Serum immunoglobulin E in early childhood wheezing

OBJECTIVE

To study the serum Ig E levels in patients presenting with wheezing under the age of 24 months.

METHODS

The study was conducted on 38 cases and 35 controls. The children presenting with first attack of wheezing were clinically considered as bronchiolitis and those with recurrent attacks with positive history of atopy in the patient or in their first degree relatives were considered as bronchial asthma. The Ig E estimation was done by immune assay method.

RESULTS

The mean serum Ig E was significantly higher in asthma patients (p < 0.001). It was also higher in bronchiolitis patients but the difference was not statistically significant. However, 26 per cent of these patients had values above 1 SD of the control mean. These patients were considered as potential cases of asthma.

CONCLUSION

The determination of serum Ig E may be of value in identifying those children presenting with first wheezing attack, who may develop asthma in future. Only a long-term follow-up of these patients can give an answer to the postulation that raised Ig E level at the time of first viral lower respiratory tract infection is a potential marker for the development of recurrent wheezing in later life.

Cerebrospinal fluid lysozyme level for the diagnosis of tuberculous meningitis in children

Lysozyme activity was assayed in the cerebrospinal fluid (CSF) of 32 tuberculous meningitis (TBM), 17 bacterial meningitis, 10 partially treated bacterial meningitis, 18 encephalitis and 18 control subjects. The mean CSF lysozyme activity was significantly raised (p < 0.001) in TBM patients compared with other study groups. A cut-off CSF lysozyme level of > or = 26 U/l had a sensitivity and specificity of 93.7 and 84.1 per cent, respectively for the diagnosis of TBM. Overall, it was found to be a better test than any other single test and thus can be used for rapid and early diagnosis of TBM in children.

Plasma glucose and tumour necrosis factor-alpha in adult patients with severe falciparum malaria

Plasma glucose was assessed in 81 patients with severe falciparum malaria at the time of presentation along with tumour necrosis factor-alpha (TNF-alpha). The lowest plasma glucose value was 3.38 mmol/l and none of the patients had hypoglycaemia at admission. Plasma glucose values were not significantly lower in those with multiple organ dysfunction (MOD) than in patients with single organ dysfunction (cerebral malaria only) and in those who died compared with patients who survived. Conversely, TNF-alpha showed a good correlation with depth of coma and was significantly higher in patients who had MOD and those who died. There was no correlation between plasma glucose and TNF-alpha values.

Molecular characterization of serotype G2 and G3 human rotavirus strains that have an apparently identical electropherotype of the short RNA pattern

The literature is conflicting whether or not rotavirus strains with different G serotype have an identical electropherotype. This is a contentious but an important issue because large parts of molecular epidemiological studies of rotaviruses have been based on the conception that a single strain of rotavirus can be defined by a single electropherotype. Here, we examined in detail by reverse-transcription PCR genotyping, electropherotyping, sequencing, and genogrouping using RNA--RNA hybridization three human rotavirus strains isolated in India that had apparently identical electropherotypes although one strain was typed as P[4], G3 while the other two typed as P[4], G2. These three strains showed an identical electropherotype on 7.5% and 12.5% polyacrylamide gels, but co-electrophoresis on a 10% gel demonstrated that segment 8 of the P[4], G3 strain migrated more slowly than the cognate segment of the P[4], G2 strains. Genogrouping assay and nucleotide sequencing provided evidence for the hypothesis that the P[4], G3 stain was an intergenogroup reassortant in which a P[4], G2 strain of the DS-1 genogroup had acquired the VP7 gene from an yet-unidentified concurrently circulating G3 strain. While electropherotyping remains a valuable asset for molecular epidemiology of rotaviruses, this study underscores the importance of co-electrophoresis under different electrophoretic conditions when pinpointing subtle differences.

Nasopharyngeal carriage of Haemophilus influenzae

OBJECTIVE

Nasopharyngeal colonization of Haemophilus influenzae (H. influenzae) in young children may be important in developing countries.

METHOD

In this study, we screened school going children for carriage of H. influenzae. A total of 44 H. influenzae isolates out of a collection of 162 were characterized for biotypes, capsular serotypes and antibiotic resistance.

RESULTS

A significant proportion of H. influenzae (25/44) isolates were serotype b. High antibiotic resistance was observed against commonly administered antibiotics like ampicillin (79%), chloramphenicol (20%), trimethoprim sulfamethoxazole (84%) and erythromycin (95%). Comparison of antibiotic resistance profile of nasopharyngeal isolates was observed to be correlated with those of H. influenzae from disease.

CONCLUSION

Multidrug resistant nasopharyngeal H. influenzae in young healthy children may act as reservoir. Monitoring of antibiotic resistance among nasopharyngeal H. influenzae as a surrogate for invasive H. influenzae seems an attractive option.

Serum cortisol and thyroid hormone levels in neonates with sepsis

OBJECTIVE

To evaluate the thyroid hormone and cortisol levels in neonates with sepsis in relation to the final outcome. It was hypothesized that the hormonal level could act as some prognostic guideline.

METHODS

Forty nine neonates, aged 8- 28 days, diagnosed as neonatal sepsis were selected for the study. Neonates below 8 days of age, 35 weeks of gestation and 2000 g of birth weight were excluded from the study. Twenty FT-AGA neonates beyond day 7 of life served as control for the study. The hormones were estimated by radioimmunoassay.

RESULTS

The neonates with sepsis had significantly higher mean serum cortisol and lower mean serum total T4 at admission as compared to healthy neonates. The mean serum total T3 level was also lower, but the difference was not statistically significant. The mean serum TSH levels were comparable in both groups. The levels normalised following recovery. Sixteen neonates succumbed to the disease process. The non-survivors had significantly lower mean total T3 and total T4 levels as compared to the survivors.

CONCLUSION

The endocrinal abnormalities are of transient nature as a response to sepsis. Low total T3 and total T4 are the predictors of adverse outcome in neonates with sepsis.

Streptococcal toxic shock syndrome

Streptococcal toxic shock syndrome (STSS) which is the most severe form of invasive infection caused by group A streptococci has made a global resurgence. To establish the presence of STSS, hypotension and multiorgan failure must accompany evidence of Streptococcal pyogenes infection. We report a case of STSS in a 61 year old diabetic man. The patient presented with septicaemia and septic arthritis of the right knee joint. Group A streptococci were cultured from both blood and pus aspirate from knee joint. The patient had signs of STSS. Early radical drainage debridement plus appropriate antibiotic therapy altered the usual devastating outcome. A wider recognition of the diverse clinical manifestations of group A streptococci is emphasized for early diagnosis, better treatment and possibly improved outcome.

Bancroftian filariasis: a 13-year follow-up study of asymptomatic microfilariae carriers and endemic normals in Orissa, India

The natural history of human filarial infections leading to development of disease has been a subject of intense debate. The models proposed so far have largely been based on cross-sectional data on microfilariae (Mf) and disease prevalence in filariasis endemic areas. In an attempt to study the parasitological and clinical consequences of filarial infection in Beldal (Orissa, India), an area endemic for Bancroftian filariasis, cohorts of 59 asymptomatic Mf carriers (AS) and 187 asymptomatic and amicrofilaraemic subjects or 'endemic normals' ('EN'), were followed-up and a fraction (73% and 46% respectively) re-examined after 13 years to monitor (a) Mf prevalence, (b) Mf density, (c) circulating filarial antigen (CFA) and (d) chronic disease manifestations. The Mf prevalence and density were also monitored in Mf carriers after 1 and 4 years. Both Mf prevalence and density decreased progressively in the cohort of Mf carriers over a period of 13 years in Beldal. Only 37% of them continued to be microfilaraemic and the Mf density in these subjects was only 10% of the original level. However, loss of circulating Mf in this cohort did not result in loss of CFA and 95% remained CFA positive regardless of Mf status. About 23% of males in the 'EN' cohort developed hydrocoele while only 5.7% of male Mf carriers, who were not treated with DEC, had developed hydrocoele after 13 years. A cohort of Mf carriers in another area, Jatni, was also examined after 10 years to study the parasitological and clinical outcome. In this area, about 59% of the Mf carriers continued to be microfilaraemic after 10 years. These results reveal that in Mf carriers adult filarial worms persist for several years and that loss of circulating Mf with or without chemotherapy with DEC (single 12-day course) does not influence adult worm survival. The findings have been discussed in the context of 'static' and 'dynamic' models describing the relationship between infection and disease in human filariasis.

SPECT changes and their correlation with EEG changes in tuberculous meningitis

OBJECTIVE

In tuberculous meningitis (TBM) blood flow may be altered due to associated vasculitis, hydrocephalus and raised intracranial pressure. Electroencephalography (EEG) and single photon emission computed tomography (SPECT) provide information about electrical activity and regional cerebral blood flow respectively. This study aims at the correlation of EEG and SPECT changes in patients with TBM.

METHOD

Sixteen patients with TBM whose age ranged between 5 and 62 years and 3 of whom were females were subjected to clinical, radiological (CT and/or MRI), EEG and SPECT studies using 99mTc ethylene cystine dimer (ECD). Ten patients were in stage III and 3 each in stage II and stage I meningitis. Cranial CT scan was carried out in 15 and MRI in 4 patients. Hydrocephalus was present in 9, infarction in 7 and tuberculoma in 5 patients.

RESULTS

SPECT studies were abnormal in all except 2 patients revealing basal ganglionic hypoperfusion in 14 and focal cortical hypoperfusion in 9 patients. The EEG was abnormal in 11 patients which included delta slowing in 5, theta slowing in 6, frontal intermittent rhythmic delta activity (FIRDA) in 3 and epileptiform discharges in 2 patients. All the patients with abnormal EEG had abnormal SPECT study except 1. In 4 patients, EEG was normal although there was subcortical hypoperfusion on SPECT. In spite of high frequency of focal cortical hypoperfusion (9 patients), EEG revealed focal abnormality in 3 patients only.

CONCLUSION

It can be concluded that the SPECT reveals more frequent abnormalities compared to EEG and CT scan. Cortical hypoperfusion with or without basal ganglia hypoperfusion is associated with FIRDA and diffuse delta slowing on EEG.

Edwardsiella tarda endotoxin as an immunopotentiator in Singhi, Heteropneustes fossilis fingerlings

Endotoxin of E. tarda grown in brain heart infusion broth at 30 degrees C for 18 hr was extracted by differential centrifugation. Fingerlings of H. fossilis (weighing 1-2 g) were allowed for hyperosmotic infiltration in the endotoxin at the rate of 0,2,4,8,16 and 20 mg/l. Mortality varied from 20-50% at 2 to 20 mg/ml. Toxin treated fishes were challenged 21 days post treatment with the same E. tarda strain containing 2.1 x 10(9) CFU/ml. There was 80% mortality in the control group whereas only 20% mortality in toxin treated group at 2 mg/l concentration after challenge with homologous E. tarda. Subsequently a second challenge of E. tarda was given to the survivors of fish one month after first challenge using same concentration where no mortality could be observed. It was concluded that the endotoxin could enhance percentage of survival against E. tarda infection in Singhi.

Group B streptococcal bacteremia in an adult: a case report from India

The incidence of group B streptococcal bacteremia in adults has increased in recent years, particularly in patients with severe underlying diseases. However, group B still remains an unusual pathogen in adults in developing countries. We report a case of group B streptococcal bacteremia in a non-pregnant adult, the only case reported in our hospital. The organism was only isolated from the blood and responded to specific therapy.

Great diversity of group A rotavirus strains and high prevalence of mixed rotavirus infections in India

We previously observed a marked diversity of rotavirus strains and a high prevalence of the uncommon serotype G9 in a small survey of rotavirus strains collected from six centers in India. In the present study, we characterized a larger collection of strains from children hospitalized with severe diarrhea in seven Indian cities between 1996 and 1998. A total of 287 strains were G and P genotyped by reverse transcription-PCR, and some were further characterized by electropherotyping and subgrouping. Of the four strains common globally, three were found in only 43% of samples (P[8], G1, 15%; P[4], G2, 22%; P[8], G4, 6%), whereas G9 strains made up 17% of the total. Three different G9 strains were present: a P[8], G9 strain, which displayed the long electropherotype and subgroup II VP6 specificity, and two P[6], G9 strains, one with the long electropherotype and subgroup II specificity and the other with the short electropherotype and subgroup I specificity. Marked diversity was observed among strains collected from different cities and collected over time. Of the 253 strains that were fully typed, 54 (21%) had a mixed G or P genotype. Serotype G2 strains were detected more often in infections caused by single strains than in mixed infections (P < 0.05), whereas serotype G1 strains were found more often in mixed infections than in infections caused by single strains (P < 0.05). The diversity of rotavirus strains and the high prevalence of mixed infections confirm trends reported earlier and help to better characterize the strains of rotavirus circulating in India. Vaccines under development should clearly target G9 strains, and G9 should be included as one of the common global serotypes.

Tetrakis(mu-acetato-O,O')bis[(4-cyanopyridine-N)copper(II)]

The title compound, [Cu(2)(C(2)H(3)O(2))(4)(C(6)H(4)N(2))(2)], has the familiar lantern-type structure that is characteristic of dimetal tetracarboxylates of copper and several other transition elements. The molecule lies about an inversion centre and the Cu atom is present in a distorted square-pyramidal coordination environment, consisting of four O atoms in equatorial positions and the pyridyl-N atoms of the two 4-cyanopyridine ligands in axial positions.

In vitro susceptibility of nosocomial isolates against a new aminoglycoside isepamicin

BACKGROUND AND OBJECTIVES

isepamicin is a new aminoglycoside with a spectrum of activity similar to amikacin with an advantage of possessing a high level of stability against different aminoglycoside modifying enzymes. the in vitro susceptibility of nosocomial isolates obtained from patients admitted to the All India Institute of Medical Sciences, New Delhi during October-December, 1999 was tested against isepamicin and compared with other aminoglycosides.

METHODS

a total of 251 clinical isolates were studied which included Escherichia coli 87, Klebsiella pneumoniae 54, Pseudonomas aeruginosa 38, Staphylococcus aureus 27 (methicillin resistant S. aureus 15, methicillin sensitive S. aureus 12), Acinetobacter species 26, Enterobacter aerogenes 9, Proteus mirabilis 5, Proteus vulgaris 2, and Citrobacter species 3. The minimum inhibitory concentration (MIC) against isepamicin and other aminoglycosides including amikacin, gentamicin, netilmicin and tobramycin was done using NCCLS guidelines. The cut-off values of isepamicin were used as that of amikacin.

RESULTS

we found that overall 153 nosocomial isolates were sensitive to isepamicin as compared to 95 for amikacin in this hospital. Isepamicin showed a superior in vitro activity compared to the other aminoglycosides tested.

INTERPRETATION AND CONCLUSIONS

isepamicin can be a good alternative in multidrug resistant nosocomial isolates in hospitals where amikacin resistance is emerging.

Classifying choledochal cysts using hepatobiliary scintigraphy

PURPOSE

This retrospective study was designed to classify choledochal cysts on the basis of the findings of hepatobiliary scintigraphy.

METHODS

Twenty-one patients with choledochal cysts (15 female, 6 male; mean age, 20 years) proved on the findings of endoscopic retrograde cholangiopancreatography (ERCP) or surgery and histopathologic analysis were included in the study. Two nuclear medicine physicians, blinded with regard to cholangiographic and operative details, were asked to review and to classify the type of choledochal cyst seen on the hepatobiliary scan. Later, scintigraphic results were compared with ERCP and surgical findings for a reference standard.

RESULTS

The findings of hepatobiliary scintigraphy correlated with ERCP and surgical findings in 18 of 21 cases (86%). Scintiscans correctly identified all type 1 cysts (12/12). The sensitivity of scintigraphy in diagnosing type 4 cysts was 66% (6 of 9 cases). It underestimated the intrahepatic extent of disease in type 4a biliary cysts (37%).

CONCLUSION

This study illustrates the utility of hepatobiliary scintigraphy in diagnosing type 1 and 4 choledochal cysts.

Parturient abdominal circumference as a predictor of low birthweight

The usefulness of parturient abdominal circumference as a predictor of low birthweight (LBW) was studied in 151 singleton pregnancies. The abdominal circumference was measured in early labour and was plotted against the birthweight of the newborns. A significant positive correlation was observed between the two parameters (r = +0.507). For the prediction of LBW, the critical limit of the abdominal circumference was 86 cm, which means that an abdominal circumference of more than 86 cm is reasonably safe while lesser values predict a higher chance of a LBW infant. From these observations, the use of a colour-coded tape by peripheral health workers and traditional birth attendants is suggested: red for abdominal circumference <82 cm, yellow for abdominal circumference 82-86 cm, and green for abdominal circumference >86 cm. Mothers who have an abdominal circumference in the 'red zone' are at risk of delivering LBW infants.

Acardiac anomaly spectrum

BACKGROUND

Acardiac anomaly spectrum is a rare congenital malformation found in monozygotic twin pregnancy. Besides the absence of heart, the condition is associated with variable grades of developmental disruption. Thus, no two cases are similar.

METHODS

This case report is based on physical examination and autopsy findings.

RESULTS

The twin had acardia and partial development of head and face. There was complete absence of upper extremities.

CONCLUSIONS

The twin reversed arterial perfusion (TRAP) theory is the most accepted etiology of the disorder. Normally, the cephalic pole is the most severely affected, being most distal to the retrograde perfusion. In acardia, partial development of head, face, and brain is usually associated with the development of the upper extremities. However, in the present case, there was extensive cephalic development in the absence of upper extremity development.

Reliability of information obtained by illiterate health workers regarding risk pregnancy

The present study aims at testing the reliability of information obtained by illiterate workers (IHW) on risk pregnancy. Eight maternal risk factors known to be related to low birth weight were utilised for the purpose. The reliability of information obtained by the IHWs were compared with that of the trainer. The reliability proportions (RP) for various parameters ranged from 0.78 to 0.96 with an average of 0.86. For the overall risk assessment, the RP was 0.73. The results of the present study suggest that the IHWs can recorded the risk indicators with fair degree of reliability and accuracy, which may be applied to the training of traditional birth attendants in field settings.

Single photon emission computed tomography in tuberculous meningitis

INTRODUCTION

Data on single photon emission computed tomography (SPECT) in tuberculous meningitis are lacking and prompted this study. SPECT findings in tuberculous meningitis are reported and correlated with clinical and radiological findings.

PATIENTS AND METHODS

Seventeen patients with tuberculous meningitis that was diagnosed on clinical, radiological, and laboratory criteria have been included. Their age ranged between 5 and 62 years and four of them were female. Computed tomography and/or magnetic resonance imaging (MRI) and SPECT using (99m)Tc-ethylene cystine dimer were performed in all the patients. On the basis of Barthel index (BI) score the patients' outcome was defined as complete (BI = 20), partial (BI = 19-12), and poor recovery (BI<12).

RESULT

Eleven patients were in stage III and three each in stage II and stage I tuberculous meningitis. Two patients had hemiplegia and five quadriplegia. Computed tomography was abnormal in 11 out of 16 patients and revealed hydrocephalus in nine, basal exudates, infarction in subcortical white matter and basal ganglia in six patients each, frontal cortical infarction in one, and granulomata in three patients. Cranial MRI was carried out in four patients and revealed multiple granulomata, hydrocephalus, and brainstem infarction in two patients each. SPECT studies were abnormal in all except two patients and revealed hypoperfusion of the basal ganglia in 14, cortical hypoperfusion in 10, and midbrain hypoperfusion in one patient. At the three month follow up four patients had died, five had poor, three partial, and five complete recovery. The SPECT studies were more frequently abnormal compared with computed tomography but did not correlate with stage of meningitis or outcome.

CONCLUSION

In tuberculous meningitis subcortical and cortical hypoperfusion is common but it does not correlate with stage of meningitis or three month outcome.

Adenosine deaminase activity and lysozyme levels in children with tuberculosis

Serum adenosine deaminase (ADA) activity and lysozyme levels were measured in 51 patients with tuberculosis (21 pulmonary, 15 miliary, 11 neurotuberculoma and four abdominal plus osteoarticular) and 20 healthy controls. The mean serum ADA activity and lysozyme levels were significantly raised in children with different forms of tuberculosis in comparison with controls (p < 0.001). The neurotuberculoma cases had the lowest mean enzyme levels and the differences were significant when compared with other forms of tuberculosis. The cut-off serum ADA activity of > or = 42 IU/l and lysozyme level of > or = 20 U/l were diagnostic of tuberculosis with 100 per cent sensitivity. A significant correlation was observed between the two parameters (r = 0.66; p < 0.001). Thus, with compatible clinical presentation, the raised serum level of either ADA or lysozyme can be used as a supportive diagnostic test.

Chronic toxic effects of quinalphos on some biochemical parameters in Labeo rohita (Ham.)

The effect of exposure to sublethal concentrations of the organophosphate pesticide, quinalphos (1.12, 0.22 mg/l) on biochemical parameters of muscle and enzyme activities in brain, liver and kidney of the Indian major carp, Labeo rohita was studied after 15, 30 and 45 days. The muscle protein and RNA levels decreased whereas DNA levels and acid phosphatase were elevated. Similarly, alkaline phosphatase was depleted. The brain acetyl cholinesterase activity was decreased most (-75.43%) in 1.12 mg/l concentration over a period of 45 days. Lactic dehydrogenase levels in brain and liver were elevated whereas in the kidney they were inhibited. Succinic dehydrogenase and adenosine triphosphatase activities were depleted in brain, liver and kidney. The effects have been discussed for different organ tissues in relation to the pesticide.

Neem (Azadirachta indica) extract as an antibacterial agent against fish pathogenic bacteria

Aquaneem, an emulsified product prepared from the neem (A. indica) kernel was tested against four pathogenic bacteria of fish (i.e. Aeromonas hydrophila, Pseudomonas fluorescens, Escherichia coli and Myxobacteria spp.) to test its efficacy as an antibacterial agent. Growth inhibitory property of the product at 10, 15 and 20 ppm has been noticed and recorded. The percentage reduction of bacterial cell population was noted to be maximum on 9th day at 20 ppm concentration (i.e. 70.14%, 74.15% and 61.75% for A. hydrophila, P. fluorescens and E. coli respectively) with the only exception of myxobacteria which showed maximum reduction percentage (63.90%) on 15th day. Among all the bacteria tested A. hydrophila, P. fluorescens and Myxobacteria spp. exhibited maximum sensitivity to Aquaneem in terms of percentage reduction of bacterial cell population in comparison to E. coli.

Screening of sputum: an experience in a tertiary care hospital

In order to reduce the work load on the clinical laboratory, it has been recommended that sputum samples, before accepting for culture, should be looked for the presence of polymorphs and squamous epithelial cells. (An appropriate sample should have more than 25 polymorphs per low power field and less than 10 epithelial cells per low power field; others are labelled as inappropriate). We examined this criteria for it's suitability on 1043 samples received at the clinical bacteriology laboratory at the All India Institute of Medical Sciences (AIIMS) for a period of one year (September, 1996 to August, 1997). Four hundred samples were found appropriate while 643 were inappropriate as per recommended criteria. Amongst the 400 appropriate samples, 215 were culture positive and 185 grew normal flora. However, we found that out of 643 inappropriate samples, 195 were culture positive (p < 0.01, statistically significant). The data was further divided into hospitalized and OPD cases. The distribution of culture positive cases in the appropriate samples was again found to be highly significant. It is apparent from our results that an attempt to process an inappropriate sample does not provide useful information.

Characterization of a protein complex containing spliceosomal proteins SAPs 49, 130, 145, and 155

SF3b is a U2 snRNP-associated protein complex essential for spliceosome assembly. Although evidence that SF3b contains the spliceosomal proteins SAPs 49, 130, 145, and 155 has accumulated, a protein-mediated association between all of these proteins has yet to be directly demonstrated. Here we report the isolation of a cDNA encoding SAP 130, which completes the cloning of the putative SF3b complex proteins. Using antibodies to SAP 130 and other putative SF3b components, we showed that SAPs 130, 145, and 155 are present in a protein complex in nuclear extracts and that these proteins associate with one another in purified U2 snRNP. Moreover, SAPs 155 and 130 interact with each other (directly or indirectly) within this complex, and SAPs 49 and 145 are known to interact directly with each other. Thus, together with prior work, our studies indicate that SAPs 49, 130, 145, and 155 are indeed components of SF3b. The Saccharomyces cerevisiae homologs of SAPs 49 and 145 are encoded by essential genes. We show here that the S. cerevisiae homologs of SAPs 130 and 155 (scSAP 130/RSE1 and scSAP 155, respectively) are also essential. Recently, the SF3b proteins were found in purified U12 snRNP, which functionally substitutes for U2 snRNP in the minor spliceosome. This high level of conservation, together with the prior observation that the SF3b proteins interact with pre-mRNA very close to the branch site, suggest that the SF3b complex plays a critical role near or at the spliceosome catalytic core.

Comparison of enzyme immunoassay and reverse transcriptase PCR for identification of serotype G9 rotaviruses

While only four globally important rotavirus G serotypes (1 to 4) have been documented, many studies suggest that serotype G9 viruses may be widely distributed and more important than previously recognized. We have evaluated 10 serotype G9 rotavirus-neutralizing monoclonal antibodies (MAbs) directed to VP7, which bound by direct enzyme immunoassay (EIA) to P1A[8], G9 rotaviruses F45, WI61, and AU32, for their ability to recognize the New Delhi G9 rotavirus 116E. Only one MAb (MAb F45:1) bound to P[11], G9 virus 116E to a high titer by EIA. This MAb was incorporated into an indirect EIA for G serotyping, which was validated with prototype cultivable human rotaviruses of G types 1 to 4 and 9. The EIA was compared with genotyping by reverse transcriptase PCR (RT-PCR) under code for the determination of the G types of rotaviruses obtained from neonates in New Delhi, India. The sensitivities of RT-PCR and EIA (after two additional freeze-thaw cycles) for the typing of G9 rotaviruses were 91 and 86%, respectively, for 24 culture-adapted rotavirus strains. The untypeable culture-adapted rotavirus samples also were unreactive with VP7 group antigen-reactive MAb 60. After two additional freeze-thaw cycles, only 26 of 42 (62%) of stools containing rotavirus typed as G9 by RT-PCR were positive for G9 rotavirus by EIA. Stools containing rotavirus untypeable by EIA contained significantly less MAb 60-reactive VP7 antigen (P = 0. 0001) than the stools containing typeable rotavirus. Thus, RT-PCR genotyping was the more sensitive method for determination of G9 type, but a serotype was readily determined in rotavirus samples containing MAb 60-reactive VP7 antigen by an EIA that incorporates MAb F45:1.

SPECT studies of regional cerebral blood flow in 8 patients with Japanese encephalitis in subacute and chronic stage

OBJECTIVE

There is a paucity of regional cerebral blood flow studies in Japanese encephalitis (JE). In this communication we report clinical, radiological and single photon emission computed tomography findings in subacute and chronic JE patients.

MATERIAL AND METHODS

Eight JE patients whose ages ranged between 10 and 50 years underwent neurological evaluation. Varying degree of parkinsonian features were present in all, dystonia in 4 and abulia in 5 patients. They were subjected to cranial CT, MRI and SPECT studies. CT scan revealed low density area in 7 patients and midbrain involvement in 1. MRI was carried out in 3 patients and revealed medial temporal involvement in addition to bilateral thalamic involvement in all.

RESULTS

SPECT results on visual analysis revealed thalamic hypoperfusion in all the patients, frontal hypoperfusion was present in 5 and lentiform hypoperfusion in 2 patients. Frontal or lentiform hypoperfusion was not associated with corresponding CT or MRI changes. On semiquantitative measurement, thalamic hypoperfusion was present in 7, frontal hypoperfusion in 3, occipital in 2 and lentiform in 1 patient.

CONCLUSION

These results confirm high frequency of thalamic involvement in JE. The hypoperfusion in thalamus, frontal cortex and lentiform area is consistent with the crucial role of thalamus and its connections in the genesis of movement disorders in JE.

Fluorescence and immunochemical studies of advanced glycation-related lens pigments

PURPOSE

To establish whether advanced glycation is the major mechanism for yellowing of lens proteins.

METHODS

Synchronous fluorescence (SF) and immunochemical assays were used to study glycation in vitro and in vivo. In the in vitro study, advanced glycation end products (AGEs) were prepared and used as antigens to induce antibodies to AGEs. The in vitro AGEs and classified nuclear cataracts were analyzed by SF and immunochemical assays.

RESULTS

In vitro AGEs generated from various glycating agents and carrier proteins displayed strong SF above 350 nm; the spectra were well resolved with major bands at 380 nm and 420 nm. Samples from human lenses manifested a band at 395 nm in addition to the two bands shown by in vitro AGEs. SF intensity is greater for the water-insoluble (WI) than water-soluble (WS) fraction, but both increased with increasing nuclear color. The immunoreactivity data also showed that the WI fraction contained more AGEs than the WS fraction and that the amount of AGEs increased with increasing nuclear color.

CONCLUSIONS

Fluorescence and immunoassays indicated that pigmented AGEs contributed to yellowing of the crystalline lens nucleus.

Thermodynamic and kinetic characterization of calf lens gammaF-crystallin

Gamma-crystallin is reported to be conformationally stable because of its internal structural symmetry, and gammaF (gammaIVa) is the most stable among the various gamma-crystallin gene products. However, there is no detailed report on its thermodynamic and kinetic stability. In the present study, detailed unfolding of gammaF-crystallin was investigated by equilibrium and kinetics methods with fluorescence and far-UV CD spectroscopic measurements. The GdnHCl-induced unfolding curves probed by Trp emission maximum and intensity showed a sharp single-step transition. Upon widening the unfolding transition with the use of urea in 1.5 M GdnHCl, a more proper fit for thermodynamic analysis was obtained. GammaF-Crystallin underwent a straightforward two-state process (N <==> U) without showing any measurable amount of intermediate. The conformational stability, as measured by deltaG(D)H2O (approximately 9 kcal/mol), indicates that gammaF-crystallin is a very stable protein. The high activation energy deltaG++H2O (approximately 24 kcal/mol), calculated from unfolding kinetics monitored by far-UV CD at 218 nm, also indicates that the native and unfolded states are separated by a high activation energy barrier.

Parturient fundal height as a predictor of low birth weight

The usefulness of parturient fundal height as a predictor of low birth weight (LBW) was studied in 151 singleton pregnancies. The symphysis to fundus (S-F) distance was measured in early labour and was plotted against the birth weight of the newborns. A significant positive correlation was observed between the two parameters (r = +0.740). For the prediction of LBW, the critical limit of the fundal height was 31 cm, meaning that a S-F distance of more than 31 cm is reasonably safe while lesser values predict a higher chance of a LBW infant. From these observations, the use of a colour-coded tape by peripheral health workers and traditional birth attendants is suggested: red for S-F < 28 cm, yellow for S-F = 28-31 cm, and green for S-F > 31 cm. Mothers who have a fundal height in the 'red zone' are at risk of delivering LBW infants.

Blood glucose and serum insulin response in protein-energy malnutrition following nutritional rehabilitation

Fifteen children with protein-energy malnutrition and eight healthy children between the ages of 6 months and 60 months were studied for blood glucose and serum insulin levels in the fasting state and 120 minutes following oral glucose load. The measurements were repeated after normalization of the body weight following 6 weeks of nutritional rehabilitation. The fasting blood glucose increased significantly in the post-treatment period and became comparable to the control value. The abnormal blood glucose response to oral glucose load also normalized. The serum insulin level rose significantly (p < 0.001) in the post-treatment period but failed to normalize. The response to oral glucose load was similar. The observed lower insulin response, despite normoglycemia, after 6 weeks of nutritional rehabilitation indicates persistence of hormonal imbalance which may need a longer duration of rehabilitation for full recovery.

Lack of maternal antibodies to P serotypes may predispose neonates to infections with unusual rotavirus strains

Rotavirus (RV) strains infecting newborns often have unique neutralization antigens (P serotypes) on their outer capsids that are distinct from those found on RV strains that cause diarrhea in older children. We examined the hypothesis that unusual RV strains preferentially infect newborns because the newborns lack maternal neutralizing antibodies to these strains. To test this hypothesis, sera and saliva samples collected from neonates infected with 116E-like (P[11]G9) strains in the maternity ward of the All India Institute of Medical Sciences (AIIMS) hospital in New Delhi were tested for neutralizing antibodies against common RV strains and those infecting newborns and these titers were compared with those of newborns who did not become infected (controls). The infected neonates had significantly lower levels of cord blood neutralizing antibodies to 116E than the controls, suggesting that immunity to neonatal RV infection is acquired transplacentally through maternal antibodies. Further, this study confirmed the immunogenicity of the AIIMS neonatal strain 116E, a vaccine candidate, in its ability to evoke a potent RV-specific immunoglobulin A and neutralizing antibody response in serum and saliva among the infected babies. Our findings have important implications for the development of an effective RV vaccine. In India, where G9 strains are common in the community, the use of 116E as a vaccine, together with the rhesus tetravalent vaccine, may provide a broader protection against all the circulating RV serotypes, including serotype G9, which is not represented in the current rhesus RV tetravalent vaccine (G1-G4).

Blood sugar and serum insulin response in protein-energy malnutrition

Blood sugar and serum insulin levels in the fasting state and following an oral glucose load in children with protein-energy malnutrition (PEM) were studied. Twenty-nine children with PEM (15 marasmus, 7 kwashiorkor, and 7 marasmic kwashiorkor) and eight healthy children aged between 6 and 60 months were the subjects of the study. Fasting samples were collected after a 6 h fast. Post-glucose samples were collected after an oral glucose load of 1.75 g/kg. Serum insulin was estimated by radioimmunoassay and glucose by the glucose oxidase method. In malnourished children, the mean fasting blood glucose levels were significantly lower. Two hours following an oral glucose load, only marasmus and marasmic kwashiorkor patients showed significantly higher blood glucose levels. Similarly, the fasting serum insulin levels were significantly lower in malnourished children. Two hours after the oral glucose load, serum insulin levels increased significantly in malnourished children but fell well short of the control values. The insulin:glucose ratio was consistently low in all cases but was more marked in PEM patients, both in the basal state as well as oral glucose loading

Malignant gastroparesis and outlet obstruction in carcinoma gall bladder

INTRODUCTION

Malignant gastroparesis and mechanical gastric outlet obstruction are two major accompaniments of advanced upper abdominal malignancies. The incidence of such problems has not been well documented in patients of carcinoma gall bladder. The aim of this study was to determine the incidence of gastric outlet problems in patients of carcinoma gall bladder and correlate them with clinical presentation. The role of prophylactic gastrojejunostomy (GJ) and its postoperative outcome was also evaluated.

PATIENTS AND METHODS

Thirty seven patients of carcinoma gall bladder were prospectively studied. Twenty five patients underwent radio labelled solid meal gastric emptying study and eleven of these underwent prophylactic GJ and followup gastric emptying study in early postoperative period.

RESULTS

Mechanical gastric outlet obstruction was seen in 10 (27%) patients. Delayed gastric emptying on scintigraphic study was found in 10 (40%) of remaining patients (n = 25). Only 6 (60%) of these patients were actually symptomatic. All patients who had delayed gastric emptying also had an advanced disease. No correlation was found between delayed gastric emptying and presence of jaundice and/or serum levels of bilirubin. Prophylactic GJ had 18% postoperative morbidity as compared to 28.5% for therapeutic GJ done during the same period. Oral feed were started latest by 11th postoperative day. Prophylactic GJ did not affect gastric emptying patterns in early postoperative period.

CONCLUSION

Mechanical gastric outlet obstruction was present in 27% patients. Delayed gastric emptying was seen in 40% of remaining patients with carcinoma gall bladder. Delayed gastric emptying correlated well with symptoms of gastric stasis and the stage of disease. Functioning of gastrojejunostomy was not fully dependent on presence or absence of malignant gastroparesis.

Sequence analysis demonstrates that VP6, NSP1 and NSP4 genes of Indian neonatal rotavirus strain 116E are of human origin

We have sequenced the genes encoding the inner capsid protein VP6 and the nonstructural proteins NSP1 and NSP4 of the Indian neonatal serotype P8[11]G9 human/bovine reassortant candidate vaccine rotavirus strain 116E. These three genes share a high degree of sequence and deduced amino acid homology with human prototype strain Wa. Our results confirm and extend those of previous RNA-RNA hybridization studies which suggested that these genes are of human origin, and will facilitate examination of the host immune response to 116E induced by natural infection and vaccination.

Sequence analysis of NSP4 gene of human rotavirus allows classification into two main genetic groups

The rotavirus nonstructural glycoprotein NSP4 may represent the first identified viral enterotoxin. We have sequenced reverse transcription-polymerase chain reaction (RT-PCR)-generated fragments of 16 NSP4 genes of human rotavirus (HRV) strains from six different countries, representing seven different G and P type combinations. Based on the amount of sequence divergence between these and 11 previously sequenced NSP4 genes of human and animal rotaviruses, three distinct genetic groups could be recognized. Most strains within a group were closely related to each other at the nucleotide (nt) and amino acid (aa) levels (usually <10% divergence) but more distantly related (maximum 30.0% nt divergence and 24.7% aa divergence) to members of the other groups. Intergroup variation occurred in two highly variable regions of NSP4 (aa 16-34 and aa 131-148). The NSP4 "toxic peptide" (aa 114-135) exhibited aa variation at its carboxy terminus both within and between genetic groups. The largest group (genetic group II) contained HRV strains of subgroup II specificity (including genotypes P[8]G1, P[8]G3, P[6]G3, and P[8]G5 and serotype P8[11]G9), and the smaller group (genetic group I) contained HRV strains of subgroup I specificity (genotype P[4]G2). The NSP4 sequence of the rhesus rotavirus vaccine strain was distinct from all other strains and formed the third group (genetic group III). The NSP4 genes of animal rotaviruses UK, NCDV, and SA11 (genetic group I) and YM (genetic group II) and two possible human-animal rotavirus reassortant strains, Brazilian P[8]G5 and Indian P[11]G9 (genetic group II), could also be classified into one of these groups, suggesting a close evolutionary relationship between human and animal NSP4 genes. These results will facilitate studies of the host immune response to NSP4, which may be relevant to future HRV vaccine design.

Detection and characterization of alpha-crystallin intermediate with maximal chaperone-like activity

Lens alpha-crystallin has been reported to act like a chaperone molecule, with the chaperone-like activity enhanced by partial unfolding. The nature of the partial unfolding, however, is not fully understood. In this project, the unfolding and refolding process of alpha-crystallin was studied with guanidine hydrochloride (GdnHCl). Trp fluorescence (tertiary structure) and far-ultraviolet circular dichroism (UVCD) (secondary structure) demonstrated the presence of an intermediate in the unfolding pathway. ANS (1-anilino-8-naphthalenesulfonate) fluorescence clearly indicated a two-step transition in the unfolding-refolding process and showed that maximum hydrophobicity of the alpha-crystallin occurred at 0.8-1.0 M GdnHCl. This alpha-crystallin intermediate appears to be in a molten globule state; conformational study by near- and far-UVCD measurements indicated that alpha-crystallin intermediate exhibited tertiary structure which was significantly altered from that of the native protein, but had nearly the same secondary structure. Quaternary structure (size of aggregate) of the intermediate also remained unchanged from that of the native protein, as shown by FPLC size exclusion chromatography. The maximal hydrophobicity of the alpha-crystallin intermediate in the unfolding-refolding pathway was accompanied by maximal protection of betaH-crystallin from aggregation. However, an adverse effect of partial unfolding is that the alpha-crystallin intermediate aggregates at high concentrations. Together, these results clearly demonstrated the biological significance of the alpha-crystallin intermediate: it is a more effective chaperone than native alpha-crystallin.

Heat-induced conformational change and increased chaperone activity of lens alpha-crystallin

PURPOSE

Alpha-crystallin is the major structural protein of the eye lens known to have chaperone-like activity. Our objective is to elucidate the nature of the thermal transition that alpha-crystallin undergoes at 60 degrees C and the effect of this transition on the chaperone activity.

METHODS

FPLC size exclusion chromatography, far- and near-ultraviolet circular dichroism, and tryptophan (Trp) and 1-anilino-8-naphthalenesulfonate (ANS) fluorescence were used to study conformational change. Turbidity of dithiothreitol (DTT)-reduced insulin was used to study chaperone activity.

RESULTS

The thermal transition was identified as a conformational change in mainly tertiary (partial unfolding) and quaternary high-molecular-weight (HMW) aggregation structures, along with a loss of 10 percentage points of secondary structure (beta-sheet). Initial partial perturbation in tertiary structure increased chaperone activity, but the increase was less in the HMW aggregate. Similar results were observed in in vivo-formed HMW alpha-crystallin.

CONCLUSIONS

The conformational change and HMW aggregation of alpha-crystallin observed at 60 degrees C, as well as in vivo-formed HMW aggregates, increased chaperone activity.

Cortical sensory loss : is it always cortical?

A 38 year male suffering from cardioembolic stroke developed acute left hemiplegia and cortical sensory loss, which included graphanesthesia, impairment of two point discrimination and tactile inattention. CT scan revealed haemorrhagic infarction inright corona radiata and anterior limb of internal capsule. On day 13, cortical SEPS were absent and there was bifrontal and left parietal hypoperfusion on SPECT studies. Both the sensory loss, and SEP improved on day 28, which correlated with improvement in regional cerebral blood flow (rCBF). The cortical sensory loss, therefore, can also occur in subcortical lesion and may be due to cerebral diaschisis.

Gastric emptying in patients with non ulcer dyspepsia (dysmotility type)

Non ulcer dyspepsia is a clinical entity characterized by chronic recurrent upper gastrointestinal symptoms in the absence of identifiable organic or systemic cause. Many such patients may have delayed gastric emptying which can easily be documented using radionuclide food markers. We evaluated gastric emptying patterns in 20 patients having non ulcer dyspepsia and 30 healthy controls. Gastric emptying was studied using indigenously prepared radiolabelled vegetarian solid food marker, the integrity of which had already been established and reported by us. Nine of the 20 (45%) non ulcer dyspepsia patients showed delayed gastric emptying. All these patients were administered cisapride and on reevaluation showed improvement in their upper gastrointestinal symptoms.

Immunoglobulins and circulating immune complexes in nephrotic syndrome

Serum immunoglobulin (IgG, IgA and IgM) levels were measured in 40 children with idiopathic nephrotic syndrome and 20 healthy controls. Significantly decreased IgG (P < 0.001), normal IgA and increased IgM (P < 0.05), averaging 92 per cent, 99 per cent and 104 per cent of normal mean, respectively, were observed in active nephrotic syndrome (ANS). The mean immunoglobulin levels did not differ significantly among different subgroups of ANS cases. In remission, a significant increase in IgG (P < 0.01), a decrease in IgA (P < 0.05) and in IgM (P < 0.01) levels were found in comparison to their corresponding ANS values. Their concentrations were significantly abnormal also when compared with controls. The circulating immune complexes (CIC), detected by polyethylene glycol (PEG) per cent index, demonstrated that overall mean serum level was significantly higher (P < 0.01, 168 per cent of normal) in ANS patients. Among different subgroups, the mean level was significantly elevated (P < 0.001, 205 per cent of normal) only in relapsing nephrotic syndrome cases. Thus, the abnormal levels of immunoglobulins were found both in active as well as in remission stage of the disease, while elevated levels of CIC were seen only in patients with relapse.

Conformational and functional differences between recombinant human lens alphaA- and alphaB-crystallin

Human and other mammalian lens proteins are composed of three major crystallins: alpha-, beta-, and gamma-crystallin. alpha-Crystallin plays a prominent role in the supramolecular assembly required to maintain lens transparency. With age, the crystallins, especially alpha-crystallin, undergo posttranslational modifications that may disrupt the supramolecular assembly, and the lens becomes susceptible to other stresses resulting in cataract formation. Because these modifications occur even at a relatively young age, it is difficult to obtain pure, unmodified crystallins for in vitro experiments. alpha-Crystallin is composed of two subunits, alphaA and alphaB. Before the application of recombinant DNA technology, these two alpha-crystallin subunits were separated from calf lens in the denatured state and reconstituted by the removal of the denaturant, but they were not refolded properly. In the present studies, we applied the recombinant DNA technology to prepare native, unmodified alphaA- and alphaB-crystallins for conformational and functional studies. The expressed proteins from Escherichia coli are in the native state and can be studied directly. First, alphaA and alphaB cDNAs were isolated from a human lens epithelial cell cDNA library. The cDNAs were cloned into a pAED4 expression vector and then expressed in E. coli strain BL21(DE3). Pure recombinant alphaA- and alphaB-crystallins were obtained after purification by gel filtration and DEAE liquid chromatography. They were subjected to conformational studies involving various spectroscopic measurements and an assessment of chaperone-like activity. alphaA- and alphaB-crystallins have not only different secondary structure, but also tertiary structure. 1-Anilino-8-naphthalene sulfonate fluorescence indicates that alphaB-crystallin is more hydrophobic than alphaA-crystallin. The chaperone-like activity, as measured by the ability to protect insulin aggregation, is about 4 times greater for alphaB- than for alphaA-crystallin. The resulting data provide a base line for further studies of human lens alpha-crystallin.