Erroneous reduction of HbA1c levels in patients with type 2 diabetes mellitus on dapsone treatment for Hansen’s disease - a single-center retrospective cohort study

Background: Dapsone treatment may reduce HbA1c levels in patients with diabetes. Aims: To assess the prevalence and characteristics of dapsone associated reduction of HbA1c in patients with Hansen’s disease. Methods: A retrospective data review of outpatient and inpatient charts of consecutive patients with Hansen’s disease and type 2 diabetes mellitus was conducted over two years from January 2014 to January 2016 at the Department of Dermatology, CMC Vellore, India. Results: Of the 245 patients with a confirmed diagnosis of Hansen’s disease who were on oral dapsone 100 mg/day as part of their treatment regimen, 49 patients had diabetes and were eligible for the study as per predetermined inclusion criteria. Of these, 35 subjects (71%) had an HbA1c discordantly lower than the corresponding mean plasma glucose levels. Patients with discordant HbA1c levels were more likely to be male and to have a higher RBC mean corpuscular volume (MCV). A greater reduction in HbA1c levels was seen during the initial 3 months of therapy of dapsone treatment. Limitations: The small sample size and retrospective design were limitations of this study. Also, we did not analyze the role of methemoglobinemia or the utility of alternative measures of glycemic control in these patients. Conclusion: We describe a high prevalence of dapsone associated inappropriate HbA1c lowering in type 2 diabetes mellitus patients. This may have serious implications for the management of diabetes in patients on therapy with dapsone.

Phenotype changes of oral epithelial stem cells after in vitro culture

Abstract The aim of our study was to isolate populations of keratinocyte stem cells based on the expression of cell surface markers and to investigate whether the culture could affect their phenotype. keratinocytes from human oral mucosa were sorted based on the expression of the epithelial stem cell markers p75NTR and CD71. We also examined the co-expression of other epithelial stem markers such as integrins β1 and α6 and their stem cell-like proprieties in in vitro assays. Three passages after being sorted by MACS, more than 93% of the p75NTR+ve cells lost the expression of p75NTR, while 5.46% of the p75NTR-ve gained it. Within the small population of the p75NTR+ve cells, 88% co-expressed other epithelial stem cell markers such as integrins β1 and α6, while only 28% of p75NTR-ve cells co-expressed these markers. These results were confirmed by sorting cells by FACS. Additionally, when double staining was used for sorting cells, 99% of the p75NTR+veCD71-ve and 33% of the p75NTR-veCD71+ve cells expressed both integrins, but just one week after culture, only 1.74% of the p75NTR+veCD71-ve cells still expressed p75NTR and only 0.32% still expressed CD71. Similar results were obtained when co-culturing p75NTR+ve and p75NTR-ve populations before analysis. Our results suggest that phenotype changes may be part of an intrinsic cellular mechanism to conserve levels of protein expression as they may found in the human body. In addition, in vitro culture may not offer ideal conditions for epithelial stem cell maintenance due to phenotype changes under standard culture conditions.

Implementing hospital-based surveillance for severe acute respiratory infections caused by influenza and other respiratory pathogens in New Zealand

Recent experience with pandemic influenza A(H1N1)pdm09 highlighted the importance of global surveillance for severe respiratory disease to support pandemic preparedness and seasonal influenza control. Improved surveillance in the southern hemisphere is needed to provide critical data on influenza epidemiology, disease burden, circulating strains and effectiveness of influenza prevention and control measures. Hospital-based surveillance for severe acute respiratory infection (SARI) cases was established in New Zealand on 30 April 2012. The aims were to measure incidence, prevalence, risk factors, clinical spectrum and outcomes for SARI and associated influenza and other respiratory pathogen cases as well as to understand influenza contribution to patients not meeting SARI case definition.All inpatients with suspected respiratory infections who were admitted overnight to the study hospitals were screened daily. If a patient met the World Health Organization’s SARI case definition, a respiratory specimen was tested for influenza and other respiratory pathogens. A case report form captured demographics, history of presenting illness, co-morbidities, disease course and outcome and risk factors. These data were supplemented from electronic clinical records and other linked data sources.Hospital-based SARI surveillance has been implemented and is fully functioning in New Zealand. Active, prospective, continuous, hospital-based SARI surveillance is useful in supporting pandemic preparedness for emerging influenza A(H7N9) virus infections and seasonal influenza prevention and control.

Defecaçäo induzida por esquema múltiplo de reforçamento / Schedule-induced defecation under multiple schedule of reinforcement

O objetivo do presente experimento foi o de verificar a relaçäo entre esquema e defecçäo induzida por esquemas de reforçamento. Através de esquema múltiplo, o controle exercido entre sessöes, previamente relatado, foi verificado intra-sessöes. Dois ratos albinos foram utilizados como sujeitos. Uma caixa operante para pequenos roedores serviu como caixa experimental. O experimento consistiu de 20 sessöes de 30 minutos, nas quais segmentos de 5 minutos de CRF eram intercalados com segmentos de 5 minutos de Fl-32 segundos. Os resultados demonstraram a ocorrência sistemática de defecaçäo durante os segmentos de Fl-32 segundos e sua ausência durante os segmentos de CRF. Os resultados confirmam o controle exercido por esquemas temporais sobre defecaçäo, tanto inter quanto intra-sessäo

Estudo de algumas variáveis de procedimento na defecaçäo induzida por esquemas de reforçamento / Study of some procedural variables on schedull induced defection

Defecaçäo induzida por esquemas de reforçamento foi estudada através de um experimento de duas fases, utilizando-se ratos como sujeitos. Uma vez que reforçamento por água e por comida produzem diferentes padröes de defecaçäo induzida, na primeira fase do experimento foi utilizado um reforçador, comida em pó, que requer uma topografia consumatória de lambedura (como em água), mas é uma comida. Padröes de defecaçäo relacionados a comida foram obtidos, sugerindo que as diferenças produzidas por comida e água säo relacionadas a natureza do reforçador ao invés da topografia da resposta que o consome. A segunda fase do experimento foi dirigida ao fato de que embora os ratos defequem sob esquemas de FI-32 seg e näo sob esquemas de CRF, os parâmetros temporais que distinguem os esquemas säo obscurecidos pelas diferenças nas quantidades de reforçamento apresentadas. O tamanho de cada apresentaçäo de reforçamento foi aumentado durante sessöes de FI-32 seg, de maneira que o total de reforçamento recebido durante cada sessäo aproximou-se do total recebido durante cada sessäo padräo de CRF. Os ratos defecaram sob os esquemas de intervalo, como antes, sugerindo que os parâmetros temporais do esquema, e näo as quantidades de reforçamento, säo as variáveis créticas em defecaçäo induzida por esquemas de reforçamento