Prevalence of Asymptomatic Microalbuminuria in HIV Positive Children in India

OBJECTIVE

To study the prevalence of covert or early renal involvement among human immunodeficiency virus (HIV) positive children.

METHODS

A cross-sectional observational study was carried out on 250 HIV positive children (2-18 y) on follow-up in a tertiary care hospital from January 2014 through June 2015. Those who met the study criteria were evaluated for microalbuminuria and glomerular and tubular dysfunctions.

RESULTS

Fifty-one out of two hundred fifty (20%) children were found to have microalbuminuria though none had any other evidence of renal dysfunction. The incidence of microalbuminuria in children on Anti Retroviral Therapy (ART) and those not on ART was 20% and 21% respectively. Neither was there any difference in those with a CD4 count ≤500/cu mm compared with those with counts >500/cu mm. However, the overall CD4 counts were significantly lower in children with microalbuminuria.

CONCLUSIONS

Microalbuminuria was detected in 20% of asymptomatic HIV positive children suggesting early glomerular dysfunction and need for regular screening and follow-up.

Seroprevalence of hepatitis B virus and hepatitis C virus co-infection among people living with HIV/AIDS visiting antiretroviral therapy centres in Nepal: a first nationally representative study

OBJECTIVES

To assess the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) co-infections among people living with HIV (PLHIV) in Nepal.

METHODS

A sample of 677 PLHIV representing key affected populations (KAP) in Nepal, who were undergoing antiretroviral (ART) therapy in ART clinics around the country, were voluntarily enrolled in the study. Rapid kit-based testing followed by ELISA for validation was performed, focusing on HBV surface antigen (HBsAg) and antibodies against HCV (anti-HCV). A multivariate logistic regression model was used to identify factors associated with HBV and HCV co-infection.

RESULTS

HCV and HBV co-infection among the 677 PLHIV was found to be 19% (95% confidence interval (CI) 16.6-22.7%) and 4.4% (95% CI 3.1-6.6%), respectively. The Eastern Region had the highest percentage of HCV infection (48%). The age group with the highest rates of co-infection was 30-39 years (58% and 70%, respectively, for HCV and HBV co-infection). After adjusting for confounding, males were more likely to have HBV co-infection than females (adjusted odds ratio (AOR) 4.61, 95% CI 1.42-14.98). Similarly, PLHIV who were male (AOR 5.7, 95% CI 2.06-15.98), had a secondary level of education (AOR 3.04, 95% CI 1.06-8.70), or who were drug users (AOR 28.7, 95% CI 14.9-55.22) were significantly more likely to have HCV co-infection.

CONCLUSION

This first ever national assessment of HIV, HBV, and HCV co-infection performed among PLHIV in Nepal demonstrates that HCV and HBV infections are a health threat to this population and that interventions are required to mitigate the effects of co-infection and to prevent further morbidity and mortality.

Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST

BACKGROUND

There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST.

METHODS

Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses.

RESULTS

The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications.

CONCLUSIONS

The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.

Galectin-3-Binding Glycomimetics that Strongly Reduce Bleomycin-Induced Lung Fibrosis and Modulate Intracellular Glycan Recognition

Discovery of glycan-competitive galectin-3-binding compounds that attenuate lung fibrosis in a murine model and that block intracellular galectin-3 accumulation at damaged vesicles, hence revealing galectin-3-glycan interactions involved in fibrosis progression and in intracellular galectin-3 activities, is reported. 3,3'-Bis-(4-aryltriazol-1-yl)thiodigalactosides were synthesized and evaluated as antagonists of galectin-1, -2, -3, and -4 N-terminal, -4 C-terminal, -7 and -8 N-terminal, -9 N-terminal, and -9 C-terminal domains. Compounds displaying low-nanomolar affinities for galectins-1 and -3 were identified in a competitive fluorescence anisotropy assay. X-ray structural analysis of selected compounds in complex with galectin-3, together with galectin-3 mutant binding experiments, revealed that both the aryltriazolyl moieties and fluoro substituents on the compounds are involved in key interactions responsible for exceptional affinities towards galectin-3. The most potent galectin-3 antagonist was demonstrated to act in an assay monitoring galectin-3 accumulation upon amitriptyline-induced vesicle damage, visualizing a biochemically/medically relevant intracellular lectin-carbohydrate binding event and that it can be blocked by a small molecule. The same antagonist administered intratracheally attenuated bleomycin-induced pulmonary fibrosis in a mouse model with a dose/response profile comparing favorably with that of oral administration of the marketed antifibrotic compound pirfenidone.

Targeting human respiratory syncytial virus transcription anti-termination factor M2-1 to inhibit in vivo viral replication

Human respiratory syncytial virus (hRSV) is a leading cause of acute lower respiratory tract infection in infants, elderly and immunocompromised individuals. To date, no specific antiviral drug is available to treat or prevent this disease. Here, we report that the Smoothened receptor (Smo) antagonist cyclopamine acts as a potent and selective inhibitor of in vitro and in vivo hRSV replication. Cyclopamine inhibits hRSV through a novel, Smo-independent mechanism. It specifically impairs the function of the hRSV RNA-dependent RNA polymerase complex notably by reducing expression levels of the viral anti-termination factor M2-1. The relevance of these findings is corroborated by the demonstration that a single R151K mutation in M2-1 is sufficient to confer virus resistance to cyclopamine in vitro and that cyclopamine is able to reduce virus titers in a mouse model of hRSV infection. The results of our study open a novel avenue for the development of future therapies against hRSV infection.

Escherichia coli biofilm: development and therapeutic strategies

Escherichia coli biofilm consists of a bacterial colony embedded in a matrix of extracellular polymeric substances (EPS) which protects the microbes from adverse environmental conditions and results in infection. Besides being the major causative agent for recurrent urinary tract infections, E. coli biofilm is also responsible for indwelling medical device-related infectivity. The cell-to-cell communication within the biofilm occurs due to quorum sensors that can modulate the key biochemical players enabling the bacteria to proliferate and intensify the resultant infections. The diversity in structural components of biofilm gets compounded due to the development of antibiotic resistance, hampering its eradication. Conventionally used antimicrobial agents have a restricted range of cellular targets and limited efficacy on biofilms. This emphasizes the need to explore the alternate therapeuticals like anti-adhesion compounds, phytochemicals, nanomaterials for effective drug delivery to restrict the growth of biofilm. The current review focuses on various aspects of E. coli biofilm development and the possible therapeutic approaches for prevention and treatment of biofilm-related infections.

Beyond the Rhetoric: Maternal, Newborn and Child Survival in Nepal

Nepal has performed exceptionally in improving reproductive, maternal and child health outcomes over the past two decades. In this article, we discuss these achievements and outline a vision for the future of maternal, newborn and child survival in Nepal after the era of the Millennium Development Goals. On the pathway towards quality universal health care services for all, we propose strengthening of health information systems, gradual health system reforms, improvement of existing facility based services, development of integrated service delivery models, improved technical and managerial capacity at district and facility levels. Elimination of all preventable causes of maternal, newborn and child deaths in Nepal should be our collective aspirational goal.

Storage stability of bevacizumab in polycarbonate and polypropylene syringes

PURPOSE

To compare and examine the storage stability of compounded bevacizumab in polycarbonate (PC) and polypropylene (PP) syringes over a 6-month period. PC syringes have been used in a recent clinical study and bevacizumab stability has not been reported for this type of syringe.

METHODS

Repackaged bevacizumab was obtained from Moorfields Pharmaceuticals in PC and PP syringes. Bevacizumab from the stored syringes was analysed at monthly time points for a 6-month period and compared with bevacizumab from a freshly opened vial at each time point. SDS-PAGE electrophoresis and size-exclusion chromatography (SEC) was used to observe aggregation and degradation. Dynamic light scattering (DLS) provided information about the hydrodynamic size and particle size distribution of bevacizumab in solution. VEGF binding and the active concentration of bevacizumab was determined by surface plasmon resonance (SPR) using Biacore.

RESULTS

SDS-PAGE and SEC analysis did not show any changes in the presence of higher molecular weight species (HMWS) or degradation products in PC and PP syringes from T0 to T6 compared with bevacizumab sampled from a freshly opened vial. The hydrodynamic diameter of bevacizumab in the PC syringe after 6 months of storage was not significantly different to bevacizumab taken from a freshly opened vial. Using SPR, the VEGF binding activity of bevacizumab in the PC syringe was comparable to bevacizumab taken from a freshly opened vial.

CONCLUSION

No significant difference over a 6-month period was observed in the quality of bevacizumab repackaged into prefilled polycarbonate and polypropylene syringes when compared with bevacizumab that is supplied from the vial.

L1014F-kdr Mutation in Indian Anopheles subpictus (Diptera: Culicidae) Arising From Two Alternative Transversions in the Voltage-Gated Sodium Channel and a Single PIRA-PCR for Their Detection

Leucine-to-phenylalanine substitution at residue L1014 in the voltage-gated sodium channel, target site of action for dichlorodiphenyltrichloroethane (DDT) and pyrethroids, is the most common knockdown resistance (kdr) mutation reported in several insects conferring resistance against DDT and pyrethroids. Here, we report presence of two coexisting alternative transversions, A>T and A>C, on the third codon position of L1014 residue in malaria vector Anopheles subpictus Grassi (species A) from Jamshedpur (India), both leading to the same amino acid substitution of Leu-to-Phe with allelic frequencies of 19 and 67%, respectively. A single primer-introduced restriction analysis-polymerase chain reaction (PIRA-PCR) was devised for the identification of L1014F-kdr mutation in An. subpictus resulting from either type of point mutation. Genotyping of samples with PIRA-PCR revealed high frequency (82%) of L1014F-kdr mutation in the study area.

Potentiometric Studies on Stepwise Mixed Ligand Complex Formation

Stepwise mixed ligand complex formation is observed in the systems containing metal ion, iminodiacetic acid (IMDA) as primary ligand and one of the diamines, such as ethylenediamine (en), 1,2-propanediamine (1,2-pn) and 1,3-propanediamine (1,3-pn) as secondary ligands. Potentionmetric titrations indicate the formation of ternary complexes having a 1:1:1 molar ratio of metal ion to iminodiacetic acid to the secondary ligand. Initially, metal-IMDA (1:1) complex is formed in the lower buffer region prior to the formation of the ternary complex and the addition of the secondary ligand takes place only after the combination with the primary ligand is complete. Formation constants (log KMAB) of the ternary complexes have been calculated and the probable reaction mechanism is suggested. The order of stability in terms of metal ion has been found to be Cu (II) > Ni (II) >Zn (II) >Cd (II) and in terms of secondary ligand as 1,2-pn>en>1,3-pn.

Retained foreign bodies: a serious threat in the Indian operation room

Retained foreign bodies (RFBs) are a surgical complication resulting from foreign materials accidently left in a patient's body. This review attempts to give an overview of different types of RFBs, problems related to them and their management after the surgical operation. The internet was searched using the Google and Google scholar. In addition, relevant electronic journals from the University's library such as Entrez (including PubMed and PubMed central), Since Direct, Scirus, NIH.gov, Medknow.com, Medscape.com, Scopus, MedHelp.org, Cochrane library, WebMD.com, and World Health Organization Hinari. It shows that the major reasons of RFBs are emergency surgical operation with unplanned changes, patient high body mass index, and poor communication. To prevent this textile material should be radiopaque marked and must be counted once at the start and twice at the conclusion of all surgical procedures. If the count is incorrect, then radiography or manually re-exploration should be performed. Ultrasonography, computerized tomography, magnetic resonance imaging and radio frequency identification are also used in the proper identification of RFBs. Safety practice should be robust and simple enough to protect patient under the most chaotic of circumstances. Proper communication among the personnel participating in surgery aimed at preventing this medical negligence would help in mitigating such errors. Finally, the surgeon should not only follow the standard recommended procedure, but also report cases of RFBs.

Protective effects of quercetin during influenza virus-induced oxidative stress

Oxidative stress was found to have a role in many viral diseases including AIDS, hepatitis and influenza. In the present study the pathology of influenza viral infection in the lungs, which may lead to oxidative stress, was investigated and an attempt was made to study the efficacy of anti-oxidants as therapeutic agents. Adult male mice of Swiss albino type were infected with influenza virus (A/Hong Kong/8/68) and studied for the antioxidant status in the lungs by evaluating the lung enzymatic anti-oxidant system including superoxide dismutase and catalase. Superoxide radical generation, which might increase by the activated alveolar macrophages, was estimated by nitroblue-tetrazolium reduction assay. We have also estimated lipid peroxidation levels in lung through thiobarbutiric acid reactive substances assay. We also examined the ability of flavonoid quercetin in protecting from influenza virus-induced oxidative stress. The influenza-infected group showed decreased levels of superoxide dismutase and catalase; however, anti-oxidant supplemented groups showed these activities to be the same as in the control group. The lipid peroxide levels were increased in virus-infected mice. Administration of quercetin lowered the lipid peroxide levels significantly. Formazan positive cells were increased by 80% in the virus-infected group and supplementation with quercetin reduced their number to 44%.

Burn injury caused by laptop computers

Laptop burn is a real condition and medical reports indicate that using a laptop across the legs can indeed cause it. in very rare cases, the condition can cause damage leading to skin cancer. A 24-year-old man presented with an asymptomatic reddish brown pigmentation on the thighs. After an extensive work-up, burning caused by use of a laptop was observed. Burning was induced in 3 days by using laptop for 4 h daily. Laptop should be used in properly ventilated and air-conditioned rooms. The most effective way of preventing erythema is to use the laptop on the table or desk.

Abstract P1-09-03: The use of MRI in the evaluation of breast cancer

Background: The availability of Magnet Resonance Imaging (MRI) has increased in the United States over the last decade. Its use for the diagnosis and staging of breast cancer remains undetermined. We examined the trends and frequency of MRI use in women with newly diagnosed breast cancer in Texas and evaluated the factors associated with a receipt of an MRI.

Methods: The Texas Cancer Registry (TCR) Medicare linked data were used to identify incident breast cancer cases between 1/1/2003-12/30/2007. We included female patients, 65 and older enrolled in both Medicare Parts A and B for 3 months prior to diagnosis and 12 months after diagnosis, and not enrolled in an HMO plan during the same period. Patients diagnosed at autopsy were excluded. Bivariate and multivariate logistic regression analysis was performed to determine the factors associated with receipt of MRI. A Cochran-Armitage trend test was performed to examine the trends in use of MRI over study period. A p-value <0.05 was considered statistically significant.

Results: Of the 292,297 patients diagnosed with breast cancer between 2003 and 2007, 18, 856 patients met the inclusion criteria. Of these, 1268 (6.72%) received an MRI. The overall use of breast MRI has increased significantly in Texas from 2.25% of women diagnosed in 2003 to 13.9% of women diagnosed in 2007 (p<0.001). In the bivariate analysis we found that age, race, number of comorbidities, poverty level, education level, and region were associated with the receipt of MRI at the time of breast cancer diagnosis. In the multivariate analysis after adjusting for those covariates, we found that women of advancing age, black race (34%) and presence of any comorbidity (29%) to be significantly less likely to get an MRI, while those with regional disease and higher level of education were more likely to receive MRI (table 1).

Conclusion: Breast MRI in newly diagnosed breast cancer in the state of Texas increased six fold during the study period. While use has increased in Texas, receipt of MRI does not appear to be uniform. To identify the group of women who would benefit most from MRI, more in depth analyses of the role of socio-economic components on receipt of MRI and patient outcomes is needed.

Multivariate analysis: Odds of receiving an MRI at the time of breast cancer diagnosisVariableOdds of MRI (95% CI)P-valueAge Group <.000165-691 70-740.784 (0.672-0.913) 75-790.518 (0.433-0.620) 80-840.415 (0.335-0.514) 85-890.215 (0.145-0.319) >900.098 (0.044-0.223) Race 0.0463White1 Black0.658 (0.492-0.880) Hispanic0.967 (0.587-1.592) Others0.931 (0.545-1.592) Comorbidity <.000101 10.713 (0.607-0.839) 20.712 (0.545-0.931) >20.304 (0.192-0.479) Education Level 0.00011st Quartile (highest)1 2nd Quartile0.743 (0.617-0.896) 3rd Quartile0.594 (0.464-0.760) 4th Quartile (lowest)0.544 (0.404-0.733) Urban/Rural <.0001Big Metro1 Metro0.467 (0.389-0.560) Urban0.558 (0.405-0.768) Less Urban0.882 (0.706-1.101) Rural1.022 (0.642-1.628) Stage 0.01710/In situ1 Localized1.135 (0.932-1.381) Regional1.334 (1.067-1.667) Distant1.166 (0.775-1.755) Unknown0.663 (0.414-1.063) 

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-03.