE) inhibitors, or whether the combination of ACE inhibitors with ARBs is preferable to ACE inhibitor alone? Microalbuminuria is a prognostic marker for cardiovascular and renal risk. The objective of the study was to compare the clinical efficacy of Ramipril alone versus combination of Ramipril and Telmisartan by assessing the fall in B.P. and the improvement in the degree of microalbuminuria in stage II hypertensive patients. 60 patients of stage II hypertension without having any other cause of microalbuminuria were selected as subjects for the present study and were randomly distributed in to 2 groups- Group A included 30 patients who were given Ramipril 5 mg/ day and Group B included the same number of patients who were given a combination of Ramipril 5 mg/day and Telmisartan 40 mg/day. Baseline parameters included were measurement of Systolic, diastolic blood pressure and mean arterial pressure; microalbuminuria, blood urea, serum creatinine and serum potassium estimations. The drugs under trial were given for 20 weeks. Microalbuminuria was determined at 0 and 20 weeks. The mean percentage fall in microalbuminuria and mean arterial pressure were statistically highly significant (p<0.0001) with combination of Ramipril and Telmisartan (Group B) in comparison to Ramipril (Group A) alone. A highly significant (p‹ 0.0001) mean percentage increase in potassium level was observed in group B at the end of 20 weeks. The side effects were less observed in the combination group. Thus to conclude the combination of Ramipril and Telmisartan provides superior blood pressure (BP) lowering and target organ protection than Ramipril alone, hence the combination of Ramipril and Telmisartan is a better choice to treat and to prevent the progression of the disease.Keywords: Hypertension; Microalbuminuria; Ramipril; Telmisarta

A novel mutation in the Choroideremia gene in a Turkish family.

Choroideremia is an X-linked recessive genetic disorder caused by mutations in the CHM gene. It is a rare retinal dystrophy that manifests as nyctalopia and vision loss, progressing to blindness in later stages. We report a 21-year Turkish man who presented with nyctalopia for the past 4-5 years. His mother and maternal grandmother had similar, but less pronounced complaints. Fundus examination revealed pigmentary changes and retinal atrophy in both eyes. Optical coherence tomography showed outer retinal loss, with central island of preserved autofluorescence surrounded by absent autofluorescence on fundus autofluorescence examination. Goldmann visual fields were constricted. Microperimetry detected retinal sensitivity losses, and full-field electroretinogram demonstrated extinguished cone responses. Genetic analysis revealed a novel nonsense mutation in the CHM gene, namely p.E480X: c.1438G \u3eT. The mutation causes a premature stop codon in exon 12. This is the first report of a G1438T mutation resulting in an E480X premature stop in the CHM gene

Undesirable aliens: factors determining the distribution of three invasive bird species in Singapore

Biological invasions are a major environmental concern due to their negative impacts on biodiversity and economics. We determined the population sizes and habitat-abundance relationships of the three most successful invasive bird species in Singapore: the house crow Corvus splendens, white-vented myna Acridotheres javanicus and common myna A. tristis. Estimated population sizes of the three species between February 2000 and February 2001 were between 106 000–176 000, 122 000–155 000 and 20 000–29 000, respectively. Population size of the house crow grew dramatically (>30-fold) in the last 15–16 y while that of the white-vented and common myna declined. Habitat–abundance relationships suggest that house crows are highly dependent on anthropogenic food. Their abundance was also positively related to proximity to coast. The common myna associated closely with agricultural areas while the white-vented myna probably preferred urban greenery among residential buildings. Our study shows that the three invasive bird species associated with different aspects of human-modified environment.Haw Chuan Lim, Navjot S. Sodhi, Barry W. Brook and Malcolm C. K. So

Acute superior vena cava obstruction due to tight pericardial closure following congenital defect repair

The obstruction of the superior vena cava (SVC) of acute onset nature following surgery is a rare and serious condition. The tight closure of the pericardium over the heart during surgical procedures may cause external compression on the SVC. Echocardiography and Computed tomography (CT) scan aids in the diagnosis. Cutting open the pericardial stitches relieves the condition

Persistence of lowland rainforest birds in a recently logged area in central Java

In 2001 and 2002, we assessed avian richness in Linggoasri (central Java) where almost all lowland rainforest had been cleared 3 years previously. Bird surveys were carried out in a selectively-logged forest, two regenerating forests and one pine Pinus merkusii plantation. A comparison with a bird list complied at least 3 years prior to logging in Linggoasri showed that 10 lowland bird species may have been extirpated from this area following logging. However, further surveys will be needed to validate these extirpations. A comparison with a list of lowland forest birds of Java shows that only 37% of these occurred in Linggoasri. From the lowland avifauna of Java, sole frugivores and insectivores were less likely to be present in Linggoasri. Smaller, generalist-feeding lowland species, endemic to Java, were more likely to be present in this area. Persisting lowland bird species, however, did not appear to be seriously affected physiologically by habitat degradation, showing no significant loss of body condition or reduction in survival and reproduction. There is an urgent need to preserve the few remaining lowland forest patches of Java and, given the alarming rate of deforestation throughout Southeast Asia, it is critical to conserve adequately large primary lowland forests (e.g. >5,000 ha) if we are to preserve existing lowland avifauna.Navjot S. Sodhi, Malcolm C. K. Soh, Dewi M. Prawiradilaga, Darjono And Barry W. Broo

Global economic trade-offs between wild nature and tropical agriculture

Global demands for agricultural and forestry products provide economic incentives for deforestation across the tropics. Much of this deforestation occurs with a lack of information on the spatial distribution of benefits and costs of deforestation. To inform global sustainable land-use policies, we combine geographic information systems (GIS) with a meta-analysis of ecosystem services (ES) studies to perform a spatially explicit analysis of the trade-offs between agricultural benefits, carbon emissions, and losses of multiple ecosystem services because of tropical deforestation from 2000 to 2012. Even though the value of ecosystem services presents large inherent uncertainties, we find a pattern supporting the argument that the externalities of destroying tropical forests are greater than the current direct economic benefits derived from agriculture in all cases bar one: when yield and rent potentials of high-value crops could be realized in the future. Our analysis identifies the Atlantic Forest, areas around the Gulf of Guinea, and Thailand as areas where agricultural conversion appears economically efficient, indicating a major impediment to the long-term financial sustainability of Reducing Emissions from Deforestation and forest Degradation (REDD+) schemes in those countries. By contrast, Latin America, insular Southeast Asia, and Madagascar present areas with low agricultural rents (ARs) and high values in carbon stocks and ES, suggesting that they are economically viable conservation targets. Our study helps identify optimal areas for conservation and agriculture together with their associated uncertainties, which could enhance the efficiency and sustainability of pantropical land-use policies and help direct future research efforts.Luis R. Carrasco, Edward L. Webb, William S. Symes, Lian P. Koh, Navjot S. Sodh

Decision support for crew rostering at NS

This paper describes a method for solving the cyclic crew rostering problem (CCRP). This is the problem of cyclically ordering a set of duties for a number of crew members, such that several complex constraints are satisfied and such that the quality of the obtained roster is as high as possible. The described method was tested on a number of instances of NS, the largest operator of passenger trains in the Netherlands. These instances involve the generation of rosters for groups of train drivers or conductors of NS. The tests show that high quality solutions for practical instances of the CCRP can be generated in an acceptable amount of computing time. Finally, we describe an experiment where we constructed rosters in an automatic way for a group of conductors. They preferred our—generated—rosters over their own manually constructed rosters

Post-Operative Carbonate-Apatite Formation in PEO/PBT Copolymers (Polyactive®)

Previous studies have stressed the importance of calcification of the polyethylene oxide (PEO) I polybutylene terephthalate (PBT) copolymer surface by establishing a direct relation with the occurrence of bone-bonding. Here, we characterized the morphology as well as the composition of this post-operative reaction product in PEOIPBT copolymers. X-ray · photoelectron spectroscopical results demonstrated the ability of PEOIPBT copolymers to rapidly adsorb calcium ions from fluids. After subcutaneous implantation in rats, it was shown that polymer calcification comprised plate-shaped crystals, whereas an electron-dense layer was frequently encountered at the interface. Cells with a characteristic morphology were directly apposed to abundantly calcified surfaces, indicating the biocompatible nature of the material. Subcutaneous calcification was composed of a carbonate-apatite structure with a crystallinity comparable to bone mineral as demonstrated by Fourier transformed infrared spectroscopy and X-ray diffraction. It was concluded that the post-operative reaction product in PEOIPBT copolymers is, in morphology and composition, highly comparable to the carbonate-containing apatitic surface layer generated on acknowledged bioactive substrates and similar to the inorganic phase of bone apatite. This may, partially, explain the bone-bonding behaviour of PEOIPBT copolymers

Existence of a Strong Correlation of Biomarkers and Mirna in Females With Metabolic Syndrome and Obesity in a Population of West Virginia

Objectives: Metabolic syndrome causes complications like cardiovascular disease and type 2 diabetes mellitus (T2DM). As metabolic syndrome develops, altered levels of cytokines and microRNAs (miRNA) are measurable in the circulation. We aimed to construct a panel detecting abnormal levels of cytokines and miRNAs in patients at risk for metabolic syndrome. Methods: Participants included 54 patients from a Family Medicine Clinic at Marshall University School of Medicine, in groups of: Control, Obese, and Metabolic Syndrome (MetS). Results: Serum levels of leptin, adiponectin, leptin: adiponectin ratio, IL-6, six miRNAs (320a, 197-3p, 23-3p, 221-3p, 27a-3p, and 130a-3p), were measured. Among the three groups, leptin, and leptin: adiponectin ratio, and IL-6 levels were highest in MetS, and levels in Obese were greater than Control (p\u3e0.05). Adiponectin levels were lower in Obese compared to Control, but lowest in MetS (p0.05). Conclusion: Our results support the clinical application of biomarkers in diagnosing early stage MetS, which will enable attenuation of disease progression before onset of irreversible complications. Since West Virginians are high-risk for developing MetS, our biomarker panel could reduce the disease burden on our population

Grappling at the Grassroots: Access to Justice in India\u27s Lower Tier

From 2010 to 2012, a team of academic and civil society researchers conducted extensive ethnographies of litigants, judges, lawyers, and courtroom personnel within multiple districts in three states: Maharashtra, Gujarat, and Himachal Pradesh. This Article provides an in-depth account of the everyday struggles these actors face in the pursuit of their respective objectives. The findings illustrate a complex matrix of variables-including infrastructure, staffing, judicial training and legal awareness, costs and continuances, gender and caste discrimination, power imbalances, intimidation and corruption, miscellaneous delays, and challenges with specialized forums-impact access to justice in the lower tier. The results of this study offer competing yet complementary narratives. On one hand, there is immense despair, frustration, and anger among the various sets of respondents about the current state of the lower tier. At the same time, however, there is great hope and optimism among individuals who work in the judicial sphere, as well as litigants desperately seeking to gain relief from long-endured grievances, toward what the lower tier can offer. Indeed, if the lower tier is empowered with greater resources and certain perverse aspects of the legal system can he reformed, it has vast potential to promote social change that advances the socioeconomic status of India\u27s most disadvantaged groups