Interrelationship Between Procalcitonin and Organ Failure in Sepsis

Sepsis suffers from lack of specific clinical symptoms which contribute to one of the major causes of mortality. In the present study, our aim was to evaluate the role of a recent biomarker Procalcitonin (PCT) in predicting organ dysfunction. 71 patients admitted with sepsis were included in the study. PCT levels were measured at 0, 24, 72 h and 7th day and sequential organ failure assessment score (SOFA) scores were calculated. PCT levels significantly decreased (p < 0.001) in 89.3 % of surviving patients, whereas, in 60 % non surviving patients the PCT level increased significantly (p < 0.001). A significant positive correlation between PCT and SOFA score was observed in survivors at each hour. These observations indicate that PCT concentration is significantly associated with severity of multi organ dysfunction and also helps in determining the prognosis of septic patients.     

Interpreting HbA1c in Presence of Deficiency Anemias

HbA1c is used extensively for the diagnosis and management of diabetes mellitus. It constitutes 80% of glycated HbA1(Glycated haemoglobin(GHb)A), and depends upon blood glucose and RBC life span. RBC life span varies with anemia, leading to a consequent alteration in the HbA1c value irrespective of the circulating blood glucose concentration. But to the best of our knowledge no Hb cut offs have been derived for appropriate interpretation of HbA1c. The prevalence of anemia in Indian population is nearly 40% as per its definition by WHO—Hb < 12 g/dL in females and < 13 g/dL in males—with most cases attributable to nutritional deficiencies. Hence, we aimed to identify Hb cut-off for accurate interpretation of HbA_1c in presence of deficiency anemias. Partial correlation between random blood glucose (RBG) and HbA_1c was studied in 1312 subjects, 470 of whom had deficiency-related anemia]. The data was adjusted for age, sex and Hb. Partial correlation between RBG and HbA1c was highly significant (p < 0.0001) till Hb of 8.1 gm/dL. Significance reduced to p = 0.003 and p = 0.006 as the cut off of Hb reduced to 7.1 gm/dL and 5.0 gm/dL, respectively, but was not lost. Hence, caution in interpretation of HbA_1c is not required till an Hb of 5 g/dL.     

Lead as a Risk Factor for Osteoporosis in Post-menopausal Women

Lead exposure is increasingly becoming an important risk factor for osteoporosis. In adults, approximately 80–90 % of absorbed lead is stored in the bones. These bone lead deposits are released into the blood during periods of enhanced bone resorption like menopause, forming a potential endogenous source of lead exposure. Postmenopausal women are at a higher risk for bone lead release because of hormonal and age related changes in bone metabolism. Estrogen deficiency is associated with increase in osteoclasts number and activity leading to both the early and late form of osteoporosis. Hence, high blood lead level coupled with concomitant environmental exposure exposes women in this age group to lead related adverse outcomes like hypertension, reduced kidney and neurocognitive functions as well as increased risk of atherosclerosis and cardiovascular mortality. A few studies have also identified coexisting variates like ethnicity, occupation, residence, education, smoking, alcohol medications, water etc. as significant determinants of bone and blood lead in women, thus increasing the magnitude of postmenopausal bone changes. Hence, interventions focused on reducing the intensity of bone resorption during menopause will help decrease exposure to endogenous lead. This would play a significant role in decreasing the morbidity and mortality associated with menopause. Also, identification of modifiable factors that prevent bone lead release will reduce the risk of chronic lead exposure and improve the health outcomes of post-menopausal women.     

Diagnosis of gastrointestinal tuberculosis: Using cytomorphological,microbiological, immunological and molecular techniques — A study from Central India

The present study included three groups: (A) age and gender matched control (n=24) with no previous signs of M. tuberculosis complex (MTBC) infection, (B) patients (n=28) diagnosed with gastro-intestinal TB (GITB), (C) patients (n=50) with clinical and histo-pathological signs of GITB, but were culture and AFB negative. Real time assay performed using fluorescence resonance energy transfer hybridization probes showed a positivity index of 36 % in group C, i.e. 18 were found reactive from the total 50 cases studied. In addition, immune characterization of these 18 cases showed depleted CD₄⁺ count and increased levels of IFN-γ and TNF-α cytokines. No positive case was found in group A, while in group B, out of total 28 cases studied 27 were found positive. A combinatorial diagnostic approach for rapid detection and characterization of GITB might provide specific therapeutic strategies for prevention and treatment of the infection in future.     

Busting the myth of gender bias: views from men and women primary-school trainees and teachers

We explore the ideology associated with gender equality that despite primary schools and initial teacher education (ITE) institutions doing all they can to recruit men into primary education, a huge gender imbalance still exists. We frame our study around the notions of gender equality and professional responsibility. Using a multi-case study approach, this inquiry examined views of men and women from 12 English primary schools and one ITE institution regarding the cause and effect of gender bias. Findings show a differentially large gender gap in the sample schools and that there is good practice where schools are successful in attracting and retaining men teachers. Implications of these findings suggest that leaders in primary schools need to take a more active role to help change and shape the perceptions of men teachers in education. We conclude that leaders also need to help close the teacher gender gap in schools and ITE institutions through collaborative dialogue.     

Studies on homocysteine demonstrating its significance as a possible tool for differential diagnosis in occlusive vascular disease

Homocysteine (Hcy) is a non-protein forming amino-acid, whose metabolism is at the intersection of two metabolic pathways: remethylation and transsulfuration which are dependent on the vitamins folic acid, B₁₂ and B₆, and the enzymes methylenetetrahydrofolate reductase and cystathionine-β-synthetase. A deficiency of any of these vitamins or enzymes results in hyperhomocysteinemia. This causes oxidative and other damage to blood vessels, thus affecting various organ systems of the body. As part of our ongoing research on cardiovascular risk factors, we have studied the Hcy levels in the plasma of normal controls and those suffering from vascular diseases. It was observed that Hcy is significantly higher in patients of vascular diseases (21.59±1.28 μmol/L, mean±SEM), as compared to normal controls (11.33±0.18 μmol/L). This significance, was more pronounced in cases of venous thrombosis (26.77±2.43 μmol/L) as opposed to cases of arterial block (17.27±0.84 μmol/L). This signifies that Hcy estimation would be beneficial in obtaining a differential diagnosis in addition to being a modifiable vascular risk factor.     

Teachers Speak Out on Assessment Practices

A 1997 statewide survey of Michigan teachers, administrators, and parents about assessment practices revealed that all 3 groups held similar views about what constitutes appropriate assessment in the early years, and they put little faith in test scores. This study reports on follow-up interviews aimed at determining the types, frequency, and utility of assessment techniques used by classroom teachers. Specifically, this study focused on the types of assessment techniques used by a sample of elementary teachers, including how often they use paper-and-pencil tests, how often they write observation notes and what they do with the notes, whether they use children's portfolios as assessment, and whether their teaching is influenced by mandated tests. Study findings revealed that paper and pencil tests were regularly used by teachers in grades 3 and 4 (92%), and rarely or occasionally used by the teachers below that level (16% rarely and 20% occasionally). Seventy-three percent of the early level teachers and 76% of the teachers in grade 3 and 4 used observation for summative rather than formative analysis. Teachers in both groups used checklists frequently, primarily for summative purposes. Portfolios, like other assessment tools, are used primarily for summative rather than formative purposes.