Decadal Change in Seroprevalence of Chikungunya Virus Infection in Pune City, India

Chikungunya virus (CHIKV) is an arthropod-borne virus capable of causing large outbreaks. We aimed to determine the decadal change in the extent of chikungunya virus infection from 2009 to 2019. We implemented a prospective cross-sectional survey in Pune City using a 30-cluster approach with probability-proportion-to-size (PPS) sampling, with blood samples collected from 1654 participants in early 2019. The study also included an additional 799 blood samples from an earlier serosurvey in late 2009. The samples were tested by an in-house anti-CHIKV IgG ELISA assay. The overall seroprevalence in 2019 was 53.2% (95% CI 50.7−55.6) as against 8.5% (95% CI 6.5−10.4) in 2009. A fivefold increase in seroprevalence was observed in a decade (p < 0.00001). The seroprevalence increased significantly with age; however, it did not differ between genders. Modeling of age-stratified seroprevalence data from 2019 coincided with a recent outbreak in 2016 followed by the low-level circulation. The mean estimated force of infection during the outbreak was 35.8% (95% CI 2.9−41.2), and it was 1.2% after the outbreak. To conclude, the study reports a fivefold increase in the seroprevalence of chikungunya infection over a decade in Pune City. The modeling approach considering intermittent outbreaks with continuous low-level circulation was a better fit and coincided with a recent outbreak reported in 2016. Community engagement and effective vector control measures are needed to avert future chikungunya outbreaks.

Smoking and COVID-19: A Literature Review of Cohort Studies in Non-Chinese Population Settings

BACKGROUND

Smoking history and its potential association with COVID-19 has attracted many researchers and the lay public alike. However, the studies published to date have several methodological limitations and are mainly from China. We set out to synthesize evidence on smoking and COVID-19 relationship drawn on cohort studies only which are published in non-Chinese population settings.

METHOD

A systematic literature search was undertaken drawn on predefined eligibility criteria and a comprehensive search strategy following the PRISMA guideline between January 2020 and August 2020, excluding preprints and gray literature. Three specific outcomes were examined: smoking history, SARS-CoV2 infection, and COVID-19 severity.

RESULTS

Of an eligible 40 full-text studies, 7 cohort studies outside of China were finally included in this literature review through independent reviewing. Four studies were from the UK, 2 from the United States, and 1 from Turkey. The sample size ranged from 200 to more than 5000 participants. The findings broadly point to 1 direction, a higher smoking prevalence and an increased risk of smoking history on both SARS-CoV2 infection and on COVID-19 severity.

CONCLUSION

A smoking history (either current or past) seems to negatively impact both SARS-CoV2 infection and COVID-19 severity. However, such an observation strengthens the argument to continue smoking cessation efforts both for individuals and for the general population health and well-being.

A Prospective Study of Computerized Digital Infrared Image Analysis (NoTouch BreastScanTM) in Biopsy Proven Breast Cancers

Introduction: Early detection of breast cancer is known to have a more favourable outcome. Currently clinical breast examination and imaging modalities, primarily mammography are used for screening purposes. In India, more than 85% of the population is below the age of 50 years, wherein the sensitivity of mammography is at best 64%. Additional drawbacks of the procedure are physical discomfort and ionizing radiation dose to the patient. So newer techniques have been investigated which detect cancer induced neovascularity with digital thermal imaging. The purpose of this clinical study was to determine the efficacy of a software assisted thermal image analysis tool to distinguish between benign and malignant lesions of the breast.Methods: A prospective study was conducted in women who presented to the breast clinic with clinically or mammographically suspicious breast lesions. They also underwent thermal imaging of the breast. All mammographically suspicious lumps were subjected to histopathological confirmation. The mammography and infrared (IR) reports were compared to the histopathology.Results: In 90 women, 180 breasts were independently analyzed by both digital IR software analysis and mammography. Eighty five out of these 180 had suspicious lesions on mammography or clinical examination which were subjected to pathological confirmation. Mammography being the present diagnostic gold standard, all normal mammograms in clinically normal breast were considered as non-malignant. The sensitivity and specificity of digital thermography in detecting malignant lesions was 88.24% and 70.52% respectively with NPV of 87.01% and PPV of 72.82%. While for mammography the sensitivity and specificity were 96.25% and 96.7% with NPV of 96.7% and PPV of 96.25%. In women below 50 years of age (62/90) the sensitivity and specificity of digital thermography was 89.83% and 64.61% with NPV of 87.5% and PPV of 69.74%. Further, in the same subset no statistically significant difference was detected in the sensitivity of digital thermography to that of mammography (p = 0.7263).Conclusion: Our initial experience shows that the detection rate by digital thermal imaging is comparable to mammography in clinically palpable breast tumors. We also note that there is no significant difference in sensitivity of thermal imaging in women on either side of 50 making it a potentially testable tool for screening in younger women.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5028.

Accelerated partial breast irradiation with interstitial brachytherapy as the sole modality of radiation for women with low risk early stage breast cancer

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Purpose: The aim of the study is to evaluate the safety and feasibility of radical brachytherapy for accelerated partial breast irradiation (APBI) and to study the outcome with respect to local control and survival. Materials and Methods: During May 2000 to December 2004, 115 women participated in the ongoing prospective study of APBI using interstitial brachytherapy as the sole modality of radiation for early breast cancer. Women with age > 40 years, single tumour up to 3 cm without diffuse microcalcification and clinically negative axilla were considered suitable. Brachytherapy was done either intraoperatively during the breast conserving surgery or postoperatively using 2–4 planes. Tumor bed demarcation was done with radiopaque clips placed during surgery, CT scans, ultrasonography and/or fluoroscopy. Cavity with 1cm margin was treated based on orthogonal pair of X rays to a dose of 34 Gy in 10 fractions over 1 week with twice daily fractionation using high dose rate iridium source. Results: Implant was done postoperatively in 35 patients while in remaining patients it was done intraoperatively. Implant procedure was tolerated well by all the patients. In 8 patients only 3 or 4 fractions of HDR Brachytherapy were delivered and this was followed by 45 Gy/25 # whole breast radiation therapy for following reasons: positive nodes (4), EIC positive (3) and poor implant coverage (1). At a median follow up of 23 months, the actuarial local control rate is 100%. Three year actuarial disease free survival is 93% while the overall survival is 100%. Complications included fat necrosis in 5 and wound gape in 4 patients. Cosmesis was good to excellent in 60% of the patients. Conclusion: In this ongoing prospective study, APBI using radical interstitial implant was well tolerated and appears to be safe and feasible in appropriately selected patients. Further follow up is needed for confirm the long term safety of the procedure.

No significant financial relationships to disclose.

Customizing a clinical data warehouse for housestaff education in practice-based learning and improvement

We developed Systems and Practice Analysis for Resident Competencies (SPARC), a Web-based tool to support teaching the practice-based learning and improvement (PBLI) ACGME competencies. SPARC allows Department of Medicine residents to explore de-identified, population-based data about their patient panels with peer comparisons. Data primarily comes from an existing data warehouse that has been customized for this application. Our preliminary evaluation suggests that it improves residents' abilities in PBLI, is easy to use, and perceived as important and useful by the housestaff.

Vagus nerve stimulation therapy for epilepsy in older adults

The authors assessed the efficacy, safety, and tolerability of vagus nerve stimulation (VNS) for refractory epilepsy in 45 adults 50 years of age and older. They determined seizure frequency, adverse effects, and quality of life. At 3 months, 12 patients had a >50% decrease in seizure frequency; at 1 year, 21 of 31 studied individuals had a >50% seizure decrease. Side effects were mild and transient. Quality of life scores improved significantly with time.

Hypocalcemic tetany in a toddler with undiagnosed rickets

A 17-month-old black girl presented to the pediatric emergency department with sudden onset of her hands and feet "drawing up." A diagnosis of vitamin D deficiency rickets with tetany was made on a history of exclusive breast-feeding, low serum calcium, phosphorus, and 25-hydroxyvitamin D levels, and bone radiographs. Nutritional rickets should be considered in the differential diagnosis of acute hypocalcemia.

Spectral modulation of cortical connections measured by EEG coherence in humans

OBJECTIVE

Description of coherence patterns of cortical EEG.

METHODS

EEG recordings were collected from 9 subdural electrode grids implanted in 6 patients undergoing EEG monitoring for refractory epilepsy.

RESULTS

Coherence decreased with increasing inter-electrode distance and exhibited considerable variability at the same inter-electrode distances. Analysis of variance demonstrated that both spatial and temporal factors contributed significantly (P < 0.01) to this variability. The spatial factor contributed the largest portion (up to 90%) of the variability, and was modulated by frequency and inter-electrode distance.

CONCLUSION

The finding that the mean frequency modulation was consistent over time for the same pair of electrodes and was different between different pairs of electrodes indicated a spatial-spectral pattern of cortical synchrony. The connections (pairs of electrodes) could be accordingly predicted from their spatial-spectral pattern, which suggested that the spatial heterogeneity of neuronal synchrony was expressed not only by the degree of synchrony, but also by distinct spectral channels of synchrony. A model based on neuronal connection and activation is proposed to account for the observations.

Correlation between low neuraminidase blood levels and a predisposition toward family-related breast cancer

It has been shown that high sialic acid levels are often found in conjunction with breast cancer, and these high concentrations are thought to be due to deficiency of the enzyme neuraminidase. The study proposes to elicit a relationship between low levels of blood neuraminidase and a family history of breast cancer. Neuraminidase blood levels were measured in 30 healthy women between the ages of 35 and 65 years with no evidence of a family history of breast cancer (control group), and in 33 healthy women between the ages of 35 to 65 years, all of whom had immediate members of their families with breast cancer (study group). The mean level of the blood neuraminidase was found to be 1.375 units in the control group. On the other hand, the mean level for the study group was 1.256 units. The difference between the two groups is statistically significant, (P value < 0.01). It is important to note that in the study group 20 of the 33 participants, 60.6 per cent, had neuraminidase levels below the mean of the study group, whereas only 3 of the 30, 10 per cent, in the control group had neuraminidase levels below the mean of the study group. Deficiency of the enzyme neuraminidase may suggest an elevated risk for breast cancer.

Hypoglycemia with hyperinsulinemia in a chronic hemodialysis patient following parathyroidectomy

We report a chronic hemodialysis patient with severe hyperparathyroidism who developed hypoglycemia with inappropriate hyperinsulinemia following parathyroidectomy. An abrupt fall in parathyroid hormone level and administration of large amounts of calcitriol may have resulted in increased insulin release and enhanced tissue sensitivity to insulin producing sustained hypoglycemia in this patient.

The disposition and metabolism of 2',3'-dideoxycytidine, an in vitro inhibitor of human T-lymphotrophic virus type III infectivity, in mice and monkeys

The pharmacokinetics and metabolism of the anti-human T-lymphotrophic virus type III/lymphadenopathy-associated virus agent 2',3-dideoxycytidine have been examined in BDF1 mice and rhesus monkeys, with ancillary enzyme studies carried out on tissue derived from both the latter species and also from human subjects. For the pharmacokinetic studies, 2',3-dideoxycytidine and its catabolic product 2',3-dideoxyuridine have been separated and measured in plasma, urine, and cerebrospinal fluid by a reverse HPLC method. For metabolic studies, tritium-labeled drug (labeled in the 5- and 6-positions of the pyrimidine ring) has been employed, utilizing an ion exchange HPLC analytical method suitable for the separation of the parent nucleoside from its mono-, di-, and triphosphates in cell extracts and in tissue homogenates. The drug is rapidly cleared from plasma in a biphasic manner (terminal t 1/2 in BDF1 mice and rhesus monkeys of 67 min and 109 min, respectively) following an iv bolus dose of 325 mg/m2. This two-compartment open model is predictive of plasma concentrations during long term ip infusions in mice. Dideoxycytidine is predominantly excreted in the urine as unchanged parent compound, although a minor urinary metabolite (2,3-dideoxyuridine) is detected in the monkey but not in the mouse. Oral absorption of 2',3'-dideoxycytidine is rapid, with plasma levels approaching those seen after iv administration within 45 min in the mouse. Entry to the central nervous system is also rapid, but the cerebrospinal fluid to plasma AUC ratio after iv administration is only 0.026-0.040 in rhesus monkeys.(ABSTRACT TRUNCATED AT 250 WORDS)

Multiple genes control particulate phosphofructokinase of yeast

Mutants of Saccharomyces cerevisiae lacking the particulate phosphofructokinase define at least four unlinked genes, PFK2, PFK3, PFK4 and PFK5. A structural role of PFK2 is indicated. Mutations in the other three have pleiotropic effects.

Mutations in the regulatory subunit of soluble phosphofructokinase from yeast

Mutant alleles of the gene PFK2 have been obtained that alter the sensitivity to ATP inhibition of the soluble yeast phosphofructokinase. One of the alleles makes the enzyme sensitive to micromolar concentrations of ATP. Intragenic revertants of PFK2 mutants confirm that the PFK2 gene determines not only the regulatory properties of the soluble enzyme but also the catalytic activity of particulate phosphofructokinase.