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Optimal outcomes in acute severe ulcerative colitis (ASUC) are related to time-bound management based upon early prediction of response to intravenous (IV) steroids. In an earlier study, we described the All India Institute of Medical Sciences (AIIMS) index (baseline Ulcerative Colitis Endoscopic Index of Severity [UCEIS] ≥ 7 and day 3 fecal calprotectin [FCP] 1000 μg/g) for predicting failure of IV steroids. The current study is designed to validate this index in a prospective cohort.IV steroid-naïve patients with ASUC, satisfying Truelove and Witts' criteria, hospitalized from August 2018 to July 2019 were included. Patients' assessment included baseline sigmoidoscopy, day 1 and 3 FCP, hemogram, biochemistry and day 3 C-reactive protein. All patients received IV steroids, and the primary outcome was steroid failure, defined as the need for colectomy or rescue therapy with cyclosporine (CYC)/infliximab (IFX) during admission.Of the 47 patients, eight were excluded (four received steroids outside, two were directly taken for surgery/infliximab therapy, one had toxic megacolon, and one had infectious colitis), and 39 patients were included (mean age: 36.1 ± 12.6 years, male: 31%). Fifteen patients (38%) failed IV steroid and required rescue therapy (IFX: 9, CYC: 2, Colectomy: 3, IFX followed by colectomy: 1). On univariate analysis, UCEIS ≥ 7 at baseline (p = 0.006), day 1 FCP (p = 0.03), day 3 FCP 1000 μg/g (p = 0.001), Oxford criteria (p = 0.04) and AIIMS index (p 0.001) were significantly different between steroid responders and steroid failures. On multivariate analysis, day 3 FCP 1000 μg/g (odds ratio (odds ratio (OR)= 6.4;(95% CI =2.2-196.1) and baseline UCEIS ≥ 7 (OR) = 10.1;(95% CI = 2.1-80.2) were independent predictors. The AIIMS index predicted steroid failure with a better specificity (100% vs. 83%, p = 0.04) and positive predictive value (100% vs. 64%, p = 0.03) than Oxford criteria.AIIMS index has been validated in 39 prospective ASUC patients as an effective early predictor of steroid failure (sensitivity = 53%, specificity = 100%).

Tracheostomy has been accepted as standard of care for patients requiring prolonged mechanical ventilation. There has been a shift from the era of open surgical tracheostomy to percutaneous tracheostomy. Some studies have reported certain advantages of percutaneous tracheostomy over open tracheostomy, yet some centres debate about its effectiveness and, hence, have not adopted it as a routine technique. We present our centre’s experience of performing 100 bedside percutaneous tracheostomies, including those in 27 patients of cervical spine injury. The aim of the study is to demonstrate the safety and efficacy of percutaneous tracheostomy such that it can be embraced as a routine technique. One hundred consecutive neurosurgical patients requiring tracheostomy for prolonged ventilation were included in the study. Patients requiring emergency tracheostomy were excluded. A prospective database was created which included demographic profile of the patient, diagnosis and related indications, procedure time and complications. Ciaglia multiple dilator technique was used for performing percutaneous tracheostomy using Cook set. Time taken was measured from skin incision to insertion of tracheostomy tube. All related complications were noted. Mean duration of procedure was 7.92 ± 0.17 min and 7.14 ± 0.1 min in patients of cervical spine injury. Cannula misplacement occurred in 5 patients and minor bleeding occurred in 4 patients, including 3 complications in patients of cervical spine injury(2 had bleeding while 1 had cannula misplacement corrected during the procedure). Conversion to open procedure was required in one patient. Percutaneous tracheostomy is a safe and effective alternative to open tracheostomy. It can be considered the first line of care in patients requiring tracheostomy, especially in patients of cervical spine injury.

Amycolatopsis mediterranei S699 produces rifamycin B and successors of this strain are in use for the industrial production of rifamycin B. Semisynthetic derivatives of rifamycin B are used against Mycobacterium tuberculosis that causes tuberculosis. Although the rifamycin biosynthetic gene cluster was characterized two decades ago, the regulation of rifamycin B biosynthesis in Amycolatopsis mediterranei S699 is poorly understood. In this study, we analysed the genome and proteome of Amycolatopsis mediterranei S699 and identified 1102 transcription factors which comprise about 10% of the total genome. Using interactomics approaches we delineated 30 unique transcription factors directly involved in secondary metabolism that regulate rifamycin B biosynthesis. We also predict the role of RifN as hub in controlling the regulation of other genes involved in rifamycin biosynthesis. RifN is important for maintaining the integrity of the rifamycin-network. Thus, these transcription factor can be exploited to improve rifamycin B production in Amycolatopsis mediterranei S699.

Strong association exists between celiac disease and autoimmune endocrinopathies such as type I diabetes and hypothyroidism; there is a lack of data on the involvement of other endocrine organs such as pituitary-gonadal axis. Furthermore, there is lack of data on the spectrum of involvement of endocrine organs varying from organ autoimmunity to subclinical and clinical disease. We evaluated consecutive treatment-naive patients with celiac disease (CeD) for clinical and subclinical endocrinopathies. Of 154 screened, 74 treatment-naive patients with CeD were recruited. They underwent hormonal and/or functional assessment of beta cell of pancreas, thyroid gland, pituitary-gonadal axis, and parathyroid glands. Of the 74 patients with CeD, 31 (41.9%) had at least one clinical or subclinical endocrinopathy and 9 (12.2%) had multiple endocrinopathies. Most common of them were clinical or subclinical type I diabetes and autoimmune thyroid disease. Interestingly, 8 (10.8%) patients also were found to have functional hypopituitarism and 7/54 (12.9%) having isolated hypogonadotropic hypogonadism. Patients with CeD have high percentages of not only clinical endocrinopathy including pituitary-gonadal axis dysfunction but also subclinical endocrinopathy. Whether commencement of gluten-free diet will lead to reversal of subclinical endocrinopathies requires further follow up studies.

This study reports the whole-genome sequencing and sequence analysis of a bacterial isolate Brevibacterium casei strain LS14, isolated from Loktak Lake, Imphal, India. The de novo assembled genome reported in this paper featured a size of 3,809,532 bp, has GC content of 68% and contains 3602 genomic features, including 3551 protein-coding genes, 46 tRNA and 5rRNA. A biosurfactant biosynthesis gene cluster in the genome of the isolated strain was identified using AntiSMASH online tool V3.0.5 and KAAS (KEGG Automatic Annotation Server). The presence of biosurfactant was demonstrated by drop collapse, oil displacement and emulsification index. Subsequent chemical characterization using FTIR and LC–MS analyses revealed surfactin and terpene containing biosurfactant moieties. Also, the presence of genes involved in terpenoid synthesis pathway in the genome sequence may account for biosurfactant terpenoid backbone, but genes for later-stage conversion of terpenoid to biosurfactant were not ascertained.

The term hygiene is deeply rooted with the concept of maintaining sound health and alertness towards cleanliness, while “hygiene hypothesis” depicts the protective role of microbial community exposure in development of early immunity and initial allergic and aesthetic reactions. The tug-of-war has now been pushed toward the literal term “hygiene” over the “hygiene hypothesis” and has continued with disinfection of all microbial loads from the related environments to avoid infections in humans. With the advancement in the microbiome studies, it became clear that humans possess warm, and significant relationships with diverse microbial community. With this opinion article, we have emphasized on the importance of hygiene hypothesis in immunological responses. We also propose the individual/targeted hygiene instead of application of unanimous hygiene hypothesis. This review also elaborates the common practices that should be employed to maintain hygiene along with the balanced microbiome.

The gut microbiome analysis, with specific interest on their direct impact towards the human health, is currently revolutionizing the unexplored frontiers of the pathogenesis and wellness. Although in-depth investigations of gut microbiome, ‘the Black Boxes’, complexities and functionalities are yet at its infancy, profound evidences are being reported for their concurrent involvement in disease etiology and its treatment. Interestingly, studies from the ‘minimal murine’ (Oligo-MM(12)), ‘humanized’ microbiota gnotobiotic mice models and patient samples, combined with multi-omics and cell biology approaches, have been revealing the implications of these findings in the treatment of gut dysbiosis associated diseases. Nonetheless, due to the inherent heterogeneity of the gut commensals and their unified co-existence with opportunistic pathobionts, it is utmost essential to highlight their functionalities in ‘good or bad’ gut in human wellness. We have specifically reviewed dietary lifestyle and infectious diseases linked with the gut bacterial consortia to delineate the ecobiotic approaches towards their treatment. This notably includes gut mucosal immunity mediated diseases such as Tuberculosis, IBD, CDI, Type 2 Diabetes, etc. Alongside of each dysbiosis, we have described the current therapeutic advancements of the pre- and probiotics derived from human microbiome studies to restore gut microbial homeostasis. With a continuous running debate on the role of microbiota in above mentioned diseases, we have collected numerous scientific evidences highlighting a previously unanticipated complex involvement of gut microbiome in the potential of human health.

A healthy gut is predominantly occupied by bacteria which play a vital role in nutrition and health. Any change in normal gut homeostasis imposes gut dysbiosis. So far, efforts have been made to mitigate the gastrointestinal symptoms using modern day probiotics. The majority of the probiotics strains used currently belong to the genera Lactobacillus, Clostridium, Bifidobacterium and Streptococcus. Recent advancements in culturomics by implementing newer techniques coupled with the use of gnotobiotic animal models provide a subtle ground to develop novel host specific probiotics therapies. In this review article, the recent advances in the development of microbe-based therapies which can now be implemented to treat a wide spectrum of diseases have been discussed. However, these probiotics are not classified as drugs and there is a lack of stringent law enforcement to protect the end users against the pseudo-probiotic products. While modern probiotics hold strong promise for the future, more rigorous regulations are needed to develop genuine probiotic products and characterize novel probiotics using the latest research and technology. This article also highlights the possibility of reducing antibiotic usage by utilizing probiotics developed using the latest concepts of syn and ecobiotics.

Sustainable poultry practices are needed to maintain an adequate supply of poultry products to the increasing human population without compromising human wellbeing. In order to achieve the understanding of the core microbiome that assumes an imperative role in digestion, absorption, and assimilation of feed as well as restrict the growth of pathogenic strains, a proper meta-data survey is required. The dysbiosis of the core microbiome or any external infection in chickens leads to huge losses in the poultry production worldwide. Along with this, the consumption of infected meat also impacts on human health as chicken meat is a regular staple in many diets as a vital source of protein. To tackle these losses, sub-therapeutic doses of antibiotics are being used as a feed additive along with other conventional approaches including selective breeding and modulation in feed composition. Altogether, these conventional approaches have improved the yield and quality of poultry products, however, the use of antibiotics encompasses the risk of developing multi-drug resistant pathogenic strains that can be harmful to human beings. Thus, there is an urgent need to understand the chicken microbiome in order to modulate chicken gut microbiome and provide alternatives to the conventional methods. Although there is now emerging literature available on some of these important microbiome aspects, in this article, we have analysed the relevant recent developments in understanding the chicken gut microbiome including the establishment of integrated gene catalogue for chicken microbiome. We have also focussed on novel strategies for the development of a chicken microbial library that can be used to develop novel microbial consortia as novel probiotics to improve the poultry meat production without compromising human health. Thus, it can be an alternative and advanced step compared to other conventional approaches to improve the gut milieu and pathogen-mediated loss in the poultry industry.

To determine the frequency of CYP1B1 p.E229K and p.R368H, gene mutations in a cohort of sporadic juvenile onset open-angle glaucoma (JOAG) patients and to evaluate their genotype/phenotype correlation. Unrelated JOAG patients whose first-degree relatives had been examined and found to be unaffected were included in the study. The patients and their parents were screened for p.E229K and p.R368H mutations. The phenotypic characteristics were compared between probands carrying the mutations and those who did not carry these mutations. Out of 120 JOAG patients included in the study, the p.E229K mutation was seen in 9 probands (7.5%) and p.R368H in 7 (5.8%). The average age of onset of the disease (p = 0.3) and the highest untreated IOP (p = 0.4) among those carrying mutations was not significantly different from those who did not have these mutations. The proportion of probands with angle dysgenesis among those with p.E229K and p.R368H mutations was 70% (11 out of 16) in comparison to 65% (67 out of 104) of those who did not harbour these mutations (p = 0.56). Similarly, the probands with moderate to high myopia among those with p.E229K and p.R368H mutations was 20% (3 out of 16) in comparison to 18% (18 out of 104) of those who did not harbour these mutations (p = 0.59). The frequency of p.E229K and p.R368H mutations of the CYP1B1 gene is low even among sporadic JOAG patients. Moreover, there is no clinical correlation between the presence of these mutations and disease severity.

The current prokaryotic taxonomy classifies phenotypically and genotypically diverse microorganisms using a polyphasic approach. With advances in the next-generation sequencing technologies and computational tools for analysis of genomes, the traditional polyphasic method is complemented with genomic data to delineate and classify bacterial genera and species as an alternative to cumbersome and error-prone laboratory tests. This review discusses the applications of sequence-based tools and techniques for bacterial classification and provides a scheme for more robust and reproducible bacterial classification based on genomic data. The present review highlights promising tools and techniques such as ortho-Average Nucleotide Identity, Genome to Genome Distance Calculator and Multi Locus Sequence Analysis, which can be validly employed for characterizing novel microorganisms and assessing phylogenetic relationships. In addition, the review discusses the possibility of employing metagenomic data to assess the phylogenetic associations of uncultured microorganisms. Through this article, we present a review of genomic approaches that can be included in the scheme of taxonomy of bacteria and archaea based on computational and in silico advances to boost the credibility of taxonomic classification in this genomic era.

Anthropologically, the majority of Indian population structure could be discerned in terms of different endogamous population groups (who marry between the clans), but unfortunately we still remain unaware about the epidemiological burden of type 2 diabetes (T2D) among different endogamous groups in India. We assessed the effect of family history on the risk of T2D among the Aggarwal (endogamous caste group) population of Delhi, a hospital-based case-control association study among the target population group of Delhi. Sixty percent of the cases reported familial history of type 2 diabetes. We found that the family history of T2D among Aggarwals significantly increases the odds of disease to 2.3 (confidence interval; 1.5041 to 3.5077). Cultural hallmarks, e.g., sedentary lifestyle, high socioeconomic status, and fat-enriched vegetarian dietary habits (86 %; pure-vegetarian) were noted in the present population. These factors correlated with age, waist to hip ratio, and blood pressure, which were important indicators for T2D in our study. The family history is a pertinent risk factor of T2D in this population group and can robustly predict the risk of T2D in their family and kinship. We suggest that the familial history of diabetes can be used as a potential public health tool for conducting population and culture-based epidemiological surveys that are required for better understanding of susceptibility to type 2 diabetes.

The cultural dimension of in-group collectivism is connected with the concept of social capital, which has been shown in prior research to be a key factor in resource access and longevity of firms. In this paper, we formulate a set of propositions on how the cultural dimension of in-group collectivism moderates the relationship between the characteristics of family businesses and longevity. We look at six characteristics of family businesses: boundary regulation, business reputation, bridging relationships, organizational professionalism, regulated family power, and competitive succession. We discuss some boundary conditions on the proposed set of relationships.

The commonest surgical treatment used for peptic ulcer perforation is omental patching. If, however, the perforation leaks, it rarely heals by itself due to persistence of duodenal fistula (DF). We present our experience with a T-tube placed into the DF for better outcome of the patients. All patients in our hospital with DF following failure of surgery for duodenal perforation were included in this study. After identification of the perforation, a size 16 French T-tube was put in place. The patients were analyzed on basis of duration of hospital stay, complications related to the T-tube and overall complications, start of oral feeds, and follow-up. In this 3-year study, ten patients with DF were admitted. The mean age was 50 years. The T-tube was kept in place within the fistula for 20.5 days. The mean duration to start oral feeds was 8.8 days. The mean duration of hospital stay was 23.2 days, and the mean follow-up period was 6.3 months. The complications observed in the postoperative period were fever in four patients, wound dehiscence in four patients, and peritoneal collection in two patients, all of which were managed easily. There was no peritubal leakage and no failure of surgery as regards placement of a T-tube. There were no deaths in this study. Placement of a T-tube into a DF appears to be very effective procedure for managing this complication of surgical repair of a perforated peptic ulcer with an omental patch. The technique appears to be simple and rewarding. Further use of this method by other workers will substantiate our efforts.

This paper examines cultural and leadership variables associated with corporate social responsibility values that managers apply to their decision-making. In this longitudinal study, we analyze data from 561 firms located in 15 countries on five continents to illustrate how the cultural dimensions of institutional collectivism and power distance predict social responsibility values on the part of top management team members. CEO visionary leadership and integrity were also uniquely predictive of such values. Journal of International Business Studies (2006) 37, 823–837. doi:10.1057/palgrave.jibs.8400230

Rice, one of the world's most important food plants, has important syntenic relationships with the other cereal species and is a model plant for the grasses. Here we present a map-based, finished quality sequence that covers 95% of the 389 Mb genome, including virtually all of the euchromatin and two complete centromeres. A total of 37,544 non-transposable-element-related protein-coding genes were identified, of which 71% had a putative homologue in Arabidopsis. In a reciprocal analysis, 90% of the Arabidopsis proteins had a putative homologue in the predicted rice proteome. Twenty-nine per cent of the 37,544 predicted genes appear in clustered gene families. The number and classes of transposable elements found in the rice genome are consistent with the expansion of syntenic regions in the maize and sorghum genomes. We find evidence for widespread and recurrent gene transfer from the organelles to the nuclear chromosomes. The map-based sequence has proven useful for the identification of genes underlying agronomic traits. The additional single-nucleotide polymorphisms and simple sequence repeats identified in our study should accelerate improvements in rice production.

In this article, we investigated some of the pre-conditions of crisis faced by technology-focused firms, as a group, in the emerging markets facing globalization and looked at the modalities for turnaround. We applied the “entrepreneurial leadership” model recently proposed by Gupta, Macmillan and Surie (2004) for defining the processes needed for adapting to the globalization-induced crisis. Our context for the globalization-induced crisis was the 1997 East Asian crisis, and we studied how the crisis galvanized a leading Chinese electronics firm—Huajing—to develop and execute a turnaround strategy for recovering from a near bankruptcy state. We discussed how organizational and other factors conjoined to create crisis at Huajing in the midst of globalization and trace the process through which entrepreneurial leadership was implemented. We distil various insights into a prototypical, unified model that underscores the significance of entrepreneurial leadership in developing and applying the different strategic flexibility platforms embedded in the resources and capabilities of the firms and in generating a relationship-anchored market position. The findings suggest that in situations where the crisis occurs at the level of organizational field, firms need turnaround strategies that help strengthen not only their organizational field but also their own value generation capabilities.

BACKGROUND: Genome wide association studies (GWAS), mostly in Europeans have identified several common variants as associated with key lipid traits. Replication of these genetic effects in South Asian populations is important since it would suggest wider relevance for these findings. Given the rising prevalence of metabolic disorders and heart disease in the Indian sub-continent, these studies could be of future clinical relevance. METHODS: We studied seven common variants associated with a variety of lipid traits in previous GWASs. The study sample comprised of 3178 sib-pairs recruited as participants for the Indian Migration Study (IMS). Associations with various lipid parameters and quantitative traits were analyzed using the Fulker genetic association model. RESULTS: We replicated five of the 7 main effect associations with p-values ranging from 0.03 to 1.97x10(-7). We identified particularly strong association signals at rs662799 in APOA5 (beta=0.18 s.d, p=1.97 x 10(-7)), rs10503669 in LPL (beta =-0.18 s.d, p=1.0 x 10(-4)) and rs780094 in GCKR (beta=0.11 s.d, p=0.001) loci in relation to triglycerides. In addition, the GCKR variant was also associated with total cholesterol (beta=0.11 s.d, p=3.9x10(-4)). We also replicated the association of rs562338 in APOB (p=0.03) and rs4775041 in LIPC (p=0.007) with LDL-cholesterol and HDL-cholesterol respectively. CONCLUSIONS: We report associations of five loci with various lipid traits with the effect size consistent with the same reported in Europeans. These results indicate an overlap of genetic effects pertaining to lipid traits across the European and Indian populations.

Dear Sir,We thank the authors for their interest in our article [1].As described by them about a wide variety of operationsfor this morbid condition, it only displays that not a singletechnique has been found as a panacea. Our study has beenan attempt towards a simple operation for this condition.We feel that there is a bit of misinterpretation regardingplacing the T-tube. It has never been used as a first optionfor a duodenal perforation. Our primary operation is alwaysan omentopexy. It is associated with placement of twodrains as described in the article. T-tube is only placed ifthe repair leaks. As detailed in the article [1], T-tube acts asa vent and stent in this condition.Although the authors dared to place the T-tube in adelayed case, we stress that placing a T-tube needs certainprerequisites: perform the operation for placing the T-tubeas soon as the diagnosis is made, peritoneal lavage, carefulclosure of the fistula around the T-tube as described, andtotal parenteral nutrition supplementation. Placing moretubes adds to the operation time, which may affect theoutcome of the patient.It is without doubts that a proper initial surgery mayprevent this dreadful complication [2]; however, given thetotal number of such surgeries in this part of the world, thiscomplication will continue to occur. Hence, the surgeonmust be ready to face it. We wish that the authors succeedwith this simple technique. Other workers also shouldutilize it, if they are satisfied with our arguments. After all,it is about those patients, who if not successfully managed,may lead to a slow, painful death.References