Wide-area transepithelial sampling with computer-assisted 3-dimensional analysis (WATS) markedly improves detection of esophageal dysplasia and Barrett's esophagus: analysis from a prospective multicenter community-based study.

The 4-quadrant forceps biopsy (FB) protocol for identifying Barrett's esophagus (BE) and esophageal dysplasia (ED) suffers from poor sensitivity due to significant sampling error. We investigated the benefit of wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS) used adjunctively to the combination of random and targeted FB in the detection of ED, and as a secondary outcome, BE. In this multicenter prospective trial, community endoscopists at 21 sites utilized WATS as an adjunct to both targeted and random FB in patients undergoing BE screening and surveillance. Investigators alternated taking FB and WATS samples first. WATS specimens were analyzed at CDx Diagnostics (Suffern, NY) while FB samples were analyzed by each site's regular pathologists. Data were de-identified and then aggregated for analysis. Of 12,899 patients enrolled, FB identified 88 cases of ED, and WATS detected an additional 213 cases missed by FB. These 213 cases represented an absolute increase of 1.65%, raising the yield from 0.68% to 2.33%. Adding WATS to FB increased the overall detection of ED by 242% (95% CI: 191%-315%). Fewer than 61 patients needed to be tested with WATS to identify an additional case of ED. The combination of random and targeted FB identified 1,684 cases of BE, and WATS detected an additional 2,570 BE cases. The absolute incremental yield of adding WATS to FB is 19.9%, increasing the rate of detection from 13.1% to 33%. Adding WATS to FB increased the overall detection of BE by 153% (95% CI: 144-162%). The number needed to test with WATS in order to detect an additional case of BE was 5. Whether FB or WATS was done first did not impact the results. In this study, comprised of the largest series of patients evaluated with WATS, adjunctive use of the technique with targeted and random FB markedly improved the detection of both ED and BE. These results underscore the shortcomings of FB in detecting BE-associated neoplasia, which can potentially impact the management and clinical outcomes of these patients.

India's integrated child development services scheme: challenges for scaling up.

BACKGROUND: India had around 158 million children under the age of 6 and about 26 million births in 2015. In the same year, India's Integrated Child Development Services Scheme served about 82 million children under 6 years and over 19 million pregnant women and lactating mothers. These 102 million beneficiaries received services in about 1.3 million centres. METHOD: This paper reviews the growth of the Scheme and considers challenges to scaling up quality with equity based on results of large-scale national or multistate studies. RESULTS: The Scheme is associated with decreased malnutrition and better child development. The size and diversity of the country, the policy context, funding mode and lack of community awareness and engagement have hindered scaling up access while the approach to service delivery, low institutional capacity and poor infrastructure have impeded scaling up of implementation quality. CONCLUSIONS: This review illustrates the challenges associated with scaling-up access and implementation quality of a multicomponent, integrated early childhood programme in a large, diverse country. The future success of the Integrated Child Development Services will depend on how well it adheres to quality standards and how well it evolves to address current weaknesses.

A comparison of infectivity between polyhedra of the Spodoptera litura multiple nucleopolyhedrovirus before and after passage through the gut of the stink bug, Eocanthecona furcellata.

Infectivity of polyhedra of Spodoptera litura multiple nucleopolyhedrovirus before and after passage through the gut of the predatory stink bug, Eocanthecona furcellata Wolff (Hemiptera: Pentatomidae) was compared through field bioassay studies. Three sets of E. furcellata were used for bioassays and these were allowed to feed on a single meal of five third instar Oriental leaf worm, Spodoptera litura (Fabricius) (Lepidoptera: Noctuidae), that were infected with polyhedra before passage, after passage, and healthy (control) larvae 1 day prior to the trial. The predators were subsequently released on cabbage plants that were infested with 100 healthy S. litura larvae. The median lethal dose (LD50) and survival time (ST50) values before and after passage through the gut were not significantly different. Additional mortality due to virus infection increased 13- 17% before and after treatments but within these treatments the mortality did not vary significantly. It was concluded that E. furcellata disseminated the virus through their feces into the ecosystem and infectivity of the SpltMNPV was not altered after passage through the gut of the predator.

Composition and antimicrobial activity of the essential oil of Heracleum thomsonii (Clarke) from the cold desert of the western Himalayas.

Volatile oil composition of hydro-distilled (HD) and supercritical carbon dioxide (SC-CO(2)) essential oil of freshly collected aerial parts of Heracleum thomsonii (Umbeliferae) from the western Himalayas was studied by GC-FID and GC-MS. Results revealed qualitative and quantitative dissimilarity in the composition of hydro-distilled and SC-CO(2) extracted oils. Nineteen constituents, which accounted for 89.32% of total constituents in HD oil, represented by limonene (4.31%), (Z)-ß-ocimene (3.69%), terpinolene (22.24%), neryl acetate (36.19%), nerol (9.51%) and p-cymene-8-ol (2.61%) were identified. In SC-CO(2) extracted oil, 24 constituents representing 89.95% of total constituents were identified. Terpinolene (5.08%), germacrene D (2.17%), neryl acetate (51.62%), nerol (9.78%), geranyl acetate (2.06%), α-bisabolol (2.48%) and 1-nonadecanol (4.96%) were the dominating constituents. In vitro antimicrobial activity of hydro-distilled oil was conducted against microrobial strains including two Gram-positive (Staphylococcus aureus and Bacillus subtilis) and five Gram-negative (Burkholderia cepacia, Escherichia coli, Enterobacter cloacae, Klebseilla pneumoniae and Pseudomonas aeruginosa) bacteria as well as seven fungi (Candida albicans, Issatchenkia orientalis, Aspergillus flavus, Aspergillus niger, Aspergillus parasiticus, Aspergillus sydowii and Trichophyton rubrum) using broth microdilution method. The results of bioassay showed that the oil exhibited moderate to high antimicrobial activity against fungi C. albicans (MIC 625 µg ml(-1)), A. parasiticus (MIC 312.5 µg ml(-1)), A. sydowii (MIC 312.5 µg ml(-1)), T. rubrum (MIC 625 µg ml(-1)), Gram-positive bacteria B. subtilis (MIC 625 µg ml(-1)) and Gram-negative bacteria P. aeruginosa (MIC 312.5 µg ml(-1)).

Synthesis of novel acetates of beta-caryophyllene under solvent-free Lewis acid catalysis.

Acylation of beta-caryophyllene, a sesquiterpene hydrocarbon with acetic anhydride, was carried out under mild catalytic conditions using Lewis acids such as BF3.Et2O, ZnCl2, FeCl3, I2 and AlCl3 as catalysts. Among these, BF3.Et2O was found to catalyse the reaction most efficiently, yielding three acylated products in 75% yield under solvent-free conditions. The structures were confirmed by NMR and MS techniques.

Simple and efficient enzymatic transglycosylation of stevioside by beta-cyclodextrin glucanotransferase from Bacillus firmus.

Stevioside was subjected to 1,4-intermolecular transglycosylation using beta-cyclodextrin glucanotransferase (beta-CGtase) produced from an alkalophilic strain of Bacillus firmus. The reaction was carried out by traditional, ultrasound-assisted and microwave-assisted techniques. Reaction under microwave conditions was faster and was completed in 1 min yielding two 1,4 transglycosylated products, 4'-O-alpha-D: -glycosyl stevioside (I) and 4''-O-alpha-D: -maltosyl stevioside (II) in 66% and 24%, respectively. The optimum transglycosylation occurred by using stevioside (1.24 mmol), beta-CD (1.76 mmol) and beta-CGtase (2 U/g) under microwave assisted reaction (MAR) in 5 ml sodium phosphate buffer (pH 7) at 50 degrees C and 80 W power. MAR is therefore potentially a useful and economical method for faster transglycosylation of stevioside.

An efficient microwave-assisted extraction process of stevioside and rebaudioside-A from Stevia rebaudiana (Bertoni).

INTRODUCTION: Stevioside and rebaudioside-A are major low-calorie diterpene steviol glycosides in the leaves of Stevia rebaudiana. They are widely used as natural sweeteners for diabetic patients, but the long extraction procedures required and the optimisation of product yield present challenging problems. OBJECTIVE: To develop a rapid and effective methodology for the extraction of stevioside and rebaudioside-A from S. rebaudiana leaves and to compare yields using different extraction techniques. METHODOLOGY: Dried and powdered leaves of S. rebaudiana were extracted by conventional, ultrasound and microwave-assisted extraction techniques using methanol, ethanol and water as single solvents as well as in binary mixtures. Conventional cold extraction was performed at 25 degrees C for 12 h while ultrasound extraction was carried out at temperature of 35 +/- 5 degrees C for 30 min. Microwave-assisted extraction (MAE) was carried out at a power level of 80 W for 1 min at 50 degrees C. RESULTS: MAE yielded 8.64 and 2.34% of stevioside and rebaudioside-A, respectively, while conventional and ultrasound techniques yielded 6.54 and 1.20%, and 4.20 and 1.98% of stevioside and rebaudioside-A, respectively. CONCLUSION: A rapid and efficient method has been developed for the extraction of stevioside and rebaudioside-A in optimum yields using MAE procedure. This method has the advantage of rapid extraction and fast screening of a large number of S. rebaudiana samples for assessment of planting material. MAE saves considerable time, energy and has implications in the quality assessment of stevioside and rebaudioside-A prior to their industrial production from the leaves of S. rebaudiana.

Insecticidal activity of Valeriana jatamansi (Valerianaceae) against mosquitoes.

A root extract of Valeriana jatamansi (code BAL-O) exhibited larvicidal and adulticidal activity against different mosquito species. The median lethal concentration (LC50) of BAL-O against larvae of Anopheles stephensi, Anopheles culicifacies, Aedes aegypti, Aedes albopictus, and Culex quinquefasciatus were 68.1, 42.8, 51.2, 53.8, and 80.6 mg/liter, respectively. The LC50 and the 90% lethal concentration against adult An. stephensi, An. culicifacies, Ae. aegypti, Ae. albopictus, and Cx. quinquefasciatus were 0.14, 0.16, 0.09, 0.08, and 0.17 and 0.24, 0.34, 0.25, 0.21, and 0.28 mg/cm2, respectively. The median knock-down time and 90% knock-down time of the fraction were 13, 13, 12, 13, and 18 and 24, 25, 21, 20, and 42 min against An. stephensi, An. culicifacies, Ae. aegypti, An. albopictus and Cx. quinquefasciatus, respectively, using 0.28 mg/cm2 impregnated papers. The median effective time and 90% effective time against An. stephensi at 4 degrees C were 46.6 and 8.7 days, and at 29 degrees C, 25.5 and 5.6 days, respectively. Gas chromatographic-mass spectrometric analysis of BAL-O showed 2-butanone,4-(2,6,6-trimethyl-2-cyclohexen-l-yl) (10.11%), patchouli alcohol (8.55%), cubenol (5.97%), caryophyllene oxide (5.46%), cadinol (5.23%), and aristolene (5.19%).

Variability of volatile constituents in Artemisia maritima in western Himalaya.

Chemical composition of the essential oil of Artemisia maritima, collected from three different high altitude locations in western Himalaya was studied by gas-chromatography mass spectrometry. Twenty-five constituents were identified in the oil distilled from the sample from Pooh, of which 1,8-cineole (23.8%) and chrysanthenone (17.54%) were the major constituents. Twenty volatile constituents were identified from the sample collected from Rhongtong pass, of which chrysanthenone (38.1%) and 1,8-cineole (37.3%) were the major constituents. In the oil distilled from the sample collected from Lahaul-Spiti 28 constituents were identified, of which 1,8-cineole (44.22%), camphor (9.16%) and borneol (10.94%) were the major constituents. In this sample chrysanthenone was present in very low percentage.

Validated high-performance thin-layer chromatography method for steviol glycosides in Stevia rebaudiana.

A high-performance thin-layer chromatographic (HPTLC) method was developed and validated as per ICH (International Conferences on Harmonization) guidelines for simultaneous quantification of three steviol glycosides, i.e. steviolbioside, stevioside and rebaudioside-A in Stevia rebaudiana leaves. For achieving good separation, mobile phase of ethyl acetate-ethanol-water (80:20:12, v/v/v) on pre-coated silica gel 60 F254 HPTLC plates were used. The densitometric quantification of steviol glycosides was carried out at lambda=510 nm in reflection-absorption mode after spraying with acetic anhydride:sulphuric acid:ethanol reagent. The calibration curves were linear in the range of 160-960 ng/spot for steviolbioside, 1-6 microg/spot for stevioside and 0.5-3 microg/spot for rebaudioside-A with good correlation coefficients (0.998-0.999). The method was found to be reproducible for quantitative analysis of steviol glycosides in S. rebaudiana leaves collected from ten different locations and will serve as a quality control indicator to monitor the commercial production of stevioside and its allied molecules during different stages of its processing.

A new phthalic acid ester from Ajuga bracteosa.

A new phthalic acid ester 1,2-benzenedicarboxylic acid bis(2S-methyl heptyl) ester (1) was isolated from the hexane extract of the whole plant of Ajuga bracteosa. In addition, chloroform and methanol extracts yielded neo-clerodane diterpene ajugarin-I and two iridoid glycosides, reptoside and 8-O-acetyl harpagide. The structures of all the compounds were confirmed by extensive spectroscopic analysis. From the two oily fractions nine and six volatile constituents respectively were identified by GCMS. Linalyl acetate was found to be common in both the oil fractions. This plant is a new source of linalyl acetate, a valuable perfumery compound.

A new alkylated benzoquinone from rhizomes of Iris kumaonensis.

A novel alkylated unsaturated p-benzoquinone designated as 3-[(z)-12'-heptadecenyl]-2-hydroxy-5-methoxy-1,4-benzoquinone was isolated from hexane extract of the rhizomes of Iris kumaonensis and it's structure was confirmed by extensive spectroscopic analysis, IR, MS, HREIMS, 1D, 2D NMR and comparison with the literature data of known compounds.

Microwave-assisted rapid synthesis of methyl 2,4,5-trimethoxyphenylpropionate, a metabolite of Cordia alliodora.

Microwave assisted condensation of asaronaldehyde (2) with malonic acid in piperidine-AcOH provides 2,4,5-trimethoxycinnamic acid (3) in 87% yield within 4 min, which upon further reduction with PdCl2- HCOOH-aq. NaOH gives 3-(2,4,5-trimethoxy)phenyl propionic acid (4) in 88% yield within 3 min. Esterification of 4 with MeOH-H+ gives methyl 2,4,5-trimethoxyphenylpropionate (1), a metabolite of Cordia alliodora, in 94% yield within 3 min (overall 69% yield).

Profound postoperative hypoglycemia in a malnourished patient.

PURPOSE: To present an unusual case of profound postoperative hypoglycemia resulting in irreversible brain damage in a malnourished patient. CLINICAL FEATURES: A 56-yr-old malnourished woman underwent laparotomy for intestinal obstruction under general anesthesia. Five hours postoperatively she was found to be unresponsive with an immeasureably low blood glucose level. This event was not associated with hyperinsulinemia. Predisposing factors like diabetes mellitus, pheochromocytoma, insulin secreting tumours, adrenal or pitutary deficiency were absent. She was treated with iv dextrose and hydrocortisone with blood glucose levels stabilizing fairly rapidly. However, she unfortunately had sustained irreversible cerebral damage and is left with significant neurological disability. CONCLUSION: Severe postoperative hypoglycemia has several well documented causes. Although hypoglycemia does occur to a moderate degree in malnutrition, it has not been reported to be so severe as to cause cerebral damage in the postoperative setting.

Intravenous metronidazole for the treatment of Clostridium difficile colitis.

PURPOSE: Severe Clostridium difficile colitis may produce abdominal distention and ileus, precluding oral antibiotic therapy. Stimulated by several case reports in which intravenous metronidazole was used, we reviewed our experience. METHODS: Using pharmacy and microbiology laboratory records, we retrospectively identified patients with C. difficile colitis who received intravenous metronidazole as initial monotherapy. To be included, patients had to fulfill the following criteria: 1) at least six doses (equivalent to two days of therapy) of intravenous metronidazole were administered, 2) no other potential cause for colitis was found, and 3) the diagnosis of C. difficile colitis was firmly established. For eligible patients, five clinical parameters were assessed before and after intravenous metronidazole. RESULTS: Our patient group (n = 10) received an average of 13.7 (range, 6-24) doses of intravenous metronidazole as initial therapy for C. difficile colitis. All received a dose of 500 mg three times daily. The majority of patients with vomiting, fever, and/or abdominal pain present at the beginning of therapy had resolution with intravenous metronidazole. Only one patient developed a symptom (vomiting) while on therapy; however, this eventually resolved when oral metronidazole was instituted. No patient required colectomy for refractory colitis or developed toxic megacolon. No patient, including those on prolonged courses, developed toxicity related to intravenous metronidazole such as peripheral neuropathy. CONCLUSIONS: Intravenous metronidazole may be effective therapy in patients with C. difficile colitis. A randomized, prospective study appears warranted.

Lipid abnormalities in coronary heart disease: a population-based case-control study.

BACKGROUND: We performed a case-control study to estimate lipid-cholesterol fractions in patients with coronary heart disease and compared them with population-based controls. METHODS AND RESULTS: A total of 635 newly diagnosed patients with coronary heart disease (518 males and 117 females) and 632 subjects (346 males and 286 females) obtained from an ongoing urban coronary heart disease risk factor epidemiological study were evaluated. Age-specific lipid values (total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and total:high-density lipoprotein cholesterol ratio) were compared using the t-test. Age-adjusted prevalence of dyslipidemia as defined by the US National Cholesterol Education Program was compared using the Chi-square test. In all the age groups, and in both males and females, levels of total and low-density lipoprotein cholesterol were not significantly different. In males, the high-density lipoprotein cholesterol (mg/dl) was significantly lower in patients with coronary heart disease as compared to controls in the age groups 30-39 years (35.1+/-11 v. 43.7+/-9), 40-49 years (39.0+/-10 v. 47.1+/-8), 50-59 years (38.9+/-11 v. 43.8+/-9) and 60-69 years (38.6+/-11, v. 42.8+/-7) (p<0.05). In females, high-density lipoprotein cholesterol was less in the age groups 30-39 years (30.2+/-9 v. 40.7+/-9), 50-59 years (39.7+/-12 v. 44.7+/-8) and 60-69 years (35.6+/-11 v. 42.2+/-9). The level of triglycerides was significantly higher in male patients in the age groups 40-49 years (195.3+/-96 v. 152.8+/-78), 50-59 years (176.7+/-76 v. 162.9+/-97), 60-69 years (175.5+/-93 v. 148.1+/-65) and >70 years (159.8+/-62 v. 100.0+/-22); and in female patients in the age group 30-39 years (170.8+/-20 v. 149.9+/-9) (p<0.05). The total:high-density lipoprotein cholesterol ratio was significantly higher in all age groups in male as well as female patients with coronary heart disease (p<0.05). CONCLUSIONS: An age-adjusted case-control comparison showed that the prevalence of hypertension, diabetes, high total cholesterol (> or =200 mg/dl) (males 48.8% v. 20.2%; females 59.8% v. 33.4%) and high low-density lipoprotein cholesterol (> or =130 mg/dl) (males 42.1% v. 15.0%; females 52.1% v. 31.0%) was significantly more in cases than in controls. The prevalence of low high-density lipoprotein cholesterol (<35 mg/dl) (males 39.6% v. 6.2%; females 39.3% iv 9.5%), high total:high-density lipoprotein ratio (> or = 5.0) and high triglycerides (> or =200 mg/ dl: males 39.6%, v. 10.2%; females 17.1% v. 11.9%) was also significantly higher in cases (p<0.05).

Should we continue oesophageal surgery in a district general hospital? A review of 200 consecutive cases.

A series of 200 oesophageal resections is presented. The results show that acceptable standards are obtainable in a district general hospital (DGH) thus favouring the suggestion that such services could be organised by 'networking' rather than centralisation. This avoids the disadvantages to many DGH patients which follow centralisation.

Non-tuberculous iliopsoas abscess due to perforated diverticulitis presenting with intestinal obstruction and a groin mass.

Psoas abscess is an uncommon condition and, contrary to traditional teaching, tends to be of non-tuberculous aetiology in developed countries. Diagnosis can be delayed since presenting features are non-specific and in many instances misleading, necessitating a high degree of clinical suspicion and early resort to cross-sectional imaging using CT or MRI. We present a case of iliopsoas abscess secondary to perforated diverticulitis to illustrate the difficulty encountered in early diagnosis and to show that successful management of secondary psoas abscess necessitates surgical resection of the underlying condition in most cases.