Investigating the Clinico-Demographic Characteristics of Dengue Fever and Its Seroprevalence at a Tertiary Care Hospital in Northern India

Background and objective Dengue virus (DENV) is a major global health threat, causing over 50,000 deaths annually. The state of Uttar Pradesh (UP) in India faces significant challenges due to the increasing number of dengue cases detected. This study aimed to assess DENV seropositivity in the Raebareli district of UP, to offer crucial insights into the region's effective control and management strategies. Materials and methods This study, after obtaining approval from the ethics committee, analyzed blood samples of individuals suspected of having dengue at a teaching hospital in rural UP between January and December 2022. To determine the disease's seroprevalence, both dengue NS1 antigen ELISA and dengue IgM Microlisa were conducted. Furthermore, RT-PCR was performed on NS1-positive samples to confirm the serotypes. The collected data were analyzed using Epi Info 7.0. Results Of the 589 suspected dengue cases, 86 (14.60%) tested positive for dengue NS1 and/or IgM. Our findings showed that males (n=330, 56.03%) and adolescents and young adults (n=301, 51.1%) from rural areas (n=523, 88.4%) were predominantly affected. Cases peaked post-monsoon, and platelet levels were notably low in NS1-positive cases. Dengue serotype 2 (DEN-2) was found in all RT-PCR-positive samples. Our results revealed a dengue seroprevalence of 14.60% (n=86), which peaked in post-monsoon months. The higher incidence among males and young adults from rural areas attending the outpatient department highlights the importance of targeted interventions and community surveillance. RT-PCR confirmed the circulation of a single serotype in the region. Conclusions This study contributes crucial insights into dengue's epidemiology and clinical profile and its findings are all the more significant now as India prepares for phase 3 trials of a quadrivalent dengue-virus vaccine in 2024. Adolescent and young adult males have an increased likelihood of acquiring the virus, and this demographic can be prioritized for vaccine trials.

Peri-prosthetic Joint Infection due to Candida albicans in a Young Immunocompetent Patient - A Rare Case Report

Introduction

The recent surge in joint replacement surgeries in India, particularly total knee and hip replacements, is notable. The majority of patients undergoing these procedures suffered from knee osteoarthritis or femoral head avascular necrosis. However, this increase in joint replacements has also led to a rise in periprosthetic joint infections (PJI), a severe and costly complication. PJI is responsible for 25% of total knee arthroplasty failures and 15% of total hip arthroplasty failures. Various risk factors, such as diabetes, fractures, and arthritis, are associated with PJI development. Bacterial infections, notably Staphylococcus species, are the primary cause of PJI, but rare fungal infections are often caused by Candida and Aspergillus. There is a lack of clinical trials and limited knowledge about the prevalence and treatment of fungal PJIs.

Case Report

This report presents a unique case of delayed PJI caused by Candida albicans in an otherwise healthy patient.

Conclusion

This case report emphasizes the need for further research and standardized treatment guidelines. Treatment typically involves a two-stage revision with extended antifungal therapy. The optimal duration of antifungal treatment remains uncertain.

Hypoalbuminaemia as a Marker of Severity of Patients of Community Acquired Pneumonia

Community-acquired pneumonia (CAP) is a common presentation with an acute infection of the pulmonary parenchyma occurring in the community level. Despite the availability of potent antibiotics, it remains as a serious illness with significant morbidity and mortality in both developed and developing countries. This study was undertaken to determine the relation between serum Albumin and severity of CAP. This was a cross sectional descriptive study which was carried out in the Department of Medicine of Mymensingh Medical College Hospital (MMCH), Bangladesh from July 2019 to December 2019. The sample size was 67. Purposive sampling technique was employed. Patients of community acquired pneumonia (CAP), aged ≥14 years of both sex with recently developed radiological pulmonary shadowing with compatible clinical symptoms and signs were included. Patients who were chronically immunosuppressed, with chronic starvation, advanced liver disease or chronic kidney disease with or without receiving haemodialysis were excluded. Data analysis was done by SPSS software for Windows (version 23.0). The mean age 65.7±15.3 years, majority 13(19.4%) patients had chronic lung disease, 12(17.9%) had diabetes mellitus, 9(13.4%) had heart failure, 6(9.0%) had cerebrovascular disease, 6(9.0%) had neoplastic disease and 5(7.5%) had chronic renal failure. Majority 22(32.8%) patients had CURB-65 score 3, out of which 12(54.5%) had albumin level <20g/l, 9(40.9%) had albumin level 20.0-24.9g/l and 1(4.5%) had albumin level 25-29g/l. 17(25.4%) had score 4-5 out of which 10(58.8%) had albumin level <20g/l and 7(41.2%) had albumin level 20.0-24.9g/l, 15(22.4%) had score 2 and 13(19.4%) had score 0-1. Negative significant correction (r=-0.782; p=0.001) was found between CURB-65 score and albumin level. Significant number of patients with severe CAP show low serum albumin level at admission which is statistically significant when compared with CURB-65 score. Thus hypoalbuminaemia may be a good marker of severity of patients with CAP.

Incidence of COVID-19 infection and its variation with demographic and clinical profile: lessons learned at a COVID-19 RT-PCR laboratory in Nagpur, India

Introduction. The coronavirus disease 2019 (COVID-19) pandemic emerged as a global health crisis in 2020. The first case in India was reported on 30 January 2020 and the disease spread throughout the country within months. Old persons, immunocompromised patients and persons with co-morbidities, especially of the respiratory system, have a more severe and often fatal outcome to the disease. In this study we have analysed the socio-demographic trend of the COVID-19 outbreak in Nagpur and adjoining districts. Methods. The study was conducted from April to December 2020. Nasopharyngeal and oropharyngeal swabs collected from suspected cases of COVID-19 were tested using reverse-transcription polymerase chain reaction (RT-PCR) at a diagnostic molecular laboratory at a tertiary care hospital in central India. Patient-related data on demographic profile and indication for testing were obtained from laboratory requisition forms. The results of the inconclusive repeat samples were also noted. The data were analysed using SPSS v24.0. Results. A total of 46 898 samples were received from April to December 2020, of which 41 410 were included in the study; 90.6 % of samples belonged to adults and 9.4 % belonged to children. The overall positivity rate in the samples was 19.3 %, although it varied over the period. The yield was significantly high in the elderly age group (25.5 %) and symptomatic patients (22.6 %). On repeat testing of patients whose first test was inconclusive, 17.1% were positive. There was a steady increase of both the number of tests and the rate of positivity in the initial period of the study, followed by a sharp decline. Conclusion. We can conclude that rigorous contact tracing and COVID-appropriate behaviour (wearing a mask, social distancing and hand hygiene) are required to break the chain of transmission. Elderly people are more susceptible to infection and should follow stringent precautions. It is also important to perform repeat testing of those individuals whose tests are inconclusive with fresh samples so that no positive cases are missed. Understanding of demographics is crucial for better management of this crisis and proper allocation of resources.

Isolation, characterization and acyclovir susceptibility of herpes simplex virus isolates among immunocompromised patients

Introduction

Herpes simplex virus (HSV) Type 2 primarily causes genital herpes, while HSV Type 1 is responsible for oral and facial lesions. The objective of this study was to isolate and characterize HSV from herpetic lesions among human immunodeficiency virus (HIV) infected patients and to evaluate their acyclovir susceptibility pattern.

Materials and Methods

Blister fluid and swabs from ulcers were collected from patients with clinical diagnosis of HSV infection among patients attending the HIV clinic of two tertiary care centers - Medical College, Kolkata, and School of Tropical Medicine, Kolkata. These samples were cultured in the Vero cell line. Growth of virus was noted by observing the characteristic cytopathic effect of HSV, which was further confirmed by immunofluorescence and polymerase chain reaction (PCR). These isolates were then subjected to the Vero cells with serial dilutions of acyclovir for determining the susceptibility pattern.

Results

Among the 52 samples received, 8 (15.38%) showed growth of HSV. After confirmation by immunofluorescence and PCR, all seven isolates from genital samples were identified as HSV-2 and the lone isolate from oral lesion was confirmed as HSV 1. Out of the eight isolates, 25% showed resistance to acyclovir. The overall isolation rate was more from genital blister than genital ulcer which was 46.15% and 2.86%, respectively.

Conclusion

HSV was isolated in 15.38% of cases of clinical herpes. There was a higher isolation rate of virus from blister fluid as compared to ulcer scrapings. Acyclovir resistance in 25% of cases is alarmingly high.

Genetic Characterisation of Colistin Resistant Klebsiella pneumoniae Clinical Isolates From North India

Background

Increasing use of colistin has led to the world-wide emergence of mobile colistin resistant gene (mcr). The present study aimed to identify and characterise mcr and other drug-resistant genes in colistin resistant Klebsiella pneumoniae clinical isolates.

Methods

Twenty-two colistin resistant K. pneumoniae were analysed for mcr and other drug-resistant genes, efflux pumps, and virulence genes, and for their biofilm forming ability. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were performed for all mcr-1 positive isolates. S1-PFGE and Southern hybridisation were performed for localisation of mcr-1 and bla_NDM.

Results

Nineteen colistin resistant K. pneumoniae harboured mcr-1 and 3 had mgrB disruption. All isolates harboured bla_OXA-48-type and ESBL genes; eight strains (five with mcr-1 and three with mgrB disruption) co-harboured bla_NDM. Efflux pumps genes AcrAB and mdtK were detected in all 22 and tol-C in 21 isolates. Virulence-related genes entB and irp-1 were detected in all 22, mrkD in 20, and fimH-1 in 18 isolates; 11 isolates were strong biofilm producers. PFGE clustered mcr-1 positive isolates into eight groups based on ≥90% similarity; MLST revealed diverse sequence types, predominant being ST-15 (n = 4) and ST-16 (n = 4). Both mcr-1 and bla_NDM were localised on plasmid and chromosome; mcr-1 was present on IncFII type and bla_NDM on IncFIB and IncA/C type plasmids.

Conclusions

Colistin resistance in K. pneumoniae was predominantly mediated by mcr-1. Co-existence of colistin, carbapenem, and other drug-resistant genes along with efflux pumps indicates towards enormous genomic plasticity in K. pneumoniae with ability to emerge as super-spreader of drug-resistance.

Synthesis and biological evaluation of [18F]fluorovinpocetine, a potential PET radioligand for TSPO imaging

Despite of various PET radioligands targeting the translocator protein TSPO 18-KDa are used for the investigations of neuroinflammatory conditions associated with neurological disorders, development of new TSPO radiotracers is still an active area of the researches with a major focus on the ¹⁸F-labelled radiotracers. Here, we report the radiochemical synthesis of [¹⁸F]vinpocetine, fluorinated analogue of previously reported TSPO radioligand, [¹¹C]vinpocetine. Radiolabeling was achieved by [¹⁸F]fluoroethylation of apovincaminic acid with [¹⁸F]fluoroethyl bromide. [¹⁸F]vinpocetine was obtained in quantities >2.7 GBq in RCY of 13% (non-decay corrected), and molar activity >60 GBq/µmol within 95 min synthesis time. Preliminary PET studies in a cynomolgus monkey and metabolite studies by HPLC demonstrated similar results by [¹⁸F]vinpocetine as for [¹¹C]vinpocetine, including high blood-brain barrier permeability, regional uptake pattern and fast washout from the NHP brain. These results demonstrate that [¹⁸F]fluorovinpocetine warrants further evaluation as an easier accessible alternative to [¹¹C]vinpocetine.

Asymptomatic filariasis and leprosy co-morbidity in a patient with suspected Guillain-Barrè syndrome: the first case report of an incidental finding in a slit-skin smear

INTRODUCTION

Lymphatic filariasis (LF) and leprosy are both endemic in India. These diseases are on the World Health Organization (WHO) list of neglected tropical diseases (NTDs), as they affect the most marginalized communities in the world, resulting in deformities and functional limitation. We report the first case of asymptomatic filariasis and leprosy co-morbidity in a patient with suspected Guillain-Barré syndrome.

CASE PRESENTATION

A 55-year-old male who was a farmer by occupation presented to the Neurology Outpatient Department (OPD) of our institute with complaints of weakness in all four limbs for the last 15 days. After admission, a detailed history revealed that the patient had been taking multi-drug therapy (MDT) for leprosy for the previous 6 months. After symptomatic management of the presenting complaints, the patient was sent to the Department of Microbiology for a consultation and six-site slit-skin sampling. The initial screening of Ziehl-Neelsen (ZN)-stained smears under a 10× objective led to the incidental finding of sheathed structures resembling microfilaria (Mf) on the smear made from ear lobules. In addition, short acid-fast bacilli (AFB) were also observed under the oil-immersion objective.

CONCLUSION

We emphasize that a high index of suspicion and thorough screening of smears by a microbiologist is essential in specimens obtained from any body site.

First report of peritonitis caused by the vancomycin-resistant coccus Pediococcus pentosaceus in a patient on continuous ambulatory peritoneal dialysis

Introduction

Worldwide, about one-tenth of end-stage renal disease (ESRD) patients are on peritoneal dialysis (PD). Peritonitis is a major cause of PD failure and change of therapy to haemodialysis. An update on peritoneal dialysis-related infections has recommended the use of a first generation cephalosporin or vancomycin as an empirical therapy for Gram-positive organisms. Pediococcus spp. is a Gram-positive environmental cocci that have been increasingly reported from various nosocomial infections but very rarely from peritoneal dialysis infections. It is intrinsically resistant to Vancomycin but sensitive to ampicillin. So, diagnosis of this bacteria is important if isolated from PD infections.

Case presentation.

An elderly female patient of ESRD on continuous ambulatory peritoneal dialysis (CAPD) was admitted with complaints of high fever and cloudy PD effluent for 2 days. She was started with vancomycin and imipenem empirically but did not improve even after 4 days. Pus cells were seen when PD fluid was examined microscopically. BACTEC culture of PD fluid isolated growth of Gram-positive cocci, which was confirmed as Pediococcus pentosaceus. It was resistant to vancomycin. The antibiotic of the patient was changed to ciprofloxacin IV. The patient responded in 2 days and was discharged after 7 days.

Conclusion

This is the first case report of Pediococcus pentosaceus peritonitis in an ESRD patient on CAPD. Accurate diagnosis and antibiotic sensitivity test of the bacteria is important especially if isolated in critical patients as it is intrinsically resistant to vancomycin.

Influence of plant extracts mixed with endodontic sealers on the growth of oral pathogens in root canal: An in vitro study

INTRODUCTION

Microbes are considered as the primary etiological agents in endodontic diseases. Ways of reducing these agents are root canal debridement and antibacterial filling materials. One of the factors in determining the success of endodontic treatment previously was sealing root canals with materials possessing potent bactericidal effect. Due to cytotoxic reactions of sealers and their inability to eliminate bacteria completely from dentinal tubules, trend to use natural plants extracts have been introduced.

AIM

To compare antimicrobial activity of endodontic sealers added to herbal extracts.

MATERIALS AND METHOD

Three sealers mixed with three herbal extracts were evaluated against seven strains of bacteria at various time intervals using Agar Diffusion Test. The mean zones of inhibition were measured.

STATISTICAL ANALYSIS

All statistical analysis was performed using the SPSS 15 statistical software version, Chicago. Intergroup comparison was evaluated using Kruskal Walls test along with Mann Whitney U test. The Intragroup comparison was evaluatd using Friedman test along with Wilcoxon test.

RESULTS

Statistically significant zones of bacterial growth inhibition were observed largest with Zinc Oxide Eugenol based sealer when mixed with Glycyrrhiza glabra (Licorice) followed in descending order by zinc oxide eugenol based sealer mixed with Tinospora cordifolia (Guduchi) and Mimusops elengi (Bakul) respectively.

CONCLUSION

Zinc Oxide Eugenol based sealer with herbal extracts produced largest inhibitory zones followed in descending order by Resin based sealer and Calcium hydroxide along with three herbal extracts respectively.

Parental Use of Sun Protection for Their Children – Does Skin Colour Matter?

BACKGROUND: Excessive sun exposure during childhood years is a known risk factor for skin cancer. Fifty percent of lifetime UV exposure is acquired by age 19, highlighting the potential for prevention strategies in childhood. Existing guidelines from established pediatric, dermatology and cancer prevention societies are general and not specific to any skin phototype.

OBJECTIVES: Our primary objective was to compare the frequency of adequate sun protection used by parents of children with different skin phototypes. Our secondary objective was to explore parental attitudes and beliefs on sun safety for their children.

DESIGN/METHODS: Parents of children between the ages of 6 months to 6 years were systematically recruited. Parents received self-administered questionnaires containing 40-items that examine the amount of sun protection parents used on their children, as well as their attitudes and beliefs about sun safety. Parents were also requested to self-assess their child’s Fitzpatrick Phototype (FP), and based on this response, they were divided into two groups: “lighter-skinned” (FP I-III) and “darker-skinned” (FP IV-VI). Guidelines from the Canadian Dermatology Association (CDA) on sun safety were used to quantify adequate sun protection.

RESULTS: A total of 183 parents completed the questionnaires, and 150 eligible parents (the first 25 of each FP) were included in the study. Overall, only 17% of parents used adequate sun protection for their children. Parents of lighter-skinned children were significantly more likely to use adequate sun protection (OR=17.0). As their child got older, parents were also significantly less likely to use adequate sun protection for them (OR=0.64). A significantly larger portion of parents of lighter-skin children believe that sun exposure was harmful (OR=14.2) and perceived more value in sun protection (OR=14.2), whereas parents of darker-skin children were significantly more likely to believe that darker skin tones provided more sun protection (OR=4.1).

CONCLUSION: Our study suggests that parental sun protection efforts were overall low, but especially in parents of darker-skinned children. The identified underlying attitudes and beliefs can aid in the design and delivery of sun protection interventions in the future, to ensure sun safety for all children, especially in a multiracial population.

Meta-Analysis of Studies Comparing Single and Multi-Tablet Fixed Dose Combination HIV Treatment Regimens

Availability of a single source review of once-daily fixed-dose single tablet regimen (STR) and multiple tablet fixed-dose regimen (MTR) would optimally inform healthcare providers and policy makers involved in the management of population with human immunodeficiency virus (HIV).We conducted a meta-analysis of published literature to compare patient adherence, clinical, and cost outcomes of STR to MTR.Published literature in English between 2005 and 2014 was searched using Embase, PubMed (Medline in-process), and ClinicalTrials.Gov databases. Two-level screening was undertaken by 2 independent researchers to finalize articles for evidence synthesis. Adherence, efficacy, safety, tolerability, healthcare resource use (HRU), and costs were assessed comparing STR to MTR. A random-effects meta-analysis was performed and heterogeneity examined using meta-regression.Thirty-five articles were identified for qualitative evidence synthesis, of which 9 had quantifiable data for meta-analysis (4 randomized controlled trials and 5 observational studies). Patients on STR were significantly more adherent when compared to patients on MTR of any frequency (odds ratio [OR]: 2.37 [95% CI: 1.68, 3.35], P < 0.001; 4 studies), twice-daily MTR (OR: 2.53 [95% CI: 1.13, 5.66], P = 0.02; 2 studies), and once-daily MTR (OR: 1.81 [95% CI: 1.15, 2.84], P = 0.01; 2 studies). The relative risk (RR) for viral load suppression at 48 weeks was higher (RR: 1.09 [95% CI: 1.04, 1.15], P = .0003; 3 studies) while RR of grade 3 to 4 laboratory abnormalities was lower among patients on STR (RR: 0.68 [95% CI: 0.49, 0.94], P = 0.02; 2 studies). Changes in CD4 count at 48 weeks, any severe adverse events (SAEs), grade 3 to 4 AEs, mortality, and tolerability were found comparable between STR and MTR. Several studies reported significant reduction in HRU and costs among STR group versus MTR.Study depicted comparable tolerability, safety (All-SAE and Grade 3-4 AE), and mortality and fewer Grade 3 to 4 lab abnormalities and better viral load suppression and adherence among patients on FDC-containing STR versus MTR; literature depicted favorable HRU and costs for STRs.These findings may help decision makers especially in resource-poor settings to plan for optimal HIV disease management when the choice of both STRs and MTRs are available.

Synthesis and biological evaluation of [¹¹C]AZ12504948; a novel tracer for imaging of glucokinase in pancreas and liver

INTRODUCTION

Glucokinase (GK) is potentially a target for imaging of islets of Langerhans. Here we report the radiosynthesis and preclinical evaluation of the GK activator, [(11)C]AZ12504948, for in vivo imaging of GK.

METHODS

[(11)C]AZ12504948 was synthesized by O-methylation of the precursor, AZ125555620, using carbon-11 methyl iodide ([(11)C]CH₃I). Preclinical evaluation was performed by autoradiography (ARG) of human tissues and PET/CT studies in pig and non-human primate.

RESULT

[(11)C]AZ12504948 was produced in reproducible good radiochemical yield in 28-30 min. Radiochemical purity of the formulated product was >98% for up to 2 h with specific radioactivities 855 ± 209 GBq/μmol (n=8). The preclinical evaluation showed some specificity for GK in liver, but not in pancreas.

CONCLUSION

[(11)C]AZ12504948 images GK in liver, but the low specificity impedes the visualization of GK in pancreas. Improved target specificity is required for further progress using PET probes based on this class of GK activators.

Activation of a Gq-coupled membrane estrogen receptor rapidly attenuates α2-adrenoceptor-induced antinociception via an ERK I/II-dependent, non-genomic mechanism in the female rat

Though sex differences in pain and analgesia are known, underlying mechanisms remain elusive. This study addresses the selective contribution of membrane estrogen receptors (mERs) and mER-initiated non-genomic signaling mechanisms in our previously reported estrogen-induced attenuation of α2-adrenoceptor-mediated antinociception. By selectively targeting spinal mERs in ovariectomized female rats using β-estradiol 6-(O-carboxy-methyl)oxime bovine serum albumin (E2BSA) (membrane impermeant estradiol analog), and ERα selective agonist 4,4',4″-(4-propyl-[1H]-pyrazole-1,3,5-triyl)trisphenol (PPT), ERβ selective agonist 2,3-bis(4-hydroxyphenyl)-propionitrile (DPN), G-protein-coupled estrogen receptor 30 (GPR30) agonist G1 and Gq-coupled mER (Gq-mER) agonist STX, we provide strong evidence that Gq-mER activation may solely contribute to suppressing clonidine (an α2-adrenoceptor agonist)-induced antinociception, using the nociceptive tail-flick test. Increased tail-flick latencies (TFLs) by intrathecal (i.t.) clonidine were not significantly altered by i.t. PPT, DPN, or G1. In contrast, E2BSA or STX rapidly and dose-dependently attenuated clonidine-induced increase in TFL. ICI 182,780, the ER antagonist, blocked this effect. Consistent with findings with the lack of effect of ERα and ERβ agonists that modulate receptor-regulated transcription, inhibition of de novo protein synthesis using anisomycin also failed to alter the effect of E2BSA or STX, arguing against a contribution of genomic mechanisms. Immunoblotting of spinal tissue revealed that mER activation increased levels of phosphorylated extracellular signal-regulated kinase (ERK) but not of protein kinase A (PKA) or C (PKC). In vivo inhibition of ERK with U0126 blocked the effect of STX and restored clonidine antinociception. Although estrogen-induced delayed genomic mechanisms may still exist, data presented here indicate that Gq-mER may solely mediate estradiol-induced attenuation of clonidine antinociception via a rapid, reversible, and ERK-dependent, non-genomic mechanism, suggesting that Gq-mER blockade might provide improved analgesia in females.

Activation of membrane estrogen receptors attenuates opioid receptor-like1 receptor-mediated antinociception via an ERK-dependent non-genomic mechanism

To our knowledge, the present data are the first to demonstrate that activation of membrane estrogen receptors (mERs) abolishes opioid receptor-like 1 (ORL1) receptor-mediated analgesia via extracellular signal-regulated kinase (ERK)-dependent non-genomic mechanisms. Estrogen was shown previously to both attenuate ORL1-mediated antinociception and down-regulate the ORL1 gene expression. The present study investigated whether non-genomic mechanisms contribute to estrogen-induced attenuation of ORL1-mediated antinociception by the mERs GPR30, Gq-coupled mER, ERα, and ERβ. E2BSA [β-estradiol-6-(O-carboxymethyl)oxime: bovine serum albumin] (0.5mM), a membrane impermeant analog of estradiol, injected intrathecally immediately prior to orphanin FQ (OFQ;10 nmol), the endogenous ligand for the ORL1 receptor, abolished OFQ's antinociceptive effect in both male and ovariectomized (OVX) female rats, assessed using the heat-induced tail-flick assay. This effect was not altered by protein synthesis inhibitor, anisomycin (125 μg), given intrathecally 15 min prior to E2BSA and OFQ. Intrathecal application of selective receptor agonists permitted the relative contributions of various estrogen receptors in mediating this blockade of the antinociceptive response of OFQ. Activation of GPR30, Gq-mER, ERα, but not ERβ abolished ORL1-mediated antinociception in males and OVX females. E2BSA produced a parallel and significant increase in the phosphorylation of ERK 2 only in OVX females, and pre-treatment with MEK/ERK 1/2 inhibitor, U0126 (10 μg), blocked the mER-mediated abolition of ORL1-mediated antinociception in OVX females. Taken together, the data are consistent with the interpretations that mER activation attenuates ORL1-mediated antinociception through a non-genomic, ERK 2-dependent mechanism in females.

Natural product MDM2 inhibitors: anticancer activity and mechanisms of action

The mdm2 oncogene has recently been suggested to be a valuable target for cancer therapy and prevention. Overexpression of mdm2 is often seen in various human cancers and correlates with high-grade, late-stage, and more treatment-resistant tumors. The MDM2-p53 auto-regulatory loop has been extensively investigated and is an attractive cancer target, which indeed has been the main focus of anti-MDM2 drug discovery. Much effort has been expended in the development of small molecule MDM2 antagonists targeting the MDM2-p53 interaction, and a few of these have advanced into clinical trials. However, MDM2 exerts its oncogenic activity through both p53-dependent and -independent mechanisms. Recently, there is an increasing interest in identifying natural MDM2 inhibitors; some of them have been shown to decrease MDM2 expression and activity in vitro and in vivo. These identified natural MDM2 inhibitors include a plethora of diverse chemical frameworks, ranging from flavonoids, steroids, and sesquiterpenes to alkaloids. In addition to a brief review of synthetic MDM2 inhibitors, this review focuses on natural product MDM2 inhibitors, summarizing their biological activities in vitro and in vivo and the underlying molecular mechanisms of action, targeting MDM2 itself, regulators of MDM2, and/or the MDM2-p53 interaction. These MDM2 inhibitors can be used alone or in combination with conventional treatments, improving the prospects for cancer therapy and prevention. Their complex and unique molecular architectures may provide a stimulus for developing synthetic analogs in the future.

Management of primary and metastatic triple negative breast cancer: perceptions of oncologists from India

BACKGROUND

In order to document the understanding of current evidence for the management of triple negative breast cancer and application of this knowledge in daily practice, we conducted an interactive survey of practicing Indian oncologists.

MATERIALS AND METHODS

A core group of academic oncologists devised two hypothetical triple negative cases (metastatic and early breast cancer, respectively) and multiple choice options under different clinical circumstances. The respondents were practicing oncologists in different Indian cities who participated in either an online survey or a meeting. The participants electronically chose their preferred option based on their everyday practice.

RESULTS

A total of 152 oncologists participated. Just over half (53.8%) preferred taxane based chemotherapy as first-line chemotherapy in the metastatic setting. In the adjuvant setting, a taxane regimen was chosen by 61%. Over half of respondents (52.6%) underestimated the baseline survival of a patient with node positive triple-negative tumor and 18.9% overestimated this survival compared to the estimate of the Adjuvant! program.

DISCUSSION

This data offers insight into the perceptions and practice of a diverse cross-section of practicing oncologists in India with respect to their therapeutic choices in metastatic and adjuvant settings in triple negative breast cancer.

Novel mixed-mode phase transition involving a composition-dependent displacive component

Solid-solid displacive, structural phase transformations typically undergo a discrete structural change from a parent to a product phase. Coupling electron microscopy, three-dimensional atom probe, and first-principles computations, we present the first direct evidence of a novel mechanism for a coupled diffusional-displacive transformation in titanium-molybdenum alloys wherein the displacive component in the product phase changes continuously with changing composition. These results have implications for other transformations and cannot be explained by conventional theories.

Review: molecular pathogenesis of blood-brain barrier breakdown in acute brain injury

Historically, the blood-brain barrier (BBB) was considered to be at the level of cerebral endothelium. Currently, the interaction of endothelium with other components of the vessel wall and with neurones and glial cells is considered to constitute a functional unit, termed the neurovascular unit that maintains cerebral homeostasis in steady states and brain injury. The emphasis of this review is on cerebral endothelium, the best-studied component of the neurovascular unit, and its permeability mechanisms in health and acute brain injury. Major advances have been made in unravelling the molecular structure of caveolae and tight junctions, both of which are components of the structural barrier to the entry of plasma proteins into brain. Time course studies suggest that caveolar changes precede junctional changes in acute brain injury. Additional factors modulating BBB permeability in acute brain injury are matrix metalloproteinases-2 and 9 and angiogenic factors, the most notable being vascular endothelial growth factor-A and angiopoietins (Ang) 1 and 2. Vascular endothelial growth factor-A and Ang2 have emerged as potent inducers of BBB breakdown while Ang1 is a potent anti-leakage factor. These factors have the potential to modulate permeability in acute brain injury and this is an area of ongoing research. Overall, a combination of haemodynamic, structural and molecular alterations affecting brain endothelium results in BBB breakdown in acute brain injury.

Optical Properties of Hydrogenated Amorphous Silicon, Silicon-Germanium and Silicon-Carbon Thin Films

The optical properties of solar cell grade hydrogenated amorphous silicon (a-Si:H), silicon germanium (a-SiGe:H) and silicon carbon (a-SiC:H) alloy thin films have been investigated over a wide photon energy range (0.8–4.8 eV) using a combination of subgap photoconductivity, reflection and transmission, and spectroscopie ellipsometry techniques in order to obtain accurate optical functions for solar cell modelling. Studies on films with thicknesses ranging from a few hundred Å to a few microns show that the optical spectra obtained by the different techniques agree closely over the energy ranges of overlap and display no thickness dependence from the Urbach tail energies and above. Thus, the results appear to be free of measurement and sample related artifacts. Three different methods provide a common value for the optical gap within ±0.02 eV and the result for a-Si:H is ∼0.1 eV below the mobility gap.

Optimising management of cancer related anemia

This review article provides the current recommendations and evidence for the correct management of anemia in cancer patients. The various options available include transfusions, iron and erythropoiesis stimulation. The indications, pros and cons of each option are discussed.

Transthoracic decompression of emphysematous bulla: a novel experience

Emphysematous bullae are closed air containing spaces in lung parenchyma that may severely compromise lung function in patients of chronic obstructive pulmonary disease (COPD). We describe a simple and minimally invasive procedure to decompress a large emphysematous bullae in a patient with advanced COPD and high surgical risk. Transthoracic decompression of the bulla was accomplished under short-acting anaesthesia and muscle relaxation resulting in significant symptomatic, radiological and functional improvement.

Prevalence and nature of anaemia in a prospective, population-based sample of people with diabetes: Teesside anaemia in diabetes (TAD) study

AIMS

Anaemia occurs in 25% of people attending hospital diabetes clinics, but this may not be representative of all people with diabetes. We aimed to determine the prevalence of anaemia in a prospective population-based sample stratified by estimated glomerular filtration rate (eGFR) using the 4-point Modification of Diet in Renal Disease (MDRD) formula.

METHODS

All 7331 patients on our district register were stratified by eGFR. Seven hundred and thirty were approached by letter on two occasions. Two hundred and thirty-four (32%) returned questionnaires and blood samples. Responders (R), non-responders (NR) and the whole cohort (C) were similar: mean +/- sd age R 61.7 +/- 12.7 years; NR 61.3 +/- 15.1 years; C 61.8 +/- 14.2 years; diabetes duration R 8.8 +/- 8.6 years; NR 8.2 +/- 7.9 years; C 7.5 +/- 7.8 years, Type 1 diabetes R 10.1%, NR 10.8%, C 9.4%. Anaemia was defined using World Health Organization criteria: haemoglobin < 13 g/dl for men, < 12 g/dl for women.

RESULTS

Previously undiagnosed anaemia was present in 15% of the whole group, 36% with eGFR < 60 ml/min per 1.73 m(2) and 9% of those with eGFR > 60 ml/min per 1.73 m(2). Anaemia was as a result of erythropoietin deficiency in 34%, abnormal haematinics in 40% and was unexplained in 26% of patients. Five per cent of the patients had anaemia below the treatment threshold of 11 g/dl.

CONCLUSIONS

The prevalence of unrecognized anaemia in population-based cohorts is lower than that in hospital-based studies. Current clinical surveillance in the UK is failing to detect anaemia in stage 3-5 chronic kidney disease (eGFR < 60 ml/min per 1.73 m(2)) and current guidelines will not detect 9% of diabetic patients with anaemia and an eGFR > 60 ml/min per 1.73 m(2).

Bromocriptine induced hypoprolactinemia and accessory reproductive glands response to testosterone in castrated male rats

Testosterone stimulates the Accessory Reproductive Glands (ARG) and may increase the serum titres of prolactin in castrated male rats. Bromocriptine antagonizes the testosterone-induced alteration of ARG responses; the testosterone antagonistic action of bromocriptine depends on the degree of serum prolactin depletion.

Expression of endothelial phosphorylated caveolin-1 is increased in brain injury

AIMS

Increased endothelial caveolae leading to transcytosis of plasma proteins is associated with blood-brain barrier (BBB) breakdown and cerebral oedema in brain injury. Increased expression of caveolin-1alpha (Cav-1), an integral caveolar membrane protein, was reported in endothelium of arterioles and veins with BBB breakdown to fibronectin post injury. In this study the phosphorylation state of Cav-1 and its association with BBB breakdown was determined in the rat cortical cold injury model over a period of days 0.5-6 post lesion.

METHODS

Expression of phosphorylated Cav-1 was determined by immunoblotting and dual labelling immunofluorescence for phosphorylated caveolin-1 and fibronectin, a marker of BBB breakdown. A phospho-specific monoclonal antibody that selectively recognizes only tyrosine 14-phosphorylated Cav-1 (PY14Cav-1) was used.

RESULTS

Immunoblots showed constitutive expression of PY14Cav-1 in cortex of control rats and a significant increase in PY14Cav-1 expression at the lesion site up to day 4 post lesion. PY14Cav-1 immunostaining was observed in the endothelium of lesion vessels at days 0.5-4 post lesion, in neutrophils at days 0.5 and 2 and in macrophages at day 6 post lesion. Dual labelling showed that 100% of vessels with BBB breakdown to fibronectin showed endothelial PY14Cav-1 on day 0.5, the percentage decreasing to 62% on day 4. On day 6, none of the vessels showed endothelial phosphorylated Cav-1.

CONCLUSIONS

The presence of phosphorylated Cav-1 in endothelium of vessels showing BBB breakdown suggests that phosphorylated Cav-1 signalling may be one of the factors associated with early BBB breakdown and brain oedema in brain injury.

A phase II study of sequential neoadjuvant gemcitabine plus doxorubicin followed by gemcitabine plus cisplatin in patients with operable breast cancer: prediction of response using molecular profiling

This study examined the pathological complete response (pCR) rate and safety of sequential gemcitabine-based combinations in breast cancer. We also examined gene expression profiles from tumour biopsies to identify biomarkers predictive of response. Indian women with large or locally advanced breast cancer received 4 cycles of gemcitabine 1200 mg m(-2) plus doxorubicin 60 mg m(-2) (Gem+Dox), then 4 cycles of gemcitabine 1000 mg m(-2) plus cisplatin 70 mg m(-2) (Gem+Cis), and surgery. Three alternate dosing sequences were used during cycle 1 to examine dynamic changes in molecular profiles. Of 65 women treated, 13 (24.5% of 53 patients with surgery) had a pCR and 22 (33.8%) had a complete clinical response. Patients administered Gem d1, 8 and Dox d2 in cycle 1 (20 of 65) reported more toxicities, with G3/4 neutropenic infection/febrile neutropenia (7 of 20) as the most common cycle-1 event. Four drug-related deaths occurred. In 46 of 65 patients, 10-fold cross validated supervised analyses identified gene expression patterns that predicted with >or=73% accuracy (1) clinical complete response after eight cycles, (2) overall clinical complete response, and (3) pCR. This regimen shows strong activity. Patients receiving Gem d1, 8 and Dox d2 experienced unacceptable toxicity, whereas patients on other sequences had manageable safety profiles. Gene expression patterns may predict benefit from gemcitabine-containing neoadjuvant therapy.

Sex-specific modulation of spinal nociception by alpha2-adrenoceptors: differential regulation by estrogen and testosterone

Sex-related differences in antinociception produced by the activation of alpha(2)-adrenoceptors (alpha(2)-ARs) have been reported, however, the precise role of gonadal steroids is still unknown. Hence, we hypothesized that estrogen and testosterone modulate antinociceptive effects of clonidine (an alpha(2)-AR agonist) on N-methyl-D-aspartate- (NMDA) and heat-induced spinal nociception. We also investigated whether estrogen or testosterone alters the expression of alpha(2A)-adrenoceptors in the spinal cord. Sprague-Dawley (SD) rats were implanted with PE10 cannulae in the intrathecal space of the lumbosacral spinal cord and divided into male, proestrous and diestrous female, ovariectomized (OVX), estradiol-treated OVX (OVX+E), castrated male (GDX), testosterone (GDX+T) and estradiol-treated castrated male (GDX+E) groups. Clonidine dose-dependently inhibited NMDA-induced scratching behavior in the male and OVX groups but to a significantly lesser extent in the OVX+E group. It also increased the tail withdrawal latency in the male, OVX, diestrous and GDX+T groups but not in the OVX+E, proestrous, GDX and GDX+E groups. Levels of alpha(2A)-AR mRNA were significantly higher in the OVX, estradiol-treated OVX, GDX and GDX+E animals. In contrast, alpha(2A)-AR protein levels were higher in estradiol-treated OVX, GDX, GDX+T and GDX+E animals as compared with the male. Indeed, no correlations were observed between changes in the mRNA or protein levels of alpha(2A)-AR and behavioral observations. These results support our hypothesis that sex-related differences in alpha(2)-AR-mediated modulation of spinal nociception are gonadal hormone-dependent: estrogen attenuates antinociceptive effects in females whereas testosterone is required for the expression of antinociception in males. In addition, results also revealed that the mechanism of action of gonadal hormones may not involve a global alternation in expression of alpha(2A)-AR in the spinal cord. Estrogen-induced attenuation of alpha(2)-AR-mediated inhibition of nociception could contribute to the higher prevalence of pain syndromes in women.

Salvage of isolated vaginal recurrences in women with surgical stage I endometrial cancer: a multiinstitutional experience

The objective of this study was to evaluate the treatment outcomes and risk factors of women with surgical stage I endometrial adenocarcinoma who were initially treated with surgery alone and subsequently developed isolated vaginal recurrences. Patients with surgical stage I endometrial adenocarcinoma diagnosed from 1975 to 2002 were identified from tumor registry databases at seven institutions. All patients were treated with surgery alone including a total hysterectomy, bilateral salpingo-oophorectomy, pelvic (+/- para-aortic) lymph node dissection, and peritoneal cytology and did not receive postoperative radiation therapy. Vaginal recurrences were documented histologically. Metastatic disease in the chest and abdomen was excluded by radiologic studies. Overall survival was calculated by the Kaplan-Meier method. Sixty-nine women with surgical stage I endometrial cancer with isolated vaginal recurrences were identified. Of the 69 patients, 10 (15%) were diagnosed with stage IA disease, 43 (62%) were diagnosed with stage IB disease, and 16 (23%) were diagnosed with stage IC disease. Patients diagnosed with grade 1 disease were 22 (32%), grade 2 disease were 26 (38%), and grade 3 disease were 21 (30%). Among women, 81% with isolated vaginal recurrences were salvaged with radiation therapy. The mean time to recurrence was 24 months, and the mean follow-up was 63 months. Among women, 18% died from subsequent recurrent disease. The 5-year overall survival was 75%. The majority of isolated vaginal recurrences in women with surgical stage I endometrial cancer can be successfully salvaged with radiation therapy, further questioning the role of adjuvant therapy for patients with uterine-confined endometrial cancer at the time of initial diagnosis.

Oral talactoferrin extends survival in patients with refractory NSCLC in a randomized, placebo-controlled, phase 2 trial

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Background: Talactoferrin alfa (TLF), an immunomodulatory protein with a novel anti-cancer mechanism of action, was active preclinically and in non-small cell lung cancer (NSCLC) patients in Phase 1b studies. Randomized Phase 2 studies in NSCLC were conducted with TLF as a single agent and combined with chemotherapy. The 110-patient combination therapy study, which was previously presented (ASCO 2006, #7095), met its primary endpoint with an improved BOR over chemotherapy alone. We now present results from the placebo- controlled single agent study. Methods: 100 Stage IIIB/IV NSCLC patients who had progressed after first or second line therapy were enrolled at 10 leading Indian cancer centers, and randomized to receive best supportive care plus either oral TLF (1.5 g bid) or placebo. TLF/placebo was administered until disease progression, for up to three 14-week cycles (12 weeks on, 2 weeks off), in a centrally monitored trial. The primary endpoint was overall survival (OS) with 80% power to detect an improvement in median OS with an a=0.05. Results: All patients had previously received a 1st line platinum based regimen; 26 also received 2nd line therapy. The TLF and placebo arms enrolled 47 and 53 patients, respectively. Baseline characteristics were similar in both groups, including proportion of patients receiving 1 or 2 prior regimens. All patients were included in the Intent To Treat (ITT) analysis. The trial met its primary endpoint with a 55% increase (2.1 month; p<0.05) in median OS. TLF was well tolerated. Adverse Events (AEs) were generally mild. No drug- related SAEs were reported. Incidence of AEs and Grade 3/4 AEs was similar in both arms. Conclusion: Oral talactoferrin, a promising new anti-cancer agent, significantly improved survival in patients with refractory NSCLC in this randomized, placebo-controlled trial. TLF was well tolerated in this population. Given its favorable toxicity profile, TLF may be particularly attractive in refractory patients with poor performance status.

[Table: see text] [Table: see text]

A novel combinatorial approach for understanding microstructural evolution and its relationship to mechanical properties in metallic biomaterials

The new generation of metallic biomaterials for prosthesis implantation (orthopedic and dental) typically have a Ti base with fully biocompatible alloying additions such as Nb, Ta, Zr, Mo, Fe and Sn. While the binary Ti-Ta and the ternary Ti-Nb-Ta systems are promising, the large composition space afforded by these systems offers tremendous scope in terms of alloy design via optimization of alloy composition and thermomechanical treatment. In the present paper a novel combinatorial approach has been developed for rapidly exploring the microstructural evolution and microstructure-microhardness (or elastic modulus) relationships in these systems. Using directed laser deposition, compositionally graded alloy samples have been fabricated and subsequently heat-treated to affect different microstructures in terms of the volume fraction and distribution of the alpha phase in the beta matrix as a function of composition. Subsequently, composition-specific indentation-based hardness and modulus information has been obtained from these graded samples, and the resulting data have been used to develop relationships between the composition, microstructure and mechanical properties. Such rapid combinatorial assessments can be very useful in optimizing not only the alloy composition but also the desired microstructure for achieving the best combination of properties for specific orthopedic or dental applications.

Transbronchial decompression of emphysematous bullae: a new therapeutic approach

Bullae are common accompaniments of chronic obstructive pulmonary disease especially emphysema. They contribute to increased lung volume and worsen the mechanical disadvantage of the inspiratory muscles by increasing the residual volume (RV) and RV/total lung capacity ratio. Thus effective decompression of a large bulla or bullae is thus important to improve the lung function of affected patients and also to provide symptomatic relief. Surgery and thoracoscopy are two commonly performed procedures used to treat bullae. Although bronchoscopic lung volume reduction has been successfully accomplished for emphysema, isolated decompression of bullae bronchoscopically has not been tried to date. A large emphysematous bulla in the left lower lobe of a surgically unfit patient was bronchoscopically punctured with a transbronchial aspiration needle; the position of the needle inside the bulla was confirmed and the air from the bulla was aspirated slowly to allow collapse. Finally, some autologous blood was instilled into the bulla before the needle was withdrawn. The patient had immediate and sustained symptomatic relief with significant improvement in lung function. Bronchoscopic transbronchial decompression of emphysematous bullae can be an effective therapeutic option and warrants further investigation.

Effects of seed migration on post-implant dosimetry of prostate brachytherapy

Brachytherapy using permanent seed implants has been an effective treatment for prostate cancer. However, seeds will migrate after implant, thus making the evaluation of post-implant dosimetry difficult. In this study, we developed a computer program to simulate seed migration and analyzed dosimetric changes due to seed migration at various migration amounts. The study was based on 14 patients treated with Pd-103 at the James Cancer Hospital. Modeling of seed migration, including direction, distance as well as day of migration, was based on clinical observations. Changes of commonly used dosimetric parameters as a function of migration amount (2, 4, 6 mm respectively), prostate size (from 20 to 90 cc), and prostate region (central vs peripheral) were studied. Change of biological outcome (tumor control probability) due to migration was also estimated. Migration reduced prostate D90 to 99+/-2% of original value in 2 mm migration, and the reduction increased to 94+/-6% in 6 mm migration. The reduction of prostate dose led to a 14% (40%) drop in the tumor control probability for 2 mm (6 mm) migration, assuming radiosensitive tumors. However, migration has less effect on a prostate implanted with a larger number of seeds. Prostate V100 was less sensitive to migration than D90 since its mean value was still 99% of original value even in 6 mm migration. Migration also showed a different effect in the peripheral region vs the central region of the prostate, where the peripheral mean dose tended to drop more significantly. Therefore, extra activity implanted in the peripheral region during pre-plan can be considered. The detrimental effects of migration were more severe in terms of increasing the dose to normal structures, as rectum V50 may be 70% higher and urethra V100 may be 50% higher in the case of 6 mm migration. Quantitative knowledge of these effects is helpful in treatment planning and post-implant evaluation.