Can Mycobacterium tuberculosis infection lead to cancer? Call for a paradigm shift in understanding TB and cancer

Infections are known to cause tumours though more attributed to viruses. Strong epidemiological links suggest association between bacterial infections and cancers as exemplified by Helicobacter pylori and Salmonella spp. Infection with Mycobacterium tuberculosis (M. tb), the etiological agent of tuberculosis (TB), has been reported to predispose patients to lung cancers and possibly in other organs as well. While this etiopathogenesis warrant inclusion of M. tb in IARC's (International Agency for Research on Cancer) classified carcinogenic agents, the lack of well-defined literature and direct experimental studies have barred the research community from accepting the role of M. tb as a carcinogen. The background research, case studies, and experimental data extensively reviewed in Roy et al., 2021; provoke the debate for elucidating carcinogenic properties of M. tb. Moreover, proper, timely and correct diagnosis of both diseases (which often mimic each other) will save millions of lives that are misdiagnosed. In addition, use of Anti Tubercular therapy (ATT) in misdiagnosed non-TB patients contributes to drug resistance in population thereby severely impacting TB disease control measures. Research in this arena can further aid in saving billions of dollars by preventing the superfluous use of cancer drugs. In order to achieve these goals, it is imperative to identify the underlying mechanism of M. tb infection acting as major risk factor for cancer.

1082 OPTIMISING CONSTIPATION IN ORTHOGERIATRIC FRACTURED NECK OF FEMUR PATIENTS THROUGH NALOXEGOL USE

Introduction

Constipation is a major concern within the care of the elderly, particularly on Orthogeriatric wards where patients are given opioids, kept nil by mouth and can be immobile for days. On average patients were opening their bowels after 4.5 days and given various laxative regimes, 43% were administered a phosphate enema. The aim of this project was to reduce the number of days that patients did not open their bowels and ultimately improve their quality of care. This was implemented by reducing the use of phosphate enemas and increasing prescriptions of Naloxegol through a stepwise structure for laxative use. NICE recommends Naloxegol prescription after 4 days of patients not opening bowels (BNO) but local policy for Wythenshawe Hospital was amended in 2020 to allow for Naloxegol to be given after 3 days.

Method

Audit data was initially collected to produce a baseline to compare to; then an initial intervention, a presentation to all ward staff on the new regime and Naloxegol prescription was given on two occasions. Following this; data on bowel movements, urinary catheterisation and MSU result was taken from electronic patient records along with prescription data from drug charts. The data was analysed, in addition to reviewing any issues that had arisen as a result of the intervention. The second intervention, a laminated poster in the doctor's office reiterating the same information as previous was implemented 4 weeks later, again the same data was collected and analysed.

Results

Phosphate enema use was reduced by 83%, and Naloxegol use increased by 336%, bowels on average opened 1.5 days earlier and patients were trialled without catheter (TWOC) approximately 4 days quicker than previous.

Conclusion

(s) Implementing a structured regime with Naloxegol prescription on Day 3 BNO at its heart provides for a significant improvement in constipation within Orthogeriatrics.

Structure-Function Analyses of New SARS-CoV-2 Variants B.1.1.7, B.1.351 and B.1.1.28.1: Clinical, Diagnostic, Therapeutic and Public Health Implications

SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus 2) has accumulated multiple mutations during its global circulation. Recently, three SARS-CoV-2 lineages, B.1.1.7 (501Y.V1), B.1.351 (501Y.V2) and B.1.1.28.1 (P.1), have emerged in the United Kingdom, South Africa and Brazil, respectively. Here, we have presented global viewpoint on implications of emerging SARS-CoV-2 variants based on structural-function impact of crucial mutations occurring in its spike (S), ORF8 and nucleocapsid (N) proteins. While the N501Y mutation was observed in all three lineages, the 501Y.V1 and P.1 accumulated a different set of mutations in the S protein. The missense mutational effects were predicted through a COVID-19 dedicated resource followed by atomistic molecular dynamics simulations. Current findings indicate that some mutations in the S protein might lead to higher affinity with host receptors and resistance against antibodies, but not all are due to different antibody binding (epitope) regions. Mutations may, however, result in diagnostic tests failures and possible interference with binding of newly identified anti-viral candidates against SARS-CoV-2, likely necessitating roll out of recurring "flu-like shots" annually for tackling COVID-19. The functional relevance of these mutations has been described in terms of modulation of host tropism, antibody resistance, diagnostic sensitivity and therapeutic candidates. Besides global economic losses, post-vaccine reinfections with emerging variants can have significant clinical, therapeutic and public health impacts.

Association of gastric fluid microbes at birth with severe bronchopulmonary dysplasia

OBJECTIVE

Gastric fluid microbes were examined in preterm infants at birth to assess their influence on the postnatal outcome.

STUDY DESIGN

Prospective cohort study.

SETTING

Level III neonatal intensive care unit.

PATIENTS

A total of 103 premature neonates with a gestational age of less than 32 weeks.

MAIN OUTCOME MEASURE

Gastric fluid microbes were identified by analysis of bacterial 16S ribosomal RNA gene. Additionally, the urease gene of Ureaplasma species was detected by polymerase chain reaction of gastric fluid obtained at birth and/or tracheal aspirate from ventilated preterm infants. The association between detection of microbes and bronchopulmonary dysplasia was investigated through assessment from clinical features and by a lung injury marker (KL-6).

RESULTS

Forty-two of 103 gastric fluid specimens were positive for microbes. Ureaplasma species were detected in 23 of the 42 (55%) gastric fluid specimens. All infants with Ureaplasma species in tracheal aspirate fluid also had positive gastric fluid specimens. Compared to infants negative for gastric fluid microbes, infants positive for microbes had higher rates of maternal chorioamnionitis (18% vs 78%), premature rupture of membranes (11% vs 55%), severe bronchopulmonary dysplasia (1.6% vs 14%) and showed higher plasma KL-6 levels during the initial 4 weeks of life.

CONCLUSION

Detection of gastric fluid microbes was correlated well with antenatal infection and severe bronchopulmonary dysplasia. Detection of Ureaplasma species in gastric fluid was associated with subsequent respiratory colonisation. These results suggest that antenatal exposure of the immature fetus to microbes may cause lung injury and promote the onset of bronchopulmonary dysplasia.

Antiretroviral therapy and HIV prevention in India: modeling costs and consequences of policy options

OBJECTIVES

The objective of this study is to assess the costs, cost-effectiveness, and HIV epidemic impact of 3 antiretroviral therapy (ART) policy options.

STUDY DESIGN

We constructed an epidemiologic model to predict the course of the HIV epidemic in the absence of expanded ART availability. Based on background studies of the willingness to pay for ART among patients with AIDS, of the costs to the government of the alternative treatment interventions, and of ART's likely effects on HIV transmission, we simulated the consequences of 3 possible alternative government ART policies.

RESULTS

A program to reduce the negative consequences of the currently unstructured private-sector provision of ART is the most cost-effective of the 3 options at a 10% discount rate and least cost-effective at a 3% rate. The costs and cost-effectiveness of all options are highly sensitive to the effect of ART on condom use.

CONCLUSION

The design of ART policy should capitalize on the potential of ART to decrease HIV transmission through institutional arrangements that reward effective prevention programs, thereby raising the likelihood that treatment has beneficial rather than negative external effects.

Nanometal Surface Energy Transfer in Optical Rulers, Breaking the FRET Barrier

Optical-based distance measurements are essential for tracking biomolecular conformational changes, drug discovery, and cell biology. Traditional Forster resonance energy transfer (FRET) is efficient for separation distances up to 100 A. We report the first successful application of a dipole-surface type energy transfer from a molecular dipole to a nanometal surface that more than doubles the traditional Forster range (220 A) and follows a 1/R(4) distance dependence. We appended a 1.4 nm Au cluster to the 5' end of one DNA strand as the energy acceptor and a fluorescein (FAM) to the 5' end of the complementary strand as the energy donor. Analysis of the energy transfer on DNA lengths (15, 20, 30, 60bp), complemented by protein-induced DNA bending, provides the basis for fully mapping the extent of this dipole surface type mechanism over its entire usable range (50-250 A). Further, protein function is fully compatible with these nanometal-DNA constructs. Significantly extending the range of optical based methods in molecular rulers is an important leap forward for biophysics.

Late onset of right Bochdalek's hernia with strangulation of the omentum

We report a case of bloody pleural effusion and infarction of the greater omentum caused by a non-traumatic diaphragmatic hernia with a late presentation. A 15-y-old boy with Down's syndrome developed abdominal pain and vomiting, as well as an elevated serum level of C-reactive protein. Chest roentgenograms showed a right-sided pleural effusion and computed tomography revealed a right diaphragmatic hernia. Barium enema confirmed the diagnosis. An operation revealed a right Bochdalek's hernia with strangulation of the greater omentum in the right pleural cavity.

CONCLUSION

Diaphragmatic hernia should be considered in patients with pleural effusion, abdominal pain and vomiting.

Community prevalence of sexually transmitted diseases and human immunodeficiency virus infection in Tamil Nadu, India: a probability proportional to size cluster survey

BACKGROUND

Human immunodeficiency virus (HIV) infection and AIDS is threatening the survival of many nations. To evaluate ongoing interventional strategies and burden of illness estimates, valid data on the prevalence of HIV are required. Often, in the absence of community prevalence data, estimates are based on surrogate markers such as prevalence of HIV in antenatal clinics. Even though the antenatal prevalence of HIV is easier to measure and can be repeated for evaluation, it is important to establish the association between antenatal and community prevalence of sexually transmitted diseases (STDs) and HIV, so that the validity of the estimates can be verified.

METHODS

A 'probability proportional to size' cluster survey was conducted in three randomly selected districts of Tamil Nadu in India. The basic unit of the survey was households from rural and urban clusters. Adults 15-45 years of age from the selected households were eligible for recruitment. Demographic, behavioural and laboratory data were collected. Clinical examination was done to identify STD syndromes and blood, urine, vaginal/urethral and endocervical swabs were taken for laboratory diagnosis of STDs from the subjects. Direct smear examination for Trichomonas vaginalis; serological tests for syphilis, hepatitis B, HIV, herpes simplex virus 2, Chlamydia trachomatis; and culture of Neisseria gonorrhoeae and Haemophilus ducreyi were performed on the collected specimens. The data were analysed adjusting for cluster effect.

RESULT

We selected and screened 1981 individuals (1157 women and 824 men) for STDs and HIV from 1114 households representing the 25 million projected adult population of Tamil Nadu. The overall community prevalence of STDs including HIV and hepatitis B in Tamil Nadu was 14.6% (CI: 14.1-15.1), and 8.3% (CI: 7.9-8.6) when HIV and hepatitis B were excluded. Community prevalence of HIV and hepatitis B infection was 1.8% (CI:1.7-1.9) and 5.3% (CI: 5.1-5.5), respectively. The distribution of HIV involved both rural and urban regions of Tamil Nadu. On clinical examination, at least one STD syndrome was noted in 486 (24.5%) of the women subjects; vaginal discharge was the most common and found in 421 women (38.4%).

CONCLUSION

The prevalence of STD and HIV in Tamil Nadu is higher than expected and has extended into the non-high risk population (generalized epidemic).

Study of perceived norms, beliefs and intended sexual behaviour among higher secondary school students in India

The objective of this paper is to understand the intended sexual and condom behaviour patterns among teenage higher secondary school students in India. To achieve this, variables including perceived norms, perceived peer group norms, risk behaviour patterns, perceived chances of getting AIDS and relevant sociodemographic variables were regressed on intended sexual behaviour. Regression of actual sexual behaviour was carried out with perceived norms, perceived peer group norms and intended sexual behaviour as the independent variables. In this paper a conceptual model has been framed based on the theory of reasoned action, health belief model and self-efficacy theory. Cumulative scores are computed for perceived norms, perceived peer group norms, risk behaviour patterns, opinion on handling condoms and perceived chances of getting AIDS. Along with these variables, possible confounding variables such as age, gender, type of family, mother's education and father's education were considered for their effect on intended sexual and condom behaviour. The results revealed that perceived norms and perceived peer group norms showed significant association with intended sexual behaviour and actual sexual behaviour and that children of more highly educated parents are less likely to engage in sexual activities in their adolescent years.

[Effects of a mental countermeasure on the physiological detection of deception using the event-related brain potentials]

This study focused on the effects of a mental countermeasure on the detection of deception using the P300 component of event-related brain potentials. Thirty-three subjects were divided into two groups: a countermeasure (CM) group and a non-countermeasure (NCM) group. The CM group was instructed to count backwards by sevens during the experiment. Relevant stimuli were subjects' own family names and irrelevant stimuli were four other typical Japanese family names. The subjects were required to press a button when the name stimuli were presented on a CRT display. The use of the mental countermeasure significantly prolonged reaction time to the stimuli and reduced overall P300 amplitudes. The P300 amplitudes to the relevant stimuli, however, were consistently larger than those to the irrelevant stimuli in both groups. The correct detection rate of the relevant stimuli was 81% in the CM and 94% in the NCM group, but the difference was not statistically significant. These findings indicate that deception can still be detected by using P300, in spite of the use of the countermeasures by subjects.

Changing epidemiology of HIV type 1 infections in India: evidence of subtype B introduction in Bombay from a common source

India has experienced multiple introductions of diverse HIV-1 subtypes A, B, C, and E, along with subtype B of HIV-2 between the 1980s and early 1990s. In this study, we have carried out a molecular investigation of 21 heterosexually and vertically acquired HIV-infected individuals from the New Bombay area, who tested positive for HIV-1 by commercial enzyme-linked immunosorbent assay (ELISA) and Western blot assay. We have sequenced the proviral DNA segments from the uncultured PBMCs in the hypervariable env V(3) region (286 bp) and a full-length vpr gene (291 bp). Overall, phylogenetic clustering of all Indian strains and also their clustering with subtype B strains were evident from both V(3)- and vpr gene-based trees, strongly supporting their recent introduction from a common source. This is the first report on subtype B introduction in Bombay, a region where subtype C predominates. Overall, these subtype B strains from Bombay shared genetic closeness with subtype B strains from Europe, the United States, and Asia.

Natural history of herpes zoster in the era of AIDS

Seventy-four consecutive patients with herpes zoster (HZ) in Mumbai were recruited into the study to determine its natural history. Thirty-five (47.3%) with HZ were infected with HIV-1/2. HZ+HIV+ and HZ+HIV- were demographically similar but HZ+HIV+ were clinically different; the latter were characterised by multidermatomal involvement of thoracic dermatomes below T6 or that of trigeminal nerve, recurrent episodes, bullous lesions and 17/35 had associated illnesses such as severe weight loss, recurrent fever, chronic cough, active tuberculosis and oral candidiasis. Significant differences in the course of healing, incidence of secondary bacterial infection and scaring emerged between the two groups after day-10. HZ+HIV+ individuals had vesicles and ulcers persisting for significantly longer time with frequent sequelae of post inflammatory pigmentation and post herpetic neuralgia. In areas where resources are limited for health information, such clinical differences between HZ+HIV+ and HZ+HIV- will serve to identify individuals with HIV infection in dermatologic clinic. These findings will also be helpful for early diagnosis of HIV infection, associated opportunistic infections and prevent their secondary transmission through appropriate interventions.

[Contingent negative variation (CNV) in the detection of deception task using a serial presentation of pictures]

The purpose of the experiment was to investigate the feasibility of using contingent negative variation (CNV) as an index of detection of deception. Twelve subjects were required to complete both an innocent and guilty condition in that order. In the innocent condition, a series of six pictures, two of which depicted different landscapes and four others which depicted different female faces, was presented repeatedly on a computer display. Subjects responded by pressing a button following the landscape picture (target stimulus) that was presented last in the sequence. In the guilty condition, the procedures were the same except that subjects were also required not to detect one of the female pictures in mind (critical item), which they had chosen after the completion of the innocent condition. As compared with the innocent condition, the CNV amplitudes decreased significantly immediately before the target stimulus in the guilty condition where subjects had to conceal the critical item. The implication of these data both for the psychological completion of the concealed task and the practice in the field were discussed.

High occurrence of HBV among STD clinic attenders in Bombay, India

The pattern of sexually transmitted disease (STD) is the basis for designing surveillance of specific STD, their trends and syndromic management protocols. Two hundred and fifteen consecutive first-time STD clinic attenders at a teaching hospital in Bombay were recruited for the study in October 1995. Thorough clinical examination and the following investigations were done: wet mount, Gram stain, Giemsa stain, modified Thayer-Martin (MTM) medium culture, Fontana stain, Venereal Disease Research Laboratory (VDRL), Treponema pallidium haemagglutination test (TPHA), HBsAg and HIV. Ulcerative STD constituted 73.5% of total STD while 15.8% were discharges and 10.2% were genital growths. Ulcers in decreasing order of frequency were chancroid (51.9%), genital herpes (29.1%) and syphilis (14.5). 76.5% of genital discharges were due to gonococcal infection. The high rate of ulcerative STD is possibly an important co-factor for the high HIV prevalence of 31.2% in Bombay. Of 182 patients tested for HBV, 16 (8.8%) were reactive for HBsAg, revealing a high prevalence among STD attenders. A high co-relation of HBsAg positive with either HIV or VDRL requires urgent attention for HBV intervention strategies in this population.

Concomitants of HIV/STD risk behaviours and intention to engage in risk behaviours in adolescents in India

A total of 1230 year 11 and 12 anglophone college students, modal age 16 and 17, in three colleges in Mumbai (Bombay), India, were studied with regard to sexual behaviours or risk of sexual behaviours, beliefs about sex, HIV/STD knowledge, and perceived norms regarding sexual behaviours. Data indicated that 8% of males and 1% of females had had sexual experience, but over one-third were not sure at all of being able to abstain from sexual activity with either steady or casual partners. However, perceived norms were slanted toward sexual abstinence for the majority of the sample. Knowledge of the protective effects of condoms was high, although half of those who had had sex did not use condoms. Logistic regression showed that knowledge was higher among males, those who believed it was OK to have sex with a steady partner and that they should not wait until they were older, those who believed that condoms should be used even if the partner is known, and those who believed it was acceptable to have multiple partners. Gender differences in sexual activity and beliefs about sexual activity showed that males were less likely to believe in abstaining from sexual activity and to engage in it. We conclude that this age-group is appropriate for HIV/STD reduction education given the low rate of sexual activity but that, despite knowledge of the importance of condom use, the social skills to apply this knowledge are lacking.