Combined Analysis of Anti SARS-CoV-2 IgG and IgM Responses in COVID19 Patients in India

Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a global health problem, India being the second most affected country. The kinetics of antibody response to SARS-CoV-2 in Indian population is not studied yet. To understand serological response in relation to age, gender, time period and severity of disease, Roche Elecsys anti-SARS-CoV-2 test was used which analysed both IgM and IgG. One hundred and three COVID-19 patients were enrolled. Seropositivity was seen in 64% of patients, with 33% at ≤ 7 days, 62% between 8 and 15 days and 81% at ≥ 16 days from the time of admission. Men (65%) showed higher antibody response than women (59%), whereas no difference was observed in seropositivity with respect to age of the patients. Dynamics of antibody responses revealed individual variations. Patients in ICU had higher antibody reactivity with 67% positivity as compared to 60% positivity in non-ICU patients. Kinetics of antibody response during COVID-19 disease varied in relation to gender, age, time period and severity and these factors might play an important role in treatment and control of COVID-19.     

Continuous improvement in schools: Understanding the practice

This article investigates conceptually and practically what it means for schools to engage in the practice of continuous improvement. The analysis draws upon prior research and discussion to predict core elements of the practice of continuous improvement in schools. The predictions are then applied to a case study of continuous improvement efforts in a Pakistani secondary school that was involved in a 10-year school–university school improvement partnership. The article concludes with a set of eight empirically based propositions about the practice of continuous improvement schools.     

Mutation Analyses in Selected Exons of the MUT Gene in Indian Patients with Methylmalonic Acidemia

Deficiency or diminished activity of a cobalamin dependent enzyme methylmalonyl-CoA mutase causes inborn error of metabolism called methylmalonic acidemia (MMA). In this study we elucidated the spectrum of mutations in 21 Indian mut MMA patients by direct sequencing. Sequence analysis identified a total of 70 mutations in exon 2, 9, 11 and 12 of MUT gene. Out of which 26 mutations were predicted to be deleterious and rest were benign. The 23 novel mutations consist of four nonsense mutations (p.N6*, p.G539*, p.E609* and p.I671*), twelve missense mutations (p.K128I, p.N547T, p.D554Y, p.A558T, p.R559P, p.A631T, p.I647T, p.E656D, p.V657E, p.Q660H, p.K679N, and p.G696Y) and seven frame shift mutations (c.375_376insA, c.1642delA, c.1655delC, c.1825_1826insT, c.1957delGA, c.2014delA and c.2062_2063insGA). All of them are point mutations or micro rearrangements. Three of these mutations (p.K621N, p.G648D, p.G630E) have been previously reported; all of them are missense mutations. The mutations are distributed throughout the exon 2, 9, 11 and 12, 38.4 % mutation are located in exon 12.     

Serum Biomarker Based Algorithms in Diagnosis of Ovarian Cancer: A Review

Epithelial ovarian cancer accounts for more than 90% of ovarian tumours and continues as a leading cause of death from gynaecological malignancies. It is often difficult to differentiate a benign ovarian mass from malignant ones. Invasive histopathological biopsy is used as the gold standard diagnostic tool to diagnose cancer in patients with ovarian mass. A wide spectrum of Biomarkers were tried in various studies to develop a non invasive diagnostic tool, out of which HE4 and CA 125 remain the only clinically useful biomarker. Consequently various Biomarker based algorithms i.e. Risk of Malignancy Index, risk of ovarian cancer algorithm, OVA1, risk of malignancy algorithm were generated that have been developed to assess the risk of a mass being malignant. These algorithms help in timely triage of patients. Recently in 2016 FDA cleared Ova1 test (OVERA) with CA 125-II, HE4, apolipoprotein A-1, FSH, and transferring (Sensitivity 91% and Specificity 69%) as a referral or Triage test in patients presenting with ovarian mass. Combination of protein and circulating Micro RNA analysis in blood, could provide a comprehensive screening and diagnostic panel, in management of patients presenting with ovarian mass in one clinical setting.     

Towards sustainable internationalisation of higher education

This article engages with the question: what does the internationalisation of higher education in times of globalisation sustain and what should it sustain? We first consider, through literature on globalisation and Stier’s (Glob Soc Educ 2(1):1–28, 2004) work, limitations of currently prevalent perspectives on internationalisation in economic terms. We then offer a brief review of how sustainability is understood in higher education and articulate our own notion of educational sustainability. We flesh it out in reference to data reflecting ideas and activities constitutive of daily practices of internationalisation in one faculty of education. We contend that our sustainability frame of reference can expand opportunities to think critically about internationalisation and, more importantly, offers opportunities to see internationalisation in its complexity, and to re-think and reorder practices that are not in alignment with educational goals and values.     

Usefulness of lipase / amylase ratio in acute pancreatitis in South Indian population

This retrospective study was conducted to assess the serum lipase / amylase ratio in acute pancreatitis for South Indian population attending the clinics of Gastroenterology and Emergency medicine in the last five years. One thousand one hundred and thirty two patients (768 males and 364 females) with acute pancreatitis (AP) were selected for the study. The diagnosis of AP was based on clinical evaluation, Computed Tomography (CT) findings and biochemical parameters such as serum lipase and amylase. Based on the etiology, the groups were divided into alcoholic, biliary and miscellaneous AP. Based on CT findings, groups were divided into mild, moderate and severe AP. Serum lipase, amylase and lipase / amylase ratio were calculated and statistically analyzed. Serum lipase levels in alcoholic group (3226.3 ± 1384.7) were significantly lower in comparison to biliary (6064.5 ± 1640.8) group though the levels were not significantly different from miscellaneous group (2132.3 ± 1210). Serum amylase values were significantly lower in alcoholic group (923.4 ± 557.5) in comparison to biliary (1736.2 ± 390.7) and there was significant difference between alcoholic and miscellaneous group (535.8 ± 477.6). The serum lipase / amylase ratio > 4 occurred in alcoholic group than with biliary and miscellaneous group. The sensitivity and specificity to predict alcoholic AP with lipase / amylase ratio at >4.0 was 84 % and 59 % respectively. In conclusion the serum lipase to amylase ratio greater than 3.0 could be used to differentiate but keeping the cut off at 4.0 would be of higher sensitivity without much change in specificity. The serum lipase to amylase ratio with a cut off of 3.0 or greater is not useful to differentiate the severe AP from milder AP. Hence, serum amylase and lipase are important for evaluation of pancreatitis though it is not a gold standard for the diagnosis or assessment of severity of acute pancreatitis.     

Pleural fluid MDA and serum-effusion albumin gradient in pleural effusion

Pleural fluid malondialdehyde (PMDA) and serum effusion albumin gradient(SEAG) were estimated in 60 patients of pleural effusion of diverse etiologies. The results were compared with Light’s criteria to distinguish between transudates and exudates. The mean PMDA level was 0.68±0.24nmol/ml and 1.17±0.25nmol/ml in transudates and exudates respectively showing a statistically significant (p<0.05) rise in exudates in comparison to transudates. SEAG registered a significant fall in exudates (P<0.001) when compared with transudates. PMDA revealed a positive correlation with pleural protein(r=+0.30) and a significant negative association with SEAG (r= −0.33).Sensitivity and specificity of PMDA were better than the parameters of Light’s criteria. Whereas SEAG documented approximately equal sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) with Light’s criteria. Therefore PMDA and SEAG can be taken together in addition to Light’s criteria to strengthen the discrimination between transudates and exudates in borderline cases of pleural effusion.     

Superior – Subordinate Request Email in Workplace Communication of a Malaysian Organisation

Email is key in workplace communication. This study examines structure of request emails and display of politeness by Malaysian superiors when writing to subordinates. Authoritative and solidarity-oriented structures with corresponding linguistic strategies were found to reflect different leadership styles, autocratic and democratic. Language and communicative style were influenced by situational context of a request. When face threat and imposition were low, superiors were authoritative and when face threat and imposition were high, they were egalitarian. Email functioned as an equalising medium that enabled superiors to be democratic as well as a channel for power enactment that reinforced hierarchical structures.     

Effect of Metformin on Hormonal and Biochemical Profile in PCOS Before and After Therapy

Insulin resistance and the resultant hyperinsulinemia exacerbate the reproductive abnormalities of Polycystic Ovarian Syndrome by increasing ovarian androgen productions and decreasing serum sex hormone binding globulin. The present study was conducted to estimate serum insulin and testosterone level in 44 PCOS cases and 32 control patients. Simultaneously the role of metformin (an insulin sensitizing agent) in modulating insulin resistance and serum androgen level was also analyzed. A significant rise in serum insulin and testosterone (P < 0.001) was observed in cases in comparison to control. Fasting Plasma Glucose to insulin ratio, a marker of insulin resistance revealed a significant fall in PCOS group. Follow up of cases with metformin for 3 months revealed a significant fall in serum insulin (P < 0.05) with improvement in insulin resistance along with a nonsignificant fall in testosterone level. Serum insulin registered a significant positive correlation (P < 0.05) with serum testosterone revealing its etiological association. Thus administration of drugs ameliorating insulin levels is expected to provide new therapeutic modality for PCOS.