Nazish Fatima

Brucellosis, a prevalent zoonotic disease in India, causes nonspecific symptoms. Humans contract it via infected animals or by consuming unpasteurized dairy products. This study evaluates the effectiveness of ELISA, Rose Bengal Plate Test (RBPT), and SAT in diagnosing brucellosis from clinical samples. A prospective study was conducted involving 218 patients with unknown fever, arthritis, and neurological symptoms. A detailed history was collected using a pre-designed questionnaire. This study aims to evaluate the clinical diagnostic efficacy of widely used serological assays for human brucellosis, focusing on their sensitivity, specificity, and applicability in clinical settings. Out of 218 clinical samples from suspected brucellosis patients, 129 tested positive for Brucella by either of the serological tests. Male:Female ratio was 1.04:1, and 60% of the patients had a clear history of exposure to cows, buffalo, and goats. ELISA IgG showed the highest positivity rates, identifying 64 (49.6%) cases; ELISA IgM detected 43 (33.3%) cases; the Serum Agglutination Test (SAT) identified 30 (23.2%) cases; RBPT detected 33 (25.5%) cases, and only 14 (10.8%) cases tested positive for ELISA IgG + ELISA IgM. The sensitivities of the ELISA IgG, ELISA IgM, RBPT, SAT, and ELISA IgG + ELISA IgM detection were 69.57%, 46.74%, 35.87%, 32.61%, and 15.22%, respectively, while the specificities were 100%, 100%, 75.40%, 84.92%, and 100%, respectively. ELISA can be used to diagnose human brucellosis reliably and is more sensitive than the SAT and RBPT.

Brucellosis is a common zoonotic infection in India, caused by a facultative intracellular bacterium, Gram-negative coccobacillus, and frequently presents with nonspecific symptoms. This study aimed to assess serum cytokine levels (IL-6, IL-10, IFN-γ, and IL-2) by ELISA and to correlate them with inflammatory markers (ESR and CRP) in patients with suspected brucellosis presenting with rheumatoid arthritis-like manifestations and polyarthralgia. This study included 111 patients, comprising 72 brucellosis-positive arthritis patients and 39 brucellosis-negative arthritis patients as controls. In this study, we investigated the variation in levels of four cytokines (IL-2, IL-6, IL-10 and IFN-γ) among brucellosis-positive and brucellosis-negative arthritis patients and their relationship with clinical parameters. The mean serum levels of IL-2 and IL-10 were numerically higher in brucellosis-positive arthritis patients compared to controls; however, these differences were not statistically significant (p > 0.05). Similarly, no statistically significant differences were observed for IL-6 and IFN-γ between the groups. Inflammatory markers such as ESR and CRP were elevated in brucellosis-positive patients, although these differences did not reach statistical significance. These findings indicate variability in cytokine and inflammatory marker levels between groups. The observed associations with raw dairy consumption, contact with unvaccinated livestock, and direct animal exposure highlight the need for early diagnosis, effective livestock immunisation programs, and strengthened One Health-based public health interventions to reduce disease burden.

Brucellosis is a common zoonotic infection in India, caused by a facultative intracellular, Gram-negative coccobacillus and frequently presents with nonspecific symptoms. This study aimed to assess serum cytokine levels (IL-6, IL-10, IFN-γ, and IL-2) by ELISA and to correlate them with inflammatory markers (ESR, and CRP)in patients with suspected brucellosis presenting with rheumatoid arthritis–like manifestations and polyarthralgia. This study included 111 patients, comprising 72 brucellosis-positive arthritis patients and 39 brucellosis- negative arthritis patients as controls. In this study, we investigated the variation in levels of four cytokines (IL-2, IL-6, IL-10 and IFN-γ) among brucellosis-positive and brucellosis-negative arthritis patients and their relationship with clinical parameters. The mean serum levels of IL-2 and IL-10 were markedly higher in brucellosis-positive arthritis patients. As brucellosis is an important cause of inflammatory arthritis, characterized by elevated serum levels of IL-10 and IL-2 and increased inflammatory markers, including ESR and CRP, along with relatively lower levels of IFN-γ and IL-6, which are linked to the inflammatory rheumatoid arthritis. The observed associations with raw dairy consumption, contact with unvaccinated livestock, and direct animal exposure highlight the need for early diagnosis, effective livestock immunization programs, and strengthened One Health–based public health interventions to reduce disease burden

Objective. Hepatitis B virus (HBV) spontaneous mutations may impact the severity of liver disease. This study aimed to assess the mutations in the pre-core (PC) region in HBV-HIV (human immunodeficiency virus) co-infected patients. Additionally, we explored its association with genotypes and examined the clinical implications. Methods. A total of 100 HBV-HIV co-infected patients and 50 HBV mono-infected patients were included in the study. We focused on the PC region of the HBV genome, sequencing it to identify PC mutant variants. PCR products were quantified via spectrophotometry and sequenced using the Sanger method. The resulting sequences were assembled, annotated and aligned in a single reading frame. Subsequent mutational and phylogenetic analyses were performed using UGENE software to determine the genotypes of the isolates. Results. The PC region was successfully amplified and sequenced in 27 samples, comprising 16 from HBV-HIV co-infected patients and 11 from HBV mono-infected patients. Phylogenetic analysis identified two HBV genotypes: genotype D, which was predominant and found in 24 samples (88.9%), and genotype A, present in 3 samples (11.1%). A T-to-C mutation at nucleotide position 1912 was detected in 48.1% of the patients. Furthermore, several additional PC mutations were observed, including A1850T, C1858T, G1899A, G1862T, G1951T, T1812C and T1809G, along with novel mutations such as C1936T, A2011G, T2020A and C2044T. Notably, the prevalence of these PC mutations did not significantly differ between the HBV mono-infected and HBV-HIV co-infected groups. Conclusion. This study underscored the prevalence of PC mutations in HBV-HIV co-infected patients. Although several of these mutations have been previously reported, our findings also revealed novel variants. Further research is needed to elucidate the clinical significance of these new mutations.

The global tuberculosis (TB) epidemic is becoming progressively more complex due to the increasing prevalence of multidrug-resistant TB (MDR-TB), particularly with resistance to fluoroquinolones (FQs). This study focuses on identifying genetic mutations in the gyrA and gyrB genes of Mycobacterium tuberculosis that drive FQ resistance. Sputum samples from suspected pulmonary TB patients were analyzed using PCR and sequencing to detect mutations within the quinolone resistance-determining regions (QRDR). The analysis revealed that mutations in gyrA, especially S95T, are prevalent and play a key role in FQ resistance. Additionally, less frequent mutations in gyrB, such as E501D and A533P, were also detected. These findings shed light on the molecular mechanisms contributing to FQ resistance in MDR-TB strains and underscore the need for enhanced diagnostic methods to identify resistance patterns more accurately. The insights gained from this research offer a foundation for improving TB treatment approaches and addressing the growing challenge of drug-resistant TB worldwide.

Introduction. Brucellosis, a globally distributed zoonotic disease, is caused by the Gram-negative bacteria known as Brucella. Humans acquire infection through direct contact with the blood, urine and placenta of animals, inhalation of dust or aerosols at infected animal farms, and raw milk and meat intake. This study aimed to assess the prevalence of brucellosis in dairy farmers in and around the Aligarh region of North India, to document various clinical signs and symptoms in Brucella-positive individuals, and to create awareness in dairy farmers concerning brucellosis and ways to prevent it. Methods. This was an observational study that included 125 dairy farmers in and around the Aligarh region. Serum samples were taken from this high-risk group after obtaining informed consent. Further, a pre-designed proforma was used to collect information about their knowledge, attitude and practices (KAP) concerning brucellosis and assess the risk factors for the disease. The Rose Bengal test (RBT), serum agglutination test (SAT) and enzyme-linked immunosorbent assay (ELISA) were performed to detect the seroprevalence of brucellosis. Result. Brucella infection was diagnosed in 64 (51.20 %) cases by indirect ELISA (IgM+IgG), 41 (32.8 %) by RBT and 4 (3.2 %) by SAT. Significant clustering of patients was seen in the 20–55 years age group. The most common symptoms in ELISA IgM-positive patients were joint pain (16.07 %), fatigue (14.28 %), anorexia (12.50 %), weight loss (8.92 %), malaise (5.35 %), undulant fever (3.57 %), night sweats (3.57 %) and headache (1.78 %). The findings of this study indicate that ELISA (IgM+IgG) exhibits great sensitivity as compared to SAT and RBT. KAP was very poor among dairy farmers. Conclusion. In India, Brucella is a frequent but severely underreported illness. ELISA is the most sensitive serological test for diagnosing brucellosis. No potential vaccine has yet been introduced for humans against brucellosis. Thus, it is necessary to impart awareness and sensitize high-risk groups concerning brucellosis.

Purpose: Early diagnosis of extrapulmonary tuberculosis (TB) with simultaneous detection of rifampicin (RIF) resistance (RR) directly from the sample is a revolution brought by GeneXpert Mycobacterium TB (MTB/RIF) assay. Line probe assay (LPA) is not recommended for extrapulmonary/nonsputum specimens; GeneXpert MTB/RIF provides a diagnostic option for these. Hence, the following study aimed to evaluate the performance of GeneXpert MTB/RIF assay in nonsputum samples. Materials and Methods: A total number of 642 extrapulmonary and nonsputum respiratory samples were subjected to Ziehl–Neelsen (ZN) staining technique, fluorescent microscopy (FM), and GeneXpert MTB/RIF Assay. All samples were cultured on a solid Lowenstein–Jensen (LJ) medium and culture-positive samples were subjected to GenoType MTBDRplus LPA and drug susceptibility testing by 1% proportion method on a solid LJ medium. Results: GeneXpert MTB/RIF assay detected MTB in 25.9% (166/642) of the samples. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ZN staining technique and FM were 21.52%, 99.35%, 91.89%, and 78.77% and 27.22%, 99.78%, 97.73%, and 80.07%, respectively. Sensitivity, specificity, PPV, and NPV of GeneXpert MTB/RIF in the detection of MTB were 93.75%, 96.53%, 90.36%, and 97.80%, and RIF RR was 92.0%, 97.74%, 88.46%, and 98.48%, respectively. LPA performed on positive culture growth showed 100% sensitivity and specificity in the detection of RIF and isoniazid resistance. Conclusion: GeneXpert MTB/RIF showed high sensitivity and specificity in detecting MTB and simultaneous RIF RR among the nonsputum samples which had a good concordance to LPA. It provides a judicious option for early detection of multidrug-resistant TB in extrapulmonary and nonsputum respiratory samples.

Introduction: Instant Messaging Applications (IMAs) like Whatsapp has changed our lives including medical education in many ways. Aim: To explore and compare the effectiveness and acceptability of Whatsapp as a Teaching Learning (TL) tool for Small Group Learning (SGL) sessions when compared with traditional classroom based learning SGL sessions, for a specific topic (pharmacokinetics) in Pharmacology in Problem Based Learning (PBL) sessions. Materials and Methods: This quasi-experimental study was conducted in a tertiary care government medical college in Eastern India on second phase Bachelors of Medicine and Bachelor of Surgery (MBBS) students in the year 2021 over a period of five weeks (from March to April 2021). After Didactic Lecture (DL) on the topic, the willing students were randomly divided into two groups, group A (n=46) and group B (n=45). Then group A and group B students attended classroom based and Whatsapp based SGL sessions, respectively, for a period of five consecutive days on "Pharmacokinetics" using PBL method. Students sat for a Multiple Choice Question (MCQ) based examination (predecided and prevalidated) of 30 marks before and after the SGL sessions. Next, group A students attended Whatsapp based PBL session on the same topic in the same manner as Group B and vice versa. Finally the students filled in a feedback form using a 5 point Likert scale. Results: The post-test scores for both the groups were significantly better compared to the pretest scores; however, there were no significant differences in the post-test scores of both the groups. Regarding students' feedback on the type of SGL, except for enjoyment (p-value=0.0345) and interactiveness (p=0.022), there were no significant differences between the two group scores. The students significantly preferred combination of both types of SGL to either of them. Conclusion: In this study, Whatsapp based SGL showed comparable effectiveness as classroom based SGL as measured in terms of MCQ based examination scores. Except for interactiveness and interest, classroom based SGL was equally acceptable to the students as Whatsapp based SGL. Interestingly, the students preferred a combination of both the type of SGL to either of them on the particular topic of Pharmacology.

Candidiasis is recognized as a significant cause of morbidity, especially in immunocompromised individuals. An epidemiologic change in Candida species and emergence of resistance can impact the usage of antifungal agents as empirical therapy for Candidiasis in patients with or without AIDS. The present study was done to find out: i) The species of Candida isolated from H.I.V. and Non-HIV infected patients. ii) The resistance pattern of these Candida isolates to antifungal agents. A total of 160 Candida species isolates (80 isolates each from H.I.V. and Non-HIV infected patients) were characterized. Identification of yeast isolates was made by standard procedures including morphology (Staib agar, cornmeal agar, CHROMagar), germ tube test, fermentation, and assimilation of sugars and growth at 42°C. In addition, sensitivity testing was done using the broth microdilution method (M27-A2) as per the C.L.S.I. guidelines against amphotericin B, nystatin, voriconazole, fluconazole, ketoconazole, and itraconazole. In both the groups, i.e., H.I.V. and Non-HIV infected patients, Candida albicans was the most common species (61.2 % and 85 % respectively), followed by Candida guilliermondi (16.2 % and 5 %), Candida tropicalis (5 % and 3.7 %), Candida krusei (5% and 2.5 %), Candida dubliniensis 1(5 % and 1.2 %) and others. Among HIV infected patients fluconazole resistance was 16.25%, ketoconazole 13.5%, clotrimazole 12.5%, itraconazole 6.25 %. In the non-HIV infected group, fluconazole resistance was 8.75% and itraconazole 1.25%. For the appropriate treatment of Candida infections, antifungal susceptibility has become an essential tool, especially in the present scenario of increasing resistance.

OBJECTIVE: To determine the association among betel nut, betel quid or smoking alone, and betel quid combined with smoking in subjects reporting with oral sub mucous fibrosis, oral submucous fibrosis with malignant transformation in to cancer and oral squamous cell carcinoma. METHODOLOGY: An analytical cross sectional, multi centric study of n = 1009 cases collected through non-probability convenience sampling. These n=1009 subjects were subdivided into four groups: group 1, who consumed areca nut only; group 2, who chewed betel quid along with areca nut; group 3, who used betel quid and smoked; and group 4, who had no chewing habits history but were smokers. These changes were further confirmed with the help of biopsy reports of the subjects with OSMFCa and OSCC. Chi square test was performed to find out association of chewing habits with the progression of disease state. Level of significance was kept at p<0.05. RESULTS: The mean age of the sample (n=1009) were 42.79±1.31 years (range: 10-70 years). Statistically significant difference was (p<0.00) found among all four groups in terms of initiation, propagation and progression of oral squamous cell carcinoma. Furthermore, statistically insignificant difference (p=0.40) was found between group 2 and group 3 as similar number of cases (OSCC) was seen among them. CONCLUSION: Current study concluded that patients who have combined habits of chewing betel quid with areca nut and betel quid with smoking were at highest risk of initiation and progression of oral cancer. However, smoking cigarettes alone was the weakest risk factor. KEYWORDS: Betel quid; Areca nut; Smoking; Oral squamous cell carcinoma, Oral submucous fibrosis HOW TO CITE: Fatima N, Mohiuddin S, Hosein S, Hosein M. Association of carcinogenic oral habits with oral squamous cell carcinoma. J Pak Dent Assoc 2021;30(1):29-33.