Immune compromise in HIV-1/HTLV-1 coinfection with paradoxical resolution of CD4 lymphocytosis during antiretroviral therapy: a case report

Human immunodeficiency virus type-1 (HIV-1) and human T lymphotropic virus type-1 (HTLV-1) infections have complex effects on adaptive immunity, with specific tropism for, but contrasting effects on, CD4 T lymphocytes: depletion with HIV-1, proliferation with HTLV-1. Impaired T lymphocyte function occurs early in HIV-1 infection but opportunistic infections (OIs) rarely occur in the absence of CD4 lymphopenia. In the unusual case where a HIV-1 infected individual with a high CD4 count presents with recurrent OIs, a clinician is faced with the possibility of a second underlying comorbidity. We present a case of pseudo-adult T cell leukemia/lymphoma (ATLL) in HIV-1/HTLV-1 coinfection where the individual fulfilled Shimoyama criteria for chronic ATLL and had pulmonary Mycobacterium kansasii, despite a high CD4 lymphocyte count. However, there was no evidence of clonal T-cell proliferation by T-cell receptor gene rearrangement studies nor of monoclonal HTLV-1 integration by high-throughput sequencing. Mutually beneficial interplay between HIV-1 and HTLV-1, maintaining high level HIV-1 and HTLV-1 viremia and proliferation of poorly functional CD4 cells despite chronicity of infection is a postulated mechanism. Despite good microbiological response to antimycobacterial therapy, the patient remained systemically unwell with refractory anemia. Subsequent initiation of combined antiretroviral therapy led to paradoxical resolution of CD4 T lymphocytosis as well as HIV-1 viral suppression and decreased HTLV-1 proviral load. This is proposed to be the result of attenuation of immune activation post-HIV virological control. This case illustrates the importance of screening for HTLV-1 in HIV-1 patients with appropriate clinical presentation and epidemiological risk factors and explores mechanisms for the complex interactions on HIV-1/HTLV-1 adaptive immunity

Relations of science students’ academic performance at university level with their gender: a case study at the faculty of science, university of Peradeniya, Sri Lanka

University is an institution for higher education, research, and social development. Hence, the students’ performance at the University is very important as graduates are supposed to become future leaders in this world. There are many factors affecting the students’ performance at the University level. Thus, this study was focusing on assessing the impact of gender on students’ academic performance at University level. This is a quantitative study. Sample of the study was drawn from the Faculty of Science, University of Peradeniya through convenient sampling technique. The sample consisted of 1729 undergraduates from four consecutive batches from 2006 to 2009. There were 822 males and 907 females in the sample. The data were collected through documents from the Faculty of Science, University of Peradeniya and analyzed using MS Excel 2010 and SPSS 17. The study established a relationship between gender of students and their performance measured according to the students’ Grade Point Average (GPA) at the University. The results of the study revealed that the performance of female students is higher than that of males. There were 18% of female undergraduates in 4.00-3.70 GPA range while only 5% of male undergraduates were in the same range. Male undergraduates are prominent in 3.30-3.00 GPA range and < 3.00 GPA.This situation could be due to many inter-related factors such as study habits, aspirations, self-concepts, motivation, other psychological conditions, and some physiological aspects. Thus, an in-depth study has to be conducted to investigate the issue in order to support especially the male students to perform well in their higher education at the University level

Review on Photomicrography based Full Blood Count (FBC) Testing and Recent Advancements

With advancements in related sub-fields, research on photomicrography in life science is emerging and this is a review on its application towards human full blood count testing which is a primary test in medical practices. For a prolonged period of time, analysis of blood samples is the basis for bio medical observations of living creatures. Cell size, shape, constituents, count, ratios are few of the features identified using DIP based analysis and these features provide an overview of the state of human body which is important in identifying present medical conditions and indicating possible future complications. In addition, functionality of the immune system is observed using results of blood tests. In FBC tests, identification of different blood cell types and counting the number of cells of each type is required to obtain results. Literature discuss various techniques and methods and this article presents an insightful review on human blood cell morphology, photomicrography, digital image processing of photomicrographs, feature extraction and classification, and recent advances. Integration of emerging technologies such as microfluidics, micro-electromechanical systems, and artificial intelligence based image processing algorithms and classifiers with cell sensing have enabled exploration of novel research directions in blood testing applications.

A study of lipid profile and glycemic status in patients with chronic kidney disease of unknown etiology in Sri Lanka

Background: Dyslipidemia and impaired glucose tolerance are common complications of chronic kidney disease (CKD) and are responsible for increased cardiovascular risk. Studies on lipid profile and glycemic status in CKD of unknown origin (CKDu) are scarce. The objective of this study was to evaluate the lipid profile and glycemic status of the patients with CKDu and to aid in preventing morbidity and mortality.Methods: The descriptive, cross sectional study was conducted in a rural CKDu endemic area, Girandurukotte.  Data was collected from February 2018 to June 2019. For the diagnosis of CKDu, history and clinical features with supportive biochemical, renal biopsy and radiological evidence were taken as criteria. Blood samples were taken for serum creatinine, lipid profile and HbA1C. Already diagnosed patients with diabetes mellitus and dyslipidemia were excluded.Results: A total of 168 patients within the age range of 32-66 years (mean 50.3±7.7) were participated. There were 106 males (63%) 46.4% were farmers. Majority of the patients (65.5%) had normal body mass index (BMI) (mean 22.9 kg/m2, normal range 18.5-23.5%) followed by overweight (23.5-30 kg/m2) in 55 (32.7%) patients. The prevalence of dyslipidemia in CKDu was found to be 55.9%.  Majority of the abnormality was seen in the HDL group with 68 (40.5%) patients having low HDL cholesterol (mean 44.7 mg/dl, SD=12.3).  There was a significant rise in the serum triglyceride concentration (>150 mg/dl) in 53 (31.5%) (mean 152.4 mg/dl, SD=73.5) and total cholesterol (>200 mg/dl) in 30 (18%) patients (mean 182 mg/dl, SD=36.9). LDL cholesterol abnormality (>130 mg/dl) was seen in only 9 patients (mean 88.7 7658mg/dl, SD=25.4). From the total, 144 (85.7%) patients had abnormal HbA1C levels; 27 (16.1%) patients had HbA1C levels between 5.7% and 6.4% (pre-diabetes), and 117 (69.6%) patients had HbA1C level more than 6.5% (diabetes mellitus). There was no statistically significant association between HbA1C levels and BMI (p=0.29) or HbA1C and lipid abnormalities (p=0.32)Conclusions: The high prevalence of dyslipidemia, pre-diabetes and diabetes mellitus in patients with CKDu may accelerate the progression of chronic kidney disease and increase the risk of cardiovascular disease. Early detection, initiation of appropriate medication and early referral to the expertise will ameliorate morbidity and mortality.

Evaluation of EPAS1 variants for association with bovine congestive heart failure [version 1; peer review: 2 approved]

Background: Bovine congestive heart failure (BCHF) has become increasingly prevalent in feedlot cattle in the Western Great Plains of North America. BCHF is an untreatable complex condition involving pulmonary hypertension that culminates in right ventricular failure and death. A protein variant of hypoxia-inducible factor 2 alpha (HIF2α, encoded by the endothelial PAS domain-containing protein 1 gene, EPAS1) was previously reported to be associated with pulmonary hypertension at altitudes exceeding 2,000 m. Our aim was to evaluate EPAS1 haplotypes for association with BCHF in feedlot cattle raised at moderate altitudes (1,200 m). Methods: Paired samples of clinical cases and unaffected controls were collected at four feedlots in Nebraska and Wyoming. Each pair (n =102) was matched for source, pen, breed type, sex, arrival date, and management conditions. Cases were identified by animal caretakers, euthanized, and diagnosis was confirmed at necropsy. Cases were derived from 30 different ranch operations, with the largest source contributing 32. Animals were tested for eight EPAS1 haplotypes encoding 36 possible different diploid combinations. Results: The common, ancestral EPAS1 haplotype encoding HIF2α with alanine (A) at position 606 and glycine (G) at position 610 was equally frequent in cases and controls (0.67). The EPAS1 variant haplotype reported to be associated with disease (encoding threonine (T) at position 606 and serine (S) at position 610) was not enriched in cases compared with controls (0.21 and 0.25, respectively). Frequencies of other EPAS1 haplotypes (e.g., encoding Q270, L362, or G671) were each less than 0.05 overall. McNemar’s test with 45 discordant pairs showed the linked T606/S610 variant was not associated with BCHF (OR = 0.73, CI 0.38 -1.4, p-value = 0.37). Conclusions: HIF2α polypeptide variants were not significantly associated with BCHF in feedlot cattle at moderate altitudes. Thus, a wider search is needed to identify genetic risk factors underlying this disease

Building local capacities in the operation and management of an integrated solid waste management programme; Experience of Ampara District, Eastern Sri Lanka

Open dumping and burning of wastes in the environmental sensitive areas were common practices in almost all the local authorities in Ampara district. It had become a big threat to public health, the beautiful natural environment and to the local economy. The Local Authorities of the District often faced severe difficulties in the management of solid waste in an environmentally, socially and economically feasible manner. The lack of technical and financial capacities to apply and practice the newly developed waste management guidelines and policies further aggravated this situation.Having identified the gravity  and the importance of this serious environmental issue, the Department of Assistant Commissioner of Local Government of Ampara District, with the financial assistance of the European Union and the technical assistance of the United Nations Office for Project Services (UNOPS), is currently implementing an Integrated Solid Waste Management Programme (ISWMP) in 12 local authorities of the District. This ISWMP is completely being operated with the full coordination of the District Office of the Central Environmental Authority, Ampara. The UNOPS, as part of its technical assistance, has constructed solid waste management facilities such as 7 engineered landfills, one Waste Transfer Station, 4 Recycling Centers, 5 compost yards, well developed collection systems  as well as provided with capability building/training assistance aiming to establish an effective and efficient solid waste management system for the District. These  facilities are now completed,  already in use and operational. With these facilities in place, and with the continued support from UNOPS in providing institutional and capacity building assistance to the LA officers and staff, haphazard dumping and littering of waste in certain areas of the LAs have now been stopped. Thus 45,000 urban households or 58% of the total urban population are benefitted under thisprogramme with a total collection of 137tonnes of wastes per day through this programme. Out of this 137tonnes of waste, 59 tonnes are collected from cluster systems involving five local authorities while the balance from the other non-clustered Local Authorities.The paper will also present the processes and methodologies to improve the landfill practices from the open dumping practices to controlled tipping and then to engineered landfills  among the implementing local authorities. It will also highlight interventions/strategies to ensure sustainability of the operation and their management through the introduction of a User Fee system/Service Charge which is currently being implemented in 04  Local Authorities. This collected User Fee covers about 80% of cost of collection of waste which would otherwise been spent through their normal budget.Key words: Integrated Solid Waste Management, Ampara, haphazard dumping, controlled tipping, engineered landfill

Serum free light chain measurement aids the diagnosis of myeloma in patients with severe renal failure

<p>Abstract</p> <p>Background</p> <p>Monoclonal free light chains (FLCs) frequently cause rapidly progressive renal failure in patients with multiple myeloma. Immunoassays which provide quantitative measurement of FLCs in serum, have now been adopted into screening algorithms for multiple myeloma and other lymphoproliferative disorders. The assays indicate monoclonal FLC production by the presence of an abnormal κ to λ FLC ratio (reference range 0.26–1.65). Previous work, however, has demonstrated that in patients with renal failure the FLC ratio can be increased above normal with no other evidence of monoclonal proteins suggesting that in this population the range should be extended (reference range 0.37–3.1). This study evaluated the diagnostic sensitivity and specificity of the immunoassays in patients with severe renal failure.</p> <p>Methods</p> <p>Sera from 142 patients with new dialysis-dependent renal failure were assessed by serum protein electrophoresis (SPE), FLC immunoassays and immunofixation electrophoresis. The sensitivity and specificity of the FLC ratio's published reference range was compared with the modified renal reference range for identifying patients with multiple myeloma; by receiver operating characteristic curve analysis.</p> <p>Results</p> <p>Forty one patients had a clinical diagnosis of multiple myeloma; all of these patients had abnormal serum FLC ratios. The modified FLC ratio range increased the specificity of the assays (from 93% to 99%), with no loss of sensitivity. Monoclonal FLCs were identified in the urine from 23 of 24 patients assessed.</p> <p>Conclusion</p> <p>Measurement of serum FLC concentrations and calculation of the serum κ/λ ratio is a convenient, sensitive and specific method for identifying monoclonal FLC production in patients with multiple myeloma and acute renal failure. Rapid diagnosis in these patients will allow early initiation of disease specific treatment, such as chemotherapy plus or minus therapies for direct removal of FLCs.</p

Proteomic analysis of urine in medication-overuse headache patients: possible relation with renal damages

Medication-overuse headache (MOH) is a chronic disorder associated with overuse of analgesic drugs, triptans, non-steroidal anti-inflammatory drugs (NSAIDs) or other acute headache compounds. Various epidemiologic investigations proved that different drug types could cause nephrotoxicity, particularly in chronic patients. The aim of the present work was to analyze, by a proteomic approach, the urinary protein profiles of MOH patients focusing on daily use of NSAIDs, mixtures and triptans that could reasonably be related to potential renal damage. We selected 43 MOH patients overusing triptans (n = 18), NSAIDs (n = 11), and mixtures (n = 14), for 2–30 years with a mean daily analgesic intake of 1.5 ± 0.9 doses, and a control group composed of 16 healthy volunteers. Urine proteins were analyzed by mono-dimensional gel electrophoresis and identified by mass spectrometry analysis. Comparing the proteomic profiles of patients and controls, we found a significantly different protein expression, especially in the NSAIDs group, in which seven proteins resulted over-secreted from kidney (OR = 49, 95% CI 2.53–948.67 vs. controls; OR = 11.6, 95% CI 0.92–147.57 vs. triptans and mixtures groups). Six of these proteins (uromodulin, α-1-microglobulin, zinc-α-2-glycoprotein, cystatin C, Ig-kappa-chain, and inter-α-trypsin heavy chain H4) were strongly correlated with various forms of kidney disorders. Otherwise, in mixtures and in triptans abusers, only three proteins were potentially associated to pathological conditions (OR = 4.2, 95% CI 0.33–53.12, vs. controls). In conclusion, this preliminary proteomic study allowed us to define the urinary protein pattern of MOH patients that is related to the abused drug. According with the obtained results, we believe that the risk of nephrotoxicity should be considered particularly in MOH patients who abuse of NSAIDs

Fabrication of Pt/Ru Nanoparticle Pair Arrays with Controlled Separation and their Electrocatalytic Properties

Aiming at the investigation of spillover and transport effects in electrocatalytic reactions on bimetallic catalyst electrodes, we have prepared novel, nanostructured electrodes consisting of arrays of homogeneously distributed pairs of Pt and Ru nanodisks of uniform size and with controlled separation on planar glassy carbon substrates. The nanodisk arrays (disk diameter approximate to 60 nm) were fabricated by hole-mask colloidal lithography; the separation between pairs of Pt and Ru disks was varied from -25 nm (overlapping) via +25 nm to +50 nm. Morphology and (surface) composition of the Pt/Ru nanodisk arrays Were characterized by scanning electron microscopy, energy dispersive X-ray analysis, and X-ray Photoelectron spectroscopy, the electrochemical/electrocatalytic properties were explored by cyclic voltammetry, COad monolayer oxidation ("COad stripping"), and potentiodynamic hydrogen oxidation. Detailed analysis of the 2 COad oxidation peaks revealed that on all bimetallic pairs these cannot be reproduced by superposition of the peaks obtained on electrodes with Pt/Pt or Ru/Ru pairs, pointing to effective Pt-Ru interactions even between rather distant pairs (50 nm). Possible reasons for this observation and its relevance for the understanding of previous reports of highly active catalysts with separate Pt and Ru nanoparticles are discussed. The results clearly demonstrate that this preparation method is perfectly suited for fabrication of planar model electrodes with well-defined arrays of bimetallic nanodisk pairs, which opens up new possibilities for model studies of electrochemical/electrocatalytic reactions