Himalayan P waves in COPD - A Rare Feature

Himalayan or giant P-waves (amplitude =5 mm) are often known to be classically associated with congenital heart diseases with right to left shunt like tricuspid atresia, Ebstein anomaly, combined tricuspid and pulmonic stenosis, etc, where they indicate a dilated right atrium and tend to be persistent. These type P waves are rarely seen in chronic obstructive pulmonary disease (COPD) and in this condition it may be due to structural right atrial changes or hypoxemia or combination of both. Here we report a case of COPD with Himalayan P waves which is a rare entity

Interannual and long-term variability of the summer monsoon and its possible link with northern hemispheric surface air temperature

Some statistical properties of the summer monsoon seasonal rainfall for India during the last 100 years (1881-1980) are presented. The most recent decade of 1971-1980 shows the lowest value of standard-decadal average monsoon rainfall (86.40 cm) and is also characterised by the second highest value of coefficient of variation in monsoon rainfall (12.4 ). The combined last two standard-decadal period of 1961-1980 was the period of the largest coefficient of variation and the lowest average monsoon rainfall for India. The possible influence of global climatic variability on the performance of the monsoon is also examined. Analyses of correlation coefficient show that a statistically significant positive relationship with a time-lag of about six months exists between monsoon rainfall and northern hemispheric surface air temperature. A cooler northern hemisphere during January/February leads to a poor monsoon. All the major drought years during the last 3 decades had much cooler January/February periods over the northern hemisphere-1972 having the coldest January/February with a temperature departure of -0.94°C and the most disastrous monsoon failure

Genetic variation in the HLA region is associated with susceptibility to herpes zoster.

Herpes zoster, commonly referred to as shingles, is caused by the varicella zoster virus (VZV). VZV initially manifests as chicken pox, most commonly in childhood, can remain asymptomatically latent in nerve tissues for many years and often re-emerges as shingles. Although reactivation may be related to immune suppression, aging and female sex, most inter-individual variability in re-emergence risk has not been explained to date. We performed a genome-wide association analyses in 22,981 participants (2280 shingles cases) from the electronic Medical Records and Genomics Network. Using Cox survival and logistic regression, we identified a genomic region in the combined and European ancestry groups that has an age of onset effect reaching genome-wide significance (P>1.0 × 10(-8)). This region tags the non-coding gene HCP5 (HLA Complex P5) in the major histocompatibility complex. This gene is an endogenous retrovirus and likely influences viral activity through regulatory functions. Variants in this genetic region are known to be associated with delay in development of AIDS in people infected by HIV. Our study provides further suggestion that this region may have a critical role in viral suppression and could potentially harbor a clinically actionable variant for the shingles vaccine

Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial

Background: Most people with stroke in India have no access to organised rehabilitation services. The effectiveness of training family members to provide stroke rehabilitation is uncertain. Our primary objective was to determine whether family-led stroke rehabilitation, initiated in hospital and continued at home, would be superior to usual care in a low-resource setting. Methods: The Family-led Rehabilitation after Stroke in India (ATTEND) trial was a prospectively randomised open trial with blinded endpoint done across 14 hospitals in India. Patients aged 18 years or older who had had a stroke within the past month, had residual disability and reasonable expectation of survival, and who had an informal family-nominated caregiver were randomly assigned to intervention or usual care by site coordinators using a secure web-based system with minimisation by site and stroke severity. The family members of participants in the intervention group received additional structured rehabilitation training—including information provision, joint goal setting, carer training, and task-specific training—that was started in hospital and continued at home for up to 2 months. The primary outcome was death or dependency at 6 months, defined by scores 3–6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) as assessed by masked observers. Analyses were by intention to treat. This trial is registered with Clinical Trials Registry-India (CTRI/2013/04/003557), Australian New Zealand Clinical Trials Registry (ACTRN12613000078752), and Universal Trial Number (U1111-1138-6707). Findings: Between Jan 13, 2014, and Feb 12, 2016, 1250 patients were randomly assigned to intervention (n=623) or control (n=627) groups. 33 patients were lost to follow-up (14 intervention, 19 control) and five patients withdrew (two intervention, three control). At 6 months, 285 (47%) of 607 patients in the intervention group and 287 (47%) of 605 controls were dead or dependent (odds ratio 0·98, 95% CI 0·78–1·23, p=0·87). 72 (12%) patients in the intervention group and 86 (14%) in the control group died (p=0·27), and we observed no difference in rehospitalisation (89 [14%]patients in the intervention group vs 82 [13%] in the control group; p=0·56). We also found no difference in total non-fatal events (112 events in 82 [13%] intervention patients vs 110 events in 79 [13%] control patients; p=0·80). Interpretation: Although task shifting is an attractive solution for health-care sustainability, our results do not support investment in new stroke rehabilitation services that shift tasks to family caregivers, unless new evidence emerges. A future avenue of research should be to investigate the effects of task shifting to health-care assistants or team-based community care. Funding: The National Health and Medical Research Council of Australia

Data Driven Stochastic Game Network-Based Smart Home Monitoring System Using IoT-Enabled Edge Computing Environments

Edge computing plays a crucial role in the processing of Consumer Internet of Things (IoT)-enabled latency-sensitive applications. In smart homes, dynamic action strategies based on multiple IoT objects with edge processing can be the best solution for handling adverse events. To overcome these challenges, the use of Stochastic Game Net (SGN) forming IoT devices as players with predefined action sets is one of the feasible solutions. Relative to this context, the edge-assisted IoT-enabled data-driven SGN model is proposed to handle various events in the smart home environment. Stochastic Petri Nets (SPNs) and game theory are integrated into our proposed model to build data-driven dynamic SGNs for the smart home environment. Dynamic SGNs for a comprehensive smart home system are generated in real-time through transitions based on sensor data, enhancing interoperability and scalability in smart home environments. We use the Net logo tool and state-of-the-art smart home sensor datasets to generate dynamic SGNs for various events. Experimental results demonstrate the effectiveness of the proposed model within a data-driven smart home environment. It shows that the present work significantly outperforms other state-of-the-art techniques in terms of decision-making at the edge layer. Moreover, using the proposed system the energy efficacy increased to around 39mJ/K nodes, and the average temporal delay for different events was reduced significantly

Mixed income housing (MIH)

Mixed Income Housing (MIH) is the outcome of a deliberate effort to build a mixed-income development, usually including a variety of housing typologies, sometime combined with the goal of creating a mixed-tenure development. International consensus on a more specific definition of MIH does not exist; instead, multiple expressions can be equally used, with similar meaning. The expression MIH is mainly used within the USA context where it is sometime replaced by mixed-income neighborhood. In Europe, MIH tend to fall within initiatives on (sustainable) urban regeneration, neighborhood restructuring, urban renewal, while the UK legislation often refers to “pepper-potting” with respect to different tenures in the same neighborhood aimed to achieve MIH. Non-English-speaking countries tend to use different terms. The MIH policies are challenged by a specific connotation, i.e., in the United States it is the combination between urban poverty and black or Latinos ghettoes; hence, spatial segregation is combined with racial considerations which are less present in other countries, except for South Africa. In the USA, desegregation in public housing estates became a legal obligation following the famous 1969 Gautreaux case, because of the application of the 1964 Civil Rights Act prohibiting racial discrimination in federally funded activities

Disulfiram/copper selectively eradicates AML leukemia stem cells in vitro and in vivo by simultaneous induction of ROS-JNK and inhibition of NF-κB and Nrf2

© 2017 The Authors. Published by Nature Publishing Group. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1038/cddis.2017.176Acute myeloid leukemia (AML) is a heterogeneous malignancy. Despite the advances in past decades, the clinical outcomes of AML patients remain poor. Leukemia stem cells (LSCs) is the major cause of the recurrence of AML even after aggressive treatment making, promoting development of LSC-targeted agents is an urgent clinical need. Although the antitumor activity of disulfiram (DS), an approved anti-alcoholism drug, has been demonstrated in multiple types of tumors including hematological malignancies such as AML, it remains unknown whether this agent would also be able to target cancer stem cells like LSCs. Here, we report the in vitro and in vivo activity of DS in combination with copper (Cu) against CD34(+)/CD38(+) leukemia stem-like cells sorted from KG1α and Kasumi-1 AML cell lines, as well as primary CD34(+) AML samples. DS plus Cu (DS/Cu) displayed marked inhibition of proliferation, induction of apoptosis, and suppression of colony formation in cultured AML cells while sparing the normal counterparts. DS/Cu also significantly inhibited the growth of human CD34(+)/CD38(+) leukemic cell-derived xenografts in NOD/SCID mice. Mechanistically, DS/Cu-induced cytotoxicity was closely associated with activation of the stress-related ROS-JNK pathway as well as simultaneous inactivation of the pro-survival Nrf2 and nuclear factor-κB pathways. In summary, our findings indicate that DS/Cu selectively targets leukemia stem-like cells both in vitro and in vivo, thus suggesting a promising LSC-targeted activity of this repurposed agent for treatment of relapsed and refractory AML

High Rate of Hypothyroidism in Multidrug-Resistant Tuberculosis Patients Co-Infected with HIV in Mumbai, India.

Adverse events (AEs) among HIV-infected patients with multidrug-resistant tuberculosis (MDR-TB) receiving anti-TB and antiretroviral treatments (ART) are under-researched and underreported. Hypothyroidism is a common AE associated with ethionamide, p-aminosalicylic acid (PAS), and stavudine. The aim of this study was to determine the frequency of and risk factors associated with hypothyroidism in HIV/MDR-TB co-infected patients

A network-based target overlap score for characterizing drug combinations: High correlation with cancer clinical trial results

Drug combinations are highly efficient in systemic treatment of complex multigene diseases such as cancer, diabetes, arthritis and hypertension. Most currently used combinations were found in empirical ways, which limits the speed of discovery for new and more effective combinations. Therefore, there is a substantial need for efficient and fast computational methods. Here, we present a principle that is based on the assumption that perturbations generated by multiple pharmaceutical agents propagate through an interaction network and can cause unexpected amplification at targets not immediately affected by the original drugs. In order to capture this phenomenon, we introduce a novel Target Overlap Score (TOS) that is defined for two pharmaceutical agents as the number of jointly perturbed targets divided by the number of all targets potentially affected by the two agents. We show that this measure is correlated with the known effects of beneficial and deleterious drug combinations taken from the DCDB, TTD and Drugs.com databases. We demonstrate the utility of TOS by correlating the score to the outcome of recent clinical trials evaluating trastuzumab, an effective anticancer agent utilized in combination with anthracycline- and taxane-based systemic chemotherapy in HER2-receptor (erb-b2 receptor tyrosine kinase 2) positive breast cancer. © 2015 Ligeti et al