Lead Toxicity in Children: Health Effects, Policies and Recommendations

Lead is a dangerous element that exists naturally in the Earth's crust. Any kind of lead causes a detrimental response in the human body. It is discharged into the environment during the manufacturing of batteries, foundries, ammunition, lead paint, water pipes, and other manufactured goods. It can enter the body through a variety of pathways, including those in the air, water, soil, food, and dust. Concern is raised since there is no amount of lead that is safe for the human body. The problem persists despite several prevention measures that the state and the federal governments have put in place. This review assesses the effects of lead exposure on children as well as suggested solutions to the issue.

Marking the Micro Details in Potentially Malignant Disorders of Oral Cavity

Background- The malignancy of the oral cavity constitutes the most important group of malignancies in South and Southeast Asia.The risk increases with the use of tobacco products. Materials & Methods- Micronuclei frequency scoring was used as a biomarker to identify different potentially malignant disorders. Results- Mean micronuclei index was found higher using Hematoxylin and Eosin stain than Papanicolaou's stainand May Grunwald's stain. Conclusion- We concluded that the micronuclei frequencies in oral exfoliated epithelial cells using three different stains- Hematoxylin and Eosin stain, Papanicolaou's stain, May Grunwald's stain may be useful in predicting the malignant potential of premalignant lesions.

Comparative Evaluation of the Effects of Black Tea Extract Mouthrinse and Chlorhexidine Mouthwash on Salivary Streptococcus Mutans Load

Background- Dental caries is one of the most frequent oral health problems. The present study shows the antibacterial effect of black tea extract on salivary Sterptococcus Mutans load. Materials & Methods- The study was conducted on 125 individuals. The differences in the Colony Forming Units and count-scores of S.mutans were analyzed in salivary samples collected from individuals before and after administration of 2% black tea extract mouth-rinse and chlorhexidine mouthwash(CM). Results- There was a statistical difference in mean salivary S. mutans colony count and mean count- score before and after administration of black tea extract mouth-rinse (p = 0.0003) and chlorhexidine mouthwash (p = 0.0002) respectively. Hence, it was found that there is no statistically significant difference in the fall of S.mutans load due to black tea mouth-rinse and chlorhexidine mouthwash. Conclusions- A 2% black tea extract mouth-rinse significantly reduces salivary S.mutans load, irrespective of age and gender. Also, it is an effective natural anti-cariogenic agent with no known implicated side effects.

Oral Submucous Fibrosis: Clinical Stage, Functional Stage, and Histopathological Grade Correlation

Background- Oral submucosal fibrosis (OSMF) is a common precancerous condition predominantly affecting the oral cavity. There are several contributing factors to its pathogenesis, areca nut chewing being the primary culprit. OSMF reversal is difficult once the disease sets in. Hence, after its diagnosis, staging becomes imperative as it affects the treatment plan. Several classification methods have been developed by various authors to categorize the disease based on its clinical, functional, and Histopathological characteristics. The main aim to conduct this study was to correlate clinical and histopathological staging. Materials & Methods- This study involved 30 patients who had been diagnosed with OSMF both Clinically and Histopathologically. All 30 patients were classified and were categorized according to their clinical and functional stages after inspection. Following this, histopathological grading was done. Results- The statistical analysis showed that there was a wide similarity between the clinical and functional staging. However, no significant similarity or correlation was found between the clinical and functional staging with its corresponding histopathological grades. Conclusions- Our study concluded that there is strong correlation between clinical and functional grading.

Feasibility of implementing an integrated tool for improvement of treatment quality and early-warning indicators for HIV drug resistance: a pilot study of centres in India.

With the rapid scale-up in use of antiretroviral therapy (ART), monitoring the quality of care and factors that may lead to emergence of HIV drug resistance (HIVDR) is an important focus point for programme managers. The National AIDS Control Organisation of India embarked on strengthening the ART programme for continuous quality improvement (CQI), using defined quality-of-care indicators (QCIs), including World Health Organization (WHO) early-warning indicators (EWIs) for HIVDR. In this feasibility study, done during July 2014, an integrated QCI and EWI tool developed by WHO India was pilot tested across 18 purposively selected ART centres. At seven ART centres, the EWI 1 target of >90% on-time pill pick-up was achieved for adult patients, while among the paediatric age group (<15 years old) it was not achieved by any centre. EWI 2 (retention of patients in ART care at 12 months after initiation) showed that two centres had retention of both adult and paediatric patients of >85% at 12 months of ART, while 11 centres had retention between 75% and 85%. EWI 3 (pharmacy stock-out) for adult and paediatric patients showed that 11 ART centres reported a minimum of one stock-out for the first-line ART drugs in the reporting period, while EWI 4 targets (pharmacy dispensing practices) were achieved by all the centres, for both adults and children. Average retention in care at 6, 12 and 24 months after ART initiation was 82%, 77% and 71%, respectively. This feasibility study showed that EWI analyses were much simpler to conduct if information was sought only for patients receiving ART, for whom the quality of record-keeping is better and more consistent. The activity has highlighted the need for improved quality of recordkeeping at the facilities and implementation of specific interventions to ensure better patient follow-up. After modifications, use of the tool will be phased in across all the ART centres in India.

Presence of CD3+ tumor infiltrating lymphocytes is significantly associated with good prognosis in infiltrating ductal carcinoma of breast.

BACKGROUND: Aim of this study was to investigate the prognostic significance of CD3+ TILs in infiltrating ductal carcinoma (IDC) of the breast. MATERIALS AND METHODS: Immuno-histochemistry was done with CD3 antibodies in tissue sections of 127 breast cancer patients, and CD3+ intra-tumoral and stromal TILs were counted in relation to clinico-pathological variables. RESULTS: Intra-tumoral and stromal CD3+ TILs were significantly associated with positive lymph node status (P = 0.006, P = 0.043, respectively) without significant association with age, menopausal status, family history, and hormonal status. The higher CD3 intra-tumoral and stromal counts both showed significant association with good prognosis (P = 0.039, P = 0.044, respectively). The intra-tumoral count was higher than stromal count and was independently associated with disease-free survival in stage I and II cancer (P = 0.021). CONCLUSIONS: CD3+ TILs may serve as independent marker of good prognosis in IDC breast. The findings of this study need further validation on a larger sample size.

Periodic syphilis profile in a New Delhi hospital.

The study reports the prevalence of syphilis determined at intervals of ten years amongst attendees of the Sexually Transmitted Diseases Centre (STD), in New Delhi, from 1954, to 1994. It was observed that the number of STD cases increased by about eight times in 1984 as compared to 1954. The prevalence of STDs had risen from 5.5 per cent in 1964 to 14.7 per cent in 1994. However, the syphilis load has been decreasing since 1974. Childhood syphilis has decreased from 12.6 per cent in 1954 to 0.5 per cent in 1994. However in adult males it increased from 62.3 per cent in 1954 to 80.4 per cent in 1984. Cardiovascular syphilis was last reported in 1954. The prevalence of syphilis was approximately three times higher in males than in females.

Ectopic pregnancy--changing trends.

This study is an attempt to have an overall view of the changing trends in the clinical presentation, diagnostic modalities and management of ectopic pregnancy over a period of three and a half decades. The incidence of ectopic pregnancy was one in 368 during the 15-year period from 1959-1973 (group A) and has increased to one in 160 during the latter part of the study period from 1988-1993 (group B). Medical termination of pregnancy, abortion, intra-uterine contraceptive device and previous tubal ligation were the important risk factors recently (group B). Unruptured tubal pregnancy was diagnosed in 9.8% (group B) as compared to only 3% in group A. However, as most of the patients came to the hospital with disturbed pregnancy, the use of ultrasonography and urine gravindex test was helpful in only 14% in the latter part of the study. The characteristic clinical features like pain abdomen with amenorrhoea, vaginal bleeding and positive culdocentesis were the most reliable diagnostic criteria in both the groups. There is an increasing trend towards conserving the tubes and methotrexate use recently.

Domiciliary health counselling in patients with sexually transmitted diseases.

To improve treatment compliance, follow-up and attendance of STD patients and their contacts, a programme, based on domiciliary visits was attempted. The programme was limited to male defaulters not responding to written and telephone calls. House visits to 79 out of 169 defaulters were made. Approximately half the number of houses were found locked. Fourteen defaulting patients reported for completion of their treatment and follow-up. Of these 11 were directly interviewed. None of the 14 patients agreed to disclose the addresses of their extramarital partners. During the study period 51 female sex contacts reported for treatment as compared to 27 in the control group. Though the numbers were small the study revealed that direct contact with the patient yielded the best results. It is suggested that to make the system cost-effective the health workers should spend time with STD patients in the clinic to mark out the correct location and time for meeting the patient either in the work place or at home in case of a follow-up.

A correlative study of seminal biochemistry and testicular histology in infertile males.

Two androgen-dependent constituents of the seminal plasma, fructose and acid phosphatase, have been estimated in 50 infertile males along with a testicular biopsy. Azoospermics, as a group, showed a very wide range of fructose (16-600 mg%) as compared to 210-397 mg% in healthy fertile males. Oligospermics tended to have low values with a mean of 218 +/- 75.1 mg%. Acid phosphatase in the controls was 1927 +/- 164.6 K.A. unit/ml and was generally higher in the infertile groups. The state of spermatogenesis, as revealed by testicular biopsy, bore no consistent relationship with the seminal fructose or acid phosphatase. It appears that there may be no inter-relationship between the activity of the germinal epithelium and the secretion of the accessory glands and, although both are androgen-dependent, they can be affected separately by a multitude of factors in human infertility.