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Background and Objectives: Rate of blood transfusion is considerably low in transurethral resection of the prostate (TURP). We follow type and crossmatch (TC) policy in TURP. The objective was to assess the suitability of TC policy along with the impact of preoperative (preop) prostate weight and hemoglobin (Hb) on the pattern of blood ordering (whether demand for TC was sent or not). Methods: Retrospective analysis of TURP patients was done from 2014 to 2017. Patients were divided into 2 groups on the basis of whether the demand for TC was sent or not. The age, preop prostate weight and preop Hb of patients where demand for TC sent was compared with patients where TC demand was not sent. Crossmatch to transfusion ratio (Crossmatch to transfusion ratio C/T ratio), Transfusion probability (%T) and Transfusion index (TI) were calculated. Results: Among the total 92 TURP patients, 42.4% (39/92) had TC samples sent preoperatively. Only three patients (3.2%, 3/92) required transfusion intraoperatively. CT ratio was 23.6, %T was 7.6% and TI was 0.07. Preop prostate weight and Hb were significantly higher and lower, respectively, for the group where request for TC was sent. Transfusion probability was also higher for this group. Conclusion: The blood utilization indices show the inadequate utilization of blood and that TC policy is unnecessary. Type and screen policy can be used for patients with large prostate and/or low Hb while type and hold would be appropriate for rest of the patients. Change in pretransfusion policy would reduce workforce and reagent wastage along with efficient inventory management. [ABSTRACT FROM AUTHOR]

Aim The present study aimed to evaluate association of genetic variants on drug response and therapy optimization parameters in patients treated with first-line antiepileptic drugs ( AEDs). Genetic variants from ion channels, their functionally related genes, and synaptic vesicle cycle ( SVC) genes with a potential role in epilepsy pathophysiology were thus prioritized. Methods A total of 12 genes from ion channels and related gene set and seven genes from SVC comprising 155 SNPs were genotyped and evaluated with drug response, dose levels, and drug levels in 408 patients with epilepsy. Results Both GABRA1 and SCN1A variants showed haplotypic and diplotypic associations in response to phenytoin ( PHT). Diplotype analysis of GABRA1 variants revealed association of rs12658835|rs7735530 ( AG/ AG) ( P-valuecorrected = 0.034, OR = 3.75, 95% CI = 1.36-11.05) and rs12658835|rs7735530|rs7732641|rs2279020 ( AGCA/ AGCA) ( P-valuecorrected = 0.035, OR = 2.48, 95% CI = 0.96-6.41) with recurrent seizures. SCN1A haplotype rs6432860|rs3812718 ( AC: P-valuecorrected = 0.022, OR = 2.72, 95% CI = 1.39-5.35) and diplotype ( AC/ AC: P-valuecorrected = 0.034, OR = 6.42, 95% CI = 1.10-65.76) were further observed to be associated with recurrent seizures. With respect to therapy optimization parameters, we observed significantly lower dose-adjusted drug levels at maximum dose of PHT in patients carrying AC/ AC diplotype ( P-value = 0.021). Conclusion The results further substantiate the role of GABRA1 in PHT mode of action and contribution of SCN1A in response and therapy optimization with PHT monotherapy. [ABSTRACT FROM AUTHOR]

Objective: Cholesterol gallstone disease (CGD) is a multifactorial and multistep disease. Apart from female gender and increasing age being the documented non-modifiable risk factor for gallstones the pathobiological mechanisms underlying the phenotypic expression of CGD appear to be rather complex, and one or more variations in genes could play critical roles in the diverse pathways further progressing to cholesterol crystal formation. In the present study we performed genotyping score, Multifactor dimensionality reduction (MDR) and Classification and Regression Tree analysis (CART) to identify combinations of alleles among the hormonal, hepatocanalicular transporter and adipogenesis differentiation pathway genes in modifying the risk for CGD. Design: The present case-control study recruited total of 450 subjects, including 230 CGD patients and 220 controls. We analyzed common ESR1, ESR2, PGR, ADRB3, ADRA2A, ABCG8, SLCO1B1, PPARγ2, and SREBP2 gene polymorphisms to find out combinations of genetic variants contributing to CGD risk, using multi-analytical approaches (G-score, MDR, and CART). Results: Single locus analysis by logistic regression showed association of ESR1 IVS1-397C>T (rs2234693), IVS1-351A>G (rs9340799) PGR ins/del (rs1042838) ADRB3-190 T>C (rs4994) ABCG8 D19H (rs11887534), SLCO1B1 Exon4 C>A (rs11045819) and SREBP2 1784G>C (rs2228314) with CGD risk. However, the MDR and CART analysis revealed ESR1 IVS1-397C>T (rs2234693) ADRB3-190 T>C (rs4994) and ABCG8 D19H (rs11887534) polymorphisms as the best polymorphic signature for discriminating between cases and controls. The overall odds ratio for the applied multi-analytical approaches ranged from 4.33 to 10.05 showing an incremental risk for cholesterol crystal formation. In conclusion, our muti-analytical approach suggests that, ESR1, ADRB3, in addition to ABCG8 genetic variants confer significant risk for cholesterol gallstone disease. [ABSTRACT FROM AUTHOR]

MicroRNAs (miRNAs) are small, non-coding RNA molecules that function as negative regulators of gene expression. Common genetic variants (single nucleotide polymorphisms, SNPs) in miRNA genes may alter their expression or maturation resulting in varied functional consequences. Present case–control study evaluated the potential association of three SNPs (rs2910164, rs11614913 and rs3746444) in pre-miRNAs with gallbladder cancer (GBC) risk in 230 GBC cases and 230 controls in a North Indian population. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated for the association of individual SNPs and their interactions with GBC. A non-significant increased risk was observed between carriers of variant genotypes of rs2910164, rs11614913 and rs3746444 (ORs=1.3, 1.3 and 1.1, respectively). This increased risk was more profound in GBC patients with gallstones (ORs=1.4, 1.6 and 1.1, respectively). To further evaluate the cumulative effects of the variant allele, we did a combined unfavorable genotype analysis, which showed a borderline statistical significance. In comparison with the low-risk group (0–2 variant alleles), the high-risk group (>2 variant alleles) had a 1.7-fold (95% CI=1.0–2.8) increased risk for GBC (Ptrend=0.056). These findings suggest, for the first time, that common miRNA variants may not contribute to GBC susceptibility in North Indian population. [ABSTRACT FROM AUTHOR]

Vertical profiles of aerosol backscatter coefficient and depolarization ratio, obtained from the Cloud–Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) satellite, were studied in the upper troposphere and lower stratosphere (UTLS) region over North India (21–30° N and 72–90° E), covering the highly polluted Indo-Gangetic Plain (IGP) for one-year period from December 2011 to November 2012. An enhanced aerosol layer was observed between 15 and 18 km altitude, in the vicinity of tropopause, with a broad layer depth of about 2 km. The aerosol layer showed strong seasonal, monthly as well as day and night time variability, with a peak value of backscatter coefficient during monsoon season (∼5.54 × 10 −3 sr −1 in September). The corresponding depolarization ratio indicates anisotropic (non-spherical) nature of particles. The aerosol layer was found to be highly linked with the variability in tropopause height, showing a positive correlation between tropopause height and the height of maximum backscatter coefficient (correlation coefficient of 0.8). However, it was found to be negatively correlated with the integrated backscatter coefficient (IBC), with a correlation coefficient of 0.3. We further analyzed outgoing long-wave radiation (OLR) data during the study period to investigate the link between the observed enhanced aerosol layer in the UTLS region and prevailing deep convective activities over the study region. Low values of OLR during monsoon (about 214 W m −2 ) indicate the occurrence of deep convection over this region, which may cause a large-scale circulation-driven vertical transport of boundary-layer pollution into the atmosphere of UTLS region. Results may have potential implications for better understanding and assessing the chemical and radiative impacts of these aerosols in the tropical UTLS region. [ABSTRACT FROM AUTHOR]

The article offers information on the association of gene polymorphism with insulin resistance in a north Indian population. Topics discussed include genetic association of ENPP1/PC-1 K121Q polymorphism with obesity, homeostasis model assessment, and statistical analysis of alleles. Also present a table depicting clinical characteristics of study participants.

Introduction: Oropharyngeal candidiasis (OPC) is the most common opportunistic fungal infection reported in human immunodeficiency virus (HIV) positive patients worldwide. This prospective study was undertaken to investigate OPC and Candida colonization (CC) and their correlation with CD4+ cell counts and antiretroviral therapy (ART) in HIV-positive patients. Methodology: In total, 190 HIV-positive patients were enrolled for study in three groups as follows: Group A, 90 patients without ART; Group B, 100 patients undergoing treatment with ART; and Group C, 75 HIV-negative control patients. All HIV patients underwent clinical examination and were subjected to CD4+ cell counts. Swabs were collected from the oral cavity of all individuals and plated on Sabouraud's dextrose agar. Identification of Candida species was performed by conventional methods. Results: Candida species were isolated in 84/190 (44.2%) and 20/75 (26.6%) of the HIV-positive subjects and controls respectively (p<0.01). OPC was noted in 21/190 (11%) of the HIV-positive patients. Candida albicans was the most frequently isolated species. Patients with CD4+ cell counts ≤ 200 cells/mm³ were significantly (p<0.001) more frequently colonized (37/63; 58.7%) and infected (18/21; 85.7 %) with Candida species. Candida species was seen in patients with CC and OPC with CD4+cell counts between 201 and 500 (21/63; 33.4% vs 3/21; 14.3%) and > 500 cell/mm³ (5/63; 7.9% versus 0/21 0%) respectively. Conclusion: OPC and Candida colonization occur more frequently in HIV-positive patients with CD4+ cell counts ≤200 cell/mm³. ART significantly reduces OPC. C. albicans is the most frequently isolated species in both OPC and colonization, suggesting endogenous infection. [ABSTRACT FROM AUTHOR]

Objective: To evaluate correlation of Alberta Stroke Program Early CT Score (ASPECTS) and early and delay outcome measures among acute anterior ischemic stroke patients who presented within 48 hours of stroke onset. Methods: In a prospective cohort study, we recruited consecutive patients with acute middle cerebral artery (MCA) ischemic stroke who presented within 48 hours of stroke onset. All the patients were evaluated at admission (Glasgow Coma Scale - GCS and National Institute of Health Stroke Scale - NIHSS) at discharge (GCS, NIHSS, Barthel Index - BI and modified Rankin Scale - mRS) and at 3 months (BI and mRS). CT ASPECTS was calculated by two observers independently. We divided patients in to two groups with 'Better' and 'Worse' ASPECTS with score of 8-10 and 0-7 respectively and compared the primary and secondary stroke outcome measures. Results: Among 100 patients with acute MCA infarction (median age 55 yrs, 62 males), median ASPECTS scores had inter-rater reliability of 0.82. The mortality, GCS and NIHSS at discharge, and mRS and BI at 3 months are significantly better among patients with 'Better' compared to 'Worse' APSECTS. The hospital stay was shorter in patients with Better ASPCTS. Conclusion: In the setting of acute ischemic stroke, ASPECTS has good correlation with severity of stroke, and is strong predictor of early and delayed outcome in acute ischemic stroke. [ABSTRACT FROM AUTHOR]

There is a paucity of data on the prevalence of elevated homocysteine and its relation with plasma folate and the methylenetetrahydrofolate reductase ( MTHFR) gene in the population of North India. This study evaluates MTHFR gene polymorphism and its relationship with plasma homocysteine and folate levels in a healthy North Indian population. The age of the 200 subjects included in this study was in the range 18–73 (mean 39.4) years. The plasma homocysteine level was elevated in 56.5%, and the plasma folate level was low in 49.5% of the subjects. Heterozygous MTHFR gene polymorphism (CT) was present in 15.5%, and homozygous (TT) in 3.5% of the subjects. Age, diet, and MTHFR gene polymorphisms were related to homocysteine level. All the subjects with the TT and 79% with the CT genotype had a high level of plasma homocysteine, whereas 51% with the CC genotype had a high homocysteine level. After adjustment for the effect of covariates, however, homocysteine was not related to MTHFR gene polymorphism. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical profile and mutation spectrum of Hunter syndrome. Methods: Evaluation of 18 cases of Hunter syndrome from 17 families was done. Mutation analysis of Iduronate sulfatase (IDS) gene was done in 9 families, and mothers of four affected children with no family history Results: Joint contracture, hepatomegaly and radiological changes were present in all children. 6 (33%) children had normal cognitive function at presentation. Point mutations were identified in all the 9 families for whom mutation analysis was done. Among 4 mothers tested from families without any family history, 2 (50%) were found to be carriers. Conclusion: Accurate etiological diagnosis by mutation analysis of IDS gene is important in Hunter syndrome. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence of Nosocomial Infection (NI) and type of bacteriological isolates among the patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in north India. Materials and Methods: This was a cross-sectional hospital based study conducted in the Wards of General Medicine, General Surgery and Orthopaedic of the hospital. The patient were admitted in the department for various surgical procedures, without evidence of initial infection, were included in the study. Results: A total of 176 patients were included in the study of which 82 were from Medical and 94 from Surgical ward. Overall incidence of NI was found to be 26.1% (Medical ward=28%, Surgical ward=24.5%., p=0.58). The isolation rate of Acinetobacter baumanii was (p=0.15) higher among the patients of medical ward (95.7%) than surgical ward (82.6). Escherichia coli was isolated in 89.1% and no significant difference was observed between medical and surgical wards. Klebsiella pneumoniae was isolated in 50% patients and was almost similar (p=0.37) in medical surgical wards. The isolation rate of Pseudomonos aeruginosa, Enterococcus faecalis, Staphylococcus aureus and Coagulase negative staphylococci were 43.5%, 73.9%, 34.8% and 17.4% respectively. A significant difference was observed in the isolation rate of Enterococcus faecalis (p=0.007) and Coagulase negative staphylococci (p=0.002) between medical and surgical wards. Overall, among the patients who developed NI, 27.2% patient's bacterial isolates were Gram positive (Surgical=64.1, Medical=80%). Conclusion: The incidence of NI is increasing in the hospitals, so extensive that more care has to be taken in cleaning the wards of the hospitals. [ABSTRACT FROM AUTHOR]

Background Pesticide sprayers in North India use different application methods for different crops.Aims To compare cholinesterase activity and symptoms in knapsack and tractor-mounted pesticide sprayers.Methods Blood cholinesterase activity and symptoms were recorded for 42 knapsack and 66 tractor-mounted sprayers attending a health camp in North India in 2009 and for 30 controls.Results One hundred and eight of 197 (55%) eligible sprayers consented to participate. Mean acetylcholinesterase (AChE) and butyrylcholinesterase activity was 33 and 60% lower, respectively, in knapsack sprayers than in controls (P < 0.001) and 56 and 62% lower, respectively, in tractor-mounted sprayers than in controls (P < 0.001). AChE depletion was greater in tractor-mounted sprayers than in knapsack sprayers (P < 0.001). In knapsack sprayers compared to controls, odds ratios (OR) were significantly raised for musculoskeletal symptoms (OR 3.9, 95% CI 1.03–18) but not for other symptoms. In tractor-mounted sprayers compared to controls, ORs were significantly raised for neurological (OR 7, 95% CI 2–23), ocular (OR 8.7, 95% CI 2.7–32), respiratory (OR 5.14, 95% CI 1–29), cardiovascular (OR 7.5, 95% CI 2–42), gastrointestinal (OR 5.43, 95% CI 2–18) and musculoskeletal (OR 6.12, 95% CI 2–26) symptoms but not for dermal symptoms (OR 1.93, 95% CI 0.3–20).Conclusions The risk of cholinesterase inhibition and symptoms is greater in tractor-mounted than in knapsack pesticide sprayers and in both groups compared to controls. Occupational exposure in pesticide sprayers in North India needs better control, perhaps through redesign of spraying equipment. [ABSTRACT FROM PUBLISHER]

Background:Global Burden of Disease Study 2010 demonstrates the impact of musculoskeletal diseases as the second greatest cause of disability globally in all regions of the world. The study was conducted to determine the role of mathematically derived body volume (BV), body volume index (BVI), body mass index (BMI), body surface area (BSA) and body fat % (BF %) on musculoskeletal pain (MSP) among housewives in National Capital Region (NCR). Methods:A cross sectional study was undertaken among 495 housewives from Gurgaon and New Okhla Industrial Development Area (NOIDA) in National Capital Region (NCR), New Delhi, India. The study includes questionnaire survey, clinical examination and body composition monitoring among housewives. Results:A significantly higher BMI, BVI, BV and BSA were observed in subjects with MSP as compared to those who had no MSP. This was also true for subjects with pain in knee for BMI category for overweight. Subjects with pain in limbs had significantly high BMI and BVI as compared to subjects with no MSP. A significant positive correlation of age with BMI, BVI, BV and BSA was observed among subjects having no MSP denoting a direct relationship of age and these body factors. Conclusions:The prevalence of MSP among housewives is associated with increasing age, BMI and BVI. This can possibly be used for formulating a strategy for prevention of MSP. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The present study deals with the in vitro study of antioxidant activity of essential oil from Palmarosa (Cymbopogon martini) of family gramineae. Methods: The in vitro study of antioxidant activity of Palmarosa essential oil has been done by using DPPH assay, Nitrogen oxide assay, reducing power assay, β-carotene bleaching assay and FRAP method. Results: IC50 values observed for DPPH and NO assay were 0.125 mg/mL and 12.5 μg/mL, respectively. In beta carotene bleaching method, the oil showed 93.15% bleaching for the first hour and it increased to 51.1% in second hour. There was a constant increase in the reducing activities with the increase in concentrations in both reducing activity and FRAP mehods. In all the methods BHT and Gallic acid were kept as standards. Conclusions: The results clearly indicate that Palmarosa essential oil is effective in scavanging free radical and has the potential to be powerful antioxidant. [Copyright &y& Elsevier]

Background & Objective: Transthyretin (TTR) has been associated with spinocerebellar ataxia (SCA) by several independent case reports. Coexistence of TTR and SCA mutations, overlapping clinical symptoms as well as altered levels of TTR in SCA patients suggest a correlation between TTR and SCA. To our knowledge, no large cohort based study has been attempted to examine the association of SCA with polymorphism in TTR gene. Here, we chose to investigate TTR variations in SCA patients (n=266) and controls (n=192) of North Indian ethnicity. Methods: We sequenced the exons including exon-intron boundaries of TTR gene in 55 patients and 55 controls. We observed four variations which were further genotyped by single base extension method (SNaPshot) in a larger cohort (SCA patients n=211 and controls n=137). Results: A novel synonymous variation c.372 C>G in exon 4 was detected in heterozygous condition in one control sample. We found nominal association for rs1800458 (Gly6Ser), with SCA (p-value < 0.05) which did not remain after Bonferroni correction for multiple tests. Pairwise linkage disequilibrium (LD) analysis revealed no LD between studied SNPs. Further, we employed two-marker sliding window analysis and observed a weak association of haplotype AT of rs1800458 and rs1667251 with SCA patients (p-value <0.05) which was not retained after Bonferroni correction. Conclusion: Our data suggests no association of genetic variations of TTR in SCA pathology. [ABSTRACT FROM AUTHOR]

Abstract: Background: Tumour necrosis factor alpha is a multifunctional proinflammatory cytokine involved in the pathogenesis of metabolic syndrome, insulin resistance, and obesity. Aim of this study is to investigate in a North Indian female population the impact of the G-308A TNF-α variant on various components of the metabolic syndrome, Insulin Resistance, serum TNF-α and Leptin levels. Methods: The G-308A TNF-α polymorphism has been studied in 269 females with metabolic syndrome (NCEP ATP III criteria) (age 31.91±6.05) and 272 healthy females without metabolic syndrome (age 30.96±7.01). The G-308A variant was detected by PCR amplification and Nco-1 digestion. Results: Homozygous mutant genotype (AA) (p=<0.001: OR=3.24: 95% CI=2.15–4.89) and mutant allele (A) (p=<0.001: OR=3.04: 95% CI=2.08–4.43) of TNF-α was significantly less frequently observed in the control population as compared to study group. Furthermore, on dividing the subjects into two groups according to the absence (TNF-1 allele) or presence of the mutant A (TNF-2) allele, significant results were obtained in most of the metabolic risk factors. Conclusions: Our results suggest that the G-308A polymorphism of the TNF-α gene may be independently associated with hypertension, leptin level and hypercholesterolemia leading to metabolic syndrome independent of Insulin resistance and hyperglycemia. [Copyright &y& Elsevier]