Ferritin concentrations in dried serum spots from capillary and venous blood in children in Sri Lanka: a validation study

BACKGROUND: Assessing iron status continues to be challenging in field situations. Spot methods developed for analyzing ferritin from serum or plasma samples that are spotted and dried on filter paper have been shown to provide reliable and accurate iron-status assessments. However, the spot methods are based on samples from venous serum or plasma and have not been evaluated in field settings. OBJECTIVE: We evaluated the validity of analyzing ferritin to assess iron status by using venous and capillary dried-serum-spot (DSS) samples by the spot method compared with using serum ferritin by the traditional method in a field setting. DESIGN: Venous and capillary blood was obtained from healthy schoolchildren (n = 100; +/- SD age: 8.9 +/- 0.3 y) in Colombo, Sri Lanka. To prepare DSS samples, we aliquoted precisely 20 microL serum per spot on filter paper, air-dried the spots, and placed them in airtight plastic bags until analysis by the spot ferritin method with the use of cellulase from Trichoderma reesei at 2 wk after collection. Venous serum (100 microL) was frozen until ferritin determination by traditional radioimmunoassay. RESULTS: Venous and capillary DSS ferritin values correlated strongly with traditional serum ferritin values (r = 0.88 and 0.86, respectively; P = 0.0001). The geometric means (+/- 1 SD) for venous and capillary DSS ferritin and traditional ferritin were 26.9 (15.3-47.4), 33.9 (20.9-54.8), and 33.1 (18.6-58.8) microg/L, respectively, and were not significantly different. Venous and capillary DSS methods on average (+/- SD) yielded ferritin values that were 5.8 +/- 10.1 microg/L lower and 0.1 +/- 9.4 microg/L higher, respectively, than serum ferritin values obtained with the traditional method. CONCLUSIONS: Capillary and venous DSS methods for analyzing ferritin provide accurate tools for assessing iron status. Furthermore, capillary DSS ferritin is a practical means of detecting iron deficiency in field settings.     

Suppression of Parathyroid Hormone and Bone Resorption by Calcium Carbonate and Calcium Citrate in Postmenopausal Women

This study was conducted to compare the suppressive effects of calcium carbonate and calcium citrate on bone resorption in early postmenopause. Calcium citrate is thought to be better absorbed. We therefore tested the hypothesis that calcium as citrate is more effective than calcium as carbonate in suppressing parathyroid hormone (PTH) and C-terminal telopeptide. Twenty-five healthy postmenopausal women were recruited in this double blind crossover study. The subjects were randomly allocated to receive either 1,000 mg of elemental calcium as carbonate or 500 mg of calcium as citrate. They were given the alternate calcium dose 1 week later. Serum measurements of total and ionized calcium, phosphate, PTH, and CrossLaps were repeated 12 hours after each dose. Analysis of variance found no significant difference between measures for the two salts. Tests for equivalence indicated that 500 mg of calcium citrate may be superior to 1,000 mg of calcium carbonate in raising serum total and ionized calcium (P = 0.04 and 0.05, respectively). For all parameters measured, 500 mg of calcium citrate was at least as beneficial as 1,000 mg of calcium carbonate. Calcium citrate is at least as effective as calcium carbonate in suppressing PTH and C-terminal telopeptide cross-links, at half the dose. This may be because calcium as citrate is better absorbed than calcium as carbonate. If calcium citrate can be used in lower doses, it may be better tolerated than calcium carbonate.     

Low folic acid status and its association with anaemia in urban adolescent girls and women of childbearing age in Sri Lanka

Folic acid deficiency is implicated in the aetiology of nutritional anaemia and adverse pregnancy outcomes for the fetus. Data on folic acid status among adolescent girls and non-pregnant, non-lactating young women are limited. We assessed folic acid status in a random sample of 552 subjects (277 adolescent girls aged 15-18.9 years and 275 women aged 19-30 years) living in Colombo, Sri Lanka. The association of low folic acid status with anaemia was evaluated. Socio-economic, food intake and anthropometric data were obtained. Hb, serum folic acid, vitamin B12 and ferritin and plasma homocysteine concentrations were measured. Forty-three per cent of subjects studied had low serum folic acid concentrations (<3 ng/ml) and 47 % had low Fe stores (serum ferritin <20 microg/l). Overall prevalence of anaemia was 12.9 %, and 43.9 % of anaemic subjects had both low folic acid status and depleted Fe stores (serum ferritin <12 microg/l). Both low folate status and depleted Fe stores were significantly associated with anaemia (odds ratio = 2.32; 95 % CI 1.34, 4.01 and odds ratio = 5.98; 95 % CI 3.36, 10.63, respectively). Serum folic acid concentration was associated (r = 0.108, P = 0.015) with folate intake as indicated by a computed folate index. Folate index was associated inversely with household size and positively with economic status and education level. In this study population low folic acid status, besides depleted Fe stores, was associated with anaemia. The high prevalence of low folic acid status observed highlights the need for nutrition education to improve intakes of folate, Fe and other micronutrients among adolescent girls and young women.     

Prevalence of Vitamin A Deficiency in South Asia: Causes,Outcomes, and Possible Remedies

Vitamin A deficiency (VAD) has been recognized as a public-health issue in developing countries. Economic constraints, sociocultural limitations, insufficient dietary intake, and poor absorption leading to depleted vitamin A stores in the body have been regarded as potential determinants of the prevalence of VAD in South Asian developing countries. VAD is exacerbated by lack of education, poor sanitation, absence of new legislation and enforcement of existing food laws, and week monitoring and surveillance system. Several recent estimates confirmed higher morbidly and mortality rate among children and pregnant and non-pregnant women of childbearing age. Xerophthalmia is the leading cause of preventable childhood blindness with its earliest manifestations as night blindness and Bitot''s spots, followed by blinding keratomalacia, all of which are the ocular manifestations of VAD. Children need additional vitamin A because they do not consume enough in their normal diet. There are three general ways for improving vitamin A status: supplementation, fortification, and dietary diversification. These approaches have not solved the problem in South Asian countries to the desired extent because of poor governmental support and supervision of vitamin A supplementation twice a year. An extensive review of the extant literature was carried out, and the data under various sections were identified by using a computerized bibliographic search via PubMed, Web of Science, and Google Scholar. All abstracts and full-text articles were examined, and the most relevant articles were selected for screening and inclusion in this review. Conclusively, high prevalence of VAD in South Asian developing countries leads to increased morbidity and mortality among infants, children, and pregnant women. Therefore, stern efforts are needed to address this issue of public-health significance at local and international level in lower- and middle-income countries of South Asia.Key words: Blindness, Infections, Malnutrition, Vitamin A, South Asia     

Immunization with the RgpA-Kgp proteinase-adhesin complexes of Porphyromonas gingivalis protects against periodontal bone loss in the rat periodontitis model

A major virulence factor of Porphyromonas gingivalis is the extracellular noncovalently associated complexes of Arg-X- and Lys-X-specific cysteine proteinases and adhesins designated the RgpA-Kgp complexes. In this study we investigated the ability of RgpA-Kgp as an immunogen to protect against P. gingivalis-induced periodontal bone loss in the rat. Specific-pathogen-free Sprague-Dawley rats were immunized with either formalin-killed whole P. gingivalis ATCC 33277 cells with incomplete Freund's adjuvant, RgpA-Kgp with incomplete Freund's adjuvant, or incomplete Freund's adjuvant alone. The animals were then challenged by oral inoculation with live P. gingivalis ATCC 33277 cells. Marked periodontal bone loss was observed in animals immunized with incomplete Freund's adjuvant alone; this bone loss was significantly (P < 0.05) greater than that detected in animals immunized with formalin-killed whole cells or RgpA-Kgp or in unchallenged animals. There was no significant difference in periodontal bone loss between animals immunized with formalin-killed whole cells and those immunized with RgpA-Kgp. The bone loss in these animals was also not significantly different from that in unchallenged animals. DNA probe analysis of subgingival plaque samples showed that 100% of the animals immunized with incomplete Freund's adjuvant alone and challenged with P. gingivalis ATCC 33277 were positive for the bacterium. However, P. gingivalis ATCC 33277 could not be detected in subgingival plaque samples from animals immunized with formalin-killed whole cells or with RgpA-Kgp. Immunization with formalin-killed whole cells or RgpA-Kgp induced a high-titer serum immunoglobulin G2a response. Western blot analysis of RgpA-Kgp using pooled protective antisera taken from rats immunized with RgpA-Kgp revealed immunodominant bands at 44, 39, and 27 kDa. In conclusion, immunization with RgpA-Kgp restricted colonization by P. gingivalis and periodontal bone loss in the rat.     

Emergency access for online personally controlled health records system

A personally controlled health records (PCHR) system allows a patient user to share his/her health records with trusted physicians by manually granting them the access privilege to his/her online records. However, it presents the problem of emergency access in situations where the user is physically unable to grant the access and the access is required by an Emergency Room (ER) physician who does not have the privilege at that moment. To deal with such a problem, we introduce an online polling system to provide the emergency access control to PCHR systems. For each emergency access request, the access privilege is controlled according to the combined opinions of the patient's preset emergency contacts and other online registered physicians. Because our system is based on the demographic number of the physician community nationwide, it provides a stable emergency access control at all times.     

Does tooth brushing influence the development and progression of non‐inflammatory gingival recession? A systematic review

Aim: The aim of this systematic review was to produce the best available evidence and pool appropriate data to evaluate the effect of tooth brushing on the initiation and progression of non‐inflammatory gingival recession. Material and Methods: A protocol was developed a priori for the question: “Do factors associated with tooth brushing predict the development and progression of non‐inflammatory gingival recession in adults?” The search covered six electronic databases between January 1966 and July 2005. Hand searching included searches of the Journal of Clinical Periodontology, Journal of Periodontal Research and the Journal of Periodontology. Bibliographies of narrative reviews, conference proceedings and relevant texts known to the authors were also searched. Inclusion of titles, abstracts and ultimately full texts was based on consensus between three reviewers. Results: The full texts of 29 papers were read and 18 texts were eligible for inclusion. One abstract from EuroPerio 5 reported a randomized‐controlled clinical trial [Level I evidence] in which the authors concluded that the toothbrushes significantly reduced recessions on buccal tooth surfaces over 18 months. Of the remaining 17 observational studies, two concluded that there appeared to be no relationship between tooth brushing frequency and gingival recession. Eight studies reported a positive association between tooth brushing frequency and recession. Other potential risk factors were duration of tooth brushing, brushing force, frequency of changing the toothbrush, brush (bristle) hardness and tooth brushing technique. None of the observational studies satisfied all the specified criteria for quality appraisal and a valid appraisal of the quality of the randomized‐controlled trial was not possible. Conclusion: The data to support or refute the association between tooth brushing and gingival recession are inconclusive.     

Prevalence of prolonged and chronic poliovirus excretion among persons with primary immune deficiency disorders in Sri Lanka

Background

The Global Polio Eradication Initiative, established in 1988, has made substantial progress toward achieving this target, with only 3 countries never having eliminated wild poliovirus. Persons with primary immune deficiency disorders (PIDD) exposed to OPV are at increased risk of vaccine-associated paralytic poliomyelitis (VAPP) and of prolonged excretion of Sabin polioviruses. However, the risk for prolonged excretion is not known. Therefore, we studied the prevalence of PIDD with long-term poliovirus excretion in Sri Lanka, a middle income country currently using OPV.

Methods

We stimulated the referral of patients under the age of 35 years, with clinical features suggestive of immune deficiency to the single immunology clinic in the country, where these patients were investigated for the presence of PIDD. Stool samples from patients with PIDD were cultured for the presence of poliovirus (PV). Poliovirus isolates were tested for intratypic differentiation (ITD). The VP1 region of all poliovirus isolates was sequenced.

Results

Of 942 patients investigated, 51 (5.4%) were diagnosed with PIDD. Five (10.2%) patients excreted poliovirus. A patient with X linked agammaglobulinemia (XLA) excreted a mixture of all three Sabin like (SL) poliovirus serotypes. One patient with severe combined immune deficiency (SCID) excreted SL type 2, and another with SCID excreted SL type 3. One patient with SCID excreted a P2 vaccine-derived poliovirus (VDPV 2), and another with common variable immune deficiency (CVID) excreted a VDPV 3. The 3 patients with SCID died before scheduled collection of subsequent samples one month later, while the patient with XLA had cleared the virus in stool sample collected after 3 and 11 months. The CVID patient with VDPV 3 excreted for 7 months, and has developed a 23 nucleotide divergence in VP1 (∼900 nucleotides) from the parental Sabin virus.

Conclusions

In our study, several patients with SCID, XLA and CVID excreted poliovirus. With improving health care quality patients with CVID and XLA may survive longer especially with provision of intravenous immune globulin. Regular screening of patients with PIDD for excretion of poliovirus is necessary to identify chronic excretors and make available specific therapies.     

Oral hygiene and periodontal status in a group of patients with rheumatoid arthritis

Background

Periodontitis (PD) and rheumatoid arthritis (RA) having similar clinico-pathological characteristics frequently affect the middle-aged population.

Objectives

To study the oral hygiene (OH) and periodontal disease (PD) status in patients with RA and without RA (control) and to investigate the association between PD and RA.

Methods

OH and PD were assessed in RA patients (n = 35) and controls (n = 35) using plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD) and connective tissue attachment loss (AL). RA severity was determined with a standardized disease activity score (DAS).

Results

Mean age of RAand control groups were 54.7 + 9.9 and 51.1 +7.1 years. Either group female participation was 91.4%. PI and AL in the RA group positively correlated with DAS (Spearman's rho 0.48, 0.67; P<0.01). PI, BOP, PPD and AL were higher in RA patients (P<0.01) than the control. RA group had higher mean number of missing teeth (16.1+7.8) than control (6.5 + 3.6) (P<0.01).

Conclusions

RA is common in middle-aged females. RA patients' PI and DAS showed positive correlation which could be attributed to compromised OH practice resulted by increasing severity of RA. AL in RA group had positive correlation with DAS implying that severe PD leads to severe arthritis and vice versa. PI, BOP, PPD and AL are high in RA patients showing that they are prone to PD. RA patients may also lose teeth early.