Molecular detection and therapeutic study of Trypanosoma brucei evansi from naturally infected horses in Punjab, Pakistan

Trypanosomiasis is one of the severe pathogenic infections, caused by several Trypanosoma species, affecting both animals and humans, causing substantial economic losses and severe illness. The objective of this study was to determine the molecular diagnosis and the risk factors associated with trypanosomiasis in District Jhang, Punjab, Pakistan. For this purpose, blood samples were randomly collected from 200 horses. A predesigned questionnaire was used to collect data on risk factors before the sample collection. The microscopy examination through Giemsa staining, formol gel test and PCR techniques were used to find the prevalence. The prevalence was recorded as 22.5% with microscopy examination, 21% through formol gel test and 15.5% with PCR based results. Analysis of risk factors associated with Trypanosoma brucei evansi occurrence was carried out using Chi-square test. It showed the prevalence of Trypanosoma brucei evansi was significantly (p⟨0.05) associated with sex, age, rearing purpose and body condition whereas non-significantly (p⟩0.05) with insects control practices. This study supports the idea that PCR is a sensitive, robust and more reliable technique to diagnose trypanosomiasis. It was concluded that Trypanosoma brucei evansi is widely prevalent in Jhang (Pakistan), highlighting a dire need to develop control strategies and education programmes to control this disease in developing countries.

Sporadic malignant peripheral nerve sheath tumour (MPNST) in a 3-year-old girl: A diagnostic challenge

INTRODUCTION

Malignant peripheral nerve sheath tumour (MPNST) is an uncommon malignant neoplasm of childhood with unfavourable prognosis. Only a limited number of cases have been reported in children less than 12 years of age, and approximately one-half arise from a benign peripheral nerve sheath tumour, especially in the background of neurofibromatosis type 1 (NF1). Primary MPNST in children is even rarer.

CASE REPORT

A 3-year-old Malay girl presented with painful right axillary swelling for six months, initially treated as axillary lymphadenitis and she defaulted follow up. She came back four months later with enlargement of the swelling. The previous biopsy was reported as Schwannoma, which correlates with a benign peripheral nerve sheath tumour's MRI findings. The final diagnosis after debulking surgery was consistent with MPNST. She succumbed to death 20 months after her initial diagnosis of advanced MPNST and lung metastasis.

PATHOLOGICAL FINDINGS

Grossly, a huge partly circumscribed soft tissue mass was noted arising from a nerve with a solid greyish yellowish myxoid cut surface. Spindle-shaped cells arranged in a herringbone pattern alternated with areas of myxoid hypocellular areas exhibited marked pleomorphism, brisk mitosis, and extensive necrosis are seen microscopically. Immunohistochemistry shows patchy S100 protein staining with loss of expression of H3K27me3.

CONCLUSION

Although MPNST is rare in the paediatric age group, the diagnosis should be considered in children without NF1 with a rapidly evolving and painful mass in the peripheral nerve distribution. In this case, the diagnosis was delayed and made after surgery. Due to its morphologic heterogeneity and lack of specific immunohistochemical markers, MPNST remains a diagnostic challenge.

Effect of garlic supplementation on zootechnical performance and hepato-renal functions in nitrate-treated rabbits

The effect of garlic supplementation on zootechnical performance and hepato-renal functions of rabbits exposed to experimental nitrate poisoning was evaluated. Adult male 6-8 week-old albino rabbits (n= 24) were randomly divided into four groups (A - D) and subjected to nitrate intoxication through the oral administration of sodium nitrate solution at 2 ml/kg bodyweight per day for 40 days. Group A was a control that received no treatment except sodium nitrate. Rabbits in groups B and C were treated with 1% methylene blue solution (2 mg/kg bodyweight per day) and aqueous garlic extract (500 mg/kg bodyweight per day) through intraperitoneal and oral routes, respectively. Rabbits in group D were treated with both 1% methylene blue solution (2 mg/kg bodyweight per day, intraperitoneally) and aqueous garlic extract (500 mg/kg bodyweight per day, orally). On completion of the treatment period, the groups were compared in growth performance, biochemical profile and histopathological changes of hepato-renal tissues. Although the total feed consumption of the groups remained comparable, Group C showed relatively better weight gain and feed conversion ratio (FCR). Likewise, garlic extract significantly increased the serum bilirubin concentration and reduced the level of other biochemical attributes in comparison with control animals. The hepatic and renal tissues of Groups C and D remained normal, whereas those of the control group exhibited distinct histopathological alterations. It was concluded that garlic supplementation ameliorated the deleterious effects of nitrate intoxication on production performance and hepato-renal functions of rabbits.

Effects of Bacillus subtilis on performance, immune system and gut in Salmonella-challenged broilers

The goal of this study was to compare the effects of Bacillus subtilis and the antibiotic enrofloxacin on growth performance, immune response, intestinal histomorphometry and cecal Salmonella numbers in broilers challenged with S. gallinarum. Salmonella-free chicks (n = 240) were allocated to four groups, comprising six replicates (n = 10) each. Group NN was not infected and received no treatment. Group SN was infected with Salmonella and received no treatment. Group SE was infected with Salmonella and treated with the antibiotic enrofloxacin. Group SP was infected with Salmonella and treated orally with the probiotic B. subtilis. Initially the groups that were infected with Salmonella had reduced growth performance compared with NN. By the fourth week, SE and SP had recovered and weighed as much as or more than NN. The SP group had greater cellular immunity and relative weights of the bursa and thymus than the other groups. SN had the lowest villus height in all the segments of the small intestine and a larger Salmonella population in the ceca. Probiotic supplementation reduced the pathological outcomes more than enrofloxacin. Prophylactic use of B. subtilis-type probiotics had similar effects to the use of antibiotics, alleviated the stress related to infection of S. gallinarum, and improved the growth performance, immune function, and gut mucosal development in broilers. Keywords: growth promoters, immunity, probiotics, poultry villi length

Development of a petroleum pipeline monitoring system for characterization of damages using a Fourier transform

Significant damage to the environment and huge economic losses are potential problems caused by leakage from petroleum pipelines. The occurrence of a leakage in a pipeline throughout its lifetime is very difficult to prevent. To minimize environmental damage and high economic losses, an efficient pipeline monitoring system is required to carry out damage characterization thereby enhancing quick response. The signal processing technique of sampling and reconstruction was adopted and mathematical algorithms for the characterization of damages in pipes were developed using the Fourier transform method. These were simulated with the results showing a good agreement between the shapes and magnitudes of the measured original and reconstructed pulses. The simulation was verified with experiments on the test rig. The results showed an underestimation in the magnitudes of the reconstructed pulses in the range of 40 – 45 %. This problem was solved by using a factor K obtained by dividing the maximum amplitude value of the original pressure pulse by that of the reconstructed pulse. Reconstruction of the measured original pulse at a damage location was achieved from combining the measured pulses from two other close locations using the developed Fourier transform based model. Keywords: Damage Pipeline-monitoring Characterization Fourier transform Reconstruction

RADIATION DOSE FROM DENTAL RADIOGRAPHY IN INDONESIA: A FIVE-YEAR SURVEY

Dose metrics on intraoral and panoramic dental radiography were analyzed to preliminarily indicate dose trend of dental radiology equipment in Indonesia. Measurements were performed in 71 healthcare institutions involving a total of 92 dental X-ray devices. Imaging modes are categorized into 'low dose' and 'high dose' based on the task. The 75th percentile for intraoral IAK was 2.8 and 4.3 mGy for 'low' and 'high' dose modes, respectively while for panoramic devices the 75th percentile of the KAP for 'low' and 'high' dose modes were 85.2 and 192.4 mGy cm2, respectively. Results compared with local regulatory recommendation for intraoral units indicated that 38.8 and 6.3% of measured dose modes on analogue and digital devices, respectively, were above the recommended range. The dose trend can be used as reference for local regulations concerning patient dose in dental radiography and preliminary value prior to the establishment of national diagnostic reference level.

Sex Hormones and Prolactin Levels and Their Association with Anti Cardiolipin Antibody in Patients with Systemic Lupus Erythematosus

Pathogenesis of systemic lupus erythematosus (SLE) is complex and multi-factorial. Among various suggested mechanisms for the disease, the hormonal theory has been considered as one of the most important mechanisms. Recently, the association of sex hormones with manifestations of antiphospholipid antibody syndrome (APLS) has been hypothesized. The aim of present study was to assess the serum levels of anticardiolipin antibody (ACA), sex hormones and prolactin in SLE female patients and their association with the disease. This study comprised 40 SLE female patients and 41 healthy age-matched female subjects. For all patients and controls, the serum levels of ACA (IgG and IgM), estradiol, testosterone, progesterone, dehydroepiandrosterone sulfate (DHEA-S) and prolactin were measured by ELISA method. Our study revealed that serum levels of testosterone, DHEA-S and progesterone were significantly lower in SLE patients than control (p<0.001). However, serum levels of estradiol and prolactin were significantly higher in SLE patients compared to controls (p<0.001). There was a significant difference between mild and moderate severity patients group for ACA positivity (95% CI 13.67-41.3; p=0.03). Also, SLE patients with positive ACA showed significantly lower (p<0.001) serum levels of testosterone, DHEA-S and progesterone and significantly higher (p<0.001) estradiol and prolactin serum levels compared to negative ACA patients. The results of our study indicated that expression and metabolism of sex hormones and prolactin are different in female SLE patients compared to healthy subjects. It seems, change in serum levels of these hormones is related to higher SLE disease activity, increased thrombotic risks and increased renal involvement.

Intraoperative diagnosis of mitral valve endocarditis secondary to Paenibacillus provencensis

We report the first case of infective endocarditis caused by Paenibacillus provencensis. A mitral valve vegetation was incidentally discovered by intraoperative transoesophageal echocardiography in a 70-year-old woman undergoing aortic valve replacement. The precise identification of the causative agent was by means of genotypic characterisation with 16S rDNA gene sequencing. The patient was successfully treated with a 6-week course of antibiotics postoperatively, following debridement of the valve vegetation.

A novel homozygous mutation disrupting the initiation codon in the SLURP1 gene underlies mal de Meleda in a consanguineous family

Mal de Meleda (MDM) is a palmoplantar keratoderma (PPK), characterized by hyperkeratosis of the palms and soles, and keratotic skin lesions. Patients with MDM can develop perioral erythema, keratotic and lichenoid plaques over the joints (including the elbows and knees), nail abnormalities, joint contractures and stiffness, brachydactyly, sclerodactyly, pseudoainhum, and malodorous maceration. MDM is associated with mutations in the SLURP1 gene. We report a consanguineous family in which MDM was inherited in an autosomal recessive manner. Genotyping using microsatellite markers established linkage in the family to the SLURP1 gene, which has been mapped previously to chromosome 8q24.3. Sequence analysis revealed a homozygous missense mutation (c.2T>C, p.Met1Thr) in affected family members. Molecular docking studies using a ZDOCK server predicted disruption of binding of the mutant variant to its target α7-nAChR. This study further supports the previously reported findings that homozygous mutations in the SLURP1 gene cause MDM.

Change in attitudes and knowledge of problem drug use and harm reduction among a community cohort in Kabul, Afghanistan

This pre-post evaluation aimed to measure changes in knowledge and attitudes towards drug users among community representatives in Kabul, Afghanistan, over a period of expansion of harm reduction and drug dependence programming. A convenience sample of 160 professionals aged 18+ years completed interview questionnaires in 2007 and 2009. Views endorsing programme quality and the provision of condoms, infection counselling/testing and needle/syringe distribution increased significantly over the 2-year period. In 13 of 38 statements, there was a substantial (> 10%) change in agreement level, most commonly among men and medical professionals. Attitudes concerning support of drug users remained largely positive, with substantial attitude changes in some subgroups of the population. Further community education through the media and a more cohesive government drug policy may be needed to strengthen community support for harm reduction/drug treatment in Afghanistan.

Paediatric continuing medical education needs and preferences of UNRWA physicians in Jordan

Most physicians who work in the United Nations Relief and Works Agency (UNRWA) infant and child health programme in Jordan are general practitioners with no postgraduate training in paediatrics. Furthermore, in resource-poor or remote settings, the ability to deliver live continuing medical education (CME) is often limited. A questionnaire exploring the resources available for accessing CME, preferences for types of CME, current sources of CME and topics of interest in the field of paediatric care was sent to all 92 physicians practising in UNRWA clinics in Jordan. Of the 89 respondents 80% had attended live medical lectures for CME and 70% CME meetings. Despite most physicians having access to the Internet only 52.8% were interested in Internet-based courses for accessing CME. There was a statistically significant relationship between year of graduation from medical school and preference for Internet-based CME. Implications for CME participation and paediatric CME topics are discussed.

Exome sequencing revealed a novel biallelic deletion in the DCAF17 gene underlying Woodhouse Sakati syndrome

Woodhouse Sakati syndrome (WSS, MIM 241080) is a rare autosomal recessive genetic condition characterized by alopecia, hypogonadism, hearing impairment, diabetes mellitus, learning disabilities and extrapydamidal manifestations. Sequence variants in the gene DCAF17, encoding nucleolar substrate receptor, were identified as the underlying cause of inherited WSS. Considerable phenotypic heterogeneity exists in WSS with regard to severity, organs involvement and age of onset, both in inter-familial and intra-familial cases. In this study, the genetic characterization of a consanguineous pedigree showing mild features of WSS was performed, followed by structural analysis of truncated protein. Exome sequencing identified a novel single base deletion variant (c.270delA; K90Nfs8*) in third exon of the gene DCAF17 (RefSeq; NM_025000), resulting in a truncated protein. Structural analysis of truncated DCAF17 revealed absence of amino acid residues crucial for interaction with DDB1. Taken together, the data confirmed the single base pair deletion as the underlying cause of this second report of WSS from Pakistan. This signifies the vital yet unexplored role of DCAF17 both in development and maintenance of adult tissues homeostasis.

Genotyping of major histocompatibility complex Class II DRB gene in Rohilkhandi goats by polymerase chain reaction-restriction fragment length polymorphism and DNA sequencing

Aim:

To study the major histocompatibility complex (MHC) Class II DRB1 gene polymorphism in Rohilkhandi goat using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and nucleotide sequencing techniques.

Materials and Methods:

DNA was isolated from 127 Rohilkhandi goats maintained at sheep and goat farm, Indian Veterinary Research Institute, Izatnagar, Bareilly. A 284 bp fragment of exon 2 of DRB1 gene was amplified and digested using BsaI and TaqI restriction enzymes. Population genetic parameters were calculated using Popgene v 1.32 and SAS 9.0. The genotypes were then sequenced using Sanger dideoxy chain termination method and were compared with related breeds/species using MEGA 6.0 and Megalign (DNASTAR) software.

Results:

TaqI locus showed three and BsaI locus showed two genotypes. Both the loci were found to be in Hardy–Weinberg equilibrium (HWE), however, population genetic parameters suggest that heterozygosity is still maintained in the population at both loci. Percent diversity and divergence matrix, as well as phylogenetic analysis revealed that the MHC Class II DRB1 gene of Rohilkhandi goats was found to be in close cluster with Garole and Scottish blackface sheep breeds as compared to other goat breeds included in the sequence comparison.

Conclusion:

The PCR-RFLP patterns showed population to be in HWE and absence of one genotype at one locus (BsaI), both the loci showed excess of one or the other homozygote genotype, however, effective number of alleles showed that allelic diversity is present in the population. Sequence comparison of DRB1 gene of Rohilkhandi goat with other sheep and goat breed assigned Rohilkhandi goat in divergence with Jamanupari and Angora goats.

Amino acids as possible alternative nitrogen source for growth of Euglena gracilis Z in life support systems

In recent times Euglena gracilis Z was employed as primary producer in closed environmental life-support system (CELSS), e.g. in space research. The photosynthetic unicellular flagellate is not capable of utilizing nitrate, nitrite, and urea as nitrogen source. Therefore, ammonium is supplied as an N-source in the lab (provided as diammonium-dihydrogenphosphate, (NH4)2HPO4) to E. gracilis cultures. While nitrate exerts low toxicity to organisms, ammonium is harmful for many aquatic organisms especially, at high pH-values, which causes the ionic NH4+ (low toxicity) to be partially transformed into the highly toxic ammonia, NH3. In earlier reports, Euglena gracilis was described to grow with various amino acids as sole N-source. Our aim was to investigate alternatives for (NH4)2HPO4 as N-source with lower toxicity for organisms co-cultivated with Euglena in a CELSS. The growth kinetics of Euglena gracilis cultures was determined in the presence of different amino acids (glycine, glutamine, glutamic acid, leucine, and threonine). In addition, uptake of those amino acids by the cells was measured. Cell growth in the presence of glycine and glutamine was quite comparable to the growth in (NH4)2HPO4 containing cultures while a delay in growth was observed in the presence of leucine and threonine. Unlike, aforementioned amino acids glutamate consumption was very poor. Cell density and glutamate concentration were almost unaltered throughout the experiment and the culture reached the stationary phase within 8 days. The data are compared with earlier studies in which utilization of amino acids in Euglena gracilis was investigated. All tested amino acids (glutamate with limitations) were found to have the potential of being an alternative N-source for Euglena gracilis. Hence, these amino acids can be used as a non-toxic surrogate for (NH4)2HPO4.

The influence of microgravity on Euglena gracilis as studied on Shenzhou 8

The German Aerospace Center (DLR) enabled German participation in the joint space campaign on the unmanned Shenzhou 8 spacecraft in November 2011. In this report, the effect of microgravity on Euglena gracilis cells is described. Custom-made dual compartment cell fixation units (containing cells in one chamber and fixative - RNA lysis buffer - in another one) were enclosed in a small container and placed in the Simbox incubator, which is an experiment support system. Cells were fixed by injecting them with fixative at different time intervals. In addition to stationary experiment slots, Simbox provides a 1 g reference centrifuge. Cell fixation units were mounted in microgravity and 1 g reference positions of Simbox. Two Simbox incubators were used, one for space flight and the other as ground reference. Cells were fixed soon after launch and shortly before return of the spaceship. Due to technical problems, only early in-flight samples (about 40 min after launch microgravity and corresponding 1 g reference) were fully mixed with fixative, therefore only data from those samples are presented. Transcription of several genes involved in signal transduction, oxidative stress defence, cell cycle regulation and heat shock responses was investigated with quantitative PCR. The data indicate that Euglena cells suffer stress upon short-term exposure to microgravity; various stress-induced genes were up-regulated. Of 32 tested genes, 18 were up-regulated, one down-regulated and the rest remained unaltered. These findings are in a good agreement with results from other research groups using other organisms.

Polymorphism of ITPA 94C>A and risk of adverse effects among patients with acute lymphoblastic leukaemia treated with 6-mercaptopurine

WHAT IS KNOWN AND OBJECTIVE

Genetic polymorphisms of thiopurine S-methyltransferase (TPMT) and inosine triphosphate pyrophosphohydrolase (ITPA 94C>A) contribute to variable responses, including fatal adverse effects, among subjects treated with 6-mercaptopurine (6-MP). Our objectives were to investigate the distribution of specific TPMT and ITPA genotypes in healthy subjects and patients with acute lymphoblastic leukaemia (ALL) from the three main ethnic groups (Malays, Chinese and Indians) in Malaysia and the association of the polymorphisms with adverse effects of 6-MP.

METHODS

Patients with ALL and healthy controls were recruited and genotyped for genetic variants of TPMT and ITPA 94C>A. The relationship between genotypes and clinical outcomes was investigated.

RESULTS AND DISCUSSION

Acute lymphoblastic leukaemia patients with allele ITPA 94A were more likely to develop fever and liver toxicity with 6-MP. The prevalence of TPMT variants was low and this makes it unlikely that testing for them would be useful in our populations. Only patients heterozygous for TPMT*3C were detected.

WHAT IS NEW AND CONCLUSION

Our results suggest that ITPA 94C>A testing, but not TPMT testing, may help in minimizing the adverse effects of 6-MP in Malaysian patients. However, whether this is true in clinical practice requires a larger study and formal randomized controlled evaluation.

Prevalence of Neospora caninum antibodies in sheep and goats in Pakistan

The purpose of the present study was to obtain seroepidemiological information on the Neospora caninum infection status of sheep and goats in different areas of Punjab Province and Azad Kashmir (Pakistan). A cross-sectional study, with the use of a competitive ELISA, showed an overall 27.7% (35 of 128) (95% confidence interval [CI] ± 7.7%) and 8.6% (13 of 142) (95% CI ± 4.6%) seroprevalence of N. caninum antibodies in sheep and goats, respectively. The difference in seroprevalence between sheep and goat populations was statistically significant (P < 0.05). The highest prevalence (37.4% ± 13.2%) was recorded in the tailless breed of sheep.

Correlation between COX-2 and APC expression in left versus right-sided human colon cancer

BACKGROUND

Because of clinicopathologic and genetic differences between left-sided colorectal cancer (LSCRC) and right-sided colon cancer (RSCC), cyclooxygenase-2(COX-2) and adenomatous polyposis coli (APC) expression may be of clinical relevance.

MATERIALS AND METHODS

Clinicopathologic information for 72 primary colon tumors, 44 left and 28 right, from 72 patients (34 F, 38 M) were analyzed. COX-2 and wild-type APC (W-APC) immunohistochemical expressions were determined for each case. The data were analyzed using the Chi-square test and exact binomial confidence intervals.

RESULTS

Overall, 31 out of 44 (70%) LSCRC were W-COX-2 positive vs. 13 out of 28 (46%) RSCC (p-value=0.042). When evaluated independently of the anatomic location, COX-2 expression showed a borderline statistical correlation with the lack of W-APC protein (p-value=0.054). When considering location of tumors, the inverse correlation between COX-2 and W-APC expression became statistically significant (p-value=0.024).

CONCLUSION

We report a strong inverse correlation between COX-2 and W-APC expression, with COX-2 being more frequently as expressed in LSCRC. These data may be useful to stratify colorectal cancer patients into right- and left-sided and COX-2 expressor and non-expressor subsets, when evaluating COX-2 inhibitor and other targeted therapies in colon cancer.

Molecular characterization of glucose-6-phosphate dehydrogenase deficiency in Pakistani population

INTRODUCTION

Glucose-6-phosphate dehydrogenase (G6PD; E.C. 1.1.1.49) deficiency is the commonest inborn error of metabolism with more than 140 genetic variants. The incidence of G6PD deficiency is 2-9% in Pakistan, but G6PD variants were never studied comprehensively. We therefore designed this study to describe the frequency of G6PD variants and their associated enzyme activities in Pakistan.

METHODS

Patients diagnosed with G6PD deficiency were enrolled. RFLP-PCR was utilized to identify common mutations previously reported from Asian countries. Where mutational analysis failed, amplification of 9-12 exons with subsequent gene sequencing was performed. G6PD enzyme activity was assessed through the quantitative enzyme assay.

RESULTS

Two hundred and seventy-six G6PD-deficient subjects (237 male and 39 women) were investigated. G6PD Mediterranean (563C-T) was the most common genetic variant (n=216 or 78%). G6PD Chatham (1003A-G) and G6PD Orissa (131C-G) were observed in 14 (5%) and two (0.7%) subjects respectively. A novel mutation 973 G-A with a predicated amino acid change of asp325asn was identified in exon 9. This was named G6PD Karachi after the place of origin of proband. Polymorphism in position 1311C/T was uniformly observed with all variants. Forty-three or 17% of DNA samples remained uncharacterized. Very low levels of G6PD enzyme activity was observed with 563C-T mutation.

CONCLUSION

We concluded that 563C-T was the commonest G6PD variant, while 1003A-G and 131C-G were less-frequent genetic variants of G6PD in Pakistani population. A novel genetic variant 973G-A was also identified. Very low levels of G6PD enzyme activity was seen with G6PD 563C-T. Mutational analysis failed in a significant proportion of samples warranting further work.

Nanotechnology and dermatology: benefits and pitfalls

Nanotechnology is the study of purposeful design in the size range of 100 nm and smaller. Discoveries stemming from nanotechnology have led to improvements in materials and devices for industrial and consumer use. The unique properties of nanoscale matter, and the ability to engineer precisely targeted function have led to a great deal of interest in medical research in nanotechnology. Recently, the skin care industry has emerged as the leader in patents issued for nanotechnology. A range of products have been developed or are being developed for the maintenance of skin health, and the diagnosis and management of skin disease. Matter also acquires a greater potential for volatility and unfavorable reactivity on the nanoscale. The skin is the first point of contact for most nanotechnologies and thus may be an early and prime target for nanotoxicity. This review discusses some of the important benefits and risks of nanotechnology within a dermatologic context.

Nanodermatology: a glimpse of caution just beyond the horizon - part II

Nanotechnology is a relatively new branch of engineering and medicine that is making rapid inroads in dermatology. Nanotechnology applies the unique properties of matter on the nanoscale (1000 nm and smaller) for the purposeful design of new materials. Dermatology is already one of the leading beneficiaries of nanotechnology. In Part I of this series, we discussed the benefits of nanotechnology in dermatology. In Part II, we discuss some of the risks. Matter on the nanoscale has the potential for significant chemical volatility, which carries with it an increased risk of cellular and tissue damage. This article summarizes some of the theoretical safety concerns regarding nanotechnology and offers suggestions for addressing them.

Genetic risk of breast cancer

Several cutting-edge strategies are being used to evaluate candidate genetic risk factors for breast cancer. These include linkage analysis for mapping out BRCA1 and BRCA2, mutational screening of candidate risk genes like CHEK2, ATM, BRIP1 and PALB2, which are associated with an intermediate level of breast cancer risk. Genome-wide association studies have revealed several low-penetrance breast cancer risk alleles. The predisposition factors are associated with different levels of breast cancer risk. Relative to control population, the risk in patients harboring high-risk BRCA1 and 2 mutations is over 10-fold, with intermediate penetrance genes 2 to 4-fold and with low penetrance alleles less than 1.5-fold. Overall, these factors account for about 25% of the genetic risk for breast cancer. In the remainder, genetic factors to contribute to the risk of breast cancer remain unknown and are a subject of current investigation. With discovery and validation of newer and clinically relevant predisposition factors, additional breast cancer risk categories may be recognized. BRCA1 and BRCA2 mutation testing allows identification of individuals at increased risk of breast cancer who are offered risk-reducing interventions. Targeted therapies are being developed that may refine management of patients with BRCA1 and BRCA2 mutations. Further genome-wide studies are required to identify clinically relevant molecular factors that will allow more accurate and widely applicable genetic risk stratification. Current efforts in discovery, validation and qualification of molecular markers of breast cancer risk offer considerable promise in the future to develop more accurate breast cancer risk assessment along with development of more effective chemopreventive and therapeutic strategies.

Primary gastroenteropancreatic poorly differentiated neuroendocrine carcinoma: Clinico-pathologic analysis of 68 cases

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Background: Primary gastro-entero-pancreatic poorly differentiated neuroendocrine carcinomas (GEP-PDNECAs) are highly aggressive neoplasms with a very poor prognosis. This study was conducted to evaluate the immuno-morphological spectrum of GEP-PDNECA, and patient survival with systemic platinum and etoposide therapy. Methods: Under an IRB-approved protocol, clinico-pathologic data were collected on 68 adult patients with GEP-PDNECA who had undergone biopsy / resection at MCC or outside institution. Data sources: Pathology archives, consultation files, tumor registry and social security index. All available slides were reviewed and tumors were histologically sub-typed. Subsequently, clinico-pathologic data and patient survival were analyzed. Results: Patients: 41 M/27 F. Age: 25–76 yrs (mean 42 yrs). Sites: Colo-rectum 39, pancreas 19, small intestine (SI) 4, stomach 3, colon/SI/pancreas 3. 63 of 68 (93%) patients presented with lymph node/distant metastases. Of 68 tumors 37 (54%) were classified as small cell carcinoma (SCCA), 16 (24%) large cell carcinoma (LCCA), 5 (7%) mixed small and large cell (MSLCCA) and 10 (15%) poorly differentiated carcinoma with neuroendocrine features (PDCA-NEF). Tumors were positive for chromogranin in 38/65 (55%), synaptophysin in 62/67 (92%), and CD56 in 17/21 (81%) cases. One marker was positive in 22/68 (32%), 2 in 40/68 (59%) and all 3 were positive in 9/68 (13%) cases. Fifty eight of 68 (85%) patients were treated with platinum and etoposide. Overall survival at 1, 3 and 5 years was 85%, 40% and 24% respectively. Patient survival was independent of age (r= -0.1022), sex (r= -0.909) and histologic subtype (r= - 0.1028) (p= 0.128) but was related to distant metastases (r=0.306; p=0.0383). Conclusions: Diagnosis of GEP-PDNECA can be based on histo-morphologic features and expression of neuroendocrine markers. Synaptophysin was the most sensitive marker; however, a panel of 2 or 3 neuroendocrine markers (Syn, Cg and CD56) may be more useful to avoid under-diagnosis of GEP-PDNECA, especially in the metastatic setting. Although survival of GEP-PDNECA patients following platinum and etoposide in our series was relatively favorable, there is need for novel therapies to improve patient survival.

No significant financial relationships to disclose.

Expression of metastasis-associated gene products and liver metastases in pancreatic endocrine tumors

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Background: Outcomes in well-differentiated pancreatic endocrine tumors can be difficult to predict using pathologic criteria. We recently identified a novel set of 3 metastasis-associated genes by microarray: Palladin, p21, RUNX1T1. Our aim was to evaluate the potential for these markers, individually or in combination, to predict liver metastases as an indicator of adverse outcome. Methods: Palladin, p21, and RUNX1T1 immunostains were done on a tissue microarray of 39 resected primary pancreatic endocrine neoplasms, 14 of which had hepatic metastases. The Allred score was determined as the sum of stain intensity (scored 0–3) and % cells stained (scored 0–5). Receiver operating characteristic (ROC) analysis was used to choose the cutpoint in Allred score (high vs low protein expression) to optimize sensitivity and specificity for predicting liver metastases. Results: Nearly all tumors with liver metastases showed high Palladin and p21 levels (Allred score > 3 and > 4, respectively), while protein expression was lower in the majority of non-metastatic tumors. In contrast, RUNX1T1 expression was low (Allred score < 4) in most tumors with liver metastases, but higher in all except one of the non-metastatic tumors. Individual test sensitivities for predicting liver metastases were 100% for high Palladin, 93% for high p21 and 85% for low RUNX1T1, while corresponding specificities were 63%, 75%, and 96%. Tumors were correctly classified as being metastatic or not (predictive accuracy) by Palladin, p21, or RUNX1T1 expression in 76%, 76%, and 92% of cases, respectively. If abnormal expression of even one of 3 proteins is considered a positive test (parallel testing), then sensitivity of all 3 together for predicting liver metastases was 100%, specificity 48%, and predictive accuracy 68%. Conclusions: 1) High Palladin, high p21, or low RUNX1T1 expression have good sensitivity and specificity for predicting liver metastases in pancreatic endocrine tumors. 2) Parallel testing with all 3 markers achieved 100% sensitivity but at a cost of reduced specificity. 3) Differential expression of these biomarkers may predict aggressive tumor behavior that warrants more aggressive management.

No significant financial relationships to disclose.

Co-circulations of two genotypes of dengue virus in 2006 out-break of dengue hemorrhagic fever in Karachi, Pakistan

BACKGROUND

The status of dengue genotypes involved in the recent epidemic out-breaks in Pakistan is not well defined.

OBJECTIVES

We sought to analyze the predominant genotype responsible for the most severe and largest out-break of dengue hemorrhagic fever (DHF) that hit Karachi in 2006.

STUDY DESIGN

Retrospective analysis of stored serum samples for dengue virus genotype by multiplex RT-PCR, anti-dengue IgM, IgG and review of clinical charts of patients admitted to Aga Khan University Hospital.

RESULTS

Viral RNA detection of 250 patients revealed positive results in 185 (74.0%) samples. DEN-2 was predominant genotype (n=104, 56.2%) Dengue specific antibodies were detected in 139 samples of which 81 were classified as primary cases. DEN-2 accounted for these. Within secondary cases, 63.2% were due to DEN-2 (total 57), the rest were positive for DEN-3. DHF (p=0.064) and abdominal pain (p=0.059) were more frequently associated with DEN-2 as compared to DEN-3. None of the samples were positive for DEN-1 or DEN-4.

CONCLUSION

Co-circulation of DEN-2 and DEN-3 was responsible for the 2006 out-break in Karachi. Primary and secondary cases were seen in both groups. Cases with DHF showed marginal association with DEN-2. Introduction of a new serotype (DEN-3) and or a genotypic shift of endemic serotype (DEN-2) are the probable factors for the recent out-break of DHF in this region.