GLUT-1 Expression: An Aid in Complementing the WHO Oral Epithelial Dysplasia Grading System.

AIM AND OBJECTIVES: The clinicopathologic parameters alone are not sufficient to precisely predict if oral potentially malignant disorders (OPMDs) remain unchanged, i.e., without any malignant changes, regress, or advance to oral squamous cell carcinomas (OSCC). Few of the OPMDs, with or without epithelial dysplasia, may transform to frank OSCC. Discovering various molecular markers that can predict OSCC transformation is essential to develop effective therapeutic strategies. GLUT-1 is one of the hypoxia as well as metabolic indicator markers that have been used to study the metabolic activity of the cells. Hence, given by the World Health Organization (WHO), GLUT-1 expression was studied in various grades of dysplasia to see whether it complements the WHO grading system (mild, moderate, and severe). MATERIALS AND METHODS: The study was carried out on paraffin-embedded tissues of 10 normal oral mucosa and 30 OPMD cases. OPMD cases were classified into hyperkeratosis, mild dysplasia, moderate dysplasia, and severe dysplasia groups. Immunohistochemistry was carried out to evaluate the expression of GLUT-1 antigen. RESULTS: According to the WHO grading system of dysplasia, 11 (36.66%) cases were classified as hyperkeratosis, 9 (30%) cases were classified as mild dysplasia, 6 (20%) cases as moderate dysplasia, and 4 (13.33%) cases as severe dysplasia. There was a significant increase in GLUT-1 expression from normal to mild, moderate, and severe dysplasia (p value = 0.00). CONCLUSION: The expression of GLUT-1 marker complements the WHO grading system of oral epithelial dysplasia. CLINICAL SIGNIFICANCE: GLUT-1 expression can be used to complement the WHO grading system to grade epithelial dysplasia.

Blood lead levels in pregnant women and their newborn infants at an Indian teaching hospital.

Background and Aim: With the growth of the world's economy and industrialization, lead (Pb) contamination in the environment has become a major issue on a global scale. Lead is typically linked to unfavorable pregnancy outcomes such as stillbirth, low birth weight preterm, and spontaneous abortion. In this study, we evaluated the blood lead levels of pregnant women and their birth outcomes attending an Indian tertiary care teaching hospital, those who were not exposed to any lead-associated industry or shops. Methods: A descriptive study was undertaken to evaluate blood lead estimation in pregnant women and umbilical blood lead levels in a community hospital. Blood samples from 104 mothers during the 1st trimester, 90 mothers during 3rd trimester, and from the umbilical cord were collected. Self-administered questionnaires were used to collect information on demographics, medical history, and concerns linked to pregnancy. Following acid digestion, the levels of lead in whole blood were determined by an atomic absorption spectrometer. The DNA damage in high blood lead-concentrated pregnant women was evaluated by comet assay methods. Results: Among 194 blood samples of pregnant women, 31 (15.98%) samples revealed ≥5 µg/dL blood lead levels. High lead concentration (≥5 µg/dL) in 1st trimester pregnant women, end of 3rd trimester and cord blood were detected 20.19%, 11.11% and 1.11% respectively. The mean blood lead levels in 1st trimester, 3rd trimester, and cord blood were 3.88 ± 3.19, 2.66 ± 1.82, and 1.53 ± 1.06 mg/dL, respectively. The blood lead concentrations were significantly higher in the 1st trimester of pregnancy than in the 3rd trimester of pregnancy (P < 0.0017). A positive correlation between maternal and infant blood lead levels was revealed (P < 0.0001). When the comet assay was used to assess the genotoxic consequences of elevated blood lead levels during pregnancy, higher amounts of DNA damage were found in the samples (P < 0.01). Conclusion: In this descriptive study, there was a significant amount of lead transferred from mother to baby through the placenta. All mothers were not exposed to lead-associated industry and most were housewives. This article may be viewed as an eye-opener for understanding the blood lead concentration during pregnancy to avoid abnormal birth outcomes. To minimize exposure to environmental lead, all possible measures should be undertaken.

Viral load could be an important determinant for fomites based transmission of viral infections.

BACKGROUND AND OBJECTIVE: Fomites are common sources of transmission of certain infections. Infectious pathogens, such as viruses known to cause respiratory tract infections, are common examples of being transmitted by fomites. However, the load of the particular pathogen on these inanimate surfaces is a crucial factor for the transmission. The current study aims at investigating the load of one such viral pathogen on the surfaces of commonly used materials. METHODS: Based on the cycle threshold (Ct) values in the diagnostic system using gene amplification for the considered viral pathogen, we categorized the positive samples for high (17 to < 24), moderate (24 to < 31), or mild (31 to < 38) viral load. Five randomly selected samples from each of these category were smeared on commonly used cardboard surface (absorbent surface) and stainless steel (non-absorbent surface). After an observation duration of 90 min, samples from the surfaces were analyzed again for gene amplification using RT-PCR. RESULTS: Viral load/titter positively correlated with the viral material on either of these investigated surfaces post-observation duration. Higher viral load (low Ct) samples exhibited higher probability of being detected on the surfaces than those samples with lower/moderate (high Ct) viral load. INTERPRETATION AND CONCLUSION: Common inanimate surfaces are potential source of the viral transmission, however the viral load on these surfaces are key determinant of such transmission.

Corrigendum to "Statistical Evaluation of Two Microbiological Diagnostic Methods of Pulmonary Tuberculosis After Implementation of a Directly Observed Treatment Short-course Program" [Osong Public Health Res Perspect 2013;4(1):45-51].

[This corrects the article on p. 45 in vol. 4, PMID: 24159529.].

The clinical and biochemical features of complicated falciparum malarial nephropathy.

OBJECTIVE: This study aimed to explore renal involvement in complicated falciparum malaria as observed in hospitalized children. METHODS: This prospective study was conducted for four consecutive years with children 6 months to 14 years old who were affected by malarial nephropathy. Malaria was confirmed by microscopic examination of a blood smear. Detailed clinical evaluation and investigations were carried out to determine multi-organ involvement with special emphasis on renal functions. The staging for Acute Kidney Injury (AKI) was carried out as per Acute Kidney Injury Network Staging, which provided three groups of patients who were further modified by Risk, Injury, Failure, Loss, End stage renal disease (RIFLE) staging. RESULTS: Out of 350 cases with malaria, 56 (16%) cases had nephropathy. One-hundred-forty cases (40%) were aged between 5 and 10 years. Serious renal involvement was observed in 14 (25%) children who were 10-14 years old. Oligo-anuria was found in 40 (71.4%) cases, and generalized oedema was found in 33 (58.9%) children from the onset of malaria. Approximately 47 cases showed associated multi-organ dysfunction, and 9 cases had isolated renal failure. Malaria-induced hepatopathy and nephropathy had a higher risk of death than nephropathy alone. CONCLUSION: The spectrum of malarial nephropathy in children is highly variable, ranging from asymptomatic proteinuria to advanced stages of AKI. Renal involvement is more common and severe in P. falciparum. Children aged between 5 and 14 years and those with oligo-anuria, symptomatic azotaemia, electrolyte abnormalities and hepatopathy are more likely to develop advanced stage AKI and subsequently have an increased risk of mortality.

The relationship of abdominal girth with blood pressure, blood sugar and lipid profile among cardiac patients.

OBJECTIVES: This study aimed to characterize and identify the relationship of abdominal girth with blood pressure, blood sugar and lipid profile among cardiac patients. METHODS: A total of 100 patients with diagnosed cardiac problems were recruited from the outpatient clinic of a multi-speciality hospital. For data collection, a self-administered questionnaire was used to gather information about patients' demographics and socio-economic status. In addition, an assessment tool on the Physical and Laboratory Characteristics was employed. The data were analysed using t tests, Pearson correlations and chi squared tests. RESULTS: The findings of the study showed that there was a significant positive correlation of abdominal girth with blood pressure, blood sugar and lipid profile, as the R-values were reported to be 0.32, 0.28, 0.02, 0.32, 0.32, 0.28 and 0.18. There was no significant association of the selected demographic variables with abdominal girth, blood pressure, blood sugar or lipid profile among the selected cohort of patients. CONCLUSION: Lifestyle factors contribute significant risk in the development of abdominal obesity, metabolic syndrome and cardiovascular diseases. This study recommends a careful monitoring of risk factors at an early age, which would go a long way towards reducing the burden of abdominal obesity and obesity related cardio metabolic risk.

Effectiveness of surgically treated symptomatic plano-valgus deformity by the calcaneo stop procedure according to radiological, functional and gait parameters.

BACKGROUND: The incidence of flatfoot is approximately 5% in children and adults. The symptomatic form of a flexible flatfoot produces subjective and objective complaints, including gait disturbances. Surgical intervention is considered when conservative management fails. The arthroereisis procedure provides a stable foot and durable correction. However, to the best of our knowledge, no study has evaluated the effectiveness of this procedure on gait parameters. METHODS: Fifteen children with painful flatfeet (10 males; 5 females) with a mean age of 12 years and 6 months underwent the calcaneo stop procedure. Radiographic, gait analysis and functional measures were evaluated to assess the changes pre- and post-operatively. RESULTS: All children were followed up for a mean period of 4 years and 6 months. The overall results of the study exhibited statistically significant improvement for all radiographic variables, functional measures and range of motion investigated in the study (p < 0.05). Although the study showed improvement in all temporal parameters (p < 0.05) measured in the gait analysis, the results demonstrated there were no statistically significant differences in the kinematic and kinetic variables (p > 0.05) before and after surgery. CONCLUSIONS: Although there was no significant improvement in the kinematic and kinetic variables investigated, this study supports the calcaneo-stop procedure as a reliable and effective procedure for treating paediatric flexible flatfoot.

An unusual presentation of extranodal Rosai-Dorfman disease threatening the airway.

Rosai-Dorfman disease (RDD) is a rare benign systemic histiocytic proliferation, characterized by massive lymph node enlargement and sometimes associated with extranodal involvement. Even though it is considered as a benign disease, fatalities can occur due to its unusually large size and its location. Our case highlighting a primary extranodal site of vallecula, which is extremely rare and not reported in literature before. It presented with almost complete obstructing the oropharyngeal airway creating a life threatening situation, needed emergency tracheostomy.

In silico attempt for adduct agent(s) against malaria: Combination of chloroquine with alkaloids of Adhatoda vasica.

With the aim of controlling drug resistant Plasmodium falciparum, a computational attempt of designing novel adduct antimalarial drugs through the molecular docking method of combining chloroquine with five alkaloids, individually is presented. These alkaloids were obtained from the medicinal plant, Adhatoda vasica. From the obtained individual docking values of important derivatives of quinine and chloroquine, as well as, individual alkaloids and adduct agents of chloroquine with Adhatoda alkaloids as ligands, it was discernible that the 'adduct agent-1 with chloroquine and adhatodine' combination had the minimum energy of interaction, as the docking score value of -11.144 kcal/mol against the target protein, triosephosphate isomerase (TIM), the key enzyme of glycolytic pathway. Drug resistance of P. falciparum is due to a mutation in the polypeptide of TIM. Moratorium of mutant TIM would disrupt the metabolism during the control of the drug resistant P. falciparum. This in silico work helped to locate the 'adduct agent-1 with chloroquine and adhatodine', which could be taken up by pharmacology for further development of this compound as a new drug against drug resistant Plasmodium.

Isolated case of mucosal histoid Hansen's disease of the nasal cavity in a post-global elimination era.

Histoid Hansen's disease is a rare form of multibacillary leprosy with distinct clinical and histopathological features. This type of leprosy is a variant of lepromatous leprosy with a very high bacterial reserve. Of alarming concern is the discovery of an isolated mucosal histoid leprotic lesion inside the nasal cavity of a patient in the post-global leprosy elimination era. Our case had no history of leprosy or exposure to dapsone/multidrug therapy but had a heavy bacillary index. We are reporting this case to highlight the rarity of mucosal lesions due to histoid leprosy and involvement of the nasal cavity, as well as to create awareness and avoid misdiagnosis. This will help facilitate prompt treatment to minimize the complications and deformities of the patient and prevent its spread throughout the community.

Success in pregnancy through intrauterine insemination at first cycle in 300 infertile couples: an analysis.

OBJECTIVE: The aim of this article was to determine digital levels of the association of factors of pregnancy success after the first cycle of intrauterine insemination (IUI) with 300 infertile couples. METHODS: The IUI procedure was followed at 36 h after triggering the ovulation, if at least one follicle measured >15 mm. Endometrium thickness (ET) and serum luteinizing hormone (LH) levels were measured at day 10 for each patient. The post-wash total motile fraction (TMF) of semen of the partner of each patient was also evaluated. The principal component analysis (PCA) was done with the data to quantify the associations of related factors. RESULTS: The clinical pregnancy rate of first cycle IUI attempts was 17.3 %, observed in females, aged 20-39 years and men with TMF >5 million spermatozoa. The ovarian stimulation enabled the development of follicles measuring >16 mm, with LH levels <10 mIU/L and ET >5 mm for success. The PCA revealed that with the female-age parameter, three factors, NF, ET, and LH were related in the component 1; similarly, NF, LH, and RFS were related in component 2; age, NF, ET, LH, LFS, and TMF were related in component 3; and NF, ET, LH, RFS, and LFS in component 4 were related, i.e., the best correlation. CONCLUSIONS: Associated principal determinative factors, LH, female-age, NF and LFS values were highly significant, but the factors, ET, RFS and TMF were statistically insignificant for success through IUI in pregnancy.

Statistical Evaluation of Two Microbiological Diagnostic Methods of Pulmonary Tuberculosis After Implementation of a Directly Observed Treatment Short-course Program.

OBJECTIVES: To evaluate the diagnostic accuracy of smear and culture tests of clinical samples of pulmonary tuberculosis after the introduction of the directly observed treatment short-course (DOTS) program. METHODS: Using sputum samples from 572 individuals as a self-selected population, both Ziehl-Neelsen staining and culturing on Lowenstein-Jensen medium were carried out as diagnostic procedures. Using Bayes' rule, the obtained data set was analyzed. RESULTS: Of the 572 samples, 33 (0.05769) were true positive (results of both tests positive) cases; 22 samples (0.03846) were false positive (smear test positive and culture test negative) cases; 62 samples (0.10839) were false negative (smear test negative and culture test positive) cases; and 455 samples (0.79545) were true negative (results of both tests negative) cases. Values of test statistics, sensitivity, and specificity were used to compute several inherent other Bayesian test statistics. The a priori probability or prevalence value of tuberculosis in the targeted population was 0.166. The a posteriori probability value computed arithmetically was 0.6614 and that obtained by the graphical method was 0.62. CONCLUSIONS: The smear test was found to be dependable for 95.4% with stable TB infections, and it was not dependable for 34.7% without stable TB infections. The culture test could be regarded as the gold standard for 96.15% as seen with the data set, which was obtained after the implementation of the DOTS program.

A report on infection dynamics of inducible clindamycin resistance of Staphylococcus aureus isolated from a teaching hospital in India.

OBJECTIVE: To investigate the infection of hospital- and community-acquired "erythromycin-induced clindamycin resistant" strains or D-test positives of clinical isolates of Staphylococcus aureus (S. aureus) (with and without methicillin resistance) in a hospital. METHODS: Strains of S. aureus isolated from clinical specimens were subjected to D-test and antibiotic profiling. RESULTS: Of the total 278 isolates, 140 (50.35%) were D-test positives and the rest were D-test negatives. Further, of 140 (100%) positives, 87 (62.14%) and 53 (37.85%) strains were from males and females, respectively. Of 140 (100%) positives, 117 (83.57%) were methicillin resistant S. aureus and 23 (16.42%) were methicillin sensitive S. aureus; of 140 strains, 103 (73.57%) strains from persons with and 37 (26.42%) were without related infections; of 140 strains, 91 (65%) and 49 (35%) were from hospital- and community-acquired samples, respectively. In 140 strains, 118 (84.28%) with comorbidities and 22 (15.71%) without comorbidities cases were recorded; similarly, persons with prior antibiotic uses contributed 108 (77.14%) and without 32 (22.85%) positive strains. These binary data of surveillance were analyzed by a univariate analysis. It was evident that the prior antibiotic uses and comorbidities due to other ailments were the determinative factors in D-test positivity, corroborated by low P values, P=0.001 1 and 0.002 4, respectively. All isolates (278) were resistant to 17 antibiotics of nine groups, in varying degrees; the minimum of 28% resistance for vancomycin and the maximum of 97% resistance for gentamicin were recorded. Further, of 278 strains, only 42 (15.1%) strains were resistant constitutively to both antibiotics, erythromycin resistant and clindamycin resistant, while 45 (16.2%) strains were constitutively sensitive to both antibiotics (erythromycin sensitive and clindamycin sensitive). Further, of the rest 191 (68.7%) strains were with erythromycin resistant and clindamycin resistant, of which only 140 (50.35%) strains were D-test positives, while the rest 51 (18.34%) strains were D-test negatives. CONCLUSIONS: In view of high prevalence of D-test positive S. aureus strains, and equally high prevalence of multidrug resistant strains both in community and hospital sectors, undertaking of D-test may be routinely conducted for suppurative infections.

Which value should be used as the lethal concentration 50 (LC(50)) with bacteria?

Computations of lethal concentration 50 (LC(50)) of a data-set of a toxicity study on an herbicide against a cyanobacterium were performed by general linear regression, Spearman-Karber and probit transformation methods, for evaluation of the methods used. It is shown that the linear regression method yields some faulty LC(50) value, while both of Spearman-Karber and probit methods yield similar and statistically respectable LC(50) values. In the Spearman-Karber method, a prerequisite of some uniform dose-interval of test-chemical and tiring calculations were involved. But, the probit method is less tiring and additionally computed LC(25) and LC(75) values help assess the solicited accuracy of the LC(50) value and other test-statistics, including minimum inhibitory concentration (MIC), highest-permissive concentration (HPC), and a few more with respect to lethal concentration 100 (LC(100)) without prerequisite of any uniform dose-interval of test-chemical. Further, the redundancy of computations of standard error (SE) and 95% confidence limits (CL) of the LC(50) value is suggested, as CL values are so wide to spoil LC(50) accuracy that is solicited in toxicology.