Defining Obesity Using a Biological End Point in Sri Lankan Children

Objective

To identify the percentage of body fat mass (FM) that would define obesity among Sri Lankan children.

Methods

A cross-sectional study was conducted among 5–15 y old children in the district of Colombo. FM was assessed using Bio Impedance Assay (BIA). After a 12 h overnight fast, blood was drawn for fasting blood glucose (FBS) and lipid profile. Oral-glucose-tolerance test (OGTT) was done along with 2 h random blood sugar (RBS). Metabolic syndrome (MetS) was diagnosed by a high waist circumference (WC) with ≥2 metabolic derangements [FBS/RBS, high density lipoprotein-cholesterol (HDL-C), triglyceride, and systolic and diastolic blood pressure (SBP/DBP)]. Receiver-Operator Characteristics (ROCs) were drawn to determine the best %FM that predicted MetS.

Results

Nine hundred twenty children were studied (547 boys). Fifteen (1.6 %) had MetS. Ninety five (10.3 %) had two and 16(1.7 %) had ≥3 metabolic derangements. MetS in boys was associated with %FM of 28.6 (sensitivity 1.000; specificity 0.870) and in girls 33.7 (sensitivity 0.875; specificity 0.808).

Conclusions

FM associated with adverse health outcomes in this population is comparable to other available data. A %FM of 28.6 % for boys and 33.7 % for girls would be acceptable cutoff limits.

     

Clinical and Microbiological Evaluation of a Chlorhexidine-Modified Glass Ionomer Cement (GIC-CHX) Restoration Placed Using the Atraumatic Restorative Treatment (ART) Technique

The aims of this study were to investigate the clinical effectiveness and patient acceptability of a modified glass ionomer cement placed using the atraumatic restorative treatment (ART) technique to treat root caries, and to carry out microbiological analysis of the restored sites. Two clinically visible root surface carious lesions per participant were restored using ART. One was restored with commercial glass ionomer cement (GIC) (ChemFil^® Superior, DENTSPLY, Konstonz, Germany) which acted as the control. The other carious root lesion was restored with the same GIC modified with 5% chlorhexidine digluconate (GIC-CHX; test). Patient acceptability and restoration survival rate were evaluated at baseline and after 6 months. Plaque and saliva samples around the test and control restorations were collected, and microbiological analysis for selected bacterial and fungal viability were completed at baseline, and after 1, 3, and 6 months. In total, 52 restorations were placed using GIC and GIC-CHX in 26 participants; 1 patient was lost to follow-up. After reviewing the restorations during their baseline appointments, participants indicated that they were satisfied with the appearance of the restorations (n = 25, 96%) and did not feel anxious during the procedure (n = 24, 92%). Forty-eight percent (n = 12) of the GIC-CHX restorations were continuous with the existing anatomic form as opposed to six for the GIC restorations (24%), a difference which was statistically significant (p = 0.036). There was no statistically significant reduction in the mean count of the tested microorganisms in plaque samples for either type of restorations after 1, 3, or 6 months. Restoration of carious root surfaces with GIC-CHX resulted in higher survival rates than the control GIC. ART using GIC-CHX may therefore be a viable approach for use in outreach dental services to restore root surface carious lesions where dental services are not readily available, and for older people and special needs groups.     

An antifungal constituent from the stem bark of Butea monosperma

The petroleum and ethyl acetate extracts of the stem bark from Butea monosperma displayed antifungal activity against Cladosporium cladosporioides. The active constituent of low polarity was isolated by bioassay-monitored chromatographic fractionation, and identified as (-)-medicarpin by comparison of physical data. The antifungal activity of (-)-medicarpin was found to be greater than that of Benlate, a standard fungicide, while (-)-medicarpin acetate also exhibited significant activity against C. cladosporiodes.     

Uncertain etiologies of proteinuric-chronic kidney disease in rural Sri Lanka

The global prevalence of chronic kidney disease (CKD) of uncertain etiology may be underreported. Community-level epidemiological studies are few due to the lack of national registries and poor focus on the reporting of non-communicable diseases. Here we describe the prevalence of proteinuric-CKD and disease characteristics of three rural populations in the North Central, Central, and Southern Provinces of Sri Lanka. Patients were selected using the random cluster sampling method and those older than 19 years of age were screened for persistent dipstick proteinuria. The prevalence of proteinuric-CKD in the Medawachchiya region (North Central) was 130 of 2600 patients, 68 of 709 patients in the Yatinuwara region (Central), and 66 of 2844 patients in the Hambantota region (Southern). The mean ages of these patients with CKD ranged from 44 to 52 years. Diabetes and long-standing hypertension were the main risk factors of CKD in the Yatinuwara and Hambantota regions. Age, exceeding 60 years, and farming were strongly associated with proteinuric-CKD in the Medawachchiya region; however, major risk factors were uncertain in 87% of these patients. Of these patients, 26 underwent renal biopsy; histology indicated tubulointerstitial disease. Thus, proteinuric-CKD of uncertain etiology is prevalent in the North Central Province of Sri Lanka. In contrast, known risk factors were associated with CKD in the Central and Southern Provinces.     

Congenital dermal sinus tract in the lateral buttock: unusual presentation of a typically midline lesion

Congenital dermal sinus tracts most commonly involve the midline and may communicate with the central nervous system. We present a 3-year-old girl with a pit in the upper lateral buttock noted since birth. Surgical exploration revealed a firm tract that dissipated in the gluteal fascia, and ultrasound confirmed the absence of any deeper extension. Microscopic examination revealed a sinus tract lined by dermal appendages and surrounded by an exuberant inflammatory reaction to hair. This location is distinctly unusual, and our report expands the clinical spectrum of congenital dermal sinus tracts and raises awareness that lesions prone to having a connection with the central nervous system may present quite laterally. Furthermore, this case provides insight into the pathogenesis of a disease that is often explained as a “defect of midline closure” and also illustrates an unusual setting for so-called “pilonidal disease.”     

Crystal Structures of Epstein–Barr Virus Bcl-2 Homolog BHRF1 Bound to Bid and Puma BH3 Motif Peptides

Apoptosis is a powerful defense mechanism used by multicellular organisms to counteract viral infection. In response to premature host cell suicide, viruses have evolved numerous countermeasures to ensure cell viability to optimize their replication by encoding proteins homologous in structure and function to cellular pro-survival Bcl-2 proteins. Epstein–Barr virus (EBV), a member of the Gammaherpesviridae, encodes the Bcl-2 homolog BHRF1, a potent inhibitor of Bcl-2-mediated apoptosis. BHRF1 acts by directly targeting Bid and Puma, two proapoptotic proteins of the Bcl-2 family. Here, we determined the crystal structures of BHRF1 bound to peptides spanning the Bcl-2 binding motifs (Bcl-2 homology 3 motif, BH3) of Bid and Puma. BHRF1 engages BH3 peptides using the canonical ligand-binding groove of its Bcl-2 fold and maintains a salt bridge between an Arg residue with a conserved Asp residue in the BH3 motif mimicking the canonical ionic interaction seen in host Bcl-2:BH3 motif complexes. Furthermore, both Bid and Puma utilize a fifth binding pocket in the canonical ligand binding groove of BHRF1 to provide an additional hydrophobic interaction distinct from the interactions previously seen with Bak and Bim. These findings provide a structural basis for EBV-mediated suppression of host cell apoptosis and reveal the flexibility of virus encoded Bcl-2 proteins in mimicking key interactions from the endogenous host signaling pathways.     

Intraarticular expression of biologically active interleukin 1-receptor-antagonist protein by ex vivo gene transfer.

Gene therapy offers a radical different approach to the treatment of arthritis. Here we have demonstrated that two marker genes (lacZ and neo) and cDNA coding for a potentially therapeutic protein (human interleukin 1-receptor-antagonist protein; IRAP or IL-1ra) can be delivered, by ex vivo techniques, to the synovial lining of joints; intraarticular expression of IRAP inhibited intraarticular responses to interleukin 1. To achieve this, lapine synoviocytes were first transduced in culture by retroviral infection. The genetically modified synovial cells were then transplanted by intraarticular injection into the knee joints of rabbits, where they efficiently colonized the synovium. Assay of joint lavages confirmed the in vivo expression of biologically active human IRAP. With allografted cells, IRAP expression was lost by 12 days after transfer. In contrast, autografted synoviocytes continued to express IRAP for approximately 5 weeks. Knee joints expressing human IRAP were protected from the leukocytosis that otherwise follows the intraarticular injection of recombinant human interleukin 1 beta. Thus, we report the intraarticular expression and activity of a potentially therapeutic protein by gene-transfer technology; these experiments demonstrate the feasibility of treating arthritis and other joint disorders with gene therapy.