Respiratory questionnaire‐based analysis of awareness of COPD in a large multicenter rural population‐based study in India

BackgroundChronic obstructive pulmonary disease (COPD) is a more prevalent chronic lung disease with a significant health burden, and the majority of these cases receive inadequate treatment.MethodsProspective, observational, interview (questionnaire) based complete workup COPD study, screened 12,000 cases with chronic respiratory symptoms with cough, sputum production, and shortness of breath. A total of 6000 COPD cases were enrolled after the spirometry test. COPD cases were assessed as disease knowledge and methods of treatment offered by applying questionnaires to patients and treating physicians.ResultsIn the present study, 3% of study cases were aware of their COPD illness, 54% were not having knowledge about the disease, and 43% cases were not accepting the COPD diagnosis (p < 0.0001). A total of 58% of cases received inhalation treatment as levosalbutamol monotherapy in 31% cases, levosalbutamol plus beclometasone in 18% cases, and formoterol plus budesonide or salmeterol plus fluticasone only in 9% of COPD cases (p < 0.0001). Total 42% cases received oral treatment as theophylline in 16% cases, salbutamol in 7% cases, oral steroids in 19% cases (p < 0.0001).Conclusion“Doctor–patient–drug trio” discordance clubbed as “difficult doctor, difficult patient, and difficult treatment” is a very crucial issue observed during diagnosis and management of COPD in peripheral settings in India.     

A nutrient relay sustains subtropical ocean productivity

The expansive gyres of the subtropical ocean account for a significant fraction of global organic carbon export from the upper ocean. In the gyre interior, vertical mixing and the heaving of nutrient-rich waters into the euphotic layer sustain local productivity, in turn depleting the layers below. However, the nutrient pathways by which these subeuphotic layers are themselves replenished remain unclear. Using a global, eddy-permitting simulation of ocean physics and biogeochemistry, we quantify nutrient resupply mechanisms along and across density surfaces, including the contribution of eddy-scale motions that are challenging to observe. We find that mesoscale eddies (10 to 100 km) flux nutrients from the shallow flanks of the gyre into the recirculating interior, through time-varying motions along density surfaces. The subeuphotic layers are ultimately replenished in approximately equal contributions by this mesoscale eddy transport and the remineralization of sinking particles. The mesoscale eddy resupply is most important in the lower thermocline for the whole subtropical region but is dominant at all depths within the gyre interior. Subtropical gyre productivity may therefore be sustained by a nutrient relay, where the lateral transport resupplies nutrients to the thermocline and allows vertical exchanges to maintain surface biological production and carbon export.

The sinking of particulate organic carbon from the sunlit euphotic zone into the deeper, dark ocean maintains an oceanic reservoir of dissolved inorganic carbon, changes in which can significantly modify atmospheric CO₂ (1). The ocean’s subtropical gyres exhibit low surface concentrations of nutrients and biomass but, due to their very large surface area, may contribute a significant fraction of global export. For example, the North Pacific subtropical gyre is estimated to represent ~20 to 50% of the total North Pacific organic sinking flux (2, 3). The wind forcing over the subtropical basins leads to a downward doming of the density surfaces that contain an extensive volume of low-nutrient waters (4), as revealed in an observed transect from the North Pacific (Fig. 1) (5). The mode of nutrient resupply and the long-term maintenance of biological productivity in subtropical gyres have presented a conundrum for several decades. Inorganic nutrients are incorporated into photosynthetic phytoplankton and pass through the food web, but despite efficient recycling within the sunlit euphotic zone (6, 7), gravitational sinking and the subduction of organic matter deplete the surface nutrients of the subtropical gyres. These surface nutrient losses are largely viewed as being offset by the physical transport of nutrient-enriched, deeper waters back into the sunlit zone, together with smaller contributions from atmospheric deposition and nitrogen fixation. However, the nature of the nutrient pathways recharging the subtropical nutrient reservoir below the euphotic zone remains poorly constrained.Open in a separate windowFig. 1.PO43− concentration (μmol kg⁻¹) in the North Pacific basin obtained from the Global Ocean Data Analysis Project (GLODAP) V2.2 atlas and plotted using Data-Interpolating Variational Analysis (DIVA) gridding in Ocean Data View. (A) Transect along 155 ^∘W, with contours of constant density σ_o (thick dashed lines) and sampling locations (gray points). The solid black line indicates the σ_o = 26.0 surface. (B) PO43− distribution along σ_o = 26.0 with sampling locations indicated by gray points.The sharp vertical gradient of nutrients just below the euphotic layer can sustain the vertical supply of nutrients up to the surface. Transfer of nutrients upward into the subtropical euphotic zone has been attributed to vertical diapycnal mixing (8–11); the passage of mesoscale eddies, which adiabatically lift nutrient-rich, subeuphotic layers into the light (12–19); and submesoscale (1 to 10 km) features that are associated with strong vertical circulations (20–24). However, all of these localized processes deliver nutrients into the euphotic layer while depleting the subeuphotic layers below (17, 25). A long-standing question is how the nutrient inventory of this subeuphotic layer, which fuels the local vertical supplies, is maintained over the longer term (26, 27).At the flanks of the subtropical gyre, wind-driven upwelling brings nutrient-rich waters toward the surface, forming nutrient gradients in the subpolar and equatorial regions, as seen in observed transects (Fig. 1A). Within the frictional boundary layer of the ocean, the wind-driven, meridional Ekman transport acts on these lateral gradients to transfer nutrients into the subtropical gyre, significantly supplementing vertical processes in sustaining local productivity (4, 28, 29). However, this lateral transport contribution is confined to the upper few tens of meters and diminishes away from the gyre margins due to biological consumption (4).Mesoscale eddies can provide a lateral transport of nutrients, which involves both stirring and advective transfer along density surfaces (11, 17, 25, 30, 31). Idealized simulations and theory suggest an important combined nutrient supply to the gyre from lateral eddy diffusion and Ekman transport (30). Diagnostics of a more realistic, global eddy-resolving model show that lateral eddy transfers do provide an important nutrient flux across the boundaries of the subtropical gyre (31). Stimulated by these model-based inferences, an observational field study, measuring microscale turbulence and nutrients, reveal signals of eddy stirring along density surfaces, providing a weak nutrient supply within the thermocline over the center of the North Atlantic subtropical gyre (11). A closure for the nutrient supply then suggests that the nutrient delivery by mesoscale eddy stirring should be one to two orders of magnitude larger over the flanks of the subtropical gyre due to an increase in nutrient gradients and a greater tilt of the density surfaces (11). These enhanced nutrient gradients and isopycnal slopes are evident near the margins of the subtropical gyre, particularly at its southern flank, between σ₀ = 24.0 and 26.5 (Fig. 1). An eddying numerical simulation reveals the associated mesoscale flux of nutrients, visible as streamers of high-phosphate waters emanating from nutrient-rich currents all around the margins of the subtropical gyre (Fig. 2A and Movie S1).Open in a separate windowFig. 2.Snapshot of simulated PO43− concentration (mmol m⁻³) during the month of September and along the σ₀ = 26.0 isopycnal (A) over the north subtropical Pacific basin and (B) in the proximity of the Hawaiian islands. The black line contours in B depict the depth of the isopycnal surface with 10-m contour intervals. Mesoscale features transport nutrients into the North Pacific subtropical gyre through the combined action of eddy stirring that draws out filaments of tracer and advection by coherent eddy structures.In this study, we quantify the nutrient pathways and fluxes of the subtropical North Pacific Ocean, in the context of a global eddy-permitting numerical model with explicit representation of biogeochemical and ecological processes (Materials and Methods). In doing so, we test and illustrate the hypothesis of ref. 11 that the lateral eddy transfer contribution is stronger at the gyre margins and in the thermocline. Complementing previous work (31), we resolve along- and across-density surface fluxes and the depth and intragyre structures in fluxes and balances, as well as the contribution of dissolved organics.We find that a nutrient relay occurs in the subtropical gyre (11), involving the eddying transfer of nutrients from the upwelling flanks of the gyre, downward along sloping isopycnals into the subtropical gyre interior. This nutrient supply into the thermocline offsets the export of organic matter to the deep ocean and fuels upward vertical transfer to the surface, helping to sustain biological production in the euphotic layer. We illustrate this nutrient relay in the following, detailed analysis of the nutrient budget for density layers over the North Pacific subtropical gyre.     

Maternal serum and fetal cord-blood ischemia-modified albumin concentrations in normal pregnancy and preeclampsia: a systematic review and meta-analysis

Background/aims: A meta-analysis of maternal serum ischemia-modified albumin (IMA) and fetal cord-blood IMA concentrations in normal pregnancy (NP) compared to non-pregnant healthy controls (HC) and in preeclampsia (PE) compared with normal pregnant controls were studied.

Methods: All major databases were searched for eligible studies. We included eight studies comparing serum IMA between NP and HC, 14 studies comparing serum IMA between PE and NP and five studies comparing cord-blood IMA between PE and NP groups. Meta-analyses on these included studies were performed using Review Manager 5.3. Pooled-overall effect size as standardized mean difference (SMD), publication bias, subgroup, and sensitivity analysis data were generated.

Results: Random-effects meta-analysis indicated a significant increase in serum IMA in the NP group (SMD?=?0.98, p?=?.01) and the PE group (SMD?=?0.94, p?p?Conclusions: This meta-analysis, the first of its kind showed that the increased serum IMA concentrations were indicative of increased oxidative stress in NP and PE. Measurement of maternal serum IMA and fetal cord-blood IMA concentrations were useful as simple, novel, and inexpensive markers of oxidative stress (OS) status in PE patients. Future large-scale studies are needed to explore IMA in relationship to the disease severity in PE.     

Skeletal metastases from a granulosa-cell tumor of the ovary: Report of a case diagnosed by fine-needle aspiration cytology

We report on the fine-needle aspiration cytological findings of a metastatic granulosa-cell tumor of the ovary to bone. The patient had undergone resection of a primary ovarian granulosa-cell tumor 15 yr prior to her last admission. Recently she injured her right hip, sustained after a fall. CT examination revealed hypodense lesions involving the posterior body and the right pedicle of the L1 vertebra. The aspirate from the bone yielded a highly cellular smear, composed of round to oval cells with scanty cytoplasm. Many of the cells revealed the presence of nuclear grooves. In areas, the cells were arranged in clusters resembling Call-Exner bodies. The rarity of skeletal metastases from granulosa-cell tumors can cause diagnostic difficulty in diagnosing this entity. Accurate clinical data, radiological findings, and cytological features are important in arriving at the correct diagnosis. Diagn. Cytopathol. 1998;19:375–377. © 1998 Wiley-Liss, Inc.     

Sperm chromosomal abnormalities are linked to sperm morphologic deformities

OBJECTIVE: To describe the association between specific sperm morphologic abnormalities and sperm chromosomal abnormalities on multicolor interphase fluorescence in situ hybridization (FISH). DESIGN: Case report.Reproductive medicine unit in a tertiary referral center. PATIENT(S): Three infertile men with severe oligoasthenospermia and total teratozoospermia who were referred for IVF treatment. MAIN OUTCOME MEASURE(S): Incidence of spermatozoal chromosomal aneuploidy for chromosome 18 and the sex chromosomes by using FISH. RESULT(S): Morphologic assessment of sperm revealed a high incidence of double heads, multinucleated sperm heads, and multiple tails. Hormone profiles and karyotyping of peripheral lymphocytes were normal in the three men. The proportion of sperm with disomy, trisomy and tetrasomy for chromosome 18, and the sex chromosomes in each patient was 100%, 76%, and 82.5%, respectively. CONCLUSION(S): Specific morphologic abnormalities of sperm may be associated with higher incidence of chromosomal abnormalities. Resolving infertility by offering patients in vitro fertilization/intracytoplasmic sperm injection must be approached with caution because of the significant risk for embryonic aneuploidy and chromosomal abnormalities in any subsequent offspring.     

A clinical study of infants presenting to a mental retardation clinic

Early detection has a central role in the prevention and management of mental retardation. The purpose of this present study is to delinerate the characteristics of developmentally delayed infants and their families attending Mental Retardation Clinic. The sample consisted of 101 infants who were registered in Mental Retardation Clinic of NIMHANS, Bangalore in 1988 constituting 12.5% of total registrations. Data was collected from case records. Majority of subjects were males, first or second born, 7 months or older, from a consanguineous lower or middle class family. Along with developmental delay, 60% had other complaints. Medical problems were reported in about half of the subjects and most had abnormalities on physical examination. Aetiology was discernible in 77.1%. Majority had associated physical disorder such as cerebral palsy, seizures and hearing and/or visual impairment. Around 17% came for follow-up thrice or more, 43% dropped out after work-up. The main conclusions are that; (i) certain socio-demographic, personal and clinical variables influence treatment seeking, and (ii) developmental delay recognised in infancy tends to be associated with clear aetiologic factors and significant medical/neurologic problems.