Causes of Acute Hospitalization in Adolescence: Burden and Spectrum of HIV-Related Morbidity in a Country with an Early-Onset and Severe HIV Epidemic: A Prospective Survey

Background

Survival to older childhood with untreated, vertically acquired HIV infection, which was previously considered extremely unusual, is increasingly well described. However, the overall impact on adolescent health in settings with high HIV seroprevalence has not previously been investigated.

Methods and Findings

Adolescents (aged 10–18 y) systematically recruited from acute admissions to the two public hospitals in Harare, Zimbabwe, answered a questionnaire and underwent standard investigations including HIV testing, with consent. Pre-set case-definitions defined cause of admission and underlying chronic conditions. Participation was 94%. 139 (46%) of 301 participants were HIV-positive (median age of diagnosis 12 y: interquartile range [IQR] 11–14 y), median CD4 count = 151; IQR 57–328 cells/µl), but only four (1.3%) were herpes simplex virus-2 (HSV-2) positive. Age (median 13 y: IQR 11–16 y) and sex (57% male) did not differ by HIV status, but HIV-infected participants were significantly more likely to be stunted (z-score<−2: 52% versus 23%, p<0.001), have pubertal delay (15% versus 2%, p<0.001), and be maternal orphans or have an HIV-infected mother (73% versus 17%, p<0.001). 69% of HIV-positive and 19% of HIV-negative admissions were for infections, most commonly tuberculosis and pneumonia. 84 (28%) participants had underlying heart, lung, or other chronic diseases. Case fatality rates were significantly higher for HIV-related admissions (22% versus 7%, p<0.001), and significantly associated with advanced HIV, pubertal immaturity, and chronic conditions.

Conclusion

HIV is the commonest cause of adolescent hospitalisation in Harare, mainly due to adult-spectrum opportunistic infections plus a high burden of chronic complications of paediatric HIV/AIDS. Low HSV-2 prevalence and high maternal orphanhood rates provide further evidence of long-term survival following mother-to-child transmission. Better recognition of this growing phenomenon is needed to promote earlier HIV diagnosis and care. Please see later in the article for the Editors'' Summary     

Immunohistochemical analysis of ageing and osteoarthritic articular cartilage

Articular cartilage degeneration seen in osteoarthritis is primarily the consequence of events within the articular cartilage that leads to the production of proteases by chondrocytes. 22 osteoarthritic cartilage specimens were obtained from patients with primary osteoarthritis (46–81 years) undergoing total knee replacement. 12 age-matched (41–86 years) and 16 young (16–40 years) non-osteoarthritic control cartilage specimens were obtained from the cadavers in the department of Anatomy and from patients undergoing lower limb amputation in Trauma center of PGIMER, Chandigarh. 5 μ thick paraffin sections were stained for osteocalcin, osteopontin, osteonectin and alkaline phosphatase to analyze their expression in hypertrophied chondrocytes and osteoarthritic cartilage matrix and to compare the staining intensity with that of normal ageing articular cartilage. Immunohistochemical staining of tissue sections revealed moderate to strong cytoplasmic staining for all four stains in all the specimens of the osteoarthritic group compared to age-matched control. The immunohistochemical scores were significantly higher in the osteoarthritic group for all four stains. The features of the osteoarthritic articular cartilage were markedly different from the non-osteoarthritic age-matched articular cartilage suggesting that osteoarthritis is not an inevitable feature of aging.     

Fine needle aspiration cytology of follicular variant of papillary carcinoma of the thyroid: Morphologic pointers to its diagnosis

OBJECTIVE: To study the cytomorphologic features of 59 cases of histologically proven follicular variant of papillary carcinoma (FVPC), compare them to those described in the literature and highlight cytologic features that may aid in the preoperative diagnosis. STUDY DESIGN: Aspiration smears from 59 histologically proven cases of FVPC were examined independently by 2 observers, and a detailed cytologic evaluation was done for architectural, cytologic and nuclear features. surgical RESULTS: On initial cytology of the 59 cases, 36 (61%) were diagnosed aspapillary carcinoma, and 17 of these were subtyped as FVPC. On reviewing the smears, 50 cases were diagnosed as papillary carcinoma, and 33 of them were typed as FVPC; however, 4 cases were diagnosed as benign lesions. Most smears showed moderate to high cellularity, with 55 cases (93%) showing syncytial clusters and 48 (81%) showing microfollicular architecture. Chromatin clearing and nuclear grooves were seen in 55 (93.2%) and 54 (91.52%) cases but were easily detected in only 36 (61%) and 44 (74%) cases, respectively. Thick colloid was identified in 28 cases, and 3 of these cases also showed thin colloid in the background. CONCLUSION: Our findings suggest that syncytial clusters, microfollicular architecture, chromatin clearing and nuclear grooves are strong morphologic pointers to the diagnosis of FVPC.     

Phylogenetic relationships of graminicolous downy mildews based on cox2 sequence data

Graminicolous downy mildews (GDM) are an understudied, yet economically important, group of plant pathogens, which are one of the major constraints to poaceous crops in the tropics and subtropics. Here we present a first molecular phylogeny based on cox2 sequences comprising all genera of the GDM currently accepted, with both lasting (Graminivora, Poakatesthia, and Viennotia) and evanescent (Peronosclerospora, Sclerophthora, and Sclerospora) sporangiophores. In addition, all other downy mildew genera currently accepted, as well as a representative sample of other oomycete taxa, have been included. It was shown that all genera of the GDM have had a long, independent evolutionary history, and that the delineation between Peronosclerospora and Sclerospora is correct. Sclerophthora was found to be a particularly divergent taxon nested within a paraphyletic Phytophthora, but without support. The results confirm that the placement of Peronosclerospora and Sclerospora in the Saprolegniomycetidae is incorrect. Sclerophthora is not closely related to Pachymetra of the family Verrucalvaceae, and also does not belong to the Saprolegniomycetidae, but shows close affinities to the Peronosporaceae. In addition, all GDM are interspersed throughout the Peronosporaceae s lat., suggesting that a separate family for the Sclerosporaceae might not be justified.     

Spatial Distribution of Tree Species Governs the Spatio-Temporal Interaction of Leaf Area Index and Soil Moisture across a Forested Landscape

Quantifying coupled spatio-temporal dynamics of phenology and hydrology and understanding underlying processes is a fundamental challenge in ecohydrology. While variation in phenology and factors influencing it have attracted the attention of ecologists for a long time, the influence of biodiversity on coupled dynamics of phenology and hydrology across a landscape is largely untested. We measured leaf area index (L) and volumetric soil water content (θ) on a co-located spatial grid to characterize forest phenology and hydrology across a forested catchment in central Pennsylvania during 2010. We used hierarchical Bayesian modeling to quantify spatio-temporal patterns of L and θ. Our results suggest that the spatial distribution of tree species across the landscape created unique spatio-temporal patterns of L, which created patterns of water demand reflected in variable soil moisture across space and time. We found a lag of about 11 days between increase in L and decline in θ. Vegetation and soil moisture become increasingly homogenized and coupled from leaf-onset to maturity but heterogeneous and uncoupled from leaf maturity to senescence. Our results provide insight into spatio-temporal coupling between biodiversity and soil hydrology that is useful to enhance ecohydrological modeling in humid temperate forests.     

Nitric oxide (NO) counteracts cadmium induced cytotoxic processes mediated by reactive oxygen species (ROS) in Brassica juncea: cross-talk between ROS, NO and antioxidant responses

Research on NO in plants has achieved huge attention in recent years mainly due to its function in plant growth and development under biotic and abiotic stresses. In the present study, we investigated Cd induced NO generation and its relationship to ROS and antioxidant regulation in Brassica juncea. Cd accumulated rapidly in roots and caused oxidative stress as indicated by increased level of lipid peroxidation and H₂O₂ thus, inhibiting the overall plant growth. It significantly decreased the root length, leaf water content and photosynthetic pigments. A rapid induction in intracellular NO was observed at initial exposures and low concentrations of Cd. A 2.74-fold increase in intracellular NO was recorded in roots treated with 25 μM Cd than control. NO effects on Malondialdehyde (MDA) content and on antioxidant system was investigated by using sodium nitroprusside (SNP), a NO donor and a scavenger, [2-(4-carboxy-2-phenyl)-4,4,5,5-tetramethylinidazoline-1-oxyl-3-oxide] (cPTIO). Roots pretreated with 5 mM SNP for 6 h when exposed to 25 μM Cd for 24 h reduced the level of proline, non-protein thiols, SOD, APX and CAT in comparison to only Cd treatments. However, this effect was almost blocked by 100 μM cPTIO pretreatment to roots for 1 h. This ameliorating effect of NO was specific because cPTIO completely reversed the effect in the presence of Cd. Thus, the present study report that NO strongly counteracts Cd induced ROS mediated cytotoxicity in B. juncea by controlling antioxidant metabolism as the related studies are not well reported in this species.     

Zingerone Suppresses Liver Inflammation Induced by Antibiotic Mediated Endotoxemia through Down Regulating Hepatic mRNA Expression of Inflammatory Markers in Pseudomonas aeruginosa Peritonitis Mouse Model

Antibiotic-induced endotoxin release is associated with high mortality rate even when appropriate antibiotics are used for the treatment of severe infections in intensive care units. Since liver is involved in systemic clearance and detoxification of endotoxin hence it becomes a primary target organ for endotoxin mediated inflammation. Currently available anti-inflammatory drugs give rise to serious side effects. Hence, there is an urgent need for safe and effective anti-inflammatory therapy. It is likely that anti-inflammatory phytochemicals and neutraceutical agents may have the potential to reduce the endotoxin mediated inflammation and complications associated with endotoxin release. Keeping this in mind, the present study was planned to evaluate the hepatoprotective potential of zingerone (active compound of zingiber officinale) against liver inflammation induced by antibiotic mediated endotoxemia. The selected antibiotics capable of releasing high content of endotoxin were employed for their in vivo efficacy in P.aeruginosa peritonitis model. Released endotoxin induced inflammation and zingerone as co-anti-inflammatory therapy significantly reduced inflammatory response. Improved liver histology and reduced inflammatory markers MDA, RNI, MPO, tissue damage markers (AST, ALT, ALP) and inflammatory cytokines (MIP-2, IL-6 and TNF-α) were indicative of therapeutic potential of zingerone. The mechanism of action of zingerone may be related to significant inhibition of the mRNA expression of inflammatory markers (TLR4, RelA, NF-kB2, TNF- α, iNOS, COX-2) indicating that zingerone interferes with cell signalling pathway and suppresses hyper expression of cell signaling molecules of inflammatory pathway. Zingerone therapy significantly protected liver from endotoxin induced inflammatory damage by down regulating biochemical as well as molecular markers of inflammation. In conclusion, this study provides evidence that zingerone is a potent anti-inflammatory phytomedicine against hepatic inflammation induced by antibiotic mediated endotoxemia. These results thus suggest that zingerone treatment can be used as a co-therapy with antibiotics to reduced endotoxin induced inflammation during treatment of severe P.aeruginosa infections.     

Design,synthesis, and comparative evaluation of 99mTc(CO)3‐labeled N‐terminal and C‐terminal modified asparagine–glycine–arginine peptide constructs

The present study describes modification of asparagine–glycine–arginine (NGR) peptide at N‐terminally and C‐terminally by introduction of a tridentate chelating scaffold via click chemistry reaction. The N‐terminal and C‐terminal modified peptides were radiometalated with [^99mTc(CO)₃]⁺ precursor. The influence of these moieties at the two termini on the targeting properties of NGR peptide was determined by in vitro cell uptake studies and in vivo biodistribution studies. The two radiolabeled constructs did not exhibit any significant variation in uptake in murine melanoma B16F10 cells during in vitro studies. In vivo studies revealed nearly similar tumor uptake of N‐terminally modified peptide construct 5 and C‐terminally construct 6 at 2 h p.i. (1.9 ± 0.1 vs 2.4 ± 0.2% ID/g, respectively). The tumor‐to‐blood (T/B) and tumor‐to‐liver (T/L) ratios of the two radiometalated peptides were also quite similar. The two constructs cleared from all the major organs (heart, lungs, spleen, stomach, and blood) at 4 h p.i. (<1% ID/g). Blocking studies carried out by coinjection of cCNGRC peptide led to approximately 50% reduction in the tumor uptake at 2 h p.i. This work thus illustrates the possibility of convenient modification/radiometalation of NGR peptide at either N‐ or C‐terminus without hampering tumor targeting and pharmacokinetics.     

Contribution of macrophage secretory products to urovirulence of Pseudomonas aeruginosa

Macrophages form one of the first lines of defense on mucosal surfaces like urinary tract, providing protection against pathogens. These cells pour their secretory products, which include a cocktail of biomolecules, at the site of infection. In the present investigation, the effect of macrophage secretory products (MSPs) obtained after interaction of macrophages with Pseudomonas aeruginosa on the virulence of this organism in planktonic and biofilm cell mode was assessed employing a mouse model of ascending pyelonephritis. When urinary tract infection (UTI) was established with P. aeruginosa grown in the presence of 30% MSPs, the extent of pyelonephritis was enhanced. Of the two cell forms, biofilm cells had an edge over the planktonic cells with respect to in vivo virulence. The enhanced virulence of MSP-grown P. aeruginosa may be attributed to increased production of quorum-sensing systems as well as increased adherence to uroepithelial cells and evasion of phagocytosis. The results of the present study reveal that macrophages can play a key role during the course of UTI, not only through their phagocytic activity, but also through effects mediated by their secretory products. Utilization of MSPs by P. aeruginosa can have far-reaching consequences, including chronicity and recurrence of infections caused by this pathogen.     

Global methylation patterns in idiopathic pulmonary fibrosis

Background

Idiopathic Pulmonary Fibrosis (IPF) is characterized by profound changes in the lung phenotype including excessive extracellular matrix deposition, myofibroblast foci, alveolar epithelial cell hyperplasia and extensive remodeling. The role of epigenetic changes in determining the lung phenotype in IPF is unknown. In this study we determine whether IPF lungs exhibit an altered global methylation profile.

Methodology/Principal Findings

Immunoprecipitated methylated DNA from 12 IPF lungs, 10 lung adenocarcinomas and 10 normal histology lungs was hybridized to Agilent human CpG Islands Microarrays and data analysis was performed using BRB-Array Tools and DAVID Bioinformatics Resources software packages. Array results were validated using the EpiTYPER MassARRAY platform for 3 CpG islands. 625 CpG islands were differentially methylated between IPF and control lungs with an estimated False Discovery Rate less than 5%. The genes associated with the differentially methylated CpG islands are involved in regulation of apoptosis, morphogenesis and cellular biosynthetic processes. The expression of three genes (STK17B, STK3 and HIST1H2AH) with hypomethylated promoters was increased in IPF lungs. Comparison of IPF methylation patterns to lung cancer or control samples, revealed that IPF lungs display an intermediate methylation profile, partly similar to lung cancer and partly similar to control with 402 differentially methylated CpG islands overlapping between IPF and cancer. Despite their similarity to cancer, IPF lungs did not exhibit hypomethylation of long interspersed nuclear element 1 (LINE-1) retrotransposon while lung cancer samples did, suggesting that the global hypomethylation observed in cancer was not typical of IPF.

Conclusions/Significance

Our results provide evidence that epigenetic changes in IPF are widespread and potentially important. The partial similarity to cancer may signify similar pathogenetic mechanisms while the differences constitute IPF or cancer specific changes. Elucidating the role of these specific changes will potentially allow better understanding of the pathogenesis of IPF.