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Human immunodeficiency virus (HIV), the causative agent in AIDS has been a challenge to medical fraternity from the time since it was first discovered in 1983. About 40 million people are living with HIV infection globally and 99% of the infected people are in South East Asia (ESA). Close monitoring of HIV infected patients is essential in reducing the morbidity and mortality of HIV patients. The monitoring HIV disease progression & deciding the time to initiate anti retro viral therapy requires evaluation of T CD4 cell counts and HIV/RNA viral load at regular intervals along with monitoring of biochemical parameters and hematological parameters in HIV Seropositive patients.The objective of the study was to evaluate some biochemical parameters and hematological parameters in newly diagnosed HIV seropositive patients (primary stage).A total of 300 newly diagnosed HIV patients and 200 age and sex matched healthy individuals as control were tested for CBC, lipid profile, renal function tests, liver function tests, electrolytes and some minerals (copper, zinc, iron). Our observations were subjected to statistical analysis Mean ± standard deviation calculated. Comparison was done by student t-test.HIV positive patients had significantly (pIt was concluded in the present study that, hematological manifestations of the HIV infection are complication associated with the disease, anaemia being a very common finding. This complications are not related to age or the sex of the patients. The lipid profile of the patients is also seen to be altered by the disease process. Decreased Lipid levels are more pronounced in anemic groups than non-anemic group.

Aim: Intense training of arm movements using robotic devices can help reduce impairments in stroke. Recent evidence indicates that independent training of individual joints of the arm with robots can be as effective as coordinated multi-joint arm training. This makes a case for designing and developing robots made for training individual joints, which can be simpler and more compact than the ones for coordinate multi-joint arm training. The design of such a robot is the aim of the work presented in this paper. Methods: An end-effector robot kinematic design was developed and the optimal robot link lengths were estimated using an optimization procedure. A simple algorithm for automatically detecting human limb parameters is proposed and its performance was evaluated through a simulation study. Results: A six-degrees-of-freedom end-effector robot with three actuated degrees-of-freedom and three non-actuated self-aligning degrees-of-freedom for safe assisted training of the individual joints (shoulder or elbow) of the human arm was conceived. The proposed robot has relaxed constraints on the relative positioning of the human limb with respect to the robot. The optimized link lengths chosen for the robot allow it to cover about 80% of the human limb’s workspace, and possess good overall manipulability. The simple estimation procedure was demonstrated to estimate human limb parameters with low bias and variance. Discussion: The proposed robot with three actuated and three non-actuated degrees-of-freedom has a compact structure suitable for both the left and right arms without any change to its structure. The proposed automatic estimation procedure allows the robot to safely apply forces and impose movements to the human limb, without the need for any manual measurements. Such compact robots have the highest potential for clinical translation

Purpose Staphylococcus aureus (S. aureus), Klebsiella pneumoniae (K. pneumoniae) and Streptococcus pneumoniae (S. pneumoniae) are among the pathogens detected during Hajj pilgrimage known to cause pneumonia. This study aims to evaluate the antibacterial activity of activated carbon cloth (ACC) with Ag+ impregnated with zinc oxide nanoparticles (ZnO NPs) against these pathogens. Design/methodology/approach ZnO NPs were impregnated into ACC-Ag+ via layer-by-layer (LbL) self-assembly. Scanning electron microscope (SEM) was used to observe the fine surface morphological details of the ACC-Ag+-ZnO sheets. Antibacterial activity of the ACC-Ag+-ZnO sheets was evaluated using the disk-diffusion susceptibility assay. Allergy patch test was done to evaluate allergic reactions of the ACC-Ag+-ZnO sheets on human skin. Findings SEM micrographs showed successful impregnation of ZnO NPs into the ACC-Ag+ sheets. Disk-diffusion susceptibility assay results of ACC-Ag+-ZnO sheets against S. aureus, K. pneumoniae and S. pneumoniae showed good antibacterial activity; with 1.82 ± 0.13 mm zone of inhibition for S. pneumoniae, at a ZnO concentration of 0.78 mg mL-1. No signs of human skin irritation were observed throughout the allergy patch test. Originality/value Results indicate that ACC-Ag+-ZnO sheets could potentially be embedded within surgical face masks (pilgrims’ preferred) to reduce the risks involved with the transmission of respiratory tract infections during and after mass gatherings (e.g. Hajj/Umrah, Olympics).

Background Studies in healthy elderly patients have shown the prevalence of autonomic dysfunction (AD) in the range of 20 to 30%. However, there is paucity in data pertaining to AD in the elderly in the Indian context. Objective To assess the prevalence of AD in the elderly irrespective of their comorbidity status. Methods A total of 141 elderly patients with or without comorbidities/symptoms of AD were included. Demographic and clinical details of the patients were recorded. Autonomic function tests (AFTs) such as deep breathing test, Valsalva ratio, orthostatic heart rate (OHR), isometric handgrip test, and orthostatic blood pressure were performed based on Ewing’s battery of tests. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of AFTs were evaluated. Results Most patients (n = 85) were aged between 60 and 69 years, with a male predominance (58.87%). Hypertension and diabetes mellitus were the most common comorbidities. Postural hypotension was the most common symptom of AD. With advancing age, symptoms of AD manifested significantly more. Overall, 73.8% of patients had AD, of whom 45.4% had early AD. Number of AD symptoms, glycated hemoglobin (HbA1c) level, and comorbid factors (diabetes and hypertension) were significantly associated with the results of AFTs (p p Conclusion The study concludes that age itself is an independent predictor of AD, which increases in severity if associated with comorbidities.

We present a case of tetralogy of Fallot (TOF) accompanied by a type II aorto-pulmonary window with severe pulmonary arterial hypertension in a pediatric patient. A successful repair of tetralogy of Fallot with trans-pulmonary patch closure of aorto-pulmonary window was done.

Background Dizziness among elderly patients is primarily treated in emergency and primary care centers. However, the causes and comorbidities responsible for dizziness in the elderly may differ in tertiary health care centers. Objective To determine the subtypes of persistent dizziness and to evaluate the number of contributory causes of dizziness among elderly patients. Methods and materials This observational cross-sectional study comprised of 130 patients aged >60 years. A detailed history of existing comorbidities was obtained. A standardized comprehensive evaluation of all patients was done using an International Delphi procedure. Data from each patient was independently reviewed for major and contributory causes of dizziness. Chi square test was used to find the association between dizziness and various contributing factors. Results Presyncope was the most frequent dizziness subtype (71.5%). Majority of patients showed one dizziness subtype (54.6%) and three contributory causes of dizziness (40.6%). An adverse effect of drug was the most common contributory cause for dizziness (20%). The most frequent underlying cause of dizziness was noted to be cardiovascular disease (40%), followed by peripheral vestibular disease (22.3%) and neurological disease (19%). Sixty six percent of the patients were identified with more than one contributing cause for dizziness. Conclusion Primary care physicians need to anticipate that many elderly dizzy patients can have more than one cause of dizziness. A systematic and planned approach can help the clinician to effectively treat dizziness in the elderly.

Ingestion of foreign bodies is common. However, ingestion of an adult tooth brush and its endoscopic removal is reported rare in literature. Here we report two cases of adult tooth brush ingestion with and without psychiatric illness in the past. Endoscopic removal of the tooth brush was done by using snare and rat tooth forceps differing from other case reports. Hence these cases are peculiar and reported.

Coronary artery fistula is a connection between coronary artery and its branch to any of the cardiac chamber, great vessel or coronary sinus bypassing the myocardial capillary bed. Majority of fistulas are congenital in origin, although acquired fistulas may be encountered occasionally after cardiac surgery, endocarditis and after repeated myocardial biopsies (Somers and Verney, Clin Radioly 44:419–421, 1991). We report a 55-year-old female patient of large coronary cameral fistula between sinoatrial nodal artery and right atrium. She presented with congestive heart failure, atrial fibrillation and deterioration of left ventricular function with mitral regurgitation with functional class 3. The patient was managed with closure of origin of fistula from inside the aorta using polytetrafluoroethylene (PTFE) patch of 1.5 × 1.5 cm, on cardiopulmonary bypass using blood cardioplegia, as rest of the right coronary artery (RCA) was rudimentary. She had uneventful recovery with improvement in the functional class 1.

Traumatic pseudoaneurysm of subscapular artery is a rare sequlae of injury in the shoulder region. Only five cases are on report and none after World War II. This rarity of the lesion is due to the anatomic location of the artery 4 . We report a 21 years old patient transferred for torrential bleeding from the wound of entry, followed by appearance of progressively expanding, pulsatile, painful swelling, after three days of splinter injury sustained in right scapular region while working in the field. The diagnosis was confirmed by Doppler ultrasonography and computerized tomographic angiography. Successful surgical aneurysmectomy and ligation of rented subscapular artery done without affecting axillary artery.

There is an increasing interest in bioinspired dynamic materials. Abundant illustrations of protein domains exist in nature, with remarkable ligand binding characteristics and structures that undergo conformational changes. For example, calmodulin (CaM) can have three conformational states, which are the unstructured Apo-state, Ca2+-bound ligand-exposed binding state, and compact ligand-bound state. CaM's mechanical response to biological cues is highly suitable for engineering dynamic materials. The distance between CaM globular terminals in the Ca2+-bound state is 5 nm and in the ligand-bound state is 1.5 nm. CaM's nanoscale conformational changes have been used to develop dynamic hydrogel microspheres that undergo reversible volume changes. The current work presents the fabrication and preliminary results of layer-by-layer (LbL) self-assembled Dynamic MicroCapsules (DynaMicCaps) whose multilayered shell walls are composed of polyelectrolytes and CaM. Quasi-dynamic perfusion results show that the DynaMicCaps undergo drastic volume changes, with up to ∼1500% increase, when exposed to a biochemical ligand trifluoperazine (TFP) at pH 6.3. Under similar test conditions, microcapsules without CaM also underwent volume changes, with only up to ∼290% increase, indicating that CaM's bio-responsiveness was retained within the shell walls of the DynaMicCaps. Furthermore, DynaMicCaps exposed to 0.1 M NaOH underwent volume changes, with only up to ∼580% volume increase. Therefore, DynaMicCaps represent a new class of polyelectrolyte multilayer (PEM) capsules that can potentially be used to release their payload at near physiological pH. With over 200 proteins that undergo marked, well-characterized conformational changes in response to specific biochemical triggers, several other versions of DynaMicCaps can potentially be developed.

Hajj is the largest annual gathering of Muslims during which time over two million people from different parts of the world are gathered within a small area, leading to very high risks of acute respiratory infections (ARI) for the pilgrims. Therefore, preventive measures and controls should be implemented, including the implementation of non-pharmaceutical prevention methods such as the use of appropriate face masks, hand hygiene, respiratory etiquette, social distancing, and quarantine. A pilot study was conducted in 2013 to identify the types of face masks used by Malaysian Umrah pilgrims as well as to identify the problems pertaining to the face masks being used and to understand the factors influencing the selection of face masks by Malaysian pilgrims. Observations and survey methods were used in the pilot study. Data was collected from thirty respondents through a survey. This paper presents the results of the pilot study. Based on the knowledge of factors influencing face mask usage and selection from the pilot study, new face mask design(s) will be proposed for the Malaysian pilgrims. It is anticipated that the use of new face mask design(s) can reduce the risk of acute respiratory infections in Hajj and Umrah pilgrims.

Study objectives were to develop a unique floating ring capsule dosage form which combines gastric soluble and insoluble portions, and to evaluate its suitability for stomach specific drug delivery. New floating ring capsules were developed using different polymers and were compared for various parameters. The formulation with HPMC and sodium CMC has better floating properties. The effects of polymers concentration on drug release were studies by in vitro release studies. The interaction studies of combined drug with polymers were determined using FT-IR spectroscopy. The entrapped air within the gel barrier and lower densities of HPMC and sodium CMC resulted in better floating behavior. Steady slow gel formations showed prolonged drug release. The in vitro release rates were generally found to be faster with low concentration of carbopol showing release within 2h, while formulations containing high amount of HPMC showed release in 8h. In particular, the higher concentration of HPMC formulation shows the best drug release performance. A very low change in peak shift was observed only with sodium alginate formulations. Further, FT-IR measurements confirmed the absence of any chemical interactions. Results indicate that new floating ring capsule is a promise dosage form for stomach specific delivery.

A microfluidic islet perifusion device was developed for the assessment of dynamic insulin secretion of multiple pancreatic islets and simultaneous fluorescence imaging of calcium influx and mitochondrial potential changes. The fanned out design of the second generation device optimized the efficient mixing and uniform distribution of rapid alternating solutions in the perifusion chamber and allowed for the generation of reproducible glucose gradients. Simultaneous imaging of calcium influx and mitochondrial potential changes in response to glucose stimulation showed high signal-noise ratio and spatial-temporal resolution. These results suggest that this system can be used for detailed study of the endocrine function of pancreatic islets with simultaneous imaging of intracellular ion fluxes and mitochondrial membrane potential changes. This tool can be used for quality assessment of islets preparation before transplantation and for in vitro studies of islet function.

Cell patterning has emerged as an elegant tool in developing cellular arrays, bioreactors, biosensors, and lab-on-chip devices and for use in engineering neotissue for repair or regeneration. In this study, micropatterned surfaces were created using the layer-by-layer lift-off (LbL-LO) method for analyzing canine chondrocytes response to patterned substrates. Five materials were chosen based on our previous studies. These included: poly(dimethyldiallylammonium chloride) (PDDA), poly(ethyleneimine) (PEI), poly(styrene sulfonate) (PSS), collagen, and chondroitin sulfate (CS). The substrates were patterned with these five different materials, in five and ten bilayers, resulting in the following multilayer nanofilm architectures: (PSS/PDDA)5, (PSS/PDDA)10; (CS/PEI)4/CS, (CS/PEI)9/CS; (PSS/PEI)5, (PSS/PEI)10; (PSS/Collagen)5, (PSS/Collagen)10; (PSS/PEI)4/PSS, (PSS/PEI)9/PSS. Cell characterization studies were used to assess the viability, longevity, and cellular response to the configured patterned multilayer architectures. The cumulative cell characterization data suggests that cell viability, longevity, and functionality were enhanced on micropatterned PEI, PSS, collagen, and CS multilayer nanofilms suggesting their possible use in biomedical applications.

Lactulose is used as a triggering substance in a unique colon-specific delivery technology called CODESTM. Colonic microflora degrades lactulose and forms short-chain fatty acids to activate the CODESTM system. However, lactulose has been reported to cause a Maillard-type reaction with substances containing primary or secondary amino groups that may produce carcinogenic compounds. Thus, the aim of this study was to look into the possibility to substitute lactulose with isomalt for fabrication of CODESTM. The in vitro degradation of both sugars before incorporating them into the CODESTM system was evaluated with the help of rat caecal microflora. The results showed that isomalt was less efficient with regard to its rate and extent of degradation into short-chain fatty acids by the microflora compared to lactulose. However, the in vitro dissolution study did not show a significant difference in the performance between lactulose and isomalt when they were incorporated separately in CODESTM. A similar result was also obtained in the in vivo study. Based on the above results, isomalt could be used as an alternative to lactulose for colonic delivery system utilizing the principles of CODESTM.

A microfluidic device to perfuse pancreatic islets while simultaneously characterizing their functionality through fluorescence imaging of the mitochondrial membrane potential and intracellular calcium ([Ca(2+)](i)) in addition to enzyme linked immunosorbent assay (ELISA) quantification of secreted insulin was developed and characterized. This multimodal characterization of islet function will facilitate rapid assessment of tissue quality immediately following isolation from donor pancreas and allow more informed transplantation decisions to be made which may improve transplantation outcomes. The microfluidic perfusion chamber allows flow rates of up to 1 mL min(-1), without any noticeable perturbation or shear of islets. This multimodal quantification was done on both mouse and human islets. The ability of this simple microfluidic device to detect subtle variations in islet responses in different functional assays performed in short time-periods demonstrates that the microfluidic perfusion chamber device can be used as a new gold standard to perform comprehensive islet analysis and obtain a more meaningful predictive value for islet functionality prior to transplantation into recipients, which is currently difficult to predict using a single functional assay.

Polydimethylsiloxane is used ubiquitously in micro fluidics both as a mold and as a device in and of itself due to the polymer's distinct physical and chemical properties. This elastomer is intrinsically hydrophobic due to the methyl group that is a part of its chemical backbone. Hydrophilicity is induced by plasma activation but is short lived as this elastomer regains its hydrophobic nature as uncrosslinked PDMS chains start to reorient back to the surface. Quantifying the bonding time frame will prove invaluable for any and all research applications that revolve around PDMS.

EDITOR—An increase in empyema thoracis complicating pneumonia in children was reported from the West Midlands in 19971 and has since been confirmed in several other centres in the United Kingdom, Europe, and North America. Most culture positive cases in the United States are related to infection with Streptococcus pneumoniae serotype 1.2 This is also the most common causative organism in the UK where most cases are culture negative as shown by using pneumococcal polymerase chain reaction and …

In tissue engineering, surface modification has becomes one of the leading methods to enhance initial cell attachment and subsequent cellular growth, differentiation and tissue formation. This work studied growth and behavior of primary bovine articular chondrocytes on self-assembled multilayer nanofilms composed of: polyelectrolytes [poly(styrene sulfonate) (PSS), poly-L-lysine (PLL), poly-D-lysine (PDL), chondroitin sulfate (CS), poly(ethyleneimine) (PEI), poly(dimethyldiallylammonium chloride) (PDDA), poly(ethylene glycol) amine (PEG - NH2)] and proteins [bovine serum albumin (BSA), collagen, fibronectin, laminin]. These biomaterials were used to build mono-, bi-, and tri-layer nanofilm architectures. Potential cytotoxic effects were assessed using Live/Dead assay and cell proliferation was quantified using MTT assay. Bright field and fluorescence microscopy were used to analyze chondrocyte morphology. ImageJ software was used to analyze the number, mean area, circularity and Feret's diameter of viable cells. Cumulative results demonstrated that chondrocyte growth; proliferation and functionality were dependent on initial cell density, nanofilm thickness and material composition of nanofilms.

Short-term cell-substrate interactions of two secondary chondrocyte cell lines (human chondrosarcoma cells, canine chondrocytes) with layer-by-layer self-assembled multilayer nanofilms were investigated for a better understanding of cellular-behaviour dependence on a number of nanofilm layers. Cell-substrate interactions were studied on polyelectrolyte multilayer nanofilms (PMNs) of eleven different biomaterials. Surface characterization of PMNs performed using AFM showed increasing surface roughness with increasing number of layers for most of the biomaterials. LDH-L and MTT assays were performed on chondrosarcoma cells and canine chondrocytes, respectively. A major observation was that 10-bilayer nanofilms exhibited lesser cytotoxicity towards human chondrosarcoma cells than their 5-bilayer counterparts. In the case of canine chondrocytes, BSA enhanced cell metabolic activity with increasing number of layers, underscoring the importance of the multilayer nanofilm architecture on cellular behaviour.