Measles outbreak investigation in Dwarahat block of District Almora, Uttarakhand.

BACKGROUND: We report an assessment of measles outbreak during the months of February 2014 to April 2014 in Dwarahat block of district Almora and the response mounted to it. MATERIALS AND METHODS: An intensive door-to-door search to six measles affected villages in Dwarahat block of district Almora, covering a population of 2,408 was carried out to identify the cases of measles by a rapid response team (RRT). A total of ten blood samples were randomly collected for detecting IgM antibody against measles. For all cases, information on personal details, place of residence, time of onset and status of immunization were obtained. RESULTS: Overall attack rate (AR) was 2.8%. AR among the population of age-group 0-16 was 7.2%. Statistically significant higher AR (16.26%) was seen for the age-group of 0-5 years as compare to 6-10 and 11-16 years of age (AR-8.71, relative risk-0.53, 95% confidence interval-0.32-0.88, P value-0.012 and AR-0.57%, relative risk-0.035, 95% confidence interval-0.00-0.14, P value-0.000, respectively). Males were affected more often than females 35 [59.2%] vs. 24 [40.8%]. Measles-related complications were seen in three children. No death was reported. Of the 10 samples, nine were positive for measles IgM antibodies by enzyme-linked immunosorbent assay (ELISA). CONCLUSION: The recognition of early warning signals, timely investigation and application of specific control measures can contain the outbreak. The unvaccinated or partially protected human beings serve as the reservoir of measles virus. Hence, there is a need for sero surveillance for measles in Uttarakhand and one catch up measles immunisation campaign to prevent future outbreak.

Characterization of ICAM-1 biophore to design cytoadherence blocking peptides.

Peptides from natural sources are good starting material to design bioactive agents with desired therapeutic property. IB peptide derived from the ICAM-1 has been studied extensively as an agent to disrupt the non-specific binding of lymphocyte to the endothelial cells. ICAM-1: IB molecular model reveals that IB peptide binds in an extended conformation to the ICAM-1, masking LFA-1 and partially covering PfEMP-1 binding site. Considering the regioselective requirement of ICAM-1: PfEMP1 binding site, IB peptide charge and 3-D conformation are optimized through generation of combinatorial peptide library containing single, double, triple, tetra and quadra amino acid substitutions of IB peptide. Further, truncation of IB peptide followed by molecular modeling studies gave us the biophoric environment of the IB peptide required for its activity. Molecular modeling of these peptides into the binding site indicates that these complexes are fitting well into the site and making extensive interactions with the residues crucial for PfEMP-1 binding. Molecular dynamics simulations were performed for 10ns each under four different temperatures to estimate comparative stability of ICAM1: IB peptide complexes. The designed peptide ICAM1: IBT213 has comparable stability at ambient temperature, while ICAM1: IBT1 shows a greater degree of robustness at higher temperatures. Overall, the study has given useful insights into IB peptide binding site on ICAM1 and its potential in designing novel peptides to disrupt the cytoadherence complex involving ICAM1: PfEMP1.

Cryopreservation of quince (Cydonia oblonga Mill.).

BACKGROUND: Quince (Cydonia oblonga Mill.) has great potential for utilisation in pharmaceutical and food industries. OBJECTIVE: The study was to develop an efficient cryopreservation approach for quince. METHODS: Factors on the survival and regrowth such as cold acclimation, explant type and recovery media composition were assessed. The effectiveness of the resultant protocols for a number of quince cultivars was determined. RESULTS AND CONCLUSION: Quince shoot tips and nodal sections are successfully cryopreserved. Sustained regrowth of quince Angers A was observed after encapsulation-osmoprotection/dehydration, encapsulation-dehydration and PVS2 vitrification. The highest regrowth rate (80%) was obtained from explants excised from cold hardened shoots and cryopreserved using encapsulation-osmoprotection/dehydration and vitrification protocols. The optimised vitrification protocol in combination with shoot cold hardening and a MS recovery medium without activated charcoal and auxin resulted in satisfactory regrowth of shoots from six quince cultivars. The morphology of acclimatised plants derived from cryopreserved shoots was comparable with non-cryopreserved plants.

Bioavailability of iodine in the UK-Peak District environment and its human bioaccessibility: an assessment of the causes of historical goitre in this area.

Iodine is an essential micronutrient for human health. Its deficiency causes a number of functional and developmental abnormalities such as goitre. The limestone region of Derbyshire, UK was goitre-endemic until it declined from the 1930s and the reason for this has escaped a conclusive explanation. The present study investigates the cause(s) of goitre in the UK-Peak District area through an assessment of iodine in terms of its environmental mobility, bioavailability, uptake into the food chain and human bioaccessibility. The goitre-endemic limestone area is compared with the background millstone grit area of the UK-Peak District. The findings of this study show that 'total' environmental iodine is not linked to goitre in the limestone area, but the governing factors include iodine mobility, bioavailability and bioaccessibility. Compared with the millstone grit area, higher soil pH and calcium content of the limestone area restrict iodine mobility in this area, also soil organic carbon in the limestone area is influential in binding the iodine to the soil. Higher calcium content in the limestone area is an important factor in terms of strongly fixing the iodine to the soil. Higher iodine bioaccessibility in the millstone grit than the limestone area suggests that its oral bioaccessibility is restricted in the limestone area. Iodine taken up by plant roots is transported freely into the aerial plant parts in the millstone grit area unlike the limestone area, thus providing higher iodine into the human food chain in the millstone grit area through grazing animals unlike the goitre-prevalent limestone area.

Laser vaporization of extravasation type of mucocele of the lower lip with 940-nm diode laser.

A 43-year-old male presented with an asymptomatic swelling of the lower labial mucosa. Examination revealed that the tip of maxillary canine was causing trauma on the affected side. A diagnosis of extravasation type of mucocele was established clinically. Vaporization of the mucocele was done with a 940-nm diode laser in contact mode. The lesion healed uneventfully and there has been no recurrence for 3 months.

Lead contamination of surgical gloves by contact with a lead hand.

Background. "Lead hands" are frequently used to maintain hand and finger position in hand surgery. The malleability and strength of lead make it ideal for this purpose. The aim of this study was to determine the amount of lead transferred to a surgeon's glove during handling of a lead hand. Method. Sterile surgical gloves were wiped over the surface of a lead hand. The number of wipes was varied, the gloves were then sent to a trace elements laboratory, and the lead content transferred to each glove was determined. Results. The amount of lead transferred to each glove increased with increasing exposure to the lead hand. After twenty wipes, up to 2 mg of lead was transferred to the surgeon's glove. Covering the lead hand with a sterile drape markedly reduced the lead transferred to the surgeon's glove. Conclusion. Significant amount of lead is transferred on to the gloves after handling a lead hand. This risks wound contamination and a foreign body reaction. Covering the lead hand with a sterile drape may minimise the risk of surgical wound contamination.

Combined off-pump coronary artery bypass grafting and thyroidectomy.

A 70-year-old Indian woman presented with an acute anterior wall myocardial infarction and a large multinodular goiter causing tracheal compression and dyspnea. Coronary artery angiography revealed severe triple-vessel disease, with an 80% occlusion of the left main stem, necessitating early coronary artery bypass grafting combined with total thyroidectomy. The procedure was performed successfully. At the 1-year follow-up, the patient remains euthyroid and in New York Heart Association functional class I. This case provides further evidence that combined coronary artery bypass grafting and total thyroidectomy is both feasible and safe.

Oswestry Disability Index scoring made easy.

INTRODUCTION: Low back pain effects up to 80% of the population at some time during their active life. Questionnaires are available to help measure pain and disability. The Oswestry Disability Index (ODI) is the most commonly used outcome measure for low back pain. The aim of this study was to see if training in completing the ODI forms improved the scoring accuracy. PATIENTS AND METHODS: The last 100 ODI forms completed in a hospital's spinal clinic were reviewed retrospectively and errors in the scoring were identified. Staff members involved in scoring the questionnaire were made aware of the errors and the correct method of scoring explained. A chart was created with all possible scores to aid the staff with scoring. A prospective audit on 50 questionnaires was subsequently performed. RESULTS: The retrospective study showed that 33 of the 100 forms had been incorrectly scored. All questionnaires where one or more sections were not completed by the patient were incorrectly scored. A scoring chart was developed and staff training was implemented. This reduced the error rate to 14% in the prospective audit. CONCLUSIONS: Clinicians applying outcome measures should read the appropriate literature to ensure they understand the scoring system. Staff must then be given adequate training in the application of the questionnaires.

Trochanteric non-union--does it influence the rate of revision following primary total hip replacement? A minimum of 15 years follow-up.

OBJECTIVE: Trochanteric non-union may alter the biomechanics and the forces going through the hip joint leading to increased polyethylene wear and hence a higher revision rate. The aim of our study was to determine if trochanteric non-union was associated with a higher incidence of acetabular and/ or femoral revision for mechanical failure, i.e. aseptic loosening. MATERIALS AND METHODS: Three hundred and twenty-six total hip replacements performed in 318 patients between 1979 and 1989 were reviewed. The status of the trochanter was determined using the senior author's (JPH) classification of trochanteric union/non-union. The mean follow-up was 16.7 years (15-25 years). RESULTS: 20.5% (61/297) of hips with united trochanter and 20.6% (6/29) with un-united trochanter had been revised at the latest follow-up. The difference was not significant (p-value > 0.1, odds ratio 1.01). CONCLUSION: We could not find any influence of trochanteric non-union on acetabular or femoral revision rate over a mean follow-up period of 17 years (range 15-25 years).

Circadian output, input, and intracellular oscillators: insights into the circadian systems of single cells.

Circadian output comprises the business end of circadian systems in terms of adaptive significance. Work on Neurospora pioneered the molecular analysis of circadian output mechanisms, and insights from this model system continue to illuminate the pathways through which clocks control metabolism and overt rhythms. In Neurospora, virtually every strain examined in the context of rhythms bears the band allele that helps to clarify the overt rhythm in asexual development. Recent cloning of band showed it to be an allele of ras-1 and to affect a wide variety of signaling pathways yielding enhanced light responses and asexual development. These can be largely phenocopied by treatments that increase levels of intracellular reactive oxygen species. Although output is often unidirectional, analysis of the prd-4 gene provided an alternative paradigm in which output feeds back to affect input. prd-4 is an allele of checkpoint kinase-2 that bypasses the requirement for DNA damage to activate this kinase; FRQ is normally a substrate of activated Chk2, so in Chk2(PRD-4), FRQ is precociously phosphorylated and the clock cycles more quickly. Finally, recent adaptation of luciferase to fully function in Neurospora now allows the core FRQ/WCC feedback loop to be followed in real time under conditions where it no longer controls the overt rhythm in development. This ability can be used to describe the hierarchical relationships among FRQ-Less Oscillators (FLOs) and to see which are connected to the circadian system. The nitrate reductase oscillator appears to be connected, but the oscillator controlling the long-period rhythm elicited upon choline starvation appears completely disconnected from the circadian system; it can be seen to run with a very long noncompensated 60-120-hour period length under conditions where the circadian FRQ/WCC oscillator continues to cycle with a fully compensated circadian 22-hour period.

A circadian clock in Neurospora: how genes and proteins cooperate to produce a sustained, entrainable, and compensated biological oscillator with a period of about a day.

Neurospora has proven to be a tractable model system for understanding the molecular bases of circadian rhythms in eukaryotes. At the core of the circadian oscillatory system is a negative feedback loop in which two transcription factors, WC-1 and WC-2, act together to drive expression of the frq gene. WC-2 enters the promoter region of frq coincident with increases in frq expression and then exits when the cycle of transcription is over, whereas WC-1 can always be found there. FRQ promotes the phosphorylation of the WCs, thereby decreasing their activity, and phosphorylation of FRQ then leads to its turnover, allowing the cycle to reinitiate. By understanding the action of light and temperature on frq and FRQ expression, the molecular basis of circadian entrainment to environmental light and temperature cues can be understood, and recently a specific role for casein kinase 2 has been found in the mechanism underlying circadian temperature-compensation. These data promise molecular explanations for all of the canonical circadian properties of this model system, providing biochemical answers and regulatory logic that may be extended to more complex eukaryotes including humans.

Bacteriology swab in primary total hip arthroplasty-- does it have a role?

Infection in joint replacement is a devastating complication, and in spite of the advances in surgery, it remains a challenge. The rate of deep infection following primary hip/knee arthroplasty is between 1% and 2%. The aim of this study was to determine whether obtaining bacteriology swabs at the time of surgery could help in further reducing the rate of infection following joint arthroplasty. A bacteriology swab of the synovial fluid was taken after opening the capsule of the hip joint and was sent for culture and sensitivity. Out of 142 swabs sent, four (2.1%) were found to be positive. Three of these patients were treated with antibiotics after obtaining sensitivities. None of the patients developed deep infection. Bacteriology swab in primary joint arthroplasty may have a role and may help in further reducing the incidence of deep infection in joint replacement surgery.

C reactive protein and skin temperature post total knee replacement.

We prospectively assessed 20 patients following uncomplicated total knee replacement (TKR). Clinical status, skin temperature and C-reactive protein (CRP) were measured preoperatively and at intervals up to 18 weeks. The CRP rose postoperatively up to 5-7 days but returned to normal values by 6 weeks. The skin temperature remained elevated up to 18 weeks. We concluded that in uncomplicated cases, the CRP should be within normal limits by 6 weeks after operation, but skin temperature may remain elevated up to 18 weeks. A sustained rise in these values may indicate the development of a complication such as infection and the patient must be closely monitored.

Anti-adhesion molecule strategies as potential neuroprotective agents in cerebral ischemia: a critical review of the literature.

Despite recent advances in the understanding of the pathophysiology of cerebral ischemia, current approaches attempting to prevent ischemic brain damage after an acute stroke remain quite inadequate. Today, ischemic stroke remains the third leading cause of death in industrialized nations, and the leading cause of disability requiring long term institutional care in the U.S and other industrialized nations. While one treatment, tissue plasminogen activator, has shown efficacy in clinical trials, safety concerns limit its role in clinical practice to a narrow time window of use. Acute cerebral ischemia has been shown to evoke a profound and deleterious upregulation of the inflammatory response, initiated within the cerebral microvasculature. Recently, research efforts have focused on targeting individual components of the inflammatory cascade, such as leukocyte activation and adhesion, in an attempt to develop potential neuroprotective agents. While these strategies have shown promise preclinically, clinical trials have yet to show clear benefit. Here, we review the current understanding of the pathophysiologic consequences of acute cerebral ischemic injury. Additionally, we discuss the role of the inflammatory cascade, with specific attention given to the deleterious role played by leukocyte activation and adhesion in stroke. Finally, relevant efforts to translate these basic science observations into clinical efficacy in acute stroke trials are critically reviewed.

A safe, simple and cost-effective protocol for blood transfusion in primary total knee replacement.

BACKGROUND: Patients undergoing total knee replacement (TKR) in the UK usually have either blood cross-matched or have an auto-transfusion of drained blood postoperatively. A previous retrospective audit of blood requirements in patients who had undergone primary TKR showed that a large amount of cross-matched blood was wasted as the CT ratio (ratio of number of units of blood cross-matched to number of units transfused) of 4.9:1 was obtained. The range recommended by the Blood Transfusion Society is 2:1 to 3:1. METHODS: A protocol was introduced to group and save plus antibody screen for all patients and to cross-match 2 units of blood pre-operatively in patients with either a haemoglobin of less than 12.5 g/dl or with multiple red cell antibodies in their blood. The trigger point for blood transfusion postoperatively was also reduced from 9.0 g/dl to 8.0 g/dl, unless the patient was clinically symptomatic. RESULTS: A further prospective study involving 50 patients was carried out using the new protocol. Five patients required cross-matching pre-operatively, three with haemoglobin less than 12.5 g/dl and two with multiple red cell antibodies. Postoperatively, the patients with haemoglobin of less than 12.5 g/dl required blood transfusion of 2 units each, reducing the CT ratio to 1.7:1. The patients with red cell antibodies did not require a blood transfusion. CONCLUSIONS: The benefits from above protocol are 2-fold: patient safety, as risks of transfusion are avoided; and cost saving, in regards to haematology technician time and auto-transfusion sets which cost around pound 70 each.