Evaluation of RURS elbow guard in the management of thumb-sucking habit in children with and without intellectual disability.

BACKGROUND: Digit sucking is a common oral habit among many children, which involves placing the thumb/finger into the mouth, which can cause malocclusion in mixed and permanent dentition. AIM: To evaluate the efficacy of the RURS elbow guard in the management of thumb-sucking habits in children with intellectual disabilities and those without in terms of the mean duration of appliance therapy. The secondary objective was to compare the RURS elbow guard with an intraoral crib in healthy children (without intellectual disabilities) to manage the habit of thumb-sucking. DESIGN: Children with intellectual disabilities and those without between the age of 4 and 16 years were included in the study and categorised into three groups, namely group I (50 normal children; intraoral crib appliance), group II (50 normal children; RURS elbow guard) and group III (50 children with intellectual disabilities; RURS elbow guard). RESULTS: The mean duration of appliance therapy for groups I, II and III were 200.20 ± 20.43 days, 204.34 ± 20.56 days, and 218.43 ± 15.66 days, respectively (p < 0.001). The differences in the mean duration between group I and group II were statistically non-significant, with statistically significant differences between group I and group III (p < 0.001) and between group II and group III (p < 0.05). CONCLUSION: The RURS elbow guard was found to be an efficient appliance in treating thumb-sucking among children who had mild to moderate intellectual disabilities. RURS elbow guard was equally efficient as an intraoral crib appliance in managing thumb-sucking habits in children without intellectual disabilities.

Assessing clinical frailty scale scoring by junior medical learners on an inpatient geriatrics consultation service.

The Clinical Frailty Scale (CFS) is incorporated into our institution's comprehensive geriatric assessment (CGA). CGAs and CFS scoring are completed by junior medical trainees on the Geriatric consult service. The agreement between CFS score assignment by junior trainees and Geriatrics trained individuals in this setting is unknown. Importantly, these scores assign a frailty level that impacts care pathways. We conducted a retrospective chart review from April-June 2019. A Geriatric medicine subspecialty resident assigned retrospective CFS scores based on data from the CGA. We compared scores to determine the level of agreement using the Cohen and Conger's Kappa inter-rater agreement metric and assessed whether patient characteristics influenced the likelihood of agreement between raters using a generalized linear model. Medical students assessed 43% (46/108) of patients (n = 13), and 57% (62/108) were assessed by PGY1s (n = 10). Inter-rater agreement measures showed substantial agreement overall and for PGY1s, but dropped to a moderate agreement for medical students. The retrospective inter-rater agreement of the CFS showed substantial agreement overall and decreased when limited to medical students, highlighting the need for interventions to improve the understanding of frailty early in medical training.

Management strategies for the painless foot drop: a systematic review of the literature.

PURPOSE: Foot drop can uncommonly be a painless presenting symptom of degenerative spinal disorders. This systematic review aimed to summarise the literature on the management and outcomes of patients with a painless foot drop. METHODS: We performed a systematic review of PubMed, EMBASE and Medline according to PRISMA guidelines. All studies published after 1980 in English referring to adult patients with a painless foot drop were included. Exclusion criteria included opinion based reports, review articles and articles in which foot drop was not caused by degenerative pathology of the thoracolumbar spine. RESULTS: Of 62 included patients, 30 (48.4%) were male with an average age of 48.7 years (range 27-84). The mean duration of symptoms was 69.0 days (1-700). 98.8% were managed operatively. 46 (74.2%) patients had symptomatic improvement, with 41 (66.1%) having a post-intervention MRC power grading of 3 or above. Patients with a pre-procedure MRC 0 had a higher median increase in MRC post-procedure than those with MRC > 0. Of two studies comparing painful and painless symptoms, painless foot drop patients were less likely to recover to MRC equal to or over 3 than those with painful symptoms OR 0.31 (95% CI 0.04-2.65). CONCLUSION: This systematic review and meta-analysis demonstrates a role for surgery in facilitating the neurological recovery of patients with a painless foot drop. Large randomised controlled studies are required to characterise the role of operative intervention in these patients and compare outcomes between patients with painless and painful foot drop.

Mistaken identity of polymorphous low-grade adenocarcinoma treated as periapical lesion in anterior maxilla: A case report.

This report presents a rare case of polymorphous low-grade adenocarcinoma (PLGA) in the anterior maxilla, mimicking a periapical lesion. A 56-year-old male reported with a painless swelling in the maxillary right canine-premolar region. The patient gave a history of root canal therapy for the same teeth one month ago. On intraoral examination, the involved teeth were restored with ceramic crowns. Radiographic examination revealed inadequate obturation with an ill-defined radiolucency in the periapical region. 3D cone beam computer tomography (CBCT) revealed erosion of the buccal cortical plate near the apices of the roots. Endodontic re-treatment was performed on both the teeth. Following this, the lesion was excised and submitted for histopathological analysis wherein it was identified as PLGA. Computerised tomographic (CT) scan and positron emission tomography scan (PET) results showed no regional or distant metastasis. Under general anaesthesia, the teeth were extracted, and wide surgical excision of the anterior maxilla was done till the healthy bone was exposed. Healing was uneventful during the follow-up period.

Gamma radiation induced changes in expression of heat shock proteins (Hsc70 and Hsp83) in the dengue vector Aedes aegypti (L.).

We aimed to assess the effect of gamma radiation on the expression of heat shock proteins Hsc70 and Hsp83 in Aedes aegypti. Adult males were irradiated with 50Gy of gamma radiation, and changes in the expression of proteins in SDS-PAGE gel bands corresponding to molecular weights ~60-75kDa and ~80-95kDa were analyzed at two different time points 6 and 12-hour post-irradiation, using a temporal mass spectrometry based semi-quantitative analysis. A 2-3-fold increase was observed in both proteins Hsc70 and Hsp83, at both time points. In addition, the experiment also revealed the overexpression of several other molecules such as Arginine Kinase - known to be upregulated in certain insects during stress, Esterase B1- implicated in insecticide resistance, and also down-regulation of the 26S proteasome non-ATPase regulatory subunit 1 and ubiquitin-activating enzyme E1 - both known to be involved in ubiquitin-mediated protein degradation. The results taken together with existing data on Hsp83 and Hsc70, indicate that these proteins may enhance the survival of Ae. aegypti following gamma radiation and could serve as molecular markers for the detection of radiation-induced stress.

Assessing the added value of group B Streptococcus maternal immunisation in preventing maternal infection and fetal harm: population surveillance study.

OBJECTIVE: To assess the incidence of maternal group B Streptococcus (GBS) infection in England. DESIGN: Population surveillance augmented through data linkage. SETTING: England. POPULATION: All pregnant women accessing the National Health Service (NHS) in England. METHODS: Invasive GBS (iGBS) infections during pregnancy or within 6 weeks of childbirth were identified by linking Public Health England (PHE) national microbiology surveillance data for 2014 to NHS hospital admission records. Capsular serotypes of GBS were determined by reference laboratory typing of clinical isolates from women aged 15-44 years. Post-caesarean section surgical site infection (SSI) caused by GBS was identified in 21 hospitals participating in PHE SSI surveillance (2009-2015). MAIN OUTCOME MEASURES: iGBS rate per 1000 maternities; risk of GBS SSI per 1000 caesarean sections. RESULTS: Of 1601 patients diagnosed with iGBS infections in England in 2014, 185 (12%) were identified as maternal infections, a rate of 0.29 (95% CI 0.25-0.33) per 1000 maternities and representing 83% of all iGBS cases in women aged 18-44 years. Seven (3.8%) were associated with miscarriage. Fetal outcome identified excess rates of stillbirth (3.4 versus 0.5%) and extreme prematurity (<28 weeks of gestation, 3.7 versus 0.5%) compared with national averages (P < 0.001). Caesarean section surveillance in 27 860 women (21 hospitals) identified 47 cases of GBS SSI, with an estimated 4.24 (3.51-5.07) per 1000 caesarean sections, a median time-to-onset of 10 days (IQR 7-13 days) and ten infections that required readmission. Capsular serotype analysis identified a diverse array of strains with serotype III as the most common (43%). CONCLUSIONS: Our assessment of maternal GBS infection in England indicates the potential additional benefit of GBS vaccination in preventing adverse maternal and fetal outcomes.

Factors influencing local and distant recurrence following resection of periampullary cancer.

BACKGROUND: Recurrence of periampullary cancer after pancreatoduodenectomy is common. The aim of this study was to investigate patterns of recurrence, incidence, and factors associated with local and distant recurrences. METHODS: This retrospective, single-centre study included consecutive patients with periampullary cancer who underwent resection with curative intent from January 2012 to January 2018. Survival, patterns of recurrence, and factors associated with recurrences were analysed. RESULTS: Median overall survival (OS) and disease-free survival among 398 included patients was 58.4 and 49.5 months respectively. Twenty-three patients (5.8 per cent) developed isolated local recurrences (LR), 50 (12.6 per cent) developed LR along with distant metastasis (DM), and 103 (25.9 per cent) developed isolated DM. Median OS was 40.4 months for patients with isolated LR versus 23 months for those with DM (P < 0.001). Tumour subtype (distal common bile duct (CBD): odds ratio (OR) 6.18, 95 per cent c.i. 2.19 to 17.46) and node-positive status (OR 2.36, 1.26 to 4.43) were independently associated with higher rates of LR. The most common site for isolated LR was along the superior mesenteric artery (12 of 23 patients). Tumour subtype (distal CBD: OR 2.86, 1.09 to 7.52), nodal positivity (OR 2.46, 1.53 to 3.94), and presence of perineural invasion (OR 1.80, 1.02 to 3.18) were independently associated with DM. CONCLUSION: Isolated LR is associated with better survival than DM and occurs most commonly along the superior mesenteric artery.

Profile of osteoarticular tuberculosis in children.

OBJECTIVE: To determine clinical profile of osteoarticular tuberculosis (TB) in children. METHODS: Cross-sectional analysis from 2007 to 2013. All patients diagnosed with bone TB, spinal TB or TB abscesses were included. RESULTS: Out of 1318 children with TB, 39 (2.96%) had osteoarticular TB, of which 16 (42%) had osteomyelitis, 8 (20.5%) had spinal involvement, 7 (17.9%) had TB synovitis, 2 (5.1%) had psoas abscess and 6 (15.4%) had abscesses. The mean age of presentation was 7.1 ± 3.5 years (range 2-14 years). Of the 33 cases in which a culture was done, 25 (64%) showed a positive culture. Drug sensitivity tests were done in 21 patients of which 10 (47.6%) tested were drug resistant, of which 4 (36.4%) were multidrug resistant (MDR), 2 (18.2%) were extensively drug resistant (XDR), 3 were pre-XDR (27.3%) and 1 was polyresistant (9.1%). Nine (23.1%) patients had TB in the past with a treatment duration of 8.3 ± 5.3 months. Contact with a TB patient had occurred in 10 (25.6%) cases. Associated pulmonary TB were seen in 6 (15.39%) and TB meningitis were seen in 1 (2.6%) patients. Surgical intervention was needed in 11 (28.2%) patients of which 5 (45.5%) underwent curettage, drainage was done in 1 (9.1%), arthrotomy in 4 (36.4%) and spinal surgery in 1 (9.1%) patient. CONCLUSION: Drug resistant osteoarticular TB is an emerging problem in children.

Tooth -A Potential Graft Material for Periodontal Regeneration ?

Use of tooth as a promising replacement substitute has been validated by various animal as well as human studies. Though widely used in GBR and Sinus grafting techniques, its use in periodontal intrabony defect is not documented. In the present case report, the tooth graft has been placed in periodontal intrabony defect. Postoperative CBCT after 26 weeks revealed homogeneous incorporation of tooth graft. Clinical parameters show bone fill. However; results with larger sample size could further validate the use of tooth graft in periodontal regeneration.

Use of anti-osteoporosis medication dispensing by patients with hip fracture: could we do better?

Although Scandinavian countries have the highest incidence of hip fracture in the world, trends in anti-osteoporosis medication use have not been studied. We found less than one-third of Danish hip fracture patients had dispensing of anti-osteoporosis medication over a 10-year period using routinely collected data from population-based registries. INTRODUCTION: To examine trend in dispensing of anti-osteoporosis medication before and after hip fracture surgery in Denmark over a 10-year period using routinely collected data from population-based registries. METHODS: From the Danish Multidisciplinary Hip Fracture Registry, we included 65,011 patients aged 65 years or older with an incident hip fracture in 2005-2015. We calculated, for each calendar year of hip fracture diagnosis, the prevalence of use of anti-osteoporosis medication (at least one dispensing of bisphosphonates, strontium ranelate, denosumab, selective estrogen receptor modulators, or teriparatide) in the year before and in the year following hip fracture diagnosis. Among those without a dispensing in the year before hip fracture, we computed 1-year cumulative incidence of use following hip fracture. We treated death as a competing risk and stratified the analysis on sex, age, and comorbidity. RESULTS: The prevalence of use before hip fracture varied between 7 and 12%, increasing slightly from 2005 to 2015. The cumulative incidence of use following hip fracture decreased from 16% in 2005 to 13% in 2010, whereupon it increased to 20%. A similar pattern was seen with each stratum of sex, age groups, and comorbidity. The overall prevalence of use after hip fracture was below 22% in all calendar years. CONCLUSIONS: Less than one-third of hip fracture patients had dispensing of anti-osteoporosis medication up to 1 year after hip fracture. We observed only a slight increase in dispensing after hip fracture over the study period, irrespective of patient sex, age, and comorbidity at the time of hip fracture.

Genetic analysis of Fourier transform infrared milk spectra in Danish Holstein and Danish Jersey.

Fourier transform infrared milk spectral data are routinely used for milk quality control and have been revealed to be driven by genetics. This study aimed to (1) estimate heritability for 1,060 wavenumbers in the infrared region from 5,008 to 925 cm-1, (2) estimate genomic correlations between wavenumbers with increased heritability, and (3) compare results between Danish Holstein and Danish Jersey cows. For Danish Holstein, 3,275 cows and 19,656 milk records were available. For Danish Jersey, 3,408 cows and 20,228 milk records were available. We used a hierarchical mixed model, with a Bayesian approach. Heritability of individual wavenumbers ranged from 0.00 to 0.31 in Danish Holstein, and from 0.00 to 0.30 in Danish Jersey. Genomic correlation was calculated between 15 selected wavenumbers, and varied from weak to very strong, in both Danish Holstein and Danish Jersey (0.03 to 0.97, and -0.11 to -0.97). Within the 15 selected wavenumbers, a subdivision into 2 groups of wavenumbers was observed, where genomic correlations were negative between groups, and positive within groups. Heritability and genomic correlations were higher in Danish Holstein compared with Danish Jersey, but followed a similar pattern in both breeds. Breed differences were most pronounced in the mid-infrared region that interacts with lactose and the spectral region that interacts with protein. In conclusion, heritability for individual wavenumbers of Fourier transform milk spectra was moderate, and strong genomic correlations were observed between wavenumbers across the spectrum. Heritability and genomic correlations were higher in Danish Holstein, with the strongest breed differences showing in spectral regions interacting with protein or lactose.

Thermal assisted alkaline pretreatment of rice husk for enhanced biomass deconstruction and enzymatic saccharification: Physico-chemical and structural characterization.

Thermal assisted alkaline pretreatment (TAAP) of rice husk (RH) was investigated to facilitate enzymatic saccharification by enhancing the enzyme accessibility to cellulosic components. Statistically guided experiments based on the Box-Behnken design involving four factors viz. biomass loading, particle size, NaOH loading and reaction time was considered for optimization. The maximum sugar yield of 371 mg g-1 biomass was obtained at optimized pretreatment condition [biomass loading (10% w/w), particle size (0.25-0.625 mm), NaOH loading (2% w/w), and reaction time (40 min)]. The TAAP of RH resulted in the efficient removal of lignin (14.9-54% (w/w)) with low hemicellulose solubilization [10.7-33.1% (w/w)] and with a simultaneous increase in cellulose concentration [32.65-51.65% (w/w)]. The SEM analysis indicated increased porosity and biomass disruption during TAAP. The FTIR analysis showed progressive removal of noncellulosic constituents, and XRD analysis revealed an increase in cellulose crystallinity post-TAAP indicating the effectiveness of pretreatment.

A comparison of two molecular methods for diagnosing leptospirosis from three different sample types in patients presenting with fever in Laos.

OBJECTIVES: To compare two molecular assays (rrs quantitative PCR (qPCR) versus a combined 16SrRNA and LipL32 qPCR) on different sample types for diagnosing leptospirosis in febrile patients presenting to Mahosot Hospital, Vientiane, Laos. METHODS: Serum, buffy coat and urine samples were collected on admission, and follow-up serum ∼10 days later. Leptospira spp. culture and microscopic agglutination tests (MAT) were performed as reference standards. Bayesian latent class modelling was performed to estimate sensitivity and specificity of each diagnostic test. RESULTS: In all, 787 patients were included in the analysis: 4/787 (0.5%) were Leptospira culture positive, 30/787 (3.8%) were MAT positive, 76/787 (9.7%) were rrs qPCR positive and 20/787 (2.5%) were 16SrRNA/LipL32 qPCR positive for pathogenic Leptospira spp. in at least one sample. Estimated sensitivity and specificity (with 95% CI) of 16SrRNA/LipL32 qPCR on serum (53.9% (33.3%-81.8%); 99.6% (99.2%-100%)), buffy coat (58.8% (34.4%-90.9%); 99.9% (99.6%-100%)) and urine samples (45.0% (27.0%-66.7%); 99.6% (99.3%-100%)) were comparable with those of rrs qPCR, except specificity of 16SrRNA/LipL32 qPCR on urine samples was significantly higher (99.6% (99.3%-100%) vs. 92.5% (92.3%-92.8%), p <0.001). Sensitivities of MAT (16% (95% CI 6.3%-29.4%)) and culture (25% (95% CI 13.3%-44.4%)) were low. Mean positive Cq values showed that buffy coat samples were more frequently inhibitory to qPCR than either serum or urine (p <0.001). CONCLUSIONS: Serum and urine are better samples for qPCR than buffy coat, and 16SrRNA/LipL32 qPCR performs better than rrs qPCR on urine. Quantitative PCR on admission is a reliable rapid diagnostic tool, performing better than MAT or culture, with significant implications for clinical and epidemiological investigations of this global neglected disease.

Evaluation of gamma radiation-induced DNA damage in Aedes aegypti using the comet assay.

The study was undertaken to evaluate gamma radiation-induced DNA damage in Aedes aegypti. The comet assay was employed to demonstrate the extent of DNA damage produced in adult male A. aegypti exposed to seven different doses of gamma radiation, ranging from 1 Gy to 50 Gy. DNA damage was measured as the percentage of comet tail DNA. A significant linear increase in DNA damage was observed in all samples; the extent of damage being proportional to the dose of gamma radiation the organism received, except in those treated with 1 Gy. The highest amount of DNA damage was noticed at 1 h postirradiation, which decreased gradually with time, that is, at 3, 6 and 12 h postirradiation. This may indicate repair of the damaged DNA and/or loss of heavily damaged cells as the postirradiation time increased. The comet assay serves as a sensitive and rapid technique to detect gamma radiation-induced DNA damage in A. aegypti. This could be used as a potential biomarker for environmental risk assessment.

Predicting methane emissions of lactating Danish Holstein cows using Fourier transform mid-infrared spectroscopy of milk.

Enteric methane (CH4), a potent greenhouse gas, is among the main targets of mitigation practices for the dairy industry. A measurement technique that is rapid, inexpensive, easy to use, and applicable at the population level is desired to estimate CH4 emission from dairy cows. In the present study, feasibility of milk Fourier transform mid-infrared (FT-IR) spectral profiles as a predictor for CH4:CO2 ratio and CH4 production (L/d) is explained. The partial least squares regression method was used to develop the prediction models. The models were validated using different random test sets, which are independent from the training set by leaving out records of 20% cows for validation and keeping records of 80% of cows for training the model. The data set consisted of 3,623 records from 500 Danish Holstein cows from both experimental and commercial farms. For both CH4:CO2 ratio and CH4 production, low prediction accuracies were found when models were obtained using FT-IR spectra. Validated coefficient of determination (R2Val) = 0.21 with validated model error root mean squared error of prediction (RMSEP) = 0.0114 L/d for CH4:CO2 ratio, and R2Val = 0.13 with RMSEP = 111 L/d for CH4 production. The important spectral wavenumbers selected using the recursive partial least squares method represented major milk components fat, protein, and lactose regions of the spectra. When fat and protein predicted by FT-IR were used instead of full spectra, a low R2Val of 0.07 was obtained for both CH4:CO2 ratio and CH4 production prediction. Other spectral wavenumbers related to lactose (carbohydrate) or additional wavenumbers related to fat or protein (amide II) are providing additional variation when using the full spectral profile. For CH4:CO2 ratio prediction, integration of FT-IR with other factors such as milk yield, herd, and lactation stage showed improvement in the prediction accuracy. However, overall prediction accuracy remained modest; R2Val increased to 0.31 with RMSEP = 0.0105. For prediction of CH4 production, the added value of FT-IR along with the aforementioned traits was marginal. These results indicated that for CH4 production prediction, FT-IR profiles reflect primarily information related to milk yield, herd, and lactation stage rather than individual milk fatty acids related to CH4 emission. Thus, it is not feasible to predict CH4 emission based on FT-IR spectra alone.

Comparison of the Nosocomial Pneumonia Mortality Prediction (NPMP) model with standard mortality prediction tools.

BACKGROUND: Severity or mortality prediction of nosocomial pneumonia could aid in the effective triage of patients and assisting physicians. AIM: To compare various severity assessment scoring systems for predicting intensive care unit (ICU) mortality in nosocomial pneumonia patients. METHODS: A prospective cohort study was conducted in a tertiary care university-affiliated hospital in Manipal, India. One hundred patients with nosocomial pneumonia, admitted in the ICUs who developed pneumonia after >48h of admission, were included. The Nosocomial Pneumonia Mortality Prediction (NPMP) model, developed in our hospital, was compared with Acute Physiology and Chronic Health Evaluation II (APACHE II), Mortality Probability Model II (MPM72 II), Simplified Acute Physiology Score II (SAPS II), Multiple Organ Dysfunction Score (MODS), Sequential Organ Failure Assessment (SOFA), Clinical Pulmonary Infection Score (CPIS), Ventilator-Associated Pneumonia Predisposition, Insult, Response, Organ dysfunction (VAP-PIRO). Data and clinical variables were collected on the day of pneumonia diagnosis. The outcome for the study was ICU mortality. The sensitivity and specificity of the various scoring systems was analysed by plotting receiver operating characteristic (ROC) curves and computing the area under the curve for each of the mortality predicting tools. FINDINGS: NPMP, APACHE II, SAPS II, MPM72 II, SOFA, and VAP-PIRO were found to have similar and acceptable discrimination power as assessed by the area under the ROC curve. The AUC values for the above scores ranged from 0.735 to 0.762. CPIS and MODS showed least discrimination. CONCLUSION: NPMP is a specific tool to predict mortality in nosocomial pneumonia and is comparable to other standard scores.

Prediction and validation of residual feed intake and dry matter intake in Danish lactating dairy cows using mid-infrared spectroscopy of milk.

The present study explored the effectiveness of Fourier transform mid-infrared (FT-IR) spectral profiles as a predictor for dry matter intake (DMI) and residual feed intake (RFI). The partial least squares regression method was used to develop the prediction models. The models were validated using different external test sets, one randomly leaving out 20% of the records (validation A), the second randomly leaving out 20% of cows (validation B), and a third (for DMI prediction models) randomly leaving out one cow (validation C). The data included 1,044 records from 140 cows; 97 were Danish Holstein and 43 Danish Jersey. Results showed better accuracies for validation A compared with other validation methods. Milk yield (MY) contributed largely to DMI prediction; MY explained 59% of the variation and the validated model error root mean square error of prediction (RMSEP) was 2.24kg. The model was improved by adding live weight (LW) as an additional predictor trait, where the accuracy R2 increased from 0.59 to 0.72 and error RMSEP decreased from 2.24 to 1.83kg. When only the milk FT-IR spectral profile was used in DMI prediction, a lower prediction ability was obtained, with R2=0.30 and RMSEP=2.91kg. However, once the spectral information was added, along with MY and LW as predictors, model accuracy improved and R2 increased to 0.81 and RMSEP decreased to 1.49kg. Prediction accuracies of RFI changed throughout lactation. The RFI prediction model for the early-lactation stage was better compared with across lactation or mid- and late-lactation stages, with R2=0.46 and RMSEP=1.70. The most important spectral wavenumbers that contributed to DMI and RFI prediction models included fat, protein, and lactose peaks. Comparable prediction results were obtained when using infrared-predicted fat, protein, and lactose instead of full spectra, indicating that FT-IR spectral data do not add significant new information to improve DMI and RFI prediction models. Therefore, in practice, if full FT-IR spectral data are not stored, it is possible to achieve similar DMI or RFI prediction results based on standard milk control data. For DMI, the milk fat region was responsible for the major variation in milk spectra; for RFI, the major variation in milk spectra was within the milk protein region.

Pernicious Anaemia with Gastric Carcinoids.

We report the case of a 42 year male with history of chronic anaemia who was found to have pernicious anaemia with beta thalassemia trait and had on esophago-gastric-duodenoscopy, gastric carcinoids with gastric atrophy. Pernicious anaemia and gastric carcinoids occurring simultaneously in a single individual is rare. Our case emphasises the need for esophago-gastric-duodenoscopy in cases of pernicious anaemia.

Relative bioavailability of folate from the traditional food plant Moringa oleifera L. as evaluated in a rat model.

Moringa oleifera is an affordable and rich source of dietary folate. Quantification of folate by HPLC showed that 5-formyl-5,6,7,8-tetrahydrofolic acid (502.1 µg/100 g DW) and 5,6,7,8-tetrahydrofolic acid (223.9 µg/100 g DW) as the most dominant forms of folate in M. oleifera leaves. The bioavailability of folate and the effects of folate depletion and repletion on biochemical and molecular markers of folate status were investigated in Wistar rats. Folate deficiency was induced by keeping the animals on a folate deficient diet with 1 % succinyl sulfathiazole (w/w). After the depletion period, animals were repleted with different levels of folic acid and M. oleifera leaves as a source of folate. Feeding the animals on a folate deficient diet for 7 weeks caused a significant (3.4-fold) decrease in serum folate content, compared to non-depleted control animals. Relative bioavailability of folate from dehydrated leaves of M. oleifera was 81.9 %. During folate depletion and repletion, no significant changes in liver glycine N-methyl transferase and 5-methyltetrahydrofolate-homocysteine methyltransferase expression were recorded. In RDA calculations, only 50 % of natural folate is assumed to be bioavailable. Therefore, the bioavailability of folate from Moringa is much higher, suggesting that M. oleifera based food can be used as a significant source of folate.

Epidemiology of male seminomatous and nonseminomatous germ cell tumors and response to first-line chemotherapy from a tertiary cancer center in India.

INTRODUCTION: Unlike the developed countries, there is a lack of good epidemiologic data for testicular germ cell tumors (GCTs) in India with majority presenting in advanced stage. This study aims to elaborate on the epidemiology of testicular GCTs and response to standard first-line chemotherapy (CT). METHODS: GCTs treated at our center from January 2013 to June 2014 were retrospectively analyzed. Patients underwent orchidectomy either outside or at our hospital. Based on stage and risk group, standard CT (bleomycin, etoposide, and cisplatin/etoposide and cisplatin/carboplatin AUC7) and radiotherapy were given as appropriate. Response was calculated based on the Response Evaluation Criteria in Solid Tumors. Statistical analysis was performed using SPSS 18 software. RESULTS: Fifty nonseminomatous germ cell tumor (NSGCT) and 36 of SGCT cases were studied. 30%, 46%, and 64% of NSGCT and 11%, 28%, and 22% of SGCT had N2, N3, and M1 diseases, respectively. The mean nodal size was 7 cm (1.5-19) in NSGCT and 5.5 cm (1.3-11) in SGCT. As per the International Germ Cell Cancer Collaborative Group classification, in patients with metastatic disease, 9% of NSGCT were good, 53% were intermediate, and 38% were poor risk whereas 75% of SGCT were good and 25% were intermediate risk. Following CT among NSGCT, 5% and 71% had radiologic complete response (CR) and partial response (PR), respectively. Among SGCT, 46% and 38% had radiologic CR and PR, respectively. 22%, 53%, and 13% of NSGCT and 12%, 24%, and 20% of SGCT developed febrile neutropenia, Grade 3 or 4 hematological and nonhematological toxicities, respectively, after standard chemotherapy. CONCLUSIONS: GCTs in India present with high nodal and high-risk diseases wherein the standard first-line CT may not be adequate as curative therapy; however, significant chemotoxicity is also a hindrance.