Automated myocardial infarction and angina detection using second derivative of photoplethysmography.

Photoplethysmography (PPG) based healthcare devices have gained enormous interest in the detection of cardiac abnormalities. Limited research has been implemented for myocardial infarction (MI) detection. Moreover, PPG-based detection of angina is still a research gap. PPG signals are not always informative. Therefore, this research work presents the use of PPG signals and their second derivative to evaluate myocardial infarction and angina using a novel set of morphological features. The obtained morphological features are fed onto the feed-forward artificial neural network for the identification of the type of MI and unstable angina (UA). The initial experiments have been carried out on non-ambulatory (public) subjects for feature extraction and later evaluated on ambulatory (self-generated) databases. The intended method attains accuracy, sensitivity, and specificity of 98%, 97%, 98% on the public database and 94%, 94%, 94% on the self-generated database. The result shows that the proposed set of features can detect MI and UA with significant accuracy.

Optimization of apricot (Prunus armeniaca L.) blended Aloe vera (Aloe barbadensis M.) based low-calorie beverage functionally enriched with aonla juice (Phyllanthus emblica L.).

The shift in food consumption pattern to accommodate an array of bioactive compounds in foods with minimum calorie intake has resulted in the development of many novel beverages in the last decade. In the present study, optimization of apricot (AP; 0-50%) blended Aloe vera (AV; 50-100%) based low-calorie beverage functionally enriched with aonla juice (AJ; 3,5,7,10%) using steviol glycoside (SG; 0-100%) was performed. The preliminary screening suggested that 40% addition of AP (AV-AP; 60:40) had an acceptable taste. While, for functional enrichment of squash, incorporation of 7% AJ with 40ºB TSS was optimized based on color, consistency, taste, and overall acceptability scores. The developed squash had higher ascorbic acid (26.83 mg/100 g), total phenols (68.77 mg/100 g), antioxidant potential (36.50%) and antimicrobial activity against Staphylococcus aureus (18.00 mm). The aloin content was recorded 0.9 ppm, well within the maximum permissible limits. Additionally, replacement of sucrose with stevioside up to 50 per cent resulted in equi-sweetness level without characteristic bitter aftertaste and a significant reduction in energy value from 142 kcal/100 g to 85.26 kcal/100 g. The developed beverage recorded a high amount of functional compounds with reduced energy values. The beverage can be a recommendation for general consumption for health- conscious people to cover their functional food desires.

Cryopreservation of a threatened medicinal plant, Valeriana jatamansi Jones, using vitrification and assessment of biosynthetic stability of regenerants.

BACKGROUND: Valeriana jatamansi Jones is a medicinal plant of the Himalayan region with high trade value. Since overexploitation of this wild species led it to be listed as threatened, a comprehensive conservation strategy is needed. Cryopreservation would be a useful complementary method to conventional conservation methods. OBJECTIVE: To develop a cryopreservation protocol for V. jatamansi with maintenance of biosynthetic stability of regenerants. MATERIALS AND METHODS: In vitro shoot tips were cryopreserved using vitrification with either PVS2 or PVS3 and the efficacy of the two cryoprotectant mixtures compared. Regenerated plantlets were evaluated by HPLC analysis for contents of four valepotriates viz. valtrate, acevaltrate, didrovaltrate and IVHD valtrate. RESULTS: The highest shoot recovery (91.6%) after transfer to liquid nitrogen was obtained when shoot tips were treated with PVS2 at 0°C for 110 min, which was significantly higher than the highest recovery (73.3%) obtained using PVS3 for any duration tested. Evaluation of biosynthetic stability showed no variation in valepotriate contents between in vitro maintained and cryopreserved derived plantlets. CONCLUSION: This protocol will be useful for the long-term conservation of this species as high frequency recovery and biosynthetic stability after cryopreservation were obtained.

Phylogeny and species delimitation of Strobilomyces (Boletaceae), with an emphasis on the Asian species.

Strobilomyces is broadly distributed geographically and serves an important ecological function. However, it has been difficult to delimit species within the genus, primarily due to developmental variations and phenotypic plasticity. To elucidate phylogenetic relationships among species within the genus and to understand its species diversity, especially in Asia, materials of the genus collected from five continents (Africa, Asia, Australia, Europe, and North/Central America) were investigated. The phylogeny of Strobilomyces was reconstructed based on nucleotide sequences of four genes coding for: the largest and the second largest subunits of the RNA polymerase II (RPB1 and RPB2); the translation elongation factor subunit 1-α (TEF1); and the mitochondrial cytochrome oxidase subunit 3 (COX3). The combined results based on molecular phylogenetics, morphological characters, host tree associations, and geographical distribution patterns support a new classification consisting of two sections, sect. Strobilomyces and sect. Echinati. Using the genealogical concordance phylogenetic species recognition (GCPSR) approach, at least 33 phylogenetic species in Asia can be delimited, all of which are supported by morphological features, and five phylogenetic species remain to be described. The mountainous region of Southwest China is especially special, containing at least 21 species and likely represents a centre of diversification. We further compared our specimens with the type specimens of 25 species of Strobilomyces. Our comparisons suggest that, there are a total of 31 distinct species, while S. sanmingensis, S. verruculosus, S. subnigricans, and S. zangii/S. areolatus, are synonyms of S. mirandus, S. giganteus, S. alpinus and S. seminudus, respectively. Eight new species, namely, S. albidus, S. anthracinus, S. calidus, S. cingulatus, S. densisquamosus, S. douformis, S. microreticulatus and S. pinophilus, are described. A dichotomous key to the Asian Strobilomyces species is provided.

Study of ultrasound-guided needle aspiration and catheter drainage in the management of liver abscesses.

PURPOSE: To evaluate and compare the efficacy of intermittent needle aspiration and continuous catheter drainage in ultrasound-guided management of liver abscesses. METHODS: This was a prospective, randomised study conducted on 100 patients (88 males and 12 females; age range 22-74 years) with liver abscess(es) and having abscess size more than 5 cm, divided into two groups: Percutaneous needle aspiration (PNA) (n = 50) and percutaneous catheter drainage (PCD) (n = 50). Criteria of exclusion were: rupture of abscess before intervention; prior intervention; uncorrectable coagulopathy; concomitant biliary tract malignancy. In the PNA group, pus was aspirated by an 18-gauge needle using freehand technique and the number of aspirations was limited to two. Failure of abscess size to decline below 50% of the original diameter or of clinical improvement after second aspiration was considered as failure of aspiration. In the PCD group, drainage was done by 12-French catheters using Seldinger technique. Drainage was considered as failure if abscess cavity did not resolve and laparotomy was needed to evacuate the pus cavity. RESULT: The success rate in the PNA group was 88% and 92% in the PCD group; however, this difference was statistically not significant, suggesting that both are equally efficacious. The total duration of hospital stay (mean 6.8 days [PNA] vs 10.5 days [PCD]; p value: 0.011) and the average duration between intervention and discharge (5.9 days [PNA] vs 10.2 days [PCD]; p value:0.026) were significantly less in the PNA group. One major complication was seen in our study: peritonitis due to peri-catheter leak in PCD group. CONCLUSION: Both procedures are equally efficacious in the management of liver abscesses; however in view of less duration of hospital stay, patient safety and comfort, procedure simplicity, and the reduced cost, needle aspiration should be used as the first-line procedure in the treatment of liver abscess (even in abscesses more than 5 cm). Catheter drainage should be reserved for cases that do not respond to a second attempt of aspiration.

Mycoflora and natural aflatoxin contamination in dried quince seeds from Jammu, India.

Eighty two samples of dried quince seeds, obtained from the markets of Jammu province, were examined for mycoflora by different isolation techniques. A total of 27 fungal species belonging to 11 genera were recovered and identified from these samples. The predominant fungal genera encountered were Aspergillus, Penicillium and Fusarium. In view of the predominance of Aspergillus flavus, a known producer of aflatoxins, screening of the fungal contaminated samples was carried out for total aflatoxin levels using high performance liquid chromatography (HPLC). Twenty one aflatoxin positive samples contained 8.07-33.45 µg g(-1) and 0.05-3946.97 µg g(-1) AFB1 and AFB2 respectively. These results suggest that biochemical composition of dried quince seeds, along with climatic conditions of the region seem to be very favourable for aflatoxin production by toxigenic strains of A. flavus. Therefore, monitoring of aflatoxins in dried quince seeds is recommended for this region.

Effect of summer pruning and CPPU on yield and quality of kiwi fruit (Actinidia deliciosa).

A field experiment was conducted on bearing vines of kiwifruit cv. Abbott to find the effect of CPPU (N-(2- chloro-4-pyridyl)-N-phenylurea) and summer pruning on fruit yield, fruit size and quality. CPPU greatly stimulated fruit growth indicating that it can be a powerful tool for improving kiwifruit cropping. Application of CPPU at 10 ppm concentration was done by dipping the fruits for 10 sec in the aqueous solution of compound at petal fall and 30 days after petal fall. CPPU applied fruits increased size by 20-70 g over control. Summer pruning along with CPPU application proved to be more effective in obtaining fruits of high grades with increased fruit weight (95.37 g fruit(-1)) and high quality. Summer pruning, when done by pinching 1/5th at Petal Fall stage + CPPU dipping (10 ml(-1)) and pinching 1/5th continued till harvest, at one month interval resulted in increased fruit yield (54.80 kg vine(-1)), high TSS (17.60 Brix), high total sugar (9.85%), advanced ripening by one week and reduced flesh firmness.

Molecular Detection of Latent Apple chlorotic leaf spot virus in Elite Mother Plants of Apple.

Apple chlorotic leaf spot virus (ACLSV; family Betaflexiviridae genus Trichovirus) is one of the economically important latent virus infecting apple (Malus × domestica Borkh.). Reverse transcriptase polymerase chain reaction (RT-PCR) procedures were used to amplify coat protein gene of ACLSV. Among 5 primer sets used, two primer sets (1F1R and 1F2R) amplified fragments of expected size (432 bp). Products visible on agarose gel were produced using templates extracted from apple leaves. The results were further validated by sequencing fragment of 432 bp which was amplified from leaf of apple by using primer set 1F 1R. Comparisons with published sequences indicated that the isolate have very high 91 % identity values to the corresponding region of ACLSV isolate from apple. Selected primer pair (1F1R) was further used for screening 42 elite mother plants collected from apple growing areas of Himachal Pradesh, India, where in 17 were found free from ACLSV. Use of NAD5 gene in mitochondrial mRNA of the apple as an internal control, reduced the risk of false negative results that may occur with routine RT-PCR assays.

Effect of cilostazol on platelet aggregation in patients with non-ST elevation acute coronary syndrome.

AIMS: The optimal antithrombotic regimen for non-ST elevation acute coronary syndrome(NSTEACS) has not yet been defined and the risk of ischemic events remains high in these patients. We aimed to evaluate the effect of cilostazol on agonist induced platelet aggregation and serum plasminogen activator inhibitor-1(PAI-1) in the patients with NSTEACS administered along with the standard antiplatelet regimen. PATIENTS AND METHODS: 40 patients of NSTEACS presenting within 72 h of onset of symptoms were randomized to cilostazol or placebo in 1 : 1 ratio, in whom a conservative treatment strategy was adopted. Cilostazol 100 mg b.i.d was administered within 12 h of hospital admission for 7 days along with standard doses of aspirin and clopidogrel. The primary end points were effect on agonist-induced platelet aggregation and serum PAI-1 levels after 7 days of treatment. Safety and clinical outcome assessment were also done at 7 and 30 days. RESULTS: Patients in the triple therapy group showed significant decrease in the ADP (25.5 +/- 27.4 vs. 5.6 +/- 8.4; p = 0.003) and collagen (24.9 +/- 25.5 vs. 11.7 +/- 11; p = 0.04) induced percentage platelet aggregation after 7 days of treatment compared to the dual therapy group. There was no significant change in levels of serum PAI-1 (50.30 +/- 10.17 ng/ml vs. 53.47 +/- 14.08 ng/ml; p = 0.42). The composite of recurrent ischemia, myocardial infarction, need for intervention and death occurred in 4 patients in the cilostazol group compared to 7 in the placebo group at the end of 30 days of follow-up (p = 0.48). CONCLUSION: Cilostazol has additional platelet aggregation inhibition action in patients with NSTEACS along with aspirin and clopidogrel.

Evaluation of the ability of clinical research participants to comprehend informed consent form.

BACKGROUND: The comprehension of informed consent is an integral part of clinical trials. Though India is rapidly becoming a hub of clinical trials very few studies have dealt with the issue of comprehension of informed consent by the patients participating in these trials. METHODS: Patients who were invited to participate in a phase 3 multicentric trial of a novel lipid lowering agent were evaluated for comprehension score. The participants were explained about the structured consent form which included the question on background details for the study, design of the study, rights of the patients and miscellaneous aspects pertinent to the clinical trial. The questionnaire comprised of 24 items and each correct answer was assigned a score of 1. Total comprehension score (CS) was obtained by summing all the scores. RESULTS: Participants were from diverse socio economic and educational backgrounds. The mean +/- SD CS achieved by the participants was 13.4 +/- 2.9; median 14(6 to 20). The highest correct responses were obtained for questions on background details (38%). For most of the categories the mean CS was more than 50%. Aspects related to design were mostly difficult to comprehend. No significant difference in the CS was noted between participants from different educational and socioeconomic groups. 8 patients refused to give consent, fear of adverse drug reactions (n = 3) and inability to follow up (n = 5) were the reasons cited by the patients. CONCLUSION: In conclusion, CS of patients in trials conducted in developing countries can be reasonably good if the investigators explain the consent form in simple language to the participants and CS is not related to the educational status of the participants. Moreover, though a larger majority of patients agree to participate after knowing study details, some patients exercise their right to refuse.

Epidemiology of group A streptococcal pharyngitis & impetigo: a cross-sectional & follow up study in a rural community of northern India.

BACKGROUND & OBJECTIVE: Group A streptococcus (GAS) causes a wide array of human diseases. Epidemiological picture of streptococcal infection in India is not complete. Hence, disease burden due to GAS in 5-15 yr old school children in northern India was studied and emm typing of GAS isolates was carried out to help in designing prevention strategies. METHODS: A cross-sectional survey was carried out among 4249 school children (5-15 yr) from Raipur Rani Block of Panchkula district in Haryana during 2000-2002; 334 children were followed up fortnightly for one year. Standard clinical and microbiological procedures were used for collection of swabs from throat and skin and confirmation of GAS and its emm types. RESULTS: Of the 4249 children studied, 658 (15.5%) had pharyngitis; 579 of them could be swabbed, of which 2.8 per cent had GAS. From 3591 children without pharyngitis, 3385 who could be swabbed, GAS was found in 1.3 per cent of them. Impetigo was rare (0.7%), but 7.1 per cent (2/28) children had GAS. In the followup study, 17.4 per cent (776/4447 child-contacts) had pharyngitis, 761 could be swabbed and 2.4 per cent had GAS; among those without pharyngitis, 2016 swabs could be taken and GAS was found in 1.3 per cent; whereas only 2.6 per cent (2/75) of skin sores had GAS. Three children had GAS pharyngitis twice during follow up. Fourteen different GAS emm types were found. emm 71, 77 and 81 constituted 69 per cent of the pharyngeal isolates. GAS pharyngitis and impetigo were more common in winters and summers respectively. INTERPRETATION & CONCLUSION: In north India, pharyngitis was more common than impetigo. Most prevalent emm types of GAS in this region differ from those included in M protein-based vaccines.

Emergence of Virulence to Sr25 of Puccinia graminis f. sp. tritici on Wheat in India.

Stem (black) rust, caused by Puccinia graminis Pers. f. sp. tritici Eriks. & Henn., is one of the most destructive diseases of wheat. It could be controlled through introgression of race-specific resistance genes. However, such kind of resistance is mostly short lived due to emergence of new virulences. For example, resistance genes Sr11, Sr24, Sr30, and Sr31 are no longer effective (2,4). Detection of new virulences has remained vital in the evaluation and identification of new sources of resistance. We report here the detection of virulence to Sr25, a gene from Thinopyrum elongatum (4), which had been effective or partially effective against stem rust worldwide, including race Ug99 (TTKSK) (4). A stem rust isolate collected in 2006 from Karnataka (southern India) produced susceptible reactions (infection type [IT] 3+ to 4) on the primary leaves of differential genotype 'Agatha' carrying Sr25 and susceptible check 'Agra Local' at 22 ± 2°C. To verify virulence to Sr25, single-pustule isolates from this sample were inoculated onto seedlings of 'Agrus', 'Agatha', 'RL6040' ('Thatcher' + Sr25), 'Superseri#1', 'Wheatear', and 'Morocco' + Sr25 (obtained from CIMMYT), which all carry Sr25. All these accessions were found susceptible (IT 3+ to 4) to this isolate, except Wheatear which expressed resistance (IT ;1), indicating the presence of additional gene(s). These genotypes are resistant (ITs ;1 to 2+) to Sr25-avirulent pathotypes. The new pathotype is avirulent to Sr11, 13, 14, 21, 22, 23, 24, 26, 27, 29, 31, 32, 33, 35, 37, 38, 39, 40, 43, and Tmp and virulent to Sr5, 6, 7a, 7b, 8a, 9a, 9b, 9d, 9e, 9f, 9g, 10, 12, 15, 16, 17, 18, 19, 20, 25, 28, 30, 34, 36, 42, Wld-1, and Gt at 22 ± 2°C. This pathotype has been designated as 58G13-3 and PKTSC according to the Indian nomenclature (1) and the North American system (3), respectively. It represents race 40 based on Stakman's differentials. It may have arisen from race 40 through mutation. The type culture of the pathotype has been added to the culture collection at Flowerdale, Shimla. Interestingly, 'Festiguay' (Sr30) was found resistant to this pathotype, indicating the presence of additional gene(s), whereas 'Webster' (Sr30) was susceptible. Adult plants of Agrus, Agatha, RL6040, Superseri#1, and Morocco+Sr25 also were susceptible, producing 20S to 60S responses. Sr25-avirulent pathotype 62G29 produced a TR (flecking in traces) response on these lines except Morocco + Sr25 that showed 20 to 40MR (moderately resistant) responses. In the same study however, adult plants of Thatcher showed a resistant reaction (10R to MR) at low (16 ± 2°C) and susceptible (20S) at high (22 ± 2°C) temperatures. Agatha and RL6040, having Thatcher as one of the parents, had similar responses. The detection of Sr25 virulence is significant since Sr25 is an important gene to be targeted for breeding wheat cultivars resistant to Ug99. We should use either adult plant resistance and/or pyramiding two or more genes for seedling resistance to enhance the field life of wheat cultivars. References: (1) P. Bahadur et al. Proc. Indian Acad. Sci. 95:29, 1985. (2) S. C. Bhardwaj et al. J. Wheat Res. 1:51, 2007. (3) Y. Jin et al. Plant Dis. 92:923, 2008. (4) R. P. Singh et al. CAB Rev. No. 054:1, 2006.

Association of anticardiolipin antibodies levels with instent restenosis in patients with coronary artery disease.

Present study was conducted to evaluate the association of IgG anticardiolipin antibodies with instent restenosis in patients having undergone percutaneous intervention with bare metal or drug eluting stents. Coronary artery disease patients with stent placement at least 6 months prior were screened for eligibility. 26 satisfied the inclusion/exclusion criteria. 10 patients with symptoms of restenosis, confirmed on check angiography served as cases and 16 without symptoms of restenosis served as control. Unpaired t- test was applied to ascertain the significance of any difference between control and study groups. Antibody levels were estimated on ELISA reader. The mean (+/- SD) anticardiolipin antibodies levels in cases and controls were 11.8 +/- 5.1 GPL/U/ml and 14.3 +/- 10.2 GPL/U/ml, respectively. The difference was not statistically significant (P > 0.05). In conclusion, we did not observe any significant correlation between the level of IgG aCL and instent restenosis.

Relapsing polychondritis in North India: a report of 10 patients.

OBJECTIVE: Relapsing polychondritis (RP) is a rare autoimmune disorder characterized by recurrent episodes of inflammation and destruction of cartilaginous tissues. We describe the outcome of 10 patients followed up at the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, over the past 10 years. METHODS: All the patients fulfilling the diagnostic criteria suggested by McAdam et al (Medicine (Baltimore) 1976;55:193-215) and modified by Damiani and Levine (Laryngoscope 1979;89;929-46) were included in the study. Detailed clinical features, investigations, treatment given, and outcome were recorded on file. RESULTS: Six women and four men, mean age 48.1 years (range 26-65 years), met the criteria for diagnosis. The mean duration of symptoms, before diagnosis, was 27 months (range 1-72 months). Clinical features included auricular chondritis (100%), arthritis (80%), fever (50%), constitutional symptoms (50%), eye involvement (50%), hearing loss (40%), collapsed bridge of nose (30%), laryngotracheal involvement (20%), aortic dilatation (10%), and nephrotic syndrome (10%). Two patients had the MAGIC (mouth and genital ulcers with inflamed cartilage) syndrome. The number of episodes of cartilaginous inflammation varied from one to eight. Treatment included oral prednisolone (n = 9), intermittent 'pulse' cyclophosphamide (n = 2), and azathioprine (n = 2). One patient required tracheostomy and died later. The others are doing well. Mean duration of follow-up was 35.5 months (range 1-79 months). CONCLUSIONS: The diagnosis of this potentially lethal condition is frequently delayed. Our series suggests that clinical manifestations of RP are similar in Caucasian, Oriental, and Asian populations. Laryngotracheal involvement was seen less frequently in our patients.

Re-use of explanted DDD pacemakers as VDD- clinical utility and cost effectiveness.

Re-use of DDD pulse generators explanted from patients died of unrelated causes is associated with an additional cost of two transvenous leads if implanted as DDD itself, and high rate of infection according to some studies. We studied the clinical and economical aspects of reutilization of explanted DDD pacemakers programmed to VDD mode. Out of 28 patients who received VDD pacemaker during the period, October 2000- September 2001 in the Department of Cardiology, PGIMER, Chandigarh, 5 poor patients were implanted with explanted DDD pulse generators programmed to VDD mode. Each implantation was planned and carried out according to a standard protocol. The age ranged from 45 to 75 (mean-61) years. The indications for pacing were complete heart block (4) and second degree AV block (1). The clinical profile, costs and complications, if any were noted and followed up at regular intervals. The results were compared with patients who received new DDD pulse generators during this period. The additional cost for the atrial lead was not required in these patients. None of these patients had any local site infection. Compared to the two-lead system, the single lead system provided more rapid implantation and minimized complications associated with placement of an atrial lead. The explanted DDD pacemaker can be safely reused as VDD mode with same efficacy in selected patient population. This is associated with lower cost and complications compared to reimplantation as DDD itself.

Effect of different aspirin doses on platelet aggregation in patients with stable coronary artery disease.

BACKGROUND: Aspirin is widely used as an antiplatelet agent in the primary and secondary prevention of cardiovascular disease. In order to spare prostacyclin formation and reduce gastrointestinal side-effects, very low doses of aspirin have been introduced. However, it remains unclear whether these low doses are equally effective with respect to inhibition of platelet aggregation. AIMS: In a randomized, controlled study in 60 patients with stable coronary artery disease, the effects on platelet aggregation of five doses (50, 80, 100, 162.5 and 325 mg) of aspirin, which are widely used in clinical practice, given for 70 days, were investigated. Two reagents, adenosine diphosphate (ADP) and epinephrine, were used to induce platelet aggregation in platelet-rich plasma. An age- and sex-matched group of people without coronary artery disease served as the control. RESULTS: ADP- and epinephrine-induced platelet aggregation was 78.2 +/- 12.8% and 76.7 +/- 15.5% of maximum aggregation in the control group. Aspirin inhibited platelet aggregation in a dose-dependent manner. Minimum platelet aggregation was observed at a dose of 325 mg aspirin (27.5 +/- 17.4% with ADP). Doses of 50 and 80 mg aspirin were much less effective in inhibiting platelet aggregation (59.1 +/- 11.4% and 50.3 +/- 12.1% with ADP, respectively). Doses of 100 and 162.5 mg aspirin produced significantly greater inhibition of platelet aggregation than lower doses (36.2 +/- 11.7% and 38.5 +/- 19.8% platelet aggregation with ADP, respectively). CONCLUSION: Our results demonstrate that doses of aspirin less than 100 mg are not as effective at inhibiting platelet aggregation as doses greater than 100 mg.