Therapeutic plasma exchange in neuro-immunological disorder

Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used to remove high molecular weight substances from the plasma. Examples of these substances include immune complexes, pathogenic autoantibodies, endotoxin, cryoglobulins and cholesterol-containing lipoproteins and myeloma light chains. Therapeutic Plasma exchange is a well-established therapeutic procedure most commonly used in many neuro-immunological disorders. The benefit of plasma exchange occurs by elimination of pathognomonic inflammatory mediators, including complement components, autoantibodies and cytokines. Various studied have demonstrated that TPE plays an important role in neuro-immunological disorder (eg. Guillain-Barré syndrome, myasthenia gravis and other forms of immune neuropathies).Methods: It is descriptive and prospective study on the effect of TPE in neuro-immunological disorders. TPE are studied prospectively for a period from September 2011 to August 2013. The amount of plasma to be exchanged during TPE was determined using the formula EPV = (0.065 x weight [kg]) x (1-hematocrit). TPE was performed using a Haemonetics MCS+ intermittent flow cell separator. An average of 1-1.5 plasma volume is removed on alternative days. Clinical outcome of TPE was assessed at the time of discharge.Results: A total of 138 Therapeutic plasma exchange procedure were performed on 30 patients. In which the improvement begins within days of commencing the treatments and progressed steadily so that 25 out of 30 patients who responded favourably to TPE with a manageable adverse reaction. And only 5 patients failed to respond this therapy. So the clinical outcome for therapeutic plasma exchange for Neuro-immunological cases were 83.3% and remaining 16.7% doesn’t show any improvement after five plasma exchanges.Conclusions: Therapeutic plasma exchange is a first line of management for most of the neuro-immunological disorder. In our study there was an improvement in motor performance after 3-5 plasma exchanges which are mainly due to removal of unbound antibodies from the plasma. Although the statistical power of our study was not sufficient to allow definitive conclusion, the result strongly suggest that 3-5 procedures on alternative days with 1-1.5 volume of plasma exchange gives a better result in patient with neuro-immunlogical diseases. The success of therapeutic plasma exchange also depends on composition of the replacement fluid. The risk and complication associated with procedure are also minimal and easily manageable

A Comparative Study of the Expression of Her2/Neu in Invasive Ductal Carcinoma of Breast Associated With and Without Ductal Carcinoma in SITU

AIM OF THE STUDY: The clinical outcome of breast carcinoma varies in every individual due to its molecular heterogeneity. Nowadays there is a rising interest whether the associated DCIS in invasive ductal carcinoma of breast affects the prognosis and overall survival of the patient. Only a very few studies has assessed the expression of molecular markers between IDC-DCIS and pure IDC (IDC without DCIS). So the present study was undertaken to study the expression of HER2/neu in invasive ductal carcinoma of breast associated with and without DCIS and also to find the correlation with other clinico-pathological variables with such expression. MATERIALS AND METHODS: Two groups were categorized based on the presence or absence of in situ component in invasive ductal carcinoma of breast. A total of 50 mastectomy specimens were studied for the expression of HER2/neu by IHC, which includes 25 cases of invasive ductal carcinoma associated with DCIS (IDCDCIS) and 25 cases of invasive ductal carcinoma without DCIS (IDC). RESULTS: There is no statistical difference in HER2/neu expression between IDCDCIS and pure IDC (IDC without DCIS). The expression of Ki 67 was significantly higher (p value 0.022) in IDC without DCIS (60%) than IDCDCIS ( 28%).The expression of HER2/neu is associated with large tumor size, positive lymph node status and ER status in IDC without DCIS. Ki 67 which is considered a predictor of chemotherapy is correlated with HER2/neu expression in both the groups but significantly higher in pure IDC (without DCIS). CONCLUSION: IDC associated with DCIS (IDC-DCIS) shows a less malignant behavior compared to IDC without DCIS. Since molecular markers play an important role in tumor carcinogenesis and progression further studies to be done in large scale which might help in identifying the subgroup for targeted therapy

A prospective study on adverse drug reactions reported in a tertiary referral hospital

Background: To determine the incidence of Adverse drug reactions in our hospital, to study the age wise distribution, the role of concurrent medication and the common drugs that are prone to cause adverse drug reactions and its seriousness.Methods: After getting prior approval from Institutional ethical committee a prospective study was done where in cases attending OPD, ward, ICU were studied over a year. A complete history was taken regarding drug exposure (dosage, date started, duration and interruptions in use), initiation of drug use and onset of reaction, previous adverse drug reactions, improvement after decrease in dosage, disease states predisposing to eruptions, previous family and personal history of skin disease, environmental and occupational exposure to chemicals. Relevant laboratory test such as blood investigations, liver and renal function tests are carried out and results were analysed statistically by SPSS version 21 and interpretations done based on the results.Results: Incidence of ADR among OPD =0.18, IPD=1.98, OPD+IPD=0.39 /1000cases.The highest incidence of Adverse drug reactions were found among the age group of 30-39 years (27.45%), 40-49 years (23.53%), with the highest among antibiotic group of drugs (35.29%) involving a maximum duration of 2-7 days. Drug reactions mostly occurred with the oral route 66.67) and most of it requiring hospitalization (47.06%), 60.78% of reactions were manifested in skin, 58.82% of patients with ADR had concomitant medications and 19.61% had Diabetes mellitus, 90% of reactions abated after drug withdrawal with regard to its outcome 94.12% of reactions recovered.Conclusions: The study suggest the adverse drug reactions commonly occur in middle age, mostly manifesting in skin with oral route of administration ,associated with concomitant medications and it requires hospitalisation with a good recovery rate with diabetes being the common comorbid disorder

Experimental investigation of Green Concrete

Currently, construction costs and sand shortages are increasing day by day. To combat this problem, sand in plastic form is partially replaced by other materials. Plastic waste is recycled in the form of new production materials that can be used as optional components of concrete, making it one of the best ways to deal with plastic waste. These techniques have also proven to be much more cost-effective than traditional methods. This paper proposes using plastic waste as random substitutes (10%, 20%, 30%) for natural river sand and testing for compressive strength, tensile strength, flexural strength and sustainability. purpose. With the amount of plastic used increasing day by day, the disposal of used plastic is a big problem. It was therefore concluded that sand must be replaced by plastic within 20 years so that the shortage of natural aggregates can be effectively dealt with and the used plastic are disposed effectively

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy.

Peer reviewe

Psychosis brain subtypes validated in first-episode cohorts and related to illness remission: results from the PHENOM consortium

Using machine learning, we recently decomposed the neuroanatomical heterogeneity of established schizophrenia to discover two volumetric subgroups-a 'lower brain volume' subgroup (SG1) and an 'higher striatal volume' subgroup (SG2) with otherwise normal brain structure. In this study, we investigated whether the MRI signatures of these subgroups were also already present at the time of the first-episode of psychosis (FEP) and whether they were related to clinical presentation and clinical remission over 1-, 3-, and 5-years. We included 572 FEP and 424 healthy controls (HC) from 4 sites (Sao Paulo, Santander, London, Melbourne) of the PHENOM consortium. Our prior MRI subgrouping models (671 participants; USA, Germany, and China) were applied to both FEP and HC. Participants were assigned into 1 of 4 categories: subgroup 1 (SG1), subgroup 2 (SG2), no subgroup membership ('None'), and mixed SG1 + SG2 subgroups ('Mixed'). Voxel-wise analyses characterized SG1 and SG2 subgroups. Supervised machine learning analyses characterized baseline and remission signatures related to SG1 and SG2 membership. The two dominant patterns of 'lower brain volume' in SG1 and 'higher striatal volume' (with otherwise normal neuromorphology) in SG2 were identified already at the first episode of psychosis. SG1 had a significantly higher proportion of FEP (32%) vs. HC (19%) than SG2 (FEP, 21%; HC, 23%). Clinical multivariate signatures separated the SG1 and SG2 subgroups (balanced accuracy = 64%; p < 0.0001), with SG2 showing higher education but also greater positive psychosis symptoms at first presentation, and an association with symptom remission at 1-year, 5-year, and when timepoints were combined. Neuromorphological subtypes of schizophrenia are already evident at illness onset, separated by distinct clinical presentations, and differentially associated with subsequent remission. These results suggest that the subgroups may be underlying risk phenotypes that could be targeted in future treatment trials and are critical to consider when interpreting neuroimaging literature

Gene Expression Profile and Functionality of ESC-Derived Lin-ckit+Sca-1+ Cells Are Distinct from Lin-ckit+Sca-1+ Cells Isolated from Fetal Liver or Bone Marrow

In vitro bioreactor-based cultures are being extensively investigated for large-scale production of differentiated cells from embryonic stem cells (ESCs). However, it is unclear whether in vitro ESC-derived progenitors have similar gene expression profiles and functionalities as their in vivo counterparts. This is crucial in establishing the validity of ESC-derived cells as replacements for adult-isolated cells for clinical therapies. In this study, we compared the gene expression profiles of Lin-ckit+Sca-1+ (LKS) cells generated in vitro from mouse ESCs using either static or bioreactor-based cultures, with that of native LKS cells isolated from mouse fetal liver (FL) or bone marrow (BM). We found that in vitro-generated LKS cells were more similar to FL- than to BM LKS cells in gene expression. Further, when compared to cells derived from bioreactor cultures, static culture-derived LKS cells showed fewer differentially expressed genes relative to both in vivo LKS populations. Overall, the expression of hematopoietic genes was lower in ESC-derived LKS cells compared to cells from BM and FL, while the levels of non-hematopoietic genes were up-regulated. In order to determine if these molecular profiles correlated with functionality, we evaluated ESC-derived LKS cells for in vitro hematopoietic-differentiation and colony formation (CFU assay). Although static culture-generated cells failed to form any colonies, they did differentiate into CD11c+ and B220+ cells indicating some hematopoietic potential. In contrast, bioreactor-derived LKS cells, when differentiated under the same conditions failed to produce any B220+ or CD11c+ cells and did not form colonies, indicating that these cells are not hematopoietic progenitors. We conclude that in vitro culture conditions significantly affect the transcriptome and functionality of ESC-derived LKS cells and although in vitro differentiated LKS cells were lineage negative and expressed both ckit and Sca-1, these cells, especially those obtained from dynamic cultures, are significantly different from native cells of the same phenotype.This work was partially supported through National Institutes of Health grant number EB005026 to KR and PWT. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding received for this study.Biomedical Engineerin