Thyroid Disorders among Type 2 Diabetes Mellitus: A Cross-sectional Study from a District Hospital in West Bengal.

INTRODUCTION: The coexistence of diabetes mellitus (DM) (both type 1 and type 2) and thyroid dysfunction, two common endocrine problems, is scientifically predictable. The prevalence of thyroid disorders among type 2 diabetics (more prevalent in India) was studied among patients visiting the outpatient department (OPD) of a district hospital in West Bengal to assess its relation with different characteristics of type 2 DM. MATERIALS AND METHODS: A total of 120 patients suffering from type 2 DM (already diagnosed and on treatment) were randomly selected from the OPD (irrespective of their glycemic status). The thyroid status of all those patients was assessed. All diabetic patients were studied with a predesigned schedule and lab investigations for the prevalence of thyroid dysfunction and its association with pertinent variables from January to December 2019. RESULTS: This study found a 28.3% prevalence of thyroid dysfunction among diabetics. It was significantly associated with poor glycemic control [rising hemoglobin A1c (HbA1c) level] (actual p-value for HbA1c vs abnormal thyroid status = 2.4 E-21) but not with other variables, including the duration of diabetes. CONCLUSION: Screening for thyroid dysfunction among diabetic persons should be routine, and strict glycemic control is essential.

Scourge of out-of-pocket expenditure on health: A study on its burden and predictors in a rural community of West Bengal.

Introduction: Globally, one-third of current health expenditure had been out-of-pocket expenditure (OOPE). The health system financing of almost all low- and middle-income countries including India rely heavily on out-of-pocket (OOP) payments for health care. OOPE on health payments is particularly hard on any community, especially the poor leading to incomplete or even no treatment during their ill health. This study estimated OOPE among residents of a rural community in West Bengal and explored the associated factors with high OOP expenses. Methods: A community-based cross-sectional study was conducted in a rural community in Singur, West Bengal from June 2019 to February 2020. The study was done among 398 villagers selected from 15 clusters or villages. Households were randomly selected in each village. All members of the selected households were interviewed. SPSS was used for data analysis both for descriptive and inferential statistics. Results: Only 14.6% of morbid persons had catastrophic expenditure. The incidence of catastrophic expenditure was higher among those who opted for private practitioners and or ayurveda, yoga and naturopathy, unani, siddha, and homeopathy (AYUSH) facilities. There was zero catastrophic expenditure for the unqualified sector. There was an increasing trend of OOP payments among the lower socioeconomic groups. Again, low-income individuals had a higher share in cumulative expenditure (Gini coefficient of 0.35). Most of the participants (78.4%) had no health insurance coverage. Conclusion: Promotion for higher utilization of public health facilities may reduce the burden of OOP expenses. Government health insurance schemes must be widened with the inclusion of coverage of outpatient services. Integrating AYUSH services in the public sector is another option to reduce OOP expenses.

Unearthing the alteration in plant volatiles induced by mycorrhizal fungi: A shield against plant pathogens.

Plants produce a large range of structurally varied low molecular weight secondary metabolites, which evaporate, known as volatile organic compounds (VOCs). Several of them are emitted in response to biotic stress as a defensive measure against pathogen attacks. Arbuscular Mycorrhizal Fungi (AMFs) can change the VOC pattern in parts of the plant and may promote plant defense via direct or indirect mechanisms. Mycorrhization of plants positively affects plant immunization along with growth and yield. The presence of AMF may raise the concentration of phenolic compounds and the activity of critical defense-related enzymes. AMF-induced changes in plant chemistry and associated volatile emissions lead to stronger immunity against pathogenic microorganisms. Despite substantial research into the origins of diversity in VOC-mediated plant communication, very little is known about the mechanism of influence of several AMFs on plant VOC emissions and modulation of plant immunization. Moreover, the molecular mechanism for VOC sensing in plants and mycorrhizal association is still unclear. In the present review, we have presented an up-to-date understanding of the cross-talk of AMF and VOC patterns in plants and the subsequent modulation of resistance against microbial pathogens.

Ethno-pharmacological and industrial attributes on the underutilized Arenga species in India.

The genus Arenga belongs to the Arecaceae family, which has a significant economic value. Several species of this genus have a decent potential of becoming an industrial crop. In India, four species of the genus, namely Arenga pinnata, A. obtusifolia, A. micranta, and A. wightii have been reported. These species have not been cultivated on a commercial scale in most of the growing regions. People use this plant directly from the forest or those produced in their backyard, even though productivity is minimal. To date, several studies from throughout the world have reported numerous beneficial roles of such species. Proper use of such plants or their products has immense significance in the food, fiber, and pharmaceutical industry. These plants are also recognized as ecologically significant plants. In this article, we have presented an up-to-date review on the species of Arenga reported from India along with their potential utility as industrial crops. This review is motivated by the desire to produce many eco-friendly resources from A. pinnata and other species of Arenga, which can contribute to an increase in the standard of living and economy of many nations, including India. PRACTICAL APPLICATIONS: Arenga has a lot of potential as medicinal as well as industrial raw materials. Despite this, these plants are somehow underutilized and have not gained much attention in international trade. In this communication, we have presented some aspects of these plants by reviewing many research articles and conference proceedings. The utilization of these plants as traditional medicine serves an important part in basic health care for many people in developing nations. Gradual study and clinical trial of different formulations of these plants can explore novel drugs for some critical disorders. We also highlighted the industrial uses of these species. Biofuel and fiber obtained from A. pinnata have been appreciated by the researchers. This article points out some attributes of these plants that required further improvement. Botanists and phytochemists will appreciate the description of the medicinal properties of these plants and the biological data provided in the article.

Imperative role of trehalose metabolism and trehalose-6-phosphate signaling on salt stress responses in plants.

Sugar transport and distribution have a direct impact on the growth and development of plants. Many sugars significantly influence salt stress response. The sensing of salt stress signals triggers a wide array of complicated network transduction pathways in plants. Trehalose and its intermediate compounds effectively modulate salt response and salt tolerance. Sugars such as trehalose and its derivatives not only serve as metabolic resources and structural components of cells in plants but also exhibit hormone-like regulating properties. Trehalose has an important physiological role in improving plant tolerance against salinity stresses in different plants. Plants finely adjust their cytoplasmic compatible solute pool to cope with high salinity. Salt stress induces a variety of structural, anatomical, molecular, biochemical, and physiological changes in plants, all of which have a detrimental influence on plant growth and development. This review highlights the recent developments in understanding trehalose and trehalose-6-phosphate signaling processes in plants, especially their impacts on plants growing in salty environments.

Seed priming with non-ionizing physical agents: plant responses and underlying physiological mechanisms.

Seed priming has long been explored as an effective value-added potential technique that results in improved germination, reduced seedling emergence time, shortened crop duration, increased stress tolerance and eventually increased higher grain production. However, the wider applicability of water or chemical-based conventional methods of seed priming is often restricted considering its deleterious effects on post-treatment storability or agricultural pollution due to the persistence of chemicals in plant systems or in the environment. In this context, the utilization of physical methods of seed priming for enhancing plant productivity has created a new horizon in the domain of seed technology. Being eco-friendly and cost-effective approaches, priming with extra-terrestrial or physical agents such as ionizing radiation such as X-rays and gamma rays and non-ionizing radiation such as ultrasonic wave, magnetic field, microwaves, and infrared light offers many advantages along with ensuring enhanced production over conventional methods. Ultraviolet radiations, bridging between ionizing and non-ionizing radiation, are important electromagnetic waves that would also be an effective priming agent. Non-ionizing radiation has certain biological advantages over ionizing radiation since it does not generate charged ions while passing through a subject, but has enough energy to cause biological effects. Extensive research works to study the effects of various non-ionizing physical priming methods are required before their wider exploitation in agriculture. With this background, this review aims to highlight the current understanding of non-ionizing physical methods of seed priming and its applicability to combat present-day challenges to achieve agro-ecological resilience.

A cross-sectional study on oral hygiene among Santhal tribal adults in a rural area of West Bengal.

CONTEXT: Oral health is a key indicator of overall health and wellbeing. Despite adequate medical advancements in global oral health, problems still persist in many communities in India especially in the hard to reach areas of the vulnerable population. AIMS: This study aimed to assess the oral hygiene status among adults of Santhal tribe in a rural area of West Bengal and to find out the factors associated with their oral hygiene status. MATERIALS AND METHODS: A community-based, cross-sectional study was conducted among adults of Santhal tribe in a rural area of Paschim Bardhhaman district, West Bengal. Data was collected from 103 participants by simple random sampling (without replacement) technique using a predesigned pretested structured schedule. Data analysis was done using Microsoft Excel 2010. RESULTS: The mean age of the study participants was 32.17 ± 12.72 years. Half (50.5%) were female participants. The proportion of poor oral hygiene status was 38.8%. Significant predictors of poor oral hygiene status on univariate logistic regression were age group (P = 0.011), gender (P = 0.013), alcohol consumption (P = 0.001), use of "datun" (P = 0.011), smokeless tobacco (SLT) use (P = 0.000), and both smoking Tobacco (ST)-SLT use (P = 0.000). In multivariable model, "datun" use (P = 0.013), SLT use (P = 0.001), both ST-SLT use (P = 0.004) retained their significant association with poor oral hygiene status. CONCLUSION: The present study findings emphasize on necessity of awareness generation regarding oral hygiene and strategic implementation of essential oral care in tribal communities residing in this area of West Bengal.

Effect of Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on COVID-19 outcome: A Record Based Observational Study in West Bengal.

BACKGROUND: Since its first identification in December 2019, in WUHAN (CHINA), SARS-COV-2, causative agent of Corona virus pandemic, has affected millions of people worldwide, causing thousands of death. There is much speculation about the interplay between ACEI/ARB and Corona virus infection, as for internalization into host cell SARS-COV-2 binds through S spike protein to ACE-2, aided TMPRSS2. METHODS: A record based observational study has been conducted (data obtained from the clinics of fourteen physicians) in two worst affected districts of West Bengal, to find out the association of ACEI/ARB on patients, suffering from Corona virus infection. The study-protocol has already been approved by Clinical Research Ethics Committee of Calcutta School of Tropical Medicine. (IEC Ref. No: CREC-STM/2020-AS-37) Results: Increasing age, male sex and presence of co-morbidities (viz. Diabetes, COPD) are significantly associated with the occurrence of moderate and severe disease. Drugs (viz. ACEI/ARB), though are associated with less severe disease, have not achieved statistical significance, in the present study. CONCLUSION: Drugs, like ACEI/ARB, should be continued in patients suffering from COVID-19 infection, (if they are already on these drugs).

How common are aches and pains among garment factory workers? A work-related musculoskeletal disorder assessment study in three factories of south 24 Parganas district, West Bengal.

CONTEXT: Garment Industry is considered to be the second-largest employment sector in India. Occupational health problems among workers are often ignored, work-related musculoskeletal disorders (WMSD) accounts for the majority of it. The leverage of a healthy workforce is indispensable in the smooth running of the country's economic machinery. AIMS: To find out the prevalence of WMSD among the workers and to assess the relationship of WMSDs with sociodemographic, behavioral, and occupational factors. SETTINGS AND DESIGN: A cross-sectional study was conducted from June 2017 to August 2019 among 222 workers in three garment factories located in a municipality area of south 24 Parganas District, West Bengal. METHODS AND MATERIAL: Sociodemographic and behavioral characteristics, occupational differentials, and morbidity profiles were assessed using a pre-designed, pre-tested schedule. STATISTICAL ANALYSIS USED: Data were analyzed by SPSS ver. 16.0. Logistic regression was done to determine the associates of WMSDs. RESULTS: Most of the workers were males (70.27%), belonged to the age-group of 36-55 (42.34%) and were illiterate (33.78%). WMSD was prevalent among 70.72% of the workers. Presence of WMSD was significantly associated with educational status{illiterate (OR: 3.59; CI: 1.56-8.22), below secondary (OR-2.89;CI: 1.26-6.62)}, sitting job (OR: 2.02; CI: 1.01-4.03), unsatisfactory working environment (OR: 8.38; CI:1.95-36.06), and level of distress {mild (OR-2.89;CI: 1.26-6.62), moderate-severe (OR: 6.98; CI: 1.46-33.25)}. CONCLUSIONS: Improving health awareness and periodic health check-up is the need of the hour for the sustenance of the massive workforce, which can be achieved through the integration of basic occupational health services (BOHS) with primary health care (PHC) infrastructure.

Prospective Evaluation of Few Homeopathic Rubrics of Kent's Repertory From Bayesian Perspective.

Absolute grading system of homeopathic repertories poses substantial threat to reliability; however, it may be resolved by evaluating rubrics prospectively using likelihood ratio (LR). The authors evaluated few "physical general" rubrics from Kent's repertory-"chilly," "hot," "ambithermal," "preference for hot/cold food," "desire/aversion for fish/egg/meat/sour/pungent/salt/sweet/bitter"-prospectively in West Bengal, India, for 1.5 years using the Outcome Related to Impact on Daily Living scale. Per symptom/rubric, LRs < 1.5 were discarded. A total of 2039 encounters were analyzed for thermal relations and 4715 for desires/aversions for specific food items. Comparison with Kent's repertory revealed discrepancies. One new rubric with corresponding medicines was suggested to be introduced, new entries of medicines were recommended, and some seemed to maintain their ascribed importance. The authors refrained from converting LRs into typefaces prematurely; still they propose introducing LR to repertories for a structural update, changing its use, and enabling homeopaths to make more reliable predictions.

SUMOylation-disrupting WAS mutation converts WASp from a transcriptional activator to a repressor of NF-κB response genes in T cells.

In Wiskott-Aldrich syndrome (WAS), immunodeficiency and autoimmunity often comanifest, yet how WAS mutations misregulate chromatin-signaling in Thelper (TH) cells favoring development of auto-inflammation over protective immunity is unclear. Previously, we identified an essential promoter-specific, coactivator role of nuclear-WASp in TH1 gene transcription. Here we identify small ubiquitin-related modifier (SUMO)ylation as a novel posttranslational modification of WASp, impairment of which converts nuclear-WASp from a transcriptional coactivator to a corepressor of nuclear factor (NF)-κB response genes in human (TH)1-differentiating cells. V75M, one of many disease-causing mutations occurring in SUMO*motif (72-ψψψψKDxxxxSY-83) of WASp, compromises WASp-SUMOylation, associates with COMMD1 to attenuate NF-κB signaling, and recruits histone deacetylases-6 (HDAC6) to p300-marked promoters of NF-κB response genes that pattern immunity but not inflammation. Consequently, proteins mediating adaptive immunity (IFNG, STAT1, TLR1) are deficient, whereas those mediating auto-inflammation (GM-CSF, TNFAIP2, IL-1ß) are paradoxically increased in TH1 cells expressing SUMOylation-deficient WASp. Moreover, SUMOylation-deficient WASp favors ectopic development of the TH17-like phenotype (↑IL17A, IL21, IL22, IL23R, RORC, and CSF2) under TH1-skewing conditions, suggesting a role for WASp in modulating TH1/TH17 plasticity. Notably, pan-histone deacetylase inhibitors lift promoter-specific repression imposed by SUMOylation-deficient WASp and restore misregulated gene expression. Our findings uncovering a SUMOylation-based mechanism controlling WASp's dichotomous roles in transcription may have implications for personalized therapy for patients carrying mutations that perturb WASp-SUMOylation.

Identification of differentially expressed transcripts associated with bast fibre development in Corchorus capsularis by suppression subtractive hybridization.

MAIN CONCLUSION: The present study documented the predominant role of WRKY transcription factor in controlling genes of different pathways related to fibre formation in jute and could be a candidate gene for the improvement of jute fiber. Understanding of molecular mechanism associated with bast fibre development is of immense significance to achieve desired improvement in jute (Corchorus sp.). Therefore, suppression subtractive hybridization was successfully applied to identify genes involved in fibre developmental process in jute. The subtracted library of normal Corchorus capsularis as tester with respect to its fibre-deficient mutant as driver resulted in 2,685 expressed sequence tags which were assumed to represent the differentially expressed genes between two genotypes. The identified expressed sequence tags were assembled and clustered into 225 contigs and 231 singletons. Among these 456 unigenes, 377 were classified into 15 different functional categories while others were of unknown functional category. Reverse Northern analysis of the unigenes showed distinct variation in hybridization intensity of 11 transcripts between two genotypes tested. The findings were also documented by Northern and real-time PCR analysis. Varied expression level of these transcripts suggested their crucial involvement in fibre development in this species. Among these transcripts, WRKY transcription factor was documented to be a most important transcript which was in agreement with its known role in other plant species in possible regulation related to cell wall biosynthesis, expansion and lignification. This report constitutes first systematic analysis of genes involved in fibre development process in jute. It may be suggested that the information generated in this study would be useful for genetic improvement of fibre traits in this plant species.

Disruption of hSWI/SNF complexes in T cells by WAS mutations distinguishes X-linked thrombocytopenia from Wiskott-Aldrich syndrome.

Wiskott-Aldrich syndrome (WAS), an immunodeficiency disorder, and X-linked thrombocytopenia (XLT), a bleeding disorder, both arise from nonsynonymous mutations in WAS, which encodes a hematopoietic-specific WASp. Intriguingly, XLT evolves into WAS in some patients but not in others; yet the biological basis for this cross-phenotype (CP) effect remains unclear. Using human T-helper (TH) cells expressing different disease-causing WAS mutations, we demonstrated that hSWI/SNF-like complexes require nuclear-WASp to execute their chromatin-remodeling activity at promoters of WASp-target, immune function genes during TH1 differentiation. Hot-spot WAS mutations Thr45Met and Arg86Cys, which result in XLT-to-WAS disease progression, impair recruitment of hBRM- but not BRG1-enriched BAF complexes to IFNG and TBX21 promoters. Moreover, promoter enrichment of histone H2A.Z and its catalyzing enzyme EP400 are both impaired. Consequently, activation of Notch signaling, a hBRM-regulated event, and its downstream effector NF-κB are both compromised, along with decreased accessibility of nucleosomal DNA and inefficient transcription-elongation of WASp-target TH1 genes. In contrast, patient mutations Ala236Gly and Arg477Lys that manifest in XLT without progressing to WAS do not disrupt chromatin remodeling or transcriptional reprogramming of TH1 genes. Our study defines an indispensable relationship between nuclear-WASp- and hSWI/SNF-complexes in gene activation and reveals molecular distinctions in TH cells that might contribute to disease severity in the XLT/WAS clinical spectrum.

Nuclear role of WASp in gene transcription is uncoupled from its ARP2/3-dependent cytoplasmic role in actin polymerization.

Defects in Wiskott-Aldrich Syndrome protein (WASp) underlie development of WAS, an X-linked immunodeficiency and autoimmunity disorder of childhood. Nucleation-promoting factors (NPFs) of the WASp family generate F-actin in the cytosol via the VCA (verprolin-homology, cofilin-homology, and acidic) domain and support RNA polymerase II-dependent transcription in the nucleus. Whether nuclear-WASp requires the integration of its actin-related protein (ARP)2/3-dependent cytoplasmic function to reprogram gene transcription, however, remains unresolved. Using the model of human TH cell differentiation, we find that WASp has a functional nuclear localizing and nuclear exit sequences, and accordingly, its effects on transcription are controlled mainly at the level of its nuclear entry and exit via the nuclear pore. Human WASp does not use its VCA-dependent, ARP2/3-driven, cytoplasmic effector mechanisms to support histone H3K4 methyltransferase activity in the nucleus of TH1-skewed cells. Accordingly, an isolated deficiency of nuclear-WASp is sufficient to impair the transcriptional reprogramming of TBX21 and IFNG promoters in TH1-skewed cells, whereas an isolated deficiency of cytosolic-WASp does not impair this process. In contrast, nuclear presence of WASp in TH2-skewed cells is small, and its loss does not impair transcriptional reprogramming of GATA3 and IL4 promoters. Our study unveils an ARP2/3:VCA-independent function of nuclear-WASp in TH1 gene activation that is uncoupled from its cytoplasmic role in actin polymerization.

A longitudinal study on health expenditure in a rural community attached to Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra.

Community based study on health expenditure is a rarity in India. A Rural Community based longitudinal study was undertaken in Jaulgaon village of Maharashtra, with objectives of finding out the health expenditure contributed by direct treatment, related travel and relevant loss of wages with certain pertinent associated factors. 50% of the village population was studied (N = 256) by pre-designed, pre-tested schedule following WHO guidelines. A monthly house to house interview was conducted over 12 months. During study period, 78% study subjects suffered some illness with mean illness episode 1.74/person and 6.37/family without any sex difference. The annual health expenditure of the community was Rs 1,576/family, 4,31/person and 2,42/episode, which was about 4.3% of their income. The major part of the expenditure (82%) was for direct treatment cost, followed by loss of wages (12%) and travel related cost (6%). Expenditure was seen to be significantly associated with family income (P = 0.000) and education (P = 0.006).

Exploring the quality of life (QOL) in the Indian software industry: a public health viewpoint.

OBJECTIVES: Our objectives were to describe the QOL and its determinants among software professionals of Kolkata, and to compare the same according to information technology (IT) and IT-enabled services (ITeS) sub-sectors. METHODS: An institution-based cross-sectional study was conducted among software professionals of Kolkata applying a two-stage stratified random sampling technique. The WHO QOL BREF questionnaire was administered along with a list of pertinent variables. RESULTS: Overall, the analysis for 338 software professionals (177 IT and 161 ITeS) clearly demonstrated significant differences between mean scores of these two sectors for each of the six outcome domains of WHO QOL BREF. Multilevel multivariate analysis outlined 13 significant predictors of QOL-four positive (age, regular fitness regimes, foreign placements and changing companies frequently) and the rest of the nine, negative (multiple sex partners, multiple addictions, extended working hours, night-shift duties, income, expenditure, carrying office work home, current illness and ITeS company type). CONCLUSIONS: Our study helps in obtaining a clear understanding of the multifaceted risk factors prevailing in this sector, the majority of which can be effectively addressed by specific health promotional interventions. A dedicated health policy is mandated at both government and company levels.

A sociodemographic study of multidrug resistant tuberculosis cases from DOTS clinics of Kolkata.

This cross-sectional, observational study was undertaken to identify rifampicin and INH resistant mycobacteria in the sputum samples of category II treatment failure tuberculosis patients from three 'DOTS' clinics of Kolkata (Ward No 15, 33, 79 of Kolkata Municipal Corporation). Conventional method of culture in solid and liquid media followed by sensitivity testing to rifampicin and INH were done. Age, sex, economic status, nutrition, history of contact, living condition, etc, were taken into consideration. Out of 66 category II treatment failure tuberculosis cases from 3 DOTS clinics, 45 (68.2%) were found to be multidrug resistant (MDR). Among them, 68.9% were male patients and 55.6% were in the economically productive age group. Most of them (73.3%) were malnourished (BMI < 18.5); 62.2% of patients belonged to 'below poverty line' (BPL) category and 82.2% patients lived in overcrowded room. Majority of them (82.3%) either had past history of tuberculosis or history of contact or both.This study also shows that apart from the biological reasons of drug resistance, the sociodemographic and economic factors are no less important for the spread of drug resistant tuberculosis.

Isolation of RNA from field-grown jute (Corchorus capsularis) plant in different developmental stages for effective downstream molecular analysis.

Jute (Corchorus capsularis), as a natural fibre producing plant species, ranks next to cotton only. Today, biotechnological approach has been considered as most accepted means for any genetic improvement of plant species. However, genetic control of the fibre development in jute has not yet been explored sufficiently for desired genetic improvement. One of the major impediments in exploring the genetic architecture in this crop at molecular level is the availability of good quality RNA from field-grown plant tissues mostly due to the presence of high amount of mucilage and phenolics. Development of a suitable RNA isolation method is becoming essential for deciphering developmental stage-specific gene expression pattern related to fibre formation in this crop species. A combination of modified hot borate buffer followed by isopycnic centrifugation (termed as HBIC) was adopted and found to be the best isolation method yielding sufficient quantity (~350-500 µg/gm fresh tissue) and good quality (A(260/280) ratio 1.88 to 1.91) RNA depending on the developmental stage of stem tissue from field-grown jute plant. The poly A(+) RNA purified from total RNA isolated by the present method was found amenable to efficient RT-PCR and cDNA library construction. The present development of RNA isolation was found to be appropriate for gene expression analysis related to fibre formation in this economically important jute plant in near future.

Nuclear role of WASp in the pathogenesis of dysregulated TH1 immunity in human Wiskott-Aldrich syndrome.

The clinical symptomatology in the X-linked Wiskott-Aldrich syndrome (WAS), a combined immunodeficiency and autoimmune disease resulting from WAS protein (WASp) deficiency, reflects the underlying coexistence of an impaired T helper 1 (TH1) immunity alongside intact TH2 immunity. This suggests a role for WASp in patterning T(H) subtype immunity, yet the molecular basis for the TH1-TH2 imbalance in human WAS is unknown. We have discovered a nuclear role for WASp in the transcriptional regulation of the TH1 regulator gene TBX21 at the chromatin level. In primary TH1-differentiating cells, a fraction of WASp is found in the nucleus, where it is recruited to the proximal promoter locus of the TBX21 gene, but not to the core promoter of GATA3 (a TH2 regulator gene) or RORc (a TH17 regulator gene). Genome-wide mapping demonstrates association of WASp in vivo with the gene-regulatory network that orchestrates TH1 cell fate choice in the human TH cell genome. Functionally, nuclear WASp associates with H3K4 trimethyltransferase [RBBP5 (retinoblastoma-binding protein 5)] and H3K9/H3K36 tridemethylase [JMJD2A (Jumonji domain-containing protein 2A)] proteins, and their enzymatic activity in vitro and in vivo is required for achieving transcription-permissive chromatin dynamics at the TBX21 proximal promoter in primary differentiating TH1 cells. During TH1 differentiation, the loss of WASp accompanies decreased enrichment of RBBP5 and, in a subset of WAS patients, also of filamentous actin at the TBX21 proximal promoter locus. Accordingly, human WASp-deficient TH cells, from natural mutation or RNA interference-mediated depletion, demonstrate repressed TBX21 promoter dynamics when driven under TH1-differentiating conditions. These chromatin derangements accompany deficient T-BET messenger RNA and protein expression and impaired TH1 function, defects that are ameliorated by reintroducing WASp. Our findings reveal a previously unappreciated role of WASp in the epigenetic control of T-BET transcription and provide a new mechanism for the pathogenesis of WAS by linking aberrant histone methylation at the TBX21 promoter to dysregulated adaptive immunity.

Validity of mid arm circumference to detect protein energy malnutrition among 8-11 months old infants in a rural medical college of West Bengal.

This institution-based cross-sectional observational validation study was conducted in the immunisation clinic of North Bengal Medical College and Hospital, Sushrutanagar. The objective was to identify the validity characteristics of mid arm circumference to detect protein energy malnutrition among 8-11 months infants and to find out a suitable cut-off value if any. Study variables were age, sex, body weight and mid arm circumference. Mid arm circumference was validated against weight for age criteria (gold standard) of malnutrition. The mean mid arm circumference of the infants was found to be almost constant with only about 2.22% change over 4 months, signifying that single cut-off point can be used to detect protein energy malnutrition. Mid arm circumference values from 13.0 to 12.5 cm were found to have the highest accuracy to detect protein energy malnutrition (about 86%). The cut-off values of 12.5 and 12.6 cm were noted to have a sensitivity and specificity of about 52% and 96% respectively, a false negativity of 48% but a false positivity of only 4%. Receiver operating characteristics curve detected 12.5(12.6) cm as the best diagnostic cut-off point which can detect more than 50% of the malnourished babies with very little false positivity/misdiagnosis (only 4%). A simple measuring tape with some reorientation of the health workers can detect the beginning of childhood malnutrition.