A Case Study Using Papaya Leaf Extract to Reverse Chemotherapy-Induced Thrombocytopenia in a GBM Patient

Chemotherapy-induced thrombocytopenia (CIT) is a critical condition in which platelet counts are abnormally reduced following the administration of chemotherapeutic compounds. CIT poses a treatment conundrum to clinicians given the increased risk of spontaneous bleeding, obstacles to surgical management of tumors, and exclusion from clinical trials. Treatment of CIT involves the removal of the offending agent combined with platelet infusion or thrombopoietin agonist treatment. However, due to the autoimmune and infection risks associated with infusions, this treatment is only reserved for patients with critically low platelet counts. One potential solution for patients in the mid to low platelet count range is Carica papaya leaf extract (CPLE). In this case, we report the novel use of CPLE as a method of bolstering platelet counts in a patient presenting with CIT. The patient was initiated on CPLE therapy consisting of 1 tablespoon twice daily with meals. Following CPLE treatment, the patient’s platelet counts rebounded from less than 10,000/µL to 113,000/µL. This clinical vignette supports the use of CPLE in the clinical context of CIT when thrombopoietin agonists are not a viable option. The potential benefits of CPLE as a method for increasing platelet count deserve further exploration, especially as a treatment option for refractory patients or those ill-suited for other traditional thrombocytopenia therapies.

COMPARATIVE EVALUATION OF YOGHURT SAMPLES FROM GOATS AND COWS MILK AND COMMERCIAL RETAIL OUTLET

This paper compared the chemical (Proximate and mineral), acidity, microbial count and organoleptic properties of yoghurt samples produced from Nigeria locally bred goat and cow milk with commercially retail yoghurt during 14days of refrigerated storage. Yoghurt production was conducted by inoculation of the milk samples at 43oC for 6hrs with 2% of streptococcus thermophillus and lactobacillus bulgarus active culture. The total ash content of yoghurt ranges from 0.23g/100g in the commercial yoghurt sample to 0.84g/100g in yoghurt from goat milk which is considered significantly higher than that observed for yoghurt from cow milk. The commercially retail yoghurt had a significantly higher (P < 0.05) total solid matter than yoghurt from goat and cow milk. Calcium and phosphorus contents were significantly (P < 0.05) lowest in the commercial yoghurt (0.28%) to a significant higher value of 0.28% in goat milk. A statisitically significant drop in pH values was observed in the commercial yoghurt sample after one and two week storage compared to yoghurt from goat and cow milk. High lactic acid bacteria were observed in yoghurt from cow milk with lactococci group being higher than the lactobacilli group throughout the storage period. The yeast count range from a significant low (P < 05) value of 2.22 cfu/ml-1 in commercial yoghurt sample to 3.22 and 3.24 in goat and cow milk respectively on day zero of storage. By the 7days of storage, the commercially retail yoghurt was significant (P < 0.05) least desirable with respect to colour, taste and overall acceptability while there was no significant difference in the consistency of all the yoghurt samples.

Trends in Carriage of Extended Spectrum β-Lactamase and Carbapenemase Producing Enterobacteria Among HIV Infected Patients and Their Antimicrobial Susceptibility Patterns in Western-Cameroon

Background: In Cameroon, studies on the prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (E-ESBLs) and carbapenemase-producing Enterobacteriaceae (CPE) among HIV infected individuals has not been investigated despite the progressively risen prevalence of HIV infection. The present study is intended determinate the magnitude of ESBL-E and CPE carriage among HIV-infected individuals. Methods: Accordingly, 152 urine, 29 stool, 8 blood, 105 vaginal exudates and 14 wound swab sample were collected from 204 HIV negative and 104 HIV positive patients attending the Regional Hospital of Bafoussam-Cameroon from September 2016 to June 2017. From these specimen, Enterobacteriaceae were isolated based on their morphological features, Gram staining and biochemical characteristics using API 20E galleries (Biomerieux, France). For each HIV infected patient, the CD4 lymphocytes were measured using cytometric technique. The antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion test against 11 antibiotics from β-lactam class. ESBL and CP in suspected strains was confirmed by double disk synergy test and combination disk test.Results: The prevalence of Enterobacteriaceae infection among HIV positive patients was 46.15% versus 27.47% among HIV-negative ones (P=0.0014). Among HIV positive patients, urine (47.91%), vaginal exudates (31.25%) and blood (4.16%) specimens were mostly colonialized and Escherichia coli (37.5%) the predominant species. The rate of Enterobacteraceae infection according to CD4 count range was 20.83%, 37.5%, 35.42% and 6.25% respectively for patients with CD4 T lymphocyte range up to 500, ]300-500], ]100-300] and < 100 cells/mm3. The overall resistance rates were 27.72 and 34.66% respectively among isolates from HIV negative and positive patients. The prevalence of ESBL, AmpC and carbapenemase producing Enterobacteriaceae infection was 16.34, 12.5, and 4.81% respectively among HIV infected patients versus 8.62, 8.65 and 0% among HIV uninfected patients (p = 0.0055). Conclusion: Our findings showed that HIV positive patients are significantly more affected by Enterobacteriaceae infection than negative ones and that the rate of these bacterial infection likely increases with decrease CD4 counts. The present study also indicates that HIV positive patients are more likely to be infected by highly resistant organisms and had the highest carriage rate of ESBL, AmpC and carbapenemase producing Enterobacteriaceae compared to uninfected individuals in Western-Cameroon.

Evaluation of Nutritional, Microbial and Sensory Attributes of Rice Tuwo Flour Fortified with Soy and Plantain Flour Blends

Aims: The aim of the work is to investigate the effect of soybean and Plantain flour fortification on the nutritional, microbial and sensory qualities of rice flour paste (Tuwo) fortified with soy and plantain flour blends. Methodology: White rice was cleansed, sorted and soaked in water for 12hrs and dried at 60OC for 12hrs. White rice was fortified with soybean and plantain flour at 10, 15, 20, 25% respectively while 100% white rice flour serve as the control. Nutrient, microbial and sensory qualities of the samples were determined using standard methods. Results: There were significant differences (p≤.05) and increase in values of all the nutritional properties with increase in substitution of soy-plantain flour. The protein content ranges from (2.19 – 21.46%), Fat content (1.67 – 18.51%), Fiber (0.68 – 6.78%), Ash content (1.37 - 2.26%), Moisture content (10.16 – 12.47%) of the blends respectively, while the carbohydrate contents of the blends was significantly lower to that of the control sample. The mineral content increased where the abundant mineral was potassium (29.22 – 45.57 mg/100g) and zinc (2.66 – 3.34 mg/100g) been the least mineral element. The microbial analysis shows a lower microbial counts of prepared tuwo samples, which makes it safe for consumption. Mean total viable count range from 1.10 to 3.50 x102 cfu/g, Staphylococcus count range from 0.00 to 1.03 x102 cfu/g. fungi count range from 0.00 to 0.60 102 cfu/g with no growh of salmonella from all the samples respectively. The sensory evaluation result shows that the sample from whole rice was highly rated but sample B with 80% rice flour, 10% soy flour and 10% plantain flour has the highest preference in terms of taste, colour, aroma, texture, smoothness and overall acceptability. Conclusion: This fortification highly improve its nutrient contents and slightly improves microbial and organoleptic properties of rice tuwo, which can serve as alternative protein supplement.

Comparative study of efficacy of Gunja Beeja lepa and Shunthi Churna lepa in Inflammatory Conditions of Arthritis - A Randomized Controlled Single Blinded Clinical Study

Background: Life style disorders are an emerging problem in India where various types of arthritis are hampering the routine activities of people due to severe pain and inflammation. In such circumstances, everybody wants quick relief with the symptoms. Visha dravya used in Ayurveda are known for their quick action. Gunja (Abrus precatorius Linn) is a visha indicated in various diseases for internal and external use. Objectives: A randomized clinical study was conducted to assess the efficacy of Gunja beeja lepa to manage the local inflammatory conditions of Arthritis in comparison with a standard anti-inflammatory Ayurvedic drug Shunthi (Zingiber officinalis Linn) to provide a potent anti-inflammatory drug for the purpose of clinical practice. Material and methods: Patients suffering from transient mono or bi-arthropathies of knee were applied Gunja beeja lepa in comparison with local application of standard anti-inflammatory Ayurvedic drug Shunthi. Assessment was done with the help of Disease Activity Score (DAS-28-3) including three variables viz; tender joint score (Range 0-28), Swollen Joint Count (Range 0-28) and Erythrocyte sedimentation rate. Statistical comparisons were performed by both paired, unpaired student’s t test by using Sigma stat software (version 3.1) for both the experimental the groups at p<0.05 (level of significance). Result: Intervention with Gunja beeja lepa was statistically significant (p=0.003) in comparison with the intervention with Shunthi churna lepa. Conclusion: Gunja Beeja lepa is effective in comparison with standard anti-inflammatory Ayurvedic drug Shunthi in inflammatory conditions of Arthritis.

On testing for seed sample heterogeneity with the exact probability distribution of the germination count range

Seed lot heterogeneity is often evaluated through the range between germination percentages of four seed samples, considering normal and binomial approximations for calculating the tolerated range (S). In this paper, an exact test for the germination count range (R) is derived based on the hypergeometric and the binomial probability model for germination count. Through Monte Carlo simulations, the empirical distribution of R is built to evaluate the quantiles of the exact distributions. Moreover, a power analysis is performed by simulation. Sample size and germination rate effects are evaluated. In lots with a high germination rate, the proposed test based on the hypergeometric model is about 20% more powerful than the test based on the S-value. A table containing the critical values is presented and recommended to be used in off-range heterogeneity testing.

Correction: Berner, D. Allele Frequency Difference AFD—An Intuitive Alternative to FST for Quantifying Genetic Population Differentiation. Genes 2019, 10, 308

This note is to correct an error in my paper, concerning the Shannon differentiation metric (DShannon) (Reference [43] in the paper). The paper states that DShannon is undefined mathematically whenever one or both populations are monomorphic, that is, fixed for a single allele. Accordingly, the DShannon curve in Figure 1a, showing population differentiation in relation to allele counts for the case in which the pooled minor allele frequency (MAF) is maximal, did not extend across the full range of allele counts; the rightmost data point reflecting complete population differentiation was missing. Moreover, DShannon was completely missing in Figure 1b visualizing the continuum of allele frequency differentiation when the MAF is minimal (one population monomorphic across the entire allele count range).

2486. Clinical Outcomes of Patients Treated with Dolutegravir Functional Monotherapy or Dolutegravir plus an Active Non-cytosine Nucleoside Analog: A Retrospective Observational Cohort Study of Treatment-Experienced Patients

Background Dual dolutegravir (DTG)-containing regimens (DCRs) are currently approved for the treatment of antiretroviral (ARV) naïve and experienced patients with HIV-1 infection. DTG monotherapy has resulted in unacceptable rates of virologic failure and subsequent development of DTG resistance. Here, we evaluate the “real-world” efficacy and “barrier to resistance” of DCRs containing 0–1 active ARVs. Methods This is a retrospective observational study evaluating clinical outcomes of treatment-experienced patients on combination DCRs found to be on DTG functional monotherapy or DTG plus an active non-cytosine analog between 2013 and 2014. The primary endpoint was virologic suppression (HIV-1 RNA< 50 copies/mL) at week 48. Virologic failure (VF) was defined as confirmed HIV-1 RNA≥ 50 copies/mL 12 weeks after initiating DTG or any time after achieving HIV-1 RNA< 50 copies/mL. Adherence, adverse events (AEs) and laboratory parameters were analyzed throughout the study. Results Thirty-nine patients were included in the analysis, 19 (49%) were on DTG functional monotherapy and 20 (51%) were on DTG plus a non-cytosine nucleoside analog. The median age (range) was 53 (40–74) years, median baseline CD4+ count (range) was 564 (92–1217) cells/mm3, 22 (56%) had baseline HIV-1 RNA< 50 copies/mL, and 24 (62%) had previously used INSTIs (Table 1). At Weeks 48 and 96, virologic suppression was observed in 78.3% and 86% of patients respectively (Figures 1 and 2). Among 7 VFs (2 on DTG functional monotherapy, 5 on DTG plus a non-cytosine nucleoside analog), there was no evidence of treatment-emergent resistance to DTG. There was a significant median increase in CD4+ count from baseline to Week 48 (+90 cells/mm3, 95% confidence interval: [14.18, 165.9]). No significant changes in lipid parameters were observed. Treatment-related AEs occurred in 17/39 (44%) patients (all Grade 1–2) and 1 patient discontinued DCR treatment due to rash. Conclusion In this “real-world” cohort of treatment-experienced patients, we observed that DTG functional monotherapy and DTG plus a non-cytosine nucleoside analog maintained long-term virologic control and was well tolerated. These data supports use of DTG as a partner for dual DCRs given its high efficacy in patients with underlying ARV resistance. Disclosures All authors: No reported disclosures.

Allostatic Load, Unhealthy Behaviors, and Depressive Symptoms by Birthplace Among Older Adults in the Sacramento Area Latino Study on Aging (SALSA)

Objective: To assess whether unhealthy behaviors moderated the relationship between allostatic load (AL) and future significant depressive symptoms (SDSs) among 1,789 older Latinos. Method: Longitudinal data included baseline AL, three unhealthy behaviors (UBs), and 2-year follow-up SDS. Multivariable logistic regression analyses, stratified by birthplace (U.S. vs. foreign born), modeled the effects of AL, UB count (range = 0-3), and their interaction on follow-up SDS. Results: Compared with U.S.-born, foreign-born participants engaged in fewer UBs (0.52 vs. 0.60 behaviors, p = .01) and had higher baseline SDS (31% vs. 20%, p < .001). Among foreign-born participants, the effect of AL on future SDS (adjusted odds ratios [aORs]; 95% confidence interval [CI]) significantly increased across UB counts of 0 to 3: 1.06 [0.83, 1.35], 1.46 [1.14, 1.87], 2.00 [1.18, 3.41], and 2.75 [1.18, 6.44], respectively. Discussion: Among foreign-born Latinos, these results were most pronounced for women and adults above age 80, which may represent higher risk groups requiring more intensive screening for depression.

A study investigating the validity of an accelerometer in quantification of step count in adult hospital inpatients recovering from critical illness

Objective: To determine the validity of the ActiGraph GT3X accelerometer in step count quantification when compared to observed step count in hospitalised adults recovering from critical illness. Setting: Large National Health Service (NHS) Hospitals Trust. Subjects: In total, 20 hospital ward-based adults (age: mean 62.3, SD 11.5) who had required greater than 48 hours of mechanical ventilation in the intensive care unit. Main measures: Participants walked self-selected distances and speeds as part of a semi-structured movement protocol not exceeding 3 hours. Two ActiGraph GT3X accelerometers were worn, one on the thigh and one on the ankle of the non-dominant leg. Accelerometer-recorded step counts were compared against observed step counts. Results: In total, 31 separate walking episodes were analysed. A mean (SD) of 45.87 (±19.72) steps was calculated for observed step count (range 15–90). Mean differences (95% limits of agreement) of −0.84 steps (−3.88 to 2.2) for the ankle placement and −17.7 steps (−40.63 to 5.25) for the thigh were calculated. Intraclass correlation coefficients (95% confidence intervals) of 0.99 (0.99 to 1.0) and 0.46 (−0.1 to 0.78) were determined for the ankle and thigh, respectively. Placement sites were well tolerated by 95% of participants. Conclusion: An ankle-mounted ActiGraph GT3X accelerometer demonstrates validity in quantification of step count in hospitalised adults recovering from critical illness. A thigh placement was not considered valid.