Shorter TB treatment regimens should be safer as well

Most ongoing and planned TB therapeutic trials are focused on shortening the duration of treatment while giving less consideration to other aspects of TB care that are important to people with TB. Here we argue that other variables besides duration of TB treatment should also be considered when developing new TB treatment regimens, including drug toxicity, time spent in monitoring and overall quality of life while on therapy. We examine the specific use of linezolid in treatment-shortening trials for drug-susceptible TB and propose additional endpoints that should be prioritised in TB treatment studies.

Intra-femoral tunnel graft lengths less than 20 mm do not predispose to early graft failure, inferior outcomes or poor function. A prospective clinico-radiological comparative study

PURPOSE

Increasing demands on skills with mounting pressures from expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions requires precise knowledge of technical details by surgeons. One such element is the minimum length of graft in femoral tunnel to allow for adequate tendon-to-bone healing and early return to activities and sports. This has, however, remained an unanswered question.

PURPOSE

To study and compare clinico-radiological outcomes of ACL reconstructions in patients with < 20 mm of intra-femoral tunnel graft length with those measuring ≥ 20 mm.

METHODS

All eligible patients undergoing arthroscopic ACL reconstruction were sequentially divided into two groups based on the intra-femoral tunnel graft lengths (A: < 20 mm, n = 27; and B: ≥ 20 mm, n = 25). Exclusions were made for those > 45 years of age, with chondral and/or multi-ligamentous injuries and with systemic pathologies. All patients were postoperatively evaluated in clinics by physical examination and functional scoring (Lysholm and modified Cincinnati scores) at 3, 6 and 12-month intervals. Graft vascularity was assessed by signal-to-noise quotient ratio (SNQR) using magnetic resonance imaging (MRI) at 3 and 12 months.

RESULTS

No significant differences were noted in mean Lysholm and modified Cincinnati scores between the two groups at the end of 1 year. There were also no significant differences in graft maturation over time and SNQR at 3 and 12 months in the region of interest (ROI).

CONCLUSIONS

Intra-femoral tunnel graft length of less than 20 mm does not compromise early clinical and functional outcomes of ACL reconstructions.

Clinical Profile and Treatment Outcomes of Patients with Malaria Complicated by Acute Kidney Injury

As Odisha is an endemic region for malaria with many acute kidney injury (AKI) cases, this study evaluated the clinical profile and treatment outcomes of patients with malaria complicated by AKI. This prospective observational study was conducted between December 2015 and September 2017. Detailed histories and clinical examinations were recorded. On admission, tests for routine hematology, plasma glucose, liver function, renal function, serum electrolytes, thick smears, thin smears, and malarial parasites were performed. Of the 958 AKI malarial patients admitted, 202 (82.6 % males) were included in the study, with a mean age of 38.37 years. In total, 86.14%, 3.46%, and 10.39% of patients had Plasmodium falciparum, Plasmodium vivax, and mixed malaria, respectively. Headache and decreased urination (83.66% each) were the most common symptoms after fever (100%). Anuria and oliguria were reported in 5.95% and 67.82% of patients, respectively, whereas 26.23% reported a urine output of >400 mL/24 h. All patients had raised serum creatinine and urea levels, and >60% had anemia, proteinuria, and/or hyponatremia. Multiple organ dysfunction syndrome was observed in 62.87% of patients. Acute tubular necrosis was seen in 60% of renal biopsy specimens (n = 15). Of the 75.75% of patients requiring dialysis, 82.12% and 17.88% of patients required hemodialysis and peritoneal dialysis, respectively, during which 11 patients died. AKI, a serious complication of P. falciparum or P. vivax malaria, is a life-threatening condition. Fever, anemia, oligo/anuria, hepatic involvement, cerebral malaria, high serum creatinine and urea, and disseminated intravascular coagulation were the main predictors of mortality in our study.

Impact of Establishing Dental Access for Preventable Infectious Dental Diseases (PIDD) in Medical Settings: Case Study from Rural Wisconsin

OBJECTIVE

The frequency of Preventable Infectious Dental Disease (PIDD) visits in medical centers was examined pre and post establishment of expanded dental access and adoption of an integrated medical-dental care delivery model.

METHODS

A retrospective observational study of patient attributes and frequency of unscheduled PIDD visits between January 1, 1990 and February 29, 2020. Chi-squared tests compared (a) the number of PIDD visits (pre/post dental center establishment), (b) age at first diagnosis, (c) gender, (d) race, (e) primary insurance at the time of PIDD visits and (f) healthcare setting where visit occurred.

RESULTS

System-wide, 21,957 unique patients were documented with a total of 34,892 PIDD visits as the primary diagnosis. Patients between 18-30 years and patients with Medicaid had the highest frequency of PIDD visits in medical settings. Following the establishment of dental centers, reduced relative risk of PIDD visits was observed for patients with no health insurance or self-pay/other coverage. PIDD visits in primary care settings was 0.87 times as likely as PIDD visits at ED/UCs after dental centers opened.

CONCLUSIONS

The number of PIDD visits to medical centers increased before the dental infrastructure was established, followed by a decline afterwards, inclusive of disparity populations. Some residual persistence of PIDD visits to primary care settings was identified. This study reinforced importance of dental healthcare access for achieving appropriate PIDD management while reducing PIDD visits to medical settings.

Microplastics in environment: global concern, challenges, and controlling measures

Plastic pollution in various forms has emerged as the most severe environmental threat. Small plastic chunks, such as microplastics and nanoplastics derived from primary and secondary sources, are a major concern worldwide due to their adverse effects on the environment and public health. Several years have been spent developing robust spectroscopic techniques that should be considered top-notch; however, researchers are still trying to find efficient and straightforward methods for the analysis of microplastics but have yet to develop a viable solution. Because of the small size of these degraded plastics, they have been found in various species, from human brains to blood and digestive systems. Several pollution-controlling methods have been tested in recent years, and these methods are prominent and need to be developed. Bacterial degradation, sunlight-driven photocatalyst, fuels, and biodegradable plastics could be game-changers in future research on plastic pollution control. However, recent fledgling steps in controlling methods appear insufficient due to widespread contamination. As a result, proper regulation of environmental microplastics is a significant challenge, and the most equitable way to manage plastic pollution. Therefore, this paper discusses the current state of microplastics, some novel and well-known identification techniques, strategies for overcoming microplastic effects, and needed solutions to mitigate this planetary pollution. This review article, we believe, will fill a void in the field of plastic identification and pollution mitigation research.

Causes of death in patients with chronic kidney disease: insights from the ASCEND-D and ASCEND-ND cardiovascular outcomes trials

Background

There are limited contemporary data available regarding adjudicated causes of death in patients with chronic kidney disease (CKD). Prior studies have indicated that cardiovascular (CV) events are one of the most common causes of death among patients with CKD, with previous reports stating approximately 30% of patients died from CV causes [1]. Here, we report the adjudicated causes of death in two recently completed large-scale randomised controlled trials (RCTs) with ∼14,200 person years of follow-up: ASCEND-D [2] (median follow-up: 2.5 years; NCT02879305) and ASCEND-ND [3] (median follow-up: 1.9 years; NCT02876835). These trials investigated the safety and efficacy of daprodustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), in correcting anaemia in patients with CKD.

Purpose

This study assessed the causes of death in patients with CKD in the ASCEND-D and ASCEND-ND trials.

Methods

ASCEND-D and ASCEND-ND were global, randomised, open-label, CV outcome trials in adult patients with CKD-related anaemia undergoing maintenance dialysis (ASCEND-D) or with pre-dialysis CKD (ASCEND-ND) who received daily oral daprodustat or conventional erythropoiesis-stimulating agents (ESAs). Cause of death was systematically and centrally adjudicated in a blinded fashion to the study treatment assignment by an independent committee.

Results

In ASCEND-D and ASCEND-ND, respectively, 2964 and 3872 patients were randomised, of which 92% and 97% completed the study. Baseline characteristics were well-balanced across treatment groups within each trial. Adjudicated causes of death for the ASCEND-D and -ND trials are shown in the Table. All-cause mortality was similar in patients treated with daprodustat as compared with those treated with conventional ESA in both the ASCEND-D and -ND trials. Overall mortality in the ASCEND-D and -ND trials was 20.0% and 15.5%, respectively, and CV causes accounted for approximately 30–40% of all deaths and infection accounted for 25–30% of all deaths in both trials.

Conclusion

Although CV events were the most common cause of death in the ASCEND-D and ASCEND-ND trials (30–40% of cases), the risk of death due to infection was also high, accounting for approximately 25–30% of all deaths across all study arms. Sudden death accounted for most CV deaths, particularly in the ASCEND-D trial. Infection as a cause of death was more frequent than previously reported in other RCTs or disease registries. Causes of death did not differ significantly between ASCEND-D and ASCEND-ND, or between treatments. However, as this is a selected population for a CV trial, it may not be representative of a real-life CKD population. Our results provide important data to inform the design of future studies in this population.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was funded by GlaxoSmithKline. Medical writing support was provided Natasha Tracey, PhD (Ashfield MedComms, Macclesfield, UK) and was funded by GlaxoSmithKline.

471 Assessing the Accuracy and Bias of Digital Symptom Checkers with Myocardial Infarction Patients

Aim

The accuracy and safety of symptom checkers in diagnosing and triaging patients is of concern; especially those with life-threatening conditions. The study's aims were to: 1. assess the accuracy of symptom checkers in diagnosing and triaging myocardial infarctions (MI) and, 2. determine whether differences in gender or presentation type exist.

Method

This prospective diagnostic accuracy study assessed 8 symptom checkers using 100 MI patients of various presentations: typical or atypical. The ability of a symptom checker in providing MI as the first diagnosis (D1) and the first 3 (D3) diagnoses were diagnostic accuracy measures. Triage advice was deemed correct if the symptom checker recommended seeking emergency treatment.

Results

Symptom checkers correctly diagnosed 48.0±31.4% of cases with MI first. D3 accuracy was 72.6±20.2%. Mean triage accuracy was 82.6±12.6%.

24.0±16.2% of atypical cases had a correct primary diagnosis. D3 accuracy for atypical MI was 43.8±20.6%, significantly lower than that of typical MI (p&lt;0.01). Atypical case triage accuracy was 52.7±20.0%, significantly lower than typical cases (84.2±14.7%, p&lt;0.01).

10.0% of the atypical female cases were diagnosed correctly with MI as the first diagnosis. Female atypical cases had significantly lower accuracy than typical female cases for all accuracy measures (p&lt;0.01).

Conclusions

Symptom checkers generally provide low accuracy for diagnosing MI. Approximately 20% of cases were under-triaged. Results varied between symptom checkers: patients who presented with atypical symptoms tended to be under-diagnosed and under-triaged, especially those who were female. This demonstrated potential gender bias and therefore raises questions regarding symptom checker regulation and safety.

Deprenyl reduces inflammation during acute SIV infection

In the era of antiretroviral therapy, inflammation is a central factor in numerous HIV-associated comorbidities, such as cardiovascular disease, cognitive impairment, and neuropsychiatric disorders. This highlights the value of developing therapeutics that both reduce HIV-associated inflammation and treat associated comorbidities. Previous research on monoamine oxidase inhibitors (MAOIs) suggests this class of drugs has anti-inflammatory properties in addition to neuropsychiatric effects. Therefore, we examined the impact of deprenyl, an MAOI, on SIV-associated inflammation during acute SIV infection using the rhesus macaque model of HIV infection. Our results show deprenyl decreased both peripheral and CNS inflammation but had no effect on viral load in either the periphery or CNS. These data show that the MAOI deprenyl may have broad anti-inflammatory effects when given during the acute stage of SIV infection, suggesting more research into the anti-inflammatory effects of this drug could result in a beneficial adjuvant for antiretroviral therapy.

O41 Quantifying the burden of survivorship associated with infra-renal abdominal aortic aneurysm repair: a systematic review

Introduction

Survivorship encompasses the physical, psychological, social, functional and economic experience of living with a chronic condition for both patients and their caregivers. It comprises 9 distinct domains and remains understudied in non-oncological pathologies, including infra-renal abdominal aortic aneurysmal disease (IRAAA). This review aims to quantify the extent to which existing IRAAA literature addresses the burden of survivorship in patients following surgical intervention.

Method

The databases; MEDLINE, EMBASE and PsychINFO, were searched from 1989 through to July 2020. Randomised controlled trials, observational studies and case series studies were included. Eligible studies had to detail outcomes related to survivorship following IRAAA surgery. Due to heterogeneity between studies and outcomes, no meta-analysis was conducted. Study quality was assessed with specific risk of bias tools.

Result

112 studies were included and only 4 of the 9 domains of survivorship have been previously studied—treatment complications, physical functioning, co-morbidities and caregivers. The available evidence is of variable quality; the majority of studies display a moderate to high risk of bias, are of an observational study design, are based within a limited number of countries and consist of an insufficient follow up period.

Conclusion

This review highlights the absence of robust evidence regarding survivorship following IRAAA surgery, regardless of repair modality. Consequently, contemporary treatment guidelines are reliant upon historic quality of life data that is narrow in scope and non-representative of contemporary clinical practice. As such, there is an urgent need to re-evaluate the scope and methodology associated with this research theme moving forwards.

Take-home Message

There is an urgent need to re-evaluate the scope and methodology associated with traditional quality of life centred IRAAA studies moving forwards in order to better empower patient decision making as well as inform treatment guidelines and health policy initiatives.

Endogenous nutrients are concentrated in specific tissues in the Zea mays seedling

K, P, Cl, and Ca are distributed in tissue-specific patterns in Zea mays seedlings. These elements were mapped and analyzed using a relatively simple semi-quantitative technique, i.e., fast freezing, followed by freeze fracturing, then freeze drying, and finally scanning electron microscopy/energy-dispersive spectroscopy (SEM/EDS). In the radicle, endogenously derived (i.e., from seed) K and P transition from being homogenous in the apical meristem to tissue-specific in older regions. At 3 mm from the radicle apex, K concentration is approximately 40 mM in mid-cortex and decreases by approximately 50% at 15 mm. From 3 to 55 mm, P concentration in pericycle is approximately twice that found in adjacent regions. Ca is not detectable in younger portions of the radicle by SEM/EDS, but in older regions, it is present at 13 mM in mid-cortex. K concentration values of entire radicles analyzed with inductively coupled plasma optical emission spectrometry (ICP-OES) exceeded the SEM/EDS values. For Ca, the reverse was true. But, SEM/EDS analysis did not include several vascular tissues that contained high concentrations of K and low concentrations of Ca. The inception of lateral root primordia was accompanied by a localized decrease in Ca in cortical regions that were centrifugal to the primordium tip. A region of O-rich cells in endosperm was identified centripetal to the aleurone. These results indicate that (1) outer, mid-, and inner cortical regions, as well as the adjacent tissues, have distinct ion accumulation properties, and (2) ions are concentrated in some radicle tissues prior to development of Casparian strips.

Online Education Status at Dental Colleges During COVID-19 Pandemic in Nepal

Background The COVID-19 pandemic has caused lockdown situation impeding all educational institutions including dental colleges. The circumstance demanded online classes as the alternative strategy for continuation of education. Objective To assess current practice and perception about online education among faculties of dental colleges in Nepal. Method A cross-sectional study was conducted among 208 faculties of all dental colleges in Nepal. Data collection was done through structured online questionnaire comprising demographic information, practice and perception of the respondents towards online education. Descriptive statistics surveyed the frequency distribution and Chisquare test assessed the difference in perception among the faculties of different universities. Result The response rate was 74.3%. Faculties commonly used PowerPoint presentation (96.6%) on Zoom platform (83.3%) using laptop (94.7%) with Wi-Fi connection (91.8%). Majority of faculties had good or satisfactory access to internet (94.8%). The faculties believed that the online class environment was interactive (95.2%); but it was not effective (86.5%) as live classroom. Majority of the faculties (79.4%) felt tracking of students' presence was difficult. There was no significant difference on perception towards online class among the faculties of Kathmandu University, Tribhuvan University and BP Koirala Institute Health Sciences at p < 0.05. Conclusion The COVID-19 pandemic has paved the way for e-learning in dental education in Nepal. Faculties agree to complete the theory syllabus and conduct sessional exams as an alternative during the lockdown period. However, they show strong reservations in carrying out practical/clinical simulations and university exams online. Training on e-learning and institutional strategy for online education is recommended.

Supercomputer-Based Ensemble Docking Drug Discovery Pipeline with Application to Covid-19

We present a supercomputer-driven pipeline for in silico drug discovery using enhanced sampling molecular dynamics (MD) and ensemble docking. Ensemble docking makes use of MD results by docking compound databases into representative protein binding-site conformations, thus taking into account the dynamic properties of the binding sites. We also describe preliminary results obtained for 24 systems involving eight proteins of the proteome of SARS-CoV-2. The MD involves temperature replica exchange enhanced sampling, making use of massively parallel supercomputing to quickly sample the configurational space of protein drug targets. Using the Summit supercomputer at the Oak Ridge National Laboratory, more than 1 ms of enhanced sampling MD can be generated per day. We have ensemble docked repurposing databases to 10 configurations of each of the 24 SARS-CoV-2 systems using AutoDock Vina. Comparison to experiment demonstrates remarkably high hit rates for the top scoring tranches of compounds identified by our ensemble approach. We also demonstrate that, using Autodock-GPU on Summit, it is possible to perform exhaustive docking of one billion compounds in under 24 h. Finally, we discuss preliminary results and planned improvements to the pipeline, including the use of quantum mechanical (QM), machine learning, and artificial intelligence (AI) methods to cluster MD trajectories and rescore docking poses.

Supercomputer-Based Ensemble Docking Drug Discovery Pipeline with Application to Covid-19

We present a supercomputer-driven pipeline for in-silico drug discovery using enhanced sampling molecular dynamics (MD) and ensemble docking. We also describe preliminary results obtained for 23 systems involving eight protein targets of the proteome of SARS CoV-2. THe MD performed is temperature replica-exchange enhanced sampling, making use of the massively parallel supercomputing on the SUMMIT supercomputer at Oak Ridge National Laboratory, with which more than 1ms of enhanced sampling MD can be generated per day. We have ensemble docked repurposing databases to ten configurations of each of the 23 SARS CoV-2 systems using AutoDock Vina. We also demonstrate that using Autodock-GPU on SUMMIT, it is possible to perform exhaustive docking of one billion compounds in under 24 hours. Finally, we discuss preliminary results and planned improvements to the pipeline, including the use of quantum mechanical (QM), machine learning, and AI methods to cluster MD trajectories and rescore docking poses.

PRP versus steroids in a deadlock for efficacy: long-term stability versus short-term intensity-results from a randomised trial

PURPOSE

A popular choice for lateral epicondylitis (LE), corticosteroid injections have been associated with prominent side effects, which has led to the conception of modalities like platelet-rich plasma (PRP). This randomised trial aimed to evaluate and compare the 6-week, 3-month and 1-year outcomes with PRP and corticosteroid injections in LE. We hypothesised that PRP would prove more effective in relieving pain and improving function.

METHODS

At the sports medicine unit of our tertiary care teaching centre, 80 patients with LE were randomised into either receiving PRP (group A) or corticosteroids (group B) injections. Pre-injection visual analogue scale (VAS), disabilities of the arm, shoulder and hand (DASH) score, Mayo elbow performance score (MEPS) and grip strength score (GSS) were recorded. Common extensor origins were identified and infiltrated with 3 ml of either PRP or corticosteroid (triamcinolone in 2% xylocaine) using a peppering technique. Follow-up scores and extent of pain relief were recorded and compared.

RESULTS

At 6 weeks, there were greater improvements in group B versus A in mean VAS (13.8 vs. 44.5; p < 0.001), DASH (64.2 vs. 53.3; p < 0.001), MEPS (88.0 vs. 74.5; p = 0.004) and GSS (89.3 vs. 73.4; p = 0.039). These scores showed a reversed pattern at 3 months when group A outcomes superseded group B (VAS p = 0.002; DASH p < 0.001; MEPS p = 0.002; GSS p = 0.045). At 1-year follow-up, group A continued to enjoy better pain relief and function (VAS p = 0.024; DASH p < 0.001; MEPS p = 0.009; GSS p = 0.028).

CONCLUSIONS

Albeit corticosteroid injections show good short-term results at 6 weeks, patients receiving PRP injections fare better at 3 and 12 months.

Integrated analysis of long noncoding RNA-associated competing endogenous RNA network in periodontitis

BACKGROUND AND OBJECTIVES

Long noncoding RNAs (lncRNAs) play critical and complex roles in regulating various biological processes of periodontitis. This bioinformatic study aims to construct a putative competing endogenous RNA (ceRNA) network by integrating lncRNA, miRNA and mRNA expression, based on high-throughput RNA sequencing and microarray data about periodontitis.

MATERIAL AND METHODS

Data from 1 miRNA and 3 mRNA expression profiles were obtained to construct the lncRNA-associated ceRNA network. Gene Ontology enrichment analysis and pathway analysis were performed using the Gene Ontology website and Kyoto Encyclopedia of Genes and Genomes. A protein-protein interaction network was constructed based on the Search Tool for the retrieval of Interacting Genes/Proteins. Transcription factors (TFs) of differentially expressed genes were identified based on TRANSFAC database and then a regulatory network was constructed.

RESULTS

Through constructing the dysregulated ceRNA network, 6 genes (HSPA4L, PANK3, YOD1, CTNNBIP1, EVI2B, ITGAL) and 3 miRNAs (miR-125a-3p, miR-200a, miR-142-3p) were detected. Three lncRNAs (MALAT1, TUG1, FGD5-AS1) were found to target both miR-125a-3p and miR-142-3p in this ceRNA network. Protein-protein interaction network analysis identified several hub genes, including VCAM1, ITGA4, UBC, LYN and SSX2IP. Three pathways (cytokine-cytokine receptor, cell adhesion molecules, chemokine signaling pathway) were identified to be overlapping results with the previous bioinformatics studies in periodontitis. Moreover, 2 TFs including FOS and EGR were identified to be involved in the regulatory network of the differentially expressed genes-TFs in periodontitis.

CONCLUSION

These findings suggest that 6 mRNAs (HSPA4L, PANK3, YOD1, CTNNBIP1, EVI2B, ITGAL), 3 miRNAs (hsa-miR-125a-3p, hsa-miR-200a, hsa-miR-142-3p) and 3 lncRNAs (MALAT1, TUG1, FGD5-AS1) might be involved in the lncRNA-associated ceRNA network of periodontitis. This study sought to illuminate further the genetic and epigenetic mechanisms of periodontitis through constructing an lncRNA-associated ceRNA network.

Screening for Diabetes Risk Using Integrated Dental and Medical Electronic Health Record Data

Undiagnosed diabetes and prediabetes present a serious public health challenge. We previously reported that data available in the dental setting can serve as a tool for early dysglycemia identification in a primarily Hispanic, urban population. In the present study, we sought to determine how the identification approach can be recalibrated to detect diabetes or prediabetes in a White, rural cohort and whether an integrated dental-medical electronic health record (iEHR) offers further value to the process. We analyzed iEHR data from the Marshfield Clinic, a health system providing care in rural Wisconsin, for dental patients who were ≥21 y of age, reported that they had never been told they had diabetes, had an initial periodontal examination of at least 2 quadrants, and had a glycemic assessment within 3 mo of that examination. We then assessed the performance of multiple predictive models for prediabetes/diabetes. The study outcome, glycemic status, was gleaned from the medical module of the iEHR based on American Diabetes Association blood test cutoffs. The sample size was 4,560 individuals. Multivariate logistic regression revealed that the best performance was achieved by a model that took advantage of the iEHR. Predictors included age, sex, race, ethnicity, number of missing teeth, percentage of teeth with at least 1 pocket ≥5 mm from the dental EHR, and overweight/obesity, hypertension, hyperlipidemia, and smoking status from the medical EHR. The model achieved an area under the receiver operating characteristic curve of 0.71 (95% confidence interval, 0.69-0.72), yielding a sensitivity of 0.70 and a specificity of 0.62. Across a range of populations, informed by certain patient characteristics, dental care team members can play a role in helping to identify dental patients with undiagnosed diabetes or prediabetes. The accuracy of the prediction increases when dental findings are combined with information from the medical EHR. Knowledge Transfer Statement: Prediabetes and diabetes often go undiagnosed for many years. Early identification and care can lead to improved glycemic outcomes and prevent wide-ranging morbidity, including adverse oral health consequences, in affected individuals. Information available in the dental office can be used by clinicians to identify those who remain undiagnosed or are at risk; the accuracy of this prediction increases when combined with information from the medical electronic health record.

Selenium nanoparticles induce suppressed function of tumor associated macrophages and inhibit Dalton's lymphoma proliferation

Selenium Nanoparticle (SeNPs) is reported that it enhances and maintains optimal immune during infection and malignancies. To this end, we examined the role of selenium on TAMS whose anti-tumor function suppressed which favor tumor progression. BALB/c (H2d) strain of mice non-Hodgkin type of Dalton's cell line was used to check the role of carboxlic group induced, synthesized SeNPs on TAMs. Screening of IC50 value was done primarily trypen blue exclusion assay and 50% proliferation of DL cells inhibited 40 ng/ml to 50 ng/. Treatment also decreases ΔΨm, fragmentation of DNA of DL cells and arrest cells cycle in G1/G0 phage. Untreated TAMs cells showing suppressed expression of ROS, adhesion, phagocytosis, fusion and receptor profiling such as ICAM-1, CD47, CD172α. Which was induced more as compare to untreated group. SeNPs have potential to induce the anti-tumor function of TAMs whose anti-tumor function down-regulated pliable shifted towards tumor progression. It decreased the proliferation of DL cell by inducing apoptosis. Therefore, the synthesized SeNPs could be used for imaging diagnosis and cancer therapy which must be cost effective with negligible side effects shifted towards tumor progression. It decreased the proliferation of DL cell by inducing apoptosis.

Meta-analysis of adjuvant therapy following curative surgery for periampullary adenocarcinoma

BACKGROUND

Periampullary cancers are uncommon malignancies, often amenable to surgery. Several studies have suggested a role for adjuvant chemotherapy and chemoradiotherapy in improving survival of patients with periampullary cancers, with variable results. The aim of this meta-analysis was to determine the survival benefit of adjuvant therapy for periampullary cancers.

METHODS

A systematic review was undertaken of literature published between 1 January 2000 and 31 December 2015 to elicit and analyse the pooled overall survival associated with the use of either adjuvant chemotherapy or chemoradiotherapy versus observation in the treatment of surgically resected periampullary cancer. Included articles were also screened for information regarding stage, prognostic factors and toxicity-related events.

RESULTS

A total of 704 titles were screened, of which 93 full-text articles were retrieved. Fourteen full-text articles were included in the study, six of which were RCTs. A total of 1671 patients (904 in the control group and 767 who received adjuvant therapy) were included. The median 5-year overall survival rate was 37·5 per cent in the control group, compared with 40·0 per cent in the adjuvant group (hazard ratio 1·08, 95 per cent c.i. 0·91 to 1·28; P = 0·067). In 32·2 per cent of patients who had adjuvant therapy, one or more WHO grade 3 or 4 toxicity-related events were noted. Advanced T category was associated worse survival (regression coefficient -0·14, P = 0·040), whereas nodal status and grade of differentiation were not.

CONCLUSION

This systematic review found no associated survival benefit for adjuvant chemotherapy or chemoradiotherapy in the treatment of periampullary cancer.

Oral and Craniofacial Anomalies of Bardet-Biedl Syndrome: Dental Management in the Context of a Rare Disease

Standardized guidelines for the oral health management of patients with rare diseases exhibiting morphologic anomalies are currently lacking. This review considers Bardet-Biedl syndrome (BBS), a monogenic autosomal recessive nonmotile ciliopathy, as an archetypal condition. Dental anomalies are present in a majority of individuals affected by BBS due to abnormal embryonic orofacial and tooth development. Genetically encoded intrinsic oral structural anomalies and heterogeneous BBS clinical phenotypes and consequent oral comorbidities confound oral health management. Since the comorbid spectrum of BBS phenotypes spans diabetes, renal disease, obesity, sleep apnea, cardiovascular disease, and cognitive disorders, a broad spectrum of collateral oral disease may be encountered. The genetic impact of BBS on the anatomic development of oral components and oral pathology encountered in the context of various BBS phenotypes and their associated comorbidities are reviewed herein. Challenges encountered in managing patients with BBS are highlighted, emphasizing the spectrum of oral pathology associated with heterogeneous clinical phenotypic expression. Guidelines for provision of care across the spectrum of BBS clinical phenotypes are considered. Establishment of integrated medical-dental delivery models of oral care in the context of rare diseases is emphasized, including involvement of caregivers in the context of managing these patients with special needs.

Salivary microbiome of an urban Indian cohort and patterns linked to subclinical inflammation

OBJECTIVE

To profile salivary microbiomes of an urban-living, healthy Indian cohort and explore associations with proinflammatory status.

METHODS

Fifty-one clinically healthy Indian subjects' salivary microbiomes were analyzed using 16S rRNA Illumina MiSeq sequencing. Community distribution was compared with salivary data from the Human Microbiome Project (HMP). Indian subjects were clustered using microbiome-based "partitioning along medoids" (PAM), and relationships of interleukin-1 beta levels with community composition were analyzed.

RESULTS

Indian subjects presented higher phylogenetic diversity than HMP. Several taxa associated with traditional societies gut microbiomes (Bacteroidales, Paraprevotellaceae, and Spirochaetaceae) were raised. Bifidobacteriaceae and Lactobacillaceae were approximately fourfold greater. A PAM cluster enriched in several Proteobacteria, Actinobacteria, and Bacilli taxa and having almost twofold higher Prevotella to Bacteroides ratio showed significant overrepresentation of subjects within the highest quartile of salivary interleukin-1 beta levels. Abiotrophia, Anaerobacillus, Micrococcus, Aggregatibacter, Halomonas, Propionivivrio, Paracoccus, Mannhemia, unclassified Bradyrhizobiaceae, and Caulobacteraceae were each significant indicators of presence in the highest interleukin-1 beta quartile. 2 OTUs representing Lactobacillus fermentum and Cardiobacterium hominis significantly correlated with interleukin-1 beta levels.

CONCLUSION

The salivary microbiome of this urban-dwelling Indian cohort differed significantly from that of a well-studied Western cohort. Specific community patterns were putatively associated with subclinical inflammation levels.

HSP70 Modulates the Enhanced Production of Reactive Intermediate Metabolites and a Proinflammatory Cytokine TNF-α Expression in a T Cell Lymphoma

Heat shock proteins are intracellular soluble proteins expressed consecutively in all cells. They are immunogenic proteins able to activate antigen-presenting cells by binding through the CD91 receptor and activate both CD4+ and CD8+ T-cells. Macrophage plays a pivotal role in innate immune response and secretes a number of regulatory molecules upon activation. In the present study, we investigate the activation of normal and tumor-associated macrophage to produce the effector molecules which have a role in immunomodulation, especially in the killing of the transformed or tumor cells. In vitro and in vivo treatment of NMO and TAMs (from T-Cell Lymphoma) with optimum dose 10 μg of hsp70 produce effector molecules such as nitric oxide (NO), hydrogen peroxide (H2O2) and tumor necrosis factor-α (TNF α). The results of our experiments reveal that the production of effector molecules is dose-dependent, and the result of immunoblots also confirms the increased expression of iNOS. These findings suggest that autologous hsp70 are highly immunogenic and potent activating agents for the enhanced production of effector molecules in NMO and TAMs in a T-cell lymphoma.

Novel Peptides Enhance the Production of Nitric Oxide and Inducible Nitric Oxide Synthase (iNOS) Gene Expression in Murine Macrophage

Bioactive novel polypeptide of Anurans skin has a wide range of antimicrobial properties against the infection and tumour cell. Macrophages are known to produce the Nitric oxide (NO) by a variety of cells upon activation. NO produced by the activated macrophages an important mediator for antimicrobial and tumoricidal activity. In-vitro macrophage exposed with medium alone, containing LPS, containing polypepeptides and LPS + polypeptides for 24 h showed enhanced production of NO with respect to control and LPS treated and significant increase in NO production in LPS + polypeptide. Western blot and PCR analysis also showed that increased production of protein expression and mRNA expression of inducible nitric oxide synthase (iNOS). These findings suggest that novel polypeptides are potent activating agent for enhanced production of NO through activation of iNOS gene.

IL-13 Neutralization Modulates Function of Type II Polarized Macrophages in vivo in a Murine T-Cell Lymphoma

IL-13 is a Th2 cytokine that suppresses the effector function and alters the phenotype and function of macrophages switching to alternatively activated or type II polarized macrophages. The type II polarized macrophages or M2 phenotype differ from normal macrophages greatly in terms of receptor expression, cytokine and NO production, that show tumor promoting function rather than tumoricidal function of classically activated macrophages. The chemokines CCL-22 and CCL-17 produced by either tumor cells or alternatively activated macrophages attract Th2 cells preferentially, which increase the local concentration of Th2 cytokines including IL-13 that further skewed the normal phenotype of macrophages at the site of the tumor micro-environment. Therefore, it is possible to restore the phenotype and function of alternatively activated macrophages by eliminating or blocking the activities of these cytokines. In the present investigation, we show that by blocking the activity/signaling of one of its major constituents IL-13, the iNOS expression and correspondingly NO production increases. The observation signifies its efficacy towards a novel approach for cancer therapy by modulating the function of tumor-associated macrophages (TAM) in vivo for the first time.

Heat Shock Proteins (HSP): Future Trends in Cancer Immunotherapy

Heat Shock Proteins (HSPs) are a large family of highly conserved proteins involved in assisting protein folding and unfolding in the cells. HSPs are expressed constitutively as well as inducibly and, interacting with antigen presenting cells, induce the expression of various cytokines and chemokines as well as the maturation and migration of dendritic cells, thus acting themselves as cytokines. HSP-chaperoned antigenic peptides are also generated within the tumor cells. Such chaperoned peptides are released in the extra cellular medium with an association of HSPs by cell stress, death or tumor cell lyses. HSP-peptide complexes from extra cellular medium are taken up by antigen presenting cells through CD91 receptor and are represented or cross-presented by their MHC class I molecules for specific anti-tumor immune response. In addition, HSPs expressed on the cell surface of tumor cells stimulate αβ T-cells and γδ T-cells as well as natural killer (NK) cells that are first-line defense mechanisms. In this manner, HSPs have the ability to stimulate both arms of the effecter mechanism of the immune system. These unique immunological attributes of HSPs are presently becoming the basis for tumor immunotherapy. Tumor-derived HSP-peptide complexes have been demonstrated to serve as anti-tumor vaccines. To date various approaches of vaccination using HSPs have been developed and tested clinically. These HSP-based vaccine approaches can be combined with hyperthermia and CTLA-4 blockade to enhance their anti-tumor potentiality.

Access to bicyclic hydroxamate macrocycles via intramolecular aza-(4 + 3) cyloaddition reactions of aza-oxyallylic cation intermediates

The intramolecular aza-(4 + 3) cycloaddition reactions of in situ generated aza-oxyallylic cations and furans have been reported for the construction of medium sized hydroxamate macrocycles.

Mucinous Cystic Borderline Tumor of the Mesentery: A Case Report

Mucinous cystic neoplasms are rare tumors of uncertain histogenesis. They arise from the ovaries, pancreas, and other intra-abdominal sites but more unusually from the mesentery. They can present with abdominal pain, distension, or a palpable mass but are commonly an incidental finding. We present a case of a 33-year-old female who presented with complain of pain abdomen for one-year duration. On Physical examination there was a palpable lump in right lumbar region extending to right iliac fossa. CT scan of abdomen and pelvis suggested the mass to be a Mesenteric Cyst. Enucleation of the cyst was done and histopathology report revealed Mucinous Cystic borderline tumor of the Mesentery.

Suppressed expression of homotypic multinucleation, extracellular domains of CD172α (SIRP-α) and CD47 (IAP) receptors in TAMs upregulated by Hsp70-peptide complex in Dalton's lymphoma

CD172α and CD47 are members of glycoprotein expressed on macrophages and various immune cells, promote immune recognition and T cell stimulation that priming phagocytosis of pathogens and apoptotic bodies and malignant cell. Tumour-releasing immunosuppressive factor promotes tumour growth and transforms the tumour resident M1 phenotype of macrophage to M2 phenotype (TAMs) that promotes tumour progression by downregulating the expression of different surface receptor including CD172α and CD47. Recent studies have reported that CD172α and CD47 are involved in the pathogenesis and promote malignancies such as lymphoma, leukaemia, melanoma, lung cancer and multiple myeloma, and their expression varies during infection and malignancies. Autologous Hsp70 is well recognized for its role in activating macrophages leading to enhance production of inflammatory cytokines. It has been observed that Hsp70 derived from normal tissues do not elicit tumour immunity, while Hsp70 preparation from tumour cell was able to elicit tumour immunity. However, the role of exogenous autologous hsp70 on the formation of giant cells is completely unknown. Therefore, in the present study, we sought to investigate the effect of Hsp70-peptide complex on the expression of CD172α and CD47 receptors in normal peritoneal macrophages (NMO) and TAMs. Finding shows that the expression of CD172α and CD47 enhances in TAMs and it reverts back the suppressed function of TAMs into M1 state of immunoregulatory phenotype that promotes tumour regression by enhanced multinucleation and phagocytosis of malignant cells and significantly enhances the homotypic fusion of macrophages and polykaryon formation in vitro by enhancing the expression of SIRPα and IAP.

Macro-anatomical variation of the olfactory apparatus in some Indian teleosts with special reference to their ecological habitat

The anatomy of the peripheral olfactory apparatus (i.e. olfactory lamellae, olfactorychambers, accessory nasal sacs, olfactory nerve tracts, olfactory bulbs and brain) of some teleosts, viz. Pseudapocryptes lanceolatus (Bloch and Schneider, 1801) - an air breathing mudskipper, Lepidocephalichthys guntea (Hamilton, 1822) - a freshwater scavenger fish and Mastacembelus armatus (Lacepède, 1800) - a freshwater potamodromous fish, has been studied in relation to their specific ecological habitat. Live, adult, sex-independent fish species were collected from the local markets of West Bengal, India, and acclimatised with the laboratory conditions (for 72 h at 32°C). The specimens were anaesthetised by MS-222 (dose: 100-200 mg/L). Olfactory apparatuses were dissected out and fixed inaqueous Bouin's solution. The macro- and microstructures (using haematoxylin and eosin) of the olfactory apparatuses were examined under binocular light microscope (LM) and trinocular LM (Primo Star; Carl Zeiss Microscpy, GmbH, Germany) respectively. P. lanceolatus possesses unilamellar olfactory apparatus at therounded snout, whereas L. guntea shows small rosette with 18 to 24 lamellae oneither side of the elliptical snout. Elongated olfactory rosette (number of lamellae ranges from 60 to 76) is present at the pointed snout of M. armatus. Morpho-anatomical variation in snout structure of the respective species is an indicative of divergence in ecological habitat, but variation in olfactory apparatus is significant for species-specific differentiation. Pseudostratified olfactory neuroepithelial components (i.e. sensory receptor cell, supporting cell and basal cell) show striking similarities amongst these species. Therefore comparative anatomical changes of the snout and olfactory apparatus are not only representing ecological habitat based on interspecific variation, but may also indicate the phylogenetic relation amongst said species.

Tracheostomy in tertiary care health institution

BACKGROUND

Tracheostomy is the most obliging and one of the oldest operations in the history of surgery. It is channel between the trachea and skin in the midline in the neck. Most common indications are upper airway obstruction, mechanical respiratory insufficiency and pulmonary toileting etc.

METHODS

It is a retrospective study done in a teaching hospital in eastern Nepal from 2005-2008. Medical records of 175 tracheostomized patients were reviewed. Demographic variations, indications and outcome were recorded and analyzed.

RESULTS

Age ranged from 1 to 88 years. Most common age group was 21-30 years followed by 51-60 years. Common indications for tracheostomy were upper air way obstruction (34.3%), prolonged intubation (20%). Common diagnoses were tumor of larynx/hypopharynx (26.3%), infectious causes (20.6%) and cut throat (13.7%).

CONCLUSIONS

Most common indication for tracheostomy in tertiary care health institution in Eastern Nepal was upper airway obstruction. Procedure is safe if done properly.

A study of prevalence of Taenia infestation and associated risk factors among the school children of Dharan

BACKGROUND

Taenia prevalence has remained high among certain ethnic groups and occupational diseases in Nepal. Taenia saginata and Taenia solium species are worldwide in distribution. Infection is found most often in rural areas of developing countries with poor hygiene and living in close contact with pigs and eating undercooked pork meats. This allows the tapeworm infection to be completed and its cycle to continue.

OBJECTIVES

To measure the prevalence of taenia infestation and to identify risk factors associated with taenia infestation among the school children of Dharan.

METHODS

A cross sectional study was conducted among 935 Government and private school going children of Grade VI, VII, and VIII of Dharan during 2007 to 2008. Stratified random sampling method was applied to choose the schools and the study subjects. The prevalence was calculated, Chi-square test was used to measure the association of risk factors and taenia infestation.

RESULTS

Taenia species was found to be high (5.5%) among the school children of Dharan. Infection rate of taenia among the male children (6.0%) was slightly higher than female (4.8%). There were no cases of taenia infestation found among children washing hands with soap. Regarding meat consumption in the non-vegetarian group, taenia infestation was found higher (6.5%) among pork eating than nonpork eating (4.7%). No significant relationship was traced among the factors in the causation of taenia infestation although slight indications present.

CONCLUSION

Taenia species was found very high among the school children of Dharan. No such association was found with the risk factors.

Using electronic dental record data for research: a data-mapping study

Anecdotal evidence suggests that, during the clinical care process, many dental practices record some data that are also collected in dental practice based research network (PBRN) studies. Since the use of existing, electronically stored data for research has multiple benefits, we investigated the overlap between research data fields used in dental PBRN studies and clinical data fields typically found in general dental records. We mapped 734 unique data elements from the Dental Information Model (DIM) to 2,487 Common Data Elements (CDE) curated by the NIDCR's PBRNs in the Cancer Data Standards Registry and Repository (caDSR). Thirty-three percent of the DIM data elements matched at least one CDE completely and 9% partially, translating to about 9% and 2%, respectively, of all data elements used in PBRN studies. The most frequently used CDEs found in the DIM included data about dental anatomy, medications, and items such as oral biopsy and caries. Our study shows that a non-trivial number of data elements in general dental records can be mapped either completely or partially to data fields in research studies. Further studies should investigate the feasibility of electronic clinical data for research purposes.

Role of Macrophage in Tumor Microenvironment: Prospect in Cancer Immunotherapy

Current evidence suggests an increasing role of macrophages in inflammation and tumor progression. Most tumors contain an abundant number of macrophages as a major component of their leukocyte infiltrate, which co-exist with tumor cells at the tumor microenvironment. Upon activation with soluble tumor antigens, macrophages release a distinct repertoire of growth factor, cytokines, chemokines and enzymes that inhibit growth of the tumor. However, the anti-tumor immune response induced by macrophages does not always ensue. Tumor cells themselves are capable of down-regulating macrophage phenotype and functions and anti-tumor immune responses in the tumor-bearing host. The present review aims to elucidate the role of macrophages in tumor growth and progression, invasion, metastasis, and angiogenesis at the site of tumor growth. Moreover, the effect of tumor microenvironment on the phenotype and function of macrophages, which are altered due to the continuous exposure of various soluble and non-soluble tumor promoting factors secreted by tumor cells, and implication of macrophages in cancer immunotherapy have been discussed in detail.

Isolation and screening of thermophilic cellulolytic bacteria from compost piles

Cellulose, a major polysaccharide found in agricultural residues and industrial and municipal wastes. In the present study thermophilic cellulolytic microorganisms were isolated. The isolates were tested for their cellulytic activity. The enzyme production from potent isolates was optimised using cellulose basal broth medium. Activity of partially purified enzyme was determined. The most potent thermophilic cellulolytic isolates were identified as Bacillus subtilis. The crude cellulase enzyme concentrated at 80-85% ammonium sulfate produced highest zone of hydrolysis. The enzymatic degradation of cellulose waste has been suggested as a feasible alternative for the conversion of lignocelluloses substrate into fermentable sugars and application for biofuel production. Scientific World, Vol. 10, No. 10, July 2012 p43-46 DOI: http://dx.doi.org/10.3126/sw.v10i10.6861

Underlay tympanoplasty with tunneling and placement of graft in anterior canal wall

Tympanoplasty is one of the commonest surgical procedures done by ENT Surgeons. Though it has a long history of about six decades, various techniques have been advocated. Today most widely used technique is underlay. Overlay technique is reserved for total perforation. A modification of the underlay technique with anterior tunneling and placement of graft in anterior canal wall was tried and evaluated. Cases were selected from patients attending CMS-TH, Bharatpur. Seventy (70) cases were included and results were evaluated. Journal of College of Medical Sciences-Nepal,2011,Vol-7,No-4, 44-47 DOI: http://dx.doi.org/10.3126/jcmsn.v7i4.6740

The oral-systemic personalized medicine model at Marshfield Clinic

Periodontal disease and diabetes, two diseases that have achieved epidemic status, share a bidirectional relationship driven by micro-inflammatory processes. The present review frames the current understanding of the pathological processes that appear to link these diseases and advances the hypothesis that reversal of the epidemic is possible through application of interdisciplinary intervention and advancement of oral-systemic personalized medicine. An overview of how Marshfield Clinic's unique clinical, informatics and bio-repository resources and infrastructures are being aligned to advance oral-systemic personalized medicine is presented as an interventional model with the potential to reverse the epidemic trends seen for these two chronic diseases over the past several decades. The overall vision is to engineer a transformational shift in paradigm from 'personalized medicine' to 'personalized health'.

High-level gentamicin resistance and vancomycin resistance in clinical isolates of enterococci in a tertiary care hospital in eastern Nepal

High-level gentamicin resistance and vancomycin resistance in enterococci, a family of important opportunistic pathogens, have emerged as a significant clinical problem over recent years. The present study was conducted to determine the high-level gentamicin and vancomycin resistance among the clinical isolates of enterococci. A total of 110 phenotypically identified enterococcal isolates were subjected to determination of high-level gentamicin resistance (by disk diffusion and agar dilution methods) and vancomycin resistance (by agar screening and agar dilution methods). About 36% of the isolates were found to have high-level gentamicin resistance, which indicates that gentamicin no longer remains an appropriate choice for inclusion in combination therapy with cell wall-active agents. Ten percent isolates exhibited resisance to vancomycin during screening. However, agar dilution confirmed that the isolates did not have resistance to vancomycin but had reduced susceptibility to it, which indicates their impending emergence of resistance to vancomycin.

Prevalence of Dental Caries in 5 – 6 Years and 12 – 13 Years Age Group of School Children of Kathmandu Valley

Introduction: Dental caries is one of the most common conditions affecting the general health of children. The present study was carried out among school children of Kathmandu valley to determine the prevalence of dental caries in two age groups. Methods: The study was conducted from December 2007 to May 2008. The age of the school children of the study was divided into two group: 5 - 6 years and 12 - 13 years. A stratifi ed cluster sampling with proportional allocation was used while grouping the subjects. The dental status examination was done with the help of trained dentists. Decayed, missed and fi lled teeth index and decayed, missed and fi lled surfaces index (dmft for primary dentition and DMFT for permanent dentition) were used as the standard tools for the determination of prevalence. Results: A total of 638 students (325 of age group 12 - 13 years and 313 of age group 5 - 6 years) from 30 different schools of the Kathmandu valley were included in the study. The caries status was found higher in the age group of 5 - 6 years than in the 12 - 13 years and it was found to be statistically signifi cant (p < 0.001). The dmfs and caries percentage of the age group 5 - 6 years and the DMFS and caries percent of the 12 - 13 years was found to be 3.79, 69 % and 1.6, 53.23 % respectively. The dmft/dmfs value was found to be signifi cant according to the districts in the 5 - 6 years age group whereas the DMFS was found statistically signifi cant among the sexes of the 12 - 13 years age group. Conclusions: The caries percentage was found to be above the recommended level of the World Health Organization. However, the DMFS and DMFT values were within the WHO level. Keywords: Children, dental caries, DMF index.

Prevalence of dental caries in 5 - 6 years and 12 - 13 years age group of school children of Kathmandu valley

INTRODUCTION

Dental caries is one of the most common conditions affecting the general health of children. The present study was carried out among school children of Kathmandu valley to determine the prevalence of dental caries in two age groups.

METHODS

The study was conducted from December 2007 to May 2008. The age of the school children of the study was divided into two group: 5 - 6 years and 12 - 13 years. A stratified cluster sampling with proportional allocation was used while grouping the subjects. The dental status examination was done with the help of trained dentists. Decayed, missed and filled teeth index and decayed, missed and filled surfaces index (dmft for primary dentition and DMFT for permanent dentition) were used as the standard tools for the determination of prevalence.

RESULTS

A total of 638 students (325 of age group 12 - 13 years and 313 of age group 5 - 6 years) from 30 different schools of the Kathmandu valley were included in the study. The caries status was found higher in the age group of 5 - 6 years than in the 12 - 13 years and it was found to be statistically significant (p < 0.001). The dmfs and caries percentage of the age group 5 - 6 years and the DMFS and caries percent of the 12 - 13 years was found to be 3.79, 69 % and 1.6, 53.23 % respectively. The dmft/dmfs value was found to be significant according to the districts in the 5 - 6 years age group whereas the DMFS was found statistically significant among the sexes of the 12 - 13 years age group.

CONCLUSION

The caries percentage was found to be above the recommended level of the World Health Organization. However, the DMFS and DMFT values were within the WHO level.

Interleukin-13 induces T helper type 2 immune responses in OVA-immunized BALB/c mice bearing a T cell lymphoma

T lymphocytes play a crucial role in the regulation of immune responses against the tumour cells. Tumour progression results in dysfunction and inhibition of T cells, which ultimately leads to impairment in the antitumour immune response. The impaired antitumour immune response in the host is represented by the decreased number of T cells and their incomplete and improper function. The immunosuppressive network in tumour-bearing host mediated by tumour cells also leads to the inequities of T cell subsets and imbalance of Th1/Th2 dichotomy. Therefore, in the present study, we sought to investigate the role of tumour progression in the development of T cell phenotype and the involvement of interleukin-13 thereof selecting Dalton's lymphoma (DL) as a tumour model. It was observed that a significant increase in the number of CD4(+) T cell population, whereas a significant decline in the CD8(+) T cells among lymphoid cell population of OVA-immunized DL-bearing BALB/c mice occurs. Similar observation was found following the administration of IL-13 to the normal healthy mice. It was further confirmed that expansion in Th2 type cells among CD4(+) T cell population occurs following the progression of tumour and administration of IL-13 to normal healthy mice by an yet to define mechanism. Therefore, it can be concluded that IL-13 has immense role in polarizing the immune responses by inducing the differentiation of Th2 type of cells.