Normative data for paediatric lymphocyte subsets: A pilot study from western India

Background & objectives

Accurate diagnosis of immunodeficiencies requires a critical comparison of values with age-matched controls. In India, the existing reference values for rare lymphocyte subsets are currently not available and we rely on the data originating from other countries for the interpretation of the results. Furthermore, there is limited information on normal variation for these rare-subset parameters in Indian children. So, this study aimed to establish normative values for clinically important lymphocyte subsets in Indian children at different age groups.

Methods

148 children aged ≥16 yr were enrolled in this study. The study population included 61 per cent males and 39 per cent females and was divided into the following groups: cord blood (n=18), 0-6 months (n=9), 6-12 months (n=13), 1-2 yr (n=19), 2-5 yr (n=27), 5-10 yr (n=25) and 10-16 yr (n=37). The absolute and relative percentage of lymphocytes, T, B, natural killer cell, along with activated, naïve and memory subsets, was determined by flow cytometry.

Results

Median values and the 10th and 90th percentiles were obtained for 34 lymphocyte sub-populations. The T and B naïve compartments showed a decreasing trend, whereas memory cells showed an increase with age. The activated T cell subset shows an increasing pattern up to one year and then declines gradually. Double negative T cells are relatively stable. TCRgd+T cell percentage increases with age.

Interpretation & conclusions

This single-centre pilot study provides preliminary data that justifies the need for future large-scale multi centric studies to generate a reference range for interpreting extended immunophenotyping profiles in the paediatric age group, making it possible for clinicians to assess the immunological status in inborn errors of immunity, infectious and autoimmune diseases.

The LDL receptor binding domain of apolipoprotein E directs the relative orientation of its C-terminal segment in reconstituted nascent HDL

Apolipoprotein E (apoE) (299 residues) is a highly helical protein that plays a critical role in cholesterol homeostasis. It comprises a four-helix bundle N-terminal (NT) and a C-terminal (CT) domain that can exist in lipid-free and lipid-associated states. In humans, there are two major apoE isoforms, apoE3 and apoE4, which differ in a single residue in the NT domain, with apoE4 strongly increasing risk of Alzheimer's disease (AD) and cardiovascular diseases (CVD). It has been proposed that the CT domain initiates rapid lipid binding, followed by a slower NT domain helix bundle opening and lipid binding to yield discoidal reconstituted high density lipoprotein (rHDL). However, the contribution of the NT domain on the CT domain organization in HDL remains poorly understood. To understand this, we employed Cys-specific cross-linking and spatially-sensitive fluorophores in the NT and CT domains of apoE3 and apoE4, and in isolated CT domain. We noted that the helices in isolated CT domain are oriented parallel to those in the neighboring molecule in rHDL, whereas full length apoE3 and apoE4 adopt either an anti-parallel or hairpin-like organization. It appears that the bulky NT domain determines the spatial organization of its CT domain in rHDL, a finding that has significance for apoE4, which is more susceptible to proteolytic cleavage in AD brains, showing increased accumulation of neurotoxic NT and CT fragments. We envisage that the structural organization of HDL apoE would have profound functional consequences in its ability to regulate cholesterol homeostasis in AD and CVD.

Anxiety symptoms in regular school students in Mumbai City, India

Aim

Anxiety disorders usually remain undiagnosed in school students owing to the internalized nature of their symptoms. The present study was conducted with the primary objective of evaluating the prevalence of anxiety symptoms in school students in Mumbai. A secondary objective was to assess the impact of variables (age, gender, presence of sibling, and type of school curriculum or school) on anxiety symptoms.

Materials and Methods

Study cases (8-15 year olds) were recruited by nonprobability sampling from four English-medium schools. Anxiety was measured using Spence Children's Anxiety Scale (SCAS)-child self-report questionnaire. T-scores (total and subscales) were calculated and cut-off scores of> 60 were considered as significant.

Results

Symptoms of overall anxiety were present in 10.8% (53/493) of the students. Older students (12-15 year olds) had greater odds of having overall anxiety symptoms (crude OR = 4.36, 95% CI 2.27 to 8.39, P < 0.0001). Symptoms of all anxiety disorders were present in the 493 participants, with obsessions/compulsions and fears of physical injury being the most common (in 29.6% and 27.2%, respectively). Older students and boys had greater odds of having obsessions/compulsions (crude OR = 2.32, 95% CI 1.56 to 3.44, P < 0.0001; and crude OR = 1.54, 95% CI 1.04 to 2.27, P= 0.035, respectively]. Students with sibling (s) had greater odds of having fears of physical injury (crude OR = 0.48, 95% CI 0.30 to 0.78, P= 0.003).

Conclusions

There is an urgent need to screen school students in our city for anxiety disorders.

Perioperative death: Its implications and management

Death to most people is a major life event. Nothing in this world prepares us to face and manage the perioperative death although the majority of anesthesiologists will be involved in an intraoperative death during the course of their careers. Whether death on the table was expected or occurred when least expected or may be even later, the anesthesiologist is most likely to be affected emotionally, physically in his personal life, and as well as will have an influence on his professional career. Anesthesiologists as perioperative physicians are likely to experience death on the operating table at some time in their careers. In case of perioperative death, meticulous record keeping including time of occurrence of event and methods and medications used during resuscitation, nature of the problem, and all sequence of events should be adopted to breaking bad news with relatives and blame game should be avoided. The anesthesiologist and the relatives of the patient should also be given emotional support to come out of this untoward event. In this article, we have highlighted the various factors and causes leading on to perioperative death and if in case such an event occurs, what are the protocols to be followed, including medicolegal aspects, giving emotional support to the concerned anesthesiologist, dealing with the relatives of the patient sympathetically, etc. We have also enumerated the various precautions to be taken to prevent perioperative mortality in this article.

Is anxiety more common in school students with newly diagnosed specific learning disabilities? A cross-sectional questionnaire-based study in Mumbai, Maharashtra, India

Background and Objectives:

School students with specific learning disabilities (SpLDs) experience chronic academic underachievement and resultant stress. The present study aimed to determine if school students with newly diagnosed SpLD were more likely to have anxiety than their regular peers.

Materials and Methods:

The study cases (aged 8-15 years) were recruited from our institute's learning disability clinic. The matched controls were recruited from four schools in Mumbai, Maharashtra, India. Anxiety was measured using the Spence Children's Anxiety Scale (SCAS)-child self-report version questionnaire. Median SCAS scores and the proportion of students with an SCAS score in the “clinical anxiety” range were compared between the groups.

Results:

SCAS scores were significantly higher in 8-11-year-old learning-disabled male and female students (P < 0.0001 for both groups) and 12-15-year-old female students (P = 0.004), as compared with matched controls. A significantly higher number of learning-disabled students were found to have “clinical anxiety” [24.64% vs 4.35%, crude odds ratio (OR) = 7.19, 95% confidence interval (CI) 2.91-17.78, P = 0.0001], as compared with the controls regardless of gender, age group, presence of comorbid attention-deficit/hyperactivity disorder (ADHD), or associated medical conditions. A significantly higher proportion of 8-11-year-old learning-disabled students, especially males, were found to have “clinical anxiety” as compared with 12-15-year-old learning-disabled students (crude OR = 4.38, 95% CI 1.94-9.92, P = 0.0004). Gender, presence of comorbid ADHD or associated medical conditions, and type of school attended or curriculum did not impact the prevalence of “clinical anxiety” in learning-disabled students.

Interpretation and Conclusions:

Students with newly diagnosed SpLD have greater odds of being “clinically anxious” relative to their regular peers. We recommend screening for anxiety in children with SpLD immediately after diagnosis so that their optimum rehabilitation can be facilitated.

Riboflavin conjugated temperature variant ZnO nanoparticles with potential medicinal application in jaundice

Significant ameliorative efficiency of riboflavin conjugated ZnO nanoparticles against jaundice stress at molecular and cellular levels.

Tobacco use in Northern India-Part 1: The detailed habit

BACKGROUND

The finite details of tobacco consumption practices in north Indian population are hitherto not well described. This study depicts the modes of tobacco use, their relative frequency, demographic and psychosocial determinants.

MATERIALS AND METHODS

Random stratified sampling from the list of blocks, villages and urban localities was done. The study was community-based house-to-house survey using interview schedule.

RESULTS

There were 1607 tobacco users: 1399 male and 208 female; 1195 urban and 412 rural. Single mode of tobacco use was reported by 769 (47.85%). Chewing tobacco was prevalent in 511 (31.80%), smoking in 258 (16.55%) subjects and majority 838 (52.15%) had consistent multiple habit of smoking and chewing. Of the 10 preparations of tobacco use, the 'top 5' ranked as tobacco-betel, gutka, cigarette, bidi and khaini. Gutka consumption was significantly higher between age group of 25 years and 55 years (χ(2) = 17.2; P<0.000). Majority of users, 576 (35.84%), started tobacco before 25 years of age and about a fifth, 439 (27.32%) before 18 years. Men significantly used tobacco more than women (χ(2) = 73.2; P<0.000). Women (χ(2) = 73.2; P<0.000) preferred smokeless tobacco and perceived social barrier for smoking.

CONCLUSION

Multiple or overlapping tobacco practices and other substances abuse were documented in Lucknow, the capital city of the most populous state Uttar Pradesh where chewing tobacco was the commonest as opposed to smoking.

Tobacco habit in northern India

To study tobacco consumption practices in north-Indian population, a community-based, stratified sampling survey using validated interview schedule was performed in rural/urban areas of Lucknow, Uttar Pradesh. There were 432 tobacco users (385 men, 47 women; 276 urban, 156 rural) taken as subjects. Tobacco use practices ie, chewing/smoking/rubbing/snuffing, frequency, starting age, supply, place/context of use, quid habit, affect, facilitating conditions/barriers, tobacco users' opinion on control measures were all taken into consideration. Single mode of tobacco use was reported by 277 subjects (64.1%) and the rest had a plethora of tobacco practices. Chewing was prevalent in 322(74.5%), smoking in 256(59.3%), rubbing in 32(7.4%) and snuffing in 4 subjects (0.9%). Of the 10 preparations in the questionnaire, the "top 5" preferences ranked as tobacco-betel, gutka, cigarette, bidi and khaini that remained unchanged between sexes, rural/urban people and age groups. Women significantly (p<0.00001) preferred smokeless tobacco and perceived social barrier for smoking. Gutka consumption was significantly higher in youngsters (<25 yeans; p<0.0001). Most subjects (235; 54.3%) used tobacco 7-24 times/day. Majority (259; 60%) users started consuming tobacco before 21 years of age and about a fifth 95(22%) before 15 years. Majority users (232; 53.6%) did not procure tobacco from a fixed shop. The commonest context of tobacco use was with any refreshment (337; 78.0%). Of the 322 tobacco chewers, about half the subjects (178; 52.2%) rotated the quid in their mouth, 313(97.2%) later spat it out, 9(2.1%) swallowed it and 15(4.7%) admitted to sleep with the quid in mouth. Tobacco along with alcohol was consumed by 82(19%) and with opium by 33 subjects (7.6%). Social barrier to tobacco use was perceived by 231 subjects (53.5%), especially by smokers. Majority users (355; 82.2%) did not have negative feelings or embarrassment in using tobacco. Most users (351; 81.4%) said they would welcome legislative control on tobacco use.

Delay in presentation of oral cancer: a multifactor analytical study

BACKGROUND

Patients with oral cancer often present late to the doctor making treatment difficult, expensive and sometimes unsuccessful. Delay in presentation may be considered to be a health risk-taking behaviour. The present study analyses the psychosocial factors related to delay in presentation of oral cancer patients through the Triandis' model of health-seeking behaviour and also examines the relationship between delay and the stage of cancer.

METHODS

Seventy-nine oral cancer patients were interviewed after evolving a valid and reliable questionnaire, and determining the sample size. Univariate and multivariate logistic regression analysis was applied between demographic variables, psychosocial factors, primary delay (defined as delay between the first symptom and the seeking of medical advice), secondary delay (interval between the first consultation and presentation at the medical college), tertiary delay (delay in definitive treatment even after being seen at a tertiary care centre) and stage of the disease. Multiple logistic regression was also carried out.

RESULTS

Primary delay ranged from less than a week in 5 (6.3%) patients to more than 1 year in 8 (10%) patients. A linear relationship was found between primary and secondary delay (F-statistic p < 0.0152). A majority of patients (70.9%) had advanced oral cancer. The stage of cancer at presentation to the hospital was significantly related to primary (G-test 6.3; p < 0.0121) but not to secondary delay. Multivariate analysis revealed that five variables, 'ill fated to have cancer', 'cancer a curse', 'non-availability of transport', 'trivial ulcers in mouth are self-limiting' and 'prolonged treatment renders family stressful' were significant independent predictors of primary delay.

CONCLUSION

The identified independent predictors of primary delay should be used to develop the main theme of an educational intervention programme for patients with oral cancer.

Effect of textile industrial effluent on tree plantation and soil chemistry

A field study was conducted at Arid Forest Research Institute to study the effect of textile industrial effluent on the growth of forest trees and associated soil properties. The effluent has high pH, electrical conductivity (EC), sodium adsorption ratio (SAR) and residual sodium carbonate (RSC) whereas the bivalent cations were in traces. Eight months old seedlings of Acacia nilotica, Acacia tortilis, Albizia lebbeck, Azadirachta indica, Parkinsonia aculeata and Prosopis juliflora were planted in July 1993. Various treatment regimes followed were; irrigation with effluent only (W1), effluent mixed with canal water in 1:1 ratio (W2), irrigation with gypsum treated effluent (W3), gypsum treated soil irrigated with effluent (W4) and wood ash treated soil irrigated with effluent (W5). Treatment regime W5 was found the best where plants attained (mean of six species) 173 cm height, 138 cm crown diameter and 9.2 cm collar girth at the age of 28 months. The poorest growth was observed under treatment regime of W3. The growth of the species varied significantly and the maximum growth was recorded for P. juliflora (188 cm height, 198 cm crown diameter and 10.0 cm collar girth). The minimum growth was recorded for A. lebbeck. Irrigation with effluent resulted in increase in percent organic matter as well as in EC. In most of the cases there were no changes in soil pH except in W5 where it was due to the effect of wood ash. Addition of wood ash influenced plant growth. These results suggest that tree species studied (except A. lebbeck) can be established successfully using textile industrial wastewater in arid region.

Efficient translocation and processing with Xenopus egg extracts of proteins synthesized in rabbit reticulocyte lysate

Cell-free translation/translocation systems are broadly applied to examine gene expression and characterize the structure-function relationship of gene products. We present the characterization of Xenopus egg extract (XEE) translocation and processing of proteins synthesized in rabbit reticulocyte lysate. The XEE was prepared from eggs laid by adult female frogs that received serial injections of gonadotropins. The eggs were then dejellied in 2% L-cysteine-HCl and the cytoplasm extracted by centrifugation at 10,000 rpm for 15 min. The in vitro translocation and processing of XEE was examined with a cell-free translation system containing reticulocyte lysate, and appropriate messenger ribonucleic acid (RNA) or complementary deoxyribonucleic acid plasmids with RNA polymerase. Cell-free production of the following proteins were used to assess posttranslational modifications: Escherichia coli beta-lactamase for signal sequence cleavage, Saccharomyces cerevisiae alpha-mating factor for translocation and N-linked glycosylation, the soluble protein luciferase for functional activity, and the membrane-bound human insulin receptor for translation efficiency. All translation products were identified by [35S]-methionine labeling, sodium dodecyl sulfate-polyacrylamide gel electrophoresis and fluorography. The results demonstrate that (1) XEE produces near-complete signal sequence and N-glycosylation processing of proteins synthesized in reticulocyte lysate, (2) XEE contains endoplasmic reticulum-equivalent microsomes, which allows for protein translocation and protease protection, (3) the addition of XEE in the translation reaction does not affect synthesis and chemiluminescence activity of luciferase, (4) XEE is efficient in processing the nascent 160-kDa human insulin receptor precursor, a transmembrane protein, and (5) as compared to canine pancreatic microsomes, XEE translocation efficiency is minimally decreased with the addition of dimethylsulfoxide. These results are the first description of the combined use of XEE with reticulocyte lysate and clearly demonstrate a higher efficiency of translocation and processing compared to canine pancreatic microsomes. This method of cell-free translation and processing allows for more extensive in vitro examination of posttranslational modifications of secretory and membrane-bound proteins.

Children, psychiatrists and the courts: understanding the ambivalence of the legal profession. Part 1--General principles

Psychiatrists and other mental health professionals are frequently involved as expert witnesses in court proceedings related to children and adolescents. Their testimony may be based on a therapeutic relationship, but frequently arises because of an assessment conducted specifically for the court process. This two part paper discusses some of the issues that arise when child psychiatrists are involved as expert witnesses in litigation, with specific focus on their role in child custody, sexual abuse and young offender cases. It also offers some practical advice for those who may be called as witnesses. There is controversy in the legal profession about the role of mental health professionals in the court process. While there is recognition of their expertise, there is also a concern about not wanting to have experts usurp the role of the courts. Legal professionals also question the "objectivity" of experts, and the reliability of their opinions. Frequently the opinions of psychiatrists about children and adolescents involved in litigation have inherently speculative and value based dimensions, and not "scientific". Participation in the court process by mental health experts is nevertheless a vitally important role, providing information, analysis and recommendations about what are often very difficult societal decisions. Part two of this paper starts on page 531.