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Millions of people die each year from viral infections across the globe. There is an urgent need to overcome the existing gap and pitfalls of the current antiviral therapy which include increased dose and dosing frequency, bioavailability challenges, non-specificity, incidences of resistance and so on. These stumbling blocks could be effectively managed by the advent of nanomedicine. Current review emphasizes over an enhanced understanding of how different lipid, polymer and elemental based nanoformulations could be potentially and precisely used to bridle the said drawbacks in antiviral therapy. The dawn of nanotechnology meeting vaccine delivery, role of RNAi therapeutics in antiviral treatment regimen, various regulatory concerns towards clinical translation of nanomedicine along with current trends and implications including unexplored research avenues for advancing the current drug delivery have been discussed in detail.

A biocomposite of poly(acrylamide-co-acrylic acid) hydrogel with β-cyclodextrin as a biomaterial was prepared through one-pot synthesis in water as a green solvent. The formation of biocomposite was confirmed by advanced techniques such as FTIR spectroscopy, XRD, DSC, TGA, and FE-SEM. In this report, straight forward and efficient synthetic protocol for biocomposite formation responded without any environmental hazard. Swelling capacity of P(AM-co-AA) and biocomposite was studied by addition of different saline solutions including monovalent, divalent, and trivalent salts. By addition of β-cyclodextrin, the swelling and saline water-absorbing properties of the biocomposite hydrogel were significantly improved. In this regard, the possible formation mechanism of the composite hydrogel is also discussed. It is deduced that the biocomposite formation can be the result of intermolecular interactions between polymer and β-cyclodextrin. The water-soluble polymer seems to have entered into the inner cavity of β-cyclodextrin to form supramolecular biocomposite structure. The results indicate that the order of water uptake decreases with increase in valency of the salts. It is believed that this is an effective method to prepare supramolecular biocomposite hydrogel materials. Its applications can be extended in marine water industries as a basis for antifouling coating, waste water treatment, and even in medical field. Hence, the synthesized materials can be biodegradable, environment-friendly, and biocompatible inspired by the green chemistry concept.

Introduction The aetiology of coccydynia can be multifactorial, with several associated factors such as obesity, female gender and low mood. The long-term results of operative interventions, such as manipulation under anaesthesia and coccygectomy are variable, ranging from 63–90%. Materials and methods Our aim was to identify whether age, trauma and body mass index (BMI) were independent prognostic factors in coccydynia treatment. All patients who presented to the Royal Derby Hospital with a primary diagnosis of coccydynia between January 2011 and January 2015 who had injections, manipulation under anaesthesia or coccygectomy were included. We used patient-reported satisfaction score as the primary outcome measure. We hypothesised that patients with preceding history of trauma and with high BMI (> 25) would be less satisfied. We divided patient BMI into four groups, following World Health Organization guidelines: group A (18.5–24.9), group B (25–29.9), group C (30–39.9) and group D (> 40). Results A total of 748 patients were diagnosed with coccydynia. Of these, 201 patients had 381 injections, 40 had 98 manipulations under anaesthesia and 9 had coccygectomy. Mean age was 46.4 years; 26% of patients had trauma to the coccyx. The mean time to follow-up was 7.3 months. We found a statistically significant difference (P = 0.03) between satisfaction scores in groups B and D. Patients who had trauma improved significantly (P = 0.04). The odds ratio calculation of coccygectomy and BMI revealed a higher risk of coccygectomy in Group A. Discussion This is the first study to establish BMI and trauma as independent prognostic factors for coccydynia treatment. Our hypothesis that patients with higher BMI would have lower satisfaction levels has been proven true.

Multinodular goiter (MNG), one of the disorders of the thyroid gland, is often detected as a mass in the neck, but sometimes produces pressure symptoms. We present successful anesthetic management of a case of an obese woman having MNG with retrosternal extension, in the setting of severe OSA, planned for total thyroidectomy. The complicated presentation of the disorder, with challenging airway management during the peri-operative period and a positive outcome is a reason for sharing this experience.

Primary hyperparathyroidism presenting first time with severe hypercalcemia is rare in pregnancy. We report a case of primary hyperparathyroidism due to a cystic parathyroid adenoma presenting as severe hypercalcemia with acute pancreatitis in second trimester of pregnancy. Acute pancreatitis was managed by conservative treatment. Hypercalcemia failed to respond to medical management and ultimately responded to ultrasound-guided ethanol ablation of parathyroid adenoma. The delivery was uneventful and patient continues to remain normocalcemic during follow up. As such, ethanol ablation of parathyroid adenoma may be considered during pregnancy in case of failure of response to medical management and when surgical removal of parathyroid adenoma is not safe.

Setting Most epidemiological studies on Mycobacterium tuberculosis focus on pulmonary tuberculosis (TB), whereas extra-pulmonary TB (EPTB) remains poorly explored. Objective To study the rate of resistant EPTB cases among individuals with suspected EPTB using a commercial line-probe assay (LPA), polymerase chain reaction (PCR) and reverse hybridisation test. We also examined the molecular profile of the EPTB isolates obtained at the Himalayan Institute of Medical Sciences, Dehradun, India. Design EPTB samples were collected from 249 patients with clinical and radiological suspicion of EPTB and subjected to automated liquid culture, PCR and GenoType MDRTBplus according to the manufacturers' instructions. Results A diagnostic yield of 15% was observed among individuals with suspected EPTB using MGIT™ (Mycobacterium Growth Indicator Tubes), which increased to 38% on LPA and PCR. LPA results had 100% concordance with MGIT, with all culture-positive samples also being positive on LPA. However, 70.2% of LPA-positive samples did not grow Mycobacterium tuberculosis in liquid culture. Two (2.1%) of the culture-negative EPTB PCR-positive samples were multidrug-resistant, 20 (21.2%) were rifampicin-monoresistant and 12 (12.7%) isoniazid-monoresistant on LPA. Conclusion Given the paucibacillary nature of EPTB, we demonstrated that PCR and LPA can have a vital role in establishing TB diagnosis in extra-pulmonary tissues.

BACKGROUND Right ventricular (RV) function has prognostic value in terms of survival and symptoms in patients with mitral stenosis (MS). The aim of the study was to assess RV function by strain analysis in the patients of mitral stenosis and the effect of percutaneous transvenous mitral commisurotomy (PTMC) on it. METHODS Eighty patients of severe mitral stenosis without overt right heart failure and normal sinus rhythm undergoing PTMC were included. Conventional echocardiography and RV function by TDI-derived longitudinal strain and strain rate were assessed prior and 24 hours post PTMC and compared with 40 healthy age-matched controls. RESULTS Eighty subjects (mean age 31 + 10 years, 70% females) were included. Patients with MS had significantly lower RV strain of basal and mid-free wall, tricuspid annular plane systolic excursion (TAPSE), and RV fractional area change (FAC) as compared to controls. There was a significant increase in pre- and post-PTMC in TAPSE (19.5 ± 2.7 mm vs 21.4 ± 3.3 mm; P

Herein, we are reporting the green and efficient synthesis of some pharmacologically important azomethine derivatives of isoniazide (INH) using Modified Fly Ash (MFA) as an excellent zeotic solid acid catalyst. The catalyst, by virtue of its terminal hydroxyl groups, forms hydrogen bonds with carbonyl compounds, which activates these reactants for condensation. The MFA was assessed for various aspects like crystallinity, porosity, elemental composition, linkages and also for its stability, which were confirmed with the help of some physical spectral analyses like XRD, BET, EDS, FTIR and TGA. An effective MFA synthesis was achieved by the calcination of an aqueous mixture of fly ash with ferric chloride, successfully incorporating the iron to generate a slightly acidic crystalline zeotic material, which served as an energy efficient catalyst by allowing access to the reaction at room temperature.

ADENOCARCINOMA OF DUODENUM AT THE DUODENOJEJUNAL FLEXURE (Abstract): Adenocarcinoma of the duodenum is an exceedingly rare condition representing not more than 0.3% to 0.4% of all gastrointestinal tract cancers. Clinical presentation is usually due to partial or complete obstruction of the duodenum. Computed tomography scan has a high accuracy in detecting metastatic spread to stage the disease. CASE REPORT: A 60 year woman presented with chief complaints of persistent bilious projectile vomiting containing undigested food material and pain in the upper abdomen since 6 months. Upper gastrointestinal endoscopy up to 2 nd part of duodenum revealed no abnormality. Contrast enhanced computed tomography (CECT) scan of abdomen showed a dilated stomach and duodenal dilatation up to 4 th part along with a concentric growth seen in the fourth part of duodenum at the duodenojejunal flexure, and multiple retroperitoneal lymph-adenopathy. Exploratory laparotomy revealed a tumor of the duodenojejunal flexure with dilatation of all the parts of duodenum and stomach. The tumor was seen encasing the superior mesenteric vessels and aorta. A palliative gastro-jejunostomy was performed. Patient had an attack of acute myocardial infarction on post-operative day 6th and expired. Histopathology of the specimen confirmed adenocarcinoma of duodenum. CONCLUSIONS: Adenocarcinoma of duodenojejunal flexure is extremely rare and sometimes difficult to diagnose. Computed tomography scan has a high accuracy in detecting the disease and its metastatic spread to stage the disease. For unresectable tumors, palliative gastro-jejunostomy is the treatment of choice.

Context: An analytical pilot study was conducted prospectively to ascertain the efficacy of a new method of throat packing “Flange Slide Pack Technique” (FSPT) in patients undergoing nasal, faciomaxillary, and oral surgeries. Aim: To compare the conventional technique of throat packing guided by direct laryngoscopy with FSPT where the Macintosh laryngoscope blade is used as aid for throat packing. Settings and Design: A comparative observational pilot study was conducted at a tertiary care hospital. Subjects and Methods: Subjects were randomly allocated into two groups based on the technique for throat packing by computer-generated random numbers as Group A (conventional technique) and Group B (FSPT). Primary outcomes measured were total time duration taken for packing the throat with a standardized length of ribbon gauze and changes in heart rate and change in Mean Arterial Pressure (MAP) from baseline. Secondary outcomes measured were incidence of postoperative sore throat (POST) at 6 h postoperatively and ease of insertion of the throat packs. Statistical Analysis: Parametric data were analyzed using “unpaired t-test.” Comparison of proportions and data were analyzed using Chi-square test. SPSS Version 17 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Results: The time taken to pack the throat was shorter in Group B; percentage increase of MAP from baseline was higher in Group A. Ease of insertion of throat pack was more in Group B. POST results were insignificant. Conclusions: FSPT can prove to be an alternative technique to the conventional method of packing the throat by minimizing duration of laryngoscopy and thereby limiting the stress response.

Objective To assess the risk of cardiovascular disease (CVD) in the parents of polycystic ovary syndrome (PCOS) patients using carotid intima medial thickness (CIMT) and brachial artery flow-mediated dilatation (FMD). Design Hospital-based case-control study. Setting Endocrine clinic of a medical institute in India. Patient(s) Case group of 41 fathers and 45 mothers of PCOS patients (confirmed by Rotterdam's criteria) compared with 42 men and 44 women matched by age, sex and body mass index (BMI) as controls. Intervention(s) CVD risk in parents of PCOS patients assessed via CIMT and FMD then correlated with various clinical and metabolic parameters. Main Outcome Measure(s) Differences in CIMT and FMD between parents and controls. Result(s) The CIMT was higher [0.6 (0.54–0.8) vs. 0.5 (0.45–0.55) mm] and brachial artery FMD was lower [11.9% (6.9%–16.2%) vs. 16.7% (13.5%–22.6%)] in the parents of PCOS patients as compared with the controls. Systolic blood pressure, diastolic blood pressure, low-density lipoprotein cholesterol, and fasting and 2-hour plasma glucose were higher in the parents of the PCOS patients. The prevalence of CVD risk factors such as systemic hypertension, diabetes mellitus, abdominal obesity, the metabolic syndrome, and a family history of coronary artery disease in first-degree relatives was also higher in the parents of PCOS patients. The prevalence of diabetes was higher in the fathers of PCOS women, but other cardiovascular disease risk factors, CIMT, and FMD were comparable among the mothers. Conclusion(s) The parents of PCOS patients have an increased CVD risk as evidenced by increased CIMT and low FMD.

Purpose: To assess the iodine status of 10‐12-year-old children, studying the role of environmental factors and the effect of iodine supplementation on those who were deecient. Design: Population survey of 10 randomly selected schools, with a placebo-controlled intervention study of the administration of iodine supplements to those found to be deecient. Methods: A total of 770 children were screened for urinary iodine estimation and estimation of the iodine in salt. A general proele and various micro-environmental factors, such as socio-economic status, sanitary status, personal hygiene, and goitrogen intake, were also studied. Selected deecient children were supplemented with an iodine solution. Results: The results of urinary iodine excretion revealed that 44.7% of the children suffered from iodine deeciency. Iodized salt was consumed by 92% of the families. The total goitre rate was 35.2% in the studied population. Signiecant differences were found in the socio-economic status, housing and sanitary conditions of the families of deecient and non-deecient children. The dietary intake pattern revealed that the diet of the children was low in calories, iodine and b -carotene. The supplementation of 112 mg of iodine to the experimental group over 10 weeks signiecantly decreased the deeciency. The analysis of the results showed that for iodine-deecient children the concentration of iodine in salt should be 60 ppm. Conclusion: The micro-environment plays an important role in iodine deeciency disorders. The deecient children in the area required a therapeutic dose of iodine to improve their low iodine status. The study urges the need for intervention to control iodine deeciency disorders.

Purpose: The term iodine deeciency disorders (IDD) reeects the spectrum of health effects owing to iodine deeciency in all age groups. Although environmental iodine deeciency leading to dietary iodine inadequacy is one major factor responsible for IDD, goitre is endemic in Terai, North India, despite iodized salt consumption by the majority of the population. The study was designed to discover the adequacy of iodine in the cooked daily diet of adults, and relate it to the prevalence of IDD in the region as the information on the iodine content of cooked mixed diets is limited. Materials and Methods: Eighty low-income group adults (40 males and 40 females) of Pantnagar, situated in Terai, North India, were randomly selected for the study. Morning urine samples, salt and the diet samples for iodine estimation were collected from selected subjects. The entire population was divided into normal and those having IDD based on their urinary iodine excretion (UIE). Percentage loss of iodine in cooking was calculated by comparing the iodine content of cooked and uncooked food. Results: An overall IDD prevalence of 44% was found, comprising 35% of males and 53% of females. In the studied population, 76% of the subjects consumed salt with 15 mg/kg or more of iodine. The average iodine content in the uncooked and cooked diet samples was 358 and 104 l g respectively indicating a loss of about 70% iodine while cooking. The cooked diets of only 32.5% of the subjects contained adequate iodine for normal functioning of the body. Conclusion: Subnormal iodine content in the cooked daily diet of adults is the main cause of IDD, despite iodized salt consumption in the region because iodine loss while cooking is appreciable. The results of the present study, therefore, stress the need to minimize loss of iodine in cooking by adding salt on cooked food rather than adding salt while cooking.

2C nuclear DNA contents were determined for 52 clones of four commercially important Mentha species viz., M. piperita, M. viridis, M. spicata and M. cardiaca. A three fold variation in 2C DNA content was detected which ranged from 2.83 pg in M. viridis to 8.73 pg in M. cardiaca. However, 2C DNA content per genome in the Mentha species was 4.64 fold. The observed significant decrease in proportionate amount of DNA values at higher ploidy may be attributed to its adaptive advantage. 2C nuclear DNA content did not show any relationship either with total chromosome length of the complement or nuclear volume.

Interspecific F1 hybrid (2x) between V. radiata var. T44 and V. mungo var. T9 showed intermediate morphological characters of both the parents and low pollen fertility (4.4%). Inspite of profused flowering there was no pod formation. However, on the contrary, the amphiploid (4x) obtained with the colchicine treatment of the F1 hybrid seedling exhibited gigantism in most of the characters and restoration of pollen fertility (81.3%) and seed fertility. The amphiploid showed negative heterosis for various agronomic traits in CI and C2 generation. Tremendous increase in the number of pods/plant resulting in 52.02% heterosis in yield over its superior parent was observed in C3 genertion. While C4 generation of amphiploid besides higher yield was also better for its nutritional value.

Identification of women at risk for osteoporosis is of great importance for the prevention of osteoporotic fractures. Routine BMD measurement of all women is not feasible for most populations, hence identification of a high-risk subset of women is an important element of effective preventive strategies. Methods: We identified 959 postmenopausal non-Hispanic women aged 51 years and above from the NHANES III study to assess the relative contribution of risk predictors for low BMD at the whole proximal femur and the femoral neck regions. Based on recognized risk factors for osteoporosis identified by a systematic literature search, we ran several multiple linear regression models based on the results of preceding bivariate analyses. We show several models based on their explanatory ability assessed by adjusted r 2, ROC, and C-value analyses rather than on the coefficients and P values. We furthermore examined the sensitivity, specificity, and predictive values of our preferred models for various cutoff T-scores—the choice of which will vary depending on different study goals and population characteristics. Results: Age and weight were by far the most informative predictors for low bone mineral density out of a list of 20 candidate risk predictors. Our preferred prediction models for the two regions hence contained only two variables: i.e., age and measured weight. The resulting parsimonious model to predict BMD at whole proximal femur had an adjusted r 2 of 0.43, an area under the ROC curve of 0.85, and a C-value of 0.70. Similarly, prediction for BMD at the femoral neck had adjusted r 2, area under the curve, and C-value of 0.39, 0.83, and 0.66, respectively. Conclusions: The model equations, predicted T-score = −1.332−0.0404 × (age) + 0.0386 × (measured weight) and predicted T-score = −1.318−0.0360 × (age) + 0.0314 × (measured weight) for whole proximal femur and femoral neck, respectively, can be used in field conditions for screening purposes. More complex prediction equations add little explanatory power. Based on the study goals and the population characteristics, specific cutoff T-scores have to be decided before using these equations.

Poly lactide-co-glycolide (PLGA) and polylactide (PLA) particles entrapping immunoreactive tetanus toxoid (TT) were prepared using the solvent evaporation method. The effect of different formulation parameters such as polymer hydrophobicity, particle size and use of additional adjuvants on the generation of immune responses in experimental animals was evaluated. Immune responses from hydrophobic polymer particles were better than those from hydrophilic polymer. Immunization with physical mixtures of different size particles resulted in further improvement in anti-TT antibody titers in Wistar rats. Physical mixture of nano and microparticles resulted in early as well as high antibody titers in experimental animals. Immunization with polymer particles encapsulating stabilized TT elicited anti-TT antibody titers, which persisted for more than 5 months and were higher than those obtained with saline TT. However, antibody responses generated by single point immunization of either particles or physical mixture of particles were lower than the conventional two doses of alum-adsorbed TT. Immunization with nanoparticles along with alum resulted in very high and early immune response: high anti-TT antibody titers were detected as early as 15 days post-immunization. Use of a squalene emulsion along with the particles during immunization enhanced the level of anti-TT antibody titers considerably. Single point immunization with admixtures of PLA microparticles and alum resulted in antibody response very close to that achieved by two injections of alum-adsorbed TT; the antibody titers were more than 50 microg/ml over a period of 6 months. These results indicated that the judicious choice of polymer and particles size, protecting the immunoreactivity of the entrapped antigen and the appropriate design of immunization protocol along with suitable adjuvant can lead to the generation of long lasting immune response from single dose vaccine formulation using polymer particles.

Background Abatacept is a biologic therapy which suppresses T-cell activation via co-stimulation blockade in rheumatoid arthritis (RA) patients. It became part of our biologic algorithm shortly after initial limited NICE approval in August 2010. In April 2013, NICE widened its recommendation of abatacept in RA patients who have failed to respond adequately to 2 disease-modifying anti-rheumatic drugs (DMARDs) including methotrexate [2]. Objectives In this study we share our experience of abatacept in patients with rheumatoid arthritis (RA) in routine clinical practice from a subregional centre in UK covering a population of 500,000. Methods This was a retrospective analysis of 84 patients who received abatacept therapy from November 2010 to January 2014. Data collected included baseline demographics, number of previous synthetic and biologic DMARDs, change in DAS28 at 3 and 6 months. Response was defined as DAS28 reduction of greater than 1.2. Results 84 patients with RA were commenced on abatacept therapy over 39 months since Nov 2010. The mean age of the patients was 62 years and 74% of them were female. The average number of prior synthetic DMARDs was 2.8 and biologic DMARDs 2.1. Only 2 patients were biologic- naive before abatacept. 75 patients had received anti-TNF therapy (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), 40 had received rituximab and 7 tocilizumab. The baseline DAS28 was 5.8 and mean DAS reduction at 3 and 6 months was 1.6 (n=41) and 2.0 (n=37) respectively. 25 out of 41 (61%) patients responded at 3 months and this increased to 76% at 6 months (28/37). 14% (5/37) achieved remission at 6 months. 11 patients stopped abatacept therapy, 5 were intolerant of which 3 had infusion reactions, 1 patient had lack of efficacy and 2 loss of efficacy (between 3 and 6 months), 1 patient refused further infusions and 2 patients moved out of area. In a subgroup, the mean DAS reduction at 6 months in seropositive (Rheumatoid Factor or Anti-CCP antibody positive n=14) and seronegative patients (n=16) were 2.54 and 1.88 respectively. Conclusions Our experience shows that abatacept is safe, well tolerated and effective in RA patients with inadequate response to previous synthetic and biologic DMARDs in routine clinical practice. The improvement in DAS28 at 3 months was sustained at 6 months. The numbers are small to draw any conclusion about better response in seropositive RA patients. References NICE recommends wider use of abatacept for treating rheumatoid arthritis (Guidance TA195) August 2010 NICE technology appraisal guidance: Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (Guidance TA280 rapid review of TA234) April 2013 Acknowledgements We would like to thank all members of the Rheumatology team at Cannock Hospital and the patients who participated. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3037

Uncommon fruits and vegetables, namely leaves of Bauhenia purpurea Linn., Chenopodium album Linn., Fagopyrum esculentum Moench., and Gleichenia linearis and green and ripe fruits of Ficus roxburghi were analysed for their proximate composition, minerals and vitamin content, in vitro bioavailability of mineral, in vitro protein digestibility and two anti-nutrients, i.e. oxalic and phytic acid. Results showed crude protein, crude fat, minerals, crude fibre, carbohydrate, energy, calcium, iron, and iodine content was in the range of 1.74 to 4.93%, 0.23 to 1.38%, 0.46 to 3.02%, 0.88 to 5.02%, 1.46 to 14.46%, 15 to 76 Kcal, 19 to 355 mg, 1.22 to 6.2 mg and 0.5 to 5.16 mg, respectively, beta-carotene, thiamin, riboflavin, niacin and ascorbic acid content ranged between 169 to 3020 micrograms, 0.03 to 0.1 mg, 0.02 to 0.24 mg, 0.07 to 0.87 mg and 3.26 to 173.13 mg per 100 g, respectively. In vitro bioavailability of iron and calcium ranged between 4.62 to 9.23% and 7.30 to 63.48%. In vitro protein digestibility ranged between 9.78 to 14.48%. Findings of the study indicate that all the samples studied are good sources of micronutrients. To provide food security there is need to explore every possible source of nutrients.

Background Necrotizing fasciitis is a rare rapidly progressive infection along the fascial planes causing fascial necrosis and thrombosis of the subcutaneous blood vessels, leading to cutaneous gangrene. It is associated with extremely high mortality ranging from 30% with treatment to, 100% without surgical debridement 1 . We present a case of a patient with Rheumatoid arthritis who presented with necrotising fasciitis secondary to herpes zoster infection affecting her left arm, 18 days after her first cycle of Rituximab treatment. Rituximab is an anti CD20 antibody which results in programmed apoptosis of B Lymphocytes and complement mediated cytotoxicity with a half-life between 1.6 to 20 days and can be detected up to 6 months after the infusion 3 . Results 62 years old female with long standing sero-positive rheumatoid arthritis having failed multiple disease modifying treatments (DMARDs) and had developed interstitial pneumonitis on methotrexate and leflunomide combination for which she had been commenced on oral prednisolone. She was on a stable dose of 15 mgs daily for 6 months when she commenced Rituximab therapy and she presented with extremely swollen painful left arm 18 days after the second pulse of her 1st cycle of Rituximab. The symptoms developed over 12 hours with no history of preceding trauma, she had one episode of rigors at home before presentation. Her left arm had evidence of early vesicles and swelling but no obvious rash, she was in a lot of pain. An initial working diagnosis of atypical herpes zoster infection with cellulitis secondary to immunosuppressive therapy was made. Initial treatment involved intravenous acyclovir with IV Tazobactam. On admission, features of sepsis were present with a temperature of 38.1°C, pulse 125 beats per minute, BP 108/70 mmHg and oxygen saturation of 96%. Within a few hours a red blotchy erythematous rash developed in surrounding skin and excruciating pain in her arm with evidence of septic shock with radiographs of her left arm and forearm failing to show any evidence of gas in soft tissue. She was transferred immediately to ITU in view of her clinical deterioration with working diagnosis of necrotising fasciitis secondary to herpes infection. A surgical review was initiated and eventually she had fasciotomy to her left arm. Intraoperative specimens and tissue swabs isolated Group A streptococcus. Unfortunately her condition worsened needing ventilation, heavy inotropic support, she developed acute kidney injury with subsequent pulseless electrical activity cardiac arrest. Conclusions Necrotising fasciitis is rare, rapidly progressive and life threatening emergency with patients on immunosuppressive therapy being at great risk. A high index of clinical suspicion and initiation of definitive management, appropriate antimicrobial therapy and surgical debridement, at the earliest opportunity may help prevent loss of life or extensive surgical debridement. The diagnosis is made on clinical grounds with radiographic findings noted to be inconsistent, the classic appearance of gas in soft tissue is only seen in only a minority of patients 4 . References Harrison’s textbook of Medicine (2008) Volume 2. Nice Guidelines Rheumatoid Arthritis-drug treatment after failure of a TNF inhibitor (TA195). D.T. Selewskia, G.V. Shahc, et al. Rituximab (Rituxan). AJNR2010 31:1178-1180. Rehman J. Kaynan A. et al Journal of Urology. 162(6):2101, 1999 Dec. Disclosure of Interest None Declared

IntroductionDysfunctional impulsivity reflects ‘recklessness without deliberation and evaluation of consequences’ and has negative consequences whereas functional impulsivity reflects ‘rapid responding to situational demands in order to maximise one's circumstances’ and often has positive consequences (1).ObjectiveTo examine the functional brain basis of dysfunctional impulsivity in healthy people and in people with schizophrenia.MethodsThirteen healthy controls and 21 schizophrenia patients (10/21 with serious repetitive violence) underwent fMRI during a Go/ NoGo task. Dysfunctional impulsivity was indexed using the Impulsiveness subscale and functional impulsivity using the Venturesomeness subscale of the Impulsiveness-Venturesomeness-Empathy questionnaire (2).ResultsViolent patients had elevated Impulsiveness scores relative to non-violent patients and controls. Impulsiveness did not correlate significantly with task performance in healthy controls or patients. Impulsiveness, but not Venturesomeness, scores correlated during the NoGO condition with lower activity in the anterior cingulate (AC) in controls, and lower inferior temporal and hippocampal activity in patients.ConclusionsThese findings accord with previously reported associations between reduced hippocampal volume and dysfunctional impulsivity in schizophrenia (3) and, combined with our earlier observations of reduced AC activation during a working memory task in violent antisocial individuals (4), suggest that the influence of dysfunctional impulsivity in antisocial and criminal behaviour is mediated via deficient (inhibitory) functions of the AC and hippocampus.

Tetraploids of six different varieties of Trigonella foenum-graecum were raised through treatment of seedlings by colchicine solution. Comparative studies were carried out for exploiting their useful traits. Cytology and chiasma frequency was studied in detail, Genotypic response of different varieties at tetraploid level with regard to multivalent frequency, chiasma frequency and pollen sterility shows significant differences. A natural occurring tetraploid and a hexaploid have been investigated. Problem of high seed sterility prevaling in autotetraploids of Trigonella foenum-graecum has been discussed. Appearance of heteromorphic bivalents along with fragments in mixoploid plant is a new report and its possible origin has been traced. Polyploids of Trigonella foenum-graecum are characterised by pollen shape variability while diploids have uniformly one type of grains.

SUMMARYCuttings of 2x and 4x Ruellia species, their 2x, 3x and 4x hybrids were irradiated at 2, 4 and 6 Krad of gamma rays (CO60). Radiosensitivity of the above genotypes in relation to ploidy and hybridity was studied using the parameters like sprouting of cuttings, survival, growth reduction, final height, number of branches and pollen fertility. Differences in sensitivity of different species of the same ploidy level were noticed. Tetraploids in general, were radioresistant. Hybridity increases the resistance of diploid hybrid above that of its parents. Polyploid hybrids were intermediate to their parents in radioresistance and the cancellation of the negative and positive effects of the alleles has been suggested as the probable reason for it. ICV (interphase chromosome volume) of all the species and hybrids was determined and the possible correlation of ICV with radiosensitivity is discussed.

SUMMARYComparative radioresistance of diploids and artificially raised tetraploids of Trigonella foenum-graecum has been investigated at 30 and 50 krad of gamma rays. Advantage of using autoploids for such studies have been discussed. Different parameters were taken into consideration. Germination in both cases show little effect of radiation. Despite higher ICV, at higher doses, 4 n were resistant in survival, growth reduction at maturity and pollen sterility. Seed setting in 4 n was severely affected. Differential response of 2 n and 4 n in chiasma frequency at different doses was noted. A possible correlation between higher frequency of abnormal cells, univalents, Lagging chromosomes, fragments in 4 n with higher ICV has been proposed.

Pentaphyllous mutants in black gram were isolated in M2 generation of a segregating family, irradiated at 20 kR. The genetic nature of mutants was tested by hybridizing with controls, and chi-square tests applied to the F2 population, proved it to be a monogenic recessive. The pentaphyllous mutant had a greater number of pods and leaves per plant and larger and more root nodules. It also showed improved nutritional value with increased seed protein percentage and no increase in TIA (trypsin inhibitor activity).

Comparative radiosensitivity of five varieties of Impatiens balsamina has been studied. Different parameters like germination/survival, growth, meiotic anomalies, pollen fertility and seed setting were taken into consideration. Response of varieties to germination survival and growth parameters was fairly uniform, but not so with regard to other parameters. A new approach for comparing radiosensi-tivity has been discussed. Stimulatory effect of radiation on chiasma frequency and seed setting in one of the variety has been reported. Insignificant difference in INV and ICV of five varieties have been reported. ICV appears not to reflect on the radiosensitivity. Genotypic constitution is responsible for the varietal difference in radiosensitivity. Study of trisomic in M2 has been presented.

Pollen mother cells (PMCs) in a strain of the dwarf variety of Trigonella foenum-graecum L. (Papilionaceae) have two B chromosomes which are indistinguishable from the standard chromosomes. The B chromosomes show regular bivalent formation and normal meiotic behavior; they have no significant effect on the mean chiasma frequency, but they increase plant-to-plant variation and variation between and within PMCs.

Breeding behaviour of any taxon is equally dependent on the cytogenetical nature and recombination pattern of both hereditary track. A complete analysis of cytogenetic behaviour must involve both sexes. From the study of male (PMC) meiosis of autotetraploid Trigonella, it has been concluded that it is quite regular and pollen fertility is also very high. To find out the meiotic behaviour on female side, MMC meiosis was studied in all the four genotypes of Trigonella. MMC meiosis was studied at metaphase I, anaphase I and telophase II. Chiasma frequency was equal during both types of meiosis. At anaphase I and telophase II, 100% normal behaviour was observed. Thus it has been found that megasporogenesis is as regular as microsporogenesis. Hence it has been concluded that there are some factors, other than meiotic anomalies, that are responsible for poor seed fertility in autotetraploid fenugreek.

Gamma irradiation is one of the most important physical mutagens which is used for cytogenetic effects. The cytogenetic changes occurring due to the storages of Trigonella foenum graecum seeds (2n and 4n) after gamma irradiation were investigated. This treatment accelerated the mitosis and decreased chromosomal aberrations in 2n as well as in 4n. Chromosomal changes produced comprised of fragments and stray in metaphase cell, laggards, fragments and bridges in anaphase. Appearance of higher frequency of aberrations per cell in tetraploid indicated that tetraploids were more sensitive to gamma irradiation rather than diploid. This study also reveals that storage of seeds after gamma irradiation may lead to genetic repairing.

The experiment was set up to resolve the controversy about uniform retention of B chromosomes at various ploidy levels. This paper presents the ploidy response of B chromosome in root meristem of Butea monosperma-a tree, growing around Lucknow. The root tips had euchromatic distinguishable 1B chromosome which showed different behaviour at different ploidy levels. On treatment with 0.2% aqueous colchicine different levels of ploidy were observed. Tetraploids and mixoploids showed 2B chromosomes instead of 1B chromosome as in diploid i.e. B chromosome divides along with A chromosome showing behaviour similar to A chromosome. But in few tetraploids, mixoploid cells and one octaploid cell undivided 1B chromosome like diploids was observed.

SUMMARYArtificially raised tetraploids in Tropaeolum majus enhanced its ornamental value. Octoploids, though had smaller flowers but umbrella shaped appearance of leaves make them quite charming. Ploidy barrier exists in the species. Tetra and octoploids were perfectly seed sterile despite good pollen fertility in tetraploids. Lack of dehiscence of anthers was noted in tetraploids but artificial pollination also failed to achieve seed setting. The pollen grain germinated normally on 4n stigma and also pollen tube travelled down through the stylar tissue. In rare cases fruit formation was initiated but after some growth they aborted and their study revealed total absence of developing embryos. Efforts to overcome ploidy barriers have been discussed.

Polyploidy has been induced in four varieties of Impatiens balsamina L. The most effective treatment for induction of polyploidy was found to be 0.2% aquous colchicine for 12 hours. The induced tetraploids were characterised by increase in height, size of flowers and late and longer blooming period. Despite good pollen fertility, polyploids have poor seed setting. Reasons for low frequency of multivalents in all the varieties have been discussed. Significant increase in chiasma frequency (C2) of 4n of three varieties have been reported. For most of the parameters distinct differences at varietal level in tetraploid were noted which appears to have genotypic base.

Effect of gamma-rays on 1) dry seeds 2) seeds presoaked for 3 hours in distilled water and 3) seeds pretreated with 0.2%colchicine for 1 hour were studied. Germination was adversely affected in presoaked seeds. Almost all the germinated seedling survived. In M2 fringed leaf mutant, strap leaf mutant, advanced stigma mutant, trisomic and male steriles were isolated. Results of genetical analysis revealed monogenic recessive nature of first two mutants. Possible pleiotropic or close likage nature of mutants has been discussed. The trisomic displayed reduced vigour and high pollen sterility, which is influenced by environmental factors. Temperature sensitivity of male steriles has also been discussed. The advanced stigma mutant changes the breeding system from inbreeder to outbreeder. Its utility in hybridization programme is obvious. As all these mutations were isolated in precolchicinized irradiated seeds the importance of colchicine treatment in combination with gammarays resulting in increased spectrum of mutations has been discussed.

For the meiotic study of Ipomea spp., flower buds were stripped of the calyx and corolla and soaked in saturated aqueous paradichlorobenzene at about 28° C for 3 hr, transferred to acetic-alcohol (1:3) for 6 hr, then into 1% saponin solution and left overnight. They were mordanted in 1:3 acetic-alcohol saturated with ferric oxide for 24 hr and stained in a mixture of 1% aceto-carmine and 2% aceto-orcein with 1 N HCl in the proportion of 9:9:1. The preparations were mounted in 1% aceto-carmine for temporary use and made permanent by dehydration through the n-butanol schedule. The pollen mother cells had clear cytoplasm with deeply stained chromosomes.

The paper presents the investigation of nondividing PMC's in the sporogenous tissue of Allium tuberosum and Allium cepa. The nuclei in such PMCs do not undergo division at all while the normal cells regularly divide. Studies of stigma squashes also revealed similar nuclear condition in pollen produced by the nondividing PMC's. Though no division takes place in such cells, yet, they are transformed into pollen grains along with the normal cells. Certain workers have reported partial suppression of meiosis during gametogenesis but this is the first record of complete suppression of nuclear division. It is suggested that nuclear division and transformation of the sporogenous cells into PMC, sporads and finally pollen are independent processes. The possible explanations of this peculiar behaviour of the nuclei of these cells is also suggested.

Summary Pollen variability in Pimpinella monoccia was artificially induced by treating seedlings with different chemicals. Positive results in the treated plants were obtained with acsculine, saponin, α-bromonapthalene and 8-hydroxy-quinolene. All these plants were 2n. Their meiosis was typified by multiple and multipolar spindles, laggards, strays, bridge-fragment configuration, spindle breakdown and unequal division of the chromosomes into many groups giving rise to variable number of spores at the sporad stage. Besides polyads the variable grains were asymmetric and nonfixiform while the controls had all radiosymmetric grains. One of the interesting facts was that similar pollen shapes were induced by all these diverse chemicals. The development of variable grains has been traced with the help of a scheme. The causes of pollen variability are discussed.

SUMMARYThe chromosome number of Citrus Assamensis has been found to be 2n — 18. Though it is ordinary diploid species yet it shows multivalent formation ranging from trivalent, quadrivalent to esavalent. The bridge fragment configuration has also been observed at anaphase. The second division is marked by stray chromosomes and laggards. The pollen sterility is 45%.

The chromosome number ofCitrus penvisculata, Mayer lemon, Italian lemons. Kagzi Kalan lemon, Hill lemon and Nepale oblong lemon has been found to be 2n=18. Bridge-fragment configurations were observed inC. penvisculata, Mayer lemon, Italian round and Kagzi Kalan lemon. Univalents and pollen sterility have been observed in varying proportions in all of the seven species and varieties. Pollen sterility is probably due to presence of univalents and inversion heterozygosity

Introduction The present investigation deals with the morpl~ological and cytological study of the variants in C o r i n n d ~ ~ ~ ~ ~ z satimznaj L. induced by colchicine following a new technique of combinations (Ragliuvanshi and Joshi, 1964~) . Induced pollen variability is a unique feature of Umbcllifers. A preliminary report of pollen variability supported by explanations of this plienon~enon has been reportcd by Joslii and Ragliuvanslii ( 1961). Treatment with colchicine and colcliicine-gammexane not only resultcd in the production of polyploids but also in obtaining diploid mutants wit11 changed characters. Materials and Methods Seedlings of Corinlzd?-znn sntivzl7rz were subjected to colcliicine and colcl~icine-gamiiiexane treatment. A saturated solution of gammexane was prepared and then a 0.2% solution of colcliicine was madc by dissolving colcliicine in the saturated solution of gammesane. The seeds were talten fro111 a true breeding variety (selection 3). Interniittant treatment of seedlings for six hours daily was repeated for two days. Tliis proved to bc thc most successful treatment. The seedlings were raised in separate pots along with suitable controls. The trcatment rcsultcd in 272 variants (Experi~iicntal 13 and 67); mixoploid (Experimental 19) and tetraploids (Espcrimental 70, 78, 89 and 96). Colcliicine treatment alone gave rise to Experimental 13, 19, 67 and 70, while the rest of the tetraploids were produccd by tlie colcliicine-gammcsanc conlbination. Fixation for the cytological studies xvas made in 1: 3 acetic-alcohol with storage in 70% alcollol under refrigcration. i\lciosis was studicd in iron acetocarminc squashes of microsporocvtes. T o study tlie ontogeny of the pollen grains an anther n.as placed in a diop of acetocarmine ~ u ~ d c r a covcrglass. Then the coverglass was tapped to release tlic spores within the respective sporads. In the case of pollen, the grains corning fro111 a single sporad remained togethcr as only slight prcssure was applied. Tliis preventcd spreading of the grains in the medium. For the study of structure of tlic pollen grains and frequency of different pollen types, slides were prepared by the usual acetolysis method (Erdtman, 1952) and mounted in glycerine jelly.

A single-flowering, male sterile variety ofTabernaemontana divaricata (2n=22) had a high frequency of univalents. Observations on material fixed at nine periods during the year showed univalent frequency to be negatively correlated with temperature. Chromosome association was normal only at temperatures around 40°C. As pollen sterility did not vary with temperature, it was concluded that it had developmental-genetic rather than meiotic causes.

The present investigation deals with a morphological and cytological comparison between the colchiploids of Capsicum frutescens cultiver Oshkhosh and its diploid progenitor. The most effective treatment for the induction of tetraploids was found to be 0.2% aqueous colchicine applied to the growing point of young seedlings for 12 hours. On the whole 64% of the plants became polyploids and survived.The induced tetraploid was characterised by deep green, thick and rough leaves with larger epidermal cells, stomata, palisade and spongy parenchyma. The number of stomata per unit area in the tetraploid was less than that of the diploid. In general the morphological characters were larger in the polyploids than their counterparts in the diploids. The 4n plants were completely sterile and no fruit setting was observed in them. The cause of complete failure of fruit formation lies in the premature disintegration of the stigma which blocks the passage of the pollen tube to reach the egg. Pollen germination in situ has been observed in anthers of a polyploid bud. The induced polyploids exhibit cytological abnormalities such as univalents, laggards, restitution nuclei, non-congression and non-orientation of certain bivalents and other irregularities such as subdivision of the chromosome complement into 2 or more groups that function independently within the cell, nondisjunction of chromosomes and unequal distribution of the chromosomes to the polar regions at anaphase were noted at either or both meiotic divisions in the PMC's. The number of microspores per PMC varied from 1-12. The gametes produced by a polyploid with such a cytological mechanism will have extremely variable chromosome number. Those gametes which have balanced genomes will be functional. The evolutionary significance of the various anomalies observed and their importance to plant breeder have been discussed.

Different diploids of Trigonella foenum-graecum L. and their corresponding autotetraploids were seed-treated with 40 krad of γ-rays, and parameters such as germination, survival, growth reduction, pollen fertility, pod setting, etc. were recorded. A stimulation of seed germination due to the irradiation could be observed. Contrary to the general rule that polyploids are more radioresistant than their corresponding diploids, one 4x strain was completely killed while the 2x version survived comparatively well. Apparently gene reduplication is not the overall protective mechanism as was once earlier believed. The importance of genotypic influence on radiosensitivity was demonstrated at both the 2x and 4x level. The limitation of interphase chromosome volume and degree of ploidy in predicting radiosensitivity is discussed.