Oral Manifestations of Multiple Endocrine Neoplasia 2B Syndrome: A Rare Case Report.

Multiple endocrine neoplasia (MEN) 2B syndrome is a rare autosomal dominant hereditary condition of neuroendocrine origin characterized by pheochromocytoma, marfanoid habitus, and mucocutaneous neuromas. Multiple mucosal neuromas on the tongue, lips, cheeks, and inner eyelids are often appeared as the earliest signs in most of the undiagnosed cases. Early diagnoses, recognition of phenotype, adequate surgery, and appropriate genetic counseling are very much essential as patients often develop medullary thyroid carcinoma (MTC) and pheochromocytoma. This case report would highlight the oral manifestations of MEN 2B in a 22-year-old female patient with multiple mucosal neuromas and a previous history of thyroidectomy due to MTC.

IL-17 A correlates with disease progression in papillary thyroid carcinoma.

BACKGROUND: Cancer progression can be promoted by chronic inflammation. Local immune response may be associated with favourable or unfavourable prognosis of Papillary Thyroid Carcinoma (PTC). Regulatory T (Treg) cells and T helper 17 (Th17) cells exert opposing function and their balance may have a vital role in promotion of tumor growth. Treg cells in tumor microenvironment (TME) may promote tumor progression and reduced survival of patients. Whereas, Th17 cells can promote or inhibit tumor progression depending on phenotypic characteristics of tumor. In this study, we aimed to analyse the kind of immune response developed and its prognostic impact in future therapeutics. METHODS: Cytometric Bead Array (CBA) analysis of pro and anti-inflammatory cytokines (IFN-gamma, IL-2, IL-6, IL-17 A, TNF-alpha and IL-4, IL-10) was done in 15 PTC irrespective of Lymphocytic Thyroiditis (LT) and 16 Hashimoto's Thyroiditis (HT) cases. Immunohistochemical expression of FoxP3 and IL-17 A was studied in 27 cases of PTC with LT. Whereas, quantitative gene expression of both was analysed in 10 cases. RESULTS: All the pro-inflammatory cytokines showed mild elevation in PTC with LT. On IHC, IL-17 A expression was observed in 74% PTC with LT. Whereas, FoxP3 was present in only 40% cases. Also, IL-17 A expression was significantly associated with age group (> 45 years), tumor size ≤ 1 cm and disease progression. CONCLUSIONS: Increased expression of cytokines suggested correlation between inflammatory factors and progression of thyroid tumors. Along with this, the balance between IL-17 A and FoxP3 may play an important role in PTC development, prognosis and future management.

In search of ethical pandemic technology.

The duration of the pandemic over the last two years has witnessed the steering of multiple technological interventions by governments. These interventions - ranging from contact tracing applications to vaccine certificates - have been developed in the specific context of the pandemic, and were meant to address its unique requirements. This family of technological interventions may be termed "pandemic technology" - having diverse uses such as preventing the transmission of Covid-19, and aiding the relaxation of pandemic-induced restrictions. We propose a four-rung ethical paradigm for the deployment of such technology. We call it the STEP model and its four pillars consist of (i) sunset clauses, (ii) trust, (iii) equity, and (iv) privacy preservation.

Role of cytotoxic T cells and PD-1 immune checkpoint pathway in papillary thyroid carcinoma.

Background: Lymphocytic thyroiditis (LT) is frequently seen in the tumor microenvironment (TME) of papillary thyroid carcinomas (PTCs). However, the characteristic of these tumor-infiltrating lymphocytes (TILs) is not well understood. Objective: We aim to define the TME of PTC cases by characterizing the TILs. Design: This is a cross-sectional observational study. Patients: We enrolled 29 PTC (23 having concurrent LT), 14 LT, and 13 hyperplastic nodules with LT (HN) patients from January 2016 to December 2020. Measurements: Immunohistochemical (IHC) expression of CD8, FoxP3, PD-1, and PD-L1 was studied in PTC with LT and compared with HN. PD-1 and PD-L1 expression was correlated at the mRNA level by quantitative real-time PCR. Immunophenotyping of TILs was done in FNAC samples of PTC and LT by flow cytometry. Results: IHC revealed the presence of CD8+ cytotoxic T lymphocytes (CTLs) and FoxP3+ T regulatory cells (Tregs) in 83% and 52% of PTC with LT cases, respectively. Flow cytometric analysis of the PTC samples revealed a significant abundance of CTL compared with Treg and a higher CTL with lower Treg counts compared with LT. On IHC, PD-1 positivity was noted in 56.5% of PTC with LT cases, while intermediate PD-L1 positivity was found in 70% of the cases. There was a significant upregulation of PD-1 mRNA in PTC with LT. A significant correlation was noted with PD-L1 expression with lymph node metastasis and presence of Treg cells. Conclusions: Increased expression of PD-1 and PD-L1 in the TME of PTC may provide a potential molecular mechanism for tumor survival despite the predominance of CTLs, possibly through their inactivation or exhaustion.

Understanding the Placental Biology of Tobacco Smoke, Nicotine, and Marijuana (THC) Exposures During Pregnancy.

Widespread public health campaigns have reduces the prevalence of tobacco and nicotine exposures during pregnancy in the United States. However, tobacco and nicotine exposures during pregnancy persist as a common modifiable perinatal risk exposure. Furthermore, declines in tobacco use have been accompanied by parallel rises in both the prevalence and incidence of marijuana use in pregnancy. This is worrisome, as the macromolecules which comprise tobacco and marijuana smoke affect placental function. In this chapter we summarize the decades of evidence contributing to our understanding of the placental molecular pathophysiology accompanying these chemical exposures, thereby rendering risk of adverse perinatal outcomes.

Epithelial expression of epithelia-cadherin in different grades of oral squamous cell carcinoma.

BACKGROUND: The incidence of oral squamous cell carcinoma (OSCC) has been increasing day by day in the Southeast Asian countries. There is variation in the incidence rates in various parts of the world, with the highest recorded in Southeast Asian countries such as Sri Lanka, India, Bangladesh, and Pakistan. The survival rate for OSCC has remained generally unchanged in the past three decades, underlining the need for more biomarkers to be developed to aid prognostication and effective treatment planning and management. The prognostic potential of epithelia-cadherin (E-cadherin) expression in OSCCs has been variable in previous studies has been correlated with improved prognosis in other cancers. The aim of the present study was to investigate and analyze the expression of E-cadherin in different histopathological grades OSCC, to understand its potential as prognostic biomarker of most common oral cancer. MATERIALS AND METHODS: E-cadherin expression was examined by immunohistochemistry in 35 cases of OSCC of the buccal mucosa and 5 of normal buccal mucosa. RESULTS: In our study, E-cadherin expression appeared in widely differentiated squamous cell carcinoma (130.75 ± 30.64) moderately differentiated squamous cell carcinoma (123.66 ± 13.17), and poorly differentiated squamous cell carcinoma (88.52 ± 30.11). CONCLUSIONS: E-cadherin expression is reduced with higher grades of OSCC. However, the present results suggest that E-cadherin expression may be useful as prognostic markers for OSCC.

Interactions between Environmental Exposures and the Microbiome: Implications for Fetal Programming.

Decades of population-based health outcomes data highlight the importance of understanding how environmental exposures in pregnancy affect maternal and neonatal outcomes. Animal model research and epidemiological studies have revealed that such exposures are able to alter fetal programming through stable changes in the epigenome, including altered DNA methylation patterns and histone modifications in the developing fetus and infant. It is similarly known that while microbes can biotransform environmental chemicals via conjugation and de-conjugation, specific exposures can also alter the community profile and function of the human microbiome. In this review, we consider how alterations to the maternal and or fetal/infant microbiome through environmental exposures could directly and indirectly alter fetal programming. We highlight two specific environmental exposures, cadmium (Cd) and polycyclic aromatic hydrocarbons (PAHs), and outline their effects on the developing fetus and the perinatal (maternal and fetal/infant) microbiome. We further consider how chemical exposures in the setting of natural disasters may be of particular importance to environmental health.

Poorly known microbial taxa dominate the microbiome of hypersaline Sambhar Lake salterns in India.

Inland athalassohaline solar salterns provide unique opportunity to study microbial successions along salinity gradients that resemble transition in natural hypersaline lakes. We analyzed for the first time 16S rRNA gene amplicon sequences of bacteria (V1-V2) and archaea (V4-V5) in saltern brines of India's largest inland hypersaline Sambhar Lake. Brines of the salterns (S1-S4) are alkaline (pH 9.5-10.5) with salinities of 130, 170, 280 and 350 gL-1 respectively. 16S rRNA gene copy-number of archaea outnumbered that of bacteria in all salterns. Their diversity also increased along S1 through S4, while that of bacteria decreased. Brines of S3 and S4 were dominated by specialized extreme halophilic bacterial (Halanaerobiales, Rhodothermaceae) and archaeal (Halobacteriales, Haloferacales) members with recognized salt-in strategy for osmoadaptation. Microbial assemblages positively correlated to saltern pH, total salinity, and ionic composition. Archaea in S1 and S2 were unprecedentedly represented by poorly known as-yet uncultivated groups, Woesearchaeota (90.35-93.51%) and Nanohaloarchaeota that belong to the newly proposed nano-sized superphylum DPANN. In fact, these taxa were identified in archaeal datasets of other athalassohaline salterns after re-analysis using latest RDP database. Thus, microbial compositions in hypersaline lakes are complex and need revisit particularly for their archaeal diversity to understand their hitherto unknown ecological function in extreme environments.

A Bacillus strain TCL isolated from Jharia coalmine with remarkable stress responses, chromium reduction capability and bioremediation potential.

Microbial reduction of Cr(VI) to Cr(III) can mitigate environmental chromium toxicity. A chromium, cadmium and nickel tolerating strain TCL with 97% 16S rRNA gene sequence homology to Bacillus cereus was isolated from a derelict open-cast, Tasra Coalmine Lake of Jharia, India. It could tolerate up to Cr2000 [2,000 mg L-1 Cr(VI)] and completely reduce Cr200 within 16 h under heterotrophic condition. TCL grown in ≥ Cr500 exhibited multifarious stress responses particularly in its prolonged lag-phase, like cell aggregation, up to two-fold elongation, increased exopolysaccharide production, and stress enzyme activities. These were relieved by increasing inoculum size or nutrient content. Chromium reduction was constitutive, with maximum activities detected in loosely-bound exopolysaccharides and membrane fractions, followed by cytoplasm and spent media. Cr(VI) was efficiently reduced to Cr(III) and >90% was released in spent media. Cells also expressed Cr-induced active efflux pumps. Growing cells or its crude enzyme extracts could efficiently reduce Cr(VI) in diverse temperatures (15-45 °C), pH (5-9); and in presence of other metals (Cd, Cu, Mo, Ni, Pb), oxyanions (SO4-2, NO2-), and metabolic inhibitors (phenol, NaN3, EDTA). Growth and reduction were also detected in nutrient-limited minimal salt media, and contaminated leather industry effluent thereby making TCL a potential candidate for bioremediation.

Increased productivity in poultry birds by sub-lethal dose of antibiotics is arbitrated by selective enrichment of gut microbiota, particularly short-chain fatty acid producers.

Antibiotics are widely used at sub-lethal concentrations as a feed supplement to enhance poultry productivity. To understand antibiotic-induced temporal changes in the structure and function of gut microbiota of chicken, two flocks were maintained for six weeks on a carbohydrate- and protein-rich diet. The feed in the conventional diet (CD) group was supplemented with sub-lethal doses of chlorotetracycline, virginiamycin and amoxicillin, while the organic diet (OD) had no such addition. Antibiotic-fed birds were more productive, with a lower feed conversion ratio (FCR). Their faecal samples also had higher total heterotrophic bacterial load and antibiotic resistance capability. Deep sequencing of 16S rDNA V1-V2 amplicons revealed Firmicutes as the most dominant phylum at all time points, with the predominant presence of Lactobacillales members in the OD group. The productivity indicator, i.e. higher Firmicutes:Bacteroidetes ratio, particularly in the late growth phase, was more marked in CD amplicon sequences, which was supported by culture-based enumerations on selective media. CD datasets also showed the prevalence of known butyrate-producing genera such as Faecalibacterium, Ruminococcus, Blautia, Coprococcus and Bacteroides, which correlates closely with their higher PICRUSt-based in silico predicted 'glycan biosynthesis and metabolism'-related Kyoto Encyclopedia of Genes and Genomes (KEGG) orthologues. Semi-quantitative end-point PCR targeting of the butyryl-CoA: acetate CoA-transferase gene also confirmed butyrate producers as being late colonizers, particularly in antibiotic-fed birds in both the CD flocks and commercial rearing farms. Thus, antibiotics preferentially enrich bacterial populations, particularly short-chain fatty acid producers that can efficiently metabolize hitherto undigestable feed material such as glycans, thereby increasing the energy budget of the host and its productivity.

Localized Gingival Overgrowths: A Report of Six Cases.

Localized gingival overgrowths are commonly encountered in our day-to-day clinical practice and often present a diagnostic dilemma to the clinicians. These lesions vary depending on the location, site, extent, histology, and/or etiopathology. Although most of the localized gingival enlargements represent the reactive lesion to plaque accumulation, the differential diagnosis ranges from peripheral fibroma to pyogenic granuloma to peripheral fibroma with ossification and/or calcification, peripheral giant cell granuloma, etc., Even the peripheral ameloblastoma may present clinically as a mere localized gingival enlargement. Therefore, proper histopathological diagnosis along with biopsy is necessary to effectively manage these lesions and to reduce their propensity for recurrence.

Household survey of pesticide practice, deliberate self-harm, and suicide in the Sundarban region of West Bengal, India.

The toxicological impact and intentional ingestion of pesticides are major public health concerns globally. This study aimed to estimate the extent of deliberate self-harm (DSH) and suicides (suicidal behaviour) and document pesticide practices in Namkhana block of the Sundarban region, India. A cross-sectional study was conducted in 1680 households (21 villages) following a mixed random and cluster design sampling. The survey questionnaire (Household Information on Pesticide Use and DSH) was developed by the research team to elicit qualitative and quantitative information. The Kappa statistic and McNemar's test were used to assess the level of agreement and association between respondents' and investigators' opinions about safe storage of pesticides. Over five years, 1680 households reported 181 incidents of suicidal behaviour. Conflict with family members was the most frequently reported reason for suicidal behaviour (53.6%). The Kappa statistic indicated poor agreement between respondents and investigators about safe storage of pesticides. The pesticide-related annual DSH rate was 158.1 (95% CI 126.2-195.5), and for suicide it was 73.4 (95% CI 52.2-100.3) per 100,000. Unsafe pesticide practice and psychosocial stressors are related to the high rates of suicidal behaviour. An intersectoral approach involving the local governments, agricultural department and the health sector would help to reduce the magnitude of this public health problem.

Participatory Research for Preventing Pesticide-Related DSH and Suicide in Sundarban, India: A Brief Report.

Deliberate self-harm (DSH) is a major public health problem in the Sundarban region, India. This study is aimed to develop a DSH-suicide prevention programme based on the principles of community-based participatory research (CBPR). Perception and opinion of community about the problem of pesticide-related DSH and suicide were elicited in a series of facilitated focus group discussions in Namkhana block of Sundarban region. Based on their suggestion, a broad preventive programme was launched involving the development of information, education, and communication (IEC) and training modules and training of the stakeholders of the block. Most of the members of each target group found that the IEC materials were culture fair (message is acceptable, understandable, and meaningful in the local context) and very useful. Analysis of Dwariknagar BPHC, DSH admission data showed a definite reduction of DSH incidents after this CBPR approach to prevention was initiated. Similar model of DSH prevention in the other blocks of Sundarban region or in agricultural community may help to reduce the enormous mortality and morbidity from pesticide-related DSH and suicide.

Factors Affecting Non-Adherence among Patients Diagnosed with Unipolar Depression in a Psychiatric Department of a Tertiary Hospital in Kolkata, India.

Non-adherence to depression treatment is a common clinical problem globally. However, limited research is available from India. This cross-sectional study aimed to assess non-adherence to prescribed treatment among patients with unipolar depression at a psychiatric out-patient department (OPD) of a tertiary hospital in Kolkata, India. The Morisky Medication Adherence Scale (MMAS) was used and a questionnaire designed by the Principal Investigator (PI) was administered. A total of 239 patients with unipolar depression were interviewed of whom 66.9% (160) were non-adherent and 33.1% (79) were adherent to treatment. The difference was significant (Fisher's Exact <0.000). Women were nearly three times at a higher risk of being non-adherent compared to men (OR 2.7; 95% CI 1.0-7.1). The non-adherent group compared to the adherent group was significantly more likely to consume extra medicines than the recommended amount (OR 2.8; 95% CI 1.1-7.3) and had lower internal locus of control (LOC) (OR 4.5; 95% CI 2.4-8.3). Adherence to prescribed treatment in an out-patient clinical setting was a problem among patients with unipolar depression. Suitable interventions on individuals with the above mentioned attributes are required in India and in similar settings where non-adherence to depression therapy is an important public health problem.

Under-nutrition among adolescents: a survey in five secondary schools in rural Goa.

BACKGROUND: This study was done in 2008-09 to assess the nutritional status among adolescents (10-19 years of age, Classes V-XII) in 5 schools in rural Goa to inform the content of a health promotion intervention in these schools. METHODS: Three methods were used. First, nutritional status was measured by assessing body mass index among 1015 students during a health camp in each school. Second, a diet analysis was done to measure energy and protein Intake of 76 randomly selected underweight students. Third, a self-report questionnaire survey measured the prevalence of hunger among 684 students. RESULTS: One-third of students (338; 37.8% boys and 27.5% girls) who attended the health camps were underweight and 59.2% of the 684 students who completed the survey reported experiencing hunger due to inadequate food consumption. More boys were underweight than girls (p<0.001) and under-nutrition was uniform across all the years of schooling. Energy intake of underweight students was significantly lower than the recommended daily allowance. The results were shared with the School Health Promotion Advisory Boards to generate information on the stakeholders' perception about the issue and ways to address it. CONCLUSION: There is an immediate need to address the high burden of hunger and under-nutrition in adolescents of both sexes in schools by instituting routine annual monitoring of nutritional status, extending the mid-day meal programme to all school-going adolescents, providing nutritional counselling for underweight adolescents and expanding research on the causes and impact of under-nutrition and evaluation of the impact of the enhanced mid-day meal programme.

Deliberate self-harm and suicide by pesticide ingestion in the Sundarban region, India.

OBJECTIVE: To examine the clinical epidemiology, including case fatality and determinants of self-harm in six island blocks of the Sundarban region of West Bengal, India. METHODS: We examined the clinical records of 1277 patients admitted for deliberate self-harm (DSH) to the six island hospitals from 1999 to 2001. RESULTS: 77.7% of the patients survived their attempt, 11.9% died and for 10.4% the outcome was not recorded. Women accounted for 65.2% of the DSH admissions and 67.1% of the deaths. Pesticides were the most commonly used means (88.7%). The case fatality of self-harm reported in these hospitals ranged from 6.0% to 50.0% (mean 13.3%; CI, 11.3-15.3). The age group 55-64 years was at highest risk of death, the age group 15-24 years at lowest risk. Higher lethality of pesticide ingestion compared to other methods was suggestive but not significant. Case fatality within the region varied but was high compared to industrialized nations. Case records and management of DSH were poor. CONCLUSION: Effective DSH prevention in the Sundarban region would require better surveillance at clinical facilities and an intersectoral approach, linking the agricultural interests of pesticide safety and mental health interests for preventing DSH.

Pesticide practices and suicide among farmers of the sundarban region in India.

BACKGROUND: Deliberate self-poisoning by ingesting pesticides is a serious health problem among farmers, especially in low- and middle-income countries. Preventing these suicides is a priority for a public mental health agenda. OBJECTIVE: To examine the role of pesticide poisoning in suicide and nonfatal deliberate self-harm, and clarify awareness of risks, safe practices concerning storage and use of pesticides, and associated self-injury, both unintentional and intentional, within farmer households of the Sundarban region, India. METHODS: Retrospective record review of adult cases of deliberate self-poisoning at the Block Primary Health Centres of 13 Sundarban Blocks was performed to analyze the relative roles of various methods of self-harm and their lethality. Focus group discussions, questionnaires, and in-depth interviews were undertaken in a community study of farmer households to examine pesticide-related views and practices, with particular attention to storage, use, and health impact. RESULTS: Pesticide poisoning was the most common method of deliberate self-harm in both men and women. Pesticide storage in most households was unsafe and knowledge was inadequate concerning adverse effects of pesticides on health, crops, and the environment. CONCLUSIONS: An intersectoral approach linking the interests of public health, mental health, and agriculture is well suited to serve the collective interests of all three agendas better than each in isolation. Such an approach is needed to reduce morbidity and mortality from unintentional and intentional self-injury in low-income agricultural communities like those of the Sundarban region.

Pesticide poisoning in non-fatal deliberate self-harm: A public health issue: Study from Sundarban delta, India.

BACKGROUND: Non-fatal deliberate self-harm (DSH), particularly with pesticides, is a major public health problem in many developing countries of the world. Agriculture is the primary occupation of most people living in the Sundarban region in West Bengal, India. Pesticides are extensively used in agriculture, and these agents are most frequently used in DSH. AIM: This study aimed to identify the nature of methods and agents used in non-fatal DSH attempts in the Sundarban area under South 24 Parganas district of West Bengal. MATERIALS AND METHODS: Detailed demographic and clinical data on DSH cases of 13 Block Primary Health Centres' (BPHCs') admission registers were analyzed. One Focus Group Discussion (FGD) with the Panchayat Samiti of each block (totally 13 FDGs) was conducted to elicit the Samiti members' perception about the problem of pesticide-related DSH or suicide in the region. RESULTS: A total of 5,178 (1,887 male and 3,291 female) subjects were admitted at the BPHCs during the study period from 1999 to 2001. Organophosphorous pesticide poisoning was found to be the most common method (85.1%) in DSH. This emphasizes the importance of developing an urgent poisoning-prevention program with a special focus on improving clinical services, as well as initiating farmers' education programs focusing on safe pesticide practices at the primary-care level.

Pesticide poisoning in nonfatal, deliberate self-harm: A public health issue.

BACKGROUND: Nonfatal, deliberate self-harm (DSH), particularly with pesticides, is a major public health problem in many developing countries of the world. Agriculture is the primary occupation of most people living in the Sundarban region in West Bengal, India. Pesticides are extensively used in agriculture and these agents are most frequently used in DSH. AIM: This study sought to identify the nature of methods and agents used in nonfatal DSH attempts in the Sundarban area under South 24 Parganas district of West Bengal. MATERIALS AND METHODS: Detailed demographic and clinical data on DSH cases of 13 Block Primary Health Centres (BPHCs') admission registers were analysed. Focus Group Discussions (FGDs) were conducted with the Panchayat Samithy of each block to elicit their perception about the problem of pesticide-related DSH or suicide in the region. RESULTS: Five thousand, one hundred and seventy-eight (1,887 male and 3,291 female) subjects were admitted in the BPHCs during the study period from 1999 to 2001. Organophosphorous pesticide poisoning was found to be the most common method (85.1%) in DSH. This emphasizes the importance of developing an urgent poisoning prevention program with a special focus on improving clinical services as well as initiating farmers' education programs focusing on safe pesticide practices at the primary care level.