Association of p53 codon72 Arg>Pro polymorphism with susceptibility to nasopharyngeal carcinoma: evidence from a case-control study and meta-analysis.

Tumor suppressor p53 is a critical player in the fight against cancer as it controls the cell cycle check point, apoptotic pathways and genomic stability. It is known to be the most frequently mutated gene in a wide variety of human cancers. Single-nucleotide polymorphism of p53 at codon72 leading to substitution of proline (Pro) in place of arginine (Arg) has been identified as a risk factor for development of many cancers, including nasopharyngeal carcinoma (NPC). However, the association of this polymorphism with NPC across the published literature has shown conflicting results. We aimed to conduct a case-control study for a possible relation of p53 codon72 Arg>Pro polymorphism with NPC risk in underdeveloped states of India, combine the result with previously available records from different databases and perform a meta-analysis to draw a more definitive conclusion. A total of 70 NPC patients and 70 healthy controls were enrolled from different hospitals of north-eastern India. The p53 codon72 Arg>Pro polymorphism was typed by polymerase chain reaction, which showed an association with NPC risk. In the meta-analysis consisting of 1842 cases and 2330 controls, it was found that individuals carrying the Pro allele and the ProPro genotype were at a significantly higher risk for NPC as compared with those with the Arg allele and the ArgArg genotype, respectively. Individuals with a ProPro genotype and a combined Pro genotype (ProPro+ArgPro) also showed a significantly higher risk for NPC over a wild homozygote ArgArg genotype. Additionally, the strength of each study was tested by power analysis and genotype distribution by Hardy-Weinberg equilibrium. The outcome of the study indicated that both allele frequency and genotype distribution of p53 codon72 Arg>Pro polymorphism were significantly associated with NPC risk. Stratified analyses based on ethnicity and source of samples supported the above result.

Diagnostic methods of malaria in Eastern Nepal: a comparative study of traditional and two rapid diagnostic tests.

This study compared the diagnostic accuracy of Quantitative Buffy Coat (QBC) a fluorescent microscopy test and OptiMAL, an immunochromatographic dip stick test against conventional microscopy for the detection of malaria at a tertiary teaching hospital situated in Eastern Nepal. 100 clinically suspected malaria patients with positive and negative parasitemia were assessed under conventional microscopy. The blood samples withdrawn from these subjects were further evaluated by the QBC Method and OptiMAL dipstick test. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of QBC and OptiMAL tests as compared with microscopy were 100%, 100%, 100%, 100%, 1 and 96%, 100%, 100%, 96.15% and 0.98 respectively. In Nepal, thick and thin blood smears remain the gold standard for malaria species diagnosis in routine diagnostic laboratories. In this study the efficacy of newer malaria rapid diagnostic tests (RDT) surpassed the diagnostic efficacy of clinical microscopy and hence these RDT's will have a greater role in clinical practice. The cost of QBC technique may impose limitations on its use in Nepal but the OptiMAL test is likely to play an important part in urgent malaria diagnosis.

Phenotypic characterisation and drug sensitivity testing of mycobacteria isolated from extra-pulmonary tuberculosis.

BACKGROUND: Tuberculosis (TB) is a major cause of morbidity and mortality globally, with most cases occurring in developing countries. The importance of extra pulmonary tuberculosis (EPTB) among all forms of tuberculosis has not yet been ascertained in developing countries. OBJECTIVE: To identify and perform phenotypic characterization of clinically important mycobacterium isolates from extra-pulmonary sites along with drug susceptibility testing. MATERIALS AND METHODS: A total of 513 specimens from patients of (EPTB) with varied presentation were studied. Speciation and characterization of isolates were done on the basis of growth and biochemical characteristics. Drug susceptibility testing for mycobacterium isolates was done by proportion method. RESULTS: Fifty four patients clinically suspected to have extra-pulmonary tuberculosis were culture positive for mycobacteria. On characterization 48 of the 54 isolates were identified as M. tuberculosis, 4 as M. bovis and 2 were M. avium/intracelulare. Drug susceptibility testing was done for the both M. tuberculosis as well as M. bovis. In single drug resistance, Streptomycin was highest followed by Isoniazid, Ethambutol and Refampicin. Multi drug resistance (MDR) was found in 6 isolates and it was observed only in group I cases. CONCLUSION: EPTB accounts for 10-15 percent of all cases of tuberculosis. Mycobacterium was present in 10.5 percent samples. 48 isolates out of 54 samples were found to be M. tuberculosis. The maximum numbers of M. tuberculosis were isolated from lymph node aspiration.

Prevalence of asymptomatic bacteriuria among elderly diabetic patients residing in Chitwan.

BACKGROUND: A retrospective study was done on Asymptomatic Bacteriuria (ASB), among elderly diabetic patients residing in Chitwan, Nepal from 1st January 2006 to 12th December 2006. Diabetic patients above 40 years of age were included in this study where as below 40 years of age group were excluded. OBJECTIVE: To study the prevalence of ASB among elderly diabetic patients for the Bacteriological profile and their antibiotic susceptibility pattern. MATERIALS AND METHODS: Urine sample was collected from 636 diabetic patients above 40 years age attending College of Medical Sciences Teaching Hospital for regular blood sugar estimation. Culture and Antibiotic susceptibility test (AST) were performed using standard microbiological technique. ASB was determined as presence of > 105(5) bacteria/ml in a culture of urine sample. RESULTS: The prevalence of ASB among diabetic patients in Bharatpur was found to be 9.43% (12.07% in females and 5.08% in males). The most common bacterial isolate was Escherichia coli (41.66%). Nitrofurantoin, Cefotaxime and Chloramphenicol were the most effective drugs for the majority of isolates. CONCLUSION: The study shows necessity of regular urine culture to detect ASB, along with blood sugar estimation for diabetic patients to prevent them from further complications due to it.

Prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) in a Tertiary-Care Hospital in Eastern Nepal.

Nosocomial infection is a major problem in the world today. Methicillin-resistant Staphylococcus aureus (MRSA) strains, usually resistant to several antibiotics, shows a particular ability to spread in hospitals and is now present in most of the countries. The aim of the present study was to determine the prevalence of MRSA infections and their antimicrobial susceptibility pattern in our hospital located in eastern Nepal. Identification of Staphylococcus aureus was confirmed by standard methods and the antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. Interpretation criteria were those of the national committee for clinical laboratory standards. During a period of one year, out of a total of 750 Staphylococcus aureus strains isolated from various clinical samples, 196 (26.14%) were found to be Methicillin-resistant. Seventy percent isolates of MRSA were from inpatient departments and amongst them only 10% of the isolates were from intensive care units (ICU). More than 65% of MRSA were found to be resistant to Penicillin, Cephalosporins, Ciprofloxacin, Gentamicin Erythromycin and Tetracycline, while 47.96% of them were resistant to Amikacin. Many MRSA strains were multidrug-resistant. However, no strains were resistant to Vancomycin. To reduce the prevalence of MRSA, the regular surveillance of hospital acquired infection, isolation nursing of patients who carry MRSA, monitoring of antimicrobial susceptibility pattern and formulation of a definite antibiotic policy may be helpful.

Opportunistic infection among HIV seropositive cases in Manipal Teaching Hospital, Pokhara, Nepal.

BACKGROUND: Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) claimed more than 22 million deaths in the past two decades. About 10,000-15,000 Nepalese are expected to die of AIDS related deaths every year in the absence of effective treatment and care. Major cause of mortality and morbidity in HIV infected people is opportunistic infection (OI). Type of pathogen(s) responsible for OI varies from region to region. OBJECTIVE: This study attempts to find out OI among HIV seropositive patients visiting MTH, Pokhara. RESULTS: Tuberculosis (30%) was found to be most common OI followed by candidiasis (14%). Pulmonary tuberculosis (21.14%) was more common than extra pulmonary tuberculosis (8.92%). Oral candidiasis (8.92%) was more common than oesophageal candidiasis (5.35%). CONCLUSION: The study findings indicate that immediate and strong action needs to be taken and guidelines and strategies to tackle the HIV AIDS problems are required and should be equally implemented to achieve a decline in the rate of prevalence of HIV.

Prevalence of asymptomatic bacteriuria in school going children in Pokhara valley.

OBJECTIVES: There were mainly two objectives of the study. One was to detect bacteriuria in school going children in Pokhara valley and the other was to identify the causative organisms in various age groups in children. MATERIALS AND METHODS: This study was carried out in the Microbiology laboratory of The School of Pharmaceutical and Biomedical Sciences, Simalchaur, Pokhara University, Nepal. A total of 502 urine samples of 5 to 13 years children from different schools of Pokhara valley were screened to see asymptomatic bacteriuria during January 2005 to June 2005. A sterile wide mouth container was given to each student to collect mid-stream urine samples. All the urine samples were transported to the Microbiology laboratory within half an hour to one hour. The samples were processed for microscopical examination to observe for turbidity and the presence of protein and sugar by dipstick method, microscopical examination to see pus cells, RBCs, epithelial cells, casts and crystals, culture of urine samples on Blood agar and MacConkey agar to identify the potential pathogens. The antibiotic sensitivity test was performed for those bacteria which were grown on culture. The colony count was evaluated and organisms were identified by biochemical tests. RESULT: Out of 502 samples, 7(1.39%) samples grew the bacterial pathogens that are responsible to cause urinary tract infection. Among them Escherichia coli 4(57.14%) was the predominant bacterial pathogen. CONCLUSION: Study of asymptomatic bacteriuria is important as found in the present study in which Escherichia coli was the most frequently incriminated as the causative agents.

Acute renal failure following consumption of raw fish gall-bladder from Manipur.

Three cases of acute renal failure following consumption of raw grass gall bladder are reported here from NE State, Manipur.

Indigenous disseminated Penicillium marneffei infection in the state of Manipur, India: report of four autochthonous cases.

We describe four cases of disseminated infection caused by endemic Penicillium marneffei in human immunodeficiency virus (HIV)-infected patients from the Manipur state of India. The most common clinical features observed were fever, anorexia, weight loss, hepatosplenomegaly, and, more importantly, skin lesions resembling molluscum contagiosum. The diagnosis in each of the four cases was achieved by direct examination of smears, observance of intracellular yeast-like cells multiplying by fission in biopsied tissue from skin lesions, and isolation of the dimorphic P. marneffei in pure culture in each case. In one case, fluorescent antibody studies allowed specific diagnosis. This report documents a new area in which P. marneffei is endemic, located in eastern India, and describes the first occurrence in India of P. marneffei in HIV-infected patients as well as the extension of the areas of P. marneffei endemicity westward to the northeastern state of Manipur.

A case of paragonimiasis in a civet cat with a new Paragonimus sub species in Manipur, India.

A case of paragonimiasis in a civet cat with a new Paragonimus sub species in Manipur, India.

HIV-2 strikes injecting drug users (IDUs) in India.

Manipur, a north-eastern state of India bordering Myanmar, observed introduction of HIV-1 among fairly large number of IDUs in October 1989, followed by rapid spread within the next 6 months. HIV-2 in injectors was not present until recently, though it was detected from other parts of India in 1991. This communication reports for the first time presence of HIV-2 among young injectors of Manipur. All the HIV-2 infected IDUs were also found to be infected with HIV-1. HIV-2 has affected a large number of people in Africa through heterosexual transmission. It remains to be seen whether HIV-2 spreads rapidly also among the drug-injecting population of Manipur. Observation of the disease progression among HIV-2 infected IDUs will also be of interest.

PIP: HIV-1 was first detected in India in 1986. HIV-2 was first detected in the country in 1991 when paid blood donors and STD clinic attenders in north India tested seropositive for the virus. HIV-2 was later detected in Bombay and Goa. HIV-2 was also introduced in Madras and followed by an exponential increase in 1992 where heterosexual transmission was found to be responsible for the spread of the virus. 433 blood samples were collected and screened during the second quarter of 1994 from blood donors, injecting drug users (IDUs), and clinically suspected HIV disease cases admitted to the Regional Medical College (RMC) Hospital or treated at the outpatient department. 60.5% of IDUs tested positive for HIV-1, 6.6% were infected with both HIV-1 and HIV-2, and none were found to be infected exclusively with HIV-2. HIV-infected IDUs were aged 15-35 years and exclusively male. Most clinically suspected cases were young males attending the various departments of RMC with a history of long continued diarrhea, herpes zoster, extreme weight loss, miliary pulmonary tuberculosis, extrapulmonary tuberculosis, or pericardial effusion. Their histories suggested that many were IDUs, while a few only gave histories of unprotected sex with commercial sex workers. The report of a possible link between IDUs of Manipur and Madras suggests that HIV-2 may have come from Madras. The study of dual infection with both HIV-1 and HIV-2 among the IDUs may help in understanding the factors responsible for the efficient transmission of the two viruses. An extensive literature search found that HIV-2 among IDUs has previously been reported only from Spain approximately two years earlier.

paragonimiasis in Manipur.

A survey was undertaken in the east district of Imphal valley of Manipur, India, using an intradermal test with saline extract of adult Paragonimus westermani as test antigen to find out the prevalence of paragonimiasis and some of the epidemiological factors attributable to it. A total of 3,467 individuals of both sexes aged five years and above were tested. A total of 2934 persons admitted eating crabs and among them 234 were found reactive to Paragonimus antigen. The prevalence rate observed was 6.7 per cent. The proportion of positive reactors (8.0%) among the crab eaters compared to 0.1 per cent among those who did not eat crabs was highly significant (P < 0.01). The difference in the prevalence rates in different age groups and different sexes was also found to be highly significant. The habit of eating raw and or undercooked crabs had significant correlation with skin reactivity. The intradermal test was found to be a good screening test for mass surveys due to its simplicity, low cost, high sensitivity and no known untoward reaction. Four persons among the skin positive reactors presented with cough, pain in the chest, recurrent haemoptysis as major clinical manifestations. Laboratory investigations revealed Paragonimus eggs in the sputum smears, raised erythrocyte sedimentation rate, and high absolute eosinophil count in their blood. Praziquantel, the drug of choice was given at a dose of 25 mg per kg body weight 3 times a day for three consecutive days to each patient for a cure.

Descriptive epidemiology of intravenous heroin users--a new risk group for transmission of HIV in India.

India is considered to have a low incidence of HIV infection so far. Nevertheless, an epidemic of HIV infection has been reported recently among intra-venous drug users (IVDUs) in Manipur, a north-eastern state of India, bordering Myanmar (Burma). This report describes the epidemiology of intravenous drug abuse in the state of Manipur. Four hundred and fifty IVDUs were interviewed. Their age (median 24 years) and sex patterns (95% male) differ from those reported from western countries. It is estimated that there may be approximately 15,000 such addicts in a population of 1.8 million and 50% of them could be positive for HIV. Knowledge of AIDS and its transmission is significantly higher among the addicts than non-addict controls. Free availability of heroin was found to be the major factor responsible for the high rate of addiction. It is presumed that two other neighbouring States which are well-connected to Manipur and also have a common border with Myanmar (part of the 'Golden Triangle') may have a similar problem with HIV infection.

Seroprevalence of HIV infection in high risk groups in Manipur.

PIP: As part of a government surveillance program aimed at tracking the incidence of human immunodeficiency virus (HIV), 635 individuals from the Indian state of Manipur who were considered at high risk of infection were screened in 1986-87 for antibodies to HIV. Screening was accomplished through use of commercial enzyme-linked immunosorbent assay (ELISA) kits supplied by the Indian Council of Medical Research and the Ministry of Health. The Manipur sample included 248 patients from sexually transmitted disease clinics, many of whom were prostitutes; 255 intravenous drug abusers; 51 professional blood donors; 66 recipients of multiple blood transfusions; 10 homosexuals; and 5 patients who did not belong to any identified risk group, but demonstrated symptoms of acquired immunodeficiency syndrome (AIDS)-related complex (ARC). 554 of those screened were male and 81 were female; 77% were in the 21-30-year age group. Of the 635 serum samples tested, none showed antibodies to HIV. However, since Manipur is a border state and its capital city, Imphal, is a focal point for illicit drug trafficking, continued surveillance of high-risk groups is recommended. By 1987, a total of 145 HIV-positive cases had been identified in India, largely from the southern part of the country.^ieng