Gut microbiota in pathophysiology, diagnosis, and therapeutics of inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a multifactorial disease, which is thought to be an interplay between genetic, environment, microbiota, and immune-mediated factors. Dysbiosis in the gut microbial composition, caused by antibiotics and diet, is closely related to the initiation and progression of IBD. Differences in gut microbiota composition between IBD patients and healthy individuals have been found, with reduced biodiversity of commensal microbes and colonization of opportunistic microbes in IBD patients. Gut microbiota can, therefore, potentially be used for diagnosing and prognosticating IBD, and predicting its treatment response. Currently, there are no curative therapies for IBD. Microbiota-based interventions, including probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, have been recognized as promising therapeutic strategies. Clinical studies and studies done in animal models have provided sufficient evidence that microbiota-based interventions may improve inflammation, the remission rate, and microscopic aspects of IBD. Further studies are required to better understand the mechanisms of action of such interventions. This will help in enhancing their effectiveness and developing personalized therapies. The present review summarizes the relationship between gut microbiota and IBD immunopathogenesis. It also discusses the use of gut microbiota as a noninvasive biomarker and potential therapeutic option.

Utility of platelet indices in alcoholic hepatitis: a retrospective study.

BACKGROUND: The commonly available platelet indices are platelet distribution width (PDW), plateletcrit (PCT), and mean platelet volume (MPV). They have been used in diagnosis and prognosis of various abdominal disorders. They have never been used to predict severity of alcoholic hepatitis. METHODS: A retrospective analysis of chronic alcohol consumers presenting with jaundice and deranged liver function tests was performed. Maddrey discriminant function (MDF) and modified end-stage liver disease (MELD) scores were calculated and patients compared between severe and nonsevere alcoholic hepatitis (MDF ≥32 vs MDF <32 and MELD >20 vs MELD ≤20). Logistic regression analysis was performed to find significant predictors. Receiver operating characteristic was used to find the area under the curve. Spearman correlation was performed to discover association between platelet indices and severity scores. RESULTS: There were 119 patients in the study. Coexisting illnesses included pancreatitis, cirrhosis, infections, and alcohol withdrawal syndrome. The mean age (years), duration of alcohol consumption (years), and ethanol (g/day) were 45.13 ±â€Š11.53, 18.84 ±â€Š11.40, and 65.61 ±â€Š45.42, respectively. The average MELD and Maddrey scores were 14.13 ±â€Š5.17 and 36.45 ±â€Š29.63, respectively. The mean platelet counts, PDW, MPV, and PCT were 194.01 ±â€Š178.82 × 109/L, 17.10 ±â€Š1.21, 5.99 ±â€Š0.96, and 0.14 ±â€Š0.04, respectively. PDW >18 and MPV had a significant positive correlation with MELD scores. Only bilirubin and prothrombin prolongation were significant predictors of severe alcoholic hepatitis. The area under the curve was highest for PCT at 0.622 (P = .07; confidence interval = 0.500-0.743). CONCLUSIONS: Platelet indices appear to be significantly altered in alcoholic hepatitis, but they do not predict severe disease. Whether this inability to predict severe alcoholic hepatitis is due to coexisting illnesses such as pancreatitis, cirrhosis, and infection needs to be studied further.

The Utility of Platelet Indices in Predicting Multiorgan Dysfunction in Scrub Typhus.

Platelet indices have been used to diagnose and prognosticate infections such as tuberculosis, malaria, dengue, and septic shock. Platelet indices have previously not been used in the prediction of multiorgan dysfunction (MODS) in patients with scrub typhus. A three-year retrospective review of patient charts was performed. Patients with and without MODS were compared. Platelet indices and other clinical and laboratory variables were used in logistic regression analysis to determine significant predictors. A ROC curve was generated with the platelet indices to predict MODS. Of 189 patients, 106 were male. Respiratory rate, serum creatinine, liver function tests, platelet count, thrombocytopenia <150 × 109/L, mean platelet volume (MPV) > 7.3 fL, and plateletcrit ≤0.19% varied significantly between patients with MODS and those without. Platelet indices are inexpensive and easily available. Only thrombocytopenia along with creatinine, alanine transaminase, and abnormal chest radiograph could significantly predict MODS in patients with scrub typhus.

Acute Parkinsonism and Cerebral Salt-wasting-related Hyponatremia in Scrub Typhus.

Scrub typhus is a multisystem disease, and the respiratory system is commonly involved. Scrub typhus-related parkinsonism has been reported in three patients previously, and none of them underwent a lumbar puncture. Cerebral salt wasting is generally observed in vascular emergencies of the brain. We report a patient with acute parkinsonism and cerebral salt wasting syndrome, a combination of which has not been previously reported in scrub typhus. A 50-year-old farmer presented with an acute febrile illness of two weeks' duration and a one-day history of parkinsonism symptoms. His workup revealed hypoosmolar hyponatremia, increased urinary sodium excretion, hepatorenal and hematological dysfunction, and normal findings on cerebrospinal fluid examination. Clinical and biochemical improvement was noticed with the institution of doxycycline. Empirical doxycycline may be needed in patients with acute parkinsonism following an acute febrile illness in areas endemic for scrub typhus. Better biochemical facilities in resource-poor tropical countries would help in evaluating the etiology of hyponatremia due to infectious causes.

Electrocardiogram Heart Rate as a Predictor of Severity in Acute Alcohol-Related Pancreatitis With Alcohol Withdrawal Syndrome.

Background The severity of acute alcohol-related pancreatitis (AAP) with alcohol withdrawal syndrome (AWS) has not been studied. Electrocardiogram (ECG) has not been used as a predictor of severity in patients with AWS and acute pancreatitis. Objectives The study aimed to determine whether the ECG heart rate (HR) could predict the severity of AAP; secondarily, whether AWS influenced the severity of AAP based on Acute Physiology and Chronic Health Evaluation (APACHE) II and Bedside Index for Severity in Acute Pancreatitis (BISAP). Methods Demographics, comorbid illnesses, AWS, biochemistry, ECG, arterial blood gases, and CT findings were noted in patients with AAP. The severity of pancreatitis was scored into mild, moderate, and severe based on CT. BISAP, APACHE II, and ECG heart rate-APACHE (E-APACHE) were compared in patients with and without AWS. A receiver operating characteristic curve was used to find the best predictor of severity. Results Among 138 patients (M=128), 94 had AWS. ECG changes (≥1) were seen in 50%. Patients with AWS were younger, had consumed alcohol for a shorter duration, had higher systemic inflammatory response syndrome (SIRS), APACHE II, and E-APACHE II scores. APACHE II and E-APACHE II correlated significantly with severity grading, HR, alcohol duration, and AWS. HR was the best predictor of severe pancreatitis; E-APACHE was the best predictor for moderately severe pancreatitis. Conclusions Mostly, AAP appears to be mild; >2/3rds have AWS. ECG findings were seen in 50%. HR has not been previously studied in patients with both AAP and AWS and is an easy and inexpensive test to predict the severity of pancreatitis in this cohort.

Methylation of guar gum for improving mechanical and barrier properties of biodegradable packaging films.

Improving functional properties of biopolymers for use as environment friendly packaging is an area of current interest. Biodegradable films with improved barrier and mechanical properties were prepared from methylated guar gum. Methylation resulted in structural modification of guar gum (GG) promoting greater crystallization thereby enhancing thermal stability towards decomposition. Reduction in radius of gyration (Rg), weight average molecular weight (Mw), and an increase in polydispersity index (PDI) were also observed due to methylation. Methylated guar gum (MGG) films exhibited 40% lower water vapor transmission rate (WVTR) as compared to control purified guar gum (PGG) films. Films prepared by partial replacement of PGG with MGG (10, 25, 50, 75 and 100% w/w) showed gradual improvement in percent elongation. The study gives an insight on the role of methylation in enhancing barrier and mechanical properties of GG based biodegradable films for possible application in food packaging.

Case Report: Acute pyelonephritis and hearing loss in scrub typhus.

Acute pyelonephritis is a common renal manifestation in patients with diabetes. A 52-year-old diabetic lady presented with loin pain, dysuria, and fever and urinary incontinence that had begun seven and three days prior to presentation respectively. She was treated with escalating spectra of intravenous antibiotics without improvement. Urine and blood cultures were sterile, while radiological investigations were suggestive of pyelonephritis. Mild hepatic dysfunction prompted consideration of scrub typhus and she improved with empirical doxycycline. Scrub IgM was later confirmed to be positive. In conclusion, local prevalence of systemic infections such as rickettsioses should always be considered in diabetics with fever, even if symptoms and signs otherwise suggest typical diabetes-related infections. We, therefore report a case of acute pyelonephritis caused by scrub typhus which has not been previously described in English medical literature.

Osler-Weber-Rendu disease: A rare cause of recurrent hemoptysis.

Osler-Weber-Rendu disease, also known as hereditary hemorrhagic telangiectasia, is a rare autosomal dominant condition causing systemic fibrovascular dysplasia. It has an incidence of 1-2/100,000. Phenotypic variation is extreme ranging from asymptomatic to severely symptomatic, from cases with no or few mucocutaneous lesions to those with diffuse cutaneous telangiectasia. We discuss a case of Osler-Weber-Rendu disease causing diffuse cutaneous telangiectasia and hemoptysis. The patient presented with complaints of hemoptysis and was extensively examined and investigated before being diagnosed with Osler-Weber-Rendu disease. We successfully managed the patient's hemoptysis by bronchial artery embolization. This case emphasizes the need for careful examination and investigation and to consider such rare diseases when all the common causes of hemoptysis are ruled out. An early and proper diagnosis will lead to more effective management of such a rare disease with few treatment options available.

Hereditary Hemorrhagic Telangiectasia with Unusual Associations.

We describe a report of an elderly lady who was hospitalized with progressive worsening of breathlessness and fatigue of one month's duration. Clinical evaluation of the patient revealed hereditary hemorrhagic telangiectasia, interstitial lung disease, pulmonary hypertension without left heart failure, and bilateral gluteal calcinosis cutis. Initially, CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome was considered in view of the telangiectasia and calcinosis cutis, but a strong autosomal inheritance pattern and endoscopies (nasal and upper gastrointestinal) favored a diagnosis of hereditary hemorrhagic telangiectasia with rare associations.

Detection of single ion channel activity with carbon nanotubes.

Many processes in life are based on ion currents and membrane voltages controlled by a sophisticated and diverse family of membrane proteins (ion channels), which are comparable in size to the most advanced nanoelectronic components currently under development. Here we demonstrate an electrical assay of individual ion channel activity by measuring the dynamic opening and closing of the ion channel nanopores using single-walled carbon nanotubes (SWNTs). Two canonical dynamic ion channels (gramicidin A (gA) and alamethicin) and one static biological nanopore (α-hemolysin (α-HL)) were successfully incorporated into supported lipid bilayers (SLBs, an artificial cell membrane), which in turn were interfaced to the carbon nanotubes through a variety of polymer-cushion surface functionalization schemes. The ion channel current directly charges the quantum capacitance of a single nanotube in a network of purified semiconducting nanotubes. This work forms the foundation for a scalable, massively parallel architecture of 1d nanoelectronic devices interrogating electrophysiology at the single ion channel level.

Lost in a haystack: the importance of physical re-examination.

We report an unusual case of varicella zoster in a 19-year-old, who presented with persisting fever even after her lesions began forming scabs. Fever workup for secondary complications was negative. A re-examination revealed an axillary eschar. She recovered completely with doxycycline. This report suggests the importance of keeping in mind, epidemiological data of common diseases in the locality, as well as the significance of a thorough physical examination in patients with fever.

Synthesis and structural and electrical investigations of a hexagonal Y(1-x)Gd(x)InO3 (0.0 ≤ x ≤ 1.0) system obtained via metastable C-type intermediates.

Detailed structural and electrical investigations were carried out on an A-site disordered hexagonal Y(1-x)Gd(x)InO3 (0.0 ≤ x ≤ 1.0) series synthesized by a self-assisted gel-combustion route. The phase relations show profound temperature dependence. The metastable C-type modification could be stabilized for all the compositions, which on further heating get converted to stable hexagonal polymorphs. The conversion temperature (C-type to hexagonal) was found to increase with an increase in Y(3+) content. The system was observed to be single-phasic hexagonal at 1250 °C throughout the composition range. Interestingly, the increase in planar bonds of InO5 polyhedra was found to be twice that of the apical bonds on Gd(3+) substitution. Careful Raman spectroscopic studies highlighted a definitive though subtle structural change from x = 0.7 onward. The same observation is also corroborated by the dielectric studies. Electric field-dependent polarization measurements showed the ferroelectric hysteresis loop for pure YInO3. The system transforms from ferroelectric in YInO3 to almost paraelectric for GdInO3. In the present study, XRD, Raman, and electrical characterizations in conjunction reveal that to tune the electrical properties of the hexagonal rare earth indates, the variation in tilting of InO5 polyhedra has to be influenced, which could not be brought about by isovalent A-site substitution.

Synergistic antioxidant activity of green tea with some herbs.

Cardiovascular diseases, cancer, arthritis, etc. are caused by free radicals that are byproducts of metabolic pathways. Selected plants namely Vitis vinifera, Phyllanthus emblica L., Punica granatum, Cinnamomum cassia, Ginkgo biloba L., and Camellia sinensis Linn. are reported to produce antioxidant property. This study is undertaken to support the hypothesis that formulation of a polyherbal combination of these plants shows a synergistic effect with green tea. The extracts of each drug were characterized by phytochemical studies and tests for phenolics and flavonoids. In vitro antioxidant activity for individual drug and its combination was determined by 1,1-diphenyl-2-picrylhydrazyl (DPPH), superoxide, and nitric oxide free radical scavenging methods. Our results suggest that a combination of all these herbs with green tea can synergistically enhance antioxidant activity and thus lower doses of each herb with green tea may be used. Antioxidant potential of polyherbal combination was also comparable to that of standard ascorbic acid. Studies showed that selected individual plants contained abundant quantity of phenolics and flavonoids and their polyherbal combination with green tea was found to produce best antioxidant activity among all individual extracts. This will help in avoiding undesirable side effects due to higher doses of single herb.

High-performance semiconducting nanotube inks: progress and prospects.

While the potential for high mobility printed semiconducting nanotube inks has been clear for over a decade, a myriad of scientific and technological issues has prevented commercialization and practical use. One of the most challenging scientific problems has been to understand the relationship between the pristine, individual nanotube mobility (known to be in the 10,000 cm(2)/V·s range) and the as-deposited random network mobility (recently demonstrated in the 100 cm(2)/V·s range). An additional significant scientific hurdle has been to understand, manage, and ultimately eliminate the effects of metallic nanotubes on the network performance, specifically the on/off ratio. Additional scientific progress is important in understanding the dependence of nanotube length, diameter, and density on device performance. Finally, the development of ink formulations that are of practical use in manufacturing is of paramount importance, especially with regard to drying time and uniformity, and ultimately, the issue of scalability and cost must be addressed. Many of these issues have recently been investigated from a phenomenological point of view, and a comprehensive understanding is beginning to emerge. In this paper, we present an overview of solution-based printed carbon nanotube devices and discuss long-term technology prospects. While significant technical challenges still remain, it is clear that the prospects for the use of nanotube ink in a myriad of systems is feasible given their unmatched mobility and compatibility with heterogeneous integration into a variety of applications in printed and flexible electronics.

Nanotube electronics for radiofrequency applications.

Electronic devices based on carbon nanotubes are among the candidates to eventually replace silicon-based devices for logic applications. Before then, however, nanotube-based radiofrequency transistors could become competitive for high-performance analogue components such as low-noise amplifiers and power amplifiers in wireless systems. Single-walled nanotubes are well suited for use in radiofrequency transistors because they demonstrate near-ballistic electron transport and are expected to have high cut-off frequencies. To achieve the best possible performance it is necessary to use dense arrays of semiconducting nanotubes with good alignment between the nanotubes, but techniques that can economically manufacture such arrays are needed to realize this potential. Here we review progress towards nanotube electronics for radiofrequency applications in terms of device physics, circuit design and the manufacturing challenges.