Characterization of indoor bioaerosols from a hospital ward in a tropical setting

Objectives

Study was conducted to assess whether temporal variation exists in airborne microbial concentrations of a hospital ward (west-Chennai, India) using active and passive methods, and characterise the microorganisms.

Methods

Air samples (duplicates) were collected simultaneously using exposed-plate, impingement (BioSampler) and filtration (personal sampling filter cassette loaded with gelatin filter) methods over different periods of the year. Bacterial plates were incubated at 37°C and observed for growth after 48h; fungal plates were incubated at 25°C and 37°C and observed upto 7 days. Microorganisms were identified using standard microbiological procedures.

Results

Microbial loads were found to vary with the sampling method. Concentrations of bacteria were higher (exposed-plate: 45–150 CFU/plate; impingement: 1.12E+03–1.6856E+05 CFU/m³; filtration: 3.788E+03−1.91111E+05 CFU/m³) than fungi (exposed-plate: 0–13 CFU/plate; impingement: 0–3.547E+03 CFU/m³; filtration: 0–1.515E+04 CFU/ m³). Coagulase-negative Staphylococci and Micrococci were the predominant Gram-positive cocci in active and passive samples. Enterobacter and Pseudomonas were the predominant Gram-negative bacilli. Among fungi, Aspergillus niger was isolated throughout the year. There was no significant temporal variation in airborne microbial loads irrespective of methods.

Conclusions

Exposed-plate method was found to capture microorganisms efficiently with little variation in duplicate samples, suggesting its use in hospitals for preliminary assessment of indoor air quality and determine pathogenic microorganisms due to particle fall-out.     

Florid reactive lymphoid hyperplasia (lymphoma-like lesion) of the uterine cervix

Lymphoma-like lesion (LLL) of the female genital tract is an older term in the literature that describes a florid reactive lymphoid proliferation that can be misinterpreted as lymphoma. Multiple causes of LLL have been suggested but most cases remain unexplained. We describe the clinicopathologic features of 6 patients with LLL involving the uterine cervix. Five patients presented with abnormal Papanicolaou test (Pap smear), and 3 patients had a biopsy procedure performed prior to detection of LLL in a loop electrosurgical excision procedure (LEEP). In each specimen, surface epithelial erosion was associated with a superficial, polymorphous lymphoid infiltrate with numerous scattered large cells, without cellular necrosis or sclerosis. Squamous dysplasia was present in 4 patients. Immunohistochemical studies revealed a mixed population of B- and T-lymphoid cells. T-cells were more numerous but B-cells and formed aggregates or sheets in areas. The large cells were predominantly B-cells positive for CD20 and negative for CD3 in all cases. CD30 was positive 3 cases, and Epstein-Barr virus-encoded RNA was positive in 3 cases. Assessment for clonality in 1 patient using polymerase chain reaction (PCR) methods revealed monoclonal immunoglobulin heavy chain (IgH) gene rearrangements. At last clinical follow-up there was no evidence of progressive or systemic disease. We conclude that LLL of the cervix has a number of etiologies and that a prior surgical procedure, present in 3 patients in this study, is another possible etiology. As has been reported by others, monoclonal IgH gene rearrangements can be detected in this entity which has a benign clinical course.     

Exposure to respirable particulates and silica in and around the stone crushing units in central India

Stone crushing unit workers suffer from particulate matters and respirable silica at work and in their residents nearby. The present study was undertaken to evaluate the area and personal exposure concentration of respirable particulate matters and silica in workplaces and in surrounding villages. PM(10), PM(4) and PM(2.5) were considered for unit area measurement and PM(4) and PM(2.5) were considered for personal exposure measurements. The ambient PM(10) and indoor respirable particulate sampling and analyses were carried out in two neighboring villages adjacent to a cluster of 100 stone crushing units in central India. The study was conducted in two years with varied seasons to provide baseline data on the existing particulate concentration with and without control intervention. Monitoring and analytical criteria were fulfilled according to the National Institute for Occupational safety and Health (NIOSH), USA protocol. The study reports the higher particulates and respirable silica with respect to the national and international guidelines in and around the study units. However, in nearby villages, the particulate concentrations and silica were comparatively less. An innovative dust abatement dry engineering control system was installed as a pilot work to reduce dust emission from the unit and the results afterward were found to be encouraging.     

Spinned Poisson distribution with health management application

Consider a data collection setup during a spread of an infectious disease. Examples include severe acute respiratory syndrome (SARS) or influenza A virus H3N2. The health management in such scenarios quickly removes the infected cases before the data collection is completed. The estimate of the incidence rate or the chance for anyone to be immune requires using a correct probability distribution. The usual Poisson distribution is inappropriate because of the impact of removing infected cases on the incidence rate as well as observing a new case. An appropriate new probability distribution is derived and is named as spinned Poisson distribution. The statistical properties of the spinned Poisson distribution are developed and illustrated using infectious smallpox incidence in Abakaliki, Nigeria.     

Osimertinib versus Standard of Care EGFR TKI as First-Line Treatment in Patients with EGFRm Advanced NSCLC: FLAURA Asian Subset

Introduction

Here we report efficacy and safety data of an Asian subset of the phase III FLAURA trial (NCT02296125), which compares osimertinib with standard of care (SoC) EGFR tyrosine kinase inhibitors (TKIs) in patients with previously untreated advanced NSCLC with tumors harboring exon 19 deletion (Ex19del)/L858R EGFR TKI–sensitizing mutations.

Galeterone and VNPT55 induce proteasomal degradation of AR/AR-V7, induce significant apoptosis via cytochrome c release and suppress growth of castration resistant prostate cancer xenografts in vivo

Galeterone (Gal) is a first-in-class multi-target oral small molecule that will soon enter pivotal phase III clinical trials in castration resistant prostate cancer (CRPC) patients. Gal disrupts androgen receptor (AR) signaling via inhibition of CYP17, AR antagonism and AR degradation. Resistance to current therapy is attributed to up-regulation of full-length AR (fAR), splice variants AR (AR-Vs) and AR mutations. The effects of gal and VNPT55 were analyzed on f-AR and AR-Vs (AR-V7/AR^v567es) in LNCaP, CWR22Rv1 and DU145 (transfected with AR-Vs) human PC cells in vitro and CRPC tumor xenografts. Galeterone/VNPT55 decreased fAR/AR-V7 mRNA levels and implicates Mdm2/CHIP enhanced ubiquitination of posttranslational modified receptors, targeting them for proteasomal degradation. Gal and VNPT55 also induced significant apoptosis in PC cells via increased Bax/Bcl2 ratio, cytochrome-c release with concomitant cleavage of caspase 3 and PARP. More importantly, gal and VNPT55 exhibited strong in vivo anti-CRPC activities, with no apparent host toxicities. This study demonstrate that gal and VNPT55 utilize cell-based mechanisms to deplete both fAR and AR-Vs. Importantly, the preclinical activity profiles, including profound apoptotic induction and inhibition of CRPC xenografts suggest that these agents offer considerable promise as new therapeutics for patients with CRPC and those resistant to current therapy.     

Diagnosing acute appendicitis using a nonoral contrast CT protocol in patients with a BMI of less than 25

The objective of this study was to compare the accuracy for the diagnosis of appendicitis in patients presenting to the emergency department (ED) with acute, nontraumatic abdominal pain and a body mass index (BMI) of less than 25 before and after the implementation of a nonoral contrast computed tomography (CT) protocol with intravenous contrast. The IRB approved this HIPAA-compliant retrospective study; informed consent was waived. This study included 736 adult patients with a BMI of less than 25 presenting to our ED with acute, nontraumatic abdominal pain over two distinct 6-month time periods. An oral and intravenous contrast-enhanced protocol was utilized in the first cohort (group A), and an intravenous contrast-enhanced protocol without oral contrast was utilized in the second cohort (group B). Three abdominal fellowship-trained readers retrospectively reviewed all CT studies and electronic medical records, including surgical/pathology reports that served as reference standards. Group A consisted of 359 patients; 41 patients had surgically proven appendicitis. The sensitivity and specificity of the readers for diagnosing appendicitis in group A ranged from 95.2–100 and 98.1–99.5 %, respectively. Group B consisted of 372 patients; 39 had surgically proven appendicitis. The sensitivity and specificity of the readers in group B ranged from 92.0–100 and 98.6–100 %, respectively. There were no statistically significant differences in sensitivity or specificity for CT scans performed in groups A and B. In patients with a BMI of less than 25, an intravenous contrast-enhanced CT protocol without oral contrast demonstrates similar accuracy to an intravenous contrast-enhanced protocol with oral contrast for diagnosing acute appendicitis.