Expanding deep phenotypic spectrum associated with atypical pathogenic structural variations overlapping 15q11-q13 imprinting region

BACKGROUND

The 15q11-q13 region is a genetic locus with genes subject to genomic imprinting, significantly influencing neurodevelopment. Genomic imprinting is an epigenetic phenomenon that causes differential gene expression based on the parent of origin. In most diploid organisms, gene expression typically involves an equal contribution from both maternal and paternal alleles, shaping the phenotype. Nevertheless, in mammals, including humans, mice, and marsupials, the functional equivalence of parental alleles is not universally maintained. Notably, during male and female gametogenesis, parental alleles may undergo differential marking or imprinting, thereby modifying gene expression without altering the underlying DNA sequence. Neurodevelopmental disorders, such as Prader-Willi syndrome (PWS) (resulting from the absence of paternally expressed genes in this region), Angelman syndrome (AS) (associated with the absence of the maternally expressed UBE3A gene), and 15q11-q13 duplication syndrome (resulting from the two common forms of duplications-either an extra isodicentric 15 chromosome or an interstitial 15 duplication), are the outcomes of genetic variations in this imprinting region.

METHODS

Conducted a genomic study to identify the frequency of pathogenic variants impacting the 15q11-q13 region in an ethnically homogenous population from Bangladesh. Screened all known disorders from the DECIPHER database and identified variant enrichment within this cohort. Using the Horizon analysis platform, performed enrichment analysis, requiring at least >60% overlap between a copy number variation and a disorder breakpoint. Deep clinical phenotyping was carried out through multiple examination sessions to evaluate a range of clinical symptoms.

RESULTS

This study included eight individuals with clinically suspected PWS/AS, all previously confirmed through chromosomal microarray analysis, which revealed chromosomal breakpoints within the 15q11-q13 region. Among this cohort, six cases (75%) exhibited variable lengths of deletions, whereas two cases (25%) showed duplications. These included one type 2 duplication, one larger atypical duplication, one shorter type 2 deletion, one larger type 1 deletion, and four cases with atypical deletions. Furthermore, thorough clinical assessments led to the diagnosis of four PWS patients, two AS patients, and two individuals with 15q11-q13 duplication syndrome.

CONCLUSION

Our deep phenotypic observations identified a spectrum of clinical features that overlap and are unique to PWS, AS, and Dup15q syndromes. Our findings establish genotype-phenotype correlation for patients impacted by variable structural variations within the 15q11-q13 region.

Mutational spectrum and phenotypic variability of Duchenne muscular dystrophy and related disorders in a Bangladeshi population

Duchenne muscular dystrophy (DMD) is a severe rare neuromuscular disorder caused by mutations in the X-linked dystrophin gene. Several mutations have been identified, yet the full mutational spectrum, and their phenotypic consequences, will require genotyping across different populations. To this end, we undertook the first detailed genotype and phenotype characterization of DMD in the Bangladeshi population. We investigated the rare mutational and phenotypic spectrum of the DMD gene in 36 DMD-suspected Bangladeshi participants using an economically affordable diagnostic strategy involving initial screening for exonic deletions in the DMD gene via multiplex PCR, followed by testing PCR-negative patients for mutations using whole exome sequencing. The deletion mapping identified two critical DMD gene hotspot regions (near proximal and distal ends, spanning exons 8-17 and exons 45-53, respectively) that comprised 95% (21/22) of the deletions for this population cohort. From our exome analysis, we detected two novel pathogenic hemizygous mutations in exons 21 and 42 of the DMD gene, and novel pathogenic recessive and loss of function variants in four additional genes: SGCD, DYSF, COL6A3, and DOK7. Our phenotypic analysis showed that DMD suspected participants presented diverse phenotypes according to the location of the mutation and which gene was impacted. Our study provides ethnicity specific new insights into both clinical and genetic aspects of DMD.

Detection of Oncogenic Human Papillomavirus (HPV-16 and HPV-18) from Bacterial Vaginosis Positive Patient Attending at Tertiary Care Hospital in Mymensingh

Cervical cancer is the fourth most common cancer in women in the world and is the second leading malignancy among Bangladeshi women. Persistent infection with high risk human papillomavirus (HPV) is an important cause of development of cervical intraepithelial neoplasia (CIN) followed by cancer. Bacterial vaginosis (BV), a common treatable vaginal infection which can disrupt the balanced vaginal ecosystem and its innate protective mechanisms against infection, can play an essential role in the acquisition and persistence of high risk human papillomavirus (HR-HPV) infection. This cross sectional study was conducted to detect the HR-HPV (HPV-16 and HPV-18) infection among bacterial vaginosis positive patient in the Department of Microbiology, Mymensingh Medical College (MMC), Bangladesh, from March 2018 to February 2019. A total of 300 endocervical swabs and high vaginal swabs were collected from the VIA (Visual inspection with acetic acid) outdoor clinic of Obstetrics and Gynaecology Department of Mymensingh Medical college Hospital. HPV DNA was tested among all 300 cases by nested PCR. Typing of HPV 16 and HPV 18 was done among HPV DNA positive cases with BV and intermediate flora by multiplex PCR. BV was diagnosed according to Nugent criteria by using the gram stained smear of high vaginal swab. A total of 57/300 (19.0%) samples were positive for HPV DNA by nested PCR. Of the total 300 cases 78(26.0%) had BV, 38(13.0%) had intermediate flora and 184(61.0%) had normal vaginal flora. HPV DNA was more positive in patients having intermediate flora 08/38 (21.05%) followed by the patients having normal vaginal flora 37/184 (20.11%) and BV 12/78 (15.38%). Among the 12 BV patients who were also HPV DNA positive (83.33%) were belong to high risk HPV (type 16 and 18) group and among them 08(66.67%) were HPV-16 and 02(16.67%) were HPV-18. But among 08 HPV DNA positive intermediate flora containing patients only 01(12.5%) were belong to HR-HPV (type 16 and no type 18 was detected).

Liver virome of a Little Corella (Cacatua sanguinea) reveals coinfection with a novel parvovirus and two beak and feather disease viruses

Emerging diseases are acknowledged as a growing threat to wildlife, with the continued identification of pathogenic and potentially pathogenic viruses in avian species resulting from ongoing advances in molecular diagnostic techniques. Parvoviruses under the genus Chaphamaparvovirus (subfamily Hamaparvovirinae) are highly divergent. The detection and characterisation of parvoviruses in psittacine birds is limited. This study reports a novel parvovirus, tentatively named psittaciform chaphamaparvovirus 3 (PsChV-3) under the genus Chaphamaparvovirus, identified in an Australian free-ranging little corella (Cacatua sanguinea). The PsChV-3 genome is 4277 bp in length and encompasses four predicted open-reading frames, including two major genes, a nonstructural replicase gene (NS1), and a structural capsid gene (VP1). The NS1 and VP1 genes showed the closest amino acid identities of 78.8% and 69.7%, respectively, with a recently sequenced psittaciform chaphamaparvovirus 2 from Australian Neophema species grass parrots. In addition, the presence of two complete novel beak and feather disease (BFDV) genomes, 1993 and 1868 nt in length, respectively, were detected from the same bird. Both these BFDV genomes contained two bidirectional ORFs encoding the putative Rep and Cap proteins. Phylogenetic analysis showed that the sequenced novel BFDV genomes clustered in a distinct subclade with other BFDVs isolated from Australian cockatoos. This study contributes to the characterisation chaphamaparvoviruses and BFDV in Australian parrots and supports the need for ongoing monitoring and molecular studies into the avian virome in native Australian psittacine bird species.

Construction of copy number variation landscape and characterization of associated genes in a Bangladeshi cohort of neurodevelopmental disorders

Introduction: Copy number variations (CNVs) play a critical role in the pathogenesis of neurodevelopmental disorders (NDD) among children. In this study, we aim to identify clinically relevant CNVs, genes and their phenotypic characteristics in an ethnically underrepresented homogenous population of Bangladesh. Methods: We have conducted chromosomal microarray analysis (CMA) for 212 NDD patients with male to female ratio of 2.2:1.0 to identify rare CNVs. To identify candidate genes within the rare CNVs, gene constraint metrics [i.e., "Critical-Exon Genes (CEGs)"] were applied to the population data. Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) was followed in a subset of 95 NDD patients to assess the severity of autism and all statistical tests were performed using the R package. Results: Of all the samples assayed, 12.26% (26/212) and 57.08% (121/212) patients carried pathogenic and variant of uncertain significance (VOUS) CNVs, respectively. While 2.83% (6/212) patients' pathogenic CNVs were found to be located in the subtelomeric regions. Further burden test identified females are significant carriers of pathogenic CNVs compared to males (OR = 4.2; p = 0.0007). We have observed an increased number of Loss of heterozygosity (LOH) within cases with 23.85% (26/109) consanguineous parents. Our analyses on imprinting genes show, 36 LOH variants disrupting 69 unique imprinted genes and classified these variants as VOUS. ADOS-2 subset shows severe social communication deficit (p = 0.014) and overall ASD symptoms severity (p = 0.026) among the patients carrying duplication CNV compared to the CNV negative group. Candidate gene analysis identified 153 unique CEGs in pathogenic CNVs and 31 in VOUS. Of the unique genes, 18 genes were found to be in smaller (<1 MB) focal CNVs in our NDD cohort and we identified PSMC3 gene as a strong candidate gene for Autism Spectrum Disorder (ASD). Moreover, we hypothesized that KMT2B gene duplication might be associated with intellectual disability. Conclusion: Our results show the utility of CMA for precise genetic diagnosis and its integration into the diagnosis, therapy and management of NDD patients.

Factors Associated with Delayed Hospital Arrival of Patients Presenting with Acute Myocardial Infarction: A Cross-Sectional Study in Bangladesh

Delay in seeking medical care of the patients with acute myocardial infarction (AMI) could affect the outcome. Therefore, it is important to recognize and reduce pre-hospital in initiating treatment of these patients. The objective of the study was to evaluate the factors associated with delayed hospital arrival of patients with AMI. This cross-sectional study was carried out among 385 patients with AMI attended in the Department of Cardiology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. The delay in arrival to the hospital was recorded along with socio-demographic data, conditions of the patients during onset and other relevant data. The mean age of the patients 59.7±9.9 years with a male-female ratio of 2.4:1. About 22% of patients with AMI arrived at the hospital within 6 hours of symptoms onset and only around 13% arrived within 2 hours of onset of symptoms. Comparatively younger (p=0.037), unmarried (p=0.008) and Muslim (p=0.008) patients were more likely to present for hospital care sooner (p=0.037). Patients coming from upper middle class of socioeconomic status (p<0.001) and those with college or post college level of education (p<0.001) were more likely to present earlier for hospital care. Prehospital delay was larger in non-manual worker patients (p<0.001) as well as in patients with onset of chest pain during rest period (p<0.001) and while at home (p<0.001). Pre-hospital delay was shorter in patients with onset of chest pain from 12am to 6am and 6am to 12pm (p<0.001). Lack of awareness of AMI symptoms and benefits of its early treatment, long distance and mode of transport were shown as the most common causes of delayed arrival of patients at hospital (p<0.001). This study has identified the factors associated with AMI in context of Bangladesh. Effective measures including increasing awareness of AMI symptoms should be taken for better outcome of the patients.

An Exploration of Physical and Phenotypic Characteristics of Bangladeshi Children with Autism Spectrum Disorder

This study explored the physical and clinical phenotype of Bangladeshi children with autism spectrum disorder (ASD). A totally of 283 children who were referred for screening and administered Module 1 of the Autism Diagnostic Observation Schedule (ADOS) were included. Overall, 209 met the ADOS algorithmic cutoff for ASD. A trend for greater weight and head circumference was observed in children with ASD versus non-ASD. Head circumference was significantly (p < 0.03) larger in ASD males compared with non-ASD males. A trend was also observed for symptom severity, higher in females than males (p = 0.068), with further analyses demonstrating that social reciprocity (p < 0.014) and functional play (p < 0.03) were significantly more impaired in ASD females than males. The findings help understand sex differences in ASD.

Estimating the health care costs of non-melanoma skin cancer in Saskatchewan using physician billing data

Introduction

Given the high occurrence and morbidity of non-melanoma skin cancer (nmsc), its economic burden on the Canadian health care system is a cause for concern. Despite that relevance, few studies have used patient-level data to calculate the cost of nmsc. The objective of the present study was to use physician billing data to describe the health care costs and service utilization associated with nmsc in Saskatchewan.

Methods

The Saskatchewan Cancer Agency's cancer registry was used to identify patients diagnosed with nmsc between 2004 and 2008. Treatment services and costs were based on physician billing claims, which detail physician services performed in an outpatient setting. Total and annual outpatient costs for nmsc and mean outpatient cost per person were calculated by skin cell type, lesion site, and geographic location. Service utilization and costs by physician specialty were also explored.

Results

Total outpatient costs grew 12.08% annually, to $845,954.98 in 2008 from $527,458.76 in 2004. The mean outpatient cost per person was estimated at $397.86. Differences in the cost-per-person estimates were observed when results were stratified by skin cell type ($403.41 for basal cell carcinoma vs. $377.85 for squamous cell carcinoma), lesion site ($425.27 for the face vs. $317.80 for an upper limb), and geographic location ($415.07 urban vs. $363.48 rural). Investigation of service utilization found that 92.14% of treatment was delivered by general practice and plastic surgery/otolaryngology physicians; dermatology delivered only 6.33% of services.

Conclusions

Our results underestimate the direct costs of nmsc because inpatient services and non-physician costs were not included in the calculations. The present research represents a first step in understanding the cost burden of nmsc in Saskatchewan.

Displaced Rohingya children at high risk for mental health problems: Findings from refugee camps within Bangladesh

BACKGROUND

The 2017 political violence against the Rohingya people in the state of Rakhine resulted in a large influx of displaced populations into Bangladesh. Given harsh conditions and experiences in Myanmar, and the harrowing journey to the border, raised levels of child neurodevelopmental disorders (NDDs) and mental health problems were expected.

METHODS

A team of child development professionals, physicians, psychologists, and developmental therapists screened 622 children in clinics within the refugee camps using the Developmental Screening Questionnaire (DSQ; 0-<2 years), and the Ten Questions Plus (TQP) for NDDs, and Strengths and Difficulties Questionnaire (SDQ; 2-16 years) for mental health problems. Any child positive on the DSQ or the TQP was assessed for NDDs.

RESULTS

Only 4.8% children aged 0-<2 years and 7.3% children aged >2-16 years screened positive for NDDs, comparable with a local Bangladesh population. However, 52% of children were in the abnormal range for emotional symptoms on the SDQ, and 25% abnormal for peer problems. Significant risk factors were being parentless and having lost one or more family members in the recent crisis.

CONCLUSIONS

This screening study provides objective evidence of the urgent need for psychosocial support of Rohingya children within camps, with special attention to those without parents, including monitoring of their well-being and counselling of families and other care providers.

Genome sequence of an Australian strain of canid alphaherpesvirus 1

OBJECTIVE

Characterisation of a complete genome sequence of an Australian strain of canid alphaherpesvirus 1 (CHV-1) and its phylogenetic relationship with other varicellovirus species.

METHODS

Standard pathology and PCR methods were used to initially detect herpesvirus in hepatic tissue from an infected 4-week-old Labrador Retriever puppy. The complete CHV-1 genome was sequenced using next-generation sequencing technology followed by de novo and reference assembly, and genome annotation.

RESULTS

The CHV-1 genome was 125 kbp in length and contained 74 predicted open reading frames encoding functional proteins, all of which have counterparts in other alphaherpesviruses. Phylogenetic analysis using the DNA polymerase gene revealed that the newly sequenced CHV-1 clustered with canid alphaherpesvirus isolated from the UK and shared a 99% overall nucleotide sequence similarity.

CONCLUSION

This is the first complete genome of an Australian strain of CHV-1, which will contribute to our understanding of the genetics and evolution of herpesvirus.

Recommendations on managing lenvatinib and everolimus in patients with advanced or metastatic renal cell carcinoma

INTRODUCTION

There are several second-line treatment options for patients with renal cell carcinoma after first-line failure of a tyrosine kinase inhibitor, especially with the recent approvals of cabozantinib, nivolumab, and the lenvatinib plus everolimus combination. A lack of reliable biomarkers and an overall lack of prospective head-to-head comparisons make it a challenge to choose a second-line treatment in the clinic. Areas covered: In this review/meta-opinion, we describe the safety profile of the lenvatinib plus everolimus combination in renal cell carcinoma. The combination of lenvatinib plus everolimus has achieved the highest rates of objective responses and the longest progression free and overall survival in cross-comparison trials. At the same time, the safety profile of this combination, including the rate of total and severe adverse events, the percentage of dose reductions required, and the rate of treatment discontinuation, was less favorable compared with available monotherapy options, suggesting that better management could help to maximize the activity of this combination while protecting patients from undue harm. Expert opinion: Herein, we aim to postulate multidisciplinary recommendations on the advice to offer to patients and caregivers before starting treatment and how to manage the combination from the perspective of daily clinical practice.

Review of psittacine beak and feather disease and its effect on Australian endangered species

BACKGROUND

Since it was first described in the early 1980s, psittacine beak and feather disease (PBFD) has become recognised as the dominant viral pathogen of psittacine birds in Australia. Our aim was to evaluate and review the effect of PBFD and its position as a key threatening process to Australian psittacine bird species. We review the origin/evolutionary pathways and potential threat of PBFD to endangered psittacine bird populations and captive-breeding flocks.

CONCLUSIONS

The most recent beak and feather disease virus (BFDV) phylogenetic analyses indicate that all endangered Australian psittacine bird species are susceptible to, and equally likely to be infected by, BFDV genotypes from a range of host psittacine species. Management of the disease in captive-breeding programs has relied on testing and culling, which has proven costly. The risk of PBFD should be considered very carefully by management teams contemplating the establishment of captive-breeding flocks for endangered species. Alternative disease prevention tools, including vaccination, which are increasingly being used in wildlife health, should be considered more seriously for managing and preventing PBFD in captive flocks of critically endangered species.

Serum Copper Status among Acute Myocardial Infarction Male Patients in Bangladesh

This case control study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2015 to December 2015. The aim of the study was to explore the serum copper status among acute myocardial infarction (AMI) patients as a means to monitor the possibility of management of these patients. A total of 120 subjects were included in this study. Among them 60 were diagnosed AMI patients denoted as case group and 60 were normal healthy individuals denoted as control group. Serum copper determined by colorimetric method from each sample. Statistical analysis was performed by SPSS windows package, version 20. Among the study groups the mean serum copper levels were 150.30±26.16 and 103.65±9.38 in case and control group respectively. Analysis showed that the mean serum copper level was significantly (p<0.01) increased in AMI patients in comparison to that of control group.

Mixture models for analyzing product reliability data: a case study

In the case of manufactured products, there are situations where some components of a product are produced over a period of time by collecting items from different vendors, using different raw materials, machines, and manpower. The physical characteristics and the reliabilities of such components may be different, but sometimes it is difficult to distinguish them clearly. In such situations, mixtures of distributions are often used in the analysis of reliability data for these components. Here a twofold Weibull-Weibull mixture model is applied to analyze product reliability data that consist of both failure and censored lifetimes. The Expectation-Maximization (EM) algorithm is used to find the maximum likelihood estimates of the model parameters. As a case study, it analyses an Aircraft component (Windshield) failure data and various characteristics of the mixture model, such as the reliability function, B10 life, mean time to failure, etc., are estimated to assess the reliability of the component. Simulation studies are performed to investigate the properties and uses of the proposed method.

Hepatitis A virus vaccination strategy and pre-immunization screening of Bangladeshi children

Background: HAV infection is endemic in many developing countries like India, Pakistan, Nepal etc. Several seroprevalence studies show high rates of sero-positivity among children by sub-clinical infection. Therefore mass vaccination against HAV has not been recommended in endemic countries. Objective: To determine whether routine hepatitis A vaccination is indicated for all Bangladeshi children & also to know whether pre-vaccination screening is necessary. Materials & Methods: Serum samples from 254 children aged between 1-15 years were tested for antibody (IgM & IgG) against hepatitis A virus (HAV) to determine the seroprevalence of HAV antibody and do a cost-benefit analysis for decision making about vaccination against HAV among the children of Bangladesh. Results: Hepatitis A virus antibody was positive in 141 (55.5%) of 254 children. Age-specific sero-prevalence was 13 (23.2%) of 56 in 1-3 year, 64 (55.2%) of 116 in 3-5 year, 39 (70.9%) of 55 in 5-10 year & 25 (92.6%) of 27 in 10-15 year age group. Cost benefit analysis showed that the total cost of screening followed by vaccination was almost 1.8 times less than the total cost of vaccination of all children without screening. Conclusions: Majority of the children were found sero-positive against HAV around 15 year of age. Therefore mass vaccination against HAV may not be required for Bangladeshi children.DOI: http://dx.doi.org/10.3329/bjms.v14i1.21561 Bangladesh Journal of Medical Science Vol.14(1) 2015 p.65-69

Hyperglycemia is a predictor of mortality and morbidity in low birth weight newborn

Early onset of hyperglycemia is common among low birth weight neonates. Increased risk for death and major morbidities has been observed among hyperglycemic low birth weight infants. This prospective observational study was done to find out hyperglycemia as a predictor of increased morbidity and mortality in the low birth weight sick newborn and was conducted among the hospitalized newborn of Special Care Baby Unit (SCABU), BIRDEM hospital, Dhaka, Bangladesh from July 2009 to December 2009. A total of 198 LBW neonates were included in this study. One third (30.8%) LBW neonates were found hyperglycemic. The mean gestational age was 33.2±3.6 weeks and mean birth weight was 1535.8±780gm in the hyperglycemic neonates. In this study, highest prevalence of hyperglycemia was observed in birth weight <1000gm (38.46%) and in gestational age ≤28 weeks (46.15%). Apnoea, confirmed sepsis and suspected sepsis, confirmed necrotizing enterocollitis (NEC) and neonatal jaundice showed statistically significant association with hyperglycemia than that of non hyperglycemic group. Mortality of neonates in hyperglycemic group was higher (31.15%) than that of non hyperglycemic neonates (10.22%) and the difference in mortality between two groups were found statistically significant (p<0.002). From this study it can be concluded that hyperglycemia in early neonatal period is related to increased morbidity and mortality in low birth weight newborn.

PATHOLOGICALSTUDY ON COLIBACILLOSIS IN CHICKENS AND DETECTION OF ESCHERICHIA COLI BY PCR

    The aim of the present study was to detect the pathogenic Escherichia coli (E. coli) through pathological study of the colibacillosis affected birds. These isolated E. coli were further confirmed by PCR using specific primer. For this purpose, a total of 20 swabs (10 from lung and 10 from intestine of 10 dead birds) were collected in sterile nutrient broth. The histopathological samples were collected in 10% buffered neutral formalin. The used methods were histopathology, isolation and identification of E. coli by conventional methods and as well as by PCR method. A total of 10 isolates of E. coli from 20 swabs of lung and intestine was characterized by conventional routine methods of bacteriology. Gross pathological lesions of all lungs in the present investigation were congested and consolidated. Duodenum showed congestion and hemorrhages with excess mucus in the luminal surface of it. Microscopically, all the lungs showed severe congestion, infiltration of heterophils, macrophages and lymphocytes in the wall of bronchus as well as in the peribronchial alveoli. E. coli infected all the duodenum showed severe infiltration of leukocytes mainly heterophils, lymphocytes and macrophages in the submucosa of the duodenal wall. In this study, DNA of 8 isolates out of 10 isolated E. coli organisms was amplified by PCR using ECO-f and ECO-r primer targeting 16S ribosomal DNA and found 585 bp amplicon which is specific for E. coli with enteroinvasive type confirmed by histopathological lesions in duodenum. Further investigation should be focused on serotyping and detection of genes of E. coli which are responsible for pathogenicity of the organism.DOI = http://dx.doi.org/10.3329/bjvm.v9i1.11205Bangl. J. Vet. Med. (2011). 9(1): 17-25 

Maternal over weight and obesity: its effect on pregnancy outcome

Obesity in pregnancy remains a significant health problem that result in physiological, emotional, social and economic consequences on woman, their families and society. Obesity is considered one of the nutritional problems complicating pregnancy in our country. This study was conducted in antenatal clinic at out patient department of Obstetrics & Gynecology, BIRDEM Hospital, one of the countries largest tertiary level hospitals, during January 2007 to December 2008. During the study period of two years, a total no. of 100 cases were enrolled in two groups. Out of this 50 were control and 50 were over weight and obese. In this study, Mean of height, weight and BMI of the over weight and obese group were 5.21±0.21, 79.35±13.66, 32.36±4.76 respectively. The Mean of birth weight, APGAR score after 1 min and after 5 min of the over weight and obese group were 3.07±0.75, 7.10±1.11, 9.92±0.98 respectively and in normal weight group were 2.74±0.55, 7.40±1.56, 9.92±1.83 respectively. There was significant difference in birth weight, APGAR score after 1 min between the groups (p<0.05) but there was no significant difference in APGAR score after 5 min between groups (p>0.05). Regarding the fetal outcome in this study, 20% of the over weight and obese group delivered macrosomic baby in comparison to only 4% in the normal weight group. On the other hand 46% of the case group had to refer their babies to the neonatal unit in comparison to only 12% in the control group. Gestational Diabetes Mellitus (GDM) (46%) and Preeclampsia (44%) developed more in obese group. Eighty eight (88%) of obese and overweight mother experienced in caesarean delivery. Asphyxia, Respiratory Distress Syndrome (RDS), congenital anomaly and prenatal death were more in the over weight and obese group than normal weight group. Thus, overweight and obesity has got significant deleterious effect on maternal and perinatal outcomes of pregnancy.

Abstract PD05-12: Combination of Notch Inhibitor MK-0752 and Endocrine Therapy for Early Stage ERα + Breast Cancer in a Presurgical Window Pilot Study

Background: Breast tumor initiating cells (TIC) use Notch receptors/ligands with other pathways for self renewal, resulting in tumor proliferation and progression. We showed that Notch inhibition with gamma secretase inhibitors (GSI) potentiates the effects of tamoxifen (tam) in xenografts (Rizzo et al. Cancer Res 2008). It is unknown whether GSIs plus endocrine therapy result in modulation of Notch and other proliferation markers in human breast cancer. Our objective was to add short exposure of the GSI MK-0752 to ongoing tam or letrozole (letr) during the presurgical window to determine 1) feasibility, 2) safety/tolerance, and 3) impact on biomarkers. We report the initial cohort of this pilot study (ClinTrials. gov NCT00756717).

Methods: Patients (pts) with early stage ERα + breast cancer were treated with 25 days of tam or letr. On day 15 MK-0752 was added to endocrine therapy (350 mg orally 3 days on, 4 days off, 3 days on), with definitive surgery day 25. Formalin fixed, paraffin embedded biopsies were obtained at baseline, day 14 and final surgery, with histologic confirmation of tumor content &gt;50% and RNA extraction by standard methods. Q-PCR was done for Notch1, Notch3, Notch4, Deltex, Jagged1, c-myc, HEY1, HEY2, HES1, PS2, C-Myc, Cyclin A2, NOXA (pro-apoptotic protein), Ki67, Dicer-1, RPL13 (internal control). Ct averages for 3 replicates were used and mRNA levels were calculated by the 2ΔΔCt method. Baseline gene expression levels were used as comparators for days 14 and 25 levels in each pt. The first cohort of 10 pts was analyzed to determine if enough signals were present to justify expanding the cohort at this dose to 20 pts and possibly test a second cohort on an alternate MK-0752 dose/schedule. Results: The initial cohort of 10 pts completed all therapy (4 tam, 6 letr), all biopsies and definitive surgery on schedule. One other pt withdrew prior to starting MK-0752 due to hypertension. Toxicity was minimal: grade 1 periorbital edema/cough, nausea, and axillary paresthesias in 1 pt each; grade 1 facial rash, 2 pts; and grade 2 fatigue, 1 pt. There was no diarrhea or surgical complications. Significant changes occurred in molecular marker levels after MK-0752 plus tam/letr (day 25) vs. end of tam/letr alone (day 14) as follows: Ki67 mRNA decreased in 9/10 pts; Notch4 decreased, 10/10; NOXA increased, 6/10; and Notch1 decreased, 6/10. Other markers showed inter-individual variations and will be presented, along with results of the global gene expression profiling (in progress). Conclusions: The addition of a short exposure of the GSI MK-0752 to ongoing endocrine therapy was feasible, safe, and well tolerated in pts with ERα + early breast cancer prior to definitive surgery. It results in anti-proliferative and pro-apoptotic effects at the molecular level. Notch4, which plays a key role in breast TIC, was the most consistent molecular marker of response in this setting. This suggests a potential anti-TIC effect of this combination and a role in overcoming endocrine resistance. Accrual to the expanded cohort is underway. If findings are confirmed, the second study with alternate MK-0752 dose/schedule may commence. Funding: Swim Across America, Inc. (clinical trial costs); Merck (drug supply, profiling)

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD05-12.

Prevalence of obesity among affluent school children in Dhaka

A cross sectional study was conducted in September 2006 in one of the private schools in Dhaka, Bangladesh to see the prevalence of obesity among affluent school children and adolescents. Informed consent was taken from school authority to take anthropometric measurement of all school children. Standing height was measured with a stadiometer and weight with a bathroom scale. Waist and hip circumference were measured with a measuring tape. The body mass index (BMI) was calculated using weight in kilogram/(height in meter)2 formula. Obesity was defined as BMI≥95th percentile for age and sex, over weight as BMI≥85th percentile for age and sex, normal weight as BMI between 5th and 84th percentile and underweight as BMI <5th percentile. Official centers for disease control (CDC) growth chart for boys and girls age 2-20 years was used. Children and adolescents were divided into group 1(3-5 years), Group 2(6-9years), group 3(10-13 years) and group 4(14-18 years). There were a total of 468 children and adolescents (male 266, female 202). In group 1 there were 110 children, in group 2 there were177 children, in group 3 and 4 there were 149 and 32 adolescents respectively. The prevalence of obesity was 17.9%, higher among males (19.9%), compared to females (15.3%). Obesity was highest (27.7%) in group 2, 14.5% in group 1, 10.7% in group 3 and 9.4% in group 4.

Antioxidant enzymes in brackishwater oyster, Saccostrea cucullata as potential biomarkers of polyaromatic hydrocarbon pollution in Hooghly Estuary (India): seasonality and its consequences

Use of antioxidant enzymes as biomarkers often becomes a complicated process at application level because they show considerable seasonal fluctuation due to both natural and biological factors. In this study, we studied the consequences of seasonal variation of antioxidant enzymes [catalase (EC 1.11.1.6), superoxide dismutase (SOD, EC 1.15.1.1), glutathione peroxidase (GPX, EC 1.11.1.9) and microsomal NADPH-DT diaphorase (EC 1.6.99.2)] in the digestive gland of wild brackishwatcr oysters, Saccostrea cucullata for biomonitoring against polyaromatic hydrocarbon (PAH) contamination in Hooghly Estuary, north-eastern coast of India. As a general trend, maximum antioxidant enzyme activities were detected in pre-monsoon period or summer (March-June) followed by a gradual decrease during monsoon (July-October) with a minimum in post-monsoon period or winter (November-February) and this pattern was similar to tissue concentrations of PAHs also. The physiological fluctuations of the antioxidant defense systems were inversely-related to the lipid peroxidation indicating an enhanced susceptibility of oyster tissues to oxidative stress during post-monsoon or winter period. However, the oysters from polluted populations exhibited consistent very high PAHs load in their tissues as well as significant increases in the activities of antioxidant enzymes than in non-polluted populations in all three seasons. The results indicated that the antioxidant enzymes, catalase, SOD and microsomal NADPH-DT diaphorase in digestive gland of S. cucullata could be useful biomarkers of PAHs contamination. It also emphasized that seasonal variation of potential biomarkers like such enzymes should be incorporated into interpretation of biomonitoring studies by the use of appropriate controls and identical treatment in analysis of polluted and non-polluted samples.

Seasonal variation of antioxidant and biotransformation enzymes in barnacle, Balanus balanoides, and their relation with polyaromatic hydrocarbons

Seasonal variations in the antioxidant enzymes (catalase, superoxide dismutase [SOD], NADH-DT diaphorase), biotransformation enzyme, glutathione-S-transferase (GST) and microsomal lipid peroxidation in digestive tissue of barnacle, Balanus balanoides, from polluted and non-polluted populations have been evaluated. Relationships with accumulated polyaromatic hydrocarbon (PAH) concentration in barnacle tissues and environmental parameters (water temperature, salinity, dissolved oxygen concentration, water pH) were determined. As a general trend, maximum antioxidant enzyme and GST activities were detected in the pre-monsoon period or summer (March-June) followed by a gradual decrease during the monsoon (July October) with a minimum in the post-monsoon period or winter (November February). This pattern was similar to tissue concentrations of PAHs, resulting in a significant positive correlation with antioxidant enzymes, mainly catalase and SOD. Microsomal lipid peroxidation exhibited an almost reverse trend of seasonal variation to that of antioxidant enzyme activities indicating an enhanced susceptibility of barnacle tissues to oxidative stress. Among the environmental parameters, only water temperature seemed to have a significant effect on observed variations of antioxidant enzymes and GST activities. The barnacles from polluted and non-polluted populations exhibited seasonal differences in the activities of all the enzymes studied, particularly catalase, SOD and GST, suggesting the possibility of some biochemical adaptation in organisms from a chronically polluted environment. The results indicated that antioxidant defense components, catalase and SOD, are sensitive parameters that could be useful biomarkers for the evaluation of contaminated aquatic ecosystems. The results also suggested the potentiality of barnacle, B. balanoides, as a bioindicator organism against organic pollution.

Revised translation start site for secM defines an atypical signal peptide that regulates Escherichia coli secA expression

The secretion-responsive regulation of Escherichia coli secA occurs by coupling its translation to the translation and secretion of an upstream regulator, secM (formerly geneX). We revise the translational start site for secM, defining a new signal peptide sequence with an extended amino-terminal region. Mutational studies indicate that certain atypical amino acyl residues within this extended region are critical for proper secA regulation.

Snake venom hemorrhagins

Viperine and crotaline snake venoms contain one or more hemorrhagic principles called hemorrhagins. These are zinc-containing metalloproteases characterized by the presence of a protease domain, with additional domains in some of them. They act essentially by degrading the component proteins of basement membrane underlying capillary endothelial cells. The toxins also act on these cells causing lysis or drifting apart, resulting in hemorrhage per rhexis or per diapedesis. Some of these toxins have been found to exert additional effects such as fibrinogenolysis and platelet aggregation that facilitate hemorrhage. The structural and functional features of this class of toxins have been discussed in this review in an attempt to get a better understanding of their toxicity. This can be of immense therapeutic value in the management of snake venom poisoning, as hemorrhagins are among the major lethal factors in snake venom.

Regulation of Escherichia coli secA by cellular protein secretion proficiency requires an intact gene X signal sequence and an active translocon

secA is translationally regulated by the protein secretion proficiency state of the Escherichia coli cell. This regulation was explored by making signal sequence mutations in the gene upstream of secA, gene X, which promotes secA translational coupling. Gene X signal sequence mutants were constitutive for secA expression, while prlA alleles partially restored secA regulation. These results show that interaction of the pre-gene X protein with the translocon is required for proper secA regulation. Furthermore, gene X signal sequence mutations disrupted secA regulation only in the cis configuration. We propose that nascent pre-gene X protein interacts with the translocon during its secretion to constitute the secretion sensor.

Single dose vitamin A treatment in acute shigellosis in Bangladesh children: randomised double blind controlled trial

OBJECTIVE

To evaluate the efficacy of a single large oral dose of vitamin A in treating acute shigellosis in children in Bangladesh.

DESIGN

Randomised double blind controlled clinical trial.

SETTING

Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh.

SUBJECTS

83 children aged 1-7 years with bacteriologically proved shigellosis but no clinical signs of vitamin A deficiency; 42 were randomised to treatment with vitamin A and 41 formed a control group.

INTERVENTION

Children were given a single oral dose of 200,000 IU of vitamin A plus 25 IU vitamin E or a control preparation of 25 IU vitamin E.

MAIN OUTCOME MEASURES

Clinical cure on study day 5 and bacteriological cure.

RESULTS

Baseline characteristics of the subjects in the two treatment groups were similar. Significantly more children in the vitamin A group than in the control group achieved clinical cure (19/42 (45%) v 8/14 (20%); chi 2 = 5.14, 1 df, P = 0.02; risk ratio = 0.68 (95% confidence interval; 0.50 to 0.93)). When cure was determined bacteriologically, the groups had similar rates (16/42 (38%) v 16/41 (39%); chi 2 = 0.02, 1 df, P = 0.89; risk ratio = 0.98 (0.70 to 1.39)).

CONCLUSIONS

Vitamin A reduces the severity of acute shigellosis in children living in areas where vitamin A deficiency is a major public health problem.

Clofilium-induced block of delayed rectifier type K+ current in atrial tumor cells (AT-1 cells)

Atrial tumor myocytes derived from transgenic mice (AT-1 cells) have been shown to express mRNAs encoding cardiac K+ channels and display a cardiac electrophysiological phenotype. The major K+ current is the rapid component of the delayed rectifier (I(kr)). The purpose of the study was to characterize the mode of action of a class III anti-arrhythmic agent (C3A), clofilium, in these cells to elucidate further the mechanism and functional consequence of block. We show that clofilium blocks this I(kr) in a dose-dependent manner with IC50 of 1.25 microM. Clofilium induced block was irreversible for higher concentrations (> or = 50 microM) and partially reversible for lower doses. The reversal potential for this current was -77.5+/-1.5 mV. The block is voltage dependent and the drug probably binds the channel in the open state.

Clinical and laboratory evaluation of powered electric toothbrushes: laboratory determination of relative abrasion of three powered toothbrushes

Previously established data on average forces applied to various brushing instruments during in vivo toothbrushing were incorporated into a laboratory abrasion model. The apparatus included a specially constructed and standardized brushing machine and utilized an acrylic resin substrate. Three powered brushing instruments (Rota-dent, Interplak and Braun Oral-B Plaque Remover) and a manual toothbrush (Oral-B P40), were compared in this model. The system demonstrated excellent precision and could distinguish between brushing instruments with as little as 10% difference in abrasivity. It was found that brushing abrasivity increased in the order of Rota-dent < Braun < Interplak.

Nuclear DNA content of fine needle aspirates of invasive ductal carcinomas of the breast

Patients with aggressive breast cancers benefit from chemotherapy prior to surgery. If the biology of the breast cancers were better characterised pre-operatively, more patients at risk could be offered chemotherapy. We have assessed nuclear DNA content of fine needle aspirates (FNA) of 103 invasive ductal breast cancers and compared this to tumour size, node status and histological grade. Median follow-up was 18 months so no prognostic studies were made. Diploid and non-diploid tumours were distributed equally in node negative and positive patients. However non-diploidy status increased in line with known prognostic markers of tumour size and histological grade. This suggests that ploidy might contribute to the pre-operative assessment of prognosis. We conclude that nuclear DNA of breast cancer FNAs may be of value in the pre-operative biological assessment of breast cancer patients.

Clinical and laboratory evaluation of powered electric toothbrushes: laboratory determination of relative interproximal cleaning efficiency of four powered toothbrushes

The clinical brushing data from the paper entitled, Clinical and Laboratory Evaluation of Powered Electric Toothbrushes: In Vivo Determination of Average Force for Use of Manual and Powered Toothbrushes, by Boyd et al. in this Special Issue, were incorporated into a laboratory cleaning model. Utilizing a standardized brushing machine and a methyl methacrylate substrate, four powered brushing instruments were tested for cleaning efficiency: Rota-dent. Braun Oral-B. Interplak and Sonicare, and a manual toothbrush (Oral-B P40). The Sonicare powered brushing instrument was tested at the manufacturer's recommended brushing force of 0.5 N as well as a calculated force of 1.0 N. The results showed that the Rota-dent was more efficient (p < 0.01-0.001) in removing stain from both flat and interproximal surfaces than any of the other tested brushes. These results, together with those reported by McLey, et al. in Clinical and laboratory Evaluation of Powered Electric Toothbrushes: Laboratory Determination of Relative Abrasion of Three Powered Toothbrushes in this Special Issue, demonstrate that the rotary action Rota-dent instrument has the most efficient combination of low abrasion and high cleaning efficiency of the four powered brushes and the manual brush when all instruments were tested using clinically documented pressures.

Clinical and laboratory evaluation of powered electric toothbrushes: relative degree of bristle end-rounding

Toothbrush bristles with sharp edges have been postulated to represent a greater threat to dental tissues than end-rounded bristles. This study evaluated the effect of both in vivo and laboratory use on bristle wear rate, tip geometry and in vitro abrasivity. Three soft manual brushes (Oral-B P40, Crest Complete and Butler GUM) and one powered brush (Rota-dent) were tested. The results of this study show that the wear rate varied directly with brushing load and amount of dentifrice, and inversely with bristle diameter. Despite the initial geometry, a flat tip with rounded rims was typically observed after only 30 minutes of manual or Rota-dent brush use. There was no statistical difference in in vitro abrasion for new brushes versus used brushes.

Ryanodine induced block of a cloned human cardiac potassium channel

The effects of ryanodine in a cloned human cardiac potassium channel (hKvl.5) expressed in a stable mouse L cell line was studied using whole cell voltage clamp technique. Ryanodine in a dose dependent manner (10(-7) - 10(-5) M) reduced the peak current as well as the current at the end of a 250 ms pulse. Dose response data fitted to a Hill equation yielded IC50 of 1.2 microM. The degree of block was not voltage dependent. Peak current was reduced from 43.6 +/- 12.5% at 10(-5) M to 11.3 +/- 4.8% at 10(-7) M ryanodine. Ryanodine reduced the tail current amplitude without changing the time course relative to the control. The inhibition was only partially reversible at concentrations below 10(-6) M.

Assessment of gastric acid output by H2 breath test

BACKGROUND

The standard method to measure gastric acid secretion is the aspiration of gastric juice. A noninvasive breath test after application of magnesium has been proposed. The aim of this study was to modify the method, to possibly improve the discriminatory value of the test in comparison with intubation tests.

METHODS

We measured the time course of the reaction of magnesium and gastric acid in vitro and determined the gastric hydrogen kinetics in humans by insufflation of hydrogen into the stomach and measuring its reappearance in the exhaled air. Thereafter, a comparison of the breath test and the intubation test was done in 10 healthy volunteers in different secretory states.

RESULTS

After hydrogen insufflation 31.4% reappeared in 90 min (16.3% exhaled, rest belched). Discriminant analysis showed that the intubation test had a good discriminatory power. On the other hand, the breath test failed to distinguish between different secretory states (stimulation, inhibition, and intermediate).

CONCLUSION

Whereas the intubation test discriminated between high and low acid secretion, the breath test did not. This test therefore seems, at least as performed here, unsuitable as a diagnostic test of gastric acid secretion.

Dextrose-, adenosine- and magnesium-induced protective actions during anoxia and reperfusion in canine Purkinje tissue

1. The effects of dextrose, magnesium (Mg) and adenosine on membrane potential and force of contraction were studied in driven and overdriven canine cardiac Purkinje tissue. 2. Dextrose (50 mmol/L) and adenosine (4-6 mmol/L) both showed protective action (the latter to a lesser extent) against simulated anoxia and reperfusion-induced arrhythmias, increased force of contraction transiently on reperfusion, and the former sustained the increase in force to a lower level as long as it was in the superfusing solution. 3. Dextrose (50 mmol/L) and Mg (5 mmol/L) restored overdrive-induced hyperpolarization during simulated anoxia. Adenosine was largely ineffective. 4. It was concluded that dextrose and adenosine (to a lesser extent) protect against arrhythmias by replenishing the critical intracellular pool of ATP which controls membrane transport of electrolytes such as K and Ca. Restoration of Na-K ATPase activity alone (as in the case of high Mg concentrations) is not sufficient to prevent arrhythmias.

Modulations of membrane potential oscillations with drive, calcium overload, ryanodine, and caffeine

The objective of this study is to determine the conditions that generate overdrive excitation and overdrive suppression in canine cardiac Purkinje tissue superfused in vitro. Drive-induced (3 Hz) perturbations in the membrane potential of a calcium overloaded (induced by strophanthidin) Purkinje fiber (from a canine heart) were differently modulated by caffeine and ryanodine. Whereas the postdrive oscillations in the membrane potential Vos (single or multiple oscillations in the diastole of the action potential) and/or spontaneous rate (postdrive suppression or postdrive excitation [PDE]) depended on the concentration of strophanthidin (PDE occurred at 2.5 x 10(-7) M, and Vos were seen variably at several concentrations), caffeine (2-3 mM) in the presence of a lower concentration of strophanthidin (1.25 x 10(-7) M) induced PDE. At these lower concentrations, either drug administered alone only induced Vos. On the contrary, the characteristic effects of ryanodine (10(-8) M) in the presence of strophanthidin (2.5 x 10(-7) M) were either a consistent postdrive suppression immediately or the induction of a pronounced afterdepolarization ([AD] a depolarization following the repolarization of the action potential) whose amplitude decreased with time and suppression. At higher concentrations of ryanodine (10(-5) M-10(-6) M) in a calcium overloaded tissue (strophanthidin, 1.25 x 10(-7) M) overdrive induced a pronounced AD in most cases, with subsequent depolarization and cessation of activity in less than 20 minutes. Ryanodine alone caused suppression of postdrive diastolic potential at lower concentrations (10(-9) M-10(-8) M), a pronounced AD (amplitude diminished with later drives), and suppression at higher concentrations (10(-6) M-10(-5) M).(ABSTRACT TRUNCATED AT 250 WORDS)

Different effects of reoxygenation on the electrical activity of ventricular muscle

Response of a hypoxic and acidotic (HA, with exogenous lactate) ventricular muscle tissue to subsequent reoxygenation in the absence of substrate (0 mM dextrose) was different from that of a Purkinje fiber. The K+ concentration in this solution (4.6 mM) was slightly higher than that in Tyrode solution (2.7 mM). The observed effects of reoxygenation of such a ventricular tissue were also variable. The ventricular muscle tissue exhibited the following different responses on reoxygenation after hypoxia and acidosis: (1) arrhythmias, without much depolarization of the membrane potential, (2) oscillatory after-potentials (OAPs) during the late diastole, which lessened in amplitude as the time of reoxygenation increased, but no arrhythmias, or (3) a pronounced slowed phase of repolarization (hump), but no arrhythmias. These different effects of reoxygenation did not occur if concentration of K+ in HA was very much higher than 4.6 mM. Common to these three different responses was the prolongation of the action potential durations during reoxygenation at the 50% and 90% levels of repolarization (APD50 and APD90) and a slight increase in the resting tension after 30-40 minutes of reoxygenation. Some of the observed responses of ventricular muscles were well mimicked by increasing extracellular calcium, but the different and variable effects of arrhythmias, OAPs, and prolonged APD require further analysis.