Prostate biopsies: Available technique, approaches and diagnostic accuracy.

Despite advances in the diagnosis of prostate cancer over the past century, it remains a leading cause of cancer related death. A recent recommendation against screening has further complicated the diagnosis and management of this condition. It remains to be demonstrated if newer diagnostic modalities will have an impact on mortality rates. Most certainly, not all prostate cancers need to be diagnosed, and methods of accurately diagnosing those cancers that lead to death needs more work. In this review article, we describe the different techniques, approaches and diagnostic accuracies of the currently used biopsy methods.

Determination of Alkyl Methanesulfonates in Doxazosin Mesylate by Gas Chromatography-mass Spectrometer.

High sensitive rapid gas chromatography-mass spectrometry method for the determination of four carcinogenic alkyl methanesulfonates viz. methyl methanesulfonate, ethyl methanesulfonate, isopropyl methanesulfonate and n-butyl methanesulfonate in doxazosin mesylate has been presented by using selective ion monitoring mode. The optimum separation was achieved between methyl methanesulfonate, ethyl methanesulfonate, isopropyl methanesulfonate and n-butyl methanesulfonate on a DB-5 (30 m×0.32 mm×1.0 µm) capillary column under programming temperature. Acetonitrile, water and ammonia (90:9:1 v/v/v) mixture was used as diluent. Various factors involved in the gas chromatography-mass spectrometry method development are also presented. This method was validated as per International Conference on Harmonization guidelines. The limit of quantitation of methyl methanesulfonate, ethyl methanesulfonate, isopropyl methanesulfonate and n-butyl methanesulfonate is 6 ppm with respect to 30 mg/ml of doxazosin mesylate.

Determination and characterization of degradation products of anastrozole by LC-MS/MS and NMR spectroscopy.

Two new degradation products for Anastrozole active pharmaceutical ingredient (ANZ) have been identified and reported in this paper. The ANZ was subjected to thermal, photolytic, oxidative and base stress conditions prescribed by ICH guidelines. Separation of ANZ from its existing impurities and the two new impurities was achieved by using on Oyster ODS-3 (100 mm×4.6 mm×3.0 µm) column with an isocratic mixture of 10 mM ammonium formate and acetonitrile in the ratio 60:40 (v/v). The flow rate was 0.5 ml min(-1). The elution was monitored at 215 nm. An isocratic stability indicating reverse phase liquid chromatographic (RP-LC) and LC-MS/MS method was developed for the determination of purity and assay of ANZ through forced degradation studies. The two new impurities detected were further subjected to spectroscopic studies. Based on the results obtained from the different spectroscopic studies, these impurities have been characterized as 2,2'-(5-((1H-1,2,4-triazol-1-yl)methyl)-1,3-phenylene)bis(2-methylpropanoicacid) (Diacid) and 2-(3-((1H-1,2,4-triazol-1-yl)methyl)-5-(2-cyanopropan-2-yl)phenyl)-2-methylpropanoicacid (Monoacid). ANZ was found to degrade in base, slightly in oxidative degradation conditions. The degradation products were well resolved from main peak and its impurities thus proved the stability, indicating power of the method. The developed method was validated as per International Conference on Harmonization (ICH) guidelines with respect to specificity, limit of detection, limit of quantitation, precision, linearity, accuracy, robustness and system suitability.

Blood pressure measurement: one arm or both arm?

Guidelines for measuring blood pressure includes measurement of blood pressure on both arms but it is often ignored. Our case report aims at highlighting the need follow the guidelines. A 60 year old 59 kg weighing male asymptomatic patient without any comobidities was posted for bilateral inguinal hernia repair. The interarm blood pressure difference was discovered incidentally during his preanaesthetic evalution. On further evaluation patient was found to be having subclavian stenosis on left side which was asymptomatic. Intraoperative and post operative period was uneventful. Blood pressure measurement should be done in accordance with the stipulated guidelines. Inter arm blood pressure difference should be noted in all patients as not only for diagnosis and treatment of hypertension but also as a tool to diagnose asymptomatic peripheral vascular disesase.

Aflatoxin contamination of pearl millet during field and storage conditions with reference to stage of grain maturation and insect damage.

Aflatoxin contamination in five varieties of pearl millet (ICMH-451, ICMP-50I, ICTP-8203, WCC-75 and ICMV-155) was studied from field and storage conditions in three districts of Andhra Pradesh State, India and the inter-relationships between various parameters such as stage of grain maturation in the field and insect pest infestation in storage in relation to aflatoxin production were evaluated. Aflatoxin contamination was more frequent in the seed samples collected from the fields during rainy season than winter season. All major aflatoxins were isolated from one or the other varieties of pearl millet, whereas aflatoxin G2 was not commonly observed in the seed samples collected during winter. Among all the varieties tested, ICMH-451 was vulnerable to aflatoxin contamination whereas ICMV-155 was the least susceptible variety. The higher amount of aflatoxins was observed in the matured seed samples followed by pre-matured and milky stage. Among all the toxins reported in the field, aflatoxin B1 was found in higher concentration (185 (µg/kg) followed by B2 (105 µg/kg). The four major types of aflatoxins with higher levels (35, 40, 140, 190 µg/kg of G1, G2, B2, B1 were reported in the rainy season seed samples after six months of storage, whereas aflatoxin G1 was not observed in any variety of stored seed sample from winter. Statistical analysis revealed that the aflatoxin incidence in relation to different parameters studied was significantly different for each factor. The relationship between aflatoxin contamination and insect damaged-grain clearly indicated that the seed samples with 16-40% of insect damage contained higher amounts of aflatoxins (758 µg/kg).

Risk factors of herpes simplex virus type 2 among STD clinic attenders in Delhi, India.

The present study was conducted to determine the seroprevalence and risk factors associated with HSV-2 infection among sexually transmitted diseases (STD) clinic attenders of Delhi in India. Out of 128 patients included, 76 were males and 52 were females. Antibodies to HSV 1 and 2 and HIV infection were determined by ELISA. Syphilis seropositivity was determined by VDRL test and confirm by TPHA test. Ulcer scrapping were stained by Giemsa for Herpes progenitalis and Donovan bodies and Grams for Haemophilus decreyi infection. The HSV-2 and HSV-I seroprevalence was found to be 85.2% and 77.3% respectively. 87.3% of HSV-2 seropositive patients were asymptomic. 10.7% of patients had coinfection of HSV-2 and HIV. STDs like syphilis, chancroid, gonococcal and non-gonococcal urethritis were significantly associated in HSV-2 infection. Thus the study demonstrates high prevalence of HSV-2 infection in Delhi city. Significant association of HSV-2 infection with previous history of STD (p < 0.02) and multiple sexual partners in males was found (p < 0.002).

Aflatoxin contamination in insect damaged seeds of horsegram under storage.

Studies on one of the protein rich pulses, horsegram (Dolichos biflorus L.) were carried out to know how far these low risk pulses are free from aflatoxin contamination under severe insect infestation in storage. A total of 150 stored seed samples of horsegram were analyzed for the presence of aflatoxins by collecting 25 samples each of undamaged and insect damaged seeds of all the three varieties (PDM-1, PHG-1 and HG-96). More than 33% of insect damaged seed samples were contaminated with aflatoxin B1 and B2, whereas less than 8% of the undamaged seed samples contain only low levels of aflatoxin B2. Higher levels of aflatoxin B1 (up to 130 µg/kg) were reported in insect damaged seed samples of all the three varieties under study. The levels of aflatoxin B2 were always lower than aflatoxin B1 of the corresponding seed samples with insect damage. Aflatoxin B1 was reported in both the undamaged and insect damaged seed samples of all the three varieties of horsegram. It is evident from the varietal response studies that PDM-1 and HG-96 varieties of horsegram are highly vulnerable to aflatoxin contamination whereas, PHG-1 variety is relatively less susceptible to it. In general, insect infestation leads to increase in fungal invasion (including aflatoxigenic fungi) and this further enhances the levels of aflatoxin contamination in horsegram seeds.

Evaluation of glucomannan for its adsorbing ability of Aflatoxin B1 and T-2 Toxin in the Gastrointestinal Tract of Broiler Chickens.

A biological experiment was conducted to evaluate the ability of glucomannan to adsorb aflatoxin B1(AFB1 and T-2 toxin in gut conditions of broiler chickens. Glucomannan (GM) was tested at 0.1 percent (1kg / ton) on a total of two hundred uniformly weighing five-week-old commercial broiler birds, which were randomly assigned to one of the ten dietary treatments with four replicates each. Four birds were sacrificed at 30 minutes intervals i.e., 0, 30, 60, 90 and 120 minutes from each treatment, and the gut contents were collected. The toxin concentrations in the dried gut samples were estimated and percent of AFB1 and T-2 toxin recovered was measured. Thein vivo results revealed that glucomannan had the ability to adsorb Aflatoxin upto 75-90% and T-2 toxin upto 30-35% in gastrointestinal tract of broilers.

Body mass index and its association with socioeconomic and behavioral variables among socioeconomically heterogeneous populations of Andhra Pradesh, India.

The nature and extent of relationship between socioeconomic and behavioral variables and body mass index [BMI = weight (kg)/height (m)2] is studied in a sample of 1119 individuals (456 males and 663 females), aged 18 to 75 years, drawn from socioeconomically diverse populations from southern Andhra Pradesh, India. These populations are categorized into four groups, with graded lifestyles toward urbanization. The BMI of the participants ranged from 12.6 to 35.1 in males and from 12.3 to 34.2 in females. There is an increasing trend in mean BMI until about 50 years, followed by a decline, indicating nonlinear nature of age effects. Mean BMI also increases with better socioeconomic status of the constituent groups and with decreased physical activity level. A trend of a decrease in the proportion of individuals with chronic energy deficiency and an increase in the proportion of obese individuals is also seen from the traditional Yerukala tribe (group 1) to the urbanized group 4, from the lower to the higher income categories, and from heavy to light physical activity types. Smokers show a greater proportion of obese cases compared with nonsmokers. The prevalence of obesity (BMI > or = 25) is 6.6% in males and 10% in females. The results of the analysis of variance suggest that three of the four socioeconomic and behavioral variables (except smoking) show significant effects on age-adjusted BMI, and the R2 suggests that these variables explain 27.4% of variation in males and 17% in females. Although income explains the largest amount of variation (24%) in males, followed by physical activity and group affiliation, in females group affiliation (12.5%), followed closely by income, accounted for most of the variation. Inclusion of age in the model improved explanatory power by 5-7%. The positive association between socioeconomic status and BMI observed in the present study is qualitatively different from the negative association that characterizes contemporary Western populations.

Can general practitioners carry out drug delivery and periodic examination of leprosy patients in Raipur city?

An intervention study to improve the MDT coverage of leprosy patients by involving general practitioners (GPs) was carried out in Raipur city. Most of the GPs (84%) were willing to undertake drug delivery and periodic examination of the leprosy patients. After involving GPs, the proportion of the patients registered for treatment increased from 33% to 89.2%. The cohort regularity was 57% only which was lower than that found in the Upgraded Urban Leprosy Centre. Drug compliance as found out by the pill count was 91%. Most of the patients (87%) were happy with the services provided by the GPs.

Cellularity of macrophage granuloma and morphological index.

In the present study, morphological index (MI) and average macrophage count per microscopic field in skin sections of 94 lepromatous (LL) patients is correlated. The subjects included 14 cases with some histoid features. The MI in the lepromatous cases varied from less than one to 40 and the corresponding macrophage counts ranged from 40 to 156. In cases with histoid changes the MI varied from 30 to 60 and the cell count ranged from 215 to 360. The histoid cases showed a higher MI and cell count compared to the other lepromatous cases. There was a positive correlation between MI and macrophage count and the hypercellular state appears to depend on living and multiplying bacteria.

Non acid-fast fluorescent M. leprae (?) in skin smears from leprosy patients.

Smears from 74 known smear negative cases of leprosy were examined after staining with Auramine 'O'. 40.54% cases were positive for fluorescent bacilli. 60.52% of cases on treatment and 19.44% cases after RFT had fluorescent bacilli in the skin smears. Results suggest the possibility of a non acid-fast fluorescent positive variant of M. leprae.

Ambiguities in leprosy histopathology.

This paper presents the percentage of definite or suggestive evidence present in 482 biopsies from different types of leprosy. The presence of acid-fast bacilli (AFB) and nerve involvement were taken as definite features for a diagnosis of leprosy, and infiltration of the dermal appendages, neurovascular bundles and dermis by granuloma cells and lymphocytes were regarded as suggestive signs of leprosy. Using these criteria, all cases were categorized into three groups having definite, suggestive, or no signs of leprosy. The results showed definite and suggestive features in 72.2% and 14.1% of the cases, respectively. The remaining 13.7% had none of these signs. These cases were mostly healed lesions. Large, epithelioid cell granulomas without any nerve element present and healed cases proved difficult for a definite diagnosis. Emphasis is placed on searching for residual nerve elements in AFB-negative sections because this increases the certainty level of the diagnosis. Also, it is suggested that for uniformity of understanding and reporting, terminologies need to be narrowed down and restricted to only definite, suggestive, or no diagnosis of leprosy.

Initial intensive therapy for multibacillary leprosy patients--in retrospect.

We analysed the results of 4845 multibacillary (MB) patients being treated with multidrug treatment (MDT) in the Srikakulam District of Andhra Pradesh, India. Of these, 2309 (47.7%) patients were given an initial 14-day intensive therapy with rifampicin, clofazimine and dapsone, followed by the WHO recommended pulse therapy. The rest of the cases were given only pulse therapy. The improvement in terms of bacteriological clearance and the proportion of cases declared released from treatment (RFT) was found to be significantly higher among patients treated with only pulse therapy. Clinic attendance was found to be better and more regular in patients treated with intensive therapy, and no relapses were seen with either therapy. The implications of these findings on the operational aspects of programme implementation are discussed.

Time lag between case registration and commencement of treatment in a leprosy control unit.

Analysis of client-based data as a part of computerised management information system in a Government leprosy control unit in Tamil Nadu reveals that there was delay in initiating treatment of leprosy patients. The mean and standard deviation of the period of delay for cases registered before, within 6 months and after 6 months of start of MDT in the Unit were 6.80 +/- 6.40, 1.97 +/- 3.60 and 0.90 +/- 2.21 months respectively. Further, the delay was longer in PB, female and child cases. Giving priority to therapy for backlog cases and an effective monitoring system with specific indicator for time lag in starting treatment is indicated.

Is bacteriological examination by skin smear necessary in all paucibacillary leprosy patients in mass control programmes?

Skin smear bacteriological examination results of 11,255 paucibacillary leprosy patients from 8 leprosy control units under the National Leprosy Eradication Programme (NLEP) in South India and the Outpatient Department (OPD) of the Central Leprosy Teaching & Research Institute (CLT&RI), Chengalpattu, between 1987 and 1989 were collected and analysed. Only 0.05% of the smears from leprosy control units and 2.49% from the OPD of CLT&RI were found to be positive. Not a single smear from indeterminate, tuberculoid and pure neuritic types of leprosy out of 8263 examined was found positive under field conditions. The relevance of carrying out routine bacteriological examination in mass leprosy control programmes is discussed.

Seroepidemiological study of leprosy in a highly endemic population of south India based on an ELISA using synthetic PGL-I.

As part of a continuing longitudinal immuno-epidemiological study, blood samples were collected by finger prick from 4243 individuals living in a highly endemic area for leprosy in South India. The samples were tested for IgM antibodies against phenolic glycolipid-I using an ELISA. Seropositivity defined as optical density greater than or equal to 0.2000 was marginally higher in the age group 10-30 years and in females. There was no evidence for a higher level in contacts than in non-contacts. The future prospect for the large scale use of this ELISA in high-endemic populations in special epidemiological investigations or routine control programs as a serological tool to detect leprosy infection appears questionable.