Scanning electron microscopy analysis of hair index on Karachi's population for social and professional appearance enhancement

OBJECTIVE

Hair texture, appearance and pigment play an important role in social and professional communication and maintaining an overall appearance. This study was especially designed for morphological assessment of hair damage caused to Karachi's population due to natural factors and cosmetic treatments using scanning electron microscopy (SEM) technique.

METHODS

Hair samples under the study of synthetic factor's effect were given several cosmetic treatments (hot straightened, bleached, synthetic dyed and henna dyed) whereas samples under natural factor's effect (variation in gender, age and pigmentation) were left untreated. Morphological assessment was performed using SEM technique. Results obtained were statistically analysed using minitab 16 and spss 18 softwares.

RESULTS

Scanning electron microscopy images revealed less number of cuticular scales in males than females of same age although size of cuticular scales was found to be larger in males than in females. Mean hair index of white hair was greater than black hair of the same head as it is comparatively newly originated. Tukey's method revealed that among cosmetic treatments, bleaching and synthetic henna caused most of the damage to the hair.

CONCLUSION

Statistical evaluation of results obtained from SEM analysis revealed that human scalp hair index show morphological variation with respect to age, gender, hair pigmentation, chemical and physical treatments. Individuals opting for cosmetic treatments could clearly visualize the extent of hair damage these may cause in long run.

Aggregate Exposure and Cumulative Risk Assessment--Integrating Occupational and Non-occupational Risk Factors

Occupational exposure limits have traditionally focused on preventing morbidity and mortality arising from inhalation exposures to individual chemical stressors in the workplace. While central to occupational risk assessment, occupational exposure limits have limited application as a refined disease prevention tool because they do not account for all of the complexities of the work and non-occupational environments and are based on varying health endpoints. To be of greater utility, occupational exposure limits and other risk management tools could integrate broader consideration of risks from multiple exposure pathways and routes (aggregate risk) as well as the combined risk from exposure to both chemical and non-chemical stressors, within and beyond the workplace, including the possibility that such exposures may cause interactions or modify the toxic effects observed (cumulative risk). Although still at a rudimentary stage in many cases, a variety of methods and tools have been developed or are being used in allied risk assessment fields to incorporate such considerations in the risk assessment process. These approaches, which are collectively referred to as cumulative risk assessment, have potential to be adapted or modified for occupational scenarios and provide a tangible path forward for occupational risk assessment. Accounting for complex exposures in the workplace and the broader risks faced by the individual also requires a more complete consideration of the composite effects of occupational and non-occupational risk factors to fully assess and manage worker health problems. Barriers to integrating these different factors remain, but new and ongoing community-based and worker health-related initiatives may provide mechanisms for identifying and integrating risk from aggregate exposures and cumulative risks from all relevant sources, be they occupational or non-occupational.

Application of pharmacokinetic modelling for 2,3,7,8-tetrachlorodibenzo-p-dioxin exposure assessment

Polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and mono- and non-ortho polychlorinated biphenyls (dioxin-like PCBs) are identified as a family or group of organic compounds known as 'dioxins' or dioxin-like chemicals (DLCs). The most toxic member of this group is 2,3,7,8-tetrachlorodibenzo-(p)-dioxin (TCDD). Historically, DLCs have caused a variety of negative human health effects, but a disfiguring skin condition known as chloracne is the only health effect reported consistently. As part of translational research to make computerized models accessible to health risk assessors, the Concentration- and Age-Dependent Model (CADM) for TCDD was recoded in the Berkeley Madonna simulation language. The US Agency for Toxic Substances and Disease Registry's computational toxicology laboratory used the recoded model to predict TCDD tissue concentrations at different exposure levels. The model simulations successfully reproduced the National Health and Nutrition Examination Survey (NHANES) 2001-2002 TCDD data in age groups from 6 to 60 years and older, as well as in other human datasets. The model also enabled the estimation of lipid-normalized serum TCDD concentrations in breastfed infants. The model performed best for low background exposures over time compared with a high acute poisoning case that could due to the large dose and associated liver toxicity. Hence, this model may be useful for interpreting human biomonitoring data as a part of an overall DLC risk assessment.

Physiologically based pharmacokinetic (PBPK) tool kit for environmental pollutants--metals

The Agency for Toxic Substances and Disease Registry (ATSDR) is mandated by the US Congress to identify significant human exposure levels, develop methods to determine such exposures, and design strategies to mitigate them. Physiologically based pharmacokinetic (PBPK) models are increasingly being used to evaluate toxicity of environmental pollutants through multiple exposure pathways. As part of its translational research project, ATSDR is developing a human 'PBPK model tool kit' that consists of a series of published models re-coded in a common simulation language. The tool kit currently consists of models, at various stages of development, for priority environmental contaminants including solvents and persistent organic pollutants. Presented here are results of translational activities of re-coding models for cadmium, mercury, and arsenic. As part of this work, following re-coding each new model was evaluated for fidelity followed by sensitivity analysis. Good agreement was generally obtained for all three models when predictions of original and re-coded model simulations were compared. Also presented is an application of the cadmium toxicokinetic model to interpret biomonitoring data from the National Health and Nutrition Examination Survey (NHANES). The PBPK tool kit will enable ATSDR scientists to perform simulations of exposures from contaminated environmental media at sites of concern and to better interpret site-specific biomonitoring data.

Remicade as TNF Suppressor in Patients with Myelodysplastic Syndromes

Remicade, a chimeric human-murine monoclonal antibody capable of neutralizing tumor necrosis factor alpha was given to 37 low-risk myelodysplastic syndromes (MDS) patients in two cohorts; 5 and 10 mg/kg intravenously every 4 weeks for 4 cycles. Median age was 68 years, 33 had primary MDS, 14 had refractory anemia (RA), 14 RA with ringed sideroblasts, 9 RA with excess blasts. Nine patients stopped therapy prior to completing 4 cycles, 3 from cohort 1 and 6 from cohort 2 and response was evaluated using the International Working Group criteria in 28 patients who completed the 4 cycles. Six patients showed disease progression, 14 had stable disease and 8 showed hematologic responses, 3/15 (20%) in cohort 1 and 5/13 (38%) in cohort 2. Two patients had multi-lineage responses, 2 had > 100% increase in absolute neutrophils, 1 had > 1 gm/dl increase in hemoglobin, 1 had reduction in blasts from 7% to 1%, and 2 had minor cytogenetic responses (> 50% reduction in + 8 and 20q-metaphases respectively). We conclude that Remicade may have a variety of activities in low risk MDS patients, is well tolerated with a high patient compliance, and may be considered for combination therapy in the future.

Prediction of the health effects of polychlorinated biphenyls (PCBs) and their metabolites using quantitative structure-activity relationship (QSAR)

Polychlorinated biphenyls (PCBs) are a group of 209 persistent environmental contaminants that are slightly different but structurally related. PCBs are known to induce a variety of health effects and often have been toxicologically tested as complex commercial mixtures (Aroclors) but environmental exposure occurs separately to a small number of specific congeners. Recently, the Third National Report on Human Exposures to Environmental Chemicals, an assessment of exposure data of the National Health and Nutrition Examination Survey (NHANES), identified 35 individual PCB congeners in the U.S. population. These types of findings necessitate the toxicity evaluation of individual congeners but adequate toxicity data for most individual PCB congeners are not available. Due to this, a quantitative structure-activity relationship (QSAR) approach was used to assess the potential mutagenesis and carcinogenesis of individual congeners and their possible metabolites. The predictions were analyzed to define the underlying generalizations between the parent PCBs, their metabolites, and some important toxicological endpoints. This analysis reveals that (1) mono and di-chlorinated PCBs and their metabolites can be potential mutagens; (2) PCB benzoquinone metabolites could be carcinogenic but the weight of evidence is poor. These results support the hypothesis that environmental exposure to some PCBs and/or their metabolites could produce mutagenicity and/or carcinogenicity. Hence, these data should be considered as priority toxicological testing data needs. As with all computational toxicology analytical findings, these conclusions must yield to empirical data as they become available.

Geochemical and geostatistical investigations of chromium pollution in groundwater

Geochemical and geostatistical study of the chromium concentration in groundwater occurring at variable depths of 12 to 33.5 m (40 to 110 ft) in the Karachi urban area of Pakistan have been made. Samples were collected at variable distances, with a maximum of 1 km interval, on the bases of population, industries, types, and density. The chromium concentration has also been worked out to deduce the threshold value of the area under study and the estimation of probability impact modeling, in terms of concentration variation, by using the disjunctive kriging technique. The outcome of the present work appears to be a good tool to decipher pollution variation in the groundwater of highly urbanized areas, with respect to the population and industries. The patterns of distribution of chromium concentration in groundwater and pollution hotspots in particular localities appear to be more related to the types of industries than to the effect of population types.

Prognostic value of low platelets in MDS patients with del(5q)

7078

The most common (10–15%) chromosomal abnormality found in myelodysplastic syndromes (MDS) is an interstitial deletion of the long arm of chromosome 5 (del(5q)). The recent finding that lenalidomide is efficacious for MDS patients with del(5q) as either the sole abnormality or as part of a complex karyotype has focused renewed interest in the prognostic characteristics of these patients. We analyzed 189 patients with del(5q), 70 having isolated and 119 having additional chromosomal abnormalities. The median survival for the isolated del(5q) patient was 2.45 years and for those with complex abnormalities was 0.63 years (p=0.001). Each of these groups was then divided by IPSS category; median survival for Low/Int1 (n=56) was 2.46 years and 0.49 years for Int2/High (n=10, p=0.019).Thus our median survival times match previously published results and we have a representative dataset. Since 5q- syndrome patients with normal to high platelets have the best survival, platelet count may be of prognostic significance. We determined the median platelet count for our dataset to be 115,000 and analyzed median survival for patients with greater (n=89) or less (n=88) than the median value. Survival for those with higher platelet counts was 2.6 years, but dropped to 0.54 years with lower counts (p=0.0001). We then analyzed each of these two groups independently for survival based on IPSS, blast % and karyotype. Median survival for patients with >115,000 platelets and either Low/Int1-risk (n=62), <5% blasts (n=46) or an isolated del(5q) (n=46) was 2.95–3.0 years. The survival of these patients dramatically decreased (0.63 years) if they had Int2/High IPSS (n=19) or >10% blasts (=11). The presence of additional chromosomal abnormalities decreased survival to 1.85 years (n=28). A different range of survival times occurred with patients that had <115,000 platelets. Their median survival based on Low/Int1 IPSS (n=20), <5% blasts (n=18) or isolated del(5q)(n=20) was only 0.68–0.84 years. Int2/High IPSS (n=64), >5% blasts (n=50) or additional chromosomal abnormalities (n=68) lowered survival to 0.44–0.49 years. Thus lower platelet counts in del(5q) MDS patients with favorable IPSS (median survival 0.84 years), <5% blasts (median survival 0.68 years) or isolated del(5q) (median survival 0.74 years) appear to have poor prognosis.

No significant financial relationships to disclose.

Validation of IPSS criteria in more than 1,600 MDS patients

7079

Myelodysplastic syndromes (MDS) are a diverse group of clonal stem cell disorders characterized by bone marrow failure, dysmyelopoiesis and peripheral cytopenias and affecting predominantly an elderly population. The International Prognostic Scoring System (IPSS) incorporates the number of peripheral cytopenias, percentage of bone marrow blasts and chromosomal abnormalities and assigns a score to predict survival and risk of disease progression to AML. Using the extensive MDS database at the University of Massachusetts we analyzed survival time in relation to IPSS scoring and also its various individual components, i.e. blast percentage, number of cell lines involved and the number of karyotype abnormalities in 1,200+ patients. The overall median survival time in 1,424 MDS patients as a group was 2.9 years. IPSS low group had the longest median survival time of 7.5 years with IPSS Int-1 3.6 years. There was minimal difference in the median survival time between IPSS Int-2 and IPSS high risk group 1.2 and 1.1 years respectively. These results were significant for a P value of <0.0001. The median survival time for blasts <5% was 5.3 years and blast 5–10% was 1.7 years. Interestingly, there was minimal survival difference between median survival time for blasts 11–20% and blasts >20% showing 1.2 years and 1.3 years respectively. Again, these results were significant for a P value of <0.0001. The median survival time for the number of cytopenias involved was also calculated with 0, 1, 2 and 3 numbers of cytopenias showing 6.4 years, 4.4 years, 2.6 years and 1.8 years respectively, with P value of <0.0001. The median survival time for normal karyotype versus one or two karyotype abnormality was 4.9 years, 2.6 years and 2.4 years respectively. Three or more karyotype abnormalities showed a median survival time of 0.8 years. The P value was again significant (<0.0001). Our results not only validate the prognostic value of IPSS scoring system as a whole but also its various individual prognostic indicators.

No significant financial relationships to disclose.

Complete blood count may provide risk stratification for survival and AML transformation in CMML

17502

We performed a retrospective analysis of 120 patients with CMML (98 de novo CMML and 22 evolving from MDS) to examine clinical features that may influence survival and AML transformation. Univariate analysis showed low hemoglobin level; WBC > 13,000, platelet count < 50,000 and abnormal cytogenetics as poor prognostic features. Univariate analysis also determined that BM blasts >5% and Int2/High IPSS were associated with higher rates of AML but IPSS could not be used for survival assessment. Multivariate analysis showed hemoglobin < 12 g/dL, older age, abnormal cytogenetics as risk factors for shorter survival; older age, male sex, low platelet count, BM blasts > 5%, lymphocyte and monocyte counts were independent risk factors for AML transformation. Previous attempts to devise prognostic scoring systems for CMML have incorporated both peripheral blood and bone marrow features. We have used hemoglobin, lymphocyte count and platelet count to generate 3 prognostic scoring systems, which differed by severity of thrombocytopenia. Score 1 (>100, 50–100, <50) identified 3 different risk groups (low, intermediate, and high) with median OS: not reached (n/a), 18, and 9 months for all CMML patients (p<0.0001) as well as for the de novo CMML patients (p<0.0001). Score 2 (>50, <50) divided patients into 3 risk groups (low, intermediate, and high) with median OS: n/a, 19 and 10 months for all CMML (p=0.0002) versus n/a, 28 and 11 months for de novo CMML patients (p=0.0011). Score 3 (<100, >100) separated all CMML (p=0.0073) and de novo CMML patients (p=0.0054) into 2 risk groups (high, low) with median time to AML 53 months and n/a. In conclusion we suggest three new scoring systems for CMML patients that can be easily calculated after an initial CBC. Scores 1 and 2 help to assess survival while score 3 indicates risk for AML transformation. *Acknowledgements: This work has been partially supported by the AMA Foundation Seed Grant Research Program 2006.

No significant financial relationships to disclose.

Low dose Vidaza and thalidomide is an effective combination for patients with myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML)

6570

Vidaza and thalidomide were administered to 29 patients with MDS or AML. Vidaza was given at a dose of 75mg/kg subq × 5 days q28 days and Thalidomide starting at 50mg/day and increasing to 100mg. Therapy was well tolerated. Median age was 70 years, and there were 16 males. Two patients had RA, 2 RARS, 9 RAEB, 4 CMMoL, 10 AML and 2 Unknowns. According to IPSS, 1 had low, 7 had Int-1, 5 had Int-2 and 4 had high risk disease, and 2 unclassified (10 had AML). Eleven patients had normal, 14 abnormal and 4 unknown for cytogenetics. Seven patients went off the study due to disease progression (5) or refused therapy (1), died within a week of treatment initiation (1) while 2 are on the first cycle and too early for evaluation. Twenty-five patients are evaluable for outcome. Ten patients received 5 or more cycles of Vidaza. HI was seen in 14/25 (56%), and stable disease in 6/25 (24%) while 5/25 (20%) had disease progression. Six patients experienced complete remission (CR) and are still receiving therapy (24%), 1 experienced HI-E, 2 HI-ANC, 3 HI-P, and 2 had a bilineage improvement (HI-P and ANC and HI-E and ANC). Of 10 AML patients, three went off study due to disease progression, 1 had stable disease, 6 responded with 4 complete remissions (CR), 1 HI-ANC and 1 HI-P. Interestingly, 6/10 AMLs had a history of prior MDS, 3/6 achieved CR, 2/6 had HI (ANC and platelets) and 1 has stable disease (continuing treatment). Among the 4 de novo AMLs, 1 had CR and 3 showed disease progression. We conclude that a combination of low dose Vidaza and thalidomide is well tolerated, and highly effective therapy for the treatment of patients with MDS as well as AML arising from a prior MDS. The ability to treat secondary MDS as out-patient and achieve such a high response rate represents a paradigm shift in AML therapy.

No significant financial relationships to disclose.

Mixture component effects on the in vitro dermal absorption of pentachlorophenol

Interactions between chemicals in a mixture and interactions of mixture components with the skin can significantly alter the rate and extent of percutaneous absorption, as well as the cutaneous disposition of a topically applied chemical. The predictive ability of dermal absorption models, and consequently the dermal risk assessment process, would be greatly improved by the elucidation and characterization of these interactions. Pentachlorophenol (PCP), a compound known to penetrate the skin readily, was used as a marker compound to examine mixture component effects using in vitro porcine skin models. PCP was administered in ethanol or in a 40% ethanol/60% water mixture or a 40% ethanol/60% water mixture containing either the rubefacient methyl nicotinate (MNA) or the surfactant sodium lauryl sulfate (SLS), or both MNA and SLS. Experiments were also conducted with 14C-labelled 3,3',4,4'-tetrachlorobiphenyl (TCB) and 3,3',4,4',5-pentachlorobiphenyl (PCB). Maximal PCP absorption was 14.12% of the applied dose from the mixture containing SLS, MNA, ethanol and water. However, when PCP was administered in ethanol only, absorption was only 1.12% of the applied dose. There were also qualitative differences among the absorption profiles for the different PCP mixtures. In contrast with the PCP results, absorption of TCB or PCB was negligible in perfused porcine skin, with only 0.14% of the applied TCB dose and 0.05% of the applied PCB dose being maximally absorbed. The low absorption levels for the PCB congeners precluded the identification of mixture component effects. These results suggest that dermal absorption estimates from a single chemical exposure may not reflect absorption seen after exposure as a chemical mixture and that absorption of both TCB and PCB are minimal in this model system.

Recurrent pyogenic cholangitis: 'sump syndrome' following choledochoduodenostomy

An uncommon and late complication of side-to-side choledochoduodenostomy (CDD), the 'sump syndrome', developed in a patient 4 years after surgery. Recurrent right upper abdominal pain, fever with chills and rigors and latterly, mild jaundice made her seek repeated hospital admissions which were treated successfully with antibiotics. During the last admission, ultrasonography, endoscopic retrograde cholangiography (ERC), computerized scanning (CT) and hepatic iminodiacetic acid (HIDA) scan using Tc99m confirmed multiple intrahepatic calculi with proximal dilatation, debris in the distal blind segment and delayed excretion through the CDD. At surgery, the choledochoduodenostomy was taken down and a Rouxen-Y hepaticojejunostomy (RHJ) was fashioned after ductal clearance. The closed end of the Roux loop was placed subcutaneously for subsequent percutaneous access for cholangiography and removal of calculi. She is asymptomatic and well 28 months after surgery.

Electrolyte content of serum, erythrocyte, kidney and heart tissue in salt induced hypertensive rats

The effect of salt load on the systolic blood pressure (SBP) and electrolyte levels of serum, erythrocyte, kidney and heart tissue was studied in rats. NaCl treatment increased sodium (5.69 +/- 0.4 mmol/L p < 0.001, 149.8 +/- 4.0 mEq/L, p < 0.001) and decreased potassium (112.6 +/- 2.4 mmol/L p < 0.001, 5.0 +/- 0.2 mEq/L, p < 0.001) in red cell and serum respectively. A decreased level of serum magnesium (1.4 +/- 0.3 mEq/L, p < 0.005) was observed. Sodium content was increased in both heart (39.93 +/- 2.9 mumol/g, p = n.s) and kidney tissues (44.39 +/- 0.5 mumol/g, p < 0.001). A pronounced increase in intracellular calcium (2.54 +/- 0.2 mumol/g, p < 0.001) and a decrease of magnesium content (6.05 +/- 0.8 mumol/g, p < 0.001) was observed in kidney tissue after treatment. The results suggested that marked changes in electrolyte levels of erythrocytes, serum, heart and kidney tissues in NaCl loaded rats may play a definite role in the development of salt induced hypertension.

Stress and hypertension: role of serum, red cell and tissue electrolytes

The role of stress in the precipitation of hypertension is often described in clinical studies, although the underlying mechanism remains unknown. The present study concerns the role of electrolytes in stress induced hypertension in rats. Acute immobilization stress of one hour elevated systolic blood pressure (SBP) in rats. Restraint induced blood pressure elevation was associated with increased sodium concentration in the red cells, heart and kidney, and decreased potassium in the red cells. Magnesium concentration increased and calcium concentration decreased in the serum. Increases of calcium and decreases of magnesium were also observed in the heart and kidney tissues. The results may help toward an understanding of the relationship between hypertension and electrolyte homeostasis. A possible role of Na(+)-K(+)-ATPase activity leading to observed changes of electrolytes or vice versa is discussed.

The identification and testing of interaction patterns

This paper presents a method for identifying and assessing the significance of interaction patterns among various chemicals and chemical classes of importance to regulatory toxicologists. To this end, efforts were made to assemble and evaluate experimental data on toxicologically significant interactions, to use this information to characterize the consistency of toxicological interactions, and to define classes of compounds that display similar toxicological interactions. The motivation for this effort is to be able to propose hypotheses, which can be validated by experimentation, on how 2 or more chemicals will interact.

Separation and quantitation of cis- and trans-thiothixene in human plasma by high-performance liquid chromatography

A high-performance liquid chromatographic procedure is described for the separation of cis and trans isomers of thiothixene, a thioxanthene derivative used as an antipsychotic agent. A radial compression module (RCM-100) was used with both silica and cyanopropyl cartridges. A fixed-wavelength UV detector (254 nm) was used in these studies for quantitation. Mesoridazine is used as an internal standard because of its separation characteristics and reproducible quantitation. C18 Sep-Pak cartridges are used for biological sample clean-up. Plasma samples from patients treated with thiothixene (Navane) were assayed for cis and trans-thiothixene. No trans-thiothixene was detectable and cis-thiothixene concentrations ranged from 0 to 22.5 ng/ml.

Evaluation of fluorometric assay methods for serotonin in platelets. Plasma and whole blood samples by comparison with GC-MS-SIM Technique

Different methods have been used for the determination of serotonin (5HT) in human blood platelets, whole blood and plasma samples, but there have been very few reports on inter-method correlations. We now report the evaluation of fluorometric method using o-phthalaldehyde (OPT), with 3H-5HT as internal standard and GC-MS method using deuterated (d4-) 5-HT as internal standard. Basic extracts (pH 9.5) of sonicated platelet samples, hemolyzed blood or plasma samples are converted to trifluoroacetyl (TFA) or pentafluoropropionyl (PFP) derivatives. An aliquot of this derivatized sample (10%) was used for 3H count for determining the percent recovery, a second aliquot for GC-MS, and the rest for quantitation of OPT fluorescence (Emax360 millimicrons and Fmax 470 millimicrons). In another series, duplicate samples are extracted, one for fluorometry and the second for GS-MS with d4-5-HT as internal standard. Ions m/e 351 and 354 are monitored for the TFA and m/e 451 and 454 for PFP derivatives. The correlation between OPT fluorescence and GS-MS methods was good (0.95) for the platelets, but was poor (0.63) for whole blood and plasma samples. Thin layer chromatography of whole blood and plasma extracts showed multiple spots which yield characteristic fluorescence with OPT spray having same Emax or high background fluorescence. Serotonin levels in platelet samples of normal controls, and patients with different diagnoses of psychiatric disorders are presented.