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Using a hand lay-up approach, both orange peel and coconut coir fibres are used in particulate form with an epoxy matrix to create partly green biodegradable composites. The findings indicate great opportunities for employing these natural fibres. The thermal conductivity of orange peel and coconut-coir epoxy composites was measured experimentally for various volume fractions of particulate fibres. The experimental findings show that as fibre concentration increases, thermal conductivity decreases. Experimental data are compared to theoretical models to determine the change in thermal conductivity with fibre amount fraction.There was a clear correlation between the hypotheses and the actual results. Regression analysis using Python programming is also done for the prediction of the thermal properties of particulate orange peel and coconut-coir fibre composites. It is observed that coir fibre composites outperformed the orange peel, indicating that the coir fibre composite is a proper thermal insulator that can be used in many industries, like the automotive industry, buildings, and steam pipes, to reduce heat transfer and thereby save a lot of energy. [ABSTRACT FROM AUTHOR]

An effective route towards improving the electrocatalytic performance of materials is the synthesis of nanocrystalline, porous, and layer-structured materials. Herein, porous nickel tungstate (NiWO4) film electrode was prepared on stainless steel (SS) substrate by inexpensive successive ionic layer adsorption and reaction (SILAR) method. This method provides a binder-free, porous, and nanocrystalline thin layer on a SS substrate. The electrocatalytic performance of the nanocrystalline NiWO4 electrocatalyst was evaluated for enzymeless glucose measurement and water-splitting application. This electrocatalyst exhibited excellent sensitivity of 9731 μA mM−1 cm−2 within the linear range of 25–325 μM. Further, the glucose concentrations present in human blood samples were measured using the proposed nanocrystalline NiWO4 electrocatalyst. Also, hydrogen evolution reaction, the electrocatalyst exhibited 171 mV of overpotential at 10 mA cm−2 with a Tafel slope of 70 mV dec−1. Further, chronopotentiometry study was carried out at 100 mA cm−2 and it showed 94% retention after 24 h. These findings greatly promote the outstanding electrocatalytic performance of nanocrystalline and porous NiWO4 electrocatalysts that outline their applicability for electrochemical catalysis purposes. [ABSTRACT FROM AUTHOR]

Extraovarian granulosa cell tumors (GCTs) are rare neoplasms. They arise from the ectopic gonadal tissue along the embryonal route of genital ridge. We present a case of an extraovarian tumor in an elderly female who presented with lump in the abdomen occupying the pelvic region. She was operated and the mass was excised with intact capsule. Histopathology revealed the mass to be an adult granulosa cell tumor. Extraovarian granulosa cell tumors are very rare with only 13 such cases reported in literature to date. The present case is the largest primary retroperitoneal adult granulosa cell tumor reported till date. [ABSTRACT FROM AUTHOR]

The number of heart transplants performed each year is steadily increasing around the world. Anesthesia and perioperative management are different in these cases. For an optimal perioperative management and improved postoperative outcome, a full understanding of the physiology of the denervated heart, post-transplant morbidities, and immunosuppressant pharmacology is required. We hereby discuss the perioperative management of a patient who had undergone orthotopic heart transplant and presented to our setup for left ureteroscopy. [ABSTRACT FROM AUTHOR]

Objectives: We conducted a longitudinal cohort analysis to evaluate the association of pre‐treatment body mass index (BMI) with CD4 recovery, virological failure (VF) and cardiovascular risk disease (CVD) markers among people living with HIV (PLHIV). Methods: Participants who were enrolled between January 2003 and March 2019 in a regional Asia HIV cohort with weight and height measurements prior to antiretroviral therapy (ART) initiation were included. Factors associated with mean CD4 increase were analysed using repeated‐measures linear regression. Time to first VF after 6 months on ART and time to first development of CVD risk markers were analysed using Cox regression models. Sensitivity analyses were done adjusting for Asian BMI thresholds. Results: Of 4993 PLHIV (66% male), 62% had pre‐treatment BMI in the normal range (18.5–25.0 kg/m2), while 26%, 10% and 2% were underweight (< 18.5 kg/m2), overweight (25–30 kg/m2) and obese (> 30 kg/m2), respectively. Both higher baseline and time‐updated BMI were associated with larger CD4 gains compared with normal BMI. After adjusting for Asian BMI thresholds, higher baseline BMIs of 23–27.5 and > 27.5 kg/m2 were associated with larger CD4 increases of 15.6 cells/µL [95% confidence interval (CI): 2.9–28.3] and 28.8 cells/µL (95% CI: 6.6–50.9), respectively, compared with normal BMI (18.5–23 kg/m2). PLHIV with BMIs of 25–30 and > 30 kg/m2 were 1.27 times (95% CI: 1.10–1.47) and 1.61 times (95% CI: 1.13–2.24) more likely to develop CVD risk factors. No relationship between pre‐treatment BMI and VF was observed. Conclusions: High pre‐treatment BMI was associated with better immune reconstitution and CVD risk factor development in an Asian PLHIV cohort. [ABSTRACT FROM AUTHOR]

Objectives: Early mortality among those still initiating antiretroviral therapy (ART) with advanced stages of HIV infection in resource‐limited settings remains high despite recommendations for universal HIV treatment. We investigated risk factors associated with early mortality in people living with HIV (PLHIV) starting ART at low CD4 levels in the Asia‐Pacific. Methods: PLHIV enrolled in the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) who initiated ART with a CD4 count < 100 cells/μL between 2003 and 2018 were included in the study. Early mortality was defined as death within 1 year of ART initiation. PLHIV in follow‐up for > 1 year were censored at 12 months. Competing risk regression was used to analyse risk factors with loss to follow‐up as a competing risk. Results: A total of 1813 PLHIV were included in the study, of whom 74% were male. With 73 (4%) deaths, the overall first‐year mortality rate was 4.27 per 100 person‐years (PY). Thirty‐eight deaths (52%) were AIDS‐related, 10 (14%) were immune reconstituted inflammatory syndrome (IRIS)‐related, 13 (18%) were non‐AIDS‐related and 12 (16%) had an unknown cause. Risk factors included having a body mass index (BMI) < 18.5 [sub‐hazard ratio (SHR) 2.91; 95% confidence interval (CI) 1.60–5.32] compared to BMI 18.5–24.9, and alanine aminotransferase (ALT) ≥ 5 times its upper limit of normal (ULN) (SHR 6.14; 95% CI 1.62–23.20) compared to ALT < 5 times its ULN. A higher CD4 count (51–100 cells/μL: SHR 0.28; 95% CI 0.14–0.55; and > 100 cells/μL: SHR 0.12; 95% CI 0.05–0.26) was associated with reduced hazard for mortality compared to CD4 count ≤ 25 cells/μL. Conclusions: Fifty‐two per cent of early deaths were AIDS‐related. Efforts to initiate ART at CD4 counts > 50 cell/μL are associated with improved short‐term survival rates, even in those with late stages of HIV disease. [ABSTRACT FROM AUTHOR]

Objectives: Initial antiretroviral therapy (ART) causes loss of bone mineral density (BMD) over the first 1–2 years. Whether this loss continues with longer therapy is unclear. We determined changes in bone and spine BMD over 5 years in adults receiving immediate or deferred initial ART. Methods: In the Strategic Timing of Antiretroviral Therapy (START) BMD substudy, ART‐naïve adults with CD4 counts > 500 cells/μL were randomized to immediate or deferred ART. Deferred group participants not yet on ART were offered ART after May 2015. Mean per cent changes in total hip and lumbar spine BMD (measured annually by dual‐energy X‐ray absorptiometry) were compared between groups using longitudinal mixed models. Fracture rates were also compared between groups for all START participants. Results: Substudy participants (immediate group, n = 201; deferred group, n = 210; median age 32 years; 80% non‐white; 24% female) were followed for a mean 4.5 years until December 2016. In the immediate group, > 96% used ART throughout. In the deferred group, 16%, 58% and 94% used ART at years 1, 3 and 5, respectively. BMD decreased more in the immediate group initially; groups had converged by year 3 at the spine and year 4 at the hip by intent‐to‐treat (ITT). BMD changes after year 1 were similar in the immediate group and in those off ART in the deferred group [mean difference: spine, 0.03% per year; 95% confidence interval (CI) −0.4, 0.4; P = 0.88; hip, −0.2% per year; 95% CI −0.7, 0.3; P = 0.37]. Fracture incidence did not differ significantly between groups (immediate group, 0.86/100 person‐years versus deferred group, 0.85/100 person‐years; hazard ratio 1.01; 95% CI 0.76, 1.35; P = 0.98). Conclusions: Significant ART‐induced bone loss slowed after the first year of ART and became similar to that in untreated HIV infection. [ABSTRACT FROM AUTHOR]

The number of anthracene (AN) and anthracene-tetracene (AN-TN) doped 4-nitrophenol (4-NP) luminophors (AN/4-NP and AN-TN/4-NP) were prepared at different proportion by conventional technique called solid state reaction. Excitation energy transfer was observed by fluorescence spectroscopy and cyclic voltammetry. 4-NP acts as an outstanding light emitting matrix. The effect of the donor emission was perceived by changing the dopant concentration; this showed that AN/4-NP and TN-AN/4-NP exhibit fluorescence emission ranging from blue to green i.e. in the range from 400 to 525 nm and 535–550 nm, respectively. Structural properties and thermal stability was studied by XRD, SEM and TGA-DSC techniques. The study reveals that the prepared materials show excellent properties which can meet the demands of optoelectronic devices as well as for light emitting devices. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes is a growing cause of morbidity and mortality in people living with HIV (PLHIV) receiving antiretroviral therapy (ART). We investigated the association between fasting plasma glucose (FPG) levels and mortality, and factors associated with FPG monitoring rates in Asia. Methods: Patients from the Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) HIV Observational Database Low Intensity Transfer (TAHOD‐LITE) cohort were included in the present study if they had initiated ART. Competing risk and Poisson regression were used to analyse the association between FPG and mortality, and assess risk factors for FPG monitoring rates, respectively. FPG was categorized as diabetes (FPG ≥ 7.0 mmol/L), prediabetes (FPG 5.6–6.9 mmol/L) and normal FPG (FPG < 5.6 mmol/L). Results: In total, 33 232 patients were included in the analysis. Throughout follow‐up, 59% had no FPG test available. The incidence rate for diabetes was 13.7 per 1000 person‐years in the 4649 patients with normal FPG at ART initiation. Prediabetes [sub‐hazard ratio (sHR) 1.32; 95% confidence interval (CI) 1.07–1.64] and diabetes (sHR 1.90; 95% CI 1.52–2.38) were associated with mortality compared to those with normal FPG. FPG monitoring increased from 0.34 to 0.78 tests per person‐year from 2012 to 2016 (P < 0.001). Male sex [incidence rate ratio (IRR) 1.08; 95% CI 1.03–1.12], age > 50 years (IRR 1.14; 95% CI 1.09–1.19) compared to ≤ 40 years, and CD4 count ≥ 500 cells/μL (IRR 1.04; 95% CI 1.00–1.09) compared to < 200 cells/μL were associated with increased FPG monitoring. Conclusions: Diabetes and prediabetes were associated with mortality. FPG monitoring increased over time; however, less than half of our cohort had been tested. Greater resources should be allocated to FPG monitoring for early diabetic treatment and intervention and to optimize survival. [ABSTRACT FROM AUTHOR]

Objectives: With earlier antiretroviral therapy (ART) initiation, time spent in HIV care is expected to increase. We aimed to investigate loss to follow‐up (LTFU) in Asian patients who remained in care 5 years after ART initiation. Methods: Long‐term LTFU was defined as LTFU occurring after 5 years on ART. LTFU was defined as (1) patients not seen in the previous 12 months; and (2) patients not seen in the previous 6 months. Factors associated with LTFU were analysed using competing risk regression. Results: Under the 12‐month definition, the LTFU rate was 2.0 per 100 person‐years (PY) [95% confidence interval (CI) 1.8–2.2 among 4889 patients included in the study. LTFU was associated with age > 50 years [sub‐hazard ratio (SHR) 1.64; 95% CI 1.17–2.31] compared with 31–40 years, viral load ≥ 1000 copies/mL (SHR 1.86; 95% CI 1.16–2.97) compared with viral load < 1000 copies/mL, and hepatitis C coinfection (SHR 1.48; 95% CI 1.06–2.05). LTFU was less likely to occur in females, in individuals with higher CD4 counts, in those with self‐reported adherence ≥ 95%, and in those living in high‐income countries. The 6‐month LTFU definition produced an incidence rate of 3.2 per 100 PY (95% CI 2.9–3.4 and had similar associations but with greater risks of LTFU for ART initiation in later years (2006–2009: SHR 2.38; 95% CI 1.93–2.94; and 2010–2011: SHR 4.26; 95% CI 3.17–5.73) compared with 2003–2005. Conclusions: The long‐term LTFU rate in our cohort was low, with older age being associated with LTFU. The increased risk of LTFU with later years of ART initiation in the 6‐month analysis, but not the 12‐month analysis, implies that there was a possible move towards longer HIV clinic scheduling in Asia. [ABSTRACT FROM AUTHOR]

The number of anthracene-tetracene (AN-TN) doped p-terphenyl (p-TP) luminophors [(TN-AN/ p-TP) (D-A)] and thin films of polystyrene doped p-TP luminophors were prepared at different proportion by conventional technique called solid state reaction and spin coating technique respectively. Excitation energy transfer (EET) was studied by fluorimetry and cyclic voltammetry technique. The result showed that, TN-AN/ p-TP in crystalline state as well as in thin films exhibit outstanding green emission at 475–550 nm, peaking at 525 nm. Structural properties and thermal stability were studied by XRD, SEM and TGA-DSC. The HOMO and LUMO energy levels obtained by CV were in the range from 5.82–5.85 eV and 2.94–2.97 eV, respectively. The Eg calculated from the CV found 2.88 eV which are in close agreement with efficient energy transfer in prepared organoluminophors. [ABSTRACT FROM AUTHOR]

Objectives: With aging of the HIV‐positive population, cardiovascular disease (CVD) increasingly contributes to morbidity and mortality. We investigated CVD‐related and other causes of death (CODs) and factors associated with CVD in a multi‐country Asian HIV‐positive cohort. Methods: Patient data from 2003–2017 were obtained from the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD). We included patients on antiretroviral therapy (ART) with > 1 day of follow‐up. Cumulative incidences were plotted for CVD‐related, AIDS‐related, non‐AIDS‐related, and unknown CODs, and any CVD (i.e. fatal and nonfatal). Competing risk regression was used to assess risk factors of any CVD. Results: Of 8069 patients with a median follow‐up of 7.3 years [interquartile range (IQR) 4.4–10.7 years], 378 patients died [incidence rate (IR) 6.2 per 1000 person‐years (PY)], and this total included 22 CVD‐related deaths (IR 0.36 per 1000 PY). Factors significantly associated with any CVD event (IR 2.2 per 1000 PY) were older age [sub‐hazard ratio (sHR) 2.21; 95% confidence interval (CI) 1.36–3.58 for age 41–50 years; sHR 5.52; 95% CI 3.43–8.91 for ≥ 51 years, compared with < 40 years], high blood pressure (sHR 1.62; 95% CI 1.04–2.52), high total cholesterol (sHR 1.89; 95% CI 1.27–2.82), high triglycerides (sHR 1.55; 95% CI 1.02–2.37) and high body mass index (BMI) (sHR 1.66; 95% CI 1.12–2.46). CVD crude IRs were lower in the later ART initiation period and in lower middle‐ and upper middle‐income countries. Conclusions: The development of fatal and nonfatal CVD events in our cohort was associated with older age, and treatable risk factors such as high blood pressure, triglycerides, total cholesterol and BMI. Lower CVD event rates in middle‐income countries may indicate under‐diagnosis of CVD in Asian‐Pacific resource‐limited settings. [ABSTRACT FROM AUTHOR]

Novel luminophors of anthracene (AN) and tetracene (TN) doped biphenyl were prepared using Conventional Solid State reaction technique. Fluorescence spectroscopy, XRD, SEM, TGA-DSC and Cyclic Voltammetry techniques have been employed for photophysical, electrochemical and thermal study. The X-ray diffraction study revealed the formation of homogeneous biphenyl solid solutions with the added guests AN and TN. Fluorescent biphenyl absorbing short wave UV radiation and emitting at long wave UV radiation has been used as a solid matrix. From the fluorescence spectra it is seen that the added guests shifts the UV fluorescence of biphenyl emitting in green region of visible spectrum at 532 nm. SEM images of the prepared luminophors showed the crystallites of average size 140 nm which makes them suitable candidates for their use in Optoelectronic devices. HOMO and LUMO energy levels of the synthesized luminophors from electrochemical data observed in 5.50-5.64 eV and 3.09-3.13 eV with band gap 2.37-2.55 eV, respectively. TGA-DSC study revealed the thermal stability of prepared luminophors.Graphical Abstract [ABSTRACT FROM AUTHOR]

A series of novel luminophors of 2-naphthol by doping anthracene were prepared using conventional solid state reaction technique. The photophysical, electrochemical and thermal properties were studied by Fluorescence spectroscopy, XRD, SEM, TGA-DSC and by Cyclic Voltammetry techniques. The thin films were characterized by Fluorescence spectroscopy. XRD study of fine grained powders exhibited sharp peaks which specify crystallinity and homogeneity of the doped luminophors. The fluorescence spectra of doped 2-naphthol exhibited emission of anthracene at 413 nm i.e. blue emission with instantaneous fluorescence quenching of 2-NP due to excitation energy transfer (EET). Electrochemical data specify that the HOMO and LUMO energy levels of the synthesized luminophors are in the range of 5.55-5.71 eV and 3.03-3.24 eV, respectively. TGA-DSC study confirmed thermal stability of prepared luminophors. Hence, overall study proposes that these luminophors seems applicable to be used as n-type materials for Optoelectronic devices. [ABSTRACT FROM AUTHOR]

5-Methylcytosine (MeC) is an endogenous modification of DNA that plays a crucial role in DNA–protein interactions, chromatin structure, epigenetic regulation, and DNA repair. MeC is produced via enzymatic methylation of the C-5 position of cytosine by DNA-methyltransferases (DNMT) which use S-adenosylmethionine (SAM) as a cofactor. Hemimethylated CG dinucleotides generated as a result of DNA replication are specifically recognized and methylated by maintenance DNA methyltransferase 1 (DNMT1). The accuracy of DNMT1-mediated methylation is essential for preserving tissue-specific DNA methylation and thus gene expression patterns. In the present study, we synthesized DNA duplexes containing MeC analogues with modified C-5 side chains and examined their ability to guide cytosine methylation by the human DNMT1 protein. We found that the ability of 5-alkylcytosines to direct cytosine methylation decreased with increased alkyl chain length and rigidity (methyl ＞ ethyl ＞ propyl ∼ vinyl). Molecular modeling studies indicated that this loss of activity may be caused by the distorted geometry of the DNA–protein complex in the presence of unnatural alkylcytosines. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to assess the prevalence and characteristics associated with current smoking in an Asian HIV-positive cohort, to calculate the predictive risks of cardiovascular disease ( CVD), coronary heart disease ( CHD) and myocardial infarction ( MI), and to identify the impact that simulated interventions may have. Methods Logistic regression analysis was used to distinguish associated current smoking characteristics. Five-year predictive risks of CVD, CHD and MI and the impact of simulated interventions were calculated utilizing the Data Collection on Adverse Effects of Anti- HIV Drugs Study (D:A:D) algorithm. Results Smoking status data were collected from 4274 participants and 1496 of these had sufficient data for simulated intervention calculations. Current smoking prevalence in these two groups was similar (23.2% vs. 19.9%, respectively). Characteristics associated with current smoking included age > 50 years compared with 30-39 years [odds ratio ( OR) 0.65; 95% confidence interval ( CI) 0.51-0.83], HIV exposure through injecting drug use compared with heterosexual exposure ( OR 3.03; 95% CI 2.25-4.07), and receiving antiretroviral therapy ( ART) at study sites in Singapore, South Korea, Malaysia, Japan and Vietnam in comparison to Thailand (all OR > 2). Women were less likely to smoke than men ( OR 0.11; 95% CI 0.08-0.14). In simulated interventions, smoking cessation demonstrated the greatest impact in reducing CVD and CHD risk and closely approximated the impact of switching from abacavir to an alternate antiretroviral in the reduction of 5-year MI risk. Conclusions Multiple interventions could reduce CVD, CHD and MI risk in Asian HIV-positive patients, with smoking cessation potentially being the most influential. [ABSTRACT FROM AUTHOR]

Objectives We evaluated the effect of the time interval between the initiation of antiretroviral therapy ( ART) and the initiation of tuberculosis ( TB) treatment on clinical outcomes in HIV/ TB-coinfected patients in an Asian regional cohort. Methods Adult HIV/ TB-coinfected patients in an observational HIV-infected cohort database who had a known date of ART initiation and a history of TB treatment were eligible for study inclusion. The time interval between the initiation of ART and the initiation of TB treatment was categorized as follows: TB diagnosed while on ART, ART initiated ≤ 90 days after initiation of TB treatment ('early ART'), ART initiated > 90 days after initiation of TB treatment ('delayed ART'), and ART not started. Outcomes were assessed using survival analyses. Results A total of 768 HIV/ TB-coinfected patients were included in this study. The median CD4 T-cell count at TB diagnosis was 100 [interquartile range ( IQR) 40-208] cells/μL. Treatment outcomes were not significantly different between the groups with early ART and delayed ART initiation. Kaplan− Meier analysis indicated that mortality was highest for those diagnosed with TB while on ART (3.77 deaths per 100 person-years), and the prognoses of other groups were not different (in deaths per 100 person-years: 2.12 for early ART, 1.46 for delayed ART, and 2.94 for ART not started). In a multivariate model, the interval between ART initiation and TB therapy initiation did not significantly impact all-cause mortality. Conclusions A negative impact of delayed ART in patients coinfected with TB was not observed in this observational cohort of moderately to severely immunosuppressed patients. The broader impact of earlier ART initiation in actual clinical practice should be monitored more closely. [ABSTRACT FROM AUTHOR]

The majority of HIV-infected patients in developing countries commences combination antiretroviral therapy (cART) with advanced disease. We examined predictors of disease progression in patients initiating cART with CD4 count ≤200 cells/mm(3) in the TREAT Asia HIV Observational Database. The main outcome measure was progression to either an AIDS-defining illness or death occurring 6 months after initiation of cART. We used survival analysis methods. A total of 1255 patients contributed 2696 person years of follow-up; 73 were diagnosed with AIDS and 9 died. The rate of progression to the combined end point was 3.0 per 100 person years. The factors significantly associated with a higher risk of disease progression were Indian ethnicity, infection through intravenous drug use, lower CD4 count, and hemoglobin ≤130 g/dL at 6 months. In conclusion, measurements of CD4 count and hemoglobin at month 6 may be useful for early identification of disease progression in resource-limited settings. [ABSTRACT FROM AUTHOR]

PurposeDespite demonstrated cost effectiveness, not all corneal disorders are amenable to type I Boston keratoprosthesis (KPro) implantation. This includes patients with autoimmune diseases, such as Stevens-Johnson syndrome/toxic epidermal necrolysis. Type II KPro is implanted through the eyelids in severe dry eye and cicatricial diseases, and its cost effectiveness was sought.Patients and methodsIn a retrospective chart review, 29 patients who underwent type II KPro surgery at the Massachusetts Eye and Ear Infirmary between the years 2000 and 2009 were identified. A total of 11 patients had 5-year follow-up data. Average cost effectiveness was determined by cost-utility analysis, comparing type II KPro surgery with no further intervention.ResultsUsing the current parameters, the cost utility of KPro from third-party insurer (Medicare) perspective was 63 196 $/quality-adjusted life year.ConclusionEfforts to refer those less likely to benefit from traditional corneal transplantation or type I KPro, for type II KPro surgery, may decrease both patient and societal costs. [ABSTRACT FROM AUTHOR]

Objectives Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource-limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes. Methods Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (≥3, 1–2 or <1) or CD4 (≥3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV-1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively. Results Increased disease progression was associated with site-reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age ( P<0.001) and ‘Other’ HIV source exposures, including injecting drug use and blood products ( P=0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting ‘Other’ HIV exposures experienced reduced suppression (OR=0.28; P<0.001). Conclusion Low measures of site resourcing were associated with less favourable patient outcomes, including a 35% increase in disease progression in patients from sites with VL testing less than once per year. [ABSTRACT FROM AUTHOR]

nti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis—the term recently applied to Wegener's granulomatosis—is a rare multi-system inflammation characterized by necrotizing granulomas and vasculitis. We investigated the ocular manifestations of this disease in a group of patients drawn from five inflammatory eye disease clinics across the United States. Of 8,562 persons with ocular inflammation, 59 individuals were diagnosed with ANCA-positive vasculitis; 35 males and 21 females, aged 16 to 96 years, were included in this study. Ocular diagnoses were scleritis (75.0%), uveitis (17.9%), and other ocular inflammatory conditions (33.9%) including peripheral ulcerative keratitis and orbital pseudotumor. Mean duration of ocular disease was 4.6 years. Oral corticosteroids and other systemic immunosuppressive agents were used by 85.7% and 78.5% of patients, respectively. Over time, patients with ANCA-positive vasculitis experienced 2.75-fold higher mortality than other patients with inflammatory eye disease. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to examine the rates and predictors of treatment modification following combination antiretroviral therapy (cART) failure in Asian patients with HIV enrolled in the TREAT Asia HIV Observational Database (TAHOD). Methods Treatment failure (immunological, virological and clinical) was defined by World Health Organization criteria. Countries were categorized as high or low income by World Bank criteria. Results Among 2446 patients who initiated cART, 447 were documented to have developed treatment failure over 5697 person-years (7.8 per 100 person-years). A total of 253 patients changed at least one drug after failure (51.6 per 100 person-years). There was no difference between patients from high- and low-income countries [adjusted hazard ratio (HR) 1.02; P=0.891]. Advanced disease stage [Centers for Disease Control and Prevention (CDC) category C vs. A; adjusted HR 1.38, P=0.040], a lower CD4 count (≥51 cells/μL vs. ≤50 cells/μL; adjusted HR 0.61, P=0.022) and a higher HIV viral load (≥400 HIV-1 RNA copies/mL vs. <400 copies/mL; adjusted HR 2.69, P<0.001) were associated with a higher rate of treatment modification after failure. Compared with patients from low-income countries, patients from high-income countries were more likely to change two or more drugs (67% vs. 49%; P=0.009) and to change to a protease-inhibitor-containing regimen (48% vs. 16%; P<0.001). Conclusions In a cohort of Asian patients with HIV infection, nearly half remained on the failing regimen in the first year following documented treatment failure. This deferred modification is likely to have negative implications for accumulation of drug resistance and response to second-line treatment. There is a need to scale up the availability of second-line regimens and virological monitoring in this region. [ABSTRACT FROM AUTHOR]

Background/objective: Little is known about the long-term clinical course and management of patients with normal pressure hydrocephalus (NPH) treated by cere-brospinal fluid (CSF) shunting. Methods: We retrospectively reviewed records of 55 patients diagnosed with idiopathic NPH (INPH) and treated with CSF shunts, all of whom were followed for more than 3 years after the original shunt surgery. At each annual follow-up visit, the patient was assessed by Folstein Mini Mental State Examination, detailed clinical evaluation of gait and assessment of headache, cognition, gait or urination, as assessed by the patient and relatives. Results: The mean duration of follow-up was 5.9 ± 2.5 years. There was an overall sustained improvement among all symptoms. Gait showed the highest maintenance of improvement over baseline (83% at 3 years and 87% at the last analysed follow-up of 7 years), cognition showed intermediary improvement (84% and 86%, respectively), and urinary incontinence showed the least improvement (84% and 80%, respectively). Fifty-three percent of patients required shunt revisions. Indications for revision included shunt malfunction (87%), infection (10%) and change of shunt configuration (3%). Overall, 74% revisions resulted in clinical improvement. Conclusions: Clinical improvement of patients with NPH can be sustained for 5-7 years in some patients with NPH, even if shunt revision surgery is needed multiple times. With earlier diagnosis and treatment of NPH and the increasing lifespan of the ageing population, the need for long-term follow-up after shunt surgery for NPH may be greater than it was in the past. Monitoring, identification and treatment of shunt obstruction is a key management principle. [ABSTRACT FROM AUTHOR]

Background The antiretroviral treatment (ART) combination of stavudine, lamivudine and nevirapine (d4T/3TC/NVP) is the most frequently used initial regimen in many Asian countries. There are few data on the outcome of this treatment in clinic cohorts in this region. Methods We selected patients from the TREAT Asia HIV Observational Database (TAHOD) who started their first ART regimen with d4T/3TC/NVP. Treatment change was defined as cessation of therapy or the addition or change of one or more drugs. Clinical failure was defined as diagnosis with an AIDS-defining illness, or death while on d4T/3TC/NVP treatment. Results The rate of treatment change among TAHOD patients starting d4T/3TC/NVP as their first antiretroviral treatment was 22.3 per 100 person-years, with lower baseline haemoglobin (i.e. anaemia) associated with slower rate of treatment change. The rate of clinical failure while on d4T/3TC/NVP treatment was 7.3 per 100 person-years, with baseline CD4 cell count significantly associated with clinical failure. After d4T/3TC/NVP was stopped, nearly 40% of patients did not restart any treatment and, of those who changed to other treatment, the majority changed to zidovudine (ZDV)/3TC/NVP and less than 3% of patients changed to a protease inhibitor (PI)-containing regimen. The rates of disease progression on the second-line regimen were similar to those on the first-line regimen. Conclusion These real-life data provide an insight into clinical practice in Asia and the Pacific region. d4T/3TC/NVP is maintained longer than other first-line regimens and change is mainly as a result of adverse effects rather than clinical failure. There is a need to develop affordable second-line antiretroviral treatment options for patients with HIV infection in developing countries. [ABSTRACT FROM AUTHOR]

A new class of 2-naphthol luminophors doped with varying amounts of pyrene were prepared by applying standard solid-state reaction method to sight new luminophors which emit at a higher wavelength. The optical and electrochemical properties of prepared luminophors were studied by fluorimetry and cyclic voltammetry technique, respectively. The fluorescence spectrum of doped 2-naphthol showed broad fluorescence band at maximum wavelength 450 nm for 1 × 10–1 mol pyrene per mole 2-naphthol. The shifted broad spectra confirmed the exciplex formation between 2-naphthol and pyrene in the excitation state. On the basis of electrochemical data, energy levels of HOMO and LUMO were obtained for the prepared luminophors. The observed values fit between 5.70–5.72 eV and 3.02–3.09 eV, respectively. Their thermal stability was studied by TGA–DSC analysis. The SEM images evidenced crystal size of ~ 115 nm. Thus, the overall study proposes that the prepared novel luminophors are useful in optoelectronics. [ABSTRACT FROM AUTHOR]

Here we report the discovery of cold-seep ecosystem and shallow methane hydrates (2-3 mbsf) associated with methane gas flares in the water column from the Indian EEZ for the first time. The seep-sites are located in the Krishna-Godavari (K-G) basin at water depths of 900-1800 m and are characterized by gas flares in the water-column images. The occurrence of methane gas hydrates at very shallow depths (2-3 mbsf) at some of the seep-sites is attributed to high methane flux and conducive P-T conditions, necessary for the stability of methane hydrate. Chemosymbiont bearing Bivalves (Vesicomidae, Mytilidae, Thyasiridae and Solemyidae families); Polychaetes (Siboglinidae family) and Gastropods (Provannidae family) are also identified from seep-sites. [ABSTRACT FROM AUTHOR]

A letter to the editor about the utility of serodiagnostic tests in cerebral toxoplasmosis is presented.

Purpose To report the long term outcomes of Boston keratoprosthesis type II implantation in the management of severe ocular surface disease and corneal blindness. Methods A retrospective review of medical records of patients after Boston keratoprosthesis type II implantation at the Massachusetts Eye and Ear Infirmary from January, 1, 2000 through December 31, 2009. Main outcome measures included visual acuity, device retention, and postoperative complications. Results A total of 29 eyes of 26 patients received a Boston keratoprosthesis type II during the study period. Operated patients had corneal blindness due to mucous membrane pemphigoid (51.7%), Stevens Johnson syndrome/toxic epidermal necrolysis (41.4%), or other ocular surface disease (6.9%). Visual acuity after surgery improved to at least 20/200 in 23 eyes (79.3%), and to 20/30 or better in 10 eyes (34.5%). In patients with at least 1 year of follow‐up (n=21), visual acuity of 20/200 or better was maintained in 14 eyes (66.7%). Of these 14 eyes, 6 eyes (42.9%) retained visual acuity of 20/200 or better for more than 5 years. Overall, visual acuity of 20/200 or better was maintained for at least 5 years in 6 of 23 eyes (26.0%). Eyes that failed to improve to 20/200 or lost vision during follow‐up were found to have end stage glaucoma, previous retinal detachment, or age related macular degeneration. Of the total of 29 eyes, 17 devices (58.6%) were retained without extrusion or replacement during a total follow‐up time of 107.9 person‐years. Conclusion The Boston keratoprosthesis type II is a viable option for corneal blindness from severe autoimmune ocular surface diseases. Complications require prompt recognition and management to promote retention of the device and preservation of vision. [ABSTRACT FROM AUTHOR]

Objective: To study the impact of Parkinson's Disease on patients' Quality of Life and financial burden of treatment on patients' lifestyle. Materials and Methods: 51 patients of Idiopathic Parkinson's Disease (IPD) from Sir J. J. Group of Hospitals & Nanavati Hospital were studied. UPDRS was obtained in all patients. Quality of Life was assessed by using Parkinson's Disease Questionnaire on Quality of Life (PDQ-8) and correlation between PDQ-8 scores and Hoehn & Yahr staging and effect of financial burden was assessed through detailed questions on expenses of treatment. Data analysis was done by using Pearson Chi-Square test. Mean age of patients was 56.8 ± 9.28 and there was male predominance. The duration of symptoms was < 5 years in 60% and > 5 years in 40%. 70% were in stage 2 & 3, only 4% were in stage 4.68% of patients scored between 26 to 30 on PDQ-8.32% scored 25 or below 25. All patients with H & Y stage 1 (n:12) scored above 26 and majority of patients with H & Y stage 3 to 4 (n:10) scored below 25. 62.75% of patients felt the financial burden of treatment. Conclusion: The Quality of Life correlates well with severity of Hoehn & Yahr staging rather than financial burden. The motor disability, emotional well-being and communication are directly related to the disease process. [ABSTRACT FROM AUTHOR]