Sequential analysis of erythrocyte aggregation in P. falciparum malaria with and without ASAQ therapy by optical signal and image analysis

The aggregation of erythrocytes is an important mechanism for blood flow through the cardiovascular system. In malaria, this is complicated by infection caused by P. falciparum and is further complicated by the severity of parasitemia. Hence analysis of this micro-mechanism is essential to know the changes in blood not only in diseased conditions but also after artemisinin combination therapy (ASAQ) to alleviate suffering. For analysis purposes, aggregation of erythrocytes was determined by LED laser aggregometer, represented in terms of various parameters related to the changes in laser transmitted intensity. Formed aggregates are further analyzed by imaging and image-processing methods. For this study blood samples from young adults (18 – 40 years old) infected with P. falciparum (n= 80), without any other serious illness, were performed. These samples were selected based on the severity of parasitemia, and were divided into low (LP), medium1 (MP1), medium 2 (MP2), and high (HP) parasitemia. For three days, the selected individuals were treated with artemisinin-based combination therapy ASAQ (Artesunate 4 mg/kg and amodiaquine 10 mg base/ kg once a day). Healthy subjects (n=20) without any history of the disease were selected as a control group. The results, as obtained by various parameters, show a significant elevation of aggregation of erythrocytes (P< 0.05) in P. falciparum malaria with the increase of parasitemia level. There was a decrease in the aggregation after treatment on day four tending towards normal. Thus the current study shows the potential beneficial role of ASAQ on erythrocytes aggregation, which may contribute to reducing the harmful effects on various organs in P. falciparum-infected blood.

ASSESSMENT OF CONCENTRATION LEVEL REPORTS: IMPLICATION TO IMPROVE ON HUMAN CONCENTRATION WITH AN ENHANCEMENT PROGRAM/TOOL FOR LEARNERS.

Background: Everyone has a different brain programming some people have a brilliant concentration but some people struggle to focus on things or to pay attention. This, research is focused on the importance of concentration for learners as the previous studies also concluded that higher levels of concentration are vulnerable to distractions. Hence this research is intended to assess the reports generated from the Aimtest tool administered by 8 Infinity Education Research group in India with the end view of identifying its implication to enhance the human concentration level. Materials and Methods: This prospective study operates on evocative research method which involved the use of documentary analysis, questionnaires and interviews with voluntary opted respondents carried by researchers' approach and analysis pertaining to the content of the data. In this pilot study, we recruited 159 individuals age 8 to 20 yearsResult: between the academic standard levels 4th to 12th who were chosen after consent for this assessment. The Aimtest calculated their Memory, concentration level and, reading speed with the proven formulas. We have found overall 83.64% satisfaction rate among all the categories. Based on the descriptive research our findings suggestConclusion: that this tool can be used to enhance the concentration level as well as it can also be embodied in academic institutions to improve on the learning ability of students.

DAKSH: Digital Partograph and Intrapartum Monitoring Mobile Application

Study design: This is a cross-sectional study which reports the development and pilot of a digital mobile partograph application in 5 primary healthcare centers of North Karnataka, India. Background: The DAKSH is a tablet-based application designed to improve care for women in the intrapartum period by addressing the issue related to paper partograph usage. Application is designed to provide real-time labor monitoring, basic decision making support by alerts and better record-keeping. The primary objective of the study was to evaluate the feasibility and acceptability of mobile partograph in low resource primary healthcare centers. Methods: The digital partograph was introduced at 5 primary healthcare centers in North Karnataka, India. Following 2 days of training, remote monitoring was done through a dashboard and a bi-monthly evaluation visit was conducted. Results were analyzed in terms of quantitative analysis (data filled into the application was compared against hospital records) and qualitative analysis (during each bi-monthly visit staff nurses were interviewed). Results: A total of 10 staff nurses from these healthcare centers used the application to monitor 424 pregnancies for a period of 10-months. During this period the hospital observed around 463 childbirths and out of which 91.56% (n=424) were recorded into the application. Conclusion: This shows good acceptability of application among staff nurses. Plotting of partograph, auditory reminders to monitor labour vitals were helpful.

Sequential functional analysis of left ventricle from 2D-echocardiography images.

The sequential changes in shape of left ventricle (LV), which are the result of cellular interactions and their levels of organizational complexity, in its long axis view during one cardiac cycle are obtained. The changes are presented in terms of shape descriptors by processing of images obtained from a normal subject and two patients with dilated left ventricular cardio-myopathy. These images are processed, frame by frame, by a semi-automatic algorithm developed by MATLAB. This is consisting of gray scale conversion, the LV contour extraction by application of median and SRAD filters, and morphological operations. By filling the identified region with pixels and number of pixels along its contour the area and perimeter are calculated, respectively. From these the changes in LV volume and shape index are calculated. Based on these the stroke volume (SV) and ejection fraction (EF) are calculated. The changes in LV area, perimeter, volume and shape index in cardiac patients are less than that of normal subject. The calculated SV and EF of normal subject are within the range as obtained by various imaging procedures.

Digital analysis of changes by Plasmodium vivax malaria in erythrocytes.

Blood samples of malaria patients (n = 30), selected based on the severity of parasitemia, were divided into low (LP), medium (MP) and high (HP) parasitemia, which represent increasing levels of the disease severity. Healthy subjects (n = 10) without any history of disease were selected as a control group. By processing of erythrocytes images their contours were obtained and from these the shape parameters area, perimeter and form factor were obtained. The gray level intensity was determined by scanning of erythrocyte along its largest diameter. A comparison of these with that of normal cells showed a significant change in shape parameters. The gray level intensity decreases with the increase of severity of the disease. The changes in shape parameters directly and gray level intensity variation inversely are correlated with the increase in parasite density due to the disease.

Localization and characterization of tissue changes by laser backscattering imaging and Monte Carlo simulation.

Laser backscattering from biological tissues depends on their composition and blood flow. The onset of the tissue abnormalities is associated with the change in composition at a specific location which may affect laser backscattering. The objective of the present work is to detect the compositional changes in tissue-equivalent phantom of fat, prepared by mixing paraffin wax with wax colors, and to characterize these in terms of their optical parameters. For this purpose these phantoms are scanned by a multi-probe non-contact automatic laser scanning system and images of the normalized backscattered intensity (NBI) are constructed. By scanning the background subtracted image of the phantom the location of the abnormality and its size from the full width at half maximum (FWHM) are determined. The data obtained by ultrasonic technique for localization of the abnormalities are in agreement with that as obtained by the present method. The optical parameters of the abnormality are obtained by matching the measured surface profiles of the abnormality with that of the profile obtained by Monte Carlo simulation. This analysis shows the possibility of detection of changes at the onset stage in tissues as required for planning of the photodynamic therapy.

Psychosocial effect and economic burden on parents of children with locomotor disability.

Objective. To assess the social and financial burden on parents of children with locomotor disability. Methods. A cross-sectional study was conducted in the Institute for Physically Handicapped (IPH), Delhi, where parents of 100 locomotor disabled children of age group 6 to 15 years were interviewed to estimate the socioeconomic burden of caregiving their children. Results. The study observed that the parents of the disabled children were severely burdened in terms of financial burden and mental health. Conclusions. There is an urgent need for support activities for such families at a national level in order to curb the huge economic and social burden of care-giving. Counselling should be an integral part of rehabilitat ion for such families.

Changes in erythrocyte aggregation and deformability in diabetes mellitus: a brief review.

Diabetes mellitus (DM) is a metabolic disorder characterized by varying or persistent hyperglycemia either due to insufficient production of insulin by pancreas or improper utilization of the glucose. Erythrocytes remain in hyperglycemic environment throughout their life span and thus are subjected to series of compositional changes, which in turn affect their flow properties through alteration of deformation at individual level and aggregation at collective level. This brief review summarizes the changes in biochemical parameters primarily contributing to the erythrocyte deformability and aggregation as measured by various techniques, of blood samples obtained from diabetic subjects. The significant changes in erythrocyte aggregation and deformability, in comparison with that of control subjects show the relevance of these measurements. These changes are further supported by in vivo observations of blood flow through microvessels. Finally the relevance of these in combination with other clinical parameters is suggested.

Erythrocyte deformability and its variation in diabetes mellitus.

Erythrocyte deformability improves blood flow in the microvessels and in large arteries at high shear rate. The major determinants of RBC deformability include cell geometry, cell shape and internal viscosity (i.e., mean cell hemoglobin concentration and components of the erythrocyte membrane). The deformability is measured by several techniques but filtration of erythrocytes through micro-pore membranes and ektacytometry are two sensitive techniques to detect changes in erythrocytes under varied experimental and diseased conditions. Diabetes mellitus (DM) is a metabolic disorder, characterized by varying or persistent hyperglycemia, which induces several changes in the erythrocyte membrane and its cytoplasm, leading to alteration in the deformability. A decreasing trend of deformability in these patients is observed. The shape descriptor form factor, as determined by processing of erythrocyte images, increases with the increase of blood glucose levels and shows a pattern similar to filtration time of erythrocyte suspensions through cellulose membranes. Fluidity of the membrane as measured in erythrocytes of these patients is decreased. With prolonged diabetic conditions the deformability of erythrocytes is further decreased, which may complicate the flow of these cells in microvessels.

Urbanization and coronary heart disease: a study of urban-rural differences in northern India.

BACKGROUND: In the West, urbanization has been accompanied by a rise in the rate of coronary heart disease. This trend has gone hand in hand with an increased consumption of processed, energy-dense food and dependence on machines for physical work. To examine whether a similar trend is underway in northern India, the prevalence of and risk factors for coronary heart disease were compared in rural, semi-urban and urban communities. METHODS AND RESULTS: A total of 7,169 adults were interviewed and examined during 1995-2000 in cross-sectional cluster sample surveys from a rural area of Haryana (Raipur Rani block), two semi-urban areas of Punjab (Mandi Gobindgarh and Morinda), and Chandigarh city. The study, which covered people in the age-group of 35+ years, also estimated the lipid, glucose and insulin levels of a sub-sample of 186 persons who did not have coronary heart disease or hypertension. The prevalence of coronary heart disease among males in the villages, towns and city was 1.7%, 2.5% and 7.4%, respectively, and among females, 1.5%, 3.4% and 7.1%,respectively. The age- and sex-adjusted prevalence odds ratio of coronary heart disease, in comparison to the villages, was 1.9 (95% CI; 1.1-3.2) in the towns and 4.9 (95% CI: 2.9-8.2) in the city. Hypertension, diabetes, obesity and physical inactivity were significantly more common in the urban areas, while the rate of tobacco smoking was significantly higher in the rural areas ( p< 0.05). The alcohol consumption rates for the urban and rural communities were similar (p> 0.05). The quantity of the food items commonly consumed, as well as the frequency with which particular items were consumed, varied across the rural, semi-urban and urban areas ( p< 0.05). The urban population had significantly higher levels of lipids and serum insulin than did the rural population, but a lower level of plasma glucose ( p< 0.05). CONCLUSION: The urban way of living is leading to an increase in the prevalence of the well-known risk factors for, as well as the rate of, coronary heart disease. Attempts to preserve the traditional lifestyle are necessary in order to prevent an epidemic of coronary heart disease in the developing countries.

Influence of malaria parasite (P. vivax) on erythrocyte aggregation: a study based on dynamic imaging and analysis.

Malaria due to P. vivax (PV) is prevalent in many countries. The present work is aimed to determine the cell-cell interaction through formation of aggregates under dynamic conditions. Blood samples are obtained from patients (n=11) suffering from PV malaria, and the normal subjects (n=10) in test tubes containing citrate phosphate dextrose (10:1.4), as an anticoagulant. The signature analysis of infected erythrocytes shows significant alterations in their shape and membrane. For aggregation analysis, erythrocyte suspension in plasma at hematocrit 5%, was placed in a glass chamber and mounted vertically on the stage of the video-microscope system. The aggregate images thus acquired show erythrocytes adhering with each other to form mash-like structures. With increase in parasitaemia, the erythrocytes show hyper-aggregation compared to that of normal cells. By processing of the sequence of recorded images during sedimentation, the various aggregation parameters are obtained. These parameters show that the formed aggregates are compact which produce distinct changes in sedimentation pattern with significantly higher sedimentation velocity compared to that in healthy blood samples. These changes in malaria could partly be responsible for alteration in blood flow through microcirculatory system.

Image reconstruction of optical attenuation coefficient variation in biological tissues.

A procedure for non-invasive imaging of the optical attenuation coefficient variation of in vivo thick organs/tissues is developed. The laser back-scattered surface profiles at various locations of human forearm, by multi-probe reflectometer, are measured. These profiles are matched by iterative procedure, with that as obtained by Monte Carlo simulation and the corresponding values of attenuation coefficient (equal to the sum of absorption and reduced scattering coefficients) are determined. By interpolation of this data a 100 x 100 grid is constructed and after median filtering of this data a color-coded image of the variability of the optical attenuation coefficient of the forearm is obtained. These images in different subjects show variation due to change in overall tissue composition and blood pooling. This non-invasive imaging procedure may help in identifying the diseased affected regions in healthy tissues and in application of photodynamic therapy.

Development of biological tissue-equivalent phantoms for optical imaging.

Optical characteristics of freshly isolated tissues depend on their color and composition. The surface backscattered profile, which account for the tissue compositional variation in fresh excised sheep's heart, lungs, bone and muscle, were measured by multi-probe reflectometer. Optical phantoms were prepared from paraffin wax by mixing a specific combination of wax color materials till the surface backscattered profile of these matched with that of the biological tissues. The optical parameters absorption coefficient (micro(a)), reduced scattering coefficient (micro(s)) and anisotropy factor (g) of these phantoms, are the same as that of biological tissues and are obtained by matching their surface backscattered profiles with that as simulated by Monte Carlo procedure. The maximum and minimum values of absorption coefficient are for the phantoms of lungs (1.0 cm(-1)) and muscle (0.02 cm(-1)), whereas, for scattering coefficient these values are for muscle (21.2 cm(-1)) and bone (13.08 cm(-1)).