Microscopic Agglutination Test Analysis Identifies Prevalence of Intermediate Species Serovars in Ruminants in Endemic States of India

Serological survey was carried out in order to investigate the seroprevalence of leptospirosis in ruminants in coastal regions (flood prone areas) of endemic states (Andhra Pradesh, Gujarat, Kerala, Maharashtra and Tamil Nadu) of India using non-purposive samples collected during the year 2011 and 2012. A total of 553 serum samples (Cattle-332; Buffaloes-85; Goats-107 and Sheep-29) collected randomly from twenty one coastal districts of five states were tested at 1:100 dilution in microscopic agglutination test using 14 reference leptospira serovars. The overall seroprevalence of 24.96 % (138/553) with 20.48 % in cattle, 20 % in buffaloes, 58.62 % in sheep and 38.3 % in goats was observed. The results of χ² tests revealed that the seroprevalance in cattle across different districts (regions) in each of the surveyed states are not associated except in Kerala (χ² = 33.98, p < 0.05). In other species (buffalo, sheep and goat) also there is no association of seroprevalance across different districts in each of the states. Among the targeted endemic states, high prevalence was observed in Maharashtra (19/53 = 35.85 %) followed by Kerala (52/165 = 31.51 %), Andhra Pradesh (16/50 = 32 %), Gujarat (48/212 = 22.64 %) and Tamil Nadu (3/72 = 4.17 %). Out of 138 reacted sera, 37 samples showed multiple reactivities with 26.81 % prevalence. The predominant leptospiral antibodies were determined against frequency of distribution of the serovars Hardjo (28.99 %) followed by Kaup (18.12 %), Pomona (15.94 %), Bankinang (14.49 %). This study supports that ruminants may have a role in maintaining intermediate species serovar Kaup apart from being a well-known reservoir for Hardjo serovar in endemic states of India.     

Prevention of benzene-induced genotoxicity in bone marrow and lung cells: superiority of polyphenolic acetates to polyphenols

Previous investigations carried out in our laboratory have highlighted that 7,8-diacetoxy-4-methylcoumarin demonstrates a mechanism-based inhibition of cytochrome P450 (Cyt-P450) activities such as microsome-mediated aflatoxin B₁ (AFB₁) epoxidation, dealkylation of alkylated resorufin, and toxicokinetics of benzene. 7,8-Diacetoxy-4-methylcoumarin, quercetin pentaacetate, and ellagic acid peracetate were also found to be effective in giving the protection of AFB₁-induced genotoxicity in rat’s bone marrow and lung cells possibly due to acetylation of Cyt-P450 apoprotein mediated by acetoxy drug: protein transacetylase. Later, this transacetylase was identified as calreticulin, and the acetyltransferase function of calreticulin was appropriately termed calreticulin transacetylase. In this communication, we have focused on the superiority of several classes of polyphenolic acetates to polyphenols in the modification of Cyt-P450-linked mixed function oxidases (MFOs) such as 7-ethoxyresorufin O-deethylase (EROD) and pentoxyresorufin O-dealkylase (PROD). Special attention has also been focused on benzene-induced genotoxicity in bone marrow and lung cells. Results clearly indicated that polyphenolic acetates demonstrated time-dependent inhibition of Cyt-P450-linked MFOs, while parent polyphenols failed to demonstrate the same. Polyphenolic acetates were found to be more superior to polyphenols in preventing benzene-induced micronuclei formation. The pattern of inhibition of Cyt-P450-dependent MFOs and benzene-induced micronuclei formation by polyphenolic acetates was found in tune with their specificities to calreticulin transacetylase. These results further substantiated that inhibition of Cyt-P450-linked MFOs and benzene-induced genotoxicity in bone marrow and lung cells by polyphenolic acetates are mediated by the action of calreticulin transacetylase that catalyzes the acetylation of concerned proteins.     

Qualifying a quantitative approach to women’s expectations of continence surgery

Introduction and hypothesis  The objective of this study is to explore expectations and goals of women undergoing continence surgery using a combined quantitative and qualitative approach. Methods  Women with urinary incontinence, recruited from the waiting list, were assessed with a structured clinical interview, and these data were transcribed and analysed thematically (grounded theory). The Kings Health Questionnaire (KHQ) was used to determine incontinence impact on patient’s life. Results  Incontinence was objectively quantified using videocystourethrography. KHQ quantitative analysis suggested that the main domains affected were incontinence impact on life and physical limitations. However, qualitative analysis based on the interview found women were most affected by incontinence impact on physical or social limitation, sexual function, emotions and body image. Conclusion  Whilst disease-specific QoL questionnaires allow broad comparisons to be made assessing patient bother; they lack sensitivity to assess individual symptoms. A qualitative approach may individualise patient care and improve patient satisfaction and overall outcome.     

The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD

Patients with nonalcoholic fatty liver disease (NAFLD) and advanced liver fibrosis are at the highest risk for progressing to end-stage liver disease. We constructed and validated a scoring system consisting of routinely measured and readily available clinical and laboratory data to separate NAFLD patients with and without advanced fibrosis. A total of 733 patients with NAFLD confirmed by liver biopsy were divided into 2 groups to construct (n = 480) and validate (n = 253) a scoring system. Routine demographic, clinical, and laboratory variables were analyzed by multivariate modeling to predict presence or absence of advanced fibrosis. Age, hyperglycemia, body mass index, platelet count, albumin, and AST/ALT ratio were independent indicators of advanced liver fibrosis. A scoring system with these 6 variables had an area under the receiver operating characteristic curve of 0.88 and 0.82 in the estimation and validation groups, respectively. By applying the low cutoff score (-1.455), advanced fibrosis could be excluded with high accuracy (negative predictive value of 93% and 88% in the estimation and validation groups, respectively). By applying the high cutoff score (0.676), the presence of advanced fibrosis could be diagnosed with high accuracy (positive predictive value of 90% and 82% in the estimation and validation groups, respectively). By applying this model, a liver biopsy would have been avoided in 549 (75%) of the 733 patients, with correct prediction in 496 (90%). CONCLUSION: a simple scoring system accurately separates patients with NAFLD with and without advanced fibrosis, rendering liver biopsy for identification of advanced fibrosis unnecessary in a substantial proportion of patients.     

Comorbidities play a larger role in predicting health-related quality of life compared to having an ostomy

BACKGROUND: Previous research suggests an ostomy worsens health-related quality of life (HR-QOL), but comorbidities also can affect HR-QOL. METHODS: Eligible patients had abdominal operation with ostomy (cases) or similar procedure without ostomy (controls). Patients were recruited for this case-control study from 3 Veterans Affairs hospital medical and pharmacy records. Comorbidities were assessed with Charlson-Deyo Comorbidity Index. Multinomial logistic regression evaluated the impact of comorbidities and having an ostomy on HR-QOL, measured using the Medical Outcomes Study Short Form 36 for Veterans. RESULTS: A total of 237 ostomates (cases) and 268 controls were studied. Average age was 69 years; 64% of cases had colostomy, 36% ileostomy. Twenty-nine percent of patients had a high level of comorbidities. Cases and controls were similar except for reasons for undergoing surgery. High comorbidity was a significant predictor of low HR-QOL in 6 domains of the Short Form 36 for Veterans; having an ostomy was a significant predictor in 4. CONCLUSIONS: High comorbidity significantly influences low HR-QOL and impacted more domains than having an ostomy.     

Treatment of plastic bronchitis

Plastic bronchitis may be seen after palliative surgery for cyanotic heart disease. Although type II (acellular) casts are seen more commonly, we describe a type I cast after palliative surgery for cyanotic heart disease in which ligation of thoracic duct did not result in complete resolution.