Background: Medical termination for missed miscarriage with the use of 800 μg of vaginal misoprostol as a single agent is recommended as a cheap option before 14 weeks of gestation in developing ...countries. A few studies have looked at its efficacy. Methods: A prospective, observational study was done on women having medical termination with up to three doses of 800 μg vaginal misoprostol at 12 hourly intervals. The number of women who needed check curettage was collected. Ultrasound findings if done were collated. Follow-up was done telephonically at the end of first week, fourth week and sixth week. Results: The cohort comprised 145 women. The primary outcome was the need for curettage after expulsion of products following medical management and this was 49/145 (37.8%) of women. The induction expulsion interval was 36 hours. The mean endometrial thickness of the 113/145 women who had an ultrasound was 11 mm. The mean endometrial thickness in women who had check curettage was 18 mm. Persistent spotting was the only significant symptom at follow-up. Resumption of cycle at the end of the sixth week was seen in 105/132 (80.15%) of women who were followed up. Conclusion: Findings of our study showed the check curettage rate of 37.8%. However, the regime which we used, that is, 800 μg vaginal misoprostol at 12 hourly intervals had a long induction to expulsion interval of 36 hours. In all, 80% of women resumed normal cycles at the end of the sixth week. No significant complications were noted on follow-up.
The objective of the study was to assess the role of variations in serum folate, vitamin B12, homocysteine and the presence of genetic polymorphisms as risk factors for congenital heart disease (CHD) ...in children.
A total of 32 children with CHD, and their mothers and 32 normal children and their mothers formed the study and control groups, respectively. Serum folate, vitamin B12 and homocysteine as well as genetic polymorphisms MTHFR C677→︀T, MTHFR A1298→︀C, MTR A2756→︀G and MTRR A66→︀G were assessed.
Low serum folate and genetic polymorphisms MTHFR C677→︀T and MTRR A66→︀G among children and their mothers and high homocysteine among mothers were noted as risk factors for CHD (P<0.05). Vitamin B12 levels were normal and showed no association. Presence of MTHFR C677→︀T and MTRR A66→︀G, both concurrently among children as well as mothers and simultaneously among mother-child pairs, showed several fold increase in the risk for CHD. On multivariate analysis, the risk factors noted for CHD were presence of MTHFR C677→︀T among children and their mothers and MTRR A66→︀G among mothers. Analyses for nutrient-gene interaction revealed significant associations between low serum folate and high serum homocysteine levels, and the presence of selected genetic polymorphisms.
Low serum folate, high homocysteine and presence of selected genetic polymorphisms among children and their mothers were noted as risk factors for CHD. Nutrient-gene interaction being a modifiable risk factor, the study recommends the use of peri-conceptional folate supplementation with vitamin B12 sufficiency for primary prevention of CHD.
Oral cavity cancer is one of the most common cancers in India responsible for significant morbidity and mortality in Indian subcontinent. Majority of cases present in advanced stages which requires ...extensive reconstruction following tumor resection. Microvascular free flap reconstruction is now considered standard of care for reconstruction for major head and neck skin-mucosal defects but, many factors still act as hindrance like patient’s comorbidities, long operating hours for microvascular reconstruction, logistic and financial issues from patient’s side. In such situation it is better to have a backup plan for reconstruction of major head and neck defects using pedicled flaps. Pectoralis major myocutaneous (PMMC) flap has been the workhorse flap for head and neck reconstruction since its introduction four decades ago. But relying too much on PMMC flap for major skin-mucosal defects especially in female patients is associated with complications and risk for flap failure leading to catastrophic and significant patient morbidities. Our study involves the use of two flaps for head and neck reconstuction involving skin-mucosal defects i.e PMMC flap for mucosal defect and cervicodeltopectoral (CDP) flap for skin defect. As of now there has been no retrospective or prospective study done which has given a conclusive statement regarding use of these two flaps simultaneously for head and neck reconstruction to the best of our knowledge. In our experience from the present study, CDP flap offers an excellent alternative for extensive head and neck reconstruction and can be readily included in the surgeon’s armamentarium with proper planning and meticulous handling.
MicroRNAs control gene expression at the posttranscriptional level by base-pairing to the 3′-UTR of their target mRNAs, thus leading to mRNA degradation of protein fabrication. We hypothesize, SNPs ...within miRNAs and their targets could be of significance to an individual's risk of developing cancer. We analyzed
in silico SNP information on cervical cancer associated aberrant alleles and further investigated this in a case-control study by examining eleven SNPs from different genes. It was observed that a C to T polymorphism in putative miRNA target site of BCL2 was significantly conspicuous for the aberrant SNP allele in cancer tissues as compared to controls. This study provides evidence that SNPs in miRNA-binding sites may play an important role in increasing risk of cancer. The results also paves way for future studies to validate these results in other well-characterized populations as well as to explore the biological significance of these particular SNPs.
To characterize the extent and impact of ancestry-related biases in precision genomic medicine, we use 642 whole-genome sequences from the Consortium on Asthma among African-ancestry Populations in ...the Americas (CAAPA) project to evaluate typical filters and databases. We find significant correlations between estimated African ancestry proportions and the number of variants per individual in all variant classification sets but one. The source of these correlations is highlighted in more detail by looking at the interaction between filtering criteria and the ClinVar and Human Gene Mutation databases. ClinVar's correlation, representing African ancestry-related bias, has changed over time amidst monthly updates, with the most extreme switch happening between March and April of 2014 (r=0.733 to r=-0.683). We identify 68 SNPs as the major drivers of this change in correlation. As long as ancestry-related bias when using these clinical databases is minimally recognized, the genetics community will face challenges with implementation, interpretation and cost-effectiveness when treating minority populations.
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•Diverse enzymatic-bioremediation strategies for emerging contaminants are available.•Oxidoreductases are most abundantly employed for the bioremediation.•Peroxidase, nitroreductase ...and cellobiose dehydrogenase are key bioremediation enzymes.•More integrated and holistic strategy for biocatalytic remediation.
The bioremediation of emerging recalcitrant pollutants in wastewater via enzyme biotechnology has been evolving as cost-effective with an input of low-energy technological approach. However, the enzyme based bioremediation technology is still not fully developed at a commercial level. The oxidoreductases being the domineering biocatalysts are promising candidates for wastewater treatments. Henceforth, comprehending their global market and biotransformation efficacy is mandatory for establishing these techno-economic bio-enzymes in commercial scale. The biocatalytic strategy can be established as a combinatorial approach with existing treatment technology to achieve towering bioremediation and effective removal of emerging pollutants from wastewater. This review provides a novel insight on the toxicological xenobiotics released from industries such as paper and pulps, soap and detergents, pharmaceuticals, textiles, pesticides, explosives and aptitude of peroxidases, nitroreductase and cellobiose dehydrogenase in their bio-based treatment. Moreover, the review comprehensively covers environmental relevance of wastewater pollution and the critical challenges based on remediation achieved through biocatalysts for future prospectives.
Object Hypercoagulability after subarachnoid hemorrhage (SAH) is well described and may be platelet-mediated. Thromboelastography (TEG) provides a global assessment of coagulation. We sought to ...determine whether the Maximum Amplitude (MA) parameter of TEG, a measure of platelet strength and function, is associated with outcome after SAH. Methods 110 TEG analyses were performed for patients with moderate-to-severe SAH and compared to 6 healthy age and sex-matched controls. TEG indices included MA, G value (G), Alpha Angle (AA), and Thrombus Generation (TG) and were correlated to functional outcomes and lab tests including CBC, ESR, hsCRP, fibrinogen, and D-dimer, obtained on post-bleed days (PBD) 1, 3, 5, 7 and 10. Results MA was significantly elevated compared to controls on PBD 3 (70.0 +/- 4.5 vs. 64.1 +/- 6.5, p=0.02), PBD 5 (72.6 +/- 5.3 vs. 64.1 +/- 6.5, p=0.003), PBD 7 (73.0 +/- 5.4 vs. 64.1 +/- 6.5, p=0.003), and PBD 10 (73.4 +/- 6 vs. 64.1 +/-6.5, p=0.005). G was significantly elevated compared to controls on PBD 3 (p=0.03), PBD 5 (p=0.01), PBD 7 (p=0.01), and PBD 10 (p=0.02)). The only biomarker associated with poor outcome was CRP. Multivariate logistic regression demonstrated an association between elevated MA and outcome (OR 39.1, p=0.006) independent of CRP, age, Hunt Hess grade and transfusion. Conclusions TEG indices are associated with poor outcome after SAH and may identify a platelet-mediated hypercoagulable state. The association between MA and outcome was stronger than that between traditional biomarkers and was independent of age and Hunt Hess grade.
We study quantum mechanical models in which the dynamical degrees of freedom are real fermionic tensors of rank 5 and higher. They are the nonrandom counterparts of the Sachdev-Ye-Kitaev (SYK) models ...where the Hamiltonian couples six or more fermions. For the tensors of rank 5, there is a unique O(N)5 symmetric sixth-order Hamiltonian leading to a solvable large−N limit dominated by the melonic diagrams. We solve for the complete energy spectrum of this model when N=2 and deduce exact expressions for all the eigenvalues. The subset of states which are gauge invariant exhibits degeneracies related to the discrete symmetries of the gauged model. We also study quantum chaos properties of the tensor model and compare them with those of the q=6 SYK model. For q>6, there is a rapidly growing number of O(N)q−1 invariant tensor interactions. We focus on those of them that are maximally single trace-their stranded diagrams stay connected when any set of q−3 colors is erased. We present a general discussion of why the tensor models with maximally single-trace interactions have large−N limits dominated by the melonic diagrams. We solve the large−N Schwinger-Dyson equations for the higher rank Majorana tensor models and show that they match those of the corresponding SYK models exactly. We also study other gauge invariant operators present in the tensor models.
Histologic analysis of the allograft biopsy specimen is the standard method used to differentiate rejection from other injury in kidney transplants. Donor-derived cell-free DNA (dd-cfDNA) is a ...noninvasive test of allograft injury that may enable more frequent, quantitative, and safer assessment of allograft rejection and injury status. To investigate this possibility, we prospectively collected blood specimens at scheduled intervals and at the time of clinically indicated biopsies. In 102 kidney recipients, we measured plasma levels of dd-cfDNA and correlated the levels with allograft rejection status ascertained by histology in 107 biopsy specimens. The dd-cfDNA level discriminated between biopsy specimens showing any rejection (T cell-mediated rejection or antibody-mediated rejection ABMR) and controls (no rejection histologically),
<0.001 (receiver operating characteristic area under the curve AUC, 0.74; 95% confidence interval 95% CI, 0.61 to 0.86). Positive and negative predictive values for active rejection at a cutoff of 1.0% dd-cfDNA were 61% and 84%, respectively. The AUC for discriminating ABMR from samples without ABMR was 0.87 (95% CI, 0.75 to 0.97). Positive and negative predictive values for ABMR at a cutoff of 1.0% dd-cfDNA were 44% and 96%, respectively. Median dd-cfDNA was 2.9% (ABMR), 1.2% (T cell-mediated types ≥IB), 0.2% (T cell-mediated type IA), and 0.3% in controls (
=0.05 for T cell-mediated rejection types ≥IB versus controls). Thus, dd-cfDNA may be used to assess allograft rejection and injury; dd-cfDNA levels <1% reflect the absence of active rejection (T cell-mediated type ≥IB or ABMR) and levels >1% indicate a probability of active rejection.
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