Integrative management of insomnia during cancer chemotherapy: A case report.

INTRODUCTION: Insomnia is common among cancer patients, affecting about 50% undergoing cancer treatment. Insomnia can be due to various reasons, such as physical-pain, psychological-distress and medication side-effects. Insomnia has significant impact on quality of life of cancer patients. Even-though managed with hypnotics and antipsychotic drugs, they cause dependency with various short-term and long-term complications. Presenting a case throwing light on Ayurveda topical intervention as add-on to standard-of-care in insomnia during cancer chemotherapy. METHOD: A 51-year-old female patient with breast-cancer with extensive necrosis extending to subcutaneous areas was due for second cycle chemotherapy and was diagnosed with moderate-insomnia with a score of 21 as per Insomnia Severity Index in the Out-Patient-Department. Quality of sleep was assessed using Pittsburgh-Sleep-Quality-Index. Treated for 14 days during the break between cycle two and cycle three with Shirothalam (applied on the vertex) using Kachuradi Churnam with Kshirabala 101 and Padabhyangam (foot massage) using Kshirabala thailam as add-on to Tab Zolpidem5mg. Assessment was conducted on baseline and after 14 days of intervention. RESULTS: Assessment for insomnia before and after intervention was conducted with Insomnia-Severity-Index. The score improved from 21 to 2. Quality of sleep before and after intervention was assessed using global PSQI. It improved from 20 to 8. DISCUSSION: In Ayurveda, Nidranasam (loss of sleep) results from aggravation of Vata-Pitta (body humors responsible for movement and cognition and digestion, metabolism and heat of body), depletion of Kapha (body humor responsible for structural cohesion of body), derangement of Manasika-Dosa (mental constituents) and other diseases. All these etiological factors are attributed by Tikshna(sharp)- Ushna(hot potency) and Ruksha(dry) chemotherapy regimens. Vata-Pitta-hara (normalising Vata and Pitta) and Indriyaprasadaka (clearing senses) action of medicines used could induce sleep and effectively improve quality of sleep. CONCLUSION: Integrative-intervention was found to be beneficial in improving insomnia and quality of sleep without any reported complications or dependency in this case. After 14 days of ayurvedic intervention, the patient could get sleep even without taking zolpidem 5mg and external therapies. Same protocol could be considered for generalization so that it could modify or reduce usage of hypnotics and antipsychotic-drugs.

Optimised neem oil-bilayer tablets: A safe, effective and stable tool for the prevention of vector-borne disease outbreaks by Aedes albopictus.

The control of mosquito breeding is an essential step towards the reduction of vector-borne disease outbreaks. Synthetic larvicidal agents produce resistance in vectors and cause safety concerns in humans, animals and aquatic species. The drawback of synthetic larvicides opened a new avenue for natural larvicidal agents, but poor dosage accuracy, need for frequent applications, low stability and sustainability are the major challenges with them. Hence, this investigation aimed to overcome those drawbacks by developing bilayer tablets loaded with neem oil to prevent mosquito breeding in stagnant water. The optimised batch of neem oil-bilayer tablets (ONBT) had 65%w/w hydroxypropyl methylcellulose K100M and 80%w/w ethylcellulose in its composition. After the completion of 4th week, 91.98 ± 0.871% azadirachtin was released from the ONBT, which was followed by a subsequent drop in the in vitro release. ONBT reported long-term larvicidal efficacy (>75%) and a good deterrent effect which was better than neem oil-based marketed products. The acute toxicity study on a non-target fish model (Poecilia reticulata), OECD Test No.203 confirmed the safety of the ONBT on non-target aquatic species. The accelerated stability studies predicted a good stability profile for the ONBT. The neem oil-based bilayer tablets can be used as an effective tool for the control of vector-borne diseases in society. The product may be a safe, effective and eco-friendly replacement for the existing synthetic as well as natural products in the market.

Comparative Evaluation of the Surface Hardness of Different Esthetic Restorative Materials: An In Vitro Study.

AIM: The aim of this study was to evaluate the surface hardness of a newly developed fiber-reinforced composite and bulkfill composites. MATERIALS AND METHODS: Fiber-reinforced composite and other commercially available bulkfill composites were used. Fifteen cylindrical specimens (5 mm × 5 mm) were made from each material in metal template. Molds were filled in one increment for both bulkfill composites and fiber-reinforced composite and cured using Ivoclar blue phase light-curing unit at a wavelength of 850 mW/cm2. A dark container was used to store specimens to keep dry at room temperature for 24 h before testing. Vickers hardness number (VHN) on the top and bottom surfaces of each specimen was measured by a microhardness tester. Data for VHN were analyzed by using analysis of variance (ANOVA) and pair-wise Newman-Keuls test. RESULTS: No significant difference was observed in Vickers hardness test. The mean value of VHN on the top and bottom surfaces showed significant difference from each other. Fiber-reinforced composite showed the highest VHN as compared with other materials. CONCLUSION: Fiber-reinforced composite has the highest Vickers hardness ratio indicating highest degree of conversion and better clinical performance.

Description of a new species of Xylophis Beddome, 1878 (Serpentes: Pareidae: Xylophiinae) from the Western Ghats, India.

We reassessed the systematics of the Indian (semi)fossorial snake Xylophis perroteti (Duméril, Bibron Duméril, 1854) based on morphological and DNA sequence data for type, historical, and new specimens. A population from the Anamalai Hills is distinct from broadly topotypic X. perroteti from the Nilgiri Hills (from which they are separated geographically by the lowland Palghat Gap) on the basis of both external morphology and DNA sequence data. We describe the Anamalai form as a new species, Xylophis mosaicus sp. nov. The new species is more closely related to X. perroteti than to X. stenorhynchus and X. captaini. A new key to identify the species of Xylophis is presented.

Structural characterization of Kannurin isoforms and evaluation of the role of ß-hydroxy fatty acid tail length in functional specificity.

The novel anti-fungal cyclic lipopeptide 'Kannurin' and its three structural variants produced by Bacillus cereus AK1 were previously reported from our laboratory. The present study reports unexplored structural variants of Kannurin those have functional benefits. Due to the difference in ß-hydroxy fatty acid tail length, they are designated here as Kannurin A (m/z 994.67 ± 0.015), B (m/z 1008.68 ± 0.017), C (m/z 1022.69 ± 0.021), D (m/z 1036.70 ± 0.01), CL (m/z 1040.71 ± 0.02) and DL (m/z 1054.72 ± 0.01). The isoform A (m/z 994.67 ± 0.015) is the shortest cyclic form of Kannurin identified so far. In addition, CL (m/z 1040.71 ± 0.02) and DL (m/z 1054.72 ± 0.01) are the rare natural linear forms. The results of the antimicrobial assays deduced that the difference in lipid tail length of the isoforms contributes tremendous differences in their antimicrobial properties. The isoforms with short lipid tails (A and B) are more selective and potent towards bacteria, whereas the isoforms with long lipid tails (C and D) are more potent against fungi. The molecular dynamics studies and electron microscopic observations supported with circular dichroic spectroscopy analysis showed the structural confirmation and formation of aggregates of Kannurin in solution. The molecular dynamics simulation studies revealed that a single molecule of Kannurin makes enormous intra-molecular interactions and structural re-arrangements to attain stable lowest energy state in solution. When they reach a particular concentration (CMC) especially in aqueous environment, tends to form structural aggregates called 'micelles'. With the structural information and activity relationship described in this study, it is trying to point out the sensitive structural entities that can be modified to improve the efficacy and target specificities of lipopeptide class of antibiotics.

Comparison of quality of life of patients on treatment with cisplatin and gemcitabine, carboplatin and gemcitabine, carboplatin and paclitaxel, carboplatin and pemetrexed for non-small cell lung cancer.

Non-small cell lung cancer is a fatal disease associated with high morbidity. It is important to evaluate the effects of treatment on patient's quality of life. Quality of life can be assessed by using EORTC QLQ - C30 and EORTC QLQ - LC 13. Eighty-six patients were enrolled in the study. The patients were divided into four arms as follows: Patients in arm 1 received cisplatin 80 mg/m 2 and gemcitabine 1.25 g/m 2 as infusion separately in isotonic normal saline. Arm 2 received carboplatin 300 mg/m 2 and gemcitabine 1.2 mg/m 2 as infusion separately in 5% dextrose injection. Arm 3 received paclitaxel 100 mg/m 2 as infusion in isotonic normal saline and carboplatin 300 mg/m 2 as infusion in 5% dextrose injection. Arm 4 received pemetrexed 500 mg/m 2 as infusion in isotonic normal saline and carboplatin 300 mg/m 2 as infusion in 5% dextrose injection. The quality of life of the enrolled patients is based on EORTC QLQ - C30 and EORTC QLQ - LC 13 questionnaire. Prevalence of non-small cell lung cancer is more in males, 60-70 years of age. Most of the subjects were from rural areas and had only school-level education. The prevalence of non-small cell lung cancer was more with smokers, ex-smokers and patients with multiple social habits. Comorbidities also increase the risk of non-small cell lung cancer. By analyzing EORTC QLQ - C30 and EORTC QLQ - LC 13 questionnaires, it was found that diarrhea was found to be significant between the groups. Global health status and quality of life are distributed equally among each group. Quality of life and global health status are distributed equally among each sub groups.

Audit of stored strain energy and extent of future earthquake rupture in central Himalaya.

The deadly 25 April 2015 Gorkha earthquake (Mw = 7.8) and aftershocks have partially released the accumulated interseismic strain along the Main Himalayan Thrust (MHT). Postseismic deformation associated with this earthquake is mainly confined to the north of the rupture. This suggests possible occurrence of future large events towards west or south, where MHT is locked. Asperities arising due to heterogeneity in the stress-strain patterns are believed to play a major role in controlling the coseismic rupture propagation. We determine interseismic coupling along the MHT and spatial variations in total strain rate using two decades of GPS, InSAR and sprit leveling data. Further, b-values derived from the seismicity data are used to identify zones of stress accumulation. We demonstrate that the 2015 earthquake ruptured an asperity which hosted high strain and stress accumulation prior to the event. A similar asperity towards west of the epicenter with unreleased strain energy is identified. This could spawn a future large earthquake akin in magnitude to the 2015 Gorkha event. These findings compel a revisit of the seismic hazard assessment of the central Himalaya.

Kyasanur forest disease virus breaking the endemic barrier: An investigation into ecological effects on disease emergence and future outlook.

Kyasanur Forest disease (KFD) is found in a limited range of India, but is epidemiologically understudied. The seasonal patterns of KFD are well known; however, the significant concern is on the extent to which changes in epidemiology happen especially under the influence of ecological destructions and by the eventual effects of resulting climate change. Presently, a southward and northward spread of the Kyasanur Forest disease virus (KFDV) along the Western Ghats has been reported in the adjoining states of Kerala, Tamil Nadu, Goa and Maharashtra. In this review, we investigate the cascade of factors that might have facilitated the resurgence of KFDV among the endemic regions in higher frequency and its recent emergence in the area previously not reported. Utilizing published data, we additionally endeavour to exhibit a portion of the impediments of control systems and embody the powerful option strategies for developing KFDV control.

Prevalence of early childhood caries among preschool children in Trivandrum and its association with various risk factors.

BACKGROUND: Early childhood caries (ECC) is a severe form of dental decay with multi-factorial origin. OBJECTIVES: The aim of this cross-sectional study was to determine the prevalence and related risk factors of ECC among preschool children residing in rural and urban areas of Trivandrum district in Kerala. METHODS: A sample size of 1329 preschool children of <60 months of age was randomly selected from rural and urban areas of Trivandrum and decayed missing filled teeth indices were recorded. A standardized questionnaire was distributed to the parents. The data were subjected to SPSS version 16 and statistically analyzed with Chi-square test. RESULTS: Prevalence of ECC in the study sample was found to be 54%. Furthermore, a positive association was obtained between ECC and age of the child, location of residence, dietary habits, and oral hygiene habits. CONCLUSION: There is an urgent need to implement preventive and curative oral health programs for preschool children in rural and urban areas.

An automated pipette puller for fabrication of glass micropipettes.

Glass micropipettes are versatile probing tools for performing micro- and nano-manipulation tasks. This paper presents the design and development of an automated pipette puller system for fabrication of glass micropipettes. The pipette puller employs a new strategy for fabrication of micropipettes that enables achieving independent control of their taper, tip diameter, and bend-angle, and also facilitates theoretical derivation of simple, approximate relationships between the pipette shape and the pulling parameters. Subsequently, the design and fabrication of the pipette puller is described, which include that of the pipette heating system, the mechanical motion stages, and the control electronics of the pipette puller. The fabricated pipette puller is experimentally evaluated to demonstrate control of the taper, tip diameter, and the bend-angle of the micropipette. Further, the dependence of the taper and tip diameter on the pulling parameters is evaluated and is shown to be in alignment with the proposed theoretical relationships.

Kannurin, a novel lipopeptide from Bacillus cereus strain AK1: isolation, structural evaluation and antifungal activities.

AIM: This study was performed to isolate and characterize novel antifungal lipopeptide from Bacillus cereus. METHODS AND RESULTS: Elucidation of its chemical structure was carried out by electrospray ionization mass spectra (ESI-MS) and Fourier transform infrared spectroscopy (FT-IR). The compound is a cyclic heptapeptide and composed of amino acids, Leu-Asp-Val-Leu-Leu-Leu-Leu. The in vitro activity of Kannurin against various pathogenic yeasts was assessed by CLSI M27-A and moulds by M38-A. It demonstrated broad-spectrum, fungicidal activity against clinically relevant yeasts and moulds. Kannurin exhibited low haemolytic activity and remained active over a wide pH and temperature range. In addition, Kannurin did not bind with melanin particles and was as active in inhibiting biofilms. CONCLUSIONS: An antifungal surfactin-like lipopeptide produced by Bacillus cereus strain AK1 was purified and chemically characterized. We propose to name this lipopeptide compound 'Kannurin'. To our knowledge, this is the first report of Bacillus cereus producing surfactin-like lipopeptide antibiotic with stronger antifungal activity. SIGNIFICANCE AND IMPACT OF THE STUDY: Our results provide a valuable contribution towards a better understanding of the lipopeptide of Bacillus cereus. Moreover, it raises the possibility of using as an alternative antibiotic in clinical medicine.

Cryptococcus laurentii biofilms: structure, development and antifungal drug resistance.

A great number of fungal infections are related to biofilm formation on inert or biological surfaces, which are recalcitrant to most treatments and cause human mortality. Cryptococcus laurentii has been diagnosed as the aetiological pathogen able to cause human infections mainly in immunosuppressed patients and the spectrum of clinical manifestations ranges from skin lesions to fungaemia. The effect of temperature, pH and surface preconditioning on C. laurentii biofilm formation was determined by 2, 3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide (XTT) reduction assay. Scanning electron microscopic (SEM) analysis of C. laurentii biofilms demonstrated surface topographies of profuse growth and dense colonization with extensive polymeric substances around the cells. In this study, we determined the activity of amphotericin B, itraconazole and fluconazole against C. laurentii free-living cells and biofilms. The activity of antifungals tested was greater against free-living cells, but sessile cells fell into the resistant range for these antifungal agents. Extracellular polymeric substances (EPS), comprising the matrix of C. laurentii biofilms, were isolated by ultrasonication. Fourier transform infrared spectroscopy (FT-IR) was performed with ethanol-precipitated and dried samples. Also, the multielement analysis of the EPS was performed by inductively coupled plasma optical emission spectroscopy (ICP-OES).

Peptide antibiotics: an alternative and effective antimicrobial strategy to circumvent fungal infections.

Mycosis, caused by both filamentous fungi and pathogenic yeasts is a major concern nowadays especially in the immunocompromised patient population. The emergence of pathogenic fungi resistant to current therapies in the last few decades has intensified the search for new antifungals like cationic peptides, which are the key components of innate defense mechanism. The review provides an inventory of different peptides from a diverse array of organisms from bacteria to mammals with proven antifungal activity, their therapeutic options and also about those which are in various stages of preclinical development. Literature, on the total and semi-synthetic variants of the parent peptides that exhibit an improved antifungal activity is also reviewed.

Levels of enzymes in leukaemic mice treated withAeromonas L-asparaginase.

L-asparaginase isolated in our laboratory fromAeromonas has been found to be antileukaemic. In the present study changes in the levels of serum enzymes in leukaemic mice and under treatment withAeromonas L-asparaginase has been compared. A significant increase in the levels of serum lactate dehydrogenase with tumour growth and a decrease during therapy was observed. A significant decrease in alanine transaminase activity during tumour growth and an increase during treatment was noticed. Increased levels of aspartate transaminase and alkaline phosphatase was observed during enzyme therapy. Total acid phosphatase was found to be increased during tumour growth and decreased considerably during treatment.

Lipid metabolism in tumour bearing mice treated withAeromonas L-asparaginase.

The anticancerous drug isolated in our laboratory from estuarineAeromonas was characterised and is found to be an enzyme, L-asparaginase. The antileukaemic effect of this drug was studied in mice by inducing leukaemia with Ehrlich ascites cell lines. It was compared with commercially available drug, Leunase, isolated fromE. coli. The lipid profiles in mice during leukaemia and under treatment was studied. The decreased levels of cholesterol and increased levels of triglycerides and phospholipids in serum, liver and kidney were observed in tumour bearing mice. Significant changes in the above values were observed with enzyme therapy. It could bring some of the values to near normal level. L-asparaginase fromAeromonas was found to be more effective.

Metabolism of proteins and glycoproteins in tumour bearing mice treated with Aeromonas L-asparaginase.

L-asparaginase, isolated in our laboratory, from Aeromonas had been found to be antileukaemic. In the present study, changes in the levels of proteins and glycoproteins in leukaemic mice and under treatment with Aeromonas L-asparaginase have been compared. Levels of protein bound hexose, fucose and sialic acid which were increased during leukaemia attained normal levels when treated with L-asparaginase. The increased blood urea level declined significantly during enzyme therapy. Effects of L-asparaginase are compared with 'Leunase', a commercially available drug used in the treatment of leukaemia.